Neuralgia strychnos arsenic & opium ([actaea]?) Itch cured by lotions of digitalis Sciatica arsenic strychnine & (actaea ?) [sul.] morph. have proved highly valuable Hemicrania cured best by ¼ gr. strychnine 3 or 4 times a day combined with morphine Strychnine 1/16 to ¼ of a grain Brucine 1/24 as strong chronic rheumatism best cured by lobelia better than by guaiacum the article commonly relied on 9 materia medica & Dr. Ives’s Paternal lecture (rear) Solanum nigrum Often mistaken (for its name) for atropa belladonna. Smell & taste nauseous moderately narcotic Its narcotic powers are very variable different in different cases Deobstruent also. It is diaphoretic diuretic (more so than conium) laxative slightly Said to be found useful in [diury[ and ischury but said to require to be drank freely Much used by the common people in ointments (of the leaves) for indolent tumours ulcers etc. IN mild cases Prof. T. has often found it answer as well or better than conium It is not worth while to fire a cannon to kill a fly. Med. dos sd to be 10-12 grs shd think this inefficient infuse zfs to oj of water Solanum tuberosum Native in Peru the tubers of the wild plant are as small as a nutmeg & bitter & nauseous. “Root sd to be perennial probably annual” Top only is used in medicine This is too weak to be used in infusion or decoction. The watery extract is found to be slightly narcotic & deobstruent It is diaphoretic, diuretic & cholagogue It will relieve some atonic inflammation cure some cutaneous diseases IT has been used principally for jaundice & dysp. connected with the liver Dose said to be 2 grs. Prof. T. gives zfs to zj Recommended in cough rheumatism hemicrania angina pectoria etc. When pushed too far it produces tremors etc. the symptoms of narcosis Most of our arrow root is made from potatoe roots and if sufficient care is taken to purify it from mucilage it does as well. The activity of these & the following article is a subject of dispute Solanum Dulcamara Possesses the same assemblage of powers as the S. [terb.] & S. nigr. Used in cutaneous affections. Acts on the fluid secretions generally as well as on that of the liver Digitalis purpurea Native of England Nat. ord. scrophulariae Leaves used (stripping from the midrib) leaves good only when of a light green colour when black they are worthless for medicine. No particular odour No good analysis has been made [Digitat??] (drystallizable) is mentioned Decoction injures it. Should be given in infusion. Infus. green, with the odour & taste of the plant Upon no subject is medical testimony so contradictory as upon the medical properties of this article. Some contend that it is stimulating others that it is never so but always the contrary Prof. T. believe it may, like other narcotics, produce an erethism of the brain without any effect upon the circulating system (N.B. This is a state which often precedes an attack of delirium tremens) It is evidently this state which has been mistaken for stimulation produced, as it will be if the article is continued for some time in doses just short of the strong narcotic doses It is from this state that the opinion has been drawn that digitalis is capable of producing an inflammatory fever The secondary operative effects of digitalis are those of other deobstruent narcotics, as actaea cicuta aethusa etc. It has been noticed that when the pulse has been reduced to 40 by digitalis if the patient is raised to a sitting position it will rise to 72 or 100 & this has been considered very strange but it is no more than always occurs in extreme exhaustion from narcotics or in its syncopalis or even from mercury Much mischief has been often done by giving digitalis to reduce frequency of pulse It will relieve none but irritative frequency. It may be made to cure some cases of intermittent pulse Under any management the article is liable to fail to operate, and after some days operate most dangerously The intermission of the pulse may continue along with the quickening of the circulation for 2 weeks after the cessation of the administration of the article Digitalis is diuretic only after nausea is produced by it but too much nausea will prevent its diuretic effect Digitalis is not or not much diuretic in health it is only so when water has accumulated It is capable of relieving some atonic infl. Opium must be conjoined Prof. T. has treated ac. rheum. by it Those who contend for the stimulant power of digitalis say that is contraindicated in phlogistic diathesis. Others say that it will relieve phlogistic cases. Both agree that in some cases it has produced no effect either beneficial or injurious But if digitalis and nothing else is given in a severe case of phlogistic disease it will have no effect and the disease will aggravate of course. In milder cases no change will be observed. The supposed phlogistic cases relieved by it were irritative cases without strength of pulse sub-putrid cases Farriar accordingly, who considers it useful in phlogistic diathesis, still says it is useful only in those cases which do not admit of v.s. and he commonly conjoined it with camphor and opium. It is equally admissible in low atonic cases. Paris supposes that a considerable number of diuretics are adapted to a different set of cases, from digitalis There is something in the general principle e.g. crem. tart. & tinct. canth. But he is entirely wrong in saying that squills and calomel are incompatible with digitalis. He supposed calomel to be a stimulant and digitalis a refrigerant. Blackall is mistaken in a similar manner calling calomel a stimulant etc. Paris supposes languor & nausea are essential to its diuretic effect and hence they must not be prevented Prof. T. has found that there is a certain range within which digitalis acts and hence sometimes aromatics, cath. & opium must be premised and cojoined and in a few cases, tart. antim. & even bleeding must be premised Many among us have lately found that tonics as canella alba are usefully conjoined with digitalis. In such cases Prof. T. conjoins tinct. canth. senega squills & cal. with digitalis yet all are incompatible according to Paris In low cases alcohol will often be needed Calomel generally increases the susceptibility of the system to the operation of this article Pharm. prep. Tinct zii to spirit of dilute alc. med. dose mx 3 or 4 times a day Infusion zii to pt. dose tablespoonful. Therap. appl. 1st Idiopathic cough where there is a leucophlegmatic habit and bloated face But other things are better and at least opium or I. paregoric should be combined say 3 of deg. & 1 of laud. or I. pareg. The opium will tend to prevent its accumulation Bex convulsion Highly recommended used the same combination as above. Prof. T. has never used it in hooping cough Dyspn. exac. & asthma very useful combined with opium. It will cut a paroxysm short as soon as any article Combined with tonics it may be given in the intervals Delirium tremens comparatively but little opium will be needed, if you use digitalis (only however, where the patient has some vigour of constitution left) Puerperal delirium ( a disease nearly allied as in the above disease where opium produces a disposition to sleep without actual sleep digitalis will produce quiet sleep Cauma recommended but Prof. T. thinks it not indicative likely to do neither good nor hurt Phlogotica useful in lotions for various of them particularly erythema vesiculare & E. oedematosum Apply it strong enough to produce a slight sensation. Recommended very highly for the poisonous [rhoes] Scalds and burns lotions highly useful relieving pain, irritability etc. Acute inflam. of brain lungs or other viscera (supposed entonic but really irritative or atonic) by Dr Currie So Ferriar who combined opium & camphor Recommended in croup but is not employed Song recommended in phthisis almost the first disease in which it was employed best adapted for the cases which require iron & myrrh Some think it useful as a diuretic in this disease but excessive urination will exhaust as much almost as excessive sweating. It is principally useful 1st as an antirritant 2nd as a deobstruent both which are indicated I membranous phthisis Digitalis is to be given in phthisis as in other disease, upon general principles Rheumatism useful as a narcotic & deobstruent combined with opium It may be made to cure acute rheumatism premise a purge of calomel & give say 10 drops of the tinct. every hour or 20 drops once in 2 hours until the disease yields, or the head is affected No cancer of a violent action, used in this way combined with opium & with diaphoretic regimen So of aub acute rheumatism but not so useful. Blenorrhea lenodis 25 drops 3 times a day conjoined with decoction of barley Struma recomm. also in the strumous phlogotica this depends on the state of the system Sparganosi puerperanum recommended internally & in lotion conjoin opium but do not adopt this practice in a feeble subject Measles & rosalia probably useful when not too atonic Hemorrhages rec. but it should not be given in the phlogistic (N.B. There are 4 sorts of hem. active phlogistic passive atonic irritative & vicarious) Digitalis will be useful in the irritative kind with a quick wiry pulse irregular throbbing heart etc. Recommended in ill conditioned venereal ulcers topically Mania rec. (said to be useful when the blood is determined to the brain which Prof. T. thinks does not occur) Prof. T. considers mania as a periodical disease & consequently an atonic dis. The paroxysm of mania precedes the disturbance of the circulating system and the effect has been mistaken for the cause. Dr Willis cured 92 per cent Dr Todd has cured 93 pr. ct. It has lately been published by Dr [Willis’s] grandson that his treatment was substantially the same as Dr Todd’s The latter allays with paroxysm by moral means he prescribes quinine etc. as for a periodical disease. Enlargement of the heart good testimony also of the large blood vessels Epilepsy hysteria convulsions (hardly advisable) Dysury of various sorts nothing specific is mentioned. Dysury of a low typhus will be aggravated by narcotics that of cantharides will be relieved. Lithia recom. Most important use is in Dropsy 1st paleness, coldness skin easily [illegible] etc. (vide Withering) Prof. T. has always found it useful but, as Dr With. gives [illegible] so he finds stimulants necessary in conjunction. Irritative cases with a dry skin etc. Digitalis does well in Dropsy of the abdomen with a distinct hard, circumscribed tumour (encysted) etc. will not be benefitted by diuretics Other cases of ascites require jalap and cremor tartar, senega & squills or elaterium Hydrops abdominis (if not encysted) hyd. thoracis etc. benefitted by digitalis Use afterwards, tonics conium & iron, myrrh etc. vide Withering Cutaneous affections impetigo herpetica scabies etc. Prof. T. has lately cured common itch oftener by digitalis than by any thing else Apply the infusion with a sponge to the eruption 1 to 2 oz to 1 pt. It cures in 3 or 4 days to 1 week Impetigo laminosa upon the fingers to relieve the irritability Recommended to prevent threatened abortion combined with opium But then opium alone, with horizontal posture, will certainly cure Poisonous effects relieved by stimulants and opium. This was well established before the springing up of the race of toxicologists! Prof. T. has had several cases where it had been given by mistake History popular in Rays time & since that time. Vide Gerhard Parkinson, Bates, [Valmon] etc. It was used to produce emesis etc. Dr Withering was first to discover and publish its true powers & operations 1785 D. lactea has been used as a substitute said to be more active probably less so as it was used more boldly D. epiglottis is mentioned by [Coxe] but by no botanist whatever. Actaea Racemosa There are 9 very nearly allied plants called by Linnaeus actaea & cimicifuga But one of them may be referred to either & these have been called macratrys by Rafinesque. Provided actaea & cimicufuga are distinct genera macrotrys must be seperated. And upon the same principles A. palmata should be referred to another genus still. [Now] some late botanists have united (judiciously & upon Linnaeus’s own principles) them all into one genus actaea. We have in N. Eur. A. rac. A. rubra & A. pachypoda (A. spiculus is not now acknowledged) The whole genus in three divisions has 1st A. cimicifuga (Siberia) A. simplex (Kamschatka) & 3 others of the division cimicifuga 2nd sub. div. macrotrys. 3d sub. div. A. christophoriana vide [illegible] Decendalles two spec. A. mucrocropa & A. cerulea are mere varieties or mistakes the latter does not differ from A. rubra Actaea racemosa Linnaeus ([illegible] [illegible]) Cimicifuga serpentaria of Pursh Cimicifuga racemosa Nuttall Macrotrys actaeoide Rafinesque Macotrys serpentaria Eaton Botophys actaeoides Rafinesque again Black cohosh. black snake root (which is applied to at least a dozen others e.g. sanicala mar.) square root rich weed rich root snake weed etc. Cornuticis Canada herb christopher Nat. ord. [Ranuncul???] Tribe I aconeae. Grows in woods among rocks in rich places etc. Flowers about July. Monogynous root an irregular tuberous rhizoma with fibrils Often the root of blue cohosh (leontica thalecteoides) is often sold for it but the fibres of this are smaller taste less bitter not virose etc. Roots of sanicula marilandica (called also black snake root) are also collected for it. (So the berries of cornus [illegible] have been found in the shops for buckthorn) But A. rubra & A. pachypoda are most commonly mistaken for it they are inferior Root he only part used Taste first to sweet & aromatic afterwards virose and bitter Tinct. of root is aromatic & bitter It should be collected only after the decay of the top. Attend to this direction, & use care in its preservation & it will retain its full virtues for years. I know of no good analysis. Dr. Meers attempted it, & gave the result of his researches in a dissertation, Tannin, extractive matter, a bitter principle, gallic acid, a gummy principle, starch, woody fibre, all which amounts to just nothing at all. HE said it probably contained an alkaline principle; but I assert positively, from repeated experiments, that it has none but calcid. I tried every means to get an active satisfiable base failed entirely don’t believe it has any. (Here Prof. T. gave the ordinary process for getting salifiable bases.) The article is prominently & decidedly a narcotic antirritant said to be anodyne & soporific; I don’t believe you can employ it for that purpose with advantage; though this, as well as all other narcotics, in certain conditions, do have such an effect. It readily & certainly produces ult. narcosis, which can always be speedily relieved by suspending its exhibition, & at the same time using those means heretofore so often directed especially opium (N.B.B.) # Dr Todd has seen decided & considerable exhiliration Prof. T. thinks it similar to the erethism of datura & conium & which occurs just before an attack of delir. trem. which is often mistaken for entony. In large doses it produces neuralgic lancinating pain in the extremities larger doses make these pains more extensive even affecting the head and eyes. Prof. T. once doubted the existence of these [illegible] but he has seen them many times They are most manifest in the calves of the legs & along the # I believe it is a nervine, though not prominently so. sciatic nerve. Opium counteracts them Cases related. Food also suspends the pains Prof. T. now employs a little food as a gill of milk porridge in conjunction with each dose Besides these neuralgic pains a large dose may produce convulsive action of the heart. Case of Charles Terry dangerously affected with extremely violent neuralgic pains under the upper part of the sternum wandering neuralgic pains soon violent palpitations beats 130 in a minute pain under the left axilla etc. Large quantities of camphor opium capsicum etc. were required. An emetic of sulph. zinc was given to change action Next day, pretty well. These effects happened twice the actaea not being at first suspected. Case related from G. K. Lawrence of the Shakers in which a large dose produced convulsive action of the uterus In both these respects it resembles strychnos nux vomica & false angostura. Some physicians give too large doses and at too long intervals & hence are always complaining of failure & of unkind effects of the narcotics Cases and testimony of physicians about its ecbolic operation. In one of the first cases, it was given as an antirritant, in a case of threatened abortion Abortion was speedily produced Dr March prefers it to clavus being more lasting leaving the uterus less inactive much less liable to destroy the fetus. Drs March and [Dyer] have found it useful in uterine hemor. Dr Dyer finds it the most valuable article for suppressing uterine hemor. not connected with pregnancy. He continues its use for some time Prof. T. thinks this [illegible] operations not specific, but as part of its narcot. He has repeatedly seen it convulse other involuntary muscles. Actaea is especially deobstruent Prof. T.’s attention was first turned to this by observing its effect when given as a diaphoretic in what was thought (by an old surgeon) a fever sores (osthitis gangrenos.) It resolved the infl. and cured the local disease, much to his surprise. He gave it merely to ally irritative heat and dryness of the skin knowing not a great deal about it. Subsequent experience with the resolvent powers of sanguinaria, colchic. varat. etc. led to the investigation of this property of actaea Dr Meers has found it produce an erythema upon the skin. Prof. T. has never experienced this. Dr. [Gasden] thinks it cholagogue Prof. T. has had no positive experience of this. Dr S. Woodward & others, however find it so Found to be emmenagogue also Seems to be expectorant also (as far as an article can be so directly Decidedly diaphoretic so say many physicians. Perhaps however it is only indirectly so as it appears to be so only in febrile (hot & dry) states. Diuretic often considerably so Yet upon the whole it seems not to be suffic. diaph. diur. & expect. to render it valuable for these indications It has been repeatedly called astringent. But it seems not to operate thus. To be sure it contains a little tannin or gallic acid but not enough to be efficient in operation Called tonic Prof. T. once thought so. Dr. Garden thought it tonic 7 reducing both. Prof. T thinks it not reducing bug prostrating merely. Prof. T. & all his friends also find it useless as a tonic. Like every other article of the materia medica this has been called stimulant. Prof. T. has watched carefully for this effect & never could perceive any. The warmth, flushing face etc. are produced merely by cerebral irritation. Very commonly said to be pectoral a term which may mean demulcent antirritant deobstruent etc. Said also to be alexipharmic Also called antiscorbutic this was the earliest quality ascribed to it in any publication. The principles of the cure of scurvy are not very well settled. The cruciferal seem to be well established as the remedies. Actaea is at least useful in restraining hemorrhage. But Prof. T. is an entire sceptic about the prescribed treatment of scurvy. All the cases treated of in the books occur at sea and seem all to be cured upon dietetic principles Concrete citric acid is useless. Lemon juice is useful in furnishing vegetable aliment. Land scurvy (apparently the same as sea scurvy) Prof. T. has found not benefitted by the treatment of the books He has cured it by lead, opium capsicum, and brandy giving food with each dose of medicine & after a few days giving quinine Rx ac. lead 1 gr. op. ¼ gr. every hour tablespoonful of brandy every 15 min. a little food with each dose. This pat. (in Albany) was cured though she was not expected to live an hour. Said to have the power of curing cutaneous eruptions The only testimony is B. Barton’s that it will cure itch Called repellent by which is probably meant discutient Prof. T. knows not that this has been well investigated. Called pellent also! Dr S. B. Woodward has found it cathartic, upon some of his patients. He is the only person who has met with such any effect probably they were anomalous cases G. K. Lawrence thinks the flowers are laxative. But all flowers are laxative unless they possess some other powers. Said to be emetic in a large dose This is very doubtful probably not more emetic than digitalis as a narcotic Darlington calls the root somewhat mucilaginous. It certainly is not so when chewed. Being narcotic it certainly could never be employed as a demulcent. Any considerable degree of phlogistic diathesis, will not admit of this article, until after reduction & evacuation It may be usefully conjoined with opium acrids & tonics Recapitulation 1st moderately nervine 2d actively deobstruent including, resolvent cholag. emmen. diuretic & perhaps diaphoretic 3d powerfully narcotic always antirritant sometimes soporific produces ultimate narcosis. 3th ecbolic Not stimulant tonic nor astringent etc. etc. vide supra This is supposed to resemble lycophus virginicus but the latter is merely nervine & tonic Most resembles digitalis but differs thus viz it does not accumulate on the system not continuing long after exhibition or returning in paroxysms does not exhaust the system like digitalis its narcotic effect is more easily relieved. Digitalis is not ecbolic & is less deobstruent It is more speedy & active than conium has most resol. power in acute conium most in chronic infl. conium more cholagogue & not diaphoretic nor diuretic Possesses the conveniences of sanguinaria & colchicum without disordering the stomach etc. like them Sources of failure are bad preparations not pushing the article far enough nor repeating [illegible] enough In many cases 2 hours is a better interval than 3 hours Another source of failure is preparatory bleeding or purging Pharm. prep. 1st very fine powder 20 to 30 grs. 2nd infusion coarse powd. zi boil. wat. 1 pt. [illegible] 1 hour & strain Tincture 4 oz coarsely powdered root to 1 pt. off. alc. macerate 10 days & strain. This is a saturated tinct. & is the only one needed for common use. It is the only preparation which will succeed in acute rheumatism Probably the active principle is perfectly soluble only in alcohol as water causes a turbidness or cloudiness though nor precipitate The powder is too inconvenient because it must be very recent & fine Medium full dose is about 30 m. Tinct. of the flowers is made by G. K. Lawrence 4 oz. to 1 pt dil. alc. He says it is cath. & less narcotic Diseases 1st dyspepsia irritable cases greatly palliated, by Drs Hale & others. Dyspepsia with a dry symptomatic cough very useful Dr Knight has found it very useful in 50 drop doses, conjoined with opium in dyspepsia with pain it cured when opium would not Diarrhoea thought highly useful by many. Colica ileus var. rhematalgica (primary rheumatic affections of the colon is known by the habits of the pat.) Dr Hooker gives 1 fl. z every hour until pain is relieved or narcosis produced & the pain is sure to be relieved. It will probably be found useful in common colic as it excites the involuntary muscles Bex dyspnoica often highly useful relieving in combination with opium when the latter alone failed Case related mistaken for [illegible] & haemoptysis (as there was oozing from the throat, caused by atony) Hooping cough much & successfully employed by Dr Woodw. of Vt. arresting the convulsive cough when pushed to narcosis Dyspn. exac. & asthma It generally cuts short the exacerbation give with the 1st dose the exacerbation of laudanum (sometimes 2 grs. op.) give a teaspoonful every 5 min. or a dessert spoonful at once or if this fails repeat it and in some cases a tablespoonful In this disease, a mixture of several narcotics give datura Prof. T. has succeeded well by equal parts tinct. actaea lobelia & datura Prof. T. at firs knew no better than to puke with tartar emetic this was worse than the disease. Next he tried ipecac. this failed. Next he tried syr. of [illegible] of squills this he thought did well but he found it always disordered the digestive function Nex the tried tinct. lobel. And one case in his own family he cured radically by anticipating the paroxysm with lobelia & laudanum Colchicum will break up the paroxysm but disorders the stomach worse than squills. Coxe’s hive syrup is much used but is one of the worst articles for disordering the al. can. Dr Mears recom. actaea for curing intermittent fever. Prof. T. tried it. He found it would suspend the paroxysm, but would not cure the disease & he would be compelled to resort to quinine Prof. T. considers this a disease of atony & has cured it only by tonics & stimulants The articles which suspend the paroxysm and do not give tone seem not to cure the disease. Slight cases may be cured by tricks of various sorts. Idiopathic hectic useful at least as an auxiliary Phlogotica apostema communis (common diffused superficial abscess generally about the hip) case related fo a cure by actaea Paristhmitis typhodes var. sub putrida (fever a synochus not scarlet fever a very rare disease most cases of malignant sore throat are cases of scarlet fever) good testimony of the utility of actaea as a gargle probably by its deobstruent effect. Perhaps it is also discutient it cures itch Pneumonit. typh. var. sub putrida (fever a synochus) Probably it might be used in most of the atonic & subputrid phlogotica & even in simple fevers of this type, if not too low Pneum. typh. var. nervosa probably it would be useful rousing nervous susceptibilities & acting as a deobstruent Pneum. typh. var. notha (which appears to be a spec. infl. of the bronch. memb.) highly useful. Arthritic infl. of the lungs misplaced gout useful especially if acute Sub acute pneumonitis (of Rush & others) (which appears to be an aff. of the bronch. mem. without an aff. of the schneiderian) precedes membraneous phthisis often should be treated with deobstruents, narcotics, nervines & diaphoretics e.g. marrubium etc. Phthisis membraneum var catarrhalis much used even by those who know nothing of its general use Vide Eberle’s practice Phthisis membranea var. dyspeptics highly useful. Remarkable case of Dr Hotchkins related at full length (Incidental remarks of Prof. T. he had hemorrhage which was checked by tartar emetic in nauseating doses left extremely weak “no wonder if tartar emetic was continued thus for some time” could not take tonics “because he too no antirritants with them, opium for instance”) cured when in the very last stages by actaea A. rubra failed in this case (it is greatly weaker) [Galium] circaezans proved a valuable expectorant. # [illegible] [illegible] drops were used Another very instructive case of Dr Hotchkins’s failed because it was not persevered in long enough This is apt to be the case with long continued diseases e.g. chronic diarrhoea & opium Scarce any remedy will do as much in phthisis as this even if given alone Yet it ought not to be given alone but combine with opium tonics etc. In m any cases actaea has prolonged life for years in desperate cases. N.B. consumptives cannot be cured by residing at the south in the winter only they must reside there for life to be permanently cured Phthisis tubercularis supposed to have cured. Laennec’s anatomical investigations Prof. T. thinks show unequivocal cures if tubercular phthisis All arthritic infl. are benefitted by it’ especially rheumatismus Prof T. has seem cases of arthritic carditis cured by actea others not. # American cough drops are equal parts elixir. pareg. & [tinct.] digitalis Cholera infantum (An infl. of muc. memb. of al. can.) has been cured Dysentery has been cured admirably by actaea. Dr Peabody has cured by 40 drops so have others Hysteritis membranifica has been found useful in many cases by Woodward of Vt etc. Prof. T. has not had an opportunity to try it in acute gout. He would give actaea once in 3 hours until narcosis was produced 30 drops or ½ tspfsful conjoining opium enough to drive off pain once in 3 hours IN this way Prof. T. has cured with verat. vir. lob. sang. & colch. # Arthritis rheumatismus atonica acute If pat. is costive give opium enough to relieve pain follow with cal. enough to purge in 12 or 18 hours After the purgation give actea once in 3 hours f zfs more or less # but the purgation from colch. is highly mischievous enough to affect the head conjoin opium 1 gr. or more or less once in 3 hours to relieve pain. When Prof. T. first began to treat atonic acute rheumatism in this way, he conjoined other articles, as ipecac but he finds them useless. The topical heat redness, soreness, swelling etc. will be relieved in 24 or 36 hours & often the fever disappears with them Dr Woodward of Vt cured 10 cases of acute rheum. in one winter all the cases he had. Dr S. B. Woodw. used it always in rheumat. he gives 25 or 30 drops (alc. tinct.) about once in 4 hours To prevent a relapse continue the actea in diminished doses Vide page next after the end of the article cinchona Ophthalmitis Hemorrhagia irritativa & [passivea] from any part Prof. T. knows it to be highly useful Porphyra haemorrhagica & [illegible] first employed to cure this disease in a large quantity of cider probably the cider had most effect It may be useful in this as in hemorrhage Neuralgia successfully with opium or arsenic by Drs Tully (he finds strychnine & opium better) & S. R. Woodward (in neuralgia of feet & legs of broken down convicts) Dr Knight has been succesful with it in neuralgic toothache Prof. T. has succeeded better with strychnus and arsenic or opium Hysteria Prof. T. used [illegible] successfully early in his practice now he uses nothing but datura. Epilepsy Dr Parrot of Western considers this article as peculiarly valuable in epilepsy from intemperance Others value it in other cases of epilepsy Carus paralysis it will probably be found useful from its resemblance to strychnos It has been found remarkably useful in palsy from lead colic camphor & arsenic may be joined Chorea from analogy Prof. T. was led to use it 15 yrs ago general testimony it its favour Vide also Am. journ. med. scien. No. 18. for interesting cases of surprising cures. Dr Hooker has used it with the most beneficial effects in chorea Tried chloroferrate of iron ([illegible] veneris) & conium & iron & various tonics with no benefit tinct. of horse warts (a powerful nervine) etc. Actea cured her Paramenia obstructionis found highly valuable. P. difficilis found useful in relieving pin, obviating irritability etc. Prof. T. uses datura Parodynia atonici lingering parturition Prof. T. now uses it instead of clavus with as much efficacy & without danger to the child Retention of placenta repeatedly used by Prof. T’s friends with good success Hydrops cellularis especially with an erythematic diathesis not used by Prof. T. but by several practitioners as a substitute for digitalis Leucorrhoea in a case which seemed to be the joint result of blenorrhoea & mercury cured other cases Ecpyesis scabies itch said to cure by lotion Prof. T. has often cured itch by lotions of digitalis. Sprains Prof. T. has often used it with advantage Bites of rattlesnakes popular alcohol & opium must be better Old chronic cases of swollen joints arising partly from injury & partly from rheumatism was proved very useful Very useful in murrain of cattle vide B. S. Barton. History. Lond. phil. trans. Petiver 1697 used in [Mariland] for scurvy. B. S. Barton various (among others the U.S. Dispens.) have copied from him. Actea rubra Distinct from A. spicata Considerably used in some places Powers similar to A. rac. but far weaker and more uncertain & less valuable Actea pachypoda A. alba (Big.) A. spicata var. alba A. rubra var. alba! etc. Necklace weed, coral & pearl etc. Mentioned in several irregular works. Used as an efficient emmenagogue by Dr McClure. Berries of this & the preceding (i.e. dry capsules!) said by Rafinesque to be poisonous Used by Dr Collins as a substitute for A. rac. but weaker Used by him with advantage topically in ophthalmia used for dysentery etc. Not worth substituting for A. rac. As the roots cannot be distinguished these are often sold for those of A. rac. hence frequent disappointments A. spicata Christopheriana herb christopher [Bane] berries berries said to be highly poisonous (vide Withering) Root and leaves acrid berries have caused delirium useful in nervous diseases as a repellent etc. Prof. I would infer that is is more active than A. rubra & less so than A. racemosa Actea Cimicifuga Linn. Cimicifuga foetida Linn. Liberian bug [bane] N.W. coast of Am. & Liberia An almost insupportable smell Used in Liberia as a bug bane Vide Good art. hydrops abd. (drastic i.e. active it is not cathartic) Abundant testimony that it is a powerful narcotic. Little doubt that it has the same powers as A. rac. but more powerful Strychnos nux vomica Nux vom. officinarum Caniram etc. nux. metalli Nat. ord. Apocyneal ([illegible] Luridae Linn) Habit. Coromandal Cochin China Fruit a berry about as big as an apple with a hard orange coloured skin seeds imbedded Seeds only used Bark said to be nearly as active. Seeds orbicular & depressed size of a dime Active principles strychnine & Brucine (brucine by mistake brucea being merely a bitter tonic) Strychnine most abundant exists combined with strychnic acid White, crystalline etc. said to be highly alkaline will it change blues? Combines with all the acids & is separated by all the min. alkalies When recovered from some combinations the alkali is changed (This is true of various veg. acids also a different acid being formed) Operative effects in ordinary doses these are so moderate and show that they can be no better distinguished than those of cinchona when properly administered & in a suitable disease, we merely perceive an amendment of disease. Diminishes morbid irritability & susceptibility & restores healthy susceptibility & tone. In its slowness it agrees with conium but disagrees with actea digitalis and lobelia It is mentioned as a peculiar property that it strengthens the voluntary muscular power. This is merely the erethism of the brain produced by all the narcotics It is more easily & more powerfully produced by this than by most narcotics Said to be anodyne is probably less so than many narcotics. It has great power however over neuralgic pain Said to be tonic & Prof. T. is satisfied that it is so Supposed to be deobstruent. Prof. T. thinks it is so though more equivocally so than some other articles. It cures gout rheumatism leucorrhoea etc. but little definite is known Not known to be cholagogue, anti psoraic etc. but has not been thoroughly investigated Said to be febrifuge (probably anti intermittent is meant). It seems to be capable of curing intermittent Said to be anthelmintic probably it is so Its slow operation adapts it more especially for chronic diseases Inconvenient effects cardialgia vertigo staggering appearance of drunkeness stiffness of [lims] & general coldness. These effects indicate a reduction or suspension of the remedy In a sufficient dose said to be capable of producing these effects in an hour & ultimately to produce stiffness of voluntary muscles i.e. tetanic spasms Ultimately it convulses the invol. mus. Noxious effects said to come on with pricking of the limbs coldness ultimately spasms & complete ultimate narcosis Paralytic parts more speedily & powerfully experience its effects viz. the pricking, local perspiration & tetanic spasms the contrast being remarkable between the two sides being affected vide Magendie Even the two halves of the tongue will be differently affected Magendie is probably correct in saying that it may affect the spinal marrow without affecting the brain Prof. T. has found strychnine more efficacious than any other preparation. Strychnine is said to be the most active principle known & the most speedy next after prussic acid Effects1st acrid narcotic 2nd tonic ([illegible] 3d deobstruent 1st resolvent others not investigated Entonic diathesis strictly prohibits this article, more indeed than it does most other narcotics The British practitioners are mostly afraid of this article yet it is more easy to manage than colchicum etc. This article, like all narcotics, gives warning of mischief. The refrigerants do not Orfila knows no antidote he directs emetics, cath. vinegar etc. tracheotomy and artificial respiration! Pharm Pres. 1st Fine powder rasp the seeds then pulverize & sift through muslin. Dose about 4 grs. 4 or 6 times a day. or dose 5 to 10 grs. Push it until moderate tetanic spasms are produced. Prof. T. pushes it until some slight startings of a paralytic limb. Sometimes 1 gr. 4 times a day has been enough 2nd Alcoh. tinct. strong alc. 1 pt? 2z of rasped seed. Dose 20 or 30 minim 3d Alc. ext. begin with 1 gr. or once a day (Magendie) But one dose a day will require too large a dose The effects of one dose will not last 24 hours For a slight effect ½ a gr. to 1 gr. pr. diem will be enough (Magendie) Dose of pure strychnine said to be ¼ to ½ a gr. 2 or 3 times per day too large a dose Some patients will not tolerate more than 1/16 of a grain. The doses must not be so large as to produce vertigo nor the quantity in the day so great as to produce tetanus Diseases 1st dyspepsia more especially where there is want of tone in the stomach but in almost all varieties Prof. T. has found it useful Diarrhoea vulgaris reported as very valuable Lead cholic especially in its secondary stages & sequel Helminthia not said what species Dyspnoea chronica like galvanism Dispnoea exacerbans. Prof. T. thinks it obviates the relaxed thickened & spongy state of the muc. memb. also relieves the paresis of the nerves etc. Sternalgia ambulantium Intermittent fever dose directed is too small. Said to succeed when quinine fails. (Prof. T: & several friends never fail to cure by quinine enough & unqualified Cases related of cure by quinine after quinine had been said to fail utterly) Typhus pustis (Levant plague) said to be specific seems to be useful Dysenteria typhodes has been used wiuth great success Arthritis podagria Said to be capable of curing if steadily administered So of rheumatism & rheumatalgia, in all their varieties either be cured or proved valuable Sciatica arsenic, sulph. strych & sulph. morphium in combination have proved highly valuable Ecphronia mania rec. in the books. Halusia hypochondrias (apparently a combination of a moderate degree of dyspepsia & of melancholia) said to be valuable Cephalia hemicrania (idiopathic not when a disguised intermittent) ¼ gr. 3 or 4 times a day usually in the required quantity. Combine also morphine. Prof. T. has succeeded better by this plan than by any other He now employs it exclusively. Case of Prof. Knight’s Neuralgia one of the best articles Prof. Knight has employed is successfully in many cases of nervous pains [Clo??] palpitatio Used with great success Chorea. Cured cases of long standing Dr Beers has found it highly successful So has Dr Woodw. of Vt Prof. T. has used it but little & that with success Hysteria said to cure Prof. T. never tried it but once & then it failed. It might be useful between the paroxysms Epilepsy recommended might be useful Dr Woodw. of Vt has used it with decided advantage Carus lethargus has been cured Carus paralysis more celebrated for this than for all others 10 to 40 grs in 24 hours It should be pushed so far as to produce some spasms in the paralytic limb Adapted to all cases caused by intemperance by venery passion etc. Has been used successfully in pregnancy (for hemiplegia) without injury to the fetus. Case quoted showing that palsy may be cured without producing any thing more than tingling no spasms. Magendie states that is now externally applied, in form of tincture Paropsis amaurosis Agenesia impotentia (probably a partial paralysis though an affection of the mind oftenest hinders this cure of the disease) Spermorrhea atonica Magendie Paruria retentionis & incontinens successful see Magendie Leucorrhea communis cured Bite of reptiles said to be cured Emaciation of extremities cured or relieved by Magendie It must be remembered that all these cases may be incurable and that the article may apparently fail Hist. Said to have been employed ever since the time of Gesner 15- Introduced into England in 17.. by Woodville Revived in France by Magendie in consequence of observint its tetanic effect on animals Strychnos psead augostura Called improperly angostura with various trivial names Always found as an adulterating article of Angostura bark 7 hence it probably grows in S. America. It is not known however, with certainty where its habitat is. Magendie Paris etc. attribute it to brucia antydysenterica [illegible] with probability attribes it to a species of strychnos Two species of strychnos grow in S. Am. Bark comes in pieces broader than long ½ inch thick covered with small warts fracture [illegible] small aromatic and nauseous, disgustingly bitter to the taste powder bright yellow Concentrated infusion muddy disgustingly bitter etc. Lat. tinct. pale rendered opaline by water? It is important to distinguish this adulteration of galipaea off. or angostura Severe accidents have happened even in this town Absolute tests said to be 1st a drop of nit. acid on the inner surface produce speedily a blood red spot (by the [brucia]) 2nd a drop of nit. ac. applied to the lichens on the outer surface, produces a deep emerald green color It is much to be regretted that the active principle is called brucine this brucine poisons as effectually as strychnine Th bark in powder [illegible] grs. killed a dog in an hour A child was killed by mistake cold extremities senses retained to the last Brucine is formed in Strychnos nux vom. said to be a bigallate in false angostura. Description of brucine vide chemistries. Taste bitter & acrimonious Nit. acid produces a deep yellow colour hence it can be detected when in combination with strychnine Wide discrepancy between the results of the ultimate analysis of brucine Andral considers 1 gram of strychnine equal to 24 gr of brucine Hence 6 grs. will be equivalent to ¼ gr of strychnine q.v. 4 grs. killed a rabbit Andral has given it in single doses of ½ gr. to 5 grs Magendie 1/8 gr. 6 times a day Operative effects differ only in degree from those of strychnine Strychnous pseud ang. is now considerably used in medicine Strychos [illegible] is the most active of all the strychnia (strychnoes) L. ignatii is next in activity. It was called ignatia by Linn. Called also faba sancti ignatii recommended in intermittents It vomits purges and produces spasms 2 grs said to be a medium dose of the seed. Strychnos colubrina posses the same sort of powers. The wood of the root is used against bites of snakes hence its name. In doses of ½ dram it has been used in intermittent. It vomits, sweats, diuretic cath. This is one of the plants called [illegible] [illegible] The other plant is the following Toxicaria macassariensis Ripa antear Antearia toxicaria etc. This is said to be the most active of all the narcotics not] excepting hyd. acid. The proxi Lobelia Inflata Said to be annual, persistent, and biennia. It seems to be biennial Rapuritium inflatum lobelia emetica. Indian tobac. eye bright etc. Nat. ord lobeliae Canada & the whole U.S. [Ra??.] & Sch. describe 15 species most of them are highly active Taste much like green tobacco It has never been analysed Operation 1st warmth in the stomach proceeding to cardialgia universal glow tremors some nausea vertigo salivation Larger doses cause more vertigo emetic diuresis more salivation expectoration Poisonous doses produced convulsions, delirium & death. Said also to produce increased secretion of bile diuresis & diaphoresis A valuable deobstruent though more adapted to atonic cases Valuable diuretic etc. Useless as a mere emetic It is too harsh and distressing. It would probably prove emmenagogue. Some think it cath. Prof. T. denies this except indirectly as an antirritant & cholagogue Seems not to be stimulant It will not prove restorative in exhaustion but rather increase it It may excite an irritative bounding of the pulse in low torpid cases. It is acrid & locally irritant not stimulant. It resembles to nicotiana tabacum but is more diffusible more sudden, mor transient, less permanent more manageable Though not stimulant yet it is contraindicated in entonic diathesis Pharmac prep. 1st powder of leaves 2nd powder of the seed 3d infusion but this has no standard strength [4th] tinctl zii to 1 pt dil. alc. 5th Tinct. of seeds by the Shakers Diseases 1st Dyspepsia with great [irritability] with wandering pains like disguised gout very beneficial in conjunction with capsicum & nit. sil. Limosis gastrodynia vide Eberle’s practice He finds it superior to opium Idiopathic cough either before or after expectoration found to be very valuable Bex dyspnoica Case related of an apparently desperate case cured by lobelia and opium f zi tinct. lob. with 2 or 3 grs op. at a dose each article failed by itself Another case related in which a large secretion of bile was produced Hooping cough found useful after the convulsive cough has begun by numerous practitioners A physician gives 10 to 60 m occasionally vomiting with it and he thinks it better [emetic] for the disease than ant. or ipecac undoubtedly because it is deobstruent Many physicians have succeeded with it Prof T. has done so sometimes conjoining opium or conium Dyspnoea exac. f zi of tinct every 5 or 10 min. until full vomiting or narcosis is produced. The certainty of the operation will be enhanced by premising opium Give it in the intervals of the paroxysms in conjunction with tonics Asthma best article for this disease as well for the preceding Still this medicine is so nauseous that many patients will not persevere with it Typhus nervosus has been used Dr Hyde of Enfield employed a powder of lobelia, or sanguinaria & of [????triphyllum] as a stimulant diaphoretic in typhus. It must be remembered that deobstrents are useful in typhus. Prof’s T & Beers used lobelia in typhus, when medical student & found it a most efficient diaphoretic Catarrhus communis & epidemicus Prof. T. has used it with great benefit Croup Dr Barney employs it in croup in the commencement and in the progress of the disease 30 m to ½ fz Croup is sometimes perfectly paroxysmal & resembles dyspnoea exacerbans & has been mistaken for asthma, as shown by Dr March’s p.m. examinations For this form lobelia is peculiarly adapted Pneum. typhodes was found a most valuable expectorant whenever squills could be tolerated does not answer well for when the stomach is irritable Acute rheumatism It has been used with success. Prof. T. has used it often with success in subacute rheumatism Case related cured in 24 hours by lobelia & opium Yet this patient had often had such attacks before which always lasted for a fortnight A. rheumatalgia var. chronica (chronic rheuma) Prof. I finds it the most valuable article much superior to guaiacum which is the article commonly depended on. Case related cured by lobelia and opium after arsenic blisters guaiacum alcohol capsicum etc. had failed Leucorrh. comm. valuable in some cases generally best conjoined with cantheris & nit. sil. Hernia recommended as a substitute for tobacco by enema Said to be nearly as effectual and not dangerous like that article Lobelia tupa Peru 6 ft. high root is 1/1/2 ft. long odour in a close room produces vomiting Juice so acrid as to produce speedily topical infl. when applied to a tender surface L. longifolia W.I. said to inflame the hands said to produce an incurable purging. Prof. T. has known several deaths by this actually incurable purging hydragogue from colchicum! L. urens most active also]L. syphilytica throughout U.S. all parts [lac] 1st deobstruent 2nd emetic 2d hydragogue cathartic apparently not narcotic 1st expectorant & emmenag. 