6 Materia Medica [illegible] Depletio Sanguinis Is an important refrigerant process & should be treated of amongst therapeutic agents It is an operation directly and exclusively refrigerant in its effects The blood itself is vital and is the medium and support of the vitality of every part of the system The first effect of v.s. is to diminish vital power generally and strength of action in every part. It constitutes the most powerful and direct method of reducing the vital energies When carried to excess its effects are most difficult to be remedied The precise quantity to be taken depends on the degree of vital power the nature of the disease the prevailing diathesis and the vigour of the constitution Yet in no process is the practice so empirical Prof I. knows of no disease so severe as to require medication in v.s. has not been recommended as the most appropriate remedy ever [illegible] When really indicated it is indispensable when not indicated it is infallibly prejudicial Divided into two kinds General & local the former from an artery or large vein the latter from the capillaries Some however consider V.S. from a large vein in a part near a local affection, as from the ext. jugular in cephalitis as a local bleeding & therefore more efficacious. They think V.S. from the arm in like manner more efficacious than from the jugular or foot and in all the phlogistica they bleed from a large vessel as near as possible to the seat of the disease This they consider as effecting a topical depletion of the diseased part. Now it is well known to every anatomist that there is no direct communication between the viscera of the thorax abdomen and cranium and the parts forming the parieties of those cavities. There is therefore no ground for calling such processes topical bleedings. The notion is a remnant of prejudices existing before the discovery of the circulation of the blood & the distinction is of no more importance in practice than the old man in the almanac Some limit the term topical bleeding to an evacuation from the capillaries of the diseased part. This evacuation must be prejudicial in atonic passive diseases where there is a gangrenous tendency especially if performed with scarification and cups An English author remarks correctly that there is no such thing as topical bleeding independent of producing an effect upon the whole system In the phlogistic phlogistica leeches and cupping with scarification are of no importance for v.s. from the arm is all that is requisite. In local entonic infl. the practice is more plausible. Here topical bleeding is the best but the irritation of cups and scarification does more injury than the evacuation does good, unless applied to a neighboring part, and then the counterirritation produces the effect. As the disease however does not affect the constitution, it is of little consequence The blood is not stagnant in the part for then it would be coagulated and would not flow consequently topical bleeding cannot empty the vessels of the part Besides infl. is not caused by accumulation of blood this accumulation is an effect, not the cause If a general phlogistic diathesis exist, topical bleeding is not substitute for v.s. if there is no general phlogistic diathesis, topical bleeding is not required The cases which have been benefitted by topical have been cases of atonic infl. Here the counterirritation produced the effect the trifling depletion [illegible] of blood being injurious as far as it goes Yet the practice is very fashionable IN these cases bloodletting is not indicated. Deobstruents & antirritants such as calomel and opium give far more speedy and perfect relief Ophthalmitis is a dis, in wh. phys. say topical bleeding is indispensable A strong sol. of nit. sil. is far better & gives a more speedy cure If you separate some of the vessels going to the part, then to be sure you may produce some beneficial effect Where general bleeding is not indicated topical bl. is always injurious The capillaries are said to have an independent action and the reasons assigned are that it is by their agency that the blood is returned to the veins, that by them assimilation secretion and [nutrition] are performed that they are the seat of infl. 6:07 PMhe reasons are probably true yet it is [illegible] no less true that the capillaries as necessarily and completely depend upon the heart as the heart upon the depletion of blood affects both the capillaries and the heart, hence the surface is pale. If the action of the heart is increased there is congestion in the capillaries and less blood in the central parts In this case topical bleeding would remove the congestion temporarily it would be again produced by the vis a tergo In infl. the value of the blood is dimin. indeed but the blood is not stagnant or it would coagulate I would not be understood to say that cupping and scarification are of no service for I have seen them used with great benefit But I do say that other means are in my opinion better [illegible] by counterirr. only that they produce their effect Thus in the chronic stages of subacute rheumatism I have known evident relief derived from them yet no one would bleed in such a case also in pneumonitis The benefit is the same as from rubefacients, blisters etc. The strongest case is infl. of the eye and the anastomosis of the ophthalmic and temporal arteries is thought to have influence But even here if there is active infl. and phlog. diath. topic. bl. will be no substitute for v.s. In atonic infl. without phlog. action the case is better without bleeding of any kind & topical bl. is beneficial only by its irritation. I have seen both plans tried Dr Cogswell treated infl. without and no man was ever more successful. Few employ it who have had extensive practice. There are other and better means of counterirritation Depletion from large vessels and depletion from capillaries are better appellations than general and topical bleeding for the latter, as we have seen is inappropriate Depletion from large vessels may be performed by v.s. or arteriotomy. The veins are the vena media basilica t the bend of the arm the vena suplina major on the inside of the ankle & the v. [illegible] minor on the outside of the ankle The vena media basilica is preferable to the ven. med. cephal. the v. seph. or the v. basil. as the latter have cutaneous nerves running over their surface. The veins on the ankle are irregular; they have cutaneous nerves running over them, and the tendons are liable to be injured Besides the incision does not heal well but is liable to become a troublesome sore. The vena jugularis externa is often [illegible] The temporal is the only artery now selected; it is the only safe one as it alone passes over a bone, so that it can be compressed. It is of no consequence whether blood is taken from a vein or from an artery, or what vein is selected so far as the disease is concerned provided the opening be large enough Depletion by the capillaries is performed by means of leeches, or by scarification and cupping. The [illegible] medici lis is used but I have seen the H. sanguinea? do nearly as well [illegible] The best instrument for v.s. Prof. I. thinks is the Dutch or spring lancet as it can be used by those who are not ambidextrous it can be used upon the most rolling vein and upon persons in epileptic or puerperal convulsions the practitioner can set it and keep it in order himself and it can be used for years, while the thumb lancet soon becomes dull Depletion of blood may be a remedy in itself or it may be preparatory to the action of other remedies. V.S. for local symptoms can never be beneficial where the general symptoms contraindicate it buy may be beneficial when they neither indicate nor contraindicate it Venesection is employed to answer six indications 1st as a mere antiphlogistic or refrigerant measure in entonic diseases 2nd for the purpose of making a sudden and strong impression upon the system in order to produce a resolution of certain no phlogistic & not materially atonic diseases 3d to equalize excitement increase susceptibility, and prepare for the better operation of other remedies in certain non phlogistic diseases 4th as a substitute for an habitual but moderate hemorrhage & to divert it to some other part for the purpose of suppressing it gradually or preventing a too rapid sanguification as in exangin, cyanea (non closure of for ovale) exangia aneurisma paracyesis irritative (morbid pregnancy) wounds of the lungs brain etc. 5th to produce sudden faintness and relaxation for the purpose of facilitating certain surgical operations as the reduction of hernia or luxation 6th to promote absorption in parabysmata emphysematous (tumours!) & perhaps in certain dropsies Venesection is the most appropriate remedy for phlogistic diseases ad shd always be employed when any considerable phlogistic diathesis exists, whatever be the sex age climate season or constitution A blood is the pabulum of life, a depletion of it has greater effect in lessening the vital powers than the evacuations of any other fluid A free evacuation of blood from a healthy subject immediately produces more or less debility & increases susceptibility, appetite and sanguification. But if carried to excess it impairs the digestive powers The strength of the pulse is the only proper indication for v.s. When Fordyce and others mention hardness as the test for phlog. diath. it is evident from the context that this means strength. When however they speak of hardness and strength in connexion they make the same distinctions as Prof. I. Hardness indicates irritation and may accompany strength or weakness of pulse It is said by some writers that in enteritis we are to expect a small hard pulse and are always to bleed The truth is there are two species of enteritis which are accurately described and distinguished 1st phlegmonous enteritis, affecting all the textures of the intestines 2nd erythematic enteritis, affecting only the mucous membranes. Now the pulse in both these species is small and sharp but in the first no pressure can extinguish the pulse either in the systole or diastole in the second it is easily extinguished. In the first species only do we find strength of pulse & in this only is v.s. indicated Hardness combined with strength heightens the indication for v.s. these combined with fullness heighten it still more. Mere fullness & hardness uncombined with strength never require v.s. The coriaceous or buffy coat often observed on the surface of blood drawn depends on several causes 1st the degree of preternatural vital energy or preternatural strength of action in the system in other words the degree of phlogistic diathesis 2nd the rapidity with which it is drawn If taken rapidly it remains longer before coagulation the red globules subside and the buffy coat of course appears If taken more slowly it coagulates sooner and the buffy coat is less or none at all even though the disease is phlogistic Even in health blood may be so drawn as to exhibit the buffy coat 3d the depth of the vessel in which the blood is received if shallow the subsidence of the red globules will be less complete & the buffy [illegible] coat less distinct 4th The specific disease whether atonic or (frequently) entonic produces a buffy coat 5 Pregnancy is almost always attended with a buffy coat It will be readily inferred that Prof. I. lays very little stress on the buffy coat as indicating the propriety of bleeding or the necessity of a repetition. Wilson Philip and others express the same opinion. The firmness of the coagulum and the concavity of the surface are better tests But the existence of these marks & also of the buffy coat is no proof that a repetition of v.s. is called for We should not mistake for strength of action, the rigidity of the coats of the arteries so common in farmers, seamen & elderly people In phlogistic diseases, as cauma and the caumatoid phlogotica F.S. if employed early will of itself effect a cure. But it must be well managed. If too sparing at a time and too often repeated it will produce too great a reduction of strength If too profuse it may lay the foundation of other diseases. Those who are celebrated for removing diseases suddenly by a free depletion of blood, lose many of their patients by subsequent dropsy If there is no considerable increase of strength of action V.S. may safely be neglected In merely entonic infl. it is of no benefit but may be if the constitution is brought to sympathise with the local affection The phlogotica & local infl. differ in their causes diathesis and proper mode of treatment There is a foundation for the distinction of active and passive Some years ago the essence of infl. was thought to be an increased strength of action in the arterial system. Wilson Philip though it to be debility. Both these views have tended to confound the distinction of active and passive It is acknowledged that there is entonic fever. Is it any more strange that there should be entonic and atonic infl.? The essence of infl. is not the quantity or strength of action, but as is well remarked by Hunter the quality, and it may attend either increased, or diminished strength of action or a state of action neither increased nor diminished, and the treatment must vary accordingly. In infl. moderately atonic V.S. might be tolerated and would not destroy life it would render the recovery slower and less perfect. In every low atonic infl. (phylogotica) V.S. would be fatal I never knew a physician in Conn who did not employ bleeding in entonic diseases. This has been asserted with respect to myself, but altogether without foundation. Dr Danforth of Boston did not bleed a patient for the last 20 years of his life (this is noticed as a strange thing a man successful and of high reputation) Now the change of diathesis occurred about that time 1807 (to 27) and though sporadic cases of phlogistic disease occurred subsequently he may not have seen one (vide The Med. B.) I have myself seen but one decided case since 1816 & that was in 1819. You will occasionally meet with a case of phlogistic disease and cases arising from [illegible] though the latter will require less bleeding than the idiopathic. When the v.s. is employed for the first indication, viz as an antiphlogistic measure in entonic diseases, the degree of effect depends entirely upon the quantity of blood abstracted and not at all upon the manner of abstracting it. It is said by some that bleeding is more effectual when it produces faintness & that in such a case a less quantity of blood suffices. Such cannot be true phlogiistic cases. In every pure medical case the production of faintness & especially of syncope is to be avoided. In phlogistic diseases we must bleed freely,. so as to meet the symptoms, but in a recumbent posture in order if possible, to avoid deliquium. On the phlegmonous phylogitica the production of deliquium is unfortunate as it may prevent a sufficient abstraction of blood The abstraction of lbj or lbfs is generally sufficient nit. pot. tart. ant. refrig. salts veg. acids ripe acid & subacid fruits cold water & air shd be employed at the same time as auxiliaries. By thus dividing your measures you produce more effect upon the dis. & with less injury to the system. In phlogistic diseases V.S. practiced early and judiciously in the forming stage will produce a complete resolution. After the forming stage has passed, the dis. cannot be broken up but will run its course of 5 or 7 days under the best treatment but this treatment will seldom fail of effecting a cure. In phlogistic dis. v.s. may act somewhat on the principle of making a strong impression on the system But if a strong impression merely is the object, ligatures on the limbs are better. A third or a half of the blood in the system is in the limbs & ligatures upon them will produce faintness & syncope than v.s. This suspend the disease, but then the ligatures are off it is found that no permanent benefit results & v.s. must be employed In genuine phlog. dis. faintness and syncope are no proof that sufficient blood has been drawn. mere reduction without counteraction will not? cure like phlogistic disease. It would seem that an aggregate of symptoms exists one of which is increase of strength & this is removed by v.s. The aggregate is thus broken up and the dis. completely cured. Mere irritative or symptomatic entonic fever requires less depletion than that which is idiopathic, and after one bleeding, opium or hyoscyam with calomel will allay all the symptoms These may even prevent the occurrence of the symptomatic fever. Irritative fever is however often atonic & then no v.s. is proper Abernethy remarks that the fever must take place and we cannot prevent it. He cautions against bleeding in cases that must be protracted as all the vital energies will be wanted before the close He says we shd never bleed unless the fever will produce greater debility than the loss of blood. He adds infl. & irr. action wear out the strength and if more strength is saved by counteracting these, than is lost by the evacuation, then is v.s. proper & not otherwise. A surgeon of more extensive practice in N.E. than any other out of Boston has remarked that he had seen more cases of death from depletion after injuries, than from the casua,ties themselves. Chas. Bell remarks “A man has received a shock, the surgeon bleeds and the landlady gives a dram now I think the landlady is right” Dr Latham remarks “that many cases of recovery after v.s. are in truth but lucky escapes from death” The symptoms are the only safe guide for v.s. A writer in the Medico Ohio Rev. remarks that the man who should draw a distinct line between spasm (or irritation) & infl. wd render great service to the profession. Prof. I. does not consider the distinction so very obscure. But they in London consider synochus as inflammatory & hence it is that they cannot distinguish irritation from infl. In cases where there is doubt whether irritation or infl. exists it is the safer practice to avoid v.s There can be no danger in delay. But we can commonly decide if during the flow of blood the pulse soon becomes weak and fluttering even though it shd rise afterwards, v.s. will do no injury But if the pulse becomes softer and fuller we may expect benefit from v.s. In doubtful cases it is better to take too little than too much blood as the error is more remediable, and besides such cases do not absolutely require v.s. The lancet is often a little instrument of mighty mischief vide Hall’s mimosis in quieta. in fever of pure irritation The second purpose for wh v.s. is employed is to effect a resolution of certain dis. by a sudden & strong impression on the system. The dis. is wh the practice can be attended with benefit are now phlog. but not materially atonic pyrectica phlogotica & exanthematica more especially those of the synochus or sub putrid type The beneficial effect of f.s. in these cases depends upon the shock and the strong impression made and not on the quantity abstracted. Hence our object shd be so to conduct the process as to produce the strongest impression with the least possible loss of blood The patient shd therefore be placed in an erect posture, the blood shd be taken from a large orifice & the flow of it stopped suddenly and instantaneously, as by the application of the finger. In this way deliquium may be produced speedily. It is most probably that ligatures upon the extremities would be a complete substitute for this practice in all non phlogistic cases with the exception of surgical ones & perhaps even in these. The relaxation is certainly as perfect for the time being. But I consider the practice of V.S. in these cases to be injudicious. We have other means for effecting this purpose, more safe & more effectual. V.S. at the commencement of typhus will give present relief, but it is always apt to occasion an unfavourable change at one of the critical periods. As was before observed the obstruction of lbjs or ljb is generally sufficient for the time being in true phlog. dis. But the abstraction of lbj would make no impression in the synochous or sub-putrid type ^ cases of this wd not tolerate a repetition of the v.s. In dis. of the synoch. or sub-putrid type does not sink fatally till the 14th or 21st day, in the pyrectica & not till the 7th or 9th in the phlogotica Fever of the synochus type influences the opinion of a great many phys. in forming their ideas of cauma or infl. fever # We must in these cases employ v.s. as counteragent & not as we would in phlog. dis. or we shall either produce no effect, or exhaust the pat. & render the dis. more obstinate & protracted. If we bleed at all in these cases we must do it suddenly and rapidly in order to produce a sudden & powerful impression and overwhelm the disease at once. In other words we must half kill the pat. in order to cure him # All the authors of the present day say nothing about real cauma they describe only synochus for cauma you must go back to more ancient authors The cases in which this practice is recommended are quite different from those of the nervous type. In t. nervosus & syncopalis no one but a complete routinist wd ever think of v.s. IN fevers of a sub putrid or synochus type only is there any question about the propriety of v.s. I consider such practice as rash If it fail of its object it must infallibly sink the patient & render the case more hopeless. I am an advocate for a milder course one which is less violent and dangerous and more steady and uniform in its operation. By it more cures can be effected, convalescences is more perfect relapses less frequent & constitutional vigour less impaired. Hence depletion of blood in atonic dis. as a mere counteragent is considered by Prof. I. as a hazardous practice exhausting the patient if iut fail in resolving the disease. In phlog. dis. there is no such nicety Blood may be taken at any time before a crisis. The fact which all acknowledge that blood if taken at all in synoch. dis. must be taken in the first stages proves the hazard of taking it at all A proper test for the propriety of bleeding, free vomiting and purging is the effect of spontaneous humor. emesis and diarrhoea It is in my opinion never proper to bleed to faintness or syncope in any purely medical case, & the mistake of synochus for cauma has led to the practice In the true phlogistic dis. there seems to be a state of the system which increases the supply of the vital energies & I would bleed purely for the purpose of reducing this state I would not apply irritants to the surface till the system is reduced nearly to its healthy standard then blisters and other irritants will remove the weak remains of phlog. act. Even cauma may sometimes be broken up in its forming stage by the use of counteragents only, as hot spirits & water forced sweats etc. in empirical practice But these means if they do not effect in resolution must aggravate the case & are always hazardous. So the sudden removal of phlogotica of a synochus type is followed by a protracted convalescence and often by the supervention of other diseases. Dr Mosely of E. [Hudson] was celebrated for curing dropsies & most of his cases were occasioned by the free depletion of Dr Woodruff for the cure of pneumonitis for the speedy cure of which Dr W. was equally celebrated. Mr Masters of Lynn remarks that many of the cases of chronic disease which came under his care were the consequence of sudden removal of phlogotica by the free depletion of another physician Dr Good in his remarks on typhus observes “we are to avoid reduction and adopt an antirritant and invigorating course. Clutterbuck supposed typhus to be an infl. of the brain & practiced v.s for its reducing effect. Armstrong supposes visceral congestions generative of a general sensorial debility & bleed as a preventative Robert Jackson supposed v.s. was a stimulating process & bled for its direct invigorating effect. Decided practice of any kind will succeed at the commencement.” Dr. G. continues “this employment of v.s. in typhus is no new practice, but the sum of medical opinion for the last three centuries is decidedly against it” Even Dr Welch of Edinburgh the most strenuous advocate for bleeding in typhus & who takes blood by the half gallon, says that the majority of practitioners are against the practice & that it makes slow progress in Edinburgh But there is one state in typhus in which Dr Good thinks v.s necessary “Congestion, says he, may take place as an effect of the disease, in the head, lungs or liver & infl. or gangrene be the result. This symptom we must combat boldly by V.S.” “There is much hazard in the practice but there is death without it” In my opinion there is far less hazard in letting it alone In pneum. typhodes, he wholly interdicts v.s. He is very unfortunate as to the time when v.s. may be serviceable. In the early stages, as we have seen there is far less danger in v.s. But as to employing it in congestions, experience, observation & reasoning a priori all unite to show that v.s. will increase the congestion (vide congestion) And if in these cases infl. is the cause of the symp. this infl. must from the state of the system be atonic & as little benefitted as that by v.s. Dr Good supposes that typhus may run into phlogistic action. This is far more improbable than that cauma should run into typhus & both are contrary to fact. Most surely stimulants and excitants can never induce phlogistic action in typhus, for even in health when given in noxious quantities they produce not phlogistic action but irritation & if carried farther erythematic infl. & irritative fever. I have seen cases of great head affection in typhus in which on p.m. exam. not only no infl. or cong. was discovered but the brain was even found preternaturally pale. The same has been the case in delirium tremens & puerperal delirium. Infl. or congestion is certainly then not essential to these cases. In great atonic hemorrhages & after great loss of blood from any cause congestions in the brain are likely to occur. The greatest bleeders have the most congestions My conclusion then is that v.s. is never indispensable in typhus & never in synochus that if ever employed it shd be in the early stages & that if employed subsequently it produces at most only transient benefit & renders moderate cases severe and severe cases incurable The third purpose for which bleeding is employed, is to equalize excitement, increase susceptibility and prepare for the operation of other remedies in non phlog. dis. that are not materially atonic In these non phlog. cases v.s. increases susceptibility and irritability so that greater remedial effects are produced by most medicinal agents. It shd therefore be avoided in those cases in which there is already too much irritability and susceptibility. The susceptibility to diseased action and to remedial action is different though v.s. may increase both V.S. is a powerful preparatory in appropriate cases. It promotes the action of emmenag. diuret. diaphoret. & cahtart. etc. It produces this effect in different ways and partly by relaxation It has been supposed that like nausea v.s. increases the susceptibility to the action of deobstruents. If phlogist. diath. exists v.s. will of course increase this susceptibility. If however there is considerable atony it will diminish the susceptibility to their remedial effects which it will increase the susceptibility to their irritating and evacuating effects Even when there is no considerable atony v.s. will often reduce the system considerably below the favorable point of susceptibility for the operation of deobstruents I have learned from experience that the higher the degree of energy short of entony, the better is the operation of deobstruents. I have observed this particularly in peristhnitis bronchitis, rheumatism, gout, & paramenia obstructionis (as it now occurs) V.S. renders the operation of deobstruents precarious in these diseases Colchicum for example will relieve rheumat. more speedily & perfectly without it & has failed where it has been employed So of actaea racem. Moderate v.s. for this purpose, when the dis. is but moderately atonic may sometimes be beneficial, but it must be used with caution and is never indispensable. Examples of diseases in which v.s. is employed for this third indication are colica ileus in certain cases dysphasia convulsio s. epilepsia [illegible] apoplexia (sanguineous apoplexy) entasia tetanus lysso canina & other diseases in some particular cases When v.s. is practised for the third indication, we should avoid drawing too much blood on the one hand & the production of syncope on the other. Tetanus and lyssa canina are however exceptions. In these, if the vital energies are perfect we should take as large a quantity of blood as the system will tolerate & in such a manner that after the requisite quantity has been taken syncope shall be produced But even to this rule there are exceptions. In general our success does not depend on the quantity of blood taken nor on the shock produced it should also be borne in mind that v.s. in these cases is only preparatory & is of no permanent benefit in itself alone. It must be followed by other appropriate remedies or we shall soon lose the advantage we have gained Bleeding for the 4th purpose is employed in habitual & passive but moderate hemorrhage, as in paramenia [illegible] Bleeding is never employed for the purpose of directly checking hemorrhage. In active hemorrhage it acts by obviating the state of the system on which the hemorrhage depend and other means will accomplish the same object for instance the exhibition of acetate of lead In irritative hemorrhages (commonly called active) v.s. may be tolerated but it will have no effect in checking the hemorrhage, unless the depletion is very copious and often repeated. And it is always a dangerous practice, producing exhaustion, hectic of inanition and even death itself. Many lives have thus been destroyed which might have been saved Vicarious hemorrhage (misplaced catamenia) may be either active, irritative or passive & in some respects follows different laws from other hemorrhages. It is important to select a particular time for v.s. & appropriate medication shd follow. The hem. recurs with the same regularity as the catamenia and is preceded by certain precursory symptoms. The time to bleed is at the first occurrence of these symptoms & means shd (then?) be adopted to excite the catamenial secretion. It is not necessary or proper to take a very large quantity of blood or produce a shock by faintness. The abstraction of a little more than would have been lost by the hem. will be sufficient to interrupt the latter, & this repeated a few times will break up the habit. In the intervals suitable emmenagogues shd be given & as there is commonly a torpid state of the digestive organs, a combination of iron, sanguinaria and aloes is often found to answer well. All the tonics are useful Paragesis irritative In the first month of pregnancy troublesome symptoms arise from pregnancy & v.s. would give no relief. In the latter months they arise from pressure and and a moderate abstraction of blood may be proper. We should however be careful not to take too much Even in the earlier stages much bleeding will occasion abortion & in the latter stages it is very apt to cause miscarriages. Indeed there is no more certain mode of effecting a miscarriage than v.s. In some places (not so much on the Conn. riv.) pregnant women are always bled, as a matter of course Not one case in fifty requires it. When practised improperly it is followed, if not immediately, yet ultimately by bad consequences Recovery after parturition may be lingering & imperfect. Bleeding in pregnancy is very apt to produce abortions I have known cases of 5 or 6 abortions in succession produced by v.s. improperly employed & where the families were childless from this cause. I was subsequently called to such a case where abortion was threatened. I ordered a horizontal posture & gave opium in small doses, at reg. interv. & removed all the sympt. In the interv. I gave ton. & invit. rem. Iron was the best in this case though it has been said to prod. abort. The sympt. themselves in these cases are not such as indic. v.s. they arise from disord. stom. IN this way I have safely carried pat. through Exanguia Aneurismus Import. in an. of large bloodvess. as of the aorta. Here it is important to get the pat. along with as little loss of blood as possible. Still it is [illegible] not to mistake palpit. of heart symptoms a. of derange. of dis. org. for anew I have known the [illegible] & the case treated with v.s. & crem. tart. till it was thought disp. when it was thrown aside & the pat. recovered Wounds of [illegible] & lungs. Extensive & repeat. bleed are necess. when a man has been shot through the lungs & perhaps when shot through the [illegible] Leave no more blood than is necessary to sustain the function of the system In wounds of the brain the dang. is from hem. Though we must bl. copiously yet we must avoid prod deliquium which might cause death hence a horiz. post. These cases are entirely diff. from accidents & casualties Abern. remarks “the surgeon must let the infl. (the danger is from hem. not from infl.) kill the man or run the danger of killing him with the lancet” & he says “the latter shd be preferred.” I think he is wrong. Sins of omission are not so bad as sins of commission V. [Chololethus] [means] prob. oth. rem. are better Lithia renalis var calculosa narcot. prob. better In carcerated hernia deplet. to faintn. said to be necess. Ice & [illegible] of ether sd by Wood to be better Certain luxations (not, I think in any case of fracture). Parodynia implastica difficult part. from rigidit. Belladonna is better In these cases the quantity of bl. taken prod. the relax & the shock, the faintness manage as for 2nd purpose stand or sit pleno rivo large orifice not stop it so soon as for 2nd purpose If when enough has been taken faintness is not produced stop suddenly to prod. faintness. If a surgical case seize this mon. for the operation Parodynia implastica the pat. is impat. the pract. is [in a hurry] & v.s is too often pract. when it does injury. A celebrated account has broken down many constitutions in this way v.s. is nec. in few cases belladon often answers VI To prod. absorpt. of parabysmata & of emphysemate in ext. tumours If the pat. is feeble it can not be employed & unless a considerable quantity can be taken it is of no service. To be effectual the v.s. shd be as free as can be tolerated without injury use judgment avoid] also shock & fainting. Employ it also in the early stage It is of no advantage in cases of long standing & may be dangerous Often it must be followed by other [illegible] & remedies to promote absorption as quick & active vomiting with turpeth mineral or blue vitriol or even sanguinaria Slow and brisk purging with elaterium is also efficacious & the free internal internal use of tinct. iodine. Those individually or in combin. are herculean remedies Situation has an influence on the quant. of bl. wh. may be taken. Persons in warm or moist situations (malarious) will not bear it so well. Phlog. dis. is less likely to occur & the same degree of it will require less v.s It is less indicated in dis. of chil. but when ind. they bear it very well. Child. are more subject to dis. of irrit. than of infl. & when infl. exists we should be less vigorous in our deplet. It is also less required in the aged In strumous habits less v.s. is required to subdue infl. & such habits will not tolerate bl. well for other purposes Avoid it in them when you can The season of the year is not to be regarded. In the Bethlehem insane hosp. London, they formerly bled all the pat. in the spring & purged them in the fall. When there is not vital energy enough to move the mass of blood, it has been thought that by taking away a portion of this mass we increase the [illegible] power. But s it is found that depletion diminishes the vis [illegible] stil more than the moles movenda A small bleeding when not indicated will not do much hurt for instance zfs to ziii with cinnamon water, as I saw in one case Excessive deplet. produces exhaustion impairs the digestive powers, occasions what are called nervous symptoms & imperfect sanguification with a deficiency of the colouring [portion] of the blood in consequence of which the minute vessels convey a colourless fluid. The nervous and absorbent systems are more weakened in proportion and hence obesity, [illegible] and dropsy ensue. Hectic [illegible] inanition is often prod. which often follows uterine hem. V.S. producing most freq. cong. in brain often in thorax or abd. A habit of being bled prod. corpulency & obesity with laxity & debility When there is a tendency to excessive formation of blood, v.s. will increase it & when there is a deficiency of sanguification v.s. will increase this also. It is well known that remedies will produce opposite effects opposite states of the system Deobstruents for instance will check morbidly increased as well as augments morbidly diminished secretion. Deplet. may produce gen. debility with morb. irritab. or debility with torpor History bloodletting (I believe) was not practised by Hippoc. Celsus bled in all fevers when the pulse was full & skin florid [Arctus] who is suppose to have preceded Galen bled in that fever called cauma Galen bled profusely even in typh the Arabians followed him the Egyptians Sydenham bled Willis bled. Boerhaave did not bled in putrid typhus. These all had a sort of routine practice & no fixed princ. The number of phlog. dis. is less than that of atonic but you wd infer the contrary from the books he causeth diath. was formerly more phlog. These are now more chronic dis. than formerly, which are generally atonic. During the reign of a phlog diath. chron. dis. may be somewhat entonic. Cauma is the only fever which is uniformly entonic throughout It is commonly supposed that all infl. is necessarily entonic, but many ] are confessedly atonic e.g. peripneumonia etc. Simple Saline Refrigerants Nitrate of Potassa A white colourless salt, crystall in hexad. prisms contain. no [illegible] of cryst. though some is mechanic united with the cryst. Undergoes igneous fusion. Decomp. by red heat, becoming nitrite & alternately oxide of potassium 1 nit. ac. + 1 ox. potassium sp. gr. 1.96 oz Solubility increased by addition of chloride of sodium Tested by throwing on a red hot combustible, as charcoal when it deflagrates or by red fumes of nitrous ac. when sulph. ac. is poured on its powder, also by th form of the crystal, but impurities make the form vary. The impurities are chloride of potassium and sodium. To remove these dissolve in boiling water, filter and crystallize. The nit. pot. cryst. first Dissolve in distilled water and add nit. sil. & no? prec. is formed. Decomposed by sulph. ac. & by baryta by sulph. of amm. magn. & alumina & by sulph. sod. at 32 [degrees] Hence all these are incompatible In phlog. dis. taken in the quantity of zi to zjv in the 24 hours it is a pure & powerful refrig. etc. etc. Ed. & [illegible] call it stimulant temperant & diuretic. Paris thinks it refrig. & that it shd be taken immediately after solution as it is then colder I think it never directly diaphoretic & the diaphoresis that sometimes follows is the result of the diminution of the entony. V.S. will do the same [illegible] thinks it one of the best of the diuretics. Paris thinks it acts primarily on the urinary organs, by passing in substance through the circulation to the kidnies, but he considers its diuretic powers as inconsiderable. In paucity of urine and diaphoresis which result from entonic action it is indirectly diuretic, but is not materially so in’ health. It moderately increases these discharges in diseases, neither entonic nor atonic. Murray is right in saying it is too inconsiderably diuretic to be useful in dropsy. It is not sedative in the sense of antirritant. Paris calls it aperient meaning probably laxative Renie says [illegible] to [illegible] is purgative but this operation is inconsider & is merely the result of obviating phlog. diath. Called also antispasmodic or nervine but spasm rarely accompanies phlog. diseases Antiseptic only upon dead animal matter It will however prevent gangrene from high entonic action. Cinchona is called the best antiseptic. But those cannot be indicated in the same disease. Dr Duncan says “Nit. pot.” is admissible only in enton. dis. & A.T.T. agrees with him. They are probably strictly correct Its ill effects (as in typhsus) may not be immediately observable injuring the tone of the stomach etc. Given in atonic dis is dyspep. it produces a small feeble frequent pulse, cold extremities, pain in the abd. like rachiale. Sluggishness and weakness in all the actions of the system & sometimes atonic humor. When it is indicated it should be given in uniform small doses v gr to [illegible] The test for too large a dose is pain at the stomach soon after it is taken indicating a dimin. of the dose so as to fall just short medium dose is called by Duncan 10 grs. others more or less this depends on the intensity of the dis. & the const. of pat. zi may not be too much Generally give it once in 3 hours in quantity just short of that which prod. the pain When its use is continued it can often be detected in the urine Paper dipped in the letter and dried, will deflagrate When the bowels were very torpid I have detected it in small quantities only & those not proportioned to the effect on the system. If the bowels were loose, no trace was discoverable. Hence it follows that its medicinal effect is not the result of its being taken into the circulation Externally applied it is a local refrigerant lessening entonic infl. Add chlor sod. to favour the solution & apply immediately. Applied to tender and irritated parts it produces topical irrit. & infl. & so does tart. ant. It is refrig. nevertheless. Even phosphorus when made to produce topical infl. & irrit prod. aton. infl. This is true of all the stim. A very large dose vomits actively & is thrown off If a poison dose less than this is taken it produces sharp pains in the stomach nausea, swell. of abd. sensa. of cold in stom. cold of extrem. weak of pulse sometimes bloody dischar. faintness, syncope convul. & death. Said to cause ulcera. of intest. & that the muc. memb. is disch. This would prove that it excited a membranific infl. The quantity constitution a pois. dose varies with the state of the system etc. IN strong entonic action it can scarcely prove pois. at least as long as there is entonic action to subdue A.T.T. says zi Rennie zfs to zi Orfila says its poisonous effects are like those of the narcotics & he recom. sulph. soda as an antid. The veget acids & antim. have the same eff. & the purging salts would also if not so soon carried off by catharsis Med. Jurisprudence Not. but detec. of article can. be relied on Treatment An emetic (if no evacuat. has taken place) immediately of turpenth min. bl. & wh. vit. though these are liable to fail hence the veg. em. are better Ipecac in large quantities, though it is less certain than gillenia trifoliata & stipulacea as also euphorbia ipecac. gracilis & corollata Probably sanguinaria & phytolacca would be good emetics. But recent finely powdered sinapis nigra is the best which prevent torpor of the stom. Give about a table sp fl. & repeat two or three times is necessary It is more effectual than the other veg. emet. & disturbs the syst. elss than the min. emetics The distilled wat. of ranum. flammula (if on hand) wd prob. be still better. A few years since a man travelled about the state selling an article to vom. without prod. sickness. It did so. Many persons took it merely for the experiment It was this article to obviate the eff. of nit. pot. give opium & alcohol demulcents. If its noxious effects have taken place & there has been no vom. cath are of no use. Castor] oil zj or ji or gtt p. to i to ol. tiglium or cast. oil with spts turpt. the latter being a stim. as well as a purge these will be better than sulph soda The refrigerants & especially nit. pot. have been much underrated of late partly from change of diath. & partly from inefficient use but chiefly from the chemical theory of their action, by a transference of their oxygen first advanced by Murray Though he has abandoned this theory he still calls them chemical rem. They are as much vital as any others Therapeutic Application [Acute] merc. ptyalism rec. as a lotion supposing it would allay the burning sensation. This eff. is irritative and as this is also the eff. of nit. pot. we shd suppose it inadmissible, but there is a fallacy in this reasoning for canth. will prod. & also cure irrit. As topical applic. there is a fallacy in arranging articles as refrig. or stim. We can draw no conclus. from their internal operation. Probably ol. pin. & nit. pot. operate on the same principle in burns The best remedies for mercr. ptyal. are op. in [illegible] wat. sol. of op. as a wash (unless it produces irrit.) Fowlers’s sol., or sol. nit. sil. topically. Dipsosis avens from recently relinquished habits of intemperance red. because it allays thirst in cauma reasoning bad it may be aggravating the atonic diath. bring on el. trem. & will certainly aggrav. the dipsosis Water & refrig. liq. will not allay this thirst. Stimulating drinks & op. will Dyspepsia rec. by W. Phil. in strong solution, with green arabic when there is inflam. [tenden???] theory Dr Chapman remarks “no article is more apt to relax the stomach & produce dyspepsia. Dr Ives remarks “it is bad in dyspepsia.” It will even produce dyspepsia a bad sort of dyspepsia being caused by long taking it into a healthy stomach The French recommend it in jaundice I know not or what grounds there is great torpor, therefore something to rouse the system is required Also in melaena, a var. of jaundice occurring in broken down constitutions the effect of hot [illegible] of intemperance & hance very diff. to cure No course succeeds with me unless stim. are conj Never prescribe to symptoms merely without regard to names Simple idiopathic cough, in both stages when dry and also after expectoration has begun sd to allay irrit. prev. inf. good if diath. phlog. Remittent, putrid, subputrid (synochous) &nervous. In no form of rem., that I ever wd it be of used irectly the opposite are required Idio, hectic & even in symptom hectic rec. as cooling & sedation it produces no such affect contraindicated directly in all sorts of hectic. Typhus never saw it do harm in synochus [illegible] t. gravior increasing calor mordax etc. which op. carb. amm. etc. will relieve Cauma is universally rec. highly valuable and important next to v.s. & perhaps tart. ant. in nauseating doses The following is called Rush’s febrifuge & is much used in Phil. Rx nit. pot zi tart. ant. gr i dichlor. merc. [illegible] Div. into 8 powd. & give one every 3 or 4 hours The dose of [illegible] & inst is too small A better formula wd be Ant. gr ¼ to 1 nitre gr 2 gr give every 3 hours Apostema commencing diffuse suppurative infl. at hip joint a topical applic of nitre as a refrig. is serviceable So of phlegm. comm. [illegible] bubo f. furunculus I have seen [illegible] in these. It has been rec. in [illegible] them. infl. but it is always bad Tinct. canth. or a blist. is better & dry flour is better than cold lotions. In infl. of fem. mamm. it has been rec. but vol. lin. wd be better or even ac. pl. Bleuorrhea [sanodes] highly rec but Murray says when there is ardor urinae it is too stimulating Tinct camph. Ol. [illegible] Bals. cop. capsic. mustard etc. will cure it & these are more stimulating Orchitis useful but ac. pl. is far preferable. Gout rec. topically but top. applic, are always dangerous. Ac. rheum. rec. by Murray as a refrig dose 5 to 20 grs 2 to 3 times a day with diluents and demulcents this depends upon whether it is phlogistic [Lavendiaur] rec. zfs daily & even in conjunction [illegible] cinchona but v.s. followed by cal. & then by cinch. It is an import. [illegible] iun all the entor. phlog. the best combination nit. pot. cal. & ant. phlog. cephalitis solut. appl. topic but ice cold water is as good Acute phlegm. qunisy, highly extolled as a gargle & not without reason. In eryth. infl. of fauces it will not do much & no art. is superior to capsicum [illegible] bad Infl. of muc. memb. of bladder highly rec. in irrit. infl. of blad. as the surgeons term it but it is doubtful or what grounds for this copaiv. ol. par. etc. are among the best articles Rec. in scarlet fever bad. Entonic active hem. useful It is so limited by Dr Thompson Murray rec. in conjunction with diluents & demulc. now these are bad in hem. Hemorrh. with plethora but it will not dim. the quant. of blood & no dis with [illegible] commences with an increase in the quant. of blood. Diluents & demulc. shd be avoided, as they fill the vessels abstinence shd be enjoined Menorrhea that had become habit. & required the health (probably enton.) it is sd to have stopped the discharge It was given in barley water zfs twice a day produce coldness of stom. cold extrem. etc. nausea “tumult in the bowels” It probably did no good to the general health A dis. is often cured by bringing one worse This article is not useful in irrit. hem. & in passive it is positively bad Porphyra nautica or sea scurvy rec. but not alone nitre with acet. acid is the continuation I am extremely sceptical with respect to articles rec in sea scurvy Land scurvy (p. hemorrh.) arise from bad food, confinement to one sort of diet usually [illegible] hard labour & is probably the same I should not think this wd be benefitted by [illegible] & acet. ac. I have seen it yield readily to tonics Ac. plumbi shd be the basis of the treatment conjoin capsic. alcoh. & nutritious fresh vig. diet. I shd pursue a similar treatment for sea scurvy Diet alone will often cure it Paroniria salax (identical with spermorrhea) Sagnesis furor & salacilates (nymphomania & satyriasis) in these it is rec. by Swed. but I shd not expect much from it Obesity & corpulence In one instance it disturbed the stomach & dig. org. but prod no abatement of dis. If it had been given less freely it would have impaired the appetite less food wd have been taken & emaciation wd have followed. The old rule keep the eye always open the mouth always shut & in feet always in motion is better than any medication In a cellular dropsy it has been given with squills. The latter are efficient but alcoh. is a better auxiliar. In many cases diuretics will not take hold without alcoh. & gin is commonly given The latter acts more by its stimulant than by its diuretic powers. The cases that require no stimulants soon yield to diuretics or [illegible] & calomel Paruria stillatitia & mellita etc. I have never seen benefit from it in p. mel. but the same is true of many other remedies In diabetes it is rather injurious but I have not used it. I have done more with tinct. canth. than anything else Lithis renalis of no use Exormia lichen & prurigo lepidosis psoriasis inveterate used internally & externally In one case it did no good Ecpyesis impetigo var. herpetica (hoopes) & lesinosa (salt rheum) Itch I have tried it repeatedly with no success. It was probably given because it was thought cooling bad reasoning another applic. altogether different has been successful with me Burns & scalds but I do not believe they are to be treated on the antiphlog. plan Bi-carb. of Pot. Sometimes called supercarbonate or carbonate formerly sal tartari essentiala or sal aeratis The common pearl ashes of the shops (?) Crystals quadranga prism Taste alkaline not caustic sp gr. 2 [illegible] soluble in 4 parts water at 60 [degrees] Boiling water taken up 5/6 of its weight More [illegible] than the carb.& has considerable activity Sd to be diuretic it may be but I do not believe it wd be useful in dropsy. Supposed to be antiemetic not much so, & must be injurious in atonic cases As an antilithic inferior to the same dose of the carb. As an antacid it has some power but the carb. ac. disturbs the stom. & weakens it by its refrig. effect. The carb. is on the whole preferable but the bi-carb is more pleasant Perhaps this is the cause that it is in great favour As a refrig. other articles are better & as an [illegible] agent the bi-carb. (or rather sesqui-carb.) soda is better Bi-carb. of Soda Called super carb. soda carb. soda trona more commonly than the preceding called sal aeratis not changed by exposure to air has formed the walls of a fort The heat of boiling water expels half its acid, reducing it to a carb. 6/10 of this salt is oxygen I know of no real superiority it possesses over bi-carb. pot. Soda water every where except in N. Haven is mere carbonated water with not 1/1000 grain of soda to a tumbler full. It is more pleasant without the soda & less injurious A free and especially a habitual use of soda water is unequivocally injurious to most persons. In slender [habits] it induces dyspepsia & in dyspepsia it aggravates the dis. Some of the worst cases of dyspep. arise from the habitual use of this article. The robust very often take it with impunity Soda powders consist of pure bi-carb. sod. zfs & pure concrete tart. acid grs. 25 which form a neutral tart. soda this water is chemically different that of the fountains It is cathartic Seidlitz powders consist of bi-carb. sod [illegible] & tart. pot. & sod (Rochelle salt) zii in one paper & tart. ac. 35 grs in another. Some add bi-carb. soda to cider it destroys its natural briskness & makes it flat neutralizing the salic acid forming a [illegible] which is more refrig. than most other salts Sesqui carb. soda Chlorite of Potasa 1 + 1 Incorrectly called potassae chloras, oxymurias, hyper oxymurias, murias hyper oxygenatus There are two oxides & 2 acids of chlorine with oxygen protox. 1 + 1 perox 1 + 4 chlorous ac 1 + [illegible] chloric ac. 1 + 7 This last some call perchloric & the preceding chloric from the fact that the chlorous was first discovered hence confusion Chlorite of potassa is formed by passing chlorine gas through a concentrated solution of protox. potassium, till it is neutralized as is said. But chlorine never combines with an alkali The alkali is partially decomposed. By gentle evaporation & cooling the chlorite of potassa is precipitated while chloride of potassium remains in solution Authors are very vague respecting its virtues It is not a stimulant It has been tried in phlogistic diseases & seemed to diminish the diathesis [Swedeaur] mentions [asthenia], cachexiae etc. chronic hepatitis etc is benefitted by it. I do not believe in the existence of chronic hepatitis The dis. so called is merely morbid sensibility in the hypochondriac region, occurring in advanced stages of dyspepsia. In post mort. ex. I have found no traces of infl. in the liver It was introduced for prophyra nautica from chemical notions, as it contains oxygen not much used Said to cure syphilis & hence to be deobstruent useless when the constitution becomes affected before this constit. rem. are not needed. Said to cure [culan.] dis. none specified Dose 15 grs to zfs weak refrigerant believe it has no other power unless deobstruent A fine subject for experiment Vide Boston Med. Gazette for Prof. T’s experiments June or July 1832 Bi-borate of soda 2 + 1 (borax) Called sub-borate borate boras sodae alkalesans (because, contrary to fact the alkali was supposed to predominate) Called formerly chrysocolla When impure & native it is called tincue Prisms hexaedral with two sides broader, terminated by triangular pyramids. Sp. gr. 1.24 changes veg. blue to green. Tastes styptic & alkaline Soluble in water 20 parts at 60 [degrees] & 6 at 212 [degrees] Effloresces slightly Loses its water by heat & 4/10 of its weight becoming friable in a strong heat converts it into a transparent glass which is soluble in water By percussion it flashes in the dark Decomposes by acids & alkalies by sulphates, nitrates & muriates, phosphates fluates etc. Found only in Tibet & Persia, obtained from wells in an impure state, by evaporation Brought from E.I. in large masses, white & green, joined by a greasy looking substance I have known it used freely in phlog. dis. & the most I can say is that id did not harm & was thought slightly refrigerant. I have known it employed in the exhaustion of low atonic diseases, not malignant & it neither increased nor diminished strength of action Not stimulant. Said to be nervine probably not. I do not think it is I have never perceived any deobstruent effect from it Said to be diuretic Prof. T. never could perceive it to be so Said to be emmenagogue doubtful Prof. T. has made no observations Swediaur calls it antacid It would be so when the acids were the hydrochloric or the phosphoric, as they may be. Lactic acid wd have some action and also the acetic, if it exists in the stom. which is doubtful. The sulphuric, nitrous, carbonic, & hydrocyanic acids are all that are inferior in energy of attraction to the boracic. Still this will be inferior to other antacids Therap. applic. mercurial ptyalism dyspepsia with cardialgia & acidity proctica [illegible] (“painful hemorrhoidal tumours”) Parabysma coactum of liver or spleen Aphtha ulcera serpentia (Swed.) parapsis acris var. [pousitus] Its most common use in aphtha at first it will allay the burning heat, but only for a moment, not effecting a cure Prof. T. has found milk porridge, barley water, rice water, or even cold water, quite as good and even better than borax It is rec. to dissolve the aphthous crusts. It has no such power & if it had it wd be injurious, as the slough defends the ulcer beneath from irritation. 99/100 of the physic. of this country & G.B. prescribe borax as a matter of course for thrush Case where nothing is done [illegible] quite as well as those where borax is used. Veg. astringents do something toward a cure Nit. silv. is good. Borax is rec. by Dewees parapsis acris. var. [pruritus] Prof. T. has had no experience For internal use as refrig. deobst. diuretic etc. the dose rec. in zfs to [illegible] I have used it in much larger doses without any appreciable effect Swed. says for a lotion in [peraps??] acris dissolve 10 to 30 grs in zfs [illegible], but we use it stronger For internal use it nearly or quite inert If it has any power it is a refrigerant For external use it is about as active as wheat flour merely palliating [teaspoon???] “But my testimony is negative merely. It is desirable that someone shd experiment on it Begin the experiment with zi & take zii ziii etc. Borate of potassa has been substituted for bi-borate of soda & that no so good Benzoates & succinates of potassa Of these Prof. T. knows nothing. Carbonate of Potassa 1 + 1 Called sub. carb. (case being supposed to predominate) Sal tartari sal absynthii more anciently nitrum [illegible] & alkali vegetabili (very inappropriately) also sal aeratis tartari It has a strong alkaline taste and a powerful action on veg. & [illegible] substances Exposed to the air it [deliquiates] & has an oily appearance, where it is called in this [illegible] oleum tartari or oleum tartari per deliquium (a name also given to solution of pure potassa It does not absorb carb. ac. from the atmosphere. It does not readily crystallize Crystals rhomboidal scales Commonly found in coarse grains The poorest is obtained by incineration of bitartrate of potassa but this contains oxide of calcium The more common impurities are sulphate of potassa & chloride of potassium which however are of little consequence except in pharmac. preparations Said to require twice its weight of boiling water for solut. I think less Sd to be insoluble in pure alcohol of the shops. Said to combine with oils & form soaps (but there must be a decomposition) Incompatible substances All the acids All the bi-salts borate of soda, muriate of ammon. nit. silver ac. lead chloride of iron proto & bi-persulphate iron Di & proto chlor. of merc. bi-persulph. copper The most uniform but not the most active operation is that of a refrigerant This is seldom expressly said by authors, though they said it may be given in phlogistic diseases & also in atonic. In very low atonic cases I have seen it prod. irrit. of stom. (i.e. nausea & retching) & impair the tone of the digestive organs It can be considered only as an auxiliary to the other refrig. Said to be deobstruent I think not As a diuretic, with diluents, it has sometimes considerable powers & is more active than as a refrigerant Yet it is rarely successful alone in dropsy. It is only in other diseases that it can be relied on as a diuretic alone & it also increases action’ of other diuretics Its operations is direct as it has no deobstruent powers In hydrops cellularis it is a useful auxiliary E. & Vav. say it is useful in passive dropsies probably meaning atonic cases. I have never seen phlog. cases those called having been merely irritative More useful in paruria inops than in any other disease It is antilithic when the calculus consists of uric acid, cystic oxide, or xanthic oxide An effectual antacid It may be taken moderately in dyspep. with acidity but lime water [illegible] (according & the bowels are lax or torpid) is better the first being a tonic carb. pot. often does mischief in the disease. It is not tonic Said to be anti-emetic. In most cases it does no good & in many it is actually noxious. I have abandoned its use as an antiemetic, unless the vomiting is occasioned by free acid in the stomach Supposed to be antispasmodic & useful in the whooping cough. It is neither recommended in parabysma [illegible] I never saw good or hurt from its use Struma I know of no principle on which it could be of use So too of gout, in which the French rec. it. In dyspep. without acidity Remitt. fev. Spasmod. vomiting employed by itself or in effervesc. mixt. better omitted refrig. are not indic. this is not the best remedy & is often injurious Saccharine matter impairs its powers sugar fulfils the functions of an acid & in some cases takes precedence of carb. ac. Dose 3-4 to 15-20 grs. The French give more 10 grs to zi Give it in water or mucilage, sufficient to prevent a disagreeable taste Do not give so much at once as to distress the stomach It is customary to add just rhubarb enough to colour it & [illegible] ppt. to flavour it & this is regularly given [as a placebo] by some when at a loss what to do Placebos are sometimes of use but I never liked them Carb. pot. is more commonly given in an efferv. mixt. but in this case we have carb. acid and citrate etc. of pot. as a purging salt. The usual proportions are carb. pot [illegible] dissolved in water to f zfs of lemon juice but lemon juice varies in strength (of no consequence) If sugar is added it shd be [illegible] with the acid, or we shall have no effervescence But the bi-carb. is best for efferv. mixt. Taken in poisonous doses it prod. eryth. infl. of intest. tormina soreness, exhaustion, small weak pulse Still zj as been taken without destroying life. Immediately after swallowing take vinegar & water as an antidote, but if infl. vom. & diarrh. have taken place vinegar wd add to the irritation Then give oleaginous demulcents & narcotic antirritants. Opium & hyoscyamus are best. Keep the pat. under a stead & uniform operation of narcotics [illegible] disturbing the stom. by the quantity of your demulcent Carb. pot. is useful externally applied in diabetes & a cataplasm of it applied to a felon or a carbuncle is useful Carbonate of Soda 1 + 1 + wat. 10 Called sub carb sal sodae sal alkalinous fixum fossilis mineral alkali impure soda barilla is to soda what potashes are to potassa prim. cryst. an octohedron Taste resembles carb. pot. but is weaker sp. gr. 1.359 Soluble 2 wat. at 60 [degrees] wat 212 [degrees] Effloresces in the air Undergoes wat. fusion by heat Sometimes it contains so much water that it remains liquid after melting seeming to deliquiate & occasioning a suspicion of impurities. A red heat change it to a transparent fluid A very violent heat drives off most of the acid The same process uses are ascribed to it as to carb. pot. It is however less nauseous & more mild. It has the advantage that it is capable of being made into a pill after driving off the water Dose 10 grs to zfs (ed. & Vav.) Some says zii The common form for pill is Rx efflor. carb. sod. ziii sapo zi ol. ceram mx water q.s. Soda is used in the same dis. as potassa The old phys. are very partial to it in jaundice I have seen no benefit from it. Many rely on it in parabysma hepatica Trit Antimoniate of Potassa This is the fist of the nauseating saline refrigerants The “panacea antimoni” of the dispensatories, accord. to the mod. improved meth. of prepar. it is a trit. antimoniate of pot. Expose “antimony” (the sulphuret?) 1 part & nit. pot. 6 parts to as great a heat as they will bear without fusion, then pulverise & wash out the remaining nit. pot. with cold water It is a white powder of an acrid taste scarcely sol. in cold wat. very sol. in boil. wat. but deposits nothing on cooling (“I do not understand this?) It contains 11.5 pr. ct. of wat. acc. to benz. it is pot. 1 + antim. ac. 3 It is commonly thought that the antimoniates & [anti????] are les emetic & more diaph. & refrig. than tart. antim. It seems to be the case that those antimoniates which remain longest in the stom. producing continued nausea, without vomiting are more refrig. Tartrate of antimony cannot be readily managed so as to nauseate without vomiting. It is on this ground that the “pulvis antimonialis of James (the composition of which is to this day unknown) the protoxide of antim. with phosph. lime & the protox. of ant. (the glass) have been employed. The panacea antimonialis has been rec. in cutaneous eruptions. Prof. T. inclines to think it a bad medicine. He never did any good with it & has continued it until it did injury. The idea seems to be that any thing that acts on the skin must be useful. He considers it useful only as a refrig. & diaph. Prof. T. wishes some enterprising young man wd expt on this & other prep. of antimony Protoxide of antim. Protoxide of antim. with lime Protoxide of antim. & potassa The protox. of antim. was once much used by phys. under the name of “glass of antimony” They made antimonial wine by pouring wine on the glass of antim. in substance. This glass of ant. is very uncertain it its effects. It is much more uniform in form of wine It was formerly used as a diaphoretic & refrig. in dysentery when all diseases were thot to be “hot” Experiments are needed on these prep. Tartrate of Antimony may be taken as the p type of all the prep. of ant. It may be formed Its aqueous solution undergoes spontaneous decomposition on exposure to the air Tests Hydrothionic ac. throws down in yellow precip. carb. pot. a white proc. The most important operations of this article are refrig. diaph. & emetic. It is supposed to be deobstruent but it is so only by its evacuant operation IT is well adapted to entonic diseases but may be used in those which are not purely entonic nor atonic without much injury In phlog. dis. it is more refrig. & diaph. in nauseating doses In non phlog dis when the constit. is also slender it prod. a leucophleg. habit & dry skin, crusts about the teeth & fetid breath. If given freely it produces an’ unmanageable diarrhoea. Its continued uses as an alterative has done this Physic. used to prescribed it in atonic & cutaneous dis. when they were not so well acquainted with it as now Some pat. are more susceptible to it than others & the same pat. is more so at one time than another. ¼ or 1/8 of a gr. will sometimes prod. hyper emesis yet prof. T. has given 35 & 40 & 75 grs. without prod. emesis. But in such cases you may produce it by a glass of brandy sling This was soon after the change of diathesis & proved that after such a change had taken place the article was not adapted to these cases [illegible] of ipecac would probably have vomited those persons freely To treat an exquisitely phlogistic disease (cephalitis, pneumonitis), bleed & give a cathartic of salts (sulph. soda) add 1 gr. of tart. antim. not enough to vomit which will heighten the refrig. effect of the salts You may add too zfs of nit. silver which will greatly heighten the effect. You may treat any phlogistic disease in this way. Laxative Saline Refrigerants Quadroxalate of Potassa Bin-oxalate of Potassa Called sal oxalis sal limonum essentialis (yet it contains not a particle of citric acid) potassa oxalis acidulas sal acetosella (Phil.) It exists ready formed in oxalis acetosella & probably in all the spec. of oxalis also in rumex acetosa & r. acetosella It is formed by dropping a solution of potassa on a saturated sol. of ox. al. ac. in water the bin. oxalate when thus formed precipitates if too much alkali is added it forms an oxalate which remains in solution Binoxalate of pot. has a bitter, pungent & acrid taste It is not affected by the air. It unites with alkalies & earths & forms salts of a triple character It is a popular article in fevers but is proper only in the entonic It is sold in small wooden boxes & called “the essential salt of lemons” It has been applied to strumous ulcers and promotes their healing hence called antiseptic Prof. T. has applied the bruised leaves of the oxalis stricta & rumex [acetis???] with advantage but there are better things It might probably be of service, chiefly as a grateful beverage in fevers Malate & Bimalate Potassa Soda & Ammonia malic acid exists in the [illegible] It exists in the berries of the rhus glabra in the form of the bi malate of potassa. Pour boiling water on the berries and let it [illegible] till cold It is a grateful beverage in fevers Acetate of Ammonia Called ammon acetate ammoniae acetum sal ammonias acetosus sal ammoniacus vegetabilis The solution is called spiritus mindereri liquor ammoniae acetalis & liq. amm. acetatae of which the former is proper It is supposed to be stim because amm. is [illetigle] it It is not so. [Thomson] says the acid and alkali shd both be concentrated to form the best article It is too volatile to crystallise readily, but by gentle evapor. acicular crystals are obtained (& by sublim.) 1 8/10 inch in length Taste first cool, then sweet, finally the united taste of sugar & nit potassa but the mawkish taste of the mit. potas. predominates It is very deliquescent, melts at 170 [degrees{ sublimes at 250 [degrees] Distilled vinegar shd be used & shd be saturated with the solution of [illegible] aqua ammonia Adding sesqui carb. amm. is a nauseous & inelegant mode & shd not be used, as the salt is less powerful and either the acid or the alkali will predominate & sometimes I have tho’t I could taste both (I know not the reason of this If used in cauma & entonic phlogotica it moderates the heat & dryness of the skin & diminishes strength of action Yet Swediaur calls it a stimulant It is a good refrig. & stands next to nit. pot. & soda. It is not nervine It is called diaphoretic, but is so only by obviating phlogistic diathesis, the heat & dryness of the skin being removed & diaphoresis ensuing It is diuretic in diseases not much phlog. nor naturally atonic, with diuretic regimen, but it cannot be relied on in dropsy If there is paucity of urine, it restores it if in the natural state it augments it moderately It is not deobstruent When Swed. assigns it this power he means that it is refrigerant Diseases Recom. in “simple fever general It is fashionable in Europe to treat simple fever as a [illegible] It is never useful in typhus. It is useful only in active infl. fev. Rec on the phlegmasia useful in the phlegmonus ones, not in the atonic or erythematic or atonic arthritic Swed. says it is useful in the atonic erythematica I never saw any other. The supposed phlogistic cases are irritative & in these the article is improper For a dose Swed. gives zfs to zii of the solut. I give zi & never saw it too much The laxative power is less prominent in this article than in any other of the group Acetate of Potassa Called acetate of pot. sal diureticus (the most common name) Tana foliata tartari Tartarum regeneratum kali acetatum kali acetas sal digesticus slivii Longer known than any other of this class except nit. pot Add carb. pot. to distilled vinegar. Citrate of Potassa The citrate of potassa soda & ammonia are all used, and are next in frequency to the acetates. Citrate of pot. is called mixture vel haustus [illegible] riverii It is formed by adding sol. of carb. pot. to citric acid till it is saturated, & drying the product It is very fashionable in London & Boston It is not good in cholera infant. or in any atonic disease, increasing the vom. & purging It is most used as a diuretic being similar in power to acet. ammon. Taken during effervescence it is effectual in allaying vomiting in phlog. cases or those which are not atonic nor entonic No better than acet. amm. not so good as nit. potassa Nitrate of Soda Found native in various parts of S. America I consider this as a refrig. precisely in the same manner as nit. potassa, but in a much less degree It is said by late writes to be laxative in doses of zfs to zi Sd to be diuretic but I think in no other manner than nit. pot. Much used in Germany. Dr Weir (?) wrote on it Refrigerantia acida Vegetable Acids vegetable acids may be divided into 3 groups 1 Those which exist in veg. in a free state or combined with alkaline or metallic bases. 1 Those which are never free but are always combined with veg. [illegible] bases 3. Those which are the product of decomposition the first group comprehends all the refrig. acids exc. the carb. They are the acetic (called also acetous & a modification of it the pyroligneous) citric malis (or sorbic) tartaric (and a modific. of this the pyrocitric etc.) & oxalic (or rheic). The carbonic shd be placed here from its properties. The second group are not [illegible] to possess any medic. power. Examples are the meconic of opium & [illegible] of cinchona. The 3d group are supposed to be nervine. There are but 3 of them benzoic, succinic & perhaps the camphoric Acetic Acid This is susceptible of a greater variety of applications than any other veg. ac. & possesses all the powers of the others There are 4 species viz. acidum aceticum [illegible] acid. acet. dilutum (distilled vinegar) acid ac empyerumaticum (pyrolig. ac.) & ar. acet [illegible] (common vinegar Pure acetic acid is very volatile & its vapour is inflammable. It is obtained by The strength of vinegar is determined by its power of neutralizing alkalies It is found free naturally but it is obtained for use by fermentation & veg. decomposition In the U.S. from cider France from wine (acetum vini) England from beer (acet. [illegible] or Aligar) This acid has been longer known than any other mentioned by Moses. It may be obtained by the destructive distillation of veg. matter in form of pyrolig. acid This or common vinegar may be purified by digesting & afterwards filtering it upon charcoal (animal is best) & then distilling it This forms acetum dilutum, formerly called acetous acid It is contained in the juices of several plants, free or combined with alkalies e.g. with phenix [deotybifera] (date tree) vitis vinefera sambucus nigra galium verum [illegible] [illegible] rhus typhinum etc. but not in large quantities It is a pure refrigerant adapted to entonic diseases abating but thirst etc. It has been given in typhus gravior & putridus, because there is heat thirst, sordes cadaverous smell etc. & the pat. craves acids but in such cases the min. acids are better The heat requires antirritants The sordes cadav. smell etc. indic. a low state of the system & require supporting agents Acetic acid will produce morbid irritability of the stomach & intestines, retching vomiting & diarrhea, exhaustion & a tendency to sink at one of the critical periods. The effects are gradual, therefore not always observed. So of all the typhus phlog. & exanthematica & all dis. of putrid type It is not stimulant nor astringent Said to be antiscorbutic I think not, because it must contain veg. matter in solution to be of service in scurvy. This is the reason why plants of the order cruciferae are useful Antiseptic only in dead an. matter It may prove [illegible] gangrene from excessive phlog. action The veg. acid are said to be anti narcotic perhaps they are after the narcotic is removed from the system. Some narcotics are heightened by them while they remain No narcotic is ascertained to be diminished in power by them. Said to be antiemetics. This depends on the state of the system & stomach Said to be diaphoretic & diuretic only indirectly is it so “Laxative” most acids move the bowels acetic, slightly only “A remedy for polysercia” indirectly so in such quantities as to injure the digestive system spare diet wd be better A sparing use of vinegar in health is wholesome, especially in assisting to digest oily food For laboring men in warm weather vinegar largely diluted with water; syrup & ginger added, is a very pleasant & healthy beverage & far better than ardent spirits Externally it is refrigerant & discutient & may be made to be rubefacient combined with water & alcohol in certain [illegible] used as a lotion in all kinds of erythem. infl. scalds from hot water malig. sore throat tumefaction from sprains & contusions uterine & nasal hemorrhages & [illegible] costiveness. It is inhaled to relieve syncope. It is supposed to destroy specific contagion & is applied to the head of convalescents from small pox. But this is rather a chemical & mechanical than a medicinal effect It is liable to change & decomposition in the ordinary form of vinegar, but the taste smell & appearance will be adequate tests It is used in pharmacy as a [menstruum] & the posers of a few articles are heightened by it, as colchicum, which contain the bi-gallate of veratrine & the acetate of veratrine is more active. So the acetate of sanguinaria is more active also that of morphine is more so than the natural salt of morphine which exists in opium But most articles have their powers impaired or destroyed by it. The preparations are nauseous and liable to decomposition even with a considerable addition of alcohol. The following are used viz acidum aromaticum, acetum scillae, A. colchici, A. veratri (3 species) & A. sanguinariae As prepared from fermentation it is uncertain & shd not be used for these purposes Citric Acid Next in importance to the preceding Found abundantly in the geum citrus of which 3 species are described C. medica (citron south of Europe) C. limonum (lemon) C. linetta (lime) These contain great abundance C. aurantium (sweet orange) C. vulgaris (Seville orange) C. vulg. var. myrtifolia (cultivated in our green houses) C. decumana (?) (shaddock) All these contain citric acid & [illegible] the other species Citric acid is contained sparingly in other genera, as oxycoccus Europeus, cerasus [illegible] (bird cherry) C. hortensis (our old fashioned red cherry) solanum dulcamara, fruit of rosa canina ribes rubrum vaccinum myrtillus fragaria vesca Citric acid is one of the most expensive but most pleasant. The juice of the recent fruit is preferable to the concrete acid in fevers etc. Malic Acid Obtained from apples & pears in considerable abundance, in which it exists ready formed in greater still from the leaves of semper vivum tectorum sorbus [aucuprin] (?) of Europe, sorbus Americana (juice of the fruit) most abundant is the red [illegible] of the fruit of rhus glaborum for medicinal purposes, macarete the berries in hot water & strain The acid thus obtained is than the juice of limes etc. for fevers Tartaric Acid Obtained exclusively from the fruit of the vitis vinifera, in which it exists in the form of bi-tartrate of potassa New wine contains it in solution & deposits it by precipitation on the casks. It is taken from these & purified & crystallized to form the [illegible] bi tartrate of potassa or cremor tartar The true tartar is not recognized in chemistry now The “adiculous syrup of lemons” consists of tartar ac. zj essential oil of lemons (rind) [illegible] white sugar zxvi boiling water zvjii This constitutes the lemon syrup of the shops If too much oil of lemons is added it gives the taste of rotten lemons. There shd be just enough to give it a taste in water. The “salt of lemons” is bin oxalate of potassa, q.v. Oxalic Acid Exists in the fomr of binoxalate of potassa in the oxales Americana acetorella, stricta, violacea, & probably in the others It exists in smaller quantities & the same combination in rumex acetum & acetorella in the juice of the stems of rheum raponticum (pie plant) & a little in R. palmatum & undulatum. The acid of R. rap. was formerly thought peculiar & called rheic ac. The citric is the most agreeable acid than the oxalic, then the tartaric least of all the acetic. The oxalic is more active than the others & is probably the most powerful refrigerant of all The effects of these acids in excessive doses are irritation followed (if a sufficient quantity has been taken & not removed) by erythematic infl. & there may be ulceration & sphacelation if not immediately fatal. The symptoms are nausea, vomiting, pain in abdomen small wiry pulse etc. The oxalic is the most poisonous, next the tartaric, then the citric Immediately after swallowing give carb. pot. lime, or magnesia & if not given immediately they may lessen the evil those however are preventives, not antidotes To obviate the effects we must give demulcents & opiates Carbonic Acid Is said not to be capable of being inhaled It is so if pure, but when much diluted it may be & will diminish irritability & produce first prostration, the exhaustion paralyzing the muscular powers & preventing all effort to escape from its influence The remedies for asphyxia from this gas are a free supply of fresh air dashing cold water over the whole body particularly the head frictions stimulating enemata artificial inflation of the lungs with good air Medicinal operation Almost all the books call it “stimulant ton. diaph. diuret. & antiseptic” Copying from each other. When I commenced practice I supposed so, but have found by actual experiment that this is not true It was injurious in atonic cases & did not aggravate phlogistic ones. If given freely in the form of carbonated water it was an evident & decided refrigerant, diminishing vital energy & strength of action & morbid heat, restlessness, irritability & irritation. It is a decided but weak refrigerant beneficial only in acute entonic diseases. It will correct the fetor of the alvine evacuations. It is analogous in its effects to the vegetable acids. I have a letter from an old physician confirming my statements Boracic acid (nervine?) Fruits Stimulants 2nd Stimulants Rhus venenata not the is vermix which is a native of Japan like R. toxicodendron is useful in palsy, dyspepsia & many diseases is no more unmanageable than any other article & is no more poisonous to the system. The other species of rhus are acrid but this is the best as R. [illegible] is probably preferable to R. toxicodendron. R. radicans is not inferior to R. toxicodendron Alcohol Discovered by an Arabian chem. A.D. 930 Some ascribe the discovery to Arnold de Villenne of Montpelier in the 14th century When strong burns with a blue, when diluted, with a yellow flame. Sp. gr. [absol.] alc. [illegible] 96 or 2 Off. alc. 835 in G.B. & U.S. take a vial find its exact weight & mark it with a diam. Pour into it 1000 grs (troy) distilled water & mark the heights Alcohol up to this mark shd weigh 835 grs. Alc. dissol. pot. amm lithia & the veg. alkalies, but not the earths. Generally all the salts which in water are insol or very sparingly sol. are also insol. in alc. The deliques. are also, exc. the carbonate of potassa Alc. also dissol. sugar, resins, manna, balsams, camphor essential oils Alc. dil. eq. pts wat. & alc. sp gr 935 The peculiar properties of alc. in different forms (as spts sacchari [illegible] spts persici [illegible] bran.) are said to be owing to oily matter always present & to a little acetic ether The former may be removed by repeated distillation & caustic pot. or soda will remove both. The carbonated alkalies do not act with suffic. energy Alc. is sd to be the same from whatever source produced Alc. is stimulant nervine & narcotic It differs from wine in producing an effect externally also, when it produces a vital contraction of the solids diminishes morbid irritability & sensibility, obviates a relaxed state of the soft parts & relieves pain IN many states of the system the use of wine & of alc. prod. the same effects, but there are considerable differences in certain states It is not tonic There is much room for discrimination between wine & alc. as between alc. & ether Greater effect on the brin is produced when atmosph. press. is removed as in ascending high mountains also on an empty stomach It does create a positive increase of power when indicated & properly managed & is not followed by exhaustion It is not a poison in a popular sense of the term i.e. in small doses Wine is indicated in non malignant typhoid disease alc. in low malignant [illegible] is better in the putrid types, alc. in in the nervous. The mode of preparation [illegible] the use of stimulants will make a difference if cal. & op. are not given in the early stages alc. will disagree in the latter & perhaps wine & the supporting agents will disagree also; but if cal. & op. be given at the outset & afterwards the sp. be continued alcohol will agree will if so strong a stim. be indicated Upon the [whole] [illegible] is indicated in chronic diseases & indicate with consid exhaustion, but alc. is advisable in very few chronic cases but is particularly appropriate in acute diseases with extreme exhaustion Intoxication is in no case a stimulant operation, but in some a narcotic, in others a nervine in others both It is not settled to which intoxic. should be attributed. I am inclined to think the remote effects of alcoh. attributable to its peculiar narcotic power No pure stim. nervine or narcotic produces them though the narcotics approach nearest. Perhaps we may consider del tremens as the eff of its nervine power & diseases of the liver of the narcotic, but I am not certain The external marks of intemperance in alc. are inflamed eyes bloated face red nose, tumid abdomen turbid urine foul breath, tremors of the muscles emaciation, peculiar cutaneous eruptions & preternatural old age The effects on the mind are inability to fix the attention failure of the memory & judgment, irresolution, cowardice Patient ultimately dies dropsical paralytic apopleptic or delirium etc. deranges the digestive organs & particularly affects the liver Swine & fowls fed in distilleries are subject to enlargement of the liver & the same eff is prod. on the human subject The constant irritation on the digestive organs causes a determination of blood to the viscera, which produces congestions infl. & parabysma. The particular diseases produced by the use of wine are a peculiar sort of dyspep. (differing from that produced by alc. & other causes) Gout, calculous diathesis & sometimes lithia renalis or gravel. These are exclusively the diseases produced by the use of pure wine The habitual use of alc. produces an obstinate dyspepsia of a different form & terminating sometimes in membranous phthisis limosis syncoptica parabysma to especially of the liver. A peculiar kind of cutaneous eruption Obstinate ophthalmia tarsi hypochondriasis nervous tremors A peculiar sort of conclusion called “drunken hysterics” delirium tremens obstinate dropsy parunia melleta or diabetes impotence paralysis & sometimes catocansis ebriosa These are all the diseases that are the peculiar effects of alcohol In cases of exhaustion from severe exercise, tho in good health, alcohol is a good remedy So if a person subject to rheumatism should accidentally get wet though a free draught of brandy will almost invariably prevent the rheumatism So too of persons predisposed to pneumonary complaints which exposures will bring on So of fever. So too an attack of an [illegible] may often be thus prevented. Yet it would undoubtedly be far better if alc. were confined to the shops of the apothecaries Therapeutic appl. of alc. & wine Limosis dyspep. It is bad practice & shd be avoided Wine is better when it agrees. Alc. may be used when there is extreme exhaustion to bring the pat. within the proper range of susceptibility to other medicines. Diarrhoea It has succeeded when it was simple & idiop. I consider the species of diarrh. as only varieties I except d. tubularis which is a membranific infl. & D. [illegible] which is a symptom of dyspepsia. Opium is far better [illegible] diarrhoea. Cholera a temporary use is often beneficial Generally before the pat. is called the pat. is reduced very low pulse weak, quick cold extrem. epig. stress. Here a small quantity of undiluted spts especially if hot will often suspend the vomiting & diarrhoea & palliate the disease Opium is more effectual but but some cases require alc. in addition Avoid giving a great bulk for this will cause vomiting Intermit. & rem. fever Wine & alc. often useful. These may be 1st of the synochus or sub putrid type 2nd of the nervous, as exquis. as in t. nervosus 3d of the putrid or typhus gravior type. When of the synochus type they are never malignant. Wine & alc. are never necessary unless the cases are protracted & run down In the nervous alc. is preferable to wine but wine is best in the Alcohol Wine 2nd 2d Stimulants putrid if not malignant & low. otherwise alc. But these are to be considered as auxiliaries, when the system has been prepared by cal & op. alc. is more applicable & agrees better. Thus is obviated the irritation which alc. would otherwise produce. Icterus melaena many cases will require either wine or alcohol. Sometimes they will agree, sometimes not give op. with either Typhus in all its forms when malig. alc. non-malig. wine answers very well When run on to a low state, alc. or wine shd be given acc. to the degree of exhaustion the previous treatment & the type Abscesses require either wine or alc. when in a low state. Apostema when low Anthrax when system is much affected & low Erythema [illegible] erysipelat. gangrenous & anatom. in the same cases as the preceding. So too of paristhmitis maligna Malignant variola rubeola & rodalia Phlogotica or visceral infl. may or may not be proper. When approaching to erythema phlegmodes they are not. if to e. gangren. they are necessary or in the early stages IN the arthritic wine & alc. may be highly useful. Arthritic infl. may be acute, subacute & what is called chronic i.e. intermediate between rheum. & neuralgia. All these forms may affect the viscera. In the advanced stages of any of them, if there is a metastasis alc. & wine may be useful Membranific Phlogotica I have not seen a case of croup this winter (1830) in which alcohol has not been employed by others as well as myself. This does not supersede the use of emetic cal. & deobst., but they fail without alc. in some cases or the dis. may run into a low state & then alc. may be required Strumous Phlogotica very often [required them] General acute febrile dysentery often indicated at the outset if malignant also if run down into a low state alc. generally is better than wine In many of the dysthetica they are important auxiliaries e.g. marasmus tabes (not so much in m. atrophins) especially var. venenata from lead & mercury. Porphyra hemorrh. (land [scurvy]) if the case is serious they are highly useful In severe cases the more intense astringents, powerful tonics & diffusible stimulants are highly necessary Gangrene especially G. sphacelus Entasia Tetanus their propriety has been controverted. Dr Hosack thinks every thing depends on giving them just to the right point & that more or less will fail his cases would not have been called tetanus in Conn. they were slight spasmodic diseases & would have got well without any treatment In genuine & severe cases we can trust to neither for a cure. In Mass. such cases S have been treated with Fowl. sol. in very large quantities, sufficient to keep the bowels open & alcohol. Practice that would destroy life summarily in health may be safe & effectual in violent disease. This practice seems to be judicious & judiciously managed Arsenic is considered the most important part of it. Opium shd be used largely at the same time. Lyssa canina proper if great exhaustion Chorea if great exhaustion Chlorosis atonica wine with some limitations Dropsy Stimulants are not incompatible with digitalis. In some cases it will do nothing without stimulants & then will act salutarily. They are those attended with exhaustion pulse weak & feeble extremities cold powers of life considerably reduced Bites & stings. The testimony is complete as to the efficacy of wine alc. & opium The practice is as old as Celsus perhaps Galen (vide my notes) Celsus recc. vinum cum pipere External Use of Alcohol Dr Ives uses alc. zi to zii ol. orig. in scalds & burns & prefers this to ol. pin. He uses it before vesication, which it prevents. If applied too long however it may produce it & be as bad as the fire. The test of sufficient applic. is the relief of pain without its returning on suspension. If the skin is removed, the burn extensive & exhaustion & irritation great, the same mixture is recc. topically Some forms of indolent tumors if early applied, it may discuss them Vapor bath of alc. (Support the bed clothes by a stick) probably some of the alc. escapes combustion & passes up in hot vapor. This bath does not fatigue the pat. does not make the bed damp like boiled blocks Useful in secondary stages of colica ileus & rhuch. in diarrhea cholera icterus melaena chololithus [illegible] limosis gastrodynia malignant intermittents & typhus Wine Vitis vinifera not an [anpelop.] D.C. vinif. & vitis jus native of south Asia. Boerhaave derives the word vinum from vieo to bend or twine It is from the celtic gruzel (pronounced vit) vine, vigne, vinea [illegible] [illegible] etc. all from two hebrew words signifying fountain & to press out. R. & Schultes describe 1 or 200 varieties of vitis vinif. Wine does not exist in the grape The great divisions of wine are alba & rubra Other divis. are acidula as Rhenish or Hock dulcia as Frontenac malaga [illegible] tokay cape austera as Portugalicum or Port, mitia i.e.. not acid sweet not austere, as sherry, madeira, claret, burgundy champaign. To these we may add vinum pomaceum or cider & v. pyraceum or perry Wine is mentioned in the works of Hippocrates in the treatment of typhus It is a stimulant, nervine & narcotic It allays the intense stinging heat of typh. gravior as infallibly as cauma is relieved by depletion & refrigerants. It promotes perspiration when defic. & restrains it when excessive It allays irritation jactitation pain & wakefull all in atonic diseases Excessive quantities produce vertigo, delirium or coma followed by languor headach. nausea vomiting & sometimes diarrhoea For diseases prod. by it vide alc. It is an undoubted fact that a free use of wine diminishes the susceptibility to diseases both entonic & atonic The power of wine in allaying irrit. sensibility increased freq. of puke restlessness watchf. pain etc. is the joint effect of its 3 powers Wine is not properly a tonic though it comes nearer the alc. to being one. White wines contain water, bi tart. pot. & colouring matter. Sweet wines contain sacch. mat. & ret wines, a little tannin. But these mixtures cannot be imitated by art. The properties of the factitious wines are those of their alcohol Hence I consider the active principle a distinct compd of the ponderable bases of prot or carburet hyd. & water in equal proportions, so that wine differs from alcohol as essentially as that from ether. I think it probable that hereafter it will be found that the active principle of alc & cider is 1 prot. carbur. hyd + 2 [illegible] But it is known the brewers add various narcotics to beer to make it more intoxicating 4th Stimulants Phosphorus This article stands next to alcohol in the quickness of its operation. Alcohol acts sooner than any other stimulant phosph. next & the cantharides, but neither of these two can be relied on as a quick stimulant in case of emergency. Ether (considered a stim. by Prof. T. in 18-1 & 1-2) capsicum, and the essential oils are sometime in operating Phosph. is I believe found in the veg. as well as in the min. kingdom. It is soluble in caustic alkalies with heat & probably unites with their metals, as it decomposes water It is not decided whether phosph. acts on the nervous syst. through the medium of the m.m. of the al. can. like ether or whether it acts on the bloodvessels like capsicum, cantharides, ammonia etc. Probably it acts in both ways It is said to be nervine & diaphoretic It cannot however be used as such Dr Ives give it in low stages of exhaustion etc. In mere torpor without exhaustion it is improper. Extreme irritability, though there may be ever so much exhaustion contraindicates it. It is only when the pat. is in a low state & the danger remote that it can be relied on & not at a sudden sinking a crisis, as yellow fever. When there is morbid irritability it is increased by phosph Dr Ives uses it when the action of the disease has worn out the sensibility of the system phosph. thus occasions a new supply of excitability & rouses the pat. in the article of death. This is contrary to the [Brunomia] theory but it is strictly true Dr I. thinks phosph. less favorable when there are topical affections. He thinks it excites appetite especially for animal food Swediaur thinks it aphrodisiac if so it would probably be from its stim. powers & in exhausted states of the system Phosph shd never be given in substance either in pill or emulsion as it wd occasion top. infl. Sulph. ether rectified by dry chloride of lime is said to be the best solvent zi will hold 6 grs of phosph. in sol. Soc. to my experience the fixed oils are the best solvent. Rx ol. oliv. purified & heat it with an excess of finely cut phos. Keep it well stopped. When used add a little spt. amm. to give it a creamy appearance & the pat. will not know that he is taking oil, at which most have a disgust. Sugar with ol. cinn. etc. makes it palatable Take it unmingled. A teaspoonful once in 3 hours is a dose of the saturated oil This was given in an extremely low case when a powerful dose was indispensible Continue this dose until the system is roused & then diminish & continue I have used it in no other than low cases. A small dose of a repeated is the only proper mode of exhibiting stimuli in low states of the system the lower the oftener Phosphorus if properly used is not dangerous & in low states of exhaustion we have no substitute for it Phosph. has been supposed to retain its medicinal powers in combination. This may be true of the binary compds [illegible] of its salts. Liquor of phosp. acid is used as a substitute for phosph. but that it has the same powers is I think more than doubtful It is formed by exposing phos. to the air, when it liquefies from the moisture in the air Sir H. Davy thought this substance a mixture of phosphoric & phosphorous acids Dr Ives’s dose is from 10-30 grs in water every 3 hours. I have not used it Particular forms of dyspep. attended with great torpor & insusceptibility & little irritation are relieved by phosph. In a form of dysp. with epigastric sinking lim. cordial or syncoptica of Good paroxysm every day sense of faintness distress at stomach, aggravated by exertion, both bodily and mental here phos. is of more use than any other remedy, unless alc. or opium which cannot be employed in chronic cases opium is not so dangerous but phosph. possesses superior power of relieving Limosis albicans (white jaundice) also lead colic with great exhaustion here ph. is the only remedy that will succeed Icterus melaena of Good occurring in broken down constitutions secretion of bile deficient differing from jaundice in being attended with exhaustion of digestive powers the skin is livid like a bruise yellowish green cases fro mthe south or intemperate persons. Common remedies do not good. Active stimulants must be conjoined with deobst capsic. or ph. with cal. or better corosive sublim. Malignant remittents & intermittents of trop. clim. & sometimes among us, & the low stages of all atonic fevers, malignant or not, when vit. energ. are low Delirium trem. Here phos. is a powerful auxiliary. In some cases opium alone will not succeed unless the vital energies are roused. Malignant continued fevers of all kinds whether with primary exhaustion or that produced by the disease Plague typh & anthrax involving the whole system Pneumonitis that kind which Good says will not bear emetics etc. In that kind of pneumonia confined to the lining membrane of the bronchiae with infl. like that of the intestines as dysentery Malignant rubelola & rosalia Atonic small pox Tabes var. dorsalis It has been partic. successful in T. venenata from lead merc. & arsenic Impotency certain cases of dropsy diabetes passive hemorrhage by Dr Ives Gangrena sphicelus & necrosis of Good Bad cases of land scurvy Spermorrhea atonica Agenesia in potens var. atonica thought to have especial power Poisonous effects of phosporus violent burning pain in stom. & intest. Alliaceous taste in the mouth obstructed respiration vomiting, hiccup extreme exhaustion Pulse very hard & small towards the close convulsions death. The stom. & intest. are inflamed & [sphicelated]. The infl. is erysip. not phlog which would spread to the other coats If called early give an em. of ipec. or sul. zinc If the phos. has passed down give cast. oil in wine glass doses with a drop of croton oil if necessary. Orfila recc. magnesia to neutralize the acid. I think the acids produced have no share in the mischief. Op shd be given sufficient to allay pain & spasm. No other remedy is needed. Antiphlog. rem. are injurious. Demulcents may be useful but not in quantities sufficient to produce distention Medical Jurisprudence Erithematic infl. of stomach pure phos. or ph. acid in al. canal no other mark decisive. If it has been given in oil, it will not be precipitated if in ether it will. The appearance of phosphorous [oxic] acids is not a proof of poison (or I think) for they are found in dyspepsia etc. & are an ingredient in the human body. Minute particles of phosph must be detested by the eye & by their white fumes, odor & luminousness. 5th Stimulants Arum triphyllum No synonym aroides (fuss.) Piperitae sinn. Possesses a peculiar acrid principle, volatile, inflammable dissipated by drying, air heat & even by pounding in a mortar It is not soluble in milk, oil, water, alcoh. vineg. I know of no solvent. Root contains ¼ part fecula This root produces a strong pricking sensation on the tongue & almost vesicates it Applied to the skin it vesicates In the stomach it produces heat, nausea a pricking sensation all over & spasms of the extremities are among its effects When dry it is inert like starch, but sometimes retains a little power The root is the only part used This root is an acrid excitant with no other power It is an expectorant & diaphoretic by virtue of its stimulant power & when dry it is demulcent & nutritious Externally it is discutient, but rarely used It is allied to capsicum in its powers. Medium dose 10-30 grs If recent 10 grs [illegible] sufficient, repeated once in 2 3, 6 hours. For an emulsion, best in a mortar with milk or sugar. Barton directs a confection by boiling, which destroys the power For extern. appl Beat with irritant or apply alone It is rubefac. & vesic. To keep it with unimpaired strength lay it in sand It is inferior to capsicum Milk, mucilage or oil most conveniently allay its effects Diseases It is put into a decayed tooth Ptyalism as in epilepsy Dysphagia from spams & that from semi [illegible] of muscles of [degl??] It is given with success in flatulent colic Other species of arum have the same properties in different degrees, as A. dracontium calla palustris less active than arum but similar Lecontia Virginica The strongest of all the arrideae acrid & mucilaginous. Arum maculatum is the off. spec. in [Eu???] Ictodes feticus Formerly called arum Americanum (Catesby) calla aquatilis (Gronov.) Dracontium fetidum lim.) posthes pectorii (B.S. Bart.) P. foetidum Lymplocorpus foetid (Salist.) Spathic [illegible] foetidum ([Rafines]) Ictodes foetidus (Bigel.) Every part has a fetid odour, depending on a volatile princ. probably a volatile oil, but it has never been separated. It is more permanent than the active princ. of A. triphyl. It has resinous & mucilaginous [illegible] its acrid & odorous properties. The seeds have an animal odor & contain a fixed oil The root and seeds are the parts used but the seeds are preferable. They retain their vital principle for years & their medical virtue as long. The root loses its strength by drying This plant is a powerful excitant like arum. It acts on the alim. canal & does not affect the circulating system immediately. It is a nervine like asafoetida. Very large doses occasion vomiting, headache vertigo & sometimes a temporary blindness It is probably not a narcotic Of the dry root 10-20-30 grs every 2-4-6 hours may be given. It may be formed into a confection or better, may may be taken in molasses & water Dry it whole & exclude the light It is doubtful whether the leaves are any better than cabbage leaves, but they have no offensive smell as cabbage has after topical application Uses & applications similar to arum maculatum It is not so powerful but it is better in flatulent colic than arum as it is nervine Dyspnea exacerbans It has more reputation in this than in any other disease Repeat it every 10 min. until it produces vomiting or relief. The vomiting itself is often of service To prevent the recurrence give 4 doses a day Dyspnoea seems to arise from paresis of the gastric branch of the par vagum & is relieved by Galvanism chronic rheumatism by a continued use like guaiacum & capsicum Convulsions particularly hysteria Paramenia cessations Dr I. recc. the limb in phleg. doleris to be wrapped in the leaves all over (as a smooth app.) Acorus Calamus [Odor] like a mixture of cinn. & pimento improved by drying. Essential oil can be obtained. The bitter principle is extracted by water It is an acrid aromatic excitant, with some tonic properties It is not inferior to cinn. & nutmeg in substance & oil. The dry powdered root is an excellent errhine IT is used for economy where cinn. & nutmeg cannot be afforded & were it as dear would probably be as much esteemed. Essential Oils These are 1 Pure stimulants 2. The milder oils as ol. anisi, a pure nervine 3d nervine & narcotic or stimulant & narcotic The terebinthinate oils are stim. & deobstruent Articles containing the oil are often used in a crude state, if it is in abundance e.g. cinnamon cloves Monarda Punctata (Wills.) The most acrid & pungent of the essential oils It flavor resembles that of thymus or satureja It is an elegant & pure aromatic & stim. Extrem. It is one of the best veg. or rubef. & vesic. For intern. use make a spt. rx f zi oil to 7 of off. alc. ( I make the spts ppermint in the same proportion) It is very good to cover the taste of unpleasant articles. So oil cinn. The oil cannot be taken pure, even on sugar For a [linin]. Rx ol. mon zfs tinct camph. zii & tinct. opii zii Probably the spt. monard. wd be as good for a rubef. Ol. monarda with ol. oliv. remains more fixed but is not so powerful The oil was introduced by Dr Atlee of Phil Ol mon. is more vesicating than ol. capsic. & less so than ol cantharides The other monardae are much less active Therap. applic. Typhus with cool skin & cold extremities use the linim. on the arms legs & breast (Eberle & Alee) to restore heat. Brandy would only evaporate & increase the coldness Cholera infantum (an enteritis) to the abdomen & extremities (Eberle) Chronic rheumatism internally & extern. peculiarly adapted partial palsy hemiplegia & [paraplegia] Tooth ache I have used the oil when the nerve is exposed apply it on cotton to the cavity of the tooth & around the adjacent parts or it may relieve by ext. app. ol. capsic. is best ol. mon. next. Mondarda oblongata Less active than m. punct. but nearly equal. The infus. is useful in the atonic stage of fevers. The weak infus. is quite effectual in the forming stage of the atonic febrile disease Monarda didyma (Banks) & monarda kalmiana ([Pursh]) These are used for nearly the same diseases as m. punctata & probably differ only in degree of power. M. kal. was first discovd at Oswego & called m. didyma Pursh gave this name to a southern species. Both are probably varieties. At least the “oswego tea” has the best claim to the name. The different spec. of mon. ether contain a less active ss. opil or a less quantity of the same oil. I know not which probably the latter. If so the same oil might be distilled from each Probably m. oblongata would furnish a large quantity Monarda fistulosa Common in N. England & has been cultivated in Europe for the oil It is the origanum spurium of old writers. 