The Classification of Medicines adopted by Dr Wood in the University of Pennsylvania. Medicines acting on the living body General Stimulants Permanent Astringents Tonics Diffusible Arterial Stimulants Cerebral stim. [illegible] Nervous stim. [Anti spasm] Sedatives Arterial Sedatives Nervous Sed. Local Functional Emetics Cathartics Diuretics Diaphoretics Expectorants Emmenagogues Sialagogues Errhines Organic Rubefacients Epispastics Escharotics Mechanical Demulcents Emollients Diluents Those medicines acting upon foreign substances contained within the body may be comprised under the heads of Anthelmintics, Antilithics, Antacids &c.  1 Notes upon Lectures delivered by Dr G. B. Wood. First Lecture. From a summary view of the Introductory Lecture, it appears that medicines operate in one of two ways -either upon parts applied by means of their effects being carried thro' the nerves to the brain, & thence distributed by the nervous system or by being absorbed: -v.c.- they act either by sympathy or absorption. In the Local action of medicines, they may act by Sympathy either directly by the nerves, or first by having their action transmitted to the brain & thence distributed by the nervous system to the other parts as in the operation of Digitalis. Their action is different also as to the different parts to which they may be applied- those places are the surface of the stomach & bowels, the external surface of the skin & the surface of the air passages.- Sometimes they are absorbed rapidly at others more slowly.- These, before mentioned, are called the primary operations, and we now 2 come to speak of the secondary, which are the results consequent upon the primary operation, as for inst. 1. Prostration following excitement. 2. General state of excitement from sympathy with a particular part. 3. Result of the principle of revulsion, as in the treatment of diseased lungs by a blister to the external surface of the skin. 4. Cessation of morbid phenomena in consequence of the removal of the cause as in some forms of headache arising from constipation, which are relieved by purging. 5. The operations of nature instituted to relieve the constitution from the effects of the medicine as in applying Caustic.- Second Lecture. The nature or character of the operation of medicines is very different because they differ much as to the parts which they affect. Each class acts upon particular organs, no matter where they may be applied. Thus, we find, that Ipecac vomits whether applied by stomach 3 blister or per annum. The explanation that we give for this is that the human frame is so constituted that each particular part has particular susceptibilities;- the cause is the undiscovered & perhaps indiscoverable principle of nervous action. In the human system, considered as adapted to our department, there may be regarded three minor systems, each coextensive with the whole body, viz. Nervous, Circulatory and Absorbent, & these three are found in every organic part. It may be viewed also as consisting of a number of distinct organs, - as the Skin, - the Stomach & Bowels, - the Kidneys & Bladder &c. Some medicines act upon some one of the Systems while others act upon some of the organs.- Thus opium acts upon the nervous system, Carb. Amerred upon the Circulatory & Iodine upon Absorbent.- The first set are called General Remedies; & the second, Local Remedies.- Medicines differ in the nature of their operations 4 operations upon particular parts, or in other words, we say medicines are specific in their operations. By the term specific, we mean that a medicine will act upon a certain part of the body & produce effects peculiar to itself i.e. that when different medicines are applied to the same parts they produce diff. effects._ This brings us then to the subject of the Classification of Medicines. Though producing not precisely the same effects, yet there are a number of medicines whose operations are so analogous that they may be properly divided into distinct classes. The first grand division is into Local and General Remedies Local Remedies are those which either primarily or secondarily affect the [cross out] different individual organs. Of these, there are 4 sets. 1. Those which affect the functions of particular organs, viz. Emetics, Cathartics, Diuretics, Antilithics, Diaphoretics, Expectorants & Emmenagogues. There are also 2 others [illegible] Sialagogues & Errhines, but these seldom used & may 5 be more properly considered as minor effects 2. Set Act on Extraneous Substances contained within the organs, viz. Anthelmintics & Antacids. 3. Alter the organization of those parts with which they come in contact. Rubefacients, Epispastics, and Escharotics. 4. Act mechanically upon the parts to which they are applied. Demulcents & Emollients General Remedies are medicines which operate upon the whole system, or upon one of the minor systems & thence have their action extended to the others.- Before proceeding with the different sets of Gen. Rem. it may be proper to say a few words respecting stimulants. This term is applied to the Circulatory system, when no other particular system is specified, & hence when we use the word stimulant without any other word qualifying it, we mean an elevation of action of the Circulatory System.- There is a great diversity of power of stimulation, both as regards the rapidity & permanency of their action, & hence they are divided into Diffusible & Permanent Stimulants 6 Many medicines both excite and diminish the different powers of the system at the same time, & hence are either sedative or stimulant according to the predominance of either of these powers & those which stimulate when given in small doses, may, if given in large doses, be very powerfully sedative. As a general rule then, we find that the same medicines are sedative or stimulant, according to the part to which they are applied, to the quantity given, and to the state of the system. Astringents have a mode of action peculiar to themselves, producing a contraction of whatever parts they may touch. With these preliminaries, we proceed to mention the Classification of the General Remedies. 1. Permanent Stimulants, as Tonics & Astringents. 2. Simple or Diffusible Stimulants, which operate upon the Circulatory System. 3. Narcotics, which may have either a sedative or stimulant influence upon the brain. 4. Antispasmodics 5. Medicines peculiar in their action as Aux vom. Merc &c 7 Third Lecture. There are a variety of modes for administering medicines, & it is happy for a physician to be able to select that form best adapted to his patient. They are given in the solid state, in the form of Powders, Pills, Troches, Electuary or Confection. In the liquid, either in Mixture or Solution and as Liniment, Cerates, Ointments, Plasters and Cataplasms.- We shall add a few remarks upon each of these Powders. Deliquescent substances should never be prescribed in the form of powder.- A light powder may be given in a little water or the like, but a heavier powder, as Calomel, should be suspended in Molasses, Syrup, Honey &c. Pills. Substances may be given in the form of pills, which are not given in large doses, which are not deliquescent, or which do not become too hard in that shape to prevent their being digested. Liquids should never be prescribed in this form, unless given in very small doses. Efflorescent substances, should 8 be first deprived of their water of Chrystallization. The mode of making pills is very important & should be well understood. Some substances require no trouble, but can be moulded with ease, as some of the soft extracts. Mass Hydray. &c. Others can be made into a mass with a little water, as Rhubarb, Jalap &c. But there are some which are more difficult, & require some discrimination in the agent. In making this choice, we should take those substances which are not chemically incompatible, or which will not make the pills too hard. The best articles for immediate use are Pulv. Gum Arab. & Syr. Sunp. Soap is good to meet any acid in the stomach, when it is not incompatible with the medicine prescribed. Confect. Ros. is much used. Mica Panis Crumb of Bread is very good for absorbing liquids which are to be given in very small doses. as Tinct dissolve the substance (if soluble) in a small quantity of water, then make up the crumbs with this solution Croton Die, solution of Argent. Nit. or Cap. Sulp. To prevent their adhering together the best substance that can be used is Pulv. Rad. Glycyrrle.- 9 With respect to the size of pills, we may say that those made from veg. powders should not exceed grs iiij in weight. A good size is about grs iij. Those from metallic substances, however, may weigh from 4 to 8 grs. Troches are not much employed. They are designed to be held in the mouth, while they gradually dissolve, consequently they should be prepared with substances which are slowly soluble in the saliva. (Farina, Gum & Sugar) Electuaries- are soft masses composed of powders mixed up with syrup or honey. Conserve or Confect. is a preparation made much in the same way for the purpose of preserving recent vegetables Both these latter Elect & Conserves are embraced under the term Confection, in pharmaceutical language. Mixtures.- This term is applied to those preparations formerly called Juleps in which insoluble substances are suspended in water by means of substances which are soluble. To form a good mucilage in ƒ℥vj mixture, add of Gum. Arab & Sacch. Alb. aa about ʒij. The yolk of an Egg may sometimes be used for the same purpose, especially 10 in mixtures containing Oils, Balsams &c. The yolk of one egg is sufficient for a mixt. of ƒ℥vj In the preparation, the medicines should be rubbed together first & the liquid afterwards added. It is necessary to avoid adding too much solid. ʒss veg. pound ʒij Elect or ʒi Extract to ƒ℥i is sufficient.- Calculation should generally be made so as to make a tablespoonful (ƒ℥ss) to be given for a close.- As for the liquids used, it is well to prescribe the aromatic waters, as Aq. Cinnam. Aq. Menth. &c. when they are compatible. Solutions.- In these it is only necessary to guard against adding substances chemically incompatible Infusions.- Preparations in which the active matter of substances is extracted by water either cold or hot, but without boiling. A Cold Infusion requires from 12 to 24 hours, while a hot one is prepared in about 2 hours. Decoction.- is when the substance is boiled in water or other liquids. Wines.- are prepared by infusing the substance in wine at the ordinary temperature. 11 Tinctures.- prepared by digesting in Alcohol for one or two weeks. There are 2 different kinds of Alc. used according to circumstances: Rectified Spirit or pure Alcohol & Proof Spirit or Diluted Alcohol. The balsams, vol. oils, &c. are soluble only in Alcohol. Vinegars.- are solutions in Vinegar, of which there are but two or three in Pharmacy as Squills &c. Syrups & Honeys.- are prep. of Sugar & Honey with veg. matter. They are made by forming a decoction or Infusion of the veg. & then adding Sugar or honey. Oxymel. Composed of Vinegar & Honey. Liniments- are preparations which are either liquid or semiliquid & of an oleaginous consistence. Ointments- are soft solids to be applied by rubbing with the finger. Cerates- are of a firmer consistences containing Wax, & are generally applied by being spread on a rag, without requiring to be heated. Plasters- are still firmer than Cerates, more tenacious, & requires to be heated before they can be spread. 12 Cataplasms- should be soft, moist & somewhat tenacious. Sometimes they are made simply by the addition of water as Mustard.- Some which will not form a mass with cold, are mixed up with hot W. as Flax-seed meal Substances, which of themselves will not form a poultice with water, have something else intervening, as Hops, which are mingled with Flax seed Meal & stewed up with Water.- Other liquid besides W. are frequently used as Vinegar, Alcohol, Milk &c. as in the Bread & Milk Poultice, so frequently used. In this, stale bread should be directed, & good sweet milk, & a little fresh Lard added to soften it.- Fourth Lecture 4/24 - 1834. Medicines are directly applied to two portions of the Alimentary Canal, the Stomach & Rectum. It is applied by the Rectum with 2 objects. 1st For irritation so as to excite purge. 2nd Through the mucous coat of the rectum to produce an impression upon the system at large.- These effects are incompatible with 13 each other & hence care must be taken to produce the desired effect. In both cases, the patient should be directed to resist the immediate impulse to evacuate & should be assisted by the application of a warm towel to the parts, with gentle pressure. The enema should generally be of the warmth of the body. As a general rule, about three times the amount of a dose by the stomach may be given by the rectum, but it is safer especially in very active medicines to give about twice the dose & repeat it if necessary. Neither of these rules, however, can be universally applied, because the relative susceptibility of the stomach & rectum differs in different persons. Instances may occur from habit or other causes in which the susceptibility of the rectum may be even greater than that of the stomach as in opium eaters &c. Hence when any medicine ceases to produce any effect upon the stomach, we may resort to other surfaces- either the skin or Rectum. There are two modes in which medicines may be introduced, either in the state of Solids or Liquids. The former are called Suppositories, & the latter Clysters, Enemata, or Injections. 14 Suppositories will be spoken of hereafter, but here we will make a few remarks respecting Enemata. They consist of soluble substances & Water is generally the vehicle used, with the addition of a little mucilage or the like. When administered for the purpose of being retained, we should use as small a quantity of liquid as possible, ƒ℥i or ƒ℥ij is sufficient. Barley Water or a solution of Starch in Hot Water makes a very good vehicle. When given in order to produce purging, about Oj of the liquid should be used. While upon this subject we may add that the character of the Syringe should be attended to, & that it should be good... The Skin affords a very convenient surface for the application of medicines. To this, they may be used in the state of vapours, liquids & soft solids, & may be applied either to the cuticle or to the skin deprived of its cuticle. A very ready method of applying vapour to the cuticle is to heat some bricks, dip them in the liquid, wrap them in flannel & place them under the bed-clothes so as not to touch the patient. 15 Raise the bed-clothes so as to form a vacant space by means of hoops or stools. Another method is by a tube passed under the clothes into a space made as before. Another method, by which the steam from herbs &c. in Water may be obtained is by placing the patient in a chair over the water &c. in a tub, & then creating a steam by putting heated bricks in the water. The patient must be wrapped round with blankets & care must be taken that the steam does not become too hot so as to scald him. Sulphur or other solids may be applied in form of vapour by passing a tube of a retort, to which heat is applied, into a box containing the patient except his head. They are more frequently applied to the skin in the liquid form, either as Lotions, Baths, Semicupium, or Pediluvium. Solids thus applied may produce local effects, or may operate upon particular organs. Frictions sometimes 16 prove beneficial, & the places best adapted to it are the inside of the legs and arms. But the most effectual method of applying solids to is what has been termed the Endermic Method The method is to deprive the skin of its cuticle, then apply the medicine to the part. The circumstances which will warrant this procedure are, when the patient is either incapable or unwilling to take or retain the medicine, & when this method may be joined with others to produce a very speedy action. Corrosive and very irritating medicines, or those which require to be given in very large doses should not be given in this way. The active principle of a medicine would be preferred to the medicine itself. To produce a blister, apply a plaster of Cantharids, 3 or 4 inches square & leave it 3 or 4 hrs. then take it off & dress the surface with a poultice so as to remove the cuticle more readily. A better plan, however, is to moisten a piece of Patent Lint with strong liquid Ammonia, lay it on the part, & keep continually dropping on more to keep it moist. In this 17 way a blister will be raised in about 15 minutes. The Powder may be sprinkled upon the surface thus prepared either alone or mixed with wheat flour. It may be in form of Cerate or Liquid, & the quantity should be generally 2 or 3 times that given by the mouth. The power of Absorption varies in different parts. The Epigastric Region is the most effectual. The inner parts of the limbs are good, and the anterior portions of the body generally better than the Posterior. We should apply beyond the morbid affections, so that during the course of Circulation, we may suppose from the direction of the absorbents that the medicines will pass directly through the affected part. Substances are absorbed most readily from the bronchial passages, but it is difficult to apply them thus, for fear of irritation. They may be thus given in the state of Inhalation: which is in 3 ways. Either 1. By diffusing thro' the air of the apartment. 2. By confining them in a bag with a tube attached. or 3. By means of an Inhaler. 18 We now come to the subject of the relative doses of medicines, which vary with the age of the patient. For this, no general rule is universally applicable. A full dose may usually be given at the age of 20, but for those under that, it is said that the dose must be diminished in the proportion of the age to the age +12. Thus to find the dose for a child 4 yrs. of age, we would have 4: 4+12=16 :: 1:4- that is- the dose would be 1/4 the quantity sufficient for an adult. Particular persons, however, are liable to peculiar affections from idiosyncrasy &c. & the effects of habit are very great,- all which must be taken into consideration in prescribing the requisite dose.- For Fifth Lecture upon Weights, Proximate Principles &c. see Book A from p. 1 to 17 inclusive. Sixth Lecture May 1st 1834 Emetics are those substances which excite vomiting by an inherent peculiar property. Their operation is peculiar, but does not immediately follow their administration, generally after a lapse of 10, 20 or sometimes 30 minutes. Soon after taking an emetic 19 the patient feels an uneasiness, which is succeeded by nausea &c. till vomiting results. Previous to vomiting, the countenance is pale, the skin cool, moist & relaxed, & the pulse frequent, small & irregular. When vomiting commences, the countenance becomes flushed from the pressure upon the veins so as to prevent the blood returning from the head, & the temples appears as if filled with the rush of blood. After vomiting, the skin is left moist, cool & relaxed, & languor succeeds, which is consequent upon the nausea excited, not upon any narcotic influence. The operation of vomiting is effected by a reversion of the motion of the stomach & by the action of the abdominal muscles. This mode is best explained by supposing that the emetic touching the mucous coat of the stomach, imparts to it a sensation which is then transmitted to the brain by the nerves, & then again the impression is transmitted by the nerves from the brain to the muscles of the stomach and abdomen. That the agency of the brain is absolutely essential to the operation of an emetic, appears 20 from the fact that if we separate the par vagum nerve, no emesis can be produced, or if the brain be rendered insensible to any degree, either from injury or from poison, it will be very difficult to make an emetic operate.- Emetics differ from other medicines in losing none of their power from repetition, but generally have a contrary effect. They do not act upon all persons or in all diseases, equally. In febrile diseases, they generally operate with facility, but in nervous diseases, they act less readily. When narcotic poisons have been taken, the stomach is not easily affected, but if mineral poisons, they facilitate the action, provided they have not been sufficient to destroy the stomach. We now come to speak of the indications for the use of an emetic, which are numerous. 1. The most obvious effect of an emetic is to evacuate the stomach; hence it is frequently called for, for this purpose; as when any irritating substances have been taken into the stomach, or 21 when the disease depends upon an over-distention of that organ,- or upon containing acrid & poisonous substances. Mineral poisons sometimes operate themselves & then it is only necessary to give warm drink plentifully, so as thoroughly to wash out the stomach:- but the Narcotic Poisons have a tendency, as before stated, to prevent the emesis & consequently more attention is requisite. We should never resort to the stomach pump, unless an emetic will not operate after waiting 1/2 or 3/4 of an hour. If the poison should be a solid as Opium the pump might not be large enough to admit its entrance & it could not be drawn out. In bilious fever, when the accumulations are acrid & unhealthy, & the bile is not properly secreted, emetics are often very effectual. But it is very necessary to distinguish between a case when vomiting occurs from the irregular biliary secretions, and when it arises merely from an irritable stomach because it would be of much importance in practice.- 22 2. Emetics act favourably by exerting a mechanic as pressure upon the liver & other abdominal viscera, in the act of vomiting. It often happens that congestion of blood takes place in those parts, the patient experiences great oppression in that region, attended with depression of spirits &c. -& then an emetic may frequently be given with advantage. The well known utility of an emetic in Jaundice is generally ascribed to the compression excited by the vomiting upon the biliary ducts, thus forcing out the bile which has been secreted in too large quantities, but we consider this, an erroneous view, & that in a great majority of cases, Jaundice arises from the bile not being secreted at all by the proper vessels, but instead of that, is taken up by other absorbents & carried thro' the system, & that emetics act in such cases by arousing the liver to its proper function, & exciting its secretions. 3. Emetics act favourably by the production of Nausea which is attended with a general relaxation & prostration of the system. There are several 23 beneficial effects resulting from Nausea. 1. Most obvious effect is a prostration of arterial action or a reduction of the force of circulation, hence its use in inflammatory diseases in an early stage, but it must not be relied on in a case when the disease has become confirmed. 2. Effect is an Increase of the power of absorption, which has been demonstrated to be in inverse proportion to the reduction of the force of circulation. 3. Relaxation of muscles, hence it is useful in spasmodic affections &c. 4. Relaxation of the skin & consequently perspiration. & 5. It probably produces an increase of biliary secretions. 4. Emetics exert not only a local power, but by the concussion or shock which they give, they exert an influence over the system, so as sometimes to break up a morbid action which may exist there. In this way, we account for their benefit in Remit. & Intermitt. Seventh Lecture May 6th 1834 5. Another favourable mode in which Emetics act, results from the principle of Revulsion. We know that by irritating one part of the system, the excitement is 24 increased in that part, while at the same time, it is drawn off or diminished in other parts. If then, during any inflammation, you can produce a flow of nervous action & consequently of the exciting cause to any other part of the system, you relieve the disease, thus it is that emetics act by revulsion as in Mania, Amaurosis, Tic douleureux, Bronchitis, Uterine Hemorrhage &c. We must bear in mind that all Emetics are apt to purge when given in small doses, & that given in exceedingly small doses, they excite diaphoresis. 6. They evacuate the blood vessels, directly by exciting diaphoresis, & other secretions & indirectly by cutting off the supply of food from the stomach: but for this purpose, they are seldom or never given. 7. The irritation of the stomach produced by their operation is sometimes useful, as in dyspepsia, but this is rather dangerous, lest gastric irritation might lead to unexpected results. Thus we find that diseases present various indications for the use of certain medicines & more especially for the 25 use of Emetics, which we find answer so great a variety of purposes. But to complete our view of Emetics, we must also remember those circumstances which contraindicate their exhibition. 1. Acute inflammation of the stomach, bowels &c. This evidently forbids them from the gastric irritation which they are known to produce. 2. In some complaints, in which the susceptibility of the stomach is diminished, it becomes necessary to increase the dose to produce any effect. In such cases, we wish particularly to warn the practitioner against the danger which may result from the reaction of the system, for if those emetics be then given in large doses, which are apt to excite inflammation, when the system reacts, great danger will arise from the gastric irritation. Even tho' the effects of large doses may leave no impression upon the stomach at first, yet when a reaction ensues, the secondary effects will be gastric irritation, terminating perhaps fatally. It is proper in such cases of insusceptibility of the stomach, 26 from whatever cause it may arise, to use those medicines which are calculated to produce no such injurious effects, as for inst. Ipecacuanha 3. A determination of blood to the head, forbids the use of an emetic without previous depletion: for we have before stated, that from the pressure upon the veins, the blood is prevented from returning freely & hence there is a rush to the temples &c. Hence it is evident that in cases of full arterial excitement, or where there is a tendency to apoplexy, - blood to the head &c. - it would not be advisable to administer an emetic without previous depletion. It is from this principle of diminishing the flow of blood to the head, that benefit results from dashing Cold Water upon the head of a person labouring under a Narcotic Poison. Bleeding also increase susceptibility of the Brain, decreases, congestion. 4. Advanced stages of pregnancy contraindicate their use, & they should be then avoided if possible. In early stages, they may be given with safety, unless in women prone to abortion. 27 5. Hernia forbids them, but if, from urgent necessity, they must be administered to such subject, the patient should be directed to place his hand upon the hernial orifice, during emesis. They are generally administered diffused or dissolved in Water, & it is a good rule to give them in divided doses, every 15 or 20 minutes till they operate. When the design is only to evacuate the stomach, give the patient plenty of warm drink, but if the object be to produce a powerful effect, & give a shock to the whole system then little or no drink should be given, but let nausea, retching &c. continue for some time. Sometimes, either from constitutional or other causes, an inordinate degree of vomiting is excited, & it becomes necessary to check it. This is done by giving 10 or 15 drops of Laudanum or a little of Sol. Morph. Sulph. & by applying a Spice Plaster or warm fomentations over the stomach. If this do not succeed, inject about 60 drops of Laudanum with 2 or 3 tablespoonfuls of solution of starch, & if these fail, we may resort to the application 28 of a Mustard Plaster to the stomach, which seldom fails to arrest the violent vomiting. Having said thus much concerning Emetics in general, we must now proceed to consider them individually. First, The Vegetables & Secondly The Minerals. The first and most important is Ipecacuanha, which is the product of the Cephaelis Ip. or Calicocca Ip. and comes from Brazil. For botanical account see Book A from page 23 to 33 inclusive. Eighth Lecture. May 8th 1834. A.23 A.33 A.37 B.181 Upon Ipecac, Gillenia, Euphorbia Ip., Lobelia, A.39 A.67 B.57 b.97 Sanguinaria, Squills, Tobacco, Chamomile Flowers, B.125 and Mustard seed, for which see Books A and B. Ninth Lecture May 12th 1834 We next proceed to consider the Mineral Emetics. Tartrate of Antimony & Potassa or Tartar Emetic. Antimonii et Potassa Tartras. or Antinmonium Tartarizatum are the officinal titles. The same rank, which Ipecacuanha holds among the vegetable emetics is sustained by this among the Minerals. 29 It is the only one given for other than emetic properties It was first made known in Paris in 1631. It is prepared by boiling Potas. Bitart. with Protox. of Ant. & should always be obtained in the state of chrystals, to prevent its being in an adulterated state. The most common impurities are Tartrate of Lime, & Cream of Tartar. The crystals are in the form of Octahedral or Trihedral Pyramids, & contain a small proportion of Water of Chrystallization, hence they effloresce on exposure. Taste is metallic & slightly styptic. When entirely pure, it is dissolved by about twice its weight of water, making a transparent solution, but if Tart. Lime is present it will soon precipitate. If the solution remains too long. Tart. Ant. undergoes spontaneous decomposition, but this is prevented by the addition of a certain proportion of Alc. In pure Alcohol, it is insoluble. It is decomposed by the Mineral Acids, alkalies & their Carbonates. Alkaline Earths, Soaps, Hydrosulphates, & astringent Infusions, such as Bark, Galls &c. and hence, these should not be prescribed together. The decoction 30 of Bark is especially incompatible, & hence may be administered as an antidote in cases of poison from an overdose of this mineral. Common Green Tea also has the same effect & is more convenient. The value of this mineral as an Emetic, depends upon the certainty, strength & permanence of its operation It remains longer in the stomach than Ipecac. & produces a greater impression upon the system, hence it is to be preferred, 1. When we wish to make an impression upon the liver and abdominal region. 2. When we wish to divert irritations by revulsion. & 3. To break up a chain of morbid action in the system. It exceeds Ipecac. in producing nausea & prostration. Its action often extends to the Duodenum & evacuates the bile secreted there, hence it may be advantageously used for that purpose, when there are no contra-indications. It is a good emetic also in various forms of fever, especially those of a bilious character, - in jaundice - nervous complaints as Amaurosis, Mania &c. - obstinate dislocations,- & in some inflammatory disorders, such as sore throat, [Dicin?y] &c. 31 Sometimes it is beneficially combined with Ipecac. and we may say that we wish to produce a mild effect give Ipecac.- if a powerful one, give Tartar Emetic, & if doubtful which is necessary, give both. Besides emesis, Tart. Ant. is frequently given with a view merely of exciting Nausea, & this has been found very beneficial in cases of high excitement, in moderating the hysterical effect of mania, & in convulsions. Give it just in sufficient doses to keep the patient constantly feeling its nauseating influence, & happy results often follow in convulsions, nervous complaints &c. It is more apt to purge, when insufficient to excite vomiting, than any other of the Emetics. It is also diaphoretic & expectorant, & sometimes diuretic & indeed seems to stimulate all the secretions. When given in very minute doses, insufficient to produce any effect upon the secretions, it appears to exert a sedative influence upon the Heart. From this cause, some modern Italians have considered it as powerfully sedative, but this is incorrect, for it is well known from the very principle of its action to be powerfully irritant 32 irritant to the stomach. Brodie found that large doses of it administered to animals suspended the action of the heart altogether, altho' artificial respiration was kept up, showing that it has a direct influence upon the heart, & that it proves fatal not only as the other Narcotics, by depressing the powers of the heart, but also by the irritation which it excites in the stomach & other organs. The poisonous effects of Tart. Emetic are violent vomiting, burning sensation of heat about the stomach, hypercatharsis, hiccup &c. & terminating in death. Remedies in such cases are mucilaginous or oily drinks in order thoroughly to cleanse the stomach, and Decoction of Bark or Tea to counteract any that might remain. Leeches may be applied to the abdomen if gastritis ensues. The medium dose is 2 or 3 grs, given in doses of 1 gr. each at intervals of 15 or 20 minutes till it operates. When combined with Ipecac, the form is about Ipecac grs XX Ant Tart grs ij mpt. Pulv No. ij. Give one & rept. if necessary 33 It will produce Nausea in the dose of from 1/4 to 1/2 gr. every hour, & gradually increase it if necessary. It proves diaphoretic in dose of 1/8 or 1/6 gr. & still less is given as an expectorant. For these purposes, it should generally be given in solution, but for its purgative effects, it is generally united with Cathartics in the form of Piee. To facilitate the administration of this medicine in small doses, more especially to children, an officinal preparation called Antimonial Wine is recognised in the Pharmacopeia. It is made from grs ij Tart. Ant. to ƒ℥i Best Sherry Wine, which should be a clear solution: if any precipitate is found in the bottle, it should be rejected, as it is evidence either of the use of inferior Wine, or of impure Tart. Emetic Dose for an adult ƒ℥ ss. every hour till it operates, but should not be given if avoidable. Dose for a child 1/2 or 1 teaspoonful. Within the month, 1 or 2 gtt. 1 yr 8 or 10 gtt. Sulphate of Zinc. or White Vitriol. This emetic is useful for the promptness of its operation, as it vomits almost immediately without any 34 nausea. Its action is confined to the stomach, & it is seldom used except for producing speedy vomiting in cases of Narcotic Poison. It is then advantageously combined with Ipecac. Medium dose 10 grs. given in solution but in cases of Poison ʒss may be given, but this quantity should be seldom repeated. Sulphate of Copper or Blue Vitriol. This acts also very speedily, with no nausea & but little succeeding languor, or effect upon the system at large. It is used in narcotic poison, but being so violent, we prefer the Sulp. Zinc. & Ipecac. Dose 2 or 3 grs. In cases of Poison from 5 to 15 grs but never exceed the latter portion. In overdose, it occasions violent vomiting, irritation of stomach, hiccup, fetid eructations, prostration, convulsions and death. The best Antidote is the White of an Egg or Albumen beat up with Water. Dry [Vo????] of Manius made of equal parts of Sulph.Cop. & Tart. Emetic (Chap) Acetate of copper is never used as an Emetic. Hydrargepum Sulphuretum Flavus, or Turpeth Mineral was formerly used, but not now on acct of its violence & tendency to salivate. Medium dose 5 grs. 35 Tenth Lecture May 15th 1834 Cathartics are medicines which evacuate the contents of the stomach & bowels by purging. They operate in three ways. 1. By making an impression upon the internal mucous coat which is thence conveyed to the muscular coat and increases the peristaltic action. 2. By increasing the secretions of the lining membrane of the bowels, & 3. By increasing the secretion of the bilious & pancreatic fluid which is poured into the intestines, & hence increase the evacuations. Calomel may be considered the only medicine belonging to the last class, but other medicines operate by one or both the former methods. Cathartics differ as to the portion of the bowels which they affect, thus Gamboge acts upon the stomach, Aloes more particularly upon the large intestines, while the neutral salts & oils influence the whole canal. Hence we find the nature of the discharges to vary according to the medicine employed, being either natural, liquid from action upon the upper portions 36 of the intestines, - watery, - bilious, - or mucous & bloody from the irritation of the medicine. Cathartics differ in the degree of force with which they operate, & hence they have been divided into Laxative & Purgative, of which the latter are the more powerful, & those of them which are very severe in their action are termed Drastic Purgatives. The division, however, into these two distinct classes, is not a very good one, because there is no medicine so weak, but that it will become more active in large doses, nor any, so powerful, that it will not operate slightly in small doses. Hence they are Laxative or Purgative according to the object & method in which they are given. Cathartics answer several indications as follows, 1. The most obvious & perhaps the most advantageous use of them is for the simple evacuation of the bowels, merely for the removal of constipation or of unwholesome accumulations. Thus in dyspepsia, cholic, hemorrhoidal affections &c. & sometimes together with the force, some irritable matter may 37 be lodged & even remain so long as to be acted on by the absorbents, & given off in the cutaneous exhalations;- then Cathartics are very beneficial in removing all such offensive matter. They are given in low forms of fever, to prevent torpor of the intestines, diarrhea, dysentery, when poisonous or noxious articles have entered the stomach & passed beyond the reach of emetics &c. The French have recently adopted a theory which forbids the use of Cathartics in fevers because they say fevers depend upon an irritation of the mucous surface of the stomach &c. & that Cathartics will only increase the irritation. But experience shows that these views are erroneous: the cathartics act favourably by driving out the irritating fœces._ 2. They act advantageously by a reduction of the general arterial excitement from the quantity of fluid which they cause to be poured out from different sources. Directly, by depletion of the blood vessels, & indirectly by expelling the Chyle before it is taken up. 38 3. They act in promoting the absorption of effused fluids. This, we have already stated, takes place in proportion to the depletion, & it is accomplished also by diminishing the serum of the blood by other secretions. Thus in a case of dropsy, the Hydragogues would be preferable. 4. They act favorably upon the principle of Revulsion. We know that when a powerful action takes place in one part of the system, the nervous excitement is drawn from other parts to that, hence we often find great benefit resulting from purging in apoplexy, Hemiplegia, Hemicrania, in local inflammations, when it is not in immediate contact with the bowels, in Rheumatic, Hip Complaints, Catarrhs, &c. of Brain 5. Cathartics act upon the Liver by increasing the secretions, & by removing congestion of the vena portarum, Hence we find congestion preceding attacks of Bilious Fever, Cholera, Cholic, Hepatitis &c. relieved by Purge It is for this reason also that a dose of Calomel or of Pil. Cath. Comp. proves very beneficial in the early part of summer complaints. 39 Sometimes Cathartics produce good effects by acting in several of these different ways, at one & the same time. Thus in a case of Dropsy, where the whole cellular membrane may probably be in an irritated condition, the Hydragogues act not only by producing an evacuation of the blood vessels, so as to cause absorption, but also by irritating the stomach & by the principle of Revulsion, withdrawing the irritation from the cellular membrane. & by depletion A few words remain to be said respecting the methods of prescribing and administering cathartics. The powers of Cathartics are modified by combinations hence by uniting several severe Purgatives in small doses, we obtain the full cathartic, but the irritation being more extensively diffused over the whole surface, is not so much felt. Their influence is promoted sometimes by the addition of Tonics, sometimes by small doses of an Emetic. When they operate powerfully, producing griping &c. this may be obviated by the addition of aromatics. Salts may be given in Mineral Water &c. 40 Medicines operate more effectually when given upon an empty stomach, hence it is adviseable to take them in the morning before breakfast, or on going to bed at night. If a prompt operation is desired, the best time is before breakfast, but if we merely wish a laxative effect, in the evening. Warm drinks of farinaceous gruel, molasses & water &c facilitate their operation, & prevent griping. Hypercatharsis subdued by 5 or 15 drops Laudanum. We now come to speak of individual Cathartics. The least active of these, is common brown Sugar, which produces this effect slightly. Molasses from the plantation also acts as a Cathartic, hence we find a diet of Rye Mush & W. India or N. Orleans Molasses an excellent laxative in cases of recent piles, prolapsus ani. &c - Wheat Bran, in form of Bread or Mush. A medicine more frequently used & approximating in its nature to Sugar is Manna, for an account of which see Book B. p. 205. 41 Eleventh Lecture May 19 1834 B.119 B.117 B.115 C.11 Upon Figs, Tamarinds, Purging Cassia, Caster Oil, Olive Oil analogous in its operation to Castor Oil, but inferior. Dose ƒ℥i or more. Melted Butter a still milder cathartic, adapted to chronic dysentery, after the irritation is subdued. It is prepared by putting it in a mug of boiling water stirring it up & skimming off the melted portion. Dose a tablespoonful every hour or two. For Rhubarb. see Book A p.43. Twelfth Lecture May 22 1834 Upon Rhubarb &c. and Senna, see Book B. p.33. Thirteenth Lecture May 26 1834 B.43 A.203 B.209 On Cassia Marylandica, Juglans & Aloes, for which see Books A and B. Fourteenth Lecture May 28 1834 A.53 A.59 C.1 A.63 On Jalap, May Apple, Scammony & Black Hellebore Fifteenth Lecture June 2 1834 B.121 C.5 C.7 On Colocynth, Gamboge, Elaterium and Croton C.19 Oil. 42 Sixteenth Lecture June 5 1834 Sulphur is found in volcanic countries mixed with earthy impurities, from which it is purified by fusion & sublimation. The best Sulphur comes from Sicily, Italy &c. In England it is obtained from Copper Pyrites, but is apt to contain the Sulphuret of Arsenic. It comes to us in rolls. Roll Sulphur is sublimed & washed, to clear it of Sulous & ic Acid. then called Flowers of Sulphur, Sulph. Sublimatum or Sul. Lotum. the latter is meant in the Pharmacop. It is of a yellow colour, nearly tasteless, has no smell except when heated or rubbed, insol. in water, [cross out] & in Alc but soluble in the vol. & fixed oils. fusible & inflammable & volatile's able It has long been a favorite laxative among physicians; it secues to act upon the lower bowels, & sometimes to produce more griping than other laxatives, which perhaps depends upon the Sulph. Hyd. formed. It has also a tendency to the skin, to the lungs, & in fact, seems to exert a general alterative influence. It is useful in costiveness, also given in slight hemorrhoidal affections, with an equal part of Cream of 43 Tartar, a teaspoonful or tablespoonful at bed time, also in dyspepsia accompanied with constipation & acidity it is combined with Magnesia, in Chronic Rheumatism, Gout, & various cutaneous affections. Hence the Warm Sulphur Springs contain Sulph. Hyd are very beneficial for Rheumatic patients. Dose as a laxative ʒi or ʒij, given in Syrup or Milk It is usefully applied in the form of an oinment of 4 parts Lard & 1 part Sulphur, in cases of Itch., Tinea Capitis &c. A solution of the Sulphuret of Potassa (ʒiij to ƒ℥viij Water) is sometimes used. Sulph. Precip. Lac Sulphuris is made by boiling Lime & Sulphur, in Water straining & adding Muriatic Acid. It is nothing Sulph. Acid is often used & then the Lac Sul. is adulterated with Sulph. Lime more than Hydrated Sulphur. Dose & use same as former Test of purity is to throw it on a hot iron, it should all be consumed. Carbonate of Magnesia. formerly called a Subcarbonate: is usually obtained from the Bitters or Mother Waters remaining after the Chrystallization of Common Salt from Sea Water. This contains the Sulphate & Muriate of Magnesia. It is heated & impure Carb. Pot. added when double decomposition 44 takes place, from which results Carb. Magnes. [illegible] form Sol. of Sulph Magnes. precip. by Carb. Sod. biter than C. Pot. This is washed, dried & cut in cubical masses. Soncet adulterated it with Carb & Sulph Lime It was first introduced into practice by Count Palmar in Rome. It is white, light, smooth, inodorous less than Magnesia 1 cu 2500 cold: & 9000 [wh??] little taste, unalterable in air & insol. in water, somet: it is adulterated with Lime, detected by dissolving in dil. Sulph. Acid, & add Oxalic Acid except to a very slight extent, when the Carbonic Acid of Water, forms it into a Bicarbonate Idinc soluble in Carb acid water Magnesia Water is a solution of it in Seltzer Water. It may be found in other forms than masses & heavier. Dose for an adult ʒij, but not much prescribed on account of its being liable to produce flatus. Efficacy is owing to acid in the stomach & bowels or usta Magnesia or Calcined Magnesia is obtained by exposing the Carbonate to a high heat Test is to add Vinegar & no effervescence First mix with water ℥i Carb. yields only about 200 grs. Magnes. alkalin Taste is disagreeable, soluble in 2000 parts water. exposed to the air, slowly absorbs Carb. Acid & is converted into a Carbonate. We meet with a preparation called Henry's Magnesia, which is essentially the same with May be in odered by [sub???] from [Sul??] [illegible] 45 4 times as heavy the Calcined, differing only in being denser, & smoother to the touch. more easily subbes up with water Magnesia is a mild aperient, supposed to operate by forming a salt with the acid with which costiveness with acidity in the stomach it meets. Used in Dyspepsia gout Diarrhea of children cholic, sick headache &c. Sick stomach after debauch Dose for an adult [cross out] ʒi, for a child 2 yrs. old, a teaspoonful. It is frequently combined with Rhubarb in bowel affections. If it do not operate it may accumulate & form masses in the stomach or intestine It is not Known that it is purgative in itself, hence if it do not operate, it is proper to aid it by giving lemonade &c. The best method of administering suspending it, is by diffusing it in water & it is important that it be equally diffused & not left in little lumps lest they should get between the teeth, & leave the taste in the mouth: first then, rub it up in a mortar with a little Syrup, then add the Water to it: or it may be taken in Soda Water, by first rubbing it up with a little Ginger Syrup. 46 The Saline Cathartics or Neutral Salts as a Class are the most important of the Cathartics. They are given generally in the same complaints & preferable to one another only for convenience, cheapness, taste or some other adventitious circumstance. They may be considered as holding a station between the Laxatives & Purgatives; they act upon the intestinal exhalents, produce watery evacuations, little pain, are refrigerant or sedative & well adapted to inflammatory & febrile complaints: but in acute attacks, the more active Cath. should be used first & these afterwards to continue the impression if needed. Soda Sulphas. Glauber's Salts this not long since was extensively employed, but is not now. It is found in the bottom of Springs & lakes but not in large quantities: all that is used is artificial. It is a kind of chance production resulting from the as Sulph. Acid. & Chlor. Sod. for Mur. Acid. processes for obtaining other products. Its great source is Sea Water. After the deposition of common Salt, this contains Sulph. Magnes. & Mur. Soda, & if it be reduced to a very low temperature, a double decomposition 47 ensues, resulting in the formation of Sulphate of Sod. & Mur. Magnes. & while so cold, the Sulph. Soda is precipitated. Hence in Russia, in the Winter, it is found at the bottom of lakes. Its Chrystals are in 4 or 6 sided Prisms with dihedral summits; striated by exposure, they give off their Water of Chrystallization, & when thus effloresced are 2 as strong as in Chrystals. It is soluble in 3 times its 1/2 at [illegible] weight of water at 60°, in 1/2 its wt. at 88°, & less 3 times at 106 sol. in boiling water than in water at 100°, Crystals melt, when heated- insoluble in Alcohol. Most sol in W. at 91°. but as a general rule, in 2 or 3 times their wt. of water. It is disagreeable & seldom prescribed. Dose ℥i Magnesia Sulphas. Epsom Salts. Exists abundantly in nature, in Sea Water, Springs, Caves &c. It was first procured from Epsom Springs in [crossed out] 1675 It was once obtained from Bittem, but not pure & frequently contained Mur. Magnes. It is now manufactured in Baltimore from a Magnesian rock which yields it abundantly by adding Sulph. Acid. also from Limestone in England. Chrystals are in 4 sided prisms with dihedral 48 summits, but as founded in the shops, it is usually in slender, needle like crystals, & very slightly efflorescent. It contains about 50 pr. Ct. Water of Chryst. soluble in water, insol in Alc. with a saline, bitter taste. It is frequently given in Soda Water. Dose ℥i. Disting. from Sulph. Sod. by adding Carb. Sod. to the Sol. It will precip. Carb. Mag. if Sulph. Mag. Seventeenth Lecture June 9. 1834 Potassa Sulphas. or Vitriolated Tarta; may be obtained by the direct union of its constituents, or by saturating Carb. Pot. with the Supersulphate which remains from distilling Nitric Acid from Nitric & Sulp. Acid. It is in Chrystals of various sizes, form 6 sided prisms, hard, contain no W. of Chrystalzation, Sol. in 9 pts Water at 60° & 4 pts at 212°, insol. in Alcohol. When heated, it decrepitates from water entangled like Common Salt. removes half the base. By the addition of acids, it is converted into a Bisulphate. Its taste is nauseous, somewhat bitter. Though cathartic in its effect, it is seldom employed for this purpose, on account of its difficult solubility. Dose about ℥ss Seldom used for any thing except the formation of the Dovers Powder. hard Hercula 49 Potassa Supertartras or Cream of Tartar, consisting is a Bitractate of Pot. & an excess of Tartaric Acid. It exists in the juice of the grape, & is deposited from new wine during fermentation, because it is insoluble in Alc. hence when by fermentation, the sugar is converted into Alc. the Crude Tartar is precipitated . This when purified by solution & chrystallization becomes Chrystals of Tartar, these we receive from S. of France, in small, irregular, semitransparent masses, sour, sol. in 60 prts Water at 60° & 15 prts at 212° insol. in Alc. & containing but little W. of Chrystallization. The Chrystal when ground form the Cream of Tartar of the Shops. This is rendered more soluble used in [An???] Inf. affections Scrof. & with Sulphur. for Piles. by boiling it with Borax. forming a compound sol. in an equal or less weight of boiling water. Potassa Tartras or Soluble Tartar. is prepared by dissolving Carb. Pot. in boiling Water. then adding the Supertartrate till effervescence ceases, then evaporate to dryness. Chrystals & Granular It has a bitterish, cooling taste, is deliquescent 50 in chrystals sol. in its own wt. of water, but in granular form, sol. in 4 times its wt. sol. in 240 prts boiling Alcohol. Its aqueous solution, when long exposed to the air is decomposed. It should never be prescribed in combination with acids. They take 1/2 base. It is a Cathartic, sometimes combined with Senna, but seldom used. Dose ℥ss to ℥i. Soda et Potassa Tartras or Rochelle Salt. 2 1 obtained by saturating Super Tart. Pot. with sol of Carb. Soda. It is in form of Chrystals, of right Rhomboidal Prisms, slightly very slowly efflorescent sol in 5 prts water at 60°, & much less boiling. It has a saline, bitter taste, was introduced into practice by Seignette of Rochelle. It resembles more palatable Dose ʒi to ʒiss the other neutral salts, but its principal use is as an ingredient in forming the Seidlitz Powders, composed of Rochelle Salt ʒij. Bicart. Soda. ℈ij in a blue paper, & Tartaric Acid grs xxxv in white Dose of Rochelle Salt ℥ss to ℥i. Result of Seidlitz is Tart. Pot. & Soda. & Tart. Sod. 51 Soda Phosphas. is obtained by taking some calcined bones, acting upon them with Dil. Sulp. Acid & a precipitate of an insoluble Sulphate of Lime falls, while a Superphosphate of Lime remains in solution Filter this & to it add Carb. Soda when efferescence & double decomp. takes place. & Phosphate of Soda remains in solution which filter & evaporate. It chrystallizes in the form of Rhomboidal Prisms, effloresces, undergoes the watery fusion by heat is soluble in 3 parts Water at 60°, & 2 pts at 212°, It contains 62 pr.ct. Water of Chrystalization. in the shops, it is generally found in the state of powder. It has a slightly saline, but no unpleasant taste, & ℥i of it may be given in a bowl of soup without the patient's knowing it. The chief objection to its use is its costliness. Dr Peasson Calomel. Of its Chemical History, we shall speak at a future period. It is termed a Proto Chloride & Submuriate, in some Pharmacopeias. The U.S. officinal title is Hydrargyri Chloridum Corrosivam Mite, distinguished from Hyd. Chlo. Forte 52 The dose of it is from 10 to 20 grs. but much larger Western practice- doses have often been given, & it is found that Cal. does not act in proportion to the quantity administered more than a regular dose; probably because the system will absorb but a certain proportion of it, & this acting upon the hepatic organs, will only produce a certain effect. It acts with little harshness or severity, producing bilious stools of different colour, according to the quantity given. Sometimes, however, it effects the stomach with violent spasms & vomiting, & this is believed to result from the quantity of vicious bile, which it causes to be secreted & poured into the stomach. Its direct effect upon the mucous coat seems to be rather soothing than irritating, & it will often remain on the stomach, when other Cathartics have Case of [Intussuscefetis?] been rejected. If it do not operate in 6 or 8 hours, it should be carried off, by a purge of Salts or Oil. Children require larger doses in proportion than adults, a child 3 yrs. may take 4, 6 or 8 grs. It is slow in its operation, hence dose of Oil may follow it. 53 When a speedy & powerful action is required, it should be combined with more active Cathartics. Thus combined, it is frequently employed in the Autumnal & Bilious Fevers, Jaundice, Hepatitis, & in fact, whenever active purging is desired. It sometimes proves beneficial in Dysentery, Enteritis, Gastritis, by its action upon the Liver. In cases of Children, it is much used in Remittents, Worms. It [Maras??s] &c. It is generally prescribed in the form of Powder or Pills. Never combine in Pill, with Soap or Magnesia. Purgative Enemata. The uses of injections are to promote the evacuation of medicines given by the mouth, or to administer medicine to a patient having a very irritable stomach &c. or when the stomach is in a state of inflammation, or when there is danger of injuring the tone of the stomach. They are also useful in constipation depending upon a collection of feces in the lower part of the intestines. A very common injection is made 54 of common Salt, Molasses, Lard or Sweet Oil, each a tablespoonful & a pint of warm water. If a more active one is needed, use Castor Oil or some one of the Neutral salts. If one still more active, use Senna Tea ℥i to Oj boiling water, or Jalap diffused in Water, 3 times dose. Ol. Tereb. tablespoofful to Oss warm water, or in Flaxseed Tea, with Yolk of Egg to diffuse it. Assafœtida may be given in flatus. Tobacco.- to overcome spasms, as in Cholic, Hernia &c. but with great care as to its strength. The proper proportion is ʒi to Oj of boiling Water, give 1/2 when cool, & the remainder in 1/2 hour if necessary. Suppositories are sometimes employed as Purgatives Soap is generally used, some take Molasses Candy. 53 Eighteenth Lecture June 12 1834 Diuretics are medicines which increase the secretion of urine. This they do in three ways. 1. As Nitre for inst. by entering into the circulation & then coming in contact with the vessels of the kidneys & stimulating them to action. This is condeuced by the saline medicines taken, having been detected in the urine. The active principle is that which is absorbed, while the remainder is digested & passes off. Thus in Turpentine, the vol. oil only is the portion absorbed. 2. Their action is extended by sympathy from the stomach to the kidneys; of this class, we can name none which act in this way alone, but there are many medicines which act by both these ways combined. 3. Some medicines act by promoting the action of the absorbents, hence they throw more fluid into the circulation, which must be eliminated through the urinary organs, & consequently increase the 56 discharge. Digitalis is said to act in this way. There are many circumstances, besides these, which influence the urinary secretions. Thus diaphoresis & diuresis are directly opposed & hence when one acts, the other will not, as in Winter, we know that more urine is secreted than in Summer when we perspire more freely. Cold Water then & cool skin promote diuresis. Active purging and diuresis are directly opposed, hence when the exhalents are pouring out fluid into the intestines, Diuresis does not occur. Diluent drinks promote Diuresis or Diaphoresis according to the state in which the patient is kept. It was formerly thought that in dropsy, copious drinking must be avoided, but we now find the reverse to be the best method of curing, & consider the patient may drink without restraint, so [as] long as the discharge equals or exceeds what is drank. In using diuretics, the pulse must always be attended to, if it is large, first deplete, for an increase of circulation above a certain point, diminishes 57 rather than increases the urinary secretion. Another reason for attending to the state of the circulation is that the secretion depends upon the nervous energy- hence if the brain be pressed upon by the fulness of the vessels, the nervous power must be diminished. Mental emotions have also much influence over the secretion of urine. Thus anxiety increases it, as every surgeon well knows, who has been labouring under great anxiety respecting an operation which he was about to perform- fear also has a similar effect, tho' probably it acts rather by relaxing the Sphincter muscle. Dropsical effusions removed [illegible] the principle of Exosmosis (Chap) The diseases in which Diuretics are applicable are those attended with effusions, as Dropsy. They operate by diminishing the quantity of fluids, either by stimulating the absorbents, by moderating the exhalents, or by a union of both. Hence they are advantageous in Dropsy, which, we know, may occur either from a diminution of the power of absorption, from an increase of the effusion 58 effusion, or from an increase of effusion & diminution of absorption combined. They may also act upon the principle of revulsion, for Dropsy may occur on account of a kind of sub-excitement over the whole surface & consequently if medicines will draw this irritation to the kidneys, they cure the disease In inflammatory diseases of the kidneys or any of the urinary organs, they act favorably after depletion. In these the saline diuretics are particularly applicable. They are useful also, where we wish to decrease the arterial excitement. In selecting those most applicable to particular diseases, great care is requisite & much must be left to the discretion & experience of the physician. Some are better adapted to peculiar cases than others. We shall now speak of them individually: & 1. Of Digitalis,- for which see Book B p. 53.- 59 Nineteenth Lecture June 16 1834 On Squill & Colchicum, See Book A p.67 & 77. Twentieth Lecture June 19 1834 A.85 A.73 B.129 On Veratrum, Taraxacum, Juniper Berries.- B.185 B.185 Erijervn Philadelphicum, Erig. Heterophyllum, B. 127 Carrot Seed, Apium Petroselinum, & Chimaphila B.183 Ap Draveolens or Cellery [illegible] species Umbellata for which see Books A. & B. Twenty First Lecture June 23 1834 Turpentine is a name applied to a peculiar vegetable juice, consisting of resin dissolved in an essential oil, & generally obtained from some species of Pine. There are several kinds found in the shops. 1. White Turpentine. Terebinthina (U.S) is obtained from the Pinus Palustris, which is a native of N. & S. Carolina & Georgia. It is called sometimes the long leaved or Pitch Pine is about 60 or 70 ft. high, & supplies nearly all that is consumed in the U.S. as well as sent to other countries. White Turpentine has a peculiar, somewhat aromatic odour, a warm, pungent & lightly bitterish taste, is of a white colour, mixed with yellow; consistence varies with the temperature, & it 60 long exposed becomes hard & dry. That in England & France comes from a different plant. 2. Canada Balsam or Balsam of Fir. is improperly so named, because it contains no Benzoic Acid. It is called also Balm of Gilead or Am. Silver Fir. derived from the Ab. Balsamifera growing in the N. on the bark of the tile are little blisters filled with the liquid. parts of this country.- It is liquid, like Honey, has a strong, not disagreeable odour, bitter taste, whitish yellow colour & semitransparent, becomes stickier & darker by exposure. 3. Venice Turpentine.- so called from the Port whence it was formerly shipped,- is the product of the P. Larix. This, however, we do not find in our market.- That which we have under this name, is probably a factitious article, made from Pitch, Ol Tereb. & White Turp. Strasburg Turpentine comes from Hamburg. 4. Chian Turpentine is never brought into this country. It is thick, tenacious liquid, pale yellow colour.- The Turpentines are fusible inflammable, burning with a white flame & much smoke,- impart neither flavour to water, but are insoluble in it, soluble in Alcohol.- consist of Oil, Resin & perhaps some Succinic Acid. They are all stimulant, diuretic, & in large doses Cathartic irritate urinary passages but have been superseded by the Oil of Turp.- 61 They are given with advantage in Chronic cases of Inflammation of the mucous membrane in different parts, also in Sciatica, Lumbago, Piles, Chronic Catarrh &c. Dose grs x to ʒi- May be given in Pill or Emulsion. Externally for Plasters. There are several substances used in medicine, which consists of Preparations of Turpentine, & may here be introduced with propriety. Tar.- Pix Liquida.- is Turpentine partly decomposed in the preparation of it.- It is procured from the P. Pacastric of N. Carolina, by burning the dead billets in piles, like Charcoal Pits, & collecting the Tar. It has a peculiar empyreumatic odour, with a bitter, resinous taste of a dark colour consists of Resin, Empyreumatic Oil & perhaps Acetic Acid, coloured with Charcoal It yields a very small portion to Water forming Aqua Piles Liquida or Tar Water. which is used in Chronic Cough, &c. Oj per day. Tar may be given in Pill or Emulsion,- or as an Electuary with Brown Sugar. 62 Tar Ointment is an excellent remedy for Scald Head & and in scaly eruptions of the skin, we have found nothing so beneficial as equal parts of Citrine & Tar Ointment mixed.- Tar & Sulph. Oint. for Scald Head &c. Pitch. Pix Nigra. (L) is Turpentine deprived of a great portion of its oil by evaporation and is solid.- It is seldom used.- Of Burgundy, & Canada Pitch, we shall speak hereafter.- Resin- common called Rosin,- is that which remains from the Turpentine, after the oil has been separated by distillation.- It is solid, brittle. semitransparent.- There are 2 varieties in the shops, Yellow & White. The Yellow is semitransparent. when melted & worked up with Water, it forms the water grad. evap. if exposed White.- Resin is not given internally Fumes Cerat. Resina Basilicon Oint. Composed of Resin, Max & Oil,- is used for keeping blisters open.- It is the best application to Burns, to prevent an de-looking scar. Ol. Terebinth.- or Spt. of Turpentine is the most important as an internal remedy. It is colourless, limpid- has a strong peculiar odours- pungent taste 63 is sparingly soluble in cold Alc.- readily in boiling.- It has a strong determination to the urinary organs, & is slightly stimulant, so that if long continued, it will produce strangury,- or bloody discharge. It is useful in Chronic Nephritic complaints,- Leucorrhea,- Gleet. Debility of Urinary & Genital Organs. Sciatica, &c. &c. Dose 10 or 15 drops 2 or 3 times In acute cases the dose may be repeated every 2 or 3 hours. a day.- It purges in the dose of ℥ss to ℥ij.- If long kept, it absorbs Ox & forms a resin. It can be purified by adding Cold Alcohol. There is a method in which Turpentine has been very beneficially employed, of which we have not yet spoken. It is in the form of fumes arising from Resin or Tar. which have proved very serviceable in chronic affections of the throat.- or of the mucous or bronchial membranes & in the first stages of consumption, before tubercles are formed. It is probable that the air of Pine forests, proves beneficial to consumptive invalids for the same reason, for the odour which there prevails. Copaiba.- Product of Copaifera Officinalis,- for an account of it, see Book C. p.25. 64 Twenty-Second Lecture June 26 1834 Canthares.- Of the History of this we shall speak hereafter when we come to treat of its vesicating properties.- now we have only a few remarks respecting its diuretic properties. The testimony of the ancients & moderns concurs in pronouncing it diuretic.- It is stimulating & sometimes produces strangury by its irritating effects upon the mucous membrane.- The symptoms of strangury are a frequent disposition to pass urine, only effecting the passage of a few drops of a red colour, with a great deal of pain.- Tinct. Canth. is useful in dropsy;- also for irritating the urinary organs in suppression or retention of urine.- If retention depends upon a stricture or upon spasm at the neck of the Bladder, Canthar. would certainly be improper, but if it depended upon an inability of the bladder to expel its contents then Tinct. Canth. would probably excite it to action. In suppression,- Canth. may be employed for stimulation. 65 In Incontinence of Urine, when it depends upon paralysis or want of power in the Sphincter muscle, Fr. Canth is useful.- Thus in Children who are constantly prone to discharge in bed, this has acted very befeficially.- It is useful also in Leucorrhea, Amenorrhea, Gleet, Seminal Weakness, &c. Dose 10 or 15 drops 2 or 3 times a day. In substance, 1 gr may be given morning & evening. Mineral Diuretics. Carbonate of Potassa.- This Salt is contained in the plants which were formerly so much employed for the cure of Dropsy. The Salts of Pot. are supposed to operate upon the vessels of the kidneys. The Carb. Pot. employed is a purified Pearl Ash, prepared by making a saturated solution of it in Water, filtering, evaporating, & stirring it till it granulates. This however is by no means pure, it contains Muriate & Sulphate of Pot. & Silica.- Silicate precip. from solution. The name, Salt of Tartar, applied to this, [illegible] properly to the Carb. Pot. obtained from Cr. Tart. by heat. 66 It is composed of 1 Eq. Carbonic Acid & 1 Eq. Potassa; was formerly, but improperly called Subcarbonate. It is always granulated,- deliquescent,- an alkali, changing veg. blue to green- forms soap with oil,- insol. in Alc. sol.- in water. It is used as a diuretic in Dropsy.- also in stimulating hepatic secretions in Jaundice.- Dose 10 to 30 grs in solution, 2 or 3 times a day. Bicarbonate of Potassa is a more pleasant preparation, formed by passing a stream of Carbonic Acid through a solution of Carb. Pot. then evaporating by heat below 120°.- It chrystallizes in 4 sided Rhomboidal Prisms,- are white,- permanent,- soluble in 4 times its weight of water at 60°. in 5/6 boiling.- Dose ʒss to ʒi 2 or 3 times a day.- The best form of giving the Carb. Pot. is in Carbonic Acid Water. Take about ʒiss of Carb. or Bicarb. Pot. & ℥i Ginger Syrup, put it in a bottle of Seltzer Water & give 1/3 at a time,- keeping the bottle well stoppes Carb. & Bicarb. Soda,- not important.- 67 Acetate of Potassa, is but little used,- it is made by adding vinegar or acetic acid to Carb. Pot.- It is white, texture, deliquescent, sol. in its wt. of water at 60° & Alcohol & decomposed by Acids. It is Cathartic & Diuretic. Dose as diuretic ʒss. 2 or 3 a day. Supertartrate of Potassa: is the best saline diuretic, which we possess. It should be given in large quantities of water to the amount of ℥ss or ℥i per day. It is refrigerant, antiphlogistic, & adapted to a febrile condition of the system. It is proper to begin with about ℥ss per day in divided doses. It is well adapted to Anasarca with excited circulation. Nitrate of Potassa is found in various parts of the world. It is most abundant in the plain over flowed by the Ganges.- The ground is scraped together & lixiviated.- & process repeated till Nitre Chrystallizes in 6 sided Prisms,- containing no water of Chrystallization Taste is sharp & cooling; even extending to the stomach. It is soluble in 4 or 5 prts. of Cold. & its own wt. boiling W.- insol. in Alc. Dose 10 or 15 grs in solution sufficiently often to give about ʒi to ʒiij in 24 hours. This will promote diuresis, by stimulating the urinary vessels.- 68 Nitre has sometimes been accidentally taken for other salts & proved poisonous. The symptoms are a strong feeling of coldness in the Epigastrium, spasms, bloody stools, hypercatriasis &c. The remedy is to wash out the stomach thoroughly & guard against intestinal irritation.-. Sweet Spirit of Nitre.- Spir. Ætheris Nitrici. has often been found advantageous as a diuretic. It is sol. in W. & Alc.- often adulter. with Alc. as their sp. gr. is nearly equal. It is often grateful to the stomach when others are not. Dose ʒss to ʒi Chapman gives from ʒij or ʒiij to ℥i. It should be administered with large quantities of liquids. It becomes sour if long kept from Nitrous Acid. Antilithics The Antilithics are medicines which were supposed to prevent a deposition in the urine, producing gravel but we are very sceptical respecting the propriety of arranging these in a distinct class.- for as the vessels in connection with these organs are diseased, general treatment is as proper as in other cases, upon the same principle that we would class Antilithics, we might form also classes of Antiscorbutics, Antidysenterics &c. &c.- 69 We think, therefore, that this class might be justly omitted in the Materia Medica. It was supposed that some medicines would enter the circulation,- come in contact with the stony depositions, & dissolve them, & hence we have a class called Lithontriptics.- but it is not so. There is no solvent for the stone, while the stone is in the bladder.- The only method in which we can act is to obviate the Lithic Diathesis, & thus we may sometimes relieve or correct the unpleasant symptoms. The urine abounds in saline matter, of different kinds, & we find that there are 2 kinds of Calcareous Deposition.- The one which is most frequent is Uric Acid,- the other, a compound of an insol. Salt of Phosphoric Acid. That state of the system, predisposing to the former is called the Lithic Acid Diathesis, & that to the latter, the Phosphoric Acid Diathesis. Whenever there is a red sediment in the urine, we may suspect the first Diathesis,- but if 70 there be any doubt, take a piece of Lithmus & immerse it, & it will be changed to red, if there be Uric Acid present. In a healthy state it always exists, in combination with more alkali. Thus the Sublithate of Ammonia will remain dissolved as long as the Alkali is in Excess, but if the acid exceeds, this is then deposited. Hence in persons of the Lithic Acid Diathesis, it is improper to accumulate acid in primæ viæ,- or to live upon acescent food. Deficiency or suppression of Perspiration also is said to be improper in such persons, because according to Dr Wilson Philip, it contains an acid- The remedies or antilithics in these cases are Alkalies & Alkaline Earths, to neutralize the acid, in the blood, urine &c.- Simple Bitters also, to strengthen the Digestive Powers, & Diaphoretics, by causing Perspiration. In the Phosphatic Diathesis,- the case is directly the reverse, & too little acid is the cause of the stony deposition.- The calculous matter 71 is such as to be soluble only when there is a certain portion of Acid, but when this proportion diminishes, a white sediment deposites, This state is also connected with disorder of the Digestive functions. Acids here, instead of Alkalies, are requisite for the cure, & Mineral acids are preferable Hard Cider has enjoyed great reputation among the vulgar for the cure of the Gravel, but we readily perceive that it is applicable only in this Diathesis, while in the former Diathesis it would prove very injurious. Tonics also are applicable.- Carb. Pot. & Soda, Calc. Magnesia, Lime Water &c. Bicarb. Pot. & Soda are preferable to the Carbonates, & the BiCarb. Soda to Bicarb. Pot. Dose ʒss to ʒi Dose of Carbonates 15 to 30 grs. Some prefer Magnesia, but it is probably inferior when it is desirable that the Antacid should reach the kidneys. Dose 15 to 30 grs. 3 times a day. Lime Water may be given with Milk, Oij per day. The Mineral Acid employed are the Nitric, 72 Sulphuric & Muriatic,- all of which are Tonics. The two last of these are preferable. All the vegetable tonics are sometimes useful. Uva Ursi has obtained great reputation, & seems well adapted to those cases where the organs are incapable of performing their duty from relaxation or debility.- It has, however, no peculiar adaptation to gravel. Twenty-third Lecture June 30 1834. Diaphoretics,- are such medicines as increase the cutaneous discharge.- The skin always, when in a healthy state, is carrying on a secretion, which generally evaporated as fast as it is formed,- but when, from an increase of secretion or from different states of the atmosphere,- it retains its liquid form it is called sweat.- At one time, it was supposed that some medicines had the power of increasing the moist secretions & others the dry,- & hence they were divided into Sudorifics & Diaphoretics,- but these distinc- are now lost, & both are comprised by medical men under the head of Diaphoretics. 73 These medicines operate in different ways.- 1. By relaxing the constricted capillaries which are often found as in cases of febrile excitement- In diseases, attended with such consequences, the diaphoretics are calculated to relax these vessels & thus promote perspiration.- This may be accomplished by nauseating doses of emetics,- by cold or warm ablutions &c. 2. By entering the circulation, & then coming in contact with the vessels of the skin, & stimulating them as diuretics do those of the kidneys;- as Cn. Pot. &c. 3. By increasing the general circulation & consequently, the cutaneous secretions:- as Carb. Ammo. &c. but these can only be given in languid circulation, with a cool, dry skin, & not in cases of high arterial excitements. 4. If the skin be in a healthy state, any thing which moderates the excitement of the heart and arteries, will produce sweating,- hence warm teas &c are said to be useful.- It is said also that the perspiration produced by entering hot ovens has been known to cure the Dropsy.- But the application of dry, 74 heat is apt to produce febrile action,- while a moist heat usually produces diaphoresis.- Dry heat can be borne at a higher temperature than moist:- These medicines are applicable to a great variety of diseases,- & rank high in the list of curatives. They operate favorably by removing the hot & dry surface,- by depleting the blood vessels, & consequently moderating the arterial excitement;- & also by eliminating the noxious matter from the blood. They act also by revulsion,- by directing the flow of blood to the surface & abstracting it from the inner parts, thus in Dysentery, Diarrhea &c. - Rheum, Gout. They are useful also in Congestion, Rheumatism, Gout, &c.- They are said to increase the action of the absorbents as in Dropsy,- but for this are not very useful. They sometimes merely change the action of the capillaries,- as Sulphur, Sarsaparilla &c. We may add a few words respecting the mode of administration.- If copious perspiration is desired,- put the patient to bed, & do not allow him to be uncovered,- advise flannel to be worn next the skin,- or in summer, the knit elastic substance. 75 When the pulse is strong & full,- the medicine should be preceded by a lancet or a purge.- After the sweating has commenced,- give warm teas, & avoid purging, vomiting, or diuresis.- If the skin be hot & febrile,- cold drink may be given. 1. Relaxing Diaphoretics. A.25 B.189 Ipecacuanha & Eup. Perfol.- see Books A & B. The Antimonials used are Tartar Emetic,- Pulv. Antim.- & Precipitated Sulphuret of Antimony. Ant. et Pot. Tartras.- given in small doses, produces profuse perspiration in two ways.- 1. By overcoming the capillary constriction by nausea, 2. By entering the circulation & stimulating the vessels of the skin to increased action. It loses its curative power, in any disease,- when it nauseates (Chapman) It is useful in excited febrile complaints, in eruptions of the skin,- chronic scrofulous complaints &c. Dose 1/8 to 1/4 gr.- As an alterative 1/10 to 1/8 gr.- Also in the commencement of consumption, with frequent pulse &c. & in catarrhal affections generally.- Dissolve about 1/2 gr. in Oi of Water & let the patient take it as his only drink thro' the day. 76 Pulvis Antimonialis.- was intended as a substitute for James' Powders.- It is made by mixing the Sulpr. Ant. with shavings of Horn & exposing them to heat.- Then we have an Oxide of Ant. Combined with Phosphate of Lime as the result.- It is a very uncertain & variable preparation.- If we were sure that it was a Protox. of Ant.- We would then know that it would unite with the acids of the stomach & form some salt of Ant.- but if it be a Perox. it will not.- It is of dull white colour.- inodorous, insipid, insol. in water, slightly Febrile diseases. sol. in Alcohol.- Dose 3 to 6 grs. every 4 hours 2 1 Sulphuretum Antimonii Precipitatum, is formed by boiling Sulp. Ant. with a sol. of Carb. Pot. then straining & adding Sulp. Acid & we have an orange-coloured precipitate.- If no Sulp. Acid be added, the precip. which falls spontaneously is Kermes Mineral of a dark brown colour if after the Kermes is obtained. we add to the remaining solution Sulp- Acid- we shall have Golden Sulphur. Ant. Sulp. Precip. is a mixture of both The Precipitated Sulphuret is similar to Antimony 77 in its effects upon the system,- but is very uncertain in its operation.- It is seldom or never employed in this country.- Given sometimes for Scrofula & cutaneous diseases, in dose of 1/2 gr or 1 gr. 2 or 3 times a day & may be combined with Calomel. It is said to be less injurious when long continued than Tartar Emetic.- Dose as a Diaphoretic 1 to 4 grs.- Emetic 8 to 10 grs.- Twenty Fourth Lecture July 3 1834. Citrate of Potassa.- is seldom kept in the shops, but is prepared extemporaneously for prescriptions &c. It is made by saturating a solution of Citric Acid or Lemon Juice with Carbon Pot. then we have in a solution of Carbonic Acid Water, Cit. Pot. Its taste is not unpleasant,- called Neutral Mixture. The common formula is to take ƒ℥iiij fresh Lemon Juice & add gradatim Carb. Pot. till effervescence ceases. Dose tablespoonful every 1, 2 or 3 hrs. with a little water. It is well calculated for Remittents & Intermittents, if it produces pain in the bowels or purges, give a few drops of Laudanum. 78 Another form in which this is given is the effervescing Draught,- which differs from the former, only in being given a state of effervescence. Make a solution of Carb. Pot. ʒij to ƒ℥iiij water & filter, then a tablespoonful of this with a tablespoonful of Lemon Juice & also one of water, will make the mixture. Sometimes the reason that no effervescence takes place is because only part of the Carb. Pot. is decomposed. & the Carb. Acid goes over to the other portion & forms a Bicarb- if however, the Bicarb. from the weakness of the Lemon Juice, no effervescence Pot. be used.- we shall always have an effervescence, but at the same time, we cannot be always sure that we have a saturated solution.- Hence Carb. is best- ensued,- then add a little more. When Lemons & Limes are scarce, a solution of Citric Acid may be used of ʒij to ƒ℥iiij water & [add] Ol Limo is gtti- Guard. against the fraud of selling Tartaric for Citric Acid.- Distinguish by dissolving & adding Carb. Pot.- the former will produce insol. Bicarb. The precipitate of Silicate of Pot. may be avoided by using the Bicarb. Pot. ʒiij to ƒ℥iiij water. To increase the Diaphoresis Tart. Emetic or Sweet Spt. of Nitre may be added. Acetate of Ammonia is also employed Liq. Ammo. Acetates (U.S.) only in solution, when it is called Spt. Mindereri It is made by saturating Distilled Vinegar with Carb. Ammo. It is a limpid, colourless fluid. When Ammo. is in excess, it is injurious on acct. of its stimulating effects. Fixed alkalies,- Strong Acids & Sulp. Magnes. are incompatibles- Dose ƒʒss every 2 or 3 hrs. 79 Citrate of Ammonia possesses no superiority Potassa Nitras.- It is doubtful whether Nitre possesses any diaphoretic properties, but it certainly exerts an influence upon the arterial excitement. It is advantageously given in fever, as in the following Rx Potas. Nit. ʒi Calomel grs xii Tart Emetic gr i Usually our Intermittents do not require a large doses of Calomel. [mft.?] Pulv. No viii Give one every 2 or 3 hours. Dose of Nitre is 10 grs. frequently repeated Swt. Spt. Nitre.- to quiet nervous derangement in fevers, as in Children gtt 20 to ƒʒi. We next come to the Stimulant Diaphoretics C.47 A.213 A.209 for Guacacum,- Xanthoxyfum, Mekereum and B.25 Sassafras,- see Books A, B & C. Twenty-Fifth Lecture July 7 1834 Sarsaparilla- see Book A. p. 107. Expectorants are those medicines which facilitate or increase the discharge of mucus from the air vessels of the lungs. This they do in several ways- 1. By relaxing the constricted vessels of the lungs. it is in this way the nauseating emetics act as Expectorants. 80 2. By reducing the quantity of the secretion which may sometimes be so great & the fluid so abundant that the patient cannot cough it up. 3. By entering the circulation, coming in contact with the secretory vessels, & stimulating them to proper action. Hence we find there are 2 classes of Expectorants. One when the lungs are excited & require depletion as in Catarrh. Pulmonic Irritation & Inflammation &c. & the other when the vessels of the lungs are relaxed & pour out more than a proper quantity of fluid as in Asthma, Consumption &c. During the use of Expect. keep the Surface of the body warm.- Purging is not incompatible.- Expectorants may act in another way, by mechanical influence, as in cases of great debility, where the power of the pectoral & other muscles, is insufficient to accomplish the desired object, these then must be stimulated, in order to call into action the nervous influence, as by Wine Whey, Vol. Alkali. Ammonia &c. 81 The best of the whole class of Expectorants to be given in cases of an excited character is Tartar Emetic. It is useful in Asthma, Pleurisy & the like. Dose 1/8 gr. Of Vin. Ant. from 15 to 30 drops. A.32 A.67 For Ipecac & Squill see Book A. Twenty Sixth Lecture July 10 1834 A.103 A.93 C.41 On Allium, Senega, Ammoniacum, Assafateda, C.43 C.43 C.29 C.25 C.49 Galbanum, Myrrh, Turpentine Copaiba, Tolu, C.49 C.51 Balsam of Peru, & Benzoinum. See Books. On Emmenagogues The menstrual fluid is a peculiar secretion of the uterine vessels. A retention or irregularity of this discharge sometimes occurs, & then the intervention of medicines called Emmenagogues is necessary. As with other organs, so from analogy we may suppose that there are medicines which have a peculiar affinity for the vessels of the Uterus, but not many of these are yet known. In practice, at present, those circumstances producing Amenorrhea are considered in order to discover the particular Emmenagogue requisite in each case, & prescribed accordingly. 