3d diuretic 4th diaphoretic First employed as a specific for syphilys Just about as active as senega and adapted to a similar set of case. It seems to have the advantage of being less liable to leave the stomach in a deranged condition than senega As to its curing syphilys Prof. T. thinks the matter not settled when it was tried the notion prevailed that syphilytic patients should be salivated and that too before the constitution became affected It is never worth while to give mercury internally when the disease has proceeded no further than a chancre & bubo You will merely protract the cure The const. aff. also Prof. T. has cured by gold. It may be cured by various articles# Lobelia Dortmanna of similar powers to the preceding Lobelia Cardinalis supposed to be similar power It is a popular remedy in dropsy & will cure used as in vermifuge for [asc. lumb] L. claytoniana still weaker most common with us and apt to be confounded with L. pallida # Some cases will prove incurable under any treatment Sanguine temperament & scrofulous habits [illegible] mercurias dulcis sublimatum dulce (Sydenham) A. [illegible] A. [maligala] [Draco] mitigatus marina metallorum [illegible] metallorum Calomel Most modern & best name is Hydrargyri dichloridum The atomic weight of mercury was formerly called [200]. It is the general principle to take the smallest weight though it is not very strictly adhered to It does not appear but that the # persons who first pitched upon 200 + 8 for the black oxide, did it at haphazard and did not investigate the subject nor give any reasons “That compound which is with most difficultly decomposed, must be presumed to be a binary one Ms. Dalton vide Henry Prof. T. knows no exception. Hence says Mr. Alison? we must suppose the peroxide of merc. and perchloride to be binary compounds We find also that black oxide is very readily reduced by heat by agitation almost by pilling to red precipitate and metallic mercury. We find the same true of the cyanides. The sp. gr. likewise of the vapour leads to the same conclusion. The sp. gr. multiplied by .555 must give in combining weight. Hence we have 100. Another argument founded on the sp. I have [shown] elsewhere that if we divide the number .376 by the spec. heat the quot. will be then atonic [illegible] of that body [illegible] the spec. heat up [illegible] .03 & 376 / .03 = 12.533+ Berzelius advances similar arguments and gives the same no. 100. Thompson sometimes uses “sub” instead of di. Sub is a vague term It was found after the discovery of def. prop. that sub carb. pot. was 1 of each! other examples of its being misapplied before the discov. of def. prog. Formerly called proto chloride This would answer if it was still the case that proto was applied to the least compound Hydrayg: chlorid. mite. Phil. ph. an unexceptable name in pharmacy muriate of mercury Sub murieta (very exceptionable because it was considered neutral) then mild muriate) Called calomelas in 1616 But this name had been previously applied to the disulphuret (Ethiops mineral) Its discoverer is not now known The alchemists were acquainted with it. Sometimes found native & called horn quicksilver & mercurial horn ore a rare mineral Dull white yellowish heavy cake crystallized in 4 sided prism terminated by 4 sided Buff coloured when finely levigated. The only way to obtain it pure is to buy it in form of crystals The powdered in the shops is variable sp. gr. 7.2. [illegible] primary operation when taken internally 1t deobstruent 2nd cathartic 3d emetic 1st sialag. 2nd expect. 3d diuret. 4th cholag. 5th emmenag 6th antipsoraic resolvent 7th diaph. From the very situation of the salivary glands the operation on them attracts more attention Next to its dialag. are its cholag. Next its expectorant Next is its antipsoraic Next its diapohoretic, diadretic & emmenagogue in the order mentioned As a cathartic it is useful 1st as a mere reducing agent (a moderate one in moderate entony unless after bleeding) 2nd it may be used much more to make a shock or strong impression & interrupt disease 3d to increase susceptibility to other remedial agents & to equalize excitement Of little value to remove effused fluids as in dropsy it is slow & not hydrag. or to remove offending matter It may be made to operate as an eccoprotic, a laxative, a purgative a drastic cathartic It cannot long be used as an eccoprotic or laxative on acc. of ptyalism Most useful as a purgative. Inferior as a [illegible] cathartic Equally copragogue & cholagog. When suffered to remain in the bowels it is always deobstruent cholag. sialag. The gall bladder will always be found distended with bile or gall after it has been freely given in acute disease. This is often attributed to a spasm of the ducts [Emalging] the liver is supposed to be the only use of giving calomel in fever but then it [opens] the skin and promotes all the secretions It acts on the stomach and upper int. when given in a purging dose Its vomiting power is little valuable but as a cathartic it more nearly resembles an emetic than any other cath. in its operation, & may often be used as a perfect substitute where emet. are indicated. When given as a deobstruent opium shd be combined with it to keep it in the bowels. But when we desire a long continued deobstruent effect give it in small doses but it will always salivate sooner or later A man in health or in vigour is salivated with less diffic than in low atonic diath. or when very feeble or in enton. diath Sometimes it does nothing but salivate This is important to distinguish Sometimes it merely purges without any deobstruent eff. But Prof. T. has always found such cases to have been recently salivated or to have an excessively irritable stomach & al. can. in which it produces vomits Given with diuretics, or emmenag. or diaph. etc. it will prove more especially diuretic etc. Hence the “dirigens” part of the ancient prescriptions Naturally a very slow cathartic dose 5 to 10 grs N.B. we determine the nat. effect of a cath. by the smallest quantity that will produce its full effects When hurried through the al. can. almost all its deobstruent effects are lost. It must also be remembered that its cath. operation is generally its least important operation Prof. T. & his friends have always experienced its good effects upon themselves before the purging began Calomel has been called a stimulant perhaps because it produces irritation sometimes & a mercurial fever which is merely irritation A single author has called it tonic This is still more absurd A large proportion of our medicines do not either stimulate or reduce Mr. Abernethy says there are some patients whose mouths will not be affected & yet the system be under a mercurial action. Prof. T. has not observed such cases The system may be above or below the grade of excitement proper for salivation There may also be certain states of the system in atonic diseases which will not admit of salivation until the state of the system is changed Case const. syph. mercurialised in N.Y. without success also in Phil. also in Botson utterly without success. [went] to Charleston and there some one recc. Dr Todd Dr Todd put him upon a bottle of wine a day & a free use of bark for a week Then gave him mercury and salivated him in 3 days Prof. T. never met with a case which he could not salivate Perhaps by bark & wine, sometimes by combining capsicum with the mercury There is no foundation for the dogma that stimulants must never be combined with mercury his use of opium & bark to bring on salivation from mercury has been long known in Connecticut It has lately been brought forward as a new discovery [illegible] & soreness are more easily cured of syphilis [because] [illegible] can be confined confine your pat. to the house better to the bed. This with opium & diaph. treatment has succeeded in giving action to merc. when otherwise it wd have failed” Most of the baneful effects of mercury in syphilis are probably owing to not giving the proper corrigent etc. Paris seems to be the only author who is aware of the necessity after of reducing the system to the point of susceptibility And even he knows nothing of the necessity of raising the system There seem to be two sorts of injurious effects 1st acute 2nd chronic The dichloride disoxide & diprotonitrate produce the acute more commonly While the proto chloride protonitrate & protoxide produce the chronic They symptoms which show the system to be under mercurial influence are 1st symptoms (previous to ptyalism) cupreous taste more or less swelling of gums sloughy whiteness of gums margins trifling soreness & a feeling of looseness of the teeth A peculiar fetor of the breath Called mercurial A peculiar fleecy appearance of the tongue Then comes the dis Ptyalismus acutus var. hydrargyratus which begins as above vide Good When cal. begins to produce heat, soreness swelling ptyalism sloughing of the inside of mouth and cheek etc. with the mercurial eruption the system is labouring under a severe disease a poisonous effect. Actual salivation is never necessary though it may be convenient to produce a slight one Caries of jaw perhaps with exhaustion & death total loss of teeth fetid breath stiffness and incarnation of limbs etc. may be the emaciation, debility, loss of appetite ultimate results more rarely a lingering death Severe ptyalism is apt to be treated as a light disease very improperly We are not to expect any specific antidote. Yet upon the notion of the absorption of mercury sulphur is proposed Sul. has 2 compd scarlet red & jet black! both are insoluble & no emenctory will the row off a [illegible]! Many suppose that repeated purging with neutral salts is useful in this disease. Another man in Ohio Dr Findley says he cures by tart. emet. “as a gargle & I believe internally” “Perhaps it may be useful topically as an irritant like nit silver.” Prof. T. has repeatedly seen antiphlogistic treatment tried and with no benefit Sarsaparilla (a weak deobstruent supposed to promote secretion is more especially for the kidnies & skin) Prof T. has often tried it for [weeks] with no benefit whatever So have others Lotions and gargles generally fail entirely in the early stages though they are useful in the advanced stage to obviate [atony] and relaxation The frequent gargling of cold water has often been of very high utility Diluted mineral acids have been found especially useful But lotions of the decoction of batesia tinctoria (acrid narcotic deobstruent emetic and cathartic) has proved one of the very best remedies in a strong solut. [illegible] I to zi water and been very popular with those who have tried it Lotions of nit. sil. are very useful (sometimes on account of the irritability, a strong sol. suits better than a weak one Arsenitis of potassa externally & internally useful Prof. T. 2 fz ol. turp. with z fz muc. gum arabic Prof. I. has found very beneficial Very strong inf. of lycopus vulg. has been very useful (bitter & nervine) Coptis trifolia has been employed & is useful Mucilages, acac. astragalus [illegible] [althaea] hibiscus typhus latefolia (root) viola pedati split twigs of [illegible] [sassaf???] [ulmus] [fulva] (rather inferior) but perhaps decoctions of rice and barley boiled long and strained are as good as any mucilages. All these are very grateful to the patient Qinine is often indicated internally to keep up the strength of the patient But the watery solution of opium is the best applic. and op. shd be given internally Milk porridge has always been preferred for diet The next inconvenient effect is Called very improperly erethismus hydrargyratis but has no other name Great exhaustion of strength anxiety frequent sighing epigastric distress vomiting irregular action of heart & arteries pulse small quick frequent sometimes intermittent tongue seldom furred cold extremities perhaps sudden death upon exertion Occurs in the feeble Treat by perfect quiet and opium tonics arsenic etc. It may occur before salivation in the feeble Eryth. vesic var. hydrargyratum Perhaps not distinct from E. [corrosivum] Called improperly eczema & hydrargyria [sepoa] etc. Prof. T. thinks it clearly an erythema vide Good Perhaps his var. corrosivum is identical with this a better description could not be given than his description of E. ves. corrosivum N.B. in erythema you may always see vesicles in a sunlight by a magnifier hence erythema is not a rash. Bateman criticized [erysipelas] & erythema are synonymous Bateman says E. v. hyd. is produced by other causes as cold but that from mercury has some peculiarities N.B. The effects of fire, frost, sun burns, an eruption caused by arsenic etc. are varieties of erythema Preceded by sense of stiffness, itching etc. about a side of thighs and scrotum or about the neck and arms next comes a redness and minute microscopic papula. The redness spreads in large patches over the body The pimples run into each other become large emit an ichorous, corroding discharge The whole body becomes raw, excoriated chapped, stiff etc. In severe cases recovery scarcely comes on in less than [illegible] weeks and may continue 8 or 10 Sometimes the hair and nails come off. The whole epidermis comes off and as is the case with other such eruptions As skin may give off 2 or 3 successive crops of scales. This Bateman’s description and a very good one Prof. T. has witnessed 3 distinct grades 1st merely local in the bands of the joints etc. caused by ointment of mercury 2nd an ulceration in the mouth in children who have used mercurial escharotics too long 3d covering the whole body attended with an irritative fever & general exhaustion Caused only by mercury internally. “It can be cured notwithstanding Bateman’s opinion to the contrary Treatment palliative (Bateman) warm mucilages in lotion poultices mild cerate after excoriation Antimonials & opium and finally mineral acids 7 bark Prof. T. dissents from this treatment (the merc. dries on) He applies at first simple ointment of datura and in the latter stages adds carb. zinc (lap. calam.) He also uses infusion of digitalis just about strong enough to create some irritation (perhaps upon a medium ½ oz to the pint) Infusions of the seeds of datura are useful also Prof T. finds the poultices & fomentations keep up the disease by relaxation The tepid bath may occasionally be advantageous Let the diet be light and nutritious Prof. T. has generally found quinine necessary. He could always give opium moderately Arsenous acid he uses in some way internally. As the appetite is generally small, so that the pat lives principally on liquid food the opium will not be apt to constipate, and if it does castor oil may be given but Prof. I has not found laxatives necessary Min. acids sometimes agree and sometimes disagrees producing tormina etc. in the bowels Prof. T. can lay down no rule Dysenteria acuta var. hydrargyrata It has the general characters of dysentery but there is more irritation & exhaustion. In adults I have seen it in all cases produced by the external Application of [illegible] inordinate quantities commonly called “roasting it in” In children I have seen it more generally brought on by by internal use in repeated doses All that is necessary commonly is the abstraction of the calomel & the vigorous employment of opium. For the exhaustion tonics & stimulants with opium may be needed (Sometimes give calomel hair of the same dog (Osgood)!) 4th Sub acute mercurial rheumatism Liable to degenerate into a chronic state and into paralysis Resembles the idiopathic Attack gradual & insidious little redness or soreness much pain on motion local aff. generally about the larger joints moderate tumefact. no supp sympathetic & irritative fever erratic pains always attended with sweats exac. at night & in stormy weather. Brought on by exposure to cold & rain etc. taking cold In the acute diseases of mercury the physician generally gets the ill? credit. But the chronic diseases have more importance attributed to them even than they deserve many cases are falsely attributed to mercury. 2 cases related of permanent lameness reported to have been treated with mercury neither of whom had taken a particle of mercury one of then had been purged a long time with brimstone & rum It is well known that sulphur will produce similar effects e.g. as perfect a dysentery as that of mercury though more generally it produces the chronic effects. Both mercury & sulphur will produce paralysis etc. Opium capsicum alcohol etc. are important remedies in the treatment of this subacute rheumatism If [illegible] the disease is pretty manageable. The nearer they approach to acute the more useful will actaea be otherwise conium Fowlers sol. Harthrytum [illegible] Digitalis guaiacum If a pat. has got out and is in great danger give him great quantity of alcohol 5th Marasmus tabes (vide. Good) General extenuation with debility, with languor, exhaustion, hectic (Neither Cullen’s nor Good’s hypotheses are worthy of consideration being mechanical)The assimilating capillaries are probably principally affected, owing to derangement of digestive functions. (The stuff about the absorption of oils mucilages, and alkalies, is poor enough) Prof. T. has found opium of more consequence (in tabes venenata) than any other remedy next conium & iron with acrids also cinchona etc. Narcotics must be in small doses frequently repeated, to obviate lesion of the nervous function. Prof. T. has known a disease closely resembling strumous cephalitis which does not exist the effusions being a mere sequel in the latter stages effusions somewhere are the common result of acute disease e.g. in the pericardium etc.) produced in children by excessive quantities of calomel 2 to 4 times a day so long as the sickness lasts and then much large quantities of calomel, would be given & produce a mercurial dysentery for which still larger doses of calomel would be given & finally the parents would refuse to allow their children to receive mercury & consequently the practitioners themselves would see that children would get well without cal. & then conclude that cal was improper for children altogether case of a distinguished teacher in a large town who holds this opinion led in this way When this affection begins, stop your mercury & give narcotics # Prof. T. has seen the same effects (not hydroc. [illegible]?) from mercurial itch ointment An irritative internal haemorrhage is often rarely but sometimes produced “Said to have happened in Eng “said to have been caused by corr. sub Abortion is often produced by a continued mercurial course said to have been produced in France by calomel Fevers treated with mercury in grain doses as a stimulant made hopeless irritation uncontrollable diarrhoea. Mercury often does more hurt by its inconvenient effects than good by its desirable Many practitioners now employ the vegetable deobstrents & use mercury almost only as a slow cathartic. # A [most] [illegible] aff. [illegible] syncopalis is sometimes produces more often by the external use of it for the itch but by the internal use in irritable subjects” Ac. lead is often preferable. it is liable to only one inconvenience viz. [illegible] Sanguinaria is often preferable Actaea is often preferable Conium is preferable, for jaundice chronic liver affections etc. The pneumonitides are better treated without mercury at least as the principal remedy (The rash & careless use, eve of narcotics even of opium, is far less dangerous than that of refrigerants, tart. em. mercury etc.) It is a rule of naval & military practitioners that mercury shd not be used where it can be avoided as it leaves the patients more exposed, for years, to injury from exposure to cold, & wet etc. This applies to all cases of persons liable to exposure i.e. seamen, blacksmiths & manufacturers No remedy is applicable to a greater variety of cases, than merc. exc. opium opium (Dr Chapman says none whatever) It is not in the latter, but in the earlier stages of disease that calomel is especially useful Hence Dr Bond’s rule (vide Chapman’s therap.) always to try mercury as a dernier reasort, as a pernicious one Therapeutic application Dyspepsia it is almost a matter of course to treat dyspepsia with di-chlor & dis-ox. merc. Prof. T. has never seen any benefit except that of an eccoprotic or a laxative and even these other articles are generally better. They are also extremely liable to produce tenderness in region of liver, stomach etc. Let this tenderness exist of itself & even be relieved by merc. they debilitate irritate etc. Yet they are occasionally proper for a short time. Occasionally proper as a slow and moderate cath. It should be employed in but a small proportion of cases Colica ileus important often in large quantities especially in the early stages “Cal. & opium are equally important auxiliaries shd be used” Large quantities shd not be pursued into the secondary stages C. rhachialgia useful in the same way as 3 or 4 dose zi [illegible] are often necessary in the course of 3 or 4 days But Prof. T. thinks corr. sub. & still more red prec. is preferable Coprostasis (idiopathic) large doses in the early stages but if it fails give other remedies Diarrhoea vulgaris moderate diar. may be broken up by vom. by purg. by almost any strong impression Sometimes cal. cures in the earlier stages by its deobstruent effect It shd not be given in the latter stages. Dr Johnson thinks the fashionable British practice of purging protracts the disease Colliquative (tropical, & intemperance & puerperal diarrh. also that of old men contraindicate calomel Cholera vulgaris generally, though a severe not a dangerous disease often protracted by treatment often broken up like diarrhoea by a strong impression as by puking Cal. may cure it by its deobstruent effect. “[illegible] doses of cal. may be good before the vom. & purg. is begun It is of no use as a cathartic nerely because more purging is useless It is of no use unless in an extraordinary dose while the evacuations are large It is not indicated as a sialogogue, nor as a stimulant, tonic etc. It is good to change the [secernents] particularly the liver & al. can. but before giving it check evacuations with opium and produce reaction by stimulants Give it in quantities short of the purging point often combined with stim., etc. Helminthia one of the best articles # Icterus vulgaris may be made to cure purge at first then in alterative doses combined as the symptoms indicate. But conium will cure more speedily and better. Though even with this a purge of calomel may be given at first though not for purging Parabysma eractum conium is better than calomel quinine is better still. Give conium & quinine. All [illegible] the cases that are the primary effect of malaria are best cured by quinine The [illegible] cure the sequel of intermittents by quinine alone Prof T. gives in such cases conium & quinine Anti corysa (often a troublesome disease) an attack may be broken up by a slow cathartic of calomel at night We should not keep repeating it however Intermittent If a cath. is needed at the commencement cal. is the best & is better than an emetic Previous to the use of quinine cal. was often necessary to obviate the inconvenient effects of the pure bark often a sub ptyalism was necessary to be kept up No inconveniences however result from the use of quinine Remittent cal. is of more importance than in intermittent purging & often a subptyalism is needed after which quinine will cut the disease short Typhus infantum very important T. nervosus perhaps only in non-malignant typhus is calomel advantageous. N.B. This is the most common fever all over the U.S. (even at the south testimony of Dr McBride etc.) Employ in the very commencement of an attack say 3 grains once in 3 hours conjoined with a diaphoretic regimen so as to produce a sub ptyalism or in one or 2 large full doses, with opium if necessary in order to keep it from purging under 15 or 18 hours the very best mode of breaking up fever. If we are a little too late, or if the cal. passes immediately off by the bowels, then give enough to produce a submercurial action for a few days and conjoin mild tonics the disease will be [mitigated] & shortened N.B. we do not wish much purging but the universal deobstruent effect of the calomel. Hurried through the al. can. it is no better than any other cath. Even if the disease is completely broken up, yet the patient shd be carefully attended to & treated like a sick person. Prof. T. has resolved 8 cases out of 10 even when the disease has been fully formed. Some of his friends think they have resolved a greater proportion Dr Todd, Dr S. B. Woodward etc. But if the disease is malignant or if the pat. has tampered with medicine, or put off the employment of a physician we cannot succeed thus Delirium tremens sometimes cal. is important where there is insusceptibility A single full dose in conjunction with opium will produce sleep with more certainty. But in the exhausted and broken down it will not answer Yellow fever agreed to be important difference of opinion as to mode of management Prof. T. finds neither purging nor salivation necessary It is agreed that there is not generally time to salivate. Useful in those cases in which there is great torpor & insusceptibility of the system with nearly a total suspension of peristaltic motion If the case is one of exhaustion and one which begins with diarrhoea cal. will be useless. In the other sort of cases tropical writers have given 1000 grs in 4 days without saliv. or purg. Prof. T. has given 400 grs in 4 days without either sal. or purg. In the same case he applied a 7 by 9 blister on the epigastrium one half as large between the shoulders blisters a quarter as large above the ankles 400 grs in molasses a teaspoonful once an hour Patient extremely delighted with the effects of both Stomach would probably have rejected a tablespoonful of bals tea. But in other cases a grain of cal. would pass off in half hour. In this case subsequently to the first 4 days quinine and a moderate use of brandy In the secondary stages of yell. fev. cal. is generally injurious Typhus putridis sometimes useful as in t. nervosus Synochus calomel is sometimes needed for purging oftener as a deobstruent Most practitioners bleed puke and purge and have to stimulate or have protracted and relapsing stages Entonic phlegmonous phlogotica Depletion & neutral salts at first afterwards use cal. for a mercurial action. Dr Rush’s compound of cal. tart. ant. & nit. potas. is the very best compound vary the proportions to suit the case. Determine the proportions just as if you were giving each separately Especially important is this practice in cephalitis still more so in pneumonitis In enteritis bleeding is still more necessary neutral salts will be rejected Calomel is the article for purging give your calomel clear to keep it from being rejected. This is the only cath. you will succeed well with. Atonic phlegm. phlogotica Calomel is very important no bleeding not so much purging s use blistering. Prof. T. has seen no atonic phleg. infl. of brain he has seen only strumous or arthritic or erythematic Atonic phlegomonous pneumonitis purging with a large quantity a strong mercurial action just as in the at. phl. hepatitis of tropical countries N.B. you must be more in a hurry to produce a mercurial action in these atonic infl. than in the others. Prof. T. thinks the weight of testimony among the tropical writers is against bleeding & drastic purging against J. Johnson Phlegmonoid erythematic erythem. known by the fever’s being [synoch] or gravior phlogotica Purge with cal. follow with calomel to produce a mercurial act. followed by serpentaria cinchona etc. Pure erythematic or gangrenous phlogotica (e.g. of fauces) calom. is injurious eryth. cephalitis & pneumonitis cal. is of more importance unless they are gangrenous Eryth. enterities is apt to have a diarrhoea generally has a diarrhoea cal. apt to purge corr. sub & especially red precipitate are better Of late years Prof. T uses conium even in some cases in dram doses Arthritic phlogotica calomel of high importance of late years Prof. T. has often gone back to the calomel practice. Case extreme pain in joints with redness & swelling extreme pain all over Cal. & opium until the pain was relieved it took 10 grs of opium with a diaphoretic regimen next op. & ipecac then a little castor oil to bring away the al. Finally alcohol & cinchona No case lasted longer than a fortnight under this practice. Next Prof. T. employed veratrum viride. Next he employed colchicum but it was inconvenient he has known persons cured of the rheumatism by colch but killed by subsequent diarrhoea Actaea is the best Sanguinaria digitalis Some conjoin calomel with these membranific phlogotica Croup hysteritis cystitis Calomel is universally agreed upon except in croup but even here though vomiting will cure cal. is better or rather both. Prof. T. has ceased to vomit in his own croupy family Strumous phlogotica more useful in the acute according to the general rule that cal. is more applicable to acute phlogotica Several phlogot. not referrible to these divisions Influenza Pneumonitis notha Cholera infantum Dysentery different modes of practice some [illegible] with large others with small doses both are proper in different cases In some epidemics calomel is inadmissible Case of the epid. at Midd. a grain of cal. or of ipecac would bring back the dysentery when it took 40 grs of opium a day to keep the disease under trouble with counsellors Epidemic (Egyptian) ophthalmia a bad disease It is the common practice to bleed the patient almost to death bad Purge with calomel give cal. & op. Bring the system immediately under mercury Treat like tropical hepatitis Conjoin actaea Sparganosis puerperar. Prof. T. has never met with a case in which it was admissible he does not doubt that they do exist Synochous exanthematica (Phlogistic exanth. are talked of but not described authors do not even suppose them phlogistic except a short time at the commencement) Typhus exanthematica contraindicate it Lues syphilis While it exists as chancre and bubo only it is purely a local disease and may be cured topically. 3 to 6 weeks ore even 3 mo saliv. is necessary to cure it through the constitution. Some use both but the topical are those that cure, even in this case But some claim that the absorption is prevented by the const. treat. Now medication cannot be thus [prevented] by anticipating the period of absorption according to the regular laws of the disease Mercury will not relieve the topical disease, without a sub salivation. Many practitioners suffer the pat. to run on a long time without sub salivation. But this may be produced in 24 hours by conjoining opium or perhaps wine & quinine Prof. T. has never known the constit. eff. follow when the disease had been cured topically. Even if they do it will be time enough to treat them when they occur Mercury will even hinder the healing of the topical affection When the father or mother infect their offspring without having symptoms of the disease left on themselves, and the children have a fatal syphiloid affection the affection of their subsequent children may be prevented by mercurializing the parents a curious fact! Prof. T. has sometimes cured such children by conium & corr. sub. The new way of treating syphilis has yet to encounter great prejudice When the const. symph. have appeared perhaps cal. is the best remedy. The others (cor. sub. & red prec.) do not produce ptyalism & a sub ptyalism is necessary The above is a very imperfect account of the therapeutic application of cal. It would require a volume to exhaust the subject Pneumonitis notha is or common pneumonitis always synochous or typhus. Atonic phlegmonous pneumonitis has a nervous fever accompanying it. N.B. Edema of the lungs (of Dr Hooker) is not a pneumonitis Erythematic cephalitis is the disease described as a fatal erysipelas of the head but the eruption comes not out till 3 or 4 days have elapsed and there is light generally on the face. Other erythematic empresmata are attended with eruptions somewhere that of the lungs (liver?) is on one or both extremities. Fever varies from synochous to t. gravior “I have never known calomel thrown up when put into the mouth & swallowed with the saliva” From [Savage’s] notes Tonics Produce increased strength of action in subordinate parts of the system e.g. appetite, digestion, pulse, muscular & mental action removes morbid mobility & irritability of atony Mr Abernethy says all strength depends on strength of digestion. But some tonics increase strength of art. act. (e.g. arsenic & cinchona) before they increase appl. & digest others first increase appetite & digestion & subsequently general strength. Hence an important rule for selecting tonics to suit a case e.g. Intermittent does not require those which act by increasing appetite Prof. T. has found the above true of cinchona, liliodendron & magnolia Tonics do not act rarely on the muscular system they certainly increase the contractility of the cell. fibre All tonics increase art. energy those articles which act on parts of the system without strength the arterial syst. are not tonic. Prof.’s I. & T. deny entirely that tonics produce ultimate debility They have known bark iron used many years with increase of strength Bark for 12 yrs vide Heberden Bitters are not necessarily tonics metallic articles are not bitter Some tonics, as cascarilla? bark of croton tiglium? etc. cinchona quinine require liquid food to make them sit well upon the stomach. So alc. requires food in exhaustion of fatigue Case of a traveller or laborer. The above tonics approximate to stimulants. Much depends on a knowledge of this principle in intermit. for inst. quinine may thus be prevented from producing a sense of stricture, nervous symptoms etc. If you excite the appetite, the stomach must have something to act on Tonics are indicated in some stage or other of all atonic, debilitating diseases They are better understood than any other articles Groups 1st tonica [amara] simplicia Limaronba excelsa (quassia of the shops) Quassia amara. Scutellaria [illegible] Little inferior to quass. & generally preferred by patients pure simple bitters like quassia [chelor??glabra] [illegible] [Hanth???] much used Canadensis like columbo a [???folia] hydrastis Gentiana [illegible] etc. The [illegible] gentians have smaller roots but are as good [illegible] [illegible] is best [chrymoplenum] [apporeti] [colum?] possessing the same smell taste & chem. prin. but pleasanter & preferred by patients [illegible] Canadense allied to Cocculus [illegible] (Columba) Menyanthis trifoliata buck bean Helnium autumnale Gratiola aurea These are mostly amer. articles & as good & cheap as foreign 2nd amara [nervousa] [illegible] G. [ochro???] is good G. saponaria is one of the best G. quinqueflora & other northern species are not so good Tops & roots are used. [lupules] (best) hoarhound Lycopus vulgaris (water hoarhound (L. virginicus is much feebler, but is most used Ballota nigra nearly allied to hoarhound 3d amara narcotici barks of cerasus virg. C. oborata the best of the genus Sorbus oborata & necrocarpa Pernica vulgaris barks of all of them 4th Tonica amara astringentia though some are merely astringent to the taste Cinchonae a large num. of species Corni C. sericea probably best next is probably C. circinata & paniculata C. florida inferior more astringent Querci Q. alba & tinctoria Alcornia latifolia Bodygin (alcorn [oaks]) Alnus serrulata (may be used for cinchona) 5 amara aromatica Galipea off. (angostura) magnolia glanca umbrella cordata etc. etc. valuable (elegant aromatics intensely bitter) Next is siriod. tulip. Ilicum floridanum (both aromatic & bitter) Croton eleutheria & cascarella & aromaticum (cascarilla) Tasmania aromatic similar caryea amara, squamosa, procina & alba (pungent aromatic acrid reminding one of guaiacum) Ptelea trifoliata bark of root & top differ considerably Hanthoxylum fraxinem (less bitter) H. tricarpum & H claraberculis (most valuable) Dryni winteri (winter bark resembles canella more agreeable almost a spice) Drynis of several other species Canella alba (called canella also) 6 Tonic. amara laxative [Federia] cordifolia (much used by the Spanish Americans the fruit) [Grellindina] [illegible] & bond cella Gallindina bondere (nickernut) [illegible] as [illegible] etc. blue & yellow nicker nut # Eupatorium perf. & rotundif. Polygala polyg. or rubellum (purges like aloe) but may be taken as a tonic without being laxative) A good bitter tonic & laxative in dyspepsia 7th metallina. Vinous prep. or iron ox. zinc hyd. bismuth sulph zinc arsen. potash & soda nit. silver Copper sulphate acet. & [nitroguret] (C. ammoniata) # preferred by g. Johnson to peruv bark in tropical climates Habille Carthagena Carthagena bean used in dysp. with torp. of bowels Arsenous acid White oxide of arsenic The word arsenic occurs first in [illegible] & applied to a sulphuret of arsenic used in painting Avicenna first recommended it internally The garlic smell is now known to arise from the dix-oxide which is the substance condensed on the tube & formerly called metallic arsenic Arsenous acid is seldom formed by chemists it is collected by the smelting of ores 77 ¾ parts and soluble in boiling water 1000 parts; in cold water only 2 ½ parts soluble in the 1000 parts. Composition 2 i ars. 7-6 ii 3 ox 24 = 100 In uniform & small doses, repeated acts on circulating system as a tonic increases heat (in a tonic coldness secondarily it increases appetite dig. power & ultimately after removing the disease muscular power Dr Potter (in his monograph) says it acts first on al. can. but its first perceptible effects are upon the sangiferous system No doubt it acts firs on al. can. but so do all remedies Given efficiently it certainly affects the sanguif. syst. before the app. & digestion. When given in nauseating & vomiting doses it of course acts first on al. can. More speedy than any other tonics but less so than the stimulants. It may be made to show its effects in 24 hours. It thus resembles cinchona in its effect on [illegible] & gangrene It has the remarkable fact that it has the power of restoring warmth to the surface though with no distinct relation to its tonic power Prof. T. has witnessed this perhaps 50 times Some patients have thus been saved. It may fail thus as an “analeptic” like other analeptics in extreme last stages This article seems to be an intermediate link between tonics and stimulants In larger doses it acts on the whole sec. & abs. syst. affecting the skin tumours ulcers etc. It is strongly antipsoraic relieves ulcers, cancers It is useful in rheumatism hence redolent Not discutient cholag. sialag. expect. or diaphoretic Acts on the brain & spine more than any other tonic & that too in remedial doses No other metallic preperation produces vertigo tremors etc. This operation has no name nor classification Prof. T. has seen however dilated pupils etc. in domestic animals from oxide & carb. of zinc. Oxide carbonate & ac. of lead act on the nervous system producing colica rhachialgia. Oxide and carb. of zinc have time immemorial been called poisonous and this must result from an operation on the nerves for they will not produce local irritation In large quantities laxative & purgative In larger it is emetic Externally applied it may be made to cure cutaneous diseases & to act as an escharotic. Dr Potter (Baltimore) says that in certain doses it is laxative and emetic It increases force and fullness of pulse without rendering it hard not admissible in phlogistic diathesis changes secretion and absorption is analeptic etc. not diuretic nor diaphoretic children bear larger doses than adults etc. N.Y. Pharm. “tonic, alterative, escharotic” Prof. Frost of M.M. Charleston says it is useful only as a tonic The injurious effects are caused by long continuance, rather than by a large dose so too of ac. lead. In acute diseases the larger quantities are of more consequence long continuance in chronic Antirritants enable larger doses to be taken generally opium in acute and conium in chronic. Veg. acids & aromatics assist it. When used freely conjoin liquid & farinaceous [nutriment] just as with quinine & stimulants The Philadelphians think it resembles tart. em. most not much foundation for this notion except as it vomits and purges Sulph. zinc of iron & of copper resemble tart. em. as much Even cinchona may be given in nauseating doses and all these then given are reducing of course Tart. emet. is of itself a refrigerant. We cannot class together articles which agree only in nauseating. Who would think of curing intermittent with tart. em. Tart. ant. & [illegible] are thought to agree in their antipsoraic power but the former is merely diaphoretic & has no antipsoraic power whatever Prof. T. came to this conclusion from observation before reasoning at all upon the subject. They both act upon the skin, but in different ways. To be sure some practitioners use arsenic in non phlogistic cases as a refrigerant & in the same way might sulph zinc etc. be managed. It is a kind of experimentum crusis that arsenic cannot be used in phlogistic cases Some suppose arsenic acts only by producing its own specific disease but it may be made to cure disease without any thing of this [effect] though this may sometimes be necessary [This] is true of all active medicines & when so pushed they produce diseases more or less specific Some think arsenic acts in a manner incapable of classific. & they call it merely alterative. But every remedy must produce an alterative operation of some sort or other and the alternative operation of arsenic resembles that of sulph. zinc of iron etc. & other tonics. It seems to be fashionable with some to deny the pathological conditions which are the foundations of the classific. of m.m. & they reduce every thing to a specific morbid affection overcome by another specific morbid action. Prof. T. thinks that all the operations of remedies may be classed Entony indicates refrigerants Atony stimulants etc. etc. Rec. [illegible] arsenic is 1st tonic strengthening pulse obviating debity increasing muscular strength etc. 2nd deobstruent curing cutaneous diseases cancerous ulcers resolving topical infl. 3d cath. 4th emetic 5 epispastic in the sort called escharotic & anti psoraic. Prof. T. thinks it far less injurious in its effect than polygala senega ornithogalum squilla & tart. em. (Hive syrup made of these three does more injury in a year than arsenic ever did) Tart. emetic causes many deaths, arsenic never does, when given as a medicine. It is accused of producing in inordinate quantities & when too long continued dyspepsia marasmus etc. But the same accusations have formerly been repeatedly made against cinchona It will never succeed when given rashly by dashing etc. as is so fashionable by larger frequent doses producing unequal excitement When too long continued & in too large doses it produces a puffy swelling of the skin & lips ophthalmia tarsi erythemia tormina etc. Dr Potter Good in his article on headache gives a summary of its ill effects These effects are more easily cured than such effects from tart. emet. An erythema vesiculare is produced by its analagous to that o f mercury. Case of Dr Todd’s pat. metastasis of pneumonitis probably arthritic to the brain took several fl. drams!! with 24 hours of ars. sol. of tinct. opii ([illegible] 120 and 240? tinct. canth [illegible]) & tinct. canth. in the second 24 hours 200 m. SS 120 m. t. canth 120 arsen. solut. In 48 hours hemiplegia cured erythema was produced with puffy swelling etc. In poisonous doses vom. purg ptyalism dysentery, haematuria sunken countenance paralysis convulsions etc. subsultus & death etc. etc. Dr Potter He says mucilages and oils are good for nothing as antidotes neither is sulphuret of potassium He directs to evacuate thoroughly & then treat on general principles Give castor oil etc. # Dr Bartlett gives as sympt. astringent metallic taste naus. vom. fetid breath ptyalism dysentery, distress etc. etc. It seems to be capable of extinguishing vitality without any of these effects in a transcending dose vide Orfila for a case So too vomiting doses will transcend its tonic effect & soon Arsenous acid retains its full powers in every form of combination, so long as its identity as an acid in combination, is preserved; so that, if you give any salt of it, enough to contain a given quantity of the acid, you get the same effects that you would if the acid were given isolated. Hence the folly of giving “chemicals,” as directed by the toxicologists. # The sequelae are dyspepsia, debility paleness, sallowness etc. etc. Pharmac. prep. 1st substance in pill Rx ars. ac. [illegible] fx. soap q.s. ft. massa in pil. 120 div (N.B. the salt thus formed in the same power as the arsenous acid) This is a very convenient prep. In acute diseases the dose varies from 1/24 to 1/12 gr. 3 hours to every hour (acute diseases) In chron. diseases 1/24 gr. 4 times a day is a minimum & 1/12 gr. a max. dose Tests of too large a dose [vertigo] etc. etc. tremors, nausea Either of them should cause the dose to be diminished Test of too much in 24 hours constant vertigo restlessness or tremors or headache general uneasiness sense of inflation at stomach or tormina or a laxative eff or a sense of inflation in epigastrium Test that pat. has taken it long enough puffy swelling under chin or face or ankles or under chin backs of the hands, a stiffness & [illegible] [illegible] slight ophthalmitis tarsi swelling of upper lip slight salivation or moderate tenderness of gums or a little ptyalism sometimes general swelling of body or erythema vesiculare. All go off soon if med. is left off. may exist several days without injury. Any one indicates a discontinuance Generally swelling appears first under chin & on backs of hands or wrists. Prof. T. has know them continue a week with no injury The salts of arsenous acid have the same effect as the acid & in the same quantity of acid 2nd Liquor arsenicalis Arsenite of potassa etc. etc. [Solutio] Fowleri Rx ars. ac. in very fine powder very pure carb. pot. aa 64 grs. distilled water 1 pint compd spt lavander zfs Boil & add the spt. lav. then add water enough to make up the pint. (Better add less than a pint at first say 14z & then fill up to a pint) This is Fowler’s original formula Phil. phar. N.Y. ph. gives arsenic ac. & sub carb. pot. & alcohol!! The compd spt lav has the advantage of giving taste colour & [illegible]. Case a colourless & tasteless sol. of ars. prescribed by Dr [Cogswell] for a [herpetic] patient. He refused to take it longer “as it was nothing but water” Dr C. told her wht it was & she refused to take it! This prep. gives 1 gr. ac. to 2 fl z of liquor hence 10 m. = 1/12 gr. & 15 m. = 1/8 gr. N.B. the solution requires a smaller dose the pill being gradually dissolved The liquid preparations of arsenic must be kept closely stopped & excluded from the light for the dis-oxide is precipitated on the inner surface of the bottle This decomposition will finally take place under any circumstances Pills shd not be given after they become hard Prof. T. has again and again known opium pills pass through unchanged. Pills of iron & conserve of roses may be cut & polished Rx arsenous ac. [illegible] fs sulph. quin zii sil. morph. 