6th Stimulants Capsicum C. grossum squash pepper is the spec. almost exclusively cultivated amongst as C. annuum is mentioned in the books as being the off. article but is far less common. The [pericarps] of C. grossum contain 1 an essential oil (called etherial by the French) which is not volatile at all, and the case also with that of piper nigrum. It is obtained by digesting the pericarps in ether for a fortnight expressing filtering & evaporating the ether. We obtain the oil & crystal of capsicine the scent of ether still remaining which perhaps might be driven off by heat. The oil thus obtained & is of a brilliant red colour aromatic in odor, pungent & warm to the taste It cannot be distilled without decomposition. It contains all the medicinal virtues of capsicum. I have for years used it as a substitute 2 Capsicine white acicular crystals without odor or taste neither acid nor alkaline. AT the 1st crystallization they are combined with some of the oil & were hance supposed to be the active principle & sold at a high price. By repeated crystallization they are purified and then have neither sensible nor medicinal properties. The same mistake was made with regard to piperine which we always see yellow from the oil, but when pure is quite tasteless & inert 3. Red colouring matter which it is difficult to separate from the oil 4. A substance not investigated containing nitrogen 5 Mucilage 6. Various salts especially nit. potassa For excessive doses of ol. caps. demulcents of opium are the proper remedies Dose of ol. cap ¼ gtt or 1/8 gtt sometime 1 [illegible] or more Of the substance 12 grs is a very large dose in our climate but more is given in the W. Indies. If we wish for the effect on the stomach only, and not on the mouth & fauces the tinct. shd be given in milk. Mix & swallow immediately & it is not tasted Pat. do not generally complain of the taste in acute disease though they may in dyspepsia etc. Nor do they in low cases of typhus & cholera. When there is very great burning in the mouth & fauces this article cools more than any thing else The vinegar of caps. is not so good in irritated states of the stomach or in the low stages of fevers but it is the best form for affections of the fauces in rubeola & rosalia Cataplasms may be made of the powder & flour & vinegar. Or the caps. may be sprinkled on a paste. If a very speedy effect is desired a paste may be made with pure powder of caps. & hot spirit As a rubefacient it excites an action sui generis & often excites one when other things fail. There is room for selection in rubefacients In many cases tart. em. is bad & caps. good & v.v. So of other rubef. Therap. applic. Rheumatic toothache The tooth is often carious if on the lower jaw drop it in the oil if on the upper moisten lint, or rub up the oil with sulph. morph & dip lint in Chronic ptyalism often symptomatic of paralysis or of epilepsy & chorea gargle the mouth with the tinct. or the dilut. essence Dysphagia atonica often a more part of general palsy but it exists sometimes independently & is then curable by capsic. Dysphagia spasmodica Limosis dyspepsia in cases attended with torpor & insusceptibility, with much flatulence & freq. reject. of food. Capsic. alone or conjoined with food, or with eccoprotics, deobstruents & tonics will cure In cases of cold extremities rub them with the diluted oil till it produces a glow more or less permanent & so as to be slightly rubefac. if the powder on cotton is used it shd be very fine, for if as coarse as we have it for the table it will produce very little effect. It is used externally on this disease as a stimulant to the epigastrium either the powd. or the ess. oil Incorporate it with a spatula with La & Butler’s (which is the best it will spread cold) adhesive plaster common pl. is too hard Limosis syncoptica a valuable adjuvant shd be given in form of tinc. or oil as more speedy Limosis albicans (“white jaundice” no jaundice at all) highly useful auxiliary to [xanthortia], percholr. narc. & opium Dr Reed of E. Wind. who uses caps. extensively recc. it in all kinds of diesth. attended with viscid secretions from the liver to check the secret. in quantity & change them in quality Colic I prefer rubefac. to blisters in their action can be kept up in the 2nd stages it is important as an auxiliary Colica rhechialgia Capsicum counteracts the sedative effects of mineral poisons particularly of lead. Lead does not always produce colic, sometimes marasmus & sometimes paralysis, without being preceeded by colic The proper remedies for all these effects are acrids & particularly capsicum Colica cibaria of Good from poisonous fish mushrooms etc. (as often however a cholera or diarrhoea as colica). The tropical practitioners depend altogether upon the acrids & say it is no matter whether the offending substance is evacuated or not I prefer evacuating if pat. is not sunk too low. It is important to know that evac. is not indispensable in such cases we may enter at once upon the acrids as capsicum with confidence of success If called early I would evacuate the al. canal & sometimes this is all that is required if not give acrids. The effects of pois fish & pois mushrooms are very similar, being in both cases speedy & direct (sometimes very rapid) exhaustion. Some persons are more affected than others the reason is inexplicable. Those of warm climates are more susceptible than of cold Colica flatulenta Coprostasis costiveness attended with torpor & atony, apparently local cases where refrig. salts have been taken till an enormous quant. is necess to operate & then with small effect. The simple acrids such as are not cathartic will often give complete relief in some cases as much capsic. as can be taken with the food has answered the purpose. I know of no certain diagnostics in these cases. The subjects are generally feeble & no harm can result from trying caps. Caps. also enhances the effect of tonic & astring. cath. as rhubarb Diarrhoea, pure or idiopathic in the secondary stage caps. can be relied on alone shd not depend on it in the 1st It is particularly adapted to 2d stag attended with excessive & morbid secretions & relaxation it restrains and changes these secretions. Cholera when the vital energies are exhausted & there is great irritability of the stomach etc. caps. will often check it vomiting when opium will be rejected The phys. is not often called in the forming stage, before the vom. & purg. has commenced, at which time some other remedy might be preferred Cholera flatulenta great flatulence & copious rejection of air, without vomiting or diarrh. Here caps. alone is sufficient & opium is unnecessary Parabysma coactum useful auxiliary to conium & perchloride of merc. Parabysma strumosa Strumous diseases always require more stimulants [illegible] stimulants Idiopathic cough from relaxation Dyspnea exacerbas & asthma humidum in the 2nd stages & attended with relaxation & excessive secretion Passive hemorrhages capsic. is a popular remedy and often prescribed successfully by physicians Erythema of the membranes of the brain Perhaps the W.I. practice of shaving the head & applying rubefac. of caps. in delirium would be useful. I know not that it has been tried Paristhmitis erythematica independent of Rosalia. The original recipe was 2 tab spf of capsic. 2 teasp. of fine salt ½ pt. boiling water when cool strain add 1/3 pt vinegar dose a tabl. sp. every half hour. This would very well in moderate cases. The lowest & most severe wd do better without the salt & vinegar Apostematous Phtisis after the formation & bursting of a vomica capsicum restrains the purulent secretion, sustains the pat. & prevents sinking Dyspeptic Phthisis Erythematic visceral phlogotica are not generally recognized & described in the books except enteritis & gastritis eyth. infl. has a great tendency to spread, throughout the membrane which it affects Erythematic Enteritis attended from the first with diarrhoea & with vomiting if the stom. is affected. At the outset give calomel freely with opium conium & often sulph. quinine capsicum is useful externally. Capsicum is useful in all the stages of genuine & malignant erythematic phlogotica & in the secondary stages of phlegmonoid eryth. phlogotica Sparganosis [illegible] in cases supervening upon excessive hemorr. & attended with a low & exhausted state very useful here often as a principal remedy & always as an auxiliary. It is not proper in cases occurring after a long period & in the more vigorous & robust gout (regular) in all low cases Podagra larvata of Good improperly called by Cullen atonic gout for all cases are atonic Case of Dr Cooley violent paroxysm in his feet he applied some sort of poultice & in twelve hours it wen to his stomach. Dr Todd & myself were called we gave ammoniated alcohol, amm. tinct. guaiac. alcoh. opium etc. apparently with little benefit got no relief & was in a dangerous situation Dr Reed of E. Winds. entered on a free use of caps. internally with speedy relief. I have known other cases Rheumatism secondary stages of all ordinary atonic acute & all stages of erythematic atonic acute rheum. Eberle is too vague Rosalia maligna Rubeola maligna Malignant small pox whether confluent or not (all malign. cases are not confl.) Cases may clearly be of distinct small p. & yet require the most vigorous stimulation Purely passive hemorrh. & perhaps irritative Marasmus Tabes var. strumosa, var. venenata, from min. poisons & var. libidinosa Cyrtosis Rhachia All the strumous phlogotica & strumous affections of the glands of the neck Porphyra hemorrhagica It is second only to ac. lead I commence with lead & continue it till the hemorrh. is stayed usually from 3 days to a week. Then I omit the lead & substitute the sulph. quine. I accompany the lead from the first with caps. & brandy. The success of this practice bears no comparison with that in the books Gangrene all the species Insanity several species is to be treated most successfully by tonics acrids & deobstruents. This is the way in the Conn. Hospital & the prop. of cases cured is greater than in any other institution Melancholia acrid most useful Hypochondriasis Chorea good auxiliary Syncope in persons habitually subject, occurring from slight causes or spontaneously 2 or 3 hours a week for 6 mo. in such cases I have given various remedies both as prophlylactics & to bring pat. out of the syncope have found nothing equal to capsic. for both purposes. She could tell when the paroxysm was coming on & zi of tinct caps. would prevent it Carus lethargus It has considerable reputation with Dr Wright of Jamaica Paralysis not depending on organic affections Cantharis pellitory capsic. & guaiacum are the best caps. one of the best. Paramenia retentionis & [obstructionis] when attended with atony as P. retentionis always is The acrids, deobstruents & tonics, are the proper remedies. P. obstructionis may arise from imprudent exposure to cold & in such a case capsic. is not proper P. superflua Leucorrhea communis & [illegible] Dr Reed of E. W. values it more highly than any other article. I prefer cantheris unless the pat. is unable to take a suffic. quant. without troublesome strangury capsic is next. Nit. silver shd accompany the acrids (localls)? & local means shd also be employed Hemorrhea Senodes I have repeatedly cured at the outsed, freely & rapidly employed Cubebs which is similar is rather more certain to cure but it is not so readily taken Spermorrhea atonica Chlorosis inops Hydrops Thoracis & cellularis a valuable acjuvant to diuretics & tonics. We must first evacuate the water & then tonics & acrids will cure, if idiopathic Empresma abdominis (Tympanitis) from diarrhoea or catharsis in typhus & colic Capsic. very useful Paruria mellita externally as a rubef. & intern. as an adjuvant Capsic. is felt in the urinary org. & is smelt in the urine Paruria in continuous var. atonica Considerable reliance can be placed upon the acrids both internally & externally Capsicum is always contraindicated in phlogistic diseases, even after depletion when cantharis might be used Forms of administration 1st Pill essential oil in bread or in substance grs ii to a pill The dose of the oil cannot be definitely given Be guided by the nature of the case & trial Substance 1 – 4 – 12 grs as much as can be borne every 1-2 hours. Some give more, even as high as 30 grs this wd be rejected Pharmac. Preparations Tincture in the best. I usually make it with zii caps. to 1 pt dil. acl. Dose 10 gtt f zi Vinegar & water will rinse the taste from the mouth Acetum caps. is a good prep. prepared as the tinct. Dose the same Infusion zii to zi to 1 pg. water If it is to be sweetened, use honey Externally the U.S. Ph, directs canth. z10 caps zi alc. 1 pt. This prep aration might be taken internally too., 8th Stimulants Alkaline Ammonia Unknown to the ancients solution & carb. discovered by the alchymists Aq. amm. shd be well stopped with a ground glass stopper as it absorbs carb. ac. from the air. Much of that in the shops is worthless The alcoholic sol. is called spt. of amm. Internally they are purely stim. & acrid They act principally on the m.m. of al. can. but at length cause a rapidly & transient in crease of the force of the circulation, if repeated at short intervals The water & spiritous preparations differ As it is unpleasant it is rarely taken for any length of time I have never seen any nervine effects from it, wakefulness & exhilaration. It does sometimes relieve morbid irritability & irritation. So does pure stimulants in exhaustion I never saw it diaphoretic except by virtue of its stimulant operation It is discutient, topically applied not resolvent, internally It is antacid neutralizing a large quantity of acid & also preventing its formation by its acrid stim. effects thus obviating the morbid condition Dose of qa. or spts f zfs – f zi If it is to be often repeated, dilute with milk & it is taken much more readily water when a strong impres. is wanted It is rubevac.vesic. & caustic applied weak for a short time it merely reddens if strong an eschar is produced. Most generally applied in liniment with ol. oliv. this is best. When applied pure, flannel will prevent its evaporating. But linim. is better, which shd be of various strength & made of aq. amm. Taken in excess it prod. aton. uinfl. of stom. & int. The infl. is eryth. like that from acids or hot water & in both cases, the less fever the more danger. Eryth. infl of m.m. is more atom. more dangerous & more diff.to cure, than of skin In the worst case of an excess. dose, there was no pain, great exhaustion as in severe scales great stupor, pulse wiry & freq. & weak, skin cool. If the dose is not so great there will be a burning pain at the stomach afterwards retching & vom. perhaps tympanitis & sometimes fever. The more pain, the more hope of saving the patient [Orfil] recc. diluted vineger in large quantities to neutralize but after a few moments the mischief is done. It may however be given in smaller quantities, even an hour or two after to prevent further mischief. V.S. & antiphlogistication will do not good & be as improper as in burns & scalds. The topical eff. requires demulc. & antim. the general, opiates. Demulc. shd be in such moder. quant. as not to prod. stim. of distent. Opium frequently is best give by enema, but this depends on circumstances Therapeutics application Colic diff forms as a rebef. & vesic. Phlegm. infl. as apostema communis & common phlegmon early stages Effects a resolution when the infl. wd otherwise grow to suppur. Infl. of fauces early stages of phleg. & all stages of eryth. to the fauces & externally Inf. of female breasts said to cure if applied early, sufficiently & properly These infl. are diseased with more certainty then most others & are more troublesome if neglected Chronic Rheumatism when perman. & fixed topically Palpitatio from functional derangement of the nerves & dig. org. & not structural or organic as a rubef. to the thorax it is an effectual applic. Carus Asphyxia several varieties. C. paralyis not structural topically & externally Idiopath. vertigo [illegible] vertigo of Good Sick headache inter. & exten. gives speedy present relief Syncope from aff. of mind in universal use Common & hysterical convulsions also To do any thing with it in sick headache zi shd be taken freely & early better in nervous and highly irritable temperament. IN such patients the head ache depends more on the state of the nerves than of stom. Paramenia obstruct. highly recc. in milk thrown into vagina strong enough to prod. a sensation So too in Leucorrhea communis & senescention about the catamine period Bits & stings every effectual, but alc. & capsic. are more so. There is not a case on record, where alc. was sufficiently employed that was not cured. Dr John Osborn of N.Y. who had practised at the south said that when called he knew not what to do till the bystanders told him. He found amm. invariably successful & when summoned sent amm. without going himself Yet alcoh. is better. It is well known that a drunken man never suffers from a bite Scalds & burns If applied before vesication it will prevent it after vesic. it is bad. It shd be applied only till smarting & pain cease or it will vesicate. But it is again useful if a bad ulcer is produced & especially if there is danger of gangrene. It is prod as a favorable & speedy separation of the slough Aq. comm. shd be kept in in all vials of not over zviii for it is injured every time it is opened For a liniment equal quantities of aq. amm. & ol. oliv. will be too strong for the best amm. & weak for the common. Skip the next page This page to be read after the next a tea sp. f. is a medium dose, moisten it a little with water or any fluid not acid & it will be readily taken. It is useful in atonic febrile diseases. It is better than Dover’s powders Formulae shd be varied acc. to circumstances The following may be useful Rx sesq. car. am. zfs syr. orange peel zfs aq. menth. vir. zviii Take zfs every ;2-3 hours (Paris) Rx Ser. car. amm zi syr. alk. off. f zviii, or orange syrup not acid Dose zfs 2-3 hours 10 grs sesq. car. amm. (Richie) Rx Ses. cer. amm. arom. conf. aa grs v pulv. canthar. gr f simple syrup q.s. Take a bolus every 6 hours (Paris) The intervals are too long The canth. is the most active article Rx s. c. amm. grs v ext. rhei grs viii fl pil. 2 To be taken soon after making (Paris) Eccoprotic & antacid for dyspepsia Dr Ives uses the following It is much weaker than Paris’s & Paris’s, than the other Rx s. c. a. zii camph. [illegible] gum arab. zii water 1 pt. The water must not be boiling hot Sesqui-Carbonate of Ammonia Boiling water volatilizes it By keeping the carb. changes into a bi-carb. losing its odor & partly its taste, but not its alkaline properties It is a stimulant but less powerful than the alkaline amm. It can be better taken however. It is inferior to the carbonate but super to the bi-carbon Sd to be nervine & diaphoretic probably so from its stimulant power IT is an antacid, but inferior to the bicarb. Dose 6-20 grs in solut. or pill Its uses are more extensive from the greater facility of giving it & its supposed additional powers. Sesq. carb. am. camph & chalk, eq. parts powdered separately & well rubbed together is one of the best form & adapted to most cases. Stop it well & exclude the light or the camphor will be crystallized. The chalk keeps the camphor & carb. am. from concreting into small masses & also covers the taste. This mixture is stimulant narcotic nervine diaphoretic and antacid Turn to the page [prece??] or it will volatilize the amm. Dose zfs – zii every 2 hours Some of the late English writers recc. sesq. carb. amm. in 2-3 gr doses as a specific in rosalia & paristhmitis It is a good remedy in moderate cases. They use it much in convulsions of children & it is considerable used for dyspepsia Dr Woodwd of Vt. used it in in dyspepsia with camph. & chalk & some acrids as capsicum & prickly ash & also with gentian, etc. Intermittents It is much used, particularly at the commencement Used to in typhus IN common epidemic catarrh gout & atonic acute rheumatism hemicrania & sick headache. Also employed with considerable success in after pains of puerperal women & when used moderately it does good, but it only accomplishes in a few days what opium would do in the same number of hours. Cathartics Cathartics Refrigerant Cathartics Sulphate of Potassa Hiatus This has been called an aperient by Duncan in doses of [illegible] to zfs & cathartic in zv. It cannot be managed as an aperient in Dr Tully’s sense of the term Hiatus It is purgative cannot be managed as a laxative nor as an eccoprotic neither as a drastic It is a hydrogoge but not sufficiently so for dropsy. Elaterium is better It operates on the whole al. canal but rather more in the upper part It is kind in its operation & leeves the al. can. in a good state It is a rapid cathartic. It is not appropriate to produce a shock or strong impression Its other operations are refrig. said to be diuretic do not think so Hooper says it is deobstruent. I know not upon what ground. It cannot be so independent of the evacuation Medium cathartic dose is zi as a refrig. from zfs to zi once in 2 or 3 hours Diseases Cauma & all the caumatoid phlogotica of course contraindicated in low atonic fever It is appropriate in any phlegmonous infl. Hooper says coprostasis this is an atonic state of the system & therefore this article cannot be indicated there is torpor of the liver & this does not act on the liver H. says too that it is good in jaundice The same rule applies here He says too in suppression of the lochia. There is no such idiopathic disease if the suppression is attended with infl. of the uterus sul. phot. may be indicated He says dropsy too but as there is no entonic diathesis, it is not indicated Sulphate of Magnesia Hiatus Duncan says it is a mild purgative. This is applicable to all the salts of which I shall treat It is said to be diaphoretic not directly so, but by virtue of its evacuating operation. Not much diuretic Duncan says it will relieve pain in colic. It will do so only in entonic diathesis, but colic is not entonic It is cathartic in the same degree & in the same way as the two preceding salts (sulph. pot. & soda?) Disease & rules of application are the same also Phosphate of Soda Sal perlatum of the old books It is similar in its effects to the other salts & requires very little if any more to a dose It is better managed as an eccoprotic & laxative than the others It is not quite as refrig. as the pre ceding, but all its other peculiarities are the same as to time, mode etc. Med. canth. dose zi – zfs Swedinaur recc. in struma & do not think it appropriate Tartrate of Potassa Elixir tartrata kuli tartras kalitartarisatum pot. tartarizata alkali vegetabile tartras tartras solubile or soluble tartar is the common name of the shops It has the same effect as the others I do not think it can be distinguished from them. I have found no article but the antirritant narcotic that wd qualify its operation so as to prevent [tarmina] Tartrate of Potassa & Soda Soda tartarizatum sal polycrestum sal seignetti, Kali & sodae tartras tartrite of p. etc. It was introduced by an apothecary of the name of Seignetti I know of no difference between it & the others it is applicable to the same uses Bi-Tartrate of Potassa Hiatus Duncan says from zfs to zi is a medium dose for a cathartic It is far more diuretic than the others yet not sufficiently so for dropsy It is of no more benefit in schirrus or dropsy from schirrus than any other deobstruent It is purgative cannot be managed as a laxative is more hydragogue than any of the others quick in its operation not so kind It is peculiarly liable to derange the al. canal. None of the other salts can be said to be irritating. This is considerably so consequently it is better adapted to produce a shock or strong impression. It is more refrig. than the others Medium dose, from 10 – 60 grs once in 3 hours 60 grs once in 3 hours will purge pretty thoroughly And 10 grs in the form of pulvis jalapae composita Rx powder of jalap one part bitartrate of pot. two parts ground together to an impalpable powder. This pulv. jal. com. is recc. as a refrig. & used to be the common hydragogue when phlogistic diathesis prevailed. It is even now retained by some phys. & is Dr Hosacks hobby he gives no other The b-tart. pot. is adapted to the same diseases as the others except that it is better in dropsy being more hydrag. & diuretic. Dyspepsia recc. by Jas Johnsn of course contraindicated he gives it in a dec. of dandelion Colic-recc. coprostasis not good Proctics marisca & bleeding from hemorrhoidal vessels It increases the irritation Oxide of Magnesium This name has been applied to the factitious carb. mag. magnesia alba M. usta calcined mag. has been applied to both ¾ of the “calcd mag.” sold in the shops is nothing more than the carbonate Its purity can be tried, by its not efferv. with a strong acid It is eccoprotic, or at most laxative & antacid Diseases cardialygia spasms convulsions tormina & other diseases produced by acids in the al. can. Swed. recc. in coprostasis Ricketts. Suppressed leucorrhea accompanied with torpid bowels Gout supposed to be peculiarly adapted small doses continued for a long time were thought to remove the gouty diathesis lithia gravel independent It is not [illegible] Medium dose 10-30 gras 3-6 times a day. One circumstance shd be attened to. It diminishes the appetite chance where the case is atonic & there is a want of appetite, it shd not be given The salts of oxide of magnesium, in appropriate cases, as phlogistic ones are kind in their operation & leave the al. can. in a good state. They make but little impression on the system & therefore are not serviceable in giving a shock Med. dose zfs – zi in solution indeed you may say zi is a med. dose. Better in solution than in substance In highly phlog. diseases it is proper to add nit. potassas or tart. antimony to increase the refrig. effect. When a cath. Is not wanted the dose as refrig. is about the same, but nit. potassa & tart ant. are better Diseases Cauma entonic phlegm. phlogotica They are sometimes applicable in diseases not exactly entonic nor atonic 2d Cathartic Factitious Carb. Magnesia mag. sub. carb. magnesia alba mag. aeratii It is soluble in water Eccoprotic & laxative may be so managed as to prove both Not purgative nor drastic under ordinary circumstances. A. T. Thomps. says it is not laxative unless it meets with acids in the stomach It is copragogue. It acts on the whole track of the al. canal. It is slow & kind & generally leaves the canal in a good state. It is antacid Cath. dose 10-30 grs several times a day Diseases Limosis cardialgia Coprostasis some cases such as do not require large doses of medicine By means of this article more carb. acid might be generated in the stomach than in any other way. But I do not approve of the great use of this acid. Mildest cathartics Manna From the Ornus rotundifolium It has been said from the fraximus rotundif. Same not. group with the olive oleaceae It is the concrete exuded juice, obtained from the descending sap by slits cut in the bark The juice is of a white frothy appearance Taste slightly nauseous The best calubrian manna comes in long light friable pieces transparent pieces. The inferior kind is moist unctuous & dark coloured Fourcroy says it consist of four principles 1. Pure manna ¾ of which is called mannite 2. a little common sugar 3. a yellow substance of a nauseous smell 4. mucilage E. & Var. call it a mild purgative Murray, a laxative It is eccoprotic & laxative It is given to children, but is unimportant for adults. The older it is, the more purgative Dose for adults zi – ziii in water milk & water or better in milk Cathartocarpus fistula Native of E. & W. Ind. but cultivated in the warmer parts of the U.S. Commonly called “Locust & wild honey” The pulp of the loment is the part used. It has a black colour & a sweetish taste. It is said to be a good cathartic when taken fresh from the pod It occasionally gripes & produces flatulence It is given for children Eccoprotic at the most laxative Copragogue Acts on the upper & middle part of the intestines. It is kind unless the patient is predisposed to tormina pains etc. Medium dose for an adult zfs - zj Rosa Damascena Damask rose Native of the south of Europe The petals are used. They are given in infusion & are a highly popular laxative for children They are made into a confection also & said to be good in habitual costiveness given in the dose of a table s. f. Laxative is moderate quantities Purgative in larger The quantity for an infusion is zii of dried petals Rosa Gallica rerubra red rose This is similar in operation to the damask Linum catharticum The whole plant possesses cathartic powers Operations Purgative difficult to manage or as a laxative or eccoprotic Its natural operation in hydragogue acts on the middle part of the canal Takes a medium time for operating rather unkind leaves the bowels in an irritable state Dose for an adult is a “handful” infused in ½ pt of boiling water or zi in substance Infusion say zii to ziv or zvi of water Cassia Lanceolata Senna There has been much dispute about the species of cassia which is the true off. senna but it is undoubtedly the c. lanceloata. This is the tone off. or Alexandrian senna, but it comes adulterate with other species & other plants the cynanchum oleifolium is found among it All the species probably possess cath. powers but in a less degree. The term senn has no specific applic. It is applied as “ipecac” is applied to any emetic article That senna is best whose leaves appear bright, fresh, free from spots, strongly scented, bitterish & nauseous, smooth & soft to the feel, sharp pointed, free from stalks & legumes Senna contains a peculiar priinciple calle sennine (cathartine?) Operations It is purgative not eccoprotic or laxative. It is more or less hydragogue the moderate its operation the more fecal the matter discharged. It acts on the colon. It takes a medium time for its operation about 4-6 hours after being taken Dose of the confection zi – zii ]of the infusion 1 troy oz. will saturate a pt. of water add some aromatics to disguise the taste This is a bad cathartic being hydragogue & apt to occasion griping etc. “Any other is better” Prof. T. has discontinued its use Poinchiania pulcherrima Cassis orientalis senna spuria pride of Barbadoes etc. Nat. ord. [leguminosa] Cultivated as an ornamental shrub The leaves flowers & seed are the parts used The leaves are the strongest & the flowers next both used in decoction The seeds are best powerful & are used in powder I to a dose This plant has considerable reputation as an emmanagogue. It is but little known with us. Aloes That for a variety of species is found in the shops. There is the aloe spicata from the Cape of Good Hope & the annibellata from the same place the former is now considred the best. There is also a ferox of [illegible]? A. socotrina & A. vulgaris of [Persova]? The greatest part of the aloes in the shops is from the A. vulgaris of Barbadoes The appellation socotrine applied to aloes means nothing more than that they are of a good quality. The apothecaries in recommending their aloes will tell you they are the socotrine aloe The best aloes are an extract made by a cut in the shrub from which the sap exudes. This has at first a sweetish taste & soon after a intensely bitter one. IT has not the glassy appearance of the poorer kind Another mode of obtaining aloes is by inspissating the juice of the plant. This is nearly as good as the exuded sap there is not much difference A third way is by decoction 3d Cathartic about 1 lb of the plant to 8 pints of water boiled down & strained. This has not the sweetish taste at first perceived in that obtained by exudation The properties. A. T. Thomps. says of this best kin A. spicata are odor rather pleasant taste sweetish at first, & very bitter soon after powder of a bright yellow & aromatic smell 2d quality very disagreeable taste intensely bitter but not differing materially in med. qualities from the 1st 3d quality of a dark brown colour, hard & friable There has been no true analysis of aloes. The old one in the books is still retained but I do not esteem it correct. Operations cathartic heating & irritating Emmenagogue per se Dr Ives thinks it is manageable as an eccoprotic & laxative & that it operates more kindly when taken with food. The latter is probably true & it is the case with many other medicines e.g. diffusible stimulants Dr Ives thinks aloes have no direct tonic effect, but an indirect one He thinks they act on the liver promoting gradually the secretion of bile. HE thinks it moderately deobstruent but I do not use the word deobst. in this sense i.e. an article affecting one gland only, the liver for instance To say that aloes acts on the [portal] system is merely saying that it acts on the liver Dr Ives thinks aloes are emmenagogue, independent of their purgative effect. They undoubtedly are so. He thinks that tho’ they irritate the kidneys & bladder & color the urine yet no increase of urine is produced Aloes are a purgative, but may be easily managed so as to prove eccoprotic & laxative. In large doses they made to act drastically They are slow in their operation from 12-24 hours The discharges are purely fecal hence they are copragogue They act on the lower part of the bowels (i.e. they act principally on that part for all cath. act on the whole canal more or less) Their operation is appropriate doses & cases in kind though if given inappropriately they irritate. Appropriately given, they leave the al. canal in a good condition In eccoprotic & laxative doses they make but little impression in full doses a strong one Next after their purgative effect aloes are emmenagogue They are said to be sub-tonic I presume indirectly so Said to be anthelmintic probably more so than most cathartics Dr. A. T. Thomps. says they are not beneficial in hemorrhoidal affections But Drs Tully & S.B. Woodd have given them with good effect in such cases. As a general rule however I would not use them in a peculiarly irritable state of the intestines though even in such cases I have cured better than with any other article. This form of piles alluded to is proctica marisca Aloes combined with about a medium dose of opium are thought to counteract the effect of the use of opium. This combination is very useful when costiveness has resulted from a continued use of opium, but you will find after a while that less of aloes will be necessary. I have made the combination in the following proportion viz. 1 part of opium to 4 of aloes It is the common practice to give a cathartic pill when a practitioner does not wish to give calomel, and aloes with gamboge & soap or some other extract is a common pill. When such a pill is wanted I have used Rx aloes grs ii gamboge gr I oil tigl. gtt ¼ soap q.s. ft 1 pill. Sometimes but ½ a pill will be necessary according to the state of the al. canal & the habit of the pat. If the patient is in the habit of using opium or has taken it for some time 2 pills may be required I do not consider aloes good at the commencement of acute diseases. When a cathartic is wanted at the commencement of a disease to break it up I would not give aloes If you wish merely to evacuate feces or to produce an eccoprotic or laxative effect in the secondary stages of a dis. aloes are good in certain doses Diseases It is difficult to specify them Swediaur says dyspepsia with great torpor Pyrosis when bowels are torpid Habitual costiveness here they are also good applied externally Ulcers with a gangrenous tendency extern.? Cases of continued discharges from the ear a solution of aloes injected The dose varies according to the susceptibility of the patient From 1-2 to 4 grs may be given as a laxative or [illegible] in the 24 hours As a purgative about 5 grs may be required There are a great variety of phar. prep. Convallaria [Maialis] I have seen it in the meadows of Middletown tho’ it is considered not indigenous with us The root & flowers are considered the medicinal parts. The extract of the root possesses some of the medicinal properties of aloes tho’ a little weaker. It acts on the rectum & I presume it would prove emmenagogue in the same way The dose as a purgative is said to be [illegible] or zi probably a smaller dose would operate if given over night The dried root pulverised is a [sternutatory] & so are the flowers The flowers when fresh are fragrant but not so when dry I do not know much of this article Polygala polygama A specimen from which the bracts had fallen off was sent to [Willdenow] & he supposed it a new species & called it P. rubella. IT is called here “low centaury” but in the middle states the name is given to hypericum parviflorum sabbatia angularis too is called centaury The English centaury is ergthraca? centaureum nat. ord. Every part of the plant is entirely bitter the leaves more so & the root most of all. It very much resembles aloes in tasting medicinal powers It is an efficient cathartic the natural operation in an appropriate dose being copragogue the discharges consisting entirely [offices]. In large quantities it may be made hydragogue It is slow the natural operation taking place in 12-24 hours It aggravates practica marisca & in great doses produces that disease. Otherwise it is kind in its operation The impression is makes is moderate It may be considered tonic also anthelmintic. It is decidedly emmenagogue It has been supposed to be diuretic but I never could discover this effect. Prof. Ives says it increases the secretions generally If so it is a deobstruent It has been said that this article is bitter & nauseous & that therefore it shd be rejected from the mat. med. This rule wd make our list of medicines very small This article will make as good beer as hops Its natural operation is that of a purgative & copragogue Pharmac. prep. 1st Infusion dried plant zii water oi 2d Decoct. dried plant zji water ojss boil to 1/3 3d Tinct. zii to oj 4th Ext. by decoc. This I think the best Make it of a consistence for pilling As a cathartic the decoction is best & the dose is zii to ziv I have given even a wine glass full I thas operated in 12-30 hours Is not [illegible] but have for [illegible] all the while? 4 Cathartics As a tonic the tinct. is best in doses of zi 3 or 4 times a day Diseases Dyspepsia with torpor in its various forms Coprostasis Paramenia retentionis & obstructionis Upon the whole & consider this a valuable article much more so than it is supposed to be Ipomea Jalapa [illegible] This has been supposed to be the root of 2 species of mirabilis but they do not produce it (they are called 4 o’clock in our gardens) Convolvulus jalapa of Lim. The plant from which the real jalap is obtained. Dr Coxe calls iponea macrorhiza for an account of which vide Coxe’s Dispens. the roots produced by this plant are like those we get in the market Mr Nuttall pronounces the plant an iponea (what plant.?) It usually comes in roundish, ovate but pointed tubers internally yellowish At the present time we get our jalap from Vera Cruz & it is not adulterated Diluted alc. is said to be the proper menstruum for jalap It is used for its cathartic powers merely it is difficult to be managed as a laxative. It may be made purgative or drastic In moderate doses & if allowed sufficient time to operate it may be made copragogue but in excessive doses it is hydragogue. It acts principally on the colon The off. jalap is called in the books a stimulating cathartic It is an irritating cathartic rather. In a phlogistic, or atonic irritable state of the system it will produce irritation & increase it when already existing The alcoholic ext. is said in the books to be irritating, but Dr Ives says it is not. The ext. in the pharmacopoeias is made partly with water. In moderate doses the alc. ext. is not irritating It is probably that several species of convolvulus & iponaea possess the same powers as the off. jalap Podophyllum Petatum may appl. mandrake etc. Triosteum perfoliatum Linn. Root perennial top [annual] It has a popular name in almost every place in which it grows fever root wild gentian wild ipecac wild coffee? etc. Nat. ord. same as that of the climbing honeysuckle The parched fruit is said to have been used as coffee The root only is used in medicine the bark of this is said to be cathartic & emetic Dose for a cathartic is [illegible] to zfs this if taken over night will be effectual. It is about as active as jalap if pure & collected in the right season. It is injured by long keeping, but if collected in the autumn & well dried it will retain its strength The operation is supposed to be modified by a conjunction with mercury etc. for instance? by as a conjunction with? of ipomaca jalapa & podoph. pelt. When a cathartic & emetic operation is desired this article combined with di? proto chloride of mercury in full doses shd be given dose [illegible] to zfs B.S. Barton thinks it diuretic but I have discovered no such effect & think it no more so than rhubarb Dyckman says it is tonic he probably inferred this from its bitterness. I have never seen this effect & think it no more tonic than rhubarb & podophyllum peltat. I think it more likely that ultimately it will be found deobstruant This article is a cathartic. Its natural operation is that of a purgative but it may be so managed as to prove laxative Its discharges are mainly fecal hence copragogue. It acts on the colon In a full dose it has a medium time of operation. Its operation is neither very kind nor very much the contrary. It leaves the canal neither in a very good nor a bad condtion Diseases It has been prescribed in Intermitt. (Shoeph?} I think it not very applicable and in “pleurisy” (but there is no such idiopath. dis. though phys. constantly speak of it Shoeph? probably meant pneumonic) I shd think it not good. Said to be good in struma I shd not think so In reality this article is applicable only to the diseases in which jalap & P. peltatum are & no other The right time to collect it is autumn. The powder shd be kept in a bottle tight & excluded from the light I wd not pulverise much at a time for it loses its strength easily. Fresh parcels shd be collected every year Leptandra Virginica Culver root physic root Indian physic etc. It is difficult to tell what is its nat. order. Said to grow in Japan but probably a diff. spec The root has a bitterish & subnauseous taste. analagous to jalap. Both alcohol & water are the proper menstruus It is cathartic In its recent state of Dr I. thinks it one of the most powerful of our indigenous cathartics. When dried it loses its cathartic power’ Rafinesque says it is deobstruent & echotic but there is no reason for supposing that it has such a power. When recent it is said that 4 or 5 grs are sufficient to prove cathartic, but when dried zi or more will be necessary I think a wine of this article (zii to f zxiv) wd be a good preparation for retaining its strength I venture to say that a syrup would answer For instance make a saturated decoction (say 4 oz to the pt) & add the q.s. of sugar to make the simple syrup of the pharmac. The add oil of wintergreen to give flavour Perhaps an ext. night retain its powers There is room for experiment Therapeutic application The diseases mentioned in the books I do not think correct Coprostasis active cathartics are not applicable to this Bilious fevers this is indefinite Rheumatism not good subacute rheumatism other articles better old chron. rheu. 5 Cathartic Ricinus communis R. major R. vulgaris more commonly palma christi ricinus. One of the older manes is agnus castus whence castor oil Nat. ord. Euphorbiciae Cultiv. with us Castor oil is obtained from the seeds. It is completely soluble in alcohol & ether. The mildest oil is obtained by decoction, which method is resorted to in the W.I. for the mode see Hooper’s Dict.’ If the cortex of the seeds be permitted to remain in the oil will be acrid. That made by expression is also thought to be acid hence decoc. I think the seeds shd be [decortirated] for the active principle probably resides in the cortex Its operation is quicker & kinder than any other cathartic & as a mere evacuative agent it is the best in the mat. med. It seldom produces any griping. It is moderate, producing at most only 2 or 3 discharges says Cullen who says it is peculiarly adapted to costiveness. Colica ileus & C. Rhach. It is not heating nor irritating to the rectum & is well adapted to hemorrhoidal affections Medium dose zfs some require more others less Its ordinary operation is mild If frequently repeated the dose may be gradually diminished, which is not the case with other cathartics. That ol. ric. increases its power by repetition is an important point The only inconvenience attending the use of this article is that it is nauseating & disgusting to some patients. To obviate this give it in a wind glass with water below & spirit or spirit of ppt. above & it may be taken by the most delicate & squeamish Even rancid oil may thus be taken without its rancidity’s being noticed. I know of no way so good as this Ed. & Vav. say this oil is only a mild laxative but it is a purgative. They say that by rancidity it produces tormina, griping etc. This is correct. Some think that it possesses greater power than any other cathartic in removing worms. I have never seen its superiority in this respect. It is always better to give some narcotic cathartic & get the worms under narcotic influence as we do by spigelia This article is laxative not so easily made to act as an eccoprotic Purgative copragogue it produces no biliary discharges It is not drastic. It affects the whole track of the bowels equally It is speedy is kind unless rancid & leaves the al. canal in a good condition It makes little impression on the system & of course is not good at the commencement of acute disease The following formula is used in the W. I. in colica rachial. Rx zii of the oil to ziii of spirit & burn them about ½ a min. or till part of the spirit is burnt. It is said that this is effectual in that disease I have beat up this oil with the yolk of an egg & this completely deceived patients & got the full operation of the article, when they had absolutely refused to take it The decorticated seeds are taken as cathartics in some parts of N. M. Probably 4 or 5 of the bruised seeds are a [illegible] dose A saturated tinct. of the seeds is said by Piso to be a more powerful cathartic than the oil. Dose of the tinct. zi (zi?) the seeds should be bruised Euophobia Lathryrus (oleum) Cultivated in all our gardens The most common name among us is caper spurge. The fruit is said to be good for pickles. Native of Europe., Nat. ord. Euphorbiaceae The oil is obtained from the seeds a common practitioner could obtain it by macerating the seeds in ether By long keeping it becomes turbid & rancid It comes in vials of zi It is said to be a mild & safe but active cathartic & a good substitute for oil of tiglium Dose for a adul 4-8 gtts in milk sugared water or any convenient vehicle Its action is certain, prompt & at the same time mild, not producing tormina or griping like o. tiglii It is purgative drastic in full doses may be used as a laxative. It is copragogue in ordinary doses. It is irritant in full doses & may be said to be sub-emetic In affects the whole track of the intest. canal It is very speedy, 1-3 hours is mile & agreeable in medium doses & leaves the canal in a good condition. It makes rather a strong impression Iatropha 2 species I. Curcus and I. cossypifolia Called Barbadoes nutts The oil from the seeds of the i. curex resembles very much the castor oil Croton Tiglium Ricinus Indicas Pinus Indicus These oils all belong to the same nat. ord The wood has been used in medicine (lignum moluccense) the seeds also grana mollucc. grana ricini in English called “purging nuts” Native country Ceylon Moluecas E. Ind. China The genus croton is said to contain 50 to 100 species of which 5 are known to be in the U.S. One species in the U.S Affords a highly aromatic oil The oil of tiglium is obtained by expression from the seeds It is said to have a sharp taste odor sui generis It is said to contain fixed oil 55 parts & an acrid principle 45 parts. This letter has been called tigline The seeds root & wood have been used in medium, but the seeds & oil are the most powerful The oil of tiglium is the most rapid cathartic known. Its operation is said to be modified by aromatics, acids etc. but better by small doses of opium. Baking or roasting the seeds before expressing the oil is said to have this effect Its natural operation is purgative or drastic. It is difficult to manage as a laxative unless by tincture or a little opium. As a laxative it is copragogue but in larger doses hydragogue & irritant In large doses it is drastic It may be said to be sub-emetic Said to be diuretic & diaphoretic but I think it cannot be directly so It operates on the whole canal is the most speedy cath. we have usual time ½ hour This can be made to depend on circumstances sometimes less than that time If the dose is not too large the operation is not unpleasant if large a burning is felt. Moderate dose leave the bowels in a good condition This article cannot be preferable to calomel in typhoid diseases nor to the refrig. salts in the inflammatory The oil of tiglium in the market is said to be adulterated. I have always found that in the shops to be full strength. When pure it produces rubefacient effects on topical application It is sd to produce catharsis when rubbed on the umbilical region Dose of the oil ½ to 1 minim. The tincture made directly from the seeds in the most eligible form. Dr Bigelow gives a formula for its strength The oil may be given in milk but I prefer the pill made of bread. Unless camphor is added the pills will mould. I prefer dough to baked bread. I may be pilled with soap Another form is Rx ol tigl. [illegible] syn papav. zi Opium better than any other article modifies the operation & obviates the unpleasant effects of this oil. In combination with castor oil it affords the best cath. for poisons It makes a good enema. You will remember that generally 3 times as much is required 6. Cathartic by enema as by the mouth The effects of an over dose are severe burning pains hyper emesis hyper catharsis etc. Opium is the best antidote Diseases Coprostosis (E. & Vav.) as a general rule this shd not be treated with drastics Tenia I think however that the ol. pini is better, for in this you have narcotic & other powers which are peculiarly desirable to hasten an evacuation the ol. tigl. may be given Delirium Tremens Some writers say that this oil has been highly serviceable in this in conjunction with opium As a general rule purging is not indicated in this disease Rheumatalgia As a topical application it will probably do good for this is generally fixed Mania in acc. of this facility of getting it down Tetanus alleged to be useful in the sam. acc. if purging is indicated Neuralgia. N. Faciei Cases of apoplex. Obesity sd to be benefitted by freq. purging Dropsy but elaterium is our best article Oil of tiglium is not a new article in medicine, but and old one revived Scammony Convulvulus scammonia is said to furnish the Smyrna scammony but this is less valuable than the Aleppo scammony Another kind is the Montpelier scammony from Montpelier Convolvulus [Sepium] (Linn.) is another species producing scammony. It grows about our hedges & is called field bindweed & poison weed though it is not poisonous The exuded & expressed inspissated juice are both employed. The exuded is the most powerful & best dose 5-20-30 grs – 30 grs is a powerful dose it grows throughout the U.S. Hiatus Scammony? It is called a gum resin, but is more so than any expressed juice Used in dropsy other art. better in helmin. spts turp. better Natur. operat. purgative drastic if given alone Modified by combination Not easily managed as a laxative Acts on the colon medium time makes an impression In large doses is an irritant Gamboge Several plants afford it Linnaeus supposed the real gamboge came from the gambogia gutta Murray from the Statagmitis gambogoides Others from the gorcina gambogia of Willdenow & others say the gambogia guttifera. The name of the plant is not derived from the place in which it is found Stalag. & garcina grow in Ceylon gambogia in the E. Indies Gamboge is the inspissated descending sap obtained by exudation improperly called a gum resin. The juice concretes & is formed into masses. It is imported from Siam, Ceylon, [illegible] in China etc. We have no analysis but the old one of so many parts solub. in alc. & insol. in wat. etc. It is said in the books to be one of our most drastic & [illegible] cath. but others are more so Being drastic it is used in helmintha but because an article is drastic it does not follow that it is good for worms. As to its hydragogue power, it is not always to e relied on in dropsy. The Italians say that gamboge is contrastimulant What they mean I do not know In purgative & laxative doses it is more reducing than the preceding articles. It is difficult to be managed as an eccoprotic It acts upon the upper part of the al. canal & all the articles that do this promote more or less the secretion of bile but it does not in the whole [secerm] & absorb. system & hence is not deobstruent It irritates the intestinal canal & may produce an acute atonic irritative infl. It has been called by orfila? a caustic poison, but it is not. HE says too that externally it is rubefacient. This is not true It is more used by the British practitioner than by the French & is given in combination with other cathartics. Thus administered it is useful Gamboge is a strong purgative is cholagogue by acting upon the stomach & duodenum is hydragogue acts on the upper part of the canal is speedy is on the whole disagreeable in its operation when given alone, leaves the al. can. not in a good condition, but if judiciously combined its operation may be made kind & agreeable while by a frequent use of gamboge & by injudicious combinations of it the al. can. is left in a very bad condition it makes a strong impression on the al. can. & whole system is irritant & finally is to some degree an emetic, though this ought not to be enumerated among its operations Dose 3-6 grs recc. triturated with sugar but I wd no recc. it alone Diseases Coprostasis recc. but not alone Tenia jaundice recc. cannot be of much use other articles better quartans used as a purge but not good Dropsy recc. [illegible] other art. better. Chron. cutan. dis. not I think good Rhamnus catharticus Buckthorn Nat. ord. rhaminaciae native of Europe cultivated in this country & sometimes grows wild on the banks of the Hudson probably from seeds dropped by birds The berries are used. They are [illegible], black & shining, with a taste bitter acrid & nauseous & containing a pulpy green juice As a cathartic, this article is both cholag. & hydrag. & its natural operation is purgative & drastic & it is not easily managed as a laxative. When drastic it is powerfully hydragogue not so much so as elaterium but more so than most drastic cathartics It acts on the middle part of the al. can. & requires a medium time It is irritating & leaves the bowels not in a very good state It requires opium to obviate its ill effects. It makes a peculiarly strong impression on the system. It irritant & may prove emetic It is said by some to be diuretic it may prove somewhat so in small & often repeated doses, with diuretic regimens & allowed to remain sometime in the al. canal. Diseases Recc. by A. T. Thomps in cachexia & also recc. in syphilis do not believe it good in this Dropsy recc. by A.T.T. better in this than most other cathartics. It is used in N. Haven in certain cutaneous eruptions & recc. in doses short of purging I have never seen much benefit from it in cutaneous diseases The common dose of the berries is 20. The expressed fermented juice is recc. in some books decidedly bad Decoction of the berries is also used it is recc. to boil 20 of the berries in 1 pt of water very weak The syrup of the berries is the best form Rx If you wish to mitigate or modify its action add a little paregoric Almost every farmer thinks he knows what buckthorn but it is not found with us. There are spurious articles sold under the name of buckthorn. The article commonly sold under the name of syrup of buckthorn is made of the berries of the cornus sericea Bryonia Disease? Nat. ord. cucurbitaceae root fusiform intensely acrid & bitter Formerly the root used to be found mixed with jalap. Sometimes the inspissated juice of the recent root is used It contains a principle bryonine which is probably its active one The root was formerly employed as a purgative & emetic applied to the skin it is said to be irritant & rubefacient Dose of powd. of rec. root is 12 grs to zfs This article is purgative & drastic acts on the middle part of the canal requires a medium time & in large doses leaves the bowels in a bad condition. 7 Cathartics Cucumis Colocynthis Nat. ord. Cucurbiticeae Native of the levant & cultivated in Europe The fruit is the part employed, under the name of colocynth It is reduced to a fine powder. I believe the pulp only ought to be used, but the whole is used. It is found in the shops in powder. Water alc. & ether dissolve its active principles E. & Vav. say it is very irritant, externally or internally they say it is a powerful cathartic purgative or drastic less hydragogue than most other cathartics equally drastic (I can’t say I ever saw a hydrag. operation from it) It acts on the colon takes a medium time alone it is more or less disagreeable, but it is agreeable in combination It is a valuable article when a compound cath. is used, it makes a strong impression It is irritant E. & V. say it produces amenorrhea. I have never had any such effects from it Enteritis recc. by E & V. but a mere cathartic in this is not wanted a deobst. operation is required, for which calomel is best perhaps in erythem. enteritis it may answer a cath. is indicated but in this form a diarrhoea is almost always attendant & even in the calomel is best Dropsy E & V. but I do not believe this article hydrag. & therefore it can seldom be proper Elaterium [Momordica] Elaterium of Linn. Ecballium elaterium of Richard Called also cucumis agrestis & c. asinius squirting cucumber. It is a perennial plant growing spontaneously in the south of Europe & might be cultivated among us The active principle resides in the juice around the seeds it is prepared by As found in the shops it is The dried juice of the fruit obtained without any preparation is best As prepared above it contains a peculiar prox. prin. called elatine. An alcoholic tinct. may be employed Elatine is [illegible] Elaterium is oftener mixed with starch. It is injured by exposure to the light yet this our apothecaries do not know It is very expensive The juice of the [illegible] is irritant to the skin Elaterium undoubtedly possesses great deobst. powers, but they do not begin to operate much till purging comes on then they are powerful Its natural operation is drastic not purgative nor laxative. It is more hydragogue than any other article. Although so drastic it leaves the bowels in a good condition It may be given in cases of extreme debility. It is speedy in single large doses less speedy in small doses. It is irritant diuretic in doses short of the purging point deobstruent Upon the whole, elaterium is the most valuable cath. in the mat. med. calomel & the neutral salts excepted Diseases Coprostosis shd not think it good parabysma Struma shd not think it good Atonic ac. rheum. it acts as a resolvent deobst. but generally is proper only in the early stages Opium will prevent is purging Sub. ac. rheum. early stages Rheumatalgia in its various forms both that called “crick in the back” & sciatica a cath. of elat. is very beneficial [illegible] Indica give a cath. followed by an internal use of conium & iodine Chronic & obstinate ulcers of the legs purging with elat. is very beneficial they were formerly cured by vom. with turp. min. Chorea a valuable remedy by acting on the system at large Param. obstruct. idiopathic & in healthy subjects Hydrops cellularis H in these diseases it is of more importance than any other Begin? early in the morning with doses of 1/16 1/12 or 1/10 gr acc. to the strength of the article once an hour or once in 2 hours continue till catharsis actually commences & then suspend The catharsis usually begins in about 5 or 6 hours. It is preferable not to have it commence under 10 or 11 hours The first discharge will be fecal & then will follow those that are purely hydragogue. Most of the books recc. in full & large doses giving all you would give at once But this is apt to produce nausea tormina, distress etc. Give it in regular doses also to get its deobst. effect If the evacuations are rapid or appear to reduce the pat (which is rarely the case) give a dose of opium, generally not less than 10 grs, acc. to the susceptibility of the pat. If the pat. is at all feeble you shd be about [illegible] at the time of the operation of the article After the useful article treat with stimulants. It may be necessary to repeat the elaterium for removing the fluid does not cure the disease, & the fluid may return. Elaterium removes the dropsical fluid better than any other article I know of. In cases of concussion followed by stupor or coma about a week or two after the accident. I have known elaterium managed as in dropsy to be most effectual acting not merely by its evac. but its deobst. power Elaterium is better by itself than conjoined with any other article Some conjoin calomel, but it is better without E. & V. recc. it in doses of ½ gr. not to exceed 5 grs but with such elaterium as I have had, a man wd not stay long enough in the world to repeat the dose The momordica balsamina has been said to possess the same powers as elaterium, but [untruly] It grows in our gardens The juice of the unripe fruit is said to be emmenagogue & styptic. This is worth enquiry into. Luffa operculata Allied to elaterium Nat. ord. cucurbiticaea Its natural habitat is Guaiana. It is formed abundantly in the W.I. & along the shore of the Gulf of Mexico. Dr Hancock calls it crosia? It is also called “bitter cucumber,” but the cucumis coloc. bears that name. It is the momordical operculata of Linnaeus & is similar to the common cucumber I derive my knowledge of this article from Dr Hancock In the fruit is a web-like substance or reticulum which possesses the medicinal powers & Dr H. says “it is the most active cathartic in nature” says it acts on the “skin kidnies & intestines.” Acc. to his account it is an effectual deobst. acting on the whole sec. & abs. syst. I do not think it a tonic directly Dr H. says that 1 gr. of the reticulum is a dose. This is undoubtedly too large & acc. to his own account ½ gr. is sufficient 8 Cathartics to produce the effects of the common dose of elaterium Dr H. prescribed it in infusion, but says was obliged to add chloride of sodium to preserve it. Would it not be better to make a powder of the reticulum? He says it is better to have it a long time in operating. It seems its operation is precisely like that of elaterium & it is best given in small doses at regular intervals This article is drastic may be managed as a purgative, but not as a laxat. or eccoprotic Full doses may vomit small ones do not. Purely hodrag. middle part of can. Medium time in small doses Makes a strong impres It is irritant & deobst. Short of purging point it is diuretic. It is emmenag. in full doses. It is resolvent. Diseases recc. in dyspepsia colic. rhach. as an enema Dr H. says it is an effic. article Parabysm coac. (enlargement of the spleen) Dr H. says in his own case it proved efficient as an enema it affected the stomach. Hydrops cellubria (or as he calls it generally dropsy) Dr H says he has cured perfectly by it recommends it in the early stages He says mercury is a most efficient article in dropsy & so says Dr Tully H. Thoracis & H. abdominis (ascites) In the latter it is necessary to repeat the article in some cases. Dr H. has found it necessary to salivate & repeat it Upon the whole it appears that this article has the same medicinal properties as elaterium. It is not liable to lose its strength like elaterium. The [crasia] or L. operculata finally is cheap & precisely equivalent Sulphur Purgative in a full dose. It is diapohoretic in non phlog & not materially atonic cases, regularly, & I am apt to think it is so indirectly. It is irritant but not tonic or stimulant. It is undoubtedly inappropriate in phlogostic & truly atonic cases Dr Duncan thinks if taken into the circulation, from the sulphurous smell etc. of persons who take it. Dr Tully thinks it digested & says the smell is that of hydrothomic acid Duncan thinks it better combined with some saline cathartic Dr T. thinks this not necessary In [illegible] he Dr D? thinks its irritant effects will be obviated Sulphur injudiciously administered & persisted in will produce rheumatism, paraplegia & effects precisely analogous to those of mercury. I have seen swelling of the joints & loss of the use of the lower extremities Sulphur in full doses is a purgative it may be managed as an eccoprotic It is copragogue Acts in the whole track. It is slow. In a full dose & under a bad condition of the system it is unkind in its operation, & leaves the bowels in a bad condition It makes a considerable impression. It is irritant & decidedly deobstruent being resolvent (I have known sub-acute rheum. cured by it) diaph. emmen. & expectorant Diseases Prctica Marisca I wd regulate its use acc. to pretty much the same rules as aloes Chronic Coryza recc. by Duncan Chronic coughs it has been used in form of “balsam of sulphur” It is good in some coughs Dyspnoea exac. & asthm. hum. Duncan probably is good in the interval Disguised gout of Cullen Rheumatalgia or chron. rheum. have never tried it but it probably is good. Scabies & various cutaneous eruptions 6 Materia Medica [illegible] Depletio Sanguinis Is an important refrigerant process & should be treated of amongst therapeutic agents It is an operation directly and exclusively refrigerant in its effects The blood itself is vital and is the medium and support of the vitality of every part of the system The first effect of v.s. is to diminish vital power generally and strength of action in every part. It constitutes the most powerful and direct method of reducing the vital energies When carried to excess its effects are most difficult to be remedied The precise quantity to be taken depends on the degree of vital power the nature of the disease the prevailing diathesis and the vigour of the constitution Yet in no process is the practice so empirical Prof I. knows of no disease so severe as to require medication in v.s. has not been recommended as the most appropriate remedy ever [illegible] When really indicated it is indispensable when not indicated it is infallibly prejudicial Divided into two kinds General & local the former from an artery or large vein the latter from the capillaries Some however consider V.S. from a large vein in a part near a local affection, as from the ext. jugular in cephalitis as a local bleeding & therefore more efficacious. They think V.S. from the arm in like manner more efficacious than from the jugular or foot and in all the phlogistica they bleed from a large vessel as near as possible to the seat of the disease This they consider as effecting a topical depletion of the diseased part. Now it is well known to every anatomist that there is no direct communication between the viscera of the thorax abdomen and cranium and the parts forming the parieties of those cavities. There is therefore no ground for calling such processes topical bleedings. The notion is a remnant of prejudices existing before the discovery of the circulation of the blood & the distinction is of no more importance in practice than the old man in the almanac Some limit the term topical bleeding to an evacuation from the capillaries of the diseased part. This evacuation must be prejudicial in atonic passive diseases where there is a gangrenous tendency especially if performed with scarification and cups An English author remarks correctly that there is no such thing as topical bleeding independent of producing an effect upon the whole system In the phlogistic phlogistica leeches and cupping with scarification are of no importance for v.s. from the arm is all that is requisite. In local entonic infl. the practice is more plausible. Here topical bleeding is the best but the irritation of cups and scarification does more injury than the evacuation does good, unless applied to a neighboring part, and then the counterirritation produces the effect. As the disease however does not affect the constitution, it is of little consequence The blood is not stagnant in the part for then it would be coagulated and would not flow consequently topical bleeding cannot empty the vessels of the part Besides infl. is not caused by accumulation of blood this accumulation is an effect, not the cause If a general phlogistic diathesis exist, topical bleeding is not substitute for v.s. if there is no general phlogistic diathesis, topical bleeding is not required The cases which have been benefitted by topical have been cases of atonic infl. Here the counterirritation produced the effect the trifling depletion [illegible] of blood being injurious as far as it goes Yet the practice is very fashionable IN these cases bloodletting is not indicated. Deobstruents & antirritants such as calomel and opium give far more speedy and perfect relief Ophthalmitis is a dis, in wh. phys. say topical bleeding is indispensable A strong sol. of nit. sil. is far better & gives a more speedy cure If you separate some of the vessels going to the part, then to be sure you may produce some beneficial effect Where general bleeding is not indicated topical bl. is always injurious The capillaries are said to have an independent action and the reasons assigned are that it is by their agency that the blood is returned to the veins, that by them assimilation secretion and [nutrition] are performed that they are the seat of infl. 6:07 PMhe reasons are probably true yet it is [illegible] no less true that the capillaries as necessarily and completely depend upon the heart as the heart upon the depletion of blood affects both the capillaries and the heart, hence the surface is pale. If the action of the heart is increased there is congestion in the capillaries and less blood in the central parts In this case topical bleeding would remove the congestion temporarily it would be again produced by the vis a tergo In infl. the value of the blood is dimin. indeed but the blood is not stagnant or it would coagulate I would not be understood to say that cupping and scarification are of no service for I have seen them used with great benefit But I do say that other means are in my opinion better [illegible] by counterirr. only that they produce their effect Thus in the chronic stages of subacute rheumatism I have known evident relief derived from them yet no one would bleed in such a case also in pneumonitis The benefit is the same as from rubefacients, blisters etc. The strongest case is infl. of the eye and the anastomosis of the ophthalmic and temporal arteries is thought to have influence But even here if there is active infl. and phlog. diath. topic. bl. will be no substitute for v.s. In atonic infl. without phlog. action the case is better without bleeding of any kind & topical bl. is beneficial only by its irritation. I have seen both plans tried Dr Cogswell treated infl. without and no man was ever more successful. Few employ it who have had extensive practice. There are other and better means of counterirritation Depletion from large vessels and depletion from capillaries are better appellations than general and topical bleeding for the latter, as we have seen is inappropriate Depletion from large vessels may be performed by v.s. or arteriotomy. The veins are the vena media basilica t the bend of the arm the vena suplina major on the inside of the ankle & the v. [illegible] minor on the outside of the ankle The vena media basilica is preferable to the ven. med. cephal. the v. seph. or the v. basil. as the latter have cutaneous nerves running over their surface. The veins on the ankle are irregular; they have cutaneous nerves running over them, and the tendons are liable to be injured Besides the incision does not heal well but is liable to become a troublesome sore. The vena jugularis externa is often [illegible] The temporal is the only artery now selected; it is the only safe one as it alone passes over a bone, so that it can be compressed. It is of no consequence whether blood is taken from a vein or from an artery, or what vein is selected so far as the disease is concerned provided the opening be large enough Depletion by the capillaries is performed by means of leeches, or by scarification and cupping. The [illegible] medici lis is used but I have seen the H. sanguinea? do nearly as well [illegible] The best instrument for v.s. Prof. I. thinks is the Dutch or spring lancet as it can be used by those who are not ambidextrous it can be used upon the most rolling vein and upon persons in epileptic or puerperal convulsions the practitioner can set it and keep it in order himself and it can be used for years, while the thumb lancet soon becomes dull Depletion of blood may be a remedy in itself or it may be preparatory to the action of other remedies. V.S. for local symptoms can never be beneficial where the general symptoms contraindicate it buy may be beneficial when they neither indicate nor contraindicate it Venesection is employed to answer six indications 1st as a mere antiphlogistic or refrigerant measure in entonic diseases 2nd for the purpose of making a sudden and strong impression upon the system in order to produce a resolution of certain no phlogistic & not materially atonic diseases 3d to equalize excitement increase susceptibility, and prepare for the better operation of other remedies in certain non phlogistic diseases 4th as a substitute for an habitual but moderate hemorrhage & to divert it to some other part for the purpose of suppressing it gradually or preventing a too rapid sanguification as in exangin, cyanea (non closure of for ovale) exangia aneurisma paracyesis irritative (morbid pregnancy) wounds of the lungs brain etc. 5th to produce sudden faintness and relaxation for the purpose of facilitating certain surgical operations as the reduction of hernia or luxation 6th to promote absorption in parabysmata emphysematous (tumours!) & perhaps in certain dropsies Venesection is the most appropriate remedy for phlogistic diseases ad shd always be employed when any considerable phlogistic diathesis exists, whatever be the sex age climate season or constitution A blood is the pabulum of life, a depletion of it has greater effect in lessening the vital powers than the evacuations of any other fluid A free evacuation of blood from a healthy subject immediately produces more or less debility & increases susceptibility, appetite and sanguification. But if carried to excess it impairs the digestive powers The strength of the pulse is the only proper indication for v.s. When Fordyce and others mention hardness as the test for phlog. diath. it is evident from the context that this means strength. When however they speak of hardness and strength in connexion they make the same distinctions as Prof. I. Hardness indicates irritation and may accompany strength or weakness of pulse It is said by some writers that in enteritis we are to expect a small hard pulse and are always to bleed The truth is there are two species of enteritis which are accurately described and distinguished 1st phlegmonous enteritis, affecting all the textures of the intestines 2nd erythematic enteritis, affecting only the mucous membranes. Now the pulse in both these species is small and sharp but in the first no pressure can extinguish the pulse either in the systole or diastole in the second it is easily extinguished. In the first species only do we find strength of pulse & in this only is v.s. indicated Hardness combined with strength heightens the indication for v.s. these combined with fullness heighten it still more. Mere fullness & hardness uncombined with strength never require v.s. The coriaceous or buffy coat often observed on the surface of blood drawn depends on several causes 1st the degree of preternatural vital energy or preternatural strength of action in the system in other words the degree of phlogistic diathesis 2nd the rapidity with which it is drawn If taken rapidly it remains longer before coagulation the red globules subside and the buffy coat of course appears If taken more slowly it coagulates sooner and the buffy coat is less or none at all even though the disease is phlogistic Even in health blood may be so drawn as to exhibit the buffy coat 3d the depth of the vessel in which the blood is received if shallow the subsidence of the red globules will be less complete & the buffy [illegible] coat less distinct 4th The specific disease whether atonic or (frequently) entonic produces a buffy coat 5 Pregnancy is almost always attended with a buffy coat It will be readily inferred that Prof. I. lays very little stress on the buffy coat as indicating the propriety of bleeding or the necessity of a repetition. Wilson Philip and others express the same opinion. The firmness of the coagulum and the concavity of the surface are better tests But the existence of these marks & also of the buffy coat is no proof that a repetition of v.s. is called for We should not mistake for strength of action, the rigidity of the coats of the arteries so common in farmers, seamen & elderly people In phlogistic diseases, as cauma and the caumatoid phlogotica F.S. if employed early will of itself effect a cure. But it must be well managed. If too sparing at a time and too often repeated it will produce too great a reduction of strength If too profuse it may lay the foundation of other diseases. Those who are celebrated for removing diseases suddenly by a free depletion of blood, lose many of their patients by subsequent dropsy If there is no considerable increase of strength of action V.S. may safely be neglected In merely entonic infl. it is of no benefit but may be if the constitution is brought to sympathise with the local affection The phlogotica & local infl. differ in their causes diathesis and proper mode of treatment There is a foundation for the distinction of active and passive Some years ago the essence of infl. was thought to be an increased strength of action in the arterial system. Wilson Philip though it to be debility. Both these views have tended to confound the distinction of active and passive It is acknowledged that there is entonic fever. Is it any more strange that there should be entonic and atonic infl.? The essence of infl. is not the quantity or strength of action, but as is well remarked by Hunter the quality, and it may attend either increased, or diminished strength of action or a state of action neither increased nor diminished, and the treatment must vary accordingly. In infl. moderately atonic V.S. might be tolerated and would not destroy life it would render the recovery slower and less perfect. In every low atonic infl. (phylogotica) V.S. would be fatal I never knew a physician in Conn who did not employ bleeding in entonic diseases. This has been asserted with respect to myself, but altogether without foundation. Dr Danforth of Boston did not bleed a patient for the last 20 years of his life (this is noticed as a strange thing a man successful and of high reputation) Now the change of diathesis occurred about that time 1807 (to 27) and though sporadic cases of phlogistic disease occurred subsequently he may not have seen one (vide The Med. B.) I have myself seen but one decided case since 1816 & that was in 1819. You will occasionally meet with a case of phlogistic disease and cases arising from [illegible] though the latter will require less bleeding than the idiopathic. When the v.s. is employed for the first indication, viz as an antiphlogistic measure in entonic diseases, the degree of effect depends entirely upon the quantity of blood abstracted and not at all upon the manner of abstracting it. It is said by some that bleeding is more effectual when it produces faintness & that in such a case a less quantity of blood suffices. Such cannot be true phlogiistic cases. In every pure medical case the production of faintness & especially of syncope is to be avoided. In phlogistic diseases we must bleed freely,. so as to meet the symptoms, but in a recumbent posture in order if possible, to avoid deliquium. On the phlegmonous phylogitica the production of deliquium is unfortunate as it may prevent a sufficient abstraction of blood The abstraction of lbj or lbfs is generally sufficient nit. pot. tart. ant. refrig. salts veg. acids ripe acid & subacid fruits cold water & air shd be employed at the same time as auxiliaries. By thus dividing your measures you produce more effect upon the dis. & with less injury to the system. In phlogistic diseases V.S. practiced early and judiciously in the forming stage will produce a complete resolution. After the forming stage has passed, the dis. cannot be broken up but will run its course of 5 or 7 days under the best treatment but this treatment will seldom fail of effecting a cure. In phlogistic dis. v.s. may act somewhat on the principle of making a strong impression on the system But if a strong impression merely is the object, ligatures on the limbs are better. A third or a half of the blood in the system is in the limbs & ligatures upon them will produce faintness & syncope than v.s. This suspend the disease, but then the ligatures are off it is found that no permanent benefit results & v.s. must be employed In genuine phlog. dis. faintness and syncope are no proof that sufficient blood has been drawn. mere reduction without counteraction will not? cure like phlogistic disease. It would seem that an aggregate of symptoms exists one of which is increase of strength & this is removed by v.s. The aggregate is thus broken up and the dis. completely cured. Mere irritative or symptomatic entonic fever requires less depletion than that which is idiopathic, and after one bleeding, opium or hyoscyam with calomel will allay all the symptoms These may even prevent the occurrence of the symptomatic fever. Irritative fever is however often atonic & then no v.s. is proper Abernethy remarks that the fever must take place and we cannot prevent it. He cautions against bleeding in cases that must be protracted as all the vital energies will be wanted before the close He says we shd never bleed unless the fever will produce greater debility than the loss of blood. He adds infl. & irr. action wear out the strength and if more strength is saved by counteracting these, than is lost by the evacuation, then is v.s. proper & not otherwise. A surgeon of more extensive practice in N.E. than any other out of Boston has remarked that he had seen more cases of death from depletion after injuries, than from the casua,ties themselves. Chas. Bell remarks “A man has received a shock, the surgeon bleeds and the landlady gives a dram now I think the landlady is right” Dr Latham remarks “that many cases of recovery after v.s. are in truth but lucky escapes from death” The symptoms are the only safe guide for v.s. A writer in the Medico Ohio Rev. remarks that the man who should draw a distinct line between spasm (or irritation) & infl. wd render great service to the profession. Prof. I. does not consider the distinction so very obscure. But they in London consider synochus as inflammatory & hence it is that they cannot distinguish irritation from infl. In cases where there is doubt whether irritation or infl. exists it is the safer practice to avoid v.s There can be no danger in delay. But we can commonly decide if during the flow of blood the pulse soon becomes weak and fluttering even though it shd rise afterwards, v.s. will do no injury But if the pulse becomes softer and fuller we may expect benefit from v.s. In doubtful cases it is better to take too little than too much blood as the error is more remediable, and besides such cases do not absolutely require v.s. The lancet is often a little instrument of mighty mischief vide Hall’s mimosis in quieta. in fever of pure irritation The second purpose for wh v.s. is employed is to effect a resolution of certain dis. by a sudden & strong impression on the system. The dis. is wh the practice can be attended with benefit are now phlog. but not materially atonic pyrectica phlogotica & exanthematica more especially those of the synochus or sub putrid type The beneficial effect of f.s. in these cases depends upon the shock and the strong impression made and not on the quantity abstracted. Hence our object shd be so to conduct the process as to produce the strongest impression with the least possible loss of blood The patient shd therefore be placed in an erect posture, the blood shd be taken from a large orifice & the flow of it stopped suddenly and instantaneously, as by the application of the finger. In this way deliquium may be produced speedily. It is most probably that ligatures upon the extremities would be a complete substitute for this practice in all non phlogistic cases with the exception of surgical ones & perhaps even in these. The relaxation is certainly as perfect for the time being. But I consider the practice of V.S. in these cases to be injudicious. We have other means for effecting this purpose, more safe & more effectual. V.S. at the commencement of typhus will give present relief, but it is always apt to occasion an unfavourable change at one of the critical periods. As was before observed the obstruction of lbjs or ljb is generally sufficient for the time being in true phlog. dis. But the abstraction of lbj would make no impression in the synochous or sub-putrid type ^ cases of this wd not tolerate a repetition of the v.s. In dis. of the synoch. or sub-putrid type does not sink fatally till the 14th or 21st day, in the pyrectica & not till the 7th or 9th in the phlogotica Fever of the synochus type influences the opinion of a great many phys. in forming their ideas of cauma or infl. fever # We must in these cases employ v.s. as counteragent & not as we would in phlog. dis. or we shall either produce no effect, or exhaust the pat. & render the dis. more obstinate & protracted. If we bleed at all in these cases we must do it suddenly and rapidly in order to produce a sudden & powerful impression and overwhelm the disease at once. In other words we must half kill the pat. in order to cure him # All the authors of the present day say nothing about real cauma they describe only synochus for cauma you must go back to more ancient authors The cases in which this practice is recommended are quite different from those of the nervous type. In t. nervosus & syncopalis no one but a complete routinist wd ever think of v.s. IN fevers of a sub putrid or synochus type only is there any question about the propriety of v.s. I consider such practice as rash If it fail of its object it must infallibly sink the patient & render the case more hopeless. I am an advocate for a milder course one which is less violent and dangerous and more steady and uniform in its operation. By it more cures can be effected, convalescences is more perfect relapses less frequent & constitutional vigour less impaired. Hence depletion of blood in atonic dis. as a mere counteragent is considered by Prof. I. as a hazardous practice exhausting the patient if iut fail in resolving the disease. In phlog. dis. there is no such nicety Blood may be taken at any time before a crisis. The fact which all acknowledge that blood if taken at all in synoch. dis. must be taken in the first stages proves the hazard of taking it at all A proper test for the propriety of bleeding, free vomiting and purging is the effect of spontaneous humor. emesis and diarrhoea It is in my opinion never proper to bleed to faintness or syncope in any purely medical case, & the mistake of synochus for cauma has led to the practice In the true phlogistic dis. there seems to be a state of the system which increases the supply of the vital energies & I would bleed purely for the purpose of reducing this state I would not apply irritants to the surface till the system is reduced nearly to its healthy standard then blisters and other irritants will remove the weak remains of phlog. act. Even cauma may sometimes be broken up in its forming stage by the use of counteragents only, as hot spirits & water forced sweats etc. in empirical practice But these means if they do not effect in resolution must aggravate the case & are always hazardous. So the sudden removal of phlogotica of a synochus type is followed by a protracted convalescence and often by the supervention of other diseases. Dr Mosely of E. [Hudson] was celebrated for curing dropsies & most of his cases were occasioned by the free depletion of Dr Woodruff for the cure of pneumonitis for the speedy cure of which Dr W. was equally celebrated. Mr Masters of Lynn remarks that many of the cases of chronic disease which came under his care were the consequence of sudden removal of phlogotica by the free depletion of another physician Dr Good in his remarks on typhus observes “we are to avoid reduction and adopt an antirritant and invigorating course. Clutterbuck supposed typhus to be an infl. of the brain & practiced v.s for its reducing effect. Armstrong supposes visceral congestions generative of a general sensorial debility & bleed as a preventative Robert Jackson supposed v.s. was a stimulating process & bled for its direct invigorating effect. Decided practice of any kind will succeed at the commencement.” Dr. G. continues “this employment of v.s. in typhus is no new practice, but the sum of medical opinion for the last three centuries is decidedly against it” Even Dr Welch of Edinburgh the most strenuous advocate for bleeding in typhus & who takes blood by the half gallon, says that the majority of practitioners are against the practice & that it makes slow progress in Edinburgh But there is one state in typhus in which Dr Good thinks v.s necessary “Congestion, says he, may take place as an effect of the disease, in the head, lungs or liver & infl. or gangrene be the result. This symptom we must combat boldly by V.S.” “There is much hazard in the practice but there is death without it” In my opinion there is far less hazard in letting it alone In pneum. typhodes, he wholly interdicts v.s. He is very unfortunate as to the time when v.s. may be serviceable. In the early stages, as we have seen there is far less danger in v.s. But as to employing it in congestions, experience, observation & reasoning a priori all unite to show that v.s. will increase the congestion (vide congestion) And if in these cases infl. is the cause of the symp. this infl. must from the state of the system be atonic & as little benefitted as that by v.s. Dr Good supposes that typhus may run into phlogistic action. This is far more improbable than that cauma should run into typhus & both are contrary to fact. Most surely stimulants and excitants can never induce phlogistic action in typhus, for even in health when given in noxious quantities they produce not phlogistic action but irritation & if carried farther erythematic infl. & irritative fever. I have seen cases of great head affection in typhus in which on p.m. exam. not only no infl. or cong. was discovered but the brain was even found preternaturally pale. The same has been the case in delirium tremens & puerperal delirium. Infl. or congestion is certainly then not essential to these cases. In great atonic hemorrhages & after great loss of blood from any cause congestions in the brain are likely to occur. The greatest bleeders have the most congestions My conclusion then is that v.s. is never indispensable in typhus & never in synochus that if ever employed it shd be in the early stages & that if employed subsequently it produces at most only transient benefit & renders moderate cases severe and severe cases incurable The third purpose for which bleeding is employed, is to equalize excitement, increase susceptibility and prepare for the operation of other remedies in non phlog. dis. that are not materially atonic In these non phlog. cases v.s. increases susceptibility and irritability so that greater remedial effects are produced by most medicinal agents. It shd therefore be avoided in those cases in which there is already too much irritability and susceptibility. The susceptibility to diseased action and to remedial action is different though v.s. may increase both V.S. is a powerful preparatory in appropriate cases. It promotes the action of emmenag. diuret. diaphoret. & cahtart. etc. It produces this effect in different ways and partly by relaxation It has been supposed that like nausea v.s. increases the susceptibility to the action of deobstruents. If phlogist. diath. exists v.s. will of course increase this susceptibility. If however there is considerable atony it will diminish the susceptibility to their remedial effects which it will increase the susceptibility to their irritating and evacuating effects Even when there is no considerable atony v.s. will often reduce the system considerably below the favorable point of susceptibility for the operation of deobstruents I have learned from experience that the higher the degree of energy short of entony, the better is the operation of deobstruents. I have observed this particularly in peristhnitis bronchitis, rheumatism, gout, & paramenia obstructionis (as it now occurs) V.S. renders the operation of deobstruents precarious in these diseases Colchicum for example will relieve rheumat. more speedily & perfectly without it & has failed where it has been employed So of actaea racem. Moderate v.s. for this purpose, when the dis. is but moderately atonic may sometimes be beneficial, but it must be used with caution and is never indispensable. Examples of diseases in which v.s. is employed for this third indication are colica ileus in certain cases dysphasia convulsio s. epilepsia [illegible] apoplexia (sanguineous apoplexy) entasia tetanus lysso canina & other diseases in some particular cases When v.s. is practised for the third indication, we should avoid drawing too much blood on the one hand & the production of syncope on the other. Tetanus and lyssa canina are however exceptions. In these, if the vital energies are perfect we should take as large a quantity of blood as the system will tolerate & in such a manner that after the requisite quantity has been taken syncope shall be produced But even to this rule there are exceptions. In general our success does not depend on the quantity of blood taken nor on the shock produced it should also be borne in mind that v.s. in these cases is only preparatory & is of no permanent benefit in itself alone. It must be followed by other appropriate remedies or we shall soon lose the advantage we have gained Bleeding for the 4th purpose is employed in habitual & passive but moderate hemorrhage, as in paramenia [illegible] Bleeding is never employed for the purpose of directly checking hemorrhage. In active hemorrhage it acts by obviating the state of the system on which the hemorrhage depend and other means will accomplish the same object for instance the exhibition of acetate of lead In irritative hemorrhages (commonly called active) v.s. may be tolerated but it will have no effect in checking the hemorrhage, unless the depletion is very copious and often repeated. And it is always a dangerous practice, producing exhaustion, hectic of inanition and even death itself. Many lives have thus been destroyed which might have been saved Vicarious hemorrhage (misplaced catamenia) may be either active, irritative or passive & in some respects follows different laws from other hemorrhages. It is important to select a particular time for v.s. & appropriate medication shd follow. The hem. recurs with the same regularity as the catamenia and is preceded by certain precursory symptoms. The time to bleed is at the first occurrence of these symptoms & means shd (then?) be adopted to excite the catamenial secretion. It is not necessary or proper to take a very large quantity of blood or produce a shock by faintness. The abstraction of a little more than would have been lost by the hem. will be sufficient to interrupt the latter, & this repeated a few times will break up the habit. In the intervals suitable emmenagogues shd be given & as there is commonly a torpid state of the digestive organs, a combination of iron, sanguinaria and aloes is often found to answer well. All the tonics are useful Paragesis irritative In the first month of pregnancy troublesome symptoms arise from pregnancy & v.s. would give no relief. In the latter months they arise from pressure and and a moderate abstraction of blood may be proper. We should however be careful not to take too much Even in the earlier stages much bleeding will occasion abortion & in the latter stages it is very apt to cause miscarriages. Indeed there is no more certain mode of effecting a miscarriage than v.s. In some places (not so much on the Conn. riv.) pregnant women are always bled, as a matter of course Not one case in fifty requires it. When practised improperly it is followed, if not immediately, yet ultimately by bad consequences Recovery after parturition may be lingering & imperfect. Bleeding in pregnancy is very apt to produce abortions I have known cases of 5 or 6 abortions in succession produced by v.s. improperly employed & where the families were childless from this cause. I was subsequently called to such a case where abortion was threatened. I ordered a horizontal posture & gave opium in small doses, at reg. interv. & removed all the sympt. In the interv. I gave ton. & invit. rem. Iron was the best in this case though it has been said to prod. abort. The sympt. themselves in these cases are not such as indic. v.s. they arise from disord. stom. IN this way I have safely carried pat. through Exanguia Aneurismus Import. in an. of large bloodvess. as of the aorta. Here it is important to get the pat. along with as little loss of blood as possible. Still it is [illegible] not to mistake palpit. of heart symptoms a. of derange. of dis. org. for anew I have known the [illegible] & the case treated with v.s. & crem. tart. till it was thought disp. when it was thrown aside & the pat. recovered Wounds of [illegible] & lungs. Extensive & repeat. bleed are necess. when a man has been shot through the lungs & perhaps when shot through the [illegible] Leave no more blood than is necessary to sustain the function of the system In wounds of the brain the dang. is from hem. Though we must bl. copiously yet we must avoid prod deliquium which might cause death hence a horiz. post. These cases are entirely diff. from accidents & casualties Abern. remarks “the surgeon must let the infl. (the danger is from hem. not from infl.) kill the man or run the danger of killing him with the lancet” & he says “the latter shd be preferred.” I think he is wrong. Sins of omission are not so bad as sins of commission V. [Chololethus] [means] prob. oth. rem. are better Lithia renalis var calculosa narcot. prob. better In carcerated hernia deplet. to faintn. said to be necess. Ice & [illegible] of ether sd by Wood to be better Certain luxations (not, I think in any case of fracture). Parodynia implastica difficult part. from rigidit. Belladonna is better In these cases the quantity of bl. taken prod. the relax & the shock, the faintness manage as for 2nd purpose stand or sit pleno rivo large orifice not stop it so soon as for 2nd purpose If when enough has been taken faintness is not produced stop suddenly to prod. faintness. If a surgical case seize this mon. for the operation Parodynia implastica the pat. is impat. the pract. is [in a hurry] & v.s is too often pract. when it does injury. A celebrated account has broken down many constitutions in this way v.s. is nec. in few cases belladon often answers VI To prod. absorpt. of parabysmata & of emphysemate in ext. tumours If the pat. is feeble it can not be employed & unless a considerable quantity can be taken it is of no service. To be effectual the v.s. shd be as free as can be tolerated without injury use judgment avoid] also shock & fainting. Employ it also in the early stage It is of no advantage in cases of long standing & may be dangerous Often it must be followed by other [illegible] & remedies to promote absorption as quick & active vomiting with turpeth mineral or blue vitriol or even sanguinaria Slow and brisk purging with elaterium is also efficacious & the free internal internal use of tinct. iodine. Those individually or in combin. are herculean remedies Situation has an influence on the quant. of bl. wh. may be taken. Persons in warm or moist situations (malarious) will not bear it so well. Phlog. dis. is less likely to occur & the same degree of it will require less v.s It is less indicated in dis. of chil. but when ind. they bear it very well. Child. are more subject to dis. of irrit. than of infl. & when infl. exists we should be less vigorous in our deplet. It is also less required in the aged In strumous habits less v.s. is required to subdue infl. & such habits will not tolerate bl. well for other purposes Avoid it in them when you can The season of the year is not to be regarded. In the Bethlehem insane hosp. London, they formerly bled all the pat. in the spring & purged them in the fall. When there is not vital energy enough to move the mass of blood, it has been thought that by taking away a portion of this mass we increase the [illegible] power. But s it is found that depletion diminishes the vis [illegible] stil more than the moles movenda A small bleeding when not indicated will not do much hurt for instance zfs to ziii with cinnamon water, as I saw in one case Excessive deplet. produces exhaustion impairs the digestive powers, occasions what are called nervous symptoms & imperfect sanguification with a deficiency of the colouring [portion] of the blood in consequence of which the minute vessels convey a colourless fluid. The nervous and absorbent systems are more weakened in proportion and hence obesity, [illegible] and dropsy ensue. Hectic [illegible] inanition is often prod. which often follows uterine hem. V.S. producing most freq. cong. in brain often in thorax or abd. A habit of being bled prod. corpulency & obesity with laxity & debility When there is a tendency to excessive formation of blood, v.s. will increase it & when there is a deficiency of sanguification v.s. will increase this also. It is well known that remedies will produce opposite effects opposite states of the system Deobstruents for instance will check morbidly increased as well as augments morbidly diminished secretion. Deplet. may produce gen. debility with morb. irritab. or debility with torpor History bloodletting (I believe) was not practised by Hippoc. Celsus bled in all fevers when the pulse was full & skin florid [Arctus] who is suppose to have preceded Galen bled in that fever called cauma Galen bled profusely even in typh the Arabians followed him the Egyptians Sydenham bled Willis bled. Boerhaave did not bled in putrid typhus. These all had a sort of routine practice & no fixed princ. The number of phlog. dis. is less than that of atonic but you wd infer the contrary from the books he causeth diath. was formerly more phlog. These are now more chronic dis. than formerly, which are generally atonic. During the reign of a phlog diath. chron. dis. may be somewhat entonic. Cauma is the only fever which is uniformly entonic throughout It is commonly supposed that all infl. is necessarily entonic, but many ] are confessedly atonic e.g. peripneumonia etc. Simple Saline Refrigerants Nitrate of Potassa A white colourless salt, crystall in hexad. prisms contain. no [illegible] of cryst. though some is mechanic united with the cryst. Undergoes igneous fusion. Decomp. by red heat, becoming nitrite & alternately oxide of potassium 1 nit. ac. + 1 ox. potassium sp. gr. 1.96 oz Solubility increased by addition of chloride of sodium Tested by throwing on a red hot combustible, as charcoal when it deflagrates or by red fumes of nitrous ac. when sulph. ac. is poured on its powder, also by th form of the crystal, but impurities make the form vary. The impurities are chloride of potassium and sodium. To remove these dissolve in boiling water, filter and crystallize. The nit. pot. cryst. first Dissolve in distilled water and add nit. sil. & no? prec. is formed. Decomposed by sulph. ac. & by baryta by sulph. of amm. magn. & alumina & by sulph. sod. at 32 [degrees] Hence all these are incompatible In phlog. dis. taken in the quantity of zi to zjv in the 24 hours it is a pure & powerful refrig. etc. etc. Ed. & [illegible] call it stimulant temperant & diuretic. Paris thinks it refrig. & that it shd be taken immediately after solution as it is then colder I think it never directly diaphoretic & the diaphoresis that sometimes follows is the result of the diminution of the entony. V.S. will do the same [illegible] thinks it one of the best of the diuretics. Paris thinks it acts primarily on the urinary organs, by passing in substance through the circulation to the kidnies, but he considers its diuretic powers as inconsiderable. In paucity of urine and diaphoresis which result from entonic action it is indirectly diuretic, but is not materially so in’ health. It moderately increases these discharges in diseases, neither entonic nor atonic. Murray is right in saying it is too inconsiderably diuretic to be useful in dropsy. It is not sedative in the sense of antirritant. Paris calls it aperient meaning probably laxative Renie says [illegible] to [illegible] is purgative but this operation is inconsider & is merely the result of obviating phlog. diath. Called also antispasmodic or nervine but spasm rarely accompanies phlog. diseases Antiseptic only upon dead animal matter It will however prevent gangrene from high entonic action. Cinchona is called the best antiseptic. But those cannot be indicated in the same disease. Dr Duncan says “Nit. pot.” is admissible only in enton. dis. & A.T.T. agrees with him. They are probably strictly correct Its ill effects (as in typhsus) may not be immediately observable injuring the tone of the stomach etc. Given in atonic dis is dyspep. it produces a small feeble frequent pulse, cold extremities, pain in the abd. like rachiale. Sluggishness and weakness in all the actions of the system & sometimes atonic humor. When it is indicated it should be given in uniform small doses v gr to [illegible] The test for too large a dose is pain at the stomach soon after it is taken indicating a dimin. of the dose so as to fall just short medium dose is called by Duncan 10 grs. others more or less this depends on the intensity of the dis. & the const. of pat. zi may not be too much Generally give it once in 3 hours in quantity just short of that which prod. the pain When its use is continued it can often be detected in the urine Paper dipped in the letter and dried, will deflagrate When the bowels were very torpid I have detected it in small quantities only & those not proportioned to the effect on the system. If the bowels were loose, no trace was discoverable. Hence it follows that its medicinal effect is not the result of its being taken into the circulation Externally applied it is a local refrigerant lessening entonic infl. Add chlor sod. to favour the solution & apply immediately. Applied to tender and irritated parts it produces topical irrit. & infl. & so does tart. ant. It is refrig. nevertheless. Even phosphorus when made to produce topical infl. & irrit prod. aton. infl. This is true of all the stim. A very large dose vomits actively & is thrown off If a poison dose less than this is taken it produces sharp pains in the stomach nausea, swell. of abd. sensa. of cold in stom. cold of extrem. weak of pulse sometimes bloody dischar. faintness, syncope convul. & death. Said to cause ulcera. of intest. & that the muc. memb. is disch. This would prove that it excited a membranific infl. The quantity constitution a pois. dose varies with the state of the system etc. IN strong entonic action it can scarcely prove pois. at least as long as there is entonic action to subdue A.T.T. says zi Rennie zfs to zi Orfila says its poisonous effects are like those of the narcotics & he recom. sulph. soda as an antid. The veget acids & antim. have the same eff. & the purging salts would also if not so soon carried off by catharsis Med. Jurisprudence Not. but detec. of article can. be relied on Treatment An emetic (if no evacuat. has taken place) immediately of turpenth min. bl. & wh. vit. though these are liable to fail hence the veg. em. are better Ipecac in large quantities, though it is less certain than gillenia trifoliata & stipulacea as also euphorbia ipecac. gracilis & corollata Probably sanguinaria & phytolacca would be good emetics. But recent finely powdered sinapis nigra is the best which prevent torpor of the stom. Give about a table sp fl. & repeat two or three times is necessary It is more effectual than the other veg. emet. & disturbs the syst. elss than the min. emetics The distilled wat. of ranum. flammula (if on hand) wd prob. be still better. A few years since a man travelled about the state selling an article to vom. without prod. sickness. It did so. Many persons took it merely for the experiment It was this article to obviate the eff. of nit. pot. give opium & alcohol demulcents. If its noxious effects have taken place & there has been no vom. cath are of no use. Castor] oil zj or ji or gtt p. to i to ol. tiglium or cast. oil with spts turpt. the latter being a stim. as well as a purge these will be better than sulph soda The refrigerants & especially nit. pot. have been much underrated of late partly from change of diath. & partly from inefficient use but chiefly from the chemical theory of their action, by a transference of their oxygen first advanced by Murray Though he has abandoned this theory he still calls them chemical rem. They are as much vital as any others Therapeutic Application [Acute] merc. ptyalism rec. as a lotion supposing it would allay the burning sensation. This eff. is irritative and as this is also the eff. of nit. pot. we shd suppose it inadmissible, but there is a fallacy in this reasoning for canth. will prod. & also cure irrit. As topical applic. there is a fallacy in arranging articles as refrig. or stim. We can draw no conclus. from their internal operation. Probably ol. pin. & nit. pot. operate on the same principle in burns The best remedies for mercr. ptyal. are op. in [illegible] wat. sol. of op. as a wash (unless it produces irrit.) Fowlers’s sol., or sol. nit. sil. topically. Dipsosis avens from recently relinquished habits of intemperance red. because it allays thirst in cauma reasoning bad it may be aggravating the atonic diath. bring on el. trem. & will certainly aggrav. the dipsosis Water & refrig. liq. will not allay this thirst. Stimulating drinks & op. will Dyspepsia rec. by W. Phil. in strong solution, with green arabic when there is inflam. [tenden???] theory Dr Chapman remarks “no article is more apt to relax the stomach & produce dyspepsia. Dr Ives remarks “it is bad in dyspepsia.” It will even produce dyspepsia a bad sort of dyspepsia being caused by long taking it into a healthy stomach The French recommend it in jaundice I know not or what grounds there is great torpor, therefore something to rouse the system is required Also in melaena, a var. of jaundice occurring in broken down constitutions the effect of hot [illegible] of intemperance & hance very diff. to cure No course succeeds with me unless stim. are conj Never prescribe to symptoms merely without regard to names Simple idiopathic cough, in both stages when dry and also after expectoration has begun sd to allay irrit. prev. inf. good if diath. phlog. Remittent, putrid, subputrid (synochous) &nervous. In no form of rem., that I ever wd it be of used irectly the opposite are required Idio, hectic & even in symptom hectic rec. as cooling & sedation it produces no such affect contraindicated directly in all sorts of hectic. Typhus never saw it do harm in synochus [illegible] t. gravior increasing calor mordax etc. which op. carb. amm. etc. will relieve Cauma is universally rec. highly valuable and important next to v.s. & perhaps tart. ant. in nauseating doses The following is called Rush’s febrifuge & is much used in Phil. Rx nit. pot zi tart. ant. gr i dichlor. merc. [illegible] Div. into 8 powd. & give one every 3 or 4 hours The dose of [illegible] & inst is too small A better formula wd be Ant. gr ¼ to 1 nitre gr 2 gr give every 3 hours Apostema commencing diffuse suppurative infl. at hip joint a topical applic of nitre as a refrig. is serviceable So of phlegm. comm. [illegible] bubo f. furunculus I have seen [illegible] in these. It has been rec. in [illegible] them. infl. but it is always bad Tinct. canth. or a blist. is better & dry flour is better than cold lotions. In infl. of fem. mamm. it has been rec. but vol. lin. wd be better or even ac. pl. Bleuorrhea [sanodes] highly rec but Murray says when there is ardor urinae it is too stimulating Tinct camph. Ol. [illegible] Bals. cop. capsic. mustard etc. will cure it & these are more stimulating Orchitis useful but ac. pl. is far preferable. Gout rec. topically but top. applic, are always dangerous. Ac. rheum. rec. by Murray as a refrig dose 5 to 20 grs 2 to 3 times a day with diluents and demulcents this depends upon whether it is phlogistic [Lavendiaur] rec. zfs daily & even in conjunction [illegible] cinchona but v.s. followed by cal. & then by cinch. It is an import. [illegible] iun all the entor. phlog. the best combination nit. pot. cal. & ant. phlog. cephalitis solut. appl. topic but ice cold water is as good Acute phlegm. qunisy, highly extolled as a gargle & not without reason. In eryth. infl. of fauces it will not do much & no art. is superior to capsicum [illegible] bad Infl. of muc. memb. of bladder highly rec. in irrit. infl. of blad. as the surgeons term it but it is doubtful or what grounds for this copaiv. ol. par. etc. are among the best articles Rec. in scarlet fever bad. Entonic active hem. useful It is so limited by Dr Thompson Murray rec. in conjunction with diluents & demulc. now these are bad in hem. Hemorrh. with plethora but it will not dim. the quant. of blood & no dis with [illegible] commences with an increase in the quant. of blood. Diluents & demulc. shd be avoided, as they fill the vessels abstinence shd be enjoined Menorrhea that had become habit. & required the health (probably enton.) it is sd to have stopped the discharge It was given in barley water zfs twice a day produce coldness of stom. cold extrem. etc. nausea “tumult in the bowels” It probably did no good to the general health A dis. is often cured by bringing one worse This article is not useful in irrit. hem. & in passive it is positively bad Porphyra nautica or sea scurvy rec. but not alone nitre with acet. acid is the continuation I am extremely sceptical with respect to articles rec in sea scurvy Land scurvy (p. hemorrh.) arise from bad food, confinement to one sort of diet usually [illegible] hard labour & is probably the same I should not think this wd be benefitted by [illegible] & acet. ac. I have seen it yield readily to tonics Ac. plumbi shd be the basis of the treatment conjoin capsic. alcoh. & nutritious fresh vig. diet. I shd pursue a similar treatment for sea scurvy Diet alone will often cure it Paroniria salax (identical with spermorrhea) Sagnesis furor & salacilates (nymphomania & satyriasis) in these it is rec. by Swed. but I shd not expect much from it Obesity & corpulence In one instance it disturbed the stomach & dig. org. but prod no abatement of dis. If it had been given less freely it would have impaired the appetite less food wd have been taken & emaciation wd have followed. The old rule keep the eye always open the mouth always shut & in feet always in motion is better than any medication In a cellular dropsy it has been given with squills. The latter are efficient but alcoh. is a better auxiliar. In many cases diuretics will not take hold without alcoh. & gin is commonly given The latter acts more by its stimulant than by its diuretic powers. The cases that require no stimulants soon yield to diuretics or [illegible] & calomel Paruria stillatitia & mellita etc. I have never seen benefit from it in p. mel. but the same is true of many other remedies In diabetes it is rather injurious but I have not used it. I have done more with tinct. canth. than anything else Lithis renalis of no use Exormia lichen & prurigo lepidosis psoriasis inveterate used internally & externally In one case it did no good Ecpyesis impetigo var. herpetica (hoopes) & lesinosa (salt rheum) Itch I have tried it repeatedly with no success. It was probably given because it was thought cooling bad reasoning another applic. altogether different has been successful with me Burns & scalds but I do not believe they are to be treated on the antiphlog. plan Bi-carb. of Pot. Sometimes called supercarbonate or carbonate formerly sal tartari essentiala or sal aeratis The common pearl ashes of the shops (?) Crystals quadranga prism Taste alkaline not caustic sp gr. 2 [illegible] soluble in 4 parts water at 60 [degrees] Boiling water taken up 5/6 of its weight More [illegible] than the carb.