82 Thus, when it is the result of debility, Tonics, by giving tone & strength to the system, act as appropriate Emmenagogues,- as,- Preparations of Iron,- Bark,- Myrrh &c. It may be the result of general excitement, then evacuants become proper. Sometimes it arises from a diseased state of the system, as in Consumption,- Dropsy &c.- & it is evident that until these are cured, it will remain. Sometimes it may arise from that state of the bowels which we find in Constipation, then of course, Purgatives are appropriate. B.209 Aloes.- From the great affinity which this has for the large intestines, we may suppose that the irritation which it causes may be extended by sympathy or it may have a specific tendency to the Uterus to the Uterine Vessels.- It is often given in combination with Iron,- Myrrh &c. A.63 Helleborus Niger.- The Tinct of this in the dose of 60 grs 2 or 3 times a day has proved very beneficial in Dr. Meigs' treatment of Amenorrhea.- Dr Wood has found Aloes & Carb. of Iron, long continued a very efficient remedy. Also in Dysmenorrhea.- 83 The Chalybeates are excellent Emmen.- & of these Ferri. Carb. Preccip. appears most efficient. on the treatment of Amenorrhea, if any disorder in any one of the other functions of the system exist, first remove that disease & then give Emmenagogues Sometimes it may be proper to give the Emmenagogues in conjunction with remedies suitable to the cure of the original disease.- Thus if constipation existed, Aloes & Iron might be joined with the remedies for constipation. Aloes & Iron should never be given in an excited state of the system, without previous depletion. Twenty-Seventh Lecture July 14 1834. A.93 C.47 B.47 B.179 On Madder, Senega, Guacaicum, Sabina, Ergot, & Tinct. Cantharides as Emmenagogues.- There yet remain 2 classes of medicines to be noticed, which act not upon the viscera themselves, but upon their contents, & these are Anthelmintics & Antacids. Adjourned July 23rd to Sept. 7 1835. Anthelmintics are medicines used either to destroy Worms or drive them from the body. There are 4 species of Worms- Lumbricoides, Ascarides, Tricuris & Tania or Tape-Worm. 84 They operate in different ways. Cathartics may act as such by operating upon the bowels, & Tonics, by imparting tone to the system, as well as by poisoning the worms. The worms may either be poisoned so that they are induced to change their place,- or they may be killed by the medicine mechanically.- Calomel is the most efficient anthelmintic & probably may act by increased the flow of acrid bile, which is very disagreeable to the worms,- they change their place, & are carried off by a subsequent dose of Oil. Dose for Child of 2 yrs. 5 grs.- Twenty-Eighth Lecture July 17. 1834 A.65 On Spigelia Marylandica:- Azedarach or Pride of India or Pride of China of which the bark of the fresh root is used.- It is a native of Syria, Persia & India & cultivated in this country. It is used extensively as an Anthelmintic in Georgia. It has a bitter, nauseous taste & is generally given a decoction, made from boiling ℥iiij in Oij to Oj- of which the dose is a tablespoonful every 2 or 3 hours, until it affects the bowels,- or morning & evening for several days & follow it with an active Cathartic. 85 B.177 A.207 also on Chenopodium, Bark of Geoffroya [Inemus?] B.177 A.181 B.139 C.29 Dolichos, Tilix Mas, Pomegranate, Oil of Turpentine, which latter is one of our most powerful Anthelmintics & especially useful in expelling the Tænia the dose is from ƒ℥ss to ƒ℥ij or ƒ℥iij. This generally heats the stomach, & even excites giddiness &c. together with acting upon the bowels. If it do not purge in 3 hrs. after it is taken, give a dose of Castor Oil. Some combine the Oil of Turpentine & Castor Oil together so as to be more certain of its operation. This answers very well, especially in Lumbricoides. The Oil of Turpentine, in small doses, is often given with advantage to children, who complain of pain in the stomach, without any fever &c. when worms may be suspected. the worms in the stomach are destroyed & digested. Whether there actually be worms or not, it often operates very favourably. Copaiba acts similarly Cedar Apple operates in much the same way. Filings of Tin, Pulv. Sfanni have very strong testimony given in favour of their anthelmintic virtues. By some, they are said to act mechanically by their rough, grating surface, but if this were so, sand would act as well 86 Others say, Tin acts favourable on account of the Hydrogen which is evolved, but if this were so, Iron or Zinc would answer the same purpose.- Others suppose that it is from the Sulphuretted Hyd. generated, but we might suppose that the worms had become sufficiently accustomed to this Gas, to feel no inconvenience from its presence. Others suppose that it acts by the Arsenic contained in the Tin, but Arsenic itself will not act thus. Why, then, may we not suppose that the Tin is a medicine noxious to the worms, & consequently acts in this rational manner.- Dose is very indefinite, varying from ʒi to ℥i, given in the morning for 2 or 3 days, then followed by a Cathartic. Aurum Mozaicum, was a compound of Sulphur & Oxide of Tin.- Dose 10 grs. twice a day Pomegranate- Bark of Root- see B.139 Adjourned till September. 87 Twenty-Ninth Lecture Sept. 1 1834 On Antacids.- Antacids are those medicines which are given to meet the acids which are sometimes found in the stomach & bowels and convert them into harmless substances. The acids arise not only from the gastric juice in health, but also more copiously in a diseased condition of the stomach. The diseases in which this state is generally found are Dyspepsia, Diarrhea, & Bowel complaints of Children,- but an acid state of the stomach may accompany almost any disease. All the salifiable bases may be considered as Antacids,- but those generally employed are the Alkalies & Alkaline Carbonates.- Potassa in its pure state is not adapted to internal administration.- Carbonate of Potassa or Salt of Tartar is frequently given as an Antacid.- It is often added to bitter infusions,- so that while the acidity is corrected, a tonic impression may also be made upon 88 the stomach.- The dose of it varies with the acid contained in the stomach.- generally from 10 to 30 grs. & repeat it if necessary.- A pleasant form for administration is in solution in Cinnamon Water with a little Sugar.- Another form in which it may be given is by taking a teacupful of Soot,- & 1 quart of Hickory Ashes,- shaking them together in 1 Gallon of Water, let them stand [cross out] 24, 24 or more hours, then pour off the liquid.- Besides the Carb. Pot. this liquid contains perhaps Kreozote &c. Carb. Ammo. & some other ingredients- The dose of it is a Wineglassful 3 or 4 times a day, & it is rendered more agreeable by adding 10 or 15 gtt of Aromatic Ammoniated Alcohol.- This a very effectual preparation for the prevention of sick headache, which frequently arises from acidity of stomach) if taken, when the symptoms warn us of its approach. Bicarbonate of Pot.- is used as the Carbonate. The only objection is the evolution of a large quantity of Gas in the Stomach.- 89 The preparations of Soda however, are better than those of Potassa; because of the less quantity necessary to neutralize a certain portion of Acid & of the less disagreeable taste.- Soda.- like Potassa,- is not given pure. Carbonate of Soda is obtained from Seaweed or from the decomposition of Sulph. Soda by Charcoal & Carb. Lime.- It chrystallizes in Octohedrons. Effloresces on exposure,- because it contains about 62 pr.ct. Water of Chrystallization,- hence its strength is constantly varying.- The chrystals are soluble in about 2 parts of Cold & less than their own weight of boiling water. It is less disagreeable to the taste than Carb. Pot. Is useful in Jaundice to assist a mercurial action probably by entering the circulation & stimulating the secreting vessels of the liver. The dose varies according to the variety of its strength before stated.- Generally from 10 grs. to ʒi may be given in solution or in Pill. If the latter, it should first be deprived of its Water of Chrystallization by heat. 90 Bicarbonate of Soda more properly Sesquicarbonate is formed by passing a stream of Carbonic Acid through a solution of Soda,- then driving off the excess by heat below 120°,- or by introducing the Gas into a cask containing the Chrystallized about 10 pr.ct. Carbonate.- It contains less water of Chrystallization than the Carbonate,- and is soluble in 10 times its weight of Cold Water. Dose of it is from ʒss to ʒi.- & may be given in Carbonic Acid Water. Ammonia, when pure is gaseous. It is obtained by mixing Mur. Ammo. & Quick Lime Water impregnated with it forms the Aq. Ammo. of the Shops;- it is colourless,- with a pungent taste & smell,- corrosive & caustic, if applied to the skin.- & should be kept in well stopped bottles to prevent the access of Carbonic Acid. Externally it is used as a Rubefacient,- & it may be employed as an [illegible] to prevent fainting. A better preparation for internal use is the Aromatic Ammoniated Alcohol made by impregnating or Arom. Spts. of Ammonia. {If the patient should take the prep. of Ammo. without} {dilution, the mouth & throat may be injured, then gargle} {in the dilute vinegar & smear the part with Oil.} 91 Alcohol with Ammonia & adding some Aromatic Volatile Oil. This a delightful Antacid pleasant to the smell & taste & grateful to the stomach. The dose of it is from 15 to 30 drops, but must be diluted before it is taken. Carbonate of Ammonia is much used p.144 as a Stimulant & will be treated of hereafter Lime.- is seldom used in its Caustic state except in the form of Liquor Calcis, which is a saturated solution of it in Water. Water takes up 1/778 part of its weight & it is more soluble in Cold than Warm Water. It has an acrid, alkaline, unpleasant taste, but when mixed with an equal proportion of milk, loses these qualities & becomes one of our best remedies for nausea & vomiting arising from gastric irritation- It corrects that disposition by calming & giving tone to the stomach. Of the Carbonate of Lime, there are several varieties,- all nearly tasteless, insoluble in Water unless impregnated with Carbonic Acid. They 92 are all composed of 1 Equiv. Carb. Acid & 1 Eq. Lime. Creta Preparata,- one form of it, is prepared by levigating ordinary Chalk. Other forms are Testa Crab's Claws Prep.- Tela Cancrorum Prep.-Ovorum Testa Prep.- said to be preferable to Cret. Prep. on acct. of the animal matter which they contain,- are more minutely divisible.- Carb. Lime is useful in Diarrhea on account of its Antacid as well as its astringent power. Dose varies from [varies] 10 grs to ʒij- From 10 to 20 grs may be given every 2 or 3 hours.- It is usually administered in the form of the Chalk Mixture or Julep,- consisting of Cret. Prep. In making mixtures &c. the Cinnamon water should always be diluted with simple water otherwise it is too strong. Tinct. Opii Acac. Gum. Sacch. Alb. Aq. Cinnam. et aq. Pura.- Magnesia & its Carbonates are both excellent Antacids, especially in cases connected with Constipation, & may be given in Dyspepsia,- Gout, & the complaints of Children. Sometimes it offends the stomach. 93 We next come to speak of those Local Remedies which affect the Organization of the Parts. Rubefacients produce a redness of the surface; when there is much irritation, the vessels pour out a serous fluid & blisters are the results. But this serous fluid is not secreted equally from every irritation, thus we find less of it from Mustard than from Cantharides, & hence we have the different names of Epispastics & Rubefacients. Some substances destroy the parts to which they are applied & are called Escharotics. Hence we have these three classes, Epispastics, Rubefacients & Escharotics. When an Epispastic is applied to the skin, it excites the subcutaneous vessels & causes them to throw out a serous fluid under the cuticle. This local irritation produces a general excitement which in the case of Cantharides is probably owing partially to the absorption of some portion of the Cantharides. 94 There are 2 Indications for the application of Blisters: 1. To rouse the dormant powers of the system. & 2. To break up the chain of morbid action. For the first, they are useful in typhoid diseases, but when these diseases have assumed a chronic form & have nearly exhausted the powers of the system, they cannot be applied with advantage because there is nothing to sustain the excitement & the system sinks lower than it was before. But in acute diseases, where there is sufficient dormant power to keep up the excitement, they often act very favourably. Hence we find that in typhoid diseases, judgment is requisite. to determine the time proper for their application. They are apt in very low cases to produce sloughing & even gangrene, & if applied, it should be to the inside of the thigh, rather than the leg. For the second indication, they are used in Intermittent & Remittent Fevers. They make a violent impression upon the system which breaks up a chain of morbid action & institutes that 95 which is more healthy.- They should be applied during the interval of Paroxysms, so that their action may take the place of the expected attack.- Blisters sometimes compose the nervous system in disease, as in Chronic forms of Fever, when the patient is very restless,- tossing about &c. he will often be composed to sleep by applying a pair of blisters to his legs.- 3. They act favourably also upon the Principle of Revulsion,- as in Chronic Opthalmia, Pleurisy, Hepatitis &c. - Nausea & Obstinate Vomiting. - A good rule for the locality of Blisters is, if it be an Inflammatory disease, apply them as near as possible to the part affected,- but if it be some nervous affection, apply them to a more distant part so as to draw off the nervous influence. Hence in Hemoptysis, after checking the Hemorrhage, blisters may be applied to the extremities to draw the blood down from the Chest. One caution however is very necessary, which is, never resort to blisters in cases of acute Inflammation 96 Inflammation without previous depletion,- because the general excitement which they produce will only aggravate, instead of cure the disease.- It is from this principle of drawing off the nervous excitement that they are beneficial in Spasmodic affections, as in Cholic & Cholera.- These are nervous affections, & when not connected with any Inflammation, sinapisms are better than Blisters. 4. They sometimes prove beneficial in Tinea Capitis & other complaints by introducing a new action. 5.- Blisters are depletory in their action. They should not be applied however in dropsical cases because they are apt to become ulcers or Gangrene.- 6. The pain from blisters is sometimes useful when the mind is diseased,- quieting the nervous excitement Case of a Lawyer who put a blister on his back, whenever he attempted to plead.- 7. Another use of blister is for the Endemic application of medicines to the denuded surface 97 Thirtieth Lecture Sept. 4 1834 Cantharis Vesicatoria.- Littus Vesica. Melöe Vesicat Spanish Fly. This insect is found in Spain, Italy, Sicily, France & the warmer latitudes of Asia, is of an oblong shape,- 3/4 in. in length & about 1/4 in width,- having a fetid odour when alive, compared to that of mice,- & is of a beautiful green colour. They are gathered by shaking or beating the trees on which they feed, and collected on linen clothes spread beneath. They are then killed by immersion in vinegar & water, then dried & carefully packed for market They are sometimes adulterated with an insect of a square shape If preserved in well-stopped bottles, they will keep a long while & retain their virtue a number of years. Sometimes they are attacked by worms and injured.- If kept in damp places, they soon putrefy.- .- They have a disagreeable odour & an acrid taste they yield their active principles to Water & Alcohol, & contain a chrystalline substance called Cantharidin 98 Cantharidin, which is insoluble in Water & Cold Alcohol, but soluble in boiling Alc. from which it precipitates when cool,- sol. in Ether & Vol. Oils.- In the insect, it exists combined with a yellow matter which renders it sol. in W. & Cold Alc.- It is said that if the flies be boiled,- they will not produce strangury when applied.- Dr M. B. Smith prevents strang. by giving teasp. of Uva Ursi during the operation of the Canth. The most extensive use of the Cantharides is in the form of Blistering Plaster, (See Dispensatory) Cerat. Canth. (U.S)- Emp. Canth (British)- It is well worthy of notice that a Plaster will keep for a long time & that its virtues are not exhausted by one application.- Ol. Canth. is not used.- There is a weaker preparation (Mug. Canth.-) used as a stimulating application to keep open blisters &c. We have also Emp. Picis cum Canth or Emp. Calefaciens.- or Warm[ing] Plaster.- consisting of 1 part of Cerat Canth to 7 prts. Burg. Pitch, which is an excellent application [consisting] used in chronic Catarrh. Rheumatism of Intercostal muscles &c. Limmentum Canth.- consists of Decoct. Canth & 99 Spt. Tereb.- There is also a Tinct. Canth. Cantharides whether applied internally or externally are apt to produce Strangury. When we have reason to apprehend this, give freely of demulcent drink, remove the Plaster & make some emollient application to the part,- as for inst.- a soft Bread and Milk Poultice, with a little Laud. spread over it.- In this manner, sometimes if the Plaster be removed in 6 or 8 hrs, & a Poultice applied, we shall frequently find a fine blister.- This caution is requisite in blistering over the eye lest the long continuance of the Plaster should create too great irritation.- But to return to Strangury,- as before stated,- remove the Plaster & give mucilaginous drinks,- & if these fail, give an anodyne injection of about 60 gtt. Laud. with 2 or 3 tablespoonfuls of Starch,- & repeat if necessary.- If these do not succeed, the last resort is to the Catheter. When a blister is left on too long, a sloughing may ensue, more common in children than in 100 adults,- as in low cases of typhus or scarlet fever With respect to the size of the Plaster, it should be generally as large as the place to which it is applied will admit. The largest size is 10 by 12.- It should be always cut to fit the part neatly.- When applied to the head, it is desirable that the head should be shaved 10 or 12 hrs previous if time will permit, so that the abrasions may heal up. The usual size for arms or legs,- 6 by 4.- After shaving the part, apply the blister & confine it by adhesive strips to prevent its slipping. On the Scalp, it should be left longer than on any other part,- generally from 18 to 24 hrs. On children, a blister is generally produced in from 4 to 8 hrs.- When the serous fluid has discharged so as to separate the cuticle, if it is desirable to heal it up immediately, do not destroy the cuticle, but make only small punctures to allow the fluid to escape. Sometimes the sac contains a gelatinous mass, which is the serous fluid coagulated.- 101 When the blistered surface becomes much inflamed & painful, apply warm milk & water,- soft Poultice,- Cream,- very weak Lime Water, or some such soothing application;- the best in Dr Wood's Practice is Goulard's Cerate, mixed at first with about an equal quantity of Simple Cerate. If it be desirable to keep the Blister running, destroy the Cuticle, & use some stimulating ointment. Cantharis Bittata. Potatoe Fly.- is another species, found in this country, & first introduced into practice as a vesicatory by It is found on Potatoe vines &c. in the morning & evening, feeding on the leaves. It has a reddish brown head;- & brown wing cases with a stripe of yellow upon the edge & along the centre. They are procured by shaking them in Hot Water, carefully drying &c. There are also other species Canth. Atrata Several vegetables possess the property of producing vesication when applied to the skin. None however are employed except Mezereum. for which See Book A p.209. Seldom used. 102 Ranunculus Bulbosus. Butter cup.- has a root possessing the properties of producing vesication, but it is uncertain & has different effects upon different individuals, consequently it is seldom or never used. Rubefacients should be preferred to blisters in cases of very violent & sudden prostration, when an immediate excitement is desired;- as in the sinking spells which occur in Typhus Fever, in the cold stages of malignant Intermittents, in prostration from Concussion of the Brain Syncope &c. But blisters, as before stated, are used to subvert morbid associations, compose the patient, for local inflammation &c. Rubefacients are very useful in spasmodic affections: At the head of the list of the individual Rubefacients, we place Mustard. see Book B. p.125. Thirty-First Lecture Sept. 8 1834 Capsicum, see Book B p.163. Ol. Terebinth. is a very good Rubefacient in low states of the system. It should be heated (with great care, lest it take fire) and applied either by friction or by flannels steeped in it.- If it gives too much pain, remove 103 it, for it sometimes produces unpleasant effects. From idiosyncrasy, it is very irritating & even poisonous to some persons, hence caution is requisites in using it. It is useful as a revulsent in deep-seated inflammation accompanied with prostration, as in Puerperal Fever,- tympanitic abdomen,- as a Liniment in Chronic Rheumatism &c.- see p.142 Pix Abietis. Burgundy Pitch. The prepared concrete juice of the Norway Spruce Fir. It exudes spontaneously on the bark of the tree, whence it is scraped, heated in Water & strained. It comes to us from Germany & Switzerland. It is brittle, opaque, brown externally, yellowish internally. Thus is hardened spontaneously exuded juice of P. Abies It differs from the Turpentines in containing less volatile oil. It softens by heat, & by contact It consists of Resin, Vol. Oil & water. becomes dark by exposure.- with the skin, it is just sufficiently softened to adhere. When thus applied excites a sufficient degree of irritation to increase the perspiration.- In one case of an old gouty patient, Dr Wood knew it to produce violent inflammation & even ulcers whenever it touched him.- It is useful in Rheumatic effection,- Chronic Catarrh,- Dyspnea,- and other Pectoral Complaints. 104 Pix Canadensis. Hemlock Pitch. derived from the Pinus Canad. or Hemlock Spruce of N. America. The juice exudes spontaneously from old trees upon the bark,- this is then stripped, boiled twice & strained. It is of a brown colour, more yellow internally. It consists of Resin & less vol. oil than Turpentine. It is used similarly to Burg. Pitch: by some preferred. Aqua Ammonia. is seldom used alone but generally in the form of Vol. Liniment, a. e. combined with Olive Oil; usually in the proportion of 1 part Aq. Ammo. to 4 parts Oil,- but this varies according to circumstances. It is useful in Catarrh, Rheumatism, Sore throat &c. of Infants especially.- Aq. Ammo. is very uncertain in its strength, & sometimes so weak that it will not unite with Oil to form a Liniment:- it should then be rejected.- A plaster can be made of common Lead Plaster Soap. & mur. ammo. which will last for about 24 hours, & answer the same purpose with the Liniment. A decomposition takes place & the Ammo. is slowly given off.- 105 Tartar Emetic. for the history of this see page 28. It is often applied externally as a Rubefacient. From one to three days generally elapses after it is applied, before any effect is produced: at length an itching & prickling sensation is felt, followed by small red pimples, which increase and become pustules, & afterwards even ulcerate if the application be continued. It acts upon the principle of Rubefacients & Epispastics.- There is however one advantage in its use:- we know that a recession of eruption oftentimes produces internal inflammation & disease, & hence when the eruption can be again brought out, the disease disappears, thus the Tart. Emetic by producing this pustular eruption, alleviates the complaint, having a much better effect than the discharge from Blisters. It operates too more deeply;- affecting not only the cuticle, but extending the pustule down to the cutis vera, & consequently, we may suppose, produces a greater effect upon the system at large. 106 With respect to locality, Dr. James thinks the arm a preferable place, but probably it is more efficient when applied to the back. In inflammatory affections, however, as a general rule, apply it as near as possible to the inflamed part. It is useful in obstinate chronic Pleuritis, Hepatitis, &c.- & an excellent application to the Spine, when there is Tenderness upon Pressure, Nervous Derangement, Hysteria &c.- First apply Cups to the part then apply the Ointment or Plaster. It must be remembered, however, that when applied to a cupped surface, instead of requiring 2 or 3 days, it become almost insupportable in from 1 to 3 hours. It may be used in the form of Lotion, Ointment or Plaster The Lotion is the least favourable mode & seldom used. Ointment is made by mixing ʒi (more if necessary ʒi or ʒij) Tartar Emetic with ℥i simple Cerate. Rub a little on every 4 or 6 hours, or spread it on linen & apply it. The most convenient form is that of the Plaster. This is simply a Plaster of Burg. Pitch, covered over with Tart. Emet. except at the cases so as to allow it to adhere 107 It is generally left on 3 or 4 days, then removed.- if it will not come off readily, apply a little Olive Oil. Almost all the volatile Oils are Rubefacients, but seldom used. One sometimes employed is Ol. Monardo Punctate. or Horsemint Oil. Croton Oil has been recently recommended, mixed with 4 prts. Olive Oil. Escharotics are those substances which destroy the life of the parts to which they are applied & produce a sloughing. They operate in 3 ways, either by their direct influence, or by chemical decomposition.- When they operate in the first manner, the life of the part is lost, because the part is unable to bear the application. In the second, the life is destroyed because of the chemical disorganization of the parts. They are employed for forming Issues, opening abscesses. & subverting diseased action by destroying the part diseased and substituting an action of its own. Of the individual Escharotics, none are more severe than the Heated Iron, or Actual Cautery. This is used for arresting Hemorrhage &c. but seldom in this country, unless in Hemorrhage from the Fauces where no ligatures &c. can be passed. 108 Another mode of applying it is by Moxa. This, too, is seldom used in this country. It is made of Pith. of Sunflower which contains Nitre or other similar plants, or of Rolls of Linen, Cotton &c. imbued with Nitre, so as to continue the combustion. or with Bichromate of Pot. Potassa is next in power as a caustic. It is obtained from Scalsed Lime & Carb. Pot. found in cylindrical pieces kept in paper & in It is deliquescent well-stopped bottles. Caust. [Coru????re] [Acen??um] (old) It is applied as follows. A piece of adhesive plaster with a hole about the size of the place required, is laid upon the part, then take the caustic, wet it & rub it on until the part is black. remove the plaster, & wipe it off with a piece of sponge, then apply a poultice, & in 8 or 9 days, an ulcer will form into which Issue Peas may be introduced to keep open the Issue. Sometimes the Pot. is mixed with Lime, water & soap, & formed into a Plaster, but this is not so good. Issues are adapted to Chronic diseases &c. Caustic is sometimes used for opening abscesses, for removing flesh from poisonous wounds &c. & dissolved in water, it has been recommended for Tetanus by Dr Hartshorne 109 Thirty-Second Lecture Sept. 11 1834 Nitrate of Silver or Lunar Caustic (Argent. Nit) is formed by dissolving Silver in Nitric Acid, drying & moulding it &c. It is white & semitransparent, but when exposed to the air & light, it becomes dark by decomposition & oxidation. It affects only the surface to which it is applied forming an eschar which prevents it from acting deeply & does not penetrate like the Potassa, hence it is employed only for destroying sores &c. as old ulcers. chancres &c. In solution, it may be used as a stimulant to ulcerated surfaces, as in ulcerated Cornea, sore opthalmia, soreness & running from the Ear, &c. for which it is almost a sovereign remedy, if properly applied. A work has lately been published recommending it in arresting cutaneous inflammation. It is generally applied by rubbing it over the surface. The proper proportion for an Eye-Walle is 1/2 gr. to grs ij to ƒ℥i Distilled or River Water. But when the Cornea is ulcerated, its strength may be increased, or a better plan is to apply it with a camel's hair- 110 pencil.- For the Ear, begin with a solution of about grs ij to ƒ℥i & increase it if necessary, to 3 or 4 grs to ƒ℥i Distilled water. If it should be applied by injection, always use a Silver Syringe, as others will decompose it. Arsenious Acid or White Oxide of Arsenic, obt. by sublimation from the Ore is sometimes used for Cancerous Affections, & is the basis of most of the empyrical remedies for that disease. There is danger, however, of the poison being absorbed, & hence it is seldom prescribed by a regular physician.- more danger in a dilute than caustic state. Sulphate of Copper (Cup. Sulph.) is sometimes employed as an Escharotic. generally in Solution: A solution of grs XX to ƒ℥i Water is an excellent application to Chancres &c. gtt i per day will often completely destroy them. A solution of it is also used for ulceration which is often seen in the mouths of Children, accompanied with fetid breath Gangrene Swollen cheeks &c. it proves a very effectual & certain remedy Verdigris, is sometimes used at Escharotic. 111 Corrosive Sublimate or Bichloride of Mercury is seldom used as an Escharotic, but as a stimulant in syphilitic affections &c.- A [solution] mixture of it, however, is very efficient in arresting a disease of the Fingers & Toes called Onychia Maligna, once considered incurable- Take equal parts of Corrosive Sublimate & Sulph. Tinc.- mix them together, & sprinkle them over the surface of the diseased parts. then apply a Pledget of Lint & over that Tinct. Myrrh or Laud.- For about 1/2 an hour, the pain is very severe, when the part becomes destroyed, & soon heals again kindly. For Syphil. ulcers in the Throat, apply a sol. of grs V to X to ƒ℥i- Cutan. eruptions grs ij to ƒ℥i Alumen Exsiccatum. Burnt Alum. is applied in the state of powder to the fungous flesh &c. which sometimes appears upon ulcers. It acts as a gentle escharotic. It has been recommended in Sore Throat, to be applied by the fingers, or in solution- grs XV to ƒ℥i. The mineral Acids may all be considered as Escharotics, especially the Sulphuric & Nitric Dilute Sullph. Acid is sometimes used for cutaneous diseases in ointment Dil. Nit. has been used for ulcers. It was also used equal parts of Nitric Acid & Water. for speedy blistering in Cholera, but is not much at present. 112 Demulcents act by a mechanical power. They are generally mild, unirritating substances, soluble in water, & usually consist of gummy, saccharine, farinaceous & Oleaginous Principles. They are used for 2 purposes. 1. To defend the surfaces with which they come in contact from irritating substances, as in Catarrh &c. 2. They mingle with the acrid matter secreted, & obtund its acrimony, hence they prove useful in Dysentery, Diarrhea & other irritations of the bowels also in Nephritis, Strangury, Gonorrhea, &c. We next notice the individual Demulcents C.51 C.53 A.215 Gum Arabic, Tragacanth, Ulmus Fulva, Flax Seed B.135 B.25 Pith of Sassafras, Quince Seeds and A.115 Liquorice Root. for which see Books A, B & C. Thirty-Third Lecture Sept. 15 1834 B.189 C.55 C.53 C.55 B.133 On Lichen Isl.- Sage,- Tapioca.- Maranta & Barley, for which see Books B & C. We next come to the General Remedies, & the first Class comprises the Astringents. These are medicines capable of contracting or corrugating the 113 living fibre, as is obvious to the senses for inst. the mouth becomes puckered by chewing an astringent. It does not act merely by a mechanical power, but every living fibre possesses a property of contractility, & the Astringent affords the stimulus necessary to produce the effect. The influence of different medicines upon the stomach is soon communicated to the whole system, & it is by this general sympathy, that we account for the operation & general effects upon the system at large, of astringents taken into the Stomach. The Indications for the Use of Astringents then are evident from their method of operation. It is plain that they would be injurious when the discharge depends upon some foreign cause, unless that cause first be removed. As they are somewhat excitant in their nature, they would be injurious in an irritated or inflamed state of the system. They would prove beneficial, then, when the morbid discharge depends upon a weakness of the vessels 114 vessels after the exciting cause has been removed. when there is no inflammation in the part: or when a suppression of the morbid discharge even without arresting the disease, would be of less serious consequence to the patient, than to allow its continuance as for inst. suppression of Diarrhea in Consumption. They are used chiefly for the purpose of restraining Diarrheas, & arresting Hemorrhages; but they are not proper to be given in fever, with excited arterial action. They are generally used as External or Local Applications. When given with a view[ing] of arresting Hemorrhage, depletion may first be used with advantage, as in blood from the Nose, from ruptured vessel, from wounds &c. tho' frequently it is not necessary.- There are 2 Classes of Astringents, the Vegetable & Mineral. The Veg. Ast. owe their property to Tannin. The Mineral; to a peculiar specific Influence. We next come to treat of the Individual Astringents. First. Oak Bark. derived from different species of Quercus, & Galls. for these, however, see Book B p.15 & p.17 115 Thirty-Fourth Lecture Sept. 18 1834 C.57 C.59 A.125 A.193 On [Catechu?], Kino, Rhatany, Logwood, Geranium A.131 A.129 Maculatum, Rubus villosus & trivialis, for which see Books A and C. Thirty-Fifth Lecture Sept. 22.- B.49 B.95 A.135 Uva Ursi.- Black Alder Bark, Roses, Tormentil, A.127 A.183 Bistort, Alkanet, for these see Book B & A.- The unripe fruit & the bark of the Persimmon, Dispyros Virginiana, have been used as Astringents Tarmin, itself, in a pure state, has recently been used as an Astringent. It is of a brown colour, brittle unchrystallisable, sol. in water & dil. Alc. but not in pure Alcohol. Dose 5 to 15 grs. Mineral Astringents. Alum:- is a double salt, consisting of the Sulph. Alumina & Sulp. Pot. with about 50 pr.ct. Water of Chrystallization. Sulph. Ammo. or Sulfs. Soll. might be Substetuted for Sulfs. Pot. in forming the Chrystals. It has an astringent taste accompanied with sweetness is soluble in about 16 times its wt. of water at 60° & 3/4 its wt. boiling water.- When exposed to heat 116 it melts, loses its W. of Chrystallization & falls into powder. Its incompatibles are the Alkalies & their Carbonates, Lime, Magnesia & Carb. Acid of Lead, & the Mercurial Salts.- also veg. infus. as Galls, Kino. Bark &c. It is employed with advantage in obstinate chronic Diarrhea, in the relaxed state of the bowels which follows Dysentery, in Passive Uterine Hemorrhage, when not connected with an excited state of arterial action. Also in Cholica Pict. united with some Aromatic as Nutmeg & it has been prescribed for curing intermittents. Internally, its powers are feeble, & hence we cannot rely upon it in Diabetes, Leucorrhea &c. When that given, it is apt to offend the stomach, combine it with Recently its powder has been recommended to be applied with the finger upon the inflamed fauces, in Scarlatina Cynauche [???silllaris] &c. also in strong solution of 15 or 20 grs to ƒ℥i, as an injection for Epistaxis, Bleeding from Rectum &c. Nutmeg or some other aromatic. Alum Whey is made by boiling ʒi Alum in Oj milk. Dose ƒ℥i or ƒ℥ij. A gargle for relaxed Uvula &c. may be made of grs V or X to ƒ℥i water. An injection of this solution into the nostrils will arrest Epistaxis. It may be used in Gonor. Fluor Albus &c. Alum Curd. made by agitating white of Egg with Alum good application for Inflamed Eye, Ecchymosis &c. 117 The Preparations of Lead, although they are Astringent, yet they have a peculiar & specific action. The symptoms which they produce upon the human system are numerous. but the most prominent are such as appear in Cholica Pictorium, where, besides the Pain in the Abdomen, Costiveness &c. we have pain in the external muscles, partial palsy, & sometimes an affection of some of the organs of sense. These preparations produce immediate nervous derangement, as well as act as Astringents. Litharge: Ox. Plumb. Semivit. is a Protoxide It is made by exposing Lead to heat in a reverberatory furnace, is in small scales of an orange yellow colour & is used chiefly for forming the Lead Plaster. Emp. Plumbi. This is done by boiling it with Olive Oil & a little water. The water unites with the Oil, so as to form Oleic & Magaric Acid, & these uniting with the Ox. of Lead form the Oleate & Magarate of Lead, of which the Plaster is probably composed. It is used principally for forming other officinal plasters, sometimes It is an excellent application to prevent ulceration from pressure in low fevers, long continued. for application to excoriated surfaces but seldom. 118 Carbonate of Lead or White Lead is formed by exposing lead in thin plates to the action of the vapours of vinegar. It is a powerful astringent, & often produces Cholica Pictorium. It is never given internally, but sometimes is applied to excoriated surfaces in the form of an ointment made of ℥i to ℥vj Simple Oinment. A plaster has also been directed by Pharm. at a substitute for May S Plaster, the principal ingredients are Lead Plaster & Carb. Lead. But the most important of the Prep. of Lead is the Acetate. Plumb. Acet.- Sacch. Saturni;- made by boiling Vinegar & Carb. Lead.- It is a neutral Acetate, consisting of 1 Eq. Acid,- 1 of the Base & 3 of Water It has a sweet, astringent taste, when dissolved in W. generally gives out the odour of Vinegar, on acct. of Sabacet.- but when pure is inodorous, efforescent, sol. in W. & Alcohol. Incompatibles are the Alkalies & Alkaline Earths, & their Carb. substances which with these Alk. form Soaps, Tart. ant. & Tart. Iron. sulphurates. Sol. Sulphates & Muriates, the Acids &c. so that the best plan when it is given is to allow the patient to 119 take nothing but Water or a solution of Gum &c. Different opinions prevail among practitioners respecting its efficacy, some considering it as a poison too dangerous to be given, & others prescribing it in a great variety of diseases. The terrors, however, which some have conceived respecting it, are unfounded, altho' in large doses or in small ones long continued, it certainly is dangerous. When given in small & continued doses, it acts upon the nervous system, more gradually, producing its peculiar effects, & will bring on Cholica Pic. sooner than if administered in larger doses. But by avoiding excessive or long-continued doses, by combining with opium, when not contra-indicated, by attending to the costiveness &c. it is safe. & frequently a very beneficial remedy. To cases of Internal Hemorrhage from the Lungs or Uterus, it is well adapted, but even though it may be given in an excited state of the system yet it must not exclude depletory remedies.- 120 In Uterine Hemorrhage, unconnected with Pregnancy, it acts favourably, combined with Op. or Ipecac It cannot be relied on, however, in Intermittents, Hooping Cough, Epilepsy &c. Dr Irvin of Charleston published a paper in 1820 recommending it strongly in Yellow Fever, & Dr W. has tried it once & was well pleased with it. The time for its administration in this disease is when Gastritis is at its highest point, when the patient begins to turn even a little yellow. Dr W. believes that it acts by coming in contact with the inflamed surface of the stomach, upon the same principle that it acts upon inflamed parts externally. It may also be beneficial in the same way in Dysentery It is useful in arresting the profuse Diarrhea in Cholera. Dr W. gives 2 grs Cal. & 1/2 gr Opii every hour. & in the intervals gives 2 grs. Acet. Lead. Parrish uses it in combination with Kino to arrest internal Hemorrhage. From its influence over the Nervous System, it might probably prove beneficial in Hydrophobia. 121 The dose of it varies according to different authors From 1 to 2 grs, & may be repeated every 2 or 3 hrs. After 10 or 12 grs. have been taken, suspend it, so that it may produce no injurious effects. It may be given in Pill [of] with Crumbs of Bread. Lead Water is made by dissolving ʒij in Oj distilled Water. This is a useful application to inflamed surfaces, by [illegible] wet with it, but must not be applied to excoriated surfaces. A Poultice may be made of it, by mixing it with bread, & enclosing it between linen. This is a good application to inflamed Eyes &c. A solution of 1 or 2 grs. Acet. Lead to ƒʒi W. is a good wash, for Optthalmia, Gonorrhea, Fluor Alb. &c. Goulard's Extract of Lead is made by boiling Letharge in Dist. Vinegar, & filtering the resulting liquor, or by boiling Letharge in a solution probably a comp. of Dis. & Trisacet. of Lead of the Acet. of Lead. It is said to be a Trisacetate. Sometimes it is of a greenish straw colour, owing to the impurity of the Vinegar, but usually is colourless alkaline in its properties, & decomposed by 122 those substances which are incompatible with the Carb. Lead already noticed & with Gum Arabic & Mucilages. Even distilled water produces a milky appearance with it, on account of the Carb. Acid which it contains. This is best test for Mucilages or Gum. It is used only as a Lotion in Eruptions & Local Inflam. Lead Water should contain about ƒʒij Goulard's Ext. to Oj Water. Goulard's Cerate is made by mixing [cross out] [simple cerate &c.] Goul. ext. with Oil & Bees wax. is a useful application to abraded surfaces, & especially beneficial to blisters in disposed to heal. Also Herpetic eruptions Sulphate and Acetate of Zinc are used as Ext. Ast. Also the Mineral Acids, which, are rather tonics. Lime-Water & Carb. Lime are sometimes useful in the Diarrhea, Cholera Infant, & the later stages of Dysentery. We next come to the subject of Tonics; upon which we will make some general observations. By this term, we designate those substances which have the power of producing & maintaining a gentle 123 exaltation of the actions of life in sudden & great prostration without necessarily causing any apparent increase of these natural actions. Unless taken in large doses, the action of tonics is not manifested by any immediate & obvious excitement.- The vigour which they impart to the system is the result of a slow operation on the animal Economy, & altogether different in its character from that temporary augmentation of force which is the immediate consequence of the operation of stimulants properly so called. When Tonics are employed in a debilitated state of the system, their operation is evinced by a gradual & permanent increase of the force of the circulation, and an invigoration of the digestive powers & of the general energies of the System. There is no term which expresses their operation so well as Corroborants, for their most prominent effect is to produce strength,- but as strength does not depend upon tension of the muscular fibre as was formerly supposed, the old name Tonic is not a suitable one.- 124 When the system is in a healthy state, Tonics are not needed to exact its powers to proper action, hence they become injurious. By long continuance, they establish irritation & chronic Inflammation & diminish the susceptibility of the organs to their impressions. But, as sometimes happens, when the disease is kept up by debility, they are useful. Tonics are not applicable to all states of the system. They are improper, when there is an increase of action beyond the natural standard in health. They act injuriously in two ways, if given for a long time and steadily. 1. They produce a certain degree of excitement which at length degenerates into Inflammation. 2. They cause a momentary elevation of the powers of the stomach by their action upon the nervous energies, & this is succeeded by a subsequent diminution of its power, so that it cannot perform its duties. Thus with the celebrated tonic, Portland Powder, it has been remarked by Cullen that the use of it was always sooner or later followed by Dropsy. 125 Tonics, therefore, should be given only when the natural powers of the system are depressed, & should not be continued too long, or given during local Inflammation. They act as corroborants in two ways: 1. When the stomach is debilitated, the food introduced into it is not digested, & the body is weakened from the loss of its natural support:- then tonics restore the digestive energies & enable the stomach to pass the food properly into the circulation. 2. Tonics may also impart tone to the system by exciting a peculiar action in the part to which they are immediately applied, & thence propagating a similar action to other parts of the body thro' the medium of the nerves.- or they may strengthen by being absorbed into the circulation, & thus acting directly on the whole organization thro' the medium of the blood. Tonics are by no means equal in the degree of their sensible power, some producing but little change while others approach to stimulants. This class of remedies may be divided into three 126 subdivisions 1. The simple Bitters. Bitterness is a property possessed by all the vegetable tonics. Cullen supposed it to be the tonic power. It does not reside exclusively in any one proximate principle. thus Quassia, Genteanin &c. are tonic, while Morphia &c. is narcotic. 2nd. Set unite an aromatic or other property with the bitterness as most prominent, as in Serpent.- August. Bark, Cascarilla. The aroma is owing to an essential oil.- These are more stimulant than the first set.- 3rd. Set are purely Aromatic, & depend for their efficiency upon an essential oil, but in some instances the property of a stimulant is united to some other property which renders them Tonic. They accelerate the action of the heart & arteries, [cross out] & produce an increase of heat, but do not act on the cerebral nerves. They are employed in combination with other tonics to cover their taste, & render them more acceptable to the stomach. Some of them might form a distinct class. Some are astringent:- 127 36th Lecture. We shall next notice the Individual Tonics, [cross out] and shall arrange them according to their stimulant powers, first treating of the simple Bitters & afterwards of the Aromatics.- a.135 A.141 A.143 Columbo, Frasera Waltri or Auc. Columbo, Gentean. A.195 & Qussia, for which See Book A. Thirty-Seventh Lecture Oct. 2 1834 B.13 B.97 B.193 [Su??aruba], Chamonmile, America Centamy A.149 B.189 A.217 Serpentarea, Eupat. Perforliatum & part of Cinchiona, for which see Books A & B [&C]. also upon Artemisia or Wormwood, Trefoil, Blessed Thistle, Horehound, & Tansy,- which are all bitter tonics & applicable to similar cases. They are used only in the absence of the others, or to suit the prejudice of the patient, so that his faith may cooperate with the remedy. Thirty Eighth Lecture Oct. 6 1834 A.217 On Cinchona & its constituents. see Book A. Thirty-Ninth Lecture Oct. 9 1834 B.1 b.11 b.3 On Augustina Bark, Cascarilea, Dogwood, Prunus B.7 c.43 Virginiana, Myrrh. for which see Books B & C. 128 also upon Aromatics, which is a term applied to those products possessing a fragrant odour, & a peculiar spicy flavour, not mixed with any other properties. Their efficacy depends upon a vol. oil. & as all oils affect chiefly the circulation, they might be called stimulants, but the[y] influence which they exert is rather more of a Tonic nature, & besides, their stimulant effects are rather local than general, because of the difficulty, with which the oils are taken up by the absorbents. Aromatics exert a peculiar cordial influence upon the stomach, obviating sickness, expelling flatus, relieving spasmodic pain, & also [cross out] obscuring in some degree the taste of nauseating medicines. They are generally joined with other remedies, with purgatives, to prevent their griping, with tonics, & stimulate to increase their power, they render medicines more acceptable to the stomach. They should never be exposed to a continued heat & hence should not be prescribed in Decoction.- 129 The Oils are concentrated forms of the Aromatics, & Distilled & are variously termed Vol.- Ess.- & Arom. Oils.- Their taste & colour are various. sp. gr. generally lighter than that of Water, sometimes heavier, & some few, equal. They are Volatile, inflammable, & when exposed to the air, deteriorate, & become changed into something of a Resinous nature. They are sparingly soluble in Water, but all of them can be made to unite with it, by means of Sugar or Gum Arab. or by rubbing them first with Carb. Magnes. then adding Water & filtering. They are often adulterated, & this can only be detected by the odour solubility,- sp. gr.- or volatility & stain on paper They are employed as the Aromatics themselves. Frequently they are used dissolved in Alcohol. then, improperly called Essences. b.165 On Individual Aromatics- as Orange Peel. b.169 b.19 Lemon Peel,- & Cinnamon, for which see Book B. Fortieth Lecture Oct. 13 1834 b.29 b.101 b.153 b.159 On Canella, Cloves, Nutmeg, Piper Nigrum, P. b.161 b.161 b.157 b.147 b.151 Lougum, Cubebs, Allspice, Cardamom, Caraway 130 b.153 b.147 b.145 Caraway Coriander, Anise Seed, Fennel Seed, b.105 b.103 Lavender, Rosemary, Sage, is an aromatic & ast. and hence an infusion of it is used as a Gargle for Sore Throat:- sometimes warm is given in Amenorrhea. b.197 b.199 b.199 Peppermint, Spearmint or Mint. European Pennyroyal, b.201 b.205 b.51 American Penny Royal, Balm, Gaultheria, a.163 a.171 Ginger, and Calamus, for which See Books A & B. Forty-First Lecture Oct. 16 1834 On Mineral Tonics, the most important of which are the preparations of Iron. & these are most extensively employed among practitioners. There is a strong resemblance between all of them in their action upon the system, they increase the force of circulation, invigorate long continued doses are said to diminish the spleen, to excite Portal Circle the powers of the stomach, & produce a permanent A long use of them in health produces Inflam. Diathesis, hence Chalybeats water injurious to healthy persons; corrobative effect upon the system. When, however, Iron & Prep. have a local tendency to Uterus. active Inflammation exists, when the Stomach is in an irritable condition, or when the liver is unhealthy secreting unhealthy bile, they are improper & injurious.- They prove advantageous in Dyspepsia, in nervous & hectic diseases, and that long train of complaints arising Cheltenham Salts are an excellent remedy for Chronic Hepatitis, teaspoonful daily before breakfast not too long continued, as Iron may produce excitementing. 131 excitementing from debility of the alimentary canal, or from general debility of the system, as Chlorosis, Amenorrhea, Anemia with swelled waxy countenance &c. Hysteria, Epilepsy, Scrofula, Phthisis &c. They are the best remedy for Amenorrhea, connected with general Debility. With regard to their modus operandi, there is much dispute, whether they act by first depressing the powers of the stomach, & then carrying this action by sympathy through the nervous system, or whether they enter the circulation & are thus distributed Iron has doubtless been detected in the blood, & it may act in that way, but the probability is that it acts by both the above mentioned methods. The redness of the blood does not depend upon the Iron continued in it, as some have supposed, but upon the invigorated action of the Lungs. Iron in its pure metallic state, has been said to be medicinal, but its effect, when thus given, is Black stools always follow. probably owing to some change which it undergoes forming salts. in the Stomach from the acid &c. which it meets.- The simplest form in which it is given is that of Filings Ferri Ramenta. Dose 10 to 30 grs. but seldom given internally produce eructations of Sulph. Hyd. &c. Dysp. Chlor. [illegible] 132 Squama Ferri are made by heating Iron & pounding it. They are a combination of Iron & oxygen, dark, brittle, pulverizable, insol. in water, readily soluble in acids. Not much employed in medicine. There are 2 Carbonates of Iron used in medicine 1. F. Carb. Prapar. or Rubigo Ferri, made by exposing Iron wire to air & Moisture, & is a Mixture of the Proto-Carbonate & Red or Peroxide of Iron. 2. F Carb. Precip. made by adding a sol. of Carb. Sod. the Precipitate is at first Proto Carb. of green colour. but on exposure, it attracts Ox. & becomes a solution of the ProtoCarb. & Perox. of a reddish colour. to a sol. of Prosulph. Iron. It is a fine, red chocolate of the Protreast .& Porox .- of a reddish colour. powder, less apt to offend the stomach than the former, because more minutely divided. Both these Carb. are insol. in water, but soluble with effervescence in Acids, & partially sol. in water impregnated with an excess of Carb. acid, hence these are generally present in the Chalybeate Springs - They are used in all cases where the prep. of Iron are indicated, and lately have proved highly serviceable in Tic Doullureux, Neuralgia &c. given in doses of ʒss to ʒi, 3 times a day gradually increases, the usual dose is from 5 to 20grs as a Tonic. 133 Dr Ruth was very partial to a prescription containing equal parts of Rubigo Ferri Pulv. Colomb. " Tingib The effect which the Carb. Iron has in Tic Douler may most reasonably be ascribed to its action upon the whole nervous system. For this, dose ʒss to ʒiss F. Suphas. Sal Martis. is made by acting for medical purposes, Iron Wire should be used, as this purer. on Iron Filings with dil. Sulph. Acid.- It has a strong styptic taste, is in greenish Chrystals, sol. in water, insol. in acids, when exposed to heat loses its W. of Chrystallization & becomes a dirty white powder, called F. Sulph. Exsiccat. Exposed to the air it becomes a Persubsulphate. at first, its efflorescence is white, the sulphate, afterwards attract Ox. becomes Perox. brown colour.- Incompatibles are all sol. Salts which form insol. compounds with its acid, earths, Alk & Carb. Pot. Nit. Acet. of Ammo. & all vegetable astringents. It is a good Chalybeate, & has an advantage by being soluble, & it may be given in Smaller doses. Use the Dried always for Pills. Dose is from 1 to 5 grs. less of the dried generally given in combination with Purgatives &c. 134 Tinct. Ferri Muriata,- consists of a Muriate of Iron dissolved in Alcohol. It is made by dissolving Carb. of Iron in dil Mur. Acid & adding 3 times as much Alcohol. It is of a brownish yellow colour, has an ethereal odour from the action of Alc. upon excess of Acid- and is decomposed by Alk. & Carb. & by astringents. It is the most active of the Chalybeates, given in Dysuria, depending upon Spasmodic stricture of the Urethra, for Venereal Warts &c. Dose 10 to 30 gtt. in a wineglassful of Water, 2 or 3 times per day. It is given also in Dyspepsia, Amenorrhea &c. Ferrum Ammoniatum is made by subliming Mur. Ammo. & Perox. Iron. It is of an orange, yellow colour, seldom used. Dose 3 to 15 grs. Ferri Phosphas, by adding sol. of Phosp. Sod. to sol. of Proto Sulp. Iron At first it is a Proto Phosph. afterwards Perphos. & we usually find it a mixture of both. It is of a light blue colour. By Carmichael it has Insol. in water 1-2 grs. been recommended for Cancer. Dose 5 to 10 grs Ter die. Tartrate of Iron & Pot. made by boiling Carb. Iron, Bitart. Pot. and Dist. Water. It is inodorous, has a At first Proto, afterwards becomes Pertartrate styptic taste, of a greenish brown colour, sol. in W. It is a mild Chalybeate, supposed to be diuretic, hence given in a tonic dropsy. Dose from 5 to 20 grs. This 135 is an ingredient in Vinum Ferri, because Bitart Pot. is contained in Wine, & this by its action on Iron Filings forms this salt. Hence Vin. Ferri possesses no advantages & It is a much more variable preparation- over a sol. of Tart. of Iron & Pot. Iodide of Iron;- a preparation upon which little Insolution in water,- Morton considers it unequal in cutaneous affections &c. with Syr. Sarsap. or no confidence can be placed. F. Ferregent insol & almost tasteless Copper.- in its metallic state, seems to have little affect upon the system, but its salts sometimes produce unpleasant consequences, & are even poisonous from the irritation excited in the mucous surfaces. Hence care is requisite in preparing food in copper vessels of any kind. & in drinking Min. Water from Copper Reservoirs Cupri Sulphas is a Bipersulphate. It is in chrystals has a harsh, styptic taste, is sol. in Water, insol. in Alc.- is decomposed by Alk. & Carbonate,- Cor. Sublimate. Nit. Silver. Permur. Mercury, & all astringents. When given in small doses, it excites the stomach. In large doses, it produces very violent vomiting & the patient has a coppery taste in the mouth.- The stomach must be washed out freely, & Albumen administered to an increased action, but the danger attending it has circumscribed its use. In that form of Intermittents called Quartan it is sometimes given as follows Cupri Sulph. gr.i mft. Pill No iv Quinia Sulph grs viij opii gr. i S. one 4 times a day 136 It is used advantageously also in Chronic Diarrhea depending upon Ulceration of the Intestine, Epilepsy &c. In Germany it has been recommended for membranous Croup. Cup. Ammoniatum.- is made by rubbing up Bisulph. Copper with Carb. Ammon. It is of a Sapphire blue colour, with a hot styptic taste, & changes to green by exposure to the air. It has been much recommended for Epilepsy, but its use is disputed. It is given also in Hysteria, Chorea &c. but never without previous depletion. Dose grss. 2 a day and gradually increase if necessary.- In form of Pill.- Zinc itself, exert no sensible effect upon the system, but there are two preparations of it used in Medicine as Tonics. They are employed in Hysteria, Epilepsy, Chorea & various other diseases. Sulphate of Zinc.- is made by adding dil. Sulph acid to Zinc.- It crystallizes in 4 sided prisms, effloresces slightly, is very sol. in Water, cold or hot, with a metallic, styptic taste, & is decomposed by Alk.- Earths.- & veg. astringents.- Is not much used as a Tonic.- It has been given in Diarrhea,- Chorea &c. Hooping Cough,- Colica Pict.- but more as an Emetic A solution of 1 1/2 or 2 grs to ƒ℥i water forms an 137 excellent injection in Gonorrhea,- & weaker for Chronic Opthalmia.- Dr W. has never failed to cure the Ulceration of the Mouth occurring in Children by touching them with a solution of from 5 to 10 grs to ƒ℥i 15 grs to ƒ℥i Water.- Also useful for cutaneous eruptions The dose internally is 1 or 2 grains. Then taken in poisonous dose, it produces great constriction & vomiting &c.- there are relieved as soon as it is evacuated. Oxide of Zinc.- may be made by burning Zinc. It is white,- inodorous,- tasteless,- insol. in W. & Alc.- unalterable in the air.- Dose 5 grs.- gradually incred. Tutty.- is an impure oxide of Zinc,- made by mixing the Ox. with Clay & Water.- It is inodorous,- tastless- brown externally, but the inside of a mass yellow used for excoriations &c. by sprinkling.- or in form of Ointment.- Calamine is an impure Carb. Zinc. has an earthy fracture.- When roasted & elutriated, it is sprinkled on excoriated surfaces,- or made into an ointment, & then applied. Tumers Cerate. Bismuth- is used in medicine,- by just making a solution in Nit. Acid,- then add Water.- A precipitate is formed which was formerly called an Oxide, it is now called Subnitrate of Bismuth. It 138 is white,- insoluble,- inodorous, & unalterable in the air. It has been highly recommended in Dyspepsia with violent pain unaccompanied with [cross out] Inflammation.- It imparts a black colour to the stools, like Iron. Dose 5 to 10 grs,- 3 or 4 times per day. Nitrate of Silver.- has a strong,- metallic, bitter taste.- It is sometimes used internally,- & has been highly recommended in Epilepsy,- but disputed. It is given also in Chorea,- Angina Pectoris,- & sometimes in Leucorrhea,- but perhaps with no benefit.- Incompatibles- Alk. & thin Earths, Soaps, Sulph, Min, & Tart. Acid & thin Salts, Arsenite Pot. Sulphurets & Tarmin An objection to its use is that when long continued it communicates a dark colour to the skin.- The rationale is that Nit. Silver is decomposed by light, hence when it enters the circulation, it is carried into the cutaneous vessels & there decomposed. Probably, however, it is inert,- because there is sufficient salt taken into every stomach to decompose it, & produce an insol. Chloride of Silver.- The dose usually given is 1/8 gr. 3 or 4 times a day,- made into pill first dissolve it in water. with bread containing no salt,- or with Pulverized Liquorice Root,- which is preferable to the former.- Preparations of Gold are not used in medicine at present.- 139 The Mineral Acids sometimes employed are the Sulphuric,- Nitric & Muriatic. Sulph. Acid, is tonic & astringent,- hence it is given in Debility accompanied with morbid discharges, as in Hemorrhage from the Lungs and Uterus.- It is also a good remedy for Hectic in Consumption. Night Sweats &c. & in loss of appetite, connected with an asthenic state of the Stomach.- It is often given in combination with Tonic Veg. Infusion. It is used diluted, as a Gargle in Sore Throat,- or locally, for cutaneous eruptions,- Psora,- White Blister in the Mouth &c.- When prescribed, it should be Ac. Sulph. Dil.- which is only 1 part to 7 parts Water Dose is 10 to 20 gtt. in a wineglass of water,- taken thro' a quill.- In hemorrhage ʒss. to ʒi may be given. Elixir Vitriol is generally used internally. Nitric Acid,- of which there are 2 kinds,- the coloured & colourless.- This is given in simple gastric debility,- in convalescence &c.- It is said to have a specific influence like Mercury.- Dose of the strong acid is 2 or 3 gtt. in 1/2 tumbler of water,- but varies in strength. 140 Muriatic Acid is seldom employed in medicine. Sometimes it is given in Malignant Scarlatina, & in Typhus Fever.- Also for Worms.- Dose 5 to 20 gtt in 1/2 a tumbler of Water.- A Gargle is ƒʒi to ƒ℥vj Water. Forty-Second Lecture Oct. 20 1834 Nitro-muriatic Acid,- is a mixture of Nitric & Muriatic Acids,- producing a third compound which owes its efficacy to Chlorine.- The acids should be highly concentrated,- otherwise they do not act upon each other,- but merely form a mixture. If they are not sufficiently strong for the purpose,- add a little Sulphuric Acid. Besides being a tonic, this is also specific, bearing a close resemblance to Mercury in its action,- producing sometimes Ptyalism & even soreness of the Gums, & its direction to the Hepatic system is shown by the increased secretion of Bile. It was first introduced into practice by Dr Scott. It is useful in Chronic Inflammation or Disorder of the Liver,- Scrofulous affections,- Cutaneous Eruptions Secondary Syphilis &c. It may be given internally 141 or externally,- similarly & in like doses with Nit. Acid A bath is a desirable form of using it, if there be much gastric irritation.- This may be either general or local.- It should be strong enough to produce a tingling sensation upon the skin.- generally the proper proportion is about ƒ℥i to Coug. i Water. Stimulants. Simple stimulants are those medicines which increase the action of the heart and arteries without exciting the brain & nervous system.- They are used in cases of debility, unaccompanied with organic disease, as in the common consequences & termination of Idiopathic Fevers of a Typhoid nature,- also in Cholera,- profuse Diarrhea &c. But they are not used exclusively in cases of simple debility.- often prostration attends local Inflammation,- organic lesions &c.- when stimulants become requisite to support the system,- as in Typhus Pneumonia,- Typhus Dysentery,- low forms of Small Pox,- & other diseases,- where, tho' the Inflammation &c. would seem to contra-indicate them, yet they are necessary 142 necessary evils,- & must be used with great caution. In that debilitated state of system, which we often find during the ulcerative or suppurating process, stimulants often prove beneficial by enabling the vessels to perform their proper secretions, & promote a healthy action.- Of Individual Stimulants. Of distilled from Turpentines. Oil of Turpentine is a stimulant of considerable when pure it contains no Ox. importance,- there being few, which act more upon the circulatory, & less upon the cerebral & nervous system. It is useful in low forms of disease,- especially those in which the head is so affected that narcotics are forbidden.- Besides this, it has a peculiar effect upon the mucous membrane of the Stomach,- hence proves beneficial in some forms of Diarrhea,- Dysentery &c. Probably the Turp. operates by changing the morbid action & substituting its own. It has proved peculiarly useful in those typhoid fevers, where the tongue cleans suddenly,- smooth, red & moist,- or sometimes it becomes dry & not completely clean,- & the abdomen is somewhat tympaustic,- then also, there may be some delirium,- & yet the patient 143 not sufficiently low to require other stimulants.- In cases of this kind,- it is plain that there is a disease in the small intestines & that this disease is ulceration, then 5, 10 or 15 drops given every 1 or 2 hours, will produce a very happy effect, In 24 or 48 hrs. you will find the tongue become moist,- a little fur will appear,- which soon after passes off & the patient recovers. It is useful also in the last stages of Gastritis, Enteritis, also Yellow Fever, Dysentery &c. It has been recommended by Dr Bretton in Puerperal Fever,- but W. thinks it must be of that form which is not connected with Peritoneal Inflammation Also useful in Chronic Rheumatism,- Epilepsy,- Piles,- Flatulent Cholic,- Gout of the Stomach &c. &c. Dose from 5 to 20 drops every 1, 2 or 3 hrs. For Capsicum see Book B. p 164. Phosphorus, is the most powerful stimulant known, & the use of it very dangerous.- Dose is 1/12. 1/8 to 1/4 gr,- 1 gr. in 24 hrs Generally given in Sol. in Ether or in Emulsion,-a better mode than in Pill. 144 Min Ammo. & Carb. Lime. Ammonia Carbonas.- or Volatile Alkali.- has more influence over the nervous system than those before mentioned. It is formed by subliming Carb. Lime & Mur. Ammo. It is a Sesquicarbonate, found in Lungs, which are hard, solid & semitransparent, white, effloresce & deteriorate by exposure. It is decomposed by Alk, Alk. Earths, Acids &c. It increases the force of circulation & invigorates the vital functions, without affecting the brain or stomach it also produces diaphoresis. Hence it is useful in Typhoid fevers, in the intermission between excitement & collapse, alternated with Wine Whey. In low forms of Fever, where the brain will not admit Narcotics, in Typhoid Pneumonia, Scarlet Fever, Retrocedent & Atonic Gout, Chronic Rheumatism, Palsy &c. As it is an Antacid, it acts favorably also in diseases of the Alimentary Canal. It has been recommended also for bite of animals, for stings of Wasps.- Hornets- Bees &c. Also is said to remedy Drunkenness. Dose 2 to 5 to 10 grs. every 1 or 2 hours. Generally given in solution. Diffusible & Transient. 145 Antispasmodics,- are medicines which are given to relax or prevent irregular muscular contractions or spasms. But all medicines producing this effect, are not ranked under this head, because they depend upon a great variety of causes, & hence demand a great variety of remedies.- They calm the restlessness & agitation which arise from nervous action, & hence prove that they act upon the nervous system. Under this head then, we rank those which, while they stimulate the circulation, would act upon the nervous system without producing any effect upon the cerebral function. The name, however, is an improper one, as well might we have Antifebriles, Antiscorbutics &c. a more proper name would be Nervines. Musk,- the product of a small male animal inhabiting Central Asia the Himmaley Mts.- of a brown or black colour fleece, & has a small, oval bag, about 2 or 3 in. long posterior to the umbilicus. The quality varies according Received from 3 ports. Canton, Calcutta, & Russia to the situation of the animal. The most valuable comes from China, & least from Russia. It is brought 146 in sacs, is of a deep brown colour, & looks like dried blood. taste bitter,- odour strong, and diffusible, & it burns with a white flame to a spongy charcoal. It is partly sol. in boiling Water,- more sol. in Alc. & still more so in Ether. From its great price, it is often adulterated, with articles not easy to detect. It was unknown to the Greeks & Romans, & was introduced into practice by the Arabs. It is a powerful stimulant & antispasmodic, exciting no cerebral action. It is used in similar cases with all antispasmodics, also peculiarly applicable in prostration & irregular nervous action, as in low Typhus attended with subsultus tendinum, tremors, Gout or Spasm in the stomach without Inflammation. hiccup, convulsions of infants from spasm of the Intestines &c. but owing to its high price can only be employed in extreme cases. In Tetanus, it had been recommended by Dr Hoff with Op. ℥ss Musk with ʒi Op. to be given in 24 hours. It has also been used in Epilepsy, Asthma, Pertussis, Palpitation of the Heart, Cholera. &c. Generally given in Pill or Julep. Dose 10 grs. varies from 5 grs to ʒi- 147 Artificial Musk is made by pouring Nitric Almonds Acid upon Rectified Oil of Amber. It is almost inefficient. Seldom or never used. Castor. is the product of Beans. It may be used similarly with Musk, but is seldom employed Dose 10 to 20 grs. Tinct fʒi or fʒij Forty-Third Lecture Oct. 27 1834 Assafætida, is the concrete juice of the Root of the Ferula Assaf. an herbaceous plant from 6 to 9 ft. in height with a perennial, fleshy, tapering root, growing in Persia and is the most important of the Antispasmodics. When the tree is four years old, the leaves & stem are twisted off, the top of the root sliced off, so that the juice exudes, & it is then concreted. It is in irregular masses, brownish yellow externally, when freshly broken at first streaks of white are seen running thro' the mass, which soon change to red & afterwards to brown. variegated in colour, has a disagreeable odour, bitter & subacrid taste. It was used by the ancients; by the Persians, & even by some of our own epicures, as a condiment. Surat is said to be completely perfumed with it- It softens by heat By long exposure it becomes brittle. Its principal constituents are Gummy matter, resin & vol. oil, & upon the virtues to last, its odour & probably its virtues depend. Alc. & Ether.- 148 It is a moderate stimulant, powerful Antispasm also, an Expectorant & Laxative. It is useful in Hysteria, Hypochondria, Convulsions, Spasms of the Stomach and Bowels without Inflammation; Also in Hooping Cough, Asthma, Catarrh accompanied with Spasmodic Disease of the Bronchia, & also as an expectorant, in various infantile catarrhal affections. From the peculiar influence which it exerts also over the nervous system, it may be given in low forms of fever, accompanied with subsultus, Hiccup &c. As an Enema, it proves useful in Tympanitic Abdomen, Hysteria, & Irritability of Stomach. Medium Dose, about 10 grs. in Pill or Emulsion. Tinct. is more stimulating. Dose ƒʒi Galbaunum, Sagapenum, & Ammonia, are Gum Resins, seldom or never used. Valeriana, see Book A p. 173 Amber is a fossil of veg. origin, found on the shores of Baltic. Ol. Succine Rectificatum. is obtained by several redistillations, is of a yellow colour, volatile, inflammable, insol. in water, partially sol. in Alcohol, of a hot and acrid taste. It is a stimulant and Antispasmodic, given in Hooping Cough, Singaltus in low fevers, Infantile Convuls &c. 149 Dose from 10 to 30 drops. It is more used externally as a Liniment, in Chronic Rheumatism Palsy & Spasmodic Disease. Dr Parrish uses ℥i ℥i ℥iij a mixture of Ol. Suc Rect, Laud. Brandy and ℥iij Sweet Oil by friction to the Spine of Children affected with Spasmodic Diseases Narcotics or Cerebral Stimulants This name is applied to that class of medicines which act upon the brain, & they are so peculiar that no two of them are precisely identical in their action. When administered, they first produce an increase of both the physical & mental powers,- causing not only arterial excitement &c. but also energy of thought.- vividness of imagination &c. Afterwards a reaction takes place, the pulse becomes composed, the muscles relax, the senses become obtuse, & there is a general inertness of all [illegible] functions both of body & mind;- pain is relieved & sleep ensues. If large doses be given, the excitement is more quickly followed by more lasting & more serious effects. 150 Sometimes there is first a slight debility, followed by nausea, vomiting &c. These show that they operate powerfully on the cerebral functions, & when Death ensues, the heart ceases to act from a secession of nervous energy from the brain. There are 2 distinct views taken of the operation of Narcotics. Cullen says, their primary tendency is to reduce the vital power, & ascribes the primary excitement to the opposition of an innate power of the system against the poison introduced. Brown considered that they directly increased the action of the system, & that prostration of the powers was a natural consequence of their elevation. Cullen, then, considered them directly sedative & indirectly stimulant. Brown considered them directly stimulant and indirectly sedative. Each had their followers. But neither of these does W. think satisfactory, but that each Narcotic operates in a manner peculiar to itself. Altho' there is at first an excitement, yet the powers of the system are not subsequently 151 depressed in a ratio corresponding to the previous exaltation, & he even went so far as to assert that the powers of the system may be directly diminished,- & that certain [powers] functions might be diminished & others excited by the same article of this class. They exercise their peculiar influence upon the system, upon whatever part they may be applied. Narcotics, more than any other class of medicines, lose their effect by repetition, hence it is apparent, that in order to maintain a given impression it becomes necessary, gradually to increase the dose. We should also vary the articles employed. This class has received different names according to the objects for which they may be given: thus when given to sooth pain, they are termed Anodynes, when given to produce sleep,- Soporifics or Hypnotics & when for their sedative effects,- Sedatives &c. We shall next treat of the individual Narcotics. The first and most stimulating of the class is 152 product of vinous fermentation.- It is obtained from the distillation of Ard. Spt.- sp. gr. ƒʒs- purest contains 11 pr. ct. water Alcohol.-but this is seldom used in any other form, than that of Proof Spirit, which contains about 50 pr. ct. W. Preferable forms, however, are Wine, Porter, Beer, &c. and of Wines, the best are Sherry, Madeira or Teneriffe, which Wines are more tonic & less stimulant proportionally than same dose of Alc. alone contain from 15 to 25 pr. ct.- In looseness of the bowels, Wine Whey- Oj boiled Milk & Oss wine. Port Wine may be applicable. But Porter, Ale, Beer &c. Dr Wood thinks should be excluded from medical For an irritable stomach combine W. with spices, by first making a hot infus of spices & then add the Wine.- use,- they are heavier for the stomach & less stimulating than wine. He never prescribes them except where patients have been addicted to their use. Tinct. vary in strength when Alc. & dil. Alc. are used,- hence important to recollect which are made of pure Alcohol. The use of these stimulants must be regulated by the symptoms, when they increase the heat of the skin.- excite the nervous or cerebral derangement, increase the force of circulation more than proper &c. they should be omitted, but if the contrary happens, & the patient does well under their use they may be continued. Sulphuric Ether made by the action of Sulph. Acid upon Alc. is a narcotic stimulant, highly diffusible, hence more speedy & more evanescent in its action. If its vapour be inhaled, it also produces a speedy action, & exhilarates somewhat like Nitrous Oxide, but a recovery from it is more dangerous 153 - being attended with more stupor, & other unpleasant consequences.- Nith Sulph. Rectif. should be presented Caution the patient of its inflammability. It is used in prostrate cases accompanied with spasmodic nervous action,- in Gout of the Stomach,- Cholic Affections,- Hysteria,- & in some stages of Typhus to obviate the nervous affections &c. "sinking spells" As it is so diffusible, it is necessary frequently to repeat the dose. It may also be given in Asthma Hiccup, Tetanus &c. Dose ƒʒss to ƒʒj- with sweetened water. It must be quickly swallowed, so that no vapour will rise in the mouth. Externally applied,- it makes 2 impressions. If applied so that it may evaporate, it produces cold hence it is used for Burns & Scalds,- Strangulated Hernia &c.- But if it be confined to that it cannot evaporate, it produces Heat, & even a considerable irritation of the skin,- hence it is applied to the Forehead for Head Ache by holding it in the hand. sp. Nith Sulph. Comp. Hoffman's Anodyne,- is a preparation of this, which is often given as a Nervine.- It allays irregular nervous action & thus produces sleep,- because it removes the cause of wakefulness. Dose ƒʒss to ƒʒi to test whether it is really good & contains Oil of wine, pour it in water & it should become turbid.- 154 Opium.- the concrete juice of the Papuver Somniferum, which grows in Europe & is cultivated in the gardens of America,- also in India, Persia, Turkey & Egypt.- The juice is obtained from the capsules by slicing them.- There are 2 varieties in commerce,- Turkey & E. India, but the latter is never brought to this country, it is taken to China. All our opium comes from the Mediterranean, & there are 3 varieties,- Constantinople,[Singma?], & Egyptian, of which the [Singma?] is the best. This is generally distinguished by being employed in the leaves & capsules of a species of Rumex,- & when these are absent, the Opium may be considered as inferior. Water & Alc. extract its virtues, it is injured by long boiling. Its principal constituents are Resin, Gum Bitter Extractive, volatile matter, Gluten or Caouchouc. Narcotin, Meconate of Morphia, Meconin & Narcein. Narcotin consists of Hyd. Ox. Carbon & Nitrogen. It is white, in small crystals, fusible, insol. in W & Cold Alc. sol. in boiling Alc. & Ether, tasteless & inodorous. Its influence upon the system is uncertain, as it is said that 40, 50 or 60 grs have been given without any effect. 155 Morphia, is the narcotic principle of opium. It is sparingly sol in Cold Ether, freely in hot but is precipitated when cold, burns when heated, neutralizes acids The Meconic Acid with which it is joined, is useful only as being the means by which we can test the presence of Opium. According to Dr Hare;- to the solution containing Op. add a sol. of Acet. Lead, then the Meconate of Lead is precip.- to this add Sulp. Acid which will set free the Meconic, & then by adding a sol of a Persalt of Iron, we get a red coloured precip. Orfila thinks it unnecessary to add the sol. of Acet. Lead, & merely adds first the Sulp. Acid, then the sol of a Persalt of Iron. See Book C. Forty-Fourth Lecture Oct. 28 1834. For application of Opium see Book C. p.69. Lactucarium concrete milky juice is sometimes substituted for Opium It is obtained from the common Lettuce. Smell & used in Europe for Peet. Affections. Nervous &c. taste are like op. Dose 2 or 3 grs. of Tinct 40 to 60 gtt. c b.141 b.77 Camphor, Hops, & Conium or Hemlock, for which see Books B. and C. 156 Sedatives. These are divided into the Arterial & Nervous. 1. The Arterial.- The most important of this class are the Preparations of Antimony,- three of which are used: D. p.28 D. p.76 p.76 viz. Tartar Emetic, Precipitated Sulphuret & Antimonial Powder.- The Neutral Salts, are sedative & act also upon some of the functions. Potas. Nitras (see pp. 67 & 79)- when taken internally, diminishes the action of the heart, & the heat of the surface by its own peculiar operation. It is also Diuretic, & acts locally as an irritant, producing Inflammation, so that when given it should be largely diluted. When given for a long time, it diminishes the general power of the system. It is useful in Inf. affections, except of the stomach & bowels,- in Bilious Fevers,- Rheumatism,- Tremor. with Plethora,- & is often combined with Tart Emetic. A solution may be made of Nitre ʒi, Tart Em. gr j in water ƒ℥ij. Dose ƒ℥ss every 1 or 2 hrs The Veg. Acids are also somewhat sedative,- & are very useful as drinks in febrile complaints, but they may be abused & produce Dyspepsia. The tendency of Vinegar to produce emaciation is well known & sometimes called into use. 157 Lemon Juice is most used.- The best method of keeping it is to convert it into Citric Acid, by Carb. Lime & dil. Sulph. Acid;- it is Chrystalline.- To avoid the fraud of Tart. Acid for it, test it with Carb. Pot.-(see p.77)- A good substitute for Lemon Juice may be made by adding ℥i of it to Oj water with gtt iv Ol. Limonis.- B. p.55 B. p.57 2. The Nervous Sedatives.- Digitalis,- Tobacco.- Hydrocyanic Acid exists in almost all plants of the Genus Prunus, or Amygdalus.- Its odour & taste are owing principally to a volatile oil combined with it.- The best preparation for administering or preserving it is the Oil of Bitter Almonds- Dose 1/4 to 1/6 of a drop.- Pure Hydrocyanic Acid is never used in medicine, but the Dilute,- which is formed by passing Sulph. Hydrogen thro' Bicyan. Merc.- forms Black Sulph. Merc. & Hydrocy. Acid,- then filter & add Carb. Lead & filter.- It should be kept in opaque bottles.- Even swelling a bottle of the Oil of Almonds, or of Hydrocy. Acid sometimes produces the unpleasant effects of the poison. Dose of the Pure, would be about 1/12 gtt. in a Wineglassful of Water,- of the Dilute, 1 gtt. every 2 or 3 hours, till the 158 effect was produced,- It is of unequal strength.- Cyanuret of Potassium- dissolved in water forms the Hydrocyanate of Pot.- which is incompatible with a great variety of substances & hence is very apt to be decomposed in the stomach.- Dose 1/4 gr to 1 gr. & should be given in a state of solution.- 159 Iodinum.- When taken in small quantities, it seems at first to sharpen the appetite,- increase the pulse &c.- acting like a Tonic,- but if it be continued, the patient begins to emaciate,- from the stimulation of the absorbents.- It also increases the secretions.- & renders the nervous system more irritable.- It was first employed by Coindet of Geneva in cure of Goitre,- afterwards in Scrofula,- indolent swellings,- somet. in Amenorrhea,- also in Gonorrhea & Gleet.- Internally, dose is from 1/4 to 1/2 gr.- Generally given in Tinct.- which contains grs XXX to ƒ℥i.- Dose 10 to 20 gtt.- given in a wineglassful of sweetened water. It should not be long kept, as a reaction seems to take place between it & the Alcohol, changing its property.- Iodide of Potassium,- which in sol. forms Hydriod. Pot. has an acrid, bitter taste.- Int. dose 1 or 2 grs.- but its effects are not like those of Iodine.- It renders Iodine sol. in water.- hence is useful.- as in Lugol's Solution,- consisting of Iodin.- ℈i Iod. Pot.- ℈ij Water ƒʒvij.- The Iodides of the 160 metals produce the effects of the metals, just as analogous compounds,- & not of the Iodine.- Externally Iodine may be used as a Bath.- or more frequently in form of an Ointment containing ℈i to ℥i Lard.