15 grs. ol. caps. f zfs. ext. daturae q.s. ft massa in pil. 120 div. N.B. Tonics are combined with advantage and narcotics is advantageously combined with arsenic This pill does not harden It answers extremely well in hemicrania & neuralgia etc. Each pill contains Therap. appl. 1st Pytal. ac. var. hydr. with secondary & advanced stage when it is subchronic very important it frequently arrests also useful in early stages when not too irritable & even in those combined with narcotics A most important article. Dysphagia constricta var. schirrhosa conjoined with conium [Dipsoneus] avens var. [illegible] conjoined with op. conium & capsicum Limosis dyspepsia Prof. T. has always used in various cases So has Dr Todd who combines quassia & ginger sometimes he conjoins conium or conium & veg. acrids So has Dr Reed who adds conium, dandelion capsicum etc. persevering in its use for a long time N.B it may be taken for a long time conjoined with veg. [ton.] conium & capsicum Prof. T. has even accomplished much with it alone preferring the substance Rx ars ac. [illegible] fs sub. quin zii ol. caps. zfs ext. con. q.s. ft. pil 120 often adding more conium or giving conijm in conjunction in short varying the prescrip. pro re nata Limosis sputatoria may always be cured by this article alone or combined Lim. syncoptica (cardialgia syncop.) here acrids are more important in in conjunction Col. rhach. combined with opium will keep the symptoms at bay. Opium is allowed to be the most important article in this disease but will not cure alone It is found that a free use of cal. is necessary corr. sub. better Prof. T. finds red prec. better still. Practitioners tell of given 5 gr corr. sub. every [2] hours!) Prof. T. has given 5 gr. red. prec. Fowlers sol. has been given in z doses without vomiting Arsen. has been given in gr. doses There is something peculiar as to the operation of min. med. in this dis. Dram doses of [illegible] have cured with opium opium shd always be combined Arsen. & strychnine are admirable for the paralytic sequelae with auxiliaries Colica callosa var. schirrhosa Epidemic cholera (it is the fashion to attempt its cure by strong impressions merely The originally incurable cases & the trifling ones shd be excluded) perhaps along with other articles it would answer well when the discharges have been stayed. Helminthia insisted on by Dr Potter the variety of this disease is not specified. It would scarcely be worth while to resort to it in any but H. taenia to improve the cond. of al. can. relying on cath. of ol. pin. to remove the worm helm. fasciola hominis (fluke or gourd seed worm) rather a rare & a very obstinate disease (N.B. in sleep the fasciola [ovis] passes into the liver up the ductus communis & cannot be wholly cured by cathartics may not this be the case with [illegible] case Prof. T. has never known a case of complete cure arsenic does much the most good seems to be by for the most effectual remedy) Helminthia erratica probably Proctica schirrhosa & parabysma schir. parabysma, strumosa arsenic conium acrids quinine cantharis conium & arsen or con. & iodine the best preparations iodine corrosive subl. etc. Bex convulsiva a long known and a well established remedy conjoin ext. con. which has been relied on exclusively Dr Beery has often found ars. pot. alone of the highest service in sequels of hoop. cough Intermittent next after quinine & perhaps the best bark in substance. It may be taken with less in convenience than bark and the latter cannot be given [illegible] to small children Vide Good for its history The instances of supposed derangement with particular doses are merely cases of too large doses for the particular circumstance Give say 8 doses in 24 h. instead of 1, 2 or more as directed by Dr Fowler (N.B. give a med. at the hours of 3, 6, 9, & 12 & but 2 doses will come in the night) Give 10 drops at least of SS. with each dose Trouble not yourself about the bowels they are generally well enough better give injections than cath. if the bowels are not spontaneously moved once in 2 or 3 days. It is well known that metallurgy in a neighborhood cures & prevents intermittents Dr Good’s case of Cornwall is not the only one known The dose shd not be large say 5 to 10 drops nor the quantity as to produce the tests often once in 2 h. never less often than once in 3 h. sometimes once in 1 h. always conjoining opium ( which itself will cure interm.) Periodicus remittens as useful compared with quinine as in intermittent though not as important in the former as in the latter. It is even said to be more unfailing than in inter. Typhus nervosus seems absolutely to be the best tonic better than quinine to be given to check coldness & cold sweat & to change secretions always when mercury seems to be indicated always conjoined with [opiate] & food perhaps with acrids sometimes 2 drops once in 2 hours or 5 drops every 3 hours sometimes more sometimes less. Typhus syncopalis vide Danielson & Mann’s account It has been used in every epidemic Anthrax pruna just as for gangrene Erythema gangrenosum but sul. quin. is of more consequence Erythema anatomicum saved several cases known to Prof. T. before quinine was discovered in one case 10 drops an hour. In but one of several cases which Prof. T. has known was there a puncture all of them resulted from exan. recent subjects one case began by a sensation resembling a sting & a minute discolored spot on the middle & fore side of the fore-arm. Ophthalmitis tarsi & psoriasis palpebrarum (which exists) probably would cure as it affects the eyelids Ancheritis strumosa (glands of neck) Cephalitis strumosa [illegible] [illegible] etc. Arthritic cephalitis highly useful Paristhm. erythem. var. putrida Pneumon. typhodes erythem. & syncopalis & putrida (gangrenous & Pneumonitis arthritis ver. atonica So arthritic carditis, diaphragmitis, & gastritis Cholera infantum Enteritis aphthosa (Prof. T. has seen two p.m. ex. which showed the whole al. can. affected) Dysenteria typhodes in the latter stages with opium even in the early stages Prof T. has known it beneficial combined with opium & used instead of calomel Mesenteriti strumosa (enlarged mesenteric glands) may almost or quite be cured in its early stages Give acrids quinine, iron cantharides, conium & especially arsenic Eryth. infl. of liver (hepat. typh. var. putrida) in secondary and exhausted stages. So to [peritonitis] typhodes var. putrida All the varieties of true rheumatism in some stage (even in the entonic, after depletion & reduction One var. of rheum is phlegmonia another is [erhthematoid] (not mentioned expressly in the books and a very formidable disease prof. T. has known one quarter of surp. of body gas [illegible] after depletion & reduction) opium conium quinine alcohol conium actaea arsenic Subacute rheumatism may often be cured by arsenic alone. Prof. T has known bed rid persons cured this seems to be the best article. The sub-variety of this disease produced by mercury are especially benefitted by arsenic Chronic stage of acute rheum. benefitted by ars. but more especially by aralia [bispida] Podagra larvata (atonic gout (Cull)) a form of rheumatism as resembles this (Theumatism larvatus) Rheumatalgia useful with conium & nux vomica more useful as it is more acute particularly when there is an early tendency to paralysis of extremities but should then be combined with ol. pip. nig. or ol liriodendron ol. caps. etc. [illegible] conium, nux vomica hyoscyamus sciatica useful conjoined with narcotics I have often cured [with] sometimes relieved by mercury when first commence & by other means arsenic one of the best articles where established Secondary & exhausted stages of scarlet fever Erythysmus hydrargyrata & tabes venenata Ricketts I have known it used with beneift in the early stages [illegible] syphilodes & syphilodes (vide Good) with black pepper much used in the east (vide Good) There is no doubt of its efficacy in S. syphilodes. Perhaps there is doubt as to true syphilis Arsenic is peculiarly valuable with quinine and opium in the ulcerations etc. from syphilis & excessive use of mercury Useful in syphilitic eruptions Carcinus vulgaris highly valuable it has sometimes produced sloughing & a cure the difficulty in managing it is that practitioners are too much in a hurry attempting to take the disease by storm and not conjoining supporting remedies & narcotics cancer is a disease always requiring support it is a disease of the abstemious never of the high living & gouty Prof. T. has known it so employed & the health improve. But iodine is better & next after arsenic is corr. sub. arsenic is next to iodine (vide Good) IT is the basis of almost all the secret remedies for cancer. of course caution is required for its use There is no foundation for the notion that the system geta accustomed to this remedy & ceases to be affected by it in such cases the dose should be increased similar assertions are made respecting opium & with no foundation. The great difficulty with authors has been that they supposed they must give it alone & only twice a day Prof. T. has witnessed several cases of unquestioned cure & others of great palliation and mitigation Elephantiasis arabica has been highly successful (vide Good) used in the east, with a considerable quantity of black pepper. “It is proved beyond all doubt that the disease has been cured by arsenic” Prof. T. has known a few cases and all were cured by arsenic alone [B??nemia] Indica Prof. T. has seen several cases and Good has done ill in associating it with spargm. puerp. which is a phlogisticum. His cases were cured by arsenic alone Gangrenous sphacelus arsenic seems preferable, perhaps, to bark though not to quinine Prof. T. has known gangrene or [illegible] [illegible] of paralytic rheumatics cured by arsenic So to of gangrene after typhus Gangrena necrosis (dry gangrene Gangrena []?staliginea] (mildew mortif.) recommended I have known vitiated ulcers highly benefitted Hypochondrias recommended Trismus & tetanus arsenic & datura & opium have cured bad cases. vide N.E. Journal of Medic. Prof. T. has known several cases cured by it. actaea too is often useful Neuralgia faciei [illegible] etc. but generally it is badly managed some cases may be cured by quinine alone arsenic alone, opium alone etc. but generally a combination should be used N.B. keep the pot. under the influence of it all the while not merely during the paroxysm Clonus palpitation & singultus are occasionally relieved by arsenic Singultus of typhus & low pneumonitis typhodes is best relieved by arsenic [illegible] case of 200 drops in one night Chorea sometimes cured by this with strychnous, quinine etc. Lysse canina some cases apparently cured Common convulsions [of infants] occasionally Hysteria epilepsy sometimes are tonic Paralysis one of the most valuable remedies with iron acrids etc. Distortion of face from paralysis Sarcoma schirrhism (curable by extirpation even at an advanced stage Prof. T. has never known a complete cure by extirpation of carcinus vulgaris Dropsy of abdomen after evacuation of water supposed to be be peculiarly appropriate Leprosy (vide Good) peculiarly valuable Lepidosis psoriadis arsen. con. etc. particularly valuable after a very severe disease (vide Good) Ecpyesis impetigo, herpetica (herpes of Cullen & herpetic eruption of authors) always curable by arsenic if persevered in useful also eternally in a weak solution Ecpyesis imp. [lamin.] (salt [illegible]) about the hands cured by a weak ointment of [arsenic] N.B. medicines will not cure when applied only when the disease is so irritable (in a sort of paroxysm) that the phys is sent for they then require only emollients the arsenic shd be applied about 8 grs arsenous ac. to 1 oz simple cerate to commence with first finely pulverizing the arsenic & mixing it with about a dram at first of the cerate to make the mixture homogenous (N.B. not a glass but a Wedgwood’s mortar pulverization cannot be effected in a glass mortar) [Ecpresia] [?origo] galeata Prof. T. has cured cases which had resisted all other remedies internally & externally Punctura venenata (vide S. Coop. Surg. Dict. last Am. ed.) used successfully time immemorial in India In Ohio they cure by laudanum giving enough Dr McBride & Dr Osborn of N. York who had practised at the south, considered alcohol infallible The people sometimes get down a gallon of spirit in 24 hours. [Celsus’] remedy was vinum cum pipera [cernatic] snake pill is Rx arsenous acid root of vella navi of another seed of croton tiglium live quicksilver, black pepper aa equal quantities each pill to contain 6 grains each pill will contain 1 gr to a teaspoonful of Fowler’s solut. and 2 or even four pills are sometimes given Case of Mr. Ireland pat. insensible in 10 min. fl. zii Fowl. [min.] sol. etc. at once. (Dr Hubbard’s case repeated once every half hour until an ounce of Fowl. sol. or 4 grs of arsen. had been given. Four other cases cured in the same manner. Cinchona First introduced into Eur. in 1640 Condamine saw the plant first in 1737. Linnaeus called all the spec. C. offic. (including C. condaminea & pubescens) C. condaminea is believed to be the original “bark” near Soxa a slender shrub 18 ft. high There are now made 8 distinct general 1st cinchona 2d pynchnea exostemena etc. All the species are bitter and tonic but none are remarkably antintermittent but those with hairy & woolly blossoms Decandolle gives 16 species of cinchona Pynchnea has but a single species in S. Car. Nat. Order Cinchonease Three species are made offic. in Brit. phar. 1st cinch. cordif. supposed to produce yellow bark but it is found not to produce it Yellow bark has odour aromatic etc. internally of a yellowish cinnamon the particular species affording it is not known contains 1st [illegible] of quinine & a little [illegible] of cinchonum 2nd tannin (a little) 3d a yellow odorous [adipocere] 4th a yellow colouring matter 5 a red colouring matter 6th [illegible] of calcia 7th fecula Cinchona lancifolia affords the pale bark though by some to be identical with C. condaminea or a variety less bitter than the preceding cinnamon coloured internally. C. condaminea contains [mainly] kinnate of cinchonine with a little kinnate of quinine with other unimportant princ. Cinch. oblongif. supposed to afford the red bark but found not to producing an inferior bark odour and taste similar to the last but more intense bark red 2 Kinnate of quinine & kinnate of cinchoniae in about equal quantities said (doubtful) twice as much of one & 3 times as much of other. The true species which produces red bark is not known. The barks of all the species are collected indiscriminately and afterwards assorted according to colour probably it is impossible to assign the true species. Cinchomine is a white alkaline substance soluble in 7 or 800 pts water decomposed at about the temperature of boil wat. little soluble in ether ([hydric]) made up of carb. nit. ox. & hyd. Quinine is a white flocculent alkali soluble in wat. very soluble in alcohol taste much more bitter than that of cinchona less soluble in water very soluble in hydric ether & thus distinguished First brought into notice in 1820 by [Pellit] & [Cam??ton] Kinnic acid is found only in bark & not medicinal Kinnate of quinine is very soluble in water but less soluble in alcohol Kinnate of cinchonum is more soluble in wat. & is more astringent (if indeed the kin of quin. is astringent at all) Water is incapable of extracting all these salts from the finest powder of bark not more than 1z of the whole hence the dregs are worth saving for the extraction of the quinine & cinch. from them N.B. none of the veg. ac. have as strong attraction for bases, as the mineral acids & generally sulph. ac. has the strongest attraction hence very dilute sul. ac. will dissolve out all the quinine & cinchonium & we have a liquid solution of sul. quin. & cinch. Ammonia will take away the acid # then macerate in alc. & various impurities will be left then distil off the alc. till the liq is muddy then cold distilled water will precipitate the alkalies repeat the process for purification if necessary The [illegible] is not in quantity to act medicinally but will destroy tart. ant. or sulph. iron or gelatine hence too an infus. of nut galls is a test for distinguishing active from inert barks, by forming a precip. of gallate of cinchonium ([illegible] is [art]) Much inert bark is sold [illegible] a pat. took inert bark for 12 weeks then was cured by good bark you cannot tell by the taste All the best bark is now used by the manufacturers of sulph. quin. & the’ poor bark is pushed into the market # and decant off the liquid sulph. amm or use a magnesia in the same way But we should never used the crude bark it is better in no respect whatever And sulph. quin. is now cheaper. Connecticut practitioners know little about the matter not having opportunities from endemic influence. N.B. Some practitioners conjoin tartar emetic with bark the latter destroys the former the former does not injure the latter Tannate of antimony is perfectly inert It is stated that 2 fl. oz of decoc. cinch. (zi to 1 pt. water) renders inert [illegible] I tart. ant. consequently a pint would decompose tart. em. zv So too bark is incompat. with the salts of iron Food is generally required with bark but bark with animal jelly will form leather! in the stomach Gallate of quinine & cinchonium is supposed to be nearly inert Case in which an [illegible] phys. rendered bark palatable by nut galls! the mixture was pleasant but perfectly inert The proportions of acid & base in sulph. quin. & cinchon. are not well known Adding a little sulph. acid renders them much more soluble forming a salt with more acid N.B. if the mixture then becomes acidulous, add a little more sul. quinine. Prof. T. has always found acidulous sulph. quin. more instead of less nauseous Case related Phosphate of quinine is said to be better than sulph quinine said to contain some of the powers of phosphorus doubtful should be attended to Some think the acetab. better others think it worse probably little if any difference much less soluble very liable to precipitate when it grows colder. Tartrate oxalate gallic etc. are insoluble in cold water. The isolated bases (quinine & cinchonium) are less soluble than the sulphates or are insoluble but they are no less active The French to the contrary notwithstanding. Crude bark is very variable in strength offends the stomach etc. In tinct. requires too much alcohol For these and other reasons always use the prox. princ. Cinchoniae & quinine are found by Dr Elliotson to possess precisely the same powers as their salts Montannin has been extracted from C. montana equal to quinine & cinchonium in utility Chlorium bromine & iodine form inert compounds with all these alkaline proc. [prac.] [prin] still they will into decompose their salts The only medicinal operations of the 3 species of cinchona are the same in kind if not in degree They are all permanently & strongly tonic with a moderate degree of astringent power Quinine & cinchonine are not astringent Caventon & Dr. Theodore Woodward (a very susceptible person) have experienced nervine exhiliration from quinine “in large quantities however 30-60 grs a day” Other persons experience this effect. Dr Woodward always experiences exhiliration This is one of the tonics which is felt in the circulating system before it affects the digestive organs. It is by no means remarkable for giving an appetite In some cases where large quantities in a short time are indic. (as in interm.) the appetite is actually diminished. It is inferior to many articles for the appetite & digestion. It may require several days to affect the appetite Called stomachic Called febrifuge by which is meant that it is appropriate for intermittent Called antiseptic i.e. stimulant or tonic The yellow bark is considered best (it is said) in Peru. Some think red bark nauseates more Bark produces no inconvenient effects but nausea & diarrhea in large quantities Dr Th. Woodw. says the only unpleasant effects from the largest quantity of sulph. quinine are a sense of astringency in the stomach & a sense of faintness which however he relieves at present by always giving a little food (milk porridge for instance) A Frenchman (Blonde) is said to have noticed a short continued deafness, produced by a large quantity of sul. quin. Probably he mistook a symptom of the disease for the effect of the medicine Dr Elliottson cured nearly 200 cases of fever with sul. quin. 5-10 gr doses & inferred that it is adapted to phlogistic fever. He meant irritative Equal confusion exists about the use of bark in acute rheumatism Most of our cases of acute rheumatism at the present day are atonic and many of our practitioners give quinine freely in rheumatism & relieve heat, dryness of skin etc. Some of them infer hance that bark is adapted to phlogistic fever It is the fashion to call bark a congesting tonic. It was the fashion long ago to do so. But Sydenham Morton & others denied this No foundation for the notion that this article may accumulate in the system or its effects accumulate upon the system. Arsenic, mercury instead of accumulating in the system produce a slight set of changes which go on increasing Prof. T. does not believe that disease is ever produced by cinchona after health is restored no effect will be produced. Dr Ives is of this opinion He has known it take for a year or more with benefit. Heberden knew it taken for 12 years with advantage etc. Admissible in all atonic contraindicated in entonic diseases Pharmaceutic preparations The salts of quin. & cinch. are sol. in wat. & insol. in alc. Quin. & cinch. by themselves are sol. in alc. & insol. in water Yet is laid down in all the books that alc. is the best menstruum this can hardly be true (probably the mistake has arisen from the utility of the alc. of the tinct. in intermittents) Infusion is better than decoction Boiling almost destroys the properties of cinchona Maceration in cold water extracts but little. Yet the pharmacop. direct to boil 15 to 30 minutes Never boil but about a minute Pour the water boiling hot on the powdered bark than stand scalding hot ½ or ¾ of an hour then boil it up about a min. This gives a decoction [illegible] Troy oz. bark saturates a pint of water Make the infusion in the same way but do not boil up at the end 1 Troy oz (1 oz. of avoirdupois oz. will not being less) saturates 1 pint of proof spirit It is not worth while to give in any form but substance in intermittent in any form but substance in continuous fever, as it will be thrown off or pass off. Therap. applic. 2st Intermittent Quinine the most important medicine In all pure and uncomplicated cases of quot. quart. or duplic. types these salts may be considered as infallible remedies. If costive, purge once with calomel (the best agent) Check diarrhea with opium. If stomach is full, vomit with sub. zinc, copp. or turpenth min. or purge with calomel. Perhaps in no disease are emetics & cathartics as much abused as in this It is a routine Sometimes the disease is thus brough back There is generally a natural state of the bowels, no fur on the tongue etc. Sulph. quin. & [illegible] are equally admissible in the cold the hot and the sweating stage & during the apyrexia. Many deny this, and yet give large quantities just before the paroxysm even [the] min. before! The article does not operate all at once but gradually Generally Prof. T. does not interrupt a paroxysm when he is first called Sometimes however he gives a large dose of quinine to cut short the cold stage & bring on the hot, or in the hot to bring on the sweating stage immediately Inappro 3 grs to [illegible] i is the appropriate dose once in 2 to 6 hours Quin., & cinch. require the same quantity as their salts [illegible] i is the smallest quantity with which Prof. T. has ever cured a case more would have been better Prof. T has known 10 grs. once in 2 hours necessary to suspend the paroxysms A writer in the Philad. Journ of large experience in intermittents lays down 20 gr. once in 2 hours as the common dose for all cases Case of a phys. who was much surprised to hear Dr [March] doubt the existence of phlogistic intermittent he took him to see such a case in the hot stage Dr March gave 2 or 3 grams of opium & cut short the parox. in 30 minutes He gave sul. quin. & the pat. had not another paroxysm A timid and inefficient use of sub. quin. will even aggravate the disease Just as with opium Dr March has repeatedly been called in clandestinely to cut an intermittent short at once which had continued under an able phys. 6 weeks! Time of continuance is variable Do not suspend the remedy immediately after the cessation of the paroxysm especially if the pat. is in a very unhealthy situation Perhaps a dram should be considered the minimum quantity to prevent a relapse Under the treatment here recommended not more than one paroxysm (not even a single parox.) after the physic. is called in should be permitted of course in pure & uncomplicated cases Mode of administration Sul. quin. & cinch. may be given either in solution in water or if you want the smallest possible bulk add a little of some acid just enough to render it soluble without giving it an acidulous taste (The combination of sulph. acid & bitter is offensive to taste) or diffused in wine or brandy & water or diffused in syrup of sugar or in pill, when the stomach is irritable pilled with ext. gentian pills made before hand get to be too hard & are to be rejected When the stom. is irritable an acrid is indicated and capsicum is the best (It is not stimulant but [illegible] irrit. to much [illegible] not acting on the blood vessels but on the muc. memb. increasing susceptibility to other remedies) Powder of bark also will cure most intermittents. It too may be given at any period of any stage though it is very liable to be repeated during the paroxysm especially during the hot stage. Sometimes bark in substance cannot be given in suffic. quantity without vom. to enable it to effect a cure Give [illegible] i to about zi 2 to six times a day Give it diffused in some liquid Still it is not worth while to retain this mode. If the stomach is very irritab. pills may be given of alcohol extract give as much as of the powder. Infus. & decoct. are too weak for intermittent Tinct. requires too much alcoh. Tinct. of bark has cured but then it was by the alc. not by the bark. Saffron (canth. tinct. and [rum]! have cured Those who do not live in an intermittent country, are apt to suppose that there are many cases in ‘ which sulph. quin. is inadmissible Prof. T. does not believe so. he has seen many such cases and thinks they were all caused by injudicious management. Some of these physic. suppose cal. & op. is curative in many such cases they talk much of it. But long ago it was settled that cal. & op. are not curative but merely preparatory (vide Good for an interesting experiment when the stock of bark was exhausted on board two ships of war They merely suspended but did not cure the disease) Physic. have more prejudices against quin. than against any other article unless it be opium & alcohol. N.B. The Parisian phys. practice upon the principle of giving large doses of sul. quin. Some suppose the intermittents of the south do not tolerate quinine so well On the contrary much more quinine; required because the disease is more intense. The practit. there use it too inefficiently. Dr. Mac Bride stated this to be wholly true Sometimes the disease will be accompanied with morbid secretions in large quantities, and hence quinine is supposed to be inadmissible. On the contrary give (after purging with cal.) quinine to cure this as it depends on the endemic influence. Sometimes the stomach is so irritable that 32 grs. of quin. will not stay on the stomach and hence it is thought to be inadmissible Give 10 grs. at once to cure the irritab. as it is produced by endemic influence Case of a woman who had long taken sulph. quin. in small doses with this effect certificates from physicians that sulph. quin. disagreed with her She was immediately by pills of 6 or 8 grs. sulph. quin. made up with ol. capsicum. Numerous such cases used to come down the canal to Rochester & be cured by T. [S] M. at Albany But intermittent is often complicated or disguised 1st Interm. accompanied with diarrhea which sometimes continues throughout the disease. Cure these by quinine and opium. They are cured as suddenly as the others If necessary we may conjoined resin of hanthorrhea [hostilis] (so effectual for diarrhea) or tolu or 2nd Intermittent complicated with cholera commending with rigor & an urgent parox. of chol. which terminates in the sweating stage and so continues day after day without a suspicion of the nature of the disease Give acrids in the paroxysm & quinine in the apyrexia 3d Intern. complicated with dysentery physic. will sometimes suppose they must wait and cure the dysentery first Give no mercury unless corr. sub. Given quinine & opium 4th Intermittents complicated with jaundice puzzling to young physicians bilious diarrhoea & akin a deep orange Give at first opium enough to check the diarrhoea & then suspend the paroxysm with quinine You may follow afterwards with conium to remove the yellow colour of skin 5 Interm. complicated with parabysmata coacta (Good) Many suppose that quinine must not be given until the parabysmata have been cured Cure with quinine Prof. T. has had testimony that quinine would cure parabysmata the sequels of intermittents Dr. Bristol said it was cured in Paris by 6 or 7 grs. of quinine 5 or 6 times in 24 hours better than by any other article. Prof. T. has generally used conium in conjunction 6th Intermitt. complic. with delirium a disease more formidable than dangerous. Cure by quinine though perhaps datura etc. might advantageously be used “opium will sometimes cure such cases 7th Intermittent complicated with syncope. Paroxysm comes on with syncope. Pat. obliged to keep his bed in the intermission Cure by quin. 8th Complic. with convulsions especially in children If called in a paroxysm give a large dose of datura then cured by quinine, as soon as possible Often you cannot give the quin. to children on account of its bitter taste Then give arsenic & opium perhaps as often as once in 1 or 2 hours 9th Complic. with epilepsy One of the most frightful & alarming forms Pat. comes out of the fit and sweats A few years ago such cases were always fatal Get down a large dose of datura and if necessary repeat it & follow with quinine Cure by quinine in the [illegible] [etc.] Complic. with catalepsy of no consequence a trifling disease is catalepsy Complic. with lethargy equally unimportant quin. cures Complic. [serous] apoplexy of Cullen (not sanguineous) quinine will cure Dropsy Purge with elaterium & remove the fluid & the cure by quin. If dropsy remains after the cure give digitalis tinct. cantharides tonics etc. Disguised Intermittents 1st Hemicrania severe cured as other intermittent Well known as a disguised form to persons in an intem. country 2nd Neuralgia (facies etc.) (vidd McCullock) cured by [the] remedies for intermittent. Case of Dr Th. Woodw. attack in calf of leg & this repeatedly for years which would be cured by opium but he would be sick the next day it was found afterwards that datura was better It takes the form of nephralgia ophthalmalgia rheumatalgia etc. 3d Dyspepsia mistaken & treated wrong 4th Hypochondrias & mistaken 5 Typhus (but it will not have 2 parox. in 24 hours as true typhus always does ruins on indefinitely) cured by quinine. This has no crisis on the 14th day as typhus has 6th Phthisis Case of a man from Rochester who came back to Connecticut to die of phthisis. Prof. T. was puzzled found opium did well and finally under the use of opium the pat. had a regular attack of intermittents Prof. T. then cured him by arsenic (as he was so afraid of being poisoned that he would take scarcely anything) given clandestinely Case cured by Dr Todd of a young lady who had come to Hartf. to die. # Remittent not time to say any thing upon the subject # Story of a young physician in N. York who detected an intermittent counterfeiting hectic & got into practice [From Savage’s copy of Talcott’s notes To be inserted in the blank space which occurs in the article actaea] “Atonic acute rheumatism rheumatismus The more acute the disease the more successful has Prof. T. been with actaea more successful while the febrile aff. is strongly marked and the topical affect. has a tendency to wander. When called, ascertain if the pat. is costive, if so give a dose of calomel over night & opium sufficient to allay pain give the opium first & if it takes a good deal to allay the pain, why give more Keep by the calomel (12, 15, 20 or 3 grs according to susceptibility & other circumstances) not less than 12 nor more than 18 hours give cal. sufficient a free evacuation. After this commence with actaea & opium at regular & short intervals say f zfs of tinct. act. every 3 hours as a general rule, some requiring more & some less. The test of the quantity is the effect on the brain. Let the brain be moderately affected but not so as to produce a troublesome narcosis. It is necessary in some cases to affect the brain more than others. In some the disease yields before the brain is at all affected, in others Prof. T. has been obliged to produce a troublesome narcosis. Opium must be given in conjunction in quantities sufficient to meet the symptoms & keep them under 1 gr or more every 3 hours may be required. If the pat. has been tampering with medicine, purging with salts etc. often the cal. will not be needed & we may enter at once upon the use of actaea so too if the bowels are free When the disease is fixed upon some particular part as a joint, topical applications will do good & actaea is not so successful though even here it is useful Under this use of actaea all the tumefaction, redness, soreness & pain of the acute form disappears, often in 12 hours sometimes not altogether till 24 or 36 hours the constit. feb. affect. disappearing at the same time in by far the greatest proportion of cases though in some the fever goes on to the next critical period. The remedy shd be continued in diminished doses to prevent a recurrence. Opium alone will sometimes answer but it is better to combine it with a reduced quantity of the deobstruent. The pat. is not perfectly well after the resolution, he is weak, feeble & languid & a little exposure or over exertion will bring on the dis. again unless the medicine is continued Prof. T. has failed with actaea in only two cases of genuine acute atonic rheumatism and then the patients could not be induced to take the remedy longer than while present relief was afforded which was effected in both cases. Dr Woodward of Wethersfield writes (1830) that he has used actaea in subacute rheumatism (meaning that form which I call atonic acute) in catarrhal phthisis in catarrhal cough & in neuralgia. He considers it one of our most valuable deobstruents, combining the powers of digitalis, sanguinaria & colchicum I [illegible] hardly ever saw it do much good till symptoms of narcosis were produced. The following are the effects of a moderate quantity vertigo, headache, impaired vision, dilated pupils. epigastric uneasiness, diminution of frequently of beat in heart & arteries (but it was irritative frequency of pulse) Dr Woodward has seen decided narcotic effects from 15 gtts of tinct repeated every 6 hour, & from teaspoonful doses violent narcotic effects & hypercatharsis (the last effect I never saw & am inclined to think it accidental or produced by something else) this was followed by a rapid subsidence of the rheumatic affection. Dr W. says he has always found it most beneficial in doses of 25 to 30 drops. He has found it very useful to allay cough & also arterial irritation. In two cases of atonic acute rheumatism following rosalia, one was treated with actaea the other with colchicum both were speedily cured Dr Beers has also used it successfully in the same kind of cases Dr Woodward thinks it more manageable & successful in inflammations of an atonic & acute form, than any other article. Dr Tully thinks so too. Dr W. says a popular article in his neighborhood is Wright’s cough drops, which he thinks is a proof spirit tincture of actaea In subacute rheumatism actaea is useful. In [mercurial] rheumatism, which is always subacute it effects as speedy & effectual a cure as in the acute, but we must conjoin opium & follow with tonics Arthritis rheumatalgia such as is unattended with redness swelling etc. chronic rheumatism (popularly so called) characterized by pain, especially on motion, without swelling etc. with no febrile disease, essentially, though there are often febrile paroxysms. Some of these cases are acute the attack is sudden, the dis. of short duration & confined to fixed periods. These are specially benefitted by actaea. When this species is subacute (often met with in boys who have continued too long in the water I formerly failed, but think I should succeed now. In the perfect chronic form of “chronic rheum.” occurring in old men & continuing year after year joints almost paralytic not much is to be expected from actaea though the exacerbations may be palliated A cure will not be effected Arthritis neuralgia neuralgic rheum. (Fothergill’s sciatica) The first symptom of an overdose is felt in the sciatic nerve though this is the peculiar effect of the article yet it will cure this neuralgic affection. Arsenic, opium & actaea will cure sciatica speedily & effectually. I give the arsenic in efficient doses giving a pill of arsen. acid ¼ gr & sulph. morph ¼ gr every three hours, with the actaea Sometimes I give a cathartic of elaterium previously It yields to this course Bucmenia sparganosis Some cases in extreme exhaustion supervening often severe hemorrhage; are often perfectly resolved by actaea The pathology & location of this disease are disputed It seems to affect all parts of the limb except the bone The lymphatics are supposed to be its peculiar seat. They are undoubtedly affected but the dis. depends on the specific nature of the affection, not on the part involved There are different varieties of it & the treatment must vary accordingly When it occurs among the debilitated females of cities, nauseating deobstruents cannot be borne not even calomel. They produce irritation, reduce the patient & aggravate the general symptoms or pass off by the bowels. Among delicate females [illegible] alcohol, & cinchona are required & these are the articles which I have always known to be indicated. But among females in the country & when it does not follow hemorrhage or derangement of the digestive organs (I have never seen such cases) calomel is useful & the more irritative the cases, the better is the actaea Ophthalmitis of this there are several species, depending upon several specific sorts of infl. Of O. conjunctiva, there are 3 varieties 1. common 2. purulent (of infants) 3 epidemic or Egyptian. Perhaps there is also another kind a chronic form with spongy granulations on the inner surface of the eyelids though this is perhaps a degree of the first variety. In the common ophthalmia there is often [chemosis]. In this form actaea is discovered to have great power & is now often used. Dr Noble of Albany gave fzi once an hour, all day long, till severe narcosis was produced at night, when he stopped the article & resumed it next day. Nothing else was used & the cure was effected in 2 days. I think Dr N’s mode of giving freely & suspending at night, the best. The more acute & recent the case the more speedy the cure. If a cath. of cal. is indicated it had better be a slow one. Narcotics are not so manageable in infants, they cannot communicate their feelings; hence this course would not answer for the purulent ophthalmia & we must rely more on topical applications. In Egyptian ophth. I have great confidence in actaea A. corneae specif. ulcerative infl. of the cornea nit. silver, however in conjunction Dr Noble has used it in this way I have since known others use it. This is also an infl. of the sclerotic coat. It is never phlogistic. Those mentioned above are not but are all specific inflammations. All the cases that I have seen of infl. of the sclerotica are rheumatic or arthritic I do not believe Sam. Cooper’s doctrines & I think his cases are not true in fl. of the sclerotic Drs Knight & Woodwd of Vt agree with me. In this infl. of the sclerotica actaea generally succeeds perfectly and sometimes it fails utterly. I can not discriminate the cases Porphyria hemorrh. & nautica I think little of the treatment in the books they proceed on the principle that diet