& has considerable activity Sd to be diuretic it may be but I do not believe it wd be useful in dropsy. Supposed to be antiemetic not much so, & must be injurious in atonic cases As an antilithic inferior to the same dose of the carb. As an antacid it has some power but the carb. ac. disturbs the stom. & weakens it by its refrig. effect. The carb. is on the whole preferable but the bi-carb is more pleasant Perhaps this is the cause that it is in great favour As a refrig. other articles are better & as an [illegible] agent the bi-carb. (or rather sesqui-carb.) soda is better Bi-carb. of Soda Called super carb. soda carb. soda trona more commonly than the preceding called sal aeratis not changed by exposure to air has formed the walls of a fort The heat of boiling water expels half its acid, reducing it to a carb. 6/10 of this salt is oxygen I know of no real superiority it possesses over bi-carb. pot. Soda water every where except in N. Haven is mere carbonated water with not 1/1000 grain of soda to a tumbler full. It is more pleasant without the soda & less injurious A free and especially a habitual use of soda water is unequivocally injurious to most persons. In slender [habits] it induces dyspepsia & in dyspepsia it aggravates the dis. Some of the worst cases of dyspep. arise from the habitual use of this article. The robust very often take it with impunity Soda powders consist of pure bi-carb. sod. zfs & pure concrete tart. acid grs. 25 which form a neutral tart. soda this water is chemically different that of the fountains It is cathartic Seidlitz powders consist of bi-carb. sod [illegible] & tart. pot. & sod (Rochelle salt) zii in one paper & tart. ac. 35 grs in another. Some add bi-carb. soda to cider it destroys its natural briskness & makes it flat neutralizing the salic acid forming a [illegible] which is more refrig. than most other salts Sesqui carb. soda Chlorite of Potasa 1 + 1 Incorrectly called potassae chloras, oxymurias, hyper oxymurias, murias hyper oxygenatus There are two oxides & 2 acids of chlorine with oxygen protox. 1 + 1 perox 1 + 4 chlorous ac 1 + [illegible] chloric ac. 1 + 7 This last some call perchloric & the preceding chloric from the fact that the chlorous was first discovered hence confusion Chlorite of potassa is formed by passing chlorine gas through a concentrated solution of protox. potassium, till it is neutralized as is said. But chlorine never combines with an alkali The alkali is partially decomposed. By gentle evaporation & cooling the chlorite of potassa is precipitated while chloride of potassium remains in solution Authors are very vague respecting its virtues It is not a stimulant It has been tried in phlogistic diseases & seemed to diminish the diathesis [Swedeaur] mentions [asthenia], cachexiae etc. chronic hepatitis etc is benefitted by it. I do not believe in the existence of chronic hepatitis The dis. so called is merely morbid sensibility in the hypochondriac region, occurring in advanced stages of dyspepsia. In post mort. ex. I have found no traces of infl. in the liver It was introduced for prophyra nautica from chemical notions, as it contains oxygen not much used Said to cure syphilis & hence to be deobstruent useless when the constitution becomes affected before this constit. rem. are not needed. Said to cure [culan.] dis. none specified Dose 15 grs to zfs weak refrigerant believe it has no other power unless deobstruent A fine subject for experiment Vide Boston Med. Gazette for Prof. T’s experiments June or July 1832 Bi-borate of soda 2 + 1 (borax) Called sub-borate borate boras sodae alkalesans (because, contrary to fact the alkali was supposed to predominate) Called formerly chrysocolla When impure & native it is called tincue Prisms hexaedral with two sides broader, terminated by triangular pyramids. Sp. gr. 1.24 changes veg. blue to green. Tastes styptic & alkaline Soluble in water 20 parts at 60 [degrees] & 6 at 212 [degrees] Effloresces slightly Loses its water by heat & 4/10 of its weight becoming friable in a strong heat converts it into a transparent glass which is soluble in water By percussion it flashes in the dark Decomposes by acids & alkalies by sulphates, nitrates & muriates, phosphates fluates etc. Found only in Tibet & Persia, obtained from wells in an impure state, by evaporation Brought from E.I. in large masses, white & green, joined by a greasy looking substance I have known it used freely in phlog. dis. & the most I can say is that id did not harm & was thought slightly refrigerant. I have known it employed in the exhaustion of low atonic diseases, not malignant & it neither increased nor diminished strength of action Not stimulant. Said to be nervine probably not. I do not think it is I have never perceived any deobstruent effect from it Said to be diuretic Prof. T. never could perceive it to be so Said to be emmenagogue doubtful Prof. T. has made no observations Swediaur calls it antacid It would be so when the acids were the hydrochloric or the phosphoric, as they may be. Lactic acid wd have some action and also the acetic, if it exists in the stom. which is doubtful. The sulphuric, nitrous, carbonic, & hydrocyanic acids are all that are inferior in energy of attraction to the boracic. Still this will be inferior to other antacids Therap. applic. mercurial ptyalism dyspepsia with cardialgia & acidity proctica [illegible] (“painful hemorrhoidal tumours”) Parabysma coactum of liver or spleen Aphtha ulcera serpentia (Swed.) parapsis acris var. [pousitus] Its most common use in aphtha at first it will allay the burning heat, but only for a moment, not effecting a cure Prof. T. has found milk porridge, barley water, rice water, or even cold water, quite as good and even better than borax It is rec. to dissolve the aphthous crusts. It has no such power & if it had it wd be injurious, as the slough defends the ulcer beneath from irritation. 99/100 of the physic. of this country & G.B. prescribe borax as a matter of course for thrush Case where nothing is done [illegible] quite as well as those where borax is used. Veg. astringents do something toward a cure Nit. silv. is good. Borax is rec. by Dewees parapsis acris. var. [pruritus] Prof. T. has had no experience For internal use as refrig. deobst. diuretic etc. the dose rec. in zfs to [illegible] I have used it in much larger doses without any appreciable effect Swed. says for a lotion in [peraps??] acris dissolve 10 to 30 grs in zfs [illegible], but we use it stronger For internal use it nearly or quite inert If it has any power it is a refrigerant For external use it is about as active as wheat flour merely palliating [teaspoon???] “But my testimony is negative merely. It is desirable that someone shd experiment on it Begin the experiment with zi & take zii ziii etc. Borate of potassa has been substituted for bi-borate of soda & that no so good Benzoates & succinates of potassa Of these Prof. T. knows nothing. Carbonate of Potassa 1 + 1 Called sub. carb. (case being supposed to predominate) Sal tartari sal absynthii more anciently nitrum [illegible] & alkali vegetabili (very inappropriately) also sal aeratis tartari It has a strong alkaline taste and a powerful action on veg. & [illegible] substances Exposed to the air it [deliquiates] & has an oily appearance, where it is called in this [illegible] oleum tartari or oleum tartari per deliquium (a name also given to solution of pure potassa It does not absorb carb. ac. from the atmosphere. It does not readily crystallize Crystals rhomboidal scales Commonly found in coarse grains The poorest is obtained by incineration of bitartrate of potassa but this contains oxide of calcium The more common impurities are sulphate of potassa & chloride of potassium which however are of little consequence except in pharmac. preparations Said to require twice its weight of boiling water for solut. I think less Sd to be insoluble in pure alcohol of the shops. Said to combine with oils & form soaps (but there must be a decomposition) Incompatible substances All the acids All the bi-salts borate of soda, muriate of ammon. nit. silver ac. lead chloride of iron proto & bi-persulphate iron Di & proto chlor. of merc. bi-persulph. copper The most uniform but not the most active operation is that of a refrigerant This is seldom expressly said by authors, though they said it may be given in phlogistic diseases & also in atonic. In very low atonic cases I have seen it prod. irrit. of stom. (i.e. nausea & retching) & impair the tone of the digestive organs It can be considered only as an auxiliary to the other refrig. Said to be deobstruent I think not As a diuretic, with diluents, it has sometimes considerable powers & is more active than as a refrigerant Yet it is rarely successful alone in dropsy. It is only in other diseases that it can be relied on as a diuretic alone & it also increases action’ of other diuretics Its operations is direct as it has no deobstruent powers In hydrops cellularis it is a useful auxiliary E. & Vav. say it is useful in passive dropsies probably meaning atonic cases. I have never seen phlog. cases those called having been merely irritative More useful in paruria inops than in any other disease It is antilithic when the calculus consists of uric acid, cystic oxide, or xanthic oxide An effectual antacid It may be taken moderately in dyspep. with acidity but lime water [illegible] (according & the bowels are lax or torpid) is better the first being a tonic carb. pot. often does mischief in the disease. It is not tonic Said to be anti-emetic. In most cases it does no good & in many it is actually noxious. I have abandoned its use as an antiemetic, unless the vomiting is occasioned by free acid in the stomach Supposed to be antispasmodic & useful in the whooping cough. It is neither recommended in parabysma [illegible] I never saw good or hurt from its use Struma I know of no principle on which it could be of use So too of gout, in which the French rec. it. In dyspep. without acidity Remitt. fev. Spasmod. vomiting employed by itself or in effervesc. mixt. better omitted refrig. are not indic. this is not the best remedy & is often injurious Saccharine matter impairs its powers sugar fulfils the functions of an acid & in some cases takes precedence of carb. ac. Dose 3-4 to 15-20 grs. The French give more 10 grs to zi Give it in water or mucilage, sufficient to prevent a disagreeable taste Do not give so much at once as to distress the stomach It is customary to add just rhubarb enough to colour it & [illegible] ppt. to flavour it & this is regularly given [as a placebo] by some when at a loss what to do Placebos are sometimes of use but I never liked them Carb. pot. is more commonly given in an efferv. mixt. but in this case we have carb. acid and citrate etc. of pot. as a purging salt. The usual proportions are carb. pot [illegible] dissolved in water to f zfs of lemon juice but lemon juice varies in strength (of no consequence) If sugar is added it shd be [illegible] with the acid, or we shall have no effervescence But the bi-carb. is best for efferv. mixt. Taken in poisonous doses it prod. eryth. infl. of intest. tormina soreness, exhaustion, small weak pulse Still zj as been taken without destroying life. Immediately after swallowing take vinegar & water as an antidote, but if infl. vom. & diarrh. have taken place vinegar wd add to the irritation Then give oleaginous demulcents & narcotic antirritants. Opium & hyoscyamus are best. Keep the pat. under a stead & uniform operation of narcotics [illegible] disturbing the stom. by the quantity of your demulcent Carb. pot. is useful externally applied in diabetes & a cataplasm of it applied to a felon or a carbuncle is useful Carbonate of Soda 1 + 1 + wat. 10 Called sub carb sal sodae sal alkalinous fixum fossilis mineral alkali impure soda barilla is to soda what potashes are to potassa prim. cryst. an octohedron Taste resembles carb. pot. but is weaker sp. gr. 1.359 Soluble 2 wat. at 60 [degrees] wat 212 [degrees] Effloresces in the air Undergoes wat. fusion by heat Sometimes it contains so much water that it remains liquid after melting seeming to deliquiate & occasioning a suspicion of impurities. A red heat change it to a transparent fluid A very violent heat drives off most of the acid The same process uses are ascribed to it as to carb. pot. It is however less nauseous & more mild. It has the advantage that it is capable of being made into a pill after driving off the water Dose 10 grs to zfs (ed. & Vav.) Some says zii The common form for pill is Rx efflor. carb. sod. ziii sapo zi ol. ceram mx water q.s. Soda is used in the same dis. as potassa The old phys. are very partial to it in jaundice I have seen no benefit from it. Many rely on it in parabysma hepatica Trit Antimoniate of Potassa This is the fist of the nauseating saline refrigerants The “panacea antimoni” of the dispensatories, accord. to the mod. improved meth. of prepar. it is a trit. antimoniate of pot. Expose “antimony” (the sulphuret?) 1 part & nit. pot. 6 parts to as great a heat as they will bear without fusion, then pulverise & wash out the remaining nit. pot. with cold water It is a white powder of an acrid taste scarcely sol. in cold wat. very sol. in boil. wat. but deposits nothing on cooling (“I do not understand this?) It contains 11.5 pr. ct. of wat. acc. to benz. it is pot. 1 + antim. ac. 3 It is commonly thought that the antimoniates & [anti????] are les emetic & more diaph. & refrig. than tart. antim. It seems to be the case that those antimoniates which remain longest in the stom. producing continued nausea, without vomiting are more refrig. Tartrate of antimony cannot be readily managed so as to nauseate without vomiting. It is on this ground that the “pulvis antimonialis of James (the composition of which is to this day unknown) the protoxide of antim. with phosph. lime & the protox. of ant. (the glass) have been employed. The panacea antimonialis has been rec. in cutaneous eruptions. Prof. T. inclines to think it a bad medicine. He never did any good with it & has continued it until it did injury. The idea seems to be that any thing that acts on the skin must be useful. He considers it useful only as a refrig. & diaph. Prof. T. wishes some enterprising young man wd expt on this & other prep. of antimony Protoxide of antim. Protoxide of antim. with lime Protoxide of antim. & potassa The protox. of antim. was once much used by phys. under the name of “glass of antimony” They made antimonial wine by pouring wine on the glass of antim. in substance. This glass of ant. is very uncertain it its effects. It is much more uniform in form of wine It was formerly used as a diaphoretic & refrig. in dysentery when all diseases were thot to be “hot” Experiments are needed on these prep. Tartrate of Antimony may be taken as the p type of all the prep. of ant. It may be formed Its aqueous solution undergoes spontaneous decomposition on exposure to the air Tests Hydrothionic ac. throws down in yellow precip. carb. pot. a white proc. The most important operations of this article are refrig. diaph. & emetic. It is supposed to be deobstruent but it is so only by its evacuant operation IT is well adapted to entonic diseases but may be used in those which are not purely entonic nor atonic without much injury In phlog. dis. it is more refrig. & diaph. in nauseating doses In non phlog dis when the constit. is also slender it prod. a leucophleg. habit & dry skin, crusts about the teeth & fetid breath. If given freely it produces an’ unmanageable diarrhoea. Its continued uses as an alterative has done this Physic. used to prescribed it in atonic & cutaneous dis. when they were not so well acquainted with it as now Some pat. are more susceptible to it than others & the same pat. is more so at one time than another. ¼ or 1/8 of a gr. will sometimes prod. hyper emesis yet prof. T. has given 35 & 40 & 75 grs. without prod. emesis. But in such cases you may produce it by a glass of brandy sling This was soon after the change of diathesis & proved that after such a change had taken place the article was not adapted to these cases [illegible] of ipecac would probably have vomited those persons freely To treat an exquisitely phlogistic disease (cephalitis, pneumonitis), bleed & give a cathartic of salts (sulph. soda) add 1 gr. of tart. antim. not enough to vomit which will heighten the refrig. effect of the salts You may add too zfs of nit. silver which will greatly heighten the effect. You may treat any phlogistic disease in this way. Laxative Saline Refrigerants Quadroxalate of Potassa Bin-oxalate of Potassa Called sal oxalis sal limonum essentialis (yet it contains not a particle of citric acid) potassa oxalis acidulas sal acetosella (Phil.) It exists ready formed in oxalis acetosella & probably in all the spec. of oxalis also in rumex acetosa & r. acetosella It is formed by dropping a solution of potassa on a saturated sol. of ox. al. ac. in water the bin. oxalate when thus formed precipitates if too much alkali is added it forms an oxalate which remains in solution Binoxalate of pot. has a bitter, pungent & acrid taste It is not affected by the air. It unites with alkalies & earths & forms salts of a triple character It is a popular article in fevers but is proper only in the entonic It is sold in small wooden boxes & called “the essential salt of lemons” It has been applied to strumous ulcers and promotes their healing hence called antiseptic Prof. T. has applied the bruised leaves of the oxalis stricta & rumex [acetis???] with advantage but there are better things It might probably be of service, chiefly as a grateful beverage in fevers Malate & Bimalate Potassa Soda & Ammonia malic acid exists in the [illegible] It exists in the berries of the rhus glabra in the form of the bi malate of potassa. Pour boiling water on the berries and let it [illegible] till cold It is a grateful beverage in fevers Acetate of Ammonia Called ammon acetate ammoniae acetum sal ammonias acetosus sal ammoniacus vegetabilis The solution is called spiritus mindereri liquor ammoniae acetalis & liq. amm. acetatae of which the former is proper It is supposed to be stim because amm. is [illetigle] it It is not so. [Thomson] says the acid and alkali shd both be concentrated to form the best article It is too volatile to crystallise readily, but by gentle evapor. acicular crystals are obtained (& by sublim.) 1 8/10 inch in length Taste first cool, then sweet, finally the united taste of sugar & nit potassa but the mawkish taste of the mit. potas. predominates It is very deliquescent, melts at 170 [degrees{ sublimes at 250 [degrees] Distilled vinegar shd be used & shd be saturated with the solution of [illegible] aqua ammonia Adding sesqui carb. amm. is a nauseous & inelegant mode & shd not be used, as the salt is less powerful and either the acid or the alkali will predominate & sometimes I have tho’t I could taste both (I know not the reason of this If used in cauma & entonic phlogotica it moderates the heat & dryness of the skin & diminishes strength of action Yet Swediaur calls it a stimulant It is a good refrig. & stands next to nit. pot. & soda. It is not nervine It is called diaphoretic, but is so only by obviating phlogistic diathesis, the heat & dryness of the skin being removed & diaphoresis ensuing It is diuretic in diseases not much phlog. nor naturally atonic, with diuretic regimen, but it cannot be relied on in dropsy If there is paucity of urine, it restores it if in the natural state it augments it moderately It is not deobstruent When Swed. assigns it this power he means that it is refrigerant Diseases Recom. in “simple fever general It is fashionable in Europe to treat simple fever as a [illegible] It is never useful in typhus. It is useful only in active infl. fev. Rec on the phlegmasia useful in the phlegmonus ones, not in the atonic or erythematic or atonic arthritic Swed. says it is useful in the atonic erythematica I never saw any other. The supposed phlogistic cases are irritative & in these the article is improper For a dose Swed. gives zfs to zii of the solut. I give zi & never saw it too much The laxative power is less prominent in this article than in any other of the group Acetate of Potassa Called acetate of pot. sal diureticus (the most common name) Tana foliata tartari Tartarum regeneratum kali acetatum kali acetas sal digesticus slivii Longer known than any other of this class except nit. pot Add carb. pot. to distilled vinegar. Citrate of Potassa The citrate of potassa soda & ammonia are all used, and are next in frequency to the acetates. Citrate of pot. is called mixture vel haustus [illegible] riverii It is formed by adding sol. of carb. pot. to citric acid till it is saturated, & drying the product It is very fashionable in London & Boston It is not good in cholera infant. or in any atonic disease, increasing the vom. & purging It is most used as a diuretic being similar in power to acet. ammon. Taken during effervescence it is effectual in allaying vomiting in phlog. cases or those which are not atonic nor entonic No better than acet. amm. not so good as nit. potassa Nitrate of Soda Found native in various parts of S. America I consider this as a refrig. precisely in the same manner as nit. potassa, but in a much less degree It is said by late writes to be laxative in doses of zfs to zi Sd to be diuretic but I think in no other manner than nit. pot. Much used in Germany. Dr Weir (?) wrote on it Refrigerantia acida Vegetable Acids vegetable acids may be divided into 3 groups 1 Those which exist in veg. in a free state or combined with alkaline or metallic bases. 1 Those which are never free but are always combined with veg. [illegible] bases 3. Those which are the product of decomposition the first group comprehends all the refrig. acids exc. the carb. They are the acetic (called also acetous & a modification of it the pyroligneous) citric malis (or sorbic) tartaric (and a modific. of this the pyrocitric etc.) & oxalic (or rheic). The carbonic shd be placed here from its properties. The second group are not [illegible] to possess any medic. power. Examples are the meconic of opium & [illegible] of cinchona. The 3d group are supposed to be nervine. There are but 3 of them benzoic, succinic & perhaps the camphoric Acetic Acid This is susceptible of a greater variety of applications than any other veg. ac. & possesses all the powers of the others There are 4 species viz. acidum aceticum [illegible] acid. acet. dilutum (distilled vinegar) acid ac empyerumaticum (pyrolig. ac.) & ar. acet [illegible] (common vinegar Pure acetic acid is very volatile & its vapour is inflammable. It is obtained by The strength of vinegar is determined by its power of neutralizing alkalies It is found free naturally but it is obtained for use by fermentation & veg. decomposition In the U.S. from cider France from wine (acetum vini) England from beer (acet. [illegible] or Aligar) This acid has been longer known than any other mentioned by Moses. It may be obtained by the destructive distillation of veg. matter in form of pyrolig. acid This or common vinegar may be purified by digesting & afterwards filtering it upon charcoal (animal is best) & then distilling it This forms acetum dilutum, formerly called acetous acid It is contained in the juices of several plants, free or combined with alkalies e.g. with phenix [deotybifera] (date tree) vitis vinefera sambucus nigra galium verum [illegible] [illegible] rhus typhinum etc. but not in large quantities It is a pure refrigerant adapted to entonic diseases abating but thirst etc. It has been given in typhus gravior & putridus, because there is heat thirst, sordes cadaverous smell etc. & the pat. craves acids but in such cases the min. acids are better The heat requires antirritants The sordes cadav. smell etc. indic. a low state of the system & require supporting agents Acetic acid will produce morbid irritability of the stomach & intestines, retching vomiting & diarrhea, exhaustion & a tendency to sink at one of the critical periods. The effects are gradual, therefore not always observed. So of all the typhus phlog. & exanthematica & all dis. of putrid type It is not stimulant nor astringent Said to be antiscorbutic I think not, because it must contain veg. matter in solution to be of service in scurvy. This is the reason why plants of the order cruciferae are useful Antiseptic only in dead an. matter It may prove [illegible] gangrene from excessive phlog. action The veg. acid are said to be anti narcotic perhaps they are after the narcotic is removed from the system. Some narcotics are heightened by them while they remain No narcotic is ascertained to be diminished in power by them. Said to be antiemetics. This depends on the state of the system & stomach Said to be diaphoretic & diuretic only indirectly is it so “Laxative” most acids move the bowels acetic, slightly only “A remedy for polysercia” indirectly so in such quantities as to injure the digestive system spare diet wd be better A sparing use of vinegar in health is wholesome, especially in assisting to digest oily food For laboring men in warm weather vinegar largely diluted with water; syrup & ginger added, is a very pleasant & healthy beverage & far better than ardent spirits Externally it is refrigerant & discutient & may be made to be rubefacient combined with water & alcohol in certain [illegible] used as a lotion in all kinds of erythem. infl. scalds from hot water malig. sore throat tumefaction from sprains & contusions uterine & nasal hemorrhages & [illegible] costiveness. It is inhaled to relieve syncope. It is supposed to destroy specific contagion & is applied to the head of convalescents from small pox. But this is rather a chemical & mechanical than a medicinal effect It is liable to change & decomposition in the ordinary form of vinegar, but the taste smell & appearance will be adequate tests It is used in pharmacy as a [menstruum] & the posers of a few articles are heightened by it, as colchicum, which contain the bi-gallate of veratrine & the acetate of veratrine is more active. So the acetate of sanguinaria is more active also that of morphine is more so than the natural salt of morphine which exists in opium But most articles have their powers impaired or destroyed by it. The preparations are nauseous and liable to decomposition even with a considerable addition of alcohol. The following are used viz acidum aromaticum, acetum scillae, A. colchici, A. veratri (3 species) & A. sanguinariae As prepared from fermentation it is uncertain & shd not be used for these purposes Citric Acid Next in importance to the preceding Found abundantly in the geum citrus of which 3 species are described C. medica (citron south of Europe) C. limonum (lemon) C. linetta (lime) These contain great abundance C. aurantium (sweet orange) C. vulgaris (Seville orange) C. vulg. var. myrtifolia (cultivated in our green houses) C. decumana (?) (shaddock) All these contain citric acid & [illegible] the other species Citric acid is contained sparingly in other genera, as oxycoccus Europeus, cerasus [illegible] (bird cherry) C. hortensis (our old fashioned red cherry) solanum dulcamara, fruit of rosa canina ribes rubrum vaccinum myrtillus fragaria vesca Citric acid is one of the most expensive but most pleasant. The juice of the recent fruit is preferable to the concrete acid in fevers etc. Malic Acid Obtained from apples & pears in considerable abundance, in which it exists ready formed in greater still from the leaves of semper vivum tectorum sorbus [aucuprin] (?) of Europe, sorbus Americana (juice of the fruit) most abundant is the red [illegible] of the fruit of rhus glaborum for medicinal purposes, macarete the berries in hot water & strain The acid thus obtained is than the juice of limes etc. for fevers Tartaric Acid Obtained exclusively from the fruit of the vitis vinifera, in which it exists in the form of bi-tartrate of potassa New wine contains it in solution & deposits it by precipitation on the casks. It is taken from these & purified & crystallized to form the [illegible] bi tartrate of potassa or cremor tartar The true tartar is not recognized in chemistry now The “adiculous syrup of lemons” consists of tartar ac. zj essential oil of lemons (rind) [illegible] white sugar zxvi boiling water zvjii This constitutes the lemon syrup of the shops If too much oil of lemons is added it gives the taste of rotten lemons. There shd be just enough to give it a taste in water. The “salt of lemons” is bin oxalate of potassa, q.v. Oxalic Acid Exists in the fomr of binoxalate of potassa in the oxales Americana acetorella, stricta, violacea, & probably in the others It exists in smaller quantities & the same combination in rumex acetum & acetorella in the juice of the stems of rheum raponticum (pie plant) & a little in R. palmatum & undulatum. The acid of R. rap. was formerly thought peculiar & called rheic ac. The citric is the most agreeable acid than the oxalic, then the tartaric least of all the acetic. The oxalic is more active than the others & is probably the most powerful refrigerant of all The effects of these acids in excessive doses are irritation followed (if a sufficient quantity has been taken & not removed) by erythematic infl. & there may be ulceration & sphacelation if not immediately fatal. The symptoms are nausea, vomiting, pain in abdomen small wiry pulse etc. The oxalic is the most poisonous, next the tartaric, then the citric Immediately after swallowing give carb. pot. lime, or magnesia & if not given immediately they may lessen the evil those however are preventives, not antidotes To obviate the effects we must give demulcents & opiates Carbonic Acid Is said not to be capable of being inhaled It is so if pure, but when much diluted it may be & will diminish irritability & produce first prostration, the exhaustion paralyzing the muscular powers & preventing all effort to escape from its influence The remedies for asphyxia from this gas are a free supply of fresh air dashing cold water over the whole body particularly the head frictions stimulating enemata artificial inflation of the lungs with good air Medicinal operation Almost all the books call it “stimulant ton. diaph. diuret. & antiseptic” Copying from each other. When I commenced practice I supposed so, but have found by actual experiment that this is not true It was injurious in atonic cases & did not aggravate phlogistic ones. If given freely in the form of carbonated water it was an evident & decided refrigerant, diminishing vital energy & strength of action & morbid heat, restlessness, irritability & irritation. It is a decided but weak refrigerant beneficial only in acute entonic diseases. It will correct the fetor of the alvine evacuations. It is analogous in its effects to the vegetable acids. I have a letter from an old physician confirming my statements Boracic acid (nervine?) Fruits Stimulants 2nd Stimulants Rhus venenata not the is vermix which is a native of Japan like R. toxicodendron is useful in palsy, dyspepsia & many diseases is no more unmanageable than any other article & is no more poisonous to the system. The other species of rhus are acrid but this is the best as R. [illegible] is probably preferable to R. toxicodendron. R. radicans is not inferior to R. toxicodendron Alcohol Discovered by an Arabian chem. A.D. 930 Some ascribe the discovery to Arnold de Villenne of Montpelier in the 14th century When strong burns with a blue, when diluted, with a yellow flame. Sp. gr. [absol.] alc. [illegible] 96 or 2 Off. alc. 835 in G.B. & U.S. take a vial find its exact weight & mark it with a diam. Pour into it 1000 grs (troy) distilled water & mark the heights Alcohol up to this mark shd weigh 835 grs. Alc. dissol. pot. amm lithia & the veg. alkalies, but not the earths. Generally all the salts which in water are insol or very sparingly sol. are also insol. in alc. The deliques. are also, exc. the carbonate of potassa Alc. also dissol. sugar, resins, manna, balsams, camphor essential oils Alc. dil. eq. pts wat. & alc. sp gr 935 The peculiar properties of alc. in different forms (as spts sacchari [illegible] spts persici [illegible] bran.) are said to be owing to oily matter always present & to a little acetic ether The former may be removed by repeated distillation & caustic pot. or soda will remove both. The carbonated alkalies do not act with suffic. energy Alc. is sd to be the same from whatever source produced Alc. is stimulant nervine & narcotic It differs from wine in producing an effect externally also, when it produces a vital contraction of the solids diminishes morbid irritability & sensibility, obviates a relaxed state of the soft parts & relieves pain IN many states of the system the use of wine & of alc. prod. the same effects, but there are considerable differences in certain states It is not tonic There is much room for discrimination between wine & alc. as between alc. & ether Greater effect on the brin is produced when atmosph. press. is removed as in ascending high mountains also on an empty stomach It does create a positive increase of power when indicated & properly managed & is not followed by exhaustion It is not a poison in a popular sense of the term i.e. in small doses Wine is indicated in non malignant typhoid disease alc. in low malignant [illegible] is better in the putrid types, alc. in in the nervous. The mode of preparation [illegible] the use of stimulants will make a difference if cal. & op. are not given in the early stages alc. will disagree in the latter & perhaps wine & the supporting agents will disagree also; but if cal. & op. be given at the outset & afterwards the sp. be continued alcohol will agree will if so strong a stim. be indicated Upon the [whole] [illegible] is indicated in chronic diseases & indicate with consid exhaustion, but alc. is advisable in very few chronic cases but is particularly appropriate in acute diseases with extreme exhaustion Intoxication is in no case a stimulant operation, but in some a narcotic, in others a nervine in others both It is not settled to which intoxic. should be attributed. I am inclined to think the remote effects of alcoh. attributable to its peculiar narcotic power No pure stim. nervine or narcotic produces them though the narcotics approach nearest. Perhaps we may consider del tremens as the eff of its nervine power & diseases of the liver of the narcotic, but I am not certain The external marks of intemperance in alc. are inflamed eyes bloated face red nose, tumid abdomen turbid urine foul breath, tremors of the muscles emaciation, peculiar cutaneous eruptions & preternatural old age The effects on the mind are inability to fix the attention failure of the memory & judgment, irresolution, cowardice Patient ultimately dies dropsical paralytic apopleptic or delirium etc. deranges the digestive organs & particularly affects the liver Swine & fowls fed in distilleries are subject to enlargement of the liver & the same eff is prod. on the human subject The constant irritation on the digestive organs causes a determination of blood to the viscera, which produces congestions infl. & parabysma. The particular diseases produced by the use of wine are a peculiar sort of dyspep. (differing from that produced by alc. & other causes) Gout, calculous diathesis & sometimes lithia renalis or gravel. These are exclusively the diseases produced by the use of pure wine The habitual use of alc. produces an obstinate dyspepsia of a different form & terminating sometimes in membranous phthisis limosis syncoptica parabysma to especially of the liver. A peculiar kind of cutaneous eruption Obstinate ophthalmia tarsi hypochondriasis nervous tremors A peculiar sort of conclusion called “drunken hysterics” delirium tremens obstinate dropsy parunia melleta or diabetes impotence paralysis & sometimes catocansis ebriosa These are all the diseases that are the peculiar effects of alcohol In cases of exhaustion from severe exercise, tho in good health, alcohol is a good remedy So if a person subject to rheumatism should accidentally get wet though a free draught of brandy will almost invariably prevent the rheumatism So too of persons predisposed to pneumonary complaints which exposures will bring on So of fever. So too an attack of an [illegible] may often be thus prevented. Yet it would undoubtedly be far better if alc. were confined to the shops of the apothecaries Therapeutic appl. of alc. & wine Limosis dyspep. It is bad practice & shd be avoided Wine is better when it agrees. Alc. may be used when there is extreme exhaustion to bring the pat. within the proper range of susceptibility to other medicines. Diarrhoea It has succeeded when it was simple & idiop. I consider the species of diarrh. as only varieties I except d. tubularis which is a membranific infl. & D. [illegible] which is a symptom of dyspepsia. Opium is far better [illegible] diarrhoea. Cholera a temporary use is often beneficial Generally before the pat. is called the pat. is reduced very low pulse weak, quick cold extrem. epig. stress. Here a small quantity of undiluted spts especially if hot will often suspend the vomiting & diarrhoea & palliate the disease Opium is more effectual but but some cases require alc. in addition Avoid giving a great bulk for this will cause vomiting Intermit. & rem. fever Wine & alc. often useful. These may be 1st of the synochus or sub putrid type 2nd of the nervous, as exquis. as in t. nervosus 3d of the putrid or typhus gravior type. When of the synochus type they are never malignant. Wine & alc. are never necessary unless the cases are protracted & run down In the nervous alc. is preferable to wine but wine is best in the Alcohol Wine 2nd 2d Stimulants putrid if not malignant & low. otherwise alc. But these are to be considered as auxiliaries, when the system has been prepared by cal & op. alc. is more applicable & agrees better. Thus is obviated the irritation which alc. would otherwise produce. Icterus melaena many cases will require either wine or alcohol. Sometimes they will agree, sometimes not give op. with either Typhus in all its forms when malig. alc. non-malig. wine answers very well When run on to a low state, alc. or wine shd be given acc. to the degree of exhaustion the previous treatment & the type Abscesses require either wine or alc. when in a low state. Apostema when low Anthrax when system is much affected & low Erythema [illegible] erysipelat. gangrenous & anatom. in the same cases as the preceding. So too of paristhmitis maligna Malignant variola rubeola & rodalia Phlogotica or visceral infl. may or may not be proper. When approaching to erythema phlegmodes they are not. if to e. gangren. they are necessary or in the early stages IN the arthritic wine & alc. may be highly useful. Arthritic infl. may be acute, subacute & what is called chronic i.e. intermediate between rheum. & neuralgia. All these forms may affect the viscera. In the advanced stages of any of them, if there is a metastasis alc. & wine may be useful Membranific Phlogotica I have not seen a case of croup this winter (1830) in which alcohol has not been employed by others as well as myself. This does not supersede the use of emetic cal. & deobst., but they fail without alc. in some cases or the dis. may run into a low state & then alc. may be required Strumous Phlogotica very often [required them] General acute febrile dysentery often indicated at the outset if malignant also if run down into a low state alc. generally is better than wine In many of the dysthetica they are important auxiliaries e.g. marasmus tabes (not so much in m. atrophins) especially var. venenata from lead & mercury. Porphyra hemorrh. (land [scurvy]) if the case is serious they are highly useful In severe cases the more intense astringents, powerful tonics & diffusible stimulants are highly necessary Gangrene especially G. sphacelus Entasia Tetanus their propriety has been controverted. Dr Hosack thinks every thing depends on giving them just to the right point & that more or less will fail his cases would not have been called tetanus in Conn. they were slight spasmodic diseases & would have got well without any treatment In genuine & severe cases we can trust to neither for a cure. In Mass. such cases S have been treated with Fowl. sol. in very large quantities, sufficient to keep the bowels open & alcohol. Practice that would destroy life summarily in health may be safe & effectual in violent disease. This practice seems to be judicious & judiciously managed Arsenic is considered the most important part of it. Opium shd be used largely at the same time. Lyssa canina proper if great exhaustion Chorea if great exhaustion Chlorosis atonica wine with some limitations Dropsy Stimulants are not incompatible with digitalis. In some cases it will do nothing without stimulants & then will act salutarily. They are those attended with exhaustion pulse weak & feeble extremities cold powers of life considerably reduced Bites & stings. The testimony is complete as to the efficacy of wine alc. & opium The practice is as old as Celsus perhaps Galen (vide my notes) Celsus recc. vinum cum pipere External Use of Alcohol Dr Ives uses alc. zi to zii ol. orig. in scalds & burns & prefers this to ol. pin. He uses it before vesication, which it prevents. If applied too long however it may produce it & be as bad as the fire. The test of sufficient applic. is the relief of pain without its returning on suspension. If the skin is removed, the burn extensive & exhaustion & irritation great, the same mixture is recc. topically Some forms of indolent tumors if early applied, it may discuss them Vapor bath of alc. (Support the bed clothes by a stick) probably some of the alc. escapes combustion & passes up in hot vapor. This bath does not fatigue the pat. does not make the bed damp like boiled blocks Useful in secondary stages of colica ileus & rhuch. in diarrhea cholera icterus melaena chololithus [illegible] limosis gastrodynia malignant intermittents & typhus Wine Vitis vinifera not an [anpelop.] D.C. vinif. & vitis jus native of south Asia. Boerhaave derives the word vinum from vieo to bend or twine It is from the celtic gruzel (pronounced vit) vine, vigne, vinea [illegible] [illegible] etc. all from two hebrew words signifying fountain & to press out. R. & Schultes describe 1 or 200 varieties of vitis vinif. Wine does not exist in the grape The great divisions of wine are alba & rubra Other divis. are acidula as Rhenish or Hock dulcia as Frontenac malaga [illegible] tokay cape austera as Portugalicum or Port, mitia i.e.. not acid sweet not austere, as sherry, madeira, claret, burgundy champaign. To these we may add vinum pomaceum or cider & v. pyraceum or perry Wine is mentioned in the works of Hippocrates in the treatment of typhus It is a stimulant, nervine & narcotic It allays the intense stinging heat of typh. gravior as infallibly as cauma is relieved by depletion & refrigerants. It promotes perspiration when defic. & restrains it when excessive It allays irritation jactitation pain & wakefull all in atonic diseases Excessive quantities produce vertigo, delirium or coma followed by languor headach. nausea vomiting & sometimes diarrhoea For diseases prod. by it vide alc. It is an undoubted fact that a free use of wine diminishes the susceptibility to diseases both entonic & atonic The power of wine in allaying irrit. sensibility increased freq. of puke restlessness watchf. pain etc. is the joint effect of its 3 powers Wine is not properly a tonic though it comes nearer the alc. to being one. White wines contain water, bi tart. pot. & colouring matter. Sweet wines contain sacch. mat. & ret wines, a little tannin. But these mixtures cannot be imitated by art. The properties of the factitious wines are those of their alcohol Hence I consider the active principle a distinct compd of the ponderable bases of prot or carburet hyd. & water in equal proportions, so that wine differs from alcohol as essentially as that from ether. I think it probable that hereafter it will be found that the active principle of alc & cider is 1 prot. carbur. hyd + 2 [illegible] But it is known the brewers add various narcotics to beer to make it more intoxicating 4th Stimulants Phosphorus This article stands next to alcohol in the quickness of its operation. Alcohol acts sooner than any other stimulant phosph. next & the cantharides, but neither of these two can be relied on as a quick stimulant in case of emergency. Ether (considered a stim. by Prof. T. in 18-1 & 1-2) capsicum, and the essential oils are sometime in operating Phosph. is I believe found in the veg. as well as in the min. kingdom. It is soluble in caustic alkalies with heat & probably unites with their metals, as it decomposes water It is not decided whether phosph. acts on the nervous syst. through the medium of the m.m. of the al. can. like ether or whether it acts on the bloodvessels like capsicum, cantharides, ammonia etc. Probably it acts in both ways It is said to be nervine & diaphoretic It cannot however be used as such Dr Ives give it in low stages of exhaustion etc. In mere torpor without exhaustion it is improper. Extreme irritability, though there may be ever so much exhaustion contraindicates it. It is only when the pat. is in a low state & the danger remote that it can be relied on & not at a sudden sinking a crisis, as yellow fever. When there is morbid irritability it is increased by phosph Dr Ives uses it when the action of the disease has worn out the sensibility of the system phosph. thus occasions a new supply of excitability & rouses the pat. in the article of death. This is contrary to the [Brunomia] theory but it is strictly true Dr I. thinks phosph. less favorable when there are topical affections. He thinks it excites appetite especially for animal food Swediaur thinks it aphrodisiac if so it would probably be from its stim. powers & in exhausted states of the system Phosph shd never be given in substance either in pill or emulsion as it wd occasion top. infl. Sulph. ether rectified by dry chloride of lime is said to be the best solvent zi will hold 6 grs of phosph. in sol. Soc. to my experience the fixed oils are the best solvent. Rx ol. oliv. purified & heat it with an excess of finely cut phos. Keep it well stopped. When used add a little spt. amm. to give it a creamy appearance & the pat. will not know that he is taking oil, at which most have a disgust. Sugar with ol. cinn. etc. makes it palatable Take it unmingled. A teaspoonful once in 3 hours is a dose of the saturated oil This was given in an extremely low case when a powerful dose was indispensible Continue this dose until the system is roused & then diminish & continue I have used it in no other than low cases. A small dose of a repeated is the only proper mode of exhibiting stimuli in low states of the system the lower the oftener Phosphorus if properly used is not dangerous & in low states of exhaustion we have no substitute for it Phosph. has been supposed to retain its medicinal powers in combination. This may be true of the binary compds [illegible] of its salts. Liquor of phosp. acid is used as a substitute for phosph. but that it has the same powers is I think more than doubtful It is formed by exposing phos. to the air, when it liquefies from the moisture in the air Sir H. Davy thought this substance a mixture of phosphoric & phosphorous acids Dr Ives’s dose is from 10-30 grs in water every 3 hours. I have not used it Particular forms of dyspep. attended with great torpor & insusceptibility & little irritation are relieved by phosph. In a form of dysp. with epigastric sinking lim. cordial or syncoptica of Good paroxysm every day sense of faintness distress at stomach, aggravated by exertion, both bodily and mental here phos. is of more use than any other remedy, unless alc. or opium which cannot be employed in chronic cases opium is not so dangerous but phosph. possesses superior power of relieving Limosis albicans (white jaundice) also lead colic with great exhaustion here ph. is the only remedy that will succeed Icterus melaena of Good occurring in broken down constitutions secretion of bile deficient differing from jaundice in being attended with exhaustion of digestive powers the skin is livid like a bruise yellowish green cases fro mthe south or intemperate persons. Common remedies do not good. Active stimulants must be conjoined with deobst capsic. or ph. with cal. or better corosive sublim. Malignant remittents & intermittents of trop. clim. & sometimes among us, & the low stages of all atonic fevers, malignant or not, when vit. energ. are low Delirium trem. Here phos. is a powerful auxiliary. In some cases opium alone will not succeed unless the vital energies are roused. Malignant continued fevers of all kinds whether with primary exhaustion or that produced by the disease Plague typh & anthrax involving the whole system Pneumonitis that kind which Good says will not bear emetics etc. In that kind of pneumonia confined to the lining membrane of the bronchiae with infl. like that of the intestines as dysentery Malignant rubelola & rosalia Atonic small pox Tabes var. dorsalis It has been partic. successful in T. venenata from lead merc. & arsenic Impotency certain cases of dropsy diabetes passive hemorrhage by Dr Ives Gangrena sphicelus & necrosis of Good Bad cases of land scurvy Spermorrhea atonica Agenesia in potens var. atonica thought to have especial power Poisonous effects of phosporus violent burning pain in stom. & intest. Alliaceous taste in the mouth obstructed respiration vomiting, hiccup extreme exhaustion Pulse very hard & small towards the close convulsions death. The stom. & intest. are inflamed & [sphicelated]. The infl. is erysip. not phlog which would spread to the other coats If called early give an em. of ipec. or sul. zinc If the phos. has passed down give cast. oil in wine glass doses with a drop of croton oil if necessary. Orfila recc. magnesia to neutralize the acid. I think the acids produced have no share in the mischief. Op shd be given sufficient to allay pain & spasm. No other remedy is needed. Antiphlog. rem. are injurious. Demulcents may be useful but not in quantities sufficient to produce distention Medical Jurisprudence Erithematic infl. of stomach pure phos. or ph. acid in al. canal no other mark decisive. If it has been given in oil, it will not be precipitated if in ether it will. The appearance of phosphorous [oxic] acids is not a proof of poison (or I think) for they are found in dyspepsia etc. & are an ingredient in the human body. Minute particles of phosph must be detested by the eye & by their white fumes, odor & luminousness. 5th Stimulants Arum triphyllum No synonym aroides (fuss.) Piperitae sinn. Possesses a peculiar acrid principle, volatile, inflammable dissipated by drying, air heat & even by pounding in a mortar It is not soluble in milk, oil, water, alcoh. vineg. I know of no solvent. Root contains ¼ part fecula This root produces a strong pricking sensation on the tongue & almost vesicates it Applied to the skin it vesicates In the stomach it produces heat, nausea a pricking sensation all over & spasms of the extremities are among its effects When dry it is inert like starch, but sometimes retains a little power The root is the only part used This root is an acrid excitant with no other power It is an expectorant & diaphoretic by virtue of its stimulant power & when dry it is demulcent & nutritious Externally it is discutient, but rarely used It is allied to capsicum in its powers. Medium dose 10-30 grs If recent 10 grs [illegible] sufficient, repeated once in 2 3, 6 hours. For an emulsion, best in a mortar with milk or sugar. Barton directs a confection by boiling, which destroys the power For extern. appl Beat with irritant or apply alone It is rubefac. & vesic. To keep it with unimpaired strength lay it in sand It is inferior to capsicum Milk, mucilage or oil most conveniently allay its effects Diseases It is put into a decayed tooth Ptyalism as in epilepsy Dysphagia from spams & that from semi [illegible] of muscles of [degl??] It is given with success in flatulent colic Other species of arum have the same properties in different degrees, as A. dracontium calla palustris less active than arum but similar Lecontia Virginica The strongest of all the arrideae acrid & mucilaginous. Arum maculatum is the off. spec. in [Eu???] Ictodes feticus Formerly called arum Americanum (Catesby) calla aquatilis (Gronov.) Dracontium fetidum lim.) posthes pectorii (B.S. Bart.) P. foetidum Lymplocorpus foetid (Salist.) Spathic [illegible] foetidum ([Rafines]) Ictodes foetidus (Bigel.) Every part has a fetid odour, depending on a volatile princ. probably a volatile oil, but it has never been separated. It is more permanent than the active princ. of A. triphyl. It has resinous & mucilaginous [illegible] its acrid & odorous properties. The seeds have an animal odor & contain a fixed oil The root and seeds are the parts used but the seeds are preferable. They retain their vital principle for years & their medical virtue as long. The root loses its strength by drying This plant is a powerful excitant like arum. It acts on the alim. canal & does not affect the circulating system immediately. It is a nervine like asafoetida. Very large doses occasion vomiting, headache vertigo & sometimes a temporary blindness It is probably not a narcotic Of the dry root 10-20-30 grs every 2-4-6 hours may be given. It may be formed into a confection or better, may may be taken in molasses & water Dry it whole & exclude the light It is doubtful whether the leaves are any better than cabbage leaves, but they have no offensive smell as cabbage has after topical application Uses & applications similar to arum maculatum It is not so powerful but it is better in flatulent colic than arum as it is nervine Dyspnea exacerbans It has more reputation in this than in any other disease Repeat it every 10 min. until it produces vomiting or relief. The vomiting itself is often of service To prevent the recurrence give 4 doses a day Dyspnoea seems to arise from paresis of the gastric branch of the par vagum & is relieved by Galvanism chronic rheumatism by a continued use like guaiacum & capsicum Convulsions particularly hysteria Paramenia cessations Dr I. recc. the limb in phleg. doleris to be wrapped in the leaves all over (as a smooth app.) Acorus Calamus [Odor] like a mixture of cinn. & pimento improved by drying. Essential oil can be obtained. The bitter principle is extracted by water It is an acrid aromatic excitant, with some tonic properties It is not inferior to cinn. & nutmeg in substance & oil. The dry powdered root is an excellent errhine IT is used for economy where cinn. & nutmeg cannot be afforded & were it as dear would probably be as much esteemed. Essential Oils These are 1 Pure stimulants 2. The milder oils as ol. anisi, a pure nervine 3d nervine & narcotic or stimulant & narcotic The terebinthinate oils are stim. & deobstruent Articles containing the oil are often used in a crude state, if it is in abundance e.g. cinnamon cloves Monarda Punctata (Wills.) The most acrid & pungent of the essential oils It flavor resembles that of thymus or satureja It is an elegant & pure aromatic & stim. Extrem. It is one of the best veg. or rubef. & vesic. For intern. use make a spt. rx f zi oil to 7 of off. alc. ( I make the spts ppermint in the same proportion) It is very good to cover the taste of unpleasant articles. So oil cinn. The oil cannot be taken pure, even on sugar For a [linin]. Rx ol. mon zfs tinct camph. zii & tinct. opii zii Probably the spt. monard. wd be as good for a rubef. Ol. monarda with ol. oliv. remains more fixed but is not so powerful The oil was introduced by Dr Atlee of Phil Ol mon. is more vesicating than ol. capsic. & less so than ol cantharides The other monardae are much less active Therap. applic. Typhus with cool skin & cold extremities use the linim. on the arms legs & breast (Eberle & Alee) to restore heat. Brandy would only evaporate & increase the coldness Cholera infantum (an enteritis) to the abdomen & extremities (Eberle) Chronic rheumatism internally & extern. peculiarly adapted partial palsy hemiplegia & [paraplegia] Tooth ache I have used the oil when the nerve is exposed apply it on cotton to the cavity of the tooth & around the adjacent parts or it may relieve by ext. app. ol. capsic. is best ol. mon. next. Mondarda oblongata Less active than m. punct. but nearly equal. The infus. is useful in the atonic stage of fevers. The weak infus. is quite effectual in the forming stage of the atonic febrile disease Monarda didyma (Banks) & monarda kalmiana ([Pursh]) These are used for nearly the same diseases as m. punctata & probably differ only in degree of power. M. kal. was first discovd at Oswego & called m. didyma Pursh gave this name to a southern species. Both are probably varieties. At least the “oswego tea” has the best claim to the name. The different spec. of mon. ether contain a less active ss. opil or a less quantity of the same oil. I know not which probably the latter. If so the same oil might be distilled from each Probably m. oblongata would furnish a large quantity Monarda fistulosa Common in N. England & has been cultivated in Europe for the oil It is the origanum spurium of old writers. 6th Stimulants Capsicum C. grossum squash pepper is the spec. almost exclusively cultivated amongst as C. annuum is mentioned in the books as being the off. article but is far less common. The [pericarps] of C. grossum contain 1 an essential oil (called etherial by the French) which is not volatile at all, and the case also with that of piper nigrum. It is obtained by digesting the pericarps in ether for a fortnight expressing filtering & evaporating the ether. We obtain the oil & crystal of capsicine the scent of ether still remaining which perhaps might be driven off by heat. The oil thus obtained & is of a brilliant red colour aromatic in odor, pungent & warm to the taste It cannot be distilled without decomposition. It contains all the medicinal virtues of capsicum. I have for years used it as a substitute 2 Capsicine white acicular crystals without odor or taste neither acid nor alkaline. AT the 1st crystallization they are combined with some of the oil & were hance supposed to be the active principle & sold at a high price. By repeated crystallization they are purified and then have neither sensible nor medicinal properties. The same mistake was made with regard to piperine which we always see yellow from the oil, but when pure is quite tasteless & inert 3. Red colouring matter which it is difficult to separate from the oil 4. A substance not investigated containing nitrogen 5 Mucilage 6. Various salts especially nit. potassa For excessive doses of ol. caps. demulcents of opium are the proper remedies Dose of ol. cap ¼ gtt or 1/8 gtt sometime 1 [illegible] or more Of the substance 12 grs is a very large dose in our climate but more is given in the W. Indies. If we wish for the effect on the stomach only, and not on the mouth & fauces the tinct. shd be given in milk. Mix & swallow immediately & it is not tasted Pat. do not generally complain of the taste in acute disease though they may in dyspepsia etc. Nor do they in low cases of typhus & cholera. When there is very great burning in the mouth & fauces this article cools more than any thing else The vinegar of caps. is not so good in irritated states of the stomach or in the low stages of fevers but it is the best form for affections of the fauces in rubeola & rosalia Cataplasms may be made of the powder & flour & vinegar. Or the caps. may be sprinkled on a paste. If a very speedy effect is desired a paste may be made with pure powder of caps. & hot spirit As a rubefacient it excites an action sui generis & often excites one when other things fail. There is room for selection in rubefacients In many cases tart. em. is bad & caps. good & v.v. So of other rubef. Therap. applic. Rheumatic toothache The tooth is often carious if on the lower jaw drop it in the oil if on the upper moisten lint, or rub up the oil with sulph. morph & dip lint in Chronic ptyalism often symptomatic of paralysis or of epilepsy & chorea gargle the mouth with the tinct. or the dilut. essence Dysphagia atonica often a more part of general palsy but it exists sometimes independently & is then curable by capsic. Dysphagia spasmodica Limosis dyspepsia in cases attended with torpor & insusceptibility, with much flatulence & freq. reject. of food. Capsic. alone or conjoined with food, or with eccoprotics, deobstruents & tonics will cure In cases of cold extremities rub them with the diluted oil till it produces a glow more or less permanent & so as to be slightly rubefac. if the powder on cotton is used it shd be very fine, for if as coarse as we have it for the table it will produce very little effect. It is used externally on this disease as a stimulant to the epigastrium either the powd. or the ess. oil Incorporate it with a spatula with La & Butler’s (which is the best it will spread cold) adhesive plaster common pl. is too hard Limosis syncoptica a valuable adjuvant shd be given in form of tinc. or oil as more speedy Limosis albicans (“white jaundice” no jaundice at all) highly useful auxiliary to [xanthortia], percholr. narc. & opium Dr Reed of E. Wind. who uses caps. extensively recc. it in all kinds of diesth. attended with viscid secretions from the liver to check the secret. in quantity & change them in quality Colic I prefer rubefac. to blisters in their action can be kept up in the 2nd stages it is important as an auxiliary Colica rhechialgia Capsicum counteracts the sedative effects of mineral poisons particularly of lead. Lead does not always produce colic, sometimes marasmus & sometimes paralysis, without being preceeded by colic The proper remedies for all these effects are acrids & particularly capsicum Colica cibaria of Good from poisonous fish mushrooms etc. (as often however a cholera or diarrhoea as colica). The tropical practitioners depend altogether upon the acrids & say it is no matter whether the offending substance is evacuated or not I prefer evacuating if pat. is not sunk too low. It is important to know that evac. is not indispensable in such cases we may enter at once upon the acrids as capsicum with confidence of success If called early I would evacuate the al. canal & sometimes this is all that is required if not give acrids. The effects of pois fish & pois mushrooms are very similar, being in both cases speedy & direct (sometimes very rapid) exhaustion. Some persons are more affected than others the reason is inexplicable. Those of warm climates are more susceptible than of cold Colica flatulenta Coprostasis costiveness attended with torpor & atony, apparently local cases where refrig. salts have been taken till an enormous quant. is necess to operate & then with small effect. The simple acrids such as are not cathartic will often give complete relief in some cases as much capsic. as can be taken with the food has answered the purpose. I know of no certain diagnostics in these cases. The subjects are generally feeble & no harm can result from trying caps. Caps. also enhances the effect of tonic & astring. cath. as rhubarb Diarrhoea, pure or idiopathic in the secondary stage caps. can be relied on alone shd not depend on it in the 1st It is particularly adapted to 2d stag attended with excessive & morbid secretions & relaxation it restrains and changes these secretions. Cholera when the vital energies are exhausted & there is great irritability of the stomach etc. caps. will often check it vomiting when opium will be rejected The phys. is not often called in the forming stage, before the vom. & purg. has commenced, at which time some other remedy might be preferred Cholera flatulenta great flatulence & copious rejection of air, without vomiting or diarrh. Here caps. alone is sufficient & opium is unnecessary Parabysma coactum useful auxiliary to conium & perchloride of merc. Parabysma strumosa Strumous diseases always require more stimulants [illegible] stimulants Idiopathic cough from relaxation Dyspnea exacerbas & asthma humidum in the 2nd stages & attended with relaxation & excessive secretion Passive hemorrhages capsic. is a popular remedy and often prescribed successfully by physicians Erythema of the membranes of the brain Perhaps the W.I. practice of shaving the head & applying rubefac. of caps. in delirium would be useful. I know not that it has been tried Paristhmitis erythematica independent of Rosalia. The original recipe was 2 tab spf of capsic. 2 teasp. of fine salt ½ pt. boiling water when cool strain add 1/3 pt vinegar dose a tabl. sp. every half hour. This would very well in moderate cases. The lowest & most severe wd do better without the salt & vinegar Apostematous Phtisis after the formation & bursting of a vomica capsicum restrains the purulent secretion, sustains the pat. & prevents sinking Dyspeptic Phthisis Erythematic visceral phlogotica are not generally recognized & described in the books except enteritis & gastritis eyth. infl. has a great tendency to spread, throughout the membrane which it affects Erythematic Enteritis attended from the first with diarrhoea & with vomiting if the stom. is affected. At the outset give calomel freely with opium conium & often sulph. quinine capsicum is useful externally. Capsicum is useful in all the stages of genuine & malignant erythematic phlogotica & in the secondary stages of phlegmonoid eryth. phlogotica Sparganosis [illegible] in cases supervening upon excessive hemorr. & attended with a low & exhausted state very useful here often as a principal remedy & always as an auxiliary. It is not proper in cases occurring after a long period & in the more vigorous & robust gout (regular) in all low cases Podagra larvata of Good improperly called by Cullen atonic gout for all cases are atonic Case of Dr Cooley violent paroxysm in his feet he applied some sort of poultice & in twelve hours it wen to his stomach. Dr Todd & myself were called we gave ammoniated alcohol, amm. tinct. guaiac. alcoh. opium etc. apparently with little benefit got no relief & was in a dangerous situation Dr Reed of E. Winds. entered on a free use of caps. internally with speedy relief. I have known other cases Rheumatism secondary stages of all ordinary atonic acute & all stages of erythematic atonic acute rheum. Eberle is too vague Rosalia maligna Rubeola maligna Malignant small pox whether confluent or not (all malign. cases are not confl.) Cases may clearly be of distinct small p. & yet require the most vigorous stimulation Purely passive hemorrh. & perhaps irritative Marasmus Tabes var. strumosa, var. venenata, from min. poisons & var. libidinosa Cyrtosis Rhachia All the strumous phlogotica & strumous affections of the glands of the neck Porphyra hemorrhagica It is second only to ac. lead I commence with lead & continue it till the hemorrh. is stayed usually from 3 days to a week. Then I omit the lead & substitute the sulph. quine. I accompany the lead from the first with caps. & brandy. The success of this practice bears no comparison with that in the books Gangrene all the species Insanity several species is to be treated most successfully by tonics acrids & deobstruents. This is the way in the Conn. Hospital & the prop. of cases cured is greater than in any other institution Melancholia acrid most useful Hypochondriasis Chorea good auxiliary Syncope in persons habitually subject, occurring from slight causes or spontaneously 2 or 3 hours a week for 6 mo. in such cases I have given various remedies both as prophlylactics & to bring pat. out of the syncope have found nothing equal to capsic. for both purposes. She could tell when the paroxysm was coming on & zi of tinct caps. would prevent it Carus lethargus It has considerable reputation with Dr Wright of Jamaica Paralysis not depending on organic affections Cantharis pellitory capsic. & guaiacum are the best caps. one of the best. Paramenia retentionis & [obstructionis] when attended with atony as P. retentionis always is The acrids, deobstruents & tonics, are the proper remedies. P. obstructionis may arise from imprudent exposure to cold & in such a case capsic. is not proper P. superflua Leucorrhea communis & [illegible] Dr Reed of E. W. values it more highly than any other article. I prefer cantheris unless the pat. is unable to take a suffic. quant. without troublesome strangury capsic is next. Nit. silver shd accompany the acrids (localls)? & local means shd also be employed Hemorrhea Senodes I have repeatedly cured at the outsed, freely & rapidly employed Cubebs which is similar is rather more certain to cure but it is not so readily taken Spermorrhea atonica Chlorosis inops Hydrops Thoracis & cellularis a valuable acjuvant to diuretics & tonics. We must first evacuate the water & then tonics & acrids will cure, if idiopathic Empresma abdominis (Tympanitis) from diarrhoea or catharsis in typhus & colic Capsic. very useful Paruria mellita externally as a rubef. & intern. as an adjuvant Capsic. is felt in the urinary org. & is smelt in the urine Paruria in continuous var. atonica Considerable reliance can be placed upon the acrids both internally & externally Capsicum is always contraindicated in phlogistic diseases, even after depletion when cantharis might be used Forms of administration 1st Pill essential oil in bread or in substance grs ii to a pill The dose of the oil cannot be definitely given Be guided by the nature of the case & trial Substance 1 – 4 – 12 grs as much as can be borne every 1-2 hours. Some give more, even as high as 30 grs this wd be rejected Pharmac. Preparations Tincture in the best. I usually make it with zii caps. to 1 pt dil. acl. Dose 10 gtt f zi Vinegar & water will rinse the taste from the mouth Acetum caps. is a good prep. prepared as the tinct. Dose the same Infusion zii to zi to 1 pg. water If it is to be sweetened, use honey Externally the U.S. Ph, directs canth. z10 caps zi alc. 1 pt. This prep aration might be taken internally too., 8th Stimulants Alkaline Ammonia Unknown to the ancients solution & carb. discovered by the alchymists Aq. amm. shd be well stopped with a ground glass stopper as it absorbs carb. ac. from the air. Much of that in the shops is worthless The alcoholic sol. is called spt. of amm. Internally they are purely stim. & acrid They act principally on the m.m. of al. can. but at length cause a rapidly & transient in crease of the force of the circulation, if repeated at short intervals The water & spiritous preparations differ As it is unpleasant it is rarely taken for any length of time I have never seen any nervine effects from it, wakefulness & exhilaration. It does sometimes relieve morbid irritability & irritation. So does pure stimulants in exhaustion I never saw it diaphoretic except by virtue of its stimulant operation It is discutient, topically applied not resolvent, internally It is antacid neutralizing a large quantity of acid & also preventing its formation by its acrid stim. effects thus obviating the morbid condition Dose of qa. or spts f zfs – f zi If it is to be often repeated, dilute with milk & it is taken much more readily water when a strong impres. is wanted It is rubevac.vesic. & caustic applied weak for a short time it merely reddens if strong an eschar is produced. Most generally applied in liniment with ol. oliv. this is best. When applied pure, flannel will prevent its evaporating. But linim. is better, which shd be of various strength & made of aq. amm. Taken in excess it prod. aton. uinfl. of stom. & int. The infl. is eryth. like that from acids or hot water & in both cases, the less fever the more danger. Eryth. infl of m.m. is more atom. more dangerous & more diff.to cure, than of skin In the worst case of an excess. dose, there was no pain, great exhaustion as in severe scales great stupor, pulse wiry & freq. & weak, skin cool. If the dose is not so great there will be a burning pain at the stomach afterwards retching & vom. perhaps tympanitis & sometimes fever. The more pain, the more hope of saving the patient [Orfil] recc. diluted vineger in large quantities to neutralize but after a few moments the mischief is done. It may however be given in smaller quantities, even an hour or two after to prevent further mischief. V.S. & antiphlogistication will do not good & be as improper as in burns & scalds. The topical eff. requires demulc. & antim. the general, opiates. Demulc. shd be in such moder. quant. as not to prod. stim. of distent. Opium frequently is best give by enema, but this depends on circumstances Therapeutics application Colic diff forms as a rebef. & vesic. Phlegm. infl. as apostema communis & common phlegmon early stages Effects a resolution when the infl. wd otherwise grow to suppur. Infl. of fauces early stages of phleg. & all stages of eryth. to the fauces & externally Inf. of female breasts said to cure if applied early, sufficiently & properly These infl. are diseased with more certainty then most others & are more troublesome if neglected Chronic Rheumatism when perman. & fixed topically Palpitatio from functional derangement of the nerves & dig. org. & not structural or organic as a rubef. to the thorax it is an effectual applic. Carus Asphyxia several varieties. C. paralyis not structural topically & externally Idiopath. vertigo [illegible] vertigo of Good Sick headache inter. & exten. gives speedy present relief Syncope from aff. of mind in universal use Common & hysterical convulsions also To do any thing with it in sick headache zi shd be taken freely & early better in nervous and highly irritable temperament. IN such patients the head ache depends more on the state of the nerves than of stom. Paramenia obstruct. highly recc. in milk thrown into vagina strong enough to prod. a sensation So too in Leucorrhea communis & senescention about the catamine period Bits & stings every effectual, but alc. & capsic. are more so. There is not a case on record, where alc. was sufficiently employed that was not cured. Dr John Osborn of N.Y. who had practised at the south said that when called he knew not what to do till the bystanders told him. He found amm. invariably successful & when summoned sent amm. without going himself Yet alcoh. is better. It is well known that a drunken man never suffers from a bite Scalds & burns If applied before vesication it will prevent it after vesic. it is bad. It shd be applied only till smarting & pain cease or it will vesicate. But it is again useful if a bad ulcer is produced & especially if there is danger of gangrene. It is prod as a favorable & speedy separation of the slough Aq. comm. shd be kept in in all vials of not over zviii for it is injured every time it is opened For a liniment equal quantities of aq. amm. & ol. oliv. will be too strong for the best amm. & weak for the common. Skip the next page This page to be read after the next a tea sp. f. is a medium dose, moisten it a little with water or any fluid not acid & it will be readily taken. It is useful in atonic febrile diseases. It is better than Dover’s powders Formulae shd be varied acc. to circumstances The following may be useful Rx sesq. car. am. zfs syr. orange peel zfs aq. menth. vir. zviii Take zfs every ;2-3 hours (Paris) Rx Ser. car. amm zi syr. alk. off. f zviii, or orange syrup not acid Dose zfs 2-3 hours 10 grs sesq. car. amm. (Richie) Rx Ses. cer. amm. arom. conf. aa grs v pulv. canthar. gr f simple syrup q.s. Take a bolus every 6 hours (Paris) The intervals are too long The canth. is the most active article Rx s. c. amm. grs v ext. rhei grs viii fl pil. 2 To be taken soon after making (Paris) Eccoprotic & antacid for dyspepsia Dr Ives uses the following It is much weaker than Paris’s & Paris’s, than the other Rx s. c. a. zii camph. [illegible] gum arab. zii water 1 pt. The water must not be boiling hot Sesqui-Carbonate of Ammonia Boiling water volatilizes it By keeping the carb. changes into a bi-carb. losing its odor & partly its taste, but not its alkaline properties It is a stimulant but less powerful than the alkaline amm. It can be better taken however. It is inferior to the carbonate but super to the bi-carbon Sd to be nervine & diaphoretic probably so from its stimulant power IT is an antacid, but inferior to the bicarb. Dose 6-20 grs in solut. or pill Its uses are more extensive from the greater facility of giving it & its supposed additional powers. Sesq. carb. am. camph & chalk, eq. parts powdered separately & well rubbed together is one of the best form & adapted to most cases. Stop it well & exclude the light or the camphor will be crystallized. The chalk keeps the camphor & carb. am. from concreting into small masses & also covers the taste. This mixture is stimulant narcotic nervine diaphoretic and antacid Turn to the page [prece??] or it will volatilize the amm. Dose zfs – zii every 2 hours Some of the late English writers recc. sesq. carb. amm. in 2-3 gr doses as a specific in rosalia & paristhmitis It is a good remedy in moderate cases. They use it much in convulsions of children & it is considerable used for dyspepsia Dr Woodwd of Vt. used it in in dyspepsia with camph. & chalk & some acrids as capsicum & prickly ash & also with gentian, etc. Intermittents It is much used, particularly at the commencement Used to in typhus IN common epidemic catarrh gout & atonic acute rheumatism hemicrania & sick headache. Also employed with considerable success in after pains of puerperal women & when used moderately it does good, but it only accomplishes in a few days what opium would do in the same number of hours. Cathartics Cathartics Refrigerant Cathartics Sulphate of Potassa Hiatus This has been called an aperient by Duncan in doses of [illegible] to zfs & cathartic in zv. It cannot be managed as an aperient in Dr Tully’s sense of the term Hiatus It is purgative cannot be managed as a laxative nor as an eccoprotic neither as a drastic It is a hydrogoge but not sufficiently so for dropsy. Elaterium is better It operates on the whole al. canal but rather more in the upper part It is kind in its operation & leeves the al. can. in a good state It is a rapid cathartic. It is not appropriate to produce a shock or strong impression Its other operations are refrig. said to be diuretic do not think so Hooper says it is deobstruent. I know not upon what ground. It cannot be so independent of the evacuation Medium cathartic dose is zi as a refrig. from zfs to zi once in 2 or 3 hours Diseases Cauma & all the caumatoid phlogotica of course contraindicated in low atonic fever It is appropriate in any phlegmonous infl. Hooper says coprostasis this is an atonic state of the system & therefore this article cannot be indicated there is torpor of the liver & this does not act on the liver H. says too that it is good in jaundice The same rule applies here He says too in suppression of the lochia. There is no such idiopathic disease if the suppression is attended with infl. of the uterus sul. phot. may be indicated He says dropsy too but as there is no entonic diathesis, it is not indicated Sulphate of Magnesia Hiatus Duncan says it is a mild purgative. This is applicable to all the salts of which I shall treat It is said to be diaphoretic not directly so, but by virtue of its evacuating operation. Not much diuretic Duncan says it will relieve pain in colic. It will do so only in entonic diathesis, but colic is not entonic It is cathartic in the same degree & in the same way as the two preceding salts (sulph. pot. & soda?) Disease & rules of application are the same also Phosphate of Soda Sal perlatum of the old books It is similar in its effects to the other salts & requires very little if any more to a dose It is better managed as an eccoprotic & laxative than the others It is not quite as refrig. as the pre ceding, but all its other peculiarities are the same as to time, mode etc. Med. canth. dose zi – zfs Swedinaur recc. in struma & do not think it appropriate Tartrate of Potassa Elixir tartrata kuli tartras kalitartarisatum pot. tartarizata alkali vegetabile tartras tartras solubile or soluble tartar is the common name of the shops It has the same effect as the others I do not think it can be distinguished from them. I have found no article but the antirritant narcotic that wd qualify its operation so as to prevent [tarmina] Tartrate of Potassa & Soda Soda tartarizatum sal polycrestum sal seignetti, Kali & sodae tartras tartrite of p. etc. It was introduced by an apothecary of the name of Seignetti I know of no difference between it & the others it is applicable to the same uses Bi-Tartrate of Potassa Hiatus Duncan says from zfs to zi is a medium dose for a cathartic It is far more diuretic than the others yet not sufficiently so for dropsy It is of no more benefit in schirrus or dropsy from schirrus than any other deobstruent It is purgative cannot be managed as a laxative is more hydragogue than any of the others quick in its operation not so kind It is peculiarly liable to derange the al. canal. None of the other salts can be said to be irritating. This is considerably so consequently it is better adapted to produce a shock or strong impression. It is more refrig. than the others Medium dose, from 10 – 60 grs once in 3 hours 60 grs once in 3 hours will purge pretty thoroughly And 10 grs in the form of pulvis jalapae composita Rx powder of jalap one part bitartrate of pot. two parts ground together to an impalpable powder. This pulv. jal. com. is recc. as a refrig. & used to be the common hydragogue when phlogistic diathesis prevailed. It is even now retained by some phys. & is Dr Hosacks hobby he gives no other The b-tart. pot. is adapted to the same diseases as the others except that it is better in dropsy being more hydrag. & diuretic. Dyspepsia recc. by Jas Johnsn of course contraindicated he gives it in a dec. of dandelion Colic-recc. coprostasis not good Proctics marisca & bleeding from hemorrhoidal vessels It increases the irritation Oxide of Magnesium This name has been applied to the factitious carb. mag. magnesia alba M. usta calcined mag. has been applied to both ¾ of the “calcd mag.” sold in the shops is nothing more than the carbonate Its purity can be tried, by its not efferv. with a strong acid It is eccoprotic, or at most laxative & antacid Diseases cardialygia spasms convulsions tormina & other diseases produced by acids in the al. can. Swed. recc. in coprostasis Ricketts. Suppressed leucorrhea accompanied with torpid bowels Gout supposed to be peculiarly adapted small doses continued for a long time were thought to remove the gouty diathesis lithia gravel independent It is not [illegible] Medium dose 10-30 gras 3-6 times a day. One circumstance shd be attened to. It diminishes the appetite chance where the case is atonic & there is a want of appetite, it shd not be given The salts of oxide of magnesium, in appropriate cases, as phlogistic ones are kind in their operation & leave the al. can. in a good state. They make but little impression on the system & therefore are not serviceable in giving a shock Med. dose zfs – zi in solution indeed you may say zi is a med. dose. Better in solution than in substance In highly phlog. diseases it is proper to add nit. potassas or tart. antimony to increase the refrig. effect. When a cath. Is not wanted the dose as refrig. is about the same, but nit. potassa & tart ant. are better Diseases Cauma entonic phlegm. phlogotica They are sometimes applicable in diseases not exactly entonic nor atonic 2d Cathartic Factitious Carb. Magnesia mag. sub. carb. magnesia alba mag. aeratii It is soluble in water Eccoprotic & laxative may be so managed as to prove both Not purgative nor drastic under ordinary circumstances. A. T. Thomps. says it is not laxative unless it meets with acids in the stomach It is copragogue. It acts on the whole track of the al. canal. It is slow & kind & generally leaves the canal in a good state. It is antacid Cath. dose 10-30 grs several times a day Diseases Limosis cardialgia Coprostasis some cases such as do not require large doses of medicine By means of this article more carb. acid might be generated in the stomach than in any other way. But I do not approve of the great use of this acid. Mildest cathartics Manna From the Ornus rotundifolium It has been said from the fraximus rotundif. Same not. group with the olive oleaceae It is the concrete exuded juice, obtained from the descending sap by slits cut in the bark The juice is of a white frothy appearance Taste slightly nauseous The best calubrian manna comes in long light friable pieces transparent pieces. The inferior kind is moist unctuous & dark coloured Fourcroy says it consist of four principles 1. Pure manna ¾ of which is called mannite 2. a little common sugar 3. a yellow substance of a nauseous smell 4. mucilage E. & Var. call it a mild purgative Murray, a laxative It is eccoprotic & laxative It is given to children, but is unimportant for adults. The older it is, the more purgative Dose for adults zi – ziii in water milk & water or better in milk Cathartocarpus fistula Native of E. & W. Ind. but cultivated in the warmer parts of the U.S. Commonly called “Locust & wild honey” The pulp of the loment is the part used. It has a black colour & a sweetish taste. It is said to be a good cathartic when taken fresh from the pod It occasionally gripes & produces flatulence It is given for children Eccoprotic at the most laxative Copragogue Acts on the upper & middle part of the intestines. It is kind unless the patient is predisposed to tormina pains etc. Medium dose for an adult zfs - zj Rosa Damascena Damask rose Native of the south of Europe The petals are used. They are given in infusion & are a highly popular laxative for children They are made into a confection also & said to be good in habitual costiveness given in the dose of a table s. f. Laxative is moderate quantities Purgative in larger The quantity for an infusion is zii of dried petals Rosa Gallica rerubra red rose This is similar in operation to the damask Linum catharticum The whole plant possesses cathartic powers Operations Purgative difficult to manage or as a laxative or eccoprotic Its natural operation in hydragogue acts on the middle part of the canal Takes a medium time for operating rather unkind leaves the bowels in an irritable state Dose for an adult is a “handful” infused in ½ pt of boiling water or zi in substance Infusion say zii to ziv or zvi of water Cassia Lanceolata Senna There has been much dispute about the species of cassia which is the true off. senna but it is undoubtedly the c. lanceloata. This is the tone off. or Alexandrian senna, but it comes adulterate with other species & other plants the cynanchum oleifolium is found among it All the species probably possess cath. powers but in a less degree. The term senn has no specific applic. It is applied as “ipecac” is applied to any emetic article That senna is best whose leaves appear bright, fresh, free from spots, strongly scented, bitterish & nauseous, smooth & soft to the feel, sharp pointed, free from stalks & legumes Senna contains a peculiar priinciple calle sennine (cathartine?) Operations It is purgative not eccoprotic or laxative. It is more or less hydragogue the moderate its operation the more fecal the matter discharged. It acts on the colon. It takes a medium time for its operation about 4-6 hours after being taken Dose of the confection zi – zii ]of the infusion 1 troy oz. will saturate a pt. of water add some aromatics to disguise the taste This is a bad cathartic being hydragogue & apt to occasion griping etc. “Any other is better” Prof. T. has discontinued its use Poinchiania pulcherrima Cassis orientalis senna spuria pride of Barbadoes etc. Nat. ord. [leguminosa] Cultivated as an ornamental shrub The leaves flowers & seed are the parts used The leaves are the strongest & the flowers next both used in decoction The seeds are best powerful & are used in powder I to a dose This plant has considerable reputation as an emmanagogue. It is but little known with us. Aloes That for a variety of species is found in the shops. There is the aloe spicata from the Cape of Good Hope & the annibellata from the same place the former is now considred the best. There is also a ferox of [illegible]? A. socotrina & A. vulgaris of [Persova]? The greatest part of the aloes in the shops is from the A. vulgaris of Barbadoes The appellation socotrine applied to aloes means nothing more than that they are of a good quality. The apothecaries in recommending their aloes will tell you they are the socotrine aloe The best aloes are an extract made by a cut in the shrub from which the sap exudes. This has at first a sweetish taste & soon after a intensely bitter one. IT has not the glassy appearance of the poorer kind Another mode of obtaining aloes is by inspissating the juice of the plant. This is nearly as good as the exuded sap there is not much difference A third way is by decoction 3d Cathartic about 1 lb of the plant to 8 pints of water boiled down & strained. This has not the sweetish taste at first perceived in that obtained by exudation The properties. A. T. Thomps. says of this best kin A. spicata are odor rather pleasant taste sweetish at first, & very bitter soon after powder of a bright yellow & aromatic smell 2d quality very disagreeable taste intensely bitter but not differing materially in med. qualities from the 1st 3d quality of a dark brown colour, hard & friable There has been no true analysis of aloes. The old one in the books is still retained but I do not esteem it correct. Operations cathartic heating & irritating Emmenagogue per se Dr Ives thinks it is manageable as an eccoprotic & laxative & that it operates more kindly when taken with food. The latter is probably true & it is the case with many other medicines e.g. diffusible stimulants Dr Ives thinks aloes have no direct tonic effect, but an indirect one He thinks they act on the liver promoting gradually the secretion of bile. HE thinks it moderately deobstruent but I do not use the word deobst. in this sense i.e. an article affecting one gland only, the liver for instance To say that aloes acts on the [portal] system is merely saying that it acts on the liver Dr Ives thinks aloes are emmenagogue, independent of their purgative effect. They undoubtedly are so. He thinks that tho’ they irritate the kidneys & bladder & color the urine yet no increase of urine is produced Aloes are a purgative, but may be easily managed so as to prove eccoprotic & laxative. In large doses they made to act drastically They are slow in their operation from 12-24 hours The discharges are purely fecal hence they are copragogue They act on the lower part of the bowels (i.e. they act principally on that part for all cath. act on the whole canal more or less) Their operation is appropriate doses & cases in kind though if given inappropriately they irritate. Appropriately given, they leave the al. canal in a good condition In eccoprotic & laxative doses they make but little impression in full doses a strong one Next after their purgative effect aloes are emmenagogue They are said to be sub-tonic I presume indirectly so Said to be anthelmintic probably more so than most cathartics Dr. A. T. Thomps. says they are not beneficial in hemorrhoidal affections But Drs Tully & S.B. Woodd have given them with good effect in such cases. As a general rule however I would not use them in a peculiarly irritable state of the intestines though even in such cases I have cured better than with any other article. This form of piles alluded to is proctica marisca Aloes combined with about a medium dose of opium are thought to counteract the effect of the use of opium. This combination is very useful when costiveness has resulted from a continued use of opium, but you will find after a while that less of aloes will be necessary. I have made the combination in the following proportion viz. 1 part of opium to 4 of aloes It is the common practice to give a cathartic pill when a practitioner does not wish to give calomel, and aloes with gamboge & soap or some other extract is a common pill. When such a pill is wanted I have used Rx aloes grs ii gamboge gr I oil tigl. gtt ¼ soap q.s. ft 1 pill. Sometimes but ½ a pill will be necessary according to the state of the al. canal & the habit of the pat. If the patient is in the habit of using opium or has taken it for some time 2 pills may be required I do not consider aloes good at the commencement of acute diseases. When a cathartic is wanted at the commencement of a disease to break it up I would not give aloes If you wish merely to evacuate feces or to produce an eccoprotic or laxative effect in the secondary stages of a dis. aloes are good in certain doses Diseases It is difficult to specify them Swediaur says dyspepsia with great torpor Pyrosis when bowels are torpid Habitual costiveness here they are also good applied externally Ulcers with a gangrenous tendency extern.? Cases of continued discharges from the ear a solution of aloes injected The dose varies according to the susceptibility of the patient From 1-2 to 4 grs may be given as a laxative or [illegible] in the 24 hours As a purgative about 5 grs may be required There are a great variety of phar. prep. Convallaria [Maialis] I have seen it in the meadows of Middletown tho’ it is considered not indigenous with us The root & flowers are considered the medicinal parts. The extract of the root possesses some of the medicinal properties of aloes tho’ a little weaker. It acts on the rectum & I presume it would prove emmenagogue in the same way The dose as a purgative is said to be [illegible] or zi probably a smaller dose would operate if given over night The dried root pulverised is a [sternutatory] & so are the flowers The flowers when fresh are fragrant but not so when dry I do not know much of this article Polygala polygama A specimen from which the bracts had fallen off was sent to [Willdenow] & he supposed it a new species & called it P. rubella. IT is called here “low centaury” but in the middle states the name is given to hypericum parviflorum sabbatia angularis too is called centaury The English centaury is ergthraca? centaureum nat. ord. Every part of the plant is entirely bitter the leaves more so & the root most of all. It very much resembles aloes in tasting medicinal powers It is an efficient cathartic the natural operation in an appropriate dose being copragogue the discharges consisting entirely [offices]. In large quantities it may be made hydragogue It is slow the natural operation taking place in 12-24 hours It aggravates practica marisca & in great doses produces that disease. Otherwise it is kind in its operation The impression is makes is moderate It may be considered tonic also anthelmintic. It is decidedly emmenagogue It has been supposed to be diuretic but I never could discover this effect. Prof. Ives says it increases the secretions generally If so it is a deobstruent It has been said that this article is bitter & nauseous & that therefore it shd be rejected from the mat. med. This rule wd make our list of medicines very small This article will make as good beer as hops Its natural operation is that of a purgative & copragogue Pharmac. prep. 1st Infusion dried plant zii water oi 2d Decoct. dried plant zji water ojss boil to 1/3 3d Tinct. zii to oj 4th Ext. by decoc. This I think the best Make it of a consistence for pilling As a cathartic the decoction is best & the dose is zii to ziv I have given even a wine glass full I thas operated in 12-30 hours Is not [illegible] but have for [illegible] all the while? 4 Cathartics As a tonic the tinct. is best in doses of zi 3 or 4 times a day Diseases Dyspepsia with torpor in its various forms Coprostasis Paramenia retentionis & obstructionis Upon the whole & consider this a valuable article much more so than it is supposed to be Ipomea Jalapa [illegible] This has been supposed to be the root of 2 species of mirabilis but they do not produce it (they are called 4 o’clock in our gardens) Convolvulus jalapa of Lim. The plant from which the real jalap is obtained. Dr Coxe calls iponea macrorhiza for an account of which vide Coxe’s Dispens. the roots produced by this plant are like those we get in the market Mr Nuttall pronounces the plant an iponea (what plant.?) It usually comes in roundish, ovate but pointed tubers internally yellowish At the present time we get our jalap from Vera Cruz & it is not adulterated Diluted alc. is said to be the proper menstruum for jalap It is used for its cathartic powers merely it is difficult to be managed as a laxative. It may be made purgative or drastic In moderate doses & if allowed sufficient time to operate it may be made copragogue but in excessive doses it is hydragogue. It acts principally on the colon The off. jalap is called in the books a stimulating cathartic It is an irritating cathartic rather. In a phlogistic, or atonic irritable state of the system it will produce irritation & increase it when already existing The alcoholic ext. is said in the books to be irritating, but Dr Ives says it is not. The ext. in the pharmacopoeias is made partly with water. In moderate doses the alc. ext. is not irritating It is probably that several species of convolvulus & iponaea possess the same powers as the off. jalap Podophyllum Petatum may appl. mandrake etc. Triosteum perfoliatum Linn. Root perennial top [annual] It has a popular name in almost every place in which it grows fever root wild gentian wild ipecac wild coffee? etc. Nat. ord. same as that of the climbing honeysuckle The parched fruit is said to have been used as coffee The root only is used in medicine the bark of this is said to be cathartic & emetic Dose for a cathartic is [illegible] to zfs this if taken over night will be effectual. It is about as active as jalap if pure & collected in the right season. It is injured by long keeping, but if collected in the autumn & well dried it will retain its strength The operation is supposed to be modified by a conjunction with mercury etc. for instance? by as a conjunction with? of ipomaca jalapa & podoph. pelt. When a cathartic & emetic operation is desired this article combined with di? proto chloride of mercury in full doses shd be given dose [illegible] to zfs B.S. Barton thinks it diuretic but I have discovered no such effect & think it no more so than rhubarb Dyckman says it is tonic he probably inferred this from its bitterness. I have never seen this effect & think it no more tonic than rhubarb & podophyllum peltat. I think it more likely that ultimately it will be found deobstruant This article is a cathartic. Its natural operation is that of a purgative but it may be so managed as to prove laxative Its discharges are mainly fecal hence copragogue. It acts on the colon In a full dose it has a medium time of operation. Its operation is neither very kind nor very much the contrary. It leaves the canal neither in a very good nor a bad condtion Diseases It has been prescribed in Intermitt. (Shoeph?} I think it not very applicable and in “pleurisy” (but there is no such idiopath. dis. though phys. constantly speak of it Shoeph? probably meant pneumonic) I shd think it not good. Said to be good in struma I shd not think so In reality this article is applicable only to the diseases in which jalap & P. peltatum are & no other The right time to collect it is autumn. The powder shd be kept in a bottle tight & excluded from the light I wd not pulverise much at a time for it loses its strength easily. Fresh parcels shd be collected every year Leptandra Virginica Culver root physic root Indian physic etc. It is difficult to tell what is its nat. order. Said to grow in Japan but probably a diff. spec The root has a bitterish & subnauseous taste. analagous to jalap. Both alcohol & water are the proper menstruus It is cathartic In its recent state of Dr I. thinks it one of the most powerful of our indigenous cathartics. When dried it loses its cathartic power’ Rafinesque says it is deobstruent & echotic but there is no reason for supposing that it has such a power. When recent it is said that 4 or 5 grs are sufficient to prove cathartic, but when dried zi or more will be necessary I think a wine of this article (zii to f zxiv) wd be a good preparation for retaining its strength I venture to say that a syrup would answer For instance make a saturated decoction (say 4 oz to the pt) & add the q.s. of sugar to make the simple syrup of the pharmac. The add oil of wintergreen to give flavour Perhaps an ext. night retain its powers There is room for experiment Therapeutic application The diseases mentioned in the books I do not think correct Coprostasis active cathartics are not applicable to this Bilious fevers this is indefinite Rheumatism not good subacute rheumatism other articles better old chron. rheu. 5 Cathartic Ricinus communis R. major R. vulgaris more commonly palma christi ricinus. One of the older manes is agnus castus whence castor oil Nat. ord. Euphorbiciae Cultiv. with us Castor oil is obtained from the seeds. It is completely soluble in alcohol & ether. The mildest oil is obtained by decoction, which method is resorted to in the W.I. for the mode see Hooper’s Dict.’ If the cortex of the seeds be permitted to remain in the oil will be acrid. That made by expression is also thought to be acid hence decoc. I think the seeds shd be [decortirated] for the active principle probably resides in the cortex Its operation is quicker & kinder than any other cathartic & as a mere evacuative agent it is the best in the mat. med. It seldom produces any griping. It is moderate, producing at most only 2 or 3 discharges says Cullen who says it is peculiarly adapted to costiveness. Colica ileus & C. Rhach. It is not heating nor irritating to the rectum & is well adapted to hemorrhoidal affections Medium dose zfs some require more others less Its ordinary operation is mild If frequently repeated the dose may be gradually diminished, which is not the case with other cathartics. That ol. ric. increases its power by repetition is an important point The only inconvenience attending the use of this article is that it is nauseating & disgusting to some patients. To obviate this give it in a wind glass with water below & spirit or spirit of ppt. above & it may be taken by the most delicate & squeamish Even rancid oil may thus be taken without its rancidity’s being noticed. I know of no way so good as this Ed. & Vav. say this oil is only a mild laxative but it is a purgative. They say that by rancidity it produces tormina, griping etc. This is correct. Some think that it possesses greater power than any other cathartic in removing worms. I have never seen its superiority in this respect. It is always better to give some narcotic cathartic & get the worms under narcotic influence as we do by spigelia This article is laxative not so easily made to act as an eccoprotic Purgative copragogue it produces no biliary discharges It is not drastic. It affects the whole track of the bowels equally It is speedy is kind unless rancid & leaves the al. canal in a good condition It makes little impression on the system & of course is not good at the commencement of acute disease The following formula is used in the W. I. in colica rachial. Rx zii of the oil to ziii of spirit & burn them about ½ a min. or till part of the spirit is burnt. It is said that this is effectual in that disease I have beat up this oil with the yolk of an egg & this completely deceived patients & got the full operation of the article, when they had absolutely refused to take it The decorticated seeds are taken as cathartics in some parts of N. M. Probably 4 or 5 of the bruised seeds are a [illegible] dose A saturated tinct. of the seeds is said by Piso to be a more powerful cathartic than the oil. Dose of the tinct. zi (zi?) the seeds should be bruised Euophobia Lathryrus (oleum) Cultivated in all our gardens The most common name among us is caper spurge. The fruit is said to be good for pickles. Native of Europe., Nat. ord. Euphorbiaceae The oil is obtained from the seeds a common practitioner could obtain it by macerating the seeds in ether By long keeping it becomes turbid & rancid It comes in vials of zi It is said to be a mild & safe but active cathartic & a good substitute for oil of tiglium Dose for a adul 4-8 gtts in milk sugared water or any convenient vehicle Its action is certain, prompt & at the same time mild, not producing tormina or griping like o. tiglii It is purgative drastic in full doses may be used as a laxative. It is copragogue in ordinary doses. It is irritant in full doses & may be said to be sub-emetic In affects the whole track of the intest. canal It is very speedy, 1-3 hours is mile & agreeable in medium doses & leaves the canal in a good condition. It makes rather a strong impression Iatropha 2 species I. Curcus and I. cossypifolia Called Barbadoes nutts The oil from the seeds of the i. curex resembles very much the castor oil Croton Tiglium Ricinus Indicas Pinus Indicus These oils all belong to the same nat. ord The wood has been used in medicine (lignum moluccense) the seeds also grana mollucc. grana ricini in English called “purging nuts” Native country Ceylon Moluecas E. Ind. China The genus croton is said to contain 50 to 100 species of which 5 are known to be in the U.S. One species in the U.S Affords a highly aromatic oil The oil of tiglium is obtained by expression from the seeds It is said to have a sharp taste odor sui generis It is said to contain fixed oil 55 parts & an acrid principle 45 parts. This letter has been called tigline The seeds root & wood have been used in medium, but the seeds & oil are the most powerful The oil of tiglium is the most rapid cathartic known. Its operation is said to be modified by aromatics, acids etc. but better by small doses of opium. Baking or roasting the seeds before expressing the oil is said to have this effect Its natural operation is purgative or drastic. It is difficult to manage as a laxative unless by tincture or a little opium. As a laxative it is copragogue but in larger doses hydragogue & irritant In large doses it is drastic It may be said to be sub-emetic Said to be diuretic & diaphoretic but I think it cannot be directly so It operates on the whole canal is the most speedy cath. we have usual time ½ hour This can be made to depend on circumstances sometimes less than that time If the dose is not too large the operation is not unpleasant if large a burning is felt. Moderate dose leave the bowels in a good condition This article cannot be preferable to calomel in typhoid diseases nor to the refrig. salts in the inflammatory The oil of tiglium in the market is said to be adulterated. I have always found that in the shops to be full strength. When pure it produces rubefacient effects on topical application It is sd to produce catharsis when rubbed on the umbilical region Dose of the oil ½ to 1 minim. The tincture made directly from the seeds in the most eligible form. Dr Bigelow gives a formula for its strength The oil may be given in milk but I prefer the pill made of bread. Unless camphor is added the pills will mould. I prefer dough to baked bread. I may be pilled with soap Another form is Rx ol tigl. [illegible] syn papav. zi Opium better than any other article modifies the operation & obviates the unpleasant effects of this oil. In combination with castor oil it affords the best cath. for poisons It makes a good enema. You will remember that generally 3 times as much is required 6. Cathartic by enema as by the mouth The effects of an over dose are severe burning pains hyper emesis hyper catharsis etc. Opium is the best antidote Diseases Coprostosis (E. & Vav.) as a general rule this shd not be treated with drastics Tenia I think however that the ol. pini is better, for in this you have narcotic & other powers which are peculiarly desirable to hasten an evacuation the ol. tigl. may be given Delirium Tremens Some writers say that this oil has been highly serviceable in this in conjunction with opium As a general rule purging is not indicated in this disease Rheumatalgia As a topical application it will probably do good for this is generally fixed Mania in acc. of this facility of getting it down Tetanus alleged to be useful in the sam. acc. if purging is indicated Neuralgia. N. Faciei Cases of apoplex. Obesity sd to be benefitted by freq. purging Dropsy but elaterium is our best article Oil of tiglium is not a new article in medicine, but and old one revived Scammony Convulvulus scammonia is said to furnish the Smyrna scammony but this is less valuable than the Aleppo scammony Another kind is the Montpelier scammony from Montpelier Convolvulus [Sepium] (Linn.) is another species producing scammony. It grows about our hedges & is called field bindweed & poison weed though it is not poisonous The exuded & expressed inspissated juice are both employed. The exuded is the most powerful & best dose 5-20-30 grs – 30 grs is a powerful dose it grows throughout the U.S. Hiatus Scammony? It is called a gum resin, but is more so than any expressed juice Used in dropsy other art. better in helmin. spts turp. better Natur. operat. purgative drastic if given alone Modified by combination Not easily managed as a laxative Acts on the colon medium time makes an impression In large doses is an irritant Gamboge Several plants afford it Linnaeus supposed the real gamboge came from the gambogia gutta Murray from the Statagmitis gambogoides Others from the gorcina gambogia of Willdenow & others say the gambogia guttifera. The name of the plant is not derived from the place in which it is found Stalag. & garcina grow in Ceylon gambogia in the E. Indies Gamboge is the inspissated descending sap obtained by exudation improperly called a gum resin. The juice concretes & is formed into masses. It is imported from Siam, Ceylon, [illegible] in China etc. We have no analysis but the old one of so many parts solub. in alc. & insol. in wat. etc. It is said in the books to be one of our most drastic & [illegible] cath. but others are more so Being drastic it is used in helmintha but because an article is drastic it does not follow that it is good for worms. As to its hydragogue power, it is not always to e relied on in dropsy. The Italians say that gamboge is contrastimulant What they mean I do not know In purgative & laxative doses it is more reducing than the preceding articles. It is difficult to be managed as an eccoprotic It acts upon the upper part of the al. canal & all the articles that do this promote more or less the secretion of bile but it does not in the whole [secerm] & absorb. system & hence is not deobstruent It irritates the intestinal canal & may produce an acute atonic irritative infl. It has been called by orfila? a caustic poison, but it is not. HE says too that externally it is rubefacient. This is not true It is more used by the British practitioner than by the French & is given in combination with other cathartics. Thus administered it is useful Gamboge is a strong purgative is cholagogue by acting upon the stomach & duodenum is hydragogue acts on the upper part of the canal is speedy is on the whole disagreeable in its operation when given alone, leaves the al. can. not in a good condition, but if judiciously combined its operation may be made kind & agreeable while by a frequent use of gamboge & by injudicious combinations of it the al. can. is left in a very bad condition it makes a strong impression on the al. can. & whole system is irritant & finally is to some degree an emetic, though this ought not to be enumerated among its operations Dose 3-6 grs recc. triturated with sugar but I wd no recc. it alone Diseases Coprostasis recc. but not alone Tenia jaundice recc. cannot be of much use other articles better quartans used as a purge but not good Dropsy recc. [illegible] other art. better. Chron. cutan. dis. not I think good Rhamnus catharticus Buckthorn Nat. ord. rhaminaciae native of Europe cultivated in this country & sometimes grows wild on the banks of the Hudson probably from seeds dropped by birds The berries are used. They are [illegible], black & shining, with a taste bitter acrid & nauseous & containing a pulpy green juice As a cathartic, this article is both cholag. & hydrag. & its natural operation is purgative & drastic & it is not easily managed as a laxative. When drastic it is powerfully hydragogue not so much so as elaterium but more so than most drastic cathartics It acts on the middle part of the al. can. & requires a medium time It is irritating & leaves the bowels not in a very good state It requires opium to obviate its ill effects. It makes a peculiarly strong impression on the system. It irritant & may prove emetic It is said by some to be diuretic it may prove somewhat so in small & often repeated doses, with diuretic regimens & allowed to remain sometime in the al. canal. Diseases Recc. by A. T. Thomps in cachexia & also recc. in syphilis do not believe it good in this Dropsy recc. by A.T.T. better in this than most other cathartics. It is used in N. Haven in certain cutaneous eruptions & recc. in doses short of purging I have never seen much benefit from it in cutaneous diseases The common dose of the berries is 20. The expressed fermented juice is recc. in some books decidedly bad Decoction of the berries is also used it is recc. to boil 20 of the berries in 1 pt of water very weak The syrup of the berries is the best form Rx If you wish to mitigate or modify its action add a little paregoric Almost every farmer thinks he knows what buckthorn but it is not found with us. There are spurious articles sold under the name of buckthorn. The article commonly sold under the name of syrup of buckthorn is made of the berries of the cornus sericea Bryonia Disease? Nat. ord. cucurbitaceae root fusiform intensely acrid & bitter Formerly the root used to be found mixed with jalap. Sometimes the inspissated juice of the recent root is used It contains a principle bryonine which is probably its active one The root was formerly employed as a purgative & emetic applied to the skin it is said to be irritant & rubefacient Dose of powd. of rec. root is 12 grs to zfs This article is purgative & drastic acts on the middle part of the canal requires a medium time & in large doses leaves the bowels in a bad condition. 7 Cathartics Cucumis Colocynthis Nat. ord. Cucurbiticeae Native of the levant & cultivated in Europe The fruit is the part employed, under the name of colocynth It is reduced to a fine powder. I believe the pulp only ought to be used, but the whole is used. It is found in the shops in powder. Water alc. & ether dissolve its active principles E. & Vav. say it is very irritant, externally or internally they say it is a powerful cathartic purgative or drastic less hydragogue than most other cathartics equally drastic (I can’t say I ever saw a hydrag. operation from it) It acts on the colon takes a medium time alone it is more or less disagreeable, but it is agreeable in combination It is a valuable article when a compound cath. is used, it makes a strong impression It is irritant E. & V. say it produces amenorrhea. I have never had any such effects from it Enteritis recc. by E & V. but a mere cathartic in this is not wanted a deobst. operation is required, for which calomel is best perhaps in erythem. enteritis it may answer a cath. is indicated but in this form a diarrhoea is almost always attendant & even in the calomel is best Dropsy E & V. but I do not believe this article hydrag. & therefore it can seldom be proper Elaterium [Momordica] Elaterium of Linn. Ecballium elaterium of Richard Called also cucumis agrestis & c. asinius squirting cucumber. It is a perennial plant growing spontaneously in the south of Europe & might be cultivated among us The active principle resides in the juice around the seeds it is prepared by As found in the shops it is The dried juice of the fruit obtained without any preparation is best As prepared above it contains a peculiar prox. prin. called elatine. An alcoholic tinct. may be employed Elatine is [illegible] Elaterium is oftener mixed with starch. It is injured by exposure to the light yet this our apothecaries do not know It is very expensive The juice of the [illegible] is irritant to the skin Elaterium undoubtedly possesses great deobst. powers, but they do not begin to operate much till purging comes on then they are powerful Its natural operation is drastic not purgative nor laxative. It is more hydragogue than any other article. Although so drastic it leaves the bowels in a good condition It may be given in cases of extreme debility. It is speedy in single large doses less speedy in small doses. It is irritant diuretic in doses short of the purging point deobstruent Upon the whole, elaterium is the most valuable cath. in the mat. med. calomel & the neutral salts excepted Diseases Coprostosis shd not think it good parabysma Struma shd not think it good Atonic ac. rheum. it acts as a resolvent deobst. but generally is proper only in the early stages Opium will prevent is purging Sub. ac. rheum. early stages Rheumatalgia in its various forms both that called “crick in the back” & sciatica a cath. of elat. is very beneficial [illegible] Indica give a cath. followed by an internal use of conium & iodine Chronic & obstinate ulcers of the legs purging with elat. is very beneficial they were formerly cured by vom. with turp. min. Chorea a valuable remedy by acting on the system at large Param. obstruct. idiopathic & in healthy subjects Hydrops cellularis H in these diseases it is of more importance than any other Begin? early in the morning with doses of 1/16 1/12 or 1/10 gr acc. to the strength of the article once an hour or once in 2 hours continue till catharsis actually commences & then suspend The catharsis usually begins in about 5 or 6 hours. It is preferable not to have it commence under 10 or 11 hours The first discharge will be fecal & then will follow those that are purely hydragogue. Most of the books recc. in full & large doses giving all you would give at once But this is apt to produce nausea tormina, distress etc. Give it in regular doses also to get its deobst. effect If the evacuations are rapid or appear to reduce the pat (which is rarely the case) give a dose of opium, generally not less than 10 grs, acc. to the susceptibility of the pat. If the pat. is at all feeble you shd be about [illegible] at the time of the operation of the article After the useful article treat with stimulants. It may be necessary to repeat the elaterium for removing the fluid does not cure the disease, & the fluid may return. Elaterium removes the dropsical fluid better than any other article I know of. In cases of concussion followed by stupor or coma about a week or two after the accident. I have known elaterium managed as in dropsy to be most effectual acting not merely by its evac. but its deobst. power Elaterium is better by itself than conjoined with any other article Some conjoin calomel, but it is better without E. & V. recc. it in doses of ½ gr. not to exceed 5 grs but with such elaterium as I have had, a man wd not stay long enough in the world to repeat the dose The momordica balsamina has been said to possess the same powers as elaterium, but [untruly] It grows in our gardens The juice of the unripe fruit is said to be emmenagogue & styptic. This is worth enquiry into. Luffa operculata Allied to elaterium Nat. ord. cucurbiticaea Its natural habitat is Guaiana. It is formed abundantly in the W.I. & along the shore of the Gulf of Mexico. Dr Hancock calls it crosia? It is also called “bitter cucumber,” but the cucumis coloc. bears that name. It is the momordical operculata of Linnaeus & is similar to the common cucumber I derive my knowledge of this article from Dr Hancock In the fruit is a web-like substance or reticulum which possesses the medicinal powers & Dr H. says “it is the most active cathartic in nature” says it acts on the “skin kidnies & intestines.” Acc. to his account it is an effectual deobst. acting on the whole sec. & abs. syst. I do not think it a tonic directly Dr H. says that 1 gr. of the reticulum is a dose. This is undoubtedly too large & acc. to his own account ½ gr. is sufficient 8 Cathartics to produce the effects of the common dose of elaterium Dr H. prescribed it in infusion, but says was obliged to add chloride of sodium to preserve it. Would it not be better to make a powder of the reticulum? He says it is better to have it a long time in operating. It seems its operation is precisely like that of elaterium & it is best given in small doses at regular intervals This article is drastic may be managed as a purgative, but not as a laxat. or eccoprotic Full doses may vomit small ones do not. Purely hodrag. middle part of can. Medium time in small doses Makes a strong impres It is irritant & deobst. Short of purging point it is diuretic. It is emmenag. in full doses. It is resolvent. Diseases recc. in dyspepsia colic. rhach. as an enema Dr H. says it is an effic. article Parabysm coac. (enlargement of the spleen) Dr H. says in his own case it proved efficient as an enema it affected the stomach. Hydrops cellubria (or as he calls it generally dropsy) Dr H says he has cured perfectly by it recommends it in the early stages He says mercury is a most efficient article in dropsy & so says Dr Tully H. Thoracis & H. abdominis (ascites) In the latter it is necessary to repeat the article in some cases. Dr H. has found it necessary to salivate & repeat it Upon the whole it appears that this article has the same medicinal properties as elaterium. It is not liable to lose its strength like elaterium. The [crasia] or L. operculata finally is cheap & precisely equivalent Sulphur Purgative in a full dose. It is diapohoretic in non phlog & not materially atonic cases, regularly, & I am apt to think it is so indirectly. It is irritant but not tonic or stimulant. It is undoubtedly inappropriate in phlogostic & truly atonic cases Dr Duncan thinks if taken into the circulation, from the sulphurous smell etc. of persons who take it. Dr Tully thinks it digested & says the smell is that of hydrothomic acid Duncan thinks it better combined with some saline cathartic Dr T. thinks this not necessary In [illegible] he Dr D? thinks its irritant effects will be obviated Sulphur injudiciously administered & persisted in will produce rheumatism, paraplegia & effects precisely analogous to those of mercury. I have seen swelling of the joints & loss of the use of the lower extremities Sulphur in full doses is a purgative it may be managed as an eccoprotic It is copragogue Acts in the whole track. It is slow. In a full dose & under a bad condition of the system it is unkind in its operation, & leaves the bowels in a bad condition It makes a considerable impression. It is irritant & decidedly deobstruent being resolvent (I have known sub-acute rheum. cured by it) diaph. emmen. & expectorant Diseases Prctica Marisca I wd regulate its use acc. to pretty much the same rules as aloes Chronic Coryza recc. by Duncan Chronic coughs it has been used in form of “balsam of sulphur” It is good in some coughs Dyspnoea exac. & asthm. hum. Duncan probably is good in the interval Disguised gout of Cullen Rheumatalgia or chron. rheum. have never tried it but it probably is good. Scabies & various cutaneous eruptions 6 Materia Medica [illegible] Depletio Sanguinis Is an important refrigerant process & should be treated of amongst therapeutic agents It is an operation directly and exclusively refrigerant in its effects The blood itself is vital and is the medium and support of the vitality of every part of the system The first effect of v.s. is to diminish vital power generally and strength of action in every part. It constitutes the most powerful and direct method of reducing the vital energies When carried to excess its effects are most difficult to be remedied The precise quantity to be taken depends on the degree of vital power the nature of the disease the prevailing diathesis and the vigour of the constitution Yet in no process is the practice so empirical Prof I. knows of no disease so severe as to require medication in v.s. has not been recommended as the most appropriate remedy ever [illegible] When really indicated it is indispensable when not indicated it is infallibly prejudicial Divided into two kinds General & local the former from an artery or large vein the latter from the capillaries Some however consider V.S. from a large vein in a part near a local affection, as from the ext. jugular in cephalitis as a local bleeding & therefore more efficacious. They think V.S. from the arm in like manner more efficacious than from the jugular or foot and in all the phlogistica they bleed from a large vessel as near as possible to the seat of the disease This they consider as effecting a topical depletion of the diseased part. Now it is well known to every anatomist that there is no direct communication between the viscera of the thorax abdomen and cranium and the parts forming the parieties of those cavities. There is therefore no ground for calling such processes topical bleedings. The notion is a remnant of prejudices existing before the discovery of the circulation of the blood & the distinction is of no more importance in practice than the old man in the almanac Some limit the term topical bleeding to an evacuation from the capillaries of the diseased part. This evacuation must be prejudicial in atonic passive diseases where there is a gangrenous tendency especially if performed with scarification and cups An English author remarks correctly that there is no such thing as topical bleeding independent of producing an effect upon the whole system In the phlogistic phlogistica leeches and cupping with scarification are of no importance for v.s. from the arm is all that is requisite. In local entonic infl. the practice is more plausible. Here topical bleeding is the best but the irritation of cups and scarification does more injury than the evacuation does good, unless applied to a neighboring part, and then the counterirritation produces the effect. As the disease however does not affect the constitution, it is of little consequence The blood is not stagnant in the part for then it would be coagulated and would not flow consequently topical bleeding cannot empty the vessels of the part Besides infl. is not caused by accumulation of blood this accumulation is an effect, not the cause If a general phlogistic diathesis exist, topical bleeding is not substitute for v.s. if there is no general phlogistic diathesis, topical bleeding is not required The cases which have been benefitted by topical have been cases of atonic infl. Here the counterirritation produced the effect the trifling depletion [illegible] of blood being injurious as far as it goes Yet the practice is very fashionable IN these cases bloodletting is not indicated. Deobstruents & antirritants such as calomel and opium give far more speedy and perfect relief Ophthalmitis is a dis, in wh. phys. say topical bleeding is indispensable A strong sol. of nit. sil. is far better & gives a more speedy cure If you separate some of the vessels going to the part, then to be sure you may produce some beneficial effect Where general bleeding is not indicated topical bl. is always injurious The capillaries are said to have an independent action and the reasons assigned are that it is by their agency that the blood is returned to the veins, that by them assimilation secretion and [nutrition] are performed that they are the seat of infl. 6:07 PMhe reasons are probably true yet it is [illegible] no less true that the capillaries as necessarily and completely depend upon the heart as the heart upon the depletion of blood affects both the capillaries and the heart, hence the surface is pale. If the action of the heart is increased there is congestion in the capillaries and less blood in the central parts In this case topical bleeding would remove the congestion temporarily it would be again produced by the vis a tergo In infl. the value of the blood is dimin. indeed but the blood is not stagnant or it would coagulate I would not be understood to say that cupping and scarification are of no service for I have seen them used with great benefit But I do say that other means are in my opinion better [illegible] by counterirr. only that they produce their effect Thus in the chronic stages of subacute rheumatism I have known evident relief derived from them yet no one would bleed in such a case also in pneumonitis The benefit is the same as from rubefacients, blisters etc. The strongest case is infl. of the eye and the anastomosis of the ophthalmic and temporal arteries is thought to have influence But even here if there is active infl. and phlog. diath. topic. bl. will be no substitute for v.s. In atonic infl. without phlog. action the case is better without bleeding of any kind & topical bl. is beneficial only by its irritation. I have seen both plans tried Dr Cogswell treated infl. without and no man was ever more successful. Few employ it who have had extensive practice. There are other and better means of counterirritation Depletion from large vessels and depletion from capillaries are better appellations than general and topical bleeding for the latter, as we have seen is inappropriate Depletion from large vessels may be performed by v.s. or arteriotomy. The veins are the vena media basilica t the bend of the arm the vena suplina major on the inside of the ankle & the v. [illegible] minor on the outside of the ankle The vena media basilica is preferable to the ven. med. cephal. the v. seph. or the v. basil. as the latter have cutaneous nerves running over their surface. The veins on the ankle are irregular; they have cutaneous nerves running over them, and the tendons are liable to be injured Besides the incision does not heal well but is liable to become a troublesome sore. The vena jugularis externa is often [illegible] The temporal is the only artery now selected; it is the only safe one as it alone passes over a bone, so that it can be compressed. It is of no consequence whether blood is taken from a vein or from an artery, or what vein is selected so far as the disease is concerned provided the opening be large enough Depletion by the capillaries is performed by means of leeches, or by scarification and cupping. The [illegible] medici lis is used but I have seen the H. sanguinea? do nearly as well [illegible] The best instrument for v.s. Prof. I. thinks is the Dutch or spring lancet as it can be used by those who are not ambidextrous it can be used upon the most rolling vein and upon persons in epileptic or puerperal convulsions the practitioner can set it and keep it in order himself and it can be used for years, while the thumb lancet soon becomes dull Depletion of blood may be a remedy in itself or it may be preparatory to the action of other remedies. V.S. for local symptoms can never be beneficial where the general symptoms contraindicate it buy may be beneficial when they neither indicate nor contraindicate it Venesection is employed to answer six indications 1st as a mere antiphlogistic or refrigerant measure in entonic diseases 2nd for the purpose of making a sudden and strong impression upon the system in order to produce a resolution of certain no phlogistic & not materially atonic diseases 3d to equalize excitement increase susceptibility, and prepare for the better operation of other remedies in certain non phlogistic diseases 4th as a substitute for an habitual but moderate hemorrhage & to divert it to some other part for the purpose of suppressing it gradually or preventing a too rapid sanguification as in exangin, cyanea (non closure of for ovale) exangia aneurisma paracyesis irritative (morbid pregnancy) wounds of the lungs brain etc. 5th to produce sudden faintness and relaxation for the purpose of facilitating certain surgical operations as the reduction of hernia or luxation 6th to promote absorption in parabysmata emphysematous (tumours!) & perhaps in certain dropsies Venesection is the most appropriate remedy for phlogistic diseases ad shd always be employed when any considerable phlogistic diathesis exists, whatever be the sex age climate season or constitution A blood is the pabulum of life, a depletion of it has greater effect in lessening the vital powers than the evacuations of any other fluid A free evacuation of blood from a healthy subject immediately produces more or less debility & increases susceptibility, appetite and sanguification. But if carried to excess it impairs the digestive powers The strength of the pulse is the only proper indication for v.s. When Fordyce and others mention hardness as the test for phlog. diath. it is evident from the context that this means strength. When however they speak of hardness and strength in connexion they make the same distinctions as Prof. I. Hardness indicates irritation and may accompany strength or weakness of pulse It is said by some writers that in enteritis we are to expect a small hard pulse and are always to bleed The truth is there are two species of enteritis which are accurately described and distinguished 1st phlegmonous enteritis, affecting all the textures of the intestines 2nd erythematic enteritis, affecting only the mucous membranes. Now the pulse in both these species is small and sharp but in the first no pressure can extinguish the pulse either in the systole or diastole in the second it is easily extinguished. In the first species only do we find strength of pulse & in this only is v.s. indicated Hardness combined with strength heightens the indication for v.s. these combined with fullness heighten it still more. Mere fullness & hardness uncombined with strength never require v.s. The coriaceous or buffy coat often observed on the surface of blood drawn depends on several causes 1st the degree of preternatural vital energy or preternatural strength of action in the system in other words the degree of phlogistic diathesis 2nd the rapidity with which it is drawn If taken rapidly it remains longer before coagulation the red globules subside and the buffy coat of course appears If taken more slowly it coagulates sooner and the buffy coat is less or none at all even though the disease is phlogistic Even in health blood may be so drawn as to exhibit the buffy coat 3d the depth of the vessel in which the blood is received if shallow the subsidence of the red globules will be less complete & the buffy [illegible] coat less distinct 4th The specific disease whether atonic or (frequently) entonic produces a buffy coat 5 Pregnancy is almost always attended with a buffy coat It will be readily inferred that Prof. I. lays very little stress on the buffy coat as indicating the propriety of bleeding or the necessity of a repetition. Wilson Philip and others express the same opinion. The firmness of the coagulum and the concavity of the surface are better tests But the existence of these marks & also of the buffy coat is no proof that a repetition of v.s. is called for We should not mistake for strength of action, the rigidity of the coats of the arteries so common in farmers, seamen & elderly people In phlogistic diseases, as cauma and the caumatoid phlogotica F.S. if employed early will of itself effect a cure. But it must be well managed. If too sparing at a time and too often repeated it will produce too great a reduction of strength If too profuse it may lay the foundation of other diseases. Those who are celebrated for removing diseases suddenly by a free depletion of blood, lose many of their patients by subsequent dropsy If there is no considerable increase of strength of action V.S. may safely be neglected In merely entonic infl. it is of no benefit but may be if the constitution is brought to sympathise with the local affection The phlogotica & local infl. differ in their causes diathesis and proper mode of treatment There is a foundation for the distinction of active and passive Some years ago the essence of infl. was thought to be an increased strength of action in the arterial system. Wilson Philip though it to be debility. Both these views have tended to confound the distinction of active and passive It is acknowledged that there is entonic fever. Is it any more strange that there should be entonic and atonic infl.? The essence of infl. is not the quantity or strength of action, but as is well remarked by Hunter the quality, and it may attend either increased, or diminished strength of action or a state of action neither increased nor diminished, and the treatment must vary accordingly. In infl. moderately atonic V.S. might be tolerated and would not destroy life it would render the recovery slower and less perfect. In every low atonic infl. (phylogotica) V.S. would be fatal I never knew a physician in Conn who did not employ bleeding in entonic diseases. This has been asserted with respect to myself, but altogether without foundation. Dr Danforth of Boston did not bleed a patient for the last 20 years of his life (this is noticed as a strange thing a man successful and of high reputation) Now the change of diathesis occurred about that time 1807 (to 27) and though sporadic cases of phlogistic disease occurred subsequently he may not have seen one (vide The Med. B.) I have myself seen but one decided case since 1816 & that was in 1819. You will occasionally meet with a case of phlogistic disease and cases arising from [illegible] though the latter will require less bleeding than the idiopathic. When the v.s. is employed for the first indication, viz as an antiphlogistic measure in entonic diseases, the degree of effect depends entirely upon the quantity of blood abstracted and not at all upon the manner of abstracting it. It is said by some that bleeding is more effectual when it produces faintness & that in such a case a less quantity of blood suffices. Such cannot be true phlogiistic cases. In every pure medical case the production of faintness & especially of syncope is to be avoided. In phlogistic diseases we must bleed freely,. so as to meet the symptoms, but in a recumbent posture in order if possible, to avoid deliquium. On the phlegmonous phylogitica the production of deliquium is unfortunate as it may prevent a sufficient abstraction of blood The abstraction of lbj or lbfs is generally sufficient nit. pot. tart. ant. refrig. salts veg. acids ripe acid & subacid fruits cold water & air shd be employed at the same time as auxiliaries. By thus dividing your measures you produce more effect upon the dis. & with less injury to the system. In phlogistic diseases V.S. practiced early and judiciously in the forming stage will produce a complete resolution. After the forming stage has passed, the dis. cannot be broken up but will run its course of 5 or 7 days under the best treatment but this treatment will seldom fail of effecting a cure. In phlogistic dis. v.s. may act somewhat on the principle of making a strong impression on the system But if a strong impression merely is the object, ligatures on the limbs are better. A third or a half of the blood in the system is in the limbs & ligatures upon them will produce faintness & syncope than v.s. This suspend the disease, but then the ligatures are off it is found that no permanent benefit results & v.s. must be employed In genuine phlog. dis. faintness and syncope are no proof that sufficient blood has been drawn. mere reduction without counteraction will not? cure like phlogistic disease. It would seem that an aggregate of symptoms exists one of which is increase of strength & this is removed by v.s. The aggregate is thus broken up and the dis. completely cured. Mere irritative or symptomatic entonic fever requires less depletion than that which is idiopathic, and after one bleeding, opium or hyoscyam with calomel will allay all the symptoms These may even prevent the occurrence of the symptomatic fever. Irritative fever is however often atonic & then no v.s. is proper Abernethy remarks that the fever must take place and we cannot prevent it. He cautions against bleeding in cases that must be protracted as all the vital energies will be wanted before the close He says we shd never bleed unless the fever will produce greater debility than the loss of blood. He adds infl. & irr. action wear out the strength and if more strength is saved by counteracting these, than is lost by the evacuation, then is v.s. proper & not otherwise. A surgeon of more extensive practice in N.E. than any other out of Boston has remarked that he had seen more cases of death from depletion after injuries, than from the casua,ties themselves. Chas. Bell remarks “A man has received a shock, the surgeon bleeds and the landlady gives a dram now I think the landlady is right” Dr Latham remarks “that many cases of recovery after v.s. are in truth but lucky escapes from death” The symptoms are the only safe guide for v.s. A writer in the Medico Ohio Rev. remarks that the man who should draw a distinct line between spasm (or irritation) & infl. wd render great service to the profession. Prof. I. does not consider the distinction so very obscure. But they in London consider synochus as inflammatory & hence it is that they cannot distinguish irritation from infl. In cases where there is doubt whether irritation or infl. exists it is the safer practice to avoid v.s There can be no danger in delay. But we can commonly decide if during the flow of blood the pulse soon becomes weak and fluttering even though it shd rise afterwards, v.s. will do no injury But if the pulse becomes softer and fuller we may expect benefit from v.s. In doubtful cases it is better to take too little than too much blood as the error is more remediable, and besides such cases do not absolutely require v.s. The lancet is often a little instrument of mighty mischief vide Hall’s mimosis in quieta. in fever of pure irritation The second purpose for wh v.s. is employed is to effect a resolution of certain dis. by a sudden & strong impression on the system. The dis. is wh the practice can be attended with benefit are now phlog. but not materially atonic pyrectica phlogotica & exanthematica more especially those of the synochus or sub putrid type The beneficial effect of f.s. in these cases depends upon the shock and the strong impression made and not on the quantity abstracted. Hence our object shd be so to conduct the process as to produce the strongest impression with the least possible loss of blood The patient shd therefore be placed in an erect posture, the blood shd be taken from a large orifice & the flow of it stopped suddenly and instantaneously, as by the application of the finger. In this way deliquium may be produced speedily. It is most probably that ligatures upon the extremities would be a complete substitute for this practice in all non phlogistic cases with the exception of surgical ones & perhaps even in these. The relaxation is certainly as perfect for the time being. But I consider the practice of V.S. in these cases to be injudicious. We have other means for effecting this purpose, more safe & more effectual. V.S. at the commencement of typhus will give present relief, but it is always apt to occasion an unfavourable change at one of the critical periods. As was before observed the obstruction of lbjs or ljb is generally sufficient for the time being in true phlog. dis. But the abstraction of lbj would make no impression in the synochous or sub-putrid type ^ cases of this wd not tolerate a repetition of the v.s. In dis. of the synoch. or sub-putrid type does not sink fatally till the 14th or 21st day, in the pyrectica & not till the 7th or 9th in the phlogotica Fever of the synochus type influences the opinion of a great many phys. in forming their ideas of cauma or infl. fever # We must in these cases employ v.s. as counteragent & not as we would in phlog. dis. or we shall either produce no effect, or exhaust the pat. & render the dis. more obstinate & protracted. If we bleed at all in these cases we must do it suddenly and rapidly in order to produce a sudden & powerful impression and overwhelm the disease at once. In other words we must half kill the pat. in order to cure him # All the authors of the present day say nothing about real cauma they describe only synochus for cauma you must go back to more ancient authors The cases in which this practice is recommended are quite different from those of the nervous type. In t. nervosus & syncopalis no one but a complete routinist wd ever think of v.s. IN fevers of a sub putrid or synochus type only is there any question about the propriety of v.s. I consider such practice as rash If it fail of its object it must infallibly sink the patient & render the case more hopeless. I am an advocate for a milder course one which is less violent and dangerous and more steady and uniform in its operation. By it more cures can be effected, convalescences is more perfect relapses less frequent & constitutional vigour less impaired. Hence depletion of blood in atonic dis. as a mere counteragent is considered by Prof. I. as a hazardous practice exhausting the patient if iut fail in resolving the disease. In phlog. dis. there is no such nicety Blood may be taken at any time before a crisis. The fact which all acknowledge that blood if taken at all in synoch. dis. must be taken in the first stages proves the hazard of taking it at all A proper test for the propriety of bleeding, free vomiting and purging is the effect of spontaneous humor. emesis and diarrhoea It is in my opinion never proper to bleed to faintness or syncope in any purely medical case, & the mistake of synochus for cauma has led to the practice In the true phlogistic dis. there seems to be a state of the system which increases the supply of the vital energies & I would bleed purely for the purpose of reducing this state I would not apply irritants to the surface till the system is reduced nearly to its healthy standard then blisters and other irritants will remove the weak remains of phlog. act. Even cauma may sometimes be broken up in its forming stage by the use of counteragents only, as hot spirits & water forced sweats etc. in empirical practice But these means if they do not effect in resolution must aggravate the case & are always hazardous. So the sudden removal of phlogotica of a synochus type is followed by a protracted convalescence and often by the supervention of other diseases. Dr Mosely of E. [Hudson] was celebrated for curing dropsies & most of his cases were occasioned by the free depletion of Dr Woodruff for the cure of pneumonitis for the speedy cure of which Dr W. was equally celebrated. Mr Masters of Lynn remarks that many of the cases of chronic disease which came under his care were the consequence of sudden removal of phlogotica by the free depletion of another physician Dr Good in his remarks on typhus observes “we are to avoid reduction and adopt an antirritant and invigorating course. Clutterbuck supposed typhus to be an infl. of the brain & practiced v.s for its reducing effect. Armstrong supposes visceral congestions generative of a general sensorial debility & bleed as a preventative Robert Jackson supposed v.s. was a stimulating process & bled for its direct invigorating effect. Decided practice of any kind will succeed at the commencement.” Dr. G. continues “this employment of v.s. in typhus is no new practice, but the sum of medical opinion for the last three centuries is decidedly against it” Even Dr Welch of Edinburgh the most strenuous advocate for bleeding in typhus & who takes blood by the half gallon, says that the majority of practitioners are against the practice & that it makes slow progress in Edinburgh But there is one state in typhus in which Dr Good thinks v.s necessary “Congestion, says he, may take place as an effect of the disease, in the head, lungs or liver & infl. or gangrene be the result. This symptom we must combat boldly by V.S.” “There is much hazard in the practice but there is death without it” In my opinion there is far less hazard in letting it alone In pneum. typhodes, he wholly interdicts v.s. He is very unfortunate as to the time when v.s. may be serviceable. In the early stages, as we have seen there is far less danger in v.s. But as to employing it in congestions, experience, observation & reasoning a priori all unite to show that v.s. will increase the congestion (vide congestion) And if in these cases infl. is the cause of the symp. this infl. must from the state of the system be atonic & as little benefitted as that by v.s. Dr Good supposes that typhus may run into phlogistic action. This is far more improbable than that cauma should run into typhus & both are contrary to fact. Most surely stimulants and excitants can never induce phlogistic action in typhus, for even in health when given in noxious quantities they produce not phlogistic action but irritation & if carried farther erythematic infl. & irritative fever. I have seen cases of great head affection in typhus in which on p.m. exam. not only no infl. or cong. was discovered but the brain was even found preternaturally pale. The same has been the case in delirium tremens & puerperal delirium. Infl. or congestion is certainly then not essential to these cases. In great atonic hemorrhages & after great loss of blood from any cause congestions in the brain are likely to occur. The greatest bleeders have the most congestions My conclusion then is that v.s. is never indispensable in typhus & never in synochus that if ever employed it shd be in the early stages & that if employed subsequently it produces at most only transient benefit & renders moderate cases severe and severe cases incurable The third purpose for which bleeding is employed, is to equalize excitement, increase susceptibility and prepare for the operation of other remedies in non phlog. dis. that are not materially atonic In these non phlog. cases v.s. increases susceptibility and irritability so that greater remedial effects are produced by most medicinal agents. It shd therefore be avoided in those cases in which there is already too much irritability and susceptibility. The susceptibility to diseased action and to remedial action is different though v.s. may increase both V.S. is a powerful preparatory in appropriate cases. It promotes the action of emmenag. diuret. diaphoret. & cahtart. etc. It produces this effect in different ways and partly by relaxation It has been supposed that like nausea v.s. increases the susceptibility to the action of deobstruents. If phlogist. diath. exists v.s. will of course increase this susceptibility. If however there is considerable atony it will diminish the susceptibility to their remedial effects which it will increase the susceptibility to their irritating and evacuating effects Even when there is no considerable atony v.s. will often reduce the system considerably below the favorable point of susceptibility for the operation of deobstruents I have learned from experience that the higher the degree of energy short of entony, the better is the operation of deobstruents. I have observed this particularly in peristhnitis bronchitis, rheumatism, gout, & paramenia obstructionis (as it now occurs) V.S. renders the operation of deobstruents precarious in these diseases Colchicum for example will relieve rheumat. more speedily & perfectly without it & has failed where it has been employed So of actaea racem. Moderate v.s. for this purpose, when the dis. is but moderately atonic may sometimes be beneficial, but it must be used with caution and is never indispensable. Examples of diseases in which v.s. is employed for this third indication are colica ileus in certain cases dysphasia convulsio s. epilepsia [illegible] apoplexia (sanguineous apoplexy) entasia tetanus lysso canina & other diseases in some particular cases When v.s. is practised for the third indication, we should avoid drawing too much blood on the one hand & the production of syncope on the other. Tetanus and lyssa canina are however exceptions. In these, if the vital energies are perfect we should take as large a quantity of blood as the system will tolerate & in such a manner that after the requisite quantity has been taken syncope shall be produced But even to this rule there are exceptions. In general our success does not depend on the quantity of blood taken nor on the shock produced it should also be borne in mind that v.s. in these cases is only preparatory & is of no permanent benefit in itself alone. It must be followed by other appropriate remedies or we shall soon lose the advantage we have gained Bleeding for the 4th purpose is employed in habitual & passive but moderate hemorrhage, as in paramenia [illegible] Bleeding is never employed for the purpose of directly checking hemorrhage. In active hemorrhage it acts by obviating the state of the system on which the hemorrhage depend and other means will accomplish the same object for instance the exhibition of acetate of lead In irritative hemorrhages (commonly called active) v.s. may be tolerated but it will have no effect in checking the hemorrhage, unless the depletion is very copious and often repeated. And it is always a dangerous practice, producing exhaustion, hectic of inanition and even death itself. Many lives have thus been destroyed which might have been saved Vicarious hemorrhage (misplaced catamenia) may be either active, irritative or passive & in some respects follows different laws from other hemorrhages. It is important to select a particular time for v.s. & appropriate medication shd follow. The hem. recurs with the same regularity as the catamenia and is preceded by certain precursory symptoms. The time to bleed is at the first occurrence of these symptoms & means shd (then?) be adopted to excite the catamenial secretion. It is not necessary or proper to take a very large quantity of blood or produce a shock by faintness. The abstraction of a little more than would have been lost by the hem. will be sufficient to interrupt the latter, & this repeated a few times will break up the habit. In the intervals suitable emmenagogues shd be given & as there is commonly a torpid state of the digestive organs, a combination of iron, sanguinaria and aloes is often found to answer well. All the tonics are useful Paragesis irritative In the first month of pregnancy troublesome symptoms arise from pregnancy & v.s. would give no relief. In the latter months they arise from pressure and and a moderate abstraction of blood may be proper. We should however be careful not to take too much Even in the earlier stages much bleeding will occasion abortion & in the latter stages it is very apt to cause miscarriages. Indeed there is no more certain mode of effecting a miscarriage than v.s. In some places (not so much on the Conn. riv.) pregnant women are always bled, as a matter of course Not one case in fifty requires it. When practised improperly it is followed, if not immediately, yet ultimately by bad consequences Recovery after parturition may be lingering & imperfect. Bleeding in pregnancy is very apt to produce abortions I have known cases of 5 or 6 abortions in succession produced by v.s. improperly employed & where the families were childless from this cause. I was subsequently called to such a case where abortion was threatened. I ordered a horizontal posture & gave opium in small doses, at reg. interv. & removed all the sympt. In the interv. I gave ton. & invit. rem. Iron was the best in this case though it has been said to prod. abort. The sympt. themselves in these cases are not such as indic. v.s. they arise from disord. stom. IN this way I have safely carried pat. through Exanguia Aneurismus Import. in an. of large bloodvess. as of the aorta. Here it is important to get the pat. along with as little loss of blood as possible. Still it is [illegible] not to mistake palpit. of heart symptoms a. of derange. of dis. org. for anew I have known the [illegible] & the case treated with v.s. & crem. tart. till it was thought disp. when it was thrown aside & the pat. recovered Wounds of [illegible] & lungs. Extensive & repeat. bleed are necess. when a man has been shot through the lungs & perhaps when shot through the [illegible] Leave no more blood than is necessary to sustain the function of the system In wounds of the brain the dang. is from hem. Though we must bl. copiously yet we must avoid prod deliquium which might cause death hence a horiz. post. These cases are entirely diff. from accidents & casualties Abern. remarks “the surgeon must let the infl. (the danger is from hem. not from infl.) kill the man or run the danger of killing him with the lancet” & he says “the latter shd be preferred.” I think he is wrong. Sins of omission are not so bad as sins of commission V. [Chololethus] [means] prob. oth. rem. are better Lithia renalis var calculosa narcot. prob. better In carcerated hernia deplet. to faintn. said to be necess. Ice & [illegible] of ether sd by Wood to be better Certain luxations (not, I think in any case of fracture). Parodynia implastica difficult part. from rigidit. Belladonna is better In these cases the quantity of bl. taken prod. the relax & the shock, the faintness manage as for 2nd purpose stand or sit pleno rivo large orifice not stop it so soon as for 2nd purpose If when enough has been taken faintness is not produced stop suddenly to prod. faintness. If a surgical case seize this mon. for the operation Parodynia implastica the pat. is impat. the pract. is [in a hurry] & v.s is too often pract. when it does injury. A celebrated account has broken down many constitutions in this way v.s. is nec. in few cases belladon often answers VI To prod. absorpt. of parabysmata & of emphysemate in ext. tumours If the pat. is feeble it can not be employed & unless a considerable quantity can be taken it is of no service. To be effectual the v.s. shd be as free as can be tolerated without injury use judgment avoid] also shock & fainting. Employ it also in the early stage It is of no advantage in cases of long standing & may be dangerous Often it must be followed by other [illegible] & remedies to promote absorption as quick & active vomiting with turpeth mineral or blue vitriol or even sanguinaria Slow and brisk purging with elaterium is also efficacious & the free internal internal use of tinct. iodine. Those individually or in combin. are herculean remedies Situation has an influence on the quant. of bl. wh. may be taken. Persons in warm or moist situations (malarious) will not bear it so well. Phlog. dis. is less likely to occur & the same degree of it will require less v.s It is less indicated in dis. of chil. but when ind. they bear it very well. Child. are more subject to dis. of irrit. than of infl. & when infl. exists we should be less vigorous in our deplet. It is also less required in the aged In strumous habits less v.s. is required to subdue infl. & such habits will not tolerate bl. well for other purposes Avoid it in them when you can The season of the year is not to be regarded. In the Bethlehem insane hosp. London, they formerly bled all the pat. in the spring & purged them in the fall. When there is not vital energy enough to move the mass of blood, it has been thought that by taking away a portion of this mass we increase the [illegible] power. But s it is found that depletion diminishes the vis [illegible] stil more than the moles movenda A small bleeding when not indicated will not do much hurt for instance zfs to ziii with cinnamon water, as I saw in one case Excessive deplet. produces exhaustion impairs the digestive powers, occasions what are called nervous symptoms & imperfect sanguification with a deficiency of the colouring [portion] of the blood in consequence of which the minute vessels convey a colourless fluid. The nervous and absorbent systems are more weakened in proportion and hence obesity, [illegible] and dropsy ensue. Hectic [illegible] inanition is often prod. which often follows uterine hem. V.S. producing most freq. cong. in brain often in thorax or abd. A habit of being bled prod. corpulency & obesity with laxity & debility When there is a tendency to excessive formation of blood, v.s. will increase it & when there is a deficiency of sanguification v.s. will increase this also. It is well known that remedies will produce opposite effects opposite states of the system Deobstruents for instance will check morbidly increased as well as augments morbidly diminished secretion. Deplet. may produce gen. debility with morb. irritab. or debility with torpor History bloodletting (I believe) was not practised by Hippoc. Celsus bled in all fevers when the pulse was full & skin florid [Arctus] who is suppose to have preceded Galen bled in that fever called cauma Galen bled profusely even in typh the Arabians followed him the Egyptians Sydenham bled Willis bled. Boerhaave did not bled in putrid typhus. These all had a sort of routine practice & no fixed princ. The number of phlog. dis. is less than that of atonic but you wd infer the contrary from the books he causeth diath. was formerly more phlog. These are now more chronic dis. than formerly, which are generally atonic. During the reign of a phlog diath. chron. dis. may be somewhat entonic. Cauma is the only fever which is uniformly entonic throughout It is commonly supposed that all infl. is necessarily entonic, but many ] are confessedly atonic e.g. peripneumonia etc. Simple Saline Refrigerants Nitrate of Potassa A white colourless salt, crystall in hexad. prisms contain. no [illegible] of cryst. though some is mechanic united with the cryst. Undergoes igneous fusion. Decomp. by red heat, becoming nitrite & alternately oxide of potassium 1 nit. ac. + 1 ox. potassium sp. gr. 1.96 oz Solubility increased by addition of chloride of sodium Tested by throwing on a red hot combustible, as charcoal when it deflagrates or by red fumes of nitrous ac. when sulph. ac. is poured on its powder, also by th form of the crystal, but impurities make the form vary. The impurities are chloride of potassium and sodium. To remove these dissolve in boiling water, filter and crystallize. The nit. pot. cryst. first Dissolve in distilled water and add nit. sil. & no? prec. is formed. Decomposed by sulph. ac. & by baryta by sulph. of amm. magn. & alumina & by sulph. sod. at 32 [degrees] Hence all these are incompatible In phlog. dis. taken in the quantity of zi to zjv in the 24 hours it is a pure & powerful refrig. etc. etc. Ed. & [illegible] call it stimulant temperant & diuretic. Paris thinks it refrig. & that it shd be taken immediately after solution as it is then colder I think it never directly diaphoretic & the diaphoresis that sometimes follows is the result of the diminution of the entony. V.S. will do the same [illegible] thinks it one of the best of the diuretics. Paris thinks it acts primarily on the urinary organs, by passing in substance through the circulation to the kidnies, but he considers its diuretic powers as inconsiderable. In paucity of urine and diaphoresis which result from entonic action it is indirectly diuretic, but is not materially so in’ health. It moderately increases these discharges in diseases, neither entonic nor atonic. Murray is right in saying it is too inconsiderably diuretic to be useful in dropsy. It is not sedative in the sense of antirritant. Paris calls it aperient meaning probably laxative Renie says [illegible] to [illegible] is purgative but this operation is inconsider & is merely the result of obviating phlog. diath. Called also antispasmodic or nervine but spasm rarely accompanies phlog. diseases Antiseptic only upon dead animal matter It will however prevent gangrene from high entonic action. Cinchona is called the best antiseptic. But those cannot be indicated in the same disease. Dr Duncan says “Nit. pot.” is admissible only in enton. dis. & A.T.T. agrees with him. They are probably strictly correct Its ill effects (as in typhsus) may not be immediately observable injuring the tone of the stomach etc. Given in atonic dis is dyspep. it produces a small feeble frequent pulse, cold extremities, pain in the abd. like rachiale. Sluggishness and weakness in all the actions of the system & sometimes atonic humor. When it is indicated it should be given in uniform small doses v gr to [illegible] The test for too large a dose is pain at the stomach soon after it is taken indicating a dimin. of the dose so as to fall just short medium dose is called by Duncan 10 grs. others more or less this depends on the intensity of the dis. & the const. of pat. zi may not be too much Generally give it once in 3 hours in quantity just short of that which prod. the pain When its use is continued it can often be detected in the urine Paper dipped in the letter and dried, will deflagrate When the bowels were very torpid I have detected it in small quantities only & those not proportioned to the effect on the system. If the bowels were loose, no trace was discoverable. Hence it follows that its medicinal effect is not the result of its being taken into the circulation Externally applied it is a local refrigerant lessening entonic infl. Add chlor sod. to favour the solution & apply immediately. Applied to tender and irritated parts it produces topical irrit. & infl. & so does tart. ant. It is refrig. nevertheless. Even phosphorus when made to produce topical infl. & irrit prod. aton. infl. This is true of all the stim. A very large dose vomits actively & is thrown off If a poison dose less than this is taken it produces sharp pains in the stomach nausea, swell. of abd. sensa. of cold in stom. cold of extrem. weak of pulse sometimes bloody dischar. faintness, syncope convul. & death. Said to cause ulcera. of intest. & that the muc. memb. is disch. This would prove that it excited a membranific infl. The quantity constitution a pois. dose varies with the state of the system etc. IN strong entonic action it can scarcely prove pois. at least as long as there is entonic action to subdue A.T.T. says zi Rennie zfs to zi Orfila says its poisonous effects are like those of the narcotics & he recom. sulph. soda as an antid. The veget acids & antim. have the same eff. & the purging salts would also if not so soon carried off by catharsis Med. Jurisprudence Not. but detec. of article can. be relied on Treatment An emetic (if no evacuat. has taken place) immediately of turpenth min. bl. & wh. vit. though these are liable to fail hence the veg. em. are better Ipecac in large quantities, though it is less certain than gillenia trifoliata & stipulacea as also euphorbia ipecac. gracilis & corollata Probably sanguinaria & phytolacca would be good emetics. But recent finely powdered sinapis nigra is the best which prevent torpor of the stom. Give about a table sp fl. & repeat two or three times is necessary It is more effectual than the other veg. emet. & disturbs the syst. elss than the min. emetics The distilled wat. of ranum. flammula (if on hand) wd prob. be still better. A few years since a man travelled about the state selling an article to vom. without prod. sickness. It did so. Many persons took it merely for the experiment It was this article to obviate the eff. of nit. pot. give opium & alcohol demulcents. If its noxious effects have taken place & there has been no vom. cath are of no use. Castor] oil zj or ji or gtt p. to i to ol. tiglium or cast. oil with spts turpt. the latter being a stim. as well as a purge these will be better than sulph soda The refrigerants & especially nit. pot. have been much underrated of late partly from change of diath. & partly from inefficient use but chiefly from the chemical theory of their action, by a transference of their oxygen first advanced by Murray Though he has abandoned this theory he still calls them chemical rem. They are as much vital as any others Therapeutic Application [Acute] merc. ptyalism rec. as a lotion supposing it would allay the burning sensation. This eff. is irritative and as this is also the eff. of nit. pot. we shd suppose it inadmissible, but there is a fallacy in this reasoning for canth. will prod. & also cure irrit. As topical applic. there is a fallacy in arranging articles as refrig. or stim. We can draw no conclus. from their internal operation. Probably ol. pin. & nit. pot. operate on the same principle in burns The best remedies for mercr. ptyal. are op. in [illegible] wat. sol. of op. as a wash (unless it produces irrit.) Fowlers’s sol., or sol. nit. sil. topically. Dipsosis avens from recently relinquished habits of intemperance red. because it allays thirst in cauma reasoning bad it may be aggravating the atonic diath. bring on el. trem. & will certainly aggrav. the dipsosis Water & refrig. liq. will not allay this thirst. Stimulating drinks & op. will Dyspepsia rec. by W. Phil. in strong solution, with green arabic when there is inflam. [tenden???] theory Dr Chapman remarks “no article is more apt to relax the stomach & produce dyspepsia. Dr Ives remarks “it is bad in dyspepsia.” It will even produce dyspepsia a bad sort of dyspepsia being caused by long taking it into a healthy stomach The French recommend it in jaundice I know not or what grounds there is great torpor, therefore something to rouse the system is required Also in melaena, a var. of jaundice occurring in broken down constitutions the effect of hot [illegible] of intemperance & hance very diff. to cure No course succeeds with me unless stim. are conj Never prescribe to symptoms merely without regard to names Simple idiopathic cough, in both stages when dry and also after expectoration has begun sd to allay irrit. prev. inf. good if diath. phlog. Remittent, putrid, subputrid (synochous) &nervous. In no form of rem., that I ever wd it be of used irectly the opposite are required Idio, hectic & even in symptom hectic rec. as cooling & sedation it produces no such affect contraindicated directly in all sorts of hectic. Typhus never saw it do harm in synochus [illegible] t. gravior increasing calor mordax etc. which op. carb. amm. etc. will relieve Cauma is universally rec. highly valuable and important next to v.s. & perhaps tart. ant. in nauseating doses The following is called Rush’s febrifuge & is much used in Phil. Rx nit. pot zi tart. ant. gr i dichlor. merc. [illegible] Div. into 8 powd. & give one every 3 or 4 hours The dose of [illegible] & inst is too small A better formula wd be Ant. gr ¼ to 1 nitre gr 2 gr give every 3 hours Apostema commencing diffuse suppurative infl. at hip joint a topical applic of nitre as a refrig. is serviceable So of phlegm. comm. [illegible] bubo f. furunculus I have seen [illegible] in these. It has been rec. in [illegible] them. infl. but it is always bad Tinct. canth. or a blist. is better & dry flour is better than cold lotions. In infl. of fem. mamm. it has been rec. but vol. lin. wd be better or even ac. pl. Bleuorrhea [sanodes] highly rec but Murray says when there is ardor urinae it is too stimulating Tinct camph. Ol. [illegible] Bals. cop. capsic. mustard etc. will cure it & these are more stimulating Orchitis useful but ac. pl. is far preferable. Gout rec. topically but top. applic, are always dangerous. Ac. rheum. rec. by Murray as a refrig dose 5 to 20 grs 2 to 3 times a day with diluents and demulcents this depends upon whether it is phlogistic [Lavendiaur] rec. zfs daily & even in conjunction [illegible] cinchona but v.s. followed by cal. & then by cinch. It is an import. [illegible] iun all the entor. phlog. the best combination nit. pot. cal. & ant. phlog. cephalitis solut. appl. topic but ice cold water is as good Acute phlegm. qunisy, highly extolled as a gargle & not without reason. In eryth. infl. of fauces it will not do much & no art. is superior to capsicum [illegible] bad Infl. of muc. memb. of bladder highly rec. in irrit. infl. of blad. as the surgeons term it but it is doubtful or what grounds for this copaiv. ol. par. etc. are among the best articles Rec. in scarlet fever bad. Entonic active hem. useful It is so limited by Dr Thompson Murray rec. in conjunction with diluents & demulc. now these are bad in hem. Hemorrh. with plethora but it will not dim. the quant. of blood & no dis with [illegible] commences with an increase in the quant. of blood. Diluents & demulc. shd be avoided, as they fill the vessels abstinence shd be enjoined Menorrhea that had become habit. & required the health (probably enton.) it is sd to have stopped the discharge It was given in barley water zfs twice a day produce coldness of stom. cold extrem. etc. nausea “tumult in the bowels” It probably did no good to the general health A dis. is often cured by bringing one worse This article is not useful in irrit. hem. & in passive it is positively bad Porphyra nautica or sea scurvy rec. but not alone nitre with acet. acid is the continuation I am extremely sceptical with respect to articles rec in sea scurvy Land scurvy (p. hemorrh.) arise from bad food, confinement to one sort of diet usually [illegible] hard labour & is probably the same I should not think this wd be benefitted by [illegible] & acet. ac. I have seen it yield readily to tonics Ac. plumbi shd be the basis of the treatment conjoin capsic. alcoh. & nutritious fresh vig. diet. I shd pursue a similar treatment for sea scurvy Diet alone will often cure it Paroniria salax (identical with spermorrhea) Sagnesis furor & salacilates (nymphomania & satyriasis) in these it is rec. by Swed. but I shd not expect much from it Obesity & corpulence In one instance it disturbed the stomach & dig. org. but prod no abatement of dis. If it had been given less freely it would have impaired the appetite less food wd have been taken & emaciation wd have followed. The old rule keep the eye always open the mouth always shut & in feet always in motion is better than any medication In a cellular dropsy it has been given with squills. The latter are efficient but alcoh. is a better auxiliar. In many cases diuretics will not take hold without alcoh. & gin is commonly given The latter acts more by its stimulant than by its diuretic powers. The cases that require no stimulants soon yield to diuretics or [illegible] & calomel Paruria stillatitia & mellita etc. I have never seen benefit from it in p. mel. but the same is true of many other remedies In diabetes it is rather injurious but I have not used it. I have done more with tinct. canth. than anything else Lithis renalis of no use Exormia lichen & prurigo lepidosis psoriasis inveterate used internally & externally In one case it did no good Ecpyesis impetigo var. herpetica (hoopes) & lesinosa (salt rheum) Itch I have tried it repeatedly with no success. It was probably given because it was thought cooling bad reasoning another applic. altogether different has been successful with me Burns & scalds but I do not believe they are to be treated on the antiphlog. plan Bi-carb. of Pot. Sometimes called supercarbonate or carbonate formerly sal tartari essentiala or sal aeratis The common pearl ashes of the shops (?) Crystals quadranga prism Taste alkaline not caustic sp gr. 2 [illegible] soluble in 4 parts water at 60 [degrees] Boiling water taken up 5/6 of its weight More [illegible] than the carb.& has considerable activity Sd to be diuretic it may be but I do not believe it wd be useful in dropsy. Supposed to be antiemetic not much so, & must be injurious in atonic cases As an antilithic inferior to the same dose of the carb. As an antacid it has some power but the carb. ac. disturbs the stom. & weakens it by its refrig. effect. The carb. is on the whole preferable but the bi-carb is more pleasant Perhaps this is the cause that it is in great favour As a refrig. other articles are better & as an [illegible] agent the bi-carb. (or rather sesqui-carb.) soda is better Bi-carb. of Soda Called super carb. soda carb. soda trona more commonly than the preceding called sal aeratis not changed by exposure to air has formed the walls of a fort The heat of boiling water expels half its acid, reducing it to a carb. 6/10 of this salt is oxygen I know of no real superiority it possesses over bi-carb. pot. Soda water every where except in N. Haven is mere carbonated water with not 1/1000 grain of soda to a tumbler full. It is more pleasant without the soda & less injurious A free and especially a habitual use of soda water is unequivocally injurious to most persons. In slender [habits] it induces dyspepsia & in dyspepsia it aggravates the dis. Some of the worst cases of dyspep. arise from the habitual use of this article. The robust very often take it with impunity Soda powders consist of pure bi-carb. sod. zfs & pure concrete tart. acid grs. 25 which form a neutral tart. soda this water is chemically different that of the fountains It is cathartic Seidlitz powders consist of bi-carb. sod [illegible] & tart. pot. & sod (Rochelle salt) zii in one paper & tart. ac. 35 grs in another. Some add bi-carb. soda to cider it destroys its natural briskness & makes it flat neutralizing the salic acid forming a [illegible] which is more refrig. than most other salts Sesqui carb. soda Chlorite of Potasa 1 + 1 Incorrectly called potassae chloras, oxymurias, hyper oxymurias, murias hyper oxygenatus There are two oxides & 2 acids of chlorine with oxygen protox. 1 + 1 perox 1 + 4 chlorous ac 1 + [illegible] chloric ac. 1 + 7 This last some call perchloric & the preceding chloric from the fact that the chlorous was first discovered hence confusion Chlorite of potassa is formed by passing chlorine gas through a concentrated solution of protox. potassium, till it is neutralized as is said. But chlorine never combines with an alkali The alkali is partially decomposed. By gentle evaporation & cooling the chlorite of potassa is precipitated while chloride of potassium remains in solution Authors are very vague respecting its virtues It is not a stimulant It has been tried in phlogistic diseases & seemed to diminish the diathesis [Swedeaur] mentions [asthenia], cachexiae etc. chronic hepatitis etc is benefitted by it. I do not believe in the existence of chronic hepatitis The dis. so called is merely morbid sensibility in the hypochondriac region, occurring in advanced stages of dyspepsia. In post mort. ex. I have found no traces of infl. in the liver It was introduced for prophyra nautica from chemical notions, as it contains oxygen not much used Said to cure syphilis & hence to be deobstruent useless when the constitution becomes affected before this constit. rem. are not needed. Said to cure [culan.] dis. none specified Dose 15 grs to zfs weak refrigerant believe it has no other power unless deobstruent A fine subject for experiment Vide Boston Med. Gazette for Prof. T’s experiments June or July 1832 Bi-borate of soda 2 + 1 (borax) Called sub-borate borate boras sodae alkalesans (because, contrary to fact the alkali was supposed to predominate) Called formerly chrysocolla When impure & native it is called tincue Prisms hexaedral with two sides broader, terminated by triangular pyramids. Sp. gr. 1.24 changes veg. blue to green. Tastes styptic & alkaline Soluble in water 20 parts at 60 [degrees] & 6 at 212 [degrees] Effloresces slightly Loses its water by heat & 4/10 of its weight becoming friable in a strong heat converts it into a transparent glass which is soluble in water By percussion it flashes in the dark Decomposes by acids & alkalies by sulphates, nitrates & muriates, phosphates fluates etc. Found only in Tibet & Persia, obtained from wells in an impure state, by evaporation Brought from E.I. in large masses, white & green, joined by a greasy looking substance I have known it used freely in phlog. dis. & the most I can say is that id did not harm & was thought slightly refrigerant. I have known it employed in the exhaustion of low atonic diseases, not malignant & it neither increased nor diminished strength of action Not stimulant. Said to be nervine probably not. I do not think it is I have never perceived any deobstruent effect from it Said to be diuretic Prof. T. never could perceive it to be so Said to be emmenagogue doubtful Prof. T. has made no observations Swediaur calls it antacid It would be so when the acids were the hydrochloric or the phosphoric, as they may be. Lactic acid wd have some action and also the acetic, if it exists in the stom. which is doubtful. The sulphuric, nitrous, carbonic, & hydrocyanic acids are all that are inferior in energy of attraction to the boracic. Still this will be inferior to other antacids Therap. applic. mercurial ptyalism dyspepsia with cardialgia & acidity proctica [illegible] (“painful hemorrhoidal tumours”) Parabysma coactum of liver or spleen Aphtha ulcera serpentia (Swed.) parapsis acris var. [pousitus] Its most common use in aphtha at first it will allay the burning heat, but only for a moment, not effecting a cure Prof. T. has found milk porridge, barley water, rice water, or even cold water, quite as good and even better than borax It is rec. to dissolve the aphthous crusts. It has no such power & if it had it wd be injurious, as the slough defends the ulcer beneath from irritation. 99/100 of the physic. of this country & G.B. prescribe borax as a matter of course for thrush Case where nothing is done [illegible] quite as well as those where borax is used. Veg. astringents do something toward a cure Nit. silv. is good. Borax is rec. by Dewees parapsis acris. var. [pruritus] Prof. T. has had no experience For internal use as refrig. deobst. diuretic etc. the dose rec. in zfs to [illegible] I have used it in much larger doses without any appreciable effect Swed. says for a lotion in [peraps??] acris dissolve 10 to 30 grs in zfs [illegible], but we use it stronger For internal use it nearly or quite inert If it has any power it is a refrigerant For external use it is about as active as wheat flour merely palliating [teaspoon???] “But my testimony is negative merely. It is desirable that someone shd experiment on it Begin the experiment with zi & take zii ziii etc. Borate of potassa has been substituted for bi-borate of soda & that no so good Benzoates & succinates of potassa Of these Prof. T. knows nothing. Carbonate of Potassa 1 + 1 Called sub. carb. (case being supposed to predominate) Sal tartari sal absynthii more anciently nitrum [illegible] & alkali vegetabili (very inappropriately) also sal aeratis tartari It has a strong alkaline taste and a powerful action on veg. & [illegible] substances Exposed to the air it [deliquiates] & has an oily appearance, where it is called in this [illegible] oleum tartari or oleum tartari per deliquium (a name also given to solution of pure potassa It does not absorb carb. ac. from the atmosphere. It does not readily crystallize Crystals rhomboidal scales Commonly found in coarse grains The poorest is obtained by incineration of bitartrate of potassa but this contains oxide of calcium The more common impurities are sulphate of potassa & chloride of potassium which however are of little consequence except in pharmac. preparations Said to require twice its weight of boiling water for solut. I think less Sd to be insoluble in pure alcohol of the shops. Said to combine with oils & form soaps (but there must be a decomposition) Incompatible substances All the acids All the bi-salts borate of soda, muriate of ammon. nit. silver ac. lead chloride of iron proto & bi-persulphate iron Di & proto chlor. of merc. bi-persulph. copper The most uniform but not the most active operation is that of a refrigerant This is seldom expressly said by authors, though they said it may be given in phlogistic diseases & also in atonic. In very low atonic cases I have seen it prod. irrit. of stom. (i.e. nausea & retching) & impair the tone of the digestive organs It can be considered only as an auxiliary to the other refrig. Said to be deobstruent I think not As a diuretic, with diluents, it has sometimes considerable powers & is more active than as a refrigerant Yet it is rarely successful alone in dropsy. It is only in other diseases that it can be relied on as a diuretic alone & it also increases action’ of other diuretics Its operations is direct as it has no deobstruent powers In hydrops cellularis it is a useful auxiliary E. & Vav. say it is useful in passive dropsies probably meaning atonic cases. I have never seen phlog. cases those called having been merely irritative More useful in paruria inops than in any other disease It is antilithic when the calculus consists of uric acid, cystic oxide, or xanthic oxide An effectual antacid It may be taken moderately in dyspep. with acidity but lime water [illegible] (according & the bowels are lax or torpid) is better the first being a tonic carb. pot. often does mischief in the disease. It is not tonic Said to be anti-emetic. In most cases it does no good & in many it is actually noxious. I have abandoned its use as an antiemetic, unless the vomiting is occasioned by free acid in the stomach Supposed to be antispasmodic & useful in the whooping cough. It is neither recommended in parabysma [illegible] I never saw good or hurt from its use Struma I know of no principle on which it could be of use So too of gout, in which the French rec. it. In dyspep. without acidity Remitt. fev. Spasmod. vomiting employed by itself or in effervesc. mixt. better omitted refrig. are not indic. this is not the best remedy & is often injurious Saccharine matter impairs its powers sugar fulfils the functions of an acid & in some cases takes precedence of carb. ac. Dose 3-4 to 15-20 grs. The French give more 10 grs to zi Give it in water or mucilage, sufficient to prevent a disagreeable taste Do not give so much at once as to distress the stomach It is customary to add just rhubarb enough to colour it & [illegible] ppt. to flavour it & this is regularly given [as a placebo] by some when at a loss what to do Placebos are sometimes of use but I never liked them Carb. pot. is more commonly given in an efferv. mixt. but in this case we have carb. acid and citrate etc. of pot. as a purging salt. The usual proportions are carb. pot [illegible] dissolved in water to f zfs of lemon juice but lemon juice varies in strength (of no consequence) If sugar is added it shd be [illegible] with the acid, or we shall have no effervescence But the bi-carb. is best for efferv. mixt. Taken in poisonous doses it prod. eryth. infl. of intest. tormina soreness, exhaustion, small weak pulse Still zj as been taken without destroying life. Immediately after swallowing take vinegar & water as an antidote, but if infl. vom. & diarrh. have taken place vinegar wd add to the irritation Then give oleaginous demulcents & narcotic antirritants. Opium & hyoscyamus are best. Keep the pat. under a stead & uniform operation of narcotics [illegible] disturbing the stom. by the quantity of your demulcent Carb. pot. is useful externally applied in diabetes & a cataplasm of it applied to a felon or a carbuncle is useful Carbonate of Soda 1 + 1 + wat. 10 Called sub carb sal sodae sal alkalinous fixum fossilis mineral alkali impure soda barilla is to soda what potashes are to potassa prim. cryst. an octohedron Taste resembles carb. pot. but is weaker sp. gr. 1.359 Soluble 2 wat. at 60 [degrees] wat 212 [degrees] Effloresces in the air Undergoes wat. fusion by heat Sometimes it contains so much water that it remains liquid after melting seeming to deliquiate & occasioning a suspicion of impurities. A red heat change it to a transparent fluid A very violent heat drives off most of the acid The same process uses are ascribed to it as to carb. pot. It is however less nauseous & more mild. It has the advantage that it is capable of being made into a pill after driving off the water Dose 10 grs to zfs (ed. & Vav.) Some says zii The common form for pill is Rx efflor. carb. sod. ziii sapo zi ol. ceram mx water q.s. Soda is used in the same dis. as potassa The old phys. are very partial to it in jaundice I have seen no benefit from it. Many rely on it in parabysma hepatica Trit Antimoniate of Potassa This is the fist of the nauseating saline refrigerants The “panacea antimoni” of the dispensatories, accord. to the mod. improved meth. of prepar. it is a trit. antimoniate of pot. Expose “antimony” (the sulphuret?) 1 part & nit. pot. 6 parts to as great a heat as they will bear without fusion, then pulverise & wash out the remaining nit. pot. with cold water It is a white powder of an acrid taste scarcely sol. in cold wat. very sol. in boil. wat. but deposits nothing on cooling (“I do not understand this?) It contains 11.5 pr. ct. of wat. acc. to benz. it is pot. 1 + antim. ac. 3 It is commonly thought that the antimoniates & [anti????] are les emetic & more diaph. & refrig. than tart. antim. It seems to be the case that those antimoniates which remain longest in the stom. producing continued nausea, without vomiting are more refrig. Tartrate of antimony cannot be readily managed so as to nauseate without vomiting. It is on this ground that the “pulvis antimonialis of James (the composition of which is to this day unknown) the protoxide of antim. with phosph. lime & the protox. of ant. (the glass) have been employed. The panacea antimonialis has been rec. in cutaneous eruptions. Prof. T. inclines to think it a bad medicine. He never did any good with it & has continued it until it did injury. The idea seems to be that any thing that acts on the skin must be useful. He considers it useful only as a refrig. & diaph. Prof. T. wishes some enterprising young man wd expt on this & other prep. of antimony Protoxide of antim. Protoxide of antim. with lime Protoxide of antim. & potassa The protox. of antim. was once much used by phys. under the name of “glass of antimony” They made antimonial wine by pouring wine on the glass of antim. in substance. This glass of ant. is very uncertain it its effects. It is much more uniform in form of wine It was formerly used as a diaphoretic & refrig. in dysentery when all diseases were thot to be “hot” Experiments are needed on these prep. Tartrate of Antimony may be taken as the p type of all the prep. of ant. It may be formed Its aqueous solution undergoes spontaneous decomposition on exposure to the air Tests Hydrothionic ac. throws down in yellow precip. carb. pot. a white proc. The most important operations of this article are refrig. diaph. & emetic. It is supposed to be deobstruent but it is so only by its evacuant operation IT is well adapted to entonic diseases but may be used in those which are not purely entonic nor atonic without much injury In phlog. dis. it is more refrig. & diaph. in nauseating doses In non phlog dis when the constit. is also slender it prod. a leucophleg. habit & dry skin, crusts about the teeth & fetid breath. If given freely it produces an’ unmanageable diarrhoea. Its continued uses as an alterative has done this Physic. used to prescribed it in atonic & cutaneous dis. when they were not so well acquainted with it as now Some pat. are more susceptible to it than others & the same pat. is more so at one time than another. ¼ or 1/8 of a gr. will sometimes prod. hyper emesis yet prof. T. has given 35 & 40 & 75 grs. without prod. emesis. But in such cases you may produce it by a glass of brandy sling This was soon after the change of diathesis & proved that after such a change had taken place the article was not adapted to these cases [illegible] of ipecac would probably have vomited those persons freely To treat an exquisitely phlogistic disease (cephalitis, pneumonitis), bleed & give a cathartic of salts (sulph. soda) add 1 gr. of tart. antim. not enough to vomit which will heighten the refrig. effect of the salts You may add too zfs of nit. silver which will greatly heighten the effect. You may treat any phlogistic disease in this way. Laxative Saline Refrigerants Quadroxalate of Potassa Bin-oxalate of Potassa Called sal oxalis sal limonum essentialis (yet it contains not a particle of citric acid) potassa oxalis acidulas sal acetosella (Phil.) It exists ready formed in oxalis acetosella & probably in all the spec. of oxalis also in rumex acetosa & r. acetosella It is formed by dropping a solution of potassa on a saturated sol. of ox. al. ac. in water the bin. oxalate when thus formed precipitates if too much alkali is added it forms an oxalate which remains in solution Binoxalate of pot. has a bitter, pungent & acrid taste It is not affected by the air. It unites with alkalies & earths & forms salts of a triple character It is a popular article in fevers but is proper only in the entonic It is sold in small wooden boxes & called “the essential salt of lemons” It has been applied to strumous ulcers and promotes their healing hence called antiseptic Prof. T. has applied the bruised leaves of the oxalis stricta & rumex [acetis???] with advantage but there are better things It might probably be of service, chiefly as a grateful beverage in fevers Malate & Bimalate Potassa Soda & Ammonia malic acid exists in the [illegible] It exists in the berries of the rhus glabra in the form of the bi malate of potassa. Pour boiling water on the berries and let it [illegible] till cold It is a grateful beverage in fevers Acetate of Ammonia Called ammon acetate ammoniae acetum sal ammonias acetosus sal ammoniacus vegetabilis The solution is called spiritus mindereri liquor ammoniae acetalis & liq. amm. acetatae of which the former is proper It is supposed to be stim because amm. is [illetigle] it It is not so. [Thomson] says the acid and alkali shd both be concentrated to form the best article It is too volatile to crystallise readily, but by gentle evapor. acicular crystals are obtained (& by sublim.) 1 8/10 inch in length Taste first cool, then sweet, finally the united taste of sugar & nit potassa but the mawkish taste of the mit. potas. predominates It is very deliquescent, melts at 170 [degrees{ sublimes at 250 [degrees] Distilled vinegar shd be used & shd be saturated with the solution of [illegible] aqua ammonia Adding sesqui carb. amm. is a nauseous & inelegant mode & shd not be used, as the salt is less powerful and either the acid or the alkali will predominate & sometimes I have tho’t I could taste both (I know not the reason of this If used in cauma & entonic phlogotica it moderates the heat & dryness of the skin & diminishes strength of action Yet Swediaur calls it a stimulant It is a good refrig. & stands next to nit. pot. & soda. It is not nervine It is called diaphoretic, but is so only by obviating phlogistic diathesis, the heat & dryness of the skin being removed & diaphoresis ensuing It is diuretic in diseases not much phlog. nor naturally atonic, with diuretic regimen, but it cannot be relied on in dropsy If there is paucity of urine, it restores it if in the natural state it augments it moderately It is not deobstruent When Swed. assigns it this power he means that it is refrigerant Diseases Recom. in “simple fever general It is fashionable in Europe to treat simple fever as a [illegible] It is never useful in typhus. It is useful only in active infl. fev. Rec on the phlegmasia useful in the phlegmonus ones, not in the atonic or erythematic or atonic arthritic Swed. says it is useful in the atonic erythematica I never saw any other. The supposed phlogistic cases are irritative & in these the article is improper For a dose Swed. gives zfs to zii of the solut. I give zi & never saw it too much The laxative power is less prominent in this article than in any other of the group Acetate of Potassa Called acetate of pot. sal diureticus (the most common name) Tana foliata tartari Tartarum regeneratum kali acetatum kali acetas sal digesticus slivii Longer known than any other of this class except nit. pot Add carb. pot. to distilled vinegar. Citrate of Potassa The citrate of potassa soda & ammonia are all used, and are next in frequency to the acetates. Citrate of pot. is called mixture vel haustus [illegible] riverii It is formed by adding sol. of carb. pot. to citric acid till it is saturated, & drying the product It is very fashionable in London & Boston It is not good in cholera infant. or in any atonic disease, increasing the vom. & purging It is most used as a diuretic being similar in power to acet. ammon. Taken during effervescence it is effectual in allaying vomiting in phlog. cases or those which are not atonic nor entonic No better than acet. amm. not so good as nit. potassa Nitrate of Soda Found native in various parts of S. America I consider this as a refrig. precisely in the same manner as nit. potassa, but in a much less degree It is said by late writes to be laxative in doses of zfs to zi Sd to be diuretic but I think in no other manner than nit. pot. Much used in Germany. Dr Weir (?) wrote on it Refrigerantia acida Vegetable Acids vegetable acids may be divided into 3 groups 1 Those which exist in veg. in a free state or combined with alkaline or metallic bases. 