- It leaves a yellow stain upon the skin, which gradually disappears by evaporation           The Classification of Medicines adopted by Dr Wood in the University of Pennsylvania. Medicines acting on the living body General Stimulants Permanent Astringents Tonics Diffusible Arterial Stimulants Cerebral stim. [illegible] Nervous stim. [Anti spasm] Sedatives Arterial Sedatives Nervous Sed. Local Functional Emetics Cathartics Diuretics Diaphoretics Expectorants Emmenagogues Sialagogues Errhines Organic Rubefacients Epispastics Escharotics Mechanical Demulcents Emollients Diluents Those medicines acting upon foreign substances contained within the body may be comprised under the heads of Anthelmintics, Antilithics, Antacids &c.  1 Notes upon Lectures delivered by Dr G. B. Wood. First Lecture. From a summary view of the Introductory Lecture, it appears that medicines operate in one of two ways -either upon parts applied by means of their effects being carried thro' the nerves to the brain, & thence distributed by the nervous system or by being absorbed: -v.c.- they act either by sympathy or absorption. In the Local action of medicines, they may act by Sympathy either directly by the nerves, or first by having their action transmitted to the brain & thence distributed by the nervous system to the other parts as in the operation of Digitalis. Their action is different also as to the different parts to which they may be applied- those places are the surface of the stomach & bowels, the external surface of the skin & the surface of the air passages.- Sometimes they are absorbed rapidly at others more slowly.- These, before mentioned, are called the primary operations, and we now 2 come to speak of the secondary, which are the results consequent upon the primary operation, as for inst. 1. Prostration following excitement. 2. General state of excitement from sympathy with a particular part. 3. Result of the principle of revulsion, as in the treatment of diseased lungs by a blister to the external surface of the skin. 4. Cessation of morbid phenomena in consequence of the removal of the cause as in some forms of headache arising from constipation, which are relieved by purging. 5. The operations of nature instituted to relieve the constitution from the effects of the medicine as in applying Caustic.- Second Lecture. The nature or character of the operation of medicines is very different because they differ much as to the parts which they affect. Each class acts upon particular organs, no matter where they may be applied. Thus, we find, that Ipecac vomits whether applied by stomach 3 blister or per annum. The explanation that we give for this is that the human frame is so constituted that each particular part has particular susceptibilities;- the cause is the undiscovered & perhaps indiscoverable principle of nervous action. In the human system, considered as adapted to our department, there may be regarded three minor systems, each coextensive with the whole body, viz. Nervous, Circulatory and Absorbent, & these three are found in every organic part. It may be viewed also as consisting of a number of distinct organs, - as the Skin, - the Stomach & Bowels, - the Kidneys & Bladder &c. Some medicines act upon some one of the Systems while others act upon some of the organs.- Thus opium acts upon the nervous system, Carb. Amerred upon the Circulatory & Iodine upon Absorbent.- The first set are called General Remedies; & the second, Local Remedies.- Medicines differ in the nature of their operations 4 operations upon particular parts, or in other words, we say medicines are specific in their operations. By the term specific, we mean that a medicine will act upon a certain part of the body & produce effects peculiar to itself i.e. that when different medicines are applied to the same parts they produce diff. effects._ This brings us then to the subject of the Classification of Medicines. Though producing not precisely the same effects, yet there are a number of medicines whose operations are so analogous that they may be properly divided into distinct classes. The first grand division is into Local and General Remedies Local Remedies are those which either primarily or secondarily affect the [cross out] different individual organs. Of these, there are 4 sets. 1. Those which affect the functions of particular organs, viz. Emetics, Cathartics, Diuretics, Antilithics, Diaphoretics, Expectorants & Emmenagogues. There are also 2 others [illegible] Sialagogues & Errhines, but these seldom used & may 5 be more properly considered as minor effects 2. Set Act on Extraneous Substances contained within the organs, viz. Anthelmintics & Antacids. 3. Alter the organization of those parts with which they come in contact. Rubefacients, Epispastics, and Escharotics. 4. Act mechanically upon the parts to which they are applied. Demulcents & Emollients General Remedies are medicines which operate upon the whole system, or upon one of the minor systems & thence have their action extended to the others.- Before proceeding with the different sets of Gen. Rem. it may be proper to say a few words respecting stimulants. This term is applied to the Circulatory system, when no other particular system is specified, & hence when we use the word stimulant without any other word qualifying it, we mean an elevation of action of the Circulatory System.- There is a great diversity of power of stimulation, both as regards the rapidity & permanency of their action, & hence they are divided into Diffusible & Permanent Stimulants 6 Many medicines both excite and diminish the different powers of the system at the same time, & hence are either sedative or stimulant according to the predominance of either of these powers & those which stimulate when given in small doses, may, if given in large doses, be very powerfully sedative. As a general rule then, we find that the same medicines are sedative or stimulant, according to the part to which they are applied, to the quantity given, and to the state of the system. Astringents have a mode of action peculiar to themselves, producing a contraction of whatever parts they may touch. With these preliminaries, we proceed to mention the Classification of the General Remedies. 1. Permanent Stimulants, as Tonics & Astringents. 2. Simple or Diffusible Stimulants, which operate upon the Circulatory System. 3. Narcotics, which may have either a sedative or stimulant influence upon the brain. 4. Antispasmodics 5. Medicines peculiar in their action as Aux vom. Merc &c 7 Third Lecture. There are a variety of modes for administering medicines, & it is happy for a physician to be able to select that form best adapted to his patient. They are given in the solid state, in the form of Powders, Pills, Troches, Electuary or Confection. In the liquid, either in Mixture or Solution and as Liniment, Cerates, Ointments, Plasters and Cataplasms.- We shall add a few remarks upon each of these Powders. Deliquescent substances should never be prescribed in the form of powder.- A light powder may be given in a little water or the like, but a heavier powder, as Calomel, should be suspended in Molasses, Syrup, Honey &c. Pills. Substances may be given in the form of pills, which are not given in large doses, which are not deliquescent, or which do not become too hard in that shape to prevent their being digested. Liquids should never be prescribed in this form, unless given in very small doses. Efflorescent substances, should 8 be first deprived of their water of Chrystallization. The mode of making pills is very important & should be well understood. Some substances require no trouble, but can be moulded with ease, as some of the soft extracts. Mass Hydray. &c. Others can be made into a mass with a little water, as Rhubarb, Jalap &c. But there are some which are more difficult, & require some discrimination in the agent. In making this choice, we should take those substances which are not chemically incompatible, or which will not make the pills too hard. The best articles for immediate use are Pulv. Gum Arab. & Syr. Sunp. Soap is good to meet any acid in the stomach, when it is not incompatible with the medicine prescribed. Confect. Ros. is much used. Mica Panis Crumb of Bread is very good for absorbing liquids which are to be given in very small doses. as Tinct dissolve the substance (if soluble) in a small quantity of water, then make up the crumbs with this solution Croton Die, solution of Argent. Nit. or Cap. Sulp. To prevent their adhering together the best substance that can be used is Pulv. Rad. Glycyrrle.- 9 With respect to the size of pills, we may say that those made from veg. powders should not exceed grs iiij in weight. A good size is about grs iij. Those from metallic substances, however, may weigh from 4 to 8 grs. Troches are not much employed. They are designed to be held in the mouth, while they gradually dissolve, consequently they should be prepared with substances which are slowly soluble in the saliva. (Farina, Gum & Sugar) Electuaries- are soft masses composed of powders mixed up with syrup or honey. Conserve or Confect. is a preparation made much in the same way for the purpose of preserving recent vegetables Both these latter Elect & Conserves are embraced under the term Confection, in pharmaceutical language. Mixtures.- This term is applied to those preparations formerly called Juleps in which insoluble substances are suspended in water by means of substances which are soluble. To form a good mucilage in ƒ℥vj mixture, add of Gum. Arab & Sacch. Alb. aa about ʒij. The yolk of an Egg may sometimes be used for the same purpose, especially 10 in mixtures containing Oils, Balsams &c. The yolk of one egg is sufficient for a mixt. of ƒ℥vj In the preparation, the medicines should be rubbed together first & the liquid afterwards added. It is necessary to avoid adding too much solid. ʒss veg. pound ʒij Elect or ʒi Extract to ƒ℥i is sufficient.- Calculation should generally be made so as to make a tablespoonful (ƒ℥ss) to be given for a close.- As for the liquids used, it is well to prescribe the aromatic waters, as Aq. Cinnam. Aq. Menth. &c. when they are compatible. Solutions.- In these it is only necessary to guard against adding substances chemically incompatible Infusions.- Preparations in which the active matter of substances is extracted by water either cold or hot, but without boiling. A Cold Infusion requires from 12 to 24 hours, while a hot one is prepared in about 2 hours. Decoction.- is when the substance is boiled in water or other liquids. Wines.- are prepared by infusing the substance in wine at the ordinary temperature. 11 Tinctures.- prepared by digesting in Alcohol for one or two weeks. There are 2 different kinds of Alc. used according to circumstances: Rectified Spirit or pure Alcohol & Proof Spirit or Diluted Alcohol. The balsams, vol. oils, &c. are soluble only in Alcohol. Vinegars.- are solutions in Vinegar, of which there are but two or three in Pharmacy as Squills &c. Syrups & Honeys.- are prep. of Sugar & Honey with veg. matter. They are made by forming a decoction or Infusion of the veg. & then adding Sugar or honey. Oxymel. Composed of Vinegar & Honey. Liniments- are preparations which are either liquid or semiliquid & of an oleaginous consistence. Ointments- are soft solids to be applied by rubbing with the finger. Cerates- are of a firmer consistences containing Wax, & are generally applied by being spread on a rag, without requiring to be heated. Plasters- are still firmer than Cerates, more tenacious, & requires to be heated before they can be spread. 12 Cataplasms- should be soft, moist & somewhat tenacious. Sometimes they are made simply by the addition of water as Mustard.- Some which will not form a mass with cold, are mixed up with hot W. as Flax-seed meal Substances, which of themselves will not form a poultice with water, have something else intervening, as Hops, which are mingled with Flax seed Meal & stewed up with Water.- Other liquid besides W. are frequently used as Vinegar, Alcohol, Milk &c. as in the Bread & Milk Poultice, so frequently used. In this, stale bread should be directed, & good sweet milk, & a little fresh Lard added to soften it.- Fourth Lecture 4/24 - 1834. Medicines are directly applied to two portions of the Alimentary Canal, the Stomach & Rectum. It is applied by the Rectum with 2 objects. 1st For irritation so as to excite purge. 2nd Through the mucous coat of the rectum to produce an impression upon the system at large.- These effects are incompatible with 13 each other & hence care must be taken to produce the desired effect. In both cases, the patient should be directed to resist the immediate impulse to evacuate & should be assisted by the application of a warm towel to the parts, with gentle pressure. The enema should generally be of the warmth of the body. As a general rule, about three times the amount of a dose by the stomach may be given by the rectum, but it is safer especially in very active medicines to give about twice the dose & repeat it if necessary. Neither of these rules, however, can be universally applied, because the relative susceptibility of the stomach & rectum differs in different persons. Instances may occur from habit or other causes in which the susceptibility of the rectum may be even greater than that of the stomach as in opium eaters &c. Hence when any medicine ceases to produce any effect upon the stomach, we may resort to other surfaces- either the skin or Rectum. There are two modes in which medicines may be introduced, either in the state of Solids or Liquids. The former are called Suppositories, & the latter Clysters, Enemata, or Injections. 14 Suppositories will be spoken of hereafter, but here we will make a few remarks respecting Enemata. They consist of soluble substances & Water is generally the vehicle used, with the addition of a little mucilage or the like. When administered for the purpose of being retained, we should use as small a quantity of liquid as possible, ƒ℥i or ƒ℥ij is sufficient. Barley Water or a solution of Starch in Hot Water makes a very good vehicle. When given in order to produce purging, about Oj of the liquid should be used. While upon this subject we may add that the character of the Syringe should be attended to, & that it should be good... The Skin affords a very convenient surface for the application of medicines. To this, they may be used in the state of vapours, liquids & soft solids, & may be applied either to the cuticle or to the skin deprived of its cuticle. A very ready method of applying vapour to the cuticle is to heat some bricks, dip them in the liquid, wrap them in flannel & place them under the bed-clothes so as not to touch the patient. 15 Raise the bed-clothes so as to form a vacant space by means of hoops or stools. Another method is by a tube passed under the clothes into a space made as before. Another method, by which the steam from herbs &c. in Water may be obtained is by placing the patient in a chair over the water &c. in a tub, & then creating a steam by putting heated bricks in the water. The patient must be wrapped round with blankets & care must be taken that the steam does not become too hot so as to scald him. Sulphur or other solids may be applied in form of vapour by passing a tube of a retort, to which heat is applied, into a box containing the patient except his head. They are more frequently applied to the skin in the liquid form, either as Lotions, Baths, Semicupium, or Pediluvium. Solids thus applied may produce local effects, or may operate upon particular organs. Frictions sometimes 16 prove beneficial, & the places best adapted to it are the inside of the legs and arms. But the most effectual method of applying solids to is what has been termed the Endermic Method The method is to deprive the skin of its cuticle, then apply the medicine to the part. The circumstances which will warrant this procedure are, when the patient is either incapable or unwilling to take or retain the medicine, & when this method may be joined with others to produce a very speedy action. Corrosive and very irritating medicines, or those which require to be given in very large doses should not be given in this way. The active principle of a medicine would be preferred to the medicine itself. To produce a blister, apply a plaster of Cantharids, 3 or 4 inches square & leave it 3 or 4 hrs. then take it off & dress the surface with a poultice so as to remove the cuticle more readily. A better plan, however, is to moisten a piece of Patent Lint with strong liquid Ammonia, lay it on the part, & keep continually dropping on more to keep it moist. In this 17 way a blister will be raised in about 15 minutes. The Powder may be sprinkled upon the surface thus prepared either alone or mixed with wheat flour. It may be in form of Cerate or Liquid, & the quantity should be generally 2 or 3 times that given by the mouth. The power of Absorption varies in different parts. The Epigastric Region is the most effectual. The inner parts of the limbs are good, and the anterior portions of the body generally better than the Posterior. We should apply beyond the morbid affections, so that during the course of Circulation, we may suppose from the direction of the absorbents that the medicines will pass directly through the affected part. Substances are absorbed most readily from the bronchial passages, but it is difficult to apply them thus, for fear of irritation. They may be thus given in the state of Inhalation: which is in 3 ways. Either 1. By diffusing thro' the air of the apartment. 2. By confining them in a bag with a tube attached. or 3. By means of an Inhaler. 18 We now come to the subject of the relative doses of medicines, which vary with the age of the patient. For this, no general rule is universally applicable. A full dose may usually be given at the age of 20, but for those under that, it is said that the dose must be diminished in the proportion of the age to the age +12. Thus to find the dose for a child 4 yrs. of age, we would have 4: 4+12=16 :: 1:4- that is- the dose would be 1/4 the quantity sufficient for an adult. Particular persons, however, are liable to peculiar affections from idiosyncrasy &c. & the effects of habit are very great,- all which must be taken into consideration in prescribing the requisite dose.- For Fifth Lecture upon Weights, Proximate Principles &c. see Book A from p. 1 to 17 inclusive. Sixth Lecture May 1st 1834 Emetics are those substances which excite vomiting by an inherent peculiar property. Their operation is peculiar, but does not immediately follow their administration, generally after a lapse of 10, 20 or sometimes 30 minutes. Soon after taking an emetic 19 the patient feels an uneasiness, which is succeeded by nausea &c. till vomiting results. Previous to vomiting, the countenance is pale, the skin cool, moist & relaxed, & the pulse frequent, small & irregular. When vomiting commences, the countenance becomes flushed from the pressure upon the veins so as to prevent the blood returning from the head, & the temples appears as if filled with the rush of blood. After vomiting, the skin is left moist, cool & relaxed, & languor succeeds, which is consequent upon the nausea excited, not upon any narcotic influence. The operation of vomiting is effected by a reversion of the motion of the stomach & by the action of the abdominal muscles. This mode is best explained by supposing that the emetic touching the mucous coat of the stomach, imparts to it a sensation which is then transmitted to the brain by the nerves, & then again the impression is transmitted by the nerves from the brain to the muscles of the stomach and abdomen. That the agency of the brain is absolutely essential to the operation of an emetic, appears 20 from the fact that if we separate the par vagum nerve, no emesis can be produced, or if the brain be rendered insensible to any degree, either from injury or from poison, it will be very difficult to make an emetic operate.- Emetics differ from other medicines in losing none of their power from repetition, but generally have a contrary effect. They do not act upon all persons or in all diseases, equally. In febrile diseases, they generally operate with facility, but in nervous diseases, they act less readily. When narcotic poisons have been taken, the stomach is not easily affected, but if mineral poisons, they facilitate the action, provided they have not been sufficient to destroy the stomach. We now come to speak of the indications for the use of an emetic, which are numerous. 1. The most obvious effect of an emetic is to evacuate the stomach; hence it is frequently called for, for this purpose; as when any irritating substances have been taken into the stomach, or 21 when the disease depends upon an over-distention of that organ,- or upon containing acrid & poisonous substances. Mineral poisons sometimes operate themselves & then it is only necessary to give warm drink plentifully, so as thoroughly to wash out the stomach:- but the Narcotic Poisons have a tendency, as before stated, to prevent the emesis & consequently more attention is requisite. We should never resort to the stomach pump, unless an emetic will not operate after waiting 1/2 or 3/4 of an hour. If the poison should be a solid as Opium the pump might not be large enough to admit its entrance & it could not be drawn out. In bilious fever, when the accumulations are acrid & unhealthy, & the bile is not properly secreted, emetics are often very effectual. But it is very necessary to distinguish between a case when vomiting occurs from the irregular biliary secretions, and when it arises merely from an irritable stomach because it would be of much importance in practice.- 22 2. Emetics act favourably by exerting a mechanic as pressure upon the liver & other abdominal viscera, in the act of vomiting. It often happens that congestion of blood takes place in those parts, the patient experiences great oppression in that region, attended with depression of spirits &c. -& then an emetic may frequently be given with advantage. The well known utility of an emetic in Jaundice is generally ascribed to the compression excited by the vomiting upon the biliary ducts, thus forcing out the bile which has been secreted in too large quantities, but we consider this, an erroneous view, & that in a great majority of cases, Jaundice arises from the bile not being secreted at all by the proper vessels, but instead of that, is taken up by other absorbents & carried thro' the system, & that emetics act in such cases by arousing the liver to its proper function, & exciting its secretions. 3. Emetics act favourably by the production of Nausea which is attended with a general relaxation & prostration of the system. There are several 23 beneficial effects resulting from Nausea. 1. Most obvious effect is a prostration of arterial action or a reduction of the force of circulation, hence its use in inflammatory diseases in an early stage, but it must not be relied on in a case when the disease has become confirmed. 2. Effect is an Increase of the power of absorption, which has been demonstrated to be in inverse proportion to the reduction of the force of circulation. 3. Relaxation of muscles, hence it is useful in spasmodic affections &c. 4. Relaxation of the skin & consequently perspiration. & 5. It probably produces an increase of biliary secretions. 4. Emetics exert not only a local power, but by the concussion or shock which they give, they exert an influence over the system, so as sometimes to break up a morbid action which may exist there. In this way, we account for their benefit in Remit. & Intermitt. Seventh Lecture May 6th 1834 5. Another favourable mode in which Emetics act, results from the principle of Revulsion. We know that by irritating one part of the system, the excitement is 24 increased in that part, while at the same time, it is drawn off or diminished in other parts. If then, during any inflammation, you can produce a flow of nervous action & consequently of the exciting cause to any other part of the system, you relieve the disease, thus it is that emetics act by revulsion as in Mania, Amaurosis, Tic douleureux, Bronchitis, Uterine Hemorrhage &c. We must bear in mind that all Emetics are apt to purge when given in small doses, & that given in exceedingly small doses, they excite diaphoresis. 6. They evacuate the blood vessels, directly by exciting diaphoresis, & other secretions & indirectly by cutting off the supply of food from the stomach: but for this purpose, they are seldom or never given. 7. The irritation of the stomach produced by their operation is sometimes useful, as in dyspepsia, but this is rather dangerous, lest gastric irritation might lead to unexpected results. Thus we find that diseases present various indications for the use of certain medicines & more especially for the 25 use of Emetics, which we find answer so great a variety of purposes. But to complete our view of Emetics, we must also remember those circumstances which contraindicate their exhibition. 1. Acute inflammation of the stomach, bowels &c. This evidently forbids them from the gastric irritation which they are known to produce. 2. In some complaints, in which the susceptibility of the stomach is diminished, it becomes necessary to increase the dose to produce any effect. In such cases, we wish particularly to warn the practitioner against the danger which may result from the reaction of the system, for if those emetics be then given in large doses, which are apt to excite inflammation, when the system reacts, great danger will arise from the gastric irritation. Even tho' the effects of large doses may leave no impression upon the stomach at first, yet when a reaction ensues, the secondary effects will be gastric irritation, terminating perhaps fatally. It is proper in such cases of insusceptibility of the stomach, 26 from whatever cause it may arise, to use those medicines which are calculated to produce no such injurious effects, as for inst. Ipecacuanha 3. A determination of blood to the head, forbids the use of an emetic without previous depletion: for we have before stated, that from the pressure upon the veins, the blood is prevented from returning freely & hence there is a rush to the temples &c. Hence it is evident that in cases of full arterial excitement, or where there is a tendency to apoplexy, - blood to the head &c. - it would not be advisable to administer an emetic without previous depletion. It is from this principle of diminishing the flow of blood to the head, that benefit results from dashing Cold Water upon the head of a person labouring under a Narcotic Poison. Bleeding also increase susceptibility of the Brain, decreases, congestion. 4. Advanced stages of pregnancy contraindicate their use, & they should be then avoided if possible. In early stages, they may be given with safety, unless in women prone to abortion. 27 5. Hernia forbids them, but if, from urgent necessity, they must be administered to such subject, the patient should be directed to place his hand upon the hernial orifice, during emesis. They are generally administered diffused or dissolved in Water, & it is a good rule to give them in divided doses, every 15 or 20 minutes till they operate. When the design is only to evacuate the stomach, give the patient plenty of warm drink, but if the object be to produce a powerful effect, & give a shock to the whole system then little or no drink should be given, but let nausea, retching &c. continue for some time. Sometimes, either from constitutional or other causes, an inordinate degree of vomiting is excited, & it becomes necessary to check it. This is done by giving 10 or 15 drops of Laudanum or a little of Sol. Morph. Sulph. & by applying a Spice Plaster or warm fomentations over the stomach. If this do not succeed, inject about 60 drops of Laudanum with 2 or 3 tablespoonfuls of solution of starch, & if these fail, we may resort to the application 28 of a Mustard Plaster to the stomach, which seldom fails to arrest the violent vomiting. Having said thus much concerning Emetics in general, we must now proceed to consider them individually. First, The Vegetables & Secondly The Minerals. The first and most important is Ipecacuanha, which is the product of the Cephaelis Ip. or Calicocca Ip. and comes from Brazil. For botanical account see Book A from page 23 to 33 inclusive. Eighth Lecture. May 8th 1834. A.23 A.33 A.37 B.181 Upon Ipecac, Gillenia, Euphorbia Ip., Lobelia, A.39 A.67 B.57 b.97 Sanguinaria, Squills, Tobacco, Chamomile Flowers, B.125 and Mustard seed, for which see Books A and B. Ninth Lecture May 12th 1834 We next proceed to consider the Mineral Emetics. Tartrate of Antimony & Potassa or Tartar Emetic. Antimonii et Potassa Tartras. or Antinmonium Tartarizatum are the officinal titles. The same rank, which Ipecacuanha holds among the vegetable emetics is sustained by this among the Minerals. 29 It is the only one given for other than emetic properties It was first made known in Paris in 1631. It is prepared by boiling Potas. Bitart. with Protox. of Ant. & should always be obtained in the state of chrystals, to prevent its being in an adulterated state. The most common impurities are Tartrate of Lime, & Cream of Tartar. The crystals are in the form of Octahedral or Trihedral Pyramids, & contain a small proportion of Water of Chrystallization, hence they effloresce on exposure. Taste is metallic & slightly styptic. When entirely pure, it is dissolved by about twice its weight of water, making a transparent solution, but if Tart. Lime is present it will soon precipitate. If the solution remains too long. Tart. Ant. undergoes spontaneous decomposition, but this is prevented by the addition of a certain proportion of Alc. In pure Alcohol, it is insoluble. It is decomposed by the Mineral Acids, alkalies & their Carbonates. Alkaline Earths, Soaps, Hydrosulphates, & astringent Infusions, such as Bark, Galls &c. and hence, these should not be prescribed together. The decoction 30 of Bark is especially incompatible, & hence may be administered as an antidote in cases of poison from an overdose of this mineral. Common Green Tea also has the same effect & is more convenient. The value of this mineral as an Emetic, depends upon the certainty, strength & permanence of its operation It remains longer in the stomach than Ipecac. & produces a greater impression upon the system, hence it is to be preferred, 1. When we wish to make an impression upon the liver and abdominal region. 2. When we wish to divert irritations by revulsion. & 3. To break up a chain of morbid action in the system. It exceeds Ipecac. in producing nausea & prostration. Its action often extends to the Duodenum & evacuates the bile secreted there, hence it may be advantageously used for that purpose, when there are no contra-indications. It is a good emetic also in various forms of fever, especially those of a bilious character, - in jaundice - nervous complaints as Amaurosis, Mania &c. - obstinate dislocations,- & in some inflammatory disorders, such as sore throat, [Dicin?y] &c. 31 Sometimes it is beneficially combined with Ipecac. and we may say that we wish to produce a mild effect give Ipecac.- if a powerful one, give Tartar Emetic, & if doubtful which is necessary, give both. Besides emesis, Tart. Ant. is frequently given with a view merely of exciting Nausea, & this has been found very beneficial in cases of high excitement, in moderating the hysterical effect of mania, & in convulsions. Give it just in sufficient doses to keep the patient constantly feeling its nauseating influence, & happy results often follow in convulsions, nervous complaints &c. It is more apt to purge, when insufficient to excite vomiting, than any other of the Emetics. It is also diaphoretic & expectorant, & sometimes diuretic & indeed seems to stimulate all the secretions. When given in very minute doses, insufficient to produce any effect upon the secretions, it appears to exert a sedative influence upon the Heart. From this cause, some modern Italians have considered it as powerfully sedative, but this is incorrect, for it is well known from the very principle of its action to be powerfully irritant 32 irritant to the stomach. Brodie found that large doses of it administered to animals suspended the action of the heart altogether, altho' artificial respiration was kept up, showing that it has a direct influence upon the heart, & that it proves fatal not only as the other Narcotics, by depressing the powers of the heart, but also by the irritation which it excites in the stomach & other organs. The poisonous effects of Tart. Emetic are violent vomiting, burning sensation of heat about the stomach, hypercatharsis, hiccup &c. & terminating in death. Remedies in such cases are mucilaginous or oily drinks in order thoroughly to cleanse the stomach, and Decoction of Bark or Tea to counteract any that might remain. Leeches may be applied to the abdomen if gastritis ensues. The medium dose is 2 or 3 grs, given in doses of 1 gr. each at intervals of 15 or 20 minutes till it operates. When combined with Ipecac, the form is about Ipecac grs XX Ant Tart grs ij mpt. Pulv No. ij. Give one & rept. if necessary 33 It will produce Nausea in the dose of from 1/4 to 1/2 gr. every hour, & gradually increase it if necessary. It proves diaphoretic in dose of 1/8 or 1/6 gr. & still less is given as an expectorant. For these purposes, it should generally be given in solution, but for its purgative effects, it is generally united with Cathartics in the form of Piee. To facilitate the administration of this medicine in small doses, more especially to children, an officinal preparation called Antimonial Wine is recognised in the Pharmacopeia. It is made from grs ij Tart. Ant. to ƒ℥i Best Sherry Wine, which should be a clear solution: if any precipitate is found in the bottle, it should be rejected, as it is evidence either of the use of inferior Wine, or of impure Tart. Emetic Dose for an adult ƒ℥ ss. every hour till it operates, but should not be given if avoidable. Dose for a child 1/2 or 1 teaspoonful. Within the month, 1 or 2 gtt. 1 yr 8 or 10 gtt. Sulphate of Zinc. or White Vitriol. This emetic is useful for the promptness of its operation, as it vomits almost immediately without any 34 nausea. Its action is confined to the stomach, & it is seldom used except for producing speedy vomiting in cases of Narcotic Poison. It is then advantageously combined with Ipecac. Medium dose 10 grs. given in solution but in cases of Poison ʒss may be given, but this quantity should be seldom repeated. Sulphate of Copper or Blue Vitriol. This acts also very speedily, with no nausea & but little succeeding languor, or effect upon the system at large. It is used in narcotic poison, but being so violent, we prefer the Sulp. Zinc. & Ipecac. Dose 2 or 3 grs. In cases of Poison from 5 to 15 grs but never exceed the latter portion. In overdose, it occasions violent vomiting, irritation of stomach, hiccup, fetid eructations, prostration, convulsions and death. The best Antidote is the White of an Egg or Albumen beat up with Water. Dry [Vo????] of Manius made of equal parts of Sulph.Cop. & Tart. Emetic (Chap) Acetate of copper is never used as an Emetic. Hydrargepum Sulphuretum Flavus, or Turpeth Mineral was formerly used, but not now on acct of its violence & tendency to salivate. Medium dose 5 grs. 35 Tenth Lecture May 15th 1834 Cathartics are medicines which evacuate the contents of the stomach & bowels by purging. They operate in three ways. 1. By making an impression upon the internal mucous coat which is thence conveyed to the muscular coat and increases the peristaltic action. 2. By increasing the secretions of the lining membrane of the bowels, & 3. By increasing the secretion of the bilious & pancreatic fluid which is poured into the intestines, & hence increase the evacuations. Calomel may be considered the only medicine belonging to the last class, but other medicines operate by one or both the former methods. Cathartics differ as to the portion of the bowels which they affect, thus Gamboge acts upon the stomach, Aloes more particularly upon the large intestines, while the neutral salts & oils influence the whole canal. Hence we find the nature of the discharges to vary according to the medicine employed, being either natural, liquid from action upon the upper portions 36 of the intestines, - watery, - bilious, - or mucous & bloody from the irritation of the medicine. Cathartics differ in the degree of force with which they operate, & hence they have been divided into Laxative & Purgative, of which the latter are the more powerful, & those of them which are very severe in their action are termed Drastic Purgatives. The division, however, into these two distinct classes, is not a very good one, because there is no medicine so weak, but that it will become more active in large doses, nor any, so powerful, that it will not operate slightly in small doses. Hence they are Laxative or Purgative according to the object & method in which they are given. Cathartics answer several indications as follows, 1. The most obvious & perhaps the most advantageous use of them is for the simple evacuation of the bowels, merely for the removal of constipation or of unwholesome accumulations. Thus in dyspepsia, cholic, hemorrhoidal affections &c. & sometimes together with the force, some irritable matter may 37 be lodged & even remain so long as to be acted on by the absorbents, & given off in the cutaneous exhalations;- then Cathartics are very beneficial in removing all such offensive matter. They are given in low forms of fever, to prevent torpor of the intestines, diarrhea, dysentery, when poisonous or noxious articles have entered the stomach & passed beyond the reach of emetics &c. The French have recently adopted a theory which forbids the use of Cathartics in fevers because they say fevers depend upon an irritation of the mucous surface of the stomach &c. & that Cathartics will only increase the irritation. But experience shows that these views are erroneous: the cathartics act favourably by driving out the irritating fœces._ 2. They act advantageously by a reduction of the general arterial excitement from the quantity of fluid which they cause to be poured out from different sources. Directly, by depletion of the blood vessels, & indirectly by expelling the Chyle before it is taken up. 38 3. They act in promoting the absorption of effused fluids. This, we have already stated, takes place in proportion to the depletion, & it is accomplished also by diminishing the serum of the blood by other secretions. Thus in a case of dropsy, the Hydragogues would be preferable. 4. They act favorably upon the principle of Revulsion. We know that when a powerful action takes place in one part of the system, the nervous excitement is drawn from other parts to that, hence we often find great benefit resulting from purging in apoplexy, Hemiplegia, Hemicrania, in local inflammations, when it is not in immediate contact with the bowels, in Rheumatic, Hip Complaints, Catarrhs, &c. of Brain 5. Cathartics act upon the Liver by increasing the secretions, & by removing congestion of the vena portarum, Hence we find congestion preceding attacks of Bilious Fever, Cholera, Cholic, Hepatitis &c. relieved by Purge It is for this reason also that a dose of Calomel or of Pil. Cath. Comp. proves very beneficial in the early part of summer complaints. 39 Sometimes Cathartics produce good effects by acting in several of these different ways, at one & the same time. Thus in a case of Dropsy, where the whole cellular membrane may probably be in an irritated condition, the Hydragogues act not only by producing an evacuation of the blood vessels, so as to cause absorption, but also by irritating the stomach & by the principle of Revulsion, withdrawing the irritation from the cellular membrane. & by depletion A few words remain to be said respecting the methods of prescribing and administering cathartics. The powers of Cathartics are modified by combinations hence by uniting several severe Purgatives in small doses, we obtain the full cathartic, but the irritation being more extensively diffused over the whole surface, is not so much felt. Their influence is promoted sometimes by the addition of Tonics, sometimes by small doses of an Emetic. When they operate powerfully, producing griping &c. this may be obviated by the addition of aromatics. Salts may be given in Mineral Water &c. 40 Medicines operate more effectually when given upon an empty stomach, hence it is adviseable to take them in the morning before breakfast, or on going to bed at night. If a prompt operation is desired, the best time is before breakfast, but if we merely wish a laxative effect, in the evening. Warm drinks of farinaceous gruel, molasses & water &c facilitate their operation, & prevent griping. Hypercatharsis subdued by 5 or 15 drops Laudanum. We now come to speak of individual Cathartics. The least active of these, is common brown Sugar, which produces this effect slightly. Molasses from the plantation also acts as a Cathartic, hence we find a diet of Rye Mush & W. India or N. Orleans Molasses an excellent laxative in cases of recent piles, prolapsus ani. &c - Wheat Bran, in form of Bread or Mush. A medicine more frequently used & approximating in its nature to Sugar is Manna, for an account of which see Book B. p. 205. 41 Eleventh Lecture May 19 1834 B.119 B.117 B.115 C.11 Upon Figs, Tamarinds, Purging Cassia, Caster Oil, Olive Oil analogous in its operation to Castor Oil, but inferior. Dose ƒ℥i or more. Melted Butter a still milder cathartic, adapted to chronic dysentery, after the irritation is subdued. It is prepared by putting it in a mug of boiling water stirring it up & skimming off the melted portion. Dose a tablespoonful every hour or two. For Rhubarb. see Book A p.43. Twelfth Lecture May 22 1834 Upon Rhubarb &c. and Senna, see Book B. p.33. Thirteenth Lecture May 26 1834 B.43 A.203 B.209 On Cassia Marylandica, Juglans & Aloes, for which see Books A and B. Fourteenth Lecture May 28 1834 A.53 A.59 C.1 A.63 On Jalap, May Apple, Scammony & Black Hellebore Fifteenth Lecture June 2 1834 B.121 C.5 C.7 On Colocynth, Gamboge, Elaterium and Croton C.19 Oil. 42 Sixteenth Lecture June 5 1834 Sulphur is found in volcanic countries mixed with earthy impurities, from which it is purified by fusion & sublimation. The best Sulphur comes from Sicily, Italy &c. In England it is obtained from Copper Pyrites, but is apt to contain the Sulphuret of Arsenic. It comes to us in rolls. Roll Sulphur is sublimed & washed, to clear it of Sulous & ic Acid. then called Flowers of Sulphur, Sulph. Sublimatum or Sul. Lotum. the latter is meant in the Pharmacop. It is of a yellow colour, nearly tasteless, has no smell except when heated or rubbed, insol. in water, [cross out] & in Alc but soluble in the vol. & fixed oils. fusible & inflammable & volatile's able It has long been a favorite laxative among physicians; it secues to act upon the lower bowels, & sometimes to produce more griping than other laxatives, which perhaps depends upon the Sulph. Hyd. formed. It has also a tendency to the skin, to the lungs, & in fact, seems to exert a general alterative influence. It is useful in costiveness, also given in slight hemorrhoidal affections, with an equal part of Cream of 43 Tartar, a teaspoonful or tablespoonful at bed time, also in dyspepsia accompanied with constipation & acidity it is combined with Magnesia, in Chronic Rheumatism, Gout, & various cutaneous affections. Hence the Warm Sulphur Springs contain Sulph. Hyd are very beneficial for Rheumatic patients. Dose as a laxative ʒi or ʒij, given in Syrup or Milk It is usefully applied in the form of an oinment of 4 parts Lard & 1 part Sulphur, in cases of Itch., Tinea Capitis &c. A solution of the Sulphuret of Potassa (ʒiij to ƒ℥viij Water) is sometimes used. Sulph. Precip. Lac Sulphuris is made by boiling Lime & Sulphur, in Water straining & adding Muriatic Acid. It is nothing Sulph. Acid is often used & then the Lac Sul. is adulterated with Sulph. Lime more than Hydrated Sulphur. Dose & use same as former Test of purity is to throw it on a hot iron, it should all be consumed. Carbonate of Magnesia. formerly called a Subcarbonate: is usually obtained from the Bitters or Mother Waters remaining after the Chrystallization of Common Salt from Sea Water. This contains the Sulphate & Muriate of Magnesia. It is heated & impure Carb. Pot. added when double decomposition 44 takes place, from which results Carb. Magnes. [illegible] form Sol. of Sulph Magnes. precip. by Carb. Sod. biter than C. Pot. This is washed, dried & cut in cubical masses. Soncet adulterated it with Carb & Sulph Lime It was first introduced into practice by Count Palmar in Rome. It is white, light, smooth, inodorous less than Magnesia 1 cu 2500 cold: & 9000 [wh??] little taste, unalterable in air & insol. in water, somet: it is adulterated with Lime, detected by dissolving in dil. Sulph. Acid, & add Oxalic Acid except to a very slight extent, when the Carbonic Acid of Water, forms it into a Bicarbonate Idinc soluble in Carb acid water Magnesia Water is a solution of it in Seltzer Water. It may be found in other forms than masses & heavier. Dose for an adult ʒij, but not much prescribed on account of its being liable to produce flatus. Efficacy is owing to acid in the stomach & bowels or usta Magnesia or Calcined Magnesia is obtained by exposing the Carbonate to a high heat Test is to add Vinegar & no effervescence First mix with water ℥i Carb. yields only about 200 grs. Magnes. alkalin Taste is disagreeable, soluble in 2000 parts water. exposed to the air, slowly absorbs Carb. Acid & is converted into a Carbonate. We meet with a preparation called Henry's Magnesia, which is essentially the same with May be in odered by [sub???] from [Sul??] [illegible] 45 4 times as heavy the Calcined, differing only in being denser, & smoother to the touch. more easily subbes up with water Magnesia is a mild aperient, supposed to operate by forming a salt with the acid with which costiveness with acidity in the stomach it meets. Used in Dyspepsia gout Diarrhea of children cholic, sick headache &c. Sick stomach after debauch Dose for an adult [cross out] ʒi, for a child 2 yrs. old, a teaspoonful. It is frequently combined with Rhubarb in bowel affections. If it do not operate it may accumulate & form masses in the stomach or intestine It is not Known that it is purgative in itself, hence if it do not operate, it is proper to aid it by giving lemonade &c. The best method of administering suspending it, is by diffusing it in water & it is important that it be equally diffused & not left in little lumps lest they should get between the teeth, & leave the taste in the mouth: first then, rub it up in a mortar with a little Syrup, then add the Water to it: or it may be taken in Soda Water, by first rubbing it up with a little Ginger Syrup. 46 The Saline Cathartics or Neutral Salts as a Class are the most important of the Cathartics. They are given generally in the same complaints & preferable to one another only for convenience, cheapness, taste or some other adventitious circumstance. They may be considered as holding a station between the Laxatives & Purgatives; they act upon the intestinal exhalents, produce watery evacuations, little pain, are refrigerant or sedative & well adapted to inflammatory & febrile complaints: but in acute attacks, the more active Cath. should be used first & these afterwards to continue the impression if needed. Soda Sulphas. Glauber's Salts this not long since was extensively employed, but is not now. It is found in the bottom of Springs & lakes but not in large quantities: all that is used is artificial. It is a kind of chance production resulting from the as Sulph. Acid. & Chlor. Sod. for Mur. Acid. processes for obtaining other products. Its great source is Sea Water. After the deposition of common Salt, this contains Sulph. Magnes. & Mur. Soda, & if it be reduced to a very low temperature, a double decomposition 47 ensues, resulting in the formation of Sulphate of Sod. & Mur. Magnes. & while so cold, the Sulph. Soda is precipitated. Hence in Russia, in the Winter, it is found at the bottom of lakes. Its Chrystals are in 4 or 6 sided Prisms with dihedral summits; striated by exposure, they give off their Water of Chrystallization, & when thus effloresced are 2 as strong as in Chrystals. It is soluble in 3 times its 1/2 at [illegible] weight of water at 60°, in 1/2 its wt. at 88°, & less 3 times at 106 sol. in boiling water than in water at 100°, Crystals melt, when heated- insoluble in Alcohol. Most sol in W. at 91°. but as a general rule, in 2 or 3 times their wt. of water. It is disagreeable & seldom prescribed. Dose ℥i Magnesia Sulphas. Epsom Salts. Exists abundantly in nature, in Sea Water, Springs, Caves &c. It was first procured from Epsom Springs in [crossed out] 1675 It was once obtained from Bittem, but not pure & frequently contained Mur. Magnes. It is now manufactured in Baltimore from a Magnesian rock which yields it abundantly by adding Sulph. Acid. also from Limestone in England. Chrystals are in 4 sided prisms with dihedral 48 summits, but as founded in the shops, it is usually in slender, needle like crystals, & very slightly efflorescent. It contains about 50 pr. Ct. Water of Chryst. soluble in water, insol in Alc. with a saline, bitter taste. It is frequently given in Soda Water. Dose ℥i. Disting. from Sulph. Sod. by adding Carb. Sod. to the Sol. It will precip. Carb. Mag. if Sulph. Mag. Seventeenth Lecture June 9. 1834 Potassa Sulphas. or Vitriolated Tarta; may be obtained by the direct union of its constituents, or by saturating Carb. Pot. with the Supersulphate which remains from distilling Nitric Acid from Nitric & Sulp. Acid. It is in Chrystals of various sizes, form 6 sided prisms, hard, contain no W. of Chrystalzation, Sol. in 9 pts Water at 60° & 4 pts at 212°, insol. in Alcohol. When heated, it decrepitates from water entangled like Common Salt. removes half the base. By the addition of acids, it is converted into a Bisulphate. Its taste is nauseous, somewhat bitter. Though cathartic in its effect, it is seldom employed for this purpose, on account of its difficult solubility. Dose about ℥ss Seldom used for any thing except the formation of the Dovers Powder. hard Hercula 49 Potassa Supertartras or Cream of Tartar, consisting is a Bitractate of Pot. & an excess of Tartaric Acid. It exists in the juice of the grape, & is deposited from new wine during fermentation, because it is insoluble in Alc. hence when by fermentation, the sugar is converted into Alc. the Crude Tartar is precipitated . This when purified by solution & chrystallization becomes Chrystals of Tartar, these we receive from S. of France, in small, irregular, semitransparent masses, sour, sol. in 60 prts Water at 60° & 15 prts at 212° insol. in Alc. & containing but little W. of Chrystallization. The Chrystal when ground form the Cream of Tartar of the Shops. This is rendered more soluble used in [An???] Inf. affections Scrof. & with Sulphur. for Piles. by boiling it with Borax. forming a compound sol. in an equal or less weight of boiling water. Potassa Tartras or Soluble Tartar. is prepared by dissolving Carb. Pot. in boiling Water. then adding the Supertartrate till effervescence ceases, then evaporate to dryness. Chrystals & Granular It has a bitterish, cooling taste, is deliquescent 50 in chrystals sol. in its own wt. of water, but in granular form, sol. in 4 times its wt. sol. in 240 prts boiling Alcohol. Its aqueous solution, when long exposed to the air is decomposed. It should never be prescribed in combination with acids. They take 1/2 base. It is a Cathartic, sometimes combined with Senna, but seldom used. Dose ℥ss to ℥i. Soda et Potassa Tartras or Rochelle Salt. 2 1 obtained by saturating Super Tart. Pot. with sol of Carb. Soda. It is in form of Chrystals, of right Rhomboidal Prisms, slightly very slowly efflorescent sol in 5 prts water at 60°, & much less boiling. It has a saline, bitter taste, was introduced into practice by Seignette of Rochelle. It resembles more palatable Dose ʒi to ʒiss the other neutral salts, but its principal use is as an ingredient in forming the Seidlitz Powders, composed of Rochelle Salt ʒij. Bicart. Soda. ℈ij in a blue paper, & Tartaric Acid grs xxxv in white Dose of Rochelle Salt ℥ss to ℥i. Result of Seidlitz is Tart. Pot. & Soda. & Tart. Sod. 51 Soda Phosphas. is obtained by taking some calcined bones, acting upon them with Dil. Sulp. Acid & a precipitate of an insoluble Sulphate of Lime falls, while a Superphosphate of Lime remains in solution Filter this & to it add Carb. Soda when efferescence & double decomp. takes place. & Phosphate of Soda remains in solution which filter & evaporate. It chrystallizes in the form of Rhomboidal Prisms, effloresces, undergoes the watery fusion by heat is soluble in 3 parts Water at 60°, & 2 pts at 212°, It contains 62 pr.ct. Water of Chrystalization. in the shops, it is generally found in the state of powder. It has a slightly saline, but no unpleasant taste, & ℥i of it may be given in a bowl of soup without the patient's knowing it. The chief objection to its use is its costliness. Dr Peasson Calomel. Of its Chemical History, we shall speak at a future period. It is termed a Proto Chloride & Submuriate, in some Pharmacopeias. The U.S. officinal title is Hydrargyri Chloridum Corrosivam Mite, distinguished from Hyd. Chlo. Forte 52 The dose of it is from 10 to 20 grs. but much larger Western practice- doses have often been given, & it is found that Cal. does not act in proportion to the quantity administered more than a regular dose; probably because the system will absorb but a certain proportion of it, & this acting upon the hepatic organs, will only produce a certain effect. It acts with little harshness or severity, producing bilious stools of different colour, according to the quantity given. Sometimes, however, it effects the stomach with violent spasms & vomiting, & this is believed to result from the quantity of vicious bile, which it causes to be secreted & poured into the stomach. Its direct effect upon the mucous coat seems to be rather soothing than irritating, & it will often remain on the stomach, when other Cathartics have Case of [Intussuscefetis?] been rejected. If it do not operate in 6 or 8 hours, it should be carried off, by a purge of Salts or Oil. Children require larger doses in proportion than adults, a child 3 yrs. may take 4, 6 or 8 grs. It is slow in its operation, hence dose of Oil may follow it. 53 When a speedy & powerful action is required, it should be combined with more active Cathartics. Thus combined, it is frequently employed in the Autumnal & Bilious Fevers, Jaundice, Hepatitis, & in fact, whenever active purging is desired. It sometimes proves beneficial in Dysentery, Enteritis, Gastritis, by its action upon the Liver. In cases of Children, it is much used in Remittents, Worms. It [Maras??s] &c. It is generally prescribed in the form of Powder or Pills. Never combine in Pill, with Soap or Magnesia. Purgative Enemata. The uses of injections are to promote the evacuation of medicines given by the mouth, or to administer medicine to a patient having a very irritable stomach &c. or when the stomach is in a state of inflammation, or when there is danger of injuring the tone of the stomach. They are also useful in constipation depending upon a collection of feces in the lower part of the intestines. A very common injection is made 54 of common Salt, Molasses, Lard or Sweet Oil, each a tablespoonful & a pint of warm water. If a more active one is needed, use Castor Oil or some one of the Neutral salts. If one still more active, use Senna Tea ℥i to Oj boiling water, or Jalap diffused in Water, 3 times dose. Ol. Tereb. tablespoofful to Oss warm water, or in Flaxseed Tea, with Yolk of Egg to diffuse it. Assafœtida may be given in flatus. Tobacco.- to overcome spasms, as in Cholic, Hernia &c. but with great care as to its strength. The proper proportion is ʒi to Oj of boiling Water, give 1/2 when cool, & the remainder in 1/2 hour if necessary. Suppositories are sometimes employed as Purgatives Soap is generally used, some take Molasses Candy. 53 Eighteenth Lecture June 12 1834 Diuretics are medicines which increase the secretion of urine. This they do in three ways. 1. As Nitre for inst. by entering into the circulation & then coming in contact with the vessels of the kidneys & stimulating them to action. This is condeuced by the saline medicines taken, having been detected in the urine. The active principle is that which is absorbed, while the remainder is digested & passes off. Thus in Turpentine, the vol. oil only is the portion absorbed. 2. Their action is extended by sympathy from the stomach to the kidneys; of this class, we can name none which act in this way alone, but there are many medicines which act by both these ways combined. 3. Some medicines act by promoting the action of the absorbents, hence they throw more fluid into the circulation, which must be eliminated through the urinary organs, & consequently increase the 56 discharge. Digitalis is said to act in this way. There are many circumstances, besides these, which influence the urinary secretions. Thus diaphoresis & diuresis are directly opposed & hence when one acts, the other will not, as in Winter, we know that more urine is secreted than in Summer when we perspire more freely. Cold Water then & cool skin promote diuresis. Active purging and diuresis are directly opposed, hence when the exhalents are pouring out fluid into the intestines, Diuresis does not occur. Diluent drinks promote Diuresis or Diaphoresis according to the state in which the patient is kept. It was formerly thought that in dropsy, copious drinking must be avoided, but we now find the reverse to be the best method of curing, & consider the patient may drink without restraint, so [as] long as the discharge equals or exceeds what is drank. In using diuretics, the pulse must always be attended to, if it is large, first deplete, for an increase of circulation above a certain point, diminishes 57 rather than increases the urinary secretion. Another reason for attending to the state of the circulation is that the secretion depends upon the nervous energy- hence if the brain be pressed upon by the fulness of the vessels, the nervous power must be diminished. Mental emotions have also much influence over the secretion of urine. Thus anxiety increases it, as every surgeon well knows, who has been labouring under great anxiety respecting an operation which he was about to perform- fear also has a similar effect, tho' probably it acts rather by relaxing the Sphincter muscle. Dropsical effusions removed [illegible] the principle of Exosmosis (Chap) The diseases in which Diuretics are applicable are those attended with effusions, as Dropsy. They operate by diminishing the quantity of fluids, either by stimulating the absorbents, by moderating the exhalents, or by a union of both. Hence they are advantageous in Dropsy, which, we know, may occur either from a diminution of the power of absorption, from an increase of the effusion 58 effusion, or from an increase of effusion & diminution of absorption combined. They may also act upon the principle of revulsion, for Dropsy may occur on account of a kind of sub-excitement over the whole surface & consequently if medicines will draw this irritation to the kidneys, they cure the disease In inflammatory diseases of the kidneys or any of the urinary organs, they act favorably after depletion. In these the saline diuretics are particularly applicable. They are useful also, where we wish to decrease the arterial excitement. In selecting those most applicable to particular diseases, great care is requisite & much must be left to the discretion & experience of the physician. Some are better adapted to peculiar cases than others. We shall now speak of them individually: & 1. Of Digitalis,- for which see Book B p. 53.- 59 Nineteenth Lecture June 16 1834 On Squill & Colchicum, See Book A p.67 & 77. Twentieth Lecture June 19 1834 A.85 A.73 B.129 On Veratrum, Taraxacum, Juniper Berries.- B.185 B.185 Erijervn Philadelphicum, Erig. Heterophyllum, B. 127 Carrot Seed, Apium Petroselinum, & Chimaphila B.183 Ap Draveolens or Cellery [illegible] species Umbellata for which see Books A. & B. Twenty First Lecture June 23 1834 Turpentine is a name applied to a peculiar vegetable juice, consisting of resin dissolved in an essential oil, & generally obtained from some species of Pine. There are several kinds found in the shops. 1. White Turpentine. Terebinthina (U.S) is obtained from the Pinus Palustris, which is a native of N. & S. Carolina & Georgia. It is called sometimes the long leaved or Pitch Pine is about 60 or 70 ft. high, & supplies nearly all that is consumed in the U.S. as well as sent to other countries. White Turpentine has a peculiar, somewhat aromatic odour, a warm, pungent & lightly bitterish taste, is of a white colour, mixed with yellow; consistence varies with the temperature, & it 60 long exposed becomes hard & dry. That in England & France comes from a different plant. 2. Canada Balsam or Balsam of Fir. is improperly so named, because it contains no Benzoic Acid. It is called also Balm of Gilead or Am. Silver Fir. derived from the Ab. Balsamifera growing in the N. on the bark of the tile are little blisters filled with the liquid. parts of this country.- It is liquid, like Honey, has a strong, not disagreeable odour, bitter taste, whitish yellow colour & semitransparent, becomes stickier & darker by exposure. 3. Venice Turpentine.- so called from the Port whence it was formerly shipped,- is the product of the P. Larix. This, however, we do not find in our market.- That which we have under this name, is probably a factitious article, made from Pitch, Ol Tereb. & White Turp. Strasburg Turpentine comes from Hamburg. 4. Chian Turpentine is never brought into this country. It is thick, tenacious liquid, pale yellow colour.- The Turpentines are fusible inflammable, burning with a white flame & much smoke,- impart neither flavour to water, but are insoluble in it, soluble in Alcohol.- consist of Oil, Resin & perhaps some Succinic Acid. They are all stimulant, diuretic, & in large doses Cathartic irritate urinary passages but have been superseded by the Oil of Turp.- 61 They are given with advantage in Chronic cases of Inflammation of the mucous membrane in different parts, also in Sciatica, Lumbago, Piles, Chronic Catarrh &c. Dose grs x to ʒi- May be given in Pill or Emulsion. Externally for Plasters. There are several substances used in medicine, which consists of Preparations of Turpentine, & may here be introduced with propriety. Tar.- Pix Liquida.- is Turpentine partly decomposed in the preparation of it.- It is procured from the P. Pacastric of N. Carolina, by burning the dead billets in piles, like Charcoal Pits, & collecting the Tar. It has a peculiar empyreumatic odour, with a bitter, resinous taste of a dark colour consists of Resin, Empyreumatic Oil & perhaps Acetic Acid, coloured with Charcoal It yields a very small portion to Water forming Aqua Piles Liquida or Tar Water. which is used in Chronic Cough, &c. Oj per day. Tar may be given in Pill or Emulsion,- or as an Electuary with Brown Sugar. 62 Tar Ointment is an excellent remedy for Scald Head & and in scaly eruptions of the skin, we have found nothing so beneficial as equal parts of Citrine & Tar Ointment mixed.- Tar & Sulph. Oint. for Scald Head &c. Pitch. Pix Nigra. (L) is Turpentine deprived of a great portion of its oil by evaporation and is solid.- It is seldom used.- Of Burgundy, & Canada Pitch, we shall speak hereafter.- Resin- common called Rosin,- is that which remains from the Turpentine, after the oil has been separated by distillation.- It is solid, brittle. semitransparent.- There are 2 varieties in the shops, Yellow & White. The Yellow is semitransparent. when melted & worked up with Water, it forms the water grad. evap. if exposed White.- Resin is not given internally Fumes Cerat. Resina Basilicon Oint. Composed of Resin, Max & Oil,- is used for keeping blisters open.- It is the best application to Burns, to prevent an de-looking scar. Ol. Terebinth.- or Spt. of Turpentine is the most important as an internal remedy. It is colourless, limpid- has a strong peculiar odours- pungent taste 63 is sparingly soluble in cold Alc.- readily in boiling.- It has a strong determination to the urinary organs, & is slightly stimulant, so that if long continued, it will produce strangury,- or bloody discharge. It is useful in Chronic Nephritic complaints,- Leucorrhea,- Gleet. Debility of Urinary & Genital Organs. Sciatica, &c. &c. Dose 10 or 15 drops 2 or 3 times In acute cases the dose may be repeated every 2 or 3 hours. a day.- It purges in the dose of ℥ss to ℥ij.- If long kept, it absorbs Ox & forms a resin. It can be purified by adding Cold Alcohol. There is a method in which Turpentine has been very beneficially employed, of which we have not yet spoken. It is in the form of fumes arising from Resin or Tar. which have proved very serviceable in chronic affections of the throat.- or of the mucous or bronchial membranes & in the first stages of consumption, before tubercles are formed. It is probable that the air of Pine forests, proves beneficial to consumptive invalids for the same reason, for the odour which there prevails. Copaiba.- Product of Copaifera Officinalis,- for an account of it, see Book C. p.25. 64 Twenty-Second Lecture June 26 1834 Canthares.- Of the History of this we shall speak hereafter when we come to treat of its vesicating properties.- now we have only a few remarks respecting its diuretic properties. The testimony of the ancients & moderns concurs in pronouncing it diuretic.- It is stimulating & sometimes produces strangury by its irritating effects upon the mucous membrane.- The symptoms of strangury are a frequent disposition to pass urine, only effecting the passage of a few drops of a red colour, with a great deal of pain.- Tinct. Canth. is useful in dropsy;- also for irritating the urinary organs in suppression or retention of urine.- If retention depends upon a stricture or upon spasm at the neck of the Bladder, Canthar. would certainly be improper, but if it depended upon an inability of the bladder to expel its contents then Tinct. Canth. would probably excite it to action. In suppression,- Canth. may be employed for stimulation. 65 In Incontinence of Urine, when it depends upon paralysis or want of power in the Sphincter muscle, Fr. Canth is useful.- Thus in Children who are constantly prone to discharge in bed, this has acted very befeficially.- It is useful also in Leucorrhea, Amenorrhea, Gleet, Seminal Weakness, &c. Dose 10 or 15 drops 2 or 3 times a day. In substance, 1 gr may be given morning & evening. Mineral Diuretics. Carbonate of Potassa.- This Salt is contained in the plants which were formerly so much employed for the cure of Dropsy. The Salts of Pot. are supposed to operate upon the vessels of the kidneys. The Carb. Pot. employed is a purified Pearl Ash, prepared by making a saturated solution of it in Water, filtering, evaporating, & stirring it till it granulates. This however is by no means pure, it contains Muriate & Sulphate of Pot. & Silica.- Silicate precip. from solution. The name, Salt of Tartar, applied to this, [illegible] properly to the Carb. Pot. obtained from Cr. Tart. by heat. 66 It is composed of 1 Eq. Carbonic Acid & 1 Eq. Potassa; was formerly, but improperly called Subcarbonate. It is always granulated,- deliquescent,- an alkali, changing veg. blue to green- forms soap with oil,- insol. in Alc. sol.- in water. It is used as a diuretic in Dropsy.- also in stimulating hepatic secretions in Jaundice.- Dose 10 to 30 grs in solution, 2 or 3 times a day. Bicarbonate of Potassa is a more pleasant preparation, formed by passing a stream of Carbonic Acid through a solution of Carb. Pot. then evaporating by heat below 120°.- It chrystallizes in 4 sided Rhomboidal Prisms,- are white,- permanent,- soluble in 4 times its weight of water at 60°. in 5/6 boiling.- Dose ʒss to ʒi 2 or 3 times a day.- The best form of giving the Carb. Pot. is in Carbonic Acid Water. Take about ʒiss of Carb. or Bicarb. Pot. & ℥i Ginger Syrup, put it in a bottle of Seltzer Water & give 1/3 at a time,- keeping the bottle well stoppes Carb. & Bicarb. Soda,- not important.- 67 Acetate of Potassa, is but little used,- it is made by adding vinegar or acetic acid to Carb. Pot.- It is white, texture, deliquescent, sol. in its wt. of water at 60° & Alcohol & decomposed by Acids. It is Cathartic & Diuretic. Dose as diuretic ʒss. 2 or 3 a day. Supertartrate of Potassa: is the best saline diuretic, which we possess. It should be given in large quantities of water to the amount of ℥ss or ℥i per day. It is refrigerant, antiphlogistic, & adapted to a febrile condition of the system. It is proper to begin with about ℥ss per day in divided doses. It is well adapted to Anasarca with excited circulation. Nitrate of Potassa is found in various parts of the world. It is most abundant in the plain over flowed by the Ganges.- The ground is scraped together & lixiviated.- & process repeated till Nitre Chrystallizes in 6 sided Prisms,- containing no water of Chrystallization Taste is sharp & cooling; even extending to the stomach. It is soluble in 4 or 5 prts. of Cold. & its own wt. boiling W.- insol. in Alc. Dose 10 or 15 grs in solution sufficiently often to give about ʒi to ʒiij in 24 hours. This will promote diuresis, by stimulating the urinary vessels.- 68 Nitre has sometimes been accidentally taken for other salts & proved poisonous. The symptoms are a strong feeling of coldness in the Epigastrium, spasms, bloody stools, hypercatriasis &c. The remedy is to wash out the stomach thoroughly & guard against intestinal irritation.-. Sweet Spirit of Nitre.- Spir. Ætheris Nitrici. has often been found advantageous as a diuretic. It is sol. in W. & Alc.- often adulter. with Alc. as their sp. gr. is nearly equal. It is often grateful to the stomach when others are not. Dose ʒss to ʒi Chapman gives from ʒij or ʒiij to ℥i. It should be administered with large quantities of liquids. It becomes sour if long kept from Nitrous Acid. Antilithics The Antilithics are medicines which were supposed to prevent a deposition in the urine, producing gravel but we are very sceptical respecting the propriety of arranging these in a distinct class.- for as the vessels in connection with these organs are diseased, general treatment is as proper as in other cases, upon the same principle that we would class Antilithics, we might form also classes of Antiscorbutics, Antidysenterics &c. &c.- 69 We think, therefore, that this class might be justly omitted in the Materia Medica. It was supposed that some medicines would enter the circulation,- come in contact with the stony depositions, & dissolve them, & hence we have a class called Lithontriptics.- but it is not so. There is no solvent for the stone, while the stone is in the bladder.- The only method in which we can act is to obviate the Lithic Diathesis, & thus we may sometimes relieve or correct the unpleasant symptoms. The urine abounds in saline matter, of different kinds, & we find that there are 2 kinds of Calcareous Deposition.- The one which is most frequent is Uric Acid,- the other, a compound of an insol. Salt of Phosphoric Acid. That state of the system, predisposing to the former is called the Lithic Acid Diathesis, & that to the latter, the Phosphoric Acid Diathesis. Whenever there is a red sediment in the urine, we may suspect the first Diathesis,- but if 70 there be any doubt, take a piece of Lithmus & immerse it, & it will be changed to red, if there be Uric Acid present. In a healthy state it always exists, in combination with more alkali. Thus the Sublithate of Ammonia will remain dissolved as long as the Alkali is in Excess, but if the acid exceeds, this is then deposited. Hence in persons of the Lithic Acid Diathesis, it is improper to accumulate acid in primæ viæ,- or to live upon acescent food. Deficiency or suppression of Perspiration also is said to be improper in such persons, because according to Dr Wilson Philip, it contains an acid- The remedies or antilithics in these cases are Alkalies & Alkaline Earths, to neutralize the acid, in the blood, urine &c.- Simple Bitters also, to strengthen the Digestive Powers, & Diaphoretics, by causing Perspiration. In the Phosphatic Diathesis,- the case is directly the reverse, & too little acid is the cause of the stony deposition.- The calculous matter 71 is such as to be soluble only when there is a certain portion of Acid, but when this proportion diminishes, a white sediment deposites, This state is also connected with disorder of the Digestive functions. Acids here, instead of Alkalies, are requisite for the cure, & Mineral acids are preferable Hard Cider has enjoyed great reputation among the vulgar for the cure of the Gravel, but we readily perceive that it is applicable only in this Diathesis, while in the former Diathesis it would prove very injurious. Tonics also are applicable.- Carb. Pot. & Soda, Calc. Magnesia, Lime Water &c. Bicarb. Pot. & Soda are preferable to the Carbonates, & the BiCarb. Soda to Bicarb. Pot. Dose ʒss to ʒi Dose of Carbonates 15 to 30 grs. Some prefer Magnesia, but it is probably inferior when it is desirable that the Antacid should reach the kidneys. Dose 15 to 30 grs. 3 times a day. Lime Water may be given with Milk, Oij per day. The Mineral Acid employed are the Nitric, 72 Sulphuric & Muriatic,- all of which are Tonics. The two last of these are preferable. All the vegetable tonics are sometimes useful. Uva Ursi has obtained great reputation, & seems well adapted to those cases where the organs are incapable of performing their duty from relaxation or debility.- It has, however, no peculiar adaptation to gravel. Twenty-third Lecture June 30 1834. Diaphoretics,- are such medicines as increase the cutaneous discharge.- The skin always, when in a healthy state, is carrying on a secretion, which generally evaporated as fast as it is formed,- but when, from an increase of secretion or from different states of the atmosphere,- it retains its liquid form it is called sweat.- At one time, it was supposed that some medicines had the power of increasing the moist secretions & others the dry,- & hence they were divided into Sudorifics & Diaphoretics,- but these distinc- are now lost, & both are comprised by medical men under the head of Diaphoretics. 73 These medicines operate in different ways.- 1. By relaxing the constricted capillaries which are often found as in cases of febrile excitement- In diseases, attended with such consequences, the diaphoretics are calculated to relax these vessels & thus promote perspiration.- This may be accomplished by nauseating doses of emetics,- by cold or warm ablutions &c. 2. By entering the circulation, & then coming in contact with the vessels of the skin, & stimulating them as diuretics do those of the kidneys;- as Cn. Pot. &c. 3. By increasing the general circulation & consequently, the cutaneous secretions:- as Carb. Ammo. &c. but these can only be given in languid circulation, with a cool, dry skin, & not in cases of high arterial excitements. 4. If the skin be in a healthy state, any thing which moderates the excitement of the heart and arteries, will produce sweating,- hence warm teas &c are said to be useful.- It is said also that the perspiration produced by entering hot ovens has been known to cure the Dropsy.- But the application of dry, 74 heat is apt to produce febrile action,- while a moist heat usually produces diaphoresis.- Dry heat can be borne at a higher temperature than moist:- These medicines are applicable to a great variety of diseases,- & rank high in the list of curatives. They operate favorably by removing the hot & dry surface,- by depleting the blood vessels, & consequently moderating the arterial excitement;- & also by eliminating the noxious matter from the blood. They act also by revulsion,- by directing the flow of blood to the surface & abstracting it from the inner parts, thus in Dysentery, Diarrhea &c. - Rheum, Gout. They are useful also in Congestion, Rheumatism, Gout, &c.- They are said to increase the action of the absorbents as in Dropsy,- but for this are not very useful. They sometimes merely change the action of the capillaries,- as Sulphur, Sarsaparilla &c. We may add a few words respecting the mode of administration.- If copious perspiration is desired,- put the patient to bed, & do not allow him to be uncovered,- advise flannel to be worn next the skin,- or in summer, the knit elastic substance. 75 When the pulse is strong & full,- the medicine should be preceded by a lancet or a purge.- After the sweating has commenced,- give warm teas, & avoid purging, vomiting, or diuresis.- If the skin be hot & febrile,- cold drink may be given. 1. Relaxing Diaphoretics. A.25 B.189 Ipecacuanha & Eup. Perfol.- see Books A & B. The Antimonials used are Tartar Emetic,- Pulv. Antim.- & Precipitated Sulphuret of Antimony. Ant. et Pot. Tartras.- given in small doses, produces profuse perspiration in two ways.- 1. By overcoming the capillary constriction by nausea, 2. By entering the circulation & stimulating the vessels of the skin to increased action. It loses its curative power, in any disease,- when it nauseates (Chapman) It is useful in excited febrile complaints, in eruptions of the skin,- chronic scrofulous complaints &c. Dose 1/8 to 1/4 gr.- As an alterative 1/10 to 1/8 gr.- Also in the commencement of consumption, with frequent pulse &c. & in catarrhal affections generally.- Dissolve about 1/2 gr. in Oi of Water & let the patient take it as his only drink thro' the day. 76 Pulvis Antimonialis.- was intended as a substitute for James' Powders.- It is made by mixing the Sulpr. Ant. with shavings of Horn & exposing them to heat.- Then we have an Oxide of Ant. Combined with Phosphate of Lime as the result.- It is a very uncertain & variable preparation.- If we were sure that it was a Protox. of Ant.- We would then know that it would unite with the acids of the stomach & form some salt of Ant.- but if it be a Perox. it will not.- It is of dull white colour.- inodorous, insipid, insol. in water, slightly Febrile diseases. sol. in Alcohol.- Dose 3 to 6 grs. every 4 hours 2 1 Sulphuretum Antimonii Precipitatum, is formed by boiling Sulp. Ant. with a sol. of Carb. Pot. then straining & adding Sulp. Acid & we have an orange-coloured precipitate.- If no Sulp. Acid be added, the precip. which falls spontaneously is Kermes Mineral of a dark brown colour if after the Kermes is obtained. we add to the remaining solution Sulp- Acid- we shall have Golden Sulphur. Ant. Sulp. Precip. is a mixture of both The Precipitated Sulphuret is similar to Antimony 77 in its effects upon the system,- but is very uncertain in its operation.- It is seldom or never employed in this country.- Given sometimes for Scrofula & cutaneous diseases, in dose of 1/2 gr or 1 gr. 2 or 3 times a day & may be combined with Calomel. It is said to be less injurious when long continued than Tartar Emetic.- Dose as a Diaphoretic 1 to 4 grs.- Emetic 8 to 10 grs.- Twenty Fourth Lecture July 3 1834. Citrate of Potassa.- is seldom kept in the shops, but is prepared extemporaneously for prescriptions &c. It is made by saturating a solution of Citric Acid or Lemon Juice with Carbon Pot. then we have in a solution of Carbonic Acid Water, Cit. Pot. Its taste is not unpleasant,- called Neutral Mixture. The common formula is to take ƒ℥iiij fresh Lemon Juice & add gradatim Carb. Pot. till effervescence ceases. Dose tablespoonful every 1, 2 or 3 hrs. with a little water. It is well calculated for Remittents & Intermittents, if it produces pain in the bowels or purges, give a few drops of Laudanum. 78 Another form in which this is given is the effervescing Draught,- which differs from the former, only in being given a state of effervescence. Make a solution of Carb. Pot. ʒij to ƒ℥iiij water & filter, then a tablespoonful of this with a tablespoonful of Lemon Juice & also one of water, will make the mixture. Sometimes the reason that no effervescence takes place is because only part of the Carb. Pot. is decomposed. & the Carb. Acid goes over to the other portion & forms a Bicarb- if however, the Bicarb. from the weakness of the Lemon Juice, no effervescence Pot. be used.- we shall always have an effervescence, but at the same time, we cannot be always sure that we have a saturated solution.- Hence Carb. is best- ensued,- then add a little more. When Lemons & Limes are scarce, a solution of Citric Acid may be used of ʒij to ƒ℥iiij water & [add] Ol Limo is gtti- Guard. against the fraud of selling Tartaric for Citric Acid.- Distinguish by dissolving & adding Carb. Pot.- the former will produce insol. Bicarb. The precipitate of Silicate of Pot. may be avoided by using the Bicarb. Pot. ʒiij to ƒ℥iiij water. To increase the Diaphoresis Tart. Emetic or Sweet Spt. of Nitre may be added. Acetate of Ammonia is also employed Liq. Ammo. Acetates (U.S.) only in solution, when it is called Spt. Mindereri It is made by saturating Distilled Vinegar with Carb. Ammo. It is a limpid, colourless fluid. When Ammo. is in excess, it is injurious on acct. of its stimulating effects. Fixed alkalies,- Strong Acids & Sulp. Magnes. are incompatibles- Dose ƒʒss every 2 or 3 hrs. 79 Citrate of Ammonia possesses no superiority Potassa Nitras.- It is doubtful whether Nitre possesses any diaphoretic properties, but it certainly exerts an influence upon the arterial excitement. It is advantageously given in fever, as in the following Rx Potas. Nit. ʒi Calomel grs xii Tart Emetic gr i Usually our Intermittents do not require a large doses of Calomel. [mft.?] Pulv. No viii Give one every 2 or 3 hours. Dose of Nitre is 10 grs. frequently repeated Swt. Spt. Nitre.- to quiet nervous derangement in fevers, as in Children gtt 20 to ƒʒi. We next come to the Stimulant Diaphoretics C.47 A.213 A.209 for Guacacum,- Xanthoxyfum, Mekereum and B.25 Sassafras,- see Books A, B & C. Twenty-Fifth Lecture July 7 1834 Sarsaparilla- see Book A. p. 107. Expectorants are those medicines which facilitate or increase the discharge of mucus from the air vessels of the lungs. This they do in several ways- 1. By relaxing the constricted vessels of the lungs. it is in this way the nauseating emetics act as Expectorants. 80 2. By reducing the quantity of the secretion which may sometimes be so great & the fluid so abundant that the patient cannot cough it up. 3. By entering the circulation, coming in contact with the secretory vessels, & stimulating them to proper action. Hence we find there are 2 classes of Expectorants. One when the lungs are excited & require depletion as in Catarrh. Pulmonic Irritation & Inflammation &c. & the other when the vessels of the lungs are relaxed & pour out more than a proper quantity of fluid as in Asthma, Consumption &c. During the use of Expect. keep the Surface of the body warm.- Purging is not incompatible.- Expectorants may act in another way, by mechanical influence, as in cases of great debility, where the power of the pectoral & other muscles, is insufficient to accomplish the desired object, these then must be stimulated, in order to call into action the nervous influence, as by Wine Whey, Vol. Alkali. Ammonia &c. 81 The best of the whole class of Expectorants to be given in cases of an excited character is Tartar Emetic. It is useful in Asthma, Pleurisy & the like. Dose 1/8 gr. Of Vin. Ant. from 15 to 30 drops. A.32 A.67 For Ipecac & Squill see Book A. Twenty Sixth Lecture July 10 1834 A.103 A.93 C.41 On Allium, Senega, Ammoniacum, Assafateda, C.43 C.43 C.29 C.25 C.49 Galbanum, Myrrh, Turpentine Copaiba, Tolu, C.49 C.51 Balsam of Peru, & Benzoinum. See Books. On Emmenagogues The menstrual fluid is a peculiar secretion of the uterine vessels. A retention or irregularity of this discharge sometimes occurs, & then the intervention of medicines called Emmenagogues is necessary. As with other organs, so from analogy we may suppose that there are medicines which have a peculiar affinity for the vessels of the Uterus, but not many of these are yet known. In practice, at present, those circumstances producing Amenorrhea are considered in order to discover the particular Emmenagogue requisite in each case, & prescribed accordingly. 