is enough to cure it. It is caused by bad diet etc. but shd be treated on general principles. Stimulants & astringents are required sugar of lead, opium & brandy with farinaceous diet constitute the proper mode of treatm saying to him “I would not trust to that boy” The pat. reposed confidence in Dr I but said to him “I must have counsel called to satisfy my friends” Dr I. called a man 70 years old The pat. says “I believe the boy has done well”! Prof. I. will never forget his sensations he was mortified & grieved. Afterwards he put on a quaker hat! to appear more old! Let judicious clergymen be called Dr when it is proper Dr Rush said “when the earthly M.M. fails apply to the heavenly” Prof. Ives’ paternal lecture 1833 Be especially careful in your primary observations. An [illegible] read in the [pentateuch] “& the tabernacle was covered with beggars’ skins” He turned to his audience & observed; to the audience “You see my friends the difference between the law & the gospel. The poor have the gospel preached to them, but under the law a beggar! could not be seen about but his skin; was immediately taken off to cover the tabernacle!” If a young physician dislikes his profession, the sooner he abandons it the better. It is difficult to distinguish between genius & a fondness for a pursuit. Dr Rush remarked that he would practice medicine as long as he could walk, when he could not walk, he would ride [illegible] he could not ride he would be carried to the bed side “Least than a wise on hi own eyes, there is more hope of a fool than of him” It is a most unfortunate thing for a young man to suppose he knows all that is to be known Diogenes laid him self down to die, saying he knew all that was to be known There came in a beggar boy to borrow fire. Diogenes told him he had nothing to carry it with “Fi you will give me the fire I will find means to carry it” He put some ashes in his hand & a coal of fire upon them! I will not die says Diogenes for a beggar boy has taught me a knew piece of knowledge! The boy understood the fact well though he could not express it in the language of ashes being a nonconductor of heat. Dr Rush remarked that he had learned much from nurses Moral principle A stranger said to Dr Monson “I wish to employ you in a very delicate case & will pay you handsomely” Dr M. replied “Sir you have not money enough” “You know not how rich I am” “If you had ten thousand times as much it would not be enough to pay me for loss of reputation & conscience” Prof. I. has often been called on to produce abortion & that too by men & women of the first standing in society to produce abortion he has been appealed to in the most moving terms “would you sacrifice a family” “I am somebody likewise” must I lose my conscience & character” The person would threaten to commit suicide. “You had better not but if you do I cannot help it” Suicides however are sly about the matter Prof. I. has known many of the infidels of the last generation They were the most bigoted & superstitious set of men he has ever known. They though there was not evidence enough for the bible, but would believe in the most foolish witch stories Franklin A young physician is not put down by the older ones as formerly there is more liberality in the profession ow than formerly. Anecdote of Dr [Birker] “We want more farmers than doctors” Dr Darwin was a large misshapen man stuttered etc. very awkward etc. yet captivating. His works contain a great collection of important facts Anecdote a young man a good scholar, rather awkward & bashful was apprehensive of being cut out by an elegant competitor eloquent in the ballroom etc. advice not to fear! It turned out as Dr I. predicted We are not to give pain to patients who have brought their diseases upon them After we have relieved them, we may endeavour to reform them Anecdote of Dr Monson man intemperate finally took a poisonous dose of laudanum Dr Monson saved his life Afterwards he remonstrated with him upon his guilt “Dr I don’t thank you for what you have done” Dr. M. then turned “I am sure the neighbors will not” An opinion formerly prevailed that it was lawful because it was expedient to tell falsehoods Dr S. has always found it advantageous to appeal to his frank veracity on all occasions Often however, patients have no right to know Secrets should be kept A man may be sued for defamation for saying he has cured a man of venereal disease You will be mortified occasionally in being called a young man. Prof. I attended a man whom friends kept Neuralgia strychnos arsenic & opium ([actaea]?) Itch cured by lotions of digitalis Sciatica arsenic strychnine & (actaea ?) [sul.] morph. have proved highly valuable Hemicrania cured best by ¼ gr. strychnine 3 or 4 times a day combined with morphine Strychnine 1/16 to ¼ of a grain Brucine 1/24 as strong chronic rheumatism best cured by lobelia better than by guaiacum the article commonly relied on 9 materia medica & Dr. Ives’s Paternal lecture (rear) Solanum nigrum Often mistaken (for its name) for atropa belladonna. Smell & taste nauseous moderately narcotic Its narcotic powers are very variable different in different cases Deobstruent also. It is diaphoretic diuretic (more so than conium) laxative slightly Said to be found useful in [diury[ and ischury but said to require to be drank freely Much used by the common people in ointments (of the leaves) for indolent tumours ulcers etc. IN mild cases Prof. T. has often found it answer as well or better than conium It is not worth while to fire a cannon to kill a fly. Med. dos sd to be 10-12 grs shd think this inefficient infuse zfs to oj of water Solanum tuberosum Native in Peru the tubers of the wild plant are as small as a nutmeg & bitter & nauseous. “Root sd to be perennial probably annual” Top only is used in medicine This is too weak to be used in infusion or decoction. The watery extract is found to be slightly narcotic & deobstruent It is diaphoretic, diuretic & cholagogue It will relieve some atonic inflammation cure some cutaneous diseases IT has been used principally for jaundice & dysp. connected with the liver Dose said to be 2 grs. Prof. T. gives zfs to zj Recommended in cough rheumatism hemicrania angina pectoria etc. When pushed too far it produces tremors etc. the symptoms of narcosis Most of our arrow root is made from potatoe roots and if sufficient care is taken to purify it from mucilage it does as well. The activity of these & the following article is a subject of dispute Solanum Dulcamara Possesses the same assemblage of powers as the S. [terb.] & S. nigr. Used in cutaneous affections. Acts on the fluid secretions generally as well as on that of the liver Digitalis purpurea Native of England Nat. ord. scrophulariae Leaves used (stripping from the midrib) leaves good only when of a light green colour when black they are worthless for medicine. No particular odour No good analysis has been made [Digitat??] (drystallizable) is mentioned Decoction injures it. Should be given in infusion. Infus. green, with the odour & taste of the plant Upon no subject is medical testimony so contradictory as upon the medical properties of this article. Some contend that it is stimulating others that it is never so but always the contrary Prof. T. believe it may, like other narcotics, produce an erethism of the brain without any effect upon the circulating system (N.B. This is a state which often precedes an attack of delirium tremens) It is evidently this state which has been mistaken for stimulation produced, as it will be if the article is continued for some time in doses just short of the strong narcotic doses It is from this state that the opinion has been drawn that digitalis is capable of producing an inflammatory fever The secondary operative effects of digitalis are those of other deobstruent narcotics, as actaea cicuta aethusa etc. It has been noticed that when the pulse has been reduced to 40 by digitalis if the patient is raised to a sitting position it will rise to 72 or 100 & this has been considered very strange but it is no more than always occurs in extreme exhaustion from narcotics or in its syncopalis or even from mercury Much mischief has been often done by giving digitalis to reduce frequency of pulse It will relieve none but irritative frequency. It may be made to cure some cases of intermittent pulse Under any management the article is liable to fail to operate, and after some days operate most dangerously The intermission of the pulse may continue along with the quickening of the circulation for 2 weeks after the cessation of the administration of the article Digitalis is diuretic only after nausea is produced by it but too much nausea will prevent its diuretic effect Digitalis is not or not much diuretic in health it is only so when water has accumulated It is capable of relieving some atonic infl. Opium must be conjoined Prof. T. has treated ac. rheum. by it Those who contend for the stimulant power of digitalis say that is contraindicated in phlogistic diathesis. Others say that it will relieve phlogistic cases. Both agree that in some cases it has produced no effect either beneficial or injurious But if digitalis and nothing else is given in a severe case of phlogistic disease it will have no effect and the disease will aggravate of course. In milder cases no change will be observed. The supposed phlogistic cases relieved by it were irritative cases without strength of pulse sub-putrid cases Farriar accordingly, who considers it useful in phlogistic diathesis, still says it is useful only in those cases which do not admit of v.s. and he commonly conjoined it with camphor and opium. It is equally admissible in low atonic cases. Paris supposes that a considerable number of diuretics are adapted to a different set of cases, from digitalis There is something in the general principle e.g. crem. tart. & tinct. canth. But he is entirely wrong in saying that squills and calomel are incompatible with digitalis. He supposed calomel to be a stimulant and digitalis a refrigerant. Blackall is mistaken in a similar manner calling calomel a stimulant etc. Paris supposes languor & nausea are essential to its diuretic effect and hence they must not be prevented Prof. T. has found that there is a certain range within which digitalis acts and hence sometimes aromatics, cath. & opium must be premised and cojoined and in a few cases, tart. antim. & even bleeding must be premised Many among us have lately found that tonics as canella alba are usefully conjoined with digitalis. In such cases Prof. T. conjoins tinct. canth. senega squills & cal. with digitalis yet all are incompatible according to Paris In low cases alcohol will often be needed Calomel generally increases the susceptibility of the system to the operation of this article Pharm. prep. Tinct zii to spirit of dilute alc. med. dose mx 3 or 4 times a day Infusion zii to pt. dose tablespoonful. Therap. appl. 1st Idiopathic cough where there is a leucophlegmatic habit and bloated face But other things are better and at least opium or I. paregoric should be combined say 3 of deg. & 1 of laud. or I. pareg. The opium will tend to prevent its accumulation Bex convulsion Highly recommended used the same combination as above. Prof. T. has never used it in hooping cough Dyspn. exac. & asthma very useful combined with opium. It will cut a paroxysm short as soon as any article Combined with tonics it may be given in the intervals Delirium tremens comparatively but little opium will be needed, if you use digitalis (only however, where the patient has some vigour of constitution left) Puerperal delirium ( a disease nearly allied as in the above disease where opium produces a disposition to sleep without actual sleep digitalis will produce quiet sleep Cauma recommended but Prof. T. thinks it not indicative likely to do neither good nor hurt Phlogotica useful in lotions for various of them particularly erythema vesiculare & E. oedematosum Apply it strong enough to produce a slight sensation. Recommended very highly for the poisonous [rhoes] Scalds and burns lotions highly useful relieving pain, irritability etc. Acute inflam. of brain lungs or other viscera (supposed entonic but really irritative or atonic) by Dr Currie So Ferriar who combined opium & camphor Recommended in croup but is not employed Song recommended in phthisis almost the first disease in which it was employed best adapted for the cases which require iron & myrrh Some think it useful as a diuretic in this disease but excessive urination will exhaust as much almost as excessive sweating. It is principally useful 1st as an antirritant 2nd as a deobstruent both which are indicated I membranous phthisis Digitalis is to be given in phthisis as in other disease, upon general principles Rheumatism useful as a narcotic & deobstruent combined with opium It may be made to cure acute rheumatism premise a purge of calomel & give say 10 drops of the tinct. every hour or 20 drops once in 2 hours until the disease yields, or the head is affected No cancer of a violent action, used in this way combined with opium & with diaphoretic regimen So of aub acute rheumatism but not so useful. Blenorrhea lenodis 25 drops 3 times a day conjoined with decoction of barley Struma recomm. also in the strumous phlogotica this depends on the state of the system Sparganosi puerperanum recommended internally & in lotion conjoin opium but do not adopt this practice in a feeble subject Measles & rosalia probably useful when not too atonic Hemorrhages rec. but it should not be given in the phlogistic (N.B. There are 4 sorts of hem. active phlogistic passive atonic irritative & vicarious) Digitalis will be useful in the irritative kind with a quick wiry pulse irregular throbbing heart etc. Recommended in ill conditioned venereal ulcers topically Mania rec. (said to be useful when the blood is determined to the brain which Prof. T. thinks does not occur) Prof. T. considers mania as a periodical disease & consequently an atonic dis. The paroxysm of mania precedes the disturbance of the circulating system and the effect has been mistaken for the cause. Dr Willis cured 92 per cent Dr Todd has cured 93 pr. ct. It has lately been published by Dr [Willis’s] grandson that his treatment was substantially the same as Dr Todd’s The latter allays with paroxysm by moral means he prescribes quinine etc. as for a periodical disease. Enlargement of the heart good testimony also of the large blood vessels Epilepsy hysteria convulsions (hardly advisable) Dysury of various sorts nothing specific is mentioned. Dysury of a low typhus will be aggravated by narcotics that of cantharides will be relieved. Lithia recom. Most important use is in Dropsy 1st paleness, coldness skin easily [illegible] etc. (vide Withering) Prof. T. has always found it useful but, as Dr With. gives [illegible] so he finds stimulants necessary in conjunction. Irritative cases with a dry skin etc. Digitalis does well in Dropsy of the abdomen with a distinct hard, circumscribed tumour (encysted) etc. will not be benefitted by diuretics Other cases of ascites require jalap and cremor tartar, senega & squills or elaterium Hydrops abdominis (if not encysted) hyd. thoracis etc. benefitted by digitalis Use afterwards, tonics conium & iron, myrrh etc. vide Withering Cutaneous affections impetigo herpetica scabies etc. Prof. T. has lately cured common itch oftener by digitalis than by any thing else Apply the infusion with a sponge to the eruption 1 to 2 oz to 1 pt. It cures in 3 or 4 days to 1 week Impetigo laminosa upon the fingers to relieve the irritability Recommended to prevent threatened abortion combined with opium But then opium alone, with horizontal posture, will certainly cure Poisonous effects relieved by stimulants and opium. This was well established before the springing up of the race of toxicologists! Prof. T. has had several cases where it had been given by mistake History popular in Rays time & since that time. Vide Gerhard Parkinson, Bates, [Valmon] etc. It was used to produce emesis etc. Dr Withering was first to discover and publish its true powers & operations 1785 D. lactea has been used as a substitute said to be more active probably less so as it was used more boldly D. epiglottis is mentioned by [Coxe] but by no botanist whatever. Actaea Racemosa There are 9 very nearly allied plants called by Linnaeus actaea & cimicifuga But one of them may be referred to either & these have been called macratrys by Rafinesque. Provided actaea & cimicufuga are distinct genera macrotrys must be seperated. And upon the same principles A. palmata should be referred to another genus still. [Now] some late botanists have united (judiciously & upon Linnaeus’s own principles) them all into one genus actaea. We have in N. Eur. A. rac. A. rubra & A. pachypoda (A. spiculus is not now acknowledged) The whole genus in three divisions has 1st A. cimicifuga (Siberia) A. simplex (Kamschatka) & 3 others of the division cimicifuga 2nd sub. div. macrotrys. 3d sub. div. A. christophoriana vide [illegible] Decendalles two spec. A. mucrocropa & A. cerulea are mere varieties or mistakes the latter does not differ from A. rubra Actaea racemosa Linnaeus ([illegible] [illegible]) Cimicifuga serpentaria of Pursh Cimicifuga racemosa Nuttall Macrotrys actaeoide Rafinesque Macotrys serpentaria Eaton Botophys actaeoides Rafinesque again Black cohosh. black snake root (which is applied to at least a dozen others e.g. sanicala mar.) square root rich weed rich root snake weed etc. Cornuticis Canada herb christopher Nat. ord. [Ranuncul???] Tribe I aconeae. Grows in woods among rocks in rich places etc. Flowers about July. Monogynous root an irregular tuberous rhizoma with fibrils Often the root of blue cohosh (leontica thalecteoides) is often sold for it but the fibres of this are smaller taste less bitter not virose etc. Roots of sanicula marilandica (called also black snake root) are also collected for it. (So the berries of cornus [illegible] have been found in the shops for buckthorn) But A. rubra & A. pachypoda are most commonly mistaken for it they are inferior Root he only part used Taste first to sweet & aromatic afterwards virose and bitter Tinct. of root is aromatic & bitter It should be collected only after the decay of the top. Attend to this direction, & use care in its preservation & it will retain its full virtues for years. I know of no good analysis. Dr. Meers attempted it, & gave the result of his researches in a dissertation, Tannin, extractive matter, a bitter principle, gallic acid, a gummy principle, starch, woody fibre, all which amounts to just nothing at all. HE said it probably contained an alkaline principle; but I assert positively, from repeated experiments, that it has none but calcid. I tried every means to get an active satisfiable base failed entirely don’t believe it has any. (Here Prof. T. gave the ordinary process for getting salifiable bases.) The article is prominently & decidedly a narcotic antirritant said to be anodyne & soporific; I don’t believe you can employ it for that purpose with advantage; though this, as well as all other narcotics, in certain conditions, do have such an effect. It readily & certainly produces ult. narcosis, which can always be speedily relieved by suspending its exhibition, & at the same time using those means heretofore so often directed especially opium (N.B.B.) # Dr Todd has seen decided & considerable exhiliration Prof. T. thinks it similar to the erethism of datura & conium & which occurs just before an attack of delir. trem. which is often mistaken for entony. In large doses it produces neuralgic lancinating pain in the extremities larger doses make these pains more extensive even affecting the head and eyes. Prof. T. once doubted the existence of these [illegible] but he has seen them many times They are most manifest in the calves of the legs & along the # I believe it is a nervine, though not prominently so. sciatic nerve. Opium counteracts them Cases related. Food also suspends the pains Prof. T. now employs a little food as a gill of milk porridge in conjunction with each dose Besides these neuralgic pains a large dose may produce convulsive action of the heart. Case of Charles Terry dangerously affected with extremely violent neuralgic pains under the upper part of the sternum wandering neuralgic pains soon violent palpitations beats 130 in a minute pain under the left axilla etc. Large quantities of camphor opium capsicum etc. were required. An emetic of sulph. zinc was given to change action Next day, pretty well. These effects happened twice the actaea not being at first suspected. Case related from G. K. Lawrence of the Shakers in which a large dose produced convulsive action of the uterus In both these respects it resembles strychnos nux vomica & false angostura. Some physicians give too large doses and at too long intervals & hence are always complaining of failure & of unkind effects of the narcotics Cases and testimony of physicians about its ecbolic operation. In one of the first cases, it was given as an antirritant, in a case of threatened abortion Abortion was speedily produced Dr March prefers it to clavus being more lasting leaving the uterus less inactive much less liable to destroy the fetus. Drs March and [Dyer] have found it useful in uterine hemor. Dr Dyer finds it the most valuable article for suppressing uterine hemor. not connected with pregnancy. He continues its use for some time Prof. T. thinks this [illegible] operations not specific, but as part of its narcot. He has repeatedly seen it convulse other involuntary muscles. Actaea is especially deobstruent Prof. T.’s attention was first turned to this by observing its effect when given as a diaphoretic in what was thought (by an old surgeon) a fever sores (osthitis gangrenos.) It resolved the infl. and cured the local disease, much to his surprise. He gave it merely to ally irritative heat and dryness of the skin knowing not a great deal about it. Subsequent experience with the resolvent powers of sanguinaria, colchic. varat. etc. led to the investigation of this property of actaea Dr Meers has found it produce an erythema upon the skin. Prof. T. has never experienced this. Dr. [Gasden] thinks it cholagogue Prof. T. has had no positive experience of this. Dr S. Woodward & others, however find it so Found to be emmenagogue also Seems to be expectorant also (as far as an article can be so directly Decidedly diaphoretic so say many physicians. Perhaps however it is only indirectly so as it appears to be so only in febrile (hot & dry) states. Diuretic often considerably so Yet upon the whole it seems not to be suffic. diaph. diur. & expect. to render it valuable for these indications It has been repeatedly called astringent. But it seems not to operate thus. To be sure it contains a little tannin or gallic acid but not enough to be efficient in operation Called tonic Prof. T. once thought so. Dr. Garden thought it tonic 7 reducing both. Prof. T thinks it not reducing bug prostrating merely. Prof. T. & all his friends also find it useless as a tonic. Like every other article of the materia medica this has been called stimulant. Prof. T. has watched carefully for this effect & never could perceive any. The warmth, flushing face etc. are produced merely by cerebral irritation. Very commonly said to be pectoral a term which may mean demulcent antirritant deobstruent etc. Said also to be alexipharmic Also called antiscorbutic this was the earliest quality ascribed to it in any publication. The principles of the cure of scurvy are not very well settled. The cruciferal seem to be well established as the remedies. Actaea is at least useful in restraining hemorrhage. But Prof. T. is an entire sceptic about the prescribed treatment of scurvy. All the cases treated of in the books occur at sea and seem all to be cured upon dietetic principles Concrete citric acid is useless. Lemon juice is useful in furnishing vegetable aliment. Land scurvy (apparently the same as sea scurvy) Prof. T. has found not benefitted by the treatment of the books He has cured it by lead, opium capsicum, and brandy giving food with each dose of medicine & after a few days giving quinine Rx ac. lead 1 gr. op. ¼ gr. every hour tablespoonful of brandy every 15 min. a little food with each dose. This pat. (in Albany) was cured though she was not expected to live an hour. Said to have the power of curing cutaneous eruptions The only testimony is B. Barton’s that it will cure itch Called repellent by which is probably meant discutient Prof. T. knows not that this has been well investigated. Called pellent also! Dr S. B. Woodward has found it cathartic, upon some of his patients. He is the only person who has met with such any effect probably they were anomalous cases G. K. Lawrence thinks the flowers are laxative. But all flowers are laxative unless they possess some other powers. Said to be emetic in a large dose This is very doubtful probably not more emetic than digitalis as a narcotic Darlington calls the root somewhat mucilaginous. It certainly is not so when chewed. Being narcotic it certainly could never be employed as a demulcent. Any considerable degree of phlogistic diathesis, will not admit of this article, until after reduction & evacuation It may be usefully conjoined with opium acrids & tonics Recapitulation 1st moderately nervine 2d actively deobstruent including, resolvent cholag. emmen. diuretic & perhaps diaphoretic 3d powerfully narcotic always antirritant sometimes soporific produces ultimate narcosis. 3th ecbolic Not stimulant tonic nor astringent etc. etc. vide supra This is supposed to resemble lycophus virginicus but the latter is merely nervine & tonic Most resembles digitalis but differs thus viz it does not accumulate on the system not continuing long after exhibition or returning in paroxysms does not exhaust the system like digitalis its narcotic effect is more easily relieved. Digitalis is not ecbolic & is less deobstruent It is more speedy & active than conium has most resol. power in acute conium most in chronic infl. conium more cholagogue & not diaphoretic nor diuretic Possesses the conveniences of sanguinaria & colchicum without disordering the stomach etc. like them Sources of failure are bad preparations not pushing the article far enough nor repeating [illegible] enough In many cases 2 hours is a better interval than 3 hours Another source of failure is preparatory bleeding or purging Pharm. prep. 1st very fine powder 20 to 30 grs. 2nd infusion coarse powd. zi boil. wat. 1 pt. [illegible] 1 hour & strain Tincture 4 oz coarsely powdered root to 1 pt. off. alc. macerate 10 days & strain. This is a saturated tinct. & is the only one needed for common use. It is the only preparation which will succeed in acute rheumatism Probably the active principle is perfectly soluble only in alcohol as water causes a turbidness or cloudiness though nor precipitate The powder is too inconvenient because it must be very recent & fine Medium full dose is about 30 m. Tinct. of the flowers is made by G. K. Lawrence 4 oz. to 1 pt dil. alc. He says it is cath. & less narcotic Diseases 1st dyspepsia irritable cases greatly palliated, by Drs Hale & others. Dyspepsia with a dry symptomatic cough very useful Dr Knight has found it very useful in 50 drop doses, conjoined with opium in dyspepsia with pain it cured when opium would not Diarrhoea thought highly useful by many. Colica ileus var. rhematalgica (primary rheumatic affections of the colon is known by the habits of the pat.) Dr Hooker gives 1 fl. z every hour until pain is relieved or narcosis produced & the pain is sure to be relieved. It will probably be found useful in common colic as it excites the involuntary muscles Bex dyspnoica often highly useful relieving in combination with opium when the latter alone failed Case related mistaken for [illegible] & haemoptysis (as there was oozing from the throat, caused by atony) Hooping cough much & successfully employed by Dr Woodw. of Vt. arresting the convulsive cough when pushed to narcosis Dyspn. exac. & asthma It generally cuts short the exacerbation give with the 1st dose the exacerbation of laudanum (sometimes 2 grs. op.) give a teaspoonful every 5 min. or a dessert spoonful at once or if this fails repeat it and in some cases a tablespoonful In this disease, a mixture of several narcotics give datura Prof. T. has succeeded well by equal parts tinct. actaea lobelia & datura Prof. T. at firs knew no better than to puke with tartar emetic this was worse than the disease. Next he tried ipecac. this failed. Next he tried syr. of [illegible] of squills this he thought did well but he found it always disordered the digestive function Nex the tried tinct. lobel. And one case in his own family he cured radically by anticipating the paroxysm with lobelia & laudanum Colchicum will break up the paroxysm but disorders the stomach worse than squills. Coxe’s hive syrup is much used but is one of the worst articles for disordering the al. can. Dr Mears recom. actaea for curing intermittent fever. Prof. T. tried it. He found it would suspend the paroxysm, but would not cure the disease & he would be compelled to resort to quinine Prof. T. considers this a disease of atony & has cured it only by tonics & stimulants The articles which suspend the paroxysm and do not give tone seem not to cure the disease. Slight cases may be cured by tricks of various sorts. Idiopathic hectic useful at least as an auxiliary Phlogotica apostema communis (common diffused superficial abscess generally about the hip) case related fo a cure by actaea Paristhmitis typhodes var. sub putrida (fever a synochus not scarlet fever a very rare disease most cases of malignant sore throat are cases of scarlet fever) good testimony of the utility of actaea as a gargle probably by its deobstruent effect. Perhaps it is also discutient it cures itch Pneumonit. typh. var. sub putrida (fever a synochus) Probably it might be used in most of the atonic & subputrid phlogotica & even in simple fevers of this type, if not too low Pneum. typh. var. nervosa probably it would be useful rousing nervous susceptibilities & acting as a deobstruent Pneum. typh. var. notha (which appears to be a spec. infl. of the bronch. memb.) highly useful. Arthritic infl. of the lungs misplaced gout useful especially if acute Sub acute pneumonitis (of Rush & others) (which appears to be an aff. of the bronch. mem. without an aff. of the schneiderian) precedes membraneous phthisis often should be treated with deobstruents, narcotics, nervines & diaphoretics e.g. marrubium etc. Phthisis membraneum var catarrhalis much used even by those who know nothing of its general use Vide Eberle’s practice Phthisis membranea var. dyspeptics highly useful. Remarkable case of Dr Hotchkins related at full length (Incidental remarks of Prof. T. he had hemorrhage which was checked by tartar emetic in nauseating doses left extremely weak “no wonder if tartar emetic was continued thus for some time” could not take tonics “because he too no antirritants with them, opium for instance”) cured when in the very last stages by actaea A. rubra failed in this case (it is greatly weaker) [Galium] circaezans proved a valuable expectorant. # [illegible] [illegible] drops were used Another very instructive case of Dr Hotchkins’s failed because it was not persevered in long enough This is apt to be the case with long continued diseases e.g. chronic diarrhoea & opium Scarce any remedy will do as much in phthisis as this even if given alone Yet it ought not to be given alone but combine with opium tonics etc. In m any cases actaea has prolonged life for years in desperate cases. N.B. consumptives cannot be cured by residing at the south in the winter only they must reside there for life to be permanently cured Phthisis tubercularis supposed to have cured. Laennec’s anatomical investigations Prof. T. thinks show unequivocal cures if tubercular phthisis All arthritic infl. are benefitted by it’ especially rheumatismus Prof T. has seem cases of arthritic carditis cured by actea others not. # American cough drops are equal parts elixir. pareg. & [tinct.] digitalis Cholera infantum (An infl. of muc. memb. of al. can.) has been cured Dysentery has been cured admirably by actaea. Dr Peabody has cured by 40 drops so have others Hysteritis membranifica has been found useful in many cases by Woodward of Vt etc. Prof. T. has not had an opportunity to try it in acute gout. He would give actaea once in 3 hours until narcosis was produced 30 drops or ½ tspfsful conjoining opium enough to drive off pain once in 3 hours IN this way Prof. T. has cured with verat. vir. lob. sang. & colch. # Arthritis rheumatismus atonica acute If pat. is costive give opium enough to relieve pain follow with cal. enough to purge in 12 or 18 hours After the purgation give actea once in 3 hours f zfs more or less # but the purgation from colch. is highly mischievous enough to affect the head conjoin opium 1 gr. or more or less once in 3 hours to relieve pain. When Prof. T. first began to treat atonic acute rheumatism in this way, he conjoined other articles, as ipecac but he finds them useless. The topical heat redness, soreness, swelling etc. will be relieved in 24 or 36 hours & often the fever disappears with them Dr Woodward of Vt cured 10 cases of acute rheum. in one winter all the cases he had. Dr S. B. Woodw. used it always in rheumat. he gives 25 or 30 drops (alc. tinct.) about once in 4 hours To prevent a relapse continue the actea in diminished doses Vide page next after the end of the article cinchona Ophthalmitis Hemorrhagia irritativa & [passivea] from any part Prof. T. knows it to be highly useful Porphyra haemorrhagica & [illegible] first employed to cure this disease in a large quantity of cider probably the cider had most effect It may be useful in this as in hemorrhage Neuralgia successfully with opium or arsenic by Drs Tully (he finds strychnine & opium better) & S. R. Woodward (in neuralgia of feet & legs of broken down convicts) Dr Knight has been succesful with it in neuralgic toothache Prof. T. has succeeded better with strychnus and arsenic or opium Hysteria Prof. T. used [illegible] successfully early in his practice now he uses nothing but datura. Epilepsy Dr Parrot of Western considers this article as peculiarly valuable in epilepsy from intemperance Others value it in other cases of epilepsy Carus paralysis it will probably be found useful from its resemblance to strychnos It has been found remarkably useful in palsy from lead colic camphor & arsenic may be joined Chorea from analogy Prof. T. was led to use it 15 yrs ago general testimony it its favour Vide also Am. journ. med. scien. No. 18. for interesting cases of surprising cures. Dr Hooker has used it with the most beneficial effects in chorea Tried chloroferrate of iron ([illegible] veneris) & conium & iron & various tonics with no benefit tinct. of horse warts (a powerful nervine) etc. Actea cured her Paramenia obstructionis found highly valuable. P. difficilis found useful in relieving pin, obviating irritability etc. Prof. T. uses datura Parodynia atonici lingering parturition Prof. T. now uses it instead of clavus with as much efficacy & without danger to the child Retention of placenta repeatedly used by Prof. T’s friends with good success Hydrops cellularis especially with an erythematic diathesis not used by Prof. T. but by several practitioners as a substitute for digitalis Leucorrhoea in a case which seemed to be the joint result of blenorrhoea & mercury cured other cases Ecpyesis scabies itch said to cure by lotion Prof. T. has often cured itch by lotions of digitalis. Sprains Prof. T. has often used it with advantage Bites of rattlesnakes popular alcohol & opium must be better Old chronic cases of swollen joints arising partly from injury & partly from rheumatism was proved very useful Very useful in murrain of cattle vide B. S. Barton. History. Lond. phil. trans. Petiver 1697 used in [Mariland] for scurvy. B. S. Barton various (among others the U.S. Dispens.) have copied from him. Actea rubra Distinct from A. spicata Considerably used in some places Powers similar to A. rac. but far weaker and more uncertain & less valuable Actea pachypoda A. alba (Big.) A. spicata var. alba A. rubra var. alba! etc. Necklace weed, coral & pearl etc. Mentioned in several irregular works. Used as an efficient emmenagogue by Dr McClure. Berries of this & the preceding (i.e. dry capsules!) said by Rafinesque to be poisonous Used by Dr Collins as a substitute for A. rac. but weaker Used by him with advantage topically in ophthalmia used for dysentery etc. Not worth substituting for A. rac. As the roots cannot be distinguished these are often sold for those of A. rac. hence frequent disappointments A. spicata Christopheriana herb christopher [Bane] berries berries said to be highly poisonous (vide Withering) Root and leaves acrid berries have caused delirium useful in nervous diseases as a repellent etc. Prof. I would infer that is is more active than A. rubra & less so than A. racemosa Actea Cimicifuga Linn. Cimicifuga foetida Linn. Liberian bug [bane] N.W. coast of Am. & Liberia An almost insupportable smell Used in Liberia as a bug bane Vide Good art. hydrops abd. (drastic i.e. active it is not cathartic) Abundant testimony that it is a powerful narcotic. Little doubt that it has the same powers as A. rac. but more powerful Strychnos nux vomica Nux vom. officinarum Caniram etc. nux. metalli Nat. ord. Apocyneal ([illegible] Luridae Linn) Habit. Coromandal Cochin China Fruit a berry about as big as an apple with a hard orange coloured skin seeds imbedded Seeds only used Bark said to be nearly as active. Seeds orbicular & depressed size of a dime Active principles strychnine & Brucine (brucine by mistake brucea being merely a bitter tonic) Strychnine most abundant exists combined with strychnic acid White, crystalline etc. said to be highly alkaline will it change blues? Combines with all the acids & is separated by all the min. alkalies When recovered from some combinations the alkali is changed (This is true of various veg. acids also a different acid being formed) Operative effects in ordinary doses these are so moderate and show that they can be no better distinguished than those of cinchona when properly administered & in a suitable disease, we merely perceive an amendment of disease. Diminishes morbid irritability & susceptibility & restores healthy susceptibility & tone. In its slowness it agrees with conium but disagrees with actea digitalis and lobelia It is mentioned as a peculiar property that it strengthens the voluntary muscular power. This is merely the erethism of the brain produced by all the narcotics It is more easily & more powerfully produced by this than by most narcotics Said to be anodyne is probably less so than many narcotics. It has great power however over neuralgic pain Said to be tonic & Prof. T. is satisfied that it is so Supposed to be deobstruent. Prof. T. thinks it is so though more equivocally so than some other articles. It cures gout rheumatism leucorrhoea etc. but little definite is known Not known to be cholagogue, anti psoraic etc. but has not been thoroughly investigated Said to be febrifuge (probably anti intermittent is meant). It seems to be capable of curing intermittent Said to be anthelmintic probably it is so Its slow operation adapts it more especially for chronic diseases Inconvenient effects cardialgia vertigo staggering appearance of drunkeness stiffness of [lims] & general coldness. These effects indicate a reduction or suspension of the remedy In a sufficient dose said to be capable of producing these effects in an hour & ultimately to produce stiffness of voluntary muscles i.e. tetanic spasms Ultimately it convulses the invol. mus. Noxious effects said to come on with pricking of the limbs coldness ultimately spasms & complete ultimate narcosis Paralytic parts more speedily & powerfully experience its effects viz. the pricking, local perspiration & tetanic spasms the contrast being remarkable between the two sides being affected vide Magendie Even the two halves of the tongue will be differently affected Magendie is probably correct in saying that it may affect the spinal marrow without affecting the brain Prof. T. has found strychnine more efficacious than any other preparation. Strychnine is said to be the most active principle known & the most speedy next after prussic acid Effects1st acrid narcotic 2nd tonic ([illegible] 3d deobstruent 1st resolvent others not investigated Entonic diathesis strictly prohibits this article, more indeed than it does most other narcotics The British practitioners are mostly afraid of this article yet it is more easy to manage than colchicum etc. This article, like all narcotics, gives warning of mischief. The refrigerants do not Orfila knows no antidote he directs emetics, cath. vinegar etc. tracheotomy and artificial respiration! Pharm Pres. 1st Fine powder rasp the seeds then pulverize & sift through muslin. Dose about 4 grs. 4 or 6 times a day. or dose 5 to 10 grs. Push it until moderate tetanic spasms are produced. Prof. T. pushes it until some slight startings of a paralytic limb. Sometimes 1 gr. 4 times a day has been enough 2nd Alcoh. tinct. strong alc. 1 pt? 2z of rasped seed. Dose 20 or 30 minim 3d Alc. ext. begin with 1 gr. or once a day (Magendie) But one dose a day will require too large a dose The effects of one dose will not last 24 hours For a slight effect ½ a gr. to 1 gr. pr. diem will be enough (Magendie) Dose of pure strychnine said to be ¼ to ½ a gr. 2 or 3 times per day too large a dose Some patients will not tolerate more than 1/16 of a grain. The doses must not be so large as to produce vertigo nor the quantity in the day so great as to produce tetanus Diseases 1st dyspepsia more especially where there is want of tone in the stomach but in almost all varieties Prof. T. has found it useful Diarrhoea vulgaris reported as very valuable Lead cholic especially in its secondary stages & sequel Helminthia not said what species Dyspnoea chronica like galvanism Dispnoea exacerbans. Prof. T. thinks it obviates the relaxed thickened & spongy state of the muc. memb. also relieves the paresis of the nerves etc. Sternalgia ambulantium Intermittent fever dose directed is too small. Said to succeed when quinine fails. (Prof. T: & several friends never fail to cure by quinine enough & unqualified Cases related of cure by quinine after quinine had been said to fail utterly) Typhus pustis (Levant plague) said to be specific seems to be useful Dysenteria typhodes has been used wiuth great success Arthritis podagria Said to be capable of curing if steadily administered So of rheumatism & rheumatalgia, in all their varieties either be cured or proved valuable Sciatica arsenic, sulph. strych & sulph. morphium in combination have proved highly valuable Ecphronia mania rec. in the books. Halusia hypochondrias (apparently a combination of a moderate degree of dyspepsia & of melancholia) said to be valuable Cephalia hemicrania (idiopathic not when a disguised intermittent) ¼ gr. 3 or 4 times a day usually in the required quantity. Combine also morphine. Prof. T. has succeeded better by this plan than by any other He now employs it exclusively. Case of Prof. Knight’s Neuralgia one of the best articles Prof. Knight has employed is successfully in many cases of nervous pains [Clo??] palpitatio Used with great success Chorea. Cured cases of long standing Dr Beers has found it highly successful So has Dr Woodw. of Vt Prof. T. has used it but little & that with success Hysteria said to cure Prof. T. never tried it but once & then it failed. It might be useful between the paroxysms Epilepsy recommended might be useful Dr Woodw. of Vt has used it with decided advantage Carus lethargus has been cured Carus paralysis more celebrated for this than for all others 10 to 40 grs in 24 hours It should be pushed so far as to produce some spasms in the paralytic limb Adapted to all cases caused by intemperance by venery passion etc. Has been used successfully in pregnancy (for hemiplegia) without injury to the fetus. Case quoted showing that palsy may be cured without producing any thing more than tingling no spasms. Magendie states that is now externally applied, in form of tincture Paropsis amaurosis Agenesia impotentia (probably a partial paralysis though an affection of the mind oftenest hinders this cure of the disease) Spermorrhea atonica Magendie Paruria retentionis & incontinens successful see Magendie Leucorrhea communis cured Bite of reptiles said to be cured Emaciation of extremities cured or relieved by Magendie It must be remembered that all these cases may be incurable and that the article may apparently fail Hist. Said to have been employed ever since the time of Gesner 15- Introduced into England in 17.. by Woodville Revived in France by Magendie in consequence of observint its tetanic effect on animals Strychnos psead augostura Called improperly angostura with various trivial names Always found as an adulterating article of Angostura bark 7 hence it probably grows in S. America. It is not known however, with certainty where its habitat is. Magendie Paris etc. attribute it to brucia antydysenterica [illegible] with probability attribes it