1 Those which are never free but are always combined with veg. [illegible] bases 3. Those which are the product of decomposition the first group comprehends all the refrig. acids exc. the carb. They are the acetic (called also acetous & a modification of it the pyroligneous) citric malis (or sorbic) tartaric (and a modific. of this the pyrocitric etc.) & oxalic (or rheic). The carbonic shd be placed here from its properties. The second group are not [illegible] to possess any medic. power. Examples are the meconic of opium & [illegible] of cinchona. The 3d group are supposed to be nervine. There are but 3 of them benzoic, succinic & perhaps the camphoric Acetic Acid This is susceptible of a greater variety of applications than any other veg. ac. & possesses all the powers of the others There are 4 species viz. acidum aceticum [illegible] acid. acet. dilutum (distilled vinegar) acid ac empyerumaticum (pyrolig. ac.) & ar. acet [illegible] (common vinegar Pure acetic acid is very volatile & its vapour is inflammable. It is obtained by The strength of vinegar is determined by its power of neutralizing alkalies It is found free naturally but it is obtained for use by fermentation & veg. decomposition In the U.S. from cider France from wine (acetum vini) England from beer (acet. [illegible] or Aligar) This acid has been longer known than any other mentioned by Moses. It may be obtained by the destructive distillation of veg. matter in form of pyrolig. acid This or common vinegar may be purified by digesting & afterwards filtering it upon charcoal (animal is best) & then distilling it This forms acetum dilutum, formerly called acetous acid It is contained in the juices of several plants, free or combined with alkalies e.g. with phenix [deotybifera] (date tree) vitis vinefera sambucus nigra galium verum [illegible] [illegible] rhus typhinum etc. but not in large quantities It is a pure refrigerant adapted to entonic diseases abating but thirst etc. It has been given in typhus gravior & putridus, because there is heat thirst, sordes cadaverous smell etc. & the pat. craves acids but in such cases the min. acids are better The heat requires antirritants The sordes cadav. smell etc. indic. a low state of the system & require supporting agents Acetic acid will produce morbid irritability of the stomach & intestines, retching vomiting & diarrhea, exhaustion & a tendency to sink at one of the critical periods. The effects are gradual, therefore not always observed. So of all the typhus phlog. & exanthematica & all dis. of putrid type It is not stimulant nor astringent Said to be antiscorbutic I think not, because it must contain veg. matter in solution to be of service in scurvy. This is the reason why plants of the order cruciferae are useful Antiseptic only in dead an. matter It may prove [illegible] gangrene from excessive phlog. action The veg. acid are said to be anti narcotic perhaps they are after the narcotic is removed from the system. Some narcotics are heightened by them while they remain No narcotic is ascertained to be diminished in power by them. Said to be antiemetics. This depends on the state of the system & stomach Said to be diaphoretic & diuretic only indirectly is it so “Laxative” most acids move the bowels acetic, slightly only “A remedy for polysercia” indirectly so in such quantities as to injure the digestive system spare diet wd be better A sparing use of vinegar in health is wholesome, especially in assisting to digest oily food For laboring men in warm weather vinegar largely diluted with water; syrup & ginger added, is a very pleasant & healthy beverage & far better than ardent spirits Externally it is refrigerant & discutient & may be made to be rubefacient combined with water & alcohol in certain [illegible] used as a lotion in all kinds of erythem. infl. scalds from hot water malig. sore throat tumefaction from sprains & contusions uterine & nasal hemorrhages & [illegible] costiveness. It is inhaled to relieve syncope. It is supposed to destroy specific contagion & is applied to the head of convalescents from small pox. But this is rather a chemical & mechanical than a medicinal effect It is liable to change & decomposition in the ordinary form of vinegar, but the taste smell & appearance will be adequate tests It is used in pharmacy as a [menstruum] & the posers of a few articles are heightened by it, as colchicum, which contain the bi-gallate of veratrine & the acetate of veratrine is more active. So the acetate of sanguinaria is more active also that of morphine is more so than the natural salt of morphine which exists in opium But most articles have their powers impaired or destroyed by it. The preparations are nauseous and liable to decomposition even with a considerable addition of alcohol. The following are used viz acidum aromaticum, acetum scillae, A. colchici, A. veratri (3 species) & A. sanguinariae As prepared from fermentation it is uncertain & shd not be used for these purposes Citric Acid Next in importance to the preceding Found abundantly in the geum citrus of which 3 species are described C. medica (citron south of Europe) C. limonum (lemon) C. linetta (lime) These contain great abundance C. aurantium (sweet orange) C. vulgaris (Seville orange) C. vulg. var. myrtifolia (cultivated in our green houses) C. decumana (?) (shaddock) All these contain citric acid & [illegible] the other species Citric acid is contained sparingly in other genera, as oxycoccus Europeus, cerasus [illegible] (bird cherry) C. hortensis (our old fashioned red cherry) solanum dulcamara, fruit of rosa canina ribes rubrum vaccinum myrtillus fragaria vesca Citric acid is one of the most expensive but most pleasant. The juice of the recent fruit is preferable to the concrete acid in fevers etc. Malic Acid Obtained from apples & pears in considerable abundance, in which it exists ready formed in greater still from the leaves of semper vivum tectorum sorbus [aucuprin] (?) of Europe, sorbus Americana (juice of the fruit) most abundant is the red [illegible] of the fruit of rhus glaborum for medicinal purposes, macarete the berries in hot water & strain The acid thus obtained is than the juice of limes etc. for fevers Tartaric Acid Obtained exclusively from the fruit of the vitis vinifera, in which it exists in the form of bi-tartrate of potassa New wine contains it in solution & deposits it by precipitation on the casks. It is taken from these & purified & crystallized to form the [illegible] bi tartrate of potassa or cremor tartar The true tartar is not recognized in chemistry now The “adiculous syrup of lemons” consists of tartar ac. zj essential oil of lemons (rind) [illegible] white sugar zxvi boiling water zvjii This constitutes the lemon syrup of the shops If too much oil of lemons is added it gives the taste of rotten lemons. There shd be just enough to give it a taste in water. The “salt of lemons” is bin oxalate of potassa, q.v. Oxalic Acid Exists in the fomr of binoxalate of potassa in the oxales Americana acetorella, stricta, violacea, & probably in the others It exists in smaller quantities & the same combination in rumex acetum & acetorella in the juice of the stems of rheum raponticum (pie plant) & a little in R. palmatum & undulatum. The acid of R. rap. was formerly thought peculiar & called rheic ac. The citric is the most agreeable acid than the oxalic, then the tartaric least of all the acetic. The oxalic is more active than the others & is probably the most powerful refrigerant of all The effects of these acids in excessive doses are irritation followed (if a sufficient quantity has been taken & not removed) by erythematic infl. & there may be ulceration & sphacelation if not immediately fatal. The symptoms are nausea, vomiting, pain in abdomen small wiry pulse etc. The oxalic is the most poisonous, next the tartaric, then the citric Immediately after swallowing give carb. pot. lime, or magnesia & if not given immediately they may lessen the evil those however are preventives, not antidotes To obviate the effects we must give demulcents & opiates Carbonic Acid Is said not to be capable of being inhaled It is so if pure, but when much diluted it may be & will diminish irritability & produce first prostration, the exhaustion paralyzing the muscular powers & preventing all effort to escape from its influence The remedies for asphyxia from this gas are a free supply of fresh air dashing cold water over the whole body particularly the head frictions stimulating enemata artificial inflation of the lungs with good air Medicinal operation Almost all the books call it “stimulant ton. diaph. diuret. & antiseptic” Copying from each other. When I commenced practice I supposed so, but have found by actual experiment that this is not true It was injurious in atonic cases & did not aggravate phlogistic ones. If given freely in the form of carbonated water it was an evident & decided refrigerant, diminishing vital energy & strength of action & morbid heat, restlessness, irritability & irritation. It is a decided but weak refrigerant beneficial only in acute entonic diseases. It will correct the fetor of the alvine evacuations. It is analogous in its effects to the vegetable acids. I have a letter from an old physician confirming my statements Boracic acid (nervine?) Fruits Stimulants 2nd Stimulants Rhus venenata not the is vermix which is a native of Japan like R. toxicodendron is useful in palsy, dyspepsia & many diseases is no more unmanageable than any other article & is no more poisonous to the system. The other species of rhus are acrid but this is the best as R. [illegible] is probably preferable to R. toxicodendron. R. radicans is not inferior to R. toxicodendron Alcohol Discovered by an Arabian chem. A.D. 930 Some ascribe the discovery to Arnold de Villenne of Montpelier in the 14th century When strong burns with a blue, when diluted, with a yellow flame. Sp. gr. [absol.] alc. [illegible] 96 or 2 Off. alc. 835 in G.B. & U.S. take a vial find its exact weight & mark it with a diam. Pour into it 1000 grs (troy) distilled water & mark the heights Alcohol up to this mark shd weigh 835 grs. Alc. dissol. pot. amm lithia & the veg. alkalies, but not the earths. Generally all the salts which in water are insol or very sparingly sol. are also insol. in alc. The deliques. are also, exc. the carbonate of potassa Alc. also dissol. sugar, resins, manna, balsams, camphor essential oils Alc. dil. eq. pts wat. & alc. sp gr 935 The peculiar properties of alc. in different forms (as spts sacchari [illegible] spts persici [illegible] bran.) are said to be owing to oily matter always present & to a little acetic ether The former may be removed by repeated distillation & caustic pot. or soda will remove both. The carbonated alkalies do not act with suffic. energy Alc. is sd to be the same from whatever source produced Alc. is stimulant nervine & narcotic It differs from wine in producing an effect externally also, when it produces a vital contraction of the solids diminishes morbid irritability & sensibility, obviates a relaxed state of the soft parts & relieves pain IN many states of the system the use of wine & of alc. prod. the same effects, but there are considerable differences in certain states It is not tonic There is much room for discrimination between wine & alc. as between alc. & ether Greater effect on the brin is produced when atmosph. press. is removed as in ascending high mountains also on an empty stomach It does create a positive increase of power when indicated & properly managed & is not followed by exhaustion It is not a poison in a popular sense of the term i.e. in small doses Wine is indicated in non malignant typhoid disease alc. in low malignant [illegible] is better in the putrid types, alc. in in the nervous. The mode of preparation [illegible] the use of stimulants will make a difference if cal. & op. are not given in the early stages alc. will disagree in the latter & perhaps wine & the supporting agents will disagree also; but if cal. & op. be given at the outset & afterwards the sp. be continued alcohol will agree will if so strong a stim. be indicated Upon the [whole] [illegible] is indicated in chronic diseases & indicate with consid exhaustion, but alc. is advisable in very few chronic cases but is particularly appropriate in acute diseases with extreme exhaustion Intoxication is in no case a stimulant operation, but in some a narcotic, in others a nervine in others both It is not settled to which intoxic. should be attributed. I am inclined to think the remote effects of alcoh. attributable to its peculiar narcotic power No pure stim. nervine or narcotic produces them though the narcotics approach nearest. Perhaps we may consider del tremens as the eff of its nervine power & diseases of the liver of the narcotic, but I am not certain The external marks of intemperance in alc. are inflamed eyes bloated face red nose, tumid abdomen turbid urine foul breath, tremors of the muscles emaciation, peculiar cutaneous eruptions & preternatural old age The effects on the mind are inability to fix the attention failure of the memory & judgment, irresolution, cowardice Patient ultimately dies dropsical paralytic apopleptic or delirium etc. deranges the digestive organs & particularly affects the liver Swine & fowls fed in distilleries are subject to enlargement of the liver & the same eff is prod. on the human subject The constant irritation on the digestive organs causes a determination of blood to the viscera, which produces congestions infl. & parabysma. The particular diseases produced by the use of wine are a peculiar sort of dyspep. (differing from that produced by alc. & other causes) Gout, calculous diathesis & sometimes lithia renalis or gravel. These are exclusively the diseases produced by the use of pure wine The habitual use of alc. produces an obstinate dyspepsia of a different form & terminating sometimes in membranous phthisis limosis syncoptica parabysma to especially of the liver. A peculiar kind of cutaneous eruption Obstinate ophthalmia tarsi hypochondriasis nervous tremors A peculiar sort of conclusion called “drunken hysterics” delirium tremens obstinate dropsy parunia melleta or diabetes impotence paralysis & sometimes catocansis ebriosa These are all the diseases that are the peculiar effects of alcohol In cases of exhaustion from severe exercise, tho in good health, alcohol is a good remedy So if a person subject to rheumatism should accidentally get wet though a free draught of brandy will almost invariably prevent the rheumatism So too of persons predisposed to pneumonary complaints which exposures will bring on So of fever. So too an attack of an [illegible] may often be thus prevented. Yet it would undoubtedly be far better if alc. were confined to the shops of the apothecaries Therapeutic appl. of alc. & wine Limosis dyspep. It is bad practice & shd be avoided Wine is better when it agrees. Alc. may be used when there is extreme exhaustion to bring the pat. within the proper range of susceptibility to other medicines. Diarrhoea It has succeeded when it was simple & idiop. I consider the species of diarrh. as only varieties I except d. tubularis which is a membranific infl. & D. [illegible] which is a symptom of dyspepsia. Opium is far better [illegible] diarrhoea. Cholera a temporary use is often beneficial Generally before the pat. is called the pat. is reduced very low pulse weak, quick cold extrem. epig. stress. Here a small quantity of undiluted spts especially if hot will often suspend the vomiting & diarrhoea & palliate the disease Opium is more effectual but but some cases require alc. in addition Avoid giving a great bulk for this will cause vomiting Intermit. & rem. fever Wine & alc. often useful. These may be 1st of the synochus or sub putrid type 2nd of the nervous, as exquis. as in t. nervosus 3d of the putrid or typhus gravior type. When of the synochus type they are never malignant. Wine & alc. are never necessary unless the cases are protracted & run down In the nervous alc. is preferable to wine but wine is best in the Alcohol Wine 2nd 2d Stimulants putrid if not malignant & low. otherwise alc. But these are to be considered as auxiliaries, when the system has been prepared by cal & op. alc. is more applicable & agrees better. Thus is obviated the irritation which alc. would otherwise produce. Icterus melaena many cases will require either wine or alcohol. Sometimes they will agree, sometimes not give op. with either Typhus in all its forms when malig. alc. non-malig. wine answers very well When run on to a low state, alc. or wine shd be given acc. to the degree of exhaustion the previous treatment & the type Abscesses require either wine or alc. when in a low state. Apostema when low Anthrax when system is much affected & low Erythema [illegible] erysipelat. gangrenous & anatom. in the same cases as the preceding. So too of paristhmitis maligna Malignant variola rubeola & rodalia Phlogotica or visceral infl. may or may not be proper. When approaching to erythema phlegmodes they are not. if to e. gangren. they are necessary or in the early stages IN the arthritic wine & alc. may be highly useful. Arthritic infl. may be acute, subacute & what is called chronic i.e. intermediate between rheum. & neuralgia. All these forms may affect the viscera. In the advanced stages of any of them, if there is a metastasis alc. & wine may be useful Membranific Phlogotica I have not seen a case of croup this winter (1830) in which alcohol has not been employed by others as well as myself. This does not supersede the use of emetic cal. & deobst., but they fail without alc. in some cases or the dis. may run into a low state & then alc. may be required Strumous Phlogotica very often [required them] General acute febrile dysentery often indicated at the outset if malignant also if run down into a low state alc. generally is better than wine In many of the dysthetica they are important auxiliaries e.g. marasmus tabes (not so much in m. atrophins) especially var. venenata from lead & mercury. Porphyra hemorrh. (land [scurvy]) if the case is serious they are highly useful In severe cases the more intense astringents, powerful tonics & diffusible stimulants are highly necessary Gangrene especially G. sphacelus Entasia Tetanus their propriety has been controverted. Dr Hosack thinks every thing depends on giving them just to the right point & that more or less will fail his cases would not have been called tetanus in Conn. they were slight spasmodic diseases & would have got well without any treatment In genuine & severe cases we can trust to neither for a cure. In Mass. such cases S have been treated with Fowl. sol. in very large quantities, sufficient to keep the bowels open & alcohol. Practice that would destroy life summarily in health may be safe & effectual in violent disease. This practice seems to be judicious & judiciously managed Arsenic is considered the most important part of it. Opium shd be used largely at the same time. Lyssa canina proper if great exhaustion Chorea if great exhaustion Chlorosis atonica wine with some limitations Dropsy Stimulants are not incompatible with digitalis. In some cases it will do nothing without stimulants & then will act salutarily. They are those attended with exhaustion pulse weak & feeble extremities cold powers of life considerably reduced Bites & stings. The testimony is complete as to the efficacy of wine alc. & opium The practice is as old as Celsus perhaps Galen (vide my notes) Celsus recc. vinum cum pipere External Use of Alcohol Dr Ives uses alc. zi to zii ol. orig. in scalds & burns & prefers this to ol. pin. He uses it before vesication, which it prevents. If applied too long however it may produce it & be as bad as the fire. The test of sufficient applic. is the relief of pain without its returning on suspension. If the skin is removed, the burn extensive & exhaustion & irritation great, the same mixture is recc. topically Some forms of indolent tumors if early applied, it may discuss them Vapor bath of alc. (Support the bed clothes by a stick) probably some of the alc. escapes combustion & passes up in hot vapor. This bath does not fatigue the pat. does not make the bed damp like boiled blocks Useful in secondary stages of colica ileus & rhuch. in diarrhea cholera icterus melaena chololithus [illegible] limosis gastrodynia malignant intermittents & typhus Wine Vitis vinifera not an [anpelop.] D.C. vinif. & vitis jus native of south Asia. Boerhaave derives the word vinum from vieo to bend or twine It is from the celtic gruzel (pronounced vit) vine, vigne, vinea [illegible] [illegible] etc. all from two hebrew words signifying fountain & to press out. R. & Schultes describe 1 or 200 varieties of vitis vinif. Wine does not exist in the grape The great divisions of wine are alba & rubra Other divis. are acidula as Rhenish or Hock dulcia as Frontenac malaga [illegible] tokay cape austera as Portugalicum or Port, mitia i.e.. not acid sweet not austere, as sherry, madeira, claret, burgundy champaign. To these we may add vinum pomaceum or cider & v. pyraceum or perry Wine is mentioned in the works of Hippocrates in the treatment of typhus It is a stimulant, nervine & narcotic It allays the intense stinging heat of typh. gravior as infallibly as cauma is relieved by depletion & refrigerants. It promotes perspiration when defic. & restrains it when excessive It allays irritation jactitation pain & wakefull all in atonic diseases Excessive quantities produce vertigo, delirium or coma followed by languor headach. nausea vomiting & sometimes diarrhoea For diseases prod. by it vide alc. It is an undoubted fact that a free use of wine diminishes the susceptibility to diseases both entonic & atonic The power of wine in allaying irrit. sensibility increased freq. of puke restlessness watchf. pain etc. is the joint effect of its 3 powers Wine is not properly a tonic though it comes nearer the alc. to being one. White wines contain water, bi tart. pot. & colouring matter. Sweet wines contain sacch. mat. & ret wines, a little tannin. But these mixtures cannot be imitated by art. The properties of the factitious wines are those of their alcohol Hence I consider the active principle a distinct compd of the ponderable bases of prot or carburet hyd. & water in equal proportions, so that wine differs from alcohol as essentially as that from ether. I think it probable that hereafter it will be found that the active principle of alc & cider is 1 prot. carbur. hyd + 2 [illegible] But it is known the brewers add various narcotics to beer to make it more intoxicating 4th Stimulants Phosphorus This article stands next to alcohol in the quickness of its operation. Alcohol acts sooner than any other stimulant phosph. next & the cantharides, but neither of these two can be relied on as a quick stimulant in case of emergency. Ether (considered a stim. by Prof. T. in 18-1 & 1-2) capsicum, and the essential oils are sometime in operating Phosph. is I believe found in the veg. as well as in the min. kingdom. It is soluble in caustic alkalies with heat & probably unites with their metals, as it decomposes water It is not decided whether phosph. acts on the nervous syst. through the medium of the m.m. of the al. can. like ether or whether it acts on the bloodvessels like capsicum, cantharides, ammonia etc. Probably it acts in both ways It is said to be nervine & diaphoretic It cannot however be used as such Dr Ives give it in low stages of exhaustion etc. In mere torpor without exhaustion it is improper. Extreme irritability, though there may be ever so much exhaustion contraindicates it. It is only when the pat. is in a low state & the danger remote that it can be relied on & not at a sudden sinking a crisis, as yellow fever. When there is morbid irritability it is increased by phosph Dr Ives uses it when the action of the disease has worn out the sensibility of the system phosph. thus occasions a new supply of excitability & rouses the pat. in the article of death. This is contrary to the [Brunomia] theory but it is strictly true Dr I. thinks phosph. less favorable when there are topical affections. He thinks it excites appetite especially for animal food Swediaur thinks it aphrodisiac if so it would probably be from its stim. powers & in exhausted states of the system Phosph shd never be given in substance either in pill or emulsion as it wd occasion top. infl. Sulph. ether rectified by dry chloride of lime is said to be the best solvent zi will hold 6 grs of phosph. in sol. Soc. to my experience the fixed oils are the best solvent. Rx ol. oliv. purified & heat it with an excess of finely cut phos. Keep it well stopped. When used add a little spt. amm. to give it a creamy appearance & the pat. will not know that he is taking oil, at which most have a disgust. Sugar with ol. cinn. etc. makes it palatable Take it unmingled. A teaspoonful once in 3 hours is a dose of the saturated oil This was given in an extremely low case when a powerful dose was indispensible Continue this dose until the system is roused & then diminish & continue I have used it in no other than low cases. A small dose of a repeated is the only proper mode of exhibiting stimuli in low states of the system the lower the oftener Phosphorus if properly used is not dangerous & in low states of exhaustion we have no substitute for it Phosph. has been supposed to retain its medicinal powers in combination. This may be true of the binary compds [illegible] of its salts. Liquor of phosp. acid is used as a substitute for phosph. but that it has the same powers is I think more than doubtful It is formed by exposing phos. to the air, when it liquefies from the moisture in the air Sir H. Davy thought this substance a mixture of phosphoric & phosphorous acids Dr Ives’s dose is from 10-30 grs in water every 3 hours. I have not used it Particular forms of dyspep. attended with great torpor & insusceptibility & little irritation are relieved by phosph. In a form of dysp. with epigastric sinking lim. cordial or syncoptica of Good paroxysm every day sense of faintness distress at stomach, aggravated by exertion, both bodily and mental here phos. is of more use than any other remedy, unless alc. or opium which cannot be employed in chronic cases opium is not so dangerous but phosph. possesses superior power of relieving Limosis albicans (white jaundice) also lead colic with great exhaustion here ph. is the only remedy that will succeed Icterus melaena of Good occurring in broken down constitutions secretion of bile deficient differing from jaundice in being attended with exhaustion of digestive powers the skin is livid like a bruise yellowish green cases fro mthe south or intemperate persons. Common remedies do not good. Active stimulants must be conjoined with deobst capsic. or ph. with cal. or better corosive sublim. Malignant remittents & intermittents of trop. clim. & sometimes among us, & the low stages of all atonic fevers, malignant or not, when vit. energ. are low Delirium trem. Here phos. is a powerful auxiliary. In some cases opium alone will not succeed unless the vital energies are roused. Malignant continued fevers of all kinds whether with primary exhaustion or that produced by the disease Plague typh & anthrax involving the whole system Pneumonitis that kind which Good says will not bear emetics etc. In that kind of pneumonia confined to the lining membrane of the bronchiae with infl. like that of the intestines as dysentery Malignant rubelola & rosalia Atonic small pox Tabes var. dorsalis It has been partic. successful in T. venenata from lead merc. & arsenic Impotency certain cases of dropsy diabetes passive hemorrhage by Dr Ives Gangrena sphicelus & necrosis of Good Bad cases of land scurvy Spermorrhea atonica Agenesia in potens var. atonica thought to have especial power Poisonous effects of phosporus violent burning pain in stom. & intest. Alliaceous taste in the mouth obstructed respiration vomiting, hiccup extreme exhaustion Pulse very hard & small towards the close convulsions death. The stom. & intest. are inflamed & [sphicelated]. The infl. is erysip. not phlog which would spread to the other coats If called early give an em. of ipec. or sul. zinc If the phos. has passed down give cast. oil in wine glass doses with a drop of croton oil if necessary. Orfila recc. magnesia to neutralize the acid. I think the acids produced have no share in the mischief. Op shd be given sufficient to allay pain & spasm. No other remedy is needed. Antiphlog. rem. are injurious. Demulcents may be useful but not in quantities sufficient to produce distention Medical Jurisprudence Erithematic infl. of stomach pure phos. or ph. acid in al. canal no other mark decisive. If it has been given in oil, it will not be precipitated if in ether it will. The appearance of phosphorous [oxic] acids is not a proof of poison (or I think) for they are found in dyspepsia etc. & are an ingredient in the human body. Minute particles of phosph must be detested by the eye & by their white fumes, odor & luminousness. 5th Stimulants Arum triphyllum No synonym aroides (fuss.) Piperitae sinn. Possesses a peculiar acrid principle, volatile, inflammable dissipated by drying, air heat & even by pounding in a mortar It is not soluble in milk, oil, water, alcoh. vineg. I know of no solvent. Root contains ¼ part fecula This root produces a strong pricking sensation on the tongue & almost vesicates it Applied to the skin it vesicates In the stomach it produces heat, nausea a pricking sensation all over & spasms of the extremities are among its effects When dry it is inert like starch, but sometimes retains a little power The root is the only part used This root is an acrid excitant with no other power It is an expectorant & diaphoretic by virtue of its stimulant power & when dry it is demulcent & nutritious Externally it is discutient, but rarely used It is allied to capsicum in its powers. Medium dose 10-30 grs If recent 10 grs [illegible] sufficient, repeated once in 2 3, 6 hours. For an emulsion, best in a mortar with milk or sugar. Barton directs a confection by boiling, which destroys the power For extern. appl Beat with irritant or apply alone It is rubefac. & vesic. To keep it with unimpaired strength lay it in sand It is inferior to capsicum Milk, mucilage or oil most conveniently allay its effects Diseases It is put into a decayed tooth Ptyalism as in epilepsy Dysphagia from spams & that from semi [illegible] of muscles of [degl??] It is given with success in flatulent colic Other species of arum have the same properties in different degrees, as A. dracontium calla palustris less active than arum but similar Lecontia Virginica The strongest of all the arrideae acrid & mucilaginous. Arum maculatum is the off. spec. in [Eu???] Ictodes feticus Formerly called arum Americanum (Catesby) calla aquatilis (Gronov.) Dracontium fetidum lim.) posthes pectorii (B.S. Bart.) P. foetidum Lymplocorpus foetid (Salist.) Spathic [illegible] foetidum ([Rafines]) Ictodes foetidus (Bigel.) Every part has a fetid odour, depending on a volatile princ. probably a volatile oil, but it has never been separated. It is more permanent than the active princ. of A. triphyl. It has resinous & mucilaginous [illegible] its acrid & odorous properties. The seeds have an animal odor & contain a fixed oil The root and seeds are the parts used but the seeds are preferable. They retain their vital principle for years & their medical virtue as long. The root loses its strength by drying This plant is a powerful excitant like arum. It acts on the alim. canal & does not affect the circulating system immediately. It is a nervine like asafoetida. Very large doses occasion vomiting, headache vertigo & sometimes a temporary blindness It is probably not a narcotic Of the dry root 10-20-30 grs every 2-4-6 hours may be given. It may be formed into a confection or better, may may be taken in molasses & water Dry it whole & exclude the light It is doubtful whether the leaves are any better than cabbage leaves, but they have no offensive smell as cabbage has after topical application Uses & applications similar to arum maculatum It is not so powerful but it is better in flatulent colic than arum as it is nervine Dyspnea exacerbans It has more reputation in this than in any other disease Repeat it every 10 min. until it produces vomiting or relief. The vomiting itself is often of service To prevent the recurrence give 4 doses a day Dyspnoea seems to arise from paresis of the gastric branch of the par vagum & is relieved by Galvanism chronic rheumatism by a continued use like guaiacum & capsicum Convulsions particularly hysteria Paramenia cessations Dr I. recc. the limb in phleg. doleris to be wrapped in the leaves all over (as a smooth app.) Acorus Calamus [Odor] like a mixture of cinn. & pimento improved by drying. Essential oil can be obtained. The bitter principle is extracted by water It is an acrid aromatic excitant, with some tonic properties It is not inferior to cinn. & nutmeg in substance & oil. The dry powdered root is an excellent errhine IT is used for economy where cinn. & nutmeg cannot be afforded & were it as dear would probably be as much esteemed. Essential Oils These are 1 Pure stimulants 2. The milder oils as ol. anisi, a pure nervine 3d nervine & narcotic or stimulant & narcotic The terebinthinate oils are stim. & deobstruent Articles containing the oil are often used in a crude state, if it is in abundance e.g. cinnamon cloves Monarda Punctata (Wills.) The most acrid & pungent of the essential oils It flavor resembles that of thymus or satureja It is an elegant & pure aromatic & stim. Extrem. It is one of the best veg. or rubef. & vesic. For intern. use make a spt. rx f zi oil to 7 of off. alc. ( I make the spts ppermint in the same proportion) It is very good to cover the taste of unpleasant articles. So oil cinn. The oil cannot be taken pure, even on sugar For a [linin]. Rx ol. mon zfs tinct camph. zii & tinct. opii zii Probably the spt. monard. wd be as good for a rubef. Ol. monarda with ol. oliv. remains more fixed but is not so powerful The oil was introduced by Dr Atlee of Phil Ol mon. is more vesicating than ol. capsic. & less so than ol cantharides The other monardae are much less active Therap. applic. Typhus with cool skin & cold extremities use the linim. on the arms legs & breast (Eberle & Alee) to restore heat. Brandy would only evaporate & increase the coldness Cholera infantum (an enteritis) to the abdomen & extremities (Eberle) Chronic rheumatism internally & extern. peculiarly adapted partial palsy hemiplegia & [paraplegia] Tooth ache I have used the oil when the nerve is exposed apply it on cotton to the cavity of the tooth & around the adjacent parts or it may relieve by ext. app. ol. capsic. is best ol. mon. next. Mondarda oblongata Less active than m. punct. but nearly equal. The infus. is useful in the atonic stage of fevers. The weak infus. is quite effectual in the forming stage of the atonic febrile disease Monarda didyma (Banks) & monarda kalmiana ([Pursh]) These are used for nearly the same diseases as m. punctata & probably differ only in degree of power. M. kal. was first discovd at Oswego & called m. didyma Pursh gave this name to a southern species. Both are probably varieties. At least the “oswego tea” has the best claim to the name. The different spec. of mon. ether contain a less active ss. opil or a less quantity of the same oil. I know not which probably the latter. If so the same oil might be distilled from each Probably m. oblongata would furnish a large quantity Monarda fistulosa Common in N. England & has been cultivated in Europe for the oil It is the origanum spurium of old writers. 6th Stimulants Capsicum C. grossum squash pepper is the spec. almost exclusively cultivated amongst as C. annuum is mentioned in the books as being the off. article but is far less common. The [pericarps] of C. grossum contain 1 an essential oil (called etherial by the French) which is not volatile at all, and the case also with that of piper nigrum. It is obtained by digesting the pericarps in ether for a fortnight expressing filtering & evaporating the ether. We obtain the oil & crystal of capsicine the scent of ether still remaining which perhaps might be driven off by heat. The oil thus obtained & is of a brilliant red colour aromatic in odor, pungent & warm to the taste It cannot be distilled without decomposition. It contains all the medicinal virtues of capsicum. I have for years used it as a substitute 2 Capsicine white acicular crystals without odor or taste neither acid nor alkaline. AT the 1st crystallization they are combined with some of the oil & were hance supposed to be the active principle & sold at a high price. By repeated crystallization they are purified and then have neither sensible nor medicinal properties. The same mistake was made with regard to piperine which we always see yellow from the oil, but when pure is quite tasteless & inert 3. Red colouring matter which it is difficult to separate from the oil 4. A substance not investigated containing nitrogen 5 Mucilage 6. Various salts especially nit. potassa For excessive doses of ol. caps. demulcents of opium are the proper remedies Dose of ol. cap ¼ gtt or 1/8 gtt sometime 1 [illegible] or more Of the substance 12 grs is a very large dose in our climate but more is given in the W. Indies. If we wish for the effect on the stomach only, and not on the mouth & fauces the tinct. shd be given in milk. Mix & swallow immediately & it is not tasted Pat. do not generally complain of the taste in acute disease though they may in dyspepsia etc. Nor do they in low cases of typhus & cholera. When there is very great burning in the mouth & fauces this article cools more than any thing else The vinegar of caps. is not so good in irritated states of the stomach or in the low stages of fevers but it is the best form for affections of the fauces in rubeola & rosalia Cataplasms may be made of the powder & flour & vinegar. Or the caps. may be sprinkled on a paste. If a very speedy effect is desired a paste may be made with pure powder of caps. & hot spirit As a rubefacient it excites an action sui generis & often excites one when other things fail. There is room for selection in rubefacients In many cases tart. em. is bad & caps. good & v.v. So of other rubef. Therap. applic. Rheumatic toothache The tooth is often carious if on the lower jaw drop it in the oil if on the upper moisten lint, or rub up the oil with sulph. morph & dip lint in Chronic ptyalism often symptomatic of paralysis or of epilepsy & chorea gargle the mouth with the tinct. or the dilut. essence Dysphagia atonica often a more part of general palsy but it exists sometimes independently & is then curable by capsic. Dysphagia spasmodica Limosis dyspepsia in cases attended with torpor & insusceptibility, with much flatulence & freq. reject. of food. Capsic. alone or conjoined with food, or with eccoprotics, deobstruents & tonics will cure In cases of cold extremities rub them with the diluted oil till it produces a glow more or less permanent & so as to be slightly rubefac. if the powder on cotton is used it shd be very fine, for if as coarse as we have it for the table it will produce very little effect. It is used externally on this disease as a stimulant to the epigastrium either the powd. or the ess. oil Incorporate it with a spatula with La & Butler’s (which is the best it will spread cold) adhesive plaster common pl. is too hard Limosis syncoptica a valuable adjuvant shd be given in form of tinc. or oil as more speedy Limosis albicans (“white jaundice” no jaundice at all) highly useful auxiliary to [xanthortia], percholr. narc. & opium Dr Reed of E. Wind. who uses caps. extensively recc. it in all kinds of diesth. attended with viscid secretions from the liver to check the secret. in quantity & change them in quality Colic I prefer rubefac. to blisters in their action can be kept up in the 2nd stages it is important as an auxiliary Colica rhechialgia Capsicum counteracts the sedative effects of mineral poisons particularly of lead. Lead does not always produce colic, sometimes marasmus & sometimes paralysis, without being preceeded by colic The proper remedies for all these effects are acrids & particularly capsicum Colica cibaria of Good from poisonous fish mushrooms etc. (as often however a cholera or diarrhoea as colica). The tropical practitioners depend altogether upon the acrids & say it is no matter whether the offending substance is evacuated or not I prefer evacuating if pat. is not sunk too low. It is important to know that evac. is not indispensable in such cases we may enter at once upon the acrids as capsicum with confidence of success If called early I would evacuate the al. canal & sometimes this is all that is required if not give acrids. The effects of pois fish & pois mushrooms are very similar, being in both cases speedy & direct (sometimes very rapid) exhaustion. Some persons are more affected than others the reason is inexplicable. Those of warm climates are more susceptible than of cold Colica flatulenta Coprostasis costiveness attended with torpor & atony, apparently local cases where refrig. salts have been taken till an enormous quant. is necess to operate & then with small effect. The simple acrids such as are not cathartic will often give complete relief in some cases as much capsic. as can be taken with the food has answered the purpose. I know of no certain diagnostics in these cases. The subjects are generally feeble & no harm can result from trying caps. Caps. also enhances the effect of tonic & astring. cath. as rhubarb Diarrhoea, pure or idiopathic in the secondary stage caps. can be relied on alone shd not depend on it in the 1st It is particularly adapted to 2d stag attended with excessive & morbid secretions & relaxation it restrains and changes these secretions. Cholera when the vital energies are exhausted & there is great irritability of the stomach etc. caps. will often check it vomiting when opium will be rejected The phys. is not often called in the forming stage, before the vom. & purg. has commenced, at which time some other remedy might be preferred Cholera flatulenta great flatulence & copious rejection of air, without vomiting or diarrh. Here caps. alone is sufficient & opium is unnecessary Parabysma coactum useful auxiliary to conium & perchloride of merc. Parabysma strumosa Strumous diseases always require more stimulants [illegible] stimulants Idiopathic cough from relaxation Dyspnea exacerbas & asthma humidum in the 2nd stages & attended with relaxation & excessive secretion Passive hemorrhages capsic. is a popular remedy and often prescribed successfully by physicians Erythema of the membranes of the brain Perhaps the W.I. practice of shaving the head & applying rubefac. of caps. in delirium would be useful. I know not that it has been tried Paristhmitis erythematica independent of Rosalia. The original recipe was 2 tab spf of capsic. 2 teasp. of fine salt ½ pt. boiling water when cool strain add 1/3 pt vinegar dose a tabl. sp. every half hour. This would very well in moderate cases. The lowest & most severe wd do better without the salt & vinegar Apostematous Phtisis after the formation & bursting of a vomica capsicum restrains the purulent secretion, sustains the pat. & prevents sinking Dyspeptic Phthisis Erythematic visceral phlogotica are not generally recognized & described in the books except enteritis & gastritis eyth. infl. has a great tendency to spread, throughout the membrane which it affects Erythematic Enteritis attended from the first with diarrhoea & with vomiting if the stom. is affected. At the outset give calomel freely with opium conium & often sulph. quinine capsicum is useful externally. Capsicum is useful in all the stages of genuine & malignant erythematic phlogotica & in the secondary stages of phlegmonoid eryth. phlogotica Sparganosis [illegible] in cases supervening upon excessive hemorr. & attended with a low & exhausted state very useful here often as a principal remedy & always as an auxiliary. It is not proper in cases occurring after a long period & in the more vigorous & robust gout (regular) in all low cases Podagra larvata of Good improperly called by Cullen atonic gout for all cases are atonic Case of Dr Cooley violent paroxysm in his feet he applied some sort of poultice & in twelve hours it wen to his stomach. Dr Todd & myself were called we gave ammoniated alcohol, amm. tinct. guaiac. alcoh. opium etc. apparently with little benefit got no relief & was in a dangerous situation Dr Reed of E. Winds. entered on a free use of caps. internally with speedy relief. I have known other cases Rheumatism secondary stages of all ordinary atonic acute & all stages of erythematic atonic acute rheum. Eberle is too vague Rosalia maligna Rubeola maligna Malignant small pox whether confluent or not (all malign. cases are not confl.) Cases may clearly be of distinct small p. & yet require the most vigorous stimulation Purely passive hemorrh. & perhaps irritative Marasmus Tabes var. strumosa, var. venenata, from min. poisons & var. libidinosa Cyrtosis Rhachia All the strumous phlogotica & strumous affections of the glands of the neck Porphyra hemorrhagica It is second only to ac. lead I commence with lead & continue it till the hemorrh. is stayed usually from 3 days to a week. Then I omit the lead & substitute the sulph. quine. I accompany the lead from the first with caps. & brandy. The success of this practice bears no comparison with that in the books Gangrene all the species Insanity several species is to be treated most successfully by tonics acrids & deobstruents. This is the way in the Conn. Hospital & the prop. of cases cured is greater than in any other institution Melancholia acrid most useful Hypochondriasis Chorea good auxiliary Syncope in persons habitually subject, occurring from slight causes or spontaneously 2 or 3 hours a week for 6 mo. in such cases I have given various remedies both as prophlylactics & to bring pat. out of the syncope have found nothing equal to capsic. for both purposes. She could tell when the paroxysm was coming on & zi of tinct caps. would prevent it Carus lethargus It has considerable reputation with Dr Wright of Jamaica Paralysis not depending on organic affections Cantharis pellitory capsic. & guaiacum are the best caps. one of the best. Paramenia retentionis & [obstructionis] when attended with atony as P. retentionis always is The acrids, deobstruents & tonics, are the proper remedies. P. obstructionis may arise from imprudent exposure to cold & in such a case capsic. is not proper P. superflua Leucorrhea communis & [illegible] Dr Reed of E. W. values it more highly than any other article. I prefer cantheris unless the pat. is unable to take a suffic. quant. without troublesome strangury capsic is next. Nit. silver shd accompany the acrids (localls)? & local means shd also be employed Hemorrhea Senodes I have repeatedly cured at the outsed, freely & rapidly employed Cubebs which is similar is rather more certain to cure but it is not so readily taken Spermorrhea atonica Chlorosis inops Hydrops Thoracis & cellularis a valuable acjuvant to diuretics & tonics. We must first evacuate the water & then tonics & acrids will cure, if idiopathic Empresma abdominis (Tympanitis) from diarrhoea or catharsis in typhus & colic Capsic. very useful Paruria mellita externally as a rubef. & intern. as an adjuvant Capsic. is felt in the urinary org. & is smelt in the urine Paruria in continuous var. atonica Considerable reliance can be placed upon the acrids both internally & externally Capsicum is always contraindicated in phlogistic diseases, even after depletion when cantharis might be used Forms of administration 1st Pill essential oil in bread or in substance grs ii to a pill The dose of the oil cannot be definitely given Be guided by the nature of the case & trial Substance 1 – 4 – 12 grs as much as can be borne every 1-2 hours. Some give more, even as high as 30 grs this wd be rejected Pharmac. Preparations Tincture in the best. I usually make it with zii caps. to 1 pt dil. acl. Dose 10 gtt f zi Vinegar & water will rinse the taste from the mouth Acetum caps. is a good prep. prepared as the tinct. Dose the same Infusion zii to zi to 1 pg. water If it is to be sweetened, use honey Externally the U.S. Ph, directs canth. z10 caps zi alc. 1 pt. This prep aration might be taken internally too., 8th Stimulants Alkaline Ammonia Unknown to the ancients solution & carb. discovered by the alchymists Aq. amm. shd be well stopped with a ground glass stopper as it absorbs carb. ac. from the air. Much of that in the shops is worthless The alcoholic sol. is called spt. of amm. Internally they are purely stim. & acrid They act principally on the m.m. of al. can. but at length cause a rapidly & transient in crease of the force of the circulation, if repeated at short intervals The water & spiritous preparations differ As it is unpleasant it is rarely taken for any length of time I have never seen any nervine effects from it, wakefulness & exhilaration. It does sometimes relieve morbid irritability & irritation. So does pure stimulants in exhaustion I never saw it diaphoretic except by virtue of its stimulant operation It is discutient, topically applied not resolvent, internally It is antacid neutralizing a large quantity of acid & also preventing its formation by its acrid stim. effects thus obviating the morbid condition Dose of qa. or spts f zfs – f zi If it is to be often repeated, dilute with milk & it is taken much more readily water when a strong impres. is wanted It is rubevac.vesic. & caustic applied weak for a short time it merely reddens if strong an eschar is produced. Most generally applied in liniment with ol. oliv. this is best. When applied pure, flannel will prevent its evaporating. But linim. is better, which shd be of various strength & made of aq. amm. Taken in excess it prod. aton. uinfl. of stom. & int. The infl. is eryth. like that from acids or hot water & in both cases, the less fever the more danger. Eryth. infl of m.m. is more atom. more dangerous & more diff.to cure, than of skin In the worst case of an excess. dose, there was no pain, great exhaustion as in severe scales great stupor, pulse wiry & freq. & weak, skin cool. If the dose is not so great there will be a burning pain at the stomach afterwards retching & vom. perhaps tympanitis & sometimes fever. The more pain, the more hope of saving the patient [Orfil] recc. diluted vineger in large quantities to neutralize but after a few moments the mischief is done. It may however be given in smaller quantities, even an hour or two after to prevent further mischief. V.S. & antiphlogistication will do not good & be as improper as in burns & scalds. The topical eff. requires demulc. & antim. the general, opiates. Demulc. shd be in such moder. quant. as not to prod. stim. of distent. Opium frequently is best give by enema, but this depends on circumstances Therapeutics application Colic diff forms as a rebef. & vesic. Phlegm. infl. as apostema communis & common phlegmon early stages Effects a resolution when the infl. wd otherwise grow to suppur. Infl. of fauces early stages of phleg. & all stages of eryth. to the fauces & externally Inf. of female breasts said to cure if applied early, sufficiently & properly These infl. are diseased with more certainty then most others & are more troublesome if neglected Chronic Rheumatism when perman. & fixed topically Palpitatio from functional derangement of the nerves & dig. org. & not structural or organic as a rubef. to the thorax it is an effectual applic. Carus Asphyxia several varieties. C. paralyis not structural topically & externally Idiopath. vertigo [illegible] vertigo of Good Sick headache inter. & exten. gives speedy present relief Syncope from aff. of mind in universal use Common & hysterical convulsions also To do any thing with it in sick headache zi shd be taken freely & early better in nervous and highly irritable temperament. IN such patients the head ache depends more on the state of the nerves than of stom. Paramenia obstruct. highly recc. in milk thrown into vagina strong enough to prod. a sensation So too in Leucorrhea communis & senescention about the catamine period Bits & stings every effectual, but alc. & capsic. are more so. There is not a case on record, where alc. was sufficiently employed that was not cured. Dr John Osborn of N.Y. who had practised at the south said that when called he knew not what to do till the bystanders told him. He found amm. invariably successful & when summoned sent amm. without going himself Yet alcoh. is better. It is well known that a drunken man never suffers from a bite Scalds & burns If applied before vesication it will prevent it after vesic. it is bad. It shd be applied only till smarting & pain cease or it will vesicate. But it is again useful if a bad ulcer is produced & especially if there is danger of gangrene. It is prod as a favorable & speedy separation of the slough Aq. comm. shd be kept in in all vials of not over zviii for it is injured every time it is opened For a liniment equal quantities of aq. amm. & ol. oliv. will be too strong for the best amm. & weak for the common. Skip the next page This page to be read after the next a tea sp. f. is a medium dose, moisten it a little with water or any fluid not acid & it will be readily taken. It is useful in atonic febrile diseases. It is better than Dover’s powders Formulae shd be varied acc. to circumstances The following may be useful Rx sesq. car. am. zfs syr. orange peel zfs aq. menth. vir. zviii Take zfs every ;2-3 hours (Paris) Rx Ser. car. amm zi syr. alk. off. f zviii, or orange syrup not acid Dose zfs 2-3 hours 10 grs sesq. car. amm. (Richie) Rx Ses. cer. amm. arom. conf. aa grs v pulv. canthar. gr f simple syrup q.s. Take a bolus every 6 hours (Paris) The intervals are too long The canth. is the most active article Rx s. c. amm. grs v ext. rhei grs viii fl pil. 2 To be taken soon after making (Paris) Eccoprotic & antacid for dyspepsia Dr Ives uses the following It is much weaker than Paris’s & Paris’s, than the other Rx s. c. a. zii camph. [illegible] gum arab. zii water 1 pt. The water must not be boiling hot Sesqui-Carbonate of Ammonia Boiling water volatilizes it By keeping the carb. changes into a bi-carb. losing its odor & partly its taste, but not its alkaline properties It is a stimulant but less powerful than the alkaline amm. It can be better taken however. It is inferior to the carbonate but super to the bi-carbon Sd to be nervine & diaphoretic probably so from its stimulant power IT is an antacid, but inferior to the bicarb. Dose 6-20 grs in solut. or pill Its uses are more extensive from the greater facility of giving it & its supposed additional powers. Sesq. carb. am. camph & chalk, eq. parts powdered separately & well rubbed together is one of the best form & adapted to most cases. Stop it well & exclude the light or the camphor will be crystallized. The chalk keeps the camphor & carb. am. from concreting into small masses & also covers the taste. This mixture is stimulant narcotic nervine diaphoretic and antacid Turn to the page [prece??] or it will volatilize the amm. Dose zfs – zii every 2 hours Some of the late English writers recc. sesq. carb. amm. in 2-3 gr doses as a specific in rosalia & paristhmitis It is a good remedy in moderate cases. They use it much in convulsions of children & it is considerable used for dyspepsia Dr Woodwd of Vt. used it in in dyspepsia with camph. & chalk & some acrids as capsicum & prickly ash & also with gentian, etc. Intermittents It is much used, particularly at the commencement Used to in typhus IN common epidemic catarrh gout & atonic acute rheumatism hemicrania & sick headache. Also employed with considerable success in after pains of puerperal women & when used moderately it does good, but it only accomplishes in a few days what opium would do in the same number of hours. Cathartics Cathartics Refrigerant Cathartics Sulphate of Potassa Hiatus This has been called an aperient by Duncan in doses of [illegible] to zfs & cathartic in zv. It cannot be managed as an aperient in Dr Tully’s sense of the term Hiatus It is purgative cannot be managed as a laxative nor as an eccoprotic neither as a drastic It is a hydrogoge but not sufficiently so for dropsy. Elaterium is better It operates on the whole al. canal but rather more in the upper part It is kind in its operation & leeves the al. can. in a good state It is a rapid cathartic. It is not appropriate to produce a shock or strong impression Its other operations are refrig. said to be diuretic do not think so Hooper says it is deobstruent. I know not upon what ground. It cannot be so independent of the evacuation Medium cathartic dose is zi as a refrig. from zfs to zi once in 2 or 3 hours Diseases Cauma & all the caumatoid phlogotica of course contraindicated in low atonic fever It is appropriate in any phlegmonous infl. Hooper says coprostasis this is an atonic state of the system & therefore this article cannot be indicated there is torpor of the liver & this does not act on the liver H. says too that it is good in jaundice The same rule applies here He says too in suppression of the lochia. There is no such idiopathic disease if the suppression is attended with infl. of the uterus sul. phot. may be indicated He says dropsy too but as there is no entonic diathesis, it is not indicated Sulphate of Magnesia Hiatus Duncan says it is a mild purgative. This is applicable to all the salts of which I shall treat It is said to be diaphoretic not directly so, but by virtue of its evacuating operation. Not much diuretic Duncan says it will relieve pain in colic. It will do so only in entonic diathesis, but colic is not entonic It is cathartic in the same degree & in the same way as the two preceding salts (sulph. pot. & soda?) Disease & rules of application are the same also Phosphate of Soda Sal perlatum of the old books It is similar in its effects to the other salts & requires very little if any more to a dose It is better managed as an eccoprotic & laxative than the others It is not quite as refrig. as the pre ceding, but all its other peculiarities are the same as to time, mode etc. Med. canth. dose zi – zfs Swedinaur recc. in struma & do not think it appropriate Tartrate of Potassa Elixir tartrata kuli tartras kalitartarisatum pot. tartarizata alkali vegetabile tartras tartras solubile or soluble tartar is the common name of the shops It has the same effect as the others I do not think it can be distinguished from them. I have found no article but the antirritant narcotic that wd qualify its operation so as to prevent [tarmina] Tartrate of Potassa & Soda Soda tartarizatum sal polycrestum sal seignetti, Kali & sodae tartras tartrite of p. etc. It was introduced by an apothecary of the name of Seignetti I know of no difference between it & the others it is applicable to the same uses Bi-Tartrate of Potassa Hiatus Duncan says from zfs to zi is a medium dose for a cathartic It is far more diuretic than the others yet not sufficiently so for dropsy It is of no more benefit in schirrus or dropsy from schirrus than any other deobstruent It is purgative cannot be managed as a laxative is more hydragogue than any of the others quick in its operation not so kind It is peculiarly liable to derange the al. canal. None of the other salts can be said to be irritating. This is considerably so consequently it is better adapted to produce a shock or strong impression. It is more refrig. than the others Medium dose, from 10 – 60 grs once in 3 hours 60 grs once in 3 hours will purge pretty thoroughly And 10 grs in the form of pulvis jalapae composita Rx powder of jalap one part bitartrate of pot. two parts ground together to an impalpable powder. This pulv. jal. com. is recc. as a refrig. & used to be the common hydragogue when phlogistic diathesis prevailed. It is even now retained by some phys. & is Dr Hosacks hobby he gives no other The b-tart. pot. is adapted to the same diseases as the others except that it is better in dropsy being more hydrag. & diuretic. Dyspepsia recc. by Jas Johnsn of course contraindicated he gives it in a dec. of dandelion Colic-recc. coprostasis not good Proctics marisca & bleeding from hemorrhoidal vessels It increases the irritation Oxide of Magnesium This name has been applied to the factitious carb. mag. magnesia alba M. usta calcined mag. has been applied to both ¾ of the “calcd mag.” sold in the shops is nothing more than the carbonate Its purity can be tried, by its not efferv. with a strong acid It is eccoprotic, or at most laxative & antacid Diseases cardialygia spasms convulsions tormina & other diseases produced by acids in the al. can. Swed. recc. in coprostasis Ricketts. Suppressed leucorrhea accompanied with torpid bowels Gout supposed to be peculiarly adapted small doses continued for a long time were thought to remove the gouty diathesis lithia gravel independent It is not [illegible] Medium dose 10-30 gras 3-6 times a day. One circumstance shd be attened to. It diminishes the appetite chance where the case is atonic & there is a want of appetite, it shd not be given The salts of oxide of magnesium, in appropriate cases, as phlogistic ones are kind in their operation & leave the al. can. in a good state. They make but little impression on the system & therefore are not serviceable in giving a shock Med. dose zfs – zi in solution indeed you may say zi is a med. dose. Better in solution than in substance In highly phlog. diseases it is proper to add nit. potassas or tart. antimony to increase the refrig. effect. When a cath. Is not wanted the dose as refrig. is about the same, but nit. potassa & tart ant. are better Diseases Cauma entonic phlegm. phlogotica They are sometimes applicable in diseases not exactly entonic nor atonic 2d Cathartic Factitious Carb. Magnesia mag. sub. carb. magnesia alba mag. aeratii It is soluble in water Eccoprotic & laxative may be so managed as to prove both Not purgative nor drastic under ordinary circumstances. A. T. Thomps. says it is not laxative unless it meets with acids in the stomach It is copragogue. It acts on the whole track of the al. canal. It is slow & kind & generally leaves the canal in a good state. It is antacid Cath. dose 10-30 grs several times a day Diseases Limosis cardialgia Coprostasis some cases such as do not require large doses of medicine By means of this article more carb. acid might be generated in the stomach than in any other way. But I do not approve of the great use of this acid. Mildest cathartics Manna From the Ornus rotundifolium It has been said from the fraximus rotundif. Same not. group with the olive oleaceae It is the concrete exuded juice, obtained from the descending sap by slits cut in the bark The juice is of a white frothy appearance Taste slightly nauseous The best calubrian manna comes in long light friable pieces transparent pieces. The inferior kind is moist unctuous & dark coloured Fourcroy says it consist of four principles 1. Pure manna ¾ of which is called mannite 2. a little common sugar 3. a yellow substance of a nauseous smell 4. mucilage E. & Var. call it a mild purgative Murray, a laxative It is eccoprotic & laxative It is given to children, but is unimportant for adults. The older it is, the more purgative Dose for adults zi – ziii in water milk & water or better in milk Cathartocarpus fistula Native of E. & W. Ind. but cultivated in the warmer parts of the U.S. Commonly called “Locust & wild honey” The pulp of the loment is the part used. It has a black colour & a sweetish taste. It is said to be a good cathartic when taken fresh from the pod It occasionally gripes & produces flatulence It is given for children Eccoprotic at the most laxative Copragogue Acts on the upper & middle part of the intestines. It is kind unless the patient is predisposed to tormina pains etc. Medium dose for an adult zfs - zj Rosa Damascena Damask rose Native of the south of Europe The petals are used. They are given in infusion & are a highly popular laxative for children They are made into a confection also & said to be good in habitual costiveness given in the dose of a table s. f. Laxative is moderate quantities Purgative in larger The quantity for an infusion is zii of dried petals Rosa Gallica rerubra red rose This is similar in operation to the damask Linum catharticum The whole plant possesses cathartic powers Operations Purgative difficult to manage or as a laxative or eccoprotic Its natural operation in hydragogue acts on the middle part of the canal Takes a medium time for operating rather unkind leaves the bowels in an irritable state Dose for an adult is a “handful” infused in ½ pt of boiling water or zi in substance Infusion say zii to ziv or zvi of water Cassia Lanceolata Senna There has been much dispute about the species of cassia which is the true off. senna but it is undoubtedly the c. lanceloata. This is the tone off. or Alexandrian senna, but it comes adulterate with other species & other plants the cynanchum oleifolium is found among it All the species probably possess cath. powers but in a less degree. The term senn has no specific applic. It is applied as “ipecac” is applied to any emetic article That senna is best whose leaves appear bright, fresh, free from spots, strongly scented, bitterish & nauseous, smooth & soft to the feel, sharp pointed, free from stalks & legumes Senna contains a peculiar priinciple calle sennine (cathartine?) Operations It is purgative not eccoprotic or laxative. It is more or less hydragogue the moderate its operation the more fecal the matter discharged. It acts on the colon. It takes a medium time for its operation about 4-6 hours after being taken Dose of the confection zi – zii ]of the infusion 1 troy oz. will saturate a pt. of water add some aromatics to disguise the taste This is a bad cathartic being hydragogue & apt to occasion griping etc. “Any other is better” Prof. T. has discontinued its use Poinchiania pulcherrima Cassis orientalis senna spuria pride of Barbadoes etc. Nat. ord. [leguminosa] Cultivated as an ornamental shrub The leaves flowers & seed are the parts used The leaves are the strongest & the flowers next both used in decoction The seeds are best powerful & are used in powder I to a dose This plant has considerable reputation as an emmanagogue. It is but little known with us. Aloes That for a variety of species is found in the shops. There is the aloe spicata from the Cape of Good Hope & the annibellata from the same place the former is now considred the best. There is also a ferox of [illegible]? A. socotrina & A. vulgaris of [Persova]? The greatest part of the aloes in the shops is from the A. vulgaris of Barbadoes The appellation socotrine applied to aloes means nothing more than that they are of a good quality. The apothecaries in recommending their aloes will tell you they are the socotrine aloe The best aloes are an extract made by a cut in the shrub from which the sap exudes. This has at first a sweetish taste & soon after a intensely bitter one. IT has not the glassy appearance of the poorer kind Another mode of obtaining aloes is by inspissating the juice of the plant. This is nearly as good as the exuded sap there is not much difference A third way is by decoction 3d Cathartic about 1 lb of the plant to 8 pints of water boiled down & strained. This has not the sweetish taste at first perceived in that obtained by exudation The properties. A. T. Thomps. says of this best kin A. spicata are odor rather pleasant taste sweetish at first, & very bitter soon after powder of a bright yellow & aromatic smell 2d quality very disagreeable taste intensely bitter but not differing materially in med. qualities from the 1st 3d quality of a dark brown colour, hard & friable There has been no true analysis of aloes. The old one in the books is still retained but I do not esteem it correct. Operations cathartic heating & irritating Emmenagogue per se Dr Ives thinks it is manageable as an eccoprotic & laxative & that it operates more kindly when taken with food. The latter is probably true & it is the case with many other medicines e.g. diffusible stimulants Dr Ives thinks aloes have no direct tonic effect, but an indirect one He thinks they act on the liver promoting gradually the secretion of bile. HE thinks it moderately deobstruent but I do not use the word deobst. in this sense i.e. an article affecting one gland only, the liver for instance To say that aloes acts on the [portal] system is merely saying that it acts on the liver Dr Ives thinks aloes are emmenagogue, independent of their purgative effect. They undoubtedly are so. He thinks that tho’ they irritate the kidneys & bladder & color the urine yet no increase of urine is produced Aloes are a purgative, but may be easily managed so as to prove eccoprotic & laxative. In large doses they made to act drastically They are slow in their operation from 12-24 hours The discharges are purely fecal hence they are copragogue They act on the lower part of the bowels (i.e. they act principally on that part for all cath. act on the whole canal more or less) Their operation is appropriate doses & cases in kind though if given inappropriately they irritate. Appropriately given, they leave the al. canal in a good condition In eccoprotic & laxative doses they make but little impression in full doses a strong one Next after their purgative effect aloes are emmenagogue They are said to be sub-tonic I presume indirectly so Said to be anthelmintic probably more so than most cathartics Dr. A. T. Thomps. says they are not beneficial in hemorrhoidal affections But Drs Tully & S.B. Woodd have given them with good effect in such cases. As a general rule however I would not use them in a peculiarly irritable state of the intestines though even in such cases I have cured better than with any other article. This form of piles alluded to is proctica marisca Aloes combined with about a medium dose of opium are thought to counteract the effect of the use of opium. This combination is very useful when costiveness has resulted from a continued use of opium, but you will find after a while that less of aloes will be necessary. I have made the combination in the following proportion viz. 1 part of opium to 4 of aloes It is the common practice to give a cathartic pill when a practitioner does not wish to give calomel, and aloes with gamboge & soap or some other extract is a common pill. When such a pill is wanted I have used Rx aloes grs ii gamboge gr I oil tigl. gtt ¼ soap q.s. ft 1 pill. Sometimes but ½ a pill will be necessary according to the state of the al. canal & the habit of the pat. If the patient is in the habit of using opium or has taken it for some time 2 pills may be required I do not consider aloes good at the commencement of acute diseases. When a cathartic is wanted at the commencement of a disease to break it up I would not give aloes If you wish merely to evacuate feces or to produce an eccoprotic or laxative effect in the secondary stages of a dis. aloes are good in certain doses Diseases It is difficult to specify them Swediaur says dyspepsia with great torpor Pyrosis when bowels are torpid Habitual costiveness here they are also good applied externally Ulcers with a gangrenous tendency extern.? Cases of continued discharges from the ear a solution of aloes injected The dose varies according to the susceptibility of the patient From 1-2 to 4 grs may be given as a laxative or [illegible] in the 24 hours As a purgative about 5 grs may be required There are a great variety of phar. prep. Convallaria [Maialis] I have seen it in the meadows of Middletown tho’ it is considered not indigenous with us The root & flowers are considered the medicinal parts. The extract of the root possesses some of the medicinal properties of aloes tho’ a little weaker. It acts on the rectum & I presume it would prove emmenagogue in the same way The dose as a purgative is said to be [illegible] or zi probably a smaller dose would operate if given over night The dried root pulverised is a [sternutatory] & so are the flowers The flowers when fresh are fragrant but not so when dry I do not know much of this article Polygala polygama A specimen from which the bracts had fallen off was sent to [Willdenow] & he supposed it a new species & called it P. rubella. IT is called here “low centaury” but in the middle states the name is given to hypericum parviflorum sabbatia angularis too is called centaury The English centaury is ergthraca? centaureum nat. ord. Every part of the plant is entirely bitter the leaves more so & the root most of all. It very much resembles aloes in tasting medicinal powers It is an efficient cathartic the natural operation in an appropriate dose being copragogue the discharges consisting entirely [offices]. In large quantities it may be made hydragogue It is slow the natural operation taking place in 12-24 hours It aggravates practica marisca & in great doses produces that disease. Otherwise it is kind in its operation The impression is makes is moderate It may be considered tonic also anthelmintic. It is decidedly emmenagogue It has been supposed to be diuretic but I never could discover this effect. Prof. Ives says it increases the secretions generally If so it is a deobstruent It has been said that this article is bitter & nauseous & that therefore it shd be rejected from the mat. med. This rule wd make our list of medicines very small This article will make as good beer as hops Its natural operation is that of a purgative & copragogue Pharmac. prep. 1st Infusion dried plant zii water oi 2d Decoct. dried plant zji water ojss boil to 1/3 3d Tinct. zii to oj 4th Ext. by decoc. This I think the best Make it of a consistence for pilling As a cathartic the decoction is best & the dose is zii to ziv I have given even a wine glass full I thas operated in 12-30 hours Is not [illegible] but have for [illegible] all the while? 4 Cathartics As a tonic the tinct. is best in doses of zi 3 or 4 times a day Diseases Dyspepsia with torpor in its various forms Coprostasis Paramenia retentionis & obstructionis Upon the whole & consider this a valuable article much more so than it is supposed to be Ipomea Jalapa [illegible] This has been supposed to be the root of 2 species of mirabilis but they do not produce it (they are called 4 o’clock in our gardens) Convolvulus jalapa of Lim. The plant from which the real jalap is obtained. Dr Coxe calls iponea macrorhiza for an account of which vide Coxe’s Dispens. the roots produced by this plant are like those we get in the market Mr Nuttall pronounces the plant an iponea (what plant.?) It usually comes in roundish, ovate but pointed tubers internally yellowish At the present time we get our jalap from Vera Cruz & it is not adulterated Diluted alc. is said to be the proper menstruum for jalap It is used for its cathartic powers merely it is difficult to be managed as a laxative. It may be made purgative or drastic In moderate doses & if allowed sufficient time to operate it may be made copragogue but in excessive doses it is hydragogue. It acts principally on the colon The off. jalap is called in the books a stimulating cathartic It is an irritating cathartic rather. In a phlogistic, or atonic irritable state of the system it will produce irritation & increase it when already existing The alcoholic ext. is said in the books to be irritating, but Dr Ives says it is not. The ext. in the pharmacopoeias is made partly with water. In moderate doses the alc. ext. is not irritating It is probably that several species of convolvulus & iponaea possess the same powers as the off. jalap Podophyllum Petatum may appl. mandrake etc. Triosteum perfoliatum Linn. Root perennial top [annual] It has a popular name in almost every place in which it grows fever root wild gentian wild ipecac wild coffee? etc. Nat. ord. same as that of the climbing honeysuckle The parched fruit is said to have been used as coffee The root only is used in medicine the bark of this is said to be cathartic & emetic Dose for a cathartic is [illegible] to zfs this if taken over night will be effectual. It is about as active as jalap if pure & collected in the right season. It is injured by long keeping, but if collected in the autumn & well dried it will retain its strength The operation is supposed to be modified by a conjunction with mercury etc. for instance? by as a conjunction with? of ipomaca jalapa & podoph. pelt. When a cathartic & emetic operation is desired this article combined with di? proto chloride of mercury in full doses shd be given dose [illegible] to zfs B.S. Barton thinks it diuretic but I have discovered no such effect & think it no more so than rhubarb Dyckman says it is tonic he probably inferred this from its bitterness. I have never seen this effect & think it no more tonic than rhubarb & podophyllum peltat. I think it more likely that ultimately it will be found deobstruant This article is a cathartic. Its natural operation is that of a purgative but it may be so managed as to prove laxative Its discharges are mainly fecal hence copragogue. It acts on the colon In a full dose it has a medium time of operation. Its operation is neither very kind nor very much the contrary. It leaves the canal neither in a very good nor a bad condtion Diseases It has been prescribed in Intermitt. (Shoeph?} I think it not very applicable and in “pleurisy” (but there is no such idiopath. dis. though phys. constantly speak of it Shoeph? probably meant pneumonic) I shd think it not good. Said to be good in struma I shd not think so In reality this article is applicable only to the diseases in which jalap & P. peltatum are & no other The right time to collect it is autumn. The powder shd be kept in a bottle tight & excluded from the light I wd not pulverise much at a time for it loses its strength easily. Fresh parcels shd be collected every year Leptandra Virginica Culver root physic root Indian physic etc. It is difficult to tell what is its nat. order. Said to grow in Japan but probably a diff. spec The root has a bitterish & subnauseous taste. analagous to jalap. Both alcohol & water are the proper menstruus It is cathartic In its recent state of Dr I. thinks it one of the most powerful of our indigenous cathartics. When dried it loses its cathartic power’ Rafinesque says it is deobstruent & echotic but there is no reason for supposing that it has such a power. When recent it is said that 4 or 5 grs are sufficient to prove cathartic, but when dried zi or more will be necessary I think a wine of this article (zii to f zxiv) wd be a good preparation for retaining its strength I venture to say that a syrup would answer For instance make a saturated decoction (say 4 oz to the pt) & add the q.s. of sugar to make the simple syrup of the pharmac. The add oil of wintergreen to give flavour Perhaps an ext. night retain its powers There is room for experiment Therapeutic application The diseases mentioned in the books I do not think correct Coprostasis active cathartics are not applicable to this Bilious fevers this is indefinite Rheumatism not good subacute rheumatism other articles better old chron. rheu. 5 Cathartic Ricinus communis R. major R. vulgaris more commonly palma christi ricinus. One of the older manes is agnus castus whence castor oil Nat. ord. Euphorbiciae Cultiv. with us Castor oil is obtained from the seeds. It is completely soluble in alcohol & ether. The mildest oil is obtained by decoction, which method is resorted to in the W.I. for the mode see Hooper’s Dict.’ If the cortex of the seeds be permitted to remain in the oil will be acrid. That made by expression is also thought to be acid hence decoc. I think the seeds shd be [decortirated] for the active principle probably resides in the cortex Its operation is quicker & kinder than any other cathartic & as a mere evacuative agent it is the best in the mat. med. It seldom produces any griping. It is moderate, producing at most only 2 or 3 discharges says Cullen who says it is peculiarly adapted to costiveness. Colica ileus & C. Rhach. It is not heating nor irritating to the rectum & is well adapted to hemorrhoidal affections Medium dose zfs some require more others less Its ordinary operation is mild If frequently repeated the dose may be gradually diminished, which is not the case with other cathartics. That ol. ric. increases its power by repetition is an important point The only inconvenience attending the use of this article is that it is nauseating & disgusting to some patients. To obviate this give it in a wind glass with water below & spirit or spirit of ppt. above & it may be taken by the most delicate & squeamish Even rancid oil may thus be taken without its rancidity’s being noticed. I know of no way so good as this Ed. & Vav. say this oil is only a mild laxative but it is a purgative. They say that by rancidity it produces tormina, griping etc. This is correct. Some think that it possesses greater power than any other cathartic in removing worms. I have never seen its superiority in this respect. It is always better to give some narcotic cathartic & get the worms under narcotic influence as we do by spigelia This article is laxative not so easily made to act as an eccoprotic Purgative copragogue it produces no biliary discharges It is not drastic. It affects the whole track of the bowels equally It is speedy is kind unless rancid & leaves the al. canal in a good condition It makes little impression on the system & of course is not good at the commencement of acute disease The following formula is used in the W. I. in colica rachial. Rx zii of the oil to ziii of spirit & burn them about ½ a min. or till part of the spirit is burnt. It is said that this is effectual in that disease I have beat up this oil with the yolk of an egg & this completely deceived patients & got the full operation of the article, when they had absolutely refused to take it The decorticated seeds are taken as cathartics in some parts of N. M. Probably 4 or 5 of the bruised seeds are a [illegible] dose A saturated tinct. of the seeds is said by Piso to be a more powerful cathartic than the oil. Dose of the tinct. zi (zi?) the seeds should be bruised Euophobia Lathryrus (oleum) Cultivated in all our gardens The most common name among us is caper spurge. The fruit is said to be good for pickles. Native of Europe., Nat. ord. Euphorbiaceae The oil is obtained from the seeds a common practitioner could obtain it by macerating the seeds in ether By long keeping it becomes turbid & rancid It comes in vials of zi It is said to be a mild & safe but active cathartic & a good substitute for oil of tiglium Dose for a adul 4-8 gtts in milk sugared water or any convenient vehicle Its action is certain, prompt & at the same time mild, not producing tormina or griping like o. tiglii It is purgative drastic in full doses may be used as a laxative. It is copragogue in ordinary doses. It is irritant in full doses & may be said to be sub-emetic In affects the whole track of the intest. canal It is very speedy, 1-3 hours is mile & agreeable in medium doses & leaves the canal in a good condition. It makes rather a strong impression Iatropha 2 species I. Curcus and I. cossypifolia Called Barbadoes nutts The oil from the seeds of the i. curex resembles very much the castor oil Croton Tiglium Ricinus Indicas Pinus Indicus These oils all belong to the same nat. ord The wood has been used in medicine (lignum moluccense) the seeds also grana mollucc. grana ricini in English called “purging nuts” Native country Ceylon Moluecas E. Ind. China The genus croton is said to contain 50 to 100 species of which 5 are known to be in the U.S. One species in the U.S Affords a highly aromatic oil The oil of tiglium is obtained by expression from the seeds It is said to have a sharp taste odor sui generis It is said to contain fixed oil 55 parts & an acrid principle 45 parts. This letter has been called tigline The seeds root & wood have been used in medium, but the seeds & oil are the most powerful The oil of tiglium is the most rapid cathartic known. Its operation is said to be modified by aromatics, acids etc. but better by small doses of opium. Baking or roasting the seeds before expressing the oil is said to have this effect Its natural operation is purgative or drastic. It is difficult to manage as a laxative unless by tincture or a little opium. As a laxative it is copragogue but in larger doses hydragogue & irritant In large doses it is drastic It may be said to be sub-emetic Said to be diuretic & diaphoretic but I think it cannot be directly so It operates on the whole canal is the most speedy cath. we have usual time ½ hour This can be made to depend on circumstances sometimes less than that time If the dose is not too large the operation is not unpleasant if large a burning is felt. Moderate dose leave the bowels in a good condition This article cannot be preferable to calomel in typhoid diseases nor to the refrig. salts in the inflammatory The oil of tiglium in the market is said to be adulterated. I have always found that in the shops to be full strength. When pure it produces rubefacient effects on topical application It is sd to produce catharsis when rubbed on the umbilical region Dose of the oil ½ to 1 minim. The tincture made directly from the seeds in the most eligible form. Dr Bigelow gives a formula for its strength The oil may be given in milk but I prefer the pill made of bread. Unless camphor is added the pills will mould. I prefer dough to baked bread. I may be pilled with soap Another form is Rx ol tigl. [illegible] syn papav. zi Opium better than any other article modifies the operation & obviates the unpleasant effects of this oil. In combination with castor oil it affords the best cath. for poisons It makes a good enema. You will remember that generally 3 times as much is required 6. Cathartic by enema as by the mouth The effects of an over dose are severe burning pains hyper emesis hyper catharsis etc. Opium is the best antidote Diseases Coprostosis (E. & Vav.) as a general rule this shd not be treated with drastics Tenia I think however that the ol. pini is better, for in this you have narcotic & other powers which are peculiarly desirable to hasten an evacuation the ol. tigl. may be given Delirium Tremens Some writers say that this oil has been highly serviceable in this in conjunction with opium As a general rule purging is not indicated in this disease Rheumatalgia As a topical application it will probably do good for this is generally fixed Mania in acc. of this facility of getting it down Tetanus alleged to be useful in the sam. acc. if purging is indicated Neuralgia. N. Faciei Cases of apoplex. Obesity sd to be benefitted by freq. purging Dropsy but elaterium is our best article Oil of tiglium is not a new article in medicine, but and old one revived Scammony Convulvulus scammonia is said to furnish the Smyrna scammony but this is less valuable than the Aleppo scammony Another kind is the Montpelier scammony from Montpelier Convolvulus [Sepium] (Linn.) is another species producing scammony. It grows about our hedges & is called field bindweed & poison weed though it is not poisonous The exuded & expressed inspissated juice are both employed. The exuded is the most powerful & best dose 5-20-30 grs – 30 grs is a powerful dose it grows throughout the U.S. Hiatus Scammony? It is called a gum resin, but is more so than any expressed juice Used in dropsy other art. better in helmin. spts turp. better Natur. operat. purgative drastic if given alone Modified by combination Not easily managed as a laxative Acts on the colon medium time makes an impression In large doses is an irritant Gamboge Several plants afford it Linnaeus supposed the real gamboge came from the gambogia gutta Murray from the Statagmitis gambogoides Others from the gorcina gambogia of Willdenow & others say the gambogia guttifera. The name of the plant is not derived from the place in which it is found Stalag. & garcina grow in Ceylon gambogia in the E. Indies Gamboge is the inspissated descending sap obtained by exudation improperly called a gum resin. The juice concretes & is formed into masses. It is imported from Siam, Ceylon, [illegible] in China etc. We have no analysis but the old one of so many parts solub. in alc. & insol. in wat. etc. It is said in the books to be one of our most drastic & [illegible] cath. but others are more so Being drastic it is used in helmintha but because an article is drastic it does not follow that it is good for worms. As to its hydragogue power, it is not always to e relied on in dropsy. The Italians say that gamboge is contrastimulant What they mean I do not know In purgative & laxative doses it is more reducing than the preceding articles. It is difficult to be managed as an eccoprotic It acts upon the upper part of the al. canal & all the articles that do this promote more or less the secretion of bile but it does not in the whole [secerm] & absorb. system & hence is not deobstruent It irritates the intestinal canal & may produce an acute atonic irritative infl. It has been called by orfila? a caustic poison, but it is not. HE says too that externally it is rubefacient. This is not true It is more used by the British practitioner than by the French & is given in combination with other cathartics. Thus administered it is useful Gamboge is a strong purgative is cholagogue by acting upon the stomach & duodenum is hydragogue acts on the upper part of the canal is speedy is on the whole disagreeable in its operation when given alone, leaves the al. can. not in a good condition, but if judiciously combined its operation may be made kind & agreeable while by a frequent use of gamboge & by injudicious combinations of it the al. can. is left in a very bad condition it makes a strong impression on the al. can. & whole system is irritant & finally is to some degree an emetic, though this ought not to be enumerated among its operations Dose 3-6 grs recc. triturated with sugar but I wd no recc. it alone Diseases Coprostasis recc. but not alone Tenia jaundice recc. cannot be of much use other articles better quartans used as a purge but not good Dropsy recc. [illegible] other art. better. Chron. cutan. dis. not I think good Rhamnus catharticus Buckthorn Nat. ord. rhaminaciae native of Europe cultivated in this country & sometimes grows wild on the banks of the Hudson probably from seeds dropped by birds The berries are used. They are [illegible], black & shining, with a taste bitter acrid & nauseous & containing a pulpy green juice As a cathartic, this article is both cholag. & hydrag. & its natural operation is purgative & drastic & it is not easily managed as a laxative. When drastic it is powerfully hydragogue not so much so as elaterium but more so than most drastic cathartics It acts on the middle part of the al. can. & requires a medium time It is irritating & leaves the bowels not in a very good state It requires opium to obviate its ill effects. It makes a peculiarly strong impression on the system. It irritant & may prove emetic It is said by some to be diuretic it may prove somewhat so in small & often repeated doses, with diuretic regimens & allowed to remain sometime in the al. canal. Diseases Recc. by A. T. Thomps in cachexia & also recc. in syphilis do not believe it good in this Dropsy recc. by A.T.T. better in this than most other cathartics. It is used in N. Haven in certain cutaneous eruptions & recc. in doses short of purging I have never seen much benefit from it in cutaneous diseases The common dose of the berries is 20. The expressed fermented juice is recc. in some books decidedly bad Decoction of the berries is also used it is recc. to boil 20 of the berries in 1 pt of water very weak The syrup of the berries is the best form Rx If you wish to mitigate or modify its action add a little paregoric Almost every farmer thinks he knows what buckthorn but it is not found with us. There are spurious articles sold under the name of buckthorn. The article commonly sold under the name of syrup of buckthorn is made of the berries of the cornus sericea Bryonia Disease? Nat. ord. cucurbitaceae root fusiform intensely acrid & bitter Formerly the root used to be found mixed with jalap. Sometimes the inspissated juice of the recent root is used It contains a principle bryonine which is probably its active one The root was formerly employed as a purgative & emetic applied to the skin it is said to be irritant & rubefacient Dose of powd. of rec. root is 12 grs to zfs This article is purgative & drastic acts on the middle part of the canal requires a medium time & in large doses leaves the bowels in a bad condition. 7 Cathartics Cucumis Colocynthis Nat. ord. Cucurbiticeae Native of the levant & cultivated in Europe The fruit is the part employed, under the name of colocynth It is reduced to a fine powder. I believe the pulp only ought to be used, but the whole is used. It is found in the shops in powder. Water alc. & ether dissolve its active principles E. & Vav. say it is very irritant, externally or internally they say it is a powerful cathartic purgative or drastic less hydragogue than most other cathartics equally drastic (I can’t say I ever saw a hydrag. operation from it) It acts on the colon takes a medium time alone it is more or less disagreeable, but it is agreeable in combination It is a valuable article when a compound cath. is used, it makes a strong impression It is irritant E. & V. say it produces amenorrhea. I have never had any such effects from it Enteritis recc. by E & V. but a mere cathartic in this is not wanted a deobst. operation is required, for which calomel is best perhaps in erythem. enteritis it may answer a cath. is indicated but in this form a diarrhoea is almost always attendant & even in the calomel is best Dropsy E & V. but I do not believe this article hydrag. & therefore it can seldom be proper Elaterium [Momordica] Elaterium of Linn. Ecballium elaterium of Richard Called also cucumis agrestis & c. asinius squirting cucumber. It is a perennial plant growing spontaneously in the south of Europe & might be cultivated among us The active principle resides in the juice around the seeds it is prepared by As found in the shops it is The dried juice of the fruit obtained without any preparation is best As prepared above it contains a peculiar prox. prin. called elatine. An alcoholic tinct. may be employed Elatine is [illegible] Elaterium is oftener mixed with starch. It is injured by exposure to the light yet this our apothecaries do not know It is very expensive The juice of the [illegible] is irritant to the skin Elaterium undoubtedly possesses great deobst. powers, but they do not begin to operate much till purging comes on then they are powerful Its natural operation is drastic not purgative nor laxative. It is more hydragogue than any other article. Although so drastic it leaves the bowels in a good condition It may be given in cases of extreme debility. It is speedy in single large doses less speedy in small doses. It is irritant diuretic in doses short of the purging point deobstruent Upon the whole, elaterium is the most valuable cath. in the mat. med. calomel & the neutral salts excepted Diseases Coprostosis shd not think it good parabysma Struma shd not think it good Atonic ac. rheum. it acts as a resolvent deobst. but generally is proper only in the early stages Opium will prevent is purging Sub. ac. rheum. early stages Rheumatalgia in its various forms both that called “crick in the back” & sciatica a cath. of elat. is very beneficial [illegible] Indica give a cath. followed by an internal use of conium & iodine Chronic & obstinate ulcers of the legs purging with elat. is very beneficial they were formerly cured by vom. with turp. min. Chorea a valuable remedy by acting on the system at large Param. obstruct. idiopathic & in healthy subjects Hydrops cellularis H in these diseases it is of more importance than any other Begin? early in the morning with doses of 1/16 1/12 or 1/10 gr acc. to the strength of the article once an hour or once in 2 hours continue till catharsis actually commences & then suspend The catharsis usually begins in about 5 or 6 hours. It is preferable not to have it commence under 10 or 11 hours The first discharge will be fecal & then will follow those that are purely hydragogue. Most of the books recc. in full & large doses giving all you would give at once But this is apt to produce nausea tormina, distress etc. Give it in regular doses also to get its deobst. effect If the evacuations are rapid or appear to reduce the pat (which is rarely the case) give a dose of opium, generally not less than 10 grs, acc. to the susceptibility of the pat. If the pat. is at all feeble you shd be about [illegible] at the time of the operation of the article After the useful article treat with stimulants. It may be necessary to repeat the elaterium for removing the fluid does not cure the disease, & the fluid may return. Elaterium removes the dropsical fluid better than any other article I know of. In cases of concussion followed by stupor or coma about a week or two after the accident. I have known elaterium managed as in dropsy to be most effectual acting not merely by its evac. but its deobst. power Elaterium is better by itself than conjoined with any other article Some conjoin calomel, but it is better without E. & V. recc. it in doses of ½ gr. not to exceed 5 grs but with such elaterium as I have had, a man wd not stay long enough in the world to repeat the dose The momordica balsamina has been said to possess the same powers as elaterium, but [untruly] It grows in our gardens The juice of the unripe fruit is said to be emmenagogue & styptic. This is worth enquiry into. Luffa operculata Allied to elaterium Nat. ord. cucurbiticaea Its natural habitat is Guaiana. It is formed abundantly in the W.I. & along the shore of the Gulf of Mexico. Dr Hancock calls it crosia? It is also called “bitter cucumber,” but the cucumis coloc. bears that name. It is the momordical operculata of Linnaeus & is similar to the common cucumber I derive my knowledge of this article from Dr Hancock In the fruit is a web-like substance or reticulum which possesses the medicinal powers & Dr H. says “it is the most active cathartic in nature” says it acts on the “skin kidnies & intestines.” Acc. to his account it is an effectual deobst. acting on the whole sec. & abs. syst. I do not think it a tonic directly Dr H. says that 1 gr. of the reticulum is a dose. This is undoubtedly too large & acc. to his own account ½ gr. is sufficient 8 Cathartics to produce the effects of the common dose of elaterium Dr H. prescribed it in infusion, but says was obliged to add chloride of sodium to preserve it. Would it not be better to make a powder of the reticulum? He says it is better to have it a long time in operating. It seems its operation is precisely like that of elaterium & it is best given in small doses at regular intervals This article is drastic may be managed as a purgative, but not as a laxat. or eccoprotic Full doses may vomit small ones do not. Purely hodrag. middle part of can. Medium time in small doses Makes a strong impres It is irritant & deobst. Short of purging point it is diuretic. It is emmenag. in full doses. It is resolvent. Diseases recc. in dyspepsia colic. rhach. as an enema Dr H. says it is an effic. article Parabysm coac. (enlargement of the spleen) Dr H. says in his own case it proved efficient as an enema it affected the stomach. Hydrops cellubria (or as he calls it generally dropsy) Dr H says he has cured perfectly by it recommends it in the early stages He says mercury is a most efficient article in dropsy & so says Dr Tully H. Thoracis & H. abdominis (ascites) In the latter it is necessary to repeat the article in some cases. Dr H. has found it necessary to salivate & repeat it Upon the whole it appears that this article has the same medicinal properties as elaterium. It is not liable to lose its strength like elaterium. The [crasia] or L. operculata finally is cheap & precisely equivalent Sulphur Purgative in a full dose. It is diapohoretic in non phlog & not materially atonic cases, regularly, & I am apt to think it is so indirectly. It is irritant but not tonic or stimulant. It is undoubtedly inappropriate in phlogostic & truly atonic cases Dr Duncan thinks if taken into the circulation, from the sulphurous smell etc. of persons who take it. Dr Tully thinks it digested & says the smell is that of hydrothomic acid Duncan thinks it better combined with some saline cathartic Dr T. thinks this not necessary In [illegible] he Dr D? thinks its irritant effects will be obviated Sulphur injudiciously administered & persisted in will produce rheumatism, paraplegia & effects precisely analogous to those of mercury. I have seen swelling of the joints & loss of the use of the lower extremities Sulphur in full doses is a purgative it may be managed as an eccoprotic It is copragogue Acts in the whole track. It is slow. In a full dose & under a bad condition of the system it is unkind in its operation, & leaves the bowels in a bad condition It makes a considerable impression. It is irritant & decidedly deobstruent being resolvent (I have known sub-acute rheum. cured by it) diaph. emmen. & expectorant Diseases Prctica Marisca I wd regulate its use acc. to pretty much the same rules as aloes Chronic Coryza recc. by Duncan Chronic coughs it has been used in form of “balsam of sulphur” It is good in some coughs Dyspnoea exac. & asthm. hum. Duncan probably is good in the interval Disguised gout of Cullen Rheumatalgia or chron. rheum. have never tried it but it probably is good. Scabies & various cutaneous eruptions 6 Materia Medica [illegible] Depletio Sanguinis Is an important refrigerant process & should be treated of amongst therapeutic agents It is an operation directly and exclusively refrigerant in its effects The blood itself is vital and is the medium and support of the vitality of every part of the system The first effect of v.s. is to diminish vital power generally and strength of action in every part. It constitutes the most powerful and direct method of reducing the vital energies When carried to excess its effects are most difficult to be remedied The precise quantity to be taken depends on the degree of vital power the nature of the disease the prevailing diathesis and the vigour of the constitution Yet in no process is the practice so empirical Prof I. knows of no disease so severe as to require medication in v.s. has not been recommended as the most appropriate remedy ever [illegible] When really indicated it is indispensable when not indicated it is infallibly prejudicial Divided into two kinds General & local the former from an artery or large vein the latter from the capillaries Some however consider V.S. from a large vein in a part near a local affection, as from the ext. jugular in cephalitis as a local bleeding & therefore more efficacious. They think V.S. from the arm in like manner more efficacious than from the jugular or foot and in all the phlogistica they bleed from a large vessel as near as possible to the seat of the disease This they consider as effecting a topical depletion of the diseased part. Now it is well known to every anatomist that there is no direct communication between the viscera of the thorax abdomen and cranium and the parts forming the parieties of those cavities. There is therefore no ground for calling such processes topical bleedings. The notion is a remnant of prejudices existing before the discovery of the circulation of the blood & the distinction is of no more importance in practice than the old man in the almanac Some limit the term topical bleeding to an evacuation from the capillaries of the diseased part. This evacuation must be prejudicial in atonic passive diseases where there is a gangrenous tendency especially if performed with scarification and cups An English author remarks correctly that there is no such thing as topical bleeding independent of producing an effect upon the whole system In the phlogistic phlogistica leeches and cupping with scarification are of no importance for v.s. from the arm is all that is requisite. In local entonic infl. the practice is more plausible. Here topical bleeding is the best but the irritation of cups and scarification does more injury than the evacuation does good, unless applied to a neighboring part, and then the counterirritation produces the effect. As the disease however does not affect the constitution, it is of little consequence The blood is not stagnant in the part for then it would be coagulated and would not flow consequently topical bleeding cannot empty the vessels of the part Besides infl. is not caused by accumulation of blood this accumulation is an effect, not the cause If a general phlogistic diathesis exist, topical bleeding is not substitute for v.s. if there is no general phlogistic diathesis, topical bleeding is not required The cases which have been benefitted by topical have been cases of atonic infl. Here the counterirritation produced the effect the trifling depletion [illegible] of blood being injurious as far as it goes Yet the practice is very fashionable IN these cases bloodletting is not indicated. Deobstruents & antirritants such as calomel and opium give far more speedy and perfect relief Ophthalmitis is a dis, in wh. phys. say topical bleeding is indispensable A strong sol. of nit. sil. is far better & gives a more speedy cure If you separate some of the vessels going to the part, then to be sure you may produce some beneficial effect Where general bleeding is not indicated topical bl. is always injurious The capillaries are said to have an independent action and the reasons assigned are that it is by their agency that the blood is returned to the veins, that by them assimilation secretion and [nutrition] are performed that they are the seat of infl. 6:07 PMhe reasons are probably true yet it is [illegible] no less true that the capillaries as necessarily and completely depend upon the heart as the heart upon the depletion of blood affects both the capillaries and the heart, hence the surface is pale. If the action of the heart is increased there is congestion in the capillaries and less blood in the central parts In this case topical bleeding would remove the congestion temporarily it would be again produced by the vis a tergo In infl. the value of the blood is dimin. indeed but the blood is not stagnant or it would coagulate I would not be understood to say that cupping and scarification are of no service for I have seen them used with great benefit But I do say that other means are in my opinion better [illegible] by counterirr. only that they produce their effect Thus in the chronic stages of subacute rheumatism I have known evident relief derived from them yet no one would bleed in such a case also in pneumonitis The benefit is the same as from rubefacients, blisters etc. The strongest case is infl. of the eye and the anastomosis of the ophthalmic and temporal arteries is thought to have influence But even here if there is active infl. and phlog. diath. topic. bl. will be no substitute for v.s. In atonic infl. without phlog. action the case is better without bleeding of any kind & topical bl. is beneficial only by its irritation. I have seen both plans tried Dr Cogswell treated infl. without and no man was ever more successful. Few employ it who have had extensive practice. There are other and better means of counterirritation Depletion from large vessels and depletion from capillaries are better appellations than general and topical bleeding for the latter, as we have seen is inappropriate Depletion from large vessels may be performed by v.s. or arteriotomy. The veins are the vena media basilica t the bend of the arm the vena suplina major on the inside of the ankle & the v. [illegible] minor on the outside of the ankle The vena media basilica is preferable to the ven. med. cephal. the v. seph. or the v. basil. as the latter have cutaneous nerves running over their surface. The veins on the ankle are irregular; they have cutaneous nerves running over them, and the tendons are liable to be injured Besides the incision does not heal well but is liable to become a troublesome sore. The vena jugularis externa is often [illegible] The temporal is the only artery now selected; it is the only safe one as it alone passes over a bone, so that it can be compressed. It is of no consequence whether blood is taken from a vein or from an artery, or what vein is selected so far as the disease is concerned provided the opening be large enough Depletion by the capillaries is performed by means of leeches, or by scarification and cupping. The [illegible] medici lis is used but I have seen the H. sanguinea? do nearly as well [illegible] The best instrument for v.s. Prof. I. thinks is the Dutch or spring lancet as it can be used by those who are not ambidextrous it can be used upon the most rolling vein and upon persons in epileptic or puerperal convulsions the practitioner can set it and keep it in order himself and it can be used for years, while the thumb lancet soon becomes dull Depletion of blood may be a remedy in itself or it may be preparatory to the action of other remedies. V.S. for local symptoms can never be beneficial where the general symptoms contraindicate it buy may be beneficial when they neither indicate nor contraindicate it Venesection is employed to answer six indications 1st as a mere antiphlogistic or refrigerant measure in entonic diseases 2nd for the purpose of making a sudden and strong impression upon the system in order to produce a resolution of certain no phlogistic & not materially atonic diseases 3d to equalize excitement increase susceptibility, and prepare for the better operation of other remedies in certain non phlogistic diseases 4th as a substitute for an habitual but moderate hemorrhage & to divert it to some other part for the purpose of suppressing it gradually or preventing a too rapid sanguification as in exangin, cyanea (non closure of for ovale) exangia aneurisma paracyesis irritative (morbid pregnancy) wounds of the lungs brain etc. 5th to produce sudden faintness and relaxation for the purpose of facilitating certain surgical operations as the reduction of hernia or luxation 6th to promote absorption in parabysmata emphysematous (tumours!) & perhaps in certain dropsies Venesection is the most appropriate remedy for phlogistic diseases ad shd always be employed when any considerable phlogistic diathesis exists, whatever be the sex age climate season or constitution A blood is the pabulum of life, a depletion of it has greater effect in lessening the vital powers than the evacuations of any other fluid A free evacuation of blood from a healthy subject immediately produces more or less debility & increases susceptibility, appetite and sanguification. But if carried to excess it impairs the digestive powers The strength of the pulse is the only proper indication for v.s. When Fordyce and others mention hardness as the test for phlog. diath. it is evident from the context that this means strength. When however they speak of hardness and strength in connexion they make the same distinctions as Prof. I. Hardness indicates irritation and may accompany strength or weakness of pulse It is said by some writers that in enteritis we are to expect a small hard pulse and are always to bleed The truth is there are two species of enteritis which are accurately described and distinguished 1st phlegmonous enteritis, affecting all the textures of the intestines 2nd erythematic enteritis, affecting only the mucous membranes. Now the pulse in both these species is small and sharp but in the first no pressure can extinguish the pulse either in the systole or diastole in the second it is easily extinguished. In the first species only do we find strength of pulse & in this only is v.s. indicated Hardness combined with strength heightens the indication for v.s. these combined with fullness heighten it still more. Mere fullness & hardness uncombined with strength never require v.s. The coriaceous or buffy coat often observed on the surface of blood drawn depends on several causes 1st the degree of preternatural vital energy or preternatural strength of action in the system in other words the degree of phlogistic diathesis 2nd the rapidity with which it is drawn If taken rapidly it remains longer before coagulation the red globules subside and the buffy coat of course appears If taken more slowly it coagulates sooner and the buffy coat is less or none at all even though the disease is phlogistic Even in health blood may be so drawn as to exhibit the buffy coat 3d the depth of the vessel in which the blood is received if shallow the subsidence of the red globules will be less complete & the buffy [illegible] coat less distinct 4th The specific disease whether atonic or (frequently) entonic produces a buffy coat 5 Pregnancy is almost always attended with a buffy coat It will be readily inferred that Prof. I. lays very little stress on the buffy coat as indicating the propriety of bleeding or the necessity of a repetition. Wilson Philip and others express the same opinion. The firmness of the coagulum and the concavity of the surface are better tests But the existence of these marks & also of the buffy coat is no proof that a repetition of v.s. is called for We should not mistake for strength of action, the rigidity of the coats of the arteries so common in farmers, seamen & elderly people In phlogistic diseases, as cauma and the caumatoid phlogotica F.S. if employed early will of itself effect a cure. But it must be well managed. If too sparing at a time and too often repeated it will produce too great a reduction of strength If too profuse it may lay the foundation of other diseases. Those who are celebrated for removing diseases suddenly by a free depletion of blood, lose many of their patients by subsequent dropsy If there is no considerable increase of strength of action V.S. may safely be neglected In merely entonic infl. it is of no benefit but may be if the constitution is brought to sympathise with the local affection The phlogotica & local infl. differ in their causes diathesis and proper mode of treatment There is a foundation for the distinction of active and passive Some years ago the essence of infl. was thought to be an increased strength of action in the arterial system. Wilson Philip though it to be debility. Both these views have tended to confound the distinction of active and passive It is acknowledged that there is entonic fever. Is it any more strange that there should be entonic and atonic infl.? The essence of infl. is not the quantity or strength of action, but as is well remarked by Hunter the quality, and it may attend either increased, or diminished strength of action or a state of action neither increased nor diminished, and the treatment must vary accordingly. In infl. moderately atonic V.S. might be tolerated and would not destroy life it would render the recovery slower and less perfect. In every low atonic infl. (phylogotica) V.S. would be fatal I never knew a physician in Conn who did not employ bleeding in entonic diseases. This has been asserted with respect to myself, but altogether without foundation. Dr Danforth of Boston did not bleed a patient for the last 20 years of his life (this is noticed as a strange thing a man successful and of high reputation) Now the change of diathesis occurred about that time 1807 (to 27) and though sporadic cases of phlogistic disease occurred subsequently he may not have seen one (vide The Med. B.) I have myself seen but one decided case since 1816 & that was in 1819. You will occasionally meet with a case of phlogistic disease and cases arising from [illegible] though the latter will require less bleeding than the idiopathic. When the v.s. is employed for the first indication, viz as an antiphlogistic measure in entonic diseases, the degree of effect depends entirely upon the quantity of blood abstracted and not at all upon the manner of abstracting it. It is said by some that bleeding is more effectual when it produces faintness & that in such a case a less quantity of blood suffices. Such cannot be true phlogiistic cases. In every pure medical case the production of faintness & especially of syncope is to be avoided. In phlogistic diseases we must bleed freely,. so as to meet the symptoms, but in a recumbent posture in order if possible, to avoid deliquium. On the phlegmonous phylogitica the production of deliquium is unfortunate as it may prevent a sufficient abstraction of blood The abstraction of lbj or lbfs is generally sufficient nit. pot. tart. ant. refrig. salts veg. acids ripe acid & subacid fruits cold water & air shd be employed at the same time as auxiliaries. By thus dividing your measures you produce more effect upon the dis. & with less injury to the system. In phlogistic diseases V.S. practiced early and judiciously in the forming stage will produce a complete resolution. After the forming stage has passed, the dis. cannot be broken up but will run its course of 5 or 7 days under the best treatment but this treatment will seldom fail of effecting a cure. In phlogistic dis. v.s. may act somewhat on the principle of making a strong impression on the system But if a strong impression merely is the object, ligatures on the limbs are better. A third or a half of the blood in the system is in the limbs & ligatures upon them will produce faintness & syncope than v.s. This suspend the disease, but then the ligatures are off it is found that no permanent benefit results & v.s. must be employed In genuine phlog. dis. faintness and syncope are no proof that sufficient blood has been drawn. mere reduction without counteraction will not? cure like phlogistic disease. It would seem that an aggregate of symptoms exists one of which is increase of strength & this is removed by v.s. The aggregate is thus broken up and the dis. completely cured. Mere irritative or symptomatic entonic fever requires less depletion than that which is idiopathic, and after one bleeding, opium or hyoscyam with calomel will allay all the symptoms These may even prevent the occurrence of the symptomatic fever. Irritative fever is however often atonic & then no v.s. is proper Abernethy remarks that the fever must take place and we cannot prevent it. He cautions against bleeding in cases that must be protracted as all the vital energies will be wanted before the close He says we shd never bleed unless the fever will produce greater debility than the loss of blood. He adds infl. & irr. action wear out the strength and if more strength is saved by counteracting these, than is lost by the evacuation, then is v.s. proper & not otherwise. A surgeon of more extensive practice in N.E. than any other out of Boston has remarked that he had seen more cases of death from depletion after injuries, than from the casua,ties themselves. Chas. Bell remarks “A man has received a shock, the surgeon bleeds and the landlady gives a dram now I think the landlady is right” Dr Latham remarks “that many cases of recovery after v.s. are in truth but lucky escapes from death” The symptoms are the only safe guide for v.s. A writer in the Medico Ohio Rev. remarks that the man who should draw a distinct line between spasm (or irritation) & infl. wd render great service to the profession. Prof. I. does not consider the distinction so very obscure. But they in London consider synochus as inflammatory & hence it is that they cannot distinguish irritation from infl. In cases where there is doubt whether irritation or infl. exists it is the safer practice to avoid v.s There can be no danger in delay. But we can commonly decide if during the flow of blood the pulse soon becomes weak and fluttering even though it shd rise afterwards, v.s. will do no injury But if the pulse becomes softer and fuller we may expect benefit from v.s. In doubtful cases it is better to take too little than too much blood as the error is more remediable, and besides such cases do not absolutely require v.s. The lancet is often a little instrument of mighty mischief vide Hall’s mimosis in quieta. in fever of pure irritation The second purpose for wh v.s. is employed is to effect a resolution of certain dis. by a sudden & strong impression on the system. The dis. is wh the practice can be attended with benefit are now phlog. but not materially atonic pyrectica phlogotica & exanthematica more especially those of the synochus or sub putrid type The beneficial effect of f.s. in these cases depends upon the shock and the strong impression made and not on the quantity abstracted. Hence our object shd be so to conduct the process as to produce the strongest impression with the least possible loss of blood The patient shd therefore be placed in an erect posture, the blood shd be taken from a large orifice & the flow of it stopped suddenly and instantaneously, as by the application of the finger. In this way deliquium may be produced speedily. It is most probably that ligatures upon the extremities would be a complete substitute for this practice in all non phlogistic cases with the exception of surgical ones & perhaps even in these. The relaxation is certainly as perfect for the time being. But I consider the practice of V.S. in these cases to be injudicious. We have other means for effecting this purpose, more safe & more effectual. V.S. at the commencement of typhus will give present relief, but it is always apt to occasion an unfavourable change at one of the critical periods. As was before observed the obstruction of lbjs or ljb is generally sufficient for the time being in true phlog. dis. But the abstraction of lbj would make no impression in the synochous or sub-putrid type ^ cases of this wd not tolerate a repetition of the v.s. In dis. of the synoch. or sub-putrid type does not sink fatally till the 14th or 21st day, in the pyrectica & not till the 7th or 9th in the phlogotica Fever of the synochus type influences the opinion of a great many phys. in forming their ideas of cauma or infl. fever # We must in these cases employ v.s. as counteragent & not as we would in phlog. dis. or we shall either produce no effect, or exhaust the pat. & render the dis. more obstinate & protracted. If we bleed at all in these cases we must do it suddenly and rapidly in order to produce a sudden & powerful impression and overwhelm the disease at once. In other words we must half kill the pat. in order to cure him # All the authors of the present day say nothing about real cauma they describe only synochus for cauma you must go back to more ancient authors The cases in which this practice is recommended are quite different from those of the nervous type. In t. nervosus & syncopalis no one but a complete routinist wd ever think of v.s. IN fevers of a sub putrid or synochus type only is there any question about the propriety of v.s. I consider such practice as rash If it fail of its object it must infallibly sink the patient & render the case more hopeless. I am an advocate for a milder course one which is less violent and dangerous and more steady and uniform in its operation. By it more cures can be effected, convalescences is more perfect relapses less frequent & constitutional vigour less impaired. Hence depletion of blood in atonic dis. as a mere counteragent is considered by Prof. I. as a hazardous practice exhausting the patient if iut fail in resolving the disease. In phlog. dis. there is no such nicety Blood may be taken at any time before a crisis. The fact which all acknowledge that blood if taken at all in synoch. dis. must be taken in the first stages proves the hazard of taking it at all A proper test for the propriety of bleeding, free vomiting and purging is the effect of spontaneous humor. emesis and diarrhoea It is in my opinion never proper to bleed to faintness or syncope in any purely medical case, & the mistake of synochus for cauma has led to the practice In the true phlogistic dis. there seems to be a state of the system which increases the supply of the vital energies & I would bleed purely for the purpose of reducing this state I would not apply irritants to the surface till the system is reduced nearly to its healthy standard then blisters and other irritants will remove the weak remains of phlog. act. Even cauma may sometimes be broken up in its forming stage by the use of counteragents only, as hot spirits & water forced sweats etc. in empirical practice But these means if they do not effect in resolution must aggravate the case & are always hazardous. So the sudden removal of phlogotica of a synochus type is followed by a protracted convalescence and often by the supervention of other diseases. Dr Mosely of E. [Hudson] was celebrated for curing dropsies & most of his cases were occasioned by the free depletion of Dr Woodruff for the cure of pneumonitis for the speedy cure of which Dr W. was equally celebrated. Mr Masters of Lynn remarks that many of the cases of chronic disease which came under his care were the consequence of sudden removal of phlogotica by the free depletion of another physician Dr Good in his remarks on typhus observes “we are to avoid reduction and adopt an antirritant and invigorating course. Clutterbuck supposed typhus to be an infl. of the brain & practiced v.s for its reducing effect. Armstrong supposes visceral congestions generative of a general sensorial debility & bleed as a preventative Robert Jackson supposed v.s. was a stimulating process & bled for its direct invigorating effect. Decided practice of any kind will succeed at the commencement.” Dr. G. continues “this employment of v.s. in typhus is no new practice, but the sum of medical opinion for the last three centuries is decidedly against it” Even Dr Welch of Edinburgh the most strenuous advocate for bleeding in typhus & who takes blood by the half gallon, says that the majority of practitioners are against the practice & that it makes slow progress in Edinburgh But there is one state in typhus in which Dr Good thinks v.s necessary “Congestion, says he, may take place as an effect of the disease, in the head, lungs or liver & infl. or gangrene be the result. This symptom we must combat boldly by V.S.” “There is much hazard in the practice but there is death without it” In my opinion there is far less hazard in letting it alone In pneum. typhodes, he wholly interdicts v.s. He is very unfortunate as to the time when v.s. may be serviceable. In the early stages, as we have seen there is far less danger in v.s. But as to employing it in congestions, experience, observation & reasoning a priori all unite to show that v.s. will increase the congestion (vide congestion) And if in these cases infl. is the cause of the symp. this infl. must from the state of the system be atonic & as little benefitted as that by v.s. Dr Good supposes that typhus may run into phlogistic action. This is far more improbable than that cauma should run into typhus & both are contrary to fact. Most surely stimulants and excitants can never induce phlogistic action in typhus, for even in health when given in noxious quantities they produce not phlogistic action but irritation & if carried farther erythematic infl. & irritative fever. I have seen cases of great head affection in typhus in which on p.m. exam. not only no infl. or cong. was discovered but the brain was even found preternaturally pale. The same has been the case in delirium tremens & puerperal delirium. Infl. or congestion is certainly then not essential to these cases. In great atonic hemorrhages & after great loss of blood from any cause congestions in the brain are likely to occur. The greatest bleeders have the most congestions My conclusion then is that v.s. is never indispensable in typhus & never in synochus that if ever employed it shd be in the early stages & that if employed subsequently it produces at most only transient benefit & renders moderate cases severe and severe cases incurable The third purpose for which bleeding is employed, is to equalize excitement, increase susceptibility and prepare for the operation of other remedies in non phlog. dis. that are not materially atonic In these non phlog. cases v.s. increases susceptibility and irritability so that greater remedial effects are produced by most medicinal agents. It shd therefore be avoided in those cases in which there is already too much irritability and susceptibility. The susceptibility to diseased action and to remedial action is different though v.s. may increase both V.S. is a powerful preparatory in appropriate cases. It promotes the action of emmenag. diuret. diaphoret. & cahtart. etc. It produces this effect in different ways and partly by relaxation It has been supposed that like nausea v.s. increases the susceptibility to the action of deobstruents. If phlogist. diath. exists v.s. will of course increase this susceptibility. If however there is considerable atony it will diminish the susceptibility to their remedial effects which it will increase the susceptibility to their irritating and evacuating effects Even when there is no considerable atony v.s. will often reduce the system considerably below the favorable point of susceptibility for the operation of deobstruents I have learned from experience that the higher the degree of energy short of entony, the better is the operation of deobstruents. I have observed this particularly in peristhnitis bronchitis, rheumatism, gout, & paramenia obstructionis (as it now occurs) V.S. renders the operation of deobstruents precarious in these diseases Colchicum for example will relieve rheumat. more speedily & perfectly without it & has failed where it has been employed So of actaea racem. Moderate v.s. for this purpose, when the dis. is but moderately atonic may sometimes be beneficial, but it must be used with caution and is never indispensable. Examples of diseases in which v.s. is employed for this third indication are colica ileus in certain cases dysphasia convulsio s. epilepsia [illegible] apoplexia (sanguineous apoplexy) entasia tetanus lysso canina & other diseases in some particular cases When v.s. is practised for the third indication, we should avoid drawing too much blood on the one hand & the production of syncope on the other. Tetanus and lyssa canina are however exceptions. In these, if the vital energies are perfect we should take as large a quantity of blood as the system will tolerate & in such a manner that after the requisite quantity has been taken syncope shall be produced But even to this rule there are exceptions. In general our success does not depend on the quantity of blood taken nor on the shock produced it should also be borne in mind that v.s. in these cases is only preparatory & is of no permanent benefit in itself alone. It must be followed by other appropriate remedies or we shall soon lose the advantage we have gained Bleeding for the 4th purpose is employed in habitual & passive but moderate hemorrhage, as in paramenia [illegible] Bleeding is never employed for the purpose of directly checking hemorrhage. In active hemorrhage it acts by obviating the state of the system on which the hemorrhage depend and other means will accomplish the same object for instance the exhibition of acetate of lead In irritative hemorrhages (commonly called active) v.s. may be tolerated but it will have no effect in checking the hemorrhage, unless the depletion is very copious and often repeated. And it is always a dangerous practice, producing exhaustion, hectic of inanition and even death itself. Many lives have thus been destroyed which might have been saved Vicarious hemorrhage (misplaced catamenia) may be either active, irritative or passive & in some respects follows different laws from other hemorrhages. It is important to select a particular time for v.s. & appropriate medication shd follow. The hem. recurs with the same regularity as the catamenia and is preceded by certain precursory symptoms. The time to bleed is at the first occurrence of these symptoms & means shd (then?) be adopted to excite the catamenial secretion. It is not necessary or proper to take a very large quantity of blood or produce a shock by faintness. The abstraction of a little more than would have been lost by the hem. will be sufficient to interrupt the latter, & this repeated a few times will break up the habit. In the intervals suitable emmenagogues shd be given & as there is commonly a torpid state of the digestive organs, a combination of iron, sanguinaria and aloes is often found to answer well. All the tonics are useful Paragesis irritative In the first month of pregnancy troublesome symptoms arise from pregnancy & v.s. would give no relief. In the latter months they arise from pressure and and a moderate abstraction of blood may be proper. We should however be careful not to take too much Even in the earlier stages much bleeding will occasion abortion & in the latter stages it is very apt to cause miscarriages. Indeed there is no more certain mode of effecting a miscarriage than v.s. In some places (not so much on the Conn. riv.) pregnant women are always bled, as a matter of course Not one case in fifty requires it. When practised improperly it is followed, if not immediately, yet ultimately by bad consequences Recovery after parturition may be lingering & imperfect. Bleeding in pregnancy is very apt to produce abortions I have known cases of 5 or 6 abortions in succession produced by v.s. improperly employed & where the families were childless from this cause. I was subsequently called to such a case where abortion was threatened. I ordered a horizontal posture & gave opium in small doses, at reg. interv. & removed all the sympt. In the interv. I gave ton. & invit. rem. Iron was the best in this case though it has been said to prod. abort. The sympt. themselves in these cases are not such as indic. v.s. they arise from disord. stom. IN this way I have safely carried pat. through Exanguia Aneurismus Import. in an. of large bloodvess. as of the aorta. Here it is important to get the pat. along with as little loss of blood as possible. Still it is [illegible] not to mistake palpit. of heart symptoms a. of derange. of dis. org. for anew I have known the [illegible] & the case treated with v.s. & crem. tart. till it was thought disp. when it was thrown aside & the pat. recovered Wounds of [illegible] & lungs. Extensive & repeat. bleed are necess. when a man has been shot through the lungs & perhaps when shot through the [illegible] Leave no more blood than is necessary to sustain the function of the system In wounds of the brain the dang. is from hem. Though we must bl. copiously yet we must avoid prod deliquium which might cause death hence a horiz. post. These cases are entirely diff. from accidents & casualties Abern. remarks “the surgeon must let the infl. (the danger is from hem. not from infl.) kill the man or run the danger of killing him with the lancet” & he says “the latter shd be preferred.” I think he is wrong. Sins of omission are not so bad as sins of commission V. [Chololethus] [means] prob. oth. rem. are better Lithia renalis var calculosa narcot. prob. better In carcerated hernia deplet. to faintn. said to be necess. Ice & [illegible] of ether sd by Wood to be better Certain luxations (not, I think in any case of fracture). Parodynia implastica difficult part. from rigidit. Belladonna is better In these cases the quantity of bl. taken prod. the relax & the shock, the faintness manage as for 2nd purpose stand or sit pleno rivo large orifice not stop it so soon as for 2nd purpose If when enough has been taken faintness is not produced stop suddenly to prod. faintness. If a surgical case seize this mon. for the operation Parodynia implastica the pat. is impat. the pract. is [in a hurry] & v.s is too often pract. when it does injury. A celebrated account has broken down many constitutions in this way v.s. is nec. in few cases belladon often answers VI To prod. absorpt. of parabysmata & of emphysemate in ext. tumours If the pat. is feeble it can not be employed & unless a considerable quantity can be taken it is of no service. To be effectual the v.s. shd be as free as can be tolerated without injury use judgment avoid] also shock & fainting. Employ it also in the early stage It is of no advantage in cases of long standing & may be dangerous Often it must be followed by other [illegible] & remedies to promote absorption as quick & active vomiting with turpeth mineral or blue vitriol or even sanguinaria Slow and brisk purging with elaterium is also efficacious & the free internal internal use of tinct. iodine. Those individually or in combin. are herculean remedies Situation has an influence on the quant. of bl. wh. may be taken. Persons in warm or moist situations (malarious) will not bear it so well. Phlog. dis. is less likely to occur & the same degree of it will require less v.s It is less indicated in dis. of chil. but when ind. they bear it very well. Child. are more subject to dis. of irrit. than of infl. & when infl. exists we should be less vigorous in our deplet. It is also less required in the aged In strumous habits less v.s. is required to subdue infl. & such habits will not tolerate bl. well for other purposes Avoid it in them when you can The season of the year is not to be regarded. In the Bethlehem insane hosp. London, they formerly bled all the pat. in the spring & purged them in the fall. When there is not vital energy enough to move the mass of blood, it has been thought that by taking away a portion of this mass we increase the [illegible] power. But s it is found that depletion diminishes the vis [illegible] stil more than the moles movenda A small bleeding when not indicated will not do much hurt for instance zfs to ziii with cinnamon water, as I saw in one case Excessive deplet. produces exhaustion impairs the digestive powers, occasions what are called nervous symptoms & imperfect sanguification with a deficiency of the colouring [portion] of the blood in consequence of which the minute vessels convey a colourless fluid. The nervous and absorbent systems are more weakened in proportion and hence obesity, [illegible] and dropsy ensue. Hectic [illegible] inanition is often prod. which often follows uterine hem. V.S. producing most freq. cong. in brain often in thorax or abd. A habit of being bled prod. corpulency & obesity with laxity & debility When there is a tendency to excessive formation of blood, v.s. will increase it & when there is a deficiency of sanguification v.s. will increase this also. It is well known that remedies will produce opposite effects opposite states of the system Deobstruents for instance will check morbidly increased as well as augments morbidly diminished secretion. Deplet. may produce gen. debility with morb. irritab. or debility with torpor History bloodletting (I believe) was not practised by Hippoc. Celsus bled in all fevers when the pulse was full & skin florid [Arctus] who is suppose to have preceded Galen bled in that fever called cauma Galen bled profusely even in typh the Arabians followed him the Egyptians Sydenham bled Willis bled. Boerhaave did not bled in putrid typhus. These all had a sort of routine practice & no fixed princ. The number of phlog. dis. is less than that of atonic but you wd infer the contrary from the books he causeth diath. was formerly more phlog. These are now more chronic dis. than formerly, which are generally atonic. During the reign of a phlog diath. chron. dis. may be somewhat entonic. Cauma is the only fever which is uniformly entonic throughout It is commonly supposed that all infl. is necessarily entonic, but many ] are confessedly atonic e.g. peripneumonia etc. Simple Saline Refrigerants Nitrate of Potassa A white colourless salt, crystall in hexad. prisms contain. no [illegible] of cryst. though some is mechanic united with the cryst. Undergoes igneous fusion. Decomp. by red heat, becoming nitrite & alternately oxide of potassium 1 nit. ac. + 1 ox. potassium sp. gr. 1.96 oz Solubility increased by addition of chloride of sodium Tested by throwing on a red hot combustible, as charcoal when it deflagrates or by red fumes of nitrous ac. when sulph. ac. is poured on its powder, also by th form of the crystal, but impurities make the form vary. The impurities are chloride of potassium and sodium. To remove these dissolve in boiling water, filter and crystallize. The nit. pot. cryst. first Dissolve in distilled water and add nit. sil. & no? prec. is formed. Decomposed by sulph. ac. & by baryta by sulph. of amm. magn. & alumina & by sulph. sod. at 32 [degrees] Hence all these are incompatible In phlog. dis. taken in the quantity of zi to zjv in the 24 hours it is a pure & powerful refrig. etc. etc. Ed. & [illegible] call it stimulant temperant & diuretic. Paris thinks it refrig. & that it shd be taken immediately after solution as it is then colder I think it never directly diaphoretic & the diaphoresis that sometimes follows is the result of the diminution of the entony. V.S. will do the same [illegible] thinks it one of the best of the diuretics. Paris thinks it acts primarily on the urinary organs, by passing in substance through the circulation to the kidnies, but he considers its diuretic powers as inconsiderable. In paucity of urine and diaphoresis which result from entonic action it is indirectly diuretic, but is not materially so in’ health. It moderately increases these discharges in diseases, neither entonic nor atonic. Murray is right in saying it is too inconsiderably diuretic to be useful in dropsy. It is not sedative in the sense of antirritant. Paris calls it aperient meaning probably laxative Renie says [illegible] to [illegible] is purgative but this operation is inconsider & is merely the result of obviating phlog. diath. Called also antispasmodic or nervine but spasm rarely accompanies phlog. diseases Antiseptic only upon dead animal matter It will however prevent gangrene from high entonic action. Cinchona is called the best antiseptic. But those cannot be indicated in the same disease. Dr Duncan says “Nit. pot.” is admissible only in enton. dis. & A.T.T. agrees with him. They are probably strictly correct Its ill effects (as in typhsus) may not be immediately observable injuring the tone of the stomach etc. Given in atonic dis is dyspep. it produces a small feeble frequent pulse, cold extremities, pain in the abd. like rachiale. Sluggishness and weakness in all the actions of the system & sometimes atonic humor. When it is indicated it should be given in uniform small doses v gr to [illegible] The test for too large a dose is pain at the stomach soon after it is taken indicating a dimin. of the dose so as to fall just short medium dose is called by Duncan 10 grs. others more or less this depends on the intensity of the dis. & the const. of pat. zi may not be too much Generally give it once in 3 hours in quantity just short of that which prod. the pain When its use is continued it can often be detected in the urine Paper dipped in the letter and dried, will deflagrate When the bowels were very torpid I have detected it in small quantities only & those not proportioned to the effect on the system. If the bowels were loose, no trace was discoverable. Hence it follows that its medicinal effect is not the result of its being taken into the circulation Externally applied it is a local refrigerant lessening entonic infl. Add chlor sod. to favour the solution & apply immediately. Applied to tender and irritated parts it produces topical irrit. & infl. & so does tart. ant. It is refrig. nevertheless. Even phosphorus when made to produce topical infl. & irrit prod. aton. infl. This is true of all the stim. A very large dose vomits actively & is thrown off If a poison dose less than this is taken it produces sharp pains in the stomach nausea, swell. of abd. sensa. of cold in stom. cold of extrem. weak of pulse sometimes bloody dischar. faintness, syncope convul. & death. Said to cause ulcera. of intest. & that the muc. memb. is disch. This would prove that it excited a membranific infl. The quantity constitution a pois. dose varies with the state of the system etc. IN strong entonic action it can scarcely prove pois. at least as long as there is entonic action to subdue A.T.T. says zi Rennie zfs to zi Orfila says its poisonous effects are like those of the narcotics & he recom. sulph. soda as an antid. The veget acids & antim. have the same eff. & the purging salts would also if not so soon carried off by catharsis Med. Jurisprudence Not. but detec. of article can. be relied on Treatment An emetic (if no evacuat. has taken place) immediately of turpenth min. bl. & wh. vit. though these are liable to fail hence the veg. em. are better Ipecac in large quantities, though it is less certain than gillenia trifoliata & stipulacea as also euphorbia ipecac. gracilis & corollata Probably sanguinaria & phytolacca would be good emetics. But recent finely powdered sinapis nigra is the best which prevent torpor of the stom. Give about a table sp fl. & repeat two or three times is necessary It is more effectual than the other veg. emet. & disturbs the syst. elss than the min. emetics The distilled wat. of ranum. flammula (if on hand) wd prob. be still better. A few years since a man travelled about the state selling an article to vom. without prod. sickness. It did so. Many persons took it merely for the experiment It was this article to obviate the eff. of nit. pot. give opium & alcohol demulcents. If its noxious effects have taken place & there has been no vom. cath are of no use. Castor] oil zj or ji or gtt p. to i to ol. tiglium or cast. oil with spts turpt. the latter being a stim. as well as a purge these will be better than sulph soda The refrigerants & especially nit. pot. have been much underrated of late partly from change of diath. & partly from inefficient use but chiefly from the chemical theory of their action, by a transference of their oxygen first advanced by Murray Though he has abandoned this theory he still calls them chemical rem. They are as much vital as any others Therapeutic Application [Acute] merc. ptyalism rec. as a lotion supposing it would allay the burning sensation. This eff. is irritative and as this is also the eff. of nit. pot. we shd suppose it inadmissible, but there is a fallacy in this reasoning for canth. will prod. & also cure irrit. As topical applic. there is a fallacy in arranging articles as refrig. or stim. We can draw no conclus. from their internal operation. Probably ol. pin. & nit. pot. operate on the same principle in burns The best remedies for mercr. ptyal. are op. in [illegible] wat. sol. of op. as a wash (unless it produces irrit.) Fowlers’s sol., or sol. nit. sil. topically. Dipsosis avens from recently relinquished habits of intemperance red. because it allays thirst in cauma reasoning bad it may be aggravating the atonic diath. bring on el. trem. & will certainly aggrav. the dipsosis Water & refrig. liq. will not allay this thirst. Stimulating drinks & op. will Dyspepsia rec. by W. Phil. in strong solution, with green arabic when there is inflam. [tenden???] theory Dr Chapman remarks “no article is more apt to relax the stomach & produce dyspepsia. Dr Ives remarks “it is bad in dyspepsia.” It will even produce dyspepsia a bad sort of dyspepsia being caused by long taking it into a healthy stomach The French recommend it in jaundice I know not or what grounds there is great torpor, therefore something to rouse the system is required Also in melaena, a var. of jaundice occurring in broken down constitutions the effect of hot [illegible] of intemperance & hance very diff. to cure No course succeeds with me unless stim. are conj Never prescribe to symptoms merely without regard to names Simple idiopathic cough, in both stages when dry and also after expectoration has begun sd to allay irrit. prev. inf. good if diath. phlog. Remittent, putrid, subputrid (synochous) &nervous. In no form of rem., that I ever wd it be of used irectly the opposite are required Idio, hectic & even in symptom hectic rec. as cooling & sedation it produces no such affect contraindicated directly in all sorts of hectic. Typhus never saw it do harm in synochus [illegible] t. gravior increasing calor mordax etc. which op. carb. amm. etc. will relieve Cauma is universally rec. highly valuable and important next to v.s. & perhaps tart. ant. in nauseating doses The following is called Rush’s febrifuge & is much used in Phil. Rx nit. pot zi tart. ant. gr i dichlor. merc. [illegible] Div. into 8 powd. & give one every 3 or 4 hours The dose of [illegible] & inst is too small A better formula wd be Ant. gr ¼ to 1 nitre gr 2 gr give every 3 hours Apostema commencing diffuse suppurative infl. at hip joint a topical applic of nitre as a refrig. is serviceable So of phlegm. comm. [illegible] bubo f. furunculus I have seen [illegible] in these. It has been rec. in [illegible] them. infl. but it is always bad Tinct. canth. or a blist. is better & dry flour is better than cold lotions. In infl. of fem. mamm. it has been rec. but vol. lin. wd be better or even ac. pl. Bleuorrhea [sanodes] highly rec but Murray says when there is ardor urinae it is too stimulating Tinct camph. Ol. [illegible] Bals. cop. capsic. mustard etc. will cure it & these are more stimulating Orchitis useful but ac. pl. is far preferable. Gout rec. topically but top. applic, are always dangerous. Ac. rheum. rec. by Murray as a refrig dose 5 to 20 grs 2 to 3 times a day with diluents and demulcents this depends upon whether it is phlogistic [Lavendiaur] rec. zfs daily & even in conjunction [illegible] cinchona but v.s. followed by cal. & then by cinch. It is an import. [illegible] iun all the entor. phlog. the best combination nit. pot. cal. & ant. phlog. cephalitis solut. appl. topic but ice cold water is as good Acute phlegm. qunisy, highly extolled as a gargle & not without reason. In eryth. infl. of fauces it will not do much & no art. is superior to capsicum [illegible] bad Infl. of muc. memb. of bladder highly rec. in irrit. infl. of blad. as the surgeons term it but it is doubtful or what grounds for this copaiv. ol. par. etc. are among the best articles Rec. in scarlet fever bad. Entonic active hem. useful It is so limited by Dr Thompson Murray rec. in conjunction with diluents & demulc. now these are bad in hem. Hemorrh. with plethora but it will not dim. the quant. of blood & no dis with [illegible] commences with an increase in the quant. of blood. Diluents & demulc. shd be avoided, as they fill the vessels abstinence shd be enjoined Menorrhea that had become habit. & required the health (probably enton.) it is sd to have stopped the discharge It was given in barley water zfs twice a day produce coldness of stom. cold extrem. etc. nausea “tumult in the bowels” It probably did no good to the general health A dis. is often cured by bringing one worse This article is not useful in irrit. hem. & in passive it is positively bad Porphyra nautica or sea scurvy rec. but not alone nitre with acet. acid is the continuation I am extremely sceptical with respect to articles rec in sea scurvy Land scurvy (p. hemorrh.) arise from bad food, confinement to one sort of diet usually [illegible] hard labour & is probably the same I should not think this wd be benefitted by [illegible] & acet. ac. I have seen it yield readily to tonics Ac. plumbi shd be the basis of the treatment conjoin capsic. alcoh. & nutritious fresh vig. diet. I shd pursue a similar treatment for sea scurvy Diet alone will often cure it Paroniria salax (identical with spermorrhea) Sagnesis furor & salacilates (nymphomania & satyriasis) in these it is rec. by Swed. but I shd not expect much from it Obesity & corpulence In one instance it disturbed the stomach & dig. org. but prod no abatement of dis. If it had been given less freely it would have impaired the appetite less food wd have been taken & emaciation wd have followed. The old rule keep the eye always open the mouth always shut & in feet always in motion is better than any medication In a cellular dropsy it has been given with squills. The latter are efficient but alcoh. is a better auxiliar. In many cases diuretics will not take hold without alcoh. & gin is commonly given The latter acts more by its stimulant than by its diuretic powers. The cases that require no stimulants soon yield to diuretics or [illegible] & calomel Paruria stillatitia & mellita etc. I have never seen benefit from it in p. mel. but the same is true of many other remedies In diabetes it is rather injurious but I have not used it. I have done more with tinct. canth. than anything else Lithis renalis of no use Exormia lichen & prurigo lepidosis psoriasis inveterate used internally & externally In one case it did no good Ecpyesis impetigo var. herpetica (hoopes) & lesinosa (salt rheum) Itch I have tried it repeatedly with no success. It was probably given because it was thought cooling bad reasoning another applic. altogether different has been successful with me Burns & scalds but I do not believe they are to be treated on the antiphlog. plan Bi-carb. of Pot. Sometimes called supercarbonate or carbonate formerly sal tartari essentiala or sal aeratis The common pearl ashes of the shops (?) Crystals quadranga prism Taste alkaline not caustic sp gr. 2 [illegible] soluble in 4 parts water at 60 [degrees] Boiling water taken up 5/6 of its weight More [illegible] than the carb.& has considerable activity Sd to be diuretic it may be but I do not believe it wd be useful in dropsy. Supposed to be antiemetic not much so, & must be injurious in atonic cases As an antilithic inferior to the same dose of the carb. As an antacid it has some power but the carb. ac. disturbs the stom. & weakens it by its refrig. effect. The carb. is on the whole preferable but the bi-carb is more pleasant Perhaps this is the cause that it is in great favour As a refrig. other articles are better & as an [illegible] agent the bi-carb. (or rather sesqui-carb.) soda is better Bi-carb. of Soda Called super carb. soda carb. soda trona more commonly than the preceding called sal aeratis not changed by exposure to air has formed the walls of a fort The heat of boiling water expels half its acid, reducing it to a carb. 6/10 of this salt is oxygen I know of no real superiority it possesses over bi-carb. pot. Soda water every where except in N. Haven is mere carbonated water with not 1/1000 grain of soda to a tumbler full. It is more pleasant without the soda & less injurious A free and especially a habitual use of soda water is unequivocally injurious to most persons. In slender [habits] it induces dyspepsia & in dyspepsia it aggravates the dis. Some of the worst cases of dyspep. arise from the habitual use of this article. The robust very often take it with impunity Soda powders consist of pure bi-carb. sod. zfs & pure concrete tart. acid grs. 25 which form a neutral tart. soda this water is chemically different that of the fountains It is cathartic Seidlitz powders consist of bi-carb. sod [illegible] & tart. pot. & sod (Rochelle salt) zii in one paper & tart. ac. 35 grs in another. Some add bi-carb. soda to cider it destroys its natural briskness & makes it flat neutralizing the salic acid forming a [illegible] which is more refrig. than most other salts Sesqui carb. soda Chlorite of Potasa 1 + 1 Incorrectly called potassae chloras, oxymurias, hyper oxymurias, murias hyper oxygenatus There are two oxides & 2 acids of chlorine with oxygen protox. 1 + 1 perox 1 + 4 chlorous ac 1 + [illegible] chloric ac. 1 + 7 This last some call perchloric & the preceding chloric from the fact that the chlorous was first discovered hence confusion Chlorite of potassa is formed by passing chlorine gas through a concentrated solution of protox. potassium, till it is neutralized as is said. But chlorine never combines with an alkali The alkali is partially decomposed. By gentle evaporation & cooling the chlorite of potassa is precipitated while chloride of potassium remains in solution Authors are very vague respecting its virtues It is not a stimulant It has been tried in phlogistic diseases & seemed to diminish the diathesis [Swedeaur] mentions [asthenia], cachexiae etc. chronic hepatitis etc is benefitted by it. I do not believe in the existence of chronic hepatitis The dis. so called is merely morbid sensibility in the hypochondriac region, occurring in advanced stages of dyspepsia. In post mort. ex. I have found no traces of infl. in the liver It was introduced for prophyra nautica from chemical notions, as it contains oxygen not much used Said to cure syphilis & hence to be deobstruent useless when the constitution becomes affected before this constit. rem. are not needed. Said to cure [culan.] dis. none specified Dose 15 grs to zfs weak refrigerant believe it has no other power unless deobstruent A fine subject for experiment Vide Boston Med. Gazette for Prof. T’s experiments June or July 1832 Bi-borate of soda 2 + 1 (borax) Called sub-borate borate boras sodae alkalesans (because, contrary to fact the alkali was supposed to predominate) Called formerly chrysocolla When impure & native it is called tincue Prisms hexaedral with two sides broader, terminated by triangular pyramids. Sp. gr. 1.24 changes veg. blue to green. Tastes styptic & alkaline Soluble in water 20 parts at 60 [degrees] & 6 at 212 [degrees] Effloresces slightly Loses its water by heat & 4/10 of its weight becoming friable in a strong heat converts it into a transparent glass which is soluble in water By percussion it flashes in the dark Decomposes by acids & alkalies by sulphates, nitrates & muriates, phosphates fluates etc. Found only in Tibet & Persia, obtained from wells in an impure state, by evaporation Brought from E.I. in large masses, white & green, joined by a greasy looking substance I have known it used freely in phlog. dis. & the most I can say is that id did not harm & was thought slightly refrigerant. I have known it employed in the exhaustion of low atonic diseases, not malignant & it neither increased nor diminished strength of action Not stimulant. Said to be nervine probably not. I do not think it is I have never perceived any deobstruent effect from it Said to be diuretic Prof. T. never could perceive it to be so Said to be emmenagogue doubtful Prof. T. has made no observations Swediaur calls it antacid It would be so when the acids were the hydrochloric or the phosphoric, as they may be. Lactic acid wd have some action and also the acetic, if it exists in the stom. which is doubtful. The sulphuric, nitrous, carbonic, & hydrocyanic acids are all that are inferior in energy of attraction to the boracic. Still this will be inferior to other antacids Therap. applic. mercurial ptyalism dyspepsia with cardialgia & acidity proctica [illegible] (“painful hemorrhoidal tumours”) Parabysma coactum of liver or spleen Aphtha ulcera serpentia (Swed.) parapsis acris var. [pousitus] Its most common use in aphtha at first it will allay the burning heat, but only for a moment, not effecting a cure Prof. T. has found milk porridge, barley water, rice water, or even cold water, quite as good and even better than borax It is rec. to dissolve the aphthous crusts. It has no such power & if it had it wd be injurious, as the slough defends the ulcer beneath from irritation. 99/100 of the physic. of this country & G.B. prescribe borax as a matter of course for thrush Case where nothing is done [illegible] quite as well as those where borax is used. Veg. astringents do something toward a cure Nit. silv. is good. Borax is rec. by Dewees parapsis acris. var. [pruritus] Prof. T. has had no experience For internal use as refrig. deobst. diuretic etc. the dose rec. in zfs to [illegible] I have used it in much larger doses without any appreciable effect Swed. says for a lotion in [peraps??] acris dissolve 10 to 30 grs in zfs [illegible], but we use it stronger For internal use it nearly or quite inert If it has any power it is a refrigerant For external use it is about as active as wheat flour merely palliating [teaspoon???] “But my testimony is negative merely. It is desirable that someone shd experiment on it Begin the experiment with zi & take zii ziii etc. Borate of potassa has been substituted for bi-borate of soda & that no so good Benzoates & succinates of potassa Of these Prof. T. knows nothing. Carbonate of Potassa 1 + 1 Called sub. carb. (case being supposed to predominate) Sal tartari sal absynthii more anciently nitrum [illegible] & alkali vegetabili (very inappropriately) also sal aeratis tartari It has a strong alkaline taste and a powerful action on veg. & [illegible] substances Exposed to the air it [deliquiates] & has an oily appearance, where it is called in this [illegible] oleum tartari or oleum tartari per deliquium (a name also given to solution of pure potassa It does not absorb carb. ac. from the atmosphere. It does not readily crystallize Crystals rhomboidal scales Commonly found in coarse grains The poorest is obtained by incineration of bitartrate of potassa but this contains oxide of calcium The more common impurities are sulphate of potassa & chloride of potassium which however are of little consequence except in pharmac. preparations Said to require twice its weight of boiling water for solut. I think less Sd to be insoluble in pure alcohol of the shops. Said to combine with oils & form soaps (but there must be a decomposition) Incompatible substances All the acids All the bi-salts borate of soda, muriate of ammon. nit. silver ac. lead chloride of iron proto & bi-persulphate iron Di & proto chlor. of merc. bi-persulph. copper The most uniform but not the most active operation is that of a refrigerant This is seldom expressly said by authors, though they said it may be given in phlogistic diseases & also in atonic. In very low atonic cases I have seen it prod. irrit. of stom. (i.e. nausea & retching) & impair the tone of the digestive organs It can be considered only as an auxiliary to the other refrig. Said to be deobstruent I think not As a diuretic, with diluents, it has sometimes considerable powers & is more active than as a refrigerant Yet it is rarely successful alone in dropsy. It is only in other diseases that it can be relied on as a diuretic alone & it also increases action’ of other diuretics Its operations is direct as it has no deobstruent powers In hydrops cellularis it is a useful auxiliary E. & Vav. say it is useful in passive dropsies probably meaning atonic cases. I have never seen phlog. cases those called having been merely irritative More useful in paruria inops than in any other disease It is antilithic when the calculus consists of uric acid, cystic oxide, or xanthic oxide An effectual antacid It may be taken moderately in dyspep. with acidity but lime water [illegible] (according & the bowels are lax or torpid) is better the first being a tonic carb. pot. often does mischief in the disease. It is not tonic Said to be anti-emetic. In most cases it does no good & in many it is actually noxious. I have abandoned its use as an antiemetic, unless the vomiting is occasioned by free acid in the stomach Supposed to be antispasmodic & useful in the whooping cough. It is neither recommended in parabysma [illegible] I never saw good or hurt from its use Struma I know of no principle on which it could be of use So too of gout, in which the French rec. it. In dyspep. without acidity Remitt. fev. Spasmod. vomiting employed by itself or in effervesc. mixt. better omitted refrig. are not indic. this is not the best remedy & is often injurious Saccharine matter impairs its powers sugar fulfils the functions of an acid & in some cases takes precedence of carb. ac. Dose 3-4 to 15-20 grs. The French give more 10 grs to zi Give it in water or mucilage, sufficient to prevent a disagreeable taste Do not give so much at once as to distress the stomach It is customary to add just rhubarb enough to colour it & [illegible] ppt. to flavour it & this is regularly given [as a placebo] by some when at a loss what to do Placebos are sometimes of use but I never liked them Carb. pot. is more commonly given in an efferv. mixt. but in this case we have carb. acid and citrate etc. of pot. as a purging salt. The usual proportions are carb. pot [illegible] dissolved in water to f zfs of lemon juice but lemon juice varies in strength (of no consequence) If sugar is added it shd be [illegible] with the acid, or we shall have no effervescence But the bi-carb. is best for efferv. mixt. Taken in poisonous doses it prod. eryth. infl. of intest. tormina soreness, exhaustion, small weak pulse Still zj as been taken without destroying life. Immediately after swallowing take vinegar & water as an antidote, but if infl. vom. & diarrh. have taken place vinegar wd add to the irritation Then give oleaginous demulcents & narcotic antirritants. Opium & hyoscyamus are best. Keep the pat. under a stead & uniform operation of narcotics [illegible] disturbing the stom. by the quantity of your demulcent Carb. pot. is useful externally applied in diabetes & a cataplasm of it applied to a felon or a carbuncle is useful Carbonate of Soda 1 + 1 + wat. 10 Called sub carb sal sodae sal alkalinous fixum fossilis mineral alkali impure soda barilla is to soda what potashes are to potassa prim. cryst. an octohedron Taste resembles carb. pot. but is weaker sp. gr. 1.359 Soluble 2 wat. at 60 [degrees] wat 212 [degrees] Effloresces in the air Undergoes wat. fusion by heat Sometimes it contains so much water that it remains liquid after melting seeming to deliquiate & occasioning a suspicion of impurities. A red heat change it to a transparent fluid A very violent heat drives off most of the acid The same process uses are ascribed to it as to carb. pot. It is however less nauseous & more mild. It has the advantage that it is capable of being made into a pill after driving off the water Dose 10 grs to zfs (ed. & Vav.) Some says zii The common form for pill is Rx efflor. carb. sod. ziii sapo zi ol. ceram mx water q.s. Soda is used in the same dis. as potassa The old phys. are very partial to it in jaundice I have seen no benefit from it. Many rely on it in parabysma hepatica Trit Antimoniate of Potassa This is the fist of the nauseating saline refrigerants The “panacea antimoni” of the dispensatories, accord. to the mod. improved meth. of prepar. it is a trit. antimoniate of pot. Expose “antimony” (the sulphuret?) 1 part & nit. pot. 6 parts to as great a heat as they will bear without fusion, then pulverise & wash out the remaining nit. pot. with cold water It is a white powder of an acrid taste scarcely sol. in cold wat. very sol. in boil. wat. but deposits nothing on cooling (“I do not understand this?) It contains 11.5 pr. ct. of wat. acc. to benz. it is pot. 1 + antim. ac. 3 It is commonly thought that the antimoniates & [anti????] are les emetic & more diaph. & refrig. than tart. antim. It seems to be the case that those antimoniates which remain longest in the stom. producing continued nausea, without vomiting are more refrig. Tartrate of antimony cannot be readily managed so as to nauseate without vomiting. It is on this ground that the “pulvis antimonialis of James (the composition of which is to this day unknown) the protoxide of antim. with phosph. lime & the protox. of ant. (the glass) have been employed. The panacea antimonialis has been rec. in cutaneous eruptions. Prof. T. inclines to think it a bad medicine. He never did any good with it & has continued it until it did injury. The idea seems to be that any thing that acts on the skin must be useful. He considers it useful only as a refrig. & diaph. Prof. T. wishes some enterprising young man wd expt on this & other prep. of antimony Protoxide of antim. Protoxide of antim. with lime Protoxide of antim. & potassa The protox. of antim. was once much used by phys. under the name of “glass of antimony” They made antimonial wine by pouring wine on the glass of antim. in substance. This glass of ant. is very uncertain it its effects. It is much more uniform in form of wine It was formerly used as a diaphoretic & refrig. in dysentery when all diseases were thot to be “hot” Experiments are needed on these prep. Tartrate of Antimony may be taken as the p type of all the prep. of ant. It may be formed Its aqueous solution undergoes spontaneous decomposition on exposure to the air Tests Hydrothionic ac. throws down in yellow precip. carb. pot. a white proc. The most important operations of this article are refrig. diaph. & emetic. It is supposed to be deobstruent but it is so only by its evacuant operation IT is well adapted to entonic diseases but may be used in those which are not purely entonic nor atonic without much injury In phlog. dis. it is more refrig. & diaph. in nauseating doses In non phlog dis when the constit. is also slender it prod. a leucophleg. habit & dry skin, crusts about the teeth & fetid breath. If given freely it produces an’ unmanageable diarrhoea. Its continued uses as an alterative has done this Physic. used to prescribed it in atonic & cutaneous dis. when they were not so well acquainted with it as now Some pat. are more susceptible to it than others & the same pat. is more so at one time than another. ¼ or 1/8 of a gr. will sometimes prod. hyper emesis yet prof. T. has given 35 & 40 & 75 grs. without prod. emesis. But in such cases you may produce it by a glass of brandy sling This was soon after the change of diathesis & proved that after such a change had taken place the article was not adapted to these cases [illegible] of ipecac would probably have vomited those persons freely To treat an exquisitely phlogistic disease (cephalitis, pneumonitis), bleed & give a cathartic of salts (sulph. soda) add 1 gr. of tart. antim. not enough to vomit which will heighten the refrig. effect of the salts You may add too zfs of nit. silver which will greatly heighten the effect. You may treat any phlogistic disease in this way. Laxative Saline Refrigerants Quadroxalate of Potassa Bin-oxalate of Potassa Called sal oxalis sal limonum essentialis (yet it contains not a particle of citric acid) potassa oxalis acidulas sal acetosella (Phil.) It exists ready formed in oxalis acetosella & probably in all the spec. of oxalis also in rumex acetosa & r. acetosella It is formed by dropping a solution of potassa on a saturated sol. of ox. al. ac. in water the bin. oxalate when thus formed precipitates if too much alkali is added it forms an oxalate which remains in solution Binoxalate of pot. has a bitter, pungent & acrid taste It is not affected by the air. It unites with alkalies & earths & forms salts of a triple character It is a popular article in fevers but is proper only in the entonic It is sold in small wooden boxes & called “the essential salt of lemons” It has been applied to strumous ulcers and promotes their healing hence called antiseptic Prof. T. has applied the bruised leaves of the oxalis stricta & rumex [acetis???] with advantage but there are better things It might probably be of service, chiefly as a grateful beverage in fevers Malate & Bimalate Potassa Soda & Ammonia malic acid exists in the [illegible] It exists in the berries of the rhus glabra in the form of the bi malate of potassa. Pour boiling water on the berries and let it [illegible] till cold It is a grateful beverage in fevers Acetate of Ammonia Called ammon acetate ammoniae acetum sal ammonias acetosus sal ammoniacus vegetabilis The solution is called spiritus mindereri liquor ammoniae acetalis & liq. amm. acetatae of which the former is proper It is supposed to be stim because amm. is [illetigle] it It is not so. [Thomson] says the acid and alkali shd both be concentrated to form the best article It is too volatile to crystallise readily, but by gentle evapor. acicular crystals are obtained (& by sublim.) 1 8/10 inch in length Taste first cool, then sweet, finally the united taste of sugar & nit potassa but the mawkish taste of the mit. potas. predominates It is very deliquescent, melts at 170 [degrees{ sublimes at 250 [degrees] Distilled vinegar shd be used & shd be saturated with the solution of [illegible] aqua ammonia Adding sesqui carb. amm. is a nauseous & inelegant mode & shd not be used, as the salt is less powerful and either the acid or the alkali will predominate & sometimes I have tho’t I could taste both (I know not the reason of this If used in cauma & entonic phlogotica it moderates the heat & dryness of the skin & diminishes strength of action Yet Swediaur calls it a stimulant It is a good refrig. & stands next to nit. pot. & soda. It is not nervine It is called diaphoretic, but is so only by obviating phlogistic diathesis, the heat & dryness of the skin being removed & diaphoresis ensuing It is diuretic in diseases not much phlog. nor naturally atonic, with diuretic regimen, but it cannot be relied on in dropsy If there is paucity of urine, it restores it if in the natural state it augments it moderately It is not deobstruent When Swed. assigns it this power he means that it is refrigerant Diseases Recom. in “simple fever general It is fashionable in Europe to treat simple fever as a [illegible] It is never useful in typhus. It is useful only in active infl. fev. Rec on the phlegmasia useful in the phlegmonus ones, not in the atonic or erythematic or atonic arthritic Swed. says it is useful in the atonic erythematica I never saw any other. The supposed phlogistic cases are irritative & in these the article is improper For a dose Swed. gives zfs to zii of the solut. I give zi & never saw it too much The laxative power is less prominent in this article than in any other of the group Acetate of Potassa Called acetate of pot. sal diureticus (the most common name) Tana foliata tartari Tartarum regeneratum kali acetatum kali acetas sal digesticus slivii Longer known than any other of this class except nit. pot Add carb. pot. to distilled vinegar. Citrate of Potassa The citrate of potassa soda & ammonia are all used, and are next in frequency to the acetates. Citrate of pot. is called mixture vel haustus [illegible] riverii It is formed by adding sol. of carb. pot. to citric acid till it is saturated, & drying the product It is very fashionable in London & Boston It is not good in cholera infant. or in any atonic disease, increasing the vom. & purging It is most used as a diuretic being similar in power to acet. ammon. Taken during effervescence it is effectual in allaying vomiting in phlog. cases or those which are not atonic nor entonic No better than acet. amm. not so good as nit. potassa Nitrate of Soda Found native in various parts of S. America I consider this as a refrig. precisely in the same manner as nit. potassa, but in a much less degree It is said by late writes to be laxative in doses of zfs to zi Sd to be diuretic but I think in no other manner than nit. pot. Much used in Germany. Dr Weir (?) wrote on it Refrigerantia acida Vegetable Acids vegetable acids may be divided into 3 groups 1 Those which exist in veg. in a free state or combined with alkaline or metallic bases. 1 Those which are never free but are always combined with veg. [illegible] bases 3. Those which are the product of decomposition the first group comprehends all the refrig. acids exc. the carb. They are the acetic (called also acetous & a modification of it the pyroligneous) citric malis (or sorbic) tartaric (and a modific. of this the pyrocitric etc.) & oxalic (or rheic). The carbonic shd be placed here from its properties. The second group are not [illegible] to possess any medic. power. Examples are the meconic of opium & [illegible] of cinchona. The 3d group are supposed to be nervine. There are but 3 of them benzoic, succinic & perhaps the camphoric Acetic Acid This is susceptible of a greater variety of applications than any other veg. ac. & possesses all the powers of the others There are 4 species viz. acidum aceticum [illegible] acid. acet. dilutum (distilled vinegar) acid ac empyerumaticum (pyrolig. ac.) & ar. acet [illegible] (common vinegar Pure acetic acid is very volatile & its vapour is inflammable. It is obtained by The strength of vinegar is determined by its power of neutralizing alkalies It is found free naturally but it is obtained for use by fermentation & veg. decomposition In the U.S. from cider France from wine (acetum vini) England from beer (acet. [illegible] or Aligar) This acid has been longer known than any other mentioned by Moses. It may be obtained by the destructive distillation of veg. matter in form of pyrolig. acid This or common vinegar may be purified by digesting & afterwards filtering it upon charcoal (animal is best) & then distilling it This forms acetum dilutum, formerly called acetous acid It is contained in the juices of several plants, free or combined with alkalies e.g. with phenix [deotybifera] (date tree) vitis vinefera sambucus nigra galium verum [illegible] [illegible] rhus typhinum etc. but not in large quantities It is a pure refrigerant adapted to entonic diseases abating but thirst etc. It has been given in typhus gravior & putridus, because there is heat thirst, sordes cadaverous smell etc. & the pat. craves acids but in such cases the min. acids are better The heat requires antirritants The sordes cadav. smell etc. indic. a low state of the system & require supporting agents Acetic acid will produce morbid irritability of the stomach & intestines, retching vomiting & diarrhea, exhaustion & a tendency to sink at one of the critical periods. The effects are gradual, therefore not always observed. So of all the typhus phlog. & exanthematica & all dis. of putrid type It is not stimulant nor astringent Said to be antiscorbutic I think not, because it must contain veg. matter in solution to be of service in scurvy. This is the reason why plants of the order cruciferae are useful Antiseptic only in dead an. matter It may prove [illegible] gangrene from excessive phlog. action The veg. acid are said to be anti narcotic perhaps they are after the narcotic is removed from the system. Some narcotics are heightened by them while they remain No narcotic is ascertained to be diminished in power by them. Said to be antiemetics. This depends on the state of the system & stomach Said to be diaphoretic & diuretic only indirectly is it so “Laxative” most acids move the bowels acetic, slightly only “A remedy for polysercia” indirectly so in such quantities as to injure the digestive system spare diet wd be better A sparing use of vinegar in health is wholesome, especially in assisting to digest oily food For laboring men in warm weather vinegar largely diluted with water; syrup & ginger added, is a very pleasant & healthy beverage & far better than ardent spirits Externally it is refrigerant & discutient & may be made to be rubefacient combined with water & alcohol in certain [illegible] used as a lotion in all kinds of erythem. infl. scalds from hot water malig. sore throat tumefaction from sprains & contusions uterine & nasal hemorrhages & [illegible] costiveness. It is inhaled to relieve syncope. It is supposed to destroy specific contagion & is applied to the head of convalescents from small pox. But this is rather a chemical & mechanical than a medicinal effect It is liable to change & decomposition in the ordinary form of vinegar, but the taste smell & appearance will be adequate tests It is used in pharmacy as a [menstruum] & the posers of a few articles are heightened by it, as colchicum, which contain the bi-gallate of veratrine & the acetate of veratrine is more active. So the acetate of sanguinaria is more active also that of morphine is more so than the natural salt of morphine which exists in opium But most articles have their powers impaired or destroyed by it. The preparations are nauseous and liable to decomposition even with a considerable addition of alcohol. The following are used viz acidum aromaticum, acetum scillae, A. colchici, A. veratri (3 species) & A. sanguinariae As prepared from fermentation it is uncertain & shd not be used for these purposes Citric Acid Next in importance to the preceding Found abundantly in the geum citrus of which 3 species are described C. medica (citron south of Europe) C. limonum (lemon) C. linetta (lime) These contain great abundance C. aurantium (sweet orange) C. vulgaris (Seville orange) C. vulg. var. myrtifolia (cultivated in our green houses) C. decumana (?) (shaddock) All these contain citric acid & [illegible] the other species Citric acid is contained sparingly in other genera, as oxycoccus Europeus, cerasus [illegible] (bird cherry) C. hortensis (our old fashioned red cherry) solanum dulcamara, fruit of rosa canina ribes rubrum vaccinum myrtillus fragaria vesca Citric acid is one of the most expensive but most pleasant. The juice of the recent fruit is preferable to the concrete acid in fevers etc. Malic Acid Obtained from apples & pears in considerable abundance, in which it exists ready formed in greater still from the leaves of semper vivum tectorum sorbus [aucuprin] (?) of Europe, sorbus Americana (juice of the fruit) most abundant is the red [illegible] of the fruit of rhus glaborum for medicinal purposes, macarete the berries in hot water & strain The acid thus obtained is than the juice of limes etc. for fevers Tartaric Acid Obtained exclusively from the fruit of the vitis vinifera, in which it exists in the form of bi-tartrate of potassa New wine contains it in solution & deposits it by precipitation on the casks. It is taken from these & purified & crystallized to form the [illegible] bi tartrate of potassa or cremor tartar The true tartar is not recognized in chemistry now The “adiculous syrup of lemons” consists of tartar ac. zj essential oil of lemons (rind) [illegible] white sugar zxvi boiling water zvjii This constitutes the lemon syrup of the shops If too much oil of lemons is added it gives the taste of rotten lemons. There shd be just enough to give it a taste in water. The “salt of lemons” is bin oxalate of potassa, q.v. Oxalic Acid Exists in the fomr of binoxalate of potassa in the oxales Americana acetorella, stricta, violacea, & probably in the others It exists in smaller quantities & the same combination in rumex acetum & acetorella in the juice of the stems of rheum raponticum (pie plant) & a little in R. palmatum & undulatum. The acid of R. rap. was formerly thought peculiar & called rheic ac. The citric is the most agreeable acid than the oxalic, then the tartaric least of all the acetic. The oxalic is more active than the others & is probably the most powerful refrigerant of all The effects of these acids in excessive doses are irritation followed (if a sufficient quantity has been taken & not removed) by erythematic infl. & there may be ulceration & sphacelation if not immediately fatal. The symptoms are nausea, vomiting, pain in abdomen small wiry pulse etc. The oxalic is the most poisonous, next the tartaric, then the citric Immediately after swallowing give carb. pot. lime, or magnesia & if not given immediately they may lessen the evil those however are preventives, not antidotes To obviate the effects we must give demulcents & opiates Carbonic Acid Is said not to be capable of being inhaled It is so if pure, but when much diluted it may be & will diminish irritability & produce first prostration, the exhaustion paralyzing the muscular powers & preventing all effort to escape from its influence The remedies for asphyxia from this gas are a free supply of fresh air dashing cold water over the whole body particularly the head frictions stimulating enemata artificial inflation of the lungs with good air Medicinal operation Almost all the books call it “stimulant ton. diaph. diuret. & antiseptic” Copying from each other. When I commenced practice I supposed so, but have found by actual experiment that this is not true It was injurious in atonic cases & did not aggravate phlogistic ones. If given freely in the form of carbonated water it was an evident & decided refrigerant, diminishing vital energy & strength of action & morbid heat, restlessness, irritability & irritation. It is a decided but weak refrigerant beneficial only in acute entonic diseases. It will correct the fetor of the alvine evacuations. It is analogous in its effects to the vegetable acids. I have a letter from an old physician confirming my statements Boracic acid (nervine?) Fruits Stimulants 2nd Stimulants Rhus venenata not the is vermix which is a native of Japan like R. toxicodendron is useful in palsy, dyspepsia & many diseases is no more unmanageable than any other article & is no more poisonous to the system. The other species of rhus are acrid but this is the best as R. [illegible] is probably preferable to R. toxicodendron. R. radicans is not inferior to R. toxicodendron Alcohol Discovered by an Arabian chem. A.D. 930 Some ascribe the discovery to Arnold de Villenne of Montpelier in the 14th century When strong burns with a blue, when diluted, with a yellow flame. Sp. gr. [absol.] alc. [illegible] 96 or 2 Off. alc. 835 in G.B. & U.S. take a vial find its exact weight & mark it with a diam. Pour into it 1000 grs (troy) distilled water & mark the heights Alcohol up to this mark shd weigh 835 grs. Alc. dissol. pot. amm lithia & the veg. alkalies, but not the earths. Generally all the salts which in water are insol or very sparingly sol. are also insol. in alc. The deliques. are also, exc. the carbonate of potassa Alc. also dissol. sugar, resins, manna, balsams, camphor essential oils Alc. dil. eq. pts wat. & alc. sp gr 935 The peculiar properties of alc. in different forms (as spts sacchari [illegible] spts persici [illegible] bran.) are said to be owing to oily matter always present & to a little acetic ether The former may be removed by repeated distillation & caustic pot. or soda will remove both. The carbonated alkalies do not act with suffic. energy Alc. is sd to be the same from whatever source produced Alc. is stimulant nervine & narcotic It differs from wine in producing an effect externally also, when it produces a vital contraction of the solids diminishes morbid irritability & sensibility, obviates a relaxed state of the soft parts & relieves pain IN many states of the system the use of wine & of alc. prod. the same effects, but there are considerable differences in certain states It is not tonic There is much room for discrimination between wine & alc. as between alc. & ether Greater effect on the brin is produced when atmosph. press. is removed as in ascending high mountains also on an empty stomach It does create a positive increase of power when indicated & properly managed & is not followed by exhaustion It is not a poison in a popular sense of the term i.e. in small doses Wine is indicated in non malignant typhoid disease alc. in low malignant [illegible] is better in the putrid types, alc. in in the nervous. The mode of preparation [illegible] the use of stimulants will make a difference if cal. & op. are not given in the early stages alc. will disagree in the latter & perhaps wine & the supporting agents will disagree also; but if cal. & op. be given at the outset & afterwards the sp. be continued alcohol will agree will if so strong a stim. be indicated Upon the [whole] [illegible] is indicated in chronic diseases & indicate with consid exhaustion, but alc. is advisable in very few chronic cases but is particularly appropriate in acute diseases with extreme exhaustion Intoxication is in no case a stimulant operation, but in some a narcotic, in others a nervine in others both It is not settled to which intoxic. should be attributed. I am inclined to think the remote effects of alcoh. attributable to its peculiar narcotic power No pure stim. nervine or narcotic produces them though the narcotics approach nearest. Perhaps we may consider del tremens as the eff of its nervine power & diseases of the liver of the narcotic, but I am not certain The external marks of intemperance in alc. are inflamed eyes bloated face red nose, tumid abdomen turbid urine foul breath, tremors of the muscles emaciation, peculiar cutaneous eruptions & preternatural old age The effects on the mind are inability to fix the attention failure of the memory & judgment, irresolution, cowardice Patient ultimately dies dropsical paralytic apopleptic or delirium etc. deranges the digestive organs & particularly affects the liver Swine & fowls fed in distilleries are subject to enlargement of the liver & the same eff is prod. on the human subject The constant irritation on the digestive organs causes a determination of blood to the viscera, which produces congestions infl. & parabysma. The particular diseases produced by the use of wine are a peculiar sort of dyspep. (differing from that produced by alc. & other causes) Gout, calculous diathesis & sometimes lithia renalis or gravel. These are exclusively the diseases produced by the use of pure wine The habitual use of alc. produces an obstinate dyspepsia of a different form & terminating sometimes in membranous phthisis limosis syncoptica parabysma to especially of the liver. A peculiar kind of cutaneous eruption Obstinate ophthalmia tarsi hypochondriasis nervous tremors A peculiar sort of conclusion called “drunken hysterics” delirium tremens obstinate dropsy parunia melleta or diabetes impotence paralysis & sometimes catocansis ebriosa These are all the diseases that are the peculiar effects of alcohol In cases of exhaustion from severe exercise, tho in good health, alcohol is a good remedy So if a person subject to rheumatism should accidentally get wet though a free draught of brandy will almost invariably prevent the rheumatism So too of persons predisposed to pneumonary complaints which exposures will bring on So of fever. So too an attack of an [illegible] may often be thus prevented. Yet it would undoubtedly be far better if alc. were confined to the shops of the apothecaries Therapeutic appl. of alc. & wine Limosis dyspep. It is bad practice & shd be avoided Wine is better when it agrees. Alc. may be used when there is extreme exhaustion to bring the pat. within the proper range of susceptibility to other medicines. Diarrhoea It has succeeded when it was simple & idiop. I consider the species of diarrh. as only varieties I except d. tubularis which is a membranific infl. & D. [illegible] which is a symptom of dyspepsia. Opium is far better [illegible] diarrhoea. Cholera a temporary use is often beneficial Generally before the pat. is called the pat. is reduced very low pulse weak, quick cold extrem. epig. stress. Here a small quantity of undiluted spts especially if hot will often suspend the vomiting & diarrhoea & palliate the disease Opium is more effectual but but some cases require alc. in addition Avoid giving a great bulk for this will cause vomiting Intermit. & rem. fever Wine & alc. often useful. These may be 1st of the synochus or sub putrid type 2nd of the nervous, as exquis. as in t. nervosus 3d of the putrid or typhus gravior type. When of the synochus type they are never malignant. Wine & alc. are never necessary unless the cases are protracted & run down In the nervous alc. is preferable to wine but wine is best in the Alcohol Wine 2nd 2d Stimulants putrid if not malignant & low. otherwise alc. But these are to be considered as auxiliaries, when the system has been prepared by cal & op. alc. is more applicable & agrees better. Thus is obviated the irritation which alc. would otherwise produce. Icterus melaena many cases will require either wine or alcohol. Sometimes they will agree, sometimes not give op. with either Typhus in all its forms when malig. alc. non-malig. wine answers very well When run on to a low state, alc. or wine shd be given acc. to the degree of exhaustion the previous treatment & the type Abscesses require either wine or alc. when in a low state. Apostema when low Anthrax when system is much affected & low Erythema [illegible] erysipelat. gangrenous & anatom. in the same cases as the preceding. So too of paristhmitis maligna Malignant variola rubeola & rodalia Phlogotica or visceral infl. may or may not be proper. When approaching to erythema phlegmodes they are not. if to e. gangren. they are necessary or in the early stages IN the arthritic wine & alc. may be highly useful. Arthritic infl. may be acute, subacute & what is called chronic i.e. intermediate between rheum. & neuralgia. All these forms may affect the viscera. In the advanced stages of any of them, if there is a metastasis alc. & wine may be useful Membranific Phlogotica I have not seen a case of croup this winter (1830) in which alcohol has not been employed by others as well as myself. This does not supersede the use of emetic cal. & deobst., but they fail without alc. in some cases or the dis. may run into a low state & then alc. may be required Strumous Phlogotica very often [required them] General acute febrile dysentery often indicated at the outset if malignant also if run down into a low state alc. generally is better than wine In many of the dysthetica they are important auxiliaries e.g. marasmus tabes (not so much in m. atrophins) especially var. venenata from lead & mercury. Porphyra hemorrh. (land [scurvy]) if the case is serious they are highly useful In severe cases the more intense astringents, powerful tonics & diffusible stimulants are highly necessary Gangrene especially G. sphacelus Entasia Tetanus their propriety has been controverted. Dr Hosack thinks every thing depends on giving them just to the right point & that more or less will fail his cases would not have been called tetanus in Conn. they were slight spasmodic diseases & would have got well without any treatment In genuine & severe cases we can trust to neither for a cure. In Mass. such cases S have been treated with Fowl. sol. in very large quantities, sufficient to keep the bowels open & alcohol. Practice that would destroy life summarily in health may be safe & effectual in violent disease. This practice seems to be judicious & judiciously managed Arsenic is considered the most important part of it. Opium shd be used largely at the same time. Lyssa canina proper if great exhaustion Chorea if great exhaustion Chlorosis atonica wine with some limitations Dropsy Stimulants are not incompatible with digitalis. In some cases it will do nothing without stimulants & then will act salutarily. They are those attended with exhaustion pulse weak & feeble extremities cold powers of life considerably reduced Bites & stings. The testimony is complete as to the efficacy of wine alc. & opium The practice is as old as Celsus perhaps Galen (vide my notes) Celsus recc. vinum cum pipere External Use of Alcohol Dr Ives uses alc. zi to zii ol. orig. in scalds & burns & prefers this to ol. pin. He uses it before vesication, which it prevents. If applied too long however it may produce it & be as bad as the fire. The test of sufficient applic. is the relief of pain without its returning on suspension. If the skin is removed, the burn extensive & exhaustion & irritation great, the same mixture is recc. topically Some forms of indolent tumors if early applied, it may discuss them Vapor bath of alc. (Support the bed clothes by a stick) probably some of the alc. escapes combustion & passes up in hot vapor. This bath does not fatigue the pat. does not make the bed damp like boiled blocks Useful in secondary stages of colica ileus & rhuch. in diarrhea cholera icterus melaena chololithus [illegible] limosis gastrodynia malignant intermittents & typhus Wine Vitis vinifera not an [anpelop.] D.C. vinif. & vitis jus native of south Asia. Boerhaave derives the word vinum from vieo to bend or twine It is from the celtic gruzel (pronounced vit) vine, vigne, vinea [illegible] [illegible] etc. all from two hebrew words signifying fountain & to press out. R. & Schultes describe 1 or 200 varieties of vitis vinif. Wine does not exist in the grape The great divisions of wine are alba & rubra Other divis. are acidula as Rhenish or Hock dulcia as Frontenac malaga [illegible] tokay cape austera as Portugalicum or Port, mitia i.e.. not acid sweet not austere, as sherry, madeira, claret, burgundy champaign. To these we may add vinum pomaceum or cider & v. pyraceum or perry Wine is mentioned in the works of Hippocrates in the treatment of typhus It is a stimulant, nervine & narcotic It allays the intense stinging heat of typh. gravior as infallibly as cauma is relieved by depletion & refrigerants. It promotes perspiration when defic. & restrains it when excessive It allays irritation jactitation pain & wakefull all in atonic diseases Excessive quantities produce vertigo, delirium or coma followed by languor headach. nausea vomiting & sometimes diarrhoea For diseases prod. by it vide alc. It is an undoubted fact that a free use of wine diminishes the susceptibility to diseases both entonic & atonic The power of wine in allaying irrit. sensibility increased freq. of puke restlessness watchf. pain etc. is the joint effect of its 3 powers Wine is not properly a tonic though it comes nearer the alc. to being one. White wines contain water, bi tart. pot. & colouring matter. Sweet wines contain sacch. mat. & ret wines, a little tannin. But these mixtures cannot be imitated by art. The properties of the factitious wines are those of their alcohol Hence I consider the active principle a distinct compd of the ponderable bases of prot or carburet hyd. & water in equal proportions, so that wine differs from alcohol as essentially as that from ether. I think it probable that hereafter it will be found that the active principle of alc & cider is 1 prot. carbur. hyd + 2 [illegible] But it is known the brewers add various narcotics to beer to make it more intoxicating 4th Stimulants Phosphorus This article stands next to alcohol in the quickness of its operation. Alcohol acts sooner than any other stimulant phosph. next & the cantharides, but neither of these two can be relied on as a quick stimulant in case of emergency. Ether (considered a stim. by Prof. T. in 18-1 & 1-2) capsicum, and the essential oils are sometime in operating Phosph. is I believe found in the veg. as well as in the min. kingdom. It is soluble in caustic alkalies with heat & probably unites with their metals, as it decomposes water It is not decided whether phosph. acts on the nervous syst. through the medium of the m.m. of the al. can. like ether or whether it acts on the bloodvessels like capsicum, cantharides, ammonia etc. Probably it acts in both ways It is said to be nervine & diaphoretic It cannot however be used as such Dr Ives give it in low stages of exhaustion etc. In mere torpor without exhaustion it is improper. Extreme irritability, though there may be ever so much exhaustion contraindicates it. It is only when the pat. is in a low state & the danger remote that it can be relied on & not at a sudden sinking a crisis, as yellow fever. When there is morbid irritability it is increased by phosph Dr Ives uses it when the action of the disease has worn out the sensibility of the system phosph. thus occasions a new supply of excitability & rouses the pat. in the article of death. This is contrary to the [Brunomia] theory but it is strictly true Dr I. thinks phosph. less favorable when there are topical affections. He thinks it excites appetite especially for animal food Swediaur thinks it aphrodisiac if so it would probably be from its stim. powers & in exhausted states of the system Phosph shd never be given in substance either in pill or emulsion as it wd occasion top. infl. Sulph. ether rectified by dry chloride of lime is said to be the best solvent zi will hold 6 grs of phosph. in sol. Soc. to my experience the fixed oils are the best solvent. Rx ol. oliv. purified & heat it with an excess of finely cut phos. Keep it well stopped. When used add a little spt. amm. to give it a creamy appearance & the pat. will not know that he is taking oil, at which most have a disgust. Sugar with ol. cinn. etc. makes it palatable Take it unmingled. A teaspoonful once in 3 hours is a dose of the saturated oil This was given in an extremely low case when a powerful dose was indispensible Continue this dose until the system is roused & then diminish & continue I have used it in no other than low cases. A small dose of a repeated is the only proper mode of exhibiting stimuli in low states of the system the lower the oftener Phosphorus if properly used is not dangerous & in low states of exhaustion we have no substitute for it Phosph. has been supposed to retain its medicinal powers in combination. This may be true of the binary compds [illegible] of its salts. Liquor of phosp. acid is used as a substitute for phosph. but that it has the same powers is I think more than doubtful It is formed by exposing phos. to the air, when it liquefies from the moisture in the air Sir H. Davy thought this substance a mixture of phosphoric & phosphorous acids Dr Ives’s dose is from 10-30 grs in water every 3 hours. I have not used it Particular forms of dyspep. attended with great torpor & insusceptibility & little irritation are relieved by phosph. In a form of dysp. with epigastric sinking lim. cordial or syncoptica of Good paroxysm every day sense of faintness distress at stomach, aggravated by exertion, both bodily and mental here phos. is of more use than any other remedy, unless alc. or opium which cannot be employed in chronic cases opium is not so dangerous but phosph. possesses superior power of relieving Limosis albicans (white jaundice) also lead colic with great exhaustion here ph. is the only remedy that will succeed Icterus melaena of Good occurring in broken down constitutions secretion of bile deficient differing from jaundice in being attended with exhaustion of digestive powers the skin is livid like a bruise yellowish green cases fro mthe south or intemperate persons. Common remedies do not good. Active stimulants must be conjoined with deobst capsic. or ph. with cal. or better corosive sublim. Malignant remittents & intermittents of trop. clim. & sometimes among us, & the low stages of all atonic fevers, malignant or not, when vit. energ. are low Delirium trem. Here phos. is a powerful auxiliary. In some cases opium alone will not succeed unless the vital energies are roused. Malignant continued fevers of all kinds whether with primary exhaustion or that produced by the disease Plague typh & anthrax involving the whole system Pneumonitis that kind which Good says will not bear emetics etc. In that kind of pneumonia confined to the lining membrane of the bronchiae with infl. like that of the intestines as dysentery Malignant rubelola & rosalia Atonic small pox Tabes var. dorsalis It has been partic. successful in T. venenata from lead merc. & arsenic Impotency certain cases of dropsy diabetes passive hemorrhage by Dr Ives Gangrena sphicelus & necrosis of Good Bad cases of land scurvy Spermorrhea atonica Agenesia in potens var. atonica thought to have especial power Poisonous effects of phosporus violent burning pain in stom. & intest. Alliaceous taste in the mouth obstructed respiration vomiting, hiccup extreme exhaustion Pulse very hard & small towards the close convulsions death. The stom. & intest. are inflamed & [sphicelated]. The infl. is erysip. not phlog which would spread to the other coats If called early give an em. of ipec. or sul. zinc If the phos. has passed down give cast. oil in wine glass doses with a drop of croton oil if necessary. Orfila recc. magnesia to neutralize the acid. I think the acids produced have no share in the mischief. Op shd be given sufficient to allay pain & spasm. No other remedy is needed. Antiphlog. rem. are injurious. Demulcents may be useful but not in quantities sufficient to produce distention Medical Jurisprudence Erithematic infl. of stomach pure phos. or ph. acid in al. canal no other mark decisive. If it has been given in oil, it will not be precipitated if in ether it will. The appearance of phosphorous [oxic] acids is not a proof of poison (or I think) for they are found in dyspepsia etc. & are an ingredient in the human body. Minute particles of phosph must be detested by the eye & by their white fumes, odor & luminousness. 5th Stimulants Arum triphyllum No synonym aroides (fuss.) Piperitae sinn. Possesses a peculiar acrid principle, volatile, inflammable dissipated by drying, air heat & even by pounding in a mortar It is not soluble in milk, oil, water, alcoh. vineg. I know of no solvent. Root contains ¼ part fecula This root produces a strong pricking sensation on the tongue & almost vesicates it Applied to the skin it vesicates In the stomach it produces heat, nausea a pricking sensation all over & spasms of the extremities are among its effects When dry it is inert like starch, but sometimes retains a little power The root is the only part used This root is an acrid excitant with no other power It is an expectorant & diaphoretic by virtue of its stimulant power & when dry it is demulcent & nutritious Externally it is discutient, but rarely used It is allied to capsicum in its powers. Medium dose 10-30 grs If recent 10 grs [illegible] sufficient, repeated once in 2 3, 6 hours. For an emulsion, best in a mortar with milk or sugar. Barton directs a confection by boiling, which destroys the power For extern. appl Beat with irritant or apply alone It is rubefac. & vesic. To keep it with unimpaired strength lay it in sand It is inferior to capsicum Milk, mucilage or oil most conveniently allay its effects Diseases It is put into a decayed tooth Ptyalism as in epilepsy Dysphagia from spams & that from semi [illegible] of muscles of [degl??] It is given with success in flatulent colic Other species of arum have the same properties in different degrees, as A. dracontium calla palustris less active than arum but similar Lecontia Virginica The strongest of all the arrideae acrid & mucilaginous. Arum maculatum is the off. spec. in [Eu???] Ictodes feticus Formerly called arum Americanum (Catesby) calla aquatilis (Gronov.) Dracontium fetidum lim.) posthes pectorii (B.S. Bart.) P. foetidum Lymplocorpus foetid (Salist.) Spathic [illegible] foetidum ([Rafines]) Ictodes foetidus (Bigel.) Every part has a fetid odour, depending on a volatile princ. probably a volatile oil, but it has never been separated. It is more permanent than the active princ. of A. triphyl. It has resinous & mucilaginous [illegible] its acrid & odorous properties. The seeds have an animal odor & contain a fixed oil The root and seeds are the parts used but the seeds are preferable. They retain their vital principle for years & their medical virtue as long. The root loses its strength by drying This plant is a powerful excitant like arum. It acts on the alim. canal & does not affect the circulating system immediately. It is a nervine like asafoetida. Very large doses occasion vomiting, headache vertigo & sometimes a temporary blindness It is probably not a narcotic Of the dry root 10-20-30 grs every 2-4-6 hours may be given. It may be formed into a confection or better, may may be taken in molasses & water Dry it whole & exclude the light It is doubtful whether the leaves are any better than cabbage leaves, but they have no offensive smell as cabbage has after topical application Uses & applications similar to arum maculatum It is not so powerful but it is better in flatulent colic than arum as it is nervine Dyspnea exacerbans It has more reputation in this than in any other disease Repeat it every 10 min. until it produces vomiting or relief. The vomiting itself is often of service To prevent the recurrence give 4 doses a day Dyspnoea seems to arise from paresis of the gastric branch of the par vagum & is relieved by Galvanism chronic rheumatism by a continued use like guaiacum & capsicum Convulsions particularly hysteria Paramenia cessations Dr I. recc. the limb in phleg. doleris to be wrapped in the leaves all over (as a smooth app.) Acorus Calamus [Odor] like a mixture of cinn. & pimento improved by drying. Essential oil can be obtained. The bitter principle is extracted by water It is an acrid aromatic excitant, with some tonic properties It is not inferior to cinn. & nutmeg in substance & oil. The dry powdered root is an excellent errhine IT is used for economy where cinn. & nutmeg cannot be afforded & were it as dear would probably be as much esteemed. Essential Oils These are 1 Pure stimulants 2. The milder oils as ol. anisi, a pure nervine 3d nervine & narcotic or stimulant & narcotic The terebinthinate oils are stim. & deobstruent Articles containing the oil are often used in a crude state, if it is in abundance e.g. cinnamon cloves Monarda Punctata (Wills.) The most acrid & pungent of the essential oils It flavor resembles that of thymus or satureja It is an elegant & pure aromatic & stim. Extrem. It is one of the best veg. or rubef. & vesic. For intern. use make a spt. rx f zi oil to 7 of off. alc. ( I make the spts ppermint in the same proportion) It is very good to cover the taste of unpleasant articles. So oil cinn. The oil cannot be taken pure, even on sugar For a [linin]. Rx ol. mon zfs tinct camph. zii & tinct. opii zii Probably the spt. monard. wd be as good for a rubef. Ol. monarda with ol. oliv. remains more fixed but is not so powerful The oil was introduced by Dr Atlee of Phil Ol mon. is more vesicating than ol. capsic. & less so than ol cantharides The other monardae are much less active Therap. applic. Typhus with cool skin & cold extremities use the linim. on the arms legs & breast (Eberle & Alee) to restore heat. Brandy would only evaporate & increase the coldness Cholera infantum (an enteritis) to the abdomen & extremities (Eberle) Chronic rheumatism internally & extern. peculiarly adapted partial palsy hemiplegia & [paraplegia] Tooth ache I have used the oil when the nerve is exposed apply it on cotton to the cavity of the tooth & around the adjacent parts or it may relieve by ext. app. ol. capsic. is best ol. mon. next. Mondarda oblongata Less active than m. punct. but nearly equal. The infus. is useful in the atonic stage of fevers. The weak infus. is quite effectual in the forming stage of the atonic febrile disease Monarda didyma (Banks) & monarda kalmiana ([Pursh]) These are used for nearly the same diseases as m. punctata & probably differ only in degree of power. M. kal. was first discovd at Oswego & called m. didyma Pursh gave this name to a southern species. Both are probably varieties. At least the “oswego tea” has the best claim to the name. The different spec. of mon. ether contain a less active ss. opil or a less quantity of the same oil. I know not which probably the latter. If so the same oil might be distilled from each Probably m. oblongata would furnish a large quantity Monarda fistulosa Common in N. England & has been cultivated in Europe for the oil It is the origanum spurium of old writers. 6th Stimulants Capsicum C. grossum squash pepper is the spec. almost exclusively cultivated amongst as C. annuum is mentioned in the books as being the off. article but is far less common. The [pericarps] of C. grossum contain 1 an essential oil (called etherial by the French) which is not volatile at all, and the case also with that of piper nigrum. It is obtained by digesting the pericarps in ether for a fortnight expressing filtering & evaporating the ether. We obtain the oil & crystal of capsicine the scent of ether still remaining which perhaps might be driven off by heat. The oil thus obtained & is of a brilliant red colour aromatic in odor, pungent & warm to the taste It cannot be distilled without decomposition. It contains all the medicinal virtues of capsicum. I have for years used it as a substitute 2 Capsicine white acicular crystals without odor or taste neither acid nor alkaline. AT the 1st crystallization they are combined with some of the oil & were hance supposed to be the active principle & sold at a high price. By repeated crystallization they are purified and then have neither sensible nor medicinal properties. The same mistake was made with regard to piperine which we always see yellow from the oil, but when pure is quite tasteless & inert 3. Red colouring matter which it is difficult to separate from the oil 4. A substance not investigated containing nitrogen 5 Mucilage 6. Various salts especially nit. potassa For excessive doses of ol. caps. demulcents of opium are the proper remedies Dose of ol. cap ¼ gtt or 1/8 gtt sometime 1 [illegible] or more Of the substance 12 grs is a very large dose in our climate but more is given in the W. Indies. If we wish for the effect on the stomach only, and not on the mouth & fauces the tinct. shd be given in milk. Mix & swallow immediately & it is not tasted Pat. do not generally complain of the taste in acute disease though they may in dyspepsia etc. Nor do they in low cases of typhus & cholera. When there is very great burning in the mouth & fauces this article cools more than any thing else The vinegar of caps. is not so good in irritated states of the stomach or in the low stages of fevers but it is the best form for affections of the fauces in rubeola & rosalia Cataplasms may be made of the powder & flour & vinegar. Or the caps. may be sprinkled on a paste. If a very speedy effect is desired a paste may be made with pure powder of caps. & hot spirit As a rubefacient it excites an action sui generis & often excites one when other things fail. There is room for selection in rubefacients In many cases tart. em. is bad & caps. good & v.v. So of other rubef. Therap. applic. Rheumatic toothache The tooth is often carious if on the lower jaw drop it in the oil if on the upper moisten lint, or rub up the oil with sulph. morph & dip lint in Chronic ptyalism often symptomatic of paralysis or of epilepsy & chorea gargle the mouth with the tinct. or the dilut. essence Dysphagia atonica often a more part of general palsy but it exists sometimes independently & is then curable by capsic. Dysphagia spasmodica Limosis dyspepsia in cases attended with torpor & insusceptibility, with much flatulence & freq. reject. of food. Capsic. alone or conjoined with food, or with eccoprotics, deobstruents & tonics will cure In cases of cold extremities rub them with the diluted oil till it produces a glow more or less permanent & so as to be slightly rubefac. if the powder on cotton is used it shd be very fine, for if as coarse as we have it for the table it will produce very little effect. It is used externally on this disease as a stimulant to the epigastrium either the powd. or the ess. oil Incorporate it with a spatula with La & Butler’s (which is the best it will spread cold) adhesive plaster common pl. is too hard Limosis syncoptica a valuable adjuvant shd be given in form of tinc. or oil as more speedy Limosis albicans (“white jaundice” no jaundice at all) highly useful auxiliary to [xanthortia], percholr. narc. & opium Dr Reed of E. Wind. who uses caps. extensively recc. it in all kinds of diesth. attended with viscid secretions from the liver to check the secret. in quantity & change them in quality Colic I prefer rubefac. to blisters in their action can be kept up in the 2nd stages it is important as an auxiliary Colica rhechialgia Capsicum counteracts the sedative effects of mineral poisons particularly of lead. Lead does not always produce colic, sometimes marasmus & sometimes paralysis, without being preceeded by colic The proper remedies for all these effects are acrids & particularly capsicum Colica cibaria of Good from poisonous fish mushrooms etc. (as often however a cholera or diarrhoea as colica). The tropical practitioners depend altogether upon the acrids & say it is no matter whether the offending substance is evacuated or not I prefer evacuating if pat. is not sunk too low. It is important to know that evac. is not indispensable in such cases we may enter at once upon the acrids as capsicum with confidence of success If called early I would evacuate the al. canal & sometimes this is all that is required if not give acrids. The effects of pois fish & pois mushrooms are very similar, being in both cases speedy & direct (sometimes very rapid) exhaustion. Some persons are more affected than others the reason is inexplicable. Those of warm climates are more susceptible than of cold Colica flatulenta Coprostasis costiveness attended with torpor & atony, apparently local cases where refrig. salts have been taken till an enormous quant. is necess to operate & then with small effect. The simple acrids such as are not cathartic will often give complete relief in some cases as much capsic. as can be taken with the food has answered the purpose. I know of no certain diagnostics in these cases. The subjects are generally feeble & no harm can result from trying caps. Caps. also enhances the effect of tonic & astring. cath. as rhubarb Diarrhoea, pure or idiopathic in the secondary stage caps. can be relied on alone shd not depend on it in the 1st It is particularly adapted to 2d stag attended with excessive & morbid secretions & relaxation it restrains and changes these secretions. Cholera when the vital energies are exhausted & there is great irritability of the stomach etc. caps. will often check it vomiting when opium will be rejected The phys. is not often called in the forming stage, before the vom. & purg. has commenced, at which time some other remedy might be preferred Cholera flatulenta great flatulence & copious rejection of air, without vomiting or diarrh. Here caps. alone is sufficient & opium is unnecessary Parabysma coactum useful auxiliary to conium & perchloride of merc. Parabysma strumosa Strumous diseases always require more stimulants [illegible] stimulants Idiopathic cough from relaxation Dyspnea exacerbas & asthma humidum in the 2nd stages & attended with relaxation & excessive secretion Passive hemorrhages capsic. is a popular remedy and often prescribed successfully by physicians Erythema of the membranes of the brain Perhaps the W.I. practice of shaving the head & applying rubefac. of caps. in delirium would be useful. I know not that it has been tried Paristhmitis erythematica independent of Rosalia. The original recipe was 2 tab spf of capsic. 2 teasp. of fine salt ½ pt. boiling water when cool strain add 1/3 pt vinegar dose a tabl. sp. every half hour. This would very well in moderate cases. The lowest & most severe wd do better without the salt & vinegar Apostematous Phtisis after the formation & bursting of a vomica capsicum restrains the purulent secretion, sustains the pat. & prevents sinking Dyspeptic Phthisis Erythematic visceral phlogotica are not generally recognized & described in the books except enteritis & gastritis eyth. infl. has a great tendency to spread, throughout the membrane which it affects Erythematic Enteritis attended from the first with diarrhoea & with vomiting if the stom. is affected. At the outset give calomel freely with opium conium & often sulph. quinine capsicum is useful externally. Capsicum is useful in all the stages of genuine & malignant erythematic phlogotica & in the secondary stages of phlegmonoid eryth. phlogotica Sparganosis [illegible] in cases supervening upon excessive hemorr. & attended with a low & exhausted state very useful here often as a principal remedy & always as an auxiliary. It is not proper in cases occurring after a long period & in the more vigorous & robust gout (regular) in all low cases Podagra larvata of Good improperly called by Cullen atonic gout for all cases are atonic Case of Dr Cooley violent paroxysm in his feet he applied some sort of poultice & in twelve hours it wen to his stomach. Dr Todd & myself were called we gave ammoniated alcohol, amm. tinct. guaiac. alcoh. opium etc. apparently with little benefit got no relief & was in a dangerous situation Dr Reed of E. Winds. entered on a free use of caps. internally with speedy relief. I have known other cases Rheumatism secondary stages of all ordinary atonic acute & all stages of erythematic atonic acute rheum. Eberle is too vague Rosalia maligna Rubeola maligna Malignant small pox whether confluent or not (all malign. cases are not confl.) Cases may clearly be of distinct small p. & yet require the most vigorous stimulation Purely passive hemorrh. & perhaps irritative Marasmus Tabes var. strumosa, var. venenata, from min. poisons & var. libidinosa Cyrtosis Rhachia All the strumous phlogotica & strumous affections of the glands of the neck Porphyra hemorrhagica It is second only to ac. lead I commence with lead & continue it till the hemorrh. is stayed usually from 3 days to a week. Then I omit the lead & substitute the sulph. quine. I accompany the lead from the first with caps. & brandy. The success of this practice bears no comparison with that in the books Gangrene all the species Insanity several species is to be treated most successfully by tonics acrids & deobstruents. This is the way in the Conn. Hospital & the prop. of cases cured is greater than in any other institution Melancholia acrid most useful Hypochondriasis Chorea good auxiliary Syncope in persons habitually subject, occurring from slight causes or spontaneously 2 or 3 hours a week for 6 mo. in such cases I have given various remedies both as prophlylactics & to bring pat. out of the syncope have found nothing equal to capsic. for both purposes. She could tell when the paroxysm was coming on & zi of tinct caps. would prevent it Carus lethargus It has considerable reputation with Dr Wright of Jamaica Paralysis not depending on organic affections Cantharis pellitory capsic. & guaiacum are the best caps. one of the best. Paramenia retentionis & [obstructionis] when attended with atony as P. retentionis always is The acrids, deobstruents & tonics, are the proper remedies. P. obstructionis may arise from imprudent exposure to cold & in such a case capsic. is not proper P. superflua Leucorrhea communis & [illegible] Dr Reed of E. W. values it more highly than any other article. I prefer cantheris unless the pat. is unable to take a suffic. quant. without troublesome strangury capsic is next. Nit. silver shd accompany the acrids (localls)? & local means shd also be employed Hemorrhea Senodes I have repeatedly cured at the outsed, freely & rapidly employed Cubebs which is similar is rather more certain to cure but it is not so readily taken Spermorrhea atonica Chlorosis inops Hydrops Thoracis & cellularis a valuable acjuvant to diuretics & tonics. We must first evacuate the water & then tonics & acrids will cure, if idiopathic Empresma abdominis (Tympanitis) from diarrhoea or catharsis in typhus & colic Capsic. very useful Paruria mellita externally as a rubef. & intern. as an adjuvant Capsic. is felt in the urinary org. & is smelt in the urine Paruria in continuous var. atonica Considerable reliance can be placed upon the acrids both internally & externally Capsicum is always contraindicated in phlogistic diseases, even after depletion when cantharis might be used Forms of administration 1st Pill essential oil in bread or in substance grs ii to a pill The dose of the oil cannot be definitely given Be guided by the nature of the case & trial Substance 1 – 4 – 12 grs as much as can be borne every 1-2 hours. Some give more, even as high as 30 grs this wd be rejected Pharmac. Preparations Tincture in the best. I usually make it with zii caps. to 1 pt dil. acl. Dose 10 gtt f zi Vinegar & water will rinse the taste from the mouth Acetum caps. is a good prep. prepared as the tinct. Dose the same Infusion zii to zi to 1 pg. water If it is to be sweetened, use honey Externally the U.S. Ph, directs canth. z10 caps zi alc. 1 pt. This prep aration might be taken internally too., 8th Stimulants Alkaline Ammonia Unknown to the ancients solution & carb. discovered by the alchymists Aq. amm. shd be well stopped with a ground glass stopper as it absorbs carb. ac. from the air. Much of that in the shops is worthless The alcoholic sol. is called spt. of amm. Internally they are purely stim. & acrid They act principally on the m.m. of al. can. but at length cause a rapidly & transient in crease of the force of the circulation, if repeated at short intervals The water & spiritous preparations differ As it is unpleasant it is rarely taken for any length of time I have never seen any nervine effects from it, wakefulness & exhilaration. It does sometimes relieve morbid irritability & irritation. So does pure stimulants in exhaustion I never saw it diaphoretic except by virtue of its stimulant operation It is discutient, topically applied not resolvent, internally It is antacid neutralizing a large quantity of acid & also preventing its formation by its acrid stim. effects thus obviating the morbid condition Dose of qa. or spts f zfs – f zi If it is to be often repeated, dilute with milk & it is taken much more readily water when a strong impres. is wanted It is rubevac.vesic. & caustic applied weak for a short time it merely reddens if strong an eschar is produced. Most generally applied in liniment with ol. oliv. this is best. When applied pure, flannel will prevent its evaporating. But linim. is better, which shd be of various strength & made of aq. amm. Taken in excess it prod. aton. uinfl. of stom. & int. The infl. is eryth. like that from acids or hot water & in both cases, the less fever the more danger. Eryth. infl of m.m. is more atom. more dangerous & more diff.to cure, than of skin In the worst case of an excess. dose, there was no pain, great exhaustion as in severe scales great stupor, pulse wiry & freq. & weak, skin cool. If the dose is not so great there will be a burning pain at the stomach afterwards retching & vom. perhaps tympanitis & sometimes fever. The more pain, the more hope of saving the patient [Orfil] recc. diluted vineger in large quantities to neutralize but after a few moments the mischief is done. It may however be given in smaller quantities, even an hour or two after to prevent further mischief. V.S. & antiphlogistication will do not good & be as improper as in burns & scalds. The topical eff. requires demulc. & antim. the general, opiates. Demulc. shd be in such moder. quant. as not to prod. stim. of distent. Opium frequently is best give by enema, but this depends on circumstances Therapeutics application Colic diff forms as a rebef. & vesic. Phlegm. infl. as apostema communis & common phlegmon early stages Effects a resolution when the infl. wd otherwise grow to suppur. Infl. of fauces early stages of phleg. & all stages of eryth. to the fauces & externally Inf. of female breasts said to cure if applied early, sufficiently & properly These infl. are diseased with more certainty then most others & are more troublesome if neglected Chronic Rheumatism when perman. & fixed topically Palpitatio from functional derangement of the nerves & dig. org. & not structural or organic as a rubef. to the thorax it is an effectual applic. Carus Asphyxia several varieties. C. paralyis not structural topically & externally Idiopath. vertigo [illegible] vertigo of Good Sick headache inter. & exten. gives speedy present relief Syncope from aff. of mind in universal use Common & hysterical convulsions also To do any thing with it in sick headache zi shd be taken freely & early better in nervous and highly irritable temperament. IN such patients the head ache depends more on the state of the nerves than of stom. Paramenia obstruct. highly recc. in milk thrown into vagina strong enough to prod. a sensation So too in Leucorrhea communis & senescention about the catamine period Bits & stings every effectual, but alc. & capsic. are more so. There is not a case on record, where alc. was sufficiently employed that was not cured. Dr John Osborn of N.Y. who had practised at the south said that when called he knew not what to do till the bystanders told him. He found amm. invariably successful & when summoned sent amm. without going himself Yet alcoh. is better. It is well known that a drunken man never suffers from a bite Scalds & burns If applied before vesication it will prevent it after vesic. it is bad. It shd be applied only till smarting & pain cease or it will vesicate. But it is again useful if a bad ulcer is produced & especially if there is danger of gangrene. It is prod as a favorable & speedy separation of the slough Aq. comm. shd be kept in in all vials of not over zviii for it is injured every time it is opened For a liniment equal quantities of aq. amm. & ol. oliv. will be too strong for the best amm. & weak for the common. Skip the next page This page to be read after the next a tea sp. f. is a medium dose, moisten it a little with water or any fluid not acid & it will be readily taken. It is useful in atonic febrile diseases. It is better than Dover’s powders Formulae shd be varied acc. to circumstances The following may be useful Rx sesq. car. am. zfs syr. orange peel zfs aq. menth. vir. zviii Take zfs every ;2-3 hours (Paris) Rx Ser. car. amm zi syr. alk. off. f zviii, or orange syrup not acid Dose zfs 2-3 hours 10 grs sesq. car. amm. (Richie) Rx Ses. cer. amm. arom. conf. aa grs v pulv. canthar. gr f simple syrup q.s. Take a bolus every 6 hours (Paris) The intervals are too long The canth. is the most active article Rx s. c. amm. grs v ext. rhei grs viii fl pil. 2 To be taken soon after making (Paris) Eccoprotic & antacid for dyspepsia Dr Ives uses the following It is much weaker than Paris’s & Paris’s, than the other Rx s. c. a. zii camph. [illegible] gum arab. zii water 1 pt. The water must not be boiling hot Sesqui-Carbonate of Ammonia Boiling water volatilizes it By keeping the carb. changes into a bi-carb. losing its odor & partly its taste, but not its alkaline properties It is a stimulant but less powerful than the alkaline amm. It can be better taken however. It is inferior to the carbonate but super to the bi-carbon Sd to be nervine & diaphoretic probably so from its stimulant power IT is an antacid, but inferior to the bicarb. Dose 6-20 grs in solut. or pill Its uses are more extensive from the greater facility of giving it & its supposed additional powers. Sesq. carb. am. camph & chalk, eq. parts powdered separately & well rubbed together is one of the best form & adapted to most cases. Stop it well & exclude the light or the camphor will be crystallized. The chalk keeps the camphor & carb. am. from concreting into small masses & also covers the taste. This mixture is stimulant narcotic nervine diaphoretic and antacid Turn to the page [prece??] or it will volatilize the amm. Dose zfs – zii every 2 hours Some of the late English writers recc. sesq. carb. amm. in 2-3 gr doses as a specific in rosalia & paristhmitis It is a good remedy in moderate cases. They use it much in convulsions of children & it is considerable used for dyspepsia Dr Woodwd of Vt. used it in in dyspepsia with camph. & chalk & some acrids as capsicum & prickly ash & also with gentian, etc. Intermittents It is much used, particularly at the commencement Used to in typhus IN common epidemic catarrh gout & atonic acute rheumatism hemicrania & sick headache. Also employed with considerable success in after pains of puerperal women & when used moderately it does good, but it only accomplishes in a few days what opium would do in the same number of hours. Cathartics Cathartics Refrigerant Cathartics Sulphate of Potassa Hiatus This has been called an aperient by Duncan in doses of [illegible] to zfs & cathartic in zv. It cannot be managed as an aperient in Dr Tully’s sense of the term Hiatus It is purgative cannot be managed as a laxative nor as an eccoprotic neither as a drastic It is a hydrogoge but not sufficiently so for dropsy. Elaterium is better It operates on the whole al. canal but rather more in the upper part It is kind in its operation & leeves the al. can. in a good state It is a rapid cathartic. It is not appropriate to produce a shock or strong impression Its other operations are refrig. said to be diuretic do not think so Hooper says it is deobstruent. I know not upon what ground. It cannot be so independent of the evacuation Medium cathartic dose is zi as a refrig. from zfs to zi once in 2 or 3 hours Diseases Cauma & all the caumatoid phlogotica of course contraindicated in low atonic fever It is appropriate in any phlegmonous infl. Hooper says coprostasis this is an atonic state of the system & therefore this article cannot be indicated there is torpor of the liver & this does not act on the liver H. says too that it is good in jaundice The same rule applies here He says too in suppression of the lochia. There is no such idiopathic disease if the suppression is attended with infl. of the uterus sul. phot. may be indicated He says dropsy too but as there is no entonic diathesis, it is not indicated Sulphate of Magnesia Hiatus Duncan says it is a mild purgative. This is applicable to all the salts of which I shall treat It is said to be diaphoretic not directly so, but by virtue of its evacuating operation. Not much diuretic Duncan says it will relieve pain in colic. It will do so only in entonic diathesis, but colic is not entonic It is cathartic in the same degree & in the same way as the two preceding salts (sulph. pot. & soda?) Disease & rules of application are the same also Phosphate of Soda Sal perlatum of the old books It is similar in its effects to the other salts & requires very little if any more to a dose It is better managed as an eccoprotic & laxative than the others It is not quite as refrig. as the pre ceding, but all its other peculiarities are the same as to time, mode etc. Med. canth. dose zi – zfs Swedinaur recc. in struma & do not think it appropriate Tartrate of Potassa Elixir tartrata kuli tartras kalitartarisatum pot. tartarizata alkali vegetabile tartras tartras solubile or soluble tartar is the common name of the shops It has the same effect as the others I do not think it can be distinguished from them. I have found no article but the antirritant narcotic that wd qualify its operation so as to prevent [tarmina] Tartrate of Potassa & Soda Soda tartarizatum sal polycrestum sal seignetti, Kali & sodae tartras tartrite of p. etc. It was introduced by an apothecary of the name of Seignetti I know of no difference between it & the others it is applicable to the same uses Bi-Tartrate of Potassa Hiatus Duncan says from zfs to zi is a medium dose for a cathartic It is far more diuretic than the others yet not sufficiently so for dropsy It is of no more benefit in schirrus or dropsy from schirrus than any other deobstruent It is purgative cannot be managed as a laxative is more hydragogue than any of the others quick in its operation not so kind It is peculiarly liable to derange the al. canal. None of the other salts can be said to be irritating. This is considerably so consequently it is better adapted to produce a shock or strong impression. It is more refrig. than the others Medium dose, from 10 – 60 grs once in 3 hours 60 grs once in 3 hours will purge pretty thoroughly And 10 grs in the form of pulvis jalapae composita Rx powder of jalap one part bitartrate of pot. two parts ground together to an impalpable powder. This pulv. jal. com. is recc. as a refrig. & used to be the common hydragogue when phlogistic diathesis prevailed. It is even now retained by some phys. & is Dr Hosacks hobby he gives no other The b-tart. pot. is adapted to the same diseases as the others except that it is better in dropsy being more hydrag. & diuretic. Dyspepsia recc. by Jas Johnsn of course contraindicated he gives it in a dec. of dandelion Colic-recc. coprostasis not good Proctics marisca & bleeding from hemorrhoidal vessels It increases the irritation Oxide of Magnesium This name has been applied to the factitious carb. mag. magnesia alba M. usta calcined mag. has been applied to both ¾ of the “calcd mag.” sold in the shops is nothing more than the carbonate Its purity can be tried, by its not efferv. with a strong acid It is eccoprotic, or at most laxative & antacid Diseases cardialygia spasms convulsions tormina & other diseases produced by acids in the al. can. Swed. recc. in coprostasis Ricketts. Suppressed leucorrhea accompanied with torpid bowels Gout supposed to be peculiarly adapted small doses continued for a long time were thought to remove the gouty diathesis lithia gravel independent It is not [illegible] Medium dose 10-30 gras 3-6 times a day. One circumstance shd be attened to. It diminishes the appetite chance where the case is atonic & there is a want of appetite, it shd not be given The salts of oxide of magnesium, in appropriate cases, as phlogistic ones are kind in their operation & leave the al. can. in a good state. They make but little impression on the system & therefore are not serviceable in giving a shock Med. dose zfs – zi in solution indeed you may say zi is a med. dose. Better in solution than in substance In highly phlog. diseases it is proper to add nit. potassas or tart. antimony to increase the refrig. effect. When a cath. Is not wanted the dose as refrig. is about the same, but nit. potassa & tart ant. are better Diseases Cauma entonic phlegm. phlogotica They are sometimes applicable in diseases not exactly entonic nor atonic 2d Cathartic Factitious Carb. Magnesia mag. sub. carb. magnesia alba mag. aeratii It is soluble in water Eccoprotic & laxative may be so managed as to prove both Not purgative nor drastic under ordinary circumstances. A. T. Thomps. says it is not laxative unless it meets with acids in the stomach It is copragogue. It acts on the whole track of the al. canal. It is slow & kind & generally leaves the canal in a good state. It is antacid Cath. dose 10-30 grs several times a day Diseases Limosis cardialgia Coprostasis some cases such as do not require large doses of medicine By means of this article more carb. acid might be generated in the stomach than in any other way. But I do not approve of the great use of this acid. Mildest cathartics Manna From the Ornus rotundifolium It has been said from the fraximus rotundif. Same not. group with the olive oleaceae It is the concrete exuded juice, obtained from the descending sap by slits cut in the bark The juice is of a white frothy appearance Taste slightly nauseous The best calubrian manna comes in long light friable pieces transparent pieces. The inferior kind is moist unctuous & dark coloured Fourcroy says it consist of four principles 1. Pure manna ¾ of which is called mannite 2. a little common sugar 3. a yellow substance of a nauseous smell 4. mucilage E. & Var. call it a mild purgative Murray, a laxative It is eccoprotic & laxative It is given to children, but is unimportant for adults. The older it is, the more purgative Dose for adults zi – ziii in water milk & water or better in milk Cathartocarpus fistula Native of E. & W. Ind. but cultivated in the warmer parts of the U.S. Commonly called “Locust & wild honey” The pulp of the loment is the part used. It has a black colour & a sweetish taste. It is said to be a good cathartic when taken fresh from the pod It occasionally gripes & produces flatulence It is given for children Eccoprotic at the most laxative Copragogue Acts on the upper & middle part of the intestines. It is kind unless the patient is predisposed to tormina pains etc. Medium dose for an adult zfs - zj Rosa Damascena Damask rose Native of the south of Europe The petals are used. They are given in infusion & are a highly popular laxative for children They are made into a confection also & said to be good in habitual costiveness given in the dose of a table s. f. Laxative is moderate quantities Purgative in larger The quantity for an infusion is zii of dried petals Rosa Gallica rerubra red rose This is similar in operation to the damask Linum catharticum The whole plant possesses cathartic powers Operations Purgative difficult to manage or as a laxative or eccoprotic Its natural operation in hydragogue acts on the middle part of the canal Takes a medium time for operating rather unkind leaves the bowels in an irritable state Dose for an adult is a “handful” infused in ½ pt of boiling water or zi in substance Infusion say zii to ziv or zvi of water Cassia Lanceolata Senna There has been much dispute about the species of cassia which is the true off. senna but it is undoubtedly the c. lanceloata. This is the tone off. or Alexandrian senna, but it comes adulterate with other species & other plants the cynanchum oleifolium is found among it All the species probably possess cath. powers but in a less degree. The term senn has no specific applic. It is applied as “ipecac” is applied to any emetic article That senna is best whose leaves appear bright, fresh, free from spots, strongly scented, bitterish & nauseous, smooth & soft to the feel, sharp pointed, free from stalks & legumes Senna contains a peculiar priinciple calle sennine (cathartine?) Operations It is purgative not eccoprotic or laxative. It is more or less hydragogue the moderate its operation the more fecal the matter discharged. It acts on the colon. It takes a medium time for its operation about 4-6 hours after being taken Dose of the confection zi – zii ]of the infusion 1 troy oz. will saturate a pt. of water add some aromatics to disguise the taste This is a bad cathartic being hydragogue & apt to occasion griping etc. “Any other is better” Prof. T. has discontinued its use Poinchiania pulcherrima Cassis orientalis senna spuria pride of Barbadoes etc. Nat. ord. [leguminosa] Cultivated as an ornamental shrub The leaves flowers & seed are the parts used The leaves are the strongest & the flowers next both used in decoction The seeds are best powerful & are used in powder I to a dose This plant has considerable reputation as an emmanagogue. It is but little known with us. Aloes That for a variety of species is found in the shops. There is the aloe spicata from the Cape of Good Hope & the annibellata from the same place the former is now considred the best. There is also a ferox of [illegible]? A. socotrina & A. vulgaris of [Persova]? The greatest part of the aloes in the shops is from the A. vulgaris of Barbadoes The appellation socotrine applied to aloes means nothing more than that they are of a good quality. The apothecaries in recommending their aloes will tell you they are the socotrine aloe The best aloes are an extract made by a cut in the shrub from which the sap exudes. This has at first a sweetish taste & soon after a intensely bitter one. IT has not the glassy appearance of the poorer kind Another mode of obtaining aloes is by inspissating the juice of the plant. This is nearly as good as the exuded sap there is not much difference A third way is by decoction 3d Cathartic about 1 lb of the plant to 8 pints of water boiled down & strained. This has not the sweetish taste at first perceived in that obtained by exudation The properties. A. T. Thomps. says of this best kin A. spicata are odor rather pleasant taste sweetish at first, & very bitter soon after powder of a bright yellow & aromatic smell 2d quality very disagreeable taste intensely bitter but not differing materially in med. qualities from the 1st 3d quality of a dark brown colour, hard & friable There has been no true analysis of aloes. The old one in the books is still retained but I do not esteem it correct. Operations cathartic heating & irritating Emmenagogue per se Dr Ives thinks it is manageable as an eccoprotic & laxative & that it operates more kindly when taken with food. The latter is probably true & it is the case with many other medicines e.g. diffusible stimulants Dr Ives thinks aloes have no direct tonic effect, but an indirect one He thinks they act on the liver promoting gradually the secretion of bile. HE thinks it moderately deobstruent but I do not use the word deobst. in this sense i.e. an article affecting one gland only, the liver for instance To say that aloes acts on the [portal] system is merely saying that it acts on the liver Dr Ives thinks aloes are emmenagogue, independent of their purgative effect. They undoubtedly are so. He thinks that tho’ they irritate the kidneys & bladder & color the urine yet no increase of urine is produced Aloes are a purgative, but may be easily managed so as to prove eccoprotic & laxative. In large doses they made to act drastically They are slow in their operation from 12-24 hours The discharges are purely fecal hence they are copragogue They act on the lower part of the bowels (i.e. they act principally on that part for all cath. act on the whole canal more or less) Their operation is appropriate doses & cases in kind though if given inappropriately they irritate. Appropriately given, they leave the al. canal in a good condition In eccoprotic & laxative doses they make but little impression in full doses a strong one Next after their purgative effect aloes are emmenagogue They are said to be sub-tonic I presume indirectly so Said to be anthelmintic probably more so than most cathartics Dr. A. T. Thomps. says they are not beneficial in hemorrhoidal affections But Drs Tully & S.B. Woodd have given them with good effect in such cases. As a general rule however I would not use them in a peculiarly irritable state of the intestines though even in such cases I have cured better than with any other article. This form of piles alluded to is proctica marisca Aloes combined with about a medium dose of opium are thought to counteract the effect of the use of opium. This combination is very useful when costiveness has resulted from a continued use of opium, but you will find after a while that less of aloes will be necessary. I have made the combination in the following proportion viz. 1 part of opium to 4 of aloes It is the common practice to give a cathartic pill when a practitioner does not wish to give calomel, and aloes with gamboge & soap or some other extract is a common pill. When such a pill is wanted I have used Rx aloes grs ii gamboge gr I oil tigl. gtt ¼ soap q.s. ft 1 pill. Sometimes but ½ a pill will be necessary according to the state of the al. canal & the habit of the pat. If the patient is in the habit of using opium or has taken it for some time 2 pills may be required I do not consider aloes good at the commencement of acute diseases. When a cathartic is wanted at the commencement of a disease to break it up I would not give aloes If you wish merely to evacuate feces or to produce an eccoprotic or laxative effect in the secondary stages of a dis. aloes are good in certain doses Diseases It is difficult to specify them Swediaur says dyspepsia with great torpor Pyrosis when bowels are torpid Habitual costiveness here they are also good applied externally Ulcers with a gangrenous tendency extern.? Cases of continued discharges from the ear a solution of aloes injected The dose varies according to the susceptibility of the patient From 1-2 to 4 grs may be given as a laxative or [illegible] in the 24 hours As a purgative about 5 grs may be required There are a great variety of phar. prep. Convallaria [Maialis] I have seen it in the meadows of Middletown tho’ it is considered not indigenous with us The root & flowers are considered the medicinal parts. The extract of the root possesses some of the medicinal properties of aloes tho’ a little weaker. It acts on the rectum & I presume it would prove emmenagogue in the same way The dose as a purgative is said to be [illegible] or zi probably a smaller dose would operate if given over night The dried root pulverised is a [sternutatory] & so are the flowers The flowers when fresh are fragrant but not so when dry I do not know much of this article Polygala polygama A specimen from which the bracts had fallen off was sent to [Willdenow] & he supposed it a new species & called it P. rubella. IT is called here “low centaury” but in the middle states the name is given to hypericum parviflorum sabbatia angularis too is called centaury The English centaury is ergthraca? centaureum nat. ord. Every part of the plant is entirely bitter the leaves more so & the root most of all. It very much resembles aloes in tasting medicinal powers It is an efficient cathartic the natural operation in an appropriate dose being copragogue the discharges consisting entirely [offices]. In large quantities it may be made hydragogue It is slow the natural operation taking place in 12-24 hours It aggravates practica marisca & in great doses produces that disease. Otherwise it is kind in its operation The impression is makes is moderate It may be considered tonic also anthelmintic. It is decidedly emmenagogue It has been supposed to be diuretic but I never could discover this effect. Prof. Ives says it increases the secretions generally If so it is a deobstruent It has been said that this article is bitter & nauseous & that therefore it shd be rejected from the mat. med. This rule wd make our list of medicines very small This article will make as good beer as hops Its natural operation is that of a purgative & copragogue Pharmac. prep. 1st Infusion dried plant zii water oi 2d Decoct. dried plant zji water ojss boil to 1/3 3d Tinct. zii to oj 4th Ext. by decoc. This I think the best Make it of a consistence for pilling As a cathartic the decoction is best & the dose is zii to ziv I have given even a wine glass full I thas operated in 12-30 hours Is not [illegible] but have for [illegible] all the while? 4 Cathartics As a tonic the tinct. is best in doses of zi 3 or 4 times a day Diseases Dyspepsia with torpor in its various forms Coprostasis Paramenia retentionis & obstructionis Upon the whole & consider this a valuable article much more so than it is supposed to be Ipomea Jalapa [illegible] This has been supposed to be the root of 2 species of mirabilis but they do not produce it (they are called 4 o’clock in our gardens) Convolvulus jalapa of Lim. The plant from which the real jalap is obtained. Dr Coxe calls iponea macrorhiza for an account of which vide Coxe’s Dispens. the roots produced by this plant are like those we get in the market Mr Nuttall pronounces the plant an iponea (what plant.?) It usually comes in roundish, ovate but pointed tubers internally yellowish At the present time we get our jalap from Vera Cruz & it is not adulterated Diluted alc. is said to be the proper menstruum for jalap It is used for its cathartic powers merely it is difficult to be managed as a laxative. It may be made purgative or drastic In moderate doses & if allowed sufficient time to operate it may be made copragogue but in excessive doses it is hydragogue. It acts principally on the colon The off. jalap is called in the books a stimulating cathartic It is an irritating cathartic rather. In a phlogistic, or atonic irritable state of the system it will produce irritation & increase it when already existing The alcoholic ext. is said in the books to be irritating, but Dr Ives says it is not. The ext. in the pharmacopoeias is made partly with water. In moderate doses the alc. ext. is not irritating It is probably that several species of convolvulus & iponaea possess the same powers as the off. jalap Podophyllum Petatum may appl. mandrake etc. Triosteum perfoliatum Linn. Root perennial top [annual] It has a popular name in almost every place in which it grows fever root wild gentian wild ipecac wild coffee? etc. Nat. ord. same as that of the climbing honeysuckle The parched fruit is said to have been used as coffee The root only is used in medicine the bark of this is said to be cathartic & emetic Dose for a cathartic is [illegible] to zfs this if taken over night will be effectual. It is about as active as jalap if pure & collected in the right season. It is injured by long keeping, but if collected in the autumn & well dried it will retain its strength The operation is supposed to be modified by a conjunction with mercury etc. for instance? by as a conjunction with? of ipomaca jalapa & podoph. pelt. When a cathartic & emetic operation is desired this article combined with di? proto chloride of mercury in full doses shd be given dose [illegible] to zfs B.S. Barton thinks it diuretic but I have discovered no such effect & think it no more so than rhubarb Dyckman says it is tonic he probably inferred this from its bitterness. I have never seen this effect & think it no more tonic than rhubarb & podophyllum peltat. I think it more likely that ultimately it will be found deobstruant This article is a cathartic. Its natural operation is that of a purgative but it may be so managed as to prove laxative Its discharges are mainly fecal hence copragogue. It acts on the colon In a full dose it has a medium time of operation. Its operation is neither very kind nor very much the contrary. It leaves the canal neither in a very good nor a bad condtion Diseases It has been prescribed in Intermitt. (Shoeph?} I think it not very applicable and in “pleurisy” (but there is no such idiopath. dis. though phys. constantly speak of it Shoeph? probably meant pneumonic) I shd think it not good. Said to be good in struma I shd not think so In reality this article is applicable only to the diseases in which jalap & P. peltatum are & no other The right time to collect it is autumn. The powder shd be kept in a bottle tight & excluded from the light I wd not pulverise much at a time for it loses its strength easily. Fresh parcels shd be collected every year Leptandra Virginica Culver root physic root Indian physic etc. It is difficult to tell what is its nat. order. Said to grow in Japan but probably a diff. spec The root has a bitterish & subnauseous taste. analagous to jalap. Both alcohol & water are the proper menstruus It is cathartic In its recent state of Dr I. thinks it one of the most powerful of our indigenous cathartics. When dried it loses its cathartic power’ Rafinesque says it is deobstruent & echotic but there is no reason for supposing that it has such a power. When recent it is said that 4 or 5 grs are sufficient to prove cathartic, but when dried zi or more will be necessary I think a wine of this article (zii to f zxiv) wd be a good preparation for retaining its strength I venture to say that a syrup would answer For instance make a saturated decoction (say 4 oz to the pt) & add the q.s. of sugar to make the simple syrup of the pharmac. The add oil of wintergreen to give flavour Perhaps an ext. night retain its powers There is room for experiment Therapeutic application The diseases mentioned in the books I do not think correct Coprostasis active cathartics are not applicable to this Bilious fevers this is indefinite Rheumatism not good subacute rheumatism other articles better old chron. rheu. 5 Cathartic Ricinus communis R. major R. vulgaris more commonly palma christi ricinus. One of the older manes is agnus castus whence castor oil Nat. ord. Euphorbiciae Cultiv. with us Castor oil is obtained from the seeds. It is completely soluble in alcohol & ether. The mildest oil is obtained by decoction, which method is resorted to in the W.I. for the mode see Hooper’s Dict.’ If the cortex of the seeds be permitted to remain in the oil will be acrid. That made by expression is also thought to be acid hence decoc. I think the seeds shd be [decortirated] for the active principle probably resides in the cortex Its operation is quicker & kinder than any other cathartic & as a mere evacuative agent it is the best in the mat. med. It seldom produces any griping. It is moderate, producing at most only 2 or 3 discharges says Cullen who says it is peculiarly adapted to costiveness. Colica ileus & C. Rhach. It is not heating nor irritating to the rectum & is well adapted to hemorrhoidal affections Medium dose zfs some require more others less Its ordinary operation is mild If frequently repeated the dose may be gradually diminished, which is not the case with other cathartics. That ol. ric. increases its power by repetition is an important point The only inconvenience attending the use of this article is that it is nauseating & disgusting to some patients. To obviate this give it in a wind glass with water below & spirit or spirit of ppt. above & it may be taken by the most delicate & squeamish Even rancid oil may thus be taken without its rancidity’s being noticed. I know of no way so good as this Ed. & Vav. say this oil is only a mild laxative but it is a purgative. They say that by rancidity it produces tormina, griping etc. This is correct. Some think that it possesses greater power than any other cathartic in removing worms. I have never seen its superiority in this respect. It is always better to give some narcotic cathartic & get the worms under narcotic influence as we do by spigelia This article is laxative not so easily made to act as an eccoprotic Purgative copragogue it produces no biliary discharges It is not drastic. It affects the whole track of the bowels equally It is speedy is kind unless rancid & leaves the al. canal in a good condition It makes little impression on the system & of course is not good at the commencement of acute disease The following formula is used in the W. I. in colica rachial. Rx zii of the oil to ziii of spirit & burn them about ½ a min. or till part of the spirit is burnt. It is said that this is effectual in that disease I have beat up this oil with the yolk of an egg & this completely deceived patients & got the full operation of the article, when they had absolutely refused to take it The decorticated seeds are taken as cathartics in some parts of N. M. Probably 4 or 5 of the bruised seeds are a [illegible] dose A saturated tinct. of the seeds is said by Piso to be a more powerful cathartic than the oil. Dose of the tinct. zi (zi?) the seeds should be bruised Euophobia Lathryrus (oleum) Cultivated in all our gardens The most common name among us is caper spurge. The fruit is said to be good for pickles. Native of Europe., Nat. ord. Euphorbiaceae The oil is obtained from the seeds a common practitioner could obtain it by macerating the seeds in ether By long keeping it becomes turbid & rancid It comes in vials of zi It is said to be a mild & safe but active cathartic & a good substitute for oil of tiglium Dose for a adul 4-8 gtts in milk sugared water or any convenient vehicle Its action is certain, prompt & at the same time mild, not producing tormina or griping like o. tiglii It is purgative drastic in full doses may be used as a laxative. It is copragogue in ordinary doses. It is irritant in full doses & may be said to be sub-emetic In affects the whole track of the intest. canal It is very speedy, 1-3 hours is mile & agreeable in medium doses & leaves the canal in a good condition. It makes rather a strong impression Iatropha 2 species I. Curcus and I. cossypifolia Called Barbadoes nutts The oil from the seeds of the i. curex resembles very much the castor oil Croton Tiglium Ricinus Indicas Pinus Indicus These oils all belong to the same nat. ord The wood has been used in medicine (lignum moluccense) the seeds also grana mollucc. grana ricini in English called “purging nuts” Native country Ceylon Moluecas E. Ind. China The genus croton is said to contain 50 to 100 species of which 5 are known to be in the U.S. One species in the U.S Affords a highly aromatic oil The oil of tiglium is obtained by expression from the seeds It is said to have a sharp taste odor sui generis It is said to contain fixed oil 55 parts & an acrid principle 45 parts. This letter has been called tigline The seeds root & wood have been used in medium, but the seeds & oil are the most powerful The oil of tiglium is the most rapid cathartic known. Its operation is said to be modified by aromatics, acids etc. but better by small doses of opium. Baking or roasting the seeds before expressing the oil is said to have this effect Its natural operation is purgative or drastic. It is difficult to manage as a laxative unless by tincture or a little opium. As a laxative it is copragogue but in larger doses hydragogue & irritant In large doses it is drastic It may be said to be sub-emetic Said to be diuretic & diaphoretic but I think it cannot be directly so It operates on the whole canal is the most speedy cath. we have usual time ½ hour This can be made to depend on circumstances sometimes less than that time If the dose is not too large the operation is not unpleasant if large a burning is felt. Moderate dose leave the bowels in a good condition This article cannot be preferable to calomel in typhoid diseases nor to the refrig. salts in the inflammatory The oil of tiglium in the market is said to be adulterated. I have always found that in the shops to be full strength. When pure it produces rubefacient effects on topical application It is sd to produce catharsis when rubbed on the umbilical region Dose of the oil ½ to 1 minim. The tincture made directly from the seeds in the most eligible form. Dr Bigelow gives a formula for its strength The oil may be given in milk but I prefer the pill made of bread. Unless camphor is added the pills will mould. I prefer dough to baked bread. I may be pilled with soap Another form is Rx ol tigl. [illegible] syn papav. zi Opium better than any other article modifies the operation & obviates the unpleasant effects of this oil. In combination with castor oil it affords the best cath. for poisons It makes a good enema. You will remember that generally 3 times as much is required 6. Cathartic by enema as by the mouth The effects of an over dose are severe burning pains hyper emesis hyper catharsis etc. Opium is the best antidote Diseases Coprostosis (E. & Vav.) as a general rule this shd not be treated with drastics Tenia I think however that the ol. pini is better, for in this you have narcotic & other powers which are peculiarly desirable to hasten an evacuation the ol. tigl. may be given Delirium Tremens Some writers say that this oil has been highly serviceable in this in conjunction with opium As a general rule purging is not indicated in this disease Rheumatalgia As a topical application it will probably do good for this is generally fixed Mania in acc. of this facility of getting it down Tetanus alleged to be useful in the sam. acc. if purging is indicated Neuralgia. N. Faciei Cases of apoplex. Obesity sd to be benefitted by freq. purging Dropsy but elaterium is our best article Oil of tiglium is not a new article in medicine, but and old one revived Scammony Convulvulus scammonia is said to furnish the Smyrna scammony but this is less valuable than the Aleppo scammony Another kind is the Montpelier scammony from Montpelier Convolvulus [Sepium] (Linn.) is another species producing scammony. It grows about our hedges & is called field bindweed & poison weed though it is not poisonous The exuded & expressed inspissated juice are both employed. The exuded is the most powerful & best dose 5-20-30 grs – 30 grs is a powerful dose it grows throughout the U.S. Hiatus Scammony? It is called a gum resin, but is more so than any expressed juice Used in dropsy other art. better in helmin. spts turp. better Natur. operat. purgative drastic if given alone Modified by combination Not easily managed as a laxative Acts on the colon medium time makes an impression In large doses is an irritant Gamboge Several plants afford it Linnaeus supposed the real gamboge came from the gambogia gutta Murray from the Statagmitis gambogoides Others from the gorcina gambogia of Willdenow & others say the gambogia guttifera. The name of the plant is not derived from the place in which it is found Stalag. & garcina grow in Ceylon gambogia in the E. Indies Gamboge is the inspissated descending sap obtained by exudation improperly called a gum resin. The juice concretes & is formed into masses. It is imported from Siam, Ceylon, [illegible] in China etc. We have no analysis but the old one of so many parts solub. in alc. & insol. in wat. etc. It is said in the books to be one of our most drastic & [illegible] cath. but others are more so Being drastic it is used in helmintha but because an article is drastic it does not follow that it is good for worms. As to its hydragogue power, it is not always to e relied on in dropsy. The Italians say that gamboge is contrastimulant What they mean I do not know In purgative & laxative doses it is more reducing than the preceding articles. It is difficult to be managed as an eccoprotic It acts upon the upper part of the al. canal & all the articles that do this promote more or less the secretion of bile but it does not in the whole [secerm] & absorb. system & hence is not deobstruent It irritates the intestinal canal & may produce an acute atonic irritative infl. It has been called by orfila? a caustic poison, but it is not. HE says too that externally it is rubefacient. This is not true It is more used by the British practitioner than by the French & is given in combination with other cathartics. Thus administered it is useful Gamboge is a strong purgative is cholagogue by acting upon the stomach & duodenum is hydragogue acts on the upper part of the canal is speedy is on the whole disagreeable in its operation when given alone, leaves the al. can. not in a good condition, but if judiciously combined its operation may be made kind & agreeable while by a frequent use of gamboge & by injudicious combinations of it the al. can. is left in a very bad condition it makes a strong impression on the al. can. & whole system is irritant & finally is to some degree an emetic, though this ought not to be enumerated among its operations Dose 3-6 grs recc. triturated with sugar but I wd no recc. it alone Diseases Coprostasis recc. but not alone Tenia jaundice recc. cannot be of much use other articles better quartans used as a purge but not good Dropsy recc. [illegible] other art. better. Chron. cutan. dis. not I think good Rhamnus catharticus Buckthorn Nat. ord. rhaminaciae native of Europe cultivated in this country & sometimes grows wild on the banks of the Hudson probably from seeds dropped by birds The berries are used. They are [illegible], black & shining, with a taste bitter acrid & nauseous & containing a pulpy green juice As a cathartic, this article is both cholag. & hydrag. & its natural operation is purgative & drastic & it is not easily managed as a laxative. When drastic it is powerfully hydragogue not so much so as elaterium but more so than most drastic cathartics It acts on the middle part of the al. can. & requires a medium time It is irritating & leaves the bowels not in a very good state It requires opium to obviate its ill effects. It makes a peculiarly strong impression on the system. It irritant & may prove emetic It is said by some to be diuretic it may prove somewhat so in small & often repeated doses, with diuretic regimens & allowed to remain sometime in the al. canal. Diseases Recc. by A. T. Thomps in cachexia & also recc. in syphilis do not believe it good in this Dropsy recc. by A.T.T. better in this than most other cathartics. It is used in N. Haven in certain cutaneous eruptions & recc. in doses short of purging I have never seen much benefit from it in cutaneous diseases The common dose of the berries is 20. The expressed fermented juice is recc. in some books decidedly bad Decoction of the berries is also used it is recc. to boil 20 of the berries in 1 pt of water very weak The syrup of the berries is the best form Rx If you wish to mitigate or modify its action add a little paregoric Almost every farmer thinks he knows what buckthorn but it is not found with us. There are spurious articles sold under the name of buckthorn. The article commonly sold under the name of syrup of buckthorn is made of the berries of the cornus sericea Bryonia Disease? Nat. ord. cucurbitaceae root fusiform intensely acrid & bitter Formerly the root used to be found mixed with jalap. Sometimes the inspissated juice of the recent root is used It contains a principle bryonine which is probably its active one The root was formerly employed as a purgative & emetic applied to the skin it is said to be irritant & rubefacient Dose of powd. of rec. root is 12 grs to zfs This article is purgative & drastic acts on the middle part of the canal requires a medium time & in large doses leaves the bowels in a bad condition. 7 Cathartics Cucumis Colocynthis Nat. ord. Cucurbiticeae Native of the levant & cultivated in Europe The fruit is the part employed, under the name of colocynth It is reduced to a fine powder. I believe the pulp only ought to be used, but the whole is used. It is found in the shops in powder. Water alc. & ether dissolve its active principles E. & Vav. say it is very irritant, externally or internally they say it is a powerful cathartic purgative or drastic less hydragogue than most other cathartics equally drastic (I can’t say I ever saw a hydrag. operation from it) It acts on the colon takes a medium time alone it is more or less disagreeable, but it is agreeable in combination It is a valuable article when a compound cath. is used, it makes a strong impression It is irritant E. & V. say it produces amenorrhea. I have never had any such effects from it Enteritis recc. by E & V. but a mere cathartic in this is not wanted a deobst. operation is required, for which calomel is best perhaps in erythem. enteritis it may answer a cath. is indicated but in this form a diarrhoea is almost always attendant & even in the calomel is best Dropsy E & V. but I do not believe this article hydrag. & therefore it can seldom be proper Elaterium [Momordica] Elaterium of Linn. Ecballium elaterium of Richard Called also cucumis agrestis & c. asinius squirting cucumber. It is a perennial plant growing spontaneously in the south of Europe & might be cultivated among us The active principle resides in the juice around the seeds it is prepared by As found in the shops it is The dried juice of the fruit obtained without any preparation is best As prepared above it contains a peculiar prox. prin. called elatine. An alcoholic tinct. may be employed Elatine is [illegible] Elaterium is oftener mixed with starch. It is injured by exposure to the light yet this our apothecaries do not know It is very expensive The juice of the [illegible] is irritant to the skin Elaterium undoubtedly possesses great deobst. powers, but they do not begin to operate much till purging comes on then they are powerful Its natural operation is drastic not purgative nor laxative. It is more hydragogue than any other article. Although so drastic it leaves the bowels in a good condition It may be given in cases of extreme debility. It is speedy in single large doses less speedy in small doses. It is irritant diuretic in doses short of the purging point deobstruent Upon the whole, elaterium is the most valuable cath. in the mat. med. calomel & the neutral salts excepted Diseases Coprostosis shd not think it good parabysma Struma shd not think it good Atonic ac. rheum. it acts as a resolvent deobst. but generally is proper only in the early stages Opium will prevent is purging Sub. ac. rheum. early stages Rheumatalgia in its various forms both that called “crick in the back” & sciatica a cath. of elat. is very beneficial [illegible] Indica give a cath. followed by an internal use of conium & iodine Chronic & obstinate ulcers of the legs purging with elat. is very beneficial they were formerly cured by vom. with turp. min. Chorea a valuable remedy by acting on the system at large Param. obstruct. idiopathic & in healthy subjects Hydrops cellularis H in these diseases it is of more importance than any other Begin? early in the morning with doses of 1/16 1/12 or 1/10 gr acc. to the strength of the article once an hour or once in 2 hours continue till catharsis actually commences & then suspend The catharsis usually begins in about 5 or 6 hours. It is preferable not to have it commence under 10 or 11 hours The first discharge will be fecal & then will follow those that are purely hydragogue. Most of the books recc. in full & large doses giving all you would give at once But this is apt to produce nausea tormina, distress etc. Give it in regular doses also to get its deobst. effect If the evacuations are rapid or appear to reduce the pat (which is rarely the case) give a dose of opium, generally not less than 10 grs, acc. to the susceptibility of the pat. If the pat. is at all feeble you shd be about [illegible] at the time of the operation of the article After the useful article treat with stimulants. It may be necessary to repeat the elaterium for removing the fluid does not cure the disease, & the fluid may return. Elaterium removes the dropsical fluid better than any other article I know of. In cases of concussion followed by stupor or coma about a week or two after the accident. I have known elaterium managed as in dropsy to be most effectual acting not merely by its evac. but its deobst. power Elaterium is better by itself than conjoined with any other article Some conjoin calomel, but it is better without E. & V. recc. it in doses of ½ gr. not to exceed 5 grs but with such elaterium as I have had, a man wd not stay long enough in the world to repeat the dose The momordica balsamina has been said to possess the same powers as elaterium, but [untruly] It grows in our gardens The juice of the unripe fruit is said to be emmenagogue & styptic. This is worth enquiry into. Luffa operculata Allied to elaterium Nat. ord. cucurbiticaea Its natural habitat is Guaiana. It is formed abundantly in the W.I. & along the shore of the Gulf of Mexico. Dr Hancock calls it crosia? It is also called “bitter cucumber,” but the cucumis coloc. bears that name. It is the momordical operculata of Linnaeus & is similar to the common cucumber I derive my knowledge of this article from Dr Hancock In the fruit is a web-like substance or reticulum which possesses the medicinal powers & Dr H. says “it is the most active cathartic in nature” says it acts on the “skin kidnies & intestines.” Acc. to his account it is an effectual deobst. acting on the whole sec. & abs. syst. I do not think it a tonic directly Dr H. says that 1 gr. of the reticulum is a dose. This is undoubtedly too large & acc. to his own account ½ gr. is sufficient 8 Cathartics to produce the effects of the common dose of elaterium Dr H. prescribed it in infusion, but says was obliged to add chloride of sodium to preserve it. Would it not be better to make a powder of the reticulum? He says it is better to have it a long time in operating. It seems its operation is precisely like that of elaterium & it is best given in small doses at regular intervals This article is drastic may be managed as a purgative, but not as a laxat. or eccoprotic Full doses may vomit small ones do not. Purely hodrag. middle part of can. Medium time in small doses Makes a strong impres It is irritant & deobst. Short of purging point it is diuretic. It is emmenag. in full doses. It is resolvent. Diseases recc. in dyspepsia colic. rhach. as an enema Dr H. says it is an effic. article Parabysm coac. (enlargement of the spleen) Dr H. says in his own case it proved efficient as an enema it affected the stomach. Hydrops cellubria (or as he calls it generally dropsy) Dr H says he has cured perfectly by it recommends it in the early stages He says mercury is a most efficient article in dropsy & so says Dr Tully H. Thoracis & H. abdominis (ascites) In the latter it is necessary to repeat the article in some cases. Dr H. has found it necessary to salivate & repeat it Upon the whole it appears that this article has the same medicinal properties as elaterium. It is not liable to lose its strength like elaterium. The [crasia] or L. operculata finally is cheap & precisely equivalent Sulphur Purgative in a full dose. It is diapohoretic in non phlog & not materially atonic cases, regularly, & I am apt to think it is so indirectly. It is irritant but not tonic or stimulant. It is undoubtedly inappropriate in phlogostic & truly atonic cases Dr Duncan thinks if taken into the circulation, from the sulphurous smell etc. of persons who take it. Dr Tully thinks it digested & says the smell is that of hydrothomic acid Duncan thinks it better combined with some saline cathartic Dr T. thinks this not necessary In [illegible] he Dr D? thinks its irritant effects will be obviated Sulphur injudiciously administered & persisted in will produce rheumatism, paraplegia & effects precisely analogous to those of mercury. I have seen swelling of the joints & loss of the use of the lower extremities Sulphur in full doses is a purgative it may be managed as an eccoprotic It is copragogue Acts in the whole track. It is slow. In a full dose & under a bad condition of the system it is unkind in its operation, & leaves the bowels in a bad condition It makes a considerable impression. It is irritant & decidedly deobstruent being resolvent (I have known sub-acute rheum. cured by it) diaph. emmen. & expectorant Diseases Prctica Marisca I wd regulate its use acc. to pretty much the same rules as aloes Chronic Coryza recc. by Duncan Chronic coughs it has been used in form of “balsam of sulphur” It is good in some coughs Dyspnoea exac. & asthm. hum. Duncan probably is good in the interval Disguised gout of Cullen Rheumatalgia or chron. rheum. have never tried it but it probably is good. Scabies & various cutaneous eruptions 6 Materia Medica [illegible] Depletio Sanguinis Is an important refrigerant process & should be treated of amongst therapeutic agents It is an operation directly and exclusively refrigerant in its effects The blood itself is vital and is the medium and support of the vitality of every part of the system The first effect of v.s. is to diminish vital power generally and strength of action in every part. It constitutes the most powerful and direct method of reducing the vital energies When carried to excess its effects are most difficult to be remedied The precise quantity to be taken depends on the degree of vital power the nature of the disease the prevailing diathesis and the vigour of the constitution Yet in no process is the practice so empirical Prof I. knows of no disease so severe as to require medication in v.s. has not been recommended as the most appropriate remedy ever [illegible] When really indicated it is indispensable when not indicated it is infallibly prejudicial Divided into two kinds General & local the former from an artery or large vein the latter from the capillaries Some however consider V.S. from a large vein in a part near a local affection, as from the ext. jugular in cephalitis as a local bleeding & therefore more efficacious. They think V.S. from the arm in like manner more efficacious than from the jugular or foot and in all the phlogistica they bleed from a large vessel as near as possible to the seat of the disease This they consider as effecting a topical depletion of the diseased part. Now it is well known to every anatomist that there is no direct communication between the viscera of the thorax abdomen and cranium and the parts forming the parieties of those cavities. There is therefore no ground for calling such processes topical bleedings. The notion is a remnant of prejudices existing before the discovery of the circulation of the blood & the distinction is of no more importance in practice than the old man in the almanac Some limit the term topical bleeding to an evacuation from the capillaries of the diseased part. This evacuation must be prejudicial in atonic passive diseases where there is a gangrenous tendency especially if performed with scarification and cups An English author remarks correctly that there is no such thing as topical bleeding independent of producing an effect upon the whole system In the phlogistic phlogistica leeches and cupping with scarification are of no importance for v.s. from the arm is all that is requisite. In local entonic infl. the practice is more plausible. Here topical bleeding is the best but the irritation of cups and scarification does more injury than the evacuation does good, unless applied to a neighboring part, and then the counterirritation produces the effect. As the disease however does not affect the constitution, it is of little consequence The blood is not stagnant in the part for then it would be coagulated and would not flow consequently topical bleeding cannot empty the vessels of the part Besides infl. is not caused by accumulation of blood this accumulation is an effect, not the cause If a general phlogistic diathesis exist, topical bleeding is not substitute for v.s. if there is no general phlogistic diathesis, topical bleeding is not required The cases which have been benefitted by topical have been cases of atonic infl. Here the counterirritation produced the effect the trifling depletion [illegible] of blood being injurious as far as it goes Yet the practice is very fashionable IN these cases bloodletting is not indicated. Deobstruents & antirritants such as calomel and opium give far more speedy and perfect relief Ophthalmitis is a dis, in wh. phys. say topical bleeding is indispensable A strong sol. of nit. sil. is far better & gives a more speedy cure If you separate some of the vessels going to the part, then to be sure you may produce some beneficial effect Where general bleeding is not indicated topical bl. is always injurious The capillaries are said to have an independent action and the reasons assigned are that it is by their agency that the blood is returned to the veins, that by them assimilation secretion and [nutrition] are performed that they are the seat of infl. 6:07 PMhe reasons are probably true yet it is [illegible] no less true that the capillaries as necessarily and completely depend upon the heart as the heart upon the depletion of blood affects both the capillaries and the heart, hence the surface is pale. If the action of the heart is increased there is congestion in the capillaries and less blood in the central parts In this case topical bleeding would remove the congestion temporarily it would be again produced by the vis a tergo In infl. the value of the blood is dimin. indeed but the blood is not stagnant or it would coagulate I would not be understood to say that cupping and scarification are of no service for I have seen them used with great benefit But I do say that other means are in my opinion better [illegible] by counterirr. only that they produce their effect Thus in the chronic stages of subacute rheumatism I have known evident relief derived from them yet no one would bleed in such a case also in pneumonitis The benefit is the same as from rubefacients, blisters etc. The strongest case is infl. of the eye and the anastomosis of the ophthalmic and temporal arteries is thought to have influence But even here if there is active infl. and phlog. diath. topic. bl. will be no substitute for v.s. In atonic infl. without phlog. action the case is better without bleeding of any kind & topical bl. is beneficial only by its irritation. I have seen both plans tried Dr Cogswell treated infl. without and no man was ever more successful. Few employ it who have had extensive practice. There are other and better means of counterirritation Depletion from large vessels and depletion from capillaries are better appellations than general and topical bleeding for the latter, as we have seen is inappropriate Depletion from large vessels may be performed by v.s. or arteriotomy. The veins are the vena media basilica t the bend of the arm the vena suplina major on the inside of the ankle & the v. [illegible] minor on the outside of the ankle The vena media basilica is preferable to the ven. med. cephal. the v. seph. or the v. basil. as the latter have cutaneous nerves running over their surface. The veins on the ankle are irregular; they have cutaneous nerves running over them, and the tendons are liable to be injured Besides the incision does not heal well but is liable to become a troublesome sore. The vena jugularis externa is often [illegible] The temporal is the only artery now selected; it is the only safe one as it alone passes over a bone, so that it can be compressed. It is of no consequence whether blood is taken from a vein or from an artery, or what vein is selected so far as the disease is concerned provided the opening be large enough Depletion by the capillaries is performed by means of leeches, or by scarification and cupping. The [illegible] medici lis is used but I have seen the H. sanguinea? do nearly as well [illegible] The best instrument for v.s. Prof. I. thinks is the Dutch or spring lancet as it can be used by those who are not ambidextrous it can be used upon the most rolling vein and upon persons in epileptic or puerperal convulsions the practitioner can set it and keep it in order himself and it can be used for years, while the thumb lancet soon becomes dull Depletion of blood may be a remedy in itself or it may be preparatory to the action of other remedies. V.S. for local symptoms can never be beneficial where the general symptoms contraindicate it buy may be beneficial when they neither indicate nor contraindicate it Venesection is employed to answer six indications 1st as a mere antiphlogistic or refrigerant measure in entonic diseases 2nd for the purpose of making a sudden and strong impression upon the system in order to produce a resolution of certain no phlogistic & not materially atonic diseases 3d to equalize excitement increase susceptibility, and prepare for the better operation of other remedies in certain non phlogistic diseases 4th as a substitute for an habitual but moderate hemorrhage & to divert it to some other part for the purpose of suppressing it gradually or preventing a too rapid sanguification as in exangin, cyanea (non closure of for ovale) exangia aneurisma paracyesis irritative (morbid pregnancy) wounds of the lungs brain etc. 5th to produce sudden faintness and relaxation for the purpose of facilitating certain surgical operations as the reduction of hernia or luxation 6th to promote absorption in parabysmata emphysematous (tumours!) & perhaps in certain dropsies Venesection is the most appropriate remedy for phlogistic diseases ad shd always be employed when any considerable phlogistic diathesis exists, whatever be the sex age climate season or constitution A blood is the pabulum of life, a depletion of it has greater effect in lessening the vital powers than the evacuations of any other fluid A free evacuation of blood from a healthy subject immediately produces more or less debility & increases susceptibility, appetite and sanguification. But if carried to excess it impairs the digestive powers The strength of the pulse is the only proper indication for v.s. When Fordyce and others mention hardness as the test for phlog. diath. it is evident from the context that this means strength. When however they speak of hardness and strength in connexion they make the same distinctions as Prof. I. Hardness indicates irritation and may accompany strength or weakness of pulse It is said by some writers that in enteritis we are to expect a small hard pulse and are always to bleed The truth is there are two species of enteritis which are accurately described and distinguished 1st phlegmonous enteritis, affecting all the textures of the intestines 2nd erythematic enteritis, affecting only the mucous membranes. Now the pulse in both these species is small and sharp but in the first no pressure can extinguish the pulse either in the systole or diastole in the second it is easily extinguished. In the first species only do we find strength of pulse & in this only is v.s. indicated Hardness combined with strength heightens the indication for v.s. these combined with fullness heighten it still more. Mere fullness & hardness uncombined with strength never require v.s. The coriaceous or buffy coat often observed on the surface of blood drawn depends on several causes 1st the degree of preternatural vital energy or preternatural strength of action in the system in other words the degree of phlogistic diathesis 2nd the rapidity with which it is drawn If taken rapidly it remains longer before coagulation the red globules subside and the buffy coat of course appears If taken more slowly it coagulates sooner and the buffy coat is less or none at all even though the disease is phlogistic Even in health blood may be so drawn as to exhibit the buffy coat 3d the depth of the vessel in which the blood is received if shallow the subsidence of the red globules will be less complete & the buffy [illegible] coat less distinct 4th The specific disease whether atonic or (frequently) entonic produces a buffy coat 5 Pregnancy is almost always attended with a buffy coat It will be readily inferred that Prof. I. lays very little stress on the buffy coat as indicating the propriety of bleeding or the necessity of a repetition. Wilson Philip and others express the same opinion. The firmness of the coagulum and the concavity of the surface are better tests But the existence of these marks & also of the buffy coat is no proof that a repetition of v.s. is called for We should not mistake for strength of action, the rigidity of the coats of the arteries so common in farmers, seamen & elderly people In phlogistic diseases, as cauma and the caumatoid phlogotica F.S. if employed early will of itself effect a cure. But it must be well managed. If too sparing at a time and too often repeated it will produce too great a reduction of strength If too profuse it may lay the foundation of other diseases. Those who are celebrated for removing diseases suddenly by a free depletion of blood, lose many of their patients by subsequent dropsy If there is no considerable increase of strength of action V.S. may safely be neglected In merely entonic infl. it is of no benefit but may be if the constitution is brought to sympathise with the local affection The phlogotica & local infl. differ in their causes diathesis and proper mode of treatment There is a foundation for the distinction of active and passive Some years ago the essence of infl. was thought to be an increased strength of action in the arterial system. Wilson Philip though it to be debility. Both these views have tended to confound the distinction of active and passive It is acknowledged that there is entonic fever. Is it any more strange that there should be entonic and atonic infl.? The essence of infl. is not the quantity or strength of action, but as is well remarked by Hunter the quality, and it may attend either increased, or diminished strength of action or a state of action neither increased nor diminished, and the treatment must vary accordingly. In infl. moderately atonic V.S. might be tolerated and would not destroy life it would render the recovery slower and less perfect. In every low atonic infl. (phylogotica) V.S. would be fatal I never knew a physician in Conn who did not employ bleeding in entonic diseases. This has been asserted with respect to myself, but altogether without foundation. Dr Danforth of Boston did not bleed a patient for the last 20 years of his life (this is noticed as a strange thing a man successful and of high reputation) Now the change of diathesis occurred about that time 1807 (to 27) and though sporadic cases of phlogistic disease occurred subsequently he may not have seen one (vide The Med. B.) I have myself seen but one decided case since 1816 & that was in 1819. You will occasionally meet with a case of phlogistic disease and cases arising from [illegible] though the latter will require less bleeding than the idiopathic. When the v.s. is employed for the first indication, viz as an antiphlogistic measure in entonic diseases, the degree of effect depends entirely upon the quantity of blood abstracted and not at all upon the manner of abstracting it. It is said by some that bleeding is more effectual when it produces faintness & that in such a case a less quantity of blood suffices. Such cannot be true phlogiistic cases. In every pure medical case the production of faintness & especially of syncope is to be avoided. In phlogistic diseases we must bleed freely,. so as to meet the symptoms, but in a recumbent posture in order if possible, to avoid deliquium. On the phlegmonous phylogitica the production of deliquium is unfortunate as it may prevent a sufficient abstraction of blood The abstraction of lbj or lbfs is generally sufficient nit. pot. tart. ant. refrig. salts veg. acids ripe acid & subacid fruits cold water & air shd be employed at the same time as auxiliaries. By thus dividing your measures you produce more effect upon the dis. & with less injury to the system. In phlogistic diseases V.S. practiced early and judiciously in the forming stage will produce a complete resolution. After the forming stage has passed, the dis. cannot be broken up but will run its course of 5 or 7 days under the best treatment but this treatment will seldom fail of effecting a cure. In phlogistic dis. v.s. may act somewhat on the principle of making a strong impression on the system But if a strong impression merely is the object, ligatures on the limbs are better. A third or a half of the blood in the system is in the limbs & ligatures upon them will produce faintness & syncope than v.s. This suspend the disease, but then the ligatures are off it is found that no permanent benefit results & v.s. must be employed In genuine phlog. dis. faintness and syncope are no proof that sufficient blood has been drawn. mere reduction without counteraction will not? cure like phlogistic disease. It would seem that an aggregate of symptoms exists one of which is increase of strength & this is removed by v.s. The aggregate is thus broken up and the dis. completely cured. Mere irritative or symptomatic entonic fever requires less depletion than that which is idiopathic, and after one bleeding, opium or hyoscyam with calomel will allay all the symptoms These may even prevent the occurrence of the symptomatic fever. Irritative fever is however often atonic & then no v.s. is proper Abernethy remarks that the fever must take place and we cannot prevent it. He cautions against bleeding in cases that must be protracted as all the vital energies will be wanted before the close He says we shd never bleed unless the fever will produce greater debility than the loss of blood. He adds infl. & irr. action wear out the strength and if more strength is saved by counteracting these, than is lost by the evacuation, then is v.s. proper & not otherwise. A surgeon of more extensive practice in N.E. than any other out of Boston has remarked that he had seen more cases of death from depletion after injuries, than from the casua,ties themselves. Chas. Bell remarks “A man has received a shock, the surgeon bleeds and the landlady gives a dram now I think the landlady is right” Dr Latham remarks “that many cases of recovery after v.s. are in truth but lucky escapes from death” The symptoms are the only safe guide for v.s. A writer in the Medico Ohio Rev. remarks that the man who should draw a distinct line between spasm (or irritation) & infl. wd render great service to the profession. Prof. I. does not consider the distinction so very obscure. But they in London consider synochus as inflammatory & hence it is that they cannot distinguish irritation from infl. In cases where there is doubt whether irritation or infl. exists it is the safer practice to avoid v.s There can be no danger in delay. But we can commonly decide if during the flow of blood the pulse soon becomes weak and fluttering even though it shd rise afterwards, v.s. will do no injury But if the pulse becomes softer and fuller we may expect benefit from v.s. In doubtful cases it is better to take too little than too much blood as the error is more remediable, and besides such cases do not absolutely require v.s. The lancet is often a little instrument of mighty mischief vide Hall’s mimosis in quieta. in fever of pure irritation The second purpose for wh v.s. is employed is to effect a resolution of certain dis. by a sudden & strong impression on the system. The dis. is wh the practice can be attended with benefit are now phlog. but not materially atonic pyrectica phlogotica & exanthematica more especially those of the synochus or sub putrid type The beneficial effect of f.s. in these cases depends upon the shock and the strong impression made and not on the quantity abstracted. Hence our object shd be so to conduct the process as to produce the strongest impression with the least possible loss of blood The patient shd therefore be placed in an erect posture, the blood shd be taken from a large orifice & the flow of it stopped suddenly and instantaneously, as by the application of the finger. In this way deliquium may be produced speedily. It is most probably that ligatures upon the extremities would be a complete substitute for this practice in all non phlogistic cases with the exception of surgical ones & perhaps even in these. The relaxation is certainly as perfect for the time being. But I consider the practice of V.S. in these cases to be injudicious. We have other means for effecting this purpose, more safe & more effectual. V.S. at the commencement of typhus will give present relief, but it is always apt to occasion an unfavourable change at one of the critical periods. As was before observed the obstruction of lbjs or ljb is generally sufficient for the time being in true phlog. dis. But the abstraction of lbj would make no impression in the synochous or sub-putrid type ^ cases of this wd not tolerate a repetition of the v.s. In dis. of the synoch. or sub-putrid type does not sink fatally till the 14th or 21st day, in the pyrectica & not till the 7th or 9th in the phlogotica Fever of the synochus type influences the opinion of a great many phys. in forming their ideas of cauma or infl. fever # We must in these cases employ v.s. as counteragent & not as we would in phlog. dis. or we shall either produce no effect, or exhaust the pat. & render the dis. more obstinate & protracted. If we bleed at all in these cases we must do it suddenly and rapidly in order to produce a sudden & powerful impression and overwhelm the disease at once. In other words we must half kill the pat. in order to cure him # All the authors of the present day say nothing about real cauma they describe only synochus for cauma you must go back to more ancient authors The cases in which this practice is recommended are quite different from those of the nervous type. In t. nervosus & syncopalis no one but a complete routinist wd ever think of v.s. IN fevers of a sub putrid or synochus type only is there any question about the propriety of v.s. I consider such practice as rash If it fail of its object it must infallibly sink the patient & render the case more hopeless. I am an advocate for a milder course one which is less violent and dangerous and more steady and uniform in its operation. By it more cures can be effected, convalescences is more perfect relapses less frequent & constitutional vigour less impaired. Hence depletion of blood in atonic dis. as a mere counteragent is considered by Prof. I. as a hazardous practice exhausting the patient if iut fail in resolving the disease. In phlog. dis. there is no such nicety Blood may be taken at any time before a crisis. The fact which all acknowledge that blood if taken at all in synoch. dis. must be taken in the first stages proves the hazard of taking it at all A proper test for the propriety of bleeding, free vomiting and purging is the effect of spontaneous humor. emesis and diarrhoea It is in my opinion never proper to bleed to faintness or syncope in any purely medical case, & the mistake of synochus for cauma has led to the practice In the true phlogistic dis. there seems to be a state of the system which increases the supply of the vital energies & I would bleed purely for the purpose of reducing this state I would not apply irritants to the surface till the system is reduced nearly to its healthy standard then blisters and other irritants will remove the weak remains of phlog. act. Even cauma may sometimes be broken up in its forming stage by the use of counteragents only, as hot spirits & water forced sweats etc. in empirical practice But these means if they do not effect in resolution must aggravate the case & are always hazardous. So the sudden removal of phlogotica of a synochus type is followed by a protracted convalescence and often by the supervention of other diseases. Dr Mosely of E. [Hudson] was celebrated for curing dropsies & most of his cases were occasioned by the free depletion of Dr Woodruff for the cure of pneumonitis for the speedy cure of which Dr W. was equally celebrated. Mr Masters of Lynn remarks that many of the cases of chronic disease which came under his care were the consequence of sudden removal of phlogotica by the free depletion of another physician Dr Good in his remarks on typhus observes “we are to avoid reduction and adopt an antirritant and invigorating course. Clutterbuck supposed typhus to be an infl. of the brain & practiced v.s for its reducing effect. Armstrong supposes visceral congestions generative of a general sensorial debility & bleed as a preventative Robert Jackson supposed v.s. was a stimulating process & bled for its direct invigorating effect. Decided practice of any kind will succeed at the commencement.” Dr. G. continues “this employment of v.s. in typhus is no new practice, but the sum of medical opinion for the last three centuries is decidedly against it” Even Dr Welch of Edinburgh the most strenuous advocate for bleeding in typhus & who takes blood by the half gallon, says that the majority of practitioners are against the practice & that it makes slow progress in Edinburgh But there is one state in typhus in which Dr Good thinks v.s necessary “Congestion, says he, may take place as an effect of the disease, in the head, lungs or liver & infl. or gangrene be the result. This symptom we must combat boldly by V.S.” “There is much hazard in the practice but there is death without it” In my opinion there is far less hazard in letting it alone In pneum. typhodes, he wholly interdicts v.s. He is very unfortunate as to the time when v.s. may be serviceable. In the early stages, as we have seen there is far less danger in v.s. But as to employing it in congestions, experience, observation & reasoning a priori all unite to show that v.s. will increase the congestion (vide congestion) And if in these cases infl. is the cause of the symp. this infl. must from the state of the system be atonic & as little benefitted as that by v.s. Dr Good supposes that typhus may run into phlogistic action. This is far more improbable than that cauma should run into typhus & both are contrary to fact. Most surely stimulants and excitants can never induce phlogistic action in typhus, for even in health when given in noxious quantities they produce not phlogistic action but irritation & if carried farther erythematic infl. & irritative fever. I have seen cases of great head affection in typhus in which on p.m. exam. not only no infl. or cong. was discovered but the brain was even found preternaturally pale. The same has been the case in delirium tremens & puerperal delirium. Infl. or congestion is certainly then not essential to these cases. In great atonic hemorrhages & after great loss of blood from any cause congestions in the brain are likely to occur. The greatest bleeders have the most congestions My conclusion then is that v.s. is never indispensable in typhus & never in synochus that if ever employed it shd be in the early stages & that if employed subsequently it produces at most only transient benefit & renders moderate cases severe and severe cases incurable The third purpose for which bleeding is employed, is to equalize excitement, increase susceptibility and prepare for the operation of other remedies in non phlog. dis. that are not materially atonic In these non phlog. cases v.s. increases susceptibility and irritability so that greater remedial effects are produced by most medicinal agents. It shd therefore be avoided in those cases in which there is already too much irritability and susceptibility. The susceptibility to diseased action and to remedial action is different though v.s. may increase both V.S. is a powerful preparatory in appropriate cases. It promotes the action of emmenag. diuret. diaphoret. & cahtart. etc. It produces this effect in different ways and partly by relaxation It has been supposed that like nausea v.s. increases the susceptibility to the action of deobstruents. If phlogist. diath. exists v.s. will of course increase this susceptibility. If however there is considerable atony it will diminish the susceptibility to their remedial effects which it will increase the susceptibility to their irritating and evacuating effects Even when there is no considerable atony v.s. will often reduce the system considerably below the favorable point of susceptibility for the operation of deobstruents I have learned from experience that the higher the degree of energy short of entony, the better is the operation of deobstruents. I have observed this particularly in peristhnitis bronchitis, rheumatism, gout, & paramenia obstructionis (as it now occurs) V.S. renders the operation of deobstruents precarious in these diseases Colchicum for example will relieve rheumat. more speedily & perfectly without it & has failed where it has been employed So of actaea racem. Moderate v.s. for this purpose, when the dis. is but moderately atonic may sometimes be beneficial, but it must be used with caution and is never indispensable. Examples of diseases in which v.s. is employed for this third indication are colica ileus in certain cases dysphasia convulsio s. epilepsia [illegible] apoplexia (sanguineous apoplexy) entasia tetanus lysso canina & other diseases in some particular cases When v.s. is practised for the third indication, we should avoid drawing too much blood on the one hand & the production of syncope on the other. Tetanus and lyssa canina are however exceptions. In these, if the vital energies are perfect we should take as large a quantity of blood as the system will tolerate & in such a manner that after the requisite quantity has been taken syncope shall be produced But even to this rule there are exceptions. In general our success does not depend on the quantity of blood taken nor on the shock produced it should also be borne in mind that v.s. in these cases is only preparatory & is of no permanent benefit in itself alone. It must be followed by other appropriate remedies or we shall soon lose the advantage we have gained Bleeding for the 4th purpose is employed in habitual & passive but moderate hemorrhage, as in paramenia [illegible] Bleeding is never employed for the purpose of directly checking hemorrhage. In active hemorrhage it acts by obviating the state of the system on which the hemorrhage depend and other means will accomplish the same object for instance the exhibition of acetate of lead In irritative hemorrhages (commonly called active) v.s. may be tolerated but it will have no effect in checking the hemorrhage, unless the depletion is very copious and often repeated. And it is always a dangerous practice, producing exhaustion, hectic of inanition and even death itself. Many lives have thus been destroyed which might have been saved Vicarious hemorrhage (misplaced catamenia) may be either active, irritative or passive & in some respects follows different laws from other hemorrhages. It is important to select a particular time for v.s. & appropriate medication shd follow. The hem. recurs with the same regularity as the catamenia and is preceded by certain precursory symptoms. The time to bleed is at the first occurrence of these symptoms & means shd (then?) be adopted to excite the catamenial secretion. It is not necessary or proper to take a very large quantity of blood or produce a shock by faintness. The abstraction of a little more than would have been lost by the hem. will be sufficient to interrupt the latter, & this repeated a few times will break up the habit. In the intervals suitable emmenagogues shd be given & as there is commonly a torpid state of the digestive organs, a combination of iron, sanguinaria and aloes is often found to answer well. All the tonics are useful Paragesis irritative In the first month of pregnancy troublesome symptoms arise from pregnancy & v.s. would give no relief. In the latter months they arise from pressure and and a moderate abstraction of blood may be proper. We should however be careful not to take too much Even in the earlier stages much bleeding will occasion abortion & in the latter stages it is very apt to cause miscarriages. Indeed there is no more certain mode of effecting a miscarriage than v.s. In some places (not so much on the Conn. riv.) pregnant women are always bled, as a matter of course Not one case in fifty requires it. When practised improperly it is followed, if not immediately, yet ultimately by bad consequences Recovery after parturition may be lingering & imperfect. Bleeding in pregnancy is very apt to produce abortions I have known cases of 5 or 6 abortions in succession produced by v.s. improperly employed & where the families were childless from this cause. I was subsequently called to such a case where abortion was threatened. I ordered a horizontal posture & gave opium in small doses, at reg. interv. & removed all the sympt. In the interv. I gave ton. & invit. rem. Iron was the best in this case though it has been said to prod. abort. The sympt. themselves in these cases are not such as indic. v.s. they arise from disord. stom. IN this way I have safely carried pat. through Exanguia Aneurismus Import. in an. of large bloodvess. as of the aorta. Here it is important to get the pat. along with as little loss of blood as possible. Still it is [illegible] not to mistake palpit. of heart symptoms a. of derange. of dis. org. for anew I have known the [illegible] & the case treated with v.s. & crem. tart. till it was thought disp. when it was thrown aside & the pat. recovered Wounds of [illegible] & lungs. Extensive & repeat. bleed are necess. when a man has been shot through the lungs & perhaps when shot through the [illegible] Leave no more blood than is necessary to sustain the function of the system In wounds of the brain the dang. is from hem. Though we must bl. copiously yet we must avoid prod deliquium which might cause death hence a horiz. post. These cases are entirely diff. from accidents & casualties Abern. remarks “the surgeon must let the infl. (the danger is from hem. not from infl.) kill the man or run the danger of killing him with the lancet” & he says “the latter shd be preferred.” I think he is wrong. Sins of omission are not so bad as sins of commission V. [Chololethus] [means] prob. oth. rem. are better Lithia renalis var calculosa narcot. prob. better In carcerated hernia deplet. to faintn. said to be necess. Ice & [illegible] of ether sd by Wood to be better Certain luxations (not, I think in any case of fracture). Parodynia implastica difficult part. from rigidit. Belladonna is better In these cases the quantity of bl. taken prod. the relax & the shock, the faintness manage as for 2nd purpose stand or sit pleno rivo large orifice not stop it so soon as for 2nd purpose If when enough has been taken faintness is not produced stop suddenly to prod. faintness. If a surgical case seize this mon. for the operation Parodynia implastica the pat. is impat. the pract. is [in a hurry] & v.s is too often pract. when it does injury. A celebrated account has broken down many constitutions in this way v.s. is nec. in few cases belladon often answers VI To prod. absorpt. of parabysmata & of emphysemate in ext. tumours If the pat. is feeble it can not be employed & unless a considerable quantity can be taken it is of no service. To be effectual the v.s. shd be as free as can be tolerated without injury use judgment avoid] also shock & fainting. Employ it also in the early stage It is of no advantage in cases of long standing & may be dangerous Often it must be followed by other [illegible] & remedies to promote absorption as quick & active vomiting with turpeth mineral or blue vitriol or even sanguinaria Slow and brisk purging with elaterium is also efficacious & the free internal internal use of tinct. iodine. Those individually or in combin. are herculean remedies Situation has an influence on the quant. of bl. wh. may be taken. Persons in warm or moist situations (malarious) will not bear it so well. Phlog. dis. is less likely to occur & the same degree of it will require less v.s It is less indicated in dis. of chil. but when ind. they bear it very well. Child. are more subject to dis. of irrit. than of infl. & when infl. exists we should be less vigorous in our deplet. It is also less required in the aged In strumous habits less v.s. is required to subdue infl. & such habits will not tolerate bl. well for other purposes Avoid it in them when you can The season of the year is not to be regarded. In the Bethlehem insane hosp. London, they formerly bled all the pat. in the spring & purged them in the fall. When there is not vital energy enough to move the mass of blood, it has been thought that by taking away a portion of this mass we increase the [illegible] power. But s it is found that depletion diminishes the vis [illegible] stil more than the moles movenda A small bleeding when not indicated will not do much hurt for instance zfs to ziii with cinnamon water, as I saw in one case Excessive deplet. produces exhaustion impairs the digestive powers, occasions what are called nervous symptoms & imperfect sanguification with a deficiency of the colouring [portion] of the blood in consequence of which the minute vessels convey a colourless fluid. The nervous and absorbent systems are more weakened in proportion and hence obesity, [illegible] and dropsy ensue. Hectic [illegible] inanition is often prod. which often follows uterine hem. V.S. producing most freq. cong. in brain often in thorax or abd. A habit of being bled prod. corpulency & obesity with laxity & debility When there is a tendency to excessive formation of blood, v.s. will increase it & when there is a deficiency of sanguification v.s. will increase this also. It is well known that remedies will produce opposite effects opposite states of the system Deobstruents for instance will check morbidly increased as well as augments morbidly diminished secretion. Deplet. may produce gen. debility with morb. irritab. or debility with torpor History bloodletting (I believe) was not practised by Hippoc. Celsus bled in all fevers when the pulse was full & skin florid [Arctus] who is suppose to have preceded Galen bled in that fever called cauma Galen bled profusely even in typh the Arabians followed him the Egyptians Sydenham bled Willis bled. Boerhaave did not bled in putrid typhus. These all had a sort of routine practice & no fixed princ. The number of phlog. dis. is less than that of atonic but you wd infer the contrary from the books he causeth diath. was formerly more phlog. These are now more chronic dis. than formerly, which are generally atonic. During the reign of a phlog diath. chron. dis. may be somewhat entonic. Cauma is the only fever which is uniformly entonic throughout It is commonly supposed that all infl. is necessarily entonic, but many ] are confessedly atonic e.g. peripneumonia etc. Simple Saline Refrigerants Nitrate of Potassa A white colourless salt, crystall in hexad. prisms contain. no [illegible] of cryst. though some is mechanic united with the cryst. Undergoes igneous fusion. Decomp. by red heat, becoming nitrite & alternately oxide of potassium 1 nit. ac. + 1 ox. potassium sp. gr. 1.96 oz Solubility increased by addition of chloride of sodium Tested by throwing on a red hot combustible, as charcoal when it deflagrates or by red fumes of nitrous ac. when sulph. ac. is poured on its powder, also by th form of the crystal, but impurities make the form vary. The impurities are chloride of potassium and sodium. To remove these dissolve in boiling water, filter and crystallize. The nit. pot. cryst. first Dissolve in distilled water and add nit. sil. & no? prec. is formed. Decomposed by sulph. ac. & by baryta by sulph. of amm. magn. & alumina & by sulph. sod. at 32 [degrees] Hence all these are incompatible In phlog. dis. taken in the quantity of zi to zjv in the 24 hours it is a pure & powerful refrig. etc. etc. Ed. & [illegible] call it stimulant temperant & diuretic. Paris thinks it refrig. & that it shd be taken immediately after solution as it is then colder I think it never directly diaphoretic & the diaphoresis that sometimes follows is the result of the diminution of the entony. V.S. will do the same [illegible] thinks it one of the best of the diuretics. Paris thinks it acts primarily on the urinary organs, by passing in substance through the circulation to the kidnies, but he considers its diuretic powers as inconsiderable. In paucity of urine and diaphoresis which result from entonic action it is indirectly diuretic, but is not materially so in’ health. It moderately increases these discharges in diseases, neither entonic nor atonic. Murray is right in saying it is too inconsiderably diuretic to be useful in dropsy. It is not sedative in the sense of antirritant. Paris calls it aperient meaning probably laxative Renie says [illegible] to [illegible] is purgative but this operation is inconsider & is merely the result of obviating phlog. diath. Called also antispasmodic or nervine but spasm rarely accompanies phlog. diseases Antiseptic only upon dead animal matter It will however prevent gangrene from high entonic action. Cinchona is called the best antiseptic. But those cannot be indicated in the same disease. Dr Duncan says “Nit. pot.” is admissible only in enton. dis. & A.T.T. agrees with him. They are probably strictly correct Its ill effects (as in typhsus) may not be immediately observable injuring the tone of the stomach etc. Given in atonic dis is dyspep. it produces a small feeble frequent pulse, cold extremities, pain in the abd. like rachiale. Sluggishness and weakness in all the actions of the system & sometimes atonic humor. When it is indicated it should be given in uniform small doses v gr to [illegible] The test for too large a dose is pain at the stomach soon after it is taken indicating a dimin. of the dose so as to fall just short medium dose is called by Duncan 10 grs. others more or less this depends on the intensity of the dis. & the const. of pat. zi may not be too much Generally give it once in 3 hours in quantity just short of that which prod. the pain When its use is continued it can often be detected in the urine Paper dipped in the letter and dried, will deflagrate When the bowels were very torpid I have detected it in small quantities only & those not proportioned to the effect on the system. If the bowels were loose, no trace was discoverable. Hence it follows that its medicinal effect is not the result of its being taken into the circulation Externally applied it is a local refrigerant lessening entonic infl. Add chlor sod. to favour the solution & apply immediately. Applied to tender and irritated parts it produces topical irrit. & infl. & so does tart. ant. It is refrig. nevertheless. Even phosphorus when made to produce topical infl. & irrit prod. aton. infl. This is true of all the stim. A very large dose vomits actively & is thrown off If a poison dose less than this is taken it produces sharp pains in the stomach nausea, swell. of abd. sensa. of cold in stom. cold of extrem. weak of pulse sometimes bloody dischar. faintness, syncope convul. & death. Said to cause ulcera. of intest. & that the muc. memb. is disch. This would prove that it excited a membranific infl. The quantity constitution a pois. dose varies with the state of the system etc. IN strong entonic action it can scarcely prove pois. at least as long as there is entonic action to subdue A.T.T. says zi Rennie zfs to zi Orfila says its poisonous effects are like those of the narcotics & he recom. sulph. soda as an antid. The veget acids & antim. have the same eff. & the purging salts would also if not so soon carried off by catharsis Med. Jurisprudence Not. but detec. of article can. be relied on Treatment An emetic (if no evacuat. has taken place) immediately of turpenth min. bl. & wh. vit. though these are liable to fail hence the veg. em. are better Ipecac in large quantities, though it is less certain than gillenia trifoliata & stipulacea as also euphorbia ipecac. gracilis & corollata Probably sanguinaria & phytolacca would be good emetics. But recent finely powdered sinapis nigra is the best which prevent torpor of the stom. Give about a table sp fl. & repeat two or three times is necessary It is more effectual than the other veg. emet. & disturbs the syst. elss than the min. emetics The distilled wat. of ranum. flammula (if on hand) wd prob. be still better. A few years since a man travelled about the state selling an article to vom. without prod. sickness. It did so. Many persons took it merely for the experiment It was this article to obviate the eff. of nit. pot. give opium & alcohol demulcents. If its noxious effects have taken place & there has been no vom. cath are of no use. Castor] oil zj or ji or gtt p. to i to ol. tiglium or cast. oil with spts turpt. the latter being a stim. as well as a purge these will be better than sulph soda The refrigerants & especially nit. pot. have been much underrated of late partly from change of diath. & partly from inefficient use but chiefly from the chemical theory of their action, by a transference of their oxygen first advanced by Murray Though he has abandoned this theory he still calls them chemical rem. They are as much vital as any others Therapeutic Application [Acute] merc. ptyalism rec. as a lotion supposing it would allay the burning sensation. This eff. is irritative and as this is also the eff. of nit. pot. we shd suppose it inadmissible, but there is a fallacy in this reasoning for canth. will prod. & also cure irrit. As topical applic. there is a fallacy in arranging articles as refrig. or stim. We can draw no conclus. from their internal operation. Probably ol. pin. & nit. pot. operate on the same principle in burns The best remedies for mercr. ptyal. are op. in [illegible] wat. sol. of op. as a wash (unless it produces irrit.) Fowlers’s sol., or sol. nit. sil. topically. Dipsosis avens from recently relinquished habits of intemperance red. because it allays thirst in cauma reasoning bad it may be aggravating the atonic diath. bring on el. trem. & will certainly aggrav. the dipsosis Water & refrig. liq. will not allay this thirst. Stimulating drinks & op. will Dyspepsia rec. by W. Phil. in strong solution, with green arabic when there is inflam. [tenden???] theory Dr Chapman remarks “no article is more apt to relax the stomach & produce dyspepsia. Dr Ives remarks “it is bad in dyspepsia.” It will even produce dyspepsia a bad sort of dyspepsia being caused by long taking it into a healthy stomach The French recommend it in jaundice I know not or what grounds there is great torpor, therefore something to rouse the system is required Also in melaena, a var. of jaundice occurring in broken down constitutions the effect of hot [illegible] of intemperance & hance very diff. to cure No course succeeds with me unless stim. are conj Never prescribe to symptoms merely without regard to names Simple idiopathic cough, in both stages when dry and also after expectoration has begun sd to allay irrit. prev. inf. good if diath. phlog. Remittent, putrid, subputrid (synochous) &nervous. In no form of rem., that I ever wd it be of used irectly the opposite are required Idio, hectic & even in symptom hectic rec. as cooling & sedation it produces no such affect contraindicated directly in all sorts of hectic. Typhus never saw it do harm in synochus [illegible] t. gravior increasing calor mordax etc. which op. carb. amm. etc. will relieve Cauma is universally rec. highly valuable and important next to v.s. & perhaps tart. ant. in nauseating doses The following is called Rush’s febrifuge & is much used in Phil. Rx nit. pot zi tart. ant. gr i dichlor. merc. [illegible] Div. into 8 powd. & give one every 3 or 4 hours The dose of [illegible] & inst is too small A better formula wd be Ant. gr ¼ to 1 nitre gr 2 gr give every 3 hours Apostema commencing diffuse suppurative infl. at hip joint a topical applic of nitre as a refrig. is serviceable So of phlegm. comm. [illegible] bubo f. furunculus I have seen [illegible] in these. It has been rec. in [illegible] them. infl. but it is always bad Tinct. canth. or a blist. is better & dry flour is better than cold lotions. In infl. of fem. mamm. it has been rec. but vol. lin. wd be better or even ac. pl. Bleuorrhea [sanodes] highly rec but Murray says when there is ardor urinae it is too stimulating Tinct camph. Ol. [illegible] Bals. cop. capsic. mustard etc. will cure it & these are more stimulating Orchitis useful but ac. pl. is far preferable. Gout rec. topically but top. applic, are always dangerous. Ac. rheum. rec. by Murray as a refrig dose 5 to 20 grs 2 to 3 times a day with diluents and demulcents this depends upon whether it is phlogistic [Lavendiaur] rec. zfs daily & even in conjunction [illegible] cinchona but v.s. followed by cal. & then by cinch. It is an import. [illegible] iun all the entor. phlog. the best combination nit. pot. cal. & ant. phlog. cephalitis solut. appl. topic but ice cold water is as good Acute phlegm. qunisy, highly extolled as a gargle & not without reason. In eryth. infl. of fauces it will not do much & no art. is superior to capsicum [illegible] bad Infl. of muc. memb. of bladder highly rec. in irrit. infl. of blad. as the surgeons term it but it is doubtful or what grounds for this copaiv. ol. par. etc. are among the best articles Rec. in scarlet fever bad. Entonic active hem. useful It is so limited by Dr Thompson Murray rec. in conjunction with diluents & demulc. now these are bad in hem. Hemorrh. with plethora but it will not dim. the quant. of blood & no dis with [illegible] commences with an increase in the quant. of blood. Diluents & demulc. shd be avoided, as they fill the vessels abstinence shd be enjoined Menorrhea that had become habit. & required the health (probably enton.) it is sd to have stopped the discharge It was given in barley water zfs twice a day produce coldness of stom. cold extrem. etc. nausea “tumult in the bowels” It probably did no good to the general health A dis. is often cured by bringing one worse This article is not useful in irrit. hem. & in passive it is positively bad Porphyra nautica or sea scurvy rec. but not alone nitre with acet. acid is the continuation I am extremely sceptical with respect to articles rec in sea scurvy Land scurvy (p. hemorrh.) arise from bad food, confinement to one sort of diet usually [illegible] hard labour & is probably the same I should not think this wd be benefitted by [illegible] & acet. ac. I have seen it yield readily to tonics Ac. plumbi shd be the basis of the treatment conjoin capsic. alcoh. & nutritious fresh vig. diet. I shd pursue a similar treatment for sea scurvy Diet alone will often cure it Paroniria salax (identical with spermorrhea) Sagnesis furor & salacilates (nymphomania & satyriasis) in these it is rec. by Swed. but I shd not expect much from it Obesity & corpulence In one instance it disturbed the stomach & dig. org. but prod no abatement of dis. If it had been given less freely it would have impaired the appetite less food wd have been taken & emaciation wd have followed. The old rule keep the eye always open the mouth always shut & in feet always in motion is better than any medication In a cellular dropsy it has been given with squills. The latter are efficient but alcoh. is a better auxiliar. In many cases diuretics will not take hold without alcoh. & gin is commonly given The latter acts more by its stimulant than by its diuretic powers. The cases that require no stimulants soon yield to diuretics or [illegible] & calomel Paruria stillatitia & mellita etc. I have never seen benefit from it in p. mel. but the same is true of many other remedies In diabetes it is rather injurious but I have not used it. I have done more with tinct. canth. than anything else Lithis renalis of no use Exormia lichen & prurigo lepidosis psoriasis inveterate used internally & externally In one case it did no good Ecpyesis impetigo var. herpetica (hoopes) & lesinosa (salt rheum) Itch I have tried it repeatedly with no success. It was probably given because it was thought cooling bad reasoning another applic. altogether different has been successful with me Burns & scalds but I do not believe they are to be treated on the antiphlog. plan Bi-carb. of Pot. Sometimes called supercarbonate or carbonate formerly sal tartari essentiala or sal aeratis The common pearl ashes of the shops (?) Crystals quadranga prism Taste alkaline not caustic sp gr. 2 [illegible] soluble in 4 parts water at 60 [degrees] Boiling water taken up 5/6 of its weight More [illegible] than the carb.& has considerable activity Sd to be diuretic it may be but I do not believe it wd be useful in dropsy. Supposed to be antiemetic not much so, & must be injurious in atonic cases As an antilithic inferior to the same dose of the carb. As an antacid it has some power but the carb. ac. disturbs the stom. & weakens it by its refrig. effect. The carb. is on the whole preferable but the bi-carb is more pleasant Perhaps this is the cause that it is in great favour As a refrig. other articles are better & as an [illegible] agent the bi-carb. (or rather sesqui-carb.) soda is better Bi-carb. of Soda Called super carb. soda carb. soda trona more commonly than the preceding called sal aeratis not changed by exposure to air has formed the walls of a fort The heat of boiling water expels half its acid, reducing it to a carb. 6/10 of this salt is oxygen I know of no real superiority it possesses over bi-carb. pot. Soda water every where except in N. Haven is mere carbonated water with not 1/1000 grain of soda to a tumbler full. It is more pleasant without the soda & less injurious A free and especially a habitual use of soda water is unequivocally injurious to most persons. In slender [habits] it induces dyspepsia & in dyspepsia it aggravates the dis. Some of the worst cases of dyspep. arise from the habitual use of this article. The robust very often take it with impunity Soda powders consist of pure bi-carb. sod. zfs & pure concrete tart. acid grs. 25 which form a neutral tart. soda this water is chemically different that of the fountains It is cathartic Seidlitz powders consist of bi-carb. sod [illegible] & tart. pot. & sod (Rochelle salt) zii in one paper & tart. ac. 35 grs in another. Some add bi-carb. soda to cider it destroys its natural briskness & makes it flat neutralizing the salic acid forming a [illegible] which is more refrig. than most other salts Sesqui carb. soda Chlorite of Potasa 1 + 1 Incorrectly called potassae chloras, oxymurias, hyper oxymurias, murias hyper oxygenatus There are two oxides & 2 acids of chlorine with oxygen protox. 1 + 1 perox 1 + 4 chlorous ac 1 + [illegible] chloric ac. 1 + 7 This last some call perchloric & the preceding chloric from the fact that the chlorous was first discovered hence confusion Chlorite of potassa is formed by passing chlorine gas through a concentrated solution of protox. potassium, till it is neutralized as is said. But chlorine never combines with an alkali The alkali is partially decomposed. By gentle evaporation & cooling the chlorite of potassa is precipitated while chloride of potassium remains in solution Authors are very vague respecting its virtues It is not a stimulant It has been tried in phlogistic diseases & seemed to diminish the diathesis [Swedeaur] mentions [asthenia], cachexiae etc. chronic hepatitis etc is benefitted by it. I do not believe in the existence of chronic hepatitis The dis. so called is merely morbid sensibility in the hypochondriac region, occurring in advanced stages of dyspepsia. In post mort. ex. I have found no traces of infl. in the liver It was introduced for prophyra nautica from chemical notions, as it contains oxygen not much used Said to cure syphilis & hence to be deobstruent useless when the constitution becomes affected before this constit. rem. are not needed. Said to cure [culan.] dis. none specified Dose 15 grs to zfs weak refrigerant believe it has no other power unless deobstruent A fine subject for experiment Vide Boston Med. Gazette for Prof. T’s experiments June or July 1832 Bi-borate of soda 2 + 1 (borax) Called sub-borate borate boras sodae alkalesans (because, contrary to fact the alkali was supposed to predominate) Called formerly chrysocolla When impure & native it is called tincue Prisms hexaedral with two sides broader, terminated by triangular pyramids. Sp. gr. 1.24 changes veg. blue to green. Tastes styptic & alkaline Soluble in water 20 parts at 60 [degrees] & 6 at 212 [degrees] Effloresces slightly Loses its water by heat & 4/10 of its weight becoming friable in a strong heat converts it into a transparent glass which is soluble in water By percussion it flashes in the dark Decomposes by acids & alkalies by sulphates, nitrates & muriates, phosphates fluates etc. Found only in Tibet & Persia, obtained from wells in an impure state, by evaporation Brought from E.I. in large masses, white & green, joined by a greasy looking substance I have known it used freely in phlog. dis. & the most I can say is that id did not harm & was thought slightly refrigerant. I have known it employed in the exhaustion of low atonic diseases, not malignant & it neither increased nor diminished strength of action Not stimulant. Said to be nervine probably not. I do not think it is I have never perceived any deobstruent effect from it Said to be diuretic Prof. T. never could perceive it to be so Said to be emmenagogue doubtful Prof. T. has made no observations Swediaur calls it antacid It would be so when the acids were the hydrochloric or the phosphoric, as they may be. Lactic acid wd have some action and also the acetic, if it exists in the stom. which is doubtful. The sulphuric, nitrous, carbonic, & hydrocyanic acids are all that are inferior in energy of attraction to the boracic. Still this will be inferior to other antacids Therap. applic. mercurial ptyalism dyspepsia with cardialgia & acidity proctica [illegible] (“painful hemorrhoidal tumours”) Parabysma coactum of liver or spleen Aphtha ulcera serpentia (Swed.) parapsis acris var. [pousitus] Its most common use in aphtha at first it will allay the burning heat, but only for a moment, not effecting a cure Prof. T. has found milk porridge, barley water, rice water, or even cold water, quite as good and even better than borax It is rec. to dissolve the aphthous crusts. It has no such power & if it had it wd be injurious, as the slough defends the ulcer beneath from irritation. 99/100 of the physic. of this country & G.B. prescribe borax as a matter of course for thrush Case where nothing is done [illegible] quite as well as those where borax is used. Veg. astringents do something toward a cure Nit. silv. is good. Borax is rec. by Dewees parapsis acris. var. [pruritus] Prof. T. has had no experience For internal use as refrig. deobst. diuretic etc. the dose rec. in zfs to [illegible] I have used it in much larger doses without any appreciable effect Swed. says for a lotion in [peraps??] acris dissolve 10 to 30 grs in zfs [illegible], but we use it stronger For internal use it nearly or quite inert If it has any power it is a refrigerant For external use it is about as active as wheat flour merely palliating [teaspoon???] “But my testimony is negative merely. It is desirable that someone shd experiment on it Begin the experiment with zi & take zii ziii etc. Borate of potassa has been substituted for bi-borate of soda & that no so good Benzoates & succinates of potassa Of these Prof. T. knows nothing. Carbonate of Potassa 1 + 1 Called sub. carb. (case being supposed to predominate) Sal tartari sal absynthii more anciently nitrum [illegible] & alkali vegetabili (very inappropriately) also sal aeratis tartari It has a strong alkaline taste and a powerful action on veg. & [illegible] substances Exposed to the air it [deliquiates] & has an oily appearance, where it is called in this [illegible] oleum tartari or oleum tartari per deliquium (a name also given to solution of pure potassa It does not absorb carb. ac. from the atmosphere. It does not readily crystallize Crystals rhomboidal scales Commonly found in coarse grains The poorest is obtained by incineration of bitartrate of potassa but this contains oxide of calcium The more common impurities are sulphate of potassa & chloride of potassium which however are of little consequence except in pharmac. preparations Said to require twice its weight of boiling water for solut. I think less Sd to be insoluble in pure alcohol of the shops. Said to combine with oils & form soaps (but there must be a decomposition) Incompatible substances All the acids All the bi-salts borate of soda, muriate of ammon. nit. silver ac. lead chloride of iron proto & bi-persulphate iron Di & proto chlor. of merc. bi-persulph. copper The most uniform but not the most active operation is that of a refrigerant This is seldom expressly said by authors, though they said it may be given in phlogistic diseases & also in atonic. In very low atonic cases I have seen it prod. irrit. of stom. (i.e. nausea & retching) & impair the tone of the digestive organs It can be considered only as an auxiliary to the other refrig. Said to be deobstruent I think not As a diuretic, with diluents, it has sometimes considerable powers & is more active than as a refrigerant Yet it is rarely successful alone in dropsy. It is only in other diseases that it can be relied on as a diuretic alone & it also increases action’ of other diuretics Its operations is direct as it has no deobstruent powers In hydrops cellularis it is a useful auxiliary E. & Vav. say it is useful in passive dropsies probably meaning atonic cases. I have never seen phlog. cases those called having been merely irritative More useful in paruria inops than in any other disease It is antilithic when the calculus consists of uric acid, cystic oxide, or xanthic oxide An effectual antacid It may be taken moderately in dyspep. with acidity but lime water [illegible] (according & the bowels are lax or torpid) is better the first being a tonic carb. pot. often does mischief in the disease. It is not tonic Said to be anti-emetic. In most cases it does no good & in many it is actually noxious. I have abandoned its use as an antiemetic, unless the vomiting is occasioned by free acid in the stomach Supposed to be antispasmodic & useful in the whooping cough. It is neither recommended in parabysma [illegible] I never saw good or hurt from its use Struma I know of no principle on which it could be of use So too of gout, in which the French rec. it. In dyspep. without acidity Remitt. fev. Spasmod. vomiting employed by itself or in effervesc. mixt. better omitted refrig. are not indic. this is not the best remedy & is often injurious Saccharine matter impairs its powers sugar fulfils the functions of an acid & in some cases takes precedence of carb. ac. Dose 3-4 to 15-20 grs. The French give more 10 grs to zi Give it in water or mucilage, sufficient to prevent a disagreeable taste Do not give so much at once as to distress the stomach It is customary to add just rhubarb enough to colour it & [illegible] ppt. to flavour it & this is regularly given [as a placebo] by some when at a loss what to do Placebos are sometimes of use but I never liked them Carb. pot. is more commonly given in an efferv. mixt. but in this case we have carb. acid and citrate etc. of pot. as a purging salt. The usual proportions are carb. pot [illegible] dissolved in water to f zfs of lemon juice but lemon juice varies in strength (of no consequence) If sugar is added it shd be [illegible] with the acid, or we shall have no effervescence But the bi-carb. is best for efferv. mixt. Taken in poisonous doses it prod. eryth. infl. of intest. tormina soreness, exhaustion, small weak pulse Still zj as been taken without destroying life. Immediately after swallowing take vinegar & water as an antidote, but if infl. vom. & diarrh. have taken place vinegar wd add to the irritation Then give oleaginous demulcents & narcotic antirritants. Opium & hyoscyamus are best. Keep the pat. under a stead & uniform operation of narcotics [illegible] disturbing the stom. by the quantity of your demulcent Carb. pot. is useful externally applied in diabetes & a cataplasm of it applied to a felon or a carbuncle is useful Carbonate of Soda 1 + 1 + wat. 10 Called sub carb sal sodae sal alkalinous fixum fossilis mineral alkali impure soda barilla is to soda what potashes are to potassa prim. cryst. an octohedron Taste resembles carb. pot. but is weaker sp. gr. 1.359 Soluble 2 wat. at 60 [degrees] wat 212 [degrees] Effloresces in the air Undergoes wat. fusion by heat Sometimes it contains so much water that it remains liquid after melting seeming to deliquiate & occasioning a suspicion of impurities. A red heat change it to a transparent fluid A very violent heat drives off most of the acid The same process uses are ascribed to it as to carb. pot. It is however less nauseous & more mild. It has the advantage that it is capable of being made into a pill after driving off the water Dose 10 grs to zfs (ed. & Vav.) Some says zii The common form for pill is Rx efflor. carb. sod. ziii sapo zi ol. ceram mx water q.s. Soda is used in the same dis. as potassa The old phys. are very partial to it in jaundice I have seen no benefit from it. Many rely on it in parabysma hepatica Trit Antimoniate of Potassa This is the fist of the nauseating saline refrigerants The “panacea antimoni” of the dispensatories, accord. to the mod. improved meth. of prepar. it is a trit. antimoniate of pot. Expose “antimony” (the sulphuret?) 1 part & nit. pot. 6 parts to as great a heat as they will bear without fusion, then pulverise & wash out the remaining nit. pot. with cold water It is a white powder of an acrid taste scarcely sol. in cold wat. very sol. in boil. wat. but deposits nothing on cooling (“I do not understand this?) It contains 11.5 pr. ct. of wat. acc. to benz. it is pot. 1 + antim. ac. 3 It is commonly thought that the antimoniates & [anti????] are les emetic & more diaph. & refrig. than tart. antim. It seems to be the case that those antimoniates which remain longest in the stom. producing continued nausea, without vomiting are more refrig. Tartrate of antimony cannot be readily managed so as to nauseate without vomiting. It is on this ground that the “pulvis antimonialis of James (the composition of which is to this day unknown) the protoxide of antim. with phosph. lime & the protox. of ant. (the glass) have been employed. The panacea antimonialis has been rec. in cutaneous eruptions. Prof. T. inclines to think it a bad medicine. He never did any good with it & has continued it until it did injury. The idea seems to be that any thing that acts on the skin must be useful. He considers it useful only as a refrig. & diaph. Prof. T. wishes some enterprising young man wd expt on this & other prep. of antimony Protoxide of antim. Protoxide of antim. with lime Protoxide of antim. & potassa The protox. of antim. was once much used by phys. under the name of “glass of antimony” They made antimonial wine by pouring wine on the glass of antim. in substance. This glass of ant. is very uncertain it its effects. It is much more uniform in form of wine It was formerly used as a diaphoretic & refrig. in dysentery when all diseases were thot to be “hot” Experiments are needed on these prep. Tartrate of Antimony may be taken as the p type of all the prep. of ant. It may be formed Its aqueous solution undergoes spontaneous decomposition on exposure to the air Tests Hydrothionic ac. throws down in yellow precip. carb. pot. a white proc. The most important operations of this article are refrig. diaph. & emetic. It is supposed to be deobstruent but it is so only by its evacuant operation IT is well adapted to entonic diseases but may be used in those which are not purely entonic nor atonic without much injury In phlog. dis. it is more refrig. & diaph. in nauseating doses In non phlog dis when the constit. is also slender it prod. a leucophleg. habit & dry skin, crusts about the teeth & fetid breath. If given freely it produces an’ unmanageable diarrhoea. Its continued uses as an alterative has done this Physic. used to prescribed it in atonic & cutaneous dis. when they were not so well acquainted with it as now Some pat. are more susceptible to it than others & the same pat. is more so at one time than another. ¼ or 1/8 of a gr. will sometimes prod. hyper emesis yet prof. T. has given 35 & 40 & 75 grs. without prod. emesis. But in such cases you may produce it by a glass of brandy sling This was soon after the change of diathesis & proved that after such a change had taken place the article was not adapted to these cases [illegible] of ipecac would probably have vomited those persons freely To treat an exquisitely phlogistic disease (cephalitis, pneumonitis), bleed & give a cathartic of salts (sulph. soda) add 1 gr. of tart. antim. not enough to vomit which will heighten the refrig. effect of the salts You may add too zfs of nit. silver which will greatly heighten the effect. You may treat any phlogistic disease in this way. Laxative Saline Refrigerants Quadroxalate of Potassa Bin-oxalate of Potassa Called sal oxalis sal limonum essentialis (yet it contains not a particle of citric acid) potassa oxalis acidulas sal acetosella (Phil.) It exists ready formed in oxalis acetosella & probably in all the spec. of oxalis also in rumex acetosa & r. acetosella It is formed by dropping a solution of potassa on a saturated sol. of ox. al. ac. in water the bin. oxalate when thus formed precipitates if too much alkali is added it forms an oxalate which remains in solution Binoxalate of pot. has a bitter, pungent & acrid taste It is not affected by the air. It unites with alkalies & earths & forms salts of a triple character It is a popular article in fevers but is proper only in the entonic It is sold in small wooden boxes & called “the essential salt of lemons” It has been applied to strumous ulcers and promotes their healing hence called antiseptic Prof. T. has applied the bruised leaves of the oxalis stricta & rumex [acetis???] with advantage but there are better things It might probably be of service, chiefly as a grateful beverage in fevers Malate & Bimalate Potassa Soda & Ammonia malic acid exists in the [illegible] It exists in the berries of the rhus glabra in the form of the bi malate of potassa. Pour boiling water on the berries and let it [illegible] till cold It is a grateful beverage in fevers Acetate of Ammonia Called ammon acetate ammoniae acetum sal ammonias acetosus sal ammoniacus vegetabilis The solution is called spiritus mindereri liquor ammoniae acetalis & liq. amm. acetatae of which the former is proper It is supposed to be stim because amm. is [illetigle] it It is not so. [Thomson] says the acid and alkali shd both be concentrated to form the best article It is too volatile to crystallise readily, but by gentle evapor. acicular crystals are obtained (& by sublim.) 1 8/10 inch in length Taste first cool, then sweet, finally the united taste of sugar & nit potassa but the mawkish taste of the mit. potas. predominates It is very deliquescent, melts at 170 [degrees{ sublimes at 250 [degrees] Distilled vinegar shd be used & shd be saturated with the solution of [illegible] aqua ammonia Adding sesqui carb. amm. is a nauseous & inelegant mode & shd not be used, as the salt is less powerful and either the acid or the alkali will predominate & sometimes I have tho’t I could taste both (I know not the reason of this If used in cauma & entonic phlogotica it moderates the heat & dryness of the skin & diminishes strength of action Yet Swediaur calls it a stimulant It is a good refrig. & stands next to nit. pot. & soda. It is not nervine It is called diaphoretic, but is so only by obviating phlogistic diathesis, the heat & dryness of the skin being removed & diaphoresis ensuing It is diuretic in diseases not much phlog. nor naturally atonic, with diuretic regimen, but it cannot be relied on in dropsy If there is paucity of urine, it restores it if in the natural state it augments it moderately It is not deobstruent When Swed. assigns it this power he means that it is refrigerant Diseases Recom. in “simple fever general It is fashionable in Europe to treat simple fever as a [illegible] It is never useful in typhus. It is useful only in active infl. fev. Rec on the phlegmasia useful in the phlegmonus ones, not in the atonic or erythematic or atonic arthritic Swed. says it is useful in the atonic erythematica I never saw any other. The supposed phlogistic cases are irritative & in these the article is improper For a dose Swed. gives zfs to zii of the solut. I give zi & never saw it too much The laxative power is less prominent in this article than in any other of the group Acetate of Potassa Called acetate of pot. sal diureticus (the most common name) Tana foliata tartari Tartarum regeneratum kali acetatum kali acetas sal digesticus slivii Longer known than any other of this class except nit. pot Add carb. pot. to distilled vinegar. Citrate of Potassa The citrate of potassa soda & ammonia are all used, and are next in frequency to the acetates. Citrate of pot. is called mixture vel haustus [illegible] riverii It is formed by adding sol. of carb. pot. to citric acid till it is saturated, & drying the product It is very fashionable in London & Boston It is not good in cholera infant. or in any atonic disease, increasing the vom. & purging It is most used as a diuretic being similar in power to acet. ammon. Taken during effervescence it is effectual in allaying vomiting in phlog. cases or those which are not atonic nor entonic No better than acet. amm. not so good as nit. potassa Nitrate of Soda Found native in various parts of S. America I consider this as a refrig. precisely in the same manner as nit. potassa, but in a much less degree It is said by late writes to be laxative in doses of zfs to zi Sd to be diuretic but I think in no other manner than nit. pot. Much used in Germany. Dr Weir (?) wrote on it Refrigerantia acida Vegetable Acids vegetable acids may be divided into 3 groups 1 Those which exist in veg. in a free state or combined with alkaline or metallic bases. 1 Those which are never free but are always combined with veg. [illegible] bases 3. Those which are the product of decomposition the first group comprehends all the refrig. acids exc. the carb. They are the acetic (called also acetous & a modification of it the pyroligneous) citric malis (or sorbic) tartaric (and a modific. of this the pyrocitric etc.) & oxalic (or rheic). The carbonic shd be placed here from its properties. The second group are not [illegible] to possess any medic. power. Examples are the meconic of opium & [illegible] of cinchona. The 3d group are supposed to be nervine. There are but 3 of them benzoic, succinic & perhaps the camphoric Acetic Acid This is susceptible of a greater variety of applications than any other veg. ac. & possesses all the powers of the others There are 4 species viz. acidum aceticum [illegible] acid. acet. dilutum (distilled vinegar) acid ac empyerumaticum (pyrolig. ac.) & ar. acet [illegible] (common vinegar Pure acetic acid is very volatile & its vapour is inflammable. It is obtained by The strength of vinegar is determined by its power of neutralizing alkalies It is found free naturally but it is obtained for use by fermentation & veg. decomposition In the U.S. from cider France from wine (acetum vini) England from beer (acet. [illegible] or Aligar) This acid has been longer known than any other mentioned by Moses. It may be obtained by the destructive distillation of veg. matter in form of pyrolig. acid This or common vinegar may be purified by digesting & afterwards filtering it upon charcoal (animal is best) & then distilling it This forms acetum dilutum, formerly called acetous acid It is contained in the juices of several plants, free or combined with alkalies e.g. with phenix [deotybifera] (date tree) vitis vinefera sambucus nigra galium verum [illegible] [illegible] rhus typhinum etc. but not in large quantities It is a pure refrigerant adapted to entonic diseases abating but thirst etc. It has been given in typhus gravior & putridus, because there is heat thirst, sordes cadaverous smell etc. & the pat. craves acids but in such cases the min. acids are better The heat requires antirritants The sordes cadav. smell etc. indic. a low state of the system & require supporting agents Acetic acid will produce morbid irritability of the stomach & intestines, retching vomiting & diarrhea, exhaustion & a tendency to sink at one of the critical periods. The effects are gradual, therefore not always observed. So of all the typhus phlog. & exanthematica & all dis. of putrid type It is not stimulant nor astringent Said to be antiscorbutic I think not, because it must contain veg. matter in solution to be of service in scurvy. This is the reason why plants of the order cruciferae are useful Antiseptic only in dead an. matter It may prove [illegible] gangrene from excessive phlog. action The veg. acid are said to be anti narcotic perhaps they are after the narcotic is removed from the system. Some narcotics are heightened by them while they remain No narcotic is ascertained to be diminished in power by them. Said to be antiemetics. This depends on the state of the system & stomach Said to be diaphoretic & diuretic only indirectly is it so “Laxative” most acids move the bowels acetic, slightly only “A remedy for polysercia” indirectly so in such quantities as to injure the digestive system spare diet wd be better A sparing use of vinegar in health is wholesome, especially in assisting to digest oily food For laboring men in warm weather vinegar largely diluted with water; syrup & ginger added, is a very pleasant & healthy beverage & far better than ardent spirits Externally it is refrigerant & discutient & may be made to be rubefacient combined with water & alcohol in certain [illegible] used as a lotion in all kinds of erythem. infl. scalds from hot water malig. sore throat tumefaction from sprains & contusions uterine & nasal hemorrhages & [illegible] costiveness. It is inhaled to relieve syncope. It is supposed to destroy specific contagion & is applied to the head of convalescents from small pox. But this is rather a chemical & mechanical than a medicinal effect It is liable to change & decomposition in the ordinary form of vinegar, but the taste smell & appearance will be adequate tests It is used in pharmacy as a [menstruum] & the posers of a few articles are heightened by it, as colchicum, which contain the bi-gallate of veratrine & the acetate of veratrine is more active. So the acetate of sanguinaria is more active also that of morphine is more so than the natural salt of morphine which exists in opium But most articles have their powers impaired or destroyed by it. The preparations are nauseous and liable to decomposition even with a considerable addition of alcohol. The following are used viz acidum aromaticum, acetum scillae, A. colchici, A. veratri (3 species) & A. sanguinariae As prepared from fermentation it is uncertain & shd not be used for these purposes Citric Acid Next in importance to the preceding Found abundantly in the geum citrus of which 3 species are described C. medica (citron south of Europe) C. limonum (lemon) C. linetta (lime) These contain great abundance C. aurantium (sweet orange) C. vulgaris (Seville orange) C. vulg. var. myrtifolia (cultivated in our green houses) C. decumana (?) (shaddock) All these contain citric acid & [illegible] the other species Citric acid is contained sparingly in other genera, as oxycoccus Europeus, cerasus [illegible] (bird cherry) C. hortensis (our old fashioned red cherry) solanum dulcamara, fruit of rosa canina ribes rubrum vaccinum myrtillus fragaria vesca Citric acid is one of the most expensive but most pleasant. The juice of the recent fruit is preferable to the concrete acid in fevers etc. Malic Acid Obtained from apples & pears in considerable abundance, in which it exists ready formed in greater still from the leaves of semper vivum tectorum sorbus [aucuprin] (?) of Europe, sorbus Americana (juice of the fruit) most abundant is the red [illegible] of the fruit of rhus glaborum for medicinal purposes, macarete the berries in hot water & strain The acid thus obtained is than the juice of limes etc. for fevers Tartaric Acid Obtained exclusively from the fruit of the vitis vinifera, in which it exists in the form of bi-tartrate of potassa New wine contains it in solution & deposits it by precipitation on the casks. It is taken from these & purified & crystallized to form the [illegible] bi tartrate of potassa or cremor tartar The true tartar is not recognized in chemistry now The “adiculous syrup of lemons” consists of tartar ac. zj essential oil of lemons (rind) [illegible] white sugar zxvi boiling water zvjii This constitutes the lemon syrup of the shops If too much oil of lemons is added it gives the taste of rotten lemons. There shd be just enough to give it a taste in water. The “salt of lemons” is bin oxalate of potassa, q.v. Oxalic Acid Exists in the fomr of binoxalate of potassa in the oxales Americana acetorella, stricta, violacea, & probably in the others It exists in smaller quantities & the same combination in rumex acetum & acetorella in the juice of the stems of rheum raponticum (pie plant) & a little in R. palmatum & undulatum. The acid of R. rap. was formerly thought peculiar & called rheic ac. The citric is the most agreeable acid than the oxalic, then the tartaric least of all the acetic. The oxalic is more active than the others & is probably the most powerful refrigerant of all The effects of these acids in excessive doses are irritation followed (if a sufficient quantity has been taken & not removed) by erythematic infl. & there may be ulceration & sphacelation if not immediately fatal. The symptoms are nausea, vomiting, pain in abdomen small wiry pulse etc. The oxalic is the most poisonous, next the tartaric, then the citric Immediately after swallowing give carb. pot. lime, or magnesia & if not given immediately they may lessen the evil those however are preventives, not antidotes To obviate the effects we must give demulcents & opiates Carbonic Acid Is said not to be capable of being inhaled It is so if pure, but when much diluted it may be & will diminish irritability & produce first prostration, the exhaustion paralyzing the muscular powers & preventing all effort to escape from its influence The remedies for asphyxia from this gas are a free supply of fresh air dashing cold water over the whole body particularly the head frictions stimulating enemata artificial inflation of the lungs with good air Medicinal operation Almost all the books call it “stimulant ton. diaph. diuret. & antiseptic” Copying from each other. When I commenced practice I supposed so, but have found by actual experiment that this is not true It was injurious in atonic cases & did not aggravate phlogistic ones. If given freely in the form of carbonated water it was an evident & decided refrigerant, diminishing vital energy & strength of action & morbid heat, restlessness, irritability & irritation. It is a decided but weak refrigerant beneficial only in acute entonic diseases. It will correct the fetor of the alvine evacuations. It is analogous in its effects to the vegetable acids. I have a letter from an old physician confirming my statements Boracic acid (nervine?) Fruits Stimulants 2nd Stimulants Rhus venenata not the is vermix which is a native of Japan like R. toxicodendron is useful in palsy, dyspepsia & many diseases is no more unmanageable than any other article & is no more poisonous to the system. The other species of rhus are acrid but this is the best as R. [illegible] is probably preferable to R. toxicodendron. R. radicans is not inferior to R. toxicodendron Alcohol Discovered by an Arabian chem. A.D. 930 Some ascribe the discovery to Arnold de Villenne of Montpelier in the 14th century When strong burns with a blue, when diluted, with a yellow flame. Sp. gr. [absol.] alc. [illegible] 96 or 2 Off. alc. 835 in G.B. & U.S. take a vial find its exact weight & mark it with a diam. Pour into it 1000 grs (troy) distilled water & mark the heights Alcohol up to this mark shd weigh 835 grs. Alc. dissol. pot. amm lithia & the veg. alkalies, but not the earths. Generally all the salts which in water are insol or very sparingly sol. are also insol. in alc. The deliques. are also, exc. the carbonate of potassa Alc. also dissol. sugar, resins, manna, balsams, camphor essential oils Alc. dil. eq. pts wat. & alc. sp gr 935 The peculiar properties of alc. in different forms (as spts sacchari [illegible] spts persici [illegible] bran.) are said to be owing to oily matter always present & to a little acetic ether The former may be removed by repeated distillation & caustic pot. or soda will remove both. The carbonated alkalies do not act with suffic. energy Alc. is sd to be the same from whatever source produced Alc. is stimulant nervine & narcotic It differs from wine in producing an effect externally also, when it produces a vital contraction of the solids diminishes morbid irritability & sensibility, obviates a relaxed state of the soft parts & relieves pain IN many states of the system the use of wine & of alc. prod. the same effects, but there are considerable differences in certain states It is not tonic There is much room for discrimination between wine & alc. as between alc. & ether Greater effect on the brin is produced when atmosph. press. is removed as in ascending high mountains also on an empty stomach It does create a positive increase of power when indicated & properly managed & is not followed by exhaustion It is not a poison in a popular sense of the term i.e. in small doses Wine is indicated in non malignant typhoid disease alc. in low malignant [illegible] is better in the putrid types, alc. in in the nervous. The mode of preparation [illegible] the use of stimulants will make a difference if cal. & op. are not given in the early stages alc. will disagree in the latter & perhaps wine & the supporting agents will disagree also; but if cal. & op. be given at the outset & afterwards the sp. be continued alcohol will agree will if so strong a stim. be indicated Upon the [whole] [illegible] is indicated in chronic diseases & indicate with consid exhaustion, but alc. is advisable in very few chronic cases but is particularly appropriate in acute diseases with extreme exhaustion Intoxication is in no case a stimulant operation, but in some a narcotic, in others a nervine in others both It is not settled to which intoxic. should be attributed. I am inclined to think the remote effects of alcoh. attributable to its peculiar narcotic power No pure stim. nervine or narcotic produces them though the narcotics approach nearest. Perhaps we may consider del tremens as the eff of its nervine power & diseases of the liver of the narcotic, but I am not certain The external marks of intemperance in alc. are inflamed eyes bloated face red nose, tumid abdomen turbid urine foul breath, tremors of the muscles emaciation, peculiar cutaneous eruptions & preternatural old age The effects on the mind are inability to fix the attention failure of the memory & judgment, irresolution, cowardice Patient ultimately dies dropsical paralytic apopleptic or delirium etc. deranges the digestive organs & particularly affects the liver Swine & fowls fed in distilleries are subject to enlargement of the liver & the same eff is prod. on the human subject The constant irritation on the digestive organs causes a determination of blood to the viscera, which produces congestions infl. & parabysma. The particular diseases produced by the use of wine are a peculiar sort of dyspep. (differing from that produced by alc. & other causes) Gout, calculous diathesis & sometimes lithia renalis or gravel. These are exclusively the diseases produced by the use of pure wine The habitual use of alc. produces an obstinate dyspepsia of a different form & terminating sometimes in membranous phthisis limosis syncoptica parabysma to especially of the liver. A peculiar kind of cutaneous eruption Obstinate ophthalmia tarsi hypochondriasis nervous tremors A peculiar sort of conclusion called “drunken hysterics” delirium tremens obstinate dropsy parunia melleta or diabetes impotence paralysis & sometimes catocansis ebriosa These are all the diseases that are the peculiar effects of alcohol In cases of exhaustion from severe exercise, tho in good health, alcohol is a good remedy So if a person subject to rheumatism should accidentally get wet though a free draught of brandy will almost invariably prevent the rheumatism So too of persons predisposed to pneumonary complaints which exposures will bring on So of fever. So too an attack of an [illegible] may often be thus prevented. Yet it would undoubtedly be far better if alc. were confined to the shops of the apothecaries Therapeutic appl. of alc. & wine Limosis dyspep. It is bad practice & shd be avoided Wine is better when it agrees. Alc. may be used when there is extreme exhaustion to bring the pat. within the proper range of susceptibility to other medicines. Diarrhoea It has succeeded when it was simple & idiop. I consider the species of diarrh. as only varieties I except d. tubularis which is a membranific infl. & D. [illegible] which is a symptom of dyspepsia. Opium is far better [illegible] diarrhoea. Cholera a temporary use is often beneficial Generally before the pat. is called the pat. is reduced very low pulse weak, quick cold extrem. epig. stress. Here a small quantity of undiluted spts especially if hot will often suspend the vomiting & diarrhoea & palliate the disease Opium is more effectual but but some cases require alc. in addition Avoid giving a great bulk for this will cause vomiting Intermit. & rem. fever Wine & alc. often useful. These may be 1st of the synochus or sub putrid type 2nd of the nervous, as exquis. as in t. nervosus 3d of the putrid or typhus gravior type. When of the synochus type they are never malignant. Wine & alc. are never necessary unless the cases are protracted & run down In the nervous alc. is preferable to wine but wine is best in the Alcohol Wine 2nd 2d Stimulants putrid if not malignant & low. otherwise alc. But these are to be considered as auxiliaries, when the system has been prepared by cal & op. alc. is more applicable & agrees better. Thus is obviated the irritation which alc. would otherwise produce. Icterus melaena many cases will require either wine or alcohol. Sometimes they will agree, sometimes not give op. with either Typhus in all its forms when malig. alc. non-malig. wine answers very well When run on to a low state, alc. or wine shd be given acc. to the degree of exhaustion the previous treatment & the type Abscesses require either wine or alc. when in a low state. Apostema when low Anthrax when system is much affected & low Erythema [illegible] erysipelat. gangrenous & anatom. in the same cases as the preceding. So too of paristhmitis maligna Malignant variola rubeola & rodalia Phlogotica or visceral infl. may or may not be proper. When approaching to erythema phlegmodes they are not. if to e. gangren. they are necessary or in the early stages IN the arthritic wine & alc. may be highly useful. Arthritic infl. may be acute, subacute & what is called chronic i.e. intermediate between rheum. & neuralgia. All these forms may affect the viscera. In the advanced stages of any of them, if there is a metastasis alc. & wine may be useful Membranific Phlogotica I have not seen a case of croup this winter (1830) in which alcohol has not been employed by others as well as myself. This does not supersede the use of emetic cal. & deobst., but they fail without alc. in some cases or the dis. may run into a low state & then alc. may be required Strumous Phlogotica very often [required them] General acute febrile dysentery often indicated at the outset if malignant also if run down into a low state alc. generally is better than wine In many of the dysthetica they are important auxiliaries e.g. marasmus tabes (not so much in m. atrophins) especially var. venenata from lead & mercury. Porphyra hemorrh. (land [scurvy]) if the case is serious they are highly useful In severe cases the more intense astringents, powerful tonics & diffusible stimulants are highly necessary Gangrene especially G. sphacelus Entasia Tetanus their propriety has been controverted. Dr Hosack thinks every thing depends on giving them just to the right point & that more or less will fail his cases would not have been called tetanus in Conn. they were slight spasmodic diseases & would have got well without any treatment In genuine & severe cases we can trust to neither for a cure. In Mass. such cases S have been treated with Fowl. sol. in very large quantities, sufficient to keep the bowels open & alcohol. Practice that would destroy life summarily in health may be safe & effectual in violent disease. This practice seems to be judicious & judiciously managed Arsenic is considered the most important part of it. Opium shd be used largely at the same time. Lyssa canina proper if great exhaustion Chorea if great exhaustion Chlorosis atonica wine with some limitations Dropsy Stimulants are not incompatible with digitalis. In some cases it will do nothing without stimulants & then will act salutarily. They are those attended with exhaustion pulse weak & feeble extremities cold powers of life considerably reduced Bites & stings. The testimony is complete as to the efficacy of wine alc. & opium The practice is as old as Celsus perhaps Galen (vide my notes) Celsus recc. vinum cum pipere External Use of Alcohol Dr Ives uses alc. zi to zii ol. orig. in scalds & burns & prefers this to ol. pin. He uses it before vesication, which it prevents. If applied too long however it may produce it & be as bad as the fire. The test of sufficient applic. is the relief of pain without its returning on suspension. If the skin is removed, the burn extensive & exhaustion & irritation great, the same mixture is recc. topically Some forms of indolent tumors if early applied, it may discuss them Vapor bath of alc. (Support the bed clothes by a stick) probably some of the alc. escapes combustion & passes up in hot vapor. This bath does not fatigue the pat. does not make the bed damp like boiled blocks Useful in secondary stages of colica ileus & rhuch. in diarrhea cholera icterus melaena chololithus [illegible] limosis gastrodynia malignant intermittents & typhus Wine Vitis vinifera not an [anpelop.] D.C. vinif. & vitis jus native of south Asia. Boerhaave derives the word vinum from vieo to bend or twine It is from the celtic gruzel (pronounced vit) vine, vigne, vinea [illegible] [illegible] etc. all from two hebrew words signifying fountain & to press out. R. & Schultes describe 1 or 200 varieties of vitis vinif. Wine does not exist in the grape The great divisions of wine are alba & rubra Other divis. are acidula as Rhenish or Hock dulcia as Frontenac malaga [illegible] tokay cape austera as Portugalicum or Port, mitia i.e.. not acid sweet not austere, as sherry, madeira, claret, burgundy champaign. To these we may add vinum pomaceum or cider & v. pyraceum or perry Wine is mentioned in the works of Hippocrates in the treatment of typhus It is a stimulant, nervine & narcotic It allays the intense stinging heat of typh. gravior as infallibly as cauma is relieved by depletion & refrigerants. It promotes perspiration when defic. & restrains it when excessive It allays irritation jactitation pain & wakefull all in atonic diseases Excessive quantities produce vertigo, delirium or coma followed by languor headach. nausea vomiting & sometimes diarrhoea For diseases prod. by it vide alc. It is an undoubted fact that a free use of wine diminishes the susceptibility to diseases both entonic & atonic The power of wine in allaying irrit. sensibility increased freq. of puke restlessness watchf. pain etc. is the joint effect of its 3 powers Wine is not properly a tonic though it comes nearer the alc. to being one. White wines contain water, bi tart. pot. & colouring matter. Sweet wines contain sacch. mat. & ret wines, a little tannin. But these mixtures cannot be imitated by art. The properties of the factitious wines are those of their alcohol Hence I consider the active principle a distinct compd of the ponderable bases of prot or carburet hyd. & water in equal proportions, so that wine differs from alcohol as essentially as that from ether. I think it probable that hereafter it will be found that the active principle of alc & cider is 1 prot. carbur. hyd + 2 [illegible] But it is known the brewers add various narcotics to beer to make it more intoxicating 4th Stimulants Phosphorus This article stands next to alcohol in the quickness of its operation. Alcohol acts sooner than any other stimulant phosph. next & the cantharides, but neither of these two can be relied on as a quick stimulant in case of emergency. Ether (considered a stim. by Prof. T. in 18-1 & 1-2) capsicum, and the essential oils are sometime in operating Phosph. is I believe found in the veg. as well as in the min. kingdom. It is soluble in caustic alkalies with heat & probably unites with their metals, as it decomposes water It is not decided whether phosph. acts on the nervous syst. through the medium of the m.m. of the al. can. like ether or whether it acts on the bloodvessels like capsicum, cantharides, ammonia etc. Probably it acts in both ways It is said to be nervine & diaphoretic It cannot however be used as such Dr Ives give it in low stages of exhaustion etc. In mere torpor without exhaustion it is improper. Extreme irritability, though there may be ever so much exhaustion contraindicates it. It is only when the pat. is in a low state & the danger remote that it can be relied on & not at a sudden sinking a crisis, as yellow fever. When there is morbid irritability it is increased by phosph Dr Ives uses it when the action of the disease has worn out the sensibility of the system phosph. thus occasions a new supply of excitability & rouses the pat. in the article of death. This is contrary to the [Brunomia] theory but it is strictly true Dr I. thinks phosph. less favorable when there are topical affections. He thinks it excites appetite especially for animal food Swediaur thinks it aphrodisiac if so it would probably be from its stim. powers & in exhausted states of the system Phosph shd never be given in substance either in pill or emulsion as it wd occasion top. infl. Sulph. ether rectified by dry chloride of lime is said to be the best solvent zi will hold 6 grs of phosph. in sol. Soc. to my experience the fixed oils are the best solvent. Rx ol. oliv. purified & heat it with an excess of finely cut phos. Keep it well stopped. When used add a little spt. amm. to give it a creamy appearance & the pat. will not know that he is taking oil, at which most have a disgust. Sugar with ol. cinn. etc. makes it palatable Take it unmingled. A teaspoonful once in 3 hours is a dose of the saturated oil This was given in an extremely low case when a powerful dose was indispensible Continue this dose until the system is roused & then diminish & continue I have used it in no other than low cases. A small dose of a repeated is the only proper mode of exhibiting stimuli in low states of the system the lower the oftener Phosphorus if properly used is not dangerous & in low states of exhaustion we have no substitute for it Phosph. has been supposed to retain its medicinal powers in combination. This may be true of the binary compds [illegible] of its salts. Liquor of phosp. acid is used as a substitute for phosph. but that it has the same powers is I think more than doubtful It is formed by exposing phos. to the air, when it liquefies from the moisture in the air Sir H. Davy thought this substance a mixture of phosphoric & phosphorous acids Dr Ives’s dose is from 10-30 grs in water every 3 hours. I have not used it Particular forms of dyspep. attended with great torpor & insusceptibility & little irritation are relieved by phosph. In a form of dysp. with epigastric sinking lim. cordial or syncoptica of Good paroxysm every day sense of faintness distress at stomach, aggravated by exertion, both bodily and mental here phos. is of more use than any other remedy, unless alc. or opium which cannot be employed in chronic cases opium is not so dangerous but phosph. possesses superior power of relieving Limosis albicans (white jaundice) also lead colic with great exhaustion here ph. is the only remedy that will succeed Icterus melaena of Good occurring in broken down constitutions secretion of bile deficient differing from jaundice in being attended with exhaustion of digestive powers the skin is livid like a bruise yellowish green cases fro mthe south or intemperate persons. Common remedies do not good. Active stimulants must be conjoined with deobst capsic. or ph. with cal. or better corosive sublim. Malignant remittents & intermittents of trop. clim. & sometimes among us, & the low stages of all atonic fevers, malignant or not, when vit. energ. are low Delirium trem. Here phos. is a powerful auxiliary. In some cases opium alone will not succeed unless the vital energies are roused. Malignant continued fevers of all kinds whether with primary exhaustion or that produced by the disease Plague typh & anthrax involving the whole system Pneumonitis that kind which Good says will not bear emetics etc. In that kind of pneumonia confined to the lining membrane of the bronchiae with infl. like that of the intestines as dysentery Malignant rubelola & rosalia Atonic small pox Tabes var. dorsalis It has been partic. successful in T. venenata from lead merc. & arsenic Impotency certain cases of dropsy diabetes passive hemorrhage by Dr Ives Gangrena sphicelus & necrosis of Good Bad cases of land scurvy Spermorrhea atonica Agenesia in potens var. atonica thought to have especial power Poisonous effects of phosporus violent burning pain in stom. & intest. Alliaceous taste in the mouth obstructed respiration vomiting, hiccup extreme exhaustion Pulse very hard & small towards the close convulsions death. The stom. & intest. are inflamed & [sphicelated]. The infl. is erysip. not phlog which would spread to the other coats If called early give an em. of ipec. or sul. zinc If the phos. has passed down give cast. oil in wine glass doses with a drop of croton oil if necessary. Orfila recc. magnesia to neutralize the acid. I think the acids produced have no share in the mischief. Op shd be given sufficient to allay pain & spasm. No other remedy is needed. Antiphlog. rem. are injurious. Demulcents may be useful but not in quantities sufficient to produce distention Medical Jurisprudence Erithematic infl. of stomach pure phos. or ph. acid in al. canal no other mark decisive. If it has been given in oil, it will not be precipitated if in ether it will. The appearance of phosphorous [oxic] acids is not a proof of poison (or I think) for they are found in dyspepsia etc. & are an ingredient in the human body. Minute particles of phosph must be detested by the eye & by their white fumes, odor & luminousness. 5th Stimulants Arum triphyllum No synonym aroides (fuss.) Piperitae sinn. Possesses a peculiar acrid principle, volatile, inflammable dissipated by drying, air heat & even by pounding in a mortar It is not soluble in milk, oil, water, alcoh. vineg. I know of no solvent. Root contains ¼ part fecula This root produces a strong pricking sensation on the tongue & almost vesicates it Applied to the skin it vesicates In the stomach it produces heat, nausea a pricking sensation all over & spasms of the extremities are among its effects When dry it is inert like starch, but sometimes retains a little power The root is the only part used This root is an acrid excitant with no other power It is an expectorant & diaphoretic by virtue of its stimulant power & when dry it is demulcent & nutritious Externally it is discutient, but rarely used It is allied to capsicum in its powers. Medium dose 10-30 grs If recent 10 grs [illegible] sufficient, repeated once in 2 3, 6 hours. For an emulsion, best in a mortar with milk or sugar. Barton directs a confection by boiling, which destroys the power For extern. appl Beat with irritant or apply alone It is rubefac. & vesic. To keep it with unimpaired strength lay it in sand It is inferior to capsicum Milk, mucilage or oil most conveniently allay its effects Diseases It is put into a decayed tooth Ptyalism as in epilepsy Dysphagia from spams & that from semi [illegible] of muscles of [degl??] It is given with success in flatulent colic Other species of arum have the same properties in different degrees, as A. dracontium calla palustris less active than arum but similar Lecontia Virginica The strongest of all the arrideae acrid & mucilaginous. Arum maculatum is the off. spec. in [Eu???] Ictodes feticus Formerly called arum Americanum (Catesby) calla aquatilis (Gronov.) Dracontium fetidum lim.) posthes pectorii (B.S. Bart.) P. foetidum Lymplocorpus foetid (Salist.) Spathic [illegible] foetidum ([Rafines]) Ictodes foetidus (Bigel.) Every part has a fetid odour, depending on a volatile princ. probably a volatile oil, but it has never been separated. It is more permanent than the active princ. of A. triphyl. It has resinous & mucilaginous [illegible] its acrid & odorous properties. The seeds have an animal odor & contain a fixed oil The root and seeds are the parts used but the seeds are preferable. They retain their vital principle for years & their medical virtue as long. The root loses its strength by drying This plant is a powerful excitant like arum. It acts on the alim. canal & does not affect the circulating system immediately. It is a nervine like asafoetida. Very large doses occasion vomiting, headache vertigo & sometimes a temporary blindness It is probably not a narcotic Of the dry root 10-20-30 grs every 2-4-6 hours may be given. It may be formed into a confection or better, may may be taken in molasses & water Dry it whole & exclude the light It is doubtful whether the leaves are any better than cabbage leaves, but they have no offensive smell as cabbage has after topical application Uses & applications similar to arum maculatum It is not so powerful but it is better in flatulent colic than arum as it is nervine Dyspnea exacerbans It has more reputation in this than in any other disease Repeat it every 10 min. until it produces vomiting or relief. The vomiting itself is often of service To prevent the recurrence give 4 doses a day Dyspnoea seems to arise from paresis of the gastric branch of the par vagum & is relieved by Galvanism chronic rheumatism by a continued use like guaiacum & capsicum Convulsions particularly hysteria Paramenia cessations Dr I. recc. the limb in phleg. doleris to be wrapped in the leaves all over (as a smooth app.) Acorus Calamus [Odor] like a mixture of cinn. & pimento improved by drying. Essential oil can be obtained. The bitter principle is extracted by water It is an acrid aromatic excitant, with some tonic properties It is not inferior to cinn. & nutmeg in substance & oil. The dry powdered root is an excellent errhine IT is used for economy where cinn. & nutmeg cannot be afforded & were it as dear would probably be as much esteemed. Essential Oils These are 1 Pure stimulants 2. The milder oils as ol. anisi, a pure nervine 3d nervine & narcotic or stimulant & narcotic The terebinthinate oils are stim. & deobstruent Articles containing the oil are often used in a crude state, if it is in abundance e.g. cinnamon cloves Monarda Punctata (Wills.) The most acrid & pungent of the essential oils It flavor resembles that of thymus or satureja It is an elegant & pure aromatic & stim. Extrem. It is one of the best veg. or rubef. & vesic. For intern. use make a spt. rx f zi oil to 7 of off. alc. ( I make the spts ppermint in the same proportion) It is very good to cover the taste of unpleasant articles. So oil cinn. The oil cannot be taken pure, even on sugar For a [linin]. Rx ol. mon zfs tinct camph. zii & tinct. opii zii Probably the spt. monard. wd be as good for a rubef. Ol. monarda with ol. oliv. remains more fixed but is not so powerful The oil was introduced by Dr Atlee of Phil Ol mon. is more vesicating than ol. capsic. & less so than ol cantharides The other monardae are much less active Therap. applic. Typhus with cool skin & cold extremities use the linim. on the arms legs & breast (Eberle & Alee) to restore heat. Brandy would only evaporate & increase the coldness Cholera infantum (an enteritis) to the abdomen & extremities (Eberle) Chronic rheumatism internally & extern. peculiarly adapted partial palsy hemiplegia & [paraplegia] Tooth ache I have used the oil when the nerve is exposed apply it on cotton to the cavity of the tooth & around the adjacent parts or it may relieve by ext. app. ol. capsic. is best ol. mon. next. Mondarda oblongata Less active than m. punct. but nearly equal. The infus. is useful in the atonic stage of fevers. The weak infus. is quite effectual in the forming stage of the atonic febrile disease Monarda didyma (Banks) & monarda kalmiana ([Pursh]) These are used for nearly the same diseases as m. punctata & probably differ only in degree of power. M. kal. was first discovd at Oswego & called m. didyma Pursh gave this name to a southern species. Both are probably varieties. At least the “oswego tea” has the best claim to the name. The different spec. of mon. ether contain a less active ss. opil or a less quantity of the same oil. I know not which probably the latter. If so the same oil might be distilled from each Probably m. oblongata would furnish a large quantity Monarda fistulosa Common in N. England & has been cultivated in Europe for the oil It is the origanum spurium of old writers. 6th Stimulants Capsicum C. grossum squash pepper is the spec. almost exclusively cultivated amongst as C. annuum is mentioned in the books as being the off. article but is far less common. The [pericarps] of C. grossum contain 1 an essential oil (called etherial by the French) which is not volatile at all, and the case also with that of piper nigrum. It is obtained by digesting the pericarps in ether for a fortnight expressing filtering & evaporating the ether. We obtain the oil & crystal of capsicine the scent of ether still remaining which perhaps might be driven off by heat. The oil thus obtained & is of a brilliant red colour aromatic in odor, pungent & warm to the taste It cannot be distilled without decomposition. It contains all the medicinal virtues of capsicum. I have for years used it as a substitute 2 Capsicine white acicular crystals without odor or taste neither acid nor alkaline. AT the 1st crystallization they are combined with some of the oil & were hance supposed to be the active principle & sold at a high price. By repeated crystallization they are purified and then have neither sensible nor medicinal properties. The same mistake was made with regard to piperine which we always see yellow from the oil, but when pure is quite tasteless & inert 3. Red colouring matter which it is difficult to separate from the oil 4. A substance not investigated containing nitrogen 5 Mucilage 6. Various salts especially nit. potassa For excessive doses of ol. caps. demulcents of opium are the proper remedies Dose of ol. cap ¼ gtt or 1/8 gtt sometime 1 [illegible] or more Of the substance 12 grs is a very large dose in our climate but more is given in the W. Indies. If we wish for the effect on the stomach only, and not on the mouth & fauces the tinct. shd be given in milk. Mix & swallow immediately & it is not tasted Pat. do not generally complain of the taste in acute disease though they may in dyspepsia etc. Nor do they in low cases of typhus & cholera. When there is very great burning in the mouth & fauces this article cools more than any thing else The vinegar of caps. is not so good in irritated states of the stomach or in the low stages of fevers but it is the best form for affections of the fauces in rubeola & rosalia Cataplasms may be made of the powder & flour & vinegar. Or the caps. may be sprinkled on a paste. If a very speedy effect is desired a paste may be made with pure powder of caps. & hot spirit As a rubefacient it excites an action sui generis & often excites one when other things fail. There is room for selection in rubefacients In many cases tart. em. is bad & caps. good & v.v. So of other rubef. Therap. applic. Rheumatic toothache The tooth is often carious if on the lower jaw drop it in the oil if on the upper moisten lint, or rub up the oil with sulph. morph & dip lint in Chronic ptyalism often symptomatic of paralysis or of epilepsy & chorea gargle the mouth with the tinct. or the dilut. essence Dysphagia atonica often a more part of general palsy but it exists sometimes independently & is then curable by capsic. Dysphagia spasmodica Limosis dyspepsia in cases attended with torpor & insusceptibility, with much flatulence & freq. reject. of food. Capsic. alone or conjoined with food, or with eccoprotics, deobstruents & tonics will cure In cases of cold extremities rub them with the diluted oil till it produces a glow more or less permanent & so as to be slightly rubefac. if the powder on cotton is used it shd be very fine, for if as coarse as we have it for the table it will produce very little effect. It is used externally on this disease as a stimulant to the epigastrium either the powd. or the ess. oil Incorporate it with a spatula with La & Butler’s (which is the best it will spread cold) adhesive plaster common pl. is too hard Limosis syncoptica a valuable adjuvant shd be given in form of tinc. or oil as more speedy Limosis albicans (“white jaundice” no jaundice at all) highly useful auxiliary to [xanthortia], percholr. narc. & opium Dr Reed of E. Wind. who uses caps. extensively recc. it in all kinds of diesth. attended with viscid secretions from the liver to check the secret. in quantity & change them in quality Colic I prefer rubefac. to blisters in their action can be kept up in the 2nd stages it is important as an auxiliary Colica rhechialgia Capsicum counteracts the sedative effects of mineral poisons particularly of lead. Lead does not always produce colic, sometimes marasmus & sometimes paralysis, without being preceeded by colic The proper remedies for all these effects are acrids & particularly capsicum Colica cibaria of Good from poisonous fish mushrooms etc. (as often however a cholera or diarrhoea as colica). The tropical practitioners depend altogether upon the acrids & say it is no matter whether the offending substance is evacuated or not I prefer evacuating if pat. is not sunk too low. It is important to know that evac. is not indispensable in such cases we may enter at once upon the acrids as capsicum with confidence of success If called early I would evacuate the al. canal & sometimes this is all that is required if not give acrids. The effects of pois fish & pois mushrooms are very similar, being in both cases speedy & direct (sometimes very rapid) exhaustion. Some persons are more affected than others the reason is inexplicable. Those of warm climates are more susceptible than of cold Colica flatulenta Coprostasis costiveness attended with torpor & atony, apparently local cases where refrig. salts have been taken till an enormous quant. is necess to operate & then with small effect. The simple acrids such as are not cathartic will often give complete relief in some cases as much capsic. as can be taken with the food has answered the purpose. I know of no certain diagnostics in these cases. The subjects are generally feeble & no harm can result from trying caps. Caps. also enhances the effect of tonic & astring. cath. as rhubarb Diarrhoea, pure or idiopathic in the secondary stage caps. can be relied on alone shd not depend on it in the 1st It is particularly adapted to 2d stag attended with excessive & morbid secretions & relaxation it restrains and changes these secretions. Cholera when the vital energies are exhausted & there is great irritability of the stomach etc. caps. will often check it vomiting when opium will be rejected The phys. is not often called in the forming stage, before the vom. & purg. has commenced, at which time some other remedy might be preferred Cholera flatulenta great flatulence & copious rejection of air, without vomiting or diarrh. Here caps. alone is sufficient & opium is unnecessary Parabysma coactum useful auxiliary to conium & perchloride of merc. Parabysma strumosa Strumous diseases always require more stimulants [illegible] stimulants Idiopathic cough from relaxation Dyspnea exacerbas & asthma humidum in the 2nd stages & attended with relaxation & excessive secretion Passive hemorrhages capsic. is a popular remedy and often prescribed successfully by physicians Erythema of the membranes of the brain Perhaps the W.I. practice of shaving the head & applying rubefac. of caps. in delirium would be useful. I know not that it has been tried Paristhmitis erythematica independent of Rosalia. The original recipe was 2 tab spf of capsic. 2 teasp. of fine salt ½ pt. boiling water when cool strain add 1/3 pt vinegar dose a tabl. sp. every half hour. This would very well in moderate cases. The lowest & most severe wd do better without the salt & vinegar Apostematous Phtisis after the formation & bursting of a vomica capsicum restrains the purulent secretion, sustains the pat. & prevents sinking Dyspeptic Phthisis Erythematic visceral phlogotica are not generally recognized & described in the books except enteritis & gastritis eyth. infl. has a great tendency to spread, throughout the membrane which it affects Erythematic Enteritis attended from the first with diarrhoea & with vomiting if the stom. is affected. At the outset give calomel freely with opium conium & often sulph. quinine capsicum is useful externally. Capsicum is useful in all the stages of genuine & malignant erythematic phlogotica & in the secondary stages of phlegmonoid eryth. phlogotica Sparganosis [illegible] in cases supervening upon excessive hemorr. & attended with a low & exhausted state very useful here often as a principal remedy & always as an auxiliary. It is not proper in cases occurring after a long period & in the more vigorous & robust gout (regular) in all low cases Podagra larvata of Good improperly called by Cullen atonic gout for all cases are atonic Case of Dr Cooley violent paroxysm in his feet he applied some sort of poultice & in twelve hours it wen to his stomach. Dr Todd & myself were called we gave ammoniated alcohol, amm. tinct. guaiac. alcoh. opium etc. apparently with little benefit got no relief & was in a dangerous situation Dr Reed of E. Winds. entered on a free use of caps. internally with speedy relief. I have known other cases Rheumatism secondary stages of all ordinary atonic acute & all stages of erythematic atonic acute rheum. Eberle is too vague Rosalia maligna Rubeola maligna Malignant small pox whether confluent or not (all malign. cases are not confl.) Cases may clearly be of distinct small p. & yet require the most vigorous stimulation Purely passive hemorrh. & perhaps irritative Marasmus Tabes var. strumosa, var. venenata, from min. poisons & var. libidinosa Cyrtosis Rhachia All the strumous phlogotica & strumous affections of the glands of the neck Porphyra hemorrhagica It is second only to ac. lead I commence with lead & continue it till the hemorrh. is stayed usually from 3 days to a week. Then I omit the lead & substitute the sulph. quine. I accompany the lead from the first with caps. & brandy. The success of this practice bears no comparison with that in the books Gangrene all the species Insanity several species is to be treated most successfully by tonics acrids & deobstruents. This is the way in the Conn. Hospital & the prop. of cases cured is greater than in any other institution Melancholia acrid most useful Hypochondriasis Chorea good auxiliary Syncope in persons habitually subject, occurring from slight causes or spontaneously 2 or 3 hours a week for 6 mo. in such cases I have given various remedies both as prophlylactics & to bring pat. out of the syncope have found nothing equal to capsic. for both purposes. She could tell when the paroxysm was coming on & zi of tinct caps. would prevent it Carus lethargus It has considerable reputation with Dr Wright of Jamaica Paralysis not depending on organic affections Cantharis pellitory capsic. & guaiacum are the best caps. one of the best. Paramenia retentionis & [obstructionis] when attended with atony as P. retentionis always is The acrids, deobstruents & tonics, are the proper remedies. P. obstructionis may arise from imprudent exposure to cold & in such a case capsic. is not proper P. superflua Leucorrhea communis & [illegible] Dr Reed of E. W. values it more highly than any other article. I prefer cantheris unless the pat. is unable to take a suffic. quant. without troublesome strangury capsic is next. Nit. silver shd accompany the acrids (localls)? & local means shd also be employed Hemorrhea Senodes I have repeatedly cured at the outsed, freely & rapidly employed Cubebs which is similar is rather more certain to cure but it is not so readily taken Spermorrhea atonica Chlorosis inops Hydrops Thoracis & cellularis a valuable acjuvant to diuretics & tonics. We must first evacuate the water & then tonics & acrids will cure, if idiopathic Empresma abdominis (Tympanitis) from diarrhoea or catharsis in typhus & colic Capsic. very useful Paruria mellita externally as a rubef. & intern. as an adjuvant Capsic. is felt in the urinary org. & is smelt in the urine Paruria in continuous var. atonica Considerable reliance can be placed upon the acrids both internally & externally Capsicum is always contraindicated in phlogistic diseases, even after depletion when cantharis might be used Forms of administration 1st Pill essential oil in bread or in substance grs ii to a pill The dose of the oil cannot be definitely given Be guided by the nature of the case & trial Substance 1 – 4 – 12 grs as much as can be borne every 1-2 hours. Some give more, even as high as 30 grs this wd be rejected Pharmac. Preparations Tincture in the best. I usually make it with zii caps. to 1 pt dil. acl. Dose 10 gtt f zi Vinegar & water will rinse the taste from the mouth Acetum caps. is a good prep. prepared as the tinct. Dose the same Infusion zii to zi to 1 pg. water If it is to be sweetened, use honey Externally the U.S. Ph, directs canth. z10 caps zi alc. 1 pt. This prep aration might be taken internally too., 8th Stimulants Alkaline Ammonia Unknown to the ancients solution & carb. discovered by the alchymists Aq. amm. shd be well stopped with a ground glass stopper as it absorbs carb. ac. from the air. Much of that in the shops is worthless The alcoholic sol. is called spt. of amm. Internally they are purely stim. & acrid They act principally on the m.m. of al. can. but at length cause a rapidly & transient in crease of the force of the circulation, if repeated at short intervals The water & spiritous preparations differ As it is unpleasant it is rarely taken for any length of time I have never seen any nervine effects from it, wakefulness & exhilaration. It does sometimes relieve morbid irritability & irritation. So does pure stimulants in exhaustion I never saw it diaphoretic except by virtue of its stimulant operation It is discutient, topically applied not resolvent, internally It is antacid neutralizing a large quantity of acid & also preventing its formation by its acrid stim. effects thus obviating the morbid condition Dose of qa. or spts f zfs – f zi If it is to be often repeated, dilute with milk & it is taken much more readily water when a strong impres. is wanted It is rubevac.vesic. & caustic applied weak for a short time it merely reddens if strong an eschar is produced. Most generally applied in liniment with ol. oliv. this is best. When applied pure, flannel will prevent its evaporating. But linim. is better, which shd be of various strength & made of aq. amm. Taken in excess it prod. aton. uinfl. of stom. & int. The infl. is eryth. like that from acids or hot water & in both cases, the less fever the more danger. Eryth. infl of m.m. is more atom. more dangerous & more diff.to cure, than of skin In the worst case of an excess. dose, there was no pain, great exhaustion as in severe scales great stupor, pulse wiry & freq. & weak, skin cool. If the dose is not so great there will be a burning pain at the stomach afterwards retching & vom. perhaps tympanitis & sometimes fever. The more pain, the more hope of saving the patient [Orfil] recc. diluted vineger in large quantities to neutralize but after a few moments the mischief is done. It may however be given in smaller quantities, even an hour or two after to prevent further mischief. V.S. & antiphlogistication will do not good & be as improper as in burns & scalds. The topical eff. requires demulc. & antim. the general, opiates. Demulc. shd be in such moder. quant. as not to prod. stim. of distent. Opium frequently is best give by enema, but this depends on circumstances Therapeutics application Colic diff forms as a rebef. & vesic. Phlegm. infl. as apostema communis & common phlegmon early stages Effects a resolution when the infl. wd otherwise grow to suppur. Infl. of fauces early stages of phleg. & all stages of eryth. to the fauces & externally Inf. of female breasts said to cure if applied early, sufficiently & properly These infl. are diseased with more certainty then most others & are more troublesome if neglected Chronic Rheumatism when perman. & fixed topically Palpitatio from functional derangement of the nerves & dig. org. & not structural or organic as a rubef. to the thorax it is an effectual applic. Carus Asphyxia several varieties. C. paralyis not structural topically & externally Idiopath. vertigo [illegible] vertigo of Good Sick headache inter. & exten. gives speedy present relief Syncope from aff. of mind in universal use Common & hysterical convulsions also To do any thing with it in sick headache zi shd be taken freely & early better in nervous and highly irritable temperament. IN such patients the head ache depends more on the state of the nerves than of stom. Paramenia obstruct. highly recc. in milk thrown into vagina strong enough to prod. a sensation So too in Leucorrhea communis & senescention about the catamine period Bits & stings every effectual, but alc. & capsic. are more so. There is not a case on record, where alc. was sufficiently employed that was not cured. Dr John Osborn of N.Y. who had practised at the south said that when called he knew not what to do till the bystanders told him. He found amm. invariably successful & when summoned sent amm. without going himself Yet alcoh. is better. It is well known that a drunken man never suffers from a bite Scalds & burns If applied before vesication it will prevent it after vesic. it is bad. It shd be applied only till smarting & pain cease or it will vesicate. But it is again useful if a bad ulcer is produced & especially if there is danger of gangrene. It is prod as a favorable & speedy separation of the slough Aq. comm. shd be kept in in all vials of not over zviii for it is injured every time it is opened For a liniment equal quantities of aq. amm. & ol. oliv. will be too strong for the best amm. & weak for the common. Skip the next page This page to be read after the next a tea sp. f. is a medium dose, moisten it a little with water or any fluid not acid & it will be readily taken. It is useful in atonic febrile diseases. It is better than Dover’s powders Formulae shd be varied acc. to circumstances The following may be useful Rx sesq. car. am. zfs syr. orange peel zfs aq. menth. vir. zviii Take zfs every ;2-3 hours (Paris) Rx Ser. car. amm zi syr. alk. off. f zviii, or orange syrup not acid Dose zfs 2-3 hours 10 grs sesq. car. amm. (Richie) Rx Ses. cer. amm. arom. conf. aa grs v pulv. canthar. gr f simple syrup q.s. Take a bolus every 6 hours (Paris) The intervals are too long The canth. is the most active article Rx s. c. amm. grs v ext. rhei grs viii fl pil. 2 To be taken soon after making (Paris) Eccoprotic & antacid for dyspepsia Dr Ives uses the following It is much weaker than Paris’s & Paris’s, than the other Rx s. c. a. zii camph. [illegible] gum arab. zii water 1 pt. The water must not be boiling hot Sesqui-Carbonate of Ammonia Boiling water volatilizes it By keeping the carb. changes into a bi-carb. losing its odor & partly its taste, but not its alkaline properties It is a stimulant but less powerful than the alkaline amm. It can be better taken however. It is inferior to the carbonate but super to the bi-carbon Sd to be nervine & diaphoretic probably so from its stimulant power IT is an antacid, but inferior to the bicarb. Dose 6-20 grs in solut. or pill Its uses are more extensive from the greater facility of giving it & its supposed additional powers. Sesq. carb. am. camph & chalk, eq. parts powdered separately & well rubbed together is one of the best form & adapted to most cases. Stop it well & exclude the light or the camphor will be crystallized. The chalk keeps the camphor & carb. am. from concreting into small masses & also covers the taste. This mixture is stimulant narcotic nervine diaphoretic and antacid Turn to the page [prece??] or it will volatilize the amm. Dose zfs – zii every 2 hours Some of the late English writers recc. sesq. carb. amm. in 2-3 gr doses as a specific in rosalia & paristhmitis It is a good remedy in moderate cases. They use it much in convulsions of children & it is considerable used for dyspepsia Dr Woodwd of Vt. used it in in dyspepsia with camph. & chalk & some acrids as capsicum & prickly ash & also with gentian, etc. Intermittents It is much used, particularly at the commencement Used to in typhus IN common epidemic catarrh gout & atonic acute rheumatism hemicrania & sick headache. Also employed with considerable success in after pains of puerperal women & when used moderately it does good, but it only accomplishes in a few days what opium would do in the same number of hours. Cathartics Cathartics Refrigerant Cathartics Sulphate of Potassa Hiatus This has been called an aperient by Duncan in doses of [illegible] to zfs & cathartic in zv. It cannot be managed as an aperient in Dr Tully’s sense of the term Hiatus It is purgative cannot be managed as a laxative nor as an eccoprotic neither as a drastic It is a hydrogoge but not sufficiently so for dropsy. Elaterium is better It operates on the whole al. canal but rather more in the upper part It is kind in its operation & leeves the al. can. in a good state It is a rapid cathartic. It is not appropriate to produce a shock or strong impression Its other operations are refrig. said to be diuretic do not think so Hooper says it is deobstruent. I know not upon what ground. It cannot be so independent of the evacuation Medium cathartic dose is zi as a refrig. from zfs to zi once in 2 or 3 hours Diseases Cauma & all the caumatoid phlogotica of course contraindicated in low atonic fever It is appropriate in any phlegmonous infl. Hooper says coprostasis this is an atonic state of the system & therefore this article cannot be indicated there is torpor of the liver & this does not act on the liver H. says too that it is good in jaundice The same rule applies here He says too in suppression of the lochia. There is no such idiopathic disease if the suppression is attended with infl. of the uterus sul. phot. may be indicated He says dropsy too but as there is no entonic diathesis, it is not indicated Sulphate of Magnesia Hiatus Duncan says it is a mild purgative. This is applicable to all the salts of which I shall treat It is said to be diaphoretic not directly so, but by virtue of its evacuating operation. Not much diuretic Duncan says it will relieve pain in colic. It will do so only in entonic diathesis, but colic is not entonic It is cathartic in the same degree & in the same way as the two preceding salts (sulph. pot. & soda?) Disease & rules of application are the same also Phosphate of Soda Sal perlatum of the old books It is similar in its effects to the other salts & requires very little if any more to a dose It is better managed as an eccoprotic & laxative than the others It is not quite as refrig. as the pre ceding, but all its other peculiarities are the same as to time, mode etc. Med. canth. dose zi – zfs Swedinaur recc. in struma & do not think it appropriate Tartrate of Potassa Elixir tartrata kuli tartras kalitartarisatum pot. tartarizata alkali vegetabile tartras tartras solubile or soluble tartar is the common name of the shops It has the same effect as the others I do not think it can be distinguished from them. I have found no article but the antirritant narcotic that wd qualify its operation so as to prevent [tarmina] Tartrate of Potassa & Soda Soda tartarizatum sal polycrestum sal seignetti, Kali & sodae tartras tartrite of p. etc. It was introduced by an apothecary of the name of Seignetti I know of no difference between it & the others it is applicable to the same uses Bi-Tartrate of Potassa Hiatus Duncan says from zfs to zi is a medium dose for a cathartic It is far more diuretic than the others yet not sufficiently so for dropsy It is of no more benefit in schirrus or dropsy from schirrus than any other deobstruent It is purgative cannot be managed as a laxative is more hydragogue than any of the others quick in its operation not so kind It is peculiarly liable to derange the al. canal. None of the other salts can be said to be irritating. This is considerably so consequently it is better adapted to produce a shock or strong impression. It is more refrig. than the others Medium dose, from 10 – 60 grs once in 3 hours 60 grs once in 3 hours will purge pretty thoroughly And 10 grs in the form of pulvis jalapae composita Rx powder of jalap one part bitartrate of pot. two parts ground together to an impalpable powder. This pulv. jal. com. is recc. as a refrig. & used to be the common hydragogue when phlogistic diathesis prevailed. It is even now retained by some phys. & is Dr Hosacks hobby he gives no other The b-tart. pot. is adapted to the same diseases as the others except that it is better in dropsy being more hydrag. & diuretic. Dyspepsia recc. by Jas Johnsn of course contraindicated he gives it in a dec. of dandelion Colic-recc. coprostasis not good Proctics marisca & bleeding from hemorrhoidal vessels It increases the irritation Oxide of Magnesium This name has been applied to the factitious carb. mag. magnesia alba M. usta calcined mag. has been applied to both ¾ of the “calcd mag.” sold in the shops is nothing more than the carbonate Its purity can be tried, by its not efferv. with a strong acid It is eccoprotic, or at most laxative & antacid Diseases cardialygia spasms convulsions tormina & other diseases produced by acids in the al. can. Swed. recc. in coprostasis Ricketts. Suppressed leucorrhea accompanied with torpid bowels Gout supposed to be peculiarly adapted small doses continued for a long time were thought to remove the gouty diathesis lithia gravel independent It is not [illegible] Medium dose 10-30 gras 3-6 times a day. One circumstance shd be attened to. It diminishes the appetite chance where the case is atonic & there is a want of appetite, it shd not be given The salts of oxide of magnesium, in appropriate cases, as phlogistic ones are kind in their operation & leave the al. can. in a good state. They make but little impression on the system & therefore are not serviceable in giving a shock Med. dose zfs – zi in solution indeed you may say zi is a med. dose. Better in solution than in substance In highly phlog. diseases it is proper to add nit. potassas or tart. antimony to increase the refrig. effect. When a cath. Is not wanted the dose as refrig. is about the same, but nit. potassa & tart ant. are better Diseases Cauma entonic phlegm. phlogotica They are sometimes applicable in diseases not exactly entonic nor atonic 2d Cathartic Factitious Carb. Magnesia mag. sub. carb. magnesia alba mag. aeratii It is soluble in water Eccoprotic & laxative may be so managed as to prove both Not purgative nor drastic under ordinary circumstances. A. T. Thomps. says it is not laxative unless it meets with acids in the stomach It is copragogue. It acts on the whole track of the al. canal. It is slow & kind & generally leaves the canal in a good state. It is antacid Cath. dose 10-30 grs several times a day Diseases Limosis cardialgia Coprostasis some cases such as do not require large doses of medicine By means of this article more carb. acid might be generated in the stomach than in any other way. But I do not approve of the great use of this acid. Mildest cathartics Manna From the Ornus rotundifolium It has been said from the fraximus rotundif. Same not. group with the olive oleaceae It is the concrete exuded juice, obtained from the descending sap by slits cut in the bark The juice is of a white frothy appearance Taste slightly nauseous The best calubrian manna comes in long light friable pieces transparent pieces. The inferior kind is moist unctuous & dark coloured Fourcroy says it consist of four principles 1. Pure manna ¾ of which is called mannite 2. a little common sugar 3. a yellow substance of a nauseous smell 4. mucilage E. & Var. call it a mild purgative Murray, a laxative It is eccoprotic & laxative It is given to children, but is unimportant for adults. The older it is, the more purgative Dose for adults zi – ziii in water milk & water or better in milk Cathartocarpus fistula Native of E. & W. Ind. but cultivated in the warmer parts of the U.S. Commonly called “Locust & wild honey” The pulp of the loment is the part used. It has a black colour & a sweetish taste. It is said to be a good cathartic when taken fresh from the pod It occasionally gripes & produces flatulence It is given for children Eccoprotic at the most laxative Copragogue Acts on the upper & middle part of the intestines. It is kind unless the patient is predisposed to tormina pains etc. Medium dose for an adult zfs - zj Rosa Damascena Damask rose Native of the south of Europe The petals are used. They are given in infusion & are a highly popular laxative for children They are made into a confection also & said to be good in habitual costiveness given in the dose of a table s. f. Laxative is moderate quantities Purgative in larger The quantity for an infusion is zii of dried petals Rosa Gallica rerubra red rose This is similar in operation to the damask Linum catharticum The whole plant possesses cathartic powers Operations Purgative difficult to manage or as a laxative or eccoprotic Its natural operation in hydragogue acts on the middle part of the canal Takes a medium time for operating rather unkind leaves the bowels in an irritable state Dose for an adult is a “handful” infused in ½ pt of boiling water or zi in substance Infusion say zii to ziv or zvi of water Cassia Lanceolata Senna There has been much dispute about the species of cassia which is the true off. senna but it is undoubtedly the c. lanceloata. This is the tone off. or Alexandrian senna, but it comes adulterate with other species & other plants the cynanchum oleifolium is found among it All the species probably possess cath. powers but in a less degree. The term senn has no specific applic. It is applied as “ipecac” is applied to any emetic article That senna is best whose leaves appear bright, fresh, free from spots, strongly scented, bitterish & nauseous, smooth & soft to the feel, sharp pointed, free from stalks & legumes Senna contains a peculiar priinciple calle sennine (cathartine?) Operations It is purgative not eccoprotic or laxative. It is more or less hydragogue the moderate its operation the more fecal the matter discharged. It acts on the colon. It takes a medium time for its operation about 4-6 hours after being taken Dose of the confection zi – zii ]of the infusion 1 troy oz. will saturate a pt. of water add some aromatics to disguise the taste This is a bad cathartic being hydragogue & apt to occasion griping etc. “Any other is better” Prof. T. has discontinued its use Poinchiania pulcherrima Cassis orientalis senna spuria pride of Barbadoes etc. Nat. ord. [leguminosa] Cultivated as an ornamental shrub The leaves flowers & seed are the parts used The leaves are the strongest & the flowers next both used in decoction The seeds are best powerful & are used in powder I to a dose This plant has considerable reputation as an emmanagogue. It is but little known with us. Aloes That for a variety of species is found in the shops. There is the aloe spicata from the Cape of Good Hope & the annibellata from the same place the former is now considred the best. There is also a ferox of [illegible]? A. socotrina & A. vulgaris of [Persova]? The greatest part of the aloes in the shops is from the A. vulgaris of Barbadoes The appellation socotrine applied to aloes means nothing more than that they are of a good quality. The apothecaries in recommending their aloes will tell you they are the socotrine aloe The best aloes are an extract made by a cut in the shrub from which the sap exudes. This has at first a sweetish taste & soon after a intensely bitter one. IT has not the glassy appearance of the poorer kind Another mode of obtaining aloes is by inspissating the juice of the plant. This is nearly as good as the exuded sap there is not much difference A third way is by decoction 3d Cathartic about 1 lb of the plant to 8 pints of water boiled down & strained. This has not the sweetish taste at first perceived in that obtained by exudation The properties. A. T. Thomps. says of this best kin A. spicata are odor rather pleasant taste sweetish at first, & very bitter soon after powder of a bright yellow & aromatic smell 2d quality very disagreeable taste intensely bitter but not differing materially in med. qualities from the 1st 3d quality of a dark brown colour, hard & friable There has been no true analysis of aloes. The old one in the books is still retained but I do not esteem it correct. Operations cathartic heating & irritating Emmenagogue per se Dr Ives thinks it is manageable as an eccoprotic & laxative & that it operates more kindly when taken with food. The latter is probably true & it is the case with many other medicines e.g. diffusible stimulants Dr Ives thinks aloes have no direct tonic effect, but an indirect one He thinks they act on the liver promoting gradually the secretion of bile. HE thinks it moderately deobstruent but I do not use the word deobst. in this sense i.e. an article affecting one gland only, the liver for instance To say that aloes acts on the [portal] system is merely saying that it acts on the liver Dr Ives thinks aloes are emmenagogue, independent of their purgative effect. They undoubtedly are so. He thinks that tho’ they irritate the kidneys & bladder & color the urine yet no increase of urine is produced Aloes are a purgative, but may be easily managed so as to prove eccoprotic & laxative. In large doses they made to act drastically They are slow in their operation from 12-24 hours The discharges are purely fecal hence they are copragogue They act on the lower part of the bowels (i.e. they act principally on that part for all cath. act on the whole canal more or less) Their operation is appropriate doses & cases in kind though if given inappropriately they irritate. Appropriately given, they leave the al. canal in a good condition In eccoprotic & laxative doses they make but little impression in full doses a strong one Next after their purgative effect aloes are emmenagogue They are said to be sub-tonic I presume indirectly so Said to be anthelmintic probably more so than most cathartics Dr. A. T. Thomps. says they are not beneficial in hemorrhoidal affections But Drs Tully & S.B. Woodd have given them with good effect in such cases. As a general rule however I would not use them in a peculiarly irritable state of the intestines though even in such cases I have cured better than with any other article. This form of piles alluded to is proctica marisca Aloes combined with about a medium dose of opium are thought to counteract the effect of the use of opium. This combination is very useful when costiveness has resulted from a continued use of opium, but you will find after a while that less of aloes will be necessary. I have made the combination in the following proportion viz. 1 part of opium to 4 of aloes It is the common practice to give a cathartic pill when a practitioner does not wish to give calomel, and aloes with gamboge & soap or some other extract is a common pill. When such a pill is wanted I have used Rx aloes grs ii gamboge gr I oil tigl. gtt ¼ soap q.s. ft 1 pill. Sometimes but ½ a pill will be necessary according to the state of the al. canal & the habit of the pat. If the patient is in the habit of using opium or has taken it for some time 2 pills may be required I do not consider aloes good at the commencement of acute diseases. When a cathartic is wanted at the commencement of a disease to break it up I would not give aloes If you wish merely to evacuate feces or to produce an eccoprotic or laxative effect in the secondary stages of a dis. aloes are good in certain doses Diseases It is difficult to specify them Swediaur says dyspepsia with great torpor Pyrosis when bowels are torpid Habitual costiveness here they are also good applied externally Ulcers with a gangrenous tendency extern.? Cases of continued discharges from the ear a solution of aloes injected The dose varies according to the susceptibility of the patient From 1-2 to 4 grs may be given as a laxative or [illegible] in the 24 hours As a purgative about 5 grs may be required There are a great variety of phar. prep. Convallaria [Maialis] I have seen it in the meadows of Middletown tho’ it is considered not indigenous with us The root & flowers are considered the medicinal parts. The extract of the root possesses some of the medicinal properties of aloes tho’ a little weaker. It acts on the rectum & I presume it would prove emmenagogue in the same way The dose as a purgative is said to be [illegible] or zi probably a smaller dose would operate if given over night The dried root pulverised is a [sternutatory] & so are the flowers The flowers when fresh are fragrant but not so when dry I do not know much of this article Polygala polygama A specimen from which the bracts had fallen off was sent to [Willdenow] & he supposed it a new species & called it P. rubella. IT is called here “low centaury” but in the middle states the name is given to hypericum parviflorum sabbatia angularis too is called centaury The English centaury is ergthraca? centaureum nat. ord. Every part of the plant is entirely bitter the leaves more so & the root most of all. It very much resembles aloes in tasting medicinal powers It is an efficient cathartic the natural operation in an appropriate dose being copragogue the discharges consisting entirely [offices]. In large quantities it may be made hydragogue It is slow the natural operation taking place in 12-24 hours It aggravates practica marisca & in great doses produces that disease. Otherwise it is kind in its operation The impression is makes is moderate It may be considered tonic also anthelmintic. It is decidedly emmenagogue It has been supposed to be diuretic but I never could discover this effect. Prof. Ives says it increases the secretions generally If so it is a deobstruent It has been said that this article is bitter & nauseous & that therefore it shd be rejected from the mat. med. This rule wd make our list of medicines very small This article will make as good beer as hops Its natural operation is that of a purgative & copragogue Pharmac. prep. 1st Infusion dried plant zii water oi 2d Decoct. dried plant zji water ojss boil to 1/3 3d Tinct. zii to oj 4th Ext. by decoc. This I think the best Make it of a consistence for pilling As a cathartic the decoction is best & the dose is zii to ziv I have given even a wine glass full I thas operated in 12-30 hours Is not [illegible] but have for [illegible] all the while? 4 Cathartics As a tonic the tinct. is best in doses of zi 3 or 4 times a day Diseases Dyspepsia with torpor in its various forms Coprostasis Paramenia retentionis & obstructionis Upon the whole & consider this a valuable article much more so than it is supposed to be Ipomea Jalapa [illegible] This has been supposed to be the root of 2 species of mirabilis but they do not produce it (they are called 4 o’clock in our gardens) Convolvulus jalapa of Lim. The plant from which the real jalap is obtained. Dr Coxe calls iponea macrorhiza for an account of which vide Coxe’s Dispens. the roots produced by this plant are like those we get in the market Mr Nuttall pronounces the plant an iponea (what plant.?) It usually comes in roundish, ovate but pointed tubers internally yellowish At the present time we get our jalap from Vera Cruz & it is not adulterated Diluted alc. is said to be the proper menstruum for jalap It is used for its cathartic powers merely it is difficult to be managed as a laxative. It may be made purgative or drastic In moderate doses & if allowed sufficient time to operate it may be made copragogue but in excessive doses it is hydragogue. It acts principally on the colon The off. jalap is called in the books a stimulating cathartic It is an irritating cathartic rather. In a phlogistic, or atonic irritable state of the system it will produce irritation & increase it when already existing The alcoholic ext. is said in the books to be irritating, but Dr Ives says it is not. The ext. in the pharmacopoeias is made partly with water. In moderate doses the alc. ext. is not irritating It is probably that several species of convolvulus & iponaea possess the same powers as the off. jalap Podophyllum Petatum may appl. mandrake etc. Triosteum perfoliatum Linn. Root perennial top [annual] It has a popular name in almost every place in which it grows fever root wild gentian wild ipecac wild coffee? etc. Nat. ord. same as that of the climbing honeysuckle The parched fruit is said to have been used as coffee The root only is used in medicine the bark of this is said to be cathartic & emetic Dose for a cathartic is [illegible] to zfs this if taken over night will be effectual. It is about as active as jalap if pure & collected in the right season. It is injured by long keeping, but if collected in the autumn & well dried it will retain its strength The operation is supposed to be modified by a conjunction with mercury etc. for instance? by as a conjunction with? of ipomaca jalapa & podoph. pelt. When a cathartic & emetic operation is desired this article combined with di? proto chloride of mercury in full doses shd be given dose [illegible] to zfs B.S. Barton thinks it diuretic but I have discovered no such effect & think it no more so than rhubarb Dyckman says it is tonic he probably inferred this from its bitterness. I have never seen this effect & think it no more tonic than rhubarb & podophyllum peltat. I think it more likely that ultimately it will be found deobstruant This article is a cathartic. Its natural operation is that of a purgative but it may be so managed as to prove laxative Its discharges are mainly fecal hence copragogue. It acts on the colon In a full dose it has a medium time of operation. Its operation is neither very kind nor very much the contrary. It leaves the canal neither in a very good nor a bad condtion Diseases It has been prescribed in Intermitt. (Shoeph?} I think it not very applicable and in “pleurisy” (but there is no such idiopath. dis. though phys. constantly speak of it Shoeph? probably meant pneumonic) I shd think it not good. Said to be good in struma I shd not think so In reality this article is applicable only to the diseases in which jalap & P. peltatum are & no other The right time to collect it is autumn. The powder shd be kept in a bottle tight & excluded from the light I wd not pulverise much at a time for it loses its strength easily. Fresh parcels shd be collected every year Leptandra Virginica Culver root physic root Indian physic etc. It is difficult to tell what is its nat. order. Said to grow in Japan but probably a diff. spec The root has a bitterish & subnauseous taste. analagous to jalap. Both alcohol & water are the proper menstruus It is cathartic In its recent state of Dr I. thinks it one of the most powerful of our indigenous cathartics. When dried it loses its cathartic power’ Rafinesque says it is deobstruent & echotic but there is no reason for supposing that it has such a power. When recent it is said that 4 or 5 grs are sufficient to prove cathartic, but when dried zi or more will be necessary I think a wine of this article (zii to f zxiv) wd be a good preparation for retaining its strength I venture to say that a syrup would answer For instance make a saturated decoction (say 4 oz to the pt) & add the q.s. of sugar to make the simple syrup of the pharmac. The add oil of wintergreen to give flavour Perhaps an ext. night retain its powers There is room for experiment Therapeutic application The diseases mentioned in the books I do not think correct Coprostasis active cathartics are not applicable to this Bilious fevers this is indefinite Rheumatism not good subacute rheumatism other articles better old chron. rheu. 5 Cathartic Ricinus communis R. major R. vulgaris more commonly palma christi ricinus. One of the older manes is agnus castus whence castor oil Nat. ord. Euphorbiciae Cultiv. with us Castor oil is obtained from the seeds. It is completely soluble in alcohol & ether. The mildest oil is obtained by decoction, which method is resorted to in the W.I. for the mode see Hooper’s Dict.’ If the cortex of the seeds be permitted to remain in the oil will be acrid. That made by expression is also thought to be acid hence decoc. I think the seeds shd be [decortirated] for the active principle probably resides in the cortex Its operation is quicker & kinder than any other cathartic & as a mere evacuative agent it is the best in the mat. med. It seldom produces any griping. It is moderate, producing at most only 2 or 3 discharges says Cullen who says it is peculiarly adapted to costiveness. Colica ileus & C. Rhach. It is not heating nor irritating to the rectum & is well adapted to hemorrhoidal affections Medium dose zfs some require more others less Its ordinary operation is mild If frequently repeated the dose may be gradually diminished, which is not the case with other cathartics. That ol. ric. increases its power by repetition is an important point The only inconvenience attending the use of this article is that it is nauseating & disgusting to some patients. To obviate this give it in a wind glass with water below & spirit or spirit of ppt. above & it may be taken by the most delicate & squeamish Even rancid oil may thus be taken without its rancidity’s being noticed. I know of no way so good as this Ed. & Vav. say this oil is only a mild laxative but it is a purgative. They say that by rancidity it produces tormina, griping etc. This is correct. Some think that it possesses greater power than any other cathartic in removing worms. I have never seen its superiority in this respect. It is always better to give some narcotic cathartic & get the worms under narcotic influence as we do by spigelia This article is laxative not so easily made to act as an eccoprotic Purgative copragogue it produces no biliary discharges It is not drastic. It affects the whole track of the bowels equally It is speedy is kind unless rancid & leaves the al. canal in a good condition It makes little impression on the system & of course is not good at the commencement of acute disease The following formula is used in the W. I. in colica rachial. Rx zii of the oil to ziii of spirit & burn them about ½ a min. or till part of the spirit is burnt. It is said that this is effectual in that disease I have beat up this oil with the yolk of an egg & this completely deceived patients & got the full operation of the article, when they had absolutely refused to take it The decorticated seeds are taken as cathartics in some parts of N. M. Probably 4 or 5 of the bruised seeds are a [illegible] dose A saturated tinct. of the seeds is said by Piso to be a more powerful cathartic than the oil. Dose of the tinct. zi (zi?) the seeds should be bruised Euophobia Lathryrus (oleum) Cultivated in all our gardens The most common name among us is caper spurge. The fruit is said to be good for pickles. Native of Europe., Nat. ord. Euphorbiaceae The oil is obtained from the seeds a common practitioner could obtain it by macerating the seeds in ether By long keeping it becomes turbid & rancid It comes in vials of zi It is said to be a mild & safe but active cathartic & a good substitute for oil of tiglium Dose for a adul 4-8 gtts in milk sugared water or any convenient vehicle Its action is certain, prompt & at the same time mild, not producing tormina or griping like o. tiglii It is purgative drastic in full doses may be used as a laxative. It is copragogue in ordinary doses. It is irritant in full doses & may be said to be sub-emetic In affects the whole track of the intest. canal It is very speedy, 1-3 hours is mile & agreeable in medium doses & leaves the canal in a good condition. It makes rather a strong impression Iatropha 2 species I. Curcus and I. cossypifolia Called Barbadoes nutts The oil from the seeds of the i. curex resembles very much the castor oil Croton Tiglium Ricinus Indicas Pinus Indicus These oils all belong to the same nat. ord The wood has been used in medicine (lignum moluccense) the seeds also grana mollucc. grana ricini in English called “purging nuts” Native country Ceylon Moluecas E. Ind. China The genus croton is said to contain 50 to 100 species of which 5 are known to be in the U.S. One species in the U.S Affords a highly aromatic oil The oil of tiglium is obtained by expression from the seeds It is said to have a sharp taste odor sui generis It is said to contain fixed oil 55 parts & an acrid principle 45 parts. This letter has been called tigline The seeds root & wood have been used in medium, but the seeds & oil are the most powerful The oil of tiglium is the most rapid cathartic known. Its operation is said to be modified by aromatics, acids etc. but better by small doses of opium. Baking or roasting the seeds before expressing the oil is said to have this effect Its natural operation is purgative or drastic. It is difficult to manage as a laxative unless by tincture or a little opium. As a laxative it is copragogue but in larger doses hydragogue & irritant In large doses it is drastic It may be said to be sub-emetic Said to be diuretic & diaphoretic but I think it cannot be directly so It operates on the whole canal is the most speedy cath. we have usual time ½ hour This can be made to depend on circumstances sometimes less than that time If the dose is not too large the operation is not unpleasant if large a burning is felt. Moderate dose leave the bowels in a good condition This article cannot be preferable to calomel in typhoid diseases nor to the refrig. salts in the inflammatory The oil of tiglium in the market is said to be adulterated. I have always found that in the shops to be full strength. When pure it produces rubefacient effects on topical application It is sd to produce catharsis when rubbed on the umbilical region Dose of the oil ½ to 1 minim. The tincture made directly from the seeds in the most eligible form. Dr Bigelow gives a formula for its strength The oil may be given in milk but I prefer the pill made of bread. Unless camphor is added the pills will mould. I prefer dough to baked bread. I may be pilled with soap Another form is Rx ol tigl. [illegible] syn papav. zi Opium better than any other article modifies the operation & obviates the unpleasant effects of this oil. In combination with castor oil it affords the best cath. for poisons It makes a good enema. You will remember that generally 3 times as much is required 6. Cathartic by enema as by the mouth The effects of an over dose are severe burning pains hyper emesis hyper catharsis etc. Opium is the best antidote Diseases Coprostosis (E. & Vav.) as a general rule this shd not be treated with drastics Tenia I think however that the ol. pini is better, for in this you have narcotic & other powers which are peculiarly desirable to hasten an evacuation the ol. tigl. may be given Delirium Tremens Some writers say that this oil has been highly serviceable in this in conjunction with opium As a general rule purging is not indicated in this disease Rheumatalgia As a topical application it will probably do good for this is generally fixed Mania in acc. of this facility of getting it down Tetanus alleged to be useful in the sam. acc. if purging is indicated Neuralgia. N. Faciei Cases of apoplex. Obesity sd to be benefitted by freq. purging Dropsy but elaterium is our best article Oil of tiglium is not a new article in medicine, but and old one revived Scammony Convulvulus scammonia is said to furnish the Smyrna scammony but this is less valuable than the Aleppo scammony Another kind is the Montpelier scammony from Montpelier Convolvulus [Sepium] (Linn.) is another species producing scammony. It grows about our hedges & is called field bindweed & poison weed though it is not poisonous The exuded & expressed inspissated juice are both employed. The exuded is the most powerful & best dose 5-20-30 grs – 30 grs is a powerful dose it grows throughout the U.S. Hiatus Scammony? It is called a gum resin, but is more so than any expressed juice Used in dropsy other art. better in helmin. spts turp. better Natur. operat. purgative drastic if given alone Modified by combination Not easily managed as a laxative Acts on the colon medium time makes an impression In large doses is an irritant Gamboge Several plants afford it Linnaeus supposed the real gamboge came from the gambogia gutta Murray from the Statagmitis gambogoides Others from the gorcina gambogia of Willdenow & others say the gambogia guttifera. The name of the plant is not derived from the place in which it is found Stalag. & garcina grow in Ceylon gambogia in the E. Indies Gamboge is the inspissated descending sap obtained by exudation improperly called a gum resin. The juice concretes & is formed into masses. It is imported from Siam, Ceylon, [illegible] in China etc. We have no analysis but the old one of so many parts solub. in alc. & insol. in wat. etc. It is said in the books to be one of our most drastic & [illegible] cath. but others are more so Being drastic it is used in helmintha but because an article is drastic it does not follow that it is good for worms. As to its hydragogue power, it is not always to e relied on in dropsy. The Italians say that gamboge is contrastimulant What they mean I do not know In purgative & laxative doses it is more reducing than the preceding articles. It is difficult to be managed as an eccoprotic It acts upon the upper part of the al. canal & all the articles that do this promote more or less the secretion of bile but it does not in the whole [secerm] & absorb. system & hence is not deobstruent It irritates the intestinal canal & may produce an acute atonic irritative infl. It has been called by orfila? a caustic poison, but it is not. HE says too that externally it is rubefacient. This is not true It is more used by the British practitioner than by the French & is given in combination with other cathartics. Thus administered it is useful Gamboge is a strong purgative is cholagogue by acting upon the stomach & duodenum is hydragogue acts on the upper part of the canal is speedy is on the whole disagreeable in its operation when given alone, leaves the al. can. not in a good condition, but if judiciously combined its operation may be made kind & agreeable while by a frequent use of gamboge & by injudicious combinations of it the al. can. is left in a very bad condition it makes a strong impression on the al. can. & whole system is irritant & finally is to some degree an emetic, though this ought not to be enumerated among its operations Dose 3-6 grs recc. triturated with sugar but I wd no recc. it alone Diseases Coprostasis recc. but not alone Tenia jaundice recc. cannot be of much use other articles better quartans used as a purge but not good Dropsy recc. [illegible] other art. better. Chron. cutan. dis. not I think good Rhamnus catharticus Buckthorn Nat. ord. rhaminaciae native of Europe cultivated in this country & sometimes grows wild on the banks of the Hudson probably from seeds dropped by birds The berries are used. They are [illegible], black & shining, with a taste bitter acrid & nauseous & containing a pulpy green juice As a cathartic, this article is both cholag. & hydrag. & its natural operation is purgative & drastic & it is not easily managed as a laxative. When drastic it is powerfully hydragogue not so much so as elaterium but more so than most drastic cathartics It acts on the middle part of the al. can. & requires a medium time It is irritating & leaves the bowels not in a very good state It requires opium to obviate its ill effects. It makes a peculiarly strong impression on the system. It irritant & may prove emetic It is said by some to be diuretic it may prove somewhat so in small & often repeated doses, with diuretic regimens & allowed to remain sometime in the al. canal. Diseases Recc. by A. T. Thomps in cachexia & also recc. in syphilis do not believe it good in this Dropsy recc. by A.T.T. better in this than most other cathartics. It is used in N. Haven in certain cutaneous eruptions & recc. in doses short of purging I have never seen much benefit from it in cutaneous diseases The common dose of the berries is 20. The expressed fermented juice is recc. in some books decidedly bad Decoction of the berries is also used it is recc. to boil 20 of the berries in 1 pt of water very weak The syrup of the berries is the best form Rx If you wish to mitigate or modify its action add a little paregoric Almost every farmer thinks he knows what buckthorn but it is not found with us. There are spurious articles sold under the name of buckthorn. The article commonly sold under the name of syrup of buckthorn is made of the berries of the cornus sericea Bryonia Disease? Nat. ord. cucurbitaceae root fusiform intensely acrid & bitter Formerly the root used to be found mixed with jalap. Sometimes the inspissated juice of the recent root is used It contains a principle bryonine which is probably its active one The root was formerly employed as a purgative & emetic applied to the skin it is said to be irritant & rubefacient Dose of powd. of rec. root is 12 grs to zfs This article is purgative & drastic acts on the middle part of the canal requires a medium time & in large doses leaves the bowels in a bad condition. 7 Cathartics Cucumis Colocynthis Nat. ord. Cucurbiticeae Native of the levant & cultivated in Europe The fruit is the part employed, under the name of colocynth It is reduced to a fine powder. I believe the pulp only ought to be used, but the whole is used. It is found in the shops in powder. Water alc. & ether dissolve its active principles E. & Vav. say it is very irritant, externally or internally they say it is a powerful cathartic purgative or drastic less hydragogue than most other cathartics equally drastic (I can’t say I ever saw a hydrag. operation from it) It acts on the colon takes a medium time alone it is more or less disagreeable, but it is agreeable in combination It is a valuable article when a compound cath. is used, it makes a strong impression It is irritant E. & V. say it produces amenorrhea. I have never had any such effects from it Enteritis recc. by E & V. but a mere cathartic in this is not wanted a deobst. operation is required, for which calomel is best perhaps in erythem. enteritis it may answer a cath. is indicated but in this form a diarrhoea is almost always attendant & even in the calomel is best Dropsy E & V. but I do not believe this article hydrag. & therefore it can seldom be proper Elaterium [Momordica] Elaterium of Linn. Ecballium elaterium of Richard Called also cucumis agrestis & c. asinius squirting cucumber. It is a perennial plant growing spontaneously in the south of Europe & might be cultivated among us The active principle resides in the juice around the seeds it is prepared by As found in the shops it is The dried juice of the fruit obtained without any preparation is best As prepared above it contains a peculiar prox. prin. called elatine. An alcoholic tinct. may be employed Elatine is [illegible] Elaterium is oftener mixed with starch. It is injured by exposure to the light yet this our apothecaries do not know It is very expensive The juice of the [illegible] is irritant to the skin Elaterium undoubtedly possesses great deobst. powers, but they do not begin to operate much till purging comes on then they are powerful Its natural operation is drastic not purgative nor laxative. It is more hydragogue than any other article. Although so drastic it leaves the bowels in a good condition It may be given in cases of extreme debility. It is speedy in single large doses less speedy in small doses. It is irritant diuretic in doses short of the purging point deobstruent Upon the whole, elaterium is the most valuable cath. in the mat. med. calomel & the neutral salts excepted Diseases Coprostosis shd not think it good parabysma Struma shd not think it good Atonic ac. rheum. it acts as a resolvent deobst. but generally is proper only in the early stages Opium will prevent is purging Sub. ac. rheum. early stages Rheumatalgia in its various forms both that called “crick in the back” & sciatica a cath. of elat. is very beneficial [illegible] Indica give a cath. followed by an internal use of conium & iodine Chronic & obstinate ulcers of the legs purging with elat. is very beneficial they were formerly cured by vom. with turp. min. Chorea a valuable remedy by acting on the system at large Param. obstruct. idiopathic & in healthy subjects Hydrops cellularis H in these diseases it is of more importance than any other Begin? early in the morning with doses of 1/16 1/12 or 1/10 gr acc. to the strength of the article once an hour or once in 2 hours continue till catharsis actually commences & then suspend The catharsis usually begins in about 5 or 6 hours. It is preferable not to have it commence under 10 or 11 hours The first discharge will be fecal & then will follow those that are purely hydragogue. Most of the books recc. in full & large doses giving all you would give at once But this is apt to produce nausea tormina, distress etc. Give it in regular doses also to get its deobst. effect If the evacuations are rapid or appear to reduce the pat (which is rarely the case) give a dose of opium, generally not less than 10 grs, acc. to the susceptibility of the pat. If the pat. is at all feeble you shd be about [illegible] at the time of the operation of the article After the useful article treat with stimulants. It may be necessary to repeat the elaterium for removing the fluid does not cure the disease, & the fluid may return. Elaterium removes the dropsical fluid better than any other article I know of. In cases of concussion followed by stupor or coma about a week or two after the accident. I have known elaterium managed as in dropsy to be most effectual acting not merely by its evac. but its deobst. power Elaterium is better by itself than conjoined with any other article Some conjoin calomel, but it is better without E. & V. recc. it in doses of ½ gr. not to exceed 5 grs but with such elaterium as I have had, a man wd not stay long enough in the world to repeat the dose The momordica balsamina has been said to possess the same powers as elaterium, but [untruly] It grows in our gardens The juice of the unripe fruit is said to be emmenagogue & styptic. This is worth enquiry into. Luffa operculata Allied to elaterium Nat. ord. cucurbiticaea Its natural habitat is Guaiana. It is formed abundantly in the W.I. & along the shore of the Gulf of Mexico. Dr Hancock calls it crosia? It is also called “bitter cucumber,” but the cucumis coloc. bears that name. It is the momordical operculata of Linnaeus & is similar to the common cucumber I derive my knowledge of this article from Dr Hancock In the fruit is a web-like substance or reticulum which possesses the medicinal powers & Dr H. says “it is the most active cathartic in nature” says it acts on the “skin kidnies & intestines.” Acc. to his account it is an effectual deobst. acting on the whole sec. & abs. syst. I do not think it a tonic directly Dr H. says that 1 gr. of the reticulum is a dose. This is undoubtedly too large & acc. to his own account ½ gr. is sufficient 8 Cathartics to produce the effects of the common dose of elaterium Dr H. prescribed it in infusion, but says was obliged to add chloride of sodium to preserve it. Would it not be better to make a powder of the reticulum? He says it is better to have it a long time in operating. It seems its operation is precisely like that of elaterium & it is best given in small doses at regular intervals This article is drastic may be managed as a purgative, but not as a laxat. or eccoprotic Full doses may vomit small ones do not. Purely hodrag. middle part of can. Medium time in small doses Makes a strong impres It is irritant & deobst. Short of purging point it is diuretic. It is emmenag. in full doses. It is resolvent. Diseases recc. in dyspepsia colic. rhach. as an enema Dr H. says it is an effic. article Parabysm coac. (enlargement of the spleen) Dr H. says in his own case it proved efficient as an enema it affected the stomach. Hydrops cellubria (or as he calls it generally dropsy) Dr H says he has cured perfectly by it recommends it in the early stages He says mercury is a most efficient article in dropsy & so says Dr Tully H. Thoracis & H. abdominis (ascites) In the latter it is necessary to repeat the article in some cases. Dr H. has found it necessary to salivate & repeat it Upon the whole it appears that this article has the same medicinal properties as elaterium. It is not liable to lose its strength like elaterium. The [crasia] or L. operculata finally is cheap & precisely equivalent Sulphur Purgative in a full dose. It is diapohoretic in non phlog & not materially atonic cases, regularly, & I am apt to think it is so indirectly. It is irritant but not tonic or stimulant. It is undoubtedly inappropriate in phlogostic & truly atonic cases Dr Duncan thinks if taken into the circulation, from the sulphurous smell etc. of persons who take it. Dr Tully thinks it digested & says the smell is that of hydrothomic acid Duncan thinks it better combined with some saline cathartic Dr T. thinks this not necessary In [illegible] he Dr D? thinks its irritant effects will be obviated Sulphur injudiciously administered & persisted in will produce rheumatism, paraplegia & effects precisely analogous to those of mercury. I have seen swelling of the joints & loss of the use of the lower extremities Sulphur in full doses is a purgative it may be managed as an eccoprotic It is copragogue Acts in the whole track. It is slow. In a full dose & under a bad condition of the system it is unkind in its operation, & leaves the bowels in a bad condition It makes a considerable impression. It is irritant & decidedly deobstruent being resolvent (I have known sub-acute rheum. cured by it) diaph. emmen. & expectorant Diseases Prctica Marisca I wd regulate its use acc. to pretty much the same rules as aloes Chronic Coryza recc. by Duncan Chronic coughs it has been used in form of “balsam of sulphur” It is good in some coughs Dyspnoea exac. & asthm. hum. Duncan probably is good in the interval Disguised gout of Cullen Rheumatalgia or chron. rheum. have never tried it but it probably is good. Scabies & various cutaneous eruptions