82 Thus, when it is the result of debility, Tonics, by giving tone & strength to the system, act as appropriate Emmenagogues,- as,- Preparations of Iron,- Bark,- Myrrh &c. It may be the result of general excitement, then evacuants become proper. Sometimes it arises from a diseased state of the system, as in Consumption,- Dropsy &c.- & it is evident that until these are cured, it will remain. Sometimes it may arise from that state of the bowels which we find in Constipation, then of course, Purgatives are appropriate. B.209 Aloes.- From the great affinity which this has for the large intestines, we may suppose that the irritation which it causes may be extended by sympathy or it may have a specific tendency to the Uterus to the Uterine Vessels.- It is often given in combination with Iron,- Myrrh &c. A.63 Helleborus Niger.- The Tinct of this in the dose of 60 grs 2 or 3 times a day has proved very beneficial in Dr. Meigs' treatment of Amenorrhea.- Dr Wood has found Aloes & Carb. of Iron, long continued a very efficient remedy. Also in Dysmenorrhea.- 83 The Chalybeates are excellent Emmen.- & of these Ferri. Carb. Preccip. appears most efficient. on the treatment of Amenorrhea, if any disorder in any one of the other functions of the system exist, first remove that disease & then give Emmenagogues Sometimes it may be proper to give the Emmenagogues in conjunction with remedies suitable to the cure of the original disease.- Thus if constipation existed, Aloes & Iron might be joined with the remedies for constipation. Aloes & Iron should never be given in an excited state of the system, without previous depletion. Twenty-Seventh Lecture July 14 1834. A.93 C.47 B.47 B.179 On Madder, Senega, Guacaicum, Sabina, Ergot, & Tinct. Cantharides as Emmenagogues.- There yet remain 2 classes of medicines to be noticed, which act not upon the viscera themselves, but upon their contents, & these are Anthelmintics & Antacids. Adjourned July 23rd to Sept. 7 1835. Anthelmintics are medicines used either to destroy Worms or drive them from the body. There are 4 species of Worms- Lumbricoides, Ascarides, Tricuris & Tania or Tape-Worm. 84 They operate in different ways. Cathartics may act as such by operating upon the bowels, & Tonics, by imparting tone to the system, as well as by poisoning the worms. The worms may either be poisoned so that they are induced to change their place,- or they may be killed by the medicine mechanically.- Calomel is the most efficient anthelmintic & probably may act by increased the flow of acrid bile, which is very disagreeable to the worms,- they change their place, & are carried off by a subsequent dose of Oil. Dose for Child of 2 yrs. 5 grs.- Twenty-Eighth Lecture July 17. 1834 A.65 On Spigelia Marylandica:- Azedarach or Pride of India or Pride of China of which the bark of the fresh root is used.- It is a native of Syria, Persia & India & cultivated in this country. It is used extensively as an Anthelmintic in Georgia. It has a bitter, nauseous taste & is generally given a decoction, made from boiling ℥iiij in Oij to Oj- of which the dose is a tablespoonful every 2 or 3 hours, until it affects the bowels,- or morning & evening for several days & follow it with an active Cathartic. 85 B.177 A.207 also on Chenopodium, Bark of Geoffroya [Inemus?] B.177 A.181 B.139 C.29 Dolichos, Tilix Mas, Pomegranate, Oil of Turpentine, which latter is one of our most powerful Anthelmintics & especially useful in expelling the Tænia the dose is from ƒ℥ss to ƒ℥ij or ƒ℥iij. This generally heats the stomach, & even excites giddiness &c. together with acting upon the bowels. If it do not purge in 3 hrs. after it is taken, give a dose of Castor Oil. Some combine the Oil of Turpentine & Castor Oil together so as to be more certain of its operation. This answers very well, especially in Lumbricoides. The Oil of Turpentine, in small doses, is often given with advantage to children, who complain of pain in the stomach, without any fever &c. when worms may be suspected. the worms in the stomach are destroyed & digested. Whether there actually be worms or not, it often operates very favourably. Copaiba acts similarly Cedar Apple operates in much the same way. Filings of Tin, Pulv. Sfanni have very strong testimony given in favour of their anthelmintic virtues. By some, they are said to act mechanically by their rough, grating surface, but if this were so, sand would act as well 86 Others say, Tin acts favourable on account of the Hydrogen which is evolved, but if this were so, Iron or Zinc would answer the same purpose.- Others suppose that it is from the Sulphuretted Hyd. generated, but we might suppose that the worms had become sufficiently accustomed to this Gas, to feel no inconvenience from its presence. Others suppose that it acts by the Arsenic contained in the Tin, but Arsenic itself will not act thus. Why, then, may we not suppose that the Tin is a medicine noxious to the worms, & consequently acts in this rational manner.- Dose is very indefinite, varying from ʒi to ℥i, given in the morning for 2 or 3 days, then followed by a Cathartic. Aurum Mozaicum, was a compound of Sulphur & Oxide of Tin.- Dose 10 grs. twice a day Pomegranate- Bark of Root- see B.139 Adjourned till September. 87 Twenty-Ninth Lecture Sept. 1 1834 On Antacids.- Antacids are those medicines which are given to meet the acids which are sometimes found in the stomach & bowels and convert them into harmless substances. The acids arise not only from the gastric juice in health, but also more copiously in a diseased condition of the stomach. The diseases in which this state is generally found are Dyspepsia, Diarrhea, & Bowel complaints of Children,- but an acid state of the stomach may accompany almost any disease. All the salifiable bases may be considered as Antacids,- but those generally employed are the Alkalies & Alkaline Carbonates.- Potassa in its pure state is not adapted to internal administration.- Carbonate of Potassa or Salt of Tartar is frequently given as an Antacid.- It is often added to bitter infusions,- so that while the acidity is corrected, a tonic impression may also be made upon 88 the stomach.- The dose of it varies with the acid contained in the stomach.- generally from 10 to 30 grs. & repeat it if necessary.- A pleasant form for administration is in solution in Cinnamon Water with a little Sugar.- Another form in which it may be given is by taking a teacupful of Soot,- & 1 quart of Hickory Ashes,- shaking them together in 1 Gallon of Water, let them stand [cross out] 24, 24 or more hours, then pour off the liquid.- Besides the Carb. Pot. this liquid contains perhaps Kreozote &c. Carb. Ammo. & some other ingredients- The dose of it is a Wineglassful 3 or 4 times a day, & it is rendered more agreeable by adding 10 or 15 gtt of Aromatic Ammoniated Alcohol.- This a very effectual preparation for the prevention of sick headache, which frequently arises from acidity of stomach) if taken, when the symptoms warn us of its approach. Bicarbonate of Pot.- is used as the Carbonate. The only objection is the evolution of a large quantity of Gas in the Stomach.- 89 The preparations of Soda however, are better than those of Potassa; because of the less quantity necessary to neutralize a certain portion of Acid & of the less disagreeable taste.- Soda.- like Potassa,- is not given pure. Carbonate of Soda is obtained from Seaweed or from the decomposition of Sulph. Soda by Charcoal & Carb. Lime.- It chrystallizes in Octohedrons. Effloresces on exposure,- because it contains about 62 pr.ct. Water of Chrystallization,- hence its strength is constantly varying.- The chrystals are soluble in about 2 parts of Cold & less than their own weight of boiling water. It is less disagreeable to the taste than Carb. Pot. Is useful in Jaundice to assist a mercurial action probably by entering the circulation & stimulating the secreting vessels of the liver. The dose varies according to the variety of its strength before stated.- Generally from 10 grs. to ʒi may be given in solution or in Pill. If the latter, it should first be deprived of its Water of Chrystallization by heat. 90 Bicarbonate of Soda more properly Sesquicarbonate is formed by passing a stream of Carbonic Acid through a solution of Soda,- then driving off the excess by heat below 120°,- or by introducing the Gas into a cask containing the Chrystallized about 10 pr.ct. Carbonate.- It contains less water of Chrystallization than the Carbonate,- and is soluble in 10 times its weight of Cold Water. Dose of it is from ʒss to ʒi.- & may be given in Carbonic Acid Water. Ammonia, when pure is gaseous. It is obtained by mixing Mur. Ammo. & Quick Lime Water impregnated with it forms the Aq. Ammo. of the Shops;- it is colourless,- with a pungent taste & smell,- corrosive & caustic, if applied to the skin.- & should be kept in well stopped bottles to prevent the access of Carbonic Acid. Externally it is used as a Rubefacient,- & it may be employed as an [illegible] to prevent fainting. A better preparation for internal use is the Aromatic Ammoniated Alcohol made by impregnating or Arom. Spts. of Ammonia. {If the patient should take the prep. of Ammo. without} {dilution, the mouth & throat may be injured, then gargle} {in the dilute vinegar & smear the part with Oil.} 91 Alcohol with Ammonia & adding some Aromatic Volatile Oil. This a delightful Antacid pleasant to the smell & taste & grateful to the stomach. The dose of it is from 15 to 30 drops, but must be diluted before it is taken. Carbonate of Ammonia is much used p.144 as a Stimulant & will be treated of hereafter Lime.- is seldom used in its Caustic state except in the form of Liquor Calcis, which is a saturated solution of it in Water. Water takes up 1/778 part of its weight & it is more soluble in Cold than Warm Water. It has an acrid, alkaline, unpleasant taste, but when mixed with an equal proportion of milk, loses these qualities & becomes one of our best remedies for nausea & vomiting arising from gastric irritation- It corrects that disposition by calming & giving tone to the stomach. Of the Carbonate of Lime, there are several varieties,- all nearly tasteless, insoluble in Water unless impregnated with Carbonic Acid. They 92 are all composed of 1 Equiv. Carb. Acid & 1 Eq. Lime. Creta Preparata,- one form of it, is prepared by levigating ordinary Chalk. Other forms are Testa Crab's Claws Prep.- Tela Cancrorum Prep.-Ovorum Testa Prep.- said to be preferable to Cret. Prep. on acct. of the animal matter which they contain,- are more minutely divisible.- Carb. Lime is useful in Diarrhea on account of its Antacid as well as its astringent power. Dose varies from [varies] 10 grs to ʒij- From 10 to 20 grs may be given every 2 or 3 hours.- It is usually administered in the form of the Chalk Mixture or Julep,- consisting of Cret. Prep. In making mixtures &c. the Cinnamon water should always be diluted with simple water otherwise it is too strong. Tinct. Opii Acac. Gum. Sacch. Alb. Aq. Cinnam. et aq. Pura.- Magnesia & its Carbonates are both excellent Antacids, especially in cases connected with Constipation, & may be given in Dyspepsia,- Gout, & the complaints of Children. Sometimes it offends the stomach. 93 We next come to speak of those Local Remedies which affect the Organization of the Parts. Rubefacients produce a redness of the surface; when there is much irritation, the vessels pour out a serous fluid & blisters are the results. But this serous fluid is not secreted equally from every irritation, thus we find less of it from Mustard than from Cantharides, & hence we have the different names of Epispastics & Rubefacients. Some substances destroy the parts to which they are applied & are called Escharotics. Hence we have these three classes, Epispastics, Rubefacients & Escharotics. When an Epispastic is applied to the skin, it excites the subcutaneous vessels & causes them to throw out a serous fluid under the cuticle. This local irritation produces a general excitement which in the case of Cantharides is probably owing partially to the absorption of some portion of the Cantharides. 94 There are 2 Indications for the application of Blisters: 1. To rouse the dormant powers of the system. & 2. To break up the chain of morbid action. For the first, they are useful in typhoid diseases, but when these diseases have assumed a chronic form & have nearly exhausted the powers of the system, they cannot be applied with advantage because there is nothing to sustain the excitement & the system sinks lower than it was before. But in acute diseases, where there is sufficient dormant power to keep up the excitement, they often act very favourably. Hence we find that in typhoid diseases, judgment is requisite. to determine the time proper for their application. They are apt in very low cases to produce sloughing & even gangrene, & if applied, it should be to the inside of the thigh, rather than the leg. For the second indication, they are used in Intermittent & Remittent Fevers. They make a violent impression upon the system which breaks up a chain of morbid action & institutes that 95 which is more healthy.- They should be applied during the interval of Paroxysms, so that their action may take the place of the expected attack.- Blisters sometimes compose the nervous system in disease, as in Chronic forms of Fever, when the patient is very restless,- tossing about &c. he will often be composed to sleep by applying a pair of blisters to his legs.- 3. They act favourably also upon the Principle of Revulsion,- as in Chronic Opthalmia, Pleurisy, Hepatitis &c. - Nausea & Obstinate Vomiting. - A good rule for the locality of Blisters is, if it be an Inflammatory disease, apply them as near as possible to the part affected,- but if it be some nervous affection, apply them to a more distant part so as to draw off the nervous influence. Hence in Hemoptysis, after checking the Hemorrhage, blisters may be applied to the extremities to draw the blood down from the Chest. One caution however is very necessary, which is, never resort to blisters in cases of acute Inflammation 96 Inflammation without previous depletion,- because the general excitement which they produce will only aggravate, instead of cure the disease.- It is from this principle of drawing off the nervous excitement that they are beneficial in Spasmodic affections, as in Cholic & Cholera.- These are nervous affections, & when not connected with any Inflammation, sinapisms are better than Blisters. 4. They sometimes prove beneficial in Tinea Capitis & other complaints by introducing a new action. 5.- Blisters are depletory in their action. They should not be applied however in dropsical cases because they are apt to become ulcers or Gangrene.- 6. The pain from blisters is sometimes useful when the mind is diseased,- quieting the nervous excitement Case of a Lawyer who put a blister on his back, whenever he attempted to plead.- 7. Another use of blister is for the Endemic application of medicines to the denuded surface 97 Thirtieth Lecture Sept. 4 1834 Cantharis Vesicatoria.- Littus Vesica. Melöe Vesicat Spanish Fly. This insect is found in Spain, Italy, Sicily, France & the warmer latitudes of Asia, is of an oblong shape,- 3/4 in. in length & about 1/4 in width,- having a fetid odour when alive, compared to that of mice,- & is of a beautiful green colour. They are gathered by shaking or beating the trees on which they feed, and collected on linen clothes spread beneath. They are then killed by immersion in vinegar & water, then dried & carefully packed for market They are sometimes adulterated with an insect of a square shape If preserved in well-stopped bottles, they will keep a long while & retain their virtue a number of years. Sometimes they are attacked by worms and injured.- If kept in damp places, they soon putrefy.- .- They have a disagreeable odour & an acrid taste they yield their active principles to Water & Alcohol, & contain a chrystalline substance called Cantharidin 98 Cantharidin, which is insoluble in Water & Cold Alcohol, but soluble in boiling Alc. from which it precipitates when cool,- sol. in Ether & Vol. Oils.- In the insect, it exists combined with a yellow matter which renders it sol. in W. & Cold Alc.- It is said that if the flies be boiled,- they will not produce strangury when applied.- Dr M. B. Smith prevents strang. by giving teasp. of Uva Ursi during the operation of the Canth. The most extensive use of the Cantharides is in the form of Blistering Plaster, (See Dispensatory) Cerat. Canth. (U.S)- Emp. Canth (British)- It is well worthy of notice that a Plaster will keep for a long time & that its virtues are not exhausted by one application.- Ol. Canth. is not used.- There is a weaker preparation (Mug. Canth.-) used as a stimulating application to keep open blisters &c. We have also Emp. Picis cum Canth or Emp. Calefaciens.- or Warm[ing] Plaster.- consisting of 1 part of Cerat Canth to 7 prts. Burg. Pitch, which is an excellent application [consisting] used in chronic Catarrh. Rheumatism of Intercostal muscles &c. Limmentum Canth.- consists of Decoct. Canth & 99 Spt. Tereb.- There is also a Tinct. Canth. Cantharides whether applied internally or externally are apt to produce Strangury. When we have reason to apprehend this, give freely of demulcent drink, remove the Plaster & make some emollient application to the part,- as for inst.- a soft Bread and Milk Poultice, with a little Laud. spread over it.- In this manner, sometimes if the Plaster be removed in 6 or 8 hrs, & a Poultice applied, we shall frequently find a fine blister.- This caution is requisite in blistering over the eye lest the long continuance of the Plaster should create too great irritation.- But to return to Strangury,- as before stated,- remove the Plaster & give mucilaginous drinks,- & if these fail, give an anodyne injection of about 60 gtt. Laud. with 2 or 3 tablespoonfuls of Starch,- & repeat if necessary.- If these do not succeed, the last resort is to the Catheter. When a blister is left on too long, a sloughing may ensue, more common in children than in 100 adults,- as in low cases of typhus or scarlet fever With respect to the size of the Plaster, it should be generally as large as the place to which it is applied will admit. The largest size is 10 by 12.- It should be always cut to fit the part neatly.- When applied to the head, it is desirable that the head should be shaved 10 or 12 hrs previous if time will permit, so that the abrasions may heal up. The usual size for arms or legs,- 6 by 4.- After shaving the part, apply the blister & confine it by adhesive strips to prevent its slipping. On the Scalp, it should be left longer than on any other part,- generally from 18 to 24 hrs. On children, a blister is generally produced in from 4 to 8 hrs.- When the serous fluid has discharged so as to separate the cuticle, if it is desirable to heal it up immediately, do not destroy the cuticle, but make only small punctures to allow the fluid to escape. Sometimes the sac contains a gelatinous mass, which is the serous fluid coagulated.- 101 When the blistered surface becomes much inflamed & painful, apply warm milk & water,- soft Poultice,- Cream,- very weak Lime Water, or some such soothing application;- the best in Dr Wood's Practice is Goulard's Cerate, mixed at first with about an equal quantity of Simple Cerate. If it be desirable to keep the Blister running, destroy the Cuticle, & use some stimulating ointment. Cantharis Bittata. Potatoe Fly.- is another species, found in this country, & first introduced into practice as a vesicatory by It is found on Potatoe vines &c. in the morning & evening, feeding on the leaves. It has a reddish brown head;- & brown wing cases with a stripe of yellow upon the edge & along the centre. They are procured by shaking them in Hot Water, carefully drying &c. There are also other species Canth. Atrata Several vegetables possess the property of producing vesication when applied to the skin. None however are employed except Mezereum. for which See Book A p.209. Seldom used. 102 Ranunculus Bulbosus. Butter cup.- has a root possessing the properties of producing vesication, but it is uncertain & has different effects upon different individuals, consequently it is seldom or never used. Rubefacients should be preferred to blisters in cases of very violent & sudden prostration, when an immediate excitement is desired;- as in the sinking spells which occur in Typhus Fever, in the cold stages of malignant Intermittents, in prostration from Concussion of the Brain Syncope &c. But blisters, as before stated, are used to subvert morbid associations, compose the patient, for local inflammation &c. Rubefacients are very useful in spasmodic affections: At the head of the list of the individual Rubefacients, we place Mustard. see Book B. p.125. Thirty-First Lecture Sept. 8 1834 Capsicum, see Book B p.163. Ol. Terebinth. is a very good Rubefacient in low states of the system. It should be heated (with great care, lest it take fire) and applied either by friction or by flannels steeped in it.- If it gives too much pain, remove 103 it, for it sometimes produces unpleasant effects. From idiosyncrasy, it is very irritating & even poisonous to some persons, hence caution is requisites in using it. It is useful as a revulsent in deep-seated inflammation accompanied with prostration, as in Puerperal Fever,- tympanitic abdomen,- as a Liniment in Chronic Rheumatism &c.- see p.142 Pix Abietis. Burgundy Pitch. The prepared concrete juice of the Norway Spruce Fir. It exudes spontaneously on the bark of the tree, whence it is scraped, heated in Water & strained. It comes to us from Germany & Switzerland. It is brittle, opaque, brown externally, yellowish internally. Thus is hardened spontaneously exuded juice of P. Abies It differs from the Turpentines in containing less volatile oil. It softens by heat, & by contact It consists of Resin, Vol. Oil & water. becomes dark by exposure.- with the skin, it is just sufficiently softened to adhere. When thus applied excites a sufficient degree of irritation to increase the perspiration.- In one case of an old gouty patient, Dr Wood knew it to produce violent inflammation & even ulcers whenever it touched him.- It is useful in Rheumatic effection,- Chronic Catarrh,- Dyspnea,- and other Pectoral Complaints. 104 Pix Canadensis. Hemlock Pitch. derived from the Pinus Canad. or Hemlock Spruce of N. America. The juice exudes spontaneously from old trees upon the bark,- this is then stripped, boiled twice & strained. It is of a brown colour, more yellow internally. It consists of Resin & less vol. oil than Turpentine. It is used similarly to Burg. Pitch: by some preferred. Aqua Ammonia. is seldom used alone but generally in the form of Vol. Liniment, a. e. combined with Olive Oil; usually in the proportion of 1 part Aq. Ammo. to 4 parts Oil,- but this varies according to circumstances. It is useful in Catarrh, Rheumatism, Sore throat &c. of Infants especially.- Aq. Ammo. is very uncertain in its strength, & sometimes so weak that it will not unite with Oil to form a Liniment:- it should then be rejected.- A plaster can be made of common Lead Plaster Soap. & mur. ammo. which will last for about 24 hours, & answer the same purpose with the Liniment. A decomposition takes place & the Ammo. is slowly given off.- 105 Tartar Emetic. for the history of this see page 28. It is often applied externally as a Rubefacient. From one to three days generally elapses after it is applied, before any effect is produced: at length an itching & prickling sensation is felt, followed by small red pimples, which increase and become pustules, & afterwards even ulcerate if the application be continued. It acts upon the principle of Rubefacients & Epispastics.- There is however one advantage in its use:- we know that a recession of eruption oftentimes produces internal inflammation & disease, & hence when the eruption can be again brought out, the disease disappears, thus the Tart. Emetic by producing this pustular eruption, alleviates the complaint, having a much better effect than the discharge from Blisters. It operates too more deeply;- affecting not only the cuticle, but extending the pustule down to the cutis vera, & consequently, we may suppose, produces a greater effect upon the system at large. 106 With respect to locality, Dr. James thinks the arm a preferable place, but probably it is more efficient when applied to the back. In inflammatory affections, however, as a general rule, apply it as near as possible to the inflamed part. It is useful in obstinate chronic Pleuritis, Hepatitis, &c.- & an excellent application to the Spine, when there is Tenderness upon Pressure, Nervous Derangement, Hysteria &c.- First apply Cups to the part then apply the Ointment or Plaster. It must be remembered, however, that when applied to a cupped surface, instead of requiring 2 or 3 days, it become almost insupportable in from 1 to 3 hours. It may be used in the form of Lotion, Ointment or Plaster The Lotion is the least favourable mode & seldom used. Ointment is made by mixing ʒi (more if necessary ʒi or ʒij) Tartar Emetic with ℥i simple Cerate. Rub a little on every 4 or 6 hours, or spread it on linen & apply it. The most convenient form is that of the Plaster. This is simply a Plaster of Burg. Pitch, covered over with Tart. Emet. except at the cases so as to allow it to adhere 107 It is generally left on 3 or 4 days, then removed.- if it will not come off readily, apply a little Olive Oil. Almost all the volatile Oils are Rubefacients, but seldom used. One sometimes employed is Ol. Monardo Punctate. or Horsemint Oil. Croton Oil has been recently recommended, mixed with 4 prts. Olive Oil. Escharotics are those substances which destroy the life of the parts to which they are applied & produce a sloughing. They operate in 3 ways, either by their direct influence, or by chemical decomposition.- When they operate in the first manner, the life of the part is lost, because the part is unable to bear the application. In the second, the life is destroyed because of the chemical disorganization of the parts. They are employed for forming Issues, opening abscesses. & subverting diseased action by destroying the part diseased and substituting an action of its own. Of the individual Escharotics, none are more severe than the Heated Iron, or Actual Cautery. This is used for arresting Hemorrhage &c. but seldom in this country, unless in Hemorrhage from the Fauces where no ligatures &c. can be passed. 108 Another mode of applying it is by Moxa. This, too, is seldom used in this country. It is made of Pith. of Sunflower which contains Nitre or other similar plants, or of Rolls of Linen, Cotton &c. imbued with Nitre, so as to continue the combustion. or with Bichromate of Pot. Potassa is next in power as a caustic. It is obtained from Scalsed Lime & Carb. Pot. found in cylindrical pieces kept in paper & in It is deliquescent well-stopped bottles. Caust. [Coru????re] [Acen??um] (old) It is applied as follows. A piece of adhesive plaster with a hole about the size of the place required, is laid upon the part, then take the caustic, wet it & rub it on until the part is black. remove the plaster, & wipe it off with a piece of sponge, then apply a poultice, & in 8 or 9 days, an ulcer will form into which Issue Peas may be introduced to keep open the Issue. Sometimes the Pot. is mixed with Lime, water & soap, & formed into a Plaster, but this is not so good. Issues are adapted to Chronic diseases &c. Caustic is sometimes used for opening abscesses, for removing flesh from poisonous wounds &c. & dissolved in water, it has been recommended for Tetanus by Dr Hartshorne 109 Thirty-Second Lecture Sept. 11 1834 Nitrate of Silver or Lunar Caustic (Argent. Nit) is formed by dissolving Silver in Nitric Acid, drying & moulding it &c. It is white & semitransparent, but when exposed to the air & light, it becomes dark by decomposition & oxidation. It affects only the surface to which it is applied forming an eschar which prevents it from acting deeply & does not penetrate like the Potassa, hence it is employed only for destroying sores &c. as old ulcers. chancres &c. In solution, it may be used as a stimulant to ulcerated surfaces, as in ulcerated Cornea, sore opthalmia, soreness & running from the Ear, &c. for which it is almost a sovereign remedy, if properly applied. A work has lately been published recommending it in arresting cutaneous inflammation. It is generally applied by rubbing it over the surface. The proper proportion for an Eye-Walle is 1/2 gr. to grs ij to ƒ℥i Distilled or River Water. But when the Cornea is ulcerated, its strength may be increased, or a better plan is to apply it with a camel's hair- 110 pencil.- For the Ear, begin with a solution of about grs ij to ƒ℥i & increase it if necessary, to 3 or 4 grs to ƒ℥i Distilled water. If it should be applied by injection, always use a Silver Syringe, as others will decompose it. Arsenious Acid or White Oxide of Arsenic, obt. by sublimation from the Ore is sometimes used for Cancerous Affections, & is the basis of most of the empyrical remedies for that disease. There is danger, however, of the poison being absorbed, & hence it is seldom prescribed by a regular physician.- more danger in a dilute than caustic state. Sulphate of Copper (Cup. Sulph.) is sometimes employed as an Escharotic. generally in Solution: A solution of grs XX to ƒ℥i Water is an excellent application to Chancres &c. gtt i per day will often completely destroy them. A solution of it is also used for ulceration which is often seen in the mouths of Children, accompanied with fetid breath Gangrene Swollen cheeks &c. it proves a very effectual & certain remedy Verdigris, is sometimes used at Escharotic. 111 Corrosive Sublimate or Bichloride of Mercury is seldom used as an Escharotic, but as a stimulant in syphilitic affections &c.- A [solution] mixture of it, however, is very efficient in arresting a disease of the Fingers & Toes called Onychia Maligna, once considered incurable- Take equal parts of Corrosive Sublimate & Sulph. Tinc.- mix them together, & sprinkle them over the surface of the diseased parts. then apply a Pledget of Lint & over that Tinct. Myrrh or Laud.- For about 1/2 an hour, the pain is very severe, when the part becomes destroyed, & soon heals again kindly. For Syphil. ulcers in the Throat, apply a sol. of grs V to X to ƒ℥i- Cutan. eruptions grs ij to ƒ℥i Alumen Exsiccatum. Burnt Alum. is applied in the state of powder to the fungous flesh &c. which sometimes appears upon ulcers. It acts as a gentle escharotic. It has been recommended in Sore Throat, to be applied by the fingers, or in solution- grs XV to ƒ℥i. The mineral Acids may all be considered as Escharotics, especially the Sulphuric & Nitric Dilute Sullph. Acid is sometimes used for cutaneous diseases in ointment Dil. Nit. has been used for ulcers. It was also used equal parts of Nitric Acid & Water. for speedy blistering in Cholera, but is not much at present. 112 Demulcents act by a mechanical power. They are generally mild, unirritating substances, soluble in water, & usually consist of gummy, saccharine, farinaceous & Oleaginous Principles. They are used for 2 purposes. 1. To defend the surfaces with which they come in contact from irritating substances, as in Catarrh &c. 2. They mingle with the acrid matter secreted, & obtund its acrimony, hence they prove useful in Dysentery, Diarrhea & other irritations of the bowels also in Nephritis, Strangury, Gonorrhea, &c. We next notice the individual Demulcents C.51 C.53 A.215 Gum Arabic, Tragacanth, Ulmus Fulva, Flax Seed B.135 B.25 Pith of Sassafras, Quince Seeds and A.115 Liquorice Root. for which see Books A, B & C. Thirty-Third Lecture Sept. 15 1834 B.189 C.55 C.53 C.55 B.133 On Lichen Isl.- Sage,- Tapioca.- Maranta & Barley, for which see Books B & C. We next come to the General Remedies, & the first Class comprises the Astringents. These are medicines capable of contracting or corrugating the 113 living fibre, as is obvious to the senses for inst. the mouth becomes puckered by chewing an astringent. It does not act merely by a mechanical power, but every living fibre possesses a property of contractility, & the Astringent affords the stimulus necessary to produce the effect. The influence of different medicines upon the stomach is soon communicated to the whole system, & it is by this general sympathy, that we account for the operation & general effects upon the system at large, of astringents taken into the Stomach. The Indications for the Use of Astringents then are evident from their method of operation. It is plain that they would be injurious when the discharge depends upon some foreign cause, unless that cause first be removed. As they are somewhat excitant in their nature, they would be injurious in an irritated or inflamed state of the system. They would prove beneficial, then, when the morbid discharge depends upon a weakness of the vessels 114 vessels after the exciting cause has been removed. when there is no inflammation in the part: or when a suppression of the morbid discharge even without arresting the disease, would be of less serious consequence to the patient, than to allow its continuance as for inst. suppression of Diarrhea in Consumption. They are used chiefly for the purpose of restraining Diarrheas, & arresting Hemorrhages; but they are not proper to be given in fever, with excited arterial action. They are generally used as External or Local Applications. When given with a view[ing] of arresting Hemorrhage, depletion may first be used with advantage, as in blood from the Nose, from ruptured vessel, from wounds &c. tho' frequently it is not necessary.- There are 2 Classes of Astringents, the Vegetable & Mineral. The Veg. Ast. owe their property to Tannin. The Mineral; to a peculiar specific Influence. We next come to treat of the Individual Astringents. First. Oak Bark. derived from different species of Quercus, & Galls. for these, however, see Book B p.15 & p.17 115 Thirty-Fourth Lecture Sept. 18 1834 C.57 C.59 A.125 A.193 On [Catechu?], Kino, Rhatany, Logwood, Geranium A.131 A.129 Maculatum, Rubus villosus & trivialis, for which see Books A and C. Thirty-Fifth Lecture Sept. 22.- B.49 B.95 A.135 Uva Ursi.- Black Alder Bark, Roses, Tormentil, A.127 A.183 Bistort, Alkanet, for these see Book B & A.- The unripe fruit & the bark of the Persimmon, Dispyros Virginiana, have been used as Astringents Tarmin, itself, in a pure state, has recently been used as an Astringent. It is of a brown colour, brittle unchrystallisable, sol. in water & dil. Alc. but not in pure Alcohol. Dose 5 to 15 grs. Mineral Astringents. Alum:- is a double salt, consisting of the Sulph. Alumina & Sulp. Pot. with about 50 pr.ct. Water of Chrystallization. Sulph. Ammo. or Sulfs. Soll. might be Substetuted for Sulfs. Pot. in forming the Chrystals. It has an astringent taste accompanied with sweetness is soluble in about 16 times its wt. of water at 60° & 3/4 its wt. boiling water.- When exposed to heat 116 it melts, loses its W. of Chrystallization & falls into powder. Its incompatibles are the Alkalies & their Carbonates, Lime, Magnesia & Carb. Acid of Lead, & the Mercurial Salts.- also veg. infus. as Galls, Kino. Bark &c. It is employed with advantage in obstinate chronic Diarrhea, in the relaxed state of the bowels which follows Dysentery, in Passive Uterine Hemorrhage, when not connected with an excited state of arterial action. Also in Cholica Pict. united with some Aromatic as Nutmeg & it has been prescribed for curing intermittents. Internally, its powers are feeble, & hence we cannot rely upon it in Diabetes, Leucorrhea &c. When that given, it is apt to offend the stomach, combine it with Recently its powder has been recommended to be applied with the finger upon the inflamed fauces, in Scarlatina Cynauche [???silllaris] &c. also in strong solution of 15 or 20 grs to ƒ℥i, as an injection for Epistaxis, Bleeding from Rectum &c. Nutmeg or some other aromatic. Alum Whey is made by boiling ʒi Alum in Oj milk. Dose ƒ℥i or ƒ℥ij. A gargle for relaxed Uvula &c. may be made of grs V or X to ƒ℥i water. An injection of this solution into the nostrils will arrest Epistaxis. It may be used in Gonor. Fluor Albus &c. Alum Curd. made by agitating white of Egg with Alum good application for Inflamed Eye, Ecchymosis &c. 117 The Preparations of Lead, although they are Astringent, yet they have a peculiar & specific action. The symptoms which they produce upon the human system are numerous. but the most prominent are such as appear in Cholica Pictorium, where, besides the Pain in the Abdomen, Costiveness &c. we have pain in the external muscles, partial palsy, & sometimes an affection of some of the organs of sense. These preparations produce immediate nervous derangement, as well as act as Astringents. Litharge: Ox. Plumb. Semivit. is a Protoxide It is made by exposing Lead to heat in a reverberatory furnace, is in small scales of an orange yellow colour & is used chiefly for forming the Lead Plaster. Emp. Plumbi. This is done by boiling it with Olive Oil & a little water. The water unites with the Oil, so as to form Oleic & Magaric Acid, & these uniting with the Ox. of Lead form the Oleate & Magarate of Lead, of which the Plaster is probably composed. It is used principally for forming other officinal plasters, sometimes It is an excellent application to prevent ulceration from pressure in low fevers, long continued. for application to excoriated surfaces but seldom. 118 Carbonate of Lead or White Lead is formed by exposing lead in thin plates to the action of the vapours of vinegar. It is a powerful astringent, & often produces Cholica Pictorium. It is never given internally, but sometimes is applied to excoriated surfaces in the form of an ointment made of ℥i to ℥vj Simple Oinment. A plaster has also been directed by Pharm. at a substitute for May S Plaster, the principal ingredients are Lead Plaster & Carb. Lead. But the most important of the Prep. of Lead is the Acetate. Plumb. Acet.- Sacch. Saturni;- made by boiling Vinegar & Carb. Lead.- It is a neutral Acetate, consisting of 1 Eq. Acid,- 1 of the Base & 3 of Water It has a sweet, astringent taste, when dissolved in W. generally gives out the odour of Vinegar, on acct. of Sabacet.- but when pure is inodorous, efforescent, sol. in W. & Alcohol. Incompatibles are the Alkalies & Alkaline Earths, & their Carb. substances which with these Alk. form Soaps, Tart. ant. & Tart. Iron. sulphurates. Sol. Sulphates & Muriates, the Acids &c. so that the best plan when it is given is to allow the patient to 119 take nothing but Water or a solution of Gum &c. Different opinions prevail among practitioners respecting its efficacy, some considering it as a poison too dangerous to be given, & others prescribing it in a great variety of diseases. The terrors, however, which some have conceived respecting it, are unfounded, altho' in large doses or in small ones long continued, it certainly is dangerous. When given in small & continued doses, it acts upon the nervous system, more gradually, producing its peculiar effects, & will bring on Cholica Pic. sooner than if administered in larger doses. But by avoiding excessive or long-continued doses, by combining with opium, when not contra-indicated, by attending to the costiveness &c. it is safe. & frequently a very beneficial remedy. To cases of Internal Hemorrhage from the Lungs or Uterus, it is well adapted, but even though it may be given in an excited state of the system yet it must not exclude depletory remedies.- 120 In Uterine Hemorrhage, unconnected with Pregnancy, it acts favourably, combined with Op. or Ipecac It cannot be relied on, however, in Intermittents, Hooping Cough, Epilepsy &c. Dr Irvin of Charleston published a paper in 1820 recommending it strongly in Yellow Fever, & Dr W. has tried it once & was well pleased with it. The time for its administration in this disease is when Gastritis is at its highest point, when the patient begins to turn even a little yellow. Dr W. believes that it acts by coming in contact with the inflamed surface of the stomach, upon the same principle that it acts upon inflamed parts externally. It may also be beneficial in the same way in Dysentery It is useful in arresting the profuse Diarrhea in Cholera. Dr W. gives 2 grs Cal. & 1/2 gr Opii every hour. & in the intervals gives 2 grs. Acet. Lead. Parrish uses it in combination with Kino to arrest internal Hemorrhage. From its influence over the Nervous System, it might probably prove beneficial in Hydrophobia. 121 The dose of it varies according to different authors From 1 to 2 grs, & may be repeated every 2 or 3 hrs. After 10 or 12 grs. have been taken, suspend it, so that it may produce no injurious effects. It may be given in Pill [of] with Crumbs of Bread. Lead Water is made by dissolving ʒij in Oj distilled Water. This is a useful application to inflamed surfaces, by [illegible] wet with it, but must not be applied to excoriated surfaces. A Poultice may be made of it, by mixing it with bread, & enclosing it between linen. This is a good application to inflamed Eyes &c. A solution of 1 or 2 grs. Acet. Lead to ƒʒi W. is a good wash, for Optthalmia, Gonorrhea, Fluor Alb. &c. Goulard's Extract of Lead is made by boiling Letharge in Dist. Vinegar, & filtering the resulting liquor, or by boiling Letharge in a solution probably a comp. of Dis. & Trisacet. of Lead of the Acet. of Lead. It is said to be a Trisacetate. Sometimes it is of a greenish straw colour, owing to the impurity of the Vinegar, but usually is colourless alkaline in its properties, & decomposed by 122 those substances which are incompatible with the Carb. Lead already noticed & with Gum Arabic & Mucilages. Even distilled water produces a milky appearance with it, on account of the Carb. Acid which it contains. This is best test for Mucilages or Gum. It is used only as a Lotion in Eruptions & Local Inflam. Lead Water should contain about ƒʒij Goulard's Ext. to Oj Water. Goulard's Cerate is made by mixing [cross out] [simple cerate &c.] Goul. ext. with Oil & Bees wax. is a useful application to abraded surfaces, & especially beneficial to blisters in disposed to heal. Also Herpetic eruptions Sulphate and Acetate of Zinc are used as Ext. Ast. Also the Mineral Acids, which, are rather tonics. Lime-Water & Carb. Lime are sometimes useful in the Diarrhea, Cholera Infant, & the later stages of Dysentery. We next come to the subject of Tonics; upon which we will make some general observations. By this term, we designate those substances which have the power of producing & maintaining a gentle 123 exaltation of the actions of life in sudden & great prostration without necessarily causing any apparent increase of these natural actions. Unless taken in large doses, the action of tonics is not manifested by any immediate & obvious excitement.- The vigour which they impart to the system is the result of a slow operation on the animal Economy, & altogether different in its character from that temporary augmentation of force which is the immediate consequence of the operation of stimulants properly so called. When Tonics are employed in a debilitated state of the system, their operation is evinced by a gradual & permanent increase of the force of the circulation, and an invigoration of the digestive powers & of the general energies of the System. There is no term which expresses their operation so well as Corroborants, for their most prominent effect is to produce strength,- but as strength does not depend upon tension of the muscular fibre as was formerly supposed, the old name Tonic is not a suitable one.- 124 When the system is in a healthy state, Tonics are not needed to exact its powers to proper action, hence they become injurious. By long continuance, they establish irritation & chronic Inflammation & diminish the susceptibility of the organs to their impressions. But, as sometimes happens, when the disease is kept up by debility, they are useful. Tonics are not applicable to all states of the system. They are improper, when there is an increase of action beyond the natural standard in health. They act injuriously in two ways, if given for a long time and steadily. 1. They produce a certain degree of excitement which at length degenerates into Inflammation. 2. They cause a momentary elevation of the powers of the stomach by their action upon the nervous energies, & this is succeeded by a subsequent diminution of its power, so that it cannot perform its duties. Thus with the celebrated tonic, Portland Powder, it has been remarked by Cullen that the use of it was always sooner or later followed by Dropsy. 125 Tonics, therefore, should be given only when the natural powers of the system are depressed, & should not be continued too long, or given during local Inflammation. They act as corroborants in two ways: 1. When the stomach is debilitated, the food introduced into it is not digested, & the body is weakened from the loss of its natural support:- then tonics restore the digestive energies & enable the stomach to pass the food properly into the circulation. 2. Tonics may also impart tone to the system by exciting a peculiar action in the part to which they are immediately applied, & thence propagating a similar action to other parts of the body thro' the medium of the nerves.- or they may strengthen by being absorbed into the circulation, & thus acting directly on the whole organization thro' the medium of the blood. Tonics are by no means equal in the degree of their sensible power, some producing but little change while others approach to stimulants. This class of remedies may be divided into three 126 subdivisions 1. The simple Bitters. Bitterness is a property possessed by all the vegetable tonics. Cullen supposed it to be the tonic power. It does not reside exclusively in any one proximate principle. thus Quassia, Genteanin &c. are tonic, while Morphia &c. is narcotic. 2nd. Set unite an aromatic or other property with the bitterness as most prominent, as in Serpent.- August. Bark, Cascarilla. The aroma is owing to an essential oil.- These are more stimulant than the first set.- 3rd. Set are purely Aromatic, & depend for their efficiency upon an essential oil, but in some instances the property of a stimulant is united to some other property which renders them Tonic. They accelerate the action of the heart & arteries, [cross out] & produce an increase of heat, but do not act on the cerebral nerves. They are employed in combination with other tonics to cover their taste, & render them more acceptable to the stomach. Some of them might form a distinct class. Some are astringent:- 127 36th Lecture. We shall next notice the Individual Tonics, [cross out] and shall arrange them according to their stimulant powers, first treating of the simple Bitters & afterwards of the Aromatics.- a.135 A.141 A.143 Columbo, Frasera Waltri or Auc. Columbo, Gentean. A.195 & Qussia, for which See Book A. Thirty-Seventh Lecture Oct. 2 1834 B.13 B.97 B.193 [Su??aruba], Chamonmile, America Centamy A.149 B.189 A.217 Serpentarea, Eupat. Perforliatum & part of Cinchiona, for which see Books A & B [&C]. also upon Artemisia or Wormwood, Trefoil, Blessed Thistle, Horehound, & Tansy,- which are all bitter tonics & applicable to similar cases. They are used only in the absence of the others, or to suit the prejudice of the patient, so that his faith may cooperate with the remedy. Thirty Eighth Lecture Oct. 6 1834 A.217 On Cinchona & its constituents. see Book A. Thirty-Ninth Lecture Oct. 9 1834 B.1 b.11 b.3 On Augustina Bark, Cascarilea, Dogwood, Prunus B.7 c.43 Virginiana, Myrrh. for which see Books B & C. 128 also upon Aromatics, which is a term applied to those products possessing a fragrant odour, & a peculiar spicy flavour, not mixed with any other properties. Their efficacy depends upon a vol. oil. & as all oils affect chiefly the circulation, they might be called stimulants, but the[y] influence which they exert is rather more of a Tonic nature, & besides, their stimulant effects are rather local than general, because of the difficulty, with which the oils are taken up by the absorbents. Aromatics exert a peculiar cordial influence upon the stomach, obviating sickness, expelling flatus, relieving spasmodic pain, & also [cross out] obscuring in some degree the taste of nauseating medicines. They are generally joined with other remedies, with purgatives, to prevent their griping, with tonics, & stimulate to increase their power, they render medicines more acceptable to the stomach. They should never be exposed to a continued heat & hence should not be prescribed in Decoction.- 129 The Oils are concentrated forms of the Aromatics, & Distilled & are variously termed Vol.- Ess.- & Arom. Oils.- Their taste & colour are various. sp. gr. generally lighter than that of Water, sometimes heavier, & some few, equal. They are Volatile, inflammable, & when exposed to the air, deteriorate, & become changed into something of a Resinous nature. They are sparingly soluble in Water, but all of them can be made to unite with it, by means of Sugar or Gum Arab. or by rubbing them first with Carb. Magnes. then adding Water & filtering. They are often adulterated, & this can only be detected by the odour solubility,- sp. gr.- or volatility & stain on paper They are employed as the Aromatics themselves. Frequently they are used dissolved in Alcohol. then, improperly called Essences. b.165 On Individual Aromatics- as Orange Peel. b.169 b.19 Lemon Peel,- & Cinnamon, for which see Book B. Fortieth Lecture Oct. 13 1834 b.29 b.101 b.153 b.159 On Canella, Cloves, Nutmeg, Piper Nigrum, P. b.161 b.161 b.157 b.147 b.151 Lougum, Cubebs, Allspice, Cardamom, Caraway 130 b.153 b.147 b.145 Caraway Coriander, Anise Seed, Fennel Seed, b.105 b.103 Lavender, Rosemary, Sage, is an aromatic & ast. and hence an infusion of it is used as a Gargle for Sore Throat:- sometimes warm is given in Amenorrhea. b.197 b.199 b.199 Peppermint, Spearmint or Mint. European Pennyroyal, b.201 b.205 b.51 American Penny Royal, Balm, Gaultheria, a.163 a.171 Ginger, and Calamus, for which See Books A & B. Forty-First Lecture Oct. 16 1834 On Mineral Tonics, the most important of which are the preparations of Iron. & these are most extensively employed among practitioners. There is a strong resemblance between all of them in their action upon the system, they increase the force of circulation, invigorate long continued doses are said to diminish the spleen, to excite Portal Circle the powers of the stomach, & produce a permanent A long use of them in health produces Inflam. Diathesis, hence Chalybeats water injurious to healthy persons; corrobative effect upon the system. When, however, Iron & Prep. have a local tendency to Uterus. active Inflammation exists, when the Stomach is in an irritable condition, or when the liver is unhealthy secreting unhealthy bile, they are improper & injurious.- They prove advantageous in Dyspepsia, in nervous & hectic diseases, and that long train of complaints arising Cheltenham Salts are an excellent remedy for Chronic Hepatitis, teaspoonful daily before breakfast not too long continued, as Iron may produce excitementing. 131 excitementing from debility of the alimentary canal, or from general debility of the system, as Chlorosis, Amenorrhea, Anemia with swelled waxy countenance &c. Hysteria, Epilepsy, Scrofula, Phthisis &c. They are the best remedy for Amenorrhea, connected with general Debility. With regard to their modus operandi, there is much dispute, whether they act by first depressing the powers of the stomach, & then carrying this action by sympathy through the nervous system, or whether they enter the circulation & are thus distributed Iron has doubtless been detected in the blood, & it may act in that way, but the probability is that it acts by both the above mentioned methods. The redness of the blood does not depend upon the Iron continued in it, as some have supposed, but upon the invigorated action of the Lungs. Iron in its pure metallic state, has been said to be medicinal, but its effect, when thus given, is Black stools always follow. probably owing to some change which it undergoes forming salts. in the Stomach from the acid &c. which it meets.- The simplest form in which it is given is that of Filings Ferri Ramenta. Dose 10 to 30 grs. but seldom given internally produce eructations of Sulph. Hyd. &c. Dysp. Chlor. [illegible] 132 Squama Ferri are made by heating Iron & pounding it. They are a combination of Iron & oxygen, dark, brittle, pulverizable, insol. in water, readily soluble in acids. Not much employed in medicine. There are 2 Carbonates of Iron used in medicine 1. F. Carb. Prapar. or Rubigo Ferri, made by exposing Iron wire to air & Moisture, & is a Mixture of the Proto-Carbonate & Red or Peroxide of Iron. 2. F Carb. Precip. made by adding a sol. of Carb. Sod. the Precipitate is at first Proto Carb. of green colour. but on exposure, it attracts Ox. & becomes a solution of the ProtoCarb. & Perox. of a reddish colour. to a sol. of Prosulph. Iron. It is a fine, red chocolate of the Protreast .& Porox .- of a reddish colour. powder, less apt to offend the stomach than the former, because more minutely divided. Both these Carb. are insol. in water, but soluble with effervescence in Acids, & partially sol. in water impregnated with an excess of Carb. acid, hence these are generally present in the Chalybeate Springs - They are used in all cases where the prep. of Iron are indicated, and lately have proved highly serviceable in Tic Doullureux, Neuralgia &c. given in doses of ʒss to ʒi, 3 times a day gradually increases, the usual dose is from 5 to 20grs as a Tonic. 133 Dr Ruth was very partial to a prescription containing equal parts of Rubigo Ferri Pulv. Colomb. " Tingib The effect which the Carb. Iron has in Tic Douler may most reasonably be ascribed to its action upon the whole nervous system. For this, dose ʒss to ʒiss F. Suphas. Sal Martis. is made by acting for medical purposes, Iron Wire should be used, as this purer. on Iron Filings with dil. Sulph. Acid.- It has a strong styptic taste, is in greenish Chrystals, sol. in water, insol. in acids, when exposed to heat loses its W. of Chrystallization & becomes a dirty white powder, called F. Sulph. Exsiccat. Exposed to the air it becomes a Persubsulphate. at first, its efflorescence is white, the sulphate, afterwards attract Ox. becomes Perox. brown colour.- Incompatibles are all sol. Salts which form insol. compounds with its acid, earths, Alk & Carb. Pot. Nit. Acet. of Ammo. & all vegetable astringents. It is a good Chalybeate, & has an advantage by being soluble, & it may be given in Smaller doses. Use the Dried always for Pills. Dose is from 1 to 5 grs. less of the dried generally given in combination with Purgatives &c. 134 Tinct. Ferri Muriata,- consists of a Muriate of Iron dissolved in Alcohol. It is made by dissolving Carb. of Iron in dil Mur. Acid & adding 3 times as much Alcohol. It is of a brownish yellow colour, has an ethereal odour from the action of Alc. upon excess of Acid- and is decomposed by Alk. & Carb. & by astringents. It is the most active of the Chalybeates, given in Dysuria, depending upon Spasmodic stricture of the Urethra, for Venereal Warts &c. Dose 10 to 30 gtt. in a wineglassful of Water, 2 or 3 times per day. It is given also in Dyspepsia, Amenorrhea &c. Ferrum Ammoniatum is made by subliming Mur. Ammo. & Perox. Iron. It is of an orange, yellow colour, seldom used. Dose 3 to 15 grs. Ferri Phosphas, by adding sol. of Phosp. Sod. to sol. of Proto Sulp. Iron At first it is a Proto Phosph. afterwards Perphos. & we usually find it a mixture of both. It is of a light blue colour. By Carmichael it has Insol. in water 1-2 grs. been recommended for Cancer. Dose 5 to 10 grs Ter die. Tartrate of Iron & Pot. made by boiling Carb. Iron, Bitart. Pot. and Dist. Water. It is inodorous, has a At first Proto, afterwards becomes Pertartrate styptic taste, of a greenish brown colour, sol. in W. It is a mild Chalybeate, supposed to be diuretic, hence given in a tonic dropsy. Dose from 5 to 20 grs. This 135 is an ingredient in Vinum Ferri, because Bitart Pot. is contained in Wine, & this by its action on Iron Filings forms this salt. Hence Vin. Ferri possesses no advantages & It is a much more variable preparation- over a sol. of Tart. of Iron & Pot. Iodide of Iron;- a preparation upon which little Insolution in water,- Morton considers it unequal in cutaneous affections &c. with Syr. Sarsap. or no confidence can be placed. F. Ferregent insol & almost tasteless Copper.- in its metallic state, seems to have little affect upon the system, but its salts sometimes produce unpleasant consequences, & are even poisonous from the irritation excited in the mucous surfaces. Hence care is requisite in preparing food in copper vessels of any kind. & in drinking Min. Water from Copper Reservoirs Cupri Sulphas is a Bipersulphate. It is in chrystals has a harsh, styptic taste, is sol. in Water, insol. in Alc.- is decomposed by Alk. & Carbonate,- Cor. Sublimate. Nit. Silver. Permur. Mercury, & all astringents. When given in small doses, it excites the stomach. In large doses, it produces very violent vomiting & the patient has a coppery taste in the mouth.- The stomach must be washed out freely, & Albumen administered to an increased action, but the danger attending it has circumscribed its use. In that form of Intermittents called Quartan it is sometimes given as follows Cupri Sulph. gr.i mft. Pill No iv Quinia Sulph grs viij opii gr. i S. one 4 times a day 136 It is used advantageously also in Chronic Diarrhea depending upon Ulceration of the Intestine, Epilepsy &c. In Germany it has been recommended for membranous Croup. Cup. Ammoniatum.- is made by rubbing up Bisulph. Copper with Carb. Ammon. It is of a Sapphire blue colour, with a hot styptic taste, & changes to green by exposure to the air. It has been much recommended for Epilepsy, but its use is disputed. It is given also in Hysteria, Chorea &c. but never without previous depletion. Dose grss. 2 a day and gradually increase if necessary.- In form of Pill.- Zinc itself, exert no sensible effect upon the system, but there are two preparations of it used in Medicine as Tonics. They are employed in Hysteria, Epilepsy, Chorea & various other diseases. Sulphate of Zinc.- is made by adding dil. Sulph acid to Zinc.- It crystallizes in 4 sided prisms, effloresces slightly, is very sol. in Water, cold or hot, with a metallic, styptic taste, & is decomposed by Alk.- Earths.- & veg. astringents.- Is not much used as a Tonic.- It has been given in Diarrhea,- Chorea &c. Hooping Cough,- Colica Pict.- but more as an Emetic A solution of 1 1/2 or 2 grs to ƒ℥i water forms an 137 excellent injection in Gonorrhea,- & weaker for Chronic Opthalmia.- Dr W. has never failed to cure the Ulceration of the Mouth occurring in Children by touching them with a solution of from 5 to 10 grs to ƒ℥i 15 grs to ƒ℥i Water.- Also useful for cutaneous eruptions The dose internally is 1 or 2 grains. Then taken in poisonous dose, it produces great constriction & vomiting &c.- there are relieved as soon as it is evacuated. Oxide of Zinc.- may be made by burning Zinc. It is white,- inodorous,- tasteless,- insol. in W. & Alc.- unalterable in the air.- Dose 5 grs.- gradually incred. Tutty.- is an impure oxide of Zinc,- made by mixing the Ox. with Clay & Water.- It is inodorous,- tastless- brown externally, but the inside of a mass yellow used for excoriations &c. by sprinkling.- or in form of Ointment.- Calamine is an impure Carb. Zinc. has an earthy fracture.- When roasted & elutriated, it is sprinkled on excoriated surfaces,- or made into an ointment, & then applied. Tumers Cerate. Bismuth- is used in medicine,- by just making a solution in Nit. Acid,- then add Water.- A precipitate is formed which was formerly called an Oxide, it is now called Subnitrate of Bismuth. It 138 is white,- insoluble,- inodorous, & unalterable in the air. It has been highly recommended in Dyspepsia with violent pain unaccompanied with [cross out] Inflammation.- It imparts a black colour to the stools, like Iron. Dose 5 to 10 grs,- 3 or 4 times per day. Nitrate of Silver.- has a strong,- metallic, bitter taste.- It is sometimes used internally,- & has been highly recommended in Epilepsy,- but disputed. It is given also in Chorea,- Angina Pectoris,- & sometimes in Leucorrhea,- but perhaps with no benefit.- Incompatibles- Alk. & thin Earths, Soaps, Sulph, Min, & Tart. Acid & thin Salts, Arsenite Pot. Sulphurets & Tarmin An objection to its use is that when long continued it communicates a dark colour to the skin.- The rationale is that Nit. Silver is decomposed by light, hence when it enters the circulation, it is carried into the cutaneous vessels & there decomposed. Probably, however, it is inert,- because there is sufficient salt taken into every stomach to decompose it, & produce an insol. Chloride of Silver.- The dose usually given is 1/8 gr. 3 or 4 times a day,- made into pill first dissolve it in water. with bread containing no salt,- or with Pulverized Liquorice Root,- which is preferable to the former.- Preparations of Gold are not used in medicine at present.- 139 The Mineral Acids sometimes employed are the Sulphuric,- Nitric & Muriatic. Sulph. Acid, is tonic & astringent,- hence it is given in Debility accompanied with morbid discharges, as in Hemorrhage from the Lungs and Uterus.- It is also a good remedy for Hectic in Consumption. Night Sweats &c. & in loss of appetite, connected with an asthenic state of the Stomach.- It is often given in combination with Tonic Veg. Infusion. It is used diluted, as a Gargle in Sore Throat,- or locally, for cutaneous eruptions,- Psora,- White Blister in the Mouth &c.- When prescribed, it should be Ac. Sulph. Dil.- which is only 1 part to 7 parts Water Dose is 10 to 20 gtt. in a wineglass of water,- taken thro' a quill.- In hemorrhage ʒss. to ʒi may be given. Elixir Vitriol is generally used internally. Nitric Acid,- of which there are 2 kinds,- the coloured & colourless.- This is given in simple gastric debility,- in convalescence &c.- It is said to have a specific influence like Mercury.- Dose of the strong acid is 2 or 3 gtt. in 1/2 tumbler of water,- but varies in strength. 140 Muriatic Acid is seldom employed in medicine. Sometimes it is given in Malignant Scarlatina, & in Typhus Fever.- Also for Worms.- Dose 5 to 20 gtt in 1/2 a tumbler of Water.- A Gargle is ƒʒi to ƒ℥vj Water. Forty-Second Lecture Oct. 20 1834 Nitro-muriatic Acid,- is a mixture of Nitric & Muriatic Acids,- producing a third compound which owes its efficacy to Chlorine.- The acids should be highly concentrated,- otherwise they do not act upon each other,- but merely form a mixture. If they are not sufficiently strong for the purpose,- add a little Sulphuric Acid. Besides being a tonic, this is also specific, bearing a close resemblance to Mercury in its action,- producing sometimes Ptyalism & even soreness of the Gums, & its direction to the Hepatic system is shown by the increased secretion of Bile. It was first introduced into practice by Dr Scott. It is useful in Chronic Inflammation or Disorder of the Liver,- Scrofulous affections,- Cutaneous Eruptions Secondary Syphilis &c. It may be given internally 141 or externally,- similarly & in like doses with Nit. Acid A bath is a desirable form of using it, if there be much gastric irritation.- This may be either general or local.- It should be strong enough to produce a tingling sensation upon the skin.- generally the proper proportion is about ƒ℥i to Coug. i Water. Stimulants. Simple stimulants are those medicines which increase the action of the heart and arteries without exciting the brain & nervous system.- They are used in cases of debility, unaccompanied with organic disease, as in the common consequences & termination of Idiopathic Fevers of a Typhoid nature,- also in Cholera,- profuse Diarrhea &c. But they are not used exclusively in cases of simple debility.- often prostration attends local Inflammation,- organic lesions &c.- when stimulants become requisite to support the system,- as in Typhus Pneumonia,- Typhus Dysentery,- low forms of Small Pox,- & other diseases,- where, tho' the Inflammation &c. would seem to contra-indicate them, yet they are necessary 142 necessary evils,- & must be used with great caution. In that debilitated state of system, which we often find during the ulcerative or suppurating process, stimulants often prove beneficial by enabling the vessels to perform their proper secretions, & promote a healthy action.- Of Individual Stimulants. Of distilled from Turpentines. Oil of Turpentine is a stimulant of considerable when pure it contains no Ox. importance,- there being few, which act more upon the circulatory, & less upon the cerebral & nervous system. It is useful in low forms of disease,- especially those in which the head is so affected that narcotics are forbidden.- Besides this, it has a peculiar effect upon the mucous membrane of the Stomach,- hence proves beneficial in some forms of Diarrhea,- Dysentery &c. Probably the Turp. operates by changing the morbid action & substituting its own. It has proved peculiarly useful in those typhoid fevers, where the tongue cleans suddenly,- smooth, red & moist,- or sometimes it becomes dry & not completely clean,- & the abdomen is somewhat tympaustic,- then also, there may be some delirium,- & yet the patient 143 not sufficiently low to require other stimulants.- In cases of this kind,- it is plain that there is a disease in the small intestines & that this disease is ulceration, then 5, 10 or 15 drops given every 1 or 2 hours, will produce a very happy effect, In 24 or 48 hrs. you will find the tongue become moist,- a little fur will appear,- which soon after passes off & the patient recovers. It is useful also in the last stages of Gastritis, Enteritis, also Yellow Fever, Dysentery &c. It has been recommended by Dr Bretton in Puerperal Fever,- but W. thinks it must be of that form which is not connected with Peritoneal Inflammation Also useful in Chronic Rheumatism,- Epilepsy,- Piles,- Flatulent Cholic,- Gout of the Stomach &c. &c. Dose from 5 to 20 drops every 1, 2 or 3 hrs. For Capsicum see Book B. p 164. Phosphorus, is the most powerful stimulant known, & the use of it very dangerous.- Dose is 1/12. 1/8 to 1/4 gr,- 1 gr. in 24 hrs Generally given in Sol. in Ether or in Emulsion,-a better mode than in Pill. 144 Min Ammo. & Carb. Lime. Ammonia Carbonas.- or Volatile Alkali.- has more influence over the nervous system than those before mentioned. It is formed by subliming Carb. Lime & Mur. Ammo. It is a Sesquicarbonate, found in Lungs, which are hard, solid & semitransparent, white, effloresce & deteriorate by exposure. It is decomposed by Alk, Alk. Earths, Acids &c. It increases the force of circulation & invigorates the vital functions, without affecting the brain or stomach it also produces diaphoresis. Hence it is useful in Typhoid fevers, in the intermission between excitement & collapse, alternated with Wine Whey. In low forms of Fever, where the brain will not admit Narcotics, in Typhoid Pneumonia, Scarlet Fever, Retrocedent & Atonic Gout, Chronic Rheumatism, Palsy &c. As it is an Antacid, it acts favorably also in diseases of the Alimentary Canal. It has been recommended also for bite of animals, for stings of Wasps.- Hornets- Bees &c. Also is said to remedy Drunkenness. Dose 2 to 5 to 10 grs. every 1 or 2 hours. Generally given in solution. Diffusible & Transient. 145 Antispasmodics,- are medicines which are given to relax or prevent irregular muscular contractions or spasms. But all medicines producing this effect, are not ranked under this head, because they depend upon a great variety of causes, & hence demand a great variety of remedies.- They calm the restlessness & agitation which arise from nervous action, & hence prove that they act upon the nervous system. Under this head then, we rank those which, while they stimulate the circulation, would act upon the nervous system without producing any effect upon the cerebral function. The name, however, is an improper one, as well might we have Antifebriles, Antiscorbutics &c. a more proper name would be Nervines. Musk,- the product of a small male animal inhabiting Central Asia the Himmaley Mts.- of a brown or black colour fleece, & has a small, oval bag, about 2 or 3 in. long posterior to the umbilicus. The quality varies according Received from 3 ports. Canton, Calcutta, & Russia to the situation of the animal. The most valuable comes from China, & least from Russia. It is brought 146 in sacs, is of a deep brown colour, & looks like dried blood. taste bitter,- odour strong, and diffusible, & it burns with a white flame to a spongy charcoal. It is partly sol. in boiling Water,- more sol. in Alc. & still more so in Ether. From its great price, it is often adulterated, with articles not easy to detect. It was unknown to the Greeks & Romans, & was introduced into practice by the Arabs. It is a powerful stimulant & antispasmodic, exciting no cerebral action. It is used in similar cases with all antispasmodics, also peculiarly applicable in prostration & irregular nervous action, as in low Typhus attended with subsultus tendinum, tremors, Gout or Spasm in the stomach without Inflammation. hiccup, convulsions of infants from spasm of the Intestines &c. but owing to its high price can only be employed in extreme cases. In Tetanus, it had been recommended by Dr Hoff with Op. ℥ss Musk with ʒi Op. to be given in 24 hours. It has also been used in Epilepsy, Asthma, Pertussis, Palpitation of the Heart, Cholera. &c. Generally given in Pill or Julep. Dose 10 grs. varies from 5 grs to ʒi- 147 Artificial Musk is made by pouring Nitric Almonds Acid upon Rectified Oil of Amber. It is almost inefficient. Seldom or never used. Castor. is the product of Beans. It may be used similarly with Musk, but is seldom employed Dose 10 to 20 grs. Tinct fʒi or fʒij Forty-Third Lecture Oct. 27 1834 Assafætida, is the concrete juice of the Root of the Ferula Assaf. an herbaceous plant from 6 to 9 ft. in height with a perennial, fleshy, tapering root, growing in Persia and is the most important of the Antispasmodics. When the tree is four years old, the leaves & stem are twisted off, the top of the root sliced off, so that the juice exudes, & it is then concreted. It is in irregular masses, brownish yellow externally, when freshly broken at first streaks of white are seen running thro' the mass, which soon change to red & afterwards to brown. variegated in colour, has a disagreeable odour, bitter & subacrid taste. It was used by the ancients; by the Persians, & even by some of our own epicures, as a condiment. Surat is said to be completely perfumed with it- It softens by heat By long exposure it becomes brittle. Its principal constituents are Gummy matter, resin & vol. oil, & upon the virtues to last, its odour & probably its virtues depend. Alc. & Ether.- 148 It is a moderate stimulant, powerful Antispasm also, an Expectorant & Laxative. It is useful in Hysteria, Hypochondria, Convulsions, Spasms of the Stomach and Bowels without Inflammation; Also in Hooping Cough, Asthma, Catarrh accompanied with Spasmodic Disease of the Bronchia, & also as an expectorant, in various infantile catarrhal affections. From the peculiar influence which it exerts also over the nervous system, it may be given in low forms of fever, accompanied with subsultus, Hiccup &c. As an Enema, it proves useful in Tympanitic Abdomen, Hysteria, & Irritability of Stomach. Medium Dose, about 10 grs. in Pill or Emulsion. Tinct. is more stimulating. Dose ƒʒi Galbaunum, Sagapenum, & Ammonia, are Gum Resins, seldom or never used. Valeriana, see Book A p. 173 Amber is a fossil of veg. origin, found on the shores of Baltic. Ol. Succine Rectificatum. is obtained by several redistillations, is of a yellow colour, volatile, inflammable, insol. in water, partially sol. in Alcohol, of a hot and acrid taste. It is a stimulant and Antispasmodic, given in Hooping Cough, Singaltus in low fevers, Infantile Convuls &c. 149 Dose from 10 to 30 drops. It is more used externally as a Liniment, in Chronic Rheumatism Palsy & Spasmodic Disease. Dr Parrish uses ℥i ℥i ℥iij a mixture of Ol. Suc Rect, Laud. Brandy and ℥iij Sweet Oil by friction to the Spine of Children affected with Spasmodic Diseases Narcotics or Cerebral Stimulants This name is applied to that class of medicines which act upon the brain, & they are so peculiar that no two of them are precisely identical in their action. When administered, they first produce an increase of both the physical & mental powers,- causing not only arterial excitement &c. but also energy of thought.- vividness of imagination &c. Afterwards a reaction takes place, the pulse becomes composed, the muscles relax, the senses become obtuse, & there is a general inertness of all [illegible] functions both of body & mind;- pain is relieved & sleep ensues. If large doses be given, the excitement is more quickly followed by more lasting & more serious effects. 150 Sometimes there is first a slight debility, followed by nausea, vomiting &c. These show that they operate powerfully on the cerebral functions, & when Death ensues, the heart ceases to act from a secession of nervous energy from the brain. There are 2 distinct views taken of the operation of Narcotics. Cullen says, their primary tendency is to reduce the vital power, & ascribes the primary excitement to the opposition of an innate power of the system against the poison introduced. Brown considered that they directly increased the action of the system, & that prostration of the powers was a natural consequence of their elevation. Cullen, then, considered them directly sedative & indirectly stimulant. Brown considered them directly stimulant and indirectly sedative. Each had their followers. But neither of these does W. think satisfactory, but that each Narcotic operates in a manner peculiar to itself. Altho' there is at first an excitement, yet the powers of the system are not subsequently 151 depressed in a ratio corresponding to the previous exaltation, & he even went so far as to assert that the powers of the system may be directly diminished,- & that certain [powers] functions might be diminished & others excited by the same article of this class. They exercise their peculiar influence upon the system, upon whatever part they may be applied. Narcotics, more than any other class of medicines, lose their effect by repetition, hence it is apparent, that in order to maintain a given impression it becomes necessary, gradually to increase the dose. We should also vary the articles employed. This class has received different names according to the objects for which they may be given: thus when given to sooth pain, they are termed Anodynes, when given to produce sleep,- Soporifics or Hypnotics & when for their sedative effects,- Sedatives &c. We shall next treat of the individual Narcotics. The first and most stimulating of the class is 152 product of vinous fermentation.- It is obtained from the distillation of Ard. Spt.- sp. gr. ƒʒs- purest contains 11 pr. ct. water Alcohol.-but this is seldom used in any other form, than that of Proof Spirit, which contains about 50 pr. ct. W. Preferable forms, however, are Wine, Porter, Beer, &c. and of Wines, the best are Sherry, Madeira or Teneriffe, which Wines are more tonic & less stimulant proportionally than same dose of Alc. alone contain from 15 to 25 pr. ct.- In looseness of the bowels, Wine Whey- Oj boiled Milk & Oss wine. Port Wine may be applicable. But Porter, Ale, Beer &c. Dr Wood thinks should be excluded from medical For an irritable stomach combine W. with spices, by first making a hot infus of spices & then add the Wine.- use,- they are heavier for the stomach & less stimulating than wine. He never prescribes them except where patients have been addicted to their use. Tinct. vary in strength when Alc. & dil. Alc. are used,- hence important to recollect which are made of pure Alcohol. The use of these stimulants must be regulated by the symptoms, when they increase the heat of the skin.- excite the nervous or cerebral derangement, increase the force of circulation more than proper &c. they should be omitted, but if the contrary happens, & the patient does well under their use they may be continued. Sulphuric Ether made by the action of Sulph. Acid upon Alc. is a narcotic stimulant, highly diffusible, hence more speedy & more evanescent in its action. If its vapour be inhaled, it also produces a speedy action, & exhilarates somewhat like Nitrous Oxide, but a recovery from it is more dangerous 153 - being attended with more stupor, & other unpleasant consequences.- Nith Sulph. Rectif. should be presented Caution the patient of its inflammability. It is used in prostrate cases accompanied with spasmodic nervous action,- in Gout of the Stomach,- Cholic Affections,- Hysteria,- & in some stages of Typhus to obviate the nervous affections &c. "sinking spells" As it is so diffusible, it is necessary frequently to repeat the dose. It may also be given in Asthma Hiccup, Tetanus &c. Dose ƒʒss to ƒʒj- with sweetened water. It must be quickly swallowed, so that no vapour will rise in the mouth. Externally applied,- it makes 2 impressions. If applied so that it may evaporate, it produces cold hence it is used for Burns & Scalds,- Strangulated Hernia &c.- But if it be confined to that it cannot evaporate, it produces Heat, & even a considerable irritation of the skin,- hence it is applied to the Forehead for Head Ache by holding it in the hand. sp. Nith Sulph. Comp. Hoffman's Anodyne,- is a preparation of this, which is often given as a Nervine.- It allays irregular nervous action & thus produces sleep,- because it removes the cause of wakefulness. Dose ƒʒss to ƒʒi to test whether it is really good & contains Oil of wine, pour it in water & it should become turbid.- 154 Opium.- the concrete juice of the Papuver Somniferum, which grows in Europe & is cultivated in the gardens of America,- also in India, Persia, Turkey & Egypt.- The juice is obtained from the capsules by slicing them.- There are 2 varieties in commerce,- Turkey & E. India, but the latter is never brought to this country, it is taken to China. All our opium comes from the Mediterranean, & there are 3 varieties,- Constantinople,[Singma?], & Egyptian, of which the [Singma?] is the best. This is generally distinguished by being employed in the leaves & capsules of a species of Rumex,- & when these are absent, the Opium may be considered as inferior. Water & Alc. extract its virtues, it is injured by long boiling. Its principal constituents are Resin, Gum Bitter Extractive, volatile matter, Gluten or Caouchouc. Narcotin, Meconate of Morphia, Meconin & Narcein. Narcotin consists of Hyd. Ox. Carbon & Nitrogen. It is white, in small crystals, fusible, insol. in W & Cold Alc. sol. in boiling Alc. & Ether, tasteless & inodorous. Its influence upon the system is uncertain, as it is said that 40, 50 or 60 grs have been given without any effect. 155 Morphia, is the narcotic principle of opium. It is sparingly sol in Cold Ether, freely in hot but is precipitated when cold, burns when heated, neutralizes acids The Meconic Acid with which it is joined, is useful only as being the means by which we can test the presence of Opium. According to Dr Hare;- to the solution containing Op. add a sol. of Acet. Lead, then the Meconate of Lead is precip.- to this add Sulp. Acid which will set free the Meconic, & then by adding a sol of a Persalt of Iron, we get a red coloured precip. Orfila thinks it unnecessary to add the sol. of Acet. Lead, & merely adds first the Sulp. Acid, then the sol of a Persalt of Iron. See Book C. Forty-Fourth Lecture Oct. 28 1834. For application of Opium see Book C. p.69. Lactucarium concrete milky juice is sometimes substituted for Opium It is obtained from the common Lettuce. Smell & used in Europe for Peet. Affections. Nervous &c. taste are like op. Dose 2 or 3 grs. of Tinct 40 to 60 gtt. c b.141 b.77 Camphor, Hops, & Conium or Hemlock, for which see Books B. and C. 156 Sedatives. These are divided into the Arterial & Nervous. 1. The Arterial.- The most important of this class are the Preparations of Antimony,- three of which are used: D. p.28 D. p.76 p.76 viz. Tartar Emetic, Precipitated Sulphuret & Antimonial Powder.- The Neutral Salts, are sedative & act also upon some of the functions. Potas. Nitras (see pp. 67 & 79)- when taken internally, diminishes the action of the heart, & the heat of the surface by its own peculiar operation. It is also Diuretic, & acts locally as an irritant, producing Inflammation, so that when given it should be largely diluted. When given for a long time, it diminishes the general power of the system. It is useful in Inf. affections, except of the stomach & bowels,- in Bilious Fevers,- Rheumatism,- Tremor. with Plethora,- & is often combined with Tart Emetic. A solution may be made of Nitre ʒi, Tart Em. gr j in water ƒ℥ij. Dose ƒ℥ss every 1 or 2 hrs The Veg. Acids are also somewhat sedative,- & are very useful as drinks in febrile complaints, but they may be abused & produce Dyspepsia. The tendency of Vinegar to produce emaciation is well known & sometimes called into use. 157 Lemon Juice is most used.- The best method of keeping it is to convert it into Citric Acid, by Carb. Lime & dil. Sulph. Acid;- it is Chrystalline.- To avoid the fraud of Tart. Acid for it, test it with Carb. Pot.-(see p.77)- A good substitute for Lemon Juice may be made by adding ℥i of it to Oj water with gtt iv Ol. Limonis.- B. p.55 B. p.57 2. The Nervous Sedatives.- Digitalis,- Tobacco.- Hydrocyanic Acid exists in almost all plants of the Genus Prunus, or Amygdalus.- Its odour & taste are owing principally to a volatile oil combined with it.- The best preparation for administering or preserving it is the Oil of Bitter Almonds- Dose 1/4 to 1/6 of a drop.- Pure Hydrocyanic Acid is never used in medicine, but the Dilute,- which is formed by passing Sulph. Hydrogen thro' Bicyan. Merc.- forms Black Sulph. Merc. & Hydrocy. Acid,- then filter & add Carb. Lead & filter.- It should be kept in opaque bottles.- Even swelling a bottle of the Oil of Almonds, or of Hydrocy. Acid sometimes produces the unpleasant effects of the poison. Dose of the Pure, would be about 1/12 gtt. in a Wineglassful of Water,- of the Dilute, 1 gtt. every 2 or 3 hours, till the 158 effect was produced,- It is of unequal strength.- Cyanuret of Potassium- dissolved in water forms the Hydrocyanate of Pot.- which is incompatible with a great variety of substances & hence is very apt to be decomposed in the stomach.- Dose 1/4 gr to 1 gr. & should be given in a state of solution.- 159 Iodinum.- When taken in small quantities, it seems at first to sharpen the appetite,- increase the pulse &c.- acting like a Tonic,- but if it be continued, the patient begins to emaciate,- from the stimulation of the absorbents.- It also increases the secretions.- & renders the nervous system more irritable.- It was first employed by Coindet of Geneva in cure of Goitre,- afterwards in Scrofula,- indolent swellings,- somet. in Amenorrhea,- also in Gonorrhea & Gleet.- Internally, dose is from 1/4 to 1/2 gr.- Generally given in Tinct.- which contains grs XXX to ƒ℥i.- Dose 10 to 20 gtt.- given in a wineglassful of sweetened water. It should not be long kept, as a reaction seems to take place between it & the Alcohol, changing its property.- Iodide of Potassium,- which in sol. forms Hydriod. Pot. has an acrid, bitter taste.- Int. dose 1 or 2 grs.- but its effects are not like those of Iodine.- It renders Iodine sol. in water.- hence is useful.- as in Lugol's Solution,- consisting of Iodin.- ℈i Iod. Pot.- ℈ij Water ƒʒvij.- The Iodides of the 160 metals produce the effects of the metals, just as analogous compounds,- & not of the Iodine.- Externally Iodine may be used as a Bath.- or more frequently in form of an Ointment containing ℈i to ℥i Lard.- It leaves a yellow stain upon the skin, which gradually disappears by evaporation           The Classification of Medicines adopted by Dr Wood in the University of Pennsylvania. Medicines acting on the living body General Stimulants Permanent Astringents Tonics Diffusible Arterial Stimulants Cerebral stim. [illegible] Nervous stim. [Anti spasm] Sedatives Arterial Sedatives Nervous Sed. Local Functional Emetics Cathartics Diuretics Diaphoretics Expectorants Emmenagogues Sialagogues Errhines Organic Rubefacients Epispastics Escharotics Mechanical Demulcents Emollients Diluents Those medicines acting upon foreign substances contained within the body may be comprised under the heads of Anthelmintics, Antilithics, Antacids &c.  1 Notes upon Lectures delivered by Dr G. B. Wood. First Lecture. From a summary view of the Introductory Lecture, it appears that medicines operate in one of two ways -either upon parts applied by means of their effects being carried thro' the nerves to the brain, & thence distributed by the nervous system or by being absorbed: -v.c.- they act either by sympathy or absorption. In the Local action of medicines, they may act by Sympathy either directly by the nerves, or first by having their action transmitted to the brain & thence distributed by the nervous system to the other parts as in the operation of Digitalis. Their action is different also as to the different parts to which they may be applied- those places are the surface of the stomach & bowels, the external surface of the skin & the surface of the air passages.- Sometimes they are absorbed rapidly at others more slowly.- These, before mentioned, are called the primary operations, and we now 2 come to speak of the secondary, which are the results consequent upon the primary operation, as for inst. 1. Prostration following excitement. 2. General state of excitement from sympathy with a particular part. 3. Result of the principle of revulsion, as in the treatment of diseased lungs by a blister to the external surface of the skin. 4. Cessation of morbid phenomena in consequence of the removal of the cause as in some forms of headache arising from constipation, which are relieved by purging. 5. The operations of nature instituted to relieve the constitution from the effects of the medicine as in applying Caustic.- Second Lecture. The nature or character of the operation of medicines is very different because they differ much as to the parts which they affect. Each class acts upon particular organs, no matter where they may be applied. Thus, we find, that Ipecac vomits whether applied by stomach 3 blister or per annum. The explanation that we give for this is that the human frame is so constituted that each particular part has particular susceptibilities;- the cause is the undiscovered & perhaps indiscoverable principle of nervous action. In the human system, considered as adapted to our department, there may be regarded three minor systems, each coextensive with the whole body, viz. Nervous, Circulatory and Absorbent, & these three are found in every organic part. It may be viewed also as consisting of a number of distinct organs, - as the Skin, - the Stomach & Bowels, - the Kidneys & Bladder &c. Some medicines act upon some one of the Systems while others act upon some of the organs.- Thus opium acts upon the nervous system, Carb. Amerred upon the Circulatory & Iodine upon Absorbent.- The first set are called General Remedies; & the second, Local Remedies.- Medicines differ in the nature of their operations 4 operations upon particular parts, or in other words, we say medicines are specific in their operations. By the term specific, we mean that a medicine will act upon a certain part of the body & produce effects peculiar to itself i.e. that when different medicines are applied to the same parts they produce diff. effects._ This brings us then to the subject of the Classification of Medicines. Though producing not precisely the same effects, yet there are a number of medicines whose operations are so analogous that they may be properly divided into distinct classes. The first grand division is into Local and General Remedies Local Remedies are those which either primarily or secondarily affect the [cross out] different individual organs. Of these, there are 4 sets. 1. Those which affect the functions of particular organs, viz. Emetics, Cathartics, Diuretics, Antilithics, Diaphoretics, Expectorants & Emmenagogues. There are also 2 others [illegible] Sialagogues & Errhines, but these seldom used & may 5 be more properly considered as minor effects 2. Set Act on Extraneous Substances contained within the organs, viz. Anthelmintics & Antacids. 3. Alter the organization of those parts with which they come in contact. Rubefacients, Epispastics, and Escharotics. 4. Act mechanically upon the parts to which they are applied. Demulcents & Emollients General Remedies are medicines which operate upon the whole system, or upon one of the minor systems & thence have their action extended to the others.- Before proceeding with the different sets of Gen. Rem. it may be proper to say a few words respecting stimulants. This term is applied to the Circulatory system, when no other particular system is specified, & hence when we use the word stimulant without any other word qualifying it, we mean an elevation of action of the Circulatory System.- There is a great diversity of power of stimulation, both as regards the rapidity & permanency of their action, & hence they are divided into Diffusible & Permanent Stimulants 6 Many medicines both excite and diminish the different powers of the system at the same time, & hence are either sedative or stimulant according to the predominance of either of these powers & those which stimulate when given in small doses, may, if given in large doses, be very powerfully sedative. As a general rule then, we find that the same medicines are sedative or stimulant, according to the part to which they are applied, to the quantity given, and to the state of the system. Astringents have a mode of action peculiar to themselves, producing a contraction of whatever parts they may touch. With these preliminaries, we proceed to mention the Classification of the General Remedies. 1. Permanent Stimulants, as Tonics & Astringents. 2. Simple or Diffusible Stimulants, which operate upon the Circulatory System. 3. Narcotics, which may have either a sedative or stimulant influence upon the brain. 4. Antispasmodics 5. Medicines peculiar in their action as Aux vom. Merc &c 7 Third Lecture. There are a variety of modes for administering medicines, & it is happy for a physician to be able to select that form best adapted to his patient. They are given in the solid state, in the form of Powders, Pills, Troches, Electuary or Confection. In the liquid, either in Mixture or Solution and as Liniment, Cerates, Ointments, Plasters and Cataplasms.- We shall add a few remarks upon each of these Powders. Deliquescent substances should never be prescribed in the form of powder.- A light powder may be given in a little water or the like, but a heavier powder, as Calomel, should be suspended in Molasses, Syrup, Honey &c. Pills. Substances may be given in the form of pills, which are not given in large doses, which are not deliquescent, or which do not become too hard in that shape to prevent their being digested. Liquids should never be prescribed in this form, unless given in very small doses. Efflorescent substances, should 8 be first deprived of their water of Chrystallization. The mode of making pills is very important & should be well understood. Some substances require no trouble, but can be moulded with ease, as some of the soft extracts. Mass Hydray. &c. Others can be made into a mass with a little water, as Rhubarb, Jalap &c. But there are some which are more difficult, & require some discrimination in the agent. In making this choice, we should take those substances which are not chemically incompatible, or which will not make the pills too hard. The best articles for immediate use are Pulv. Gum Arab. & Syr. Sunp. Soap is good to meet any acid in the stomach, when it is not incompatible with the medicine prescribed. Confect. Ros. is much used. Mica Panis Crumb of Bread is very good for absorbing liquids which are to be given in very small doses. as Tinct dissolve the substance (if soluble) in a small quantity of water, then make up the crumbs with this solution Croton Die, solution of Argent. Nit. or Cap. Sulp. To prevent their adhering together the best substance that can be used is Pulv. Rad. Glycyrrle.- 9 With respect to the size of pills, we may say that those made from veg. powders should not exceed grs iiij in weight. A good size is about grs iij. Those from metallic substances, however, may weigh from 4 to 8 grs. Troches are not much employed. They are designed to be held in the mouth, while they gradually dissolve, consequently they should be prepared with substances which are slowly soluble in the saliva. (Farina, Gum & Sugar) Electuaries- are soft masses composed of powders mixed up with syrup or honey. Conserve or Confect. is a preparation made much in the same way for the purpose of preserving recent vegetables Both these latter Elect & Conserves are embraced under the term Confection, in pharmaceutical language. Mixtures.- This term is applied to those preparations formerly called Juleps in which insoluble substances are suspended in water by means of substances which are soluble. To form a good mucilage in ƒ℥vj mixture, add of Gum. Arab & Sacch. Alb. aa about ʒij. The yolk of an Egg may sometimes be used for the same purpose, especially 10 in mixtures containing Oils, Balsams &c. The yolk of one egg is sufficient for a mixt. of ƒ℥vj In the preparation, the medicines should be rubbed together first & the liquid afterwards added. It is necessary to avoid adding too much solid. ʒss veg. pound ʒij Elect or ʒi Extract to ƒ℥i is sufficient.- Calculation should generally be made so as to make a tablespoonful (ƒ℥ss) to be given for a close.- As for the liquids used, it is well to prescribe the aromatic waters, as Aq. Cinnam. Aq. Menth. &c. when they are compatible. Solutions.- In these it is only necessary to guard against adding substances chemically incompatible Infusions.- Preparations in which the active matter of substances is extracted by water either cold or hot, but without boiling. A Cold Infusion requires from 12 to 24 hours, while a hot one is prepared in about 2 hours. Decoction.- is when the substance is boiled in water or other liquids. Wines.- are prepared by infusing the substance in wine at the ordinary temperature. 11 Tinctures.- prepared by digesting in Alcohol for one or two weeks. There are 2 different kinds of Alc. used according to circumstances: Rectified Spirit or pure Alcohol & Proof Spirit or Diluted Alcohol. The balsams, vol. oils, &c. are soluble only in Alcohol. Vinegars.- are solutions in Vinegar, of which there are but two or three in Pharmacy as Squills &c. Syrups & Honeys.- are prep. of Sugar & Honey with veg. matter. They are made by forming a decoction or Infusion of the veg. & then adding Sugar or honey. Oxymel. Composed of Vinegar & Honey. Liniments- are preparations which are either liquid or semiliquid & of an oleaginous consistence. Ointments- are soft solids to be applied by rubbing with the finger. Cerates- are of a firmer consistences containing Wax, & are generally applied by being spread on a rag, without requiring to be heated. Plasters- are still firmer than Cerates, more tenacious, & requires to be heated before they can be spread. 12 Cataplasms- should be soft, moist & somewhat tenacious. Sometimes they are made simply by the addition of water as Mustard.- Some which will not form a mass with cold, are mixed up with hot W. as Flax-seed meal Substances, which of themselves will not form a poultice with water, have something else intervening, as Hops, which are mingled with Flax seed Meal & stewed up with Water.- Other liquid besides W. are frequently used as Vinegar, Alcohol, Milk &c. as in the Bread & Milk Poultice, so frequently used. In this, stale bread should be directed, & good sweet milk, & a little fresh Lard added to soften it.- Fourth Lecture 4/24 - 1834. Medicines are directly applied to two portions of the Alimentary Canal, the Stomach & Rectum. It is applied by the Rectum with 2 objects. 1st For irritation so as to excite purge. 2nd Through the mucous coat of the rectum to produce an impression upon the system at large.- These effects are incompatible with 13 each other & hence care must be taken to produce the desired effect. In both cases, the patient should be directed to resist the immediate impulse to evacuate & should be assisted by the application of a warm towel to the parts, with gentle pressure. The enema should generally be of the warmth of the body. As a general rule, about three times the amount of a dose by the stomach may be given by the rectum, but it is safer especially in very active medicines to give about twice the dose & repeat it if necessary. Neither of these rules, however, can be universally applied, because the relative susceptibility of the stomach & rectum differs in different persons. Instances may occur from habit or other causes in which the susceptibility of the rectum may be even greater than that of the stomach as in opium eaters &c. Hence when any medicine ceases to produce any effect upon the stomach, we may resort to other surfaces- either the skin or Rectum. There are two modes in which medicines may be introduced, either in the state of Solids or Liquids. The former are called Suppositories, & the latter Clysters, Enemata, or Injections. 14 Suppositories will be spoken of hereafter, but here we will make a few remarks respecting Enemata. They consist of soluble substances & Water is generally the vehicle used, with the addition of a little mucilage or the like. When administered for the purpose of being retained, we should use as small a quantity of liquid as possible, ƒ℥i or ƒ℥ij is sufficient. Barley Water or a solution of Starch in Hot Water makes a very good vehicle. When given in order to produce purging, about Oj of the liquid should be used. While upon this subject we may add that the character of the Syringe should be attended to, & that it should be good... The Skin affords a very convenient surface for the application of medicines. To this, they may be used in the state of vapours, liquids & soft solids, & may be applied either to the cuticle or to the skin deprived of its cuticle. A very ready method of applying vapour to the cuticle is to heat some bricks, dip them in the liquid, wrap them in flannel & place them under the bed-clothes so as not to touch the patient. 15 Raise the bed-clothes so as to form a vacant space by means of hoops or stools. Another method is by a tube passed under the clothes into a space made as before. Another method, by which the steam from herbs &c. in Water may be obtained is by placing the patient in a chair over the water &c. in a tub, & then creating a steam by putting heated bricks in the water. The patient must be wrapped round with blankets & care must be taken that the steam does not become too hot so as to scald him. Sulphur or other solids may be applied in form of vapour by passing a tube of a retort, to which heat is applied, into a box containing the patient except his head. They are more frequently applied to the skin in the liquid form, either as Lotions, Baths, Semicupium, or Pediluvium. Solids thus applied may produce local effects, or may operate upon particular organs. Frictions sometimes 16 prove beneficial, & the places best adapted to it are the inside of the legs and arms. But the most effectual method of applying solids to is what has been termed the Endermic Method The method is to deprive the skin of its cuticle, then apply the medicine to the part. The circumstances which will warrant this procedure are, when the patient is either incapable or unwilling to take or retain the medicine, & when this method may be joined with others to produce a very speedy action. Corrosive and very irritating medicines, or those which require to be given in very large doses should not be given in this way. The active principle of a medicine would be preferred to the medicine itself. To produce a blister, apply a plaster of Cantharids, 3 or 4 inches square & leave it 3 or 4 hrs. then take it off & dress the surface with a poultice so as to remove the cuticle more readily. A better plan, however, is to moisten a piece of Patent Lint with strong liquid Ammonia, lay it on the part, & keep continually dropping on more to keep it moist. In this 17 way a blister will be raised in about 15 minutes. The Powder may be sprinkled upon the surface thus prepared either alone or mixed with wheat flour. It may be in form of Cerate or Liquid, & the quantity should be generally 2 or 3 times that given by the mouth. The power of Absorption varies in different parts. The Epigastric Region is the most effectual. The inner parts of the limbs are good, and the anterior portions of the body generally better than the Posterior. We should apply beyond the morbid affections, so that during the course of Circulation, we may suppose from the direction of the absorbents that the medicines will pass directly through the affected part. Substances are absorbed most readily from the bronchial passages, but it is difficult to apply them thus, for fear of irritation. They may be thus given in the state of Inhalation: which is in 3 ways. Either 1. By diffusing thro' the air of the apartment. 2. By confining them in a bag with a tube attached. or 3. By means of an Inhaler. 18 We now come to the subject of the relative doses of medicines, which vary with the age of the patient. For this, no general rule is universally applicable. A full dose may usually be given at the age of 20, but for those under that, it is said that the dose must be diminished in the proportion of the age to the age +12. Thus to find the dose for a child 4 yrs. of age, we would have 4: 4+12=16 :: 1:4- that is- the dose would be 1/4 the quantity sufficient for an adult. Particular persons, however, are liable to peculiar affections from idiosyncrasy &c. & the effects of habit are very great,- all which must be taken into consideration in prescribing the requisite dose.- For Fifth Lecture upon Weights, Proximate Principles &c. see Book A from p. 1 to 17 inclusive. Sixth Lecture May 1st 1834 Emetics are those substances which excite vomiting by an inherent peculiar property. Their operation is peculiar, but does not immediately follow their administration, generally after a lapse of 10, 20 or sometimes 30 minutes. Soon after taking an emetic 19 the patient feels an uneasiness, which is succeeded by nausea &c. till vomiting results. Previous to vomiting, the countenance is pale, the skin cool, moist & relaxed, & the pulse frequent, small & irregular. When vomiting commences, the countenance becomes flushed from the pressure upon the veins so as to prevent the blood returning from the head, & the temples appears as if filled with the rush of blood. After vomiting, the skin is left moist, cool & relaxed, & languor succeeds, which is consequent upon the nausea excited, not upon any narcotic influence. The operation of vomiting is effected by a reversion of the motion of the stomach & by the action of the abdominal muscles. This mode is best explained by supposing that the emetic touching the mucous coat of the stomach, imparts to it a sensation which is then transmitted to the brain by the nerves, & then again the impression is transmitted by the nerves from the brain to the muscles of the stomach and abdomen. That the agency of the brain is absolutely essential to the operation of an emetic, appears 20 from the fact that if we separate the par vagum nerve, no emesis can be produced, or if the brain be rendered insensible to any degree, either from injury or from poison, it will be very difficult to make an emetic operate.- Emetics differ from other medicines in losing none of their power from repetition, but generally have a contrary effect. They do not act upon all persons or in all diseases, equally. In febrile diseases, they generally operate with facility, but in nervous diseases, they act less readily. When narcotic poisons have been taken, the stomach is not easily affected, but if mineral poisons, they facilitate the action, provided they have not been sufficient to destroy the stomach. We now come to speak of the indications for the use of an emetic, which are numerous. 1. The most obvious effect of an emetic is to evacuate the stomach; hence it is frequently called for, for this purpose; as when any irritating substances have been taken into the stomach, or 21 when the disease depends upon an over-distention of that organ,- or upon containing acrid & poisonous substances. Mineral poisons sometimes operate themselves & then it is only necessary to give warm drink plentifully, so as thoroughly to wash out the stomach:- but the Narcotic Poisons have a tendency, as before stated, to prevent the emesis & consequently more attention is requisite. We should never resort to the stomach pump, unless an emetic will not operate after waiting 1/2 or 3/4 of an hour. If the poison should be a solid as Opium the pump might not be large enough to admit its entrance & it could not be drawn out. In bilious fever, when the accumulations are acrid & unhealthy, & the bile is not properly secreted, emetics are often very effectual. But it is very necessary to distinguish between a case when vomiting occurs from the irregular biliary secretions, and when it arises merely from an irritable stomach because it would be of much importance in practice.- 22 2. Emetics act favourably by exerting a mechanic as pressure upon the liver & other abdominal viscera, in the act of vomiting. It often happens that congestion of blood takes place in those parts, the patient experiences great oppression in that region, attended with depression of spirits &c. -& then an emetic may frequently be given with advantage. The well known utility of an emetic in Jaundice is generally ascribed to the compression excited by the vomiting upon the biliary ducts, thus forcing out the bile which has been secreted in too large quantities, but we consider this, an erroneous view, & that in a great majority of cases, Jaundice arises from the bile not being secreted at all by the proper vessels, but instead of that, is taken up by other absorbents & carried thro' the system, & that emetics act in such cases by arousing the liver to its proper function, & exciting its secretions. 3. Emetics act favourably by the production of Nausea which is attended with a general relaxation & prostration of the system. There are several 23 beneficial effects resulting from Nausea. 1. Most obvious effect is a prostration of arterial action or a reduction of the force of circulation, hence its use in inflammatory diseases in an early stage, but it must not be relied on in a case when the disease has become confirmed. 2. Effect is an Increase of the power of absorption, which has been demonstrated to be in inverse proportion to the reduction of the force of circulation. 3. Relaxation of muscles, hence it is useful in spasmodic affections &c. 4. Relaxation of the skin & consequently perspiration. & 5. It probably produces an increase of biliary secretions. 4. Emetics exert not only a local power, but by the concussion or shock which they give, they exert an influence over the system, so as sometimes to break up a morbid action which may exist there. In this way, we account for their benefit in Remit. & Intermitt. Seventh Lecture May 6th 1834 5. Another favourable mode in which Emetics act, results from the principle of Revulsion. We know that by irritating one part of the system, the excitement is 24 increased in that part, while at the same time, it is drawn off or diminished in other parts. If then, during any inflammation, you can produce a flow of nervous action & consequently of the exciting cause to any other part of the system, you relieve the disease, thus it is that emetics act by revulsion as in Mania, Amaurosis, Tic douleureux, Bronchitis, Uterine Hemorrhage &c. We must bear in mind that all Emetics are apt to purge when given in small doses, & that given in exceedingly small doses, they excite diaphoresis. 6. They evacuate the blood vessels, directly by exciting diaphoresis, & other secretions & indirectly by cutting off the supply of food from the stomach: but for this purpose, they are seldom or never given. 7. The irritation of the stomach produced by their operation is sometimes useful, as in dyspepsia, but this is rather dangerous, lest gastric irritation might lead to unexpected results. Thus we find that diseases present various indications for the use of certain medicines & more especially for the 25 use of Emetics, which we find answer so great a variety of purposes. But to complete our view of Emetics, we must also remember those circumstances which contraindicate their exhibition. 1. Acute inflammation of the stomach, bowels &c. This evidently forbids them from the gastric irritation which they are known to produce. 2. In some complaints, in which the susceptibility of the stomach is diminished, it becomes necessary to increase the dose to produce any effect. In such cases, we wish particularly to warn the practitioner against the danger which may result from the reaction of the system, for if those emetics be then given in large doses, which are apt to excite inflammation, when the system reacts, great danger will arise from the gastric irritation. Even tho' the effects of large doses may leave no impression upon the stomach at first, yet when a reaction ensues, the secondary effects will be gastric irritation, terminating perhaps fatally. It is proper in such cases of insusceptibility of the stomach, 26 from whatever cause it may arise, to use those medicines which are calculated to produce no such injurious effects, as for inst. Ipecacuanha 3. A determination of blood to the head, forbids the use of an emetic without previous depletion: for we have before stated, that from the pressure upon the veins, the blood is prevented from returning freely & hence there is a rush to the temples &c. Hence it is evident that in cases of full arterial excitement, or where there is a tendency to apoplexy, - blood to the head &c. - it would not be advisable to administer an emetic without previous depletion. It is from this principle of diminishing the flow of blood to the head, that benefit results from dashing Cold Water upon the head of a person labouring under a Narcotic Poison. Bleeding also increase susceptibility of the Brain, decreases, congestion. 4. Advanced stages of pregnancy contraindicate their use, & they should be then avoided if possible. In early stages, they may be given with safety, unless in women prone to abortion. 27 5. Hernia forbids them, but if, from urgent necessity, they must be administered to such subject, the patient should be directed to place his hand upon the hernial orifice, during emesis. They are generally administered diffused or dissolved in Water, & it is a good rule to give them in divided doses, every 15 or 20 minutes till they operate. When the design is only to evacuate the stomach, give the patient plenty of warm drink, but if the object be to produce a powerful effect, & give a shock to the whole system then little or no drink should be given, but let nausea, retching &c. continue for some time. Sometimes, either from constitutional or other causes, an inordinate degree of vomiting is excited, & it becomes necessary to check it. This is done by giving 10 or 15 drops of Laudanum or a little of Sol. Morph. Sulph. & by applying a Spice Plaster or warm fomentations over the stomach. If this do not succeed, inject about 60 drops of Laudanum with 2 or 3 tablespoonfuls of solution of starch, & if these fail, we may resort to the application 28 of a Mustard Plaster to the stomach, which seldom fails to arrest the violent vomiting. Having said thus much concerning Emetics in general, we must now proceed to consider them individually. First, The Vegetables & Secondly The Minerals. The first and most important is Ipecacuanha, which is the product of the Cephaelis Ip. or Calicocca Ip. and comes from Brazil. For botanical account see Book A from page 23 to 33 inclusive. Eighth Lecture. May 8th 1834. A.23 A.33 A.37 B.181 Upon Ipecac, Gillenia, Euphorbia Ip., Lobelia, A.39 A.67 B.57 b.97 Sanguinaria, Squills, Tobacco, Chamomile Flowers, B.125 and Mustard seed, for which see Books A and B. Ninth Lecture May 12th 1834 We next proceed to consider the Mineral Emetics. Tartrate of Antimony & Potassa or Tartar Emetic. Antimonii et Potassa Tartras. or Antinmonium Tartarizatum are the officinal titles. The same rank, which Ipecacuanha holds among the vegetable emetics is sustained by this among the Minerals. 29 It is the only one given for other than emetic properties It was first made known in Paris in 1631. It is prepared by boiling Potas. Bitart. with Protox. of Ant. & should always be obtained in the state of chrystals, to prevent its being in an adulterated state. The most common impurities are Tartrate of Lime, & Cream of Tartar. The crystals are in the form of Octahedral or Trihedral Pyramids, & contain a small proportion of Water of Chrystallization, hence they effloresce on exposure. Taste is metallic & slightly styptic. When entirely pure, it is dissolved by about twice its weight of water, making a transparent solution, but if Tart. Lime is present it will soon precipitate. If the solution remains too long. Tart. Ant. undergoes spontaneous decomposition, but this is prevented by the addition of a certain proportion of Alc. In pure Alcohol, it is insoluble. It is decomposed by the Mineral Acids, alkalies & their Carbonates. Alkaline Earths, Soaps, Hydrosulphates, & astringent Infusions, such as Bark, Galls &c. and hence, these should not be prescribed together. The decoction 30 of Bark is especially incompatible, & hence may be administered as an antidote in cases of poison from an overdose of this mineral. Common Green Tea also has the same effect & is more convenient. The value of this mineral as an Emetic, depends upon the certainty, strength & permanence of its operation It remains longer in the stomach than Ipecac. & produces a greater impression upon the system, hence it is to be preferred, 1. When we wish to make an impression upon the liver and abdominal region. 2. When we wish to divert irritations by revulsion. & 3. To break up a chain of morbid action in the system. It exceeds Ipecac. in producing nausea & prostration. Its action often extends to the Duodenum & evacuates the bile secreted there, hence it may be advantageously used for that purpose, when there are no contra-indications. It is a good emetic also in various forms of fever, especially those of a bilious character, - in jaundice - nervous complaints as Amaurosis, Mania &c. - obstinate dislocations,- & in some inflammatory disorders, such as sore throat, [Dicin?y] &c. 31 Sometimes it is beneficially combined with Ipecac. and we may say that we wish to produce a mild effect give Ipecac.- if a powerful one, give Tartar Emetic, & if doubtful which is necessary, give both. Besides emesis, Tart. Ant. is frequently given with a view merely of exciting Nausea, & this has been found very beneficial in cases of high excitement, in moderating the hysterical effect of mania, & in convulsions. Give it just in sufficient doses to keep the patient constantly feeling its nauseating influence, & happy results often follow in convulsions, nervous complaints &c. It is more apt to purge, when insufficient to excite vomiting, than any other of the Emetics. It is also diaphoretic & expectorant, & sometimes diuretic & indeed seems to stimulate all the secretions. When given in very minute doses, insufficient to produce any effect upon the secretions, it appears to exert a sedative influence upon the Heart. From this cause, some modern Italians have considered it as powerfully sedative, but this is incorrect, for it is well known from the very principle of its action to be powerfully irritant 32 irritant to the stomach. Brodie found that large doses of it administered to animals suspended the action of the heart altogether, altho' artificial respiration was kept up, showing that it has a direct influence upon the heart, & that it proves fatal not only as the other Narcotics, by depressing the powers of the heart, but also by the irritation which it excites in the stomach & other organs. The poisonous effects of Tart. Emetic are violent vomiting, burning sensation of heat about the stomach, hypercatharsis, hiccup &c. & terminating in death. Remedies in such cases are mucilaginous or oily drinks in order thoroughly to cleanse the stomach, and Decoction of Bark or Tea to counteract any that might remain. Leeches may be applied to the abdomen if gastritis ensues. The medium dose is 2 or 3 grs, given in doses of 1 gr. each at intervals of 15 or 20 minutes till it operates. When combined with Ipecac, the form is about Ipecac grs XX Ant Tart grs ij mpt. Pulv No. ij. Give one & rept. if necessary 33 It will produce Nausea in the dose of from 1/4 to 1/2 gr. every hour, & gradually increase it if necessary. It proves diaphoretic in dose of 1/8 or 1/6 gr. & still less is given as an expectorant. For these purposes, it should generally be given in solution, but for its purgative effects, it is generally united with Cathartics in the form of Piee. To facilitate the administration of this medicine in small doses, more especially to children, an officinal preparation called Antimonial Wine is recognised in the Pharmacopeia. It is made from grs ij Tart. Ant. to ƒ℥i Best Sherry Wine, which should be a clear solution: if any precipitate is found in the bottle, it should be rejected, as it is evidence either of the use of inferior Wine, or of impure Tart. Emetic Dose for an adult ƒ℥ ss. every hour till it operates, but should not be given if avoidable. Dose for a child 1/2 or 1 teaspoonful. Within the month, 1 or 2 gtt. 1 yr 8 or 10 gtt. Sulphate of Zinc. or White Vitriol. This emetic is useful for the promptness of its operation, as it vomits almost immediately without any 34 nausea. Its action is confined to the stomach, & it is seldom used except for producing speedy vomiting in cases of Narcotic Poison. It is then advantageously combined with Ipecac. Medium dose 10 grs. given in solution but in cases of Poison ʒss may be given, but this quantity should be seldom repeated. Sulphate of Copper or Blue Vitriol. This acts also very speedily, with no nausea & but little succeeding languor, or effect upon the system at large. It is used in narcotic poison, but being so violent, we prefer the Sulp. Zinc. & Ipecac. Dose 2 or 3 grs. In cases of Poison from 5 to 15 grs but never exceed the latter portion. In overdose, it occasions violent vomiting, irritation of stomach, hiccup, fetid eructations, prostration, convulsions and death. The best Antidote is the White of an Egg or Albumen beat up with Water. Dry [Vo????] of Manius made of equal parts of Sulph.Cop. & Tart. Emetic (Chap) Acetate of copper is never used as an Emetic. Hydrargepum Sulphuretum Flavus, or Turpeth Mineral was formerly used, but not now on acct of its violence & tendency to salivate. Medium dose 5 grs. 35 Tenth Lecture May 15th 1834 Cathartics are medicines which evacuate the contents of the stomach & bowels by purging. They operate in three ways. 1. By making an impression upon the internal mucous coat which is thence conveyed to the muscular coat and increases the peristaltic action. 2. By increasing the secretions of the lining membrane of the bowels, & 3. By increasing the secretion of the bilious & pancreatic fluid which is poured into the intestines, & hence increase the evacuations. Calomel may be considered the only medicine belonging to the last class, but other medicines operate by one or both the former methods. Cathartics differ as to the portion of the bowels which they affect, thus Gamboge acts upon the stomach, Aloes more particularly upon the large intestines, while the neutral salts & oils influence the whole canal. Hence we find the nature of the discharges to vary according to the medicine employed, being either natural, liquid from action upon the upper portions 36 of the intestines, - watery, - bilious, - or mucous & bloody from the irritation of the medicine. Cathartics differ in the degree of force with which they operate, & hence they have been divided into Laxative & Purgative, of which the latter are the more powerful, & those of them which are very severe in their action are termed Drastic Purgatives. The division, however, into these two distinct classes, is not a very good one, because there is no medicine so weak, but that it will become more active in large doses, nor any, so powerful, that it will not operate slightly in small doses. Hence they are Laxative or Purgative according to the object & method in which they are given. Cathartics answer several indications as follows, 1. The most obvious & perhaps the most advantageous use of them is for the simple evacuation of the bowels, merely for the removal of constipation or of unwholesome accumulations. Thus in dyspepsia, cholic, hemorrhoidal affections &c. & sometimes together with the force, some irritable matter may 37 be lodged & even remain so long as to be acted on by the absorbents, & given off in the cutaneous exhalations;- then Cathartics are very beneficial in removing all such offensive matter. They are given in low forms of fever, to prevent torpor of the intestines, diarrhea, dysentery, when poisonous or noxious articles have entered the stomach & passed beyond the reach of emetics &c. The French have recently adopted a theory which forbids the use of Cathartics in fevers because they say fevers depend upon an irritation of the mucous surface of the stomach &c. & that Cathartics will only increase the irritation. But experience shows that these views are erroneous: the cathartics act favourably by driving out the irritating fœces._ 2. They act advantageously by a reduction of the general arterial excitement from the quantity of fluid which they cause to be poured out from different sources. Directly, by depletion of the blood vessels, & indirectly by expelling the Chyle before it is taken up. 38 3. They act in promoting the absorption of effused fluids. This, we have already stated, takes place in proportion to the depletion, & it is accomplished also by diminishing the serum of the blood by other secretions. Thus in a case of dropsy, the Hydragogues would be preferable. 4. They act favorably upon the principle of Revulsion. We know that when a powerful action takes place in one part of the system, the nervous excitement is drawn from other parts to that, hence we often find great benefit resulting from purging in apoplexy, Hemiplegia, Hemicrania, in local inflammations, when it is not in immediate contact with the bowels, in Rheumatic, Hip Complaints, Catarrhs, &c. of Brain 5. Cathartics act upon the Liver by increasing the secretions, & by removing congestion of the vena portarum, Hence we find congestion preceding attacks of Bilious Fever, Cholera, Cholic, Hepatitis &c. relieved by Purge It is for this reason also that a dose of Calomel or of Pil. Cath. Comp. proves very beneficial in the early part of summer complaints. 39 Sometimes Cathartics produce good effects by acting in several of these different ways, at one & the same time. Thus in a case of Dropsy, where the whole cellular membrane may probably be in an irritated condition, the Hydragogues act not only by producing an evacuation of the blood vessels, so as to cause absorption, but also by irritating the stomach & by the principle of Revulsion, withdrawing the irritation from the cellular membrane. & by depletion A few words remain to be said respecting the methods of prescribing and administering cathartics. The powers of Cathartics are modified by combinations hence by uniting several severe Purgatives in small doses, we obtain the full cathartic, but the irritation being more extensively diffused over the whole surface, is not so much felt. Their influence is promoted sometimes by the addition of Tonics, sometimes by small doses of an Emetic. When they operate powerfully, producing griping &c. this may be obviated by the addition of aromatics. Salts may be given in Mineral Water &c. 40 Medicines operate more effectually when given upon an empty stomach, hence it is adviseable to take them in the morning before breakfast, or on going to bed at night. If a prompt operation is desired, the best time is before breakfast, but if we merely wish a laxative effect, in the evening. Warm drinks of farinaceous gruel, molasses & water &c facilitate their operation, & prevent griping. Hypercatharsis subdued by 5 or 15 drops Laudanum. We now come to speak of individual Cathartics. The least active of these, is common brown Sugar, which produces this effect slightly. Molasses from the plantation also acts as a Cathartic, hence we find a diet of Rye Mush & W. India or N. Orleans Molasses an excellent laxative in cases of recent piles, prolapsus ani. &c - Wheat Bran, in form of Bread or Mush. A medicine more frequently used & approximating in its nature to Sugar is Manna, for an account of which see Book B. p. 205. 41 Eleventh Lecture May 19 1834 B.119 B.117 B.115 C.11 Upon Figs, Tamarinds, Purging Cassia, Caster Oil, Olive Oil analogous in its operation to Castor Oil, but inferior. Dose ƒ℥i or more. Melted Butter a still milder cathartic, adapted to chronic dysentery, after the irritation is subdued. It is prepared by putting it in a mug of boiling water stirring it up & skimming off the melted portion. Dose a tablespoonful every hour or two. For Rhubarb. see Book A p.43. Twelfth Lecture May 22 1834 Upon Rhubarb &c. and Senna, see Book B. p.33. Thirteenth Lecture May 26 1834 B.43 A.203 B.209 On Cassia Marylandica, Juglans & Aloes, for which see Books A and B. Fourteenth Lecture May 28 1834 A.53 A.59 C.1 A.63 On Jalap, May Apple, Scammony & Black Hellebore Fifteenth Lecture June 2 1834 B.121 C.5 C.7 On Colocynth, Gamboge, Elaterium and Croton C.19 Oil. 42 Sixteenth Lecture June 5 1834 Sulphur is found in volcanic countries mixed with earthy impurities, from which it is purified by fusion & sublimation. The best Sulphur comes from Sicily, Italy &c. In England it is obtained from Copper Pyrites, but is apt to contain the Sulphuret of Arsenic. It comes to us in rolls. Roll Sulphur is sublimed & washed, to clear it of Sulous & ic Acid. then called Flowers of Sulphur, Sulph. Sublimatum or Sul. Lotum. the latter is meant in the Pharmacop. It is of a yellow colour, nearly tasteless, has no smell except when heated or rubbed, insol. in water, [cross out] & in Alc but soluble in the vol. & fixed oils. fusible & inflammable & volatile's able It has long been a favorite laxative among physicians; it secues to act upon the lower bowels, & sometimes to produce more griping than other laxatives, which perhaps depends upon the Sulph. Hyd. formed. It has also a tendency to the skin, to the lungs, & in fact, seems to exert a general alterative influence. It is useful in costiveness, also given in slight hemorrhoidal affections, with an equal part of Cream of 43 Tartar, a teaspoonful or tablespoonful at bed time, also in dyspepsia accompanied with constipation & acidity it is combined with Magnesia, in Chronic Rheumatism, Gout, & various cutaneous affections. Hence the Warm Sulphur Springs contain Sulph. Hyd are very beneficial for Rheumatic patients. Dose as a laxative ʒi or ʒij, given in Syrup or Milk It is usefully applied in the form of an oinment of 4 parts Lard & 1 part Sulphur, in cases of Itch., Tinea Capitis &c. A solution of the Sulphuret of Potassa (ʒiij to ƒ℥viij Water) is sometimes used. Sulph. Precip. Lac Sulphuris is made by boiling Lime & Sulphur, in Water straining & adding Muriatic Acid. It is nothing Sulph. Acid is often used & then the Lac Sul. is adulterated with Sulph. Lime more than Hydrated Sulphur. Dose & use same as former Test of purity is to throw it on a hot iron, it should all be consumed. Carbonate of Magnesia. formerly called a Subcarbonate: is usually obtained from the Bitters or Mother Waters remaining after the Chrystallization of Common Salt from Sea Water. This contains the Sulphate & Muriate of Magnesia. It is heated & impure Carb. Pot. added when double decomposition 44 takes place, from which results Carb. Magnes. [illegible] form Sol. of Sulph Magnes. precip. by Carb. Sod. biter than C. Pot. This is washed, dried & cut in cubical masses. Soncet adulterated it with Carb & Sulph Lime It was first introduced into practice by Count Palmar in Rome. It is white, light, smooth, inodorous less than Magnesia 1 cu 2500 cold: & 9000 [wh??] little taste, unalterable in air & insol. in water, somet: it is adulterated with Lime, detected by dissolving in dil. Sulph. Acid, & add Oxalic Acid except to a very slight extent, when the Carbonic Acid of Water, forms it into a Bicarbonate Idinc soluble in Carb acid water Magnesia Water is a solution of it in Seltzer Water. It may be found in other forms than masses & heavier. Dose for an adult ʒij, but not much prescribed on account of its being liable to produce flatus. Efficacy is owing to acid in the stomach & bowels or usta Magnesia or Calcined Magnesia is obtained by exposing the Carbonate to a high heat Test is to add Vinegar & no effervescence First mix with water ℥i Carb. yields only about 200 grs. Magnes. alkalin Taste is disagreeable, soluble in 2000 parts water. exposed to the air, slowly absorbs Carb. Acid & is converted into a Carbonate. We meet with a preparation called Henry's Magnesia, which is essentially the same with May be in odered by [sub???] from [Sul??] [illegible] 45 4 times as heavy the Calcined, differing only in being denser, & smoother to the touch. more easily subbes up with water Magnesia is a mild aperient, supposed to operate by forming a salt with the acid with which costiveness with acidity in the stomach it meets. Used in Dyspepsia gout Diarrhea of children cholic, sick headache &c. Sick stomach after debauch Dose for an adult [cross out] ʒi, for a child 2 yrs. old, a teaspoonful. It is frequently combined with Rhubarb in bowel affections. If it do not operate it may accumulate & form masses in the stomach or intestine It is not Known that it is purgative in itself, hence if it do not operate, it is proper to aid it by giving lemonade &c. The best method of administering suspending it, is by diffusing it in water & it is important that it be equally diffused & not left in little lumps lest they should get between the teeth, & leave the taste in the mouth: first then, rub it up in a mortar with a little Syrup, then add the Water to it: or it may be taken in Soda Water, by first rubbing it up with a little Ginger Syrup. 46 The Saline Cathartics or Neutral Salts as a Class are the most important of the Cathartics. They are given generally in the same complaints & preferable to one another only for convenience, cheapness, taste or some other adventitious circumstance. They may be considered as holding a station between the Laxatives & Purgatives; they act upon the intestinal exhalents, produce watery evacuations, little pain, are refrigerant or sedative & well adapted to inflammatory & febrile complaints: but in acute attacks, the more active Cath. should be used first & these afterwards to continue the impression if needed. Soda Sulphas. Glauber's Salts this not long since was extensively employed, but is not now. It is found in the bottom of Springs & lakes but not in large quantities: all that is used is artificial. It is a kind of chance production resulting from the as Sulph. Acid. & Chlor. Sod. for Mur. Acid. processes for obtaining other products. Its great source is Sea Water. After the deposition of common Salt, this contains Sulph. Magnes. & Mur. Soda, & if it be reduced to a very low temperature, a double decomposition 47 ensues, resulting in the formation of Sulphate of Sod. & Mur. Magnes. & while so cold, the Sulph. Soda is precipitated. Hence in Russia, in the Winter, it is found at the bottom of lakes. Its Chrystals are in 4 or 6 sided Prisms with dihedral summits; striated by exposure, they give off their Water of Chrystallization, & when thus effloresced are 2 as strong as in Chrystals. It is soluble in 3 times its 1/2 at [illegible] weight of water at 60°, in 1/2 its wt. at 88°, & less 3 times at 106 sol. in boiling water than in water at 100°, Crystals melt, when heated- insoluble in Alcohol. Most sol in W. at 91°. but as a general rule, in 2 or 3 times their wt. of water. It is disagreeable & seldom prescribed. Dose ℥i Magnesia Sulphas. Epsom Salts. Exists abundantly in nature, in Sea Water, Springs, Caves &c. It was first procured from Epsom Springs in [crossed out] 1675 It was once obtained from Bittem, but not pure & frequently contained Mur. Magnes. It is now manufactured in Baltimore from a Magnesian rock which yields it abundantly by adding Sulph. Acid. also from Limestone in England. Chrystals are in 4 sided prisms with dihedral 48 summits, but as founded in the shops, it is usually in slender, needle like crystals, & very slightly efflorescent. It contains about 50 pr. Ct. Water of Chryst. soluble in water, insol in Alc. with a saline, bitter taste. It is frequently given in Soda Water. Dose ℥i. Disting. from Sulph. Sod. by adding Carb. Sod. to the Sol. It will precip. Carb. Mag. if Sulph. Mag. Seventeenth Lecture June 9. 1834 Potassa Sulphas. or Vitriolated Tarta; may be obtained by the direct union of its constituents, or by saturating Carb. Pot. with the Supersulphate which remains from distilling Nitric Acid from Nitric & Sulp. Acid. It is in Chrystals of various sizes, form 6 sided prisms, hard, contain no W. of Chrystalzation, Sol. in 9 pts Water at 60° & 4 pts at 212°, insol. in Alcohol. When heated, it decrepitates from water entangled like Common Salt. removes half the base. By the addition of acids, it is converted into a Bisulphate. Its taste is nauseous, somewhat bitter. Though cathartic in its effect, it is seldom employed for this purpose, on account of its difficult solubility. Dose about ℥ss Seldom used for any thing except the formation of the Dovers Powder. hard Hercula 49 Potassa Supertartras or Cream of Tartar, consisting is a Bitractate of Pot. & an excess of Tartaric Acid. It exists in the juice of the grape, & is deposited from new wine during fermentation, because it is insoluble in Alc. hence when by fermentation, the sugar is converted into Alc. the Crude Tartar is precipitated . This when purified by solution & chrystallization becomes Chrystals of Tartar, these we receive from S. of France, in small, irregular, semitransparent masses, sour, sol. in 60 prts Water at 60° & 15 prts at 212° insol. in Alc. & containing but little W. of Chrystallization. The Chrystal when ground form the Cream of Tartar of the Shops. This is rendered more soluble used in [An???] Inf. affections Scrof. & with Sulphur. for Piles. by boiling it with Borax. forming a compound sol. in an equal or less weight of boiling water. Potassa Tartras or Soluble Tartar. is prepared by dissolving Carb. Pot. in boiling Water. then adding the Supertartrate till effervescence ceases, then evaporate to dryness. Chrystals & Granular It has a bitterish, cooling taste, is deliquescent 50 in chrystals sol. in its own wt. of water, but in granular form, sol. in 4 times its wt. sol. in 240 prts boiling Alcohol. Its aqueous solution, when long exposed to the air is decomposed. It should never be prescribed in combination with acids. They take 1/2 base. It is a Cathartic, sometimes combined with Senna, but seldom used. Dose ℥ss to ℥i. Soda et Potassa Tartras or Rochelle Salt. 2 1 obtained by saturating Super Tart. Pot. with sol of Carb. Soda. It is in form of Chrystals, of right Rhomboidal Prisms, slightly very slowly efflorescent sol in 5 prts water at 60°, & much less boiling. It has a saline, bitter taste, was introduced into practice by Seignette of Rochelle. It resembles more palatable Dose ʒi to ʒiss the other neutral salts, but its principal use is as an ingredient in forming the Seidlitz Powders, composed of Rochelle Salt ʒij. Bicart. Soda. ℈ij in a blue paper, & Tartaric Acid grs xxxv in white Dose of Rochelle Salt ℥ss to ℥i. Result of Seidlitz is Tart. Pot. & Soda. & Tart. Sod. 51 Soda Phosphas. is obtained by taking some calcined bones, acting upon them with Dil. Sulp. Acid & a precipitate of an insoluble Sulphate of Lime falls, while a Superphosphate of Lime remains in solution Filter this & to it add Carb. Soda when efferescence & double decomp. takes place. & Phosphate of Soda remains in solution which filter & evaporate. It chrystallizes in the form of Rhomboidal Prisms, effloresces, undergoes the watery fusion by heat is soluble in 3 parts Water at 60°, & 2 pts at 212°, It contains 62 pr.ct. Water of Chrystalization. in the shops, it is generally found in the state of powder. It has a slightly saline, but no unpleasant taste, & ℥i of it may be given in a bowl of soup without the patient's knowing it. The chief objection to its use is its costliness. Dr Peasson Calomel. Of its Chemical History, we shall speak at a future period. It is termed a Proto Chloride & Submuriate, in some Pharmacopeias. The U.S. officinal title is Hydrargyri Chloridum Corrosivam Mite, distinguished from Hyd. Chlo. Forte 52 The dose of it is from 10 to 20 grs. but much larger Western practice- doses have often been given, & it is found that Cal. does not act in proportion to the quantity administered more than a regular dose; probably because the system will absorb but a certain proportion of it, & this acting upon the hepatic organs, will only produce a certain effect. It acts with little harshness or severity, producing bilious stools of different colour, according to the quantity given. Sometimes, however, it effects the stomach with violent spasms & vomiting, & this is believed to result from the quantity of vicious bile, which it causes to be secreted & poured into the stomach. Its direct effect upon the mucous coat seems to be rather soothing than irritating, & it will often remain on the stomach, when other Cathartics have Case of [Intussuscefetis?] been rejected. If it do not operate in 6 or 8 hours, it should be carried off, by a purge of Salts or Oil. Children require larger doses in proportion than adults, a child 3 yrs. may take 4, 6 or 8 grs. It is slow in its operation, hence dose of Oil may follow it. 53 When a speedy & powerful action is required, it should be combined with more active Cathartics. Thus combined, it is frequently employed in the Autumnal & Bilious Fevers, Jaundice, Hepatitis, & in fact, whenever active purging is desired. It sometimes proves beneficial in Dysentery, Enteritis, Gastritis, by its action upon the Liver. In cases of Children, it is much used in Remittents, Worms. It [Maras??s] &c. It is generally prescribed in the form of Powder or Pills. Never combine in Pill, with Soap or Magnesia. Purgative Enemata. The uses of injections are to promote the evacuation of medicines given by the mouth, or to administer medicine to a patient having a very irritable stomach &c. or when the stomach is in a state of inflammation, or when there is danger of injuring the tone of the stomach. They are also useful in constipation depending upon a collection of feces in the lower part of the intestines. A very common injection is made 54 of common Salt, Molasses, Lard or Sweet Oil, each a tablespoonful & a pint of warm water. If a more active one is needed, use Castor Oil or some one of the Neutral salts. If one still more active, use Senna Tea ℥i to Oj boiling water, or Jalap diffused in Water, 3 times dose. Ol. Tereb. tablespoofful to Oss warm water, or in Flaxseed Tea, with Yolk of Egg to diffuse it. Assafœtida may be given in flatus. Tobacco.- to overcome spasms, as in Cholic, Hernia &c. but with great care as to its strength. The proper proportion is ʒi to Oj of boiling Water, give 1/2 when cool, & the remainder in 1/2 hour if necessary. Suppositories are sometimes employed as Purgatives Soap is generally used, some take Molasses Candy. 53 Eighteenth Lecture June 12 1834 Diuretics are medicines which increase the secretion of urine. This they do in three ways. 1. As Nitre for inst. by entering into the circulation & then coming in contact with the vessels of the kidneys & stimulating them to action. This is condeuced by the saline medicines taken, having been detected in the urine. The active principle is that which is absorbed, while the remainder is digested & passes off. Thus in Turpentine, the vol. oil only is the portion absorbed. 2. Their action is extended by sympathy from the stomach to the kidneys; of this class, we can name none which act in this way alone, but there are many medicines which act by both these ways combined. 3. Some medicines act by promoting the action of the absorbents, hence they throw more fluid into the circulation, which must be eliminated through the urinary organs, & consequently increase the 56 discharge. Digitalis is said to act in this way. There are many circumstances, besides these, which influence the urinary secretions. Thus diaphoresis & diuresis are directly opposed & hence when one acts, the other will not, as in Winter, we know that more urine is secreted than in Summer when we perspire more freely. Cold Water then & cool skin promote diuresis. Active purging and diuresis are directly opposed, hence when the exhalents are pouring out fluid into the intestines, Diuresis does not occur. Diluent drinks promote Diuresis or Diaphoresis according to the state in which the patient is kept. It was formerly thought that in dropsy, copious drinking must be avoided, but we now find the reverse to be the best method of curing, & consider the patient may drink without restraint, so [as] long as the discharge equals or exceeds what is drank. In using diuretics, the pulse must always be attended to, if it is large, first deplete, for an increase of circulation above a certain point, diminishes 57 rather than increases the urinary secretion. Another reason for attending to the state of the circulation is that the secretion depends upon the nervous energy- hence if the brain be pressed upon by the fulness of the vessels, the nervous power must be diminished. Mental emotions have also much influence over the secretion of urine. Thus anxiety increases it, as every surgeon well knows, who has been labouring under great anxiety respecting an operation which he was about to perform- fear also has a similar effect, tho' probably it acts rather by relaxing the Sphincter muscle. Dropsical effusions removed [illegible] the principle of Exosmosis (Chap) The diseases in which Diuretics are applicable are those attended with effusions, as Dropsy. They operate by diminishing the quantity of fluids, either by stimulating the absorbents, by moderating the exhalents, or by a union of both. Hence they are advantageous in Dropsy, which, we know, may occur either from a diminution of the power of absorption, from an increase of the effusion 58 effusion, or from an increase of effusion & diminution of absorption combined. They may also act upon the principle of revulsion, for Dropsy may occur on account of a kind of sub-excitement over the whole surface & consequently if medicines will draw this irritation to the kidneys, they cure the disease In inflammatory diseases of the kidneys or any of the urinary organs, they act favorably after depletion. In these the saline diuretics are particularly applicable. They are useful also, where we wish to decrease the arterial excitement. In selecting those most applicable to particular diseases, great care is requisite & much must be left to the discretion & experience of the physician. Some are better adapted to peculiar cases than others. We shall now speak of them individually: & 1. Of Digitalis,- for which see Book B p. 53.- 59 Nineteenth Lecture June 16 1834 On Squill & Colchicum, See Book A p.67 & 77. Twentieth Lecture June 19 1834 A.85 A.73 B.129 On Veratrum, Taraxacum, Juniper Berries.- B.185 B.185 Erijervn Philadelphicum, Erig. Heterophyllum, B. 127 Carrot Seed, Apium Petroselinum, & Chimaphila B.183 Ap Draveolens or Cellery [illegible] species Umbellata for which see Books A. & B. Twenty First Lecture June 23 1834 Turpentine is a name applied to a peculiar vegetable juice, consisting of resin dissolved in an essential oil, & generally obtained from some species of Pine. There are several kinds found in the shops. 1. White Turpentine. Terebinthina (U.S) is obtained from the Pinus Palustris, which is a native of N. & S. Carolina & Georgia. It is called sometimes the long leaved or Pitch Pine is about 60 or 70 ft. high, & supplies nearly all that is consumed in the U.S. as well as sent to other countries. White Turpentine has a peculiar, somewhat aromatic odour, a warm, pungent & lightly bitterish taste, is of a white colour, mixed with yellow; consistence varies with the temperature, & it 60 long exposed becomes hard & dry. That in England & France comes from a different plant. 2. Canada Balsam or Balsam of Fir. is improperly so named, because it contains no Benzoic Acid. It is called also Balm of Gilead or Am. Silver Fir. derived from the Ab. Balsamifera growing in the N. on the bark of the tile are little blisters filled with the liquid. parts of this country.- It is liquid, like Honey, has a strong, not disagreeable odour, bitter taste, whitish yellow colour & semitransparent, becomes stickier & darker by exposure. 3. Venice Turpentine.- so called from the Port whence it was formerly shipped,- is the product of the P. Larix. This, however, we do not find in our market.- That which we have under this name, is probably a factitious article, made from Pitch, Ol Tereb. & White Turp. Strasburg Turpentine comes from Hamburg. 4. Chian Turpentine is never brought into this country. It is thick, tenacious liquid, pale yellow colour.- The Turpentines are fusible inflammable, burning with a white flame & much smoke,- impart neither flavour to water, but are insoluble in it, soluble in Alcohol.- consist of Oil, Resin & perhaps some Succinic Acid. They are all stimulant, diuretic, & in large doses Cathartic irritate urinary passages but have been superseded by the Oil of Turp.- 61 They are given with advantage in Chronic cases of Inflammation of the mucous membrane in different parts, also in Sciatica, Lumbago, Piles, Chronic Catarrh &c. Dose grs x to ʒi- May be given in Pill or Emulsion. Externally for Plasters. There are several substances used in medicine, which consists of Preparations of Turpentine, & may here be introduced with propriety. Tar.- Pix Liquida.- is Turpentine partly decomposed in the preparation of it.- It is procured from the P. Pacastric of N. Carolina, by burning the dead billets in piles, like Charcoal Pits, & collecting the Tar. It has a peculiar empyreumatic odour, with a bitter, resinous taste of a dark colour consists of Resin, Empyreumatic Oil & perhaps Acetic Acid, coloured with Charcoal It yields a very small portion to Water forming Aqua Piles Liquida or Tar Water. which is used in Chronic Cough, &c. Oj per day. Tar may be given in Pill or Emulsion,- or as an Electuary with Brown Sugar. 62 Tar Ointment is an excellent remedy for Scald Head & and in scaly eruptions of the skin, we have found nothing so beneficial as equal parts of Citrine & Tar Ointment mixed.- Tar & Sulph. Oint. for Scald Head &c. Pitch. Pix Nigra. (L) is Turpentine deprived of a great portion of its oil by evaporation and is solid.- It is seldom used.- Of Burgundy, & Canada Pitch, we shall speak hereafter.- Resin- common called Rosin,- is that which remains from the Turpentine, after the oil has been separated by distillation.- It is solid, brittle. semitransparent.- There are 2 varieties in the shops, Yellow & White. The Yellow is semitransparent. when melted & worked up with Water, it forms the water grad. evap. if exposed White.- Resin is not given internally Fumes Cerat. Resina Basilicon Oint. Composed of Resin, Max & Oil,- is used for keeping blisters open.- It is the best application to Burns, to prevent an de-looking scar. Ol. Terebinth.- or Spt. of Turpentine is the most important as an internal remedy. It is colourless, limpid- has a strong peculiar odours- pungent taste 63 is sparingly soluble in cold Alc.- readily in boiling.- It has a strong determination to the urinary organs, & is slightly stimulant, so that if long continued, it will produce strangury,- or bloody discharge. It is useful in Chronic Nephritic complaints,- Leucorrhea,- Gleet. Debility of Urinary & Genital Organs. Sciatica, &c. &c. Dose 10 or 15 drops 2 or 3 times In acute cases the dose may be repeated every 2 or 3 hours. a day.- It purges in the dose of ℥ss to ℥ij.- If long kept, it absorbs Ox & forms a resin. It can be purified by adding Cold Alcohol. There is a method in which Turpentine has been very beneficially employed, of which we have not yet spoken. It is in the form of fumes arising from Resin or Tar. which have proved very serviceable in chronic affections of the throat.- or of the mucous or bronchial membranes & in the first stages of consumption, before tubercles are formed. It is probable that the air of Pine forests, proves beneficial to consumptive invalids for the same reason, for the odour which there prevails. Copaiba.- Product of Copaifera Officinalis,- for an account of it, see Book C. p.25. 64 Twenty-Second Lecture June 26 1834 Canthares.- Of the History of this we shall speak hereafter when we come to treat of its vesicating properties.- now we have only a few remarks respecting its diuretic properties. The testimony of the ancients & moderns concurs in pronouncing it diuretic.- It is stimulating & sometimes produces strangury by its irritating effects upon the mucous membrane.- The symptoms of strangury are a frequent disposition to pass urine, only effecting the passage of a few drops of a red colour, with a great deal of pain.- Tinct. Canth. is useful in dropsy;- also for irritating the urinary organs in suppression or retention of urine.- If retention depends upon a stricture or upon spasm at the neck of the Bladder, Canthar. would certainly be improper, but if it depended upon an inability of the bladder to expel its contents then Tinct. Canth. would probably excite it to action. In suppression,- Canth. may be employed for stimulation. 65 In Incontinence of Urine, when it depends upon paralysis or want of power in the Sphincter muscle, Fr. Canth is useful.- Thus in Children who are constantly prone to discharge in bed, this has acted very befeficially.- It is useful also in Leucorrhea, Amenorrhea, Gleet, Seminal Weakness, &c. Dose 10 or 15 drops 2 or 3 times a day. In substance, 1 gr may be given morning & evening. Mineral Diuretics. Carbonate of Potassa.- This Salt is contained in the plants which were formerly so much employed for the cure of Dropsy. The Salts of Pot. are supposed to operate upon the vessels of the kidneys. The Carb. Pot. employed is a purified Pearl Ash, prepared by making a saturated solution of it in Water, filtering, evaporating, & stirring it till it granulates. This however is by no means pure, it contains Muriate & Sulphate of Pot. & Silica.- Silicate precip. from solution. The name, Salt of Tartar, applied to this, [illegible] properly to the Carb. Pot. obtained from Cr. Tart. by heat. 66 It is composed of 1 Eq. Carbonic Acid & 1 Eq. Potassa; was formerly, but improperly called Subcarbonate. It is always granulated,- deliquescent,- an alkali, changing veg. blue to green- forms soap with oil,- insol. in Alc. sol.- in water. It is used as a diuretic in Dropsy.- also in stimulating hepatic secretions in Jaundice.- Dose 10 to 30 grs in solution, 2 or 3 times a day. Bicarbonate of Potassa is a more pleasant preparation, formed by passing a stream of Carbonic Acid through a solution of Carb. Pot. then evaporating by heat below 120°.- It chrystallizes in 4 sided Rhomboidal Prisms,- are white,- permanent,- soluble in 4 times its weight of water at 60°. in 5/6 boiling.- Dose ʒss to ʒi 2 or 3 times a day.- The best form of giving the Carb. Pot. is in Carbonic Acid Water. Take about ʒiss of Carb. or Bicarb. Pot. & ℥i Ginger Syrup, put it in a bottle of Seltzer Water & give 1/3 at a time,- keeping the bottle well stoppes Carb. & Bicarb. Soda,- not important.- 67 Acetate of Potassa, is but little used,- it is made by adding vinegar or acetic acid to Carb. Pot.- It is white, texture, deliquescent, sol. in its wt. of water at 60° & Alcohol & decomposed by Acids. It is Cathartic & Diuretic. Dose as diuretic ʒss. 2 or 3 a day. Supertartrate of Potassa: is the best saline diuretic, which we possess. It should be given in large quantities of water to the amount of ℥ss or ℥i per day. It is refrigerant, antiphlogistic, & adapted to a febrile condition of the system. It is proper to begin with about ℥ss per day in divided doses. It is well adapted to Anasarca with excited circulation. Nitrate of Potassa is found in various parts of the world. It is most abundant in the plain over flowed by the Ganges.- The ground is scraped together & lixiviated.- & process repeated till Nitre Chrystallizes in 6 sided Prisms,- containing no water of Chrystallization Taste is sharp & cooling; even extending to the stomach. It is soluble in 4 or 5 prts. of Cold. & its own wt. boiling W.- insol. in Alc. Dose 10 or 15 grs in solution sufficiently often to give about ʒi to ʒiij in 24 hours. This will promote diuresis, by stimulating the urinary vessels.- 68 Nitre has sometimes been accidentally taken for other salts & proved poisonous. The symptoms are a strong feeling of coldness in the Epigastrium, spasms, bloody stools, hypercatriasis &c. The remedy is to wash out the stomach thoroughly & guard against intestinal irritation.-. Sweet Spirit of Nitre.- Spir. Ætheris Nitrici. has often been found advantageous as a diuretic. It is sol. in W. & Alc.- often adulter. with Alc. as their sp. gr. is nearly equal. It is often grateful to the stomach when others are not. Dose ʒss to ʒi Chapman gives from ʒij or ʒiij to ℥i. It should be administered with large quantities of liquids. It becomes sour if long kept from Nitrous Acid. Antilithics The Antilithics are medicines which were supposed to prevent a deposition in the urine, producing gravel but we are very sceptical respecting the propriety of arranging these in a distinct class.- for as the vessels in connection with these organs are diseased, general treatment is as proper as in other cases, upon the same principle that we would class Antilithics, we might form also classes of Antiscorbutics, Antidysenterics &c. &c.- 69 We think, therefore, that this class might be justly omitted in the Materia Medica. It was supposed that some medicines would enter the circulation,- come in contact with the stony depositions, & dissolve them, & hence we have a class called Lithontriptics.- but it is not so. There is no solvent for the stone, while the stone is in the bladder.- The only method in which we can act is to obviate the Lithic Diathesis, & thus we may sometimes relieve or correct the unpleasant symptoms. The urine abounds in saline matter, of different kinds, & we find that there are 2 kinds of Calcareous Deposition.- The one which is most frequent is Uric Acid,- the other, a compound of an insol. Salt of Phosphoric Acid. That state of the system, predisposing to the former is called the Lithic Acid Diathesis, & that to the latter, the Phosphoric Acid Diathesis. Whenever there is a red sediment in the urine, we may suspect the first Diathesis,- but if 70 there be any doubt, take a piece of Lithmus & immerse it, & it will be changed to red, if there be Uric Acid present. In a healthy state it always exists, in combination with more alkali. Thus the Sublithate of Ammonia will remain dissolved as long as the Alkali is in Excess, but if the acid exceeds, this is then deposited. Hence in persons of the Lithic Acid Diathesis, it is improper to accumulate acid in primæ viæ,- or to live upon acescent food. Deficiency or suppression of Perspiration also is said to be improper in such persons, because according to Dr Wilson Philip, it contains an acid- The remedies or antilithics in these cases are Alkalies & Alkaline Earths, to neutralize the acid, in the blood, urine &c.- Simple Bitters also, to strengthen the Digestive Powers, & Diaphoretics, by causing Perspiration. In the Phosphatic Diathesis,- the case is directly the reverse, & too little acid is the cause of the stony deposition.- The calculous matter 71 is such as to be soluble only when there is a certain portion of Acid, but when this proportion diminishes, a white sediment deposites, This state is also connected with disorder of the Digestive functions. Acids here, instead of Alkalies, are requisite for the cure, & Mineral acids are preferable Hard Cider has enjoyed great reputation among the vulgar for the cure of the Gravel, but we readily perceive that it is applicable only in this Diathesis, while in the former Diathesis it would prove very injurious. Tonics also are applicable.- Carb. Pot. & Soda, Calc. Magnesia, Lime Water &c. Bicarb. Pot. & Soda are preferable to the Carbonates, & the BiCarb. Soda to Bicarb. Pot. Dose ʒss to ʒi Dose of Carbonates 15 to 30 grs. Some prefer Magnesia, but it is probably inferior when it is desirable that the Antacid should reach the kidneys. Dose 15 to 30 grs. 3 times a day. Lime Water may be given with Milk, Oij per day. The Mineral Acid employed are the Nitric, 72 Sulphuric & Muriatic,- all of which are Tonics. The two last of these are preferable. All the vegetable tonics are sometimes useful. Uva Ursi has obtained great reputation, & seems well adapted to those cases where the organs are incapable of performing their duty from relaxation or debility.- It has, however, no peculiar adaptation to gravel. Twenty-third Lecture June 30 1834. Diaphoretics,- are such medicines as increase the cutaneous discharge.- The skin always, when in a healthy state, is carrying on a secretion, which generally evaporated as fast as it is formed,- but when, from an increase of secretion or from different states of the atmosphere,- it retains its liquid form it is called sweat.- At one time, it was supposed that some medicines had the power of increasing the moist secretions & others the dry,- & hence they were divided into Sudorifics & Diaphoretics,- but these distinc- are now lost, & both are comprised by medical men under the head of Diaphoretics. 73 These medicines operate in different ways.- 1. By relaxing the constricted capillaries which are often found as in cases of febrile excitement- In diseases, attended with such consequences, the diaphoretics are calculated to relax these vessels & thus promote perspiration.- This may be accomplished by nauseating doses of emetics,- by cold or warm ablutions &c. 2. By entering the circulation, & then coming in contact with the vessels of the skin, & stimulating them as diuretics do those of the kidneys;- as Cn. Pot. &c. 3. By increasing the general circulation & consequently, the cutaneous secretions:- as Carb. Ammo. &c. but these can only be given in languid circulation, with a cool, dry skin, & not in cases of high arterial excitements. 4. If the skin be in a healthy state, any thing which moderates the excitement of the heart and arteries, will produce sweating,- hence warm teas &c are said to be useful.- It is said also that the perspiration produced by entering hot ovens has been known to cure the Dropsy.- But the application of dry, 74 heat is apt to produce febrile action,- while a moist heat usually produces diaphoresis.- Dry heat can be borne at a higher temperature than moist:- These medicines are applicable to a great variety of diseases,- & rank high in the list of curatives. They operate favorably by removing the hot & dry surface,- by depleting the blood vessels, & consequently moderating the arterial excitement;- & also by eliminating the noxious matter from the blood. They act also by revulsion,- by directing the flow of blood to the surface & abstracting it from the inner parts, thus in Dysentery, Diarrhea &c. - Rheum, Gout. They are useful also in Congestion, Rheumatism, Gout, &c.- They are said to increase the action of the absorbents as in Dropsy,- but for this are not very useful. They sometimes merely change the action of the capillaries,- as Sulphur, Sarsaparilla &c. We may add a few words respecting the mode of administration.- If copious perspiration is desired,- put the patient to bed, & do not allow him to be uncovered,- advise flannel to be worn next the skin,- or in summer, the knit elastic substance. 75 When the pulse is strong & full,- the medicine should be preceded by a lancet or a purge.- After the sweating has commenced,- give warm teas, & avoid purging, vomiting, or diuresis.- If the skin be hot & febrile,- cold drink may be given. 1. Relaxing Diaphoretics. A.25 B.189 Ipecacuanha & Eup. Perfol.- see Books A & B. The Antimonials used are Tartar Emetic,- Pulv. Antim.- & Precipitated Sulphuret of Antimony. Ant. et Pot. Tartras.- given in small doses, produces profuse perspiration in two ways.- 1. By overcoming the capillary constriction by nausea, 2. By entering the circulation & stimulating the vessels of the skin to increased action. It loses its curative power, in any disease,- when it nauseates (Chapman) It is useful in excited febrile complaints, in eruptions of the skin,- chronic scrofulous complaints &c. Dose 1/8 to 1/4 gr.- As an alterative 1/10 to 1/8 gr.- Also in the commencement of consumption, with frequent pulse &c. & in catarrhal affections generally.- Dissolve about 1/2 gr. in Oi of Water & let the patient take it as his only drink thro' the day. 76 Pulvis Antimonialis.- was intended as a substitute for James' Powders.- It is made by mixing the Sulpr. Ant. with shavings of Horn & exposing them to heat.- Then we have an Oxide of Ant. Combined with Phosphate of Lime as the result.- It is a very uncertain & variable preparation.- If we were sure that it was a Protox. of Ant.- We would then know that it would unite with the acids of the stomach & form some salt of Ant.- but if it be a Perox. it will not.- It is of dull white colour.- inodorous, insipid, insol. in water, slightly Febrile diseases. sol. in Alcohol.- Dose 3 to 6 grs. every 4 hours 2 1 Sulphuretum Antimonii Precipitatum, is formed by boiling Sulp. Ant. with a sol. of Carb. Pot. then straining & adding Sulp. Acid & we have an orange-coloured precipitate.- If no Sulp. Acid be added, the precip. which falls spontaneously is Kermes Mineral of a dark brown colour if after the Kermes is obtained. we add to the remaining solution Sulp- Acid- we shall have Golden Sulphur. Ant. Sulp. Precip. is a mixture of both The Precipitated Sulphuret is similar to Antimony 77 in its effects upon the system,- but is very uncertain in its operation.- It is seldom or never employed in this country.- Given sometimes for Scrofula & cutaneous diseases, in dose of 1/2 gr or 1 gr. 2 or 3 times a day & may be combined with Calomel. It is said to be less injurious when long continued than Tartar Emetic.- Dose as a Diaphoretic 1 to 4 grs.- Emetic 8 to 10 grs.- Twenty Fourth Lecture July 3 1834. Citrate of Potassa.- is seldom kept in the shops, but is prepared extemporaneously for prescriptions &c. It is made by saturating a solution of Citric Acid or Lemon Juice with Carbon Pot. then we have in a solution of Carbonic Acid Water, Cit. Pot. Its taste is not unpleasant,- called Neutral Mixture. The common formula is to take ƒ℥iiij fresh Lemon Juice & add gradatim Carb. Pot. till effervescence ceases. Dose tablespoonful every 1, 2 or 3 hrs. with a little water. It is well calculated for Remittents & Intermittents, if it produces pain in the bowels or purges, give a few drops of Laudanum. 78 Another form in which this is given is the effervescing Draught,- which differs from the former, only in being given a state of effervescence. Make a solution of Carb. Pot. ʒij to ƒ℥iiij water & filter, then a tablespoonful of this with a tablespoonful of Lemon Juice & also one of water, will make the mixture. Sometimes the reason that no effervescence takes place is because only part of the Carb. Pot. is decomposed. & the Carb. Acid goes over to the other portion & forms a Bicarb- if however, the Bicarb. from the weakness of the Lemon Juice, no effervescence Pot. be used.- we shall always have an effervescence, but at the same time, we cannot be always sure that we have a saturated solution.- Hence Carb. is best- ensued,- then add a little more. When Lemons & Limes are scarce, a solution of Citric Acid may be used of ʒij to ƒ℥iiij water & [add] Ol Limo is gtti- Guard. against the fraud of selling Tartaric for Citric Acid.- Distinguish by dissolving & adding Carb. Pot.- the former will produce insol. Bicarb. The precipitate of Silicate of Pot. may be avoided by using the Bicarb. Pot. ʒiij to ƒ℥iiij water. To increase the Diaphoresis Tart. Emetic or Sweet Spt. of Nitre may be added. Acetate of Ammonia is also employed Liq. Ammo. Acetates (U.S.) only in solution, when it is called Spt. Mindereri It is made by saturating Distilled Vinegar with Carb. Ammo. It is a limpid, colourless fluid. When Ammo. is in excess, it is injurious on acct. of its stimulating effects. Fixed alkalies,- Strong Acids & Sulp. Magnes. are incompatibles- Dose ƒʒss every 2 or 3 hrs. 79 Citrate of Ammonia possesses no superiority Potassa Nitras.- It is doubtful whether Nitre possesses any diaphoretic properties, but it certainly exerts an influence upon the arterial excitement. It is advantageously given in fever, as in the following Rx Potas. Nit. ʒi Calomel grs xii Tart Emetic gr i Usually our Intermittents do not require a large doses of Calomel. [mft.?] Pulv. No viii Give one every 2 or 3 hours. Dose of Nitre is 10 grs. frequently repeated Swt. Spt. Nitre.- to quiet nervous derangement in fevers, as in Children gtt 20 to ƒʒi. We next come to the Stimulant Diaphoretics C.47 A.213 A.209 for Guacacum,- Xanthoxyfum, Mekereum and B.25 Sassafras,- see Books A, B & C. Twenty-Fifth Lecture July 7 1834 Sarsaparilla- see Book A. p. 107. Expectorants are those medicines which facilitate or increase the discharge of mucus from the air vessels of the lungs. This they do in several ways- 1. By relaxing the constricted vessels of the lungs. it is in this way the nauseating emetics act as Expectorants. 80 2. By reducing the quantity of the secretion which may sometimes be so great & the fluid so abundant that the patient cannot cough it up. 3. By entering the circulation, coming in contact with the secretory vessels, & stimulating them to proper action. Hence we find there are 2 classes of Expectorants. One when the lungs are excited & require depletion as in Catarrh. Pulmonic Irritation & Inflammation &c. & the other when the vessels of the lungs are relaxed & pour out more than a proper quantity of fluid as in Asthma, Consumption &c. During the use of Expect. keep the Surface of the body warm.- Purging is not incompatible.- Expectorants may act in another way, by mechanical influence, as in cases of great debility, where the power of the pectoral & other muscles, is insufficient to accomplish the desired object, these then must be stimulated, in order to call into action the nervous influence, as by Wine Whey, Vol. Alkali. Ammonia &c. 81 The best of the whole class of Expectorants to be given in cases of an excited character is Tartar Emetic. It is useful in Asthma, Pleurisy & the like. Dose 1/8 gr. Of Vin. Ant. from 15 to 30 drops. A.32 A.67 For Ipecac & Squill see Book A. Twenty Sixth Lecture July 10 1834 A.103 A.93 C.41 On Allium, Senega, Ammoniacum, Assafateda, C.43 C.43 C.29 C.25 C.49 Galbanum, Myrrh, Turpentine Copaiba, Tolu, C.49 C.51 Balsam of Peru, & Benzoinum. See Books. On Emmenagogues The menstrual fluid is a peculiar secretion of the uterine vessels. A retention or irregularity of this discharge sometimes occurs, & then the intervention of medicines called Emmenagogues is necessary. As with other organs, so from analogy we may suppose that there are medicines which have a peculiar affinity for the vessels of the Uterus, but not many of these are yet known. In practice, at present, those circumstances producing Amenorrhea are considered in order to discover the particular Emmenagogue requisite in each case, & prescribed accordingly. 82 Thus, when it is the result of debility, Tonics, by giving tone & strength to the system, act as appropriate Emmenagogues,- as,- Preparations of Iron,- Bark,- Myrrh &c. It may be the result of general excitement, then evacuants become proper. Sometimes it arises from a diseased state of the system, as in Consumption,- Dropsy &c.- & it is evident that until these are cured, it will remain. Sometimes it may arise from that state of the bowels which we find in Constipation, then of course, Purgatives are appropriate. B.209 Aloes.- From the great affinity which this has for the large intestines, we may suppose that the irritation which it causes may be extended by sympathy or it may have a specific tendency to the Uterus to the Uterine Vessels.- It is often given in combination with Iron,- Myrrh &c. A.63 Helleborus Niger.- The Tinct of this in the dose of 60 grs 2 or 3 times a day has proved very beneficial in Dr. Meigs' treatment of Amenorrhea.- Dr Wood has found Aloes & Carb. of Iron, long continued a very efficient remedy. Also in Dysmenorrhea.- 83 The Chalybeates are excellent Emmen.- & of these Ferri. Carb. Preccip. appears most efficient. on the treatment of Amenorrhea, if any disorder in any one of the other functions of the system exist, first remove that disease & then give Emmenagogues Sometimes it may be proper to give the Emmenagogues in conjunction with remedies suitable to the cure of the original disease.- Thus if constipation existed, Aloes & Iron might be joined with the remedies for constipation. Aloes & Iron should never be given in an excited state of the system, without previous depletion. Twenty-Seventh Lecture July 14 1834. A.93 C.47 B.47 B.179 On Madder, Senega, Guacaicum, Sabina, Ergot, & Tinct. Cantharides as Emmenagogues.- There yet remain 2 classes of medicines to be noticed, which act not upon the viscera themselves, but upon their contents, & these are Anthelmintics & Antacids. Adjourned July 23rd to Sept. 7 1835. Anthelmintics are medicines used either to destroy Worms or drive them from the body. There are 4 species of Worms- Lumbricoides, Ascarides, Tricuris & Tania or Tape-Worm. 84 They operate in different ways. Cathartics may act as such by operating upon the bowels, & Tonics, by imparting tone to the system, as well as by poisoning the worms. The worms may either be poisoned so that they are induced to change their place,- or they may be killed by the medicine mechanically.- Calomel is the most efficient anthelmintic & probably may act by increased the flow of acrid bile, which is very disagreeable to the worms,- they change their place, & are carried off by a subsequent dose of Oil. Dose for Child of 2 yrs. 5 grs.- Twenty-Eighth Lecture July 17. 1834 A.65 On Spigelia Marylandica:- Azedarach or Pride of India or Pride of China of which the bark of the fresh root is used.- It is a native of Syria, Persia & India & cultivated in this country. It is used extensively as an Anthelmintic in Georgia. It has a bitter, nauseous taste & is generally given a decoction, made from boiling ℥iiij in Oij to Oj- of which the dose is a tablespoonful every 2 or 3 hours, until it affects the bowels,- or morning & evening for several days & follow it with an active Cathartic. 85 B.177 A.207 also on Chenopodium, Bark of Geoffroya [Inemus?] B.177 A.181 B.139 C.29 Dolichos, Tilix Mas, Pomegranate, Oil of Turpentine, which latter is one of our most powerful Anthelmintics & especially useful in expelling the Tænia the dose is from ƒ℥ss to ƒ℥ij or ƒ℥iij. This generally heats the stomach, & even excites giddiness &c. together with acting upon the bowels. If it do not purge in 3 hrs. after it is taken, give a dose of Castor Oil. Some combine the Oil of Turpentine & Castor Oil together so as to be more certain of its operation. This answers very well, especially in Lumbricoides. The Oil of Turpentine, in small doses, is often given with advantage to children, who complain of pain in the stomach, without any fever &c. when worms may be suspected. the worms in the stomach are destroyed & digested. Whether there actually be worms or not, it often operates very favourably. Copaiba acts similarly Cedar Apple operates in much the same way. Filings of Tin, Pulv. Sfanni have very strong testimony given in favour of their anthelmintic virtues. By some, they are said to act mechanically by their rough, grating surface, but if this were so, sand would act as well 86 Others say, Tin acts favourable on account of the Hydrogen which is evolved, but if this were so, Iron or Zinc would answer the same purpose.- Others suppose that it is from the Sulphuretted Hyd. generated, but we might suppose that the worms had become sufficiently accustomed to this Gas, to feel no inconvenience from its presence. Others suppose that it acts by the Arsenic contained in the Tin, but Arsenic itself will not act thus. Why, then, may we not suppose that the Tin is a medicine noxious to the worms, & consequently acts in this rational manner.- Dose is very indefinite, varying from ʒi to ℥i, given in the morning for 2 or 3 days, then followed by a Cathartic. Aurum Mozaicum, was a compound of Sulphur & Oxide of Tin.- Dose 10 grs. twice a day Pomegranate- Bark of Root- see B.139 Adjourned till September. 87 Twenty-Ninth Lecture Sept. 1 1834 On Antacids.- Antacids are those medicines which are given to meet the acids which are sometimes found in the stomach & bowels and convert them into harmless substances. The acids arise not only from the gastric juice in health, but also more copiously in a diseased condition of the stomach. The diseases in which this state is generally found are Dyspepsia, Diarrhea, & Bowel complaints of Children,- but an acid state of the stomach may accompany almost any disease. All the salifiable bases may be considered as Antacids,- but those generally employed are the Alkalies & Alkaline Carbonates.- Potassa in its pure state is not adapted to internal administration.- Carbonate of Potassa or Salt of Tartar is frequently given as an Antacid.- It is often added to bitter infusions,- so that while the acidity is corrected, a tonic impression may also be made upon 88 the stomach.- The dose of it varies with the acid contained in the stomach.- generally from 10 to 30 grs. & repeat it if necessary.- A pleasant form for administration is in solution in Cinnamon Water with a little Sugar.- Another form in which it may be given is by taking a teacupful of Soot,- & 1 quart of Hickory Ashes,- shaking them together in 1 Gallon of Water, let them stand [cross out] 24, 24 or more hours, then pour off the liquid.- Besides the Carb. Pot. this liquid contains perhaps Kreozote &c. Carb. Ammo. & some other ingredients- The dose of it is a Wineglassful 3 or 4 times a day, & it is rendered more agreeable by adding 10 or 15 gtt of Aromatic Ammoniated Alcohol.- This a very effectual preparation for the prevention of sick headache, which frequently arises from acidity of stomach) if taken, when the symptoms warn us of its approach. Bicarbonate of Pot.- is used as the Carbonate. The only objection is the evolution of a large quantity of Gas in the Stomach.- 89 The preparations of Soda however, are better than those of Potassa; because of the less quantity necessary to neutralize a certain portion of Acid & of the less disagreeable taste.- Soda.- like Potassa,- is not given pure. Carbonate of Soda is obtained from Seaweed or from the decomposition of Sulph. Soda by Charcoal & Carb. Lime.- It chrystallizes in Octohedrons. Effloresces on exposure,- because it contains about 62 pr.ct. Water of Chrystallization,- hence its strength is constantly varying.- The chrystals are soluble in about 2 parts of Cold & less than their own weight of boiling water. It is less disagreeable to the taste than Carb. Pot. Is useful in Jaundice to assist a mercurial action probably by entering the circulation & stimulating the secreting vessels of the liver. The dose varies according to the variety of its strength before stated.- Generally from 10 grs. to ʒi may be given in solution or in Pill. If the latter, it should first be deprived of its Water of Chrystallization by heat. 90 Bicarbonate of Soda more properly Sesquicarbonate is formed by passing a stream of Carbonic Acid through a solution of Soda,- then driving off the excess by heat below 120°,- or by introducing the Gas into a cask containing the Chrystallized about 10 pr.ct. Carbonate.- It contains less water of Chrystallization than the Carbonate,- and is soluble in 10 times its weight of Cold Water. Dose of it is from ʒss to ʒi.- & may be given in Carbonic Acid Water. Ammonia, when pure is gaseous. It is obtained by mixing Mur. Ammo. & Quick Lime Water impregnated with it forms the Aq. Ammo. of the Shops;- it is colourless,- with a pungent taste & smell,- corrosive & caustic, if applied to the skin.- & should be kept in well stopped bottles to prevent the access of Carbonic Acid. Externally it is used as a Rubefacient,- & it may be employed as an [illegible] to prevent fainting. A better preparation for internal use is the Aromatic Ammoniated Alcohol made by impregnating or Arom. Spts. of Ammonia. {If the patient should take the prep. of Ammo. without} {dilution, the mouth & throat may be injured, then gargle} {in the dilute vinegar & smear the part with Oil.} 91 Alcohol with Ammonia & adding some Aromatic Volatile Oil. This a delightful Antacid pleasant to the smell & taste & grateful to the stomach. The dose of it is from 15 to 30 drops, but must be diluted before it is taken. Carbonate of Ammonia is much used p.144 as a Stimulant & will be treated of hereafter Lime.- is seldom used in its Caustic state except in the form of Liquor Calcis, which is a saturated solution of it in Water. Water takes up 1/778 part of its weight & it is more soluble in Cold than Warm Water. It has an acrid, alkaline, unpleasant taste, but when mixed with an equal proportion of milk, loses these qualities & becomes one of our best remedies for nausea & vomiting arising from gastric irritation- It corrects that disposition by calming & giving tone to the stomach. Of the Carbonate of Lime, there are several varieties,- all nearly tasteless, insoluble in Water unless impregnated with Carbonic Acid. They 92 are all composed of 1 Equiv. Carb. Acid & 1 Eq. Lime. Creta Preparata,- one form of it, is prepared by levigating ordinary Chalk. Other forms are Testa Crab's Claws Prep.- Tela Cancrorum Prep.-Ovorum Testa Prep.- said to be preferable to Cret. Prep. on acct. of the animal matter which they contain,- are more minutely divisible.- Carb. Lime is useful in Diarrhea on account of its Antacid as well as its astringent power. Dose varies from [varies] 10 grs to ʒij- From 10 to 20 grs may be given every 2 or 3 hours.- It is usually administered in the form of the Chalk Mixture or Julep,- consisting of Cret. Prep. In making mixtures &c. the Cinnamon water should always be diluted with simple water otherwise it is too strong. Tinct. Opii Acac. Gum. Sacch. Alb. Aq. Cinnam. et aq. Pura.- Magnesia & its Carbonates are both excellent Antacids, especially in cases connected with Constipation, & may be given in Dyspepsia,- Gout, & the complaints of Children. Sometimes it offends the stomach. 93 We next come to speak of those Local Remedies which affect the Organization of the Parts. Rubefacients produce a redness of the surface; when there is much irritation, the vessels pour out a serous fluid & blisters are the results. But this serous fluid is not secreted equally from every irritation, thus we find less of it from Mustard than from Cantharides, & hence we have the different names of Epispastics & Rubefacients. Some substances destroy the parts to which they are applied & are called Escharotics. Hence we have these three classes, Epispastics, Rubefacients & Escharotics. When an Epispastic is applied to the skin, it excites the subcutaneous vessels & causes them to throw out a serous fluid under the cuticle. This local irritation produces a general excitement which in the case of Cantharides is probably owing partially to the absorption of some portion of the Cantharides. 94 There are 2 Indications for the application of Blisters: 1. To rouse the dormant powers of the system. & 2. To break up the chain of morbid action. For the first, they are useful in typhoid diseases, but when these diseases have assumed a chronic form & have nearly exhausted the powers of the system, they cannot be applied with advantage because there is nothing to sustain the excitement & the system sinks lower than it was before. But in acute diseases, where there is sufficient dormant power to keep up the excitement, they often act very favourably. Hence we find that in typhoid diseases, judgment is requisite. to determine the time proper for their application. They are apt in very low cases to produce sloughing & even gangrene, & if applied, it should be to the inside of the thigh, rather than the leg. For the second indication, they are used in Intermittent & Remittent Fevers. They make a violent impression upon the system which breaks up a chain of morbid action & institutes that 95 which is more healthy.- They should be applied during the interval of Paroxysms, so that their action may take the place of the expected attack.- Blisters sometimes compose the nervous system in disease, as in Chronic forms of Fever, when the patient is very restless,- tossing about &c. he will often be composed to sleep by applying a pair of blisters to his legs.- 3. They act favourably also upon the Principle of Revulsion,- as in Chronic Opthalmia, Pleurisy, Hepatitis &c. - Nausea & Obstinate Vomiting. - A good rule for the locality of Blisters is, if it be an Inflammatory disease, apply them as near as possible to the part affected,- but if it be some nervous affection, apply them to a more distant part so as to draw off the nervous influence. Hence in Hemoptysis, after checking the Hemorrhage, blisters may be applied to the extremities to draw the blood down from the Chest. One caution however is very necessary, which is, never resort to blisters in cases of acute Inflammation 96 Inflammation without previous depletion,- because the general excitement which they produce will only aggravate, instead of cure the disease.- It is from this principle of drawing off the nervous excitement that they are beneficial in Spasmodic affections, as in Cholic & Cholera.- These are nervous affections, & when not connected with any Inflammation, sinapisms are better than Blisters. 4. They sometimes prove beneficial in Tinea Capitis & other complaints by introducing a new action. 5.- Blisters are depletory in their action. They should not be applied however in dropsical cases because they are apt to become ulcers or Gangrene.- 6. The pain from blisters is sometimes useful when the mind is diseased,- quieting the nervous excitement Case of a Lawyer who put a blister on his back, whenever he attempted to plead.- 7. Another use of blister is for the Endemic application of medicines to the denuded surface 97 Thirtieth Lecture Sept. 4 1834 Cantharis Vesicatoria.- Littus Vesica. Melöe Vesicat Spanish Fly. This insect is found in Spain, Italy, Sicily, France & the warmer latitudes of Asia, is of an oblong shape,- 3/4 in. in length & about 1/4 in width,- having a fetid odour when alive, compared to that of mice,- & is of a beautiful green colour. They are gathered by shaking or beating the trees on which they feed, and collected on linen clothes spread beneath. They are then killed by immersion in vinegar & water, then dried & carefully packed for market They are sometimes adulterated with an insect of a square shape If preserved in well-stopped bottles, they will keep a long while & retain their virtue a number of years. Sometimes they are attacked by worms and injured.- If kept in damp places, they soon putrefy.- .- They have a disagreeable odour & an acrid taste they yield their active principles to Water & Alcohol, & contain a chrystalline substance called Cantharidin 98 Cantharidin, which is insoluble in Water & Cold Alcohol, but soluble in boiling Alc. from which it precipitates when cool,- sol. in Ether & Vol. Oils.- In the insect, it exists combined with a yellow matter which renders it sol. in W. & Cold Alc.- It is said that if the flies be boiled,- they will not produce strangury when applied.- Dr M. B. Smith prevents strang. by giving teasp. of Uva Ursi during the operation of the Canth. The most extensive use of the Cantharides is in the form of Blistering Plaster, (See Dispensatory) Cerat. Canth. (U.S)- Emp. Canth (British)- It is well worthy of notice that a Plaster will keep for a long time & that its virtues are not exhausted by one application.- Ol. Canth. is not used.- There is a weaker preparation (Mug. Canth.-) used as a stimulating application to keep open blisters &c. We have also Emp. Picis cum Canth or Emp. Calefaciens.- or Warm[ing] Plaster.- consisting of 1 part of Cerat Canth to 7 prts. Burg. Pitch, which is an excellent application [consisting] used in chronic Catarrh. Rheumatism of Intercostal muscles &c. Limmentum Canth.- consists of Decoct. Canth & 99 Spt. Tereb.- There is also a Tinct. Canth. Cantharides whether applied internally or externally are apt to produce Strangury. When we have reason to apprehend this, give freely of demulcent drink, remove the Plaster & make some emollient application to the part,- as for inst.- a soft Bread and Milk Poultice, with a little Laud. spread over it.- In this manner, sometimes if the Plaster be removed in 6 or 8 hrs, & a Poultice applied, we shall frequently find a fine blister.- This caution is requisite in blistering over the eye lest the long continuance of the Plaster should create too great irritation.- But to return to Strangury,- as before stated,- remove the Plaster & give mucilaginous drinks,- & if these fail, give an anodyne injection of about 60 gtt. Laud. with 2 or 3 tablespoonfuls of Starch,- & repeat if necessary.- If these do not succeed, the last resort is to the Catheter. When a blister is left on too long, a sloughing may ensue, more common in children than in 100 adults,- as in low cases of typhus or scarlet fever With respect to the size of the Plaster, it should be generally as large as the place to which it is applied will admit. The largest size is 10 by 12.- It should be always cut to fit the part neatly.- When applied to the head, it is desirable that the head should be shaved 10 or 12 hrs previous if time will permit, so that the abrasions may heal up. The usual size for arms or legs,- 6 by 4.- After shaving the part, apply the blister & confine it by adhesive strips to prevent its slipping. On the Scalp, it should be left longer than on any other part,- generally from 18 to 24 hrs. On children, a blister is generally produced in from 4 to 8 hrs.- When the serous fluid has discharged so as to separate the cuticle, if it is desirable to heal it up immediately, do not destroy the cuticle, but make only small punctures to allow the fluid to escape. Sometimes the sac contains a gelatinous mass, which is the serous fluid coagulated.- 101 When the blistered surface becomes much inflamed & painful, apply warm milk & water,- soft Poultice,- Cream,- very weak Lime Water, or some such soothing application;- the best in Dr Wood's Practice is Goulard's Cerate, mixed at first with about an equal quantity of Simple Cerate. If it be desirable to keep the Blister running, destroy the Cuticle, & use some stimulating ointment. Cantharis Bittata. Potatoe Fly.- is another species, found in this country, & first introduced into practice as a vesicatory by It is found on Potatoe vines &c. in the morning & evening, feeding on the leaves. It has a reddish brown head;- & brown wing cases with a stripe of yellow upon the edge & along the centre. They are procured by shaking them in Hot Water, carefully drying &c. There are also other species Canth. Atrata Several vegetables possess the property of producing vesication when applied to the skin. None however are employed except Mezereum. for which See Book A p.209. Seldom used. 102 Ranunculus Bulbosus. Butter cup.- has a root possessing the properties of producing vesication, but it is uncertain & has different effects upon different individuals, consequently it is seldom or never used. Rubefacients should be preferred to blisters in cases of very violent & sudden prostration, when an immediate excitement is desired;- as in the sinking spells which occur in Typhus Fever, in the cold stages of malignant Intermittents, in prostration from Concussion of the Brain Syncope &c. But blisters, as before stated, are used to subvert morbid associations, compose the patient, for local inflammation &c. Rubefacients are very useful in spasmodic affections: At the head of the list of the individual Rubefacients, we place Mustard. see Book B. p.125. Thirty-First Lecture Sept. 8 1834 Capsicum, see Book B p.163. Ol. Terebinth. is a very good Rubefacient in low states of the system. It should be heated (with great care, lest it take fire) and applied either by friction or by flannels steeped in it.- If it gives too much pain, remove 103 it, for it sometimes produces unpleasant effects. From idiosyncrasy, it is very irritating & even poisonous to some persons, hence caution is requisites in using it. It is useful as a revulsent in deep-seated inflammation accompanied with prostration, as in Puerperal Fever,- tympanitic abdomen,- as a Liniment in Chronic Rheumatism &c.- see p.142 Pix Abietis. Burgundy Pitch. The prepared concrete juice of the Norway Spruce Fir. It exudes spontaneously on the bark of the tree, whence it is scraped, heated in Water & strained. It comes to us from Germany & Switzerland. It is brittle, opaque, brown externally, yellowish internally. Thus is hardened spontaneously exuded juice of P. Abies It differs from the Turpentines in containing less volatile oil. It softens by heat, & by contact It consists of Resin, Vol. Oil & water. becomes dark by exposure.- with the skin, it is just sufficiently softened to adhere. When thus applied excites a sufficient degree of irritation to increase the perspiration.- In one case of an old gouty patient, Dr Wood knew it to produce violent inflammation & even ulcers whenever it touched him.- It is useful in Rheumatic effection,- Chronic Catarrh,- Dyspnea,- and other Pectoral Complaints. 104 Pix Canadensis. Hemlock Pitch. derived from the Pinus Canad. or Hemlock Spruce of N. America. The juice exudes spontaneously from old trees upon the bark,- this is then stripped, boiled twice & strained. It is of a brown colour, more yellow internally. It consists of Resin & less vol. oil than Turpentine. It is used similarly to Burg. Pitch: by some preferred. Aqua Ammonia. is seldom used alone but generally in the form of Vol. Liniment, a. e. combined with Olive Oil; usually in the proportion of 1 part Aq. Ammo. to 4 parts Oil,- but this varies according to circumstances. It is useful in Catarrh, Rheumatism, Sore throat &c. of Infants especially.- Aq. Ammo. is very uncertain in its strength, & sometimes so weak that it will not unite with Oil to form a Liniment:- it should then be rejected.- A plaster can be made of common Lead Plaster Soap. & mur. ammo. which will last for about 24 hours, & answer the same purpose with the Liniment. A decomposition takes place & the Ammo. is slowly given off.- 105 Tartar Emetic. for the history of this see page 28. It is often applied externally as a Rubefacient. From one to three days generally elapses after it is applied, before any effect is produced: at length an itching & prickling sensation is felt, followed by small red pimples, which increase and become pustules, & afterwards even ulcerate if the application be continued. It acts upon the principle of Rubefacients & Epispastics.- There is however one advantage in its use:- we know that a recession of eruption oftentimes produces internal inflammation & disease, & hence when the eruption can be again brought out, the disease disappears, thus the Tart. Emetic by producing this pustular eruption, alleviates the complaint, having a much better effect than the discharge from Blisters. It operates too more deeply;- affecting not only the cuticle, but extending the pustule down to the cutis vera, & consequently, we may suppose, produces a greater effect upon the system at large. 106 With respect to locality, Dr. James thinks the arm a preferable place, but probably it is more efficient when applied to the back. In inflammatory affections, however, as a general rule, apply it as near as possible to the inflamed part. It is useful in obstinate chronic Pleuritis, Hepatitis, &c.- & an excellent application to the Spine, when there is Tenderness upon Pressure, Nervous Derangement, Hysteria &c.- First apply Cups to the part then apply the Ointment or Plaster. It must be remembered, however, that when applied to a cupped surface, instead of requiring 2 or 3 days, it become almost insupportable in from 1 to 3 hours. It may be used in the form of Lotion, Ointment or Plaster The Lotion is the least favourable mode & seldom used. Ointment is made by mixing ʒi (more if necessary ʒi or ʒij) Tartar Emetic with ℥i simple Cerate. Rub a little on every 4 or 6 hours, or spread it on linen & apply it. The most convenient form is that of the Plaster. This is simply a Plaster of Burg. Pitch, covered over with Tart. Emet. except at the cases so as to allow it to adhere 107 It is generally left on 3 or 4 days, then removed.- if it will not come off readily, apply a little Olive Oil. Almost all the volatile Oils are Rubefacients, but seldom used. One sometimes employed is Ol. Monardo Punctate. or Horsemint Oil. Croton Oil has been recently recommended, mixed with 4 prts. Olive Oil. Escharotics are those substances which destroy the life of the parts to which they are applied & produce a sloughing. They operate in 3 ways, either by their direct influence, or by chemical decomposition.- When they operate in the first manner, the life of the part is lost, because the part is unable to bear the application. In the second, the life is destroyed because of the chemical disorganization of the parts. They are employed for forming Issues, opening abscesses. & subverting diseased action by destroying the part diseased and substituting an action of its own. Of the individual Escharotics, none are more severe than the Heated Iron, or Actual Cautery. This is used for arresting Hemorrhage &c. but seldom in this country, unless in Hemorrhage from the Fauces where no ligatures &c. can be passed. 108 Another mode of applying it is by Moxa. This, too, is seldom used in this country. It is made of Pith. of Sunflower which contains Nitre or other similar plants, or of Rolls of Linen, Cotton &c. imbued with Nitre, so as to continue the combustion. or with Bichromate of Pot. Potassa is next in power as a caustic. It is obtained from Scalsed Lime & Carb. Pot. found in cylindrical pieces kept in paper & in It is deliquescent well-stopped bottles. Caust. [Coru????re] [Acen??um] (old) It is applied as follows. A piece of adhesive plaster with a hole about the size of the place required, is laid upon the part, then take the caustic, wet it & rub it on until the part is black. remove the plaster, & wipe it off with a piece of sponge, then apply a poultice, & in 8 or 9 days, an ulcer will form into which Issue Peas may be introduced to keep open the Issue. Sometimes the Pot. is mixed with Lime, water & soap, & formed into a Plaster, but this is not so good. Issues are adapted to Chronic diseases &c. Caustic is sometimes used for opening abscesses, for removing flesh from poisonous wounds &c. & dissolved in water, it has been recommended for Tetanus by Dr Hartshorne 109 Thirty-Second Lecture Sept. 11 1834 Nitrate of Silver or Lunar Caustic (Argent. Nit) is formed by dissolving Silver in Nitric Acid, drying & moulding it &c. It is white & semitransparent, but when exposed to the air & light, it becomes dark by decomposition & oxidation. It affects only the surface to which it is applied forming an eschar which prevents it from acting deeply & does not penetrate like the Potassa, hence it is employed only for destroying sores &c. as old ulcers. chancres &c. In solution, it may be used as a stimulant to ulcerated surfaces, as in ulcerated Cornea, sore opthalmia, soreness & running from the Ear, &c. for which it is almost a sovereign remedy, if properly applied. A work has lately been published recommending it in arresting cutaneous inflammation. It is generally applied by rubbing it over the surface. The proper proportion for an Eye-Walle is 1/2 gr. to grs ij to ƒ℥i Distilled or River Water. But when the Cornea is ulcerated, its strength may be increased, or a better plan is to apply it with a camel's hair- 110 pencil.- For the Ear, begin with a solution of about grs ij to ƒ℥i & increase it if necessary, to 3 or 4 grs to ƒ℥i Distilled water. If it should be applied by injection, always use a Silver Syringe, as others will decompose it. Arsenious Acid or White Oxide of Arsenic, obt. by sublimation from the Ore is sometimes used for Cancerous Affections, & is the basis of most of the empyrical remedies for that disease. There is danger, however, of the poison being absorbed, & hence it is seldom prescribed by a regular physician.- more danger in a dilute than caustic state. Sulphate of Copper (Cup. Sulph.) is sometimes employed as an Escharotic. generally in Solution: A solution of grs XX to ƒ℥i Water is an excellent application to Chancres &c. gtt i per day will often completely destroy them. A solution of it is also used for ulceration which is often seen in the mouths of Children, accompanied with fetid breath Gangrene Swollen cheeks &c. it proves a very effectual & certain remedy Verdigris, is sometimes used at Escharotic. 111 Corrosive Sublimate or Bichloride of Mercury is seldom used as an Escharotic, but as a stimulant in syphilitic affections &c.- A [solution] mixture of it, however, is very efficient in arresting a disease of the Fingers & Toes called Onychia Maligna, once considered incurable- Take equal parts of Corrosive Sublimate & Sulph. Tinc.- mix them together, & sprinkle them over the surface of the diseased parts. then apply a Pledget of Lint & over that Tinct. Myrrh or Laud.- For about 1/2 an hour, the pain is very severe, when the part becomes destroyed, & soon heals again kindly. For Syphil. ulcers in the Throat, apply a sol. of grs V to X to ƒ℥i- Cutan. eruptions grs ij to ƒ℥i Alumen Exsiccatum. Burnt Alum. is applied in the state of powder to the fungous flesh &c. which sometimes appears upon ulcers. It acts as a gentle escharotic. It has been recommended in Sore Throat, to be applied by the fingers, or in solution- grs XV to ƒ℥i. The mineral Acids may all be considered as Escharotics, especially the Sulphuric & Nitric Dilute Sullph. Acid is sometimes used for cutaneous diseases in ointment Dil. Nit. has been used for ulcers. It was also used equal parts of Nitric Acid & Water. for speedy blistering in Cholera, but is not much at present. 112 Demulcents act by a mechanical power. They are generally mild, unirritating substances, soluble in water, & usually consist of gummy, saccharine, farinaceous & Oleaginous Principles. They are used for 2 purposes. 1. To defend the surfaces with which they come in contact from irritating substances, as in Catarrh &c. 2. They mingle with the acrid matter secreted, & obtund its acrimony, hence they prove useful in Dysentery, Diarrhea & other irritations of the bowels also in Nephritis, Strangury, Gonorrhea, &c. We next notice the individual Demulcents C.51 C.53 A.215 Gum Arabic, Tragacanth, Ulmus Fulva, Flax Seed B.135 B.25 Pith of Sassafras, Quince Seeds and A.115 Liquorice Root. for which see Books A, B & C. Thirty-Third Lecture Sept. 15 1834 B.189 C.55 C.53 C.55 B.133 On Lichen Isl.- Sage,- Tapioca.- Maranta & Barley, for which see Books B & C. We next come to the General Remedies, & the first Class comprises the Astringents. These are medicines capable of contracting or corrugating the 113 living fibre, as is obvious to the senses for inst. the mouth becomes puckered by chewing an astringent. It does not act merely by a mechanical power, but every living fibre possesses a property of contractility, & the Astringent affords the stimulus necessary to produce the effect. The influence of different medicines upon the stomach is soon communicated to the whole system, & it is by this general sympathy, that we account for the operation & general effects upon the system at large, of astringents taken into the Stomach. The Indications for the Use of Astringents then are evident from their method of operation. It is plain that they would be injurious when the discharge depends upon some foreign cause, unless that cause first be removed. As they are somewhat excitant in their nature, they would be injurious in an irritated or inflamed state of the system. They would prove beneficial, then, when the morbid discharge depends upon a weakness of the vessels 114 vessels after the exciting cause has been removed. when there is no inflammation in the part: or when a suppression of the morbid discharge even without arresting the disease, would be of less serious consequence to the patient, than to allow its continuance as for inst. suppression of Diarrhea in Consumption. They are used chiefly for the purpose of restraining Diarrheas, & arresting Hemorrhages; but they are not proper to be given in fever, with excited arterial action. They are generally used as External or Local Applications. When given with a view[ing] of arresting Hemorrhage, depletion may first be used with advantage, as in blood from the Nose, from ruptured vessel, from wounds &c. tho' frequently it is not necessary.- There are 2 Classes of Astringents, the Vegetable & Mineral. The Veg. Ast. owe their property to Tannin. The Mineral; to a peculiar specific Influence. We next come to treat of the Individual Astringents. First. Oak Bark. derived from different species of Quercus, & Galls. for these, however, see Book B p.15 & p.17 115 Thirty-Fourth Lecture Sept. 18 1834 C.57 C.59 A.125 A.193 On [Catechu?], Kino, Rhatany, Logwood, Geranium A.131 A.129 Maculatum, Rubus villosus & trivialis, for which see Books A and C. Thirty-Fifth Lecture Sept. 22.- B.49 B.95 A.135 Uva Ursi.- Black Alder Bark, Roses, Tormentil, A.127 A.183 Bistort, Alkanet, for these see Book B & A.- The unripe fruit & the bark of the Persimmon, Dispyros Virginiana, have been used as Astringents Tarmin, itself, in a pure state, has recently been used as an Astringent. It is of a brown colour, brittle unchrystallisable, sol. in water & dil. Alc. but not in pure Alcohol. Dose 5 to 15 grs. Mineral Astringents. Alum:- is a double salt, consisting of the Sulph. Alumina & Sulp. Pot. with about 50 pr.ct. Water of Chrystallization. Sulph. Ammo. or Sulfs. Soll. might be Substetuted for Sulfs. Pot. in forming the Chrystals. It has an astringent taste accompanied with sweetness is soluble in about 16 times its wt. of water at 60° & 3/4 its wt. boiling water.- When exposed to heat 116 it melts, loses its W. of Chrystallization & falls into powder. Its incompatibles are the Alkalies & their Carbonates, Lime, Magnesia & Carb. Acid of Lead, & the Mercurial Salts.- also veg. infus. as Galls, Kino. Bark &c. It is employed with advantage in obstinate chronic Diarrhea, in the relaxed state of the bowels which follows Dysentery, in Passive Uterine Hemorrhage, when not connected with an excited state of arterial action. Also in Cholica Pict. united with some Aromatic as Nutmeg & it has been prescribed for curing intermittents. Internally, its powers are feeble, & hence we cannot rely upon it in Diabetes, Leucorrhea &c. When that given, it is apt to offend the stomach, combine it with Recently its powder has been recommended to be applied with the finger upon the inflamed fauces, in Scarlatina Cynauche [???silllaris] &c. also in strong solution of 15 or 20 grs to ƒ℥i, as an injection for Epistaxis, Bleeding from Rectum &c. Nutmeg or some other aromatic. Alum Whey is made by boiling ʒi Alum in Oj milk. Dose ƒ℥i or ƒ℥ij. A gargle for relaxed Uvula &c. may be made of grs V or X to ƒ℥i water. An injection of this solution into the nostrils will arrest Epistaxis. It may be used in Gonor. Fluor Albus &c. Alum Curd. made by agitating white of Egg with Alum good application for Inflamed Eye, Ecchymosis &c. 117 The Preparations of Lead, although they are Astringent, yet they have a peculiar & specific action. The symptoms which they produce upon the human system are numerous. but the most prominent are such as appear in Cholica Pictorium, where, besides the Pain in the Abdomen, Costiveness &c. we have pain in the external muscles, partial palsy, & sometimes an affection of some of the organs of sense. These preparations produce immediate nervous derangement, as well as act as Astringents. Litharge: Ox. Plumb. Semivit. is a Protoxide It is made by exposing Lead to heat in a reverberatory furnace, is in small scales of an orange yellow colour & is used chiefly for forming the Lead Plaster. Emp. Plumbi. This is done by boiling it with Olive Oil & a little water. The water unites with the Oil, so as to form Oleic & Magaric Acid, & these uniting with the Ox. of Lead form the Oleate & Magarate of Lead, of which the Plaster is probably composed. It is used principally for forming other officinal plasters, sometimes It is an excellent application to prevent ulceration from pressure in low fevers, long continued. for application to excoriated surfaces but seldom. 118 Carbonate of Lead or White Lead is formed by exposing lead in thin plates to the action of the vapours of vinegar. It is a powerful astringent, & often produces Cholica Pictorium. It is never given internally, but sometimes is applied to excoriated surfaces in the form of an ointment made of ℥i to ℥vj Simple Oinment. A plaster has also been directed by Pharm. at a substitute for May S Plaster, the principal ingredients are Lead Plaster & Carb. Lead. But the most important of the Prep. of Lead is the Acetate. Plumb. Acet.- Sacch. Saturni;- made by boiling Vinegar & Carb. Lead.- It is a neutral Acetate, consisting of 1 Eq. Acid,- 1 of the Base & 3 of Water It has a sweet, astringent taste, when dissolved in W. generally gives out the odour of Vinegar, on acct. of Sabacet.- but when pure is inodorous, efforescent, sol. in W. & Alcohol. Incompatibles are the Alkalies & Alkaline Earths, & their Carb. substances which with these Alk. form Soaps, Tart. ant. & Tart. Iron. sulphurates. Sol. Sulphates & Muriates, the Acids &c. so that the best plan when it is given is to allow the patient to 119 take nothing but Water or a solution of Gum &c. Different opinions prevail among practitioners respecting its efficacy, some considering it as a poison too dangerous to be given, & others prescribing it in a great variety of diseases. The terrors, however, which some have conceived respecting it, are unfounded, altho' in large doses or in small ones long continued, it certainly is dangerous. When given in small & continued doses, it acts upon the nervous system, more gradually, producing its peculiar effects, & will bring on Cholica Pic. sooner than if administered in larger doses. But by avoiding excessive or long-continued doses, by combining with opium, when not contra-indicated, by attending to the costiveness &c. it is safe. & frequently a very beneficial remedy. To cases of Internal Hemorrhage from the Lungs or Uterus, it is well adapted, but even though it may be given in an excited state of the system yet it must not exclude depletory remedies.- 120 In Uterine Hemorrhage, unconnected with Pregnancy, it acts favourably, combined with Op. or Ipecac It cannot be relied on, however, in Intermittents, Hooping Cough, Epilepsy &c. Dr Irvin of Charleston published a paper in 1820 recommending it strongly in Yellow Fever, & Dr W. has tried it once & was well pleased with it. The time for its administration in this disease is when Gastritis is at its highest point, when the patient begins to turn even a little yellow. Dr W. believes that it acts by coming in contact with the inflamed surface of the stomach, upon the same principle that it acts upon inflamed parts externally. It may also be beneficial in the same way in Dysentery It is useful in arresting the profuse Diarrhea in Cholera. Dr W. gives 2 grs Cal. & 1/2 gr Opii every hour. & in the intervals gives 2 grs. Acet. Lead. Parrish uses it in combination with Kino to arrest internal Hemorrhage. From its influence over the Nervous System, it might probably prove beneficial in Hydrophobia. 121 The dose of it varies according to different authors From 1 to 2 grs, & may be repeated every 2 or 3 hrs. After 10 or 12 grs. have been taken, suspend it, so that it may produce no injurious effects. It may be given in Pill [of] with Crumbs of Bread. Lead Water is made by dissolving ʒij in Oj distilled Water. This is a useful application to inflamed surfaces, by [illegible] wet with it, but must not be applied to excoriated surfaces. A Poultice may be made of it, by mixing it with bread, & enclosing it between linen. This is a good application to inflamed Eyes &c. A solution of 1 or 2 grs. Acet. Lead to ƒʒi W. is a good wash, for Optthalmia, Gonorrhea, Fluor Alb. &c. Goulard's Extract of Lead is made by boiling Letharge in Dist. Vinegar, & filtering the resulting liquor, or by boiling Letharge in a solution probably a comp. of Dis. & Trisacet. of Lead of the Acet. of Lead. It is said to be a Trisacetate. Sometimes it is of a greenish straw colour, owing to the impurity of the Vinegar, but usually is colourless alkaline in its properties, & decomposed by 122 those substances which are incompatible with the Carb. Lead already noticed & with Gum Arabic & Mucilages. Even distilled water produces a milky appearance with it, on account of the Carb. Acid which it contains. This is best test for Mucilages or Gum. It is used only as a Lotion in Eruptions & Local Inflam. Lead Water should contain about ƒʒij Goulard's Ext. to Oj Water. Goulard's Cerate is made by mixing [cross out] [simple cerate &c.] Goul. ext. with Oil & Bees wax. is a useful application to abraded surfaces, & especially beneficial to blisters in disposed to heal. Also Herpetic eruptions Sulphate and Acetate of Zinc are used as Ext. Ast. Also the Mineral Acids, which, are rather tonics. Lime-Water & Carb. Lime are sometimes useful in the Diarrhea, Cholera Infant, & the later stages of Dysentery. We next come to the subject of Tonics; upon which we will make some general observations. By this term, we designate those substances which have the power of producing & maintaining a gentle 123 exaltation of the actions of life in sudden & great prostration without necessarily causing any apparent increase of these natural actions. Unless taken in large doses, the action of tonics is not manifested by any immediate & obvious excitement.- The vigour which they impart to the system is the result of a slow operation on the animal Economy, & altogether different in its character from that temporary augmentation of force which is the immediate consequence of the operation of stimulants properly so called. When Tonics are employed in a debilitated state of the system, their operation is evinced by a gradual & permanent increase of the force of the circulation, and an invigoration of the digestive powers & of the general energies of the System. There is no term which expresses their operation so well as Corroborants, for their most prominent effect is to produce strength,- but as strength does not depend upon tension of the muscular fibre as was formerly supposed, the old name Tonic is not a suitable one.- 124 When the system is in a healthy state, Tonics are not needed to exact its powers to proper action, hence they become injurious. By long continuance, they establish irritation & chronic Inflammation & diminish the susceptibility of the organs to their impressions. But, as sometimes happens, when the disease is kept up by debility, they are useful. Tonics are not applicable to all states of the system. They are improper, when there is an increase of action beyond the natural standard in health. They act injuriously in two ways, if given for a long time and steadily. 1. They produce a certain degree of excitement which at length degenerates into Inflammation. 2. They cause a momentary elevation of the powers of the stomach by their action upon the nervous energies, & this is succeeded by a subsequent diminution of its power, so that it cannot perform its duties. Thus with the celebrated tonic, Portland Powder, it has been remarked by Cullen that the use of it was always sooner or later followed by Dropsy. 125 Tonics, therefore, should be given only when the natural powers of the system are depressed, & should not be continued too long, or given during local Inflammation. They act as corroborants in two ways: 1. When the stomach is debilitated, the food introduced into it is not digested, & the body is weakened from the loss of its natural support:- then tonics restore the digestive energies & enable the stomach to pass the food properly into the circulation. 2. Tonics may also impart tone to the system by exciting a peculiar action in the part to which they are immediately applied, & thence propagating a similar action to other parts of the body thro' the medium of the nerves.- or they may strengthen by being absorbed into the circulation, & thus acting directly on the whole organization thro' the medium of the blood. Tonics are by no means equal in the degree of their sensible power, some producing but little change while others approach to stimulants. This class of remedies may be divided into three 126 subdivisions 1. The simple Bitters. Bitterness is a property possessed by all the vegetable tonics. Cullen supposed it to be the tonic power. It does not reside exclusively in any one proximate principle. thus Quassia, Genteanin &c. are tonic, while Morphia &c. is narcotic. 2nd. Set unite an aromatic or other property with the bitterness as most prominent, as in Serpent.- August. Bark, Cascarilla. The aroma is owing to an essential oil.- These are more stimulant than the first set.- 3rd. Set are purely Aromatic, & depend for their efficiency upon an essential oil, but in some instances the property of a stimulant is united to some other property which renders them Tonic. They accelerate the action of the heart & arteries, [cross out] & produce an increase of heat, but do not act on the cerebral nerves. They are employed in combination with other tonics to cover their taste, & render them more acceptable to the stomach. Some of them might form a distinct class. Some are astringent:- 127 36th Lecture. We shall next notice the Individual Tonics, [cross out] and shall arrange them according to their stimulant powers, first treating of the simple Bitters & afterwards of the Aromatics.- a.135 A.141 A.143 Columbo, Frasera Waltri or Auc. Columbo, Gentean. A.195 & Qussia, for which See Book A. Thirty-Seventh Lecture Oct. 2 1834 B.13 B.97 B.193 [Su??aruba], Chamonmile, America Centamy A.149 B.189 A.217 Serpentarea, Eupat. Perforliatum & part of Cinchiona, for which see Books A & B [&C]. also upon Artemisia or Wormwood, Trefoil, Blessed Thistle, Horehound, & Tansy,- which are all bitter tonics & applicable to similar cases. They are used only in the absence of the others, or to suit the prejudice of the patient, so that his faith may cooperate with the remedy. Thirty Eighth Lecture Oct. 6 1834 A.217 On Cinchona & its constituents. see Book A. Thirty-Ninth Lecture Oct. 9 1834 B.1 b.11 b.3 On Augustina Bark, Cascarilea, Dogwood, Prunus B.7 c.43 Virginiana, Myrrh. for which see Books B & C. 128 also upon Aromatics, which is a term applied to those products possessing a fragrant odour, & a peculiar spicy flavour, not mixed with any other properties. Their efficacy depends upon a vol. oil. & as all oils affect chiefly the circulation, they might be called stimulants, but the[y] influence which they exert is rather more of a Tonic nature, & besides, their stimulant effects are rather local than general, because of the difficulty, with which the oils are taken up by the absorbents. Aromatics exert a peculiar cordial influence upon the stomach, obviating sickness, expelling flatus, relieving spasmodic pain, & also [cross out] obscuring in some degree the taste of nauseating medicines. They are generally joined with other remedies, with purgatives, to prevent their griping, with tonics, & stimulate to increase their power, they render medicines more acceptable to the stomach. They should never be exposed to a continued heat & hence should not be prescribed in Decoction.- 129 The Oils are concentrated forms of the Aromatics, & Distilled & are variously termed Vol.- Ess.- & Arom. Oils.- Their taste & colour are various. sp. gr. generally lighter than that of Water, sometimes heavier, & some few, equal. They are Volatile, inflammable, & when exposed to the air, deteriorate, & become changed into something of a Resinous nature. They are sparingly soluble in Water, but all of them can be made to unite with it, by means of Sugar or Gum Arab. or by rubbing them first with Carb. Magnes. then adding Water & filtering. They are often adulterated, & this can only be detected by the odour solubility,- sp. gr.- or volatility & stain on paper They are employed as the Aromatics themselves. Frequently they are used dissolved in Alcohol. then, improperly called Essences. b.165 On Individual Aromatics- as Orange Peel. b.169 b.19 Lemon Peel,- & Cinnamon, for which see Book B. Fortieth Lecture Oct. 13 1834 b.29 b.101 b.153 b.159 On Canella, Cloves, Nutmeg, Piper Nigrum, P. b.161 b.161 b.157 b.147 b.151 Lougum, Cubebs, Allspice, Cardamom, Caraway 130 b.153 b.147 b.145 Caraway Coriander, Anise Seed, Fennel Seed, b.105 b.103 Lavender, Rosemary, Sage, is an aromatic & ast. and hence an infusion of it is used as a Gargle for Sore Throat:- sometimes warm is given in Amenorrhea. b.197 b.199 b.199 Peppermint, Spearmint or Mint. European Pennyroyal, b.201 b.205 b.51 American Penny Royal, Balm, Gaultheria, a.163 a.171 Ginger, and Calamus, for which See Books A & B. Forty-First Lecture Oct. 16 1834 On Mineral Tonics, the most important of which are the preparations of Iron. & these are most extensively employed among practitioners. There is a strong resemblance between all of them in their action upon the system, they increase the force of circulation, invigorate long continued doses are said to diminish the spleen, to excite Portal Circle the powers of the stomach, & produce a permanent A long use of them in health produces Inflam. Diathesis, hence Chalybeats water injurious to healthy persons; corrobative effect upon the system. When, however, Iron & Prep. have a local tendency to Uterus. active Inflammation exists, when the Stomach is in an irritable condition, or when the liver is unhealthy secreting unhealthy bile, they are improper & injurious.- They prove advantageous in Dyspepsia, in nervous & hectic diseases, and that long train of complaints arising Cheltenham Salts are an excellent remedy for Chronic Hepatitis, teaspoonful daily before breakfast not too long continued, as Iron may produce excitementing. 131 excitementing from debility of the alimentary canal, or from general debility of the system, as Chlorosis, Amenorrhea, Anemia with swelled waxy countenance &c. Hysteria, Epilepsy, Scrofula, Phthisis &c. They are the best remedy for Amenorrhea, connected with general Debility. With regard to their modus operandi, there is much dispute, whether they act by first depressing the powers of the stomach, & then carrying this action by sympathy through the nervous system, or whether they enter the circulation & are thus distributed Iron has doubtless been detected in the blood, & it may act in that way, but the probability is that it acts by both the above mentioned methods. The redness of the blood does not depend upon the Iron continued in it, as some have supposed, but upon the invigorated action of the Lungs. Iron in its pure metallic state, has been said to be medicinal, but its effect, when thus given, is Black stools always follow. probably owing to some change which it undergoes forming salts. in the Stomach from the acid &c. which it meets.- The simplest form in which it is given is that of Filings Ferri Ramenta. Dose 10 to 30 grs. but seldom given internally produce eructations of Sulph. Hyd. &c. Dysp. Chlor. [illegible] 132 Squama Ferri are made by heating Iron & pounding it. They are a combination of Iron & oxygen, dark, brittle, pulverizable, insol. in water, readily soluble in acids. Not much employed in medicine. There are 2 Carbonates of Iron used in medicine 1. F. Carb. Prapar. or Rubigo Ferri, made by exposing Iron wire to air & Moisture, & is a Mixture of the Proto-Carbonate & Red or Peroxide of Iron. 2. F Carb. Precip. made by adding a sol. of Carb. Sod. the Precipitate is at first Proto Carb. of green colour. but on exposure, it attracts Ox. & becomes a solution of the ProtoCarb. & Perox. of a reddish colour. to a sol. of Prosulph. Iron. It is a fine, red chocolate of the Protreast .& Porox .- of a reddish colour. powder, less apt to offend the stomach than the former, because more minutely divided. Both these Carb. are insol. in water, but soluble with effervescence in Acids, & partially sol. in water impregnated with an excess of Carb. acid, hence these are generally present in the Chalybeate Springs - They are used in all cases where the prep. of Iron are indicated, and lately have proved highly serviceable in Tic Doullureux, Neuralgia &c. given in doses of ʒss to ʒi, 3 times a day gradually increases, the usual dose is from 5 to 20grs as a Tonic. 133 Dr Ruth was very partial to a prescription containing equal parts of Rubigo Ferri Pulv. Colomb. " Tingib The effect which the Carb. Iron has in Tic Douler may most reasonably be ascribed to its action upon the whole nervous system. For this, dose ʒss to ʒiss F. Suphas. Sal Martis. is made by acting for medical purposes, Iron Wire should be used, as this purer. on Iron Filings with dil. Sulph. Acid.- It has a strong styptic taste, is in greenish Chrystals, sol. in water, insol. in acids, when exposed to heat loses its W. of Chrystallization & becomes a dirty white powder, called F. Sulph. Exsiccat. Exposed to the air it becomes a Persubsulphate. at first, its efflorescence is white, the sulphate, afterwards attract Ox. becomes Perox. brown colour.- Incompatibles are all sol. Salts which form insol. compounds with its acid, earths, Alk & Carb. Pot. Nit. Acet. of Ammo. & all vegetable astringents. It is a good Chalybeate, & has an advantage by being soluble, & it may be given in Smaller doses. Use the Dried always for Pills. Dose is from 1 to 5 grs. less of the dried generally given in combination with Purgatives &c. 134 Tinct. Ferri Muriata,- consists of a Muriate of Iron dissolved in Alcohol. It is made by dissolving Carb. of Iron in dil Mur. Acid & adding 3 times as much Alcohol. It is of a brownish yellow colour, has an ethereal odour from the action of Alc. upon excess of Acid- and is decomposed by Alk. & Carb. & by astringents. It is the most active of the Chalybeates, given in Dysuria, depending upon Spasmodic stricture of the Urethra, for Venereal Warts &c. Dose 10 to 30 gtt. in a wineglassful of Water, 2 or 3 times per day. It is given also in Dyspepsia, Amenorrhea &c. Ferrum Ammoniatum is made by subliming Mur. Ammo. & Perox. Iron. It is of an orange, yellow colour, seldom used. Dose 3 to 15 grs. Ferri Phosphas, by adding sol. of Phosp. Sod. to sol. of Proto Sulp. Iron At first it is a Proto Phosph. afterwards Perphos. & we usually find it a mixture of both. It is of a light blue colour. By Carmichael it has Insol. in water 1-2 grs. been recommended for Cancer. Dose 5 to 10 grs Ter die. Tartrate of Iron & Pot. made by boiling Carb. Iron, Bitart. Pot. and Dist. Water. It is inodorous, has a At first Proto, afterwards becomes Pertartrate styptic taste, of a greenish brown colour, sol. in W. It is a mild Chalybeate, supposed to be diuretic, hence given in a tonic dropsy. Dose from 5 to 20 grs. This 135 is an ingredient in Vinum Ferri, because Bitart Pot. is contained in Wine, & this by its action on Iron Filings forms this salt. Hence Vin. Ferri possesses no advantages & It is a much more variable preparation- over a sol. of Tart. of Iron & Pot. Iodide of Iron;- a preparation upon which little Insolution in water,- Morton considers it unequal in cutaneous affections &c. with Syr. Sarsap. or no confidence can be placed. F. Ferregent insol & almost tasteless Copper.- in its metallic state, seems to have little affect upon the system, but its salts sometimes produce unpleasant consequences, & are even poisonous from the irritation excited in the mucous surfaces. Hence care is requisite in preparing food in copper vessels of any kind. & in drinking Min. Water from Copper Reservoirs Cupri Sulphas is a Bipersulphate. It is in chrystals has a harsh, styptic taste, is sol. in Water, insol. in Alc.- is decomposed by Alk. & Carbonate,- Cor. Sublimate. Nit. Silver. Permur. Mercury, & all astringents. When given in small doses, it excites the stomach. In large doses, it produces very violent vomiting & the patient has a coppery taste in the mouth.- The stomach must be washed out freely, & Albumen administered to an increased action, but the danger attending it has circumscribed its use. In that form of Intermittents called Quartan it is sometimes given as follows Cupri Sulph. gr.i mft. Pill No iv Quinia Sulph grs viij opii gr. i S. one 4 times a day 136 It is used advantageously also in Chronic Diarrhea depending upon Ulceration of the Intestine, Epilepsy &c. In Germany it has been recommended for membranous Croup. Cup. Ammoniatum.- is made by rubbing up Bisulph. Copper with Carb. Ammon. It is of a Sapphire blue colour, with a hot styptic taste, & changes to green by exposure to the air. It has been much recommended for Epilepsy, but its use is disputed. It is given also in Hysteria, Chorea &c. but never without previous depletion. Dose grss. 2 a day and gradually increase if necessary.- In form of Pill.- Zinc itself, exert no sensible effect upon the system, but there are two preparations of it used in Medicine as Tonics. They are employed in Hysteria, Epilepsy, Chorea & various other diseases. Sulphate of Zinc.- is made by adding dil. Sulph acid to Zinc.- It crystallizes in 4 sided prisms, effloresces slightly, is very sol. in Water, cold or hot, with a metallic, styptic taste, & is decomposed by Alk.- Earths.- & veg. astringents.- Is not much used as a Tonic.- It has been given in Diarrhea,- Chorea &c. Hooping Cough,- Colica Pict.- but more as an Emetic A solution of 1 1/2 or 2 grs to ƒ℥i water forms an 137 excellent injection in Gonorrhea,- & weaker for Chronic Opthalmia.- Dr W. has never failed to cure the Ulceration of the Mouth occurring in Children by touching them with a solution of from 5 to 10 grs to ƒ℥i 15 grs to ƒ℥i Water.- Also useful for cutaneous eruptions The dose internally is 1 or 2 grains. Then taken in poisonous dose, it produces great constriction & vomiting &c.- there are relieved as soon as it is evacuated. Oxide of Zinc.- may be made by burning Zinc. It is white,- inodorous,- tasteless,- insol. in W. & Alc.- unalterable in the air.- Dose 5 grs.- gradually incred. Tutty.- is an impure oxide of Zinc,- made by mixing the Ox. with Clay & Water.- It is inodorous,- tastless- brown externally, but the inside of a mass yellow used for excoriations &c. by sprinkling.- or in form of Ointment.- Calamine is an impure Carb. Zinc. has an earthy fracture.- When roasted & elutriated, it is sprinkled on excoriated surfaces,- or made into an ointment, & then applied. Tumers Cerate. Bismuth- is used in medicine,- by just making a solution in Nit. Acid,- then add Water.- A precipitate is formed which was formerly called an Oxide, it is now called Subnitrate of Bismuth. It 138 is white,- insoluble,- inodorous, & unalterable in the air. It has been highly recommended in Dyspepsia with violent pain unaccompanied with [cross out] Inflammation.- It imparts a black colour to the stools, like Iron. Dose 5 to 10 grs,- 3 or 4 times per day. Nitrate of Silver.- has a strong,- metallic, bitter taste.- It is sometimes used internally,- & has been highly recommended in Epilepsy,- but disputed. It is given also in Chorea,- Angina Pectoris,- & sometimes in Leucorrhea,- but perhaps with no benefit.- Incompatibles- Alk. & thin Earths, Soaps, Sulph, Min, & Tart. Acid & thin Salts, Arsenite Pot. Sulphurets & Tarmin An objection to its use is that when long continued it communicates a dark colour to the skin.- The rationale is that Nit. Silver is decomposed by light, hence when it enters the circulation, it is carried into the cutaneous vessels & there decomposed. Probably, however, it is inert,- because there is sufficient salt taken into every stomach to decompose it, & produce an insol. Chloride of Silver.- The dose usually given is 1/8 gr. 3 or 4 times a day,- made into pill first dissolve it in water. with bread containing no salt,- or with Pulverized Liquorice Root,- which is preferable to the former.- Preparations of Gold are not used in medicine at present.- 139 The Mineral Acids sometimes employed are the Sulphuric,- Nitric & Muriatic. Sulph. Acid, is tonic & astringent,- hence it is given in Debility accompanied with morbid discharges, as in Hemorrhage from the Lungs and Uterus.- It is also a good remedy for Hectic in Consumption. Night Sweats &c. & in loss of appetite, connected with an asthenic state of the Stomach.- It is often given in combination with Tonic Veg. Infusion. It is used diluted, as a Gargle in Sore Throat,- or locally, for cutaneous eruptions,- Psora,- White Blister in the Mouth &c.- When prescribed, it should be Ac. Sulph. Dil.- which is only 1 part to 7 parts Water Dose is 10 to 20 gtt. in a wineglass of water,- taken thro' a quill.- In hemorrhage ʒss. to ʒi may be given. Elixir Vitriol is generally used internally. Nitric Acid,- of which there are 2 kinds,- the coloured & colourless.- This is given in simple gastric debility,- in convalescence &c.- It is said to have a specific influence like Mercury.- Dose of the strong acid is 2 or 3 gtt. in 1/2 tumbler of water,- but varies in strength. 140 Muriatic Acid is seldom employed in medicine. Sometimes it is given in Malignant Scarlatina, & in Typhus Fever.- Also for Worms.- Dose 5 to 20 gtt in 1/2 a tumbler of Water.- A Gargle is ƒʒi to ƒ℥vj Water. Forty-Second Lecture Oct. 20 1834 Nitro-muriatic Acid,- is a mixture of Nitric & Muriatic Acids,- producing a third compound which owes its efficacy to Chlorine.- The acids should be highly concentrated,- otherwise they do not act upon each other,- but merely form a mixture. If they are not sufficiently strong for the purpose,- add a little Sulphuric Acid. Besides being a tonic, this is also specific, bearing a close resemblance to Mercury in its action,- producing sometimes Ptyalism & even soreness of the Gums, & its direction to the Hepatic system is shown by the increased secretion of Bile. It was first introduced into practice by Dr Scott. It is useful in Chronic Inflammation or Disorder of the Liver,- Scrofulous affections,- Cutaneous Eruptions Secondary Syphilis &c. It may be given internally 141 or externally,- similarly & in like doses with Nit. Acid A bath is a desirable form of using it, if there be much gastric irritation.- This may be either general or local.- It should be strong enough to produce a tingling sensation upon the skin.- generally the proper proportion is about ƒ℥i to Coug. i Water. Stimulants. Simple stimulants are those medicines which increase the action of the heart and arteries without exciting the brain & nervous system.- They are used in cases of debility, unaccompanied with organic disease, as in the common consequences & termination of Idiopathic Fevers of a Typhoid nature,- also in Cholera,- profuse Diarrhea &c. But they are not used exclusively in cases of simple debility.- often prostration attends local Inflammation,- organic lesions &c.- when stimulants become requisite to support the system,- as in Typhus Pneumonia,- Typhus Dysentery,- low forms of Small Pox,- & other diseases,- where, tho' the Inflammation &c. would seem to contra-indicate them, yet they are necessary 142 necessary evils,- & must be used with great caution. In that debilitated state of system, which we often find during the ulcerative or suppurating process, stimulants often prove beneficial by enabling the vessels to perform their proper secretions, & promote a healthy action.- Of Individual Stimulants. Of distilled from Turpentines. Oil of Turpentine is a stimulant of considerable when pure it contains no Ox. importance,- there being few, which act more upon the circulatory, & less upon the cerebral & nervous system. It is useful in low forms of disease,- especially those in which the head is so affected that narcotics are forbidden.- Besides this, it has a peculiar effect upon the mucous membrane of the Stomach,- hence proves beneficial in some forms of Diarrhea,- Dysentery &c. Probably the Turp. operates by changing the morbid action & substituting its own. It has proved peculiarly useful in those typhoid fevers, where the tongue cleans suddenly,- smooth, red & moist,- or sometimes it becomes dry & not completely clean,- & the abdomen is somewhat tympaustic,- then also, there may be some delirium,- & yet the patient 143 not sufficiently low to require other stimulants.- In cases of this kind,- it is plain that there is a disease in the small intestines & that this disease is ulceration, then 5, 10 or 15 drops given every 1 or 2 hours, will produce a very happy effect, In 24 or 48 hrs. you will find the tongue become moist,- a little fur will appear,- which soon after passes off & the patient recovers. It is useful also in the last stages of Gastritis, Enteritis, also Yellow Fever, Dysentery &c. It has been recommended by Dr Bretton in Puerperal Fever,- but W. thinks it must be of that form which is not connected with Peritoneal Inflammation Also useful in Chronic Rheumatism,- Epilepsy,- Piles,- Flatulent Cholic,- Gout of the Stomach &c. &c. Dose from 5 to 20 drops every 1, 2 or 3 hrs. For Capsicum see Book B. p 164. Phosphorus, is the most powerful stimulant known, & the use of it very dangerous.- Dose is 1/12. 1/8 to 1/4 gr,- 1 gr. in 24 hrs Generally given in Sol. in Ether or in Emulsion,-a better mode than in Pill. 144 Min Ammo. & Carb. Lime. Ammonia Carbonas.- or Volatile Alkali.- has more influence over the nervous system than those before mentioned. It is formed by subliming Carb. Lime & Mur. Ammo. It is a Sesquicarbonate, found in Lungs, which are hard, solid & semitransparent, white, effloresce & deteriorate by exposure. It is decomposed by Alk, Alk. Earths, Acids &c. It increases the force of circulation & invigorates the vital functions, without affecting the brain or stomach it also produces diaphoresis. Hence it is useful in Typhoid fevers, in the intermission between excitement & collapse, alternated with Wine Whey. In low forms of Fever, where the brain will not admit Narcotics, in Typhoid Pneumonia, Scarlet Fever, Retrocedent & Atonic Gout, Chronic Rheumatism, Palsy &c. As it is an Antacid, it acts favorably also in diseases of the Alimentary Canal. It has been recommended also for bite of animals, for stings of Wasps.- Hornets- Bees &c. Also is said to remedy Drunkenness. Dose 2 to 5 to 10 grs. every 1 or 2 hours. Generally given in solution. Diffusible & Transient. 145 Antispasmodics,- are medicines which are given to relax or prevent irregular muscular contractions or spasms. But all medicines producing this effect, are not ranked under this head, because they depend upon a great variety of causes, & hence demand a great variety of remedies.- They calm the restlessness & agitation which arise from nervous action, & hence prove that they act upon the nervous system. Under this head then, we rank those which, while they stimulate the circulation, would act upon the nervous system without producing any effect upon the cerebral function. The name, however, is an improper one, as well might we have Antifebriles, Antiscorbutics &c. a more proper name would be Nervines. Musk,- the product of a small male animal inhabiting Central Asia the Himmaley Mts.- of a brown or black colour fleece, & has a small, oval bag, about 2 or 3 in. long posterior to the umbilicus. The quality varies according Received from 3 ports. Canton, Calcutta, & Russia to the situation of the animal. The most valuable comes from China, & least from Russia. It is brought 146 in sacs, is of a deep brown colour, & looks like dried blood. taste bitter,- odour strong, and diffusible, & it burns with a white flame to a spongy charcoal. It is partly sol. in boiling Water,- more sol. in Alc. & still more so in Ether. From its great price, it is often adulterated, with articles not easy to detect. It was unknown to the Greeks & Romans, & was introduced into practice by the Arabs. It is a powerful stimulant & antispasmodic, exciting no cerebral action. It is used in similar cases with all antispasmodics, also peculiarly applicable in prostration & irregular nervous action, as in low Typhus attended with subsultus tendinum, tremors, Gout or Spasm in the stomach without Inflammation. hiccup, convulsions of infants from spasm of the Intestines &c. but owing to its high price can only be employed in extreme cases. In Tetanus, it had been recommended by Dr Hoff with Op. ℥ss Musk with ʒi Op. to be given in 24 hours. It has also been used in Epilepsy, Asthma, Pertussis, Palpitation of the Heart, Cholera. &c. Generally given in Pill or Julep. Dose 10 grs. varies from 5 grs to ʒi- 147 Artificial Musk is made by pouring Nitric Almonds Acid upon Rectified Oil of Amber. It is almost inefficient. Seldom or never used. Castor. is the product of Beans. It may be used similarly with Musk, but is seldom employed Dose 10 to 20 grs. Tinct fʒi or fʒij Forty-Third Lecture Oct. 27 1834 Assafætida, is the concrete juice of the Root of the Ferula Assaf. an herbaceous plant from 6 to 9 ft. in height with a perennial, fleshy, tapering root, growing in Persia and is the most important of the Antispasmodics. When the tree is four years old, the leaves & stem are twisted off, the top of the root sliced off, so that the juice exudes, & it is then concreted. It is in irregular masses, brownish yellow externally, when freshly broken at first streaks of white are seen running thro' the mass, which soon change to red & afterwards to brown. variegated in colour, has a disagreeable odour, bitter & subacrid taste. It was used by the ancients; by the Persians, & even by some of our own epicures, as a condiment. Surat is said to be completely perfumed with it- It softens by heat By long exposure it becomes brittle. Its principal constituents are Gummy matter, resin & vol. oil, & upon the virtues to last, its odour & probably its virtues depend. Alc. & Ether.- 148 It is a moderate stimulant, powerful Antispasm also, an Expectorant & Laxative. It is useful in Hysteria, Hypochondria, Convulsions, Spasms of the Stomach and Bowels without Inflammation; Also in Hooping Cough, Asthma, Catarrh accompanied with Spasmodic Disease of the Bronchia, & also as an expectorant, in various infantile catarrhal affections. From the peculiar influence which it exerts also over the nervous system, it may be given in low forms of fever, accompanied with subsultus, Hiccup &c. As an Enema, it proves useful in Tympanitic Abdomen, Hysteria, & Irritability of Stomach. Medium Dose, about 10 grs. in Pill or Emulsion. Tinct. is more stimulating. Dose ƒʒi Galbaunum, Sagapenum, & Ammonia, are Gum Resins, seldom or never used. Valeriana, see Book A p. 173 Amber is a fossil of veg. origin, found on the shores of Baltic. Ol. Succine Rectificatum. is obtained by several redistillations, is of a yellow colour, volatile, inflammable, insol. in water, partially sol. in Alcohol, of a hot and acrid taste. It is a stimulant and Antispasmodic, given in Hooping Cough, Singaltus in low fevers, Infantile Convuls &c. 149 Dose from 10 to 30 drops. It is more used externally as a Liniment, in Chronic Rheumatism Palsy & Spasmodic Disease. Dr Parrish uses ℥i ℥i ℥iij a mixture of Ol. Suc Rect, Laud. Brandy and ℥iij Sweet Oil by friction to the Spine of Children affected with Spasmodic Diseases Narcotics or Cerebral Stimulants This name is applied to that class of medicines which act upon the brain, & they are so peculiar that no two of them are precisely identical in their action. When administered, they first produce an increase of both the physical & mental powers,- causing not only arterial excitement &c. but also energy of thought.- vividness of imagination &c. Afterwards a reaction takes place, the pulse becomes composed, the muscles relax, the senses become obtuse, & there is a general inertness of all [illegible] functions both of body & mind;- pain is relieved & sleep ensues. If large doses be given, the excitement is more quickly followed by more lasting & more serious effects. 150 Sometimes there is first a slight debility, followed by nausea, vomiting &c. These show that they operate powerfully on the cerebral functions, & when Death ensues, the heart ceases to act from a secession of nervous energy from the brain. There are 2 distinct views taken of the operation of Narcotics. Cullen says, their primary tendency is to reduce the vital power, & ascribes the primary excitement to the opposition of an innate power of the system against the poison introduced. Brown considered that they directly increased the action of the system, & that prostration of the powers was a natural consequence of their elevation. Cullen, then, considered them directly sedative & indirectly stimulant. Brown considered them directly stimulant and indirectly sedative. Each had their followers. But neither of these does W. think satisfactory, but that each Narcotic operates in a manner peculiar to itself. Altho' there is at first an excitement, yet the powers of the system are not subsequently 151 depressed in a ratio corresponding to the previous exaltation, & he even went so far as to assert that the powers of the system may be directly diminished,- & that certain [powers] functions might be diminished & others excited by the same article of this class. They exercise their peculiar influence upon the system, upon whatever part they may be applied. Narcotics, more than any other class of medicines, lose their effect by repetition, hence it is apparent, that in order to maintain a given impression it becomes necessary, gradually to increase the dose. We should also vary the articles employed. This class has received different names according to the objects for which they may be given: thus when given to sooth pain, they are termed Anodynes, when given to produce sleep,- Soporifics or Hypnotics & when for their sedative effects,- Sedatives &c. We shall next treat of the individual Narcotics. The first and most stimulating of the class is 152 product of vinous fermentation.- It is obtained from the distillation of Ard. Spt.- sp. gr. ƒʒs- purest contains 11 pr. ct. water Alcohol.-but this is seldom used in any other form, than that of Proof Spirit, which contains about 50 pr. ct. W. Preferable forms, however, are Wine, Porter, Beer, &c. and of Wines, the best are Sherry, Madeira or Teneriffe, which Wines are more tonic & less stimulant proportionally than same dose of Alc. alone contain from 15 to 25 pr. ct.- In looseness of the bowels, Wine Whey- Oj boiled Milk & Oss wine. Port Wine may be applicable. But Porter, Ale, Beer &c. Dr Wood thinks should be excluded from medical For an irritable stomach combine W. with spices, by first making a hot infus of spices & then add the Wine.- use,- they are heavier for the stomach & less stimulating than wine. He never prescribes them except where patients have been addicted to their use. Tinct. vary in strength when Alc. & dil. Alc. are used,- hence important to recollect which are made of pure Alcohol. The use of these stimulants must be regulated by the symptoms, when they increase the heat of the skin.- excite the nervous or cerebral derangement, increase the force of circulation more than proper &c. they should be omitted, but if the contrary happens, & the patient does well under their use they may be continued. Sulphuric Ether made by the action of Sulph. Acid upon Alc. is a narcotic stimulant, highly diffusible, hence more speedy & more evanescent in its action. If its vapour be inhaled, it also produces a speedy action, & exhilarates somewhat like Nitrous Oxide, but a recovery from it is more dangerous 153 - being attended with more stupor, & other unpleasant consequences.- Nith Sulph. Rectif. should be presented Caution the patient of its inflammability. It is used in prostrate cases accompanied with spasmodic nervous action,- in Gout of the Stomach,- Cholic Affections,- Hysteria,- & in some stages of Typhus to obviate the nervous affections &c. "sinking spells" As it is so diffusible, it is necessary frequently to repeat the dose. It may also be given in Asthma Hiccup, Tetanus &c. Dose ƒʒss to ƒʒj- with sweetened water. It must be quickly swallowed, so that no vapour will rise in the mouth. Externally applied,- it makes 2 impressions. If applied so that it may evaporate, it produces cold hence it is used for Burns & Scalds,- Strangulated Hernia &c.- But if it be confined to that it cannot evaporate, it produces Heat, & even a considerable irritation of the skin,- hence it is applied to the Forehead for Head Ache by holding it in the hand. sp. Nith Sulph. Comp. Hoffman's Anodyne,- is a preparation of this, which is often given as a Nervine.- It allays irregular nervous action & thus produces sleep,- because it removes the cause of wakefulness. Dose ƒʒss to ƒʒi to test whether it is really good & contains Oil of wine, pour it in water & it should become turbid.- 154 Opium.- the concrete juice of the Papuver Somniferum, which grows in Europe & is cultivated in the gardens of America,- also in India, Persia, Turkey & Egypt.- The juice is obtained from the capsules by slicing them.- There are 2 varieties in commerce,- Turkey & E. India, but the latter is never brought to this country, it is taken to China. All our opium comes from the Mediterranean, & there are 3 varieties,- Constantinople,[Singma?], & Egyptian, of which the [Singma?] is the best. This is generally distinguished by being employed in the leaves & capsules of a species of Rumex,- & when these are absent, the Opium may be considered as inferior. Water & Alc. extract its virtues, it is injured by long boiling. Its principal constituents are Resin, Gum Bitter Extractive, volatile matter, Gluten or Caouchouc. Narcotin, Meconate of Morphia, Meconin & Narcein. Narcotin consists of Hyd. Ox. Carbon & Nitrogen. It is white, in small crystals, fusible, insol. in W & Cold Alc. sol. in boiling Alc. & Ether, tasteless & inodorous. Its influence upon the system is uncertain, as it is said that 40, 50 or 60 grs have been given without any effect. 155 Morphia, is the narcotic principle of opium. It is sparingly sol in Cold Ether, freely in hot but is precipitated when cold, burns when heated, neutralizes acids The Meconic Acid with which it is joined, is useful only as being the means by which we can test the presence of Opium. According to Dr Hare;- to the solution containing Op. add a sol. of Acet. Lead, then the Meconate of Lead is precip.- to this add Sulp. Acid which will set free the Meconic, & then by adding a sol of a Persalt of Iron, we get a red coloured precip. Orfila thinks it unnecessary to add the sol. of Acet. Lead, & merely adds first the Sulp. Acid, then the sol of a Persalt of Iron. See Book C. Forty-Fourth Lecture Oct. 28 1834. For application of Opium see Book C. p.69. Lactucarium concrete milky juice is sometimes substituted for Opium It is obtained from the common Lettuce. Smell & used in Europe for Peet. Affections. Nervous &c. taste are like op. Dose 2 or 3 grs. of Tinct 40 to 60 gtt. c b.141 b.77 Camphor, Hops, & Conium or Hemlock, for which see Books B. and C. 156 Sedatives. These are divided into the Arterial & Nervous. 1. The Arterial.- The most important of this class are the Preparations of Antimony,- three of which are used: D. p.28 D. p.76 p.76 viz. Tartar Emetic, Precipitated Sulphuret & Antimonial Powder.- The Neutral Salts, are sedative & act also upon some of the functions. Potas. Nitras (see pp. 67 & 79)- when taken internally, diminishes the action of the heart, & the heat of the surface by its own peculiar operation. It is also Diuretic, & acts locally as an irritant, producing Inflammation, so that when given it should be largely diluted. When given for a long time, it diminishes the general power of the system. It is useful in Inf. affections, except of the stomach & bowels,- in Bilious Fevers,- Rheumatism,- Tremor. with Plethora,- & is often combined with Tart Emetic. A solution may be made of Nitre ʒi, Tart Em. gr j in water ƒ℥ij. Dose ƒ℥ss every 1 or 2 hrs The Veg. Acids are also somewhat sedative,- & are very useful as drinks in febrile complaints, but they may be abused & produce Dyspepsia. The tendency of Vinegar to produce emaciation is well known & sometimes called into use. 157 Lemon Juice is most used.- The best method of keeping it is to convert it into Citric Acid, by Carb. Lime & dil. Sulph. Acid;- it is Chrystalline.- To avoid the fraud of Tart. Acid for it, test it with Carb. Pot.-(see p.77)- A good substitute for Lemon Juice may be made by adding ℥i of it to Oj water with gtt iv Ol. Limonis.- B. p.55 B. p.57 2. The Nervous Sedatives.- Digitalis,- Tobacco.- Hydrocyanic Acid exists in almost all plants of the Genus Prunus, or Amygdalus.- Its odour & taste are owing principally to a volatile oil combined with it.- The best preparation for administering or preserving it is the Oil of Bitter Almonds- Dose 1/4 to 1/6 of a drop.- Pure Hydrocyanic Acid is never used in medicine, but the Dilute,- which is formed by passing Sulph. Hydrogen thro' Bicyan. Merc.- forms Black Sulph. Merc. & Hydrocy. Acid,- then filter & add Carb. Lead & filter.- It should be kept in opaque bottles.- Even swelling a bottle of the Oil of Almonds, or of Hydrocy. Acid sometimes produces the unpleasant effects of the poison. Dose of the Pure, would be about 1/12 gtt. in a Wineglassful of Water,- of the Dilute, 1 gtt. every 2 or 3 hours, till the 158 effect was produced,- It is of unequal strength.- Cyanuret of Potassium- dissolved in water forms the Hydrocyanate of Pot.- which is incompatible with a great variety of substances & hence is very apt to be decomposed in the stomach.- Dose 1/4 gr to 1 gr. & should be given in a state of solution.- 159 Iodinum.- When taken in small quantities, it seems at first to sharpen the appetite,- increase the pulse &c.- acting like a Tonic,- but if it be continued, the patient begins to emaciate,- from the stimulation of the absorbents.- It also increases the secretions.- & renders the nervous system more irritable.- It was first employed by Coindet of Geneva in cure of Goitre,- afterwards in Scrofula,- indolent swellings,- somet. in Amenorrhea,- also in Gonorrhea & Gleet.- Internally, dose is from 1/4 to 1/2 gr.- Generally given in Tinct.- which contains grs XXX to ƒ℥i.- Dose 10 to 20 gtt.- given in a wineglassful of sweetened water. It should not be long kept, as a reaction seems to take place between it & the Alcohol, changing its property.- Iodide of Potassium,- which in sol. forms Hydriod. Pot. has an acrid, bitter taste.- Int. dose 1 or 2 grs.- but its effects are not like those of Iodine.- It renders Iodine sol. in water.- hence is useful.- as in Lugol's Solution,- consisting of Iodin.- ℈i Iod. Pot.- ℈ij Water ƒʒvij.- The Iodides of the 160 metals produce the effects of the metals, just as analogous compounds,- & not of the Iodine.- Externally Iodine may be used as a Bath.- or more frequently in form of an Ointment containing ℈i to ℥i Lard.- It leaves a yellow stain upon the skin, which gradually disappears by evaporation           The Classification of Medicines adopted by Dr Wood in the University of Pennsylvania. Medicines acting on the living body General Stimulants Permanent Astringents Tonics Diffusible Arterial Stimulants Cerebral stim. [illegible] Nervous stim. [Anti spasm] Sedatives Arterial Sedatives Nervous Sed. Local Functional Emetics Cathartics Diuretics Diaphoretics Expectorants Emmenagogues Sialagogues Errhines Organic Rubefacients Epispastics Escharotics Mechanical Demulcents Emollients Diluents Those medicines acting upon foreign substances contained within the body may be comprised under the heads of Anthelmintics, Antilithics, Antacids &c.  1 Notes upon Lectures delivered by Dr G. B. Wood. First Lecture. From a summary view of the Introductory Lecture, it appears that medicines operate in one of two ways -either upon parts applied by means of their effects being carried thro' the nerves to the brain, & thence distributed by the nervous system or by being absorbed: -v.c.- they act either by sympathy or absorption. In the Local action of medicines, they may act by Sympathy either directly by the nerves, or first by having their action transmitted to the brain & thence distributed by the nervous system to the other parts as in the operation of Digitalis. Their action is different also as to the different parts to which they may be applied- those places are the surface of the stomach & bowels, the external surface of the skin & the surface of the air passages.- Sometimes they are absorbed rapidly at others more slowly.- These, before mentioned, are called the primary operations, and we now 2 come to speak of the secondary, which are the results consequent upon the primary operation, as for inst. 1. Prostration following excitement. 2. General state of excitement from sympathy with a particular part. 3. Result of the principle of revulsion, as in the treatment of diseased lungs by a blister to the external surface of the skin. 4. Cessation of morbid phenomena in consequence of the removal of the cause as in some forms of headache arising from constipation, which are relieved by purging. 5. The operations of nature instituted to relieve the constitution from the effects of the medicine as in applying Caustic.- Second Lecture. The nature or character of the operation of medicines is very different because they differ much as to the parts which they affect. Each class acts upon particular organs, no matter where they may be applied. Thus, we find, that Ipecac vomits whether applied by stomach 3 blister or per annum. The explanation that we give for this is that the human frame is so constituted that each particular part has particular susceptibilities;- the cause is the undiscovered & perhaps indiscoverable principle of nervous action. In the human system, considered as adapted to our department, there may be regarded three minor systems, each coextensive with the whole body, viz. Nervous, Circulatory and Absorbent, & these three are found in every organic part. It may be viewed also as consisting of a number of distinct organs, - as the Skin, - the Stomach & Bowels, - the Kidneys & Bladder &c. Some medicines act upon some one of the Systems while others act upon some of the organs.- Thus opium acts upon the nervous system, Carb. Amerred upon the Circulatory & Iodine upon Absorbent.- The first set are called General Remedies; & the second, Local Remedies.- Medicines differ in the nature of their operations 4 operations upon particular parts, or in other words, we say medicines are specific in their operations. By the term specific, we mean that a medicine will act upon a certain part of the body & produce effects peculiar to itself i.e. that when different medicines are applied to the same parts they produce diff. effects._ This brings us then to the subject of the Classification of Medicines. Though producing not precisely the same effects, yet there are a number of medicines whose operations are so analogous that they may be properly divided into distinct classes. The first grand division is into Local and General Remedies Local Remedies are those which either primarily or secondarily affect the [cross out] different individual organs. Of these, there are 4 sets. 1. Those which affect the functions of particular organs, viz. Emetics, Cathartics, Diuretics, Antilithics, Diaphoretics, Expectorants & Emmenagogues. There are also 2 others [illegible] Sialagogues & Errhines, but these seldom used & may 5 be more properly considered as minor effects 2. Set Act on Extraneous Substances contained within the organs, viz. Anthelmintics & Antacids. 3. Alter the organization of those parts with which they come in contact. Rubefacients, Epispastics, and Escharotics. 4. Act mechanically upon the parts to which they are applied. Demulcents & Emollients General Remedies are medicines which operate upon the whole system, or upon one of the minor systems & thence have their action extended to the others.- Before proceeding with the different sets of Gen. Rem. it may be proper to say a few words respecting stimulants. This term is applied to the Circulatory system, when no other particular system is specified, & hence when we use the word stimulant without any other word qualifying it, we mean an elevation of action of the Circulatory System.- There is a great diversity of power of stimulation, both as regards the rapidity & permanency of their action, & hence they are divided into Diffusible & Permanent Stimulants 6 Many medicines both excite and diminish the different powers of the system at the same time, & hence are either sedative or stimulant according to the predominance of either of these powers & those which stimulate when given in small doses, may, if given in large doses, be very powerfully sedative. As a general rule then, we find that the same medicines are sedative or stimulant, according to the part to which they are applied, to the quantity given, and to the state of the system. Astringents have a mode of action peculiar to themselves, producing a contraction of whatever parts they may touch. With these preliminaries, we proceed to mention the Classification of the General Remedies. 1. Permanent Stimulants, as Tonics & Astringents. 2. Simple or Diffusible Stimulants, which operate upon the Circulatory System. 3. Narcotics, which may have either a sedative or stimulant influence upon the brain. 4. Antispasmodics 5. Medicines peculiar in their action as Aux vom. Merc &c 7 Third Lecture. There are a variety of modes for administering medicines, & it is happy for a physician to be able to select that form best adapted to his patient. They are given in the solid state, in the form of Powders, Pills, Troches, Electuary or Confection. In the liquid, either in Mixture or Solution and as Liniment, Cerates, Ointments, Plasters and Cataplasms.- We shall add a few remarks upon each of these Powders. Deliquescent substances should never be prescribed in the form of powder.- A light powder may be given in a little water or the like, but a heavier powder, as Calomel, should be suspended in Molasses, Syrup, Honey &c. Pills. Substances may be given in the form of pills, which are not given in large doses, which are not deliquescent, or which do not become too hard in that shape to prevent their being digested. Liquids should never be prescribed in this form, unless given in very small doses. Efflorescent substances, should 8 be first deprived of their water of Chrystallization. The mode of making pills is very important & should be well understood. Some substances require no trouble, but can be moulded with ease, as some of the soft extracts. Mass Hydray. &c. Others can be made into a mass with a little water, as Rhubarb, Jalap &c. But there are some which are more difficult, & require some discrimination in the agent. In making this choice, we should take those substances which are not chemically incompatible, or which will not make the pills too hard. The best articles for immediate use are Pulv. Gum Arab. & Syr. Sunp. Soap is good to meet any acid in the stomach, when it is not incompatible with the medicine prescribed. Confect. Ros. is much used. Mica Panis Crumb of Bread is very good for absorbing liquids which are to be given in very small doses. as Tinct dissolve the substance (if soluble) in a small quantity of water, then make up the crumbs with this solution Croton Die, solution of Argent. Nit. or Cap. Sulp. To prevent their adhering together the best substance that can be used is Pulv. Rad. Glycyrrle.- 9 With respect to the size of pills, we may say that those made from veg. powders should not exceed grs iiij in weight. A good size is about grs iij. Those from metallic substances, however, may weigh from 4 to 8 grs. Troches are not much employed. They are designed to be held in the mouth, while they gradually dissolve, consequently they should be prepared with substances which are slowly soluble in the saliva. (Farina, Gum & Sugar) Electuaries- are soft masses composed of powders mixed up with syrup or honey. Conserve or Confect. is a preparation made much in the same way for the purpose of preserving recent vegetables Both these latter Elect & Conserves are embraced under the term Confection, in pharmaceutical language. Mixtures.- This term is applied to those preparations formerly called Juleps in which insoluble substances are suspended in water by means of substances which are soluble. To form a good mucilage in ƒ℥vj mixture, add of Gum. Arab & Sacch. Alb. aa about ʒij. The yolk of an Egg may sometimes be used for the same purpose, especially 10 in mixtures containing Oils, Balsams &c. The yolk of one egg is sufficient for a mixt. of ƒ℥vj In the preparation, the medicines should be rubbed together first & the liquid afterwards added. It is necessary to avoid adding too much solid. ʒss veg. pound ʒij Elect or ʒi Extract to ƒ℥i is sufficient.- Calculation should generally be made so as to make a tablespoonful (ƒ℥ss) to be given for a close.- As for the liquids used, it is well to prescribe the aromatic waters, as Aq. Cinnam. Aq. Menth. &c. when they are compatible. Solutions.- In these it is only necessary to guard against adding substances chemically incompatible Infusions.- Preparations in which the active matter of substances is extracted by water either cold or hot, but without boiling. A Cold Infusion requires from 12 to 24 hours, while a hot one is prepared in about 2 hours. Decoction.- is when the substance is boiled in water or other liquids. Wines.- are prepared by infusing the substance in wine at the ordinary temperature. 11 Tinctures.- prepared by digesting in Alcohol for one or two weeks. There are 2 different kinds of Alc. used according to circumstances: Rectified Spirit or pure Alcohol & Proof Spirit or Diluted Alcohol. The balsams, vol. oils, &c. are soluble only in Alcohol. Vinegars.- are solutions in Vinegar, of which there are but two or three in Pharmacy as Squills &c. Syrups & Honeys.- are prep. of Sugar & Honey with veg. matter. They are made by forming a decoction or Infusion of the veg. & then adding Sugar or honey. Oxymel. Composed of Vinegar & Honey. Liniments- are preparations which are either liquid or semiliquid & of an oleaginous consistence. Ointments- are soft solids to be applied by rubbing with the finger. Cerates- are of a firmer consistences containing Wax, & are generally applied by being spread on a rag, without requiring to be heated. Plasters- are still firmer than Cerates, more tenacious, & requires to be heated before they can be spread. 12 Cataplasms- should be soft, moist & somewhat tenacious. Sometimes they are made simply by the addition of water as Mustard.- Some which will not form a mass with cold, are mixed up with hot W. as Flax-seed meal Substances, which of themselves will not form a poultice with water, have something else intervening, as Hops, which are mingled with Flax seed Meal & stewed up with Water.- Other liquid besides W. are frequently used as Vinegar, Alcohol, Milk &c. as in the Bread & Milk Poultice, so frequently used. In this, stale bread should be directed, & good sweet milk, & a little fresh Lard added to soften it.- Fourth Lecture 4/24 - 1834. Medicines are directly applied to two portions of the Alimentary Canal, the Stomach & Rectum. It is applied by the Rectum with 2 objects. 1st For irritation so as to excite purge. 2nd Through the mucous coat of the rectum to produce an impression upon the system at large.- These effects are incompatible with 13 each other & hence care must be taken to produce the desired effect. In both cases, the patient should be directed to resist the immediate impulse to evacuate & should be assisted by the application of a warm towel to the parts, with gentle pressure. The enema should generally be of the warmth of the body. As a general rule, about three times the amount of a dose by the stomach may be given by the rectum, but it is safer especially in very active medicines to give about twice the dose & repeat it if necessary. Neither of these rules, however, can be universally applied, because the relative susceptibility of the stomach & rectum differs in different persons. Instances may occur from habit or other causes in which the susceptibility of the rectum may be even greater than that of the stomach as in opium eaters &c. Hence when any medicine ceases to produce any effect upon the stomach, we may resort to other surfaces- either the skin or Rectum. There are two modes in which medicines may be introduced, either in the state of Solids or Liquids. The former are called Suppositories, & the latter Clysters, Enemata, or Injections. 14 Suppositories will be spoken of hereafter, but here we will make a few remarks respecting Enemata. They consist of soluble substances & Water is generally the vehicle used, with the addition of a little mucilage or the like. When administered for the purpose of being retained, we should use as small a quantity of liquid as possible, ƒ℥i or ƒ℥ij is sufficient. Barley Water or a solution of Starch in Hot Water makes a very good vehicle. When given in order to produce purging, about Oj of the liquid should be used. While upon this subject we may add that the character of the Syringe should be attended to, & that it should be good... The Skin affords a very convenient surface for the application of medicines. To this, they may be used in the state of vapours, liquids & soft solids, & may be applied either to the cuticle or to the skin deprived of its cuticle. A very ready method of applying vapour to the cuticle is to heat some bricks, dip them in the liquid, wrap them in flannel & place them under the bed-clothes so as not to touch the patient. 15 Raise the bed-clothes so as to form a vacant space by means of hoops or stools. Another method is by a tube passed under the clothes into a space made as before. Another method, by which the steam from herbs &c. in Water may be obtained is by placing the patient in a chair over the water &c. in a tub, & then creating a steam by putting heated bricks in the water. The patient must be wrapped round with blankets & care must be taken that the steam does not become too hot so as to scald him. Sulphur or other solids may be applied in form of vapour by passing a tube of a retort, to which heat is applied, into a box containing the patient except his head. They are more frequently applied to the skin in the liquid form, either as Lotions, Baths, Semicupium, or Pediluvium. Solids thus applied may produce local effects, or may operate upon particular organs. Frictions sometimes 16 prove beneficial, & the places best adapted to it are the inside of the legs and arms. But the most effectual method of applying solids to is what has been termed the Endermic Method The method is to deprive the skin of its cuticle, then apply the medicine to the part. The circumstances which will warrant this procedure are, when the patient is either incapable or unwilling to take or retain the medicine, & when this method may be joined with others to produce a very speedy action. Corrosive and very irritating medicines, or those which require to be given in very large doses should not be given in this way. The active principle of a medicine would be preferred to the medicine itself. To produce a blister, apply a plaster of Cantharids, 3 or 4 inches square & leave it 3 or 4 hrs. then take it off & dress the surface with a poultice so as to remove the cuticle more readily. A better plan, however, is to moisten a piece of Patent Lint with strong liquid Ammonia, lay it on the part, & keep continually dropping on more to keep it moist. In this 17 way a blister will be raised in about 15 minutes. The Powder may be sprinkled upon the surface thus prepared either alone or mixed with wheat flour. It may be in form of Cerate or Liquid, & the quantity should be generally 2 or 3 times that given by the mouth. The power of Absorption varies in different parts. The Epigastric Region is the most effectual. The inner parts of the limbs are good, and the anterior portions of the body generally better than the Posterior. We should apply beyond the morbid affections, so that during the course of Circulation, we may suppose from the direction of the absorbents that the medicines will pass directly through the affected part. Substances are absorbed most readily from the bronchial passages, but it is difficult to apply them thus, for fear of irritation. They may be thus given in the state of Inhalation: which is in 3 ways. Either 1. By diffusing thro' the air of the apartment. 2. By confining them in a bag with a tube attached. or 3. By means of an Inhaler. 18 We now come to the subject of the relative doses of medicines, which vary with the age of the patient. For this, no general rule is universally applicable. A full dose may usually be given at the age of 20, but for those under that, it is said that the dose must be diminished in the proportion of the age to the age +12. Thus to find the dose for a child 4 yrs. of age, we would have 4: 4+12=16 :: 1:4- that is- the dose would be 1/4 the quantity sufficient for an adult. Particular persons, however, are liable to peculiar affections from idiosyncrasy &c. & the effects of habit are very great,- all which must be taken into consideration in prescribing the requisite dose.- For Fifth Lecture upon Weights, Proximate Principles &c. see Book A from p. 1 to 17 inclusive. Sixth Lecture May 1st 1834 Emetics are those substances which excite vomiting by an inherent peculiar property. Their operation is peculiar, but does not immediately follow their administration, generally after a lapse of 10, 20 or sometimes 30 minutes. Soon after taking an emetic 19 the patient feels an uneasiness, which is succeeded by nausea &c. till vomiting results. Previous to vomiting, the countenance is pale, the skin cool, moist & relaxed, & the pulse frequent, small & irregular. When vomiting commences, the countenance becomes flushed from the pressure upon the veins so as to prevent the blood returning from the head, & the temples appears as if filled with the rush of blood. After vomiting, the skin is left moist, cool & relaxed, & languor succeeds, which is consequent upon the nausea excited, not upon any narcotic influence. The operation of vomiting is effected by a reversion of the motion of the stomach & by the action of the abdominal muscles. This mode is best explained by supposing that the emetic touching the mucous coat of the stomach, imparts to it a sensation which is then transmitted to the brain by the nerves, & then again the impression is transmitted by the nerves from the brain to the muscles of the stomach and abdomen. That the agency of the brain is absolutely essential to the operation of an emetic, appears 20 from the fact that if we separate the par vagum nerve, no emesis can be produced, or if the brain be rendered insensible to any degree, either from injury or from poison, it will be very difficult to make an emetic operate.- Emetics differ from other medicines in losing none of their power from repetition, but generally have a contrary effect. They do not act upon all persons or in all diseases, equally. In febrile diseases, they generally operate with facility, but in nervous diseases, they act less readily. When narcotic poisons have been taken, the stomach is not easily affected, but if mineral poisons, they facilitate the action, provided they have not been sufficient to destroy the stomach. We now come to speak of the indications for the use of an emetic, which are numerous. 1. The most obvious effect of an emetic is to evacuate the stomach; hence it is frequently called for, for this purpose; as when any irritating substances have been taken into the stomach, or 21 when the disease depends upon an over-distention of that organ,- or upon containing acrid & poisonous substances. Mineral poisons sometimes operate themselves & then it is only necessary to give warm drink plentifully, so as thoroughly to wash out the stomach:- but the Narcotic Poisons have a tendency, as before stated, to prevent the emesis & consequently more attention is requisite. We should never resort to the stomach pump, unless an emetic will not operate after waiting 1/2 or 3/4 of an hour. If the poison should be a solid as Opium the pump might not be large enough to admit its entrance & it could not be drawn out. In bilious fever, when the accumulations are acrid & unhealthy, & the bile is not properly secreted, emetics are often very effectual. But it is very necessary to distinguish between a case when vomiting occurs from the irregular biliary secretions, and when it arises merely from an irritable stomach because it would be of much importance in practice.- 22 2. Emetics act favourably by exerting a mechanic as pressure upon the liver & other abdominal viscera, in the act of vomiting. It often happens that congestion of blood takes place in those parts, the patient experiences great oppression in that region, attended with depression of spirits &c. -& then an emetic may frequently be given with advantage. The well known utility of an emetic in Jaundice is generally ascribed to the compression excited by the vomiting upon the biliary ducts, thus forcing out the bile which has been secreted in too large quantities, but we consider this, an erroneous view, & that in a great majority of cases, Jaundice arises from the bile not being secreted at all by the proper vessels, but instead of that, is taken up by other absorbents & carried thro' the system, & that emetics act in such cases by arousing the liver to its proper function, & exciting its secretions. 3. Emetics act favourably by the production of Nausea which is attended with a general relaxation & prostration of the system. There are several 23 beneficial effects resulting from Nausea. 1. Most obvious effect is a prostration of arterial action or a reduction of the force of circulation, hence its use in inflammatory diseases in an early stage, but it must not be relied on in a case when the disease has become confirmed. 2. Effect is an Increase of the power of absorption, which has been demonstrated to be in inverse proportion to the reduction of the force of circulation. 3. Relaxation of muscles, hence it is useful in spasmodic affections &c. 4. Relaxation of the skin & consequently perspiration. & 5. It probably produces an increase of biliary secretions. 4. Emetics exert not only a local power, but by the concussion or shock which they give, they exert an influence over the system, so as sometimes to break up a morbid action which may exist there. In this way, we account for their benefit in Remit. & Intermitt. Seventh Lecture May 6th 1834 5. Another favourable mode in which Emetics act, results from the principle of Revulsion. We know that by irritating one part of the system, the excitement is 24 increased in that part, while at the same time, it is drawn off or diminished in other parts. If then, during any inflammation, you can produce a flow of nervous action & consequently of the exciting cause to any other part of the system, you relieve the disease, thus it is that emetics act by revulsion as in Mania, Amaurosis, Tic douleureux, Bronchitis, Uterine Hemorrhage &c. We must bear in mind that all Emetics are apt to purge when given in small doses, & that given in exceedingly small doses, they excite diaphoresis. 6. They evacuate the blood vessels, directly by exciting diaphoresis, & other secretions & indirectly by cutting off the supply of food from the stomach: but for this purpose, they are seldom or never given. 7. The irritation of the stomach produced by their operation is sometimes useful, as in dyspepsia, but this is rather dangerous, lest gastric irritation might lead to unexpected results. Thus we find that diseases present various indications for the use of certain medicines & more especially for the 25 use of Emetics, which we find answer so great a variety of purposes. But to complete our view of Emetics, we must also remember those circumstances which contraindicate their exhibition. 1. Acute inflammation of the stomach, bowels &c. This evidently forbids them from the gastric irritation which they are known to produce. 2. In some complaints, in which the susceptibility of the stomach is diminished, it becomes necessary to increase the dose to produce any effect. In such cases, we wish particularly to warn the practitioner against the danger which may result from the reaction of the system, for if those emetics be then given in large doses, which are apt to excite inflammation, when the system reacts, great danger will arise from the gastric irritation. Even tho' the effects of large doses may leave no impression upon the stomach at first, yet when a reaction ensues, the secondary effects will be gastric irritation, terminating perhaps fatally. It is proper in such cases of insusceptibility of the stomach, 26 from whatever cause it may arise, to use those medicines which are calculated to produce no such injurious effects, as for inst. Ipecacuanha 3. A determination of blood to the head, forbids the use of an emetic without previous depletion: for we have before stated, that from the pressure upon the veins, the blood is prevented from returning freely & hence there is a rush to the temples &c. Hence it is evident that in cases of full arterial excitement, or where there is a tendency to apoplexy, - blood to the head &c. - it would not be advisable to administer an emetic without previous depletion. It is from this principle of diminishing the flow of blood to the head, that benefit results from dashing Cold Water upon the head of a person labouring under a Narcotic Poison. Bleeding also increase susceptibility of the Brain, decreases, congestion. 4. Advanced stages of pregnancy contraindicate their use, & they should be then avoided if possible. In early stages, they may be given with safety, unless in women prone to abortion. 27 5. Hernia forbids them, but if, from urgent necessity, they must be administered to such subject, the patient should be directed to place his hand upon the hernial orifice, during emesis. They are generally administered diffused or dissolved in Water, & it is a good rule to give them in divided doses, every 15 or 20 minutes till they operate. When the design is only to evacuate the stomach, give the patient plenty of warm drink, but if the object be to produce a powerful effect, & give a shock to the whole system then little or no drink should be given, but let nausea, retching &c. continue for some time. Sometimes, either from constitutional or other causes, an inordinate degree of vomiting is excited, & it becomes necessary to check it. This is done by giving 10 or 15 drops of Laudanum or a little of Sol. Morph. Sulph. & by applying a Spice Plaster or warm fomentations over the stomach. If this do not succeed, inject about 60 drops of Laudanum with 2 or 3 tablespoonfuls of solution of starch, & if these fail, we may resort to the application 28 of a Mustard Plaster to the stomach, which seldom fails to arrest the violent vomiting. Having said thus much concerning Emetics in general, we must now proceed to consider them individually. First, The Vegetables & Secondly The Minerals. The first and most important is Ipecacuanha, which is the product of the Cephaelis Ip. or Calicocca Ip. and comes from Brazil. For botanical account see Book A from page 23 to 33 inclusive. Eighth Lecture. May 8th 1834. A.23 A.33 A.37 B.181 Upon Ipecac, Gillenia, Euphorbia Ip., Lobelia, A.39 A.67 B.57 b.97 Sanguinaria, Squills, Tobacco, Chamomile Flowers, B.125 and Mustard seed, for which see Books A and B. Ninth Lecture May 12th 1834 We next proceed to consider the Mineral Emetics. Tartrate of Antimony & Potassa or Tartar Emetic. Antimonii et Potassa Tartras. or Antinmonium Tartarizatum are the officinal titles. The same rank, which Ipecacuanha holds among the vegetable emetics is sustained by this among the Minerals. 29 It is the only one given for other than emetic properties It was first made known in Paris in 1631. It is prepared by boiling Potas. Bitart. with Protox. of Ant. & should always be obtained in the state of chrystals, to prevent its being in an adulterated state. The most common impurities are Tartrate of Lime, & Cream of Tartar. The crystals are in the form of Octahedral or Trihedral Pyramids, & contain a small proportion of Water of Chrystallization, hence they effloresce on exposure. Taste is metallic & slightly styptic. When entirely pure, it is dissolved by about twice its weight of water, making a transparent solution, but if Tart. Lime is present it will soon precipitate. If the solution remains too long. Tart. Ant. undergoes spontaneous decomposition, but this is prevented by the addition of a certain proportion of Alc. In pure Alcohol, it is insoluble. It is decomposed by the Mineral Acids, alkalies & their Carbonates. Alkaline Earths, Soaps, Hydrosulphates, & astringent Infusions, such as Bark, Galls &c. and hence, these should not be prescribed together. The decoction 30 of Bark is especially incompatible, & hence may be administered as an antidote in cases of poison from an overdose of this mineral. Common Green Tea also has the same effect & is more convenient. The value of this mineral as an Emetic, depends upon the certainty, strength & permanence of its operation It remains longer in the stomach than Ipecac. & produces a greater impression upon the system, hence it is to be preferred, 1. When we wish to make an impression upon the liver and abdominal region. 2. When we wish to divert irritations by revulsion. & 3. To break up a chain of morbid action in the system. It exceeds Ipecac. in producing nausea & prostration. Its action often extends to the Duodenum & evacuates the bile secreted there, hence it may be advantageously used for that purpose, when there are no contra-indications. It is a good emetic also in various forms of fever, especially those of a bilious character, - in jaundice - nervous complaints as Amaurosis, Mania &c. - obstinate dislocations,- & in some inflammatory disorders, such as sore throat, [Dicin?y] &c. 31 Sometimes it is beneficially combined with Ipecac. and we may say that we wish to produce a mild effect give Ipecac.- if a powerful one, give Tartar Emetic, & if doubtful which is necessary, give both. Besides emesis, Tart. Ant. is frequently given with a view merely of exciting Nausea, & this has been found very beneficial in cases of high excitement, in moderating the hysterical effect of mania, & in convulsions. Give it just in sufficient doses to keep the patient constantly feeling its nauseating influence, & happy results often follow in convulsions, nervous complaints &c. It is more apt to purge, when insufficient to excite vomiting, than any other of the Emetics. It is also diaphoretic & expectorant, & sometimes diuretic & indeed seems to stimulate all the secretions. When given in very minute doses, insufficient to produce any effect upon the secretions, it appears to exert a sedative influence upon the Heart. From this cause, some modern Italians have considered it as powerfully sedative, but this is incorrect, for it is well known from the very principle of its action to be powerfully irritant 32 irritant to the stomach. Brodie found that large doses of it administered to animals suspended the action of the heart altogether, altho' artificial respiration was kept up, showing that it has a direct influence upon the heart, & that it proves fatal not only as the other Narcotics, by depressing the powers of the heart, but also by the irritation which it excites in the stomach & other organs. The poisonous effects of Tart. Emetic are violent vomiting, burning sensation of heat about the stomach, hypercatharsis, hiccup &c. & terminating in death. Remedies in such cases are mucilaginous or oily drinks in order thoroughly to cleanse the stomach, and Decoction of Bark or Tea to counteract any that might remain. Leeches may be applied to the abdomen if gastritis ensues. The medium dose is 2 or 3 grs, given in doses of 1 gr. each at intervals of 15 or 20 minutes till it operates. When combined with Ipecac, the form is about Ipecac grs XX Ant Tart grs ij mpt. Pulv No. ij. Give one & rept. if necessary 33 It will produce Nausea in the dose of from 1/4 to 1/2 gr. every hour, & gradually increase it if necessary. It proves diaphoretic in dose of 1/8 or 1/6 gr. & still less is given as an expectorant. For these purposes, it should generally be given in solution, but for its purgative effects, it is generally united with Cathartics in the form of Piee. To facilitate the administration of this medicine in small doses, more especially to children, an officinal preparation called Antimonial Wine is recognised in the Pharmacopeia. It is made from grs ij Tart. Ant. to ƒ℥i Best Sherry Wine, which should be a clear solution: if any precipitate is found in the bottle, it should be rejected, as it is evidence either of the use of inferior Wine, or of impure Tart. Emetic Dose for an adult ƒ℥ ss. every hour till it operates, but should not be given if avoidable. Dose for a child 1/2 or 1 teaspoonful. Within the month, 1 or 2 gtt. 1 yr 8 or 10 gtt. Sulphate of Zinc. or White Vitriol. This emetic is useful for the promptness of its operation, as it vomits almost immediately without any 34 nausea. Its action is confined to the stomach, & it is seldom used except for producing speedy vomiting in cases of Narcotic Poison. It is then advantageously combined with Ipecac. Medium dose 10 grs. given in solution but in cases of Poison ʒss may be given, but this quantity should be seldom repeated. Sulphate of Copper or Blue Vitriol. This acts also very speedily, with no nausea & but little succeeding languor, or effect upon the system at large. It is used in narcotic poison, but being so violent, we prefer the Sulp. Zinc. & Ipecac. Dose 2 or 3 grs. In cases of Poison from 5 to 15 grs but never exceed the latter portion. In overdose, it occasions violent vomiting, irritation of stomach, hiccup, fetid eructations, prostration, convulsions and death. The best Antidote is the White of an Egg or Albumen beat up with Water. Dry [Vo????] of Manius made of equal parts of Sulph.Cop. & Tart. Emetic (Chap) Acetate of copper is never used as an Emetic. Hydrargepum Sulphuretum Flavus, or Turpeth Mineral was formerly used, but not now on acct of its violence & tendency to salivate. Medium dose 5 grs. 35 Tenth Lecture May 15th 1834 Cathartics are medicines which evacuate the contents of the stomach & bowels by purging. They operate in three ways. 1. By making an impression upon the internal mucous coat which is thence conveyed to the muscular coat and increases the peristaltic action. 2. By increasing the secretions of the lining membrane of the bowels, & 3. By increasing the secretion of the bilious & pancreatic fluid which is poured into the intestines, & hence increase the evacuations. Calomel may be considered the only medicine belonging to the last class, but other medicines operate by one or both the former methods. Cathartics differ as to the portion of the bowels which they affect, thus Gamboge acts upon the stomach, Aloes more particularly upon the large intestines, while the neutral salts & oils influence the whole canal. Hence we find the nature of the discharges to vary according to the medicine employed, being either natural, liquid from action upon the upper portions 36 of the intestines, - watery, - bilious, - or mucous & bloody from the irritation of the medicine. Cathartics differ in the degree of force with which they operate, & hence they have been divided into Laxative & Purgative, of which the latter are the more powerful, & those of them which are very severe in their action are termed Drastic Purgatives. The division, however, into these two distinct classes, is not a very good one, because there is no medicine so weak, but that it will become more active in large doses, nor any, so powerful, that it will not operate slightly in small doses. Hence they are Laxative or Purgative according to the object & method in which they are given. Cathartics answer several indications as follows, 1. The most obvious & perhaps the most advantageous use of them is for the simple evacuation of the bowels, merely for the removal of constipation or of unwholesome accumulations. Thus in dyspepsia, cholic, hemorrhoidal affections &c. & sometimes together with the force, some irritable matter may 37 be lodged & even remain so long as to be acted on by the absorbents, & given off in the cutaneous exhalations;- then Cathartics are very beneficial in removing all such offensive matter. They are given in low forms of fever, to prevent torpor of the intestines, diarrhea, dysentery, when poisonous or noxious articles have entered the stomach & passed beyond the reach of emetics &c. The French have recently adopted a theory which forbids the use of Cathartics in fevers because they say fevers depend upon an irritation of the mucous surface of the stomach &c. & that Cathartics will only increase the irritation. But experience shows that these views are erroneous: the cathartics act favourably by driving out the irritating fœces._ 2. They act advantageously by a reduction of the general arterial excitement from the quantity of fluid which they cause to be poured out from different sources. Directly, by depletion of the blood vessels, & indirectly by expelling the Chyle before it is taken up. 38 3. They act in promoting the absorption of effused fluids. This, we have already stated, takes place in proportion to the depletion, & it is accomplished also by diminishing the serum of the blood by other secretions. Thus in a case of dropsy, the Hydragogues would be preferable. 4. They act favorably upon the principle of Revulsion. We know that when a powerful action takes place in one part of the system, the nervous excitement is drawn from other parts to that, hence we often find great benefit resulting from purging in apoplexy, Hemiplegia, Hemicrania, in local inflammations, when it is not in immediate contact with the bowels, in Rheumatic, Hip Complaints, Catarrhs, &c. of Brain 5. Cathartics act upon the Liver by increasing the secretions, & by removing congestion of the vena portarum, Hence we find congestion preceding attacks of Bilious Fever, Cholera, Cholic, Hepatitis &c. relieved by Purge It is for this reason also that a dose of Calomel or of Pil. Cath. Comp. proves very beneficial in the early part of summer complaints. 39 Sometimes Cathartics produce good effects by acting in several of these different ways, at one & the same time. Thus in a case of Dropsy, where the whole cellular membrane may probably be in an irritated condition, the Hydragogues act not only by producing an evacuation of the blood vessels, so as to cause absorption, but also by irritating the stomach & by the principle of Revulsion, withdrawing the irritation from the cellular membrane. & by depletion A few words remain to be said respecting the methods of prescribing and administering cathartics. The powers of Cathartics are modified by combinations hence by uniting several severe Purgatives in small doses, we obtain the full cathartic, but the irritation being more extensively diffused over the whole surface, is not so much felt. Their influence is promoted sometimes by the addition of Tonics, sometimes by small doses of an Emetic. When they operate powerfully, producing griping &c. this may be obviated by the addition of aromatics. Salts may be given in Mineral Water &c. 40 Medicines operate more effectually when given upon an empty stomach, hence it is adviseable to take them in the morning before breakfast, or on going to bed at night. If a prompt operation is desired, the best time is before breakfast, but if we merely wish a laxative effect, in the evening. Warm drinks of farinaceous gruel, molasses & water &c facilitate their operation, & prevent griping. Hypercatharsis subdued by 5 or 15 drops Laudanum. We now come to speak of individual Cathartics. The least active of these, is common brown Sugar, which produces this effect slightly. Molasses from the plantation also acts as a Cathartic, hence we find a diet of Rye Mush & W. India or N. Orleans Molasses an excellent laxative in cases of recent piles, prolapsus ani. &c - Wheat Bran, in form of Bread or Mush. A medicine more frequently used & approximating in its nature to Sugar is Manna, for an account of which see Book B. p. 205. 41 Eleventh Lecture May 19 1834 B.119 B.117 B.115 C.11 Upon Figs, Tamarinds, Purging Cassia, Caster Oil, Olive Oil analogous in its operation to Castor Oil, but inferior. Dose ƒ℥i or more. Melted Butter a still milder cathartic, adapted to chronic dysentery, after the irritation is subdued. It is prepared by putting it in a mug of boiling water stirring it up & skimming off the melted portion. Dose a tablespoonful every hour or two. For Rhubarb. see Book A p.43. Twelfth Lecture May 22 1834 Upon Rhubarb &c. and Senna, see Book B. p.33. Thirteenth Lecture May 26 1834 B.43 A.203 B.209 On Cassia Marylandica, Juglans & Aloes, for which see Books A and B. Fourteenth Lecture May 28 1834 A.53 A.59 C.1 A.63 On Jalap, May Apple, Scammony & Black Hellebore Fifteenth Lecture June 2 1834 B.121 C.5 C.7 On Colocynth, Gamboge, Elaterium and Croton C.19 Oil. 42 Sixteenth Lecture June 5 1834 Sulphur is found in volcanic countries mixed with earthy impurities, from which it is purified by fusion & sublimation. The best Sulphur comes from Sicily, Italy &c. In England it is obtained from Copper Pyrites, but is apt to contain the Sulphuret of Arsenic. It comes to us in rolls. Roll Sulphur is sublimed & washed, to clear it of Sulous & ic Acid. then called Flowers of Sulphur, Sulph. Sublimatum or Sul. Lotum. the latter is meant in the Pharmacop. It is of a yellow colour, nearly tasteless, has no smell except when heated or rubbed, insol. in water, [cross out] & in Alc but soluble in the vol. & fixed oils. fusible & inflammable & volatile's able It has long been a favorite laxative among physicians; it secues to act upon the lower bowels, & sometimes to produce more griping than other laxatives, which perhaps depends upon the Sulph. Hyd. formed. It has also a tendency to the skin, to the lungs, & in fact, seems to exert a general alterative influence. It is useful in costiveness, also given in slight hemorrhoidal affections, with an equal part of Cream of 43 Tartar, a teaspoonful or tablespoonful at bed time, also in dyspepsia accompanied with constipation & acidity it is combined with Magnesia, in Chronic Rheumatism, Gout, & various cutaneous affections. Hence the Warm Sulphur Springs contain Sulph. Hyd are very beneficial for Rheumatic patients. Dose as a laxative ʒi or ʒij, given in Syrup or Milk It is usefully applied in the form of an oinment of 4 parts Lard & 1 part Sulphur, in cases of Itch., Tinea Capitis &c. A solution of the Sulphuret of Potassa (ʒiij to ƒ℥viij Water) is sometimes used. Sulph. Precip. Lac Sulphuris is made by boiling Lime & Sulphur, in Water straining & adding Muriatic Acid. It is nothing Sulph. Acid is often used & then the Lac Sul. is adulterated with Sulph. Lime more than Hydrated Sulphur. Dose & use same as former Test of purity is to throw it on a hot iron, it should all be consumed. Carbonate of Magnesia. formerly called a Subcarbonate: is usually obtained from the Bitters or Mother Waters remaining after the Chrystallization of Common Salt from Sea Water. This contains the Sulphate & Muriate of Magnesia. It is heated & impure Carb. Pot. added when double decomposition 44 takes place, from which results Carb. Magnes. [illegible] form Sol. of Sulph Magnes. precip. by Carb. Sod. biter than C. Pot. This is washed, dried & cut in cubical masses. Soncet adulterated it with Carb & Sulph Lime It was first introduced into practice by Count Palmar in Rome. It is white, light, smooth, inodorous less than Magnesia 1 cu 2500 cold: & 9000 [wh??] little taste, unalterable in air & insol. in water, somet: it is adulterated with Lime, detected by dissolving in dil. Sulph. Acid, & add Oxalic Acid except to a very slight extent, when the Carbonic Acid of Water, forms it into a Bicarbonate Idinc soluble in Carb acid water Magnesia Water is a solution of it in Seltzer Water. It may be found in other forms than masses & heavier. Dose for an adult ʒij, but not much prescribed on account of its being liable to produce flatus. Efficacy is owing to acid in the stomach & bowels or usta Magnesia or Calcined Magnesia is obtained by exposing the Carbonate to a high heat Test is to add Vinegar & no effervescence First mix with water ℥i Carb. yields only about 200 grs. Magnes. alkalin Taste is disagreeable, soluble in 2000 parts water. exposed to the air, slowly absorbs Carb. Acid & is converted into a Carbonate. We meet with a preparation called Henry's Magnesia, which is essentially the same with May be in odered by [sub???] from [Sul??] [illegible] 45 4 times as heavy the Calcined, differing only in being denser, & smoother to the touch. more easily subbes up with water Magnesia is a mild aperient, supposed to operate by forming a salt with the acid with which costiveness with acidity in the stomach it meets. Used in Dyspepsia gout Diarrhea of children cholic, sick headache &c. Sick stomach after debauch Dose for an adult [cross out] ʒi, for a child 2 yrs. old, a teaspoonful. It is frequently combined with Rhubarb in bowel affections. If it do not operate it may accumulate & form masses in the stomach or intestine It is not Known that it is purgative in itself, hence if it do not operate, it is proper to aid it by giving lemonade &c. The best method of administering suspending it, is by diffusing it in water & it is important that it be equally diffused & not left in little lumps lest they should get between the teeth, & leave the taste in the mouth: first then, rub it up in a mortar with a little Syrup, then add the Water to it: or it may be taken in Soda Water, by first rubbing it up with a little Ginger Syrup. 46 The Saline Cathartics or Neutral Salts as a Class are the most important of the Cathartics. They are given generally in the same complaints & preferable to one another only for convenience, cheapness, taste or some other adventitious circumstance. They may be considered as holding a station between the Laxatives & Purgatives; they act upon the intestinal exhalents, produce watery evacuations, little pain, are refrigerant or sedative & well adapted to inflammatory & febrile complaints: but in acute attacks, the more active Cath. should be used first & these afterwards to continue the impression if needed. Soda Sulphas. Glauber's Salts this not long since was extensively employed, but is not now. It is found in the bottom of Springs & lakes but not in large quantities: all that is used is artificial. It is a kind of chance production resulting from the as Sulph. Acid. & Chlor. Sod. for Mur. Acid. processes for obtaining other products. Its great source is Sea Water. After the deposition of common Salt, this contains Sulph. Magnes. & Mur. Soda, & if it be reduced to a very low temperature, a double decomposition 47 ensues, resulting in the formation of Sulphate of Sod. & Mur. Magnes. & while so cold, the Sulph. Soda is precipitated. Hence in Russia, in the Winter, it is found at the bottom of lakes. Its Chrystals are in 4 or 6 sided Prisms with dihedral summits; striated by exposure, they give off their Water of Chrystallization, & when thus effloresced are 2 as strong as in Chrystals. It is soluble in 3 times its 1/2 at [illegible] weight of water at 60°, in 1/2 its wt. at 88°, & less 3 times at 106 sol. in boiling water than in water at 100°, Crystals melt, when heated- insoluble in Alcohol. Most sol in W. at 91°. but as a general rule, in 2 or 3 times their wt. of water. It is disagreeable & seldom prescribed. Dose ℥i Magnesia Sulphas. Epsom Salts. Exists abundantly in nature, in Sea Water, Springs, Caves &c. It was first procured from Epsom Springs in [crossed out] 1675 It was once obtained from Bittem, but not pure & frequently contained Mur. Magnes. It is now manufactured in Baltimore from a Magnesian rock which yields it abundantly by adding Sulph. Acid. also from Limestone in England. Chrystals are in 4 sided prisms with dihedral 48 summits, but as founded in the shops, it is usually in slender, needle like crystals, & very slightly efflorescent. It contains about 50 pr. Ct. Water of Chryst. soluble in water, insol in Alc. with a saline, bitter taste. It is frequently given in Soda Water. Dose ℥i. Disting. from Sulph. Sod. by adding Carb. Sod. to the Sol. It will precip. Carb. Mag. if Sulph. Mag. Seventeenth Lecture June 9. 1834 Potassa Sulphas. or Vitriolated Tarta; may be obtained by the direct union of its constituents, or by saturating Carb. Pot. with the Supersulphate which remains from distilling Nitric Acid from Nitric & Sulp. Acid. It is in Chrystals of various sizes, form 6 sided prisms, hard, contain no W. of Chrystalzation, Sol. in 9 pts Water at 60° & 4 pts at 212°, insol. in Alcohol. When heated, it decrepitates from water entangled like Common Salt. removes half the base. By the addition of acids, it is converted into a Bisulphate. Its taste is nauseous, somewhat bitter. Though cathartic in its effect, it is seldom employed for this purpose, on account of its difficult solubility. Dose about ℥ss Seldom used for any thing except the formation of the Dovers Powder. hard Hercula 49 Potassa Supertartras or Cream of Tartar, consisting is a Bitractate of Pot. & an excess of Tartaric Acid. It exists in the juice of the grape, & is deposited from new wine during fermentation, because it is insoluble in Alc. hence when by fermentation, the sugar is converted into Alc. the Crude Tartar is precipitated . This when purified by solution & chrystallization becomes Chrystals of Tartar, these we receive from S. of France, in small, irregular, semitransparent masses, sour, sol. in 60 prts Water at 60° & 15 prts at 212° insol. in Alc. & containing but little W. of Chrystallization. The Chrystal when ground form the Cream of Tartar of the Shops. This is rendered more soluble used in [An???] Inf. affections Scrof. & with Sulphur. for Piles. by boiling it with Borax. forming a compound sol. in an equal or less weight of boiling water. Potassa Tartras or Soluble Tartar. is prepared by dissolving Carb. Pot. in boiling Water. then adding the Supertartrate till effervescence ceases, then evaporate to dryness. Chrystals & Granular It has a bitterish, cooling taste, is deliquescent 50 in chrystals sol. in its own wt. of water, but in granular form, sol. in 4 times its wt. sol. in 240 prts boiling Alcohol. Its aqueous solution, when long exposed to the air is decomposed. It should never be prescribed in combination with acids. They take 1/2 base. It is a Cathartic, sometimes combined with Senna, but seldom used. Dose ℥ss to ℥i. Soda et Potassa Tartras or Rochelle Salt. 2 1 obtained by saturating Super Tart. Pot. with sol of Carb. Soda. It is in form of Chrystals, of right Rhomboidal Prisms, slightly very slowly efflorescent sol in 5 prts water at 60°, & much less boiling. It has a saline, bitter taste, was introduced into practice by Seignette of Rochelle. It resembles more palatable Dose ʒi to ʒiss the other neutral salts, but its principal use is as an ingredient in forming the Seidlitz Powders, composed of Rochelle Salt ʒij. Bicart. Soda. ℈ij in a blue paper, & Tartaric Acid grs xxxv in white Dose of Rochelle Salt ℥ss to ℥i. Result of Seidlitz is Tart. Pot. & Soda. & Tart. Sod. 51 Soda Phosphas. is obtained by taking some calcined bones, acting upon them with Dil. Sulp. Acid & a precipitate of an insoluble Sulphate of Lime falls, while a Superphosphate of Lime remains in solution Filter this & to it add Carb. Soda when efferescence & double decomp. takes place. & Phosphate of Soda remains in solution which filter & evaporate. It chrystallizes in the form of Rhomboidal Prisms, effloresces, undergoes the watery fusion by heat is soluble in 3 parts Water at 60°, & 2 pts at 212°, It contains 62 pr.ct. Water of Chrystalization. in the shops, it is generally found in the state of powder. It has a slightly saline, but no unpleasant taste, & ℥i of it may be given in a bowl of soup without the patient's knowing it. The chief objection to its use is its costliness. Dr Peasson Calomel. Of its Chemical History, we shall speak at a future period. It is termed a Proto Chloride & Submuriate, in some Pharmacopeias. The U.S. officinal title is Hydrargyri Chloridum Corrosivam Mite, distinguished from Hyd. Chlo. Forte 52 The dose of it is from 10 to 20 grs. but much larger Western practice- doses have often been given, & it is found that Cal. does not act in proportion to the quantity administered more than a regular dose; probably because the system will absorb but a certain proportion of it, & this acting upon the hepatic organs, will only produce a certain effect. It acts with little harshness or severity, producing bilious stools of different colour, according to the quantity given. Sometimes, however, it effects the stomach with violent spasms & vomiting, & this is believed to result from the quantity of vicious bile, which it causes to be secreted & poured into the stomach. Its direct effect upon the mucous coat seems to be rather soothing than irritating, & it will often remain on the stomach, when other Cathartics have Case of [Intussuscefetis?] been rejected. If it do not operate in 6 or 8 hours, it should be carried off, by a purge of Salts or Oil. Children require larger doses in proportion than adults, a child 3 yrs. may take 4, 6 or 8 grs. It is slow in its operation, hence dose of Oil may follow it. 53 When a speedy & powerful action is required, it should be combined with more active Cathartics. Thus combined, it is frequently employed in the Autumnal & Bilious Fevers, Jaundice, Hepatitis, & in fact, whenever active purging is desired. It sometimes proves beneficial in Dysentery, Enteritis, Gastritis, by its action upon the Liver. In cases of Children, it is much used in Remittents, Worms. It [Maras??s] &c. It is generally prescribed in the form of Powder or Pills. Never combine in Pill, with Soap or Magnesia. Purgative Enemata. The uses of injections are to promote the evacuation of medicines given by the mouth, or to administer medicine to a patient having a very irritable stomach &c. or when the stomach is in a state of inflammation, or when there is danger of injuring the tone of the stomach. They are also useful in constipation depending upon a collection of feces in the lower part of the intestines. A very common injection is made 54 of common Salt, Molasses, Lard or Sweet Oil, each a tablespoonful & a pint of warm water. If a more active one is needed, use Castor Oil or some one of the Neutral salts. If one still more active, use Senna Tea ℥i to Oj boiling water, or Jalap diffused in Water, 3 times dose. Ol. Tereb. tablespoofful to Oss warm water, or in Flaxseed Tea, with Yolk of Egg to diffuse it. Assafœtida may be given in flatus. Tobacco.- to overcome spasms, as in Cholic, Hernia &c. but with great care as to its strength. The proper proportion is ʒi to Oj of boiling Water, give 1/2 when cool, & the remainder in 1/2 hour if necessary. Suppositories are sometimes employed as Purgatives Soap is generally used, some take Molasses Candy. 53 Eighteenth Lecture June 12 1834 Diuretics are medicines which increase the secretion of urine. This they do in three ways. 1. As Nitre for inst. by entering into the circulation & then coming in contact with the vessels of the kidneys & stimulating them to action. This is condeuced by the saline medicines taken, having been detected in the urine. The active principle is that which is absorbed, while the remainder is digested & passes off. Thus in Turpentine, the vol. oil only is the portion absorbed. 2. Their action is extended by sympathy from the stomach to the kidneys; of this class, we can name none which act in this way alone, but there are many medicines which act by both these ways combined. 3. Some medicines act by promoting the action of the absorbents, hence they throw more fluid into the circulation, which must be eliminated through the urinary organs, & consequently increase the 56 discharge. Digitalis is said to act in this way. There are many circumstances, besides these, which influence the urinary secretions. Thus diaphoresis & diuresis are directly opposed & hence when one acts, the other will not, as in Winter, we know that more urine is secreted than in Summer when we perspire more freely. Cold Water then & cool skin promote diuresis. Active purging and diuresis are directly opposed, hence when the exhalents are pouring out fluid into the intestines, Diuresis does not occur. Diluent drinks promote Diuresis or Diaphoresis according to the state in which the patient is kept. It was formerly thought that in dropsy, copious drinking must be avoided, but we now find the reverse to be the best method of curing, & consider the patient may drink without restraint, so [as] long as the discharge equals or exceeds what is drank. In using diuretics, the pulse must always be attended to, if it is large, first deplete, for an increase of circulation above a certain point, diminishes 57 rather than increases the urinary secretion. Another reason for attending to the state of the circulation is that the secretion depends upon the nervous energy- hence if the brain be pressed upon by the fulness of the vessels, the nervous power must be diminished. Mental emotions have also much influence over the secretion of urine. Thus anxiety increases it, as every surgeon well knows, who has been labouring under great anxiety respecting an operation which he was about to perform- fear also has a similar effect, tho' probably it acts rather by relaxing the Sphincter muscle. Dropsical effusions removed [illegible] the principle of Exosmosis (Chap) The diseases in which Diuretics are applicable are those attended with effusions, as Dropsy. They operate by diminishing the quantity of fluids, either by stimulating the absorbents, by moderating the exhalents, or by a union of both. Hence they are advantageous in Dropsy, which, we know, may occur either from a diminution of the power of absorption, from an increase of the effusion 58 effusion, or from an increase of effusion & diminution of absorption combined. They may also act upon the principle of revulsion, for Dropsy may occur on account of a kind of sub-excitement over the whole surface & consequently if medicines will draw this irritation to the kidneys, they cure the disease In inflammatory diseases of the kidneys or any of the urinary organs, they act favorably after depletion. In these the saline diuretics are particularly applicable. They are useful also, where we wish to decrease the arterial excitement. In selecting those most applicable to particular diseases, great care is requisite & much must be left to the discretion & experience of the physician. Some are better adapted to peculiar cases than others. We shall now speak of them individually: & 1. Of Digitalis,- for which see Book B p. 53.- 59 Nineteenth Lecture June 16 1834 On Squill & Colchicum, See Book A p.67 & 77. Twentieth Lecture June 19 1834 A.85 A.73 B.129 On Veratrum, Taraxacum, Juniper Berries.- B.185 B.185 Erijervn Philadelphicum, Erig. Heterophyllum, B. 127 Carrot Seed, Apium Petroselinum, & Chimaphila B.183 Ap Draveolens or Cellery [illegible] species Umbellata for which see Books A. & B. Twenty First Lecture June 23 1834 Turpentine is a name applied to a peculiar vegetable juice, consisting of resin dissolved in an essential oil, & generally obtained from some species of Pine. There are several kinds found in the shops. 1. White Turpentine. Terebinthina (U.S) is obtained from the Pinus Palustris, which is a native of N. & S. Carolina & Georgia. It is called sometimes the long leaved or Pitch Pine is about 60 or 70 ft. high, & supplies nearly all that is consumed in the U.S. as well as sent to other countries. White Turpentine has a peculiar, somewhat aromatic odour, a warm, pungent & lightly bitterish taste, is of a white colour, mixed with yellow; consistence varies with the temperature, & it 60 long exposed becomes hard & dry. That in England & France comes from a different plant. 2. Canada Balsam or Balsam of Fir. is improperly so named, because it contains no Benzoic Acid. It is called also Balm of Gilead or Am. Silver Fir. derived from the Ab. Balsamifera growing in the N. on the bark of the tile are little blisters filled with the liquid. parts of this country.- It is liquid, like Honey, has a strong, not disagreeable odour, bitter taste, whitish yellow colour & semitransparent, becomes stickier & darker by exposure. 3. Venice Turpentine.- so called from the Port whence it was formerly shipped,- is the product of the P. Larix. This, however, we do not find in our market.- That which we have under this name, is probably a factitious article, made from Pitch, Ol Tereb. & White Turp. Strasburg Turpentine comes from Hamburg. 4. Chian Turpentine is never brought into this country. It is thick, tenacious liquid, pale yellow colour.- The Turpentines are fusible inflammable, burning with a white flame & much smoke,- impart neither flavour to water, but are insoluble in it, soluble in Alcohol.- consist of Oil, Resin & perhaps some Succinic Acid. They are all stimulant, diuretic, & in large doses Cathartic irritate urinary passages but have been superseded by the Oil of Turp.- 61 They are given with advantage in Chronic cases of Inflammation of the mucous membrane in different parts, also in Sciatica, Lumbago, Piles, Chronic Catarrh &c. Dose grs x to ʒi- May be given in Pill or Emulsion. Externally for Plasters. There are several substances used in medicine, which consists of Preparations of Turpentine, & may here be introduced with propriety. Tar.- Pix Liquida.- is Turpentine partly decomposed in the preparation of it.- It is procured from the P. Pacastric of N. Carolina, by burning the dead billets in piles, like Charcoal Pits, & collecting the Tar. It has a peculiar empyreumatic odour, with a bitter, resinous taste of a dark colour consists of Resin, Empyreumatic Oil & perhaps Acetic Acid, coloured with Charcoal It yields a very small portion to Water forming Aqua Piles Liquida or Tar Water. which is used in Chronic Cough, &c. Oj per day. Tar may be given in Pill or Emulsion,- or as an Electuary with Brown Sugar. 62 Tar Ointment is an excellent remedy for Scald Head & and in scaly eruptions of the skin, we have found nothing so beneficial as equal parts of Citrine & Tar Ointment mixed.- Tar & Sulph. Oint. for Scald Head &c. Pitch. Pix Nigra. (L) is Turpentine deprived of a great portion of its oil by evaporation and is solid.- It is seldom used.- Of Burgundy, & Canada Pitch, we shall speak hereafter.- Resin- common called Rosin,- is that which remains from the Turpentine, after the oil has been separated by distillation.- It is solid, brittle. semitransparent.- There are 2 varieties in the shops, Yellow & White. The Yellow is semitransparent. when melted & worked up with Water, it forms the water grad. evap. if exposed White.- Resin is not given internally Fumes Cerat. Resina Basilicon Oint. Composed of Resin, Max & Oil,- is used for keeping blisters open.- It is the best application to Burns, to prevent an de-looking scar. Ol. Terebinth.- or Spt. of Turpentine is the most important as an internal remedy. It is colourless, limpid- has a strong peculiar odours- pungent taste 63 is sparingly soluble in cold Alc.- readily in boiling.- It has a strong determination to the urinary organs, & is slightly stimulant, so that if long continued, it will produce strangury,- or bloody discharge. It is useful in Chronic Nephritic complaints,- Leucorrhea,- Gleet. Debility of Urinary & Genital Organs. Sciatica, &c. &c. Dose 10 or 15 drops 2 or 3 times In acute cases the dose may be repeated every 2 or 3 hours. a day.- It purges in the dose of ℥ss to ℥ij.- If long kept, it absorbs Ox & forms a resin. It can be purified by adding Cold Alcohol. There is a method in which Turpentine has been very beneficially employed, of which we have not yet spoken. It is in the form of fumes arising from Resin or Tar. which have proved very serviceable in chronic affections of the throat.- or of the mucous or bronchial membranes & in the first stages of consumption, before tubercles are formed. It is probable that the air of Pine forests, proves beneficial to consumptive invalids for the same reason, for the odour which there prevails. Copaiba.- Product of Copaifera Officinalis,- for an account of it, see Book C. p.25. 64 Twenty-Second Lecture June 26 1834 Canthares.- Of the History of this we shall speak hereafter when we come to treat of its vesicating properties.- now we have only a few remarks respecting its diuretic properties. The testimony of the ancients & moderns concurs in pronouncing it diuretic.- It is stimulating & sometimes produces strangury by its irritating effects upon the mucous membrane.- The symptoms of strangury are a frequent disposition to pass urine, only effecting the passage of a few drops of a red colour, with a great deal of pain.- Tinct. Canth. is useful in dropsy;- also for irritating the urinary organs in suppression or retention of urine.- If retention depends upon a stricture or upon spasm at the neck of the Bladder, Canthar. would certainly be improper, but if it depended upon an inability of the bladder to expel its contents then Tinct. Canth. would probably excite it to action. In suppression,- Canth. may be employed for stimulation. 65 In Incontinence of Urine, when it depends upon paralysis or want of power in the Sphincter muscle, Fr. Canth is useful.- Thus in Children who are constantly prone to discharge in bed, this has acted very befeficially.- It is useful also in Leucorrhea, Amenorrhea, Gleet, Seminal Weakness, &c. Dose 10 or 15 drops 2 or 3 times a day. In substance, 1 gr may be given morning & evening. Mineral Diuretics. Carbonate of Potassa.- This Salt is contained in the plants which were formerly so much employed for the cure of Dropsy. The Salts of Pot. are supposed to operate upon the vessels of the kidneys. The Carb. Pot. employed is a purified Pearl Ash, prepared by making a saturated solution of it in Water, filtering, evaporating, & stirring it till it granulates. This however is by no means pure, it contains Muriate & Sulphate of Pot. & Silica.- Silicate precip. from solution. The name, Salt of Tartar, applied to this, [illegible] properly to the Carb. Pot. obtained from Cr. Tart. by heat. 66 It is composed of 1 Eq. Carbonic Acid & 1 Eq. Potassa; was formerly, but improperly called Subcarbonate. It is always granulated,- deliquescent,- an alkali, changing veg. blue to green- forms soap with oil,- insol. in Alc. sol.- in water. It is used as a diuretic in Dropsy.- also in stimulating hepatic secretions in Jaundice.- Dose 10 to 30 grs in solution, 2 or 3 times a day. Bicarbonate of Potassa is a more pleasant preparation, formed by passing a stream of Carbonic Acid through a solution of Carb. Pot. then evaporating by heat below 120°.- It chrystallizes in 4 sided Rhomboidal Prisms,- are white,- permanent,- soluble in 4 times its weight of water at 60°. in 5/6 boiling.- Dose ʒss to ʒi 2 or 3 times a day.- The best form of giving the Carb. Pot. is in Carbonic Acid Water. Take about ʒiss of Carb. or Bicarb. Pot. & ℥i Ginger Syrup, put it in a bottle of Seltzer Water & give 1/3 at a time,- keeping the bottle well stoppes Carb. & Bicarb. Soda,- not important.- 67 Acetate of Potassa, is but little used,- it is made by adding vinegar or acetic acid to Carb. Pot.- It is white, texture, deliquescent, sol. in its wt. of water at 60° & Alcohol & decomposed by Acids. It is Cathartic & Diuretic. Dose as diuretic ʒss. 2 or 3 a day. Supertartrate of Potassa: is the best saline diuretic, which we possess. It should be given in large quantities of water to the amount of ℥ss or ℥i per day. It is refrigerant, antiphlogistic, & adapted to a febrile condition of the system. It is proper to begin with about ℥ss per day in divided doses. It is well adapted to Anasarca with excited circulation. Nitrate of Potassa is found in various parts of the world. It is most abundant in the plain over flowed by the Ganges.- The ground is scraped together & lixiviated.- & process repeated till Nitre Chrystallizes in 6 sided Prisms,- containing no water of Chrystallization Taste is sharp & cooling; even extending to the stomach. It is soluble in 4 or 5 prts. of Cold. & its own wt. boiling W.- insol. in Alc. Dose 10 or 15 grs in solution sufficiently often to give about ʒi to ʒiij in 24 hours. This will promote diuresis, by stimulating the urinary vessels.- 68 Nitre has sometimes been accidentally taken for other salts & proved poisonous. The symptoms are a strong feeling of coldness in the Epigastrium, spasms, bloody stools, hypercatriasis &c. The remedy is to wash out the stomach thoroughly & guard against intestinal irritation.-. Sweet Spirit of Nitre.- Spir. Ætheris Nitrici. has often been found advantageous as a diuretic. It is sol. in W. & Alc.- often adulter. with Alc. as their sp. gr. is nearly equal. It is often grateful to the stomach when others are not. Dose ʒss to ʒi Chapman gives from ʒij or ʒiij to ℥i. It should be administered with large quantities of liquids. It becomes sour if long kept from Nitrous Acid. Antilithics The Antilithics are medicines which were supposed to prevent a deposition in the urine, producing gravel but we are very sceptical respecting the propriety of arranging these in a distinct class.- for as the vessels in connection with these organs are diseased, general treatment is as proper as in other cases, upon the same principle that we would class Antilithics, we might form also classes of Antiscorbutics, Antidysenterics &c. &c.- 69 We think, therefore, that this class might be justly omitted in the Materia Medica. It was supposed that some medicines would enter the circulation,- come in contact with the stony depositions, & dissolve them, & hence we have a class called Lithontriptics.- but it is not so. There is no solvent for the stone, while the stone is in the bladder.- The only method in which we can act is to obviate the Lithic Diathesis, & thus we may sometimes relieve or correct the unpleasant symptoms. The urine abounds in saline matter, of different kinds, & we find that there are 2 kinds of Calcareous Deposition.- The one which is most frequent is Uric Acid,- the other, a compound of an insol. Salt of Phosphoric Acid. That state of the system, predisposing to the former is called the Lithic Acid Diathesis, & that to the latter, the Phosphoric Acid Diathesis. Whenever there is a red sediment in the urine, we may suspect the first Diathesis,- but if 70 there be any doubt, take a piece of Lithmus & immerse it, & it will be changed to red, if there be Uric Acid present. In a healthy state it always exists, in combination with more alkali. Thus the Sublithate of Ammonia will remain dissolved as long as the Alkali is in Excess, but if the acid exceeds, this is then deposited. Hence in persons of the Lithic Acid Diathesis, it is improper to accumulate acid in primæ viæ,- or to live upon acescent food. Deficiency or suppression of Perspiration also is said to be improper in such persons, because according to Dr Wilson Philip, it contains an acid- The remedies or antilithics in these cases are Alkalies & Alkaline Earths, to neutralize the acid, in the blood, urine &c.- Simple Bitters also, to strengthen the Digestive Powers, & Diaphoretics, by causing Perspiration. In the Phosphatic Diathesis,- the case is directly the reverse, & too little acid is the cause of the stony deposition.- The calculous matter 71 is such as to be soluble only when there is a certain portion of Acid, but when this proportion diminishes, a white sediment deposites, This state is also connected with disorder of the Digestive functions. Acids here, instead of Alkalies, are requisite for the cure, & Mineral acids are preferable Hard Cider has enjoyed great reputation among the vulgar for the cure of the Gravel, but we readily perceive that it is applicable only in this Diathesis, while in the former Diathesis it would prove very injurious. Tonics also are applicable.- Carb. Pot. & Soda, Calc. Magnesia, Lime Water &c. Bicarb. Pot. & Soda are preferable to the Carbonates, & the BiCarb. Soda to Bicarb. Pot. Dose ʒss to ʒi Dose of Carbonates 15 to 30 grs. Some prefer Magnesia, but it is probably inferior when it is desirable that the Antacid should reach the kidneys. Dose 15 to 30 grs. 3 times a day. Lime Water may be given with Milk, Oij per day. The Mineral Acid employed are the Nitric, 72 Sulphuric & Muriatic,- all of which are Tonics. The two last of these are preferable. All the vegetable tonics are sometimes useful. Uva Ursi has obtained great reputation, & seems well adapted to those cases where the organs are incapable of performing their duty from relaxation or debility.- It has, however, no peculiar adaptation to gravel. Twenty-third Lecture June 30 1834. Diaphoretics,- are such medicines as increase the cutaneous discharge.- The skin always, when in a healthy state, is carrying on a secretion, which generally evaporated as fast as it is formed,- but when, from an increase of secretion or from different states of the atmosphere,- it retains its liquid form it is called sweat.- At one time, it was supposed that some medicines had the power of increasing the moist secretions & others the dry,- & hence they were divided into Sudorifics & Diaphoretics,- but these distinc- are now lost, & both are comprised by medical men under the head of Diaphoretics. 73 These medicines operate in different ways.- 1. By relaxing the constricted capillaries which are often found as in cases of febrile excitement- In diseases, attended with such consequences, the diaphoretics are calculated to relax these vessels & thus promote perspiration.- This may be accomplished by nauseating doses of emetics,- by cold or warm ablutions &c. 2. By entering the circulation, & then coming in contact with the vessels of the skin, & stimulating them as diuretics do those of the kidneys;- as Cn. Pot. &c. 3. By increasing the general circulation & consequently, the cutaneous secretions:- as Carb. Ammo. &c. but these can only be given in languid circulation, with a cool, dry skin, & not in cases of high arterial excitements. 4. If the skin be in a healthy state, any thing which moderates the excitement of the heart and arteries, will produce sweating,- hence warm teas &c are said to be useful.- It is said also that the perspiration produced by entering hot ovens has been known to cure the Dropsy.- But the application of dry, 74 heat is apt to produce febrile action,- while a moist heat usually produces diaphoresis.- Dry heat can be borne at a higher temperature than moist:- These medicines are applicable to a great variety of diseases,- & rank high in the list of curatives. They operate favorably by removing the hot & dry surface,- by depleting the blood vessels, & consequently moderating the arterial excitement;- & also by eliminating the noxious matter from the blood. They act also by revulsion,- by directing the flow of blood to the surface & abstracting it from the inner parts, thus in Dysentery, Diarrhea &c. - Rheum, Gout. They are useful also in Congestion, Rheumatism, Gout, &c.- They are said to increase the action of the absorbents as in Dropsy,- but for this are not very useful. They sometimes merely change the action of the capillaries,- as Sulphur, Sarsaparilla &c. We may add a few words respecting the mode of administration.- If copious perspiration is desired,- put the patient to bed, & do not allow him to be uncovered,- advise flannel to be worn next the skin,- or in summer, the knit elastic substance. 75 When the pulse is strong & full,- the medicine should be preceded by a lancet or a purge.- After the sweating has commenced,- give warm teas, & avoid purging, vomiting, or diuresis.- If the skin be hot & febrile,- cold drink may be given. 1. Relaxing Diaphoretics. A.25 B.189 Ipecacuanha & Eup. Perfol.- see Books A & B. The Antimonials used are Tartar Emetic,- Pulv. Antim.- & Precipitated Sulphuret of Antimony. Ant. et Pot. Tartras.- given in small doses, produces profuse perspiration in two ways.- 1. By overcoming the capillary constriction by nausea, 2. By entering the circulation & stimulating the vessels of the skin to increased action. It loses its curative power, in any disease,- when it nauseates (Chapman) It is useful in excited febrile complaints, in eruptions of the skin,- chronic scrofulous complaints &c. Dose 1/8 to 1/4 gr.- As an alterative 1/10 to 1/8 gr.- Also in the commencement of consumption, with frequent pulse &c. & in catarrhal affections generally.- Dissolve about 1/2 gr. in Oi of Water & let the patient take it as his only drink thro' the day. 76 Pulvis Antimonialis.- was intended as a substitute for James' Powders.- It is made by mixing the Sulpr. Ant. with shavings of Horn & exposing them to heat.- Then we have an Oxide of Ant. Combined with Phosphate of Lime as the result.- It is a very uncertain & variable preparation.- If we were sure that it was a Protox. of Ant.- We would then know that it would unite with the acids of the stomach & form some salt of Ant.- but if it be a Perox. it will not.- It is of dull white colour.- inodorous, insipid, insol. in water, slightly Febrile diseases. sol. in Alcohol.- Dose 3 to 6 grs. every 4 hours 2 1 Sulphuretum Antimonii Precipitatum, is formed by boiling Sulp. Ant. with a sol. of Carb. Pot. then straining & adding Sulp. Acid & we have an orange-coloured precipitate.- If no Sulp. Acid be added, the precip. which falls spontaneously is Kermes Mineral of a dark brown colour if after the Kermes is obtained. we add to the remaining solution Sulp- Acid- we shall have Golden Sulphur. Ant. Sulp. Precip. is a mixture of both The Precipitated Sulphuret is similar to Antimony 77 in its effects upon the system,- but is very uncertain in its operation.- It is seldom or never employed in this country.- Given sometimes for Scrofula & cutaneous diseases, in dose of 1/2 gr or 1 gr. 2 or 3 times a day & may be combined with Calomel. It is said to be less injurious when long continued than Tartar Emetic.- Dose as a Diaphoretic 1 to 4 grs.- Emetic 8 to 10 grs.- Twenty Fourth Lecture July 3 1834. Citrate of Potassa.- is seldom kept in the shops, but is prepared extemporaneously for prescriptions &c. It is made by saturating a solution of Citric Acid or Lemon Juice with Carbon Pot. then we have in a solution of Carbonic Acid Water, Cit. Pot. Its taste is not unpleasant,- called Neutral Mixture. The common formula is to take ƒ℥iiij fresh Lemon Juice & add gradatim Carb. Pot. till effervescence ceases. Dose tablespoonful every 1, 2 or 3 hrs. with a little water. It is well calculated for Remittents & Intermittents, if it produces pain in the bowels or purges, give a few drops of Laudanum. 78 Another form in which this is given is the effervescing Draught,- which differs from the former, only in being given a state of effervescence. Make a solution of Carb. Pot. ʒij to ƒ℥iiij water & filter, then a tablespoonful of this with a tablespoonful of Lemon Juice & also one of water, will make the mixture. Sometimes the reason that no effervescence takes place is because only part of the Carb. Pot. is decomposed. & the Carb. Acid goes over to the other portion & forms a Bicarb- if however, the Bicarb. from the weakness of the Lemon Juice, no effervescence Pot. be used.- we shall always have an effervescence, but at the same time, we cannot be always sure that we have a saturated solution.- Hence Carb. is best- ensued,- then add a little more. When Lemons & Limes are scarce, a solution of Citric Acid may be used of ʒij to ƒ℥iiij water & [add] Ol Limo is gtti- Guard. against the fraud of selling Tartaric for Citric Acid.- Distinguish by dissolving & adding Carb. Pot.- the former will produce insol. Bicarb. The precipitate of Silicate of Pot. may be avoided by using the Bicarb. Pot. ʒiij to ƒ℥iiij water. To increase the Diaphoresis Tart. Emetic or Sweet Spt. of Nitre may be added. Acetate of Ammonia is also employed Liq. Ammo. Acetates (U.S.) only in solution, when it is called Spt. Mindereri It is made by saturating Distilled Vinegar with Carb. Ammo. It is a limpid, colourless fluid. When Ammo. is in excess, it is injurious on acct. of its stimulating effects. Fixed alkalies,- Strong Acids & Sulp. Magnes. are incompatibles- Dose ƒʒss every 2 or 3 hrs. 79 Citrate of Ammonia possesses no superiority Potassa Nitras.- It is doubtful whether Nitre possesses any diaphoretic properties, but it certainly exerts an influence upon the arterial excitement. It is advantageously given in fever, as in the following Rx Potas. Nit. ʒi Calomel grs xii Tart Emetic gr i Usually our Intermittents do not require a large doses of Calomel. [mft.?] Pulv. No viii Give one every 2 or 3 hours. Dose of Nitre is 10 grs. frequently repeated Swt. Spt. Nitre.- to quiet nervous derangement in fevers, as in Children gtt 20 to ƒʒi. We next come to the Stimulant Diaphoretics C.47 A.213 A.209 for Guacacum,- Xanthoxyfum, Mekereum and B.25 Sassafras,- see Books A, B & C. Twenty-Fifth Lecture July 7 1834 Sarsaparilla- see Book A. p. 107. Expectorants are those medicines which facilitate or increase the discharge of mucus from the air vessels of the lungs. This they do in several ways- 1. By relaxing the constricted vessels of the lungs. it is in this way the nauseating emetics act as Expectorants. 80 2. By reducing the quantity of the secretion which may sometimes be so great & the fluid so abundant that the patient cannot cough it up. 3. By entering the circulation, coming in contact with the secretory vessels, & stimulating them to proper action. Hence we find there are 2 classes of Expectorants. One when the lungs are excited & require depletion as in Catarrh. Pulmonic Irritation & Inflammation &c. & the other when the vessels of the lungs are relaxed & pour out more than a proper quantity of fluid as in Asthma, Consumption &c. During the use of Expect. keep the Surface of the body warm.- Purging is not incompatible.- Expectorants may act in another way, by mechanical influence, as in cases of great debility, where the power of the pectoral & other muscles, is insufficient to accomplish the desired object, these then must be stimulated, in order to call into action the nervous influence, as by Wine Whey, Vol. Alkali. Ammonia &c. 81 The best of the whole class of Expectorants to be given in cases of an excited character is Tartar Emetic. It is useful in Asthma, Pleurisy & the like. Dose 1/8 gr. Of Vin. Ant. from 15 to 30 drops. A.32 A.67 For Ipecac & Squill see Book A. Twenty Sixth Lecture July 10 1834 A.103 A.93 C.41 On Allium, Senega, Ammoniacum, Assafateda, C.43 C.43 C.29 C.25 C.49 Galbanum, Myrrh, Turpentine Copaiba, Tolu, C.49 C.51 Balsam of Peru, & Benzoinum. See Books. On Emmenagogues The menstrual fluid is a peculiar secretion of the uterine vessels. A retention or irregularity of this discharge sometimes occurs, & then the intervention of medicines called Emmenagogues is necessary. As with other organs, so from analogy we may suppose that there are medicines which have a peculiar affinity for the vessels of the Uterus, but not many of these are yet known. In practice, at present, those circumstances producing Amenorrhea are considered in order to discover the particular Emmenagogue requisite in each case, & prescribed accordingly. 82 Thus, when it is the result of debility, Tonics, by giving tone & strength to the system, act as appropriate Emmenagogues,- as,- Preparations of Iron,- Bark,- Myrrh &c. It may be the result of general excitement, then evacuants become proper. Sometimes it arises from a diseased state of the system, as in Consumption,- Dropsy &c.- & it is evident that until these are cured, it will remain. Sometimes it may arise from that state of the bowels which we find in Constipation, then of course, Purgatives are appropriate. B.209 Aloes.- From the great affinity which this has for the large intestines, we may suppose that the irritation which it causes may be extended by sympathy or it may have a specific tendency to the Uterus to the Uterine Vessels.- It is often given in combination with Iron,- Myrrh &c. A.63 Helleborus Niger.- The Tinct of this in the dose of 60 grs 2 or 3 times a day has proved very beneficial in Dr. Meigs' treatment of Amenorrhea.- Dr Wood has found Aloes & Carb. of Iron, long continued a very efficient remedy. Also in Dysmenorrhea.- 83 The Chalybeates are excellent Emmen.- & of these Ferri. Carb. Preccip. appears most efficient. on the treatment of Amenorrhea, if any disorder in any one of the other functions of the system exist, first remove that disease & then give Emmenagogues Sometimes it may be proper to give the Emmenagogues in conjunction with remedies suitable to the cure of the original disease.- Thus if constipation existed, Aloes & Iron might be joined with the remedies for constipation. Aloes & Iron should never be given in an excited state of the system, without previous depletion. Twenty-Seventh Lecture July 14 1834. A.93 C.47 B.47 B.179 On Madder, Senega, Guacaicum, Sabina, Ergot, & Tinct. Cantharides as Emmenagogues.- There yet remain 2 classes of medicines to be noticed, which act not upon the viscera themselves, but upon their contents, & these are Anthelmintics & Antacids. Adjourned July 23rd to Sept. 7 1835. Anthelmintics are medicines used either to destroy Worms or drive them from the body. There are 4 species of Worms- Lumbricoides, Ascarides, Tricuris & Tania or Tape-Worm. 84 They operate in different ways. Cathartics may act as such by operating upon the bowels, & Tonics, by imparting tone to the system, as well as by poisoning the worms. The worms may either be poisoned so that they are induced to change their place,- or they may be killed by the medicine mechanically.- Calomel is the most efficient anthelmintic & probably may act by increased the flow of acrid bile, which is very disagreeable to the worms,- they change their place, & are carried off by a subsequent dose of Oil. Dose for Child of 2 yrs. 5 grs.- Twenty-Eighth Lecture July 17. 1834 A.65 On Spigelia Marylandica:- Azedarach or Pride of India or Pride of China of which the bark of the fresh root is used.- It is a native of Syria, Persia & India & cultivated in this country. It is used extensively as an Anthelmintic in Georgia. It has a bitter, nauseous taste & is generally given a decoction, made from boiling ℥iiij in Oij to Oj- of which the dose is a tablespoonful every 2 or 3 hours, until it affects the bowels,- or morning & evening for several days & follow it with an active Cathartic. 85 B.177 A.207 also on Chenopodium, Bark of Geoffroya [Inemus?] B.177 A.181 B.139 C.29 Dolichos, Tilix Mas, Pomegranate, Oil of Turpentine, which latter is one of our most powerful Anthelmintics & especially useful in expelling the Tænia the dose is from ƒ℥ss to ƒ℥ij or ƒ℥iij. This generally heats the stomach, & even excites giddiness &c. together with acting upon the bowels. If it do not purge in 3 hrs. after it is taken, give a dose of Castor Oil. Some combine the Oil of Turpentine & Castor Oil together so as to be more certain of its operation. This answers very well, especially in Lumbricoides. The Oil of Turpentine, in small doses, is often given with advantage to children, who complain of pain in the stomach, without any fever &c. when worms may be suspected. the worms in the stomach are destroyed & digested. Whether there actually be worms or not, it often operates very favourably. Copaiba acts similarly Cedar Apple operates in much the same way. Filings of Tin, Pulv. Sfanni have very strong testimony given in favour of their anthelmintic virtues. By some, they are said to act mechanically by their rough, grating surface, but if this were so, sand would act as well 86 Others say, Tin acts favourable on account of the Hydrogen which is evolved, but if this were so, Iron or Zinc would answer the same purpose.- Others suppose that it is from the Sulphuretted Hyd. generated, but we might suppose that the worms had become sufficiently accustomed to this Gas, to feel no inconvenience from its presence. Others suppose that it acts by the Arsenic contained in the Tin, but Arsenic itself will not act thus. Why, then, may we not suppose that the Tin is a medicine noxious to the worms, & consequently acts in this rational manner.- Dose is very indefinite, varying from ʒi to ℥i, given in the morning for 2 or 3 days, then followed by a Cathartic. Aurum Mozaicum, was a compound of Sulphur & Oxide of Tin.- Dose 10 grs. twice a day Pomegranate- Bark of Root- see B.139 Adjourned till September. 87 Twenty-Ninth Lecture Sept. 1 1834 On Antacids.- Antacids are those medicines which are given to meet the acids which are sometimes found in the stomach & bowels and convert them into harmless substances. The acids arise not only from the gastric juice in health, but also more copiously in a diseased condition of the stomach. The diseases in which this state is generally found are Dyspepsia, Diarrhea, & Bowel complaints of Children,- but an acid state of the stomach may accompany almost any disease. All the salifiable bases may be considered as Antacids,- but those generally employed are the Alkalies & Alkaline Carbonates.- Potassa in its pure state is not adapted to internal administration.- Carbonate of Potassa or Salt of Tartar is frequently given as an Antacid.- It is often added to bitter infusions,- so that while the acidity is corrected, a tonic impression may also be made upon 88 the stomach.- The dose of it varies with the acid contained in the stomach.- generally from 10 to 30 grs. & repeat it if necessary.- A pleasant form for administration is in solution in Cinnamon Water with a little Sugar.- Another form in which it may be given is by taking a teacupful of Soot,- & 1 quart of Hickory Ashes,- shaking them together in 1 Gallon of Water, let them stand [cross out] 24, 24 or more hours, then pour off the liquid.- Besides the Carb. Pot. this liquid contains perhaps Kreozote &c. Carb. Ammo. & some other ingredients- The dose of it is a Wineglassful 3 or 4 times a day, & it is rendered more agreeable by adding 10 or 15 gtt of Aromatic Ammoniated Alcohol.- This a very effectual preparation for the prevention of sick headache, which frequently arises from acidity of stomach) if taken, when the symptoms warn us of its approach. Bicarbonate of Pot.- is used as the Carbonate. The only objection is the evolution of a large quantity of Gas in the Stomach.- 89 The preparations of Soda however, are better than those of Potassa; because of the less quantity necessary to neutralize a certain portion of Acid & of the less disagreeable taste.- Soda.- like Potassa,- is not given pure. Carbonate of Soda is obtained from Seaweed or from the decomposition of Sulph. Soda by Charcoal & Carb. Lime.- It chrystallizes in Octohedrons. Effloresces on exposure,- because it contains about 62 pr.ct. Water of Chrystallization,- hence its strength is constantly varying.- The chrystals are soluble in about 2 parts of Cold & less than their own weight of boiling water. It is less disagreeable to the taste than Carb. Pot. Is useful in Jaundice to assist a mercurial action probably by entering the circulation & stimulating the secreting vessels of the liver. The dose varies according to the variety of its strength before stated.- Generally from 10 grs. to ʒi may be given in solution or in Pill. If the latter, it should first be deprived of its Water of Chrystallization by heat. 90 Bicarbonate of Soda more properly Sesquicarbonate is formed by passing a stream of Carbonic Acid through a solution of Soda,- then driving off the excess by heat below 120°,- or by introducing the Gas into a cask containing the Chrystallized about 10 pr.ct. Carbonate.- It contains less water of Chrystallization than the Carbonate,- and is soluble in 10 times its weight of Cold Water. Dose of it is from ʒss to ʒi.- & may be given in Carbonic Acid Water. Ammonia, when pure is gaseous. It is obtained by mixing Mur. Ammo. & Quick Lime Water impregnated with it forms the Aq. Ammo. of the Shops;- it is colourless,- with a pungent taste & smell,- corrosive & caustic, if applied to the skin.- & should be kept in well stopped bottles to prevent the access of Carbonic Acid. Externally it is used as a Rubefacient,- & it may be employed as an [illegible] to prevent fainting. A better preparation for internal use is the Aromatic Ammoniated Alcohol made by impregnating or Arom. Spts. of Ammonia. {If the patient should take the prep. of Ammo. without} {dilution, the mouth & throat may be injured, then gargle} {in the dilute vinegar & smear the part with Oil.} 91 Alcohol with Ammonia & adding some Aromatic Volatile Oil. This a delightful Antacid pleasant to the smell & taste & grateful to the stomach. The dose of it is from 15 to 30 drops, but must be diluted before it is taken. Carbonate of Ammonia is much used p.144 as a Stimulant & will be treated of hereafter Lime.- is seldom used in its Caustic state except in the form of Liquor Calcis, which is a saturated solution of it in Water. Water takes up 1/778 part of its weight & it is more soluble in Cold than Warm Water. It has an acrid, alkaline, unpleasant taste, but when mixed with an equal proportion of milk, loses these qualities & becomes one of our best remedies for nausea & vomiting arising from gastric irritation- It corrects that disposition by calming & giving tone to the stomach. Of the Carbonate of Lime, there are several varieties,- all nearly tasteless, insoluble in Water unless impregnated with Carbonic Acid. They 92 are all composed of 1 Equiv. Carb. Acid & 1 Eq. Lime. Creta Preparata,- one form of it, is prepared by levigating ordinary Chalk. Other forms are Testa Crab's Claws Prep.- Tela Cancrorum Prep.-Ovorum Testa Prep.- said to be preferable to Cret. Prep. on acct. of the animal matter which they contain,- are more minutely divisible.- Carb. Lime is useful in Diarrhea on account of its Antacid as well as its astringent power. Dose varies from [varies] 10 grs to ʒij- From 10 to 20 grs may be given every 2 or 3 hours.- It is usually administered in the form of the Chalk Mixture or Julep,- consisting of Cret. Prep. In making mixtures &c. the Cinnamon water should always be diluted with simple water otherwise it is too strong. Tinct. Opii Acac. Gum. Sacch. Alb. Aq. Cinnam. et aq. Pura.- Magnesia & its Carbonates are both excellent Antacids, especially in cases connected with Constipation, & may be given in Dyspepsia,- Gout, & the complaints of Children. Sometimes it offends the stomach. 93 We next come to speak of those Local Remedies which affect the Organization of the Parts. Rubefacients produce a redness of the surface; when there is much irritation, the vessels pour out a serous fluid & blisters are the results. But this serous fluid is not secreted equally from every irritation, thus we find less of it from Mustard than from Cantharides, & hence we have the different names of Epispastics & Rubefacients. Some substances destroy the parts to which they are applied & are called Escharotics. Hence we have these three classes, Epispastics, Rubefacients & Escharotics. When an Epispastic is applied to the skin, it excites the subcutaneous vessels & causes them to throw out a serous fluid under the cuticle. This local irritation produces a general excitement which in the case of Cantharides is probably owing partially to the absorption of some portion of the Cantharides. 94 There are 2 Indications for the application of Blisters: 1. To rouse the dormant powers of the system. & 2. To break up the chain of morbid action. For the first, they are useful in typhoid diseases, but when these diseases have assumed a chronic form & have nearly exhausted the powers of the system, they cannot be applied with advantage because there is nothing to sustain the excitement & the system sinks lower than it was before. But in acute diseases, where there is sufficient dormant power to keep up the excitement, they often act very favourably. Hence we find that in typhoid diseases, judgment is requisite. to determine the time proper for their application. They are apt in very low cases to produce sloughing & even gangrene, & if applied, it should be to the inside of the thigh, rather than the leg. For the second indication, they are used in Intermittent & Remittent Fevers. They make a violent impression upon the system which breaks up a chain of morbid action & institutes that 95 which is more healthy.- They should be applied during the interval of Paroxysms, so that their action may take the place of the expected attack.- Blisters sometimes compose the nervous system in disease, as in Chronic forms of Fever, when the patient is very restless,- tossing about &c. he will often be composed to sleep by applying a pair of blisters to his legs.- 3. They act favourably also upon the Principle of Revulsion,- as in Chronic Opthalmia, Pleurisy, Hepatitis &c. - Nausea & Obstinate Vomiting. - A good rule for the locality of Blisters is, if it be an Inflammatory disease, apply them as near as possible to the part affected,- but if it be some nervous affection, apply them to a more distant part so as to draw off the nervous influence. Hence in Hemoptysis, after checking the Hemorrhage, blisters may be applied to the extremities to draw the blood down from the Chest. One caution however is very necessary, which is, never resort to blisters in cases of acute Inflammation 96 Inflammation without previous depletion,- because the general excitement which they produce will only aggravate, instead of cure the disease.- It is from this principle of drawing off the nervous excitement that they are beneficial in Spasmodic affections, as in Cholic & Cholera.- These are nervous affections, & when not connected with any Inflammation, sinapisms are better than Blisters. 4. They sometimes prove beneficial in Tinea Capitis & other complaints by introducing a new action. 5.- Blisters are depletory in their action. They should not be applied however in dropsical cases because they are apt to become ulcers or Gangrene.- 6. The pain from blisters is sometimes useful when the mind is diseased,- quieting the nervous excitement Case of a Lawyer who put a blister on his back, whenever he attempted to plead.- 7. Another use of blister is for the Endemic application of medicines to the denuded surface 97 Thirtieth Lecture Sept. 4 1834 Cantharis Vesicatoria.- Littus Vesica. Melöe Vesicat Spanish Fly. This insect is found in Spain, Italy, Sicily, France & the warmer latitudes of Asia, is of an oblong shape,- 3/4 in. in length & about 1/4 in width,- having a fetid odour when alive, compared to that of mice,- & is of a beautiful green colour. They are gathered by shaking or beating the trees on which they feed, and collected on linen clothes spread beneath. They are then killed by immersion in vinegar & water, then dried & carefully packed for market They are sometimes adulterated with an insect of a square shape If preserved in well-stopped bottles, they will keep a long while & retain their virtue a number of years. Sometimes they are attacked by worms and injured.- If kept in damp places, they soon putrefy.- .- They have a disagreeable odour & an acrid taste they yield their active principles to Water & Alcohol, & contain a chrystalline substance called Cantharidin 98 Cantharidin, which is insoluble in Water & Cold Alcohol, but soluble in boiling Alc. from which it precipitates when cool,- sol. in Ether & Vol. Oils.- In the insect, it exists combined with a yellow matter which renders it sol. in W. & Cold Alc.- It is said that if the flies be boiled,- they will not produce strangury when applied.- Dr M. B. Smith prevents strang. by giving teasp. of Uva Ursi during the operation of the Canth. The most extensive use of the Cantharides is in the form of Blistering Plaster, (See Dispensatory) Cerat. Canth. (U.S)- Emp. Canth (British)- It is well worthy of notice that a Plaster will keep for a long time & that its virtues are not exhausted by one application.- Ol. Canth. is not used.- There is a weaker preparation (Mug. Canth.-) used as a stimulating application to keep open blisters &c. We have also Emp. Picis cum Canth or Emp. Calefaciens.- or Warm[ing] Plaster.- consisting of 1 part of Cerat Canth to 7 prts. Burg. Pitch, which is an excellent application [consisting] used in chronic Catarrh. Rheumatism of Intercostal muscles &c. Limmentum Canth.- consists of Decoct. Canth & 99 Spt. Tereb.- There is also a Tinct. Canth. Cantharides whether applied internally or externally are apt to produce Strangury. When we have reason to apprehend this, give freely of demulcent drink, remove the Plaster & make some emollient application to the part,- as for inst.- a soft Bread and Milk Poultice, with a little Laud. spread over it.- In this manner, sometimes if the Plaster be removed in 6 or 8 hrs, & a Poultice applied, we shall frequently find a fine blister.- This caution is requisite in blistering over the eye lest the long continuance of the Plaster should create too great irritation.- But to return to Strangury,- as before stated,- remove the Plaster & give mucilaginous drinks,- & if these fail, give an anodyne injection of about 60 gtt. Laud. with 2 or 3 tablespoonfuls of Starch,- & repeat if necessary.- If these do not succeed, the last resort is to the Catheter. When a blister is left on too long, a sloughing may ensue, more common in children than in 100 adults,- as in low cases of typhus or scarlet fever With respect to the size of the Plaster, it should be generally as large as the place to which it is applied will admit. The largest size is 10 by 12.- It should be always cut to fit the part neatly.- When applied to the head, it is desirable that the head should be shaved 10 or 12 hrs previous if time will permit, so that the abrasions may heal up. The usual size for arms or legs,- 6 by 4.- After shaving the part, apply the blister & confine it by adhesive strips to prevent its slipping. On the Scalp, it should be left longer than on any other part,- generally from 18 to 24 hrs. On children, a blister is generally produced in from 4 to 8 hrs.- When the serous fluid has discharged so as to separate the cuticle, if it is desirable to heal it up immediately, do not destroy the cuticle, but make only small punctures to allow the fluid to escape. Sometimes the sac contains a gelatinous mass, which is the serous fluid coagulated.- 101 When the blistered surface becomes much inflamed & painful, apply warm milk & water,- soft Poultice,- Cream,- very weak Lime Water, or some such soothing application;- the best in Dr Wood's Practice is Goulard's Cerate, mixed at first with about an equal quantity of Simple Cerate. If it be desirable to keep the Blister running, destroy the Cuticle, & use some stimulating ointment. Cantharis Bittata. Potatoe Fly.- is another species, found in this country, & first introduced into practice as a vesicatory by It is found on Potatoe vines &c. in the morning & evening, feeding on the leaves. It has a reddish brown head;- & brown wing cases with a stripe of yellow upon the edge & along the centre. They are procured by shaking them in Hot Water, carefully drying &c. There are also other species Canth. Atrata Several vegetables possess the property of producing vesication when applied to the skin. None however are employed except Mezereum. for which See Book A p.209. Seldom used. 102 Ranunculus Bulbosus. Butter cup.- has a root possessing the properties of producing vesication, but it is uncertain & has different effects upon different individuals, consequently it is seldom or never used. Rubefacients should be preferred to blisters in cases of very violent & sudden prostration, when an immediate excitement is desired;- as in the sinking spells which occur in Typhus Fever, in the cold stages of malignant Intermittents, in prostration from Concussion of the Brain Syncope &c. But blisters, as before stated, are used to subvert morbid associations, compose the patient, for local inflammation &c. Rubefacients are very useful in spasmodic affections: At the head of the list of the individual Rubefacients, we place Mustard. see Book B. p.125. Thirty-First Lecture Sept. 8 1834 Capsicum, see Book B p.163. Ol. Terebinth. is a very good Rubefacient in low states of the system. It should be heated (with great care, lest it take fire) and applied either by friction or by flannels steeped in it.- If it gives too much pain, remove 103 it, for it sometimes produces unpleasant effects. From idiosyncrasy, it is very irritating & even poisonous to some persons, hence caution is requisites in using it. It is useful as a revulsent in deep-seated inflammation accompanied with prostration, as in Puerperal Fever,- tympanitic abdomen,- as a Liniment in Chronic Rheumatism &c.- see p.142 Pix Abietis. Burgundy Pitch. The prepared concrete juice of the Norway Spruce Fir. It exudes spontaneously on the bark of the tree, whence it is scraped, heated in Water & strained. It comes to us from Germany & Switzerland. It is brittle, opaque, brown externally, yellowish internally. Thus is hardened spontaneously exuded juice of P. Abies It differs from the Turpentines in containing less volatile oil. It softens by heat, & by contact It consists of Resin, Vol. Oil & water. becomes dark by exposure.- with the skin, it is just sufficiently softened to adhere. When thus applied excites a sufficient degree of irritation to increase the perspiration.- In one case of an old gouty patient, Dr Wood knew it to produce violent inflammation & even ulcers whenever it touched him.- It is useful in Rheumatic effection,- Chronic Catarrh,- Dyspnea,- and other Pectoral Complaints. 104 Pix Canadensis. Hemlock Pitch. derived from the Pinus Canad. or Hemlock Spruce of N. America. The juice exudes spontaneously from old trees upon the bark,- this is then stripped, boiled twice & strained. It is of a brown colour, more yellow internally. It consists of Resin & less vol. oil than Turpentine. It is used similarly to Burg. Pitch: by some preferred. Aqua Ammonia. is seldom used alone but generally in the form of Vol. Liniment, a. e. combined with Olive Oil; usually in the proportion of 1 part Aq. Ammo. to 4 parts Oil,- but this varies according to circumstances. It is useful in Catarrh, Rheumatism, Sore throat &c. of Infants especially.- Aq. Ammo. is very uncertain in its strength, & sometimes so weak that it will not unite with Oil to form a Liniment:- it should then be rejected.- A plaster can be made of common Lead Plaster Soap. & mur. ammo. which will last for about 24 hours, & answer the same purpose with the Liniment. A decomposition takes place & the Ammo. is slowly given off.- 105 Tartar Emetic. for the history of this see page 28. It is often applied externally as a Rubefacient. From one to three days generally elapses after it is applied, before any effect is produced: at length an itching & prickling sensation is felt, followed by small red pimples, which increase and become pustules, & afterwards even ulcerate if the application be continued. It acts upon the principle of Rubefacients & Epispastics.- There is however one advantage in its use:- we know that a recession of eruption oftentimes produces internal inflammation & disease, & hence when the eruption can be again brought out, the disease disappears, thus the Tart. Emetic by producing this pustular eruption, alleviates the complaint, having a much better effect than the discharge from Blisters. It operates too more deeply;- affecting not only the cuticle, but extending the pustule down to the cutis vera, & consequently, we may suppose, produces a greater effect upon the system at large. 106 With respect to locality, Dr. James thinks the arm a preferable place, but probably it is more efficient when applied to the back. In inflammatory affections, however, as a general rule, apply it as near as possible to the inflamed part. It is useful in obstinate chronic Pleuritis, Hepatitis, &c.- & an excellent application to the Spine, when there is Tenderness upon Pressure, Nervous Derangement, Hysteria &c.- First apply Cups to the part then apply the Ointment or Plaster. It must be remembered, however, that when applied to a cupped surface, instead of requiring 2 or 3 days, it become almost insupportable in from 1 to 3 hours. It may be used in the form of Lotion, Ointment or Plaster The Lotion is the least favourable mode & seldom used. Ointment is made by mixing ʒi (more if necessary ʒi or ʒij) Tartar Emetic with ℥i simple Cerate. Rub a little on every 4 or 6 hours, or spread it on linen & apply it. The most convenient form is that of the Plaster. This is simply a Plaster of Burg. Pitch, covered over with Tart. Emet. except at the cases so as to allow it to adhere 107 It is generally left on 3 or 4 days, then removed.- if it will not come off readily, apply a little Olive Oil. Almost all the volatile Oils are Rubefacients, but seldom used. One sometimes employed is Ol. Monardo Punctate. or Horsemint Oil. Croton Oil has been recently recommended, mixed with 4 prts. Olive Oil. Escharotics are those substances which destroy the life of the parts to which they are applied & produce a sloughing. They operate in 3 ways, either by their direct influence, or by chemical decomposition.- When they operate in the first manner, the life of the part is lost, because the part is unable to bear the application. In the second, the life is destroyed because of the chemical disorganization of the parts. They are employed for forming Issues, opening abscesses. & subverting diseased action by destroying the part diseased and substituting an action of its own. Of the individual Escharotics, none are more severe than the Heated Iron, or Actual Cautery. This is used for arresting Hemorrhage &c. but seldom in this country, unless in Hemorrhage from the Fauces where no ligatures &c. can be passed. 108 Another mode of applying it is by Moxa. This, too, is seldom used in this country. It is made of Pith. of Sunflower which contains Nitre or other similar plants, or of Rolls of Linen, Cotton &c. imbued with Nitre, so as to continue the combustion. or with Bichromate of Pot. Potassa is next in power as a caustic. It is obtained from Scalsed Lime & Carb. Pot. found in cylindrical pieces kept in paper & in It is deliquescent well-stopped bottles. Caust. [Coru????re] [Acen??um] (old) It is applied as follows. A piece of adhesive plaster with a hole about the size of the place required, is laid upon the part, then take the caustic, wet it & rub it on until the part is black. remove the plaster, & wipe it off with a piece of sponge, then apply a poultice, & in 8 or 9 days, an ulcer will form into which Issue Peas may be introduced to keep open the Issue. Sometimes the Pot. is mixed with Lime, water & soap, & formed into a Plaster, but this is not so good. Issues are adapted to Chronic diseases &c. Caustic is sometimes used for opening abscesses, for removing flesh from poisonous wounds &c. & dissolved in water, it has been recommended for Tetanus by Dr Hartshorne 109 Thirty-Second Lecture Sept. 11 1834 Nitrate of Silver or Lunar Caustic (Argent. Nit) is formed by dissolving Silver in Nitric Acid, drying & moulding it &c. It is white & semitransparent, but when exposed to the air & light, it becomes dark by decomposition & oxidation. It affects only the surface to which it is applied forming an eschar which prevents it from acting deeply & does not penetrate like the Potassa, hence it is employed only for destroying sores &c. as old ulcers. chancres &c. In solution, it may be used as a stimulant to ulcerated surfaces, as in ulcerated Cornea, sore opthalmia, soreness & running from the Ear, &c. for which it is almost a sovereign remedy, if properly applied. A work has lately been published recommending it in arresting cutaneous inflammation. It is generally applied by rubbing it over the surface. The proper proportion for an Eye-Walle is 1/2 gr. to grs ij to ƒ℥i Distilled or River Water. But when the Cornea is ulcerated, its strength may be increased, or a better plan is to apply it with a camel's hair- 110 pencil.- For the Ear, begin with a solution of about grs ij to ƒ℥i & increase it if necessary, to 3 or 4 grs to ƒ℥i Distilled water. If it should be applied by injection, always use a Silver Syringe, as others will decompose it. Arsenious Acid or White Oxide of Arsenic, obt. by sublimation from the Ore is sometimes used for Cancerous Affections, & is the basis of most of the empyrical remedies for that disease. There is danger, however, of the poison being absorbed, & hence it is seldom prescribed by a regular physician.- more danger in a dilute than caustic state. Sulphate of Copper (Cup. Sulph.) is sometimes employed as an Escharotic. generally in Solution: A solution of grs XX to ƒ℥i Water is an excellent application to Chancres &c. gtt i per day will often completely destroy them. A solution of it is also used for ulceration which is often seen in the mouths of Children, accompanied with fetid breath Gangrene Swollen cheeks &c. it proves a very effectual & certain remedy Verdigris, is sometimes used at Escharotic. 111 Corrosive Sublimate or Bichloride of Mercury is seldom used as an Escharotic, but as a stimulant in syphilitic affections &c.- A [solution] mixture of it, however, is very efficient in arresting a disease of the Fingers & Toes called Onychia Maligna, once considered incurable- Take equal parts of Corrosive Sublimate & Sulph. Tinc.- mix them together, & sprinkle them over the surface of the diseased parts. then apply a Pledget of Lint & over that Tinct. Myrrh or Laud.- For about 1/2 an hour, the pain is very severe, when the part becomes destroyed, & soon heals again kindly. For Syphil. ulcers in the Throat, apply a sol. of grs V to X to ƒ℥i- Cutan. eruptions grs ij to ƒ℥i Alumen Exsiccatum. Burnt Alum. is applied in the state of powder to the fungous flesh &c. which sometimes appears upon ulcers. It acts as a gentle escharotic. It has been recommended in Sore Throat, to be applied by the fingers, or in solution- grs XV to ƒ℥i. The mineral Acids may all be considered as Escharotics, especially the Sulphuric & Nitric Dilute Sullph. Acid is sometimes used for cutaneous diseases in ointment Dil. Nit. has been used for ulcers. It was also used equal parts of Nitric Acid & Water. for speedy blistering in Cholera, but is not much at present. 112 Demulcents act by a mechanical power. They are generally mild, unirritating substances, soluble in water, & usually consist of gummy, saccharine, farinaceous & Oleaginous Principles. They are used for 2 purposes. 1. To defend the surfaces with which they come in contact from irritating substances, as in Catarrh &c. 2. They mingle with the acrid matter secreted, & obtund its acrimony, hence they prove useful in Dysentery, Diarrhea & other irritations of the bowels also in Nephritis, Strangury, Gonorrhea, &c. We next notice the individual Demulcents C.51 C.53 A.215 Gum Arabic, Tragacanth, Ulmus Fulva, Flax Seed B.135 B.25 Pith of Sassafras, Quince Seeds and A.115 Liquorice Root. for which see Books A, B & C. Thirty-Third Lecture Sept. 15 1834 B.189 C.55 C.53 C.55 B.133 On Lichen Isl.- Sage,- Tapioca.- Maranta & Barley, for which see Books B & C. We next come to the General Remedies, & the first Class comprises the Astringents. These are medicines capable of contracting or corrugating the 113 living fibre, as is obvious to the senses for inst. the mouth becomes puckered by chewing an astringent. It does not act merely by a mechanical power, but every living fibre possesses a property of contractility, & the Astringent affords the stimulus necessary to produce the effect. The influence of different medicines upon the stomach is soon communicated to the whole system, & it is by this general sympathy, that we account for the operation & general effects upon the system at large, of astringents taken into the Stomach. The Indications for the Use of Astringents then are evident from their method of operation. It is plain that they would be injurious when the discharge depends upon some foreign cause, unless that cause first be removed. As they are somewhat excitant in their nature, they would be injurious in an irritated or inflamed state of the system. They would prove beneficial, then, when the morbid discharge depends upon a weakness of the vessels 114 vessels after the exciting cause has been removed. when there is no inflammation in the part: or when a suppression of the morbid discharge even without arresting the disease, would be of less serious consequence to the patient, than to allow its continuance as for inst. suppression of Diarrhea in Consumption. They are used chiefly for the purpose of restraining Diarrheas, & arresting Hemorrhages; but they are not proper to be given in fever, with excited arterial action. They are generally used as External or Local Applications. When given with a view[ing] of arresting Hemorrhage, depletion may first be used with advantage, as in blood from the Nose, from ruptured vessel, from wounds &c. tho' frequently it is not necessary.- There are 2 Classes of Astringents, the Vegetable & Mineral. The Veg. Ast. owe their property to Tannin. The Mineral; to a peculiar specific Influence. We next come to treat of the Individual Astringents. First. Oak Bark. derived from different species of Quercus, & Galls. for these, however, see Book B p.15 & p.17 115 Thirty-Fourth Lecture Sept. 18 1834 C.57 C.59 A.125 A.193 On [Catechu?], Kino, Rhatany, Logwood, Geranium A.131 A.129 Maculatum, Rubus villosus & trivialis, for which see Books A and C. Thirty-Fifth Lecture Sept. 22.- B.49 B.95 A.135 Uva Ursi.- Black Alder Bark, Roses, Tormentil, A.127 A.183 Bistort, Alkanet, for these see Book B & A.- The unripe fruit & the bark of the Persimmon, Dispyros Virginiana, have been used as Astringents Tarmin, itself, in a pure state, has recently been used as an Astringent. It is of a brown colour, brittle unchrystallisable, sol. in water & dil. Alc. but not in pure Alcohol. Dose 5 to 15 grs. Mineral Astringents. Alum:- is a double salt, consisting of the Sulph. Alumina & Sulp. Pot. with about 50 pr.ct. Water of Chrystallization. Sulph. Ammo. or Sulfs. Soll. might be Substetuted for Sulfs. Pot. in forming the Chrystals. It has an astringent taste accompanied with sweetness is soluble in about 16 times its wt. of water at 60° & 3/4 its wt. boiling water.- When exposed to heat 116 it melts, loses its W. of Chrystallization & falls into powder. Its incompatibles are the Alkalies & their Carbonates, Lime, Magnesia & Carb. Acid of Lead, & the Mercurial Salts.- also veg. infus. as Galls, Kino. Bark &c. It is employed with advantage in obstinate chronic Diarrhea, in the relaxed state of the bowels which follows Dysentery, in Passive Uterine Hemorrhage, when not connected with an excited state of arterial action. Also in Cholica Pict. united with some Aromatic as Nutmeg & it has been prescribed for curing intermittents. Internally, its powers are feeble, & hence we cannot rely upon it in Diabetes, Leucorrhea &c. When that given, it is apt to offend the stomach, combine it with Recently its powder has been recommended to be applied with the finger upon the inflamed fauces, in Scarlatina Cynauche [???silllaris] &c. also in strong solution of 15 or 20 grs to ƒ℥i, as an injection for Epistaxis, Bleeding from Rectum &c. Nutmeg or some other aromatic. Alum Whey is made by boiling ʒi Alum in Oj milk. Dose ƒ℥i or ƒ℥ij. A gargle for relaxed Uvula &c. may be made of grs V or X to ƒ℥i water. An injection of this solution into the nostrils will arrest Epistaxis. It may be used in Gonor. Fluor Albus &c. Alum Curd. made by agitating white of Egg with Alum good application for Inflamed Eye, Ecchymosis &c. 117 The Preparations of Lead, although they are Astringent, yet they have a peculiar & specific action. The symptoms which they produce upon the human system are numerous. but the most prominent are such as appear in Cholica Pictorium, where, besides the Pain in the Abdomen, Costiveness &c. we have pain in the external muscles, partial palsy, & sometimes an affection of some of the organs of sense. These preparations produce immediate nervous derangement, as well as act as Astringents. Litharge: Ox. Plumb. Semivit. is a Protoxide It is made by exposing Lead to heat in a reverberatory furnace, is in small scales of an orange yellow colour & is used chiefly for forming the Lead Plaster. Emp. Plumbi. This is done by boiling it with Olive Oil & a little water. The water unites with the Oil, so as to form Oleic & Magaric Acid, & these uniting with the Ox. of Lead form the Oleate & Magarate of Lead, of which the Plaster is probably composed. It is used principally for forming other officinal plasters, sometimes It is an excellent application to prevent ulceration from pressure in low fevers, long continued. for application to excoriated surfaces but seldom. 118 Carbonate of Lead or White Lead is formed by exposing lead in thin plates to the action of the vapours of vinegar. It is a powerful astringent, & often produces Cholica Pictorium. It is never given internally, but sometimes is applied to excoriated surfaces in the form of an ointment made of ℥i to ℥vj Simple Oinment. A plaster has also been directed by Pharm. at a substitute for May S Plaster, the principal ingredients are Lead Plaster & Carb. Lead. But the most important of the Prep. of Lead is the Acetate. Plumb. Acet.- Sacch. Saturni;- made by boiling Vinegar & Carb. Lead.- It is a neutral Acetate, consisting of 1 Eq. Acid,- 1 of the Base & 3 of Water It has a sweet, astringent taste, when dissolved in W. generally gives out the odour of Vinegar, on acct. of Sabacet.- but when pure is inodorous, efforescent, sol. in W. & Alcohol. Incompatibles are the Alkalies & Alkaline Earths, & their Carb. substances which with these Alk. form Soaps, Tart. ant. & Tart. Iron. sulphurates. Sol. Sulphates & Muriates, the Acids &c. so that the best plan when it is given is to allow the patient to 119 take nothing but Water or a solution of Gum &c. Different opinions prevail among practitioners respecting its efficacy, some considering it as a poison too dangerous to be given, & others prescribing it in a great variety of diseases. The terrors, however, which some have conceived respecting it, are unfounded, altho' in large doses or in small ones long continued, it certainly is dangerous. When given in small & continued doses, it acts upon the nervous system, more gradually, producing its peculiar effects, & will bring on Cholica Pic. sooner than if administered in larger doses. But by avoiding excessive or long-continued doses, by combining with opium, when not contra-indicated, by attending to the costiveness &c. it is safe. & frequently a very beneficial remedy. To cases of Internal Hemorrhage from the Lungs or Uterus, it is well adapted, but even though it may be given in an excited state of the system yet it must not exclude depletory remedies.- 120 In Uterine Hemorrhage, unconnected with Pregnancy, it acts favourably, combined with Op. or Ipecac It cannot be relied on, however, in Intermittents, Hooping Cough, Epilepsy &c. Dr Irvin of Charleston published a paper in 1820 recommending it strongly in Yellow Fever, & Dr W. has tried it once & was well pleased with it. The time for its administration in this disease is when Gastritis is at its highest point, when the patient begins to turn even a little yellow. Dr W. believes that it acts by coming in contact with the inflamed surface of the stomach, upon the same principle that it acts upon inflamed parts externally. It may also be beneficial in the same way in Dysentery It is useful in arresting the profuse Diarrhea in Cholera. Dr W. gives 2 grs Cal. & 1/2 gr Opii every hour. & in the intervals gives 2 grs. Acet. Lead. Parrish uses it in combination with Kino to arrest internal Hemorrhage. From its influence over the Nervous System, it might probably prove beneficial in Hydrophobia. 121 The dose of it varies according to different authors From 1 to 2 grs, & may be repeated every 2 or 3 hrs. After 10 or 12 grs. have been taken, suspend it, so that it may produce no injurious effects. It may be given in Pill [of] with Crumbs of Bread. Lead Water is made by dissolving ʒij in Oj distilled Water. This is a useful application to inflamed surfaces, by [illegible] wet with it, but must not be applied to excoriated surfaces. A Poultice may be made of it, by mixing it with bread, & enclosing it between linen. This is a good application to inflamed Eyes &c. A solution of 1 or 2 grs. Acet. Lead to ƒʒi W. is a good wash, for Optthalmia, Gonorrhea, Fluor Alb. &c. Goulard's Extract of Lead is made by boiling Letharge in Dist. Vinegar, & filtering the resulting liquor, or by boiling Letharge in a solution probably a comp. of Dis. & Trisacet. of Lead of the Acet. of Lead. It is said to be a Trisacetate. Sometimes it is of a greenish straw colour, owing to the impurity of the Vinegar, but usually is colourless alkaline in its properties, & decomposed by 122 those substances which are incompatible with the Carb. Lead already noticed & with Gum Arabic & Mucilages. Even distilled water produces a milky appearance with it, on account of the Carb. Acid which it contains. This is best test for Mucilages or Gum. It is used only as a Lotion in Eruptions & Local Inflam. Lead Water should contain about ƒʒij Goulard's Ext. to Oj Water. Goulard's Cerate is made by mixing [cross out] [simple cerate &c.] Goul. ext. with Oil & Bees wax. is a useful application to abraded surfaces, & especially beneficial to blisters in disposed to heal. Also Herpetic eruptions Sulphate and Acetate of Zinc are used as Ext. Ast. Also the Mineral Acids, which, are rather tonics. Lime-Water & Carb. Lime are sometimes useful in the Diarrhea, Cholera Infant, & the later stages of Dysentery. We next come to the subject of Tonics; upon which we will make some general observations. By this term, we designate those substances which have the power of producing & maintaining a gentle 123 exaltation of the actions of life in sudden & great prostration without necessarily causing any apparent increase of these natural actions. Unless taken in large doses, the action of tonics is not manifested by any immediate & obvious excitement.- The vigour which they impart to the system is the result of a slow operation on the animal Economy, & altogether different in its character from that temporary augmentation of force which is the immediate consequence of the operation of stimulants properly so called. When Tonics are employed in a debilitated state of the system, their operation is evinced by a gradual & permanent increase of the force of the circulation, and an invigoration of the digestive powers & of the general energies of the System. There is no term which expresses their operation so well as Corroborants, for their most prominent effect is to produce strength,- but as strength does not depend upon tension of the muscular fibre as was formerly supposed, the old name Tonic is not a suitable one.- 124 When the system is in a healthy state, Tonics are not needed to exact its powers to proper action, hence they become injurious. By long continuance, they establish irritation & chronic Inflammation & diminish the susceptibility of the organs to their impressions. But, as sometimes happens, when the disease is kept up by debility, they are useful. Tonics are not applicable to all states of the system. They are improper, when there is an increase of action beyond the natural standard in health. They act injuriously in two ways, if given for a long time and steadily. 1. They produce a certain degree of excitement which at length degenerates into Inflammation. 2. They cause a momentary elevation of the powers of the stomach by their action upon the nervous energies, & this is succeeded by a subsequent diminution of its power, so that it cannot perform its duties. Thus with the celebrated tonic, Portland Powder, it has been remarked by Cullen that the use of it was always sooner or later followed by Dropsy. 125 Tonics, therefore, should be given only when the natural powers of the system are depressed, & should not be continued too long, or given during local Inflammation. They act as corroborants in two ways: 1. When the stomach is debilitated, the food introduced into it is not digested, & the body is weakened from the loss of its natural support:- then tonics restore the digestive energies & enable the stomach to pass the food properly into the circulation. 2. Tonics may also impart tone to the system by exciting a peculiar action in the part to which they are immediately applied, & thence propagating a similar action to other parts of the body thro' the medium of the nerves.- or they may strengthen by being absorbed into the circulation, & thus acting directly on the whole organization thro' the medium of the blood. Tonics are by no means equal in the degree of their sensible power, some producing but little change while others approach to stimulants. This class of remedies may be divided into three 126 subdivisions 1. The simple Bitters. Bitterness is a property possessed by all the vegetable tonics. Cullen supposed it to be the tonic power. It does not reside exclusively in any one proximate principle. thus Quassia, Genteanin &c. are tonic, while Morphia &c. is narcotic. 2nd. Set unite an aromatic or other property with the bitterness as most prominent, as in Serpent.- August. Bark, Cascarilla. The aroma is owing to an essential oil.- These are more stimulant than the first set.- 3rd. Set are purely Aromatic, & depend for their efficiency upon an essential oil, but in some instances the property of a stimulant is united to some other property which renders them Tonic. They accelerate the action of the heart & arteries, [cross out] & produce an increase of heat, but do not act on the cerebral nerves. They are employed in combination with other tonics to cover their taste, & render them more acceptable to the stomach. Some of them might form a distinct class. Some are astringent:- 127 36th Lecture. We shall next notice the Individual Tonics, [cross out] and shall arrange them according to their stimulant powers, first treating of the simple Bitters & afterwards of the Aromatics.- a.135 A.141 A.143 Columbo, Frasera Waltri or Auc. Columbo, Gentean. A.195 & Qussia, for which See Book A. Thirty-Seventh Lecture Oct. 2 1834 B.13 B.97 B.193 [Su??aruba], Chamonmile, America Centamy A.149 B.189 A.217 Serpentarea, Eupat. Perforliatum & part of Cinchiona, for which see Books A & B [&C]. also upon Artemisia or Wormwood, Trefoil, Blessed Thistle, Horehound, & Tansy,- which are all bitter tonics & applicable to similar cases. They are used only in the absence of the others, or to suit the prejudice of the patient, so that his faith may cooperate with the remedy. Thirty Eighth Lecture Oct. 6 1834 A.217 On Cinchona & its constituents. see Book A. Thirty-Ninth Lecture Oct. 9 1834 B.1 b.11 b.3 On Augustina Bark, Cascarilea, Dogwood, Prunus B.7 c.43 Virginiana, Myrrh. for which see Books B & C. 128 also upon Aromatics, which is a term applied to those products possessing a fragrant odour, & a peculiar spicy flavour, not mixed with any other properties. Their efficacy depends upon a vol. oil. & as all oils affect chiefly the circulation, they might be called stimulants, but the[y] influence which they exert is rather more of a Tonic nature, & besides, their stimulant effects are rather local than general, because of the difficulty, with which the oils are taken up by the absorbents. Aromatics exert a peculiar cordial influence upon the stomach, obviating sickness, expelling flatus, relieving spasmodic pain, & also [cross out] obscuring in some degree the taste of nauseating medicines. They are generally joined with other remedies, with purgatives, to prevent their griping, with tonics, & stimulate to increase their power, they render medicines more acceptable to the stomach. They should never be exposed to a continued heat & hence should not be prescribed in Decoction.- 129 The Oils are concentrated forms of the Aromatics, & Distilled & are variously termed Vol.- Ess.- & Arom. Oils.- Their taste & colour are various. sp. gr. generally lighter than that of Water, sometimes heavier, & some few, equal. They are Volatile, inflammable, & when exposed to the air, deteriorate, & become changed into something of a Resinous nature. They are sparingly soluble in Water, but all of them can be made to unite with it, by means of Sugar or Gum Arab. or by rubbing them first with Carb. Magnes. then adding Water & filtering. They are often adulterated, & this can only be detected by the odour solubility,- sp. gr.- or volatility & stain on paper They are employed as the Aromatics themselves. Frequently they are used dissolved in Alcohol. then, improperly called Essences. b.165 On Individual Aromatics- as Orange Peel. b.169 b.19 Lemon Peel,- & Cinnamon, for which see Book B. Fortieth Lecture Oct. 13 1834 b.29 b.101 b.153 b.159 On Canella, Cloves, Nutmeg, Piper Nigrum, P. b.161 b.161 b.157 b.147 b.151 Lougum, Cubebs, Allspice, Cardamom, Caraway 130 b.153 b.147 b.145 Caraway Coriander, Anise Seed, Fennel Seed, b.105 b.103 Lavender, Rosemary, Sage, is an aromatic & ast. and hence an infusion of it is used as a Gargle for Sore Throat:- sometimes warm is given in Amenorrhea. b.197 b.199 b.199 Peppermint, Spearmint or Mint. European Pennyroyal, b.201 b.205 b.51 American Penny Royal, Balm, Gaultheria, a.163 a.171 Ginger, and Calamus, for which See Books A & B. Forty-First Lecture Oct. 16 1834 On Mineral Tonics, the most important of which are the preparations of Iron. & these are most extensively employed among practitioners. There is a strong resemblance between all of them in their action upon the system, they increase the force of circulation, invigorate long continued doses are said to diminish the spleen, to excite Portal Circle the powers of the stomach, & produce a permanent A long use of them in health produces Inflam. Diathesis, hence Chalybeats water injurious to healthy persons; corrobative effect upon the system. When, however, Iron & Prep. have a local tendency to Uterus. active Inflammation exists, when the Stomach is in an irritable condition, or when the liver is unhealthy secreting unhealthy bile, they are improper & injurious.- They prove advantageous in Dyspepsia, in nervous & hectic diseases, and that long train of complaints arising Cheltenham Salts are an excellent remedy for Chronic Hepatitis, teaspoonful daily before breakfast not too long continued, as Iron may produce excitementing. 131 excitementing from debility of the alimentary canal, or from general debility of the system, as Chlorosis, Amenorrhea, Anemia with swelled waxy countenance &c. Hysteria, Epilepsy, Scrofula, Phthisis &c. They are the best remedy for Amenorrhea, connected with general Debility. With regard to their modus operandi, there is much dispute, whether they act by first depressing the powers of the stomach, & then carrying this action by sympathy through the nervous system, or whether they enter the circulation & are thus distributed Iron has doubtless been detected in the blood, & it may act in that way, but the probability is that it acts by both the above mentioned methods. The redness of the blood does not depend upon the Iron continued in it, as some have supposed, but upon the invigorated action of the Lungs. Iron in its pure metallic state, has been said to be medicinal, but its effect, when thus given, is Black stools always follow. probably owing to some change which it undergoes forming salts. in the Stomach from the acid &c. which it meets.- The simplest form in which it is given is that of Filings Ferri Ramenta. Dose 10 to 30 grs. but seldom given internally produce eructations of Sulph. Hyd. &c. Dysp. Chlor. [illegible] 132 Squama Ferri are made by heating Iron & pounding it. They are a combination of Iron & oxygen, dark, brittle, pulverizable, insol. in water, readily soluble in acids. Not much employed in medicine. There are 2 Carbonates of Iron used in medicine 1. F. Carb. Prapar. or Rubigo Ferri, made by exposing Iron wire to air & Moisture, & is a Mixture of the Proto-Carbonate & Red or Peroxide of Iron. 2. F Carb. Precip. made by adding a sol. of Carb. Sod. the Precipitate is at first Proto Carb. of green colour. but on exposure, it attracts Ox. & becomes a solution of the ProtoCarb. & Perox. of a reddish colour. to a sol. of Prosulph. Iron. It is a fine, red chocolate of the Protreast .& Porox .- of a reddish colour. powder, less apt to offend the stomach than the former, because more minutely divided. Both these Carb. are insol. in water, but soluble with effervescence in Acids, & partially sol. in water impregnated with an excess of Carb. acid, hence these are generally present in the Chalybeate Springs - They are used in all cases where the prep. of Iron are indicated, and lately have proved highly serviceable in Tic Doullureux, Neuralgia &c. given in doses of ʒss to ʒi, 3 times a day gradually increases, the usual dose is from 5 to 20grs as a Tonic. 133 Dr Ruth was very partial to a prescription containing equal parts of Rubigo Ferri Pulv. Colomb. " Tingib The effect which the Carb. Iron has in Tic Douler may most reasonably be ascribed to its action upon the whole nervous system. For this, dose ʒss to ʒiss F. Suphas. Sal Martis. is made by acting for medical purposes, Iron Wire should be used, as this purer. on Iron Filings with dil. Sulph. Acid.- It has a strong styptic taste, is in greenish Chrystals, sol. in water, insol. in acids, when exposed to heat loses its W. of Chrystallization & becomes a dirty white powder, called F. Sulph. Exsiccat. Exposed to the air it becomes a Persubsulphate. at first, its efflorescence is white, the sulphate, afterwards attract Ox. becomes Perox. brown colour.- Incompatibles are all sol. Salts which form insol. compounds with its acid, earths, Alk & Carb. Pot. Nit. Acet. of Ammo. & all vegetable astringents. It is a good Chalybeate, & has an advantage by being soluble, & it may be given in Smaller doses. Use the Dried always for Pills. Dose is from 1 to 5 grs. less of the dried generally given in combination with Purgatives &c. 134 Tinct. Ferri Muriata,- consists of a Muriate of Iron dissolved in Alcohol. It is made by dissolving Carb. of Iron in dil Mur. Acid & adding 3 times as much Alcohol. It is of a brownish yellow colour, has an ethereal odour from the action of Alc. upon excess of Acid- and is decomposed by Alk. & Carb. & by astringents. It is the most active of the Chalybeates, given in Dysuria, depending upon Spasmodic stricture of the Urethra, for Venereal Warts &c. Dose 10 to 30 gtt. in a wineglassful of Water, 2 or 3 times per day. It is given also in Dyspepsia, Amenorrhea &c. Ferrum Ammoniatum is made by subliming Mur. Ammo. & Perox. Iron. It is of an orange, yellow colour, seldom used. Dose 3 to 15 grs. Ferri Phosphas, by adding sol. of Phosp. Sod. to sol. of Proto Sulp. Iron At first it is a Proto Phosph. afterwards Perphos. & we usually find it a mixture of both. It is of a light blue colour. By Carmichael it has Insol. in water 1-2 grs. been recommended for Cancer. Dose 5 to 10 grs Ter die. Tartrate of Iron & Pot. made by boiling Carb. Iron, Bitart. Pot. and Dist. Water. It is inodorous, has a At first Proto, afterwards becomes Pertartrate styptic taste, of a greenish brown colour, sol. in W. It is a mild Chalybeate, supposed to be diuretic, hence given in a tonic dropsy. Dose from 5 to 20 grs. This 135 is an ingredient in Vinum Ferri, because Bitart Pot. is contained in Wine, & this by its action on Iron Filings forms this salt. Hence Vin. Ferri possesses no advantages & It is a much more variable preparation- over a sol. of Tart. of Iron & Pot. Iodide of Iron;- a preparation upon which little Insolution in water,- Morton considers it unequal in cutaneous affections &c. with Syr. Sarsap. or no confidence can be placed. F. Ferregent insol & almost tasteless Copper.- in its metallic state, seems to have little affect upon the system, but its salts sometimes produce unpleasant consequences, & are even poisonous from the irritation excited in the mucous surfaces. Hence care is requisite in preparing food in copper vessels of any kind. & in drinking Min. Water from Copper Reservoirs Cupri Sulphas is a Bipersulphate. It is in chrystals has a harsh, styptic taste, is sol. in Water, insol. in Alc.- is decomposed by Alk. & Carbonate,- Cor. Sublimate. Nit. Silver. Permur. Mercury, & all astringents. When given in small doses, it excites the stomach. In large doses, it produces very violent vomiting & the patient has a coppery taste in the mouth.- The stomach must be washed out freely, & Albumen administered to an increased action, but the danger attending it has circumscribed its use. In that form of Intermittents called Quartan it is sometimes given as follows Cupri Sulph. gr.i mft. Pill No iv Quinia Sulph grs viij opii gr. i S. one 4 times a day 136 It is used advantageously also in Chronic Diarrhea depending upon Ulceration of the Intestine, Epilepsy &c. In Germany it has been recommended for membranous Croup. Cup. Ammoniatum.- is made by rubbing up Bisulph. Copper with Carb. Ammon. It is of a Sapphire blue colour, with a hot styptic taste, & changes to green by exposure to the air. It has been much recommended for Epilepsy, but its use is disputed. It is given also in Hysteria, Chorea &c. but never without previous depletion. Dose grss. 2 a day and gradually increase if necessary.- In form of Pill.- Zinc itself, exert no sensible effect upon the system, but there are two preparations of it used in Medicine as Tonics. They are employed in Hysteria, Epilepsy, Chorea & various other diseases. Sulphate of Zinc.- is made by adding dil. Sulph acid to Zinc.- It crystallizes in 4 sided prisms, effloresces slightly, is very sol. in Water, cold or hot, with a metallic, styptic taste, & is decomposed by Alk.- Earths.- & veg. astringents.- Is not much used as a Tonic.- It has been given in Diarrhea,- Chorea &c. Hooping Cough,- Colica Pict.- but more as an Emetic A solution of 1 1/2 or 2 grs to ƒ℥i water forms an 137 excellent injection in Gonorrhea,- & weaker for Chronic Opthalmia.- Dr W. has never failed to cure the Ulceration of the Mouth occurring in Children by touching them with a solution of from 5 to 10 grs to ƒ℥i 15 grs to ƒ℥i Water.- Also useful for cutaneous eruptions The dose internally is 1 or 2 grains. Then taken in poisonous dose, it produces great constriction & vomiting &c.- there are relieved as soon as it is evacuated. Oxide of Zinc.- may be made by burning Zinc. It is white,- inodorous,- tasteless,- insol. in W. & Alc.- unalterable in the air.- Dose 5 grs.- gradually incred. Tutty.- is an impure oxide of Zinc,- made by mixing the Ox. with Clay & Water.- It is inodorous,- tastless- brown externally, but the inside of a mass yellow used for excoriations &c. by sprinkling.- or in form of Ointment.- Calamine is an impure Carb. Zinc. has an earthy fracture.- When roasted & elutriated, it is sprinkled on excoriated surfaces,- or made into an ointment, & then applied. Tumers Cerate. Bismuth- is used in medicine,- by just making a solution in Nit. Acid,- then add Water.- A precipitate is formed which was formerly called an Oxide, it is now called Subnitrate of Bismuth. It 138 is white,- insoluble,- inodorous, & unalterable in the air. It has been highly recommended in Dyspepsia with violent pain unaccompanied with [cross out] Inflammation.- It imparts a black colour to the stools, like Iron. Dose 5 to 10 grs,- 3 or 4 times per day. Nitrate of Silver.- has a strong,- metallic, bitter taste.- It is sometimes used internally,- & has been highly recommended in Epilepsy,- but disputed. It is given also in Chorea,- Angina Pectoris,- & sometimes in Leucorrhea,- but perhaps with no benefit.- Incompatibles- Alk. & thin Earths, Soaps, Sulph, Min, & Tart. Acid & thin Salts, Arsenite Pot. Sulphurets & Tarmin An objection to its use is that when long continued it communicates a dark colour to the skin.- The rationale is that Nit. Silver is decomposed by light, hence when it enters the circulation, it is carried into the cutaneous vessels & there decomposed. Probably, however, it is inert,- because there is sufficient salt taken into every stomach to decompose it, & produce an insol. Chloride of Silver.- The dose usually given is 1/8 gr. 3 or 4 times a day,- made into pill first dissolve it in water. with bread containing no salt,- or with Pulverized Liquorice Root,- which is preferable to the former.- Preparations of Gold are not used in medicine at present.- 139 The Mineral Acids sometimes employed are the Sulphuric,- Nitric & Muriatic. Sulph. Acid, is tonic & astringent,- hence it is given in Debility accompanied with morbid discharges, as in Hemorrhage from the Lungs and Uterus.- It is also a good remedy for Hectic in Consumption. Night Sweats &c. & in loss of appetite, connected with an asthenic state of the Stomach.- It is often given in combination with Tonic Veg. Infusion. It is used diluted, as a Gargle in Sore Throat,- or locally, for cutaneous eruptions,- Psora,- White Blister in the Mouth &c.- When prescribed, it should be Ac. Sulph. Dil.- which is only 1 part to 7 parts Water Dose is 10 to 20 gtt. in a wineglass of water,- taken thro' a quill.- In hemorrhage ʒss. to ʒi may be given. Elixir Vitriol is generally used internally. Nitric Acid,- of which there are 2 kinds,- the coloured & colourless.- This is given in simple gastric debility,- in convalescence &c.- It is said to have a specific influence like Mercury.- Dose of the strong acid is 2 or 3 gtt. in 1/2 tumbler of water,- but varies in strength. 140 Muriatic Acid is seldom employed in medicine. Sometimes it is given in Malignant Scarlatina, & in Typhus Fever.- Also for Worms.- Dose 5 to 20 gtt in 1/2 a tumbler of Water.- A Gargle is ƒʒi to ƒ℥vj Water. Forty-Second Lecture Oct. 20 1834 Nitro-muriatic Acid,- is a mixture of Nitric & Muriatic Acids,- producing a third compound which owes its efficacy to Chlorine.- The acids should be highly concentrated,- otherwise they do not act upon each other,- but merely form a mixture. If they are not sufficiently strong for the purpose,- add a little Sulphuric Acid. Besides being a tonic, this is also specific, bearing a close resemblance to Mercury in its action,- producing sometimes Ptyalism & even soreness of the Gums, & its direction to the Hepatic system is shown by the increased secretion of Bile. It was first introduced into practice by Dr Scott. It is useful in Chronic Inflammation or Disorder of the Liver,- Scrofulous affections,- Cutaneous Eruptions Secondary Syphilis &c. It may be given internally 141 or externally,- similarly & in like doses with Nit. Acid A bath is a desirable form of using it, if there be much gastric irritation.- This may be either general or local.- It should be strong enough to produce a tingling sensation upon the skin.- generally the proper proportion is about ƒ℥i to Coug. i Water. Stimulants. Simple stimulants are those medicines which increase the action of the heart and arteries without exciting the brain & nervous system.- They are used in cases of debility, unaccompanied with organic disease, as in the common consequences & termination of Idiopathic Fevers of a Typhoid nature,- also in Cholera,- profuse Diarrhea &c. But they are not used exclusively in cases of simple debility.- often prostration attends local Inflammation,- organic lesions &c.- when stimulants become requisite to support the system,- as in Typhus Pneumonia,- Typhus Dysentery,- low forms of Small Pox,- & other diseases,- where, tho' the Inflammation &c. would seem to contra-indicate them, yet they are necessary 142 necessary evils,- & must be used with great caution. In that debilitated state of system, which we often find during the ulcerative or suppurating process, stimulants often prove beneficial by enabling the vessels to perform their proper secretions, & promote a healthy action.- Of Individual Stimulants. Of distilled from Turpentines. Oil of Turpentine is a stimulant of considerable when pure it contains no Ox. importance,- there being few, which act more upon the circulatory, & less upon the cerebral & nervous system. It is useful in low forms of disease,- especially those in which the head is so affected that narcotics are forbidden.- Besides this, it has a peculiar effect upon the mucous membrane of the Stomach,- hence proves beneficial in some forms of Diarrhea,- Dysentery &c. Probably the Turp. operates by changing the morbid action & substituting its own. It has proved peculiarly useful in those typhoid fevers, where the tongue cleans suddenly,- smooth, red & moist,- or sometimes it becomes dry & not completely clean,- & the abdomen is somewhat tympaustic,- then also, there may be some delirium,- & yet the patient 143 not sufficiently low to require other stimulants.- In cases of this kind,- it is plain that there is a disease in the small intestines & that this disease is ulceration, then 5, 10 or 15 drops given every 1 or 2 hours, will produce a very happy effect, In 24 or 48 hrs. you will find the tongue become moist,- a little fur will appear,- which soon after passes off & the patient recovers. It is useful also in the last stages of Gastritis, Enteritis, also Yellow Fever, Dysentery &c. It has been recommended by Dr Bretton in Puerperal Fever,- but W. thinks it must be of that form which is not connected with Peritoneal Inflammation Also useful in Chronic Rheumatism,- Epilepsy,- Piles,- Flatulent Cholic,- Gout of the Stomach &c. &c. Dose from 5 to 20 drops every 1, 2 or 3 hrs. For Capsicum see Book B. p 164. Phosphorus, is the most powerful stimulant known, & the use of it very dangerous.- Dose is 1/12. 1/8 to 1/4 gr,- 1 gr. in 24 hrs Generally given in Sol. in Ether or in Emulsion,-a better mode than in Pill. 144 Min Ammo. & Carb. Lime. Ammonia Carbonas.- or Volatile Alkali.- has more influence over the nervous system than those before mentioned. It is formed by subliming Carb. Lime & Mur. Ammo. It is a Sesquicarbonate, found in Lungs, which are hard, solid & semitransparent, white, effloresce & deteriorate by exposure. It is decomposed by Alk, Alk. Earths, Acids &c. It increases the force of circulation & invigorates the vital functions, without affecting the brain or stomach it also produces diaphoresis. Hence it is useful in Typhoid fevers, in the intermission between excitement & collapse, alternated with Wine Whey. In low forms of Fever, where the brain will not admit Narcotics, in Typhoid Pneumonia, Scarlet Fever, Retrocedent & Atonic Gout, Chronic Rheumatism, Palsy &c. As it is an Antacid, it acts favorably also in diseases of the Alimentary Canal. It has been recommended also for bite of animals, for stings of Wasps.- Hornets- Bees &c. Also is said to remedy Drunkenness. Dose 2 to 5 to 10 grs. every 1 or 2 hours. Generally given in solution. Diffusible & Transient. 145 Antispasmodics,- are medicines which are given to relax or prevent irregular muscular contractions or spasms. But all medicines producing this effect, are not ranked under this head, because they depend upon a great variety of causes, & hence demand a great variety of remedies.- They calm the restlessness & agitation which arise from nervous action, & hence prove that they act upon the nervous system. Under this head then, we rank those which, while they stimulate the circulation, would act upon the nervous system without producing any effect upon the cerebral function. The name, however, is an improper one, as well might we have Antifebriles, Antiscorbutics &c. a more proper name would be Nervines. Musk,- the product of a small male animal inhabiting Central Asia the Himmaley Mts.- of a brown or black colour fleece, & has a small, oval bag, about 2 or 3 in. long posterior to the umbilicus. The quality varies according Received from 3 ports. Canton, Calcutta, & Russia to the situation of the animal. The most valuable comes from China, & least from Russia. It is brought 146 in sacs, is of a deep brown colour, & looks like dried blood. taste bitter,- odour strong, and diffusible, & it burns with a white flame to a spongy charcoal. It is partly sol. in boiling Water,- more sol. in Alc. & still more so in Ether. From its great price, it is often adulterated, with articles not easy to detect. It was unknown to the Greeks & Romans, & was introduced into practice by the Arabs. It is a powerful stimulant & antispasmodic, exciting no cerebral action. It is used in similar cases with all antispasmodics, also peculiarly applicable in prostration & irregular nervous action, as in low Typhus attended with subsultus tendinum, tremors, Gout or Spasm in the stomach without Inflammation. hiccup, convulsions of infants from spasm of the Intestines &c. but owing to its high price can only be employed in extreme cases. In Tetanus, it had been recommended by Dr Hoff with Op. ℥ss Musk with ʒi Op. to be given in 24 hours. It has also been used in Epilepsy, Asthma, Pertussis, Palpitation of the Heart, Cholera. &c. Generally given in Pill or Julep. Dose 10 grs. varies from 5 grs to ʒi- 147 Artificial Musk is made by pouring Nitric Almonds Acid upon Rectified Oil of Amber. It is almost inefficient. Seldom or never used. Castor. is the product of Beans. It may be used similarly with Musk, but is seldom employed Dose 10 to 20 grs. Tinct fʒi or fʒij Forty-Third Lecture Oct. 27 1834 Assafætida, is the concrete juice of the Root of the Ferula Assaf. an herbaceous plant from 6 to 9 ft. in height with a perennial, fleshy, tapering root, growing in Persia and is the most important of the Antispasmodics. When the tree is four years old, the leaves & stem are twisted off, the top of the root sliced off, so that the juice exudes, & it is then concreted. It is in irregular masses, brownish yellow externally, when freshly broken at first streaks of white are seen running thro' the mass, which soon change to red & afterwards to brown. variegated in colour, has a disagreeable odour, bitter & subacrid taste. It was used by the ancients; by the Persians, & even by some of our own epicures, as a condiment. Surat is said to be completely perfumed with it- It softens by heat By long exposure it becomes brittle. Its principal constituents are Gummy matter, resin & vol. oil, & upon the virtues to last, its odour & probably its virtues depend. Alc. & Ether.- 148 It is a moderate stimulant, powerful Antispasm also, an Expectorant & Laxative. It is useful in Hysteria, Hypochondria, Convulsions, Spasms of the Stomach and Bowels without Inflammation; Also in Hooping Cough, Asthma, Catarrh accompanied with Spasmodic Disease of the Bronchia, & also as an expectorant, in various infantile catarrhal affections. From the peculiar influence which it exerts also over the nervous system, it may be given in low forms of fever, accompanied with subsultus, Hiccup &c. As an Enema, it proves useful in Tympanitic Abdomen, Hysteria, & Irritability of Stomach. Medium Dose, about 10 grs. in Pill or Emulsion. Tinct. is more stimulating. Dose ƒʒi Galbaunum, Sagapenum, & Ammonia, are Gum Resins, seldom or never used. Valeriana, see Book A p. 173 Amber is a fossil of veg. origin, found on the shores of Baltic. Ol. Succine Rectificatum. is obtained by several redistillations, is of a yellow colour, volatile, inflammable, insol. in water, partially sol. in Alcohol, of a hot and acrid taste. It is a stimulant and Antispasmodic, given in Hooping Cough, Singaltus in low fevers, Infantile Convuls &c. 149 Dose from 10 to 30 drops. It is more used externally as a Liniment, in Chronic Rheumatism Palsy & Spasmodic Disease. Dr Parrish uses ℥i ℥i ℥iij a mixture of Ol. Suc Rect, Laud. Brandy and ℥iij Sweet Oil by friction to the Spine of Children affected with Spasmodic Diseases Narcotics or Cerebral Stimulants This name is applied to that class of medicines which act upon the brain, & they are so peculiar that no two of them are precisely identical in their action. When administered, they first produce an increase of both the physical & mental powers,- causing not only arterial excitement &c. but also energy of thought.- vividness of imagination &c. Afterwards a reaction takes place, the pulse becomes composed, the muscles relax, the senses become obtuse, & there is a general inertness of all [illegible] functions both of body & mind;- pain is relieved & sleep ensues. If large doses be given, the excitement is more quickly followed by more lasting & more serious effects. 150 Sometimes there is first a slight debility, followed by nausea, vomiting &c. These show that they operate powerfully on the cerebral functions, & when Death ensues, the heart ceases to act from a secession of nervous energy from the brain. There are 2 distinct views taken of the operation of Narcotics. Cullen says, their primary tendency is to reduce the vital power, & ascribes the primary excitement to the opposition of an innate power of the system against the poison introduced. Brown considered that they directly increased the action of the system, & that prostration of the powers was a natural consequence of their elevation. Cullen, then, considered them directly sedative & indirectly stimulant. Brown considered them directly stimulant and indirectly sedative. Each had their followers. But neither of these does W. think satisfactory, but that each Narcotic operates in a manner peculiar to itself. Altho' there is at first an excitement, yet the powers of the system are not subsequently 151 depressed in a ratio corresponding to the previous exaltation, & he even went so far as to assert that the powers of the system may be directly diminished,- & that certain [powers] functions might be diminished & others excited by the same article of this class. They exercise their peculiar influence upon the system, upon whatever part they may be applied. Narcotics, more than any other class of medicines, lose their effect by repetition, hence it is apparent, that in order to maintain a given impression it becomes necessary, gradually to increase the dose. We should also vary the articles employed. This class has received different names according to the objects for which they may be given: thus when given to sooth pain, they are termed Anodynes, when given to produce sleep,- Soporifics or Hypnotics & when for their sedative effects,- Sedatives &c. We shall next treat of the individual Narcotics. The first and most stimulating of the class is 152 product of vinous fermentation.- It is obtained from the distillation of Ard. Spt.- sp. gr. ƒʒs- purest contains 11 pr. ct. water Alcohol.-but this is seldom used in any other form, than that of Proof Spirit, which contains about 50 pr. ct. W. Preferable forms, however, are Wine, Porter, Beer, &c. and of Wines, the best are Sherry, Madeira or Teneriffe, which Wines are more tonic & less stimulant proportionally than same dose of Alc. alone contain from 15 to 25 pr. ct.- In looseness of the bowels, Wine Whey- Oj boiled Milk & Oss wine. Port Wine may be applicable. But Porter, Ale, Beer &c. Dr Wood thinks should be excluded from medical For an irritable stomach combine W. with spices, by first making a hot infus of spices & then add the Wine.- use,- they are heavier for the stomach & less stimulating than wine. He never prescribes them except where patients have been addicted to their use. Tinct. vary in strength when Alc. & dil. Alc. are used,- hence important to recollect which are made of pure Alcohol. The use of these stimulants must be regulated by the symptoms, when they increase the heat of the skin.- excite the nervous or cerebral derangement, increase the force of circulation more than proper &c. they should be omitted, but if the contrary happens, & the patient does well under their use they may be continued. Sulphuric Ether made by the action of Sulph. Acid upon Alc. is a narcotic stimulant, highly diffusible, hence more speedy & more evanescent in its action. If its vapour be inhaled, it also produces a speedy action, & exhilarates somewhat like Nitrous Oxide, but a recovery from it is more dangerous 153 - being attended with more stupor, & other unpleasant consequences.- Nith Sulph. Rectif. should be presented Caution the patient of its inflammability. It is used in prostrate cases accompanied with spasmodic nervous action,- in Gout of the Stomach,- Cholic Affections,- Hysteria,- & in some stages of Typhus to obviate the nervous affections &c. "sinking spells" As it is so diffusible, it is necessary frequently to repeat the dose. It may also be given in Asthma Hiccup, Tetanus &c. Dose ƒʒss to ƒʒj- with sweetened water. It must be quickly swallowed, so that no vapour will rise in the mouth. Externally applied,- it makes 2 impressions. If applied so that it may evaporate, it produces cold hence it is used for Burns & Scalds,- Strangulated Hernia &c.- But if it be confined to that it cannot evaporate, it produces Heat, & even a considerable irritation of the skin,- hence it is applied to the Forehead for Head Ache by holding it in the hand. sp. Nith Sulph. Comp. Hoffman's Anodyne,- is a preparation of this, which is often given as a Nervine.- It allays irregular nervous action & thus produces sleep,- because it removes the cause of wakefulness. Dose ƒʒss to ƒʒi to test whether it is really good & contains Oil of wine, pour it in water & it should become turbid.- 154 Opium.- the concrete juice of the Papuver Somniferum, which grows in Europe & is cultivated in the gardens of America,- also in India, Persia, Turkey & Egypt.- The juice is obtained from the capsules by slicing them.- There are 2 varieties in commerce,- Turkey & E. India, but the latter is never brought to this country, it is taken to China. All our opium comes from the Mediterranean, & there are 3 varieties,- Constantinople,[Singma?], & Egyptian, of which the [Singma?] is the best. This is generally distinguished by being employed in the leaves & capsules of a species of Rumex,- & when these are absent, the Opium may be considered as inferior. Water & Alc. extract its virtues, it is injured by long boiling. Its principal constituents are Resin, Gum Bitter Extractive, volatile matter, Gluten or Caouchouc. Narcotin, Meconate of Morphia, Meconin & Narcein. Narcotin consists of Hyd. Ox. Carbon & Nitrogen. It is white, in small crystals, fusible, insol. in W & Cold Alc. sol. in boiling Alc. & Ether, tasteless & inodorous. Its influence upon the system is uncertain, as it is said that 40, 50 or 60 grs have been given without any effect. 155 Morphia, is the narcotic principle of opium. It is sparingly sol in Cold Ether, freely in hot but is precipitated when cold, burns when heated, neutralizes acids The Meconic Acid with which it is joined, is useful only as being the means by which we can test the presence of Opium. According to Dr Hare;- to the solution containing Op. add a sol. of Acet. Lead, then the Meconate of Lead is precip.- to this add Sulp. Acid which will set free the Meconic, & then by adding a sol of a Persalt of Iron, we get a red coloured precip. Orfila thinks it unnecessary to add the sol. of Acet. Lead, & merely adds first the Sulp. Acid, then the sol of a Persalt of Iron. See Book C. Forty-Fourth Lecture Oct. 28 1834. For application of Opium see Book C. p.69. Lactucarium concrete milky juice is sometimes substituted for Opium It is obtained from the common Lettuce. Smell & used in Europe for Peet. Affections. Nervous &c. taste are like op. Dose 2 or 3 grs. of Tinct 40 to 60 gtt. c b.141 b.77 Camphor, Hops, & Conium or Hemlock, for which see Books B. and C. 156 Sedatives. These are divided into the Arterial & Nervous. 1. The Arterial.- The most important of this class are the Preparations of Antimony,- three of which are used: D. p.28 D. p.76 p.76 viz. Tartar Emetic, Precipitated Sulphuret & Antimonial Powder.- The Neutral Salts, are sedative & act also upon some of the functions. Potas. Nitras (see pp. 67 & 79)- when taken internally, diminishes the action of the heart, & the heat of the surface by its own peculiar operation. It is also Diuretic, & acts locally as an irritant, producing Inflammation, so that when given it should be largely diluted. When given for a long time, it diminishes the general power of the system. It is useful in Inf. affections, except of the stomach & bowels,- in Bilious Fevers,- Rheumatism,- Tremor. with Plethora,- & is often combined with Tart Emetic. A solution may be made of Nitre ʒi, Tart Em. gr j in water ƒ℥ij. Dose ƒ℥ss every 1 or 2 hrs The Veg. Acids are also somewhat sedative,- & are very useful as drinks in febrile complaints, but they may be abused & produce Dyspepsia. The tendency of Vinegar to produce emaciation is well known & sometimes called into use. 157 Lemon Juice is most used.- The best method of keeping it is to convert it into Citric Acid, by Carb. Lime & dil. Sulph. Acid;- it is Chrystalline.- To avoid the fraud of Tart. Acid for it, test it with Carb. Pot.-(see p.77)- A good substitute for Lemon Juice may be made by adding ℥i of it to Oj water with gtt iv Ol. Limonis.- B. p.55 B. p.57 2. The Nervous Sedatives.- Digitalis,- Tobacco.- Hydrocyanic Acid exists in almost all plants of the Genus Prunus, or Amygdalus.- Its odour & taste are owing principally to a volatile oil combined with it.- The best preparation for administering or preserving it is the Oil of Bitter Almonds- Dose 1/4 to 1/6 of a drop.- Pure Hydrocyanic Acid is never used in medicine, but the Dilute,- which is formed by passing Sulph. Hydrogen thro' Bicyan. Merc.- forms Black Sulph. Merc. & Hydrocy. Acid,- then filter & add Carb. Lead & filter.- It should be kept in opaque bottles.- Even swelling a bottle of the Oil of Almonds, or of Hydrocy. Acid sometimes produces the unpleasant effects of the poison. Dose of the Pure, would be about 1/12 gtt. in a Wineglassful of Water,- of the Dilute, 1 gtt. every 2 or 3 hours, till the 158 effect was produced,- It is of unequal strength.- Cyanuret of Potassium- dissolved in water forms the Hydrocyanate of Pot.- which is incompatible with a great variety of substances & hence is very apt to be decomposed in the stomach.- Dose 1/4 gr to 1 gr. & should be given in a state of solution.- 159 Iodinum.- When taken in small quantities, it seems at first to sharpen the appetite,- increase the pulse &c.- acting like a Tonic,- but if it be continued, the patient begins to emaciate,- from the stimulation of the absorbents.- It also increases the secretions.- & renders the nervous system more irritable.- It was first employed by Coindet of Geneva in cure of Goitre,- afterwards in Scrofula,- indolent swellings,- somet. in Amenorrhea,- also in Gonorrhea & Gleet.- Internally, dose is from 1/4 to 1/2 gr.- Generally given in Tinct.- which contains grs XXX to ƒ℥i.- Dose 10 to 20 gtt.- given in a wineglassful of sweetened water. It should not be long kept, as a reaction seems to take place between it & the Alcohol, changing its property.- Iodide of Potassium,- which in sol. forms Hydriod. Pot. has an acrid, bitter taste.- Int. dose 1 or 2 grs.- but its effects are not like those of Iodine.- It renders Iodine sol. in water.- hence is useful.- as in Lugol's Solution,- consisting of Iodin.- ℈i Iod. Pot.- ℈ij Water ƒʒvij.- The Iodides of the 160 metals produce the effects of the metals, just as analogous compounds,- & not of the Iodine.- Externally Iodine may be used as a Bath.- or more frequently in form of an Ointment containing ℈i to ℥i Lard.- It leaves a yellow stain upon the skin, which gradually disappears by evaporation