to a species of strychnos Two species of strychnos grow in S. Am. Bark comes in pieces broader than long ½ inch thick covered with small warts fracture [illegible] small aromatic and nauseous, disgustingly bitter to the taste powder bright yellow Concentrated infusion muddy disgustingly bitter etc. Lat. tinct. pale rendered opaline by water? It is important to distinguish this adulteration of galipaea off. or angostura Severe accidents have happened even in this town Absolute tests said to be 1st a drop of nit. acid on the inner surface produce speedily a blood red spot (by the [brucia]) 2nd a drop of nit. ac. applied to the lichens on the outer surface, produces a deep emerald green color It is much to be regretted that the active principle is called brucine this brucine poisons as effectually as strychnine Th bark in powder [illegible] grs. killed a dog in an hour A child was killed by mistake cold extremities senses retained to the last Brucine is formed in Strychnos nux vom. said to be a bigallate in false angostura. Description of brucine vide chemistries. Taste bitter & acrimonious Nit. acid produces a deep yellow colour hence it can be detected when in combination with strychnine Wide discrepancy between the results of the ultimate analysis of brucine Andral considers 1 gram of strychnine equal to 24 gr of brucine Hence 6 grs. will be equivalent to ¼ gr of strychnine q.v. 4 grs. killed a rabbit Andral has given it in single doses of ½ gr. to 5 grs Magendie 1/8 gr. 6 times a day Operative effects differ only in degree from those of strychnine Strychnous pseud ang. is now considerably used in medicine Strychos [illegible] is the most active of all the strychnia (strychnoes) L. ignatii is next in activity. It was called ignatia by Linn. Called also faba sancti ignatii recommended in intermittents It vomits purges and produces spasms 2 grs said to be a medium dose of the seed. Strychnos colubrina posses the same sort of powers. The wood of the root is used against bites of snakes hence its name. In doses of ½ dram it has been used in intermittent. It vomits, sweats, diuretic cath. This is one of the plants called [illegible] [illegible] The other plant is the following Toxicaria macassariensis Ripa antear Antearia toxicaria etc. This is said to be the most active of all the narcotics not] excepting hyd. acid. The proxi Lobelia Inflata Said to be annual, persistent, and biennia. It seems to be biennial Rapuritium inflatum lobelia emetica. Indian tobac. eye bright etc. Nat. ord lobeliae Canada & the whole U.S. [Ra??.] & Sch. describe 15 species most of them are highly active Taste much like green tobacco It has never been analysed Operation 1st warmth in the stomach proceeding to cardialgia universal glow tremors some nausea vertigo salivation Larger doses cause more vertigo emetic diuresis more salivation expectoration Poisonous doses produced convulsions, delirium & death. Said also to produce increased secretion of bile diuresis & diaphoresis A valuable deobstruent though more adapted to atonic cases Valuable diuretic etc. Useless as a mere emetic It is too harsh and distressing. It would probably prove emmenagogue. Some think it cath. Prof. T. denies this except indirectly as an antirritant & cholagogue Seems not to be stimulant It will not prove restorative in exhaustion but rather increase it It may excite an irritative bounding of the pulse in low torpid cases. It is acrid & locally irritant not stimulant. It resembles to nicotiana tabacum but is more diffusible more sudden, mor transient, less permanent more manageable Though not stimulant yet it is contraindicated in entonic diathesis Pharmac prep. 1st powder of leaves 2nd powder of the seed 3d infusion but this has no standard strength [4th] tinctl zii to 1 pt dil. alc. 5th Tinct. of seeds by the Shakers Diseases 1st Dyspepsia with great [irritability] with wandering pains like disguised gout very beneficial in conjunction with capsicum & nit. sil. Limosis gastrodynia vide Eberle’s practice He finds it superior to opium Idiopathic cough either before or after expectoration found to be very valuable Bex dyspnoica Case related of an apparently desperate case cured by lobelia and opium f zi tinct. lob. with 2 or 3 grs op. at a dose each article failed by itself Another case related in which a large secretion of bile was produced Hooping cough found useful after the convulsive cough has begun by numerous practitioners A physician gives 10 to 60 m occasionally vomiting with it and he thinks it better [emetic] for the disease than ant. or ipecac undoubtedly because it is deobstruent Many physicians have succeeded with it Prof T. has done so sometimes conjoining opium or conium Dyspnoea exac. f zi of tinct every 5 or 10 min. until full vomiting or narcosis is produced. The certainty of the operation will be enhanced by premising opium Give it in the intervals of the paroxysms in conjunction with tonics Asthma best article for this disease as well for the preceding Still this medicine is so nauseous that many patients will not persevere with it Typhus nervosus has been used Dr Hyde of Enfield employed a powder of lobelia, or sanguinaria & of [????triphyllum] as a stimulant diaphoretic in typhus. It must be remembered that deobstrents are useful in typhus. Prof’s T & Beers used lobelia in typhus, when medical student & found it a most efficient diaphoretic Catarrhus communis & epidemicus Prof. T. has used it with great benefit Croup Dr Barney employs it in croup in the commencement and in the progress of the disease 30 m to ½ fz Croup is sometimes perfectly paroxysmal & resembles dyspnoea exacerbans & has been mistaken for asthma, as shown by Dr March’s p.m. examinations For this form lobelia is peculiarly adapted Pneum. typhodes was found a most valuable expectorant whenever squills could be tolerated does not answer well for when the stomach is irritable Acute rheumatism It has been used with success. Prof. T. has used it often with success in subacute rheumatism Case related cured in 24 hours by lobelia & opium Yet this patient had often had such attacks before which always lasted for a fortnight A. rheumatalgia var. chronica (chronic rheuma) Prof. I finds it the most valuable article much superior to guaiacum which is the article commonly depended on. Case related cured by lobelia and opium after arsenic blisters guaiacum alcohol capsicum etc. had failed Leucorrh. comm. valuable in some cases generally best conjoined with cantheris & nit. sil. Hernia recommended as a substitute for tobacco by enema Said to be nearly as effectual and not dangerous like that article Lobelia tupa Peru 6 ft. high root is 1/1/2 ft. long odour in a close room produces vomiting Juice so acrid as to produce speedily topical infl. when applied to a tender surface L. longifolia W.I. said to inflame the hands said to produce an incurable purging. Prof. T. has known several deaths by this actually incurable purging hydragogue from colchicum! L. urens most active also]L. syphilytica throughout U.S. all parts [lac] 1st deobstruent 2nd emetic 2d hydragogue cathartic apparently not narcotic 1st expectorant & emmenag. 3d diuretic 4th diaphoretic First employed as a specific for syphilys Just about as active as senega and adapted to a similar set of case. It seems to have the advantage of being less liable to leave the stomach in a deranged condition than senega As to its curing syphilys Prof. T. thinks the matter not settled when it was tried the notion prevailed that syphilytic patients should be salivated and that too before the constitution became affected It is never worth while to give mercury internally when the disease has proceeded no further than a chancre & bubo You will merely protract the cure The const. aff. also Prof. T. has cured by gold. It may be cured by various articles# Lobelia Dortmanna of similar powers to the preceding Lobelia Cardinalis supposed to be similar power It is a popular remedy in dropsy & will cure used as in vermifuge for [asc. lumb] L. claytoniana still weaker most common with us and apt to be confounded with L. pallida # Some cases will prove incurable under any treatment Sanguine temperament & scrofulous habits [illegible] mercurias dulcis sublimatum dulce (Sydenham) A. [illegible] A. [maligala] [Draco] mitigatus marina metallorum [illegible] metallorum Calomel Most modern & best name is Hydrargyri dichloridum The atomic weight of mercury was formerly called [200]. It is the general principle to take the smallest weight though it is not very strictly adhered to It does not appear but that the # persons who first pitched upon 200 + 8 for the black oxide, did it at haphazard and did not investigate the subject nor give any reasons “That compound which is with most difficultly decomposed, must be presumed to be a binary one Ms. Dalton vide Henry Prof. T. knows no exception. Hence says Mr. Alison? we must suppose the peroxide of merc. and perchloride to be binary compounds We find also that black oxide is very readily reduced by heat by agitation almost by pilling to red precipitate and metallic mercury. We find the same true of the cyanides. The sp. gr. likewise of the vapour leads to the same conclusion. The sp. gr. multiplied by .555 must give in combining weight. Hence we have 100. Another argument founded on the sp. I have [shown] elsewhere that if we divide the number .376 by the spec. heat the quot. will be then atonic [illegible] of that body [illegible] the spec. heat up [illegible] .03 & 376 / .03 = 12.533+ Berzelius advances similar arguments and gives the same no. 100. Thompson sometimes uses “sub” instead of di. Sub is a vague term It was found after the discovery of def. prop. that sub carb. pot. was 1 of each! other examples of its being misapplied before the discov. of def. prog. Formerly called proto chloride This would answer if it was still the case that proto was applied to the least compound Hydrayg: chlorid. mite. Phil. ph. an unexceptable name in pharmacy muriate of mercury Sub murieta (very exceptionable because it was considered neutral) then mild muriate) Called calomelas in 1616 But this name had been previously applied to the disulphuret (Ethiops mineral) Its discoverer is not now known The alchemists were acquainted with it. Sometimes found native & called horn quicksilver & mercurial horn ore a rare mineral Dull white yellowish heavy cake crystallized in 4 sided prism terminated by 4 sided Buff coloured when finely levigated. The only way to obtain it pure is to buy it in form of crystals The powdered in the shops is variable sp. gr. 7.2. [illegible] primary operation when taken internally 1t deobstruent 2nd cathartic 3d emetic 1st sialag. 2nd expect. 3d diuret. 4th cholag. 5th emmenag 6th antipsoraic resolvent 7th diaph. From the very situation of the salivary glands the operation on them attracts more attention Next to its dialag. are its cholag. Next its expectorant Next is its antipsoraic Next its diapohoretic, diadretic & emmenagogue in the order mentioned As a cathartic it is useful 1st as a mere reducing agent (a moderate one in moderate entony unless after bleeding) 2nd it may be used much more to make a shock or strong impression & interrupt disease 3d to increase susceptibility to other remedial agents & to equalize excitement Of little value to remove effused fluids as in dropsy it is slow & not hydrag. or to remove offending matter It may be made to operate as an eccoprotic, a laxative, a purgative a drastic cathartic It cannot long be used as an eccoprotic or laxative on acc. of ptyalism Most useful as a purgative. Inferior as a [illegible] cathartic Equally copragogue & cholagog. When suffered to remain in the bowels it is always deobstruent cholag. sialag. The gall bladder will always be found distended with bile or gall after it has been freely given in acute disease. This is often attributed to a spasm of the ducts [Emalging] the liver is supposed to be the only use of giving calomel in fever but then it [opens] the skin and promotes all the secretions It acts on the stomach and upper int. when given in a purging dose Its vomiting power is little valuable but as a cathartic it more nearly resembles an emetic than any other cath. in its operation, & may often be used as a perfect substitute where emet. are indicated. When given as a deobstruent opium shd be combined with it to keep it in the bowels. But when we desire a long continued deobstruent effect give it in small doses but it will always salivate sooner or later A man in health or in vigour is salivated with less diffic than in low atonic diath. or when very feeble or in enton. diath Sometimes it does nothing but salivate This is important to distinguish Sometimes it merely purges without any deobstruent eff. But Prof. T. has always found such cases to have been recently salivated or to have an excessively irritable stomach & al. can. in which it produces vomits Given with diuretics, or emmenag. or diaph. etc. it will prove more especially diuretic etc. Hence the “dirigens” part of the ancient prescriptions Naturally a very slow cathartic dose 5 to 10 grs N.B. we determine the nat. effect of a cath. by the smallest quantity that will produce its full effects When hurried through the al. can. almost all its deobstruent effects are lost. It must also be remembered that its cath. operation is generally its least important operation Prof. T. & his friends have always experienced its good effects upon themselves before the purging began Calomel has been called a stimulant perhaps because it produces irritation sometimes & a mercurial fever which is merely irritation A single author has called it tonic This is still more absurd A large proportion of our medicines do not either stimulate or reduce Mr. Abernethy says there are some patients whose mouths will not be affected & yet the system be under a mercurial action. Prof. T. has not observed such cases The system may be above or below the grade of excitement proper for salivation There may also be certain states of the system in atonic diseases which will not admit of salivation until the state of the system is changed Case const. syph. mercurialised in N.Y. without success also in Phil. also in Botson utterly without success. [went] to Charleston and there some one recc. Dr Todd Dr Todd put him upon a bottle of wine a day & a free use of bark for a week Then gave him mercury and salivated him in 3 days Prof. T. never met with a case which he could not salivate Perhaps by bark & wine, sometimes by combining capsicum with the mercury There is no foundation for the dogma that stimulants must never be combined with mercury his use of opium & bark to bring on salivation from mercury has been long known in Connecticut It has lately been brought forward as a new discovery [illegible] & soreness are more easily cured of syphilis [because] [illegible] can be confined confine your pat. to the house better to the bed. This with opium & diaph. treatment has succeeded in giving action to merc. when otherwise it wd have failed” Most of the baneful effects of mercury in syphilis are probably owing to not giving the proper corrigent etc. Paris seems to be the only author who is aware of the necessity after of reducing the system to the point of susceptibility And even he knows nothing of the necessity of raising the system There seem to be two sorts of injurious effects 1st acute 2nd chronic The dichloride disoxide & diprotonitrate produce the acute more commonly While the proto chloride protonitrate & protoxide produce the chronic They symptoms which show the system to be under mercurial influence are 1st symptoms (previous to ptyalism) cupreous taste more or less swelling of gums sloughy whiteness of gums margins trifling soreness & a feeling of looseness of the teeth A peculiar fetor of the breath Called mercurial A peculiar fleecy appearance of the tongue Then comes the dis Ptyalismus acutus var. hydrargyratus which begins as above vide Good When cal. begins to produce heat, soreness swelling ptyalism sloughing of the inside of mouth and cheek etc. with the mercurial eruption the system is labouring under a severe disease a poisonous effect. Actual salivation is never necessary though it may be convenient to produce a slight one Caries of jaw perhaps with exhaustion & death total loss of teeth fetid breath stiffness and incarnation of limbs etc. may be the emaciation, debility, loss of appetite ultimate results more rarely a lingering death Severe ptyalism is apt to be treated as a light disease very improperly We are not to expect any specific antidote. Yet upon the notion of the absorption of mercury sulphur is proposed Sul. has 2 compd scarlet red & jet black! both are insoluble & no emenctory will the row off a [illegible]! Many suppose that repeated purging with neutral salts is useful in this disease. Another man in Ohio Dr Findley says he cures by tart. emet. “as a gargle & I believe internally” “Perhaps it may be useful topically as an irritant like nit silver.” Prof. T. has repeatedly seen antiphlogistic treatment tried and with no benefit Sarsaparilla (a weak deobstruent supposed to promote secretion is more especially for the kidnies & skin) Prof T. has often tried it for [weeks] with no benefit whatever So have others Lotions and gargles generally fail entirely in the early stages though they are useful in the advanced stage to obviate [atony] and relaxation The frequent gargling of cold water has often been of very high utility Diluted mineral acids have been found especially useful But lotions of the decoction of batesia tinctoria (acrid narcotic deobstruent emetic and cathartic) has proved one of the very best remedies in a strong solut. [illegible] I to zi water and been very popular with those who have tried it Lotions of nit. sil. are very useful (sometimes on account of the irritability, a strong sol. suits better than a weak one Arsenitis of potassa externally & internally useful Prof. T. 2 fz ol. turp. with z fz muc. gum arabic Prof. I. has found very beneficial Very strong inf. of lycopus vulg. has been very useful (bitter & nervine) Coptis trifolia has been employed & is useful Mucilages, acac. astragalus [illegible] [althaea] hibiscus typhus latefolia (root) viola pedati split twigs of [illegible] [sassaf???] [ulmus] [fulva] (rather inferior) but perhaps decoctions of rice and barley boiled long and strained are as good as any mucilages. All these are very grateful to the patient Qinine is often indicated internally to keep up the strength of the patient But the watery solution of opium is the best applic. and op. shd be given internally Milk porridge has always been preferred for diet The next inconvenient effect is Called very improperly erethismus hydrargyratis but has no other name Great exhaustion of strength anxiety frequent sighing epigastric distress vomiting irregular action of heart & arteries pulse small quick frequent sometimes intermittent tongue seldom furred cold extremities perhaps sudden death upon exertion Occurs in the feeble Treat by perfect quiet and opium tonics arsenic etc. It may occur before salivation in the feeble Eryth. vesic var. hydrargyratum Perhaps not distinct from E. [corrosivum] Called improperly eczema & hydrargyria [sepoa] etc. Prof. T. thinks it clearly an erythema vide Good Perhaps his var. corrosivum is identical with this a better description could not be given than his description of E. ves. corrosivum N.B. in erythema you may always see vesicles in a sunlight by a magnifier hence erythema is not a rash. Bateman criticized [erysipelas] & erythema are synonymous Bateman says E. v. hyd. is produced by other causes as cold but that from mercury has some peculiarities N.B. The effects of fire, frost, sun burns, an eruption caused by arsenic etc. are varieties of erythema Preceded by sense of stiffness, itching etc. about a side of thighs and scrotum or about the neck and arms next comes a redness and minute microscopic papula. The redness spreads in large patches over the body The pimples run into each other become large emit an ichorous, corroding discharge The whole body becomes raw, excoriated chapped, stiff etc. In severe cases recovery scarcely comes on in less than [illegible] weeks and may continue 8 or 10 Sometimes the hair and nails come off. The whole epidermis comes off and as is the case with other such eruptions As skin may give off 2 or 3 successive crops of scales. This Bateman’s description and a very good one Prof. T. has witnessed 3 distinct grades 1st merely local in the bands of the joints etc. caused by ointment of mercury 2nd an ulceration in the mouth in children who have used mercurial escharotics too long 3d covering the whole body attended with an irritative fever & general exhaustion Caused only by mercury internally. “It can be cured notwithstanding Bateman’s opinion to the contrary Treatment palliative (Bateman) warm mucilages in lotion poultices mild cerate after excoriation Antimonials & opium and finally mineral acids 7 bark Prof. T. dissents from this treatment (the merc. dries on) He applies at first simple ointment of datura and in the latter stages adds carb. zinc (lap. calam.) He also uses infusion of digitalis just about strong enough to create some irritation (perhaps upon a medium ½ oz to the pint) Infusions of the seeds of datura are useful also Prof T. finds the poultices & fomentations keep up the disease by relaxation The tepid bath may occasionally be advantageous Let the diet be light and nutritious Prof. T. has generally found quinine necessary. He could always give opium moderately Arsenous acid he uses in some way internally. As the appetite is generally small, so that the pat lives principally on liquid food the opium will not be apt to constipate, and if it does castor oil may be given but Prof. I has not found laxatives necessary Min. acids sometimes agree and sometimes disagrees producing tormina etc. in the bowels Prof. T. can lay down no rule Dysenteria acuta var. hydrargyrata It has the general characters of dysentery but there is more irritation & exhaustion. In adults I have seen it in all cases produced by the external Application of [illegible] inordinate quantities commonly called “roasting it in” In children I have seen it more generally brought on by by internal use in repeated doses All that is necessary commonly is the abstraction of the calomel & the vigorous employment of opium. For the exhaustion tonics & stimulants with opium may be needed (Sometimes give calomel hair of the same dog (Osgood)!) 4th Sub acute mercurial rheumatism Liable to degenerate into a chronic state and into paralysis Resembles the idiopathic Attack gradual & insidious little redness or soreness much pain on motion local aff. generally about the larger joints moderate tumefact. no supp sympathetic & irritative fever erratic pains always attended with sweats exac. at night & in stormy weather. Brought on by exposure to cold & rain etc. taking cold In the acute diseases of mercury the physician generally gets the ill? credit. But the chronic diseases have more importance attributed to them even than they deserve many cases are falsely attributed to mercury. 2 cases related of permanent lameness reported to have been treated with mercury neither of whom had taken a particle of mercury one of then had been purged a long time with brimstone & rum It is well known that sulphur will produce similar effects e.g. as perfect a dysentery as that of mercury though more generally it produces the chronic effects. Both mercury & sulphur will produce paralysis etc. Opium capsicum alcohol etc. are important remedies in the treatment of this subacute rheumatism If [illegible] the disease is pretty manageable. The nearer they approach to acute the more useful will actaea be otherwise conium Fowlers sol. Harthrytum [illegible] Digitalis guaiacum If a pat. has got out and is in great danger give him great quantity of alcohol 5th Marasmus tabes (vide. Good) General extenuation with debility, with languor, exhaustion, hectic (Neither Cullen’s nor Good’s hypotheses are worthy of consideration being mechanical)The assimilating capillaries are probably principally affected, owing to derangement of digestive functions. (The stuff about the absorption of oils mucilages, and alkalies, is poor enough) Prof. T. has found opium of more consequence (in tabes venenata) than any other remedy next conium & iron with acrids also cinchona etc. Narcotics must be in small doses frequently repeated, to obviate lesion of the nervous function. Prof. T. has known a disease closely resembling strumous cephalitis which does not exist the effusions being a mere sequel in the latter stages effusions somewhere are the common result of acute disease e.g. in the pericardium etc.) produced in children by excessive quantities of calomel 2 to 4 times a day so long as the sickness lasts and then much large quantities of calomel, would be given & produce a mercurial dysentery for which still larger doses of calomel would be given & finally the parents would refuse to allow their children to receive mercury & consequently the practitioners themselves would see that children would get well without cal. & then conclude that cal was improper for children altogether case of a distinguished teacher in a large town who holds this opinion led in this way When this affection begins, stop your mercury & give narcotics # Prof. T. has seen the same effects (not hydroc. [illegible]?) from mercurial itch ointment An irritative internal haemorrhage is often rarely but sometimes produced “Said to have happened in Eng “said to have been caused by corr. sub Abortion is often produced by a continued mercurial course said to have been produced in France by calomel Fevers treated with mercury in grain doses as a stimulant made hopeless irritation uncontrollable diarrhoea. Mercury often does more hurt by its inconvenient effects than good by its desirable Many practitioners now employ the vegetable deobstrents & use mercury almost only as a slow cathartic. # A [most] [illegible] aff. [illegible] syncopalis is sometimes produces more often by the external use of it for the itch but by the internal use in irritable subjects” Ac. lead is often preferable. it is liable to only one inconvenience viz. [illegible] Sanguinaria is often preferable Actaea is often preferable Conium is preferable, for jaundice chronic liver affections etc. The pneumonitides are better treated without mercury at least as the principal remedy (The rash & careless use, eve of narcotics even of opium, is far less dangerous than that of refrigerants, tart. em. mercury etc.) It is a rule of naval & military practitioners that mercury shd not be used where it can be avoided as it leaves the patients more exposed, for years, to injury from exposure to cold, & wet etc. This applies to all cases of persons liable to exposure i.e. seamen, blacksmiths & manufacturers No remedy is applicable to a greater variety of cases, than merc. exc. opium opium (Dr Chapman says none whatever) It is not in the latter, but in the earlier stages of disease that calomel is especially useful Hence Dr Bond’s rule (vide Chapman’s therap.) always to try mercury as a dernier reasort, as a pernicious one Therapeutic application Dyspepsia it is almost a matter of course to treat dyspepsia with di-chlor & dis-ox. merc. Prof. T. has never seen any benefit except that of an eccoprotic or a laxative and even these other articles are generally better. They are also extremely liable to produce tenderness in region of liver, stomach etc. Let this tenderness exist of itself & even be relieved by merc. they debilitate irritate etc. Yet they are occasionally proper for a short time. Occasionally proper as a slow and moderate cath. It should be employed in but a small proportion of cases Colica ileus important often in large quantities especially in the early stages “Cal. & opium are equally important auxiliaries shd be used” Large quantities shd not be pursued into the secondary stages C. rhachialgia useful in the same way as 3 or 4 dose zi [illegible] are often necessary in the course of 3 or 4 days But Prof. T. thinks corr. sub. & still more red prec. is preferable Coprostasis (idiopathic) large doses in the early stages but if it fails give other remedies Diarrhoea vulgaris moderate diar. may be broken up by vom. by purg. by almost any strong impression Sometimes cal. cures in the earlier stages by its deobstruent effect It shd not be given in the latter stages. Dr Johnson thinks the fashionable British practice of purging protracts the disease Colliquative (tropical, & intemperance & puerperal diarrh. also that of old men contraindicate calomel Cholera vulgaris generally, though a severe not a dangerous disease often protracted by treatment often broken up like diarrhoea by a strong impression as by puking Cal. may cure it by its deobstruent effect. “[illegible] doses of cal. may be good before the vom. & purg. is begun It is of no use as a cathartic nerely because more purging is useless It is of no use unless in an extraordinary dose while the evacuations are large It is not indicated as a sialogogue, nor as a stimulant, tonic etc. It is good to change the [secernents] particularly the liver & al. can. but before giving it check evacuations with opium and produce reaction by stimulants Give it in quantities short of the purging point often combined with stim., etc. Helminthia one of the best articles # Icterus vulgaris may be made to cure purge at first then in alterative doses combined as the symptoms indicate. But conium will cure more speedily and better. Though even with this a purge of calomel may be given at first though not for purging Parabysma eractum conium is better than calomel quinine is better still. Give conium & quinine. All [illegible] the cases that are the primary effect of malaria are best cured by quinine The [illegible] cure the sequel of intermittents by quinine alone Prof T. gives in such cases conium & quinine Anti corysa (often a troublesome disease) an attack may be broken up by a slow cathartic of calomel at night We should not keep repeating it however Intermittent If a cath. is needed at the commencement cal. is the best & is better than an emetic Previous to the use of quinine cal. was often necessary to obviate the inconvenient effects of the pure bark often a sub ptyalism was necessary to be kept up No inconveniences however result from the use of quinine Remittent cal. is of more importance than in intermittent purging & often a subptyalism is needed after which quinine will cut the disease short Typhus infantum very important T. nervosus perhaps only in non-malignant typhus is calomel advantageous. N.B. This is the most common fever all over the U.S. (even at the south testimony of Dr McBride etc.) Employ in the very commencement of an attack say 3 grains once in 3 hours conjoined with a diaphoretic regimen so as to produce a sub ptyalism or in one or 2 large full doses, with opium if necessary in order to keep it from purging under 15 or 18 hours the very best mode of breaking up fever. If we are a little too late, or if the cal. passes immediately off by the bowels, then give enough to produce a submercurial action for a few days and conjoin mild tonics the disease will be [mitigated] & shortened N.B. we do not wish much purging but the universal deobstruent effect of the calomel. Hurried through the al. can. it is no better than any other cath. Even if the disease is completely broken up, yet the patient shd be carefully attended to & treated like a sick person. Prof. T. has resolved 8 cases out of 10 even when the disease has been fully formed. Some of his friends think they have resolved a greater proportion Dr Todd, Dr S. B. Woodward etc. But if the disease is malignant or if the pat. has tampered with medicine, or put off the employment of a physician we cannot succeed thus Delirium tremens sometimes cal. is important where there is insusceptibility A single full dose in conjunction with opium will produce sleep with more certainty. But in the exhausted and broken down it will not answer Yellow fever agreed to be important difference of opinion as to mode of management Prof. T. finds neither purging nor salivation necessary It is agreed that there is not generally time to salivate. Useful in those cases in which there is great torpor & insusceptibility of the system with nearly a total suspension of peristaltic motion If the case is one of exhaustion and one which begins with diarrhoea cal. will be useless. In the other sort of cases tropical writers have given 1000 grs in 4 days without saliv. or purg. Prof. T. has given 400 grs in 4 days without either sal. or purg. In the same case he applied a 7 by 9 blister on the epigastrium one half as large between the shoulders blisters a quarter as large above the ankles 400 grs in molasses a teaspoonful once an hour Patient extremely delighted with the effects of both Stomach would probably have rejected a tablespoonful of bals tea. But in other cases a grain of cal. would pass off in half hour. In this case subsequently to the first 4 days quinine and a moderate use of brandy In the secondary stages of yell. fev. cal. is generally injurious Typhus putridis sometimes useful as in t. nervosus Synochus calomel is sometimes needed for purging oftener as a deobstruent Most practitioners bleed puke and purge and have to stimulate or have protracted and relapsing stages Entonic phlegmonous phlogotica Depletion & neutral salts at first afterwards use cal. for a mercurial action. Dr Rush’s compound of cal. tart. ant. & nit. potas. is the very best compound vary the proportions to suit the case. Determine the proportions just as if you were giving each separately Especially important is this practice in cephalitis still more so in pneumonitis In enteritis bleeding is still more necessary neutral salts will be rejected Calomel is the article for purging give your calomel clear to keep it from being rejected. This is the only cath. you will succeed well with. Atonic phlegm. phlogotica Calomel is very important no bleeding not so much purging s use blistering. Prof. T. has seen no atonic phleg. infl. of brain he has seen only strumous or arthritic or erythematic Atonic phlegomonous pneumonitis purging with a large quantity a strong mercurial action just as in the at. phl. hepatitis of tropical countries N.B. you must be more in a hurry to produce a mercurial action in these atonic infl. than in the others. Prof. T. thinks the weight of testimony among the tropical writers is against bleeding & drastic purging against J. Johnson Phlegmonoid erythematic erythem. known by the fever’s being [synoch] or gravior phlogotica Purge with cal. follow with calomel to produce a mercurial act. followed by serpentaria cinchona etc. Pure erythematic or gangrenous phlogotica (e.g. of fauces) calom. is injurious eryth. cephalitis & pneumonitis cal. is of more importance unless they are gangrenous Eryth. enterities is apt to have a diarrhoea generally has a diarrhoea cal. apt to purge corr. sub & especially red precipitate are better Of late years Prof. T uses conium even in some cases in dram doses Arthritic phlogotica calomel of high importance of late years Prof. T. has often gone back to the calomel practice. Case extreme pain in joints with redness & swelling extreme pain all over Cal. & opium until the pain was relieved it took 10 grs of opium with a diaphoretic regimen next op. & ipecac then a little castor oil to bring away the al. Finally alcohol & cinchona No case lasted longer than a fortnight under this practice. Next Prof. T. employed veratrum viride. Next he employed colchicum but it was inconvenient he has known persons cured of the rheumatism by colch but killed by subsequent diarrhoea Actaea is the best Sanguinaria digitalis Some conjoin calomel with these membranific phlogotica Croup hysteritis cystitis Calomel is universally agreed upon except in croup but even here though vomiting will cure cal. is better or rather both. Prof. T. has ceased to vomit in his own croupy family Strumous phlogotica more useful in the acute according to the general rule that cal. is more applicable to acute phlogotica Several phlogot. not referrible to these divisions Influenza Pneumonitis notha Cholera infantum Dysentery different modes of practice some [illegible] with large others with small doses both are proper in different cases In some epidemics calomel is inadmissible Case of the epid. at Midd. a grain of cal. or of ipecac would bring back the dysentery when it took 40 grs of opium a day to keep the disease under trouble with counsellors Epidemic (Egyptian) ophthalmia a bad disease It is the common practice to bleed the patient almost to death bad Purge with calomel give cal. & op. Bring the system immediately under mercury Treat like tropical hepatitis Conjoin actaea Sparganosis puerperar. Prof. T. has never met with a case in which it was admissible he does not doubt that they do exist Synochous exanthematica (Phlogistic exanth. are talked of but not described authors do not even suppose them phlogistic except a short time at the commencement) Typhus exanthematica contraindicate it Lues syphilis While it exists as chancre and bubo only it is purely a local disease and may be cured topically. 3 to 6 weeks ore even 3 mo saliv. is necessary to cure it through the constitution. Some use both but the topical are those that cure, even in this case But some claim that the absorption is prevented by the const. treat. Now medication cannot be thus [prevented] by anticipating the period of absorption according to the regular laws of the disease Mercury will not relieve the topical disease, without a sub salivation. Many practitioners suffer the pat. to run on a long time without sub salivation. But this may be produced in 24 hours by conjoining opium or perhaps wine & quinine Prof. T. has never known the constit. eff. follow when the disease had been cured topically. Even if they do it will be time enough to treat them when they occur Mercury will even hinder the healing of the topical affection When the father or mother infect their offspring without having symptoms of the disease left on themselves, and the children have a fatal syphiloid affection the affection of their subsequent children may be prevented by mercurializing the parents a curious fact! Prof. T. has sometimes cured such children by conium & corr. sub. The new way of treating syphilis has yet to encounter great prejudice When the const. symph. have appeared perhaps cal. is the best remedy. The others (cor. sub. & red prec.) do not produce ptyalism & a sub ptyalism is necessary The above is a very imperfect account of the therapeutic application of cal. It would require a volume to exhaust the subject Pneumonitis notha is or common pneumonitis always synochous or typhus. Atonic phlegmonous pneumonitis has a nervous fever accompanying it. N.B. Edema of the lungs (of Dr Hooker) is not a pneumonitis Erythematic cephalitis is the disease described as a fatal erysipelas of the head but the eruption comes not out till 3 or 4 days have elapsed and there is light generally on the face. Other erythematic empresmata are attended with eruptions somewhere that of the lungs (liver?) is on one or both extremities. Fever varies from synochous to t. gravior “I have never known calomel thrown up when put into the mouth & swallowed with the saliva” From [Savage’s] notes Tonics Produce increased strength of action in subordinate parts of the system e.g. appetite, digestion, pulse, muscular & mental action removes morbid mobility & irritability of atony Mr Abernethy says all strength depends on strength of digestion. But some tonics increase strength of art. act. (e.g. arsenic & cinchona) before they increase appl. & digest others first increase appetite & digestion & subsequently general strength. Hence an important rule for selecting tonics to suit a case e.g. Intermittent does not require those which act by increasing appetite Prof. T. has found the above true of cinchona, liliodendron & magnolia Tonics do not act rarely on the muscular system they certainly increase the contractility of the cell. fibre All tonics increase art. energy those articles which act on parts of the system without strength the arterial syst. are not tonic. Prof.’s I. & T. deny entirely that tonics produce ultimate debility They have known bark iron used many years with increase of strength Bark for 12 yrs vide Heberden Bitters are not necessarily tonics metallic articles are not bitter Some tonics, as cascarilla? bark of croton tiglium? etc. cinchona quinine require liquid food to make them sit well upon the stomach. So alc. requires food in exhaustion of fatigue Case of a traveller or laborer. The above tonics approximate to stimulants. Much depends on a knowledge of this principle in intermit. for inst. quinine may thus be prevented from producing a sense of stricture, nervous symptoms etc. If you excite the appetite, the stomach must have something to act on Tonics are indicated in some stage or other of all atonic, debilitating diseases They are better understood than any other articles Groups 1st tonica [amara] simplicia Limaronba excelsa (quassia of the shops) Quassia amara. Scutellaria [illegible] Little inferior to quass. & generally preferred by patients pure simple bitters like quassia [chelor??glabra] [illegible] [Hanth???] much used Canadensis like columbo a [???folia] hydrastis Gentiana [illegible] etc. The [illegible] gentians have smaller roots but are as good [illegible] [illegible] is best [chrymoplenum] [apporeti] [colum?] possessing the same smell taste & chem. prin. but pleasanter & preferred by patients [illegible] Canadense allied to Cocculus [illegible] (Columba) Menyanthis trifoliata buck bean Helnium autumnale Gratiola aurea These are mostly amer. articles & as good & cheap as foreign 2nd amara [nervousa] [illegible] G. [ochro???] is good G. saponaria is one of the best G. quinqueflora & other northern species are not so good Tops & roots are used. [lupules] (best) hoarhound Lycopus vulgaris (water hoarhound (L. virginicus is much feebler, but is most used Ballota nigra nearly allied to hoarhound 3d amara narcotici barks of cerasus virg. C. oborata the best of the genus Sorbus oborata & necrocarpa Pernica vulgaris barks of all of them 4th Tonica amara astringentia though some are merely astringent to the taste Cinchonae a large num. of species Corni C. sericea probably best next is probably C. circinata & paniculata C. florida inferior more astringent Querci Q. alba & tinctoria Alcornia latifolia Bodygin (alcorn [oaks]) Alnus serrulata (may be used for cinchona) 5 amara aromatica Galipea off. (angostura) magnolia glanca umbrella cordata etc. etc. valuable (elegant aromatics intensely bitter) Next is siriod. tulip. Ilicum floridanum (both aromatic & bitter) Croton eleutheria & cascarella & aromaticum (cascarilla) Tasmania aromatic similar caryea amara, squamosa, procina & alba (pungent aromatic acrid reminding one of guaiacum) Ptelea trifoliata bark of root & top differ considerably Hanthoxylum fraxinem (less bitter) H. tricarpum & H claraberculis (most valuable) Dryni winteri (winter bark resembles canella more agreeable almost a spice) Drynis of several other species Canella alba (called canella also) 6 Tonic. amara laxative [Federia] cordifolia (much used by the Spanish Americans the fruit) [Grellindina] [illegible] & bond cella Gallindina bondere (nickernut) [illegible] as [illegible] etc. blue & yellow nicker nut # Eupatorium perf. & rotundif. Polygala polyg. or rubellum (purges like aloe) but may be taken as a tonic without being laxative) A good bitter tonic & laxative in dyspepsia 7th metallina. Vinous prep. or iron ox. zinc hyd. bismuth sulph zinc arsen. potash & soda nit. silver Copper sulphate acet. & [nitroguret] (C. ammoniata) # preferred by g. Johnson to peruv bark in tropical climates Habille Carthagena Carthagena bean used in dysp. with torp. of bowels Arsenous acid White oxide of arsenic The word arsenic occurs first in [illegible] & applied to a sulphuret of arsenic used in painting Avicenna first recommended it internally The garlic smell is now known to arise from the dix-oxide which is the substance condensed on the tube & formerly called metallic arsenic Arsenous acid is seldom formed by chemists it is collected by the smelting of ores 77 ¾ parts and soluble in boiling water 1000 parts; in cold water only 2 ½ parts soluble in the 1000 parts. Composition 2 i ars. 7-6 ii 3 ox 24 = 100 In uniform & small doses, repeated acts on circulating system as a tonic increases heat (in a tonic coldness secondarily it increases appetite dig. power & ultimately after removing the disease muscular power Dr Potter (in his monograph) says it acts first on al. can. but its first perceptible effects are upon the sangiferous system No doubt it acts firs on al. can. but so do all remedies Given efficiently it certainly affects the sanguif. syst. before the app. & digestion. When given in nauseating & vomiting doses it of course acts first on al. can. More speedy than any other tonics but less so than the stimulants. It may be made to show its effects in 24 hours. It thus resembles cinchona in its effect on [illegible] & gangrene It has the remarkable fact that it has the power of restoring warmth to the surface though with no distinct relation to its tonic power Prof. T. has witnessed this perhaps 50 times Some patients have thus been saved. It may fail thus as an “analeptic” like other analeptics in extreme last stages This article seems to be an intermediate link between tonics and stimulants In larger doses it acts on the whole sec. & abs. syst. affecting the skin tumours ulcers etc. It is strongly antipsoraic relieves ulcers, cancers It is useful in rheumatism hence redolent Not discutient cholag. sialag. expect. or diaphoretic Acts on the brain & spine more than any other tonic & that too in remedial doses No other metallic preperation produces vertigo tremors etc. This operation has no name nor classification Prof. T. has seen however dilated pupils etc. in domestic animals from oxide & carb. of zinc. Oxide carbonate & ac. of lead act on the nervous system producing colica rhachialgia. Oxide and carb. of zinc have time immemorial been called poisonous and this must result from an operation on the nerves for they will not produce local irritation In large quantities laxative & purgative In larger it is emetic Externally applied it may be made to cure cutaneous diseases & to act as an escharotic. Dr Potter (Baltimore) says that in certain doses it is laxative and emetic It increases force and fullness of pulse without rendering it hard not admissible in phlogistic diathesis changes secretion and absorption is analeptic etc. not diuretic nor diaphoretic children bear larger doses than adults etc. N.Y. Pharm. “tonic, alterative, escharotic” Prof. Frost of M.M. Charleston says it is useful only as a tonic The injurious effects are caused by long continuance, rather than by a large dose so too of ac. lead. In acute diseases the larger quantities are of more consequence long continuance in chronic Antirritants enable larger doses to be taken generally opium in acute and conium in chronic. Veg. acids & aromatics assist it. When used freely conjoin liquid & farinaceous [nutriment] just as with quinine & stimulants The Philadelphians think it resembles tart. em. most not much foundation for this notion except as it vomits and purges Sulph. zinc of iron & of copper resemble tart. em. as much Even cinchona may be given in nauseating doses and all these then given are reducing of course Tart. emet. is of itself a refrigerant. We cannot class together articles which agree only in nauseating. Who would think of curing intermittent with tart. em. Tart. ant. & [illegible] are thought to agree in their antipsoraic power but the former is merely diaphoretic & has no antipsoraic power whatever Prof. T. came to this conclusion from observation before reasoning at all upon the subject. They both act upon the skin, but in different ways. To be sure some practitioners use arsenic in non phlogistic cases as a refrigerant & in the same way might sulph zinc etc. be managed. It is a kind of experimentum crusis that arsenic cannot be used in phlogistic cases Some suppose arsenic acts only by producing its own specific disease but it may be made to cure disease without any thing of this [effect] though this may sometimes be necessary [This] is true of all active medicines & when so pushed they produce diseases more or less specific Some think arsenic acts in a manner incapable of classific. & they call it merely alterative. But every remedy must produce an alterative operation of some sort or other and the alternative operation of arsenic resembles that of sulph. zinc of iron etc. & other tonics. It seems to be fashionable with some to deny the pathological conditions which are the foundations of the classific. of m.m. & they reduce every thing to a specific morbid affection overcome by another specific morbid action. Prof. T. thinks that all the operations of remedies may be classed Entony indicates refrigerants Atony stimulants etc. etc. Rec. [illegible] arsenic is 1st tonic strengthening pulse obviating debity increasing muscular strength etc. 2nd deobstruent curing cutaneous diseases cancerous ulcers resolving topical infl. 3d cath. 4th emetic 5 epispastic in the sort called escharotic & anti psoraic. Prof. T. thinks it far less injurious in its effect than polygala senega ornithogalum squilla & tart. em. (Hive syrup made of these three does more injury in a year than arsenic ever did) Tart. emetic causes many deaths, arsenic never does, when given as a medicine. It is accused of producing in inordinate quantities & when too long continued dyspepsia marasmus etc. But the same accusations have formerly been repeatedly made against cinchona It will never succeed when given rashly by dashing etc. as is so fashionable by larger frequent doses producing unequal excitement When too long continued & in too large doses it produces a puffy swelling of the skin & lips ophthalmia tarsi erythemia tormina etc. Dr Potter Good in his article on headache gives a summary of its ill effects These effects are more easily cured than such effects from tart. emet. An erythema vesiculare is produced by its analagous to that o f mercury. Case of Dr Todd’s pat. metastasis of pneumonitis probably arthritic to the brain took several fl. drams!! with 24 hours of ars. sol. of tinct. opii ([illegible] 120 and 240? tinct. canth [illegible]) & tinct. canth. in the second 24 hours 200 m. SS 120 m. t. canth 120 arsen. solut. In 48 hours hemiplegia cured erythema was produced with puffy swelling etc. In poisonous doses vom. purg ptyalism dysentery, haematuria sunken countenance paralysis convulsions etc. subsultus & death etc. etc. Dr Potter He says mucilages and oils are good for nothing as antidotes neither is sulphuret of potassium He directs to evacuate thoroughly & then treat on general principles Give castor oil etc. # Dr Bartlett gives as sympt. astringent metallic taste naus. vom. fetid breath ptyalism dysentery, distress etc. etc. It seems to be capable of extinguishing vitality without any of these effects in a transcending dose vide Orfila for a case So too vomiting doses will transcend its tonic effect & soon Arsenous acid retains its full powers in every form of combination, so long as its identity as an acid in combination, is preserved; so that, if you give any salt of it, enough to contain a given quantity of the acid, you get the same effects that you would if the acid were given isolated. Hence the folly of giving “chemicals,” as directed by the toxicologists. # The sequelae are dyspepsia, debility paleness, sallowness etc. etc. Pharmac. prep. 1st substance in pill Rx ars. ac. [illegible] fx. soap q.s. ft. massa in pil. 120 div (N.B. the salt thus formed in the same power as the arsenous acid) This is a very convenient prep. In acute diseases the dose varies from 1/24 to 1/12 gr. 3 hours to every hour (acute diseases) In chron. diseases 1/24 gr. 4 times a day is a minimum & 1/12 gr. a max. dose Tests of too large a dose [vertigo] etc. etc. tremors, nausea Either of them should cause the dose to be diminished Test of too much in 24 hours constant vertigo restlessness or tremors or headache general uneasiness sense of inflation at stomach or tormina or a laxative eff or a sense of inflation in epigastrium Test that pat. has taken it long enough puffy swelling under chin or face or ankles or under chin backs of the hands, a stiffness & [illegible] [illegible] slight ophthalmitis tarsi swelling of upper lip slight salivation or moderate tenderness of gums or a little ptyalism sometimes general swelling of body or erythema vesiculare. All go off soon if med. is left off. may exist several days without injury. Any one indicates a discontinuance Generally swelling appears first under chin & on backs of hands or wrists. Prof. T. has know them continue a week with no injury The salts of arsenous acid have the same effect as the acid & in the same quantity of acid 2nd Liquor arsenicalis Arsenite of potassa etc. etc. [Solutio] Fowleri Rx ars. ac. in very fine powder very pure carb. pot. aa 64 grs. distilled water 1 pint compd spt lavander zfs Boil & add the spt. lav. then add water enough to make up the pint. (Better add less than a pint at first say 14z & then fill up to a pint) This is Fowler’s original formula Phil. phar. N.Y. ph. gives arsenic ac. & sub carb. pot. & alcohol!! The compd spt lav has the advantage of giving taste colour & [illegible]. Case a colourless & tasteless sol. of ars. prescribed by Dr [Cogswell] for a [herpetic] patient. He refused to take it longer “as it was nothing but water” Dr C. told her wht it was & she refused to take it! This prep. gives 1 gr. ac. to 2 fl z of liquor hence 10 m. = 1/12 gr. & 15 m. = 1/8 gr. N.B. the solution requires a smaller dose the pill being gradually dissolved The liquid preparations of arsenic must be kept closely stopped & excluded from the light for the dis-oxide is precipitated on the inner surface of the bottle This decomposition will finally take place under any circumstances Pills shd not be given after they become hard Prof. T. has again and again known opium pills pass through unchanged. Pills of iron & conserve of roses may be cut & polished Rx arsenous ac. [illegible] fs sulph. quin zii sil. morph. 15 grs. ol. caps. f zfs. ext. daturae q.s. ft massa in pil. 120 div. N.B. Tonics are combined with advantage and narcotics is advantageously combined with arsenic This pill does not harden It answers extremely well in hemicrania & neuralgia etc. Each pill contains Therap. appl. 1st Pytal. ac. var. hydr. with secondary & advanced stage when it is subchronic very important it frequently arrests also useful in early stages when not too irritable & even in those combined with narcotics A most important article. Dysphagia constricta var. schirrhosa conjoined with conium [Dipsoneus] avens var. [illegible] conjoined with op. conium & capsicum Limosis dyspepsia Prof. T. has always used in various cases So has Dr Todd who combines quassia & ginger sometimes he conjoins conium or conium & veg. acrids So has Dr Reed who adds conium, dandelion capsicum etc. persevering in its use for a long time N.B it may be taken for a long time conjoined with veg. [ton.] conium & capsicum Prof. T. has even accomplished much with it alone preferring the substance Rx ars ac. [illegible] fs sub. quin zii ol. caps. zfs ext. con. q.s. ft. pil 120 often adding more conium or giving conijm in conjunction in short varying the prescrip. pro re nata Limosis sputatoria may always be cured by this article alone or combined Lim. syncoptica (cardialgia syncop.) here acrids are more important in in conjunction Col. rhach. combined with opium will keep the symptoms at bay. Opium is allowed to be the most important article in this disease but will not cure alone It is found that a free use of cal. is necessary corr. sub. better Prof. T. finds red prec. better still. Practitioners tell of given 5 gr corr. sub. every [2] hours!) Prof. T. has given 5 gr. red. prec. Fowlers sol. has been given in z doses without vomiting Arsen. has been given in gr. doses There is something peculiar as to the operation of min. med. in this dis. Dram doses of [illegible] have cured with opium opium shd always be combined Arsen. & strychnine are admirable for the paralytic sequelae with auxiliaries Colica callosa var. schirrhosa Epidemic cholera (it is the fashion to attempt its cure by strong impressions merely The originally incurable cases & the trifling ones shd be excluded) perhaps along with other articles it would answer well when the discharges have been stayed. Helminthia insisted on by Dr Potter the variety of this disease is not specified. It would scarcely be worth while to resort to it in any but H. taenia to improve the cond. of al. can. relying on cath. of ol. pin. to remove the worm helm. fasciola hominis (fluke or gourd seed worm) rather a rare & a very obstinate disease (N.B. in sleep the fasciola [ovis] passes into the liver up the ductus communis & cannot be wholly cured by cathartics may not this be the case with [illegible] case Prof. T. has never known a case of complete cure arsenic does much the most good seems to be by for the most effectual remedy) Helminthia erratica probably Proctica schirrhosa & parabysma schir. parabysma, strumosa arsenic conium acrids quinine cantharis conium & arsen or con. & iodine the best preparations iodine corrosive subl. etc. Bex convulsiva a long known and a well established remedy conjoin ext. con. which has been relied on exclusively Dr Beery has often found ars. pot. alone of the highest service in sequels of hoop. cough Intermittent next after quinine & perhaps the best bark in substance. It may be taken with less in convenience than bark and the latter cannot be given [illegible] to small children Vide Good for its history The instances of supposed derangement with particular doses are merely cases of too large doses for the particular circumstance Give say 8 doses in 24 h. instead of 1, 2 or more as directed by Dr Fowler (N.B. give a med. at the hours of 3, 6, 9, & 12 & but 2 doses will come in the night) Give 10 drops at least of SS. with each dose Trouble not yourself about the bowels they are generally well enough better give injections than cath. if the bowels are not spontaneously moved once in 2 or 3 days. It is well known that metallurgy in a neighborhood cures & prevents intermittents Dr Good’s case of Cornwall is not the only one known The dose shd not be large say 5 to 10 drops nor the quantity as to produce the tests often once in 2 h. never less often than once in 3 h. sometimes once in 1 h. always conjoining opium ( which itself will cure interm.) Periodicus remittens as useful compared with quinine as in intermittent though not as important in the former as in the latter. It is even said to be more unfailing than in inter. Typhus nervosus seems absolutely to be the best tonic better than quinine to be given to check coldness & cold sweat & to change secretions always when mercury seems to be indicated always conjoined with [opiate] & food perhaps with acrids sometimes 2 drops once in 2 hours or 5 drops every 3 hours sometimes more sometimes less. Typhus syncopalis vide Danielson & Mann’s account It has been used in every epidemic Anthrax pruna just as for gangrene Erythema gangrenosum but sul. quin. is of more consequence Erythema anatomicum saved several cases known to Prof. T. before quinine was discovered in one case 10 drops an hour. In but one of several cases which Prof. T. has known was there a puncture all of them resulted from exan. recent subjects one case began by a sensation resembling a sting & a minute discolored spot on the middle & fore side of the fore-arm. Ophthalmitis tarsi & psoriasis palpebrarum (which exists) probably would cure as it affects the eyelids Ancheritis strumosa (glands of neck) Cephalitis strumosa [illegible] [illegible] etc. Arthritic cephalitis highly useful Paristhm. erythem. var. putrida Pneumon. typhodes erythem. & syncopalis & putrida (gangrenous & Pneumonitis arthritis ver. atonica So arthritic carditis, diaphragmitis, & gastritis Cholera infantum Enteritis aphthosa (Prof. T. has seen two p.m. ex. which showed the whole al. can. affected) Dysenteria typhodes in the latter stages with opium even in the early stages Prof T. has known it beneficial combined with opium & used instead of calomel Mesenteriti strumosa (enlarged mesenteric glands) may almost or quite be cured in its early stages Give acrids quinine, iron cantharides, conium & especially arsenic Eryth. infl. of liver (hepat. typh. var. putrida) in secondary and exhausted stages. So to [peritonitis] typhodes var. putrida All the varieties of true rheumatism in some stage (even in the entonic, after depletion & reduction One var. of rheum is phlegmonia another is [erhthematoid] (not mentioned expressly in the books and a very formidable disease prof. T. has known one quarter of surp. of body gas [illegible] after depletion & reduction) opium conium quinine alcohol conium actaea arsenic Subacute rheumatism may often be cured by arsenic alone. Prof. T has known bed rid persons cured this seems to be the best article. The sub-variety of this disease produced by mercury are especially benefitted by arsenic Chronic stage of acute rheum. benefitted by ars. but more especially by aralia [bispida] Podagra larvata (atonic gout (Cull)) a form of rheumatism as resembles this (Theumatism larvatus) Rheumatalgia useful with conium & nux vomica more useful as it is more acute particularly when there is an early tendency to paralysis of extremities but should then be combined with ol. pip. nig. or ol liriodendron ol. caps. etc. [illegible] conium, nux vomica hyoscyamus sciatica useful conjoined with narcotics I have often cured [with] sometimes relieved by mercury when first commence & by other means arsenic one of the best articles where established Secondary & exhausted stages of scarlet fever Erythysmus hydrargyrata & tabes venenata Ricketts I have known it used with beneift in the early stages [illegible] syphilodes & syphilodes (vide Good) with black pepper much used in the east (vide Good) There is no doubt of its efficacy in S. syphilodes. Perhaps there is doubt as to true syphilis Arsenic is peculiarly valuable with quinine and opium in the ulcerations etc. from syphilis & excessive use of mercury Useful in syphilitic eruptions Carcinus vulgaris highly valuable it has sometimes produced sloughing & a cure the difficulty in managing it is that practitioners are too much in a hurry attempting to take the disease by storm and not conjoining supporting remedies & narcotics cancer is a disease always requiring support it is a disease of the abstemious never of the high living & gouty Prof. T. has known it so employed & the health improve. But iodine is better & next after arsenic is corr. sub. arsenic is next to iodine (vide Good) IT is the basis of almost all the secret remedies for cancer. of course caution is required for its use There is no foundation for the notion that the system geta accustomed to this remedy & ceases to be affected by it in such cases the dose should be increased similar assertions are made respecting opium & with no foundation. The great difficulty with authors has been that they supposed they must give it alone & only twice a day Prof. T. has witnessed several cases of unquestioned cure & others of great palliation and mitigation Elephantiasis arabica has been highly successful (vide Good) used in the east, with a considerable quantity of black pepper. “It is proved beyond all doubt that the disease has been cured by arsenic” Prof. T. has known a few cases and all were cured by arsenic alone [B??nemia] Indica Prof. T. has seen several cases and Good has done ill in associating it with spargm. puerp. which is a phlogisticum. His cases were cured by arsenic alone Gangrenous sphacelus arsenic seems preferable, perhaps, to bark though not to quinine Prof. T. has known gangrene or [illegible] [illegible] of paralytic rheumatics cured by arsenic So to of gangrene after typhus Gangrena necrosis (dry gangrene Gangrena []?staliginea] (mildew mortif.) recommended I have known vitiated ulcers highly benefitted Hypochondrias recommended Trismus & tetanus arsenic & datura & opium have cured bad cases. vide N.E. Journal of Medic. Prof. T. has known several cases cured by it. actaea too is often useful Neuralgia faciei [illegible] etc. but generally it is badly managed some cases may be cured by quinine alone arsenic alone, opium alone etc. but generally a combination should be used N.B. keep the pot. under the influence of it all the while not merely during the paroxysm Clonus palpitation & singultus are occasionally relieved by arsenic Singultus of typhus & low pneumonitis typhodes is best relieved by arsenic [illegible] case of 200 drops in one night Chorea sometimes cured by this with strychnous, quinine etc. Lysse canina some cases apparently cured Common convulsions [of infants] occasionally Hysteria epilepsy sometimes are tonic Paralysis one of the most valuable remedies with iron acrids etc. Distortion of face from paralysis Sarcoma schirrhism (curable by extirpation even at an advanced stage Prof. T. has never known a complete cure by extirpation of carcinus vulgaris Dropsy of abdomen after evacuation of water supposed to be be peculiarly appropriate Leprosy (vide Good) peculiarly valuable Lepidosis psoriadis arsen. con. etc. particularly valuable after a very severe disease (vide Good) Ecpyesis impetigo, herpetica (herpes of Cullen & herpetic eruption of authors) always curable by arsenic if persevered in useful also eternally in a weak solution Ecpyesis imp. [lamin.] (salt [illegible]) about the hands cured by a weak ointment of [arsenic] N.B. medicines will not cure when applied only when the disease is so irritable (in a sort of paroxysm) that the phys is sent for they then require only emollients the arsenic shd be applied about 8 grs arsenous ac. to 1 oz simple cerate to commence with first finely pulverizing the arsenic & mixing it with about a dram at first of the cerate to make the mixture homogenous (N.B. not a glass but a Wedgwood’s mortar pulverization cannot be effected in a glass mortar) [Ecpresia] [?origo] galeata Prof. T. has cured cases which had resisted all other remedies internally & externally Punctura venenata (vide S. Coop. Surg. Dict. last Am. ed.) used successfully time immemorial in India In Ohio they cure by laudanum giving enough Dr McBride & Dr Osborn of N. York who had practised at the south, considered alcohol infallible The people sometimes get down a gallon of spirit in 24 hours. [Celsus’] remedy was vinum cum pipera [cernatic] snake pill is Rx arsenous acid root of vella navi of another seed of croton tiglium live quicksilver, black pepper aa equal quantities each pill to contain 6 grains each pill will contain 1 gr to a teaspoonful of Fowler’s solut. and 2 or even four pills are sometimes given Case of Mr. Ireland pat. insensible in 10 min. fl. zii Fowl. [min.] sol. etc. at once. (Dr Hubbard’s case repeated once every half hour until an ounce of Fowl. sol. or 4 grs of arsen. had been given. Four other cases cured in the same manner. Cinchona First introduced into Eur. in 1640 Condamine saw the plant first in 1737. Linnaeus called all the spec. C. offic. (including C. condaminea & pubescens) C. condaminea is believed to be the original “bark” near Soxa a slender shrub 18 ft. high There are now made 8 distinct general 1st cinchona 2d pynchnea exostemena etc. All the species are bitter and tonic but none are remarkably antintermittent but those with hairy & woolly blossoms Decandolle gives 16 species of cinchona Pynchnea has but a single species in S. Car. Nat. Order Cinchonease Three species are made offic. in Brit. phar. 1st cinch. cordif. supposed to produce yellow bark but it is found not to produce it Yellow bark has odour aromatic etc. internally of a yellowish cinnamon the particular species affording it is not known contains 1st [illegible] of quinine & a little [illegible] of cinchonum 2nd tannin (a little) 3d a yellow odorous [adipocere] 4th a yellow colouring matter 5 a red colouring matter 6th [illegible] of calcia 7th fecula Cinchona lancifolia affords the pale bark though by some to be identical with C. condaminea or a variety less bitter than the preceding cinnamon coloured internally. C. condaminea contains [mainly] kinnate of cinchonine with a little kinnate of quinine with other unimportant princ. Cinch. oblongif. supposed to afford the red bark but found not to producing an inferior bark odour and taste similar to the last but more intense bark red 2 Kinnate of quinine & kinnate of cinchoniae in about equal quantities said (doubtful) twice as much of one & 3 times as much of other. The true species which produces red bark is not known. The barks of all the species are collected indiscriminately and afterwards assorted according to colour probably it is impossible to assign the true species. Cinchomine is a white alkaline substance soluble in 7 or 800 pts water decomposed at about the temperature of boil wat. little soluble in ether ([hydric]) made up of carb. nit. ox. & hyd. Quinine is a white flocculent alkali soluble in wat. very soluble in alcohol taste much more bitter than that of cinchona less soluble in water very soluble in hydric ether & thus distinguished First brought into notice in 1820 by [Pellit] & [Cam??ton] Kinnic acid is found only in bark & not medicinal Kinnate of quinine is very soluble in water but less soluble in alcohol Kinnate of cinchonum is more soluble in wat. & is more astringent (if indeed the kin of quin. is astringent at all) Water is incapable of extracting all these salts from the finest powder of bark not more than 1z of the whole hence the dregs are worth saving for the extraction of the quinine & cinch. from them N.B. none of the veg. ac. have as strong attraction for bases, as the mineral acids & generally sulph. ac. has the strongest attraction hence very dilute sul. ac. will dissolve out all the quinine & cinchonium & we have a liquid solution of sul. quin. & cinch. Ammonia will take away the acid # then macerate in alc. & various impurities will be left then distil off the alc. till the liq is muddy then cold distilled water will precipitate the alkalies repeat the process for purification if necessary The [illegible] is not in quantity to act medicinally but will destroy tart. ant. or sulph. iron or gelatine hence too an infus. of nut galls is a test for distinguishing active from inert barks, by forming a precip. of gallate of cinchonium ([illegible] is [art]) Much inert bark is sold [illegible] a pat. took inert bark for 12 weeks then was cured by good bark you cannot tell by the taste All the best bark is now used by the manufacturers of sulph. quin. & the’ poor bark is pushed into the market # and decant off the liquid sulph. amm or use a magnesia in the same way But we should never used the crude bark it is better in no respect whatever And sulph. quin. is now cheaper. Connecticut practitioners know little about the matter not having opportunities from endemic influence. N.B. Some practitioners conjoin tartar emetic with bark the latter destroys the former the former does not injure the latter Tannate of antimony is perfectly inert It is stated that 2 fl. oz of decoc. cinch. (zi to 1 pt. water) renders inert [illegible] I tart. ant. consequently a pint would decompose tart. em. zv So too bark is incompat. with the salts of iron Food is generally required with bark but bark with animal jelly will form leather! in the stomach Gallate of quinine & cinchonium is supposed to be nearly inert Case in which an [illegible] phys. rendered bark palatable by nut galls! the mixture was pleasant but perfectly inert The proportions of acid & base in sulph. quin. & cinchon. are not well known Adding a little sulph. acid renders them much more soluble forming a salt with more acid N.B. if the mixture then becomes acidulous, add a little more sul. quinine. Prof. T. has always found acidulous sulph. quin. more instead of less nauseous Case related Phosphate of quinine is said to be better than sulph quinine said to contain some of the powers of phosphorus doubtful should be attended to Some think the acetab. better others think it worse probably little if any difference much less soluble very liable to precipitate when it grows colder. Tartrate oxalate gallic etc. are insoluble in cold water. The isolated bases (quinine & cinchonium) are less soluble than the sulphates or are insoluble but they are no less active The French to the contrary notwithstanding. Crude bark is very variable in strength offends the stomach etc. In tinct. requires too much alcohol For these and other reasons always use the prox. princ. Cinchoniae & quinine are found by Dr Elliotson to possess precisely the same powers as their salts Montannin has been extracted from C. montana equal to quinine & cinchonium in utility Chlorium bromine & iodine form inert compounds with all these alkaline proc. [prac.] [prin] still they will into decompose their salts The only medicinal operations of the 3 species of cinchona are the same in kind if not in degree They are all permanently & strongly tonic with a moderate degree of astringent power Quinine & cinchonine are not astringent Caventon & Dr. Theodore Woodward (a very susceptible person) have experienced nervine exhiliration from quinine “in large quantities however 30-60 grs a day” Other persons experience this effect. Dr Woodward always experiences exhiliration This is one of the tonics which is felt in the circulating system before it affects the digestive organs. It is by no means remarkable for giving an appetite In some cases where large quantities in a short time are indic. (as in interm.) the appetite is actually diminished. It is inferior to many articles for the appetite & digestion. It may require several days to affect the appetite Called stomachic Called febrifuge by which is meant that it is appropriate for intermittent Called antiseptic i.e. stimulant or tonic The yellow bark is considered best (it is said) in Peru. Some think red bark nauseates more Bark produces no inconvenient effects but nausea & diarrhea in large quantities Dr Th. Woodw. says the only unpleasant effects from the largest quantity of sulph. quinine are a sense of astringency in the stomach & a sense of faintness which however he relieves at present by always giving a little food (milk porridge for instance) A Frenchman (Blonde) is said to have noticed a short continued deafness, produced by a large quantity of sul. quin. Probably he mistook a symptom of the disease for the effect of the medicine Dr Elliottson cured nearly 200 cases of fever with sul. quin. 5-10 gr doses & inferred that it is adapted to phlogistic fever. He meant irritative Equal confusion exists about the use of bark in acute rheumatism Most of our cases of acute rheumatism at the present day are atonic and many of our practitioners give quinine freely in rheumatism & relieve heat, dryness of skin etc. Some of them infer hance that bark is adapted to phlogistic fever It is the fashion to call bark a congesting tonic. It was the fashion long ago to do so. But Sydenham Morton & others denied this No foundation for the notion that this article may accumulate in the system or its effects accumulate upon the system. Arsenic, mercury instead of accumulating in the system produce a slight set of changes which go on increasing Prof. T. does not believe that disease is ever produced by cinchona after health is restored no effect will be produced. Dr Ives is of this opinion He has known it take for a year or more with benefit. Heberden knew it taken for 12 years with advantage etc. Admissible in all atonic contraindicated in entonic diseases Pharmaceutic preparations The salts of quin. & cinch. are sol. in wat. & insol. in alc. Quin. & cinch. by themselves are sol. in alc. & insol. in water Yet is laid down in all the books that alc. is the best menstruum this can hardly be true (probably the mistake has arisen from the utility of the alc. of the tinct. in intermittents) Infusion is better than decoction Boiling almost destroys the properties of cinchona Maceration in cold water extracts but little. Yet the pharmacop. direct to boil 15 to 30 minutes Never boil but about a minute Pour the water boiling hot on the powdered bark than stand scalding hot ½ or ¾ of an hour then boil it up about a min. This gives a decoction [illegible] Troy oz. bark saturates a pint of water Make the infusion in the same way but do not boil up at the end 1 Troy oz (1 oz. of avoirdupois oz. will not being less) saturates 1 pint of proof spirit It is not worth while to give in any form but substance in intermittent in any form but substance in continuous fever, as it will be thrown off or pass off. Therap. applic. 2st Intermittent Quinine the most important medicine In all pure and uncomplicated cases of quot. quart. or duplic. types these salts may be considered as infallible remedies. If costive, purge once with calomel (the best agent) Check diarrhea with opium. If stomach is full, vomit with sub. zinc, copp. or turpenth min. or purge with calomel. Perhaps in no disease are emetics & cathartics as much abused as in this It is a routine Sometimes the disease is thus brough back There is generally a natural state of the bowels, no fur on the tongue etc. Sulph. quin. & [illegible] are equally admissible in the cold the hot and the sweating stage & during the apyrexia. Many deny this, and yet give large quantities just before the paroxysm even [the] min. before! The article does not operate all at once but gradually Generally Prof. T. does not interrupt a paroxysm when he is first called Sometimes however he gives a large dose of quinine to cut short the cold stage & bring on the hot, or in the hot to bring on the sweating stage immediately Inappro 3 grs to [illegible] i is the appropriate dose once in 2 to 6 hours Quin., & cinch. require the same quantity as their salts [illegible] i is the smallest quantity with which Prof. T. has ever cured a case more would have been better Prof. T has known 10 grs. once in 2 hours necessary to suspend the paroxysms A writer in the Philad. Journ of large experience in intermittents lays down 20 gr. once in 2 hours as the common dose for all cases Case of a phys. who was much surprised to hear Dr [March] doubt the existence of phlogistic intermittent he took him to see such a case in the hot stage Dr March gave 2 or 3 grams of opium & cut short the parox. in 30 minutes He gave sul. quin. & the pat. had not another paroxysm A timid and inefficient use of sub. quin. will even aggravate the disease Just as with opium Dr March has repeatedly been called in clandestinely to cut an intermittent short at once which had continued under an able phys. 6 weeks! Time of continuance is variable Do not suspend the remedy immediately after the cessation of the paroxysm especially if the pat. is in a very unhealthy situation Perhaps a dram should be considered the minimum quantity to prevent a relapse Under the treatment here recommended not more than one paroxysm (not even a single parox.) after the physic. is called in should be permitted of course in pure & uncomplicated cases Mode of administration Sul. quin. & cinch. may be given either in solution in water or if you want the smallest possible bulk add a little of some acid just enough to render it soluble without giving it an acidulous taste (The combination of sulph. acid & bitter is offensive to taste) or diffused in wine or brandy & water or diffused in syrup of sugar or in pill, when the stomach is irritable pilled with ext. gentian pills made before hand get to be too hard & are to be rejected When the stom. is irritable an acrid is indicated and capsicum is the best (It is not stimulant but [illegible] irrit. to much [illegible] not acting on the blood vessels but on the muc. memb. increasing susceptibility to other remedies) Powder of bark also will cure most intermittents. It too may be given at any period of any stage though it is very liable to be repeated during the paroxysm especially during the hot stage. Sometimes bark in substance cannot be given in suffic. quantity without vom. to enable it to effect a cure Give [illegible] i to about zi 2 to six times a day Give it diffused in some liquid Still it is not worth while to retain this mode. If the stomach is very irritab. pills may be given of alcohol extract give as much as of the powder. Infus. & decoct. are too weak for intermittent Tinct. requires too much alcoh. Tinct. of bark has cured but then it was by the alc. not by the bark. Saffron (canth. tinct. and [rum]! have cured Those who do not live in an intermittent country, are apt to suppose that there are many cases in ‘ which sulph. quin. is inadmissible Prof. T. does not believe so. he has seen many such cases and thinks they were all caused by injudicious management. Some of these physic. suppose cal. & op. is curative in many such cases they talk much of it. But long ago it was settled that cal. & op. are not curative but merely preparatory (vide Good for an interesting experiment when the stock of bark was exhausted on board two ships of war They merely suspended but did not cure the disease) Physic. have more prejudices against quin. than against any other article unless it be opium & alcohol. N.B. The Parisian phys. practice upon the principle of giving large doses of sul. quin. Some suppose the intermittents of the south do not tolerate quinine so well On the contrary much more quinine; required because the disease is more intense. The practit. there use it too inefficiently. Dr. Mac Bride stated this to be wholly true Sometimes the disease will be accompanied with morbid secretions in large quantities, and hence quinine is supposed to be inadmissible. On the contrary give (after purging with cal.) quinine to cure this as it depends on the endemic influence. Sometimes the stomach is so irritable that 32 grs. of quin. will not stay on the stomach and hence it is thought to be inadmissible Give 10 grs. at once to cure the irritab. as it is produced by endemic influence Case of a woman who had long taken sulph. quin. in small doses with this effect certificates from physicians that sulph. quin. disagreed with her She was immediately by pills of 6 or 8 grs. sulph. quin. made up with ol. capsicum. Numerous such cases used to come down the canal to Rochester & be cured by T. [S] M. at Albany But intermittent is often complicated or disguised 1st Interm. accompanied with diarrhea which sometimes continues throughout the disease. Cure these by quinine and opium. They are cured as suddenly as the others If necessary we may conjoined resin of hanthorrhea [hostilis] (so effectual for diarrhea) or tolu or 2nd Intermittent complicated with cholera commending with rigor & an urgent parox. of chol. which terminates in the sweating stage and so continues day after day without a suspicion of the nature of the disease Give acrids in the paroxysm & quinine in the apyrexia 3d Intern. complicated with dysentery physic. will sometimes suppose they must wait and cure the dysentery first Give no mercury unless corr. sub. Given quinine & opium 4th Intermittents complicated with jaundice puzzling to young physicians bilious diarrhoea & akin a deep orange Give at first opium enough to check the diarrhoea & then suspend the paroxysm with quinine You may follow afterwards with conium to remove the yellow colour of skin 5 Interm. complicated with parabysmata coacta (Good) Many suppose that quinine must not be given until the parabysmata have been cured Cure with quinine Prof. T. has had testimony that quinine would cure parabysmata the sequels of intermittents Dr. Bristol said it was cured in Paris by 6 or 7 grs. of quinine 5 or 6 times in 24 hours better than by any other article. Prof. T. has generally used conium in conjunction 6th Intermitt. complic. with delirium a disease more formidable than dangerous. Cure by quinine though perhaps datura etc. might advantageously be used “opium will sometimes cure such cases 7th Intermittent complicated with syncope. Paroxysm comes on with syncope. Pat. obliged to keep his bed in the intermission Cure by quin. 8th Complic. with convulsions especially in children If called in a paroxysm give a large dose of datura then cured by quinine, as soon as possible Often you cannot give the quin. to children on account of its bitter taste Then give arsenic & opium perhaps as often as once in 1 or 2 hours 9th Complic. with epilepsy One of the most frightful & alarming forms Pat. comes out of the fit and sweats A few years ago such cases were always fatal Get down a large dose of datura and if necessary repeat it & follow with quinine Cure by quinine in the [illegible] [etc.] Complic. with catalepsy of no consequence a trifling disease is catalepsy Complic. with lethargy equally unimportant quin. cures Complic. [serous] apoplexy of Cullen (not sanguineous) quinine will cure Dropsy Purge with elaterium & remove the fluid & the cure by quin. If dropsy remains after the cure give digitalis tinct. cantharides tonics etc. Disguised Intermittents 1st Hemicrania severe cured as other intermittent Well known as a disguised form to persons in an intem. country 2nd Neuralgia (facies etc.) (vidd McCullock) cured by [the] remedies for intermittent. Case of Dr Th. Woodw. attack in calf of leg & this repeatedly for years which would be cured by opium but he would be sick the next day it was found afterwards that datura was better It takes the form of nephralgia ophthalmalgia rheumatalgia etc. 3d Dyspepsia mistaken & treated wrong 4th Hypochondrias & mistaken 5 Typhus (but it will not have 2 parox. in 24 hours as true typhus always does ruins on indefinitely) cured by quinine. This has no crisis on the 14th day as typhus has 6th Phthisis Case of a man from Rochester who came back to Connecticut to die of phthisis. Prof. T. was puzzled found opium did well and finally under the use of opium the pat. had a regular attack of intermittents Prof. T. then cured him by arsenic (as he was so afraid of being poisoned that he would take scarcely anything) given clandestinely Case cured by Dr Todd of a young lady who had come to Hartf. to die. # Remittent not time to say any thing upon the subject # Story of a young physician in N. York who detected an intermittent counterfeiting hectic & got into practice [From Savage’s copy of Talcott’s notes To be inserted in the blank space which occurs in the article actaea] “Atonic acute rheumatism rheumatismus The more acute the disease the more successful has Prof. T. been with actaea more successful while the febrile aff. is strongly marked and the topical affect. has a tendency to wander. When called, ascertain if the pat. is costive, if so give a dose of calomel over night & opium sufficient to allay pain give the opium first & if it takes a good deal to allay the pain, why give more Keep by the calomel (12, 15, 20 or 3 grs according to susceptibility & other circumstances) not less than 12 nor more than 18 hours give cal. sufficient a free evacuation. After this commence with actaea & opium at regular & short intervals say f zfs of tinct. act. every 3 hours as a general rule, some requiring more & some less. The test of the quantity is the effect on the brain. Let the brain be moderately affected but not so as to produce a troublesome narcosis. It is necessary in some cases to affect the brain more than others. In some the disease yields before the brain is at all affected, in others Prof. T. has been obliged to produce a troublesome narcosis. Opium must be given in conjunction in quantities sufficient to meet the symptoms & keep them under 1 gr or more every 3 hours may be required. If the pat. has been tampering with medicine, purging with salts etc. often the cal. will not be needed & we may enter at once upon the use of actaea so too if the bowels are free When the disease is fixed upon some particular part as a joint, topical applications will do good & actaea is not so successful though even here it is useful Under this use of actaea all the tumefaction, redness, soreness & pain of the acute form disappears, often in 12 hours sometimes not altogether till 24 or 36 hours the constit. feb. affect. disappearing at the same time in by far the greatest proportion of cases though in some the fever goes on to the next critical period. The remedy shd be continued in diminished doses to prevent a recurrence. Opium alone will sometimes answer but it is better to combine it with a reduced quantity of the deobstruent. The pat. is not perfectly well after the resolution, he is weak, feeble & languid & a little exposure or over exertion will bring on the dis. again unless the medicine is continued Prof. T. has failed with actaea in only two cases of genuine acute atonic rheumatism and then the patients could not be induced to take the remedy longer than while present relief was afforded which was effected in both cases. Dr Woodward of Wethersfield writes (1830) that he has used actaea in subacute rheumatism (meaning that form which I call atonic acute) in catarrhal phthisis in catarrhal cough & in neuralgia. He considers it one of our most valuable deobstruents, combining the powers of digitalis, sanguinaria & colchicum I [illegible] hardly ever saw it do much good till symptoms of narcosis were produced. The following are the effects of a moderate quantity vertigo, headache, impaired vision, dilated pupils. epigastric uneasiness, diminution of frequently of beat in heart & arteries (but it was irritative frequency of pulse) Dr Woodward has seen decided narcotic effects from 15 gtts of tinct repeated every 6 hour, & from teaspoonful doses violent narcotic effects & hypercatharsis (the last effect I never saw & am inclined to think it accidental or produced by something else) this was followed by a rapid subsidence of the rheumatic affection. Dr W. says he has always found it most beneficial in doses of 25 to 30 drops. He has found it very useful to allay cough & also arterial irritation. In two cases of atonic acute rheumatism following rosalia, one was treated with actaea the other with colchicum both were speedily cured Dr Beers has also used it successfully in the same kind of cases Dr Woodward thinks it more manageable & successful in inflammations of an atonic & acute form, than any other article. Dr Tully thinks so too. Dr W. says a popular article in his neighborhood is Wright’s cough drops, which he thinks is a proof spirit tincture of actaea In subacute rheumatism actaea is useful. In [mercurial] rheumatism, which is always subacute it effects as speedy & effectual a cure as in the acute, but we must conjoin opium & follow with tonics Arthritis rheumatalgia such as is unattended with redness swelling etc. chronic rheumatism (popularly so called) characterized by pain, especially on motion, without swelling etc. with no febrile disease, essentially, though there are often febrile paroxysms. Some of these cases are acute the attack is sudden, the dis. of short duration & confined to fixed periods. These are specially benefitted by actaea. When this species is subacute (often met with in boys who have continued too long in the water I formerly failed, but think I should succeed now. In the perfect chronic form of “chronic rheum.” occurring in old men & continuing year after year joints almost paralytic not much is to be expected from actaea though the exacerbations may be palliated A cure will not be effected Arthritis neuralgia neuralgic rheum. (Fothergill’s sciatica) The first symptom of an overdose is felt in the sciatic nerve though this is the peculiar effect of the article yet it will cure this neuralgic affection. Arsenic, opium & actaea will cure sciatica speedily & effectually. I give the arsenic in efficient doses giving a pill of arsen. acid ¼ gr & sulph. morph ¼ gr every three hours, with the actaea Sometimes I give a cathartic of elaterium previously It yields to this course Bucmenia sparganosis Some cases in extreme exhaustion supervening often severe hemorrhage; are often perfectly resolved by actaea The pathology & location of this disease are disputed It seems to affect all parts of the limb except the bone The lymphatics are supposed to be its peculiar seat. They are undoubtedly affected but the dis. depends on the specific nature of the affection, not on the part involved There are different varieties of it & the treatment must vary accordingly When it occurs among the debilitated females of cities, nauseating deobstruents cannot be borne not even calomel. They produce irritation, reduce the patient & aggravate the general symptoms or pass off by the bowels. Among delicate females [illegible] alcohol, & cinchona are required & these are the articles which I have always known to be indicated. But among females in the country & when it does not follow hemorrhage or derangement of the digestive organs (I have never seen such cases) calomel is useful & the more irritative the cases, the better is the actaea Ophthalmitis of this there are several species, depending upon several specific sorts of infl. Of O. conjunctiva, there are 3 varieties 1. common 2. purulent (of infants) 3 epidemic or Egyptian. Perhaps there is also another kind a chronic form with spongy granulations on the inner surface of the eyelids though this is perhaps a degree of the first variety. In the common ophthalmia there is often [chemosis]. In this form actaea is discovered to have great power & is now often used. Dr Noble of Albany gave fzi once an hour, all day long, till severe narcosis was produced at night, when he stopped the article & resumed it next day. Nothing else was used & the cure was effected in 2 days. I think Dr N’s mode of giving freely & suspending at night, the best. The more acute & recent the case the more speedy the cure. If a cath. of cal. is indicated it had better be a slow one. Narcotics are not so manageable in infants, they cannot communicate their feelings; hence this course would not answer for the purulent ophthalmia & we must rely more on topical applications. In Egyptian ophth. I have great confidence in actaea A. corneae specif. ulcerative infl. of the cornea nit. silver, however in conjunction Dr Noble has used it in this way I have since known others use it. This is also an infl. of the sclerotic coat. It is never phlogistic. Those mentioned above are not but are all specific inflammations. All the cases that I have seen of infl. of the sclerotica are rheumatic or arthritic I do not believe Sam. Cooper’s doctrines & I think his cases are not true in fl. of the sclerotic Drs Knight & Woodwd of Vt agree with me. In this infl. of the sclerotica actaea generally succeeds perfectly and sometimes it fails utterly. I can not discriminate the cases Porphyria hemorrh. & nautica I think little of the treatment in the books they proceed on the principle that diet is enough to cure it. It is caused by bad diet etc. but shd be treated on general principles. Stimulants & astringents are required sugar of lead, opium & brandy with farinaceous diet constitute the proper mode of treatm saying to him “I would not trust to that boy” The pat. reposed confidence in Dr I but said to him “I must have counsel called to satisfy my friends” Dr I. called a man 70 years old The pat. says “I believe the boy has done well”! Prof. I. will never forget his sensations he was mortified & grieved. Afterwards he put on a quaker hat! to appear more old! Let judicious clergymen be called Dr when it is proper Dr Rush said “when the earthly M.M. fails apply to the heavenly” Prof. Ives’ paternal lecture 1833 Be especially careful in your primary observations. An [illegible] read in the [pentateuch] “& the tabernacle was covered with beggars’ skins” He turned to his audience & observed; to the audience “You see my friends the difference between the law & the gospel. The poor have the gospel preached to them, but under the law a beggar! could not be seen about but his skin; was immediately taken off to cover the tabernacle!” If a young physician dislikes his profession, the sooner he abandons it the better. It is difficult to distinguish between genius & a fondness for a pursuit. Dr Rush remarked that he would practice medicine as long as he could walk, when he could not walk, he would ride [illegible] he could not ride he would be carried to the bed side “Least than a wise on hi own eyes, there is more hope of a fool than of him” It is a most unfortunate thing for a young man to suppose he knows all that is to be known Diogenes laid him self down to die, saying he knew all that was to be known There came in a beggar boy to borrow fire. Diogenes told him he had nothing to carry it with “Fi you will give me the fire I will find means to carry it” He put some ashes in his hand & a coal of fire upon them! I will not die says Diogenes for a beggar boy has taught me a knew piece of knowledge! The boy understood the fact well though he could not express it in the language of ashes being a nonconductor of heat. Dr Rush remarked that he had learned much from nurses Moral principle A stranger said to Dr Monson “I wish to employ you in a very delicate case & will pay you handsomely” Dr M. replied “Sir you have not money enough” “You know not how rich I am” “If you had ten thousand times as much it would not be enough to pay me for loss of reputation & conscience” Prof. I. has often been called on to produce abortion & that too by men & women of the first standing in society to produce abortion he has been appealed to in the most moving terms “would you sacrifice a family” “I am somebody likewise” must I lose my conscience & character” The person would threaten to commit suicide. “You had better not but if you do I cannot help it” Suicides however are sly about the matter Prof. I. has known many of the infidels of the last generation They were the most bigoted & superstitious set of men he has ever known. They though there was not evidence enough for the bible, but would believe in the most foolish witch stories Franklin A young physician is not put down by the older ones as formerly there is more liberality in the profession ow than formerly. Anecdote of Dr [Birker] “We want more farmers than doctors” Dr Darwin was a large misshapen man stuttered etc. very awkward etc. yet captivating. His works contain a great collection of important facts Anecdote a young man a good scholar, rather awkward & bashful was apprehensive of being cut out by an elegant competitor eloquent in the ballroom etc. advice not to fear! It turned out as Dr I. predicted We are not to give pain to patients who have brought their diseases upon them After we have relieved them, we may endeavour to reform them Anecdote of Dr Monson man intemperate finally took a poisonous dose of laudanum Dr Monson saved his life Afterwards he remonstrated with him upon his guilt “Dr I don’t thank you for what you have done” Dr. M. then turned “I am sure the neighbors will not” An opinion formerly prevailed that it was lawful because it was expedient to tell falsehoods Dr S. has always found it advantageous to appeal to his frank veracity on all occasions Often however, patients have no right to know Secrets should be kept A man may be sued for defamation for saying he has cured a man of venereal disease You will be mortified occasionally in being called a young man. Prof. I attended a man whom friends kept Neuralgia strychnos arsenic & opium ([actaea]?) Itch cured by lotions of digitalis Sciatica arsenic strychnine & (actaea ?) [sul.] morph. have proved highly valuable Hemicrania cured best by ¼ gr. strychnine 3 or 4 times a day combined with morphine Strychnine 1/16 to ¼ of a grain Brucine 1/24 as strong chronic rheumatism best cured by lobelia better than by guaiacum the article commonly relied on 9 materia medica & Dr. Ives’s Paternal lecture (rear) Solanum nigrum Often mistaken (for its name) for atropa belladonna. Smell & taste nauseous moderately narcotic Its narcotic powers are very variable different in different cases Deobstruent also. It is diaphoretic diuretic (more so than conium) laxative slightly Said to be found useful in [diury[ and ischury but said to require to be drank freely Much used by the common people in ointments (of the leaves) for indolent tumours ulcers etc. IN mild cases Prof. T. has often found it answer as well or better than conium It is not worth while to fire a cannon to kill a fly. Med. dos sd to be 10-12 grs shd think this inefficient infuse zfs to oj of water Solanum tuberosum Native in Peru the tubers of the wild plant are as small as a nutmeg & bitter & nauseous. “Root sd to be perennial probably annual” Top only is used in medicine This is too weak to be used in infusion or decoction. The watery extract is found to be slightly narcotic & deobstruent It is diaphoretic, diuretic & cholagogue It will relieve some atonic inflammation cure some cutaneous diseases IT has been used principally for jaundice & dysp. connected with the liver Dose said to be 2 grs. Prof. T. gives zfs to zj Recommended in cough rheumatism hemicrania angina pectoria etc. When pushed too far it produces tremors etc. the symptoms of narcosis Most of our arrow root is made from potatoe roots and if sufficient care is taken to purify it from mucilage it does as well. The activity of these & the following article is a subject of dispute Solanum Dulcamara Possesses the same assemblage of powers as the S. [terb.] & S. nigr. Used in cutaneous affections. Acts on the fluid secretions generally as well as on that of the liver Digitalis purpurea Native of England Nat. ord. scrophulariae Leaves used (stripping from the midrib) leaves good only when of a light green colour when black they are worthless for medicine. No particular odour No good analysis has been made [Digitat??] (drystallizable) is mentioned Decoction injures it. Should be given in infusion. Infus. green, with the odour & taste of the plant Upon no subject is medical testimony so contradictory as upon the medical properties of this article. Some contend that it is stimulating others that it is never so but always the contrary Prof. T. believe it may, like other narcotics, produce an erethism of the brain without any effect upon the circulating system (N.B. This is a state which often precedes an attack of delirium tremens) It is evidently this state which has been mistaken for stimulation produced, as it will be if the article is continued for some time in doses just short of the strong narcotic doses It is from this state that the opinion has been drawn that digitalis is capable of producing an inflammatory fever The secondary operative effects of digitalis are those of other deobstruent narcotics, as actaea cicuta aethusa etc. It has been noticed that when the pulse has been reduced to 40 by digitalis if the patient is raised to a sitting position it will rise to 72 or 100 & this has been considered very strange but it is no more than always occurs in extreme exhaustion from narcotics or in its syncopalis or even from mercury Much mischief has been often done by giving digitalis to reduce frequency of pulse It will relieve none but irritative frequency. It may be made to cure some cases of intermittent pulse Under any management the article is liable to fail to operate, and after some days operate most dangerously The intermission of the pulse may continue along with the quickening of the circulation for 2 weeks after the cessation of the administration of the article Digitalis is diuretic only after nausea is produced by it but too much nausea will prevent its diuretic effect Digitalis is not or not much diuretic in health it is only so when water has accumulated It is capable of relieving some atonic infl. Opium must be conjoined Prof. T. has treated ac. rheum. by it Those who contend for the stimulant power of digitalis say that is contraindicated in phlogistic diathesis. Others say that it will relieve phlogistic cases. Both agree that in some cases it has produced no effect either beneficial or injurious But if digitalis and nothing else is given in a severe case of phlogistic disease it will have no effect and the disease will aggravate of course. In milder cases no change will be observed. The supposed phlogistic cases relieved by it were irritative cases without strength of pulse sub-putrid cases Farriar accordingly, who considers it useful in phlogistic diathesis, still says it is useful only in those cases which do not admit of v.s. and he commonly conjoined it with camphor and opium. It is equally admissible in low atonic cases. Paris supposes that a considerable number of diuretics are adapted to a different set of cases, from digitalis There is something in the general principle e.g. crem. tart. & tinct. canth. But he is entirely wrong in saying that squills and calomel are incompatible with digitalis. He supposed calomel to be a stimulant and digitalis a refrigerant. Blackall is mistaken in a similar manner calling calomel a stimulant etc. Paris supposes languor & nausea are essential to its diuretic effect and hence they must not be prevented Prof. T. has found that there is a certain range within which digitalis acts and hence sometimes aromatics, cath. & opium must be premised and cojoined and in a few cases, tart. antim. & even bleeding must be premised Many among us have lately found that tonics as canella alba are usefully conjoined with digitalis. In such cases Prof. T. conjoins tinct. canth. senega squills & cal. with digitalis yet all are incompatible according to Paris In low cases alcohol will often be needed Calomel generally increases the susceptibility of the system to the operation of this article Pharm. prep. Tinct zii to spirit of dilute alc. med. dose mx 3 or 4 times a day Infusion zii to pt. dose tablespoonful. Therap. appl. 1st Idiopathic cough where there is a leucophlegmatic habit and bloated face But other things are better and at least opium or I. paregoric should be combined say 3 of deg. & 1 of laud. or I. pareg. The opium will tend to prevent its accumulation Bex convulsion Highly recommended used the same combination as above. Prof. T. has never used it in hooping cough Dyspn. exac. & asthma very useful combined with opium. It will cut a paroxysm short as soon as any article Combined with tonics it may be given in the intervals Delirium tremens comparatively but little opium will be needed, if you use digitalis (only however, where the patient has some vigour of constitution left) Puerperal delirium ( a disease nearly allied as in the above disease where opium produces a disposition to sleep without actual sleep digitalis will produce quiet sleep Cauma recommended but Prof. T. thinks it not indicative likely to do neither good nor hurt Phlogotica useful in lotions for various of them particularly erythema vesiculare & E. oedematosum Apply it strong enough to produce a slight sensation. Recommended very highly for the poisonous [rhoes] Scalds and burns lotions highly useful relieving pain, irritability etc. Acute inflam. of brain lungs or other viscera (supposed entonic but really irritative or atonic) by Dr Currie So Ferriar who combined opium & camphor Recommended in croup but is not employed Song recommended in phthisis almost the first disease in which it was employed best adapted for the cases which require iron & myrrh Some think it useful as a diuretic in this disease but excessive urination will exhaust as much almost as excessive sweating. It is principally useful 1st as an antirritant 2nd as a deobstruent both which are indicated I membranous phthisis Digitalis is to be given in phthisis as in other disease, upon general principles Rheumatism useful as a narcotic & deobstruent combined with opium It may be made to cure acute rheumatism premise a purge of calomel & give say 10 drops of the tinct. every hour or 20 drops once in 2 hours until the disease yields, or the head is affected No cancer of a violent action, used in this way combined with opium & with diaphoretic regimen So of aub acute rheumatism but not so useful. Blenorrhea lenodis 25 drops 3 times a day conjoined with decoction of barley Struma recomm. also in the strumous phlogotica this depends on the state of the system Sparganosi puerperanum recommended internally & in lotion conjoin opium but do not adopt this practice in a feeble subject Measles & rosalia probably useful when not too atonic Hemorrhages rec. but it should not be given in the phlogistic (N.B. There are 4 sorts of hem. active phlogistic passive atonic irritative & vicarious) Digitalis will be useful in the irritative kind with a quick wiry pulse irregular throbbing heart etc. Recommended in ill conditioned venereal ulcers topically Mania rec. (said to be useful when the blood is determined to the brain which Prof. T. thinks does not occur) Prof. T. considers mania as a periodical disease & consequently an atonic dis. The paroxysm of mania precedes the disturbance of the circulating system and the effect has been mistaken for the cause. Dr Willis cured 92 per cent Dr Todd has cured 93 pr. ct. It has lately been published by Dr [Willis’s] grandson that his treatment was substantially the same as Dr Todd’s The latter allays with paroxysm by moral means he prescribes quinine etc. as for a periodical disease. Enlargement of the heart good testimony also of the large blood vessels Epilepsy hysteria convulsions (hardly advisable) Dysury of various sorts nothing specific is mentioned. Dysury of a low typhus will be aggravated by narcotics that of cantharides will be relieved. Lithia recom. Most important use is in Dropsy 1st paleness, coldness skin easily [illegible] etc. (vide Withering) Prof. T. has always found it useful but, as Dr With. gives [illegible] so he finds stimulants necessary in conjunction. Irritative cases with a dry skin etc. Digitalis does well in Dropsy of the abdomen with a distinct hard, circumscribed tumour (encysted) etc. will not be benefitted by diuretics Other cases of ascites require jalap and cremor tartar, senega & squills or elaterium Hydrops abdominis (if not encysted) hyd. thoracis etc. benefitted by digitalis Use afterwards, tonics conium & iron, myrrh etc. vide Withering Cutaneous affections impetigo herpetica scabies etc. Prof. T. has lately cured common itch oftener by digitalis than by any thing else Apply the infusion with a sponge to the eruption 1 to 2 oz to 1 pt. It cures in 3 or 4 days to 1 week Impetigo laminosa upon the fingers to relieve the irritability Recommended to prevent threatened abortion combined with opium But then opium alone, with horizontal posture, will certainly cure Poisonous effects relieved by stimulants and opium. This was well established before the springing up of the race of toxicologists! Prof. T. has had several cases where it had been given by mistake History popular in Rays time & since that time. Vide Gerhard Parkinson, Bates, [Valmon] etc. It was used to produce emesis etc. Dr Withering was first to discover and publish its true powers & operations 1785 D. lactea has been used as a substitute said to be more active probably less so as it was used more boldly D. epiglottis is mentioned by [Coxe] but by no botanist whatever. Actaea Racemosa There are 9 very nearly allied plants called by Linnaeus actaea & cimicifuga But one of them may be referred to either & these have been called macratrys by Rafinesque. Provided actaea & cimicufuga are distinct genera macrotrys must be seperated. And upon the same principles A. palmata should be referred to another genus still. [Now] some late botanists have united (judiciously & upon Linnaeus’s own principles) them all into one genus actaea. We have in N. Eur. A. rac. A. rubra & A. pachypoda (A. spiculus is not now acknowledged) The whole genus in three divisions has 1st A. cimicifuga (Siberia) A. simplex (Kamschatka) & 3 others of the division cimicifuga 2nd sub. div. macrotrys. 3d sub. div. A. christophoriana vide [illegible] Decendalles two spec. A. mucrocropa & A. cerulea are mere varieties or mistakes the latter does not differ from A. rubra Actaea racemosa Linnaeus ([illegible] [illegible]) Cimicifuga serpentaria of Pursh Cimicifuga racemosa Nuttall Macrotrys actaeoide Rafinesque Macotrys serpentaria Eaton Botophys actaeoides Rafinesque again Black cohosh. black snake root (which is applied to at least a dozen others e.g. sanicala mar.) square root rich weed rich root snake weed etc. Cornuticis Canada herb christopher Nat. ord. [Ranuncul???] Tribe I aconeae. Grows in woods among rocks in rich places etc. Flowers about July. Monogynous root an irregular tuberous rhizoma with fibrils Often the root of blue cohosh (leontica thalecteoides) is often sold for it but the fibres of this are smaller taste less bitter not virose etc. Roots of sanicula marilandica (called also black snake root) are also collected for it. (So the berries of cornus [illegible] have been found in the shops for buckthorn) But A. rubra & A. pachypoda are most commonly mistaken for it they are inferior Root he only part used Taste first to sweet & aromatic afterwards virose and bitter Tinct. of root is aromatic & bitter It should be collected only after the decay of the top. Attend to this direction, & use care in its preservation & it will retain its full virtues for years. I know of no good analysis. Dr. Meers attempted it, & gave the result of his researches in a dissertation, Tannin, extractive matter, a bitter principle, gallic acid, a gummy principle, starch, woody fibre, all which amounts to just nothing at all. HE said it probably contained an alkaline principle; but I assert positively, from repeated experiments, that it has none but calcid. I tried every means to get an active satisfiable base failed entirely don’t believe it has any. (Here Prof. T. gave the ordinary process for getting salifiable bases.) The article is prominently & decidedly a narcotic antirritant said to be anodyne & soporific; I don’t believe you can employ it for that purpose with advantage; though this, as well as all other narcotics, in certain conditions, do have such an effect. It readily & certainly produces ult. narcosis, which can always be speedily relieved by suspending its exhibition, & at the same time using those means heretofore so often directed especially opium (N.B.B.) # Dr Todd has seen decided & considerable exhiliration Prof. T. thinks it similar to the erethism of datura & conium & which occurs just before an attack of delir. trem. which is often mistaken for entony. In large doses it produces neuralgic lancinating pain in the extremities larger doses make these pains more extensive even affecting the head and eyes. Prof. T. once doubted the existence of these [illegible] but he has seen them many times They are most manifest in the calves of the legs & along the # I believe it is a nervine, though not prominently so. sciatic nerve. Opium counteracts them Cases related. Food also suspends the pains Prof. T. now employs a little food as a gill of milk porridge in conjunction with each dose Besides these neuralgic pains a large dose may produce convulsive action of the heart. Case of Charles Terry dangerously affected with extremely violent neuralgic pains under the upper part of the sternum wandering neuralgic pains soon violent palpitations beats 130 in a minute pain under the left axilla etc. Large quantities of camphor opium capsicum etc. were required. An emetic of sulph. zinc was given to change action Next day, pretty well. These effects happened twice the actaea not being at first suspected. Case related from G. K. Lawrence of the Shakers in which a large dose produced convulsive action of the uterus In both these respects it resembles strychnos nux vomica & false angostura. Some physicians give too large doses and at too long intervals & hence are always complaining of failure & of unkind effects of the narcotics Cases and testimony of physicians about its ecbolic operation. In one of the first cases, it was given as an antirritant, in a case of threatened abortion Abortion was speedily produced Dr March prefers it to clavus being more lasting leaving the uterus less inactive much less liable to destroy the fetus. Drs March and [Dyer] have found it useful in uterine hemor. Dr Dyer finds it the most valuable article for suppressing uterine hemor. not connected with pregnancy. He continues its use for some time Prof. T. thinks this [illegible] operations not specific, but as part of its narcot. He has repeatedly seen it convulse other involuntary muscles. Actaea is especially deobstruent Prof. T.’s attention was first turned to this by observing its effect when given as a diaphoretic in what was thought (by an old surgeon) a fever sores (osthitis gangrenos.) It resolved the infl. and cured the local disease, much to his surprise. He gave it merely to ally irritative heat and dryness of the skin knowing not a great deal about it. Subsequent experience with the resolvent powers of sanguinaria, colchic. varat. etc. led to the investigation of this property of actaea Dr Meers has found it produce an erythema upon the skin. Prof. T. has never experienced this. Dr. [Gasden] thinks it cholagogue Prof. T. has had no positive experience of this. Dr S. Woodward & others, however find it so Found to be emmenagogue also Seems to be expectorant also (as far as an article can be so directly Decidedly diaphoretic so say many physicians. Perhaps however it is only indirectly so as it appears to be so only in febrile (hot & dry) states. Diuretic often considerably so Yet upon the whole it seems not to be suffic. diaph. diur. & expect. to render it valuable for these indications It has been repeatedly called astringent. But it seems not to operate thus. To be sure it contains a little tannin or gallic acid but not enough to be efficient in operation Called tonic Prof. T. once thought so. Dr. Garden thought it tonic 7 reducing both. Prof. T thinks it not reducing bug prostrating merely. Prof. T. & all his friends also find it useless as a tonic. Like every other article of the materia medica this has been called stimulant. Prof. T. has watched carefully for this effect & never could perceive any. The warmth, flushing face etc. are produced merely by cerebral irritation. Very commonly said to be pectoral a term which may mean demulcent antirritant deobstruent etc. Said also to be alexipharmic Also called antiscorbutic this was the earliest quality ascribed to it in any publication. The principles of the cure of scurvy are not very well settled. The cruciferal seem to be well established as the remedies. Actaea is at least useful in restraining hemorrhage. But Prof. T. is an entire sceptic about the prescribed treatment of scurvy. All the cases treated of in the books occur at sea and seem all to be cured upon dietetic principles Concrete citric acid is useless. Lemon juice is useful in furnishing vegetable aliment. Land scurvy (apparently the same as sea scurvy) Prof. T. has found not benefitted by the treatment of the books He has cured it by lead, opium capsicum, and brandy giving food with each dose of medicine & after a few days giving quinine Rx ac. lead 1 gr. op. ¼ gr. every hour tablespoonful of brandy every 15 min. a little food with each dose. This pat. (in Albany) was cured though she was not expected to live an hour. Said to have the power of curing cutaneous eruptions The only testimony is B. Barton’s that it will cure itch Called repellent by which is probably meant discutient Prof. T. knows not that this has been well investigated. Called pellent also! Dr S. B. Woodward has found it cathartic, upon some of his patients. He is the only person who has met with such any effect probably they were anomalous cases G. K. Lawrence thinks the flowers are laxative. But all flowers are laxative unless they possess some other powers. Said to be emetic in a large dose This is very doubtful probably not more emetic than digitalis as a narcotic Darlington calls the root somewhat mucilaginous. It certainly is not so when chewed. Being narcotic it certainly could never be employed as a demulcent. Any considerable degree of phlogistic diathesis, will not admit of this article, until after reduction & evacuation It may be usefully conjoined with opium acrids & tonics Recapitulation 1st moderately nervine 2d actively deobstruent including, resolvent cholag. emmen. diuretic & perhaps diaphoretic 3d powerfully narcotic always antirritant sometimes soporific produces ultimate narcosis. 3th ecbolic Not stimulant tonic nor astringent etc. etc. vide supra This is supposed to resemble lycophus virginicus but the latter is merely nervine & tonic Most resembles digitalis but differs thus viz it does not accumulate on the system not continuing long after exhibition or returning in paroxysms does not exhaust the system like digitalis its narcotic effect is more easily relieved. Digitalis is not ecbolic & is less deobstruent It is more speedy & active than conium has most resol. power in acute conium most in chronic infl. conium more cholagogue & not diaphoretic nor diuretic Possesses the conveniences of sanguinaria & colchicum without disordering the stomach etc. like them Sources of failure are bad preparations not pushing the article far enough nor repeating [illegible] enough In many cases 2 hours is a better interval than 3 hours Another source of failure is preparatory bleeding or purging Pharm. prep. 1st very fine powder 20 to 30 grs. 2nd infusion coarse powd. zi boil. wat. 1 pt. [illegible] 1 hour & strain Tincture 4 oz coarsely powdered root to 1 pt. off. alc. macerate 10 days & strain. This is a saturated tinct. & is the only one needed for common use. It is the only preparation which will succeed in acute rheumatism Probably the active principle is perfectly soluble only in alcohol as water causes a turbidness or cloudiness though nor precipitate The powder is too inconvenient because it must be very recent & fine Medium full dose is about 30 m. Tinct. of the flowers is made by G. K. Lawrence 4 oz. to 1 pt dil. alc. He says it is cath. & less narcotic Diseases 1st dyspepsia irritable cases greatly palliated, by Drs Hale & others. Dyspepsia with a dry symptomatic cough very useful Dr Knight has found it very useful in 50 drop doses, conjoined with opium in dyspepsia with pain it cured when opium would not Diarrhoea thought highly useful by many. Colica ileus var. rhematalgica (primary rheumatic affections of the colon is known by the habits of the pat.) Dr Hooker gives 1 fl. z every hour until pain is relieved or narcosis produced & the pain is sure to be relieved. It will probably be found useful in common colic as it excites the involuntary muscles Bex dyspnoica often highly useful relieving in combination with opium when the latter alone failed Case related mistaken for [illegible] & haemoptysis (as there was oozing from the throat, caused by atony) Hooping cough much & successfully employed by Dr Woodw. of Vt. arresting the convulsive cough when pushed to narcosis Dyspn. exac. & asthma It generally cuts short the exacerbation give with the 1st dose the exacerbation of laudanum (sometimes 2 grs. op.) give a teaspoonful every 5 min. or a dessert spoonful at once or if this fails repeat it and in some cases a tablespoonful In this disease, a mixture of several narcotics give datura Prof. T. has succeeded well by equal parts tinct. actaea lobelia & datura Prof. T. at firs knew no better than to puke with tartar emetic this was worse than the disease. Next he tried ipecac. this failed. Next he tried syr. of [illegible] of squills this he thought did well but he found it always disordered the digestive function Nex the tried tinct. lobel. And one case in his own family he cured radically by anticipating the paroxysm with lobelia & laudanum Colchicum will break up the paroxysm but disorders the stomach worse than squills. Coxe’s hive syrup is much used but is one of the worst articles for disordering the al. can. Dr Mears recom. actaea for curing intermittent fever. Prof. T. tried it. He found it would suspend the paroxysm, but would not cure the disease & he would be compelled to resort to quinine Prof. T. considers this a disease of atony & has cured it only by tonics & stimulants The articles which suspend the paroxysm and do not give tone seem not to cure the disease. Slight cases may be cured by tricks of various sorts. Idiopathic hectic useful at least as an auxiliary Phlogotica apostema communis (common diffused superficial abscess generally about the hip) case related fo a cure by actaea Paristhmitis typhodes var. sub putrida (fever a synochus not scarlet fever a very rare disease most cases of malignant sore throat are cases of scarlet fever) good testimony of the utility of actaea as a gargle probably by its deobstruent effect. Perhaps it is also discutient it cures itch Pneumonit. typh. var. sub putrida (fever a synochus) Probably it might be used in most of the atonic & subputrid phlogotica & even in simple fevers of this type, if not too low Pneum. typh. var. nervosa probably it would be useful rousing nervous susceptibilities & acting as a deobstruent Pneum. typh. var. notha (which appears to be a spec. infl. of the bronch. memb.) highly useful. Arthritic infl. of the lungs misplaced gout useful especially if acute Sub acute pneumonitis (of Rush & others) (which appears to be an aff. of the bronch. mem. without an aff. of the schneiderian) precedes membraneous phthisis often should be treated with deobstruents, narcotics, nervines & diaphoretics e.g. marrubium etc. Phthisis membraneum var catarrhalis much used even by those who know nothing of its general use Vide Eberle’s practice Phthisis membranea var. dyspeptics highly useful. Remarkable case of Dr Hotchkins related at full length (Incidental remarks of Prof. T. he had hemorrhage which was checked by tartar emetic in nauseating doses left extremely weak “no wonder if tartar emetic was continued thus for some time” could not take tonics “because he too no antirritants with them, opium for instance”) cured when in the very last stages by actaea A. rubra failed in this case (it is greatly weaker) [Galium] circaezans proved a valuable expectorant. # [illegible] [illegible] drops were used Another very instructive case of Dr Hotchkins’s failed because it was not persevered in long enough This is apt to be the case with long continued diseases e.g. chronic diarrhoea & opium Scarce any remedy will do as much in phthisis as this even if given alone Yet it ought not to be given alone but combine with opium tonics etc. In m any cases actaea has prolonged life for years in desperate cases. N.B. consumptives cannot be cured by residing at the south in the winter only they must reside there for life to be permanently cured Phthisis tubercularis supposed to have cured. Laennec’s anatomical investigations Prof. T. thinks show unequivocal cures if tubercular phthisis All arthritic infl. are benefitted by it’ especially rheumatismus Prof T. has seem cases of arthritic carditis cured by actea others not. # American cough drops are equal parts elixir. pareg. & [tinct.] digitalis Cholera infantum (An infl. of muc. memb. of al. can.) has been cured Dysentery has been cured admirably by actaea. Dr Peabody has cured by 40 drops so have others Hysteritis membranifica has been found useful in many cases by Woodward of Vt etc. Prof. T. has not had an opportunity to try it in acute gout. He would give actaea once in 3 hours until narcosis was produced 30 drops or ½ tspfsful conjoining opium enough to drive off pain once in 3 hours IN this way Prof. T. has cured with verat. vir. lob. sang. & colch. # Arthritis rheumatismus atonica acute If pat. is costive give opium enough to relieve pain follow with cal. enough to purge in 12 or 18 hours After the purgation give actea once in 3 hours f zfs more or less # but the purgation from colch. is highly mischievous enough to affect the head conjoin opium 1 gr. or more or less once in 3 hours to relieve pain. When Prof. T. first began to treat atonic acute rheumatism in this way, he conjoined other articles, as ipecac but he finds them useless. The topical heat redness, soreness, swelling etc. will be relieved in 24 or 36 hours & often the fever disappears with them Dr Woodward of Vt cured 10 cases of acute rheum. in one winter all the cases he had. Dr S. B. Woodw. used it always in rheumat. he gives 25 or 30 drops (alc. tinct.) about once in 4 hours To prevent a relapse continue the actea in diminished doses Vide page next after the end of the article cinchona Ophthalmitis Hemorrhagia irritativa & [passivea] from any part Prof. T. knows it to be highly useful Porphyra haemorrhagica & [illegible] first employed to cure this disease in a large quantity of cider probably the cider had most effect It may be useful in this as in hemorrhage Neuralgia successfully with opium or arsenic by Drs Tully (he finds strychnine & opium better) & S. R. Woodward (in neuralgia of feet & legs of broken down convicts) Dr Knight has been succesful with it in neuralgic toothache Prof. T. has succeeded better with strychnus and arsenic or opium Hysteria Prof. T. used [illegible] successfully early in his practice now he uses nothing but datura. Epilepsy Dr Parrot of Western considers this article as peculiarly valuable in epilepsy from intemperance Others value it in other cases of epilepsy Carus paralysis it will probably be found useful from its resemblance to strychnos It has been found remarkably useful in palsy from lead colic camphor & arsenic may be joined Chorea from analogy Prof. T. was led to use it 15 yrs ago general testimony it its favour Vide also Am. journ. med. scien. No. 18. for interesting cases of surprising cures. Dr Hooker has used it with the most beneficial effects in chorea Tried chloroferrate of iron ([illegible] veneris) & conium & iron & various tonics with no benefit tinct. of horse warts (a powerful nervine) etc. Actea cured her Paramenia obstructionis found highly valuable. P. difficilis found useful in relieving pin, obviating irritability etc. Prof. T. uses datura Parodynia atonici lingering parturition Prof. T. now uses it instead of clavus with as much efficacy & without danger to the child Retention of placenta repeatedly used by Prof. T’s friends with good success Hydrops cellularis especially with an erythematic diathesis not used by Prof. T. but by several practitioners as a substitute for digitalis Leucorrhoea in a case which seemed to be the joint result of blenorrhoea & mercury cured other cases Ecpyesis scabies itch said to cure by lotion Prof. T. has often cured itch by lotions of digitalis. Sprains Prof. T. has often used it with advantage Bites of rattlesnakes popular alcohol & opium must be better Old chronic cases of swollen joints arising partly from injury & partly from rheumatism was proved very useful Very useful in murrain of cattle vide B. S. Barton. History. Lond. phil. trans. Petiver 1697 used in [Mariland] for scurvy. B. S. Barton various (among others the U.S. Dispens.) have copied from him. Actea rubra Distinct from A. spicata Considerably used in some places Powers similar to A. rac. but far weaker and more uncertain & less valuable Actea pachypoda A. alba (Big.) A. spicata var. alba A. rubra var. alba! etc. Necklace weed, coral & pearl etc. Mentioned in several irregular works. Used as an efficient emmenagogue by Dr McClure. Berries of this & the preceding (i.e. dry capsules!) said by Rafinesque to be poisonous Used by Dr Collins as a substitute for A. rac. but weaker Used by him with advantage topically in ophthalmia used for dysentery etc. Not worth substituting for A. rac. As the roots cannot be distinguished these are often sold for those of A. rac. hence frequent disappointments A. spicata Christopheriana herb christopher [Bane] berries berries said to be highly poisonous (vide Withering) Root and leaves acrid berries have caused delirium useful in nervous diseases as a repellent etc. Prof. I would infer that is is more active than A. rubra & less so than A. racemosa Actea Cimicifuga Linn. Cimicifuga foetida Linn. Liberian bug [bane] N.W. coast of Am. & Liberia An almost insupportable smell Used in Liberia as a bug bane Vide Good art. hydrops abd. (drastic i.e. active it is not cathartic) Abundant testimony that it is a powerful narcotic. Little doubt that it has the same powers as A. rac. but more powerful Strychnos nux vomica Nux vom. officinarum Caniram etc. nux. metalli Nat. ord. Apocyneal ([illegible] Luridae Linn) Habit. Coromandal Cochin China Fruit a berry about as big as an apple with a hard orange coloured skin seeds imbedded Seeds only used Bark said to be nearly as active. Seeds orbicular & depressed size of a dime Active principles strychnine & Brucine (brucine by mistake brucea being merely a bitter tonic) Strychnine most abundant exists combined with strychnic acid White, crystalline etc. said to be highly alkaline will it change blues? Combines with all the acids & is separated by all the min. alkalies When recovered from some combinations the alkali is changed (This is true of various veg. acids also a different acid being formed) Operative effects in ordinary doses these are so moderate and show that they can be no better distinguished than those of cinchona when properly administered & in a suitable disease, we merely perceive an amendment of disease. Diminishes morbid irritability & susceptibility & restores healthy susceptibility & tone. In its slowness it agrees with conium but disagrees with actea digitalis and lobelia It is mentioned as a peculiar property that it strengthens the voluntary muscular power. This is merely the erethism of the brain produced by all the narcotics It is more easily & more powerfully produced by this than by most narcotics Said to be anodyne is probably less so than many narcotics. It has great power however over neuralgic pain Said to be tonic & Prof. T. is satisfied that it is so Supposed to be deobstruent. Prof. T. thinks it is so though more equivocally so than some other articles. It cures gout rheumatism leucorrhoea etc. but little definite is known Not known to be cholagogue, anti psoraic etc. but has not been thoroughly investigated Said to be febrifuge (probably anti intermittent is meant). It seems to be capable of curing intermittent Said to be anthelmintic probably it is so Its slow operation adapts it more especially for chronic diseases Inconvenient effects cardialgia vertigo staggering appearance of drunkeness stiffness of [lims] & general coldness. These effects indicate a reduction or suspension of the remedy In a sufficient dose said to be capable of producing these effects in an hour & ultimately to produce stiffness of voluntary muscles i.e. tetanic spasms Ultimately it convulses the invol. mus. Noxious effects said to come on with pricking of the limbs coldness ultimately spasms & complete ultimate narcosis Paralytic parts more speedily & powerfully experience its effects viz. the pricking, local perspiration & tetanic spasms the contrast being remarkable between the two sides being affected vide Magendie Even the two halves of the tongue will be differently affected Magendie is probably correct in saying that it may affect the spinal marrow without affecting the brain Prof. T. has found strychnine more efficacious than any other preparation. Strychnine is said to be the most active principle known & the most speedy next after prussic acid Effects1st acrid narcotic 2nd tonic ([illegible] 3d deobstruent 1st resolvent others not investigated Entonic diathesis strictly prohibits this article, more indeed than it does most other narcotics The British practitioners are mostly afraid of this article yet it is more easy to manage than colchicum etc. This article, like all narcotics, gives warning of mischief. The refrigerants do not Orfila knows no antidote he directs emetics, cath. vinegar etc. tracheotomy and artificial respiration! Pharm Pres. 1st Fine powder rasp the seeds then pulverize & sift through muslin. Dose about 4 grs. 4 or 6 times a day. or dose 5 to 10 grs. Push it until moderate tetanic spasms are produced. Prof. T. pushes it until some slight startings of a paralytic limb. Sometimes 1 gr. 4 times a day has been enough 2nd Alcoh. tinct. strong alc. 1 pt? 2z of rasped seed. Dose 20 or 30 minim 3d Alc. ext. begin with 1 gr. or once a day (Magendie) But one dose a day will require too large a dose The effects of one dose will not last 24 hours For a slight effect ½ a gr. to 1 gr. pr. diem will be enough (Magendie) Dose of pure strychnine said to be ¼ to ½ a gr. 2 or 3 times per day too large a dose Some patients will not tolerate more than 1/16 of a grain. The doses must not be so large as to produce vertigo nor the quantity in the day so great as to produce tetanus Diseases 1st dyspepsia more especially where there is want of tone in the stomach but in almost all varieties Prof. T. has found it useful Diarrhoea vulgaris reported as very valuable Lead cholic especially in its secondary stages & sequel Helminthia not said what species Dyspnoea chronica like galvanism Dispnoea exacerbans. Prof. T. thinks it obviates the relaxed thickened & spongy state of the muc. memb. also relieves the paresis of the nerves etc. Sternalgia ambulantium Intermittent fever dose directed is too small. Said to succeed when quinine fails. (Prof. T: & several friends never fail to cure by quinine enough & unqualified Cases related of cure by quinine after quinine had been said to fail utterly) Typhus pustis (Levant plague) said to be specific seems to be useful Dysenteria typhodes has been used wiuth great success Arthritis podagria Said to be capable of curing if steadily administered So of rheumatism & rheumatalgia, in all their varieties either be cured or proved valuable Sciatica arsenic, sulph. strych & sulph. morphium in combination have proved highly valuable Ecphronia mania rec. in the books. Halusia hypochondrias (apparently a combination of a moderate degree of dyspepsia & of melancholia) said to be valuable Cephalia hemicrania (idiopathic not when a disguised intermittent) ¼ gr. 3 or 4 times a day usually in the required quantity. Combine also morphine. Prof. T. has succeeded better by this plan than by any other He now employs it exclusively. Case of Prof. Knight’s Neuralgia one of the best articles Prof. Knight has employed is successfully in many cases of nervous pains [Clo??] palpitatio Used with great success Chorea. Cured cases of long standing Dr Beers has found it highly successful So has Dr Woodw. of Vt Prof. T. has used it but little & that with success Hysteria said to cure Prof. T. never tried it but once & then it failed. It might be useful between the paroxysms Epilepsy recommended might be useful Dr Woodw. of Vt has used it with decided advantage Carus lethargus has been cured Carus paralysis more celebrated for this than for all others 10 to 40 grs in 24 hours It should be pushed so far as to produce some spasms in the paralytic limb Adapted to all cases caused by intemperance by venery passion etc. Has been used successfully in pregnancy (for hemiplegia) without injury to the fetus. Case quoted showing that palsy may be cured without producing any thing more than tingling no spasms. Magendie states that is now externally applied, in form of tincture Paropsis amaurosis Agenesia impotentia (probably a partial paralysis though an affection of the mind oftenest hinders this cure of the disease) Spermorrhea atonica Magendie Paruria retentionis & incontinens successful see Magendie Leucorrhea communis cured Bite of reptiles said to be cured Emaciation of extremities cured or relieved by Magendie It must be remembered that all these cases may be incurable and that the article may apparently fail Hist. Said to have been employed ever since the time of Gesner 15- Introduced into England in 17.. by Woodville Revived in France by Magendie in consequence of observint its tetanic effect on animals Strychnos psead augostura Called improperly angostura with various trivial names Always found as an adulterating article of Angostura bark 7 hence it probably grows in S. America. It is not known however, with certainty where its habitat is. Magendie Paris etc. attribute it to brucia antydysenterica [illegible] with probability attribes it to a species of strychnos Two species of strychnos grow in S. Am. Bark comes in pieces broader than long ½ inch thick covered with small warts fracture [illegible] small aromatic and nauseous, disgustingly bitter to the taste powder bright yellow Concentrated infusion muddy disgustingly bitter etc. Lat. tinct. pale rendered opaline by water? It is important to distinguish this adulteration of galipaea off. or angostura Severe accidents have happened even in this town Absolute tests said to be 1st a drop of nit. acid on the inner surface produce speedily a blood red spot (by the [brucia]) 2nd a drop of nit. ac. applied to the lichens on the outer surface, produces a deep emerald green color It is much to be regretted that the active principle is called brucine this brucine poisons as effectually as strychnine Th bark in powder [illegible] grs. killed a dog in an hour A child was killed by mistake cold extremities senses retained to the last Brucine is formed in Strychnos nux vom. said to be a bigallate in false angostura. Description of brucine vide chemistries. Taste bitter & acrimonious Nit. acid produces a deep yellow colour hence it can be detected when in combination with strychnine Wide discrepancy between the results of the ultimate analysis of brucine Andral considers 1 gram of strychnine equal to 24 gr of brucine Hence 6 grs. will be equivalent to ¼ gr of strychnine q.v. 4 grs. killed a rabbit Andral has given it in single doses of ½ gr. to 5 grs Magendie 1/8 gr. 6 times a day Operative effects differ only in degree from those of strychnine Strychnous pseud ang. is now considerably used in medicine Strychos [illegible] is the most active of all the strychnia (strychnoes) L. ignatii is next in activity. It was called ignatia by Linn. Called also faba sancti ignatii recommended in intermittents It vomits purges and produces spasms 2 grs said to be a medium dose of the seed. Strychnos colubrina posses the same sort of powers. The wood of the root is used against bites of snakes hence its name. In doses of ½ dram it has been used in intermittent. It vomits, sweats, diuretic cath. This is one of the plants called [illegible] [illegible] The other plant is the following Toxicaria macassariensis Ripa antear Antearia toxicaria etc. This is said to be the most active of all the narcotics not] excepting hyd. acid. The proxi Lobelia Inflata Said to be annual, persistent, and biennia. It seems to be biennial Rapuritium inflatum lobelia emetica. Indian tobac. eye bright etc. Nat. ord lobeliae Canada & the whole U.S. [Ra??.] & Sch. describe 15 species most of them are highly active Taste much like green tobacco It has never been analysed Operation 1st warmth in the stomach proceeding to cardialgia universal glow tremors some nausea vertigo salivation Larger doses cause more vertigo emetic diuresis more salivation expectoration Poisonous doses produced convulsions, delirium & death. Said also to produce increased secretion of bile diuresis & diaphoresis A valuable deobstruent though more adapted to atonic cases Valuable diuretic etc. Useless as a mere emetic It is too harsh and distressing. It would probably prove emmenagogue. Some think it cath. Prof. T. denies this except indirectly as an antirritant & cholagogue Seems not to be stimulant It will not prove restorative in exhaustion but rather increase it It may excite an irritative bounding of the pulse in low torpid cases. It is acrid & locally irritant not stimulant. It resembles to nicotiana tabacum but is more diffusible more sudden, mor transient, less permanent more manageable Though not stimulant yet it is contraindicated in entonic diathesis Pharmac prep. 1st powder of leaves 2nd powder of the seed 3d infusion but this has no standard strength [4th] tinctl zii to 1 pt dil. alc. 5th Tinct. of seeds by the Shakers Diseases 1st Dyspepsia with great [irritability] with wandering pains like disguised gout very beneficial in conjunction with capsicum & nit. sil. Limosis gastrodynia vide Eberle’s practice He finds it superior to opium Idiopathic cough either before or after expectoration found to be very valuable Bex dyspnoica Case related of an apparently desperate case cured by lobelia and opium f zi tinct. lob. with 2 or 3 grs op. at a dose each article failed by itself Another case related in which a large secretion of bile was produced Hooping cough found useful after the convulsive cough has begun by numerous practitioners A physician gives 10 to 60 m occasionally vomiting with it and he thinks it better [emetic] for the disease than ant. or ipecac undoubtedly because it is deobstruent Many physicians have succeeded with it Prof T. has done so sometimes conjoining opium or conium Dyspnoea exac. f zi of tinct every 5 or 10 min. until full vomiting or narcosis is produced. The certainty of the operation will be enhanced by premising opium Give it in the intervals of the paroxysms in conjunction with tonics Asthma best article for this disease as well for the preceding Still this medicine is so nauseous that many patients will not persevere with it Typhus nervosus has been used Dr Hyde of Enfield employed a powder of lobelia, or sanguinaria & of [????triphyllum] as a stimulant diaphoretic in typhus. It must be remembered that deobstrents are useful in typhus. Prof’s T & Beers used lobelia in typhus, when medical student & found it a most efficient diaphoretic Catarrhus communis & epidemicus Prof. T. has used it with great benefit Croup Dr Barney employs it in croup in the commencement and in the progress of the disease 30 m to ½ fz Croup is sometimes perfectly paroxysmal & resembles dyspnoea exacerbans & has been mistaken for asthma, as shown by Dr March’s p.m. examinations For this form lobelia is peculiarly adapted Pneum. typhodes was found a most valuable expectorant whenever squills could be tolerated does not answer well for when the stomach is irritable Acute rheumatism It has been used with success. Prof. T. has used it often with success in subacute rheumatism Case related cured in 24 hours by lobelia & opium Yet this patient had often had such attacks before which always lasted for a fortnight A. rheumatalgia var. chronica (chronic rheuma) Prof. I finds it the most valuable article much superior to guaiacum which is the article commonly depended on. Case related cured by lobelia and opium after arsenic blisters guaiacum alcohol capsicum etc. had failed Leucorrh. comm. valuable in some cases generally best conjoined with cantheris & nit. sil. Hernia recommended as a substitute for tobacco by enema Said to be nearly as effectual and not dangerous like that article Lobelia tupa Peru 6 ft. high root is 1/1/2 ft. long odour in a close room produces vomiting Juice so acrid as to produce speedily topical infl. when applied to a tender surface L. longifolia W.I. said to inflame the hands said to produce an incurable purging. Prof. T. has known several deaths by this actually incurable purging hydragogue from colchicum! L. urens most active also]L. syphilytica throughout U.S. all parts [lac] 1st deobstruent 2nd emetic 2d hydragogue cathartic apparently not narcotic 1st expectorant & emmenag. 3d diuretic 4th diaphoretic First employed as a specific for syphilys Just about as active as senega and adapted to a similar set of case. It seems to have the advantage of being less liable to leave the stomach in a deranged condition than senega As to its curing syphilys Prof. T. thinks the matter not settled when it was tried the notion prevailed that syphilytic patients should be salivated and that too before the constitution became affected It is never worth while to give mercury internally when the disease has proceeded no further than a chancre & bubo You will merely protract the cure The const. aff. also Prof. T. has cured by gold. It may be cured by various articles# Lobelia Dortmanna of similar powers to the preceding Lobelia Cardinalis supposed to be similar power It is a popular remedy in dropsy & will cure used as in vermifuge for [asc. lumb] L. claytoniana still weaker most common with us and apt to be confounded with L. pallida # Some cases will prove incurable under any treatment Sanguine temperament & scrofulous habits [illegible] mercurias dulcis sublimatum dulce (Sydenham) A. [illegible] A. [maligala] [Draco] mitigatus marina metallorum [illegible] metallorum Calomel Most modern & best name is Hydrargyri dichloridum The atomic weight of mercury was formerly called [200]. It is the general principle to take the smallest weight though it is not very strictly adhered to It does not appear but that the # persons who first pitched upon 200 + 8 for the black oxide, did it at haphazard and did not investigate the subject nor give any reasons “That compound which is with most difficultly decomposed, must be presumed to be a binary one Ms. Dalton vide Henry Prof. T. knows no exception. Hence says Mr. Alison? we must suppose the peroxide of merc. and perchloride to be binary compounds We find also that black oxide is very readily reduced by heat by agitation almost by pilling to red precipitate and metallic mercury. We find the same true of the cyanides. The sp. gr. likewise of the vapour leads to the same conclusion. The sp. gr. multiplied by .555 must give in combining weight. Hence we have 100. Another argument founded on the sp. I have [shown] elsewhere that if we divide the number .376 by the spec. heat the quot. will be then atonic [illegible] of that body [illegible] the spec. heat up [illegible] .03 & 376 / .03 = 12.533+ Berzelius advances similar arguments and gives the same no. 100. Thompson sometimes uses “sub” instead of di. Sub is a vague term It was found after the discovery of def. prop. that sub carb. pot. was 1 of each! other examples of its being misapplied before the discov. of def. prog. Formerly called proto chloride This would answer if it was still the case that proto was applied to the least compound Hydrayg: chlorid. mite. Phil. ph. an unexceptable name in pharmacy muriate of mercury Sub murieta (very exceptionable because it was considered neutral) then mild muriate) Called calomelas in 1616 But this name had been previously applied to the disulphuret (Ethiops mineral) Its discoverer is not now known The alchemists were acquainted with it. Sometimes found native & called horn quicksilver & mercurial horn ore a rare mineral Dull white yellowish heavy cake crystallized in 4 sided prism terminated by 4 sided Buff coloured when finely levigated. The only way to obtain it pure is to buy it in form of crystals The powdered in the shops is variable sp. gr. 7.2. [illegible] primary operation when taken internally 1t deobstruent 2nd cathartic 3d emetic 1st sialag. 2nd expect. 3d diuret. 4th cholag. 5th emmenag 6th antipsoraic resolvent 7th diaph. From the very situation of the salivary glands the operation on them attracts more attention Next to its dialag. are its cholag. Next its expectorant Next is its antipsoraic Next its diapohoretic, diadretic & emmenagogue in the order mentioned As a cathartic it is useful 1st as a mere reducing agent (a moderate one in moderate entony unless after bleeding) 2nd it may be used much more to make a shock or strong impression & interrupt disease 3d to increase susceptibility to other remedial agents & to equalize excitement Of little value to remove effused fluids as in dropsy it is slow & not hydrag. or to remove offending matter It may be made to operate as an eccoprotic, a laxative, a purgative a drastic cathartic It cannot long be used as an eccoprotic or laxative on acc. of ptyalism Most useful as a purgative. Inferior as a [illegible] cathartic Equally copragogue & cholagog. When suffered to remain in the bowels it is always deobstruent cholag. sialag. The gall bladder will always be found distended with bile or gall after it has been freely given in acute disease. This is often attributed to a spasm of the ducts [Emalging] the liver is supposed to be the only use of giving calomel in fever but then it [opens] the skin and promotes all the secretions It acts on the stomach and upper int. when given in a purging dose Its vomiting power is little valuable but as a cathartic it more nearly resembles an emetic than any other cath. in its operation, & may often be used as a perfect substitute where emet. are indicated. When given as a deobstruent opium shd be combined with it to keep it in the bowels. But when we desire a long continued deobstruent effect give it in small doses but it will always salivate sooner or later A man in health or in vigour is salivated with less diffic than in low atonic diath. or when very feeble or in enton. diath Sometimes it does nothing but salivate This is important to distinguish Sometimes it merely purges without any deobstruent eff. But Prof. T. has always found such cases to have been recently salivated or to have an excessively irritable stomach & al. can. in which it produces vomits Given with diuretics, or emmenag. or diaph. etc. it will prove more especially diuretic etc. Hence the “dirigens” part of the ancient prescriptions Naturally a very slow cathartic dose 5 to 10 grs N.B. we determine the nat. effect of a cath. by the smallest quantity that will produce its full effects When hurried through the al. can. almost all its deobstruent effects are lost. It must also be remembered that its cath. operation is generally its least important operation Prof. T. & his friends have always experienced its good effects upon themselves before the purging began Calomel has been called a stimulant perhaps because it produces irritation sometimes & a mercurial fever which is merely irritation A single author has called it tonic This is still more absurd A large proportion of our medicines do not either stimulate or reduce Mr. Abernethy says there are some patients whose mouths will not be affected & yet the system be under a mercurial action. Prof. T. has not observed such cases The system may be above or below the grade of excitement proper for salivation There may also be certain states of the system in atonic diseases which will not admit of salivation until the state of the system is changed Case const. syph. mercurialised in N.Y. without success also in Phil. also in Botson utterly without success. [went] to Charleston and there some one recc. Dr Todd Dr Todd put him upon a bottle of wine a day & a free use of bark for a week Then gave him mercury and salivated him in 3 days Prof. T. never met with a case which he could not salivate Perhaps by bark & wine, sometimes by combining capsicum with the mercury There is no foundation for the dogma that stimulants must never be combined with mercury his use of opium & bark to bring on salivation from mercury has been long known in Connecticut It has lately been brought forward as a new discovery [illegible] & soreness are more easily cured of syphilis [because] [illegible] can be confined confine your pat. to the house better to the bed. This with opium & diaph. treatment has succeeded in giving action to merc. when otherwise it wd have failed” Most of the baneful effects of mercury in syphilis are probably owing to not giving the proper corrigent etc. Paris seems to be the only author who is aware of the necessity after of reducing the system to the point of susceptibility And even he knows nothing of the necessity of raising the system There seem to be two sorts of injurious effects 1st acute 2nd chronic The dichloride disoxide & diprotonitrate produce the acute more commonly While the proto chloride protonitrate & protoxide produce the chronic They symptoms which show the system to be under mercurial influence are 1st symptoms (previous to ptyalism) cupreous taste more or less swelling of gums sloughy whiteness of gums margins trifling soreness & a feeling of looseness of the teeth A peculiar fetor of the breath Called mercurial A peculiar fleecy appearance of the tongue Then comes the dis Ptyalismus acutus var. hydrargyratus which begins as above vide Good When cal. begins to produce heat, soreness swelling ptyalism sloughing of the inside of mouth and cheek etc. with the mercurial eruption the system is labouring under a severe disease a poisonous effect. Actual salivation is never necessary though it may be convenient to produce a slight one Caries of jaw perhaps with exhaustion & death total loss of teeth fetid breath stiffness and incarnation of limbs etc. may be the emaciation, debility, loss of appetite ultimate results more rarely a lingering death Severe ptyalism is apt to be treated as a light disease very improperly We are not to expect any specific antidote. Yet upon the notion of the absorption of mercury sulphur is proposed Sul. has 2 compd scarlet red & jet black! both are insoluble & no emenctory will the row off a [illegible]! Many suppose that repeated purging with neutral salts is useful in this disease. Another man in Ohio Dr Findley says he cures by tart. emet. “as a gargle & I believe internally” “Perhaps it may be useful topically as an irritant like nit silver.” Prof. T. has repeatedly seen antiphlogistic treatment tried and with no benefit Sarsaparilla (a weak deobstruent supposed to promote secretion is more especially for the kidnies & skin) Prof T. has often tried it for [weeks] with no benefit whatever So have others Lotions and gargles generally fail entirely in the early stages though they are useful in the advanced stage to obviate [atony] and relaxation The frequent gargling of cold water has often been of very high utility Diluted mineral acids have been found especially useful But lotions of the decoction of batesia tinctoria (acrid narcotic deobstruent emetic and cathartic) has proved one of the very best remedies in a strong solut. [illegible] I to zi water and been very popular with those who have tried it Lotions of nit. sil. are very useful (sometimes on account of the irritability, a strong sol. suits better than a weak one Arsenitis of potassa externally & internally useful Prof. T. 2 fz ol. turp. with z fz muc. gum arabic Prof. I. has found very beneficial Very strong inf. of lycopus vulg. has been very useful (bitter & nervine) Coptis trifolia has been employed & is useful Mucilages, acac. astragalus [illegible] [althaea] hibiscus typhus latefolia (root) viola pedati split twigs of [illegible] [sassaf???] [ulmus] [fulva] (rather inferior) but perhaps decoctions of rice and barley boiled long and strained are as good as any mucilages. All these are very grateful to the patient Qinine is often indicated internally to keep up the strength of the patient But the watery solution of opium is the best applic. and op. shd be given internally Milk porridge has always been preferred for diet The next inconvenient effect is Called very improperly erethismus hydrargyratis but has no other name Great exhaustion of strength anxiety frequent sighing epigastric distress vomiting irregular action of heart & arteries pulse small quick frequent sometimes intermittent tongue seldom furred cold extremities perhaps sudden death upon exertion Occurs in the feeble Treat by perfect quiet and opium tonics arsenic etc. It may occur before salivation in the feeble Eryth. vesic var. hydrargyratum Perhaps not distinct from E. [corrosivum] Called improperly eczema & hydrargyria [sepoa] etc. Prof. T. thinks it clearly an erythema vide Good Perhaps his var. corrosivum is identical with this a better description could not be given than his description of E. ves. corrosivum N.B. in erythema you may always see vesicles in a sunlight by a magnifier hence erythema is not a rash. Bateman criticized [erysipelas] & erythema are synonymous Bateman says E. v. hyd. is produced by other causes as cold but that from mercury has some peculiarities N.B. The effects of fire, frost, sun burns, an eruption caused by arsenic etc. are varieties of erythema Preceded by sense of stiffness, itching etc. about a side of thighs and scrotum or about the neck and arms next comes a redness and minute microscopic papula. The redness spreads in large patches over the body The pimples run into each other become large emit an ichorous, corroding discharge The whole body becomes raw, excoriated chapped, stiff etc. In severe cases recovery scarcely comes on in less than [illegible] weeks and may continue 8 or 10 Sometimes the hair and nails come off. The whole epidermis comes off and as is the case with other such eruptions As skin may give off 2 or 3 successive crops of scales. This Bateman’s description and a very good one Prof. T. has witnessed 3 distinct grades 1st merely local in the bands of the joints etc. caused by ointment of mercury 2nd an ulceration in the mouth in children who have used mercurial escharotics too long 3d covering the whole body attended with an irritative fever & general exhaustion Caused only by mercury internally. “It can be cured notwithstanding Bateman’s opinion to the contrary Treatment palliative (Bateman) warm mucilages in lotion poultices mild cerate after excoriation Antimonials & opium and finally mineral acids 7 bark Prof. T. dissents from this treatment (the merc. dries on) He applies at first simple ointment of datura and in the latter stages adds carb. zinc (lap. calam.) He also uses infusion of digitalis just about strong enough to create some irritation (perhaps upon a medium ½ oz to the pint) Infusions of the seeds of datura are useful also Prof T. finds the poultices & fomentations keep up the disease by relaxation The tepid bath may occasionally be advantageous Let the diet be light and nutritious Prof. T. has generally found quinine necessary. He could always give opium moderately Arsenous acid he uses in some way internally. As the appetite is generally small, so that the pat lives principally on liquid food the opium will not be apt to constipate, and if it does castor oil may be given but Prof. I has not found laxatives necessary Min. acids sometimes agree and sometimes disagrees producing tormina etc. in the bowels Prof. T. can lay down no rule Dysenteria acuta var. hydrargyrata It has the general characters of dysentery but there is more irritation & exhaustion. In adults I have seen it in all cases produced by the external Application of [illegible] inordinate quantities commonly called “roasting it in” In children I have seen it more generally brought on by by internal use in repeated doses All that is necessary commonly is the abstraction of the calomel & the vigorous employment of opium. For the exhaustion tonics & stimulants with opium may be needed (Sometimes give calomel hair of the same dog (Osgood)!) 4th Sub acute mercurial rheumatism Liable to degenerate into a chronic state and into paralysis Resembles the idiopathic Attack gradual & insidious little redness or soreness much pain on motion local aff. generally about the larger joints moderate tumefact. no supp sympathetic & irritative fever erratic pains always attended with sweats exac. at night & in stormy weather. Brought on by exposure to cold & rain etc. taking cold In the acute diseases of mercury the physician generally gets the ill? credit. But the chronic diseases have more importance attributed to them even than they deserve many cases are falsely attributed to mercury. 2 cases related of permanent lameness reported to have been treated with mercury neither of whom had taken a particle of mercury one of then had been purged a long time with brimstone & rum It is well known that sulphur will produce similar effects e.g. as perfect a dysentery as that of mercury though more generally it produces the chronic effects. Both mercury & sulphur will produce paralysis etc. Opium capsicum alcohol etc. are important remedies in the treatment of this subacute rheumatism If [illegible] the disease is pretty manageable. The nearer they approach to acute the more useful will actaea be otherwise conium Fowlers sol. Harthrytum [illegible] Digitalis guaiacum If a pat. has got out and is in great danger give him great quantity of alcohol 5th Marasmus tabes (vide. Good) General extenuation with debility, with languor, exhaustion, hectic (Neither Cullen’s nor Good’s hypotheses are worthy of consideration being mechanical)The assimilating capillaries are probably principally affected, owing to derangement of digestive functions. (The stuff about the absorption of oils mucilages, and alkalies, is poor enough) Prof. T. has found opium of more consequence (in tabes venenata) than any other remedy next conium & iron with acrids also cinchona etc. Narcotics must be in small doses frequently repeated, to obviate lesion of the nervous function. Prof. T. has known a disease closely resembling strumous cephalitis which does not exist the effusions being a mere sequel in the latter stages effusions somewhere are the common result of acute disease e.g. in the pericardium etc.) produced in children by excessive quantities of calomel 2 to 4 times a day so long as the sickness lasts and then much large quantities of calomel, would be given & produce a mercurial dysentery for which still larger doses of calomel would be given & finally the parents would refuse to allow their children to receive mercury & consequently the practitioners themselves would see that children would get well without cal. & then conclude that cal was improper for children altogether case of a distinguished teacher in a large town who holds this opinion led in this way When this affection begins, stop your mercury & give narcotics # Prof. T. has seen the same effects (not hydroc. [illegible]?) from mercurial itch ointment An irritative internal haemorrhage is often rarely but sometimes produced “Said to have happened in Eng “said to have been caused by corr. sub Abortion is often produced by a continued mercurial course said to have been produced in France by calomel Fevers treated with mercury in grain doses as a stimulant made hopeless irritation uncontrollable diarrhoea. Mercury often does more hurt by its inconvenient effects than good by its desirable Many practitioners now employ the vegetable deobstrents & use mercury almost only as a slow cathartic. # A [most] [illegible] aff. [illegible] syncopalis is sometimes produces more often by the external use of it for the itch but by the internal use in irritable subjects” Ac. lead is often preferable. it is liable to only one inconvenience viz. [illegible] Sanguinaria is often preferable Actaea is often preferable Conium is preferable, for jaundice chronic liver affections etc. The pneumonitides are better treated without mercury at least as the principal remedy (The rash & careless use, eve of narcotics even of opium, is far less dangerous than that of refrigerants, tart. em. mercury etc.) It is a rule of naval & military practitioners that mercury shd not be used where it can be avoided as it leaves the patients more exposed, for years, to injury from exposure to cold, & wet etc. This applies to all cases of persons liable to exposure i.e. seamen, blacksmiths & manufacturers No remedy is applicable to a greater variety of cases, than merc. exc. opium opium (Dr Chapman says none whatever) It is not in the latter, but in the earlier stages of disease that calomel is especially useful Hence Dr Bond’s rule (vide Chapman’s therap.) always to try mercury as a dernier reasort, as a pernicious one Therapeutic application Dyspepsia it is almost a matter of course to treat dyspepsia with di-chlor & dis-ox. merc. Prof. T. has never seen any benefit except that of an eccoprotic or a laxative and even these other articles are generally better. They are also extremely liable to produce tenderness in region of liver, stomach etc. Let this tenderness exist of itself & even be relieved by merc. they debilitate irritate etc. Yet they are occasionally proper for a short time. Occasionally proper as a slow and moderate cath. It should be employed in but a small proportion of cases Colica ileus important often in large quantities especially in the early stages “Cal. & opium are equally important auxiliaries shd be used” Large quantities shd not be pursued into the secondary stages C. rhachialgia useful in the same way as 3 or 4 dose zi [illegible] are often necessary in the course of 3 or 4 days But Prof. T. thinks corr. sub. & still more red prec. is preferable Coprostasis (idiopathic) large doses in the early stages but if it fails give other remedies Diarrhoea vulgaris moderate diar. may be broken up by vom. by purg. by almost any strong impression Sometimes cal. cures in the earlier stages by its deobstruent effect It shd not be given in the latter stages. Dr Johnson thinks the fashionable British practice of purging protracts the disease Colliquative (tropical, & intemperance & puerperal diarrh. also that of old men contraindicate calomel Cholera vulgaris generally, though a severe not a dangerous disease often protracted by treatment often broken up like diarrhoea by a strong impression as by puking Cal. may cure it by its deobstruent effect. “[illegible] doses of cal. may be good before the vom. & purg. is begun It is of no use as a cathartic nerely because more purging is useless It is of no use unless in an extraordinary dose while the evacuations are large It is not indicated as a sialogogue, nor as a stimulant, tonic etc. It is good to change the [secernents] particularly the liver & al. can. but before giving it check evacuations with opium and produce reaction by stimulants Give it in quantities short of the purging point often combined with stim., etc. Helminthia one of the best articles # Icterus vulgaris may be made to cure purge at first then in alterative doses combined as the symptoms indicate. But conium will cure more speedily and better. Though even with this a purge of calomel may be given at first though not for purging Parabysma eractum conium is better than calomel quinine is better still. Give conium & quinine. All [illegible] the cases that are the primary effect of malaria are best cured by quinine The [illegible] cure the sequel of intermittents by quinine alone Prof T. gives in such cases conium & quinine Anti corysa (often a troublesome disease) an attack may be broken up by a slow cathartic of calomel at night We should not keep repeating it however Intermittent If a cath. is needed at the commencement cal. is the best & is better than an emetic Previous to the use of quinine cal. was often necessary to obviate the inconvenient effects of the pure bark often a sub ptyalism was necessary to be kept up No inconveniences however result from the use of quinine Remittent cal. is of more importance than in intermittent purging & often a subptyalism is needed after which quinine will cut the disease short Typhus infantum very important T. nervosus perhaps only in non-malignant typhus is calomel advantageous. N.B. This is the most common fever all over the U.S. (even at the south testimony of Dr McBride etc.) Employ in the very commencement of an attack say 3 grains once in 3 hours conjoined with a diaphoretic regimen so as to produce a sub ptyalism or in one or 2 large full doses, with opium if necessary in order to keep it from purging under 15 or 18 hours the very best mode of breaking up fever. If we are a little too late, or if the cal. passes immediately off by the bowels, then give enough to produce a submercurial action for a few days and conjoin mild tonics the disease will be [mitigated] & shortened N.B. we do not wish much purging but the universal deobstruent effect of the calomel. Hurried through the al. can. it is no better than any other cath. Even if the disease is completely broken up, yet the patient shd be carefully attended to & treated like a sick person. Prof. T. has resolved 8 cases out of 10 even when the disease has been fully formed. Some of his friends think they have resolved a greater proportion Dr Todd, Dr S. B. Woodward etc. But if the disease is malignant or if the pat. has tampered with medicine, or put off the employment of a physician we cannot succeed thus Delirium tremens sometimes cal. is important where there is insusceptibility A single full dose in conjunction with opium will produce sleep with more certainty. But in the exhausted and broken down it will not answer Yellow fever agreed to be important difference of opinion as to mode of management Prof. T. finds neither purging nor salivation necessary It is agreed that there is not generally time to salivate. Useful in those cases in which there is great torpor & insusceptibility of the system with nearly a total suspension of peristaltic motion If the case is one of exhaustion and one which begins with diarrhoea cal. will be useless. In the other sort of cases tropical writers have given 1000 grs in 4 days without saliv. or purg. Prof. T. has given 400 grs in 4 days without either sal. or purg. In the same case he applied a 7 by 9 blister on the epigastrium one half as large between the shoulders blisters a quarter as large above the ankles 400 grs in molasses a teaspoonful once an hour Patient extremely delighted with the effects of both Stomach would probably have rejected a tablespoonful of bals tea. But in other cases a grain of cal. would pass off in half hour. In this case subsequently to the first 4 days quinine and a moderate use of brandy In the secondary stages of yell. fev. cal. is generally injurious Typhus putridis sometimes useful as in t. nervosus Synochus calomel is sometimes needed for purging oftener as a deobstruent Most practitioners bleed puke and purge and have to stimulate or have protracted and relapsing stages Entonic phlegmonous phlogotica Depletion & neutral salts at first afterwards use cal. for a mercurial action. Dr Rush’s compound of cal. tart. ant. & nit. potas. is the very best compound vary the proportions to suit the case. Determine the proportions just as if you were giving each separately Especially important is this practice in cephalitis still more so in pneumonitis In enteritis bleeding is still more necessary neutral salts will be rejected Calomel is the article for purging give your calomel clear to keep it from being rejected. This is the only cath. you will succeed well with. Atonic phlegm. phlogotica Calomel is very important no bleeding not so much purging s use blistering. Prof. T. has seen no atonic phleg. infl. of brain he has seen only strumous or arthritic or erythematic Atonic phlegomonous pneumonitis purging with a large quantity a strong mercurial action just as in the at. phl. hepatitis of tropical countries N.B. you must be more in a hurry to produce a mercurial action in these atonic infl. than in the others. Prof. T. thinks the weight of testimony among the tropical writers is against bleeding & drastic purging against J. Johnson Phlegmonoid erythematic erythem. known by the fever’s being [synoch] or gravior phlogotica Purge with cal. follow with calomel to produce a mercurial act. followed by serpentaria cinchona etc. Pure erythematic or gangrenous phlogotica (e.g. of fauces) calom. is injurious eryth. cephalitis & pneumonitis cal. is of more importance unless they are gangrenous Eryth. enterities is apt to have a diarrhoea generally has a diarrhoea cal. apt to purge corr. sub & especially red precipitate are better Of late years Prof. T uses conium even in some cases in dram doses Arthritic phlogotica calomel of high importance of late years Prof. T. has often gone back to the calomel practice. Case extreme pain in joints with redness & swelling extreme pain all over Cal. & opium until the pain was relieved it took 10 grs of opium with a diaphoretic regimen next op. & ipecac then a little castor oil to bring away the al. Finally alcohol & cinchona No case lasted longer than a fortnight under this practice. Next Prof. T. employed veratrum viride. Next he employed colchicum but it was inconvenient he has known persons cured of the rheumatism by colch but killed by subsequent diarrhoea Actaea is the best Sanguinaria digitalis Some conjoin calomel with these membranific phlogotica Croup hysteritis cystitis Calomel is universally agreed upon except in croup but even here though vomiting will cure cal. is better or rather both. Prof. T. has ceased to vomit in his own croupy family Strumous phlogotica more useful in the acute according to the general rule that cal. is more applicable to acute phlogotica Several phlogot. not referrible to these divisions Influenza Pneumonitis notha Cholera infantum Dysentery different modes of practice some [illegible] with large others with small doses both are proper in different cases In some epidemics calomel is inadmissible Case of the epid. at Midd. a grain of cal. or of ipecac would bring back the dysentery when it took 40 grs of opium a day to keep the disease under trouble with counsellors Epidemic (Egyptian) ophthalmia a bad disease It is the common practice to bleed the patient almost to death bad Purge with calomel give cal. & op. Bring the system immediately under mercury Treat like tropical hepatitis Conjoin actaea Sparganosis puerperar. Prof. T. has never met with a case in which it was admissible he does not doubt that they do exist Synochous exanthematica (Phlogistic exanth. are talked of but not described authors do not even suppose them phlogistic except a short time at the commencement) Typhus exanthematica contraindicate it Lues syphilis While it exists as chancre and bubo only it is purely a local disease and may be cured topically. 3 to 6 weeks ore even 3 mo saliv. is necessary to cure it through the constitution. Some use both but the topical are those that cure, even in this case But some claim that the absorption is prevented by the const. treat. Now medication cannot be thus [prevented] by anticipating the period of absorption according to the regular laws of the disease Mercury will not relieve the topical disease, without a sub salivation. Many practitioners suffer the pat. to run on a long time without sub salivation. But this may be produced in 24 hours by conjoining opium or perhaps wine & quinine Prof. T. has never known the constit. eff. follow when the disease had been cured topically. Even if they do it will be time enough to treat them when they occur Mercury will even hinder the healing of the topical affection When the father or mother infect their offspring without having symptoms of the disease left on themselves, and the children have a fatal syphiloid affection the affection of their subsequent children may be prevented by mercurializing the parents a curious fact! Prof. T. has sometimes cured such children by conium & corr. sub. The new way of treating syphilis has yet to encounter great prejudice When the const. symph. have appeared perhaps cal. is the best remedy. The others (cor. sub. & red prec.) do not produce ptyalism & a sub ptyalism is necessary The above is a very imperfect account of the therapeutic application of cal. It would require a volume to exhaust the subject Pneumonitis notha is or common pneumonitis always synochous or typhus. Atonic phlegmonous pneumonitis has a nervous fever accompanying it. N.B. Edema of the lungs (of Dr Hooker) is not a pneumonitis Erythematic cephalitis is the disease described as a fatal erysipelas of the head but the eruption comes not out till 3 or 4 days have elapsed and there is light generally on the face. Other erythematic empresmata are attended with eruptions somewhere that of the lungs (liver?) is on one or both extremities. Fever varies from synochous to t. gravior “I have never known calomel thrown up when put into the mouth & swallowed with the saliva” From [Savage’s] notes Tonics Produce increased strength of action in subordinate parts of the system e.g. appetite, digestion, pulse, muscular & mental action removes morbid mobility & irritability of atony Mr Abernethy says all strength depends on strength of digestion. But some tonics increase strength of art. act. (e.g. arsenic & cinchona) before they increase appl. & digest others first increase appetite & digestion & subsequently general strength. Hence an important rule for selecting tonics to suit a case e.g. Intermittent does not require those which act by increasing appetite Prof. T. has found the above true of cinchona, liliodendron & magnolia Tonics do not act rarely on the muscular system they certainly increase the contractility of the cell. fibre All tonics increase art. energy those articles which act on parts of the system without strength the arterial syst. are not tonic. Prof.’s I. & T. deny entirely that tonics produce ultimate debility They have known bark iron used many years with increase of strength Bark for 12 yrs vide Heberden Bitters are not necessarily tonics metallic articles are not bitter Some tonics, as cascarilla? bark of croton tiglium? etc. cinchona quinine require liquid food to make them sit well upon the stomach. So alc. requires food in exhaustion of fatigue Case of a traveller or laborer. The above tonics approximate to stimulants. Much depends on a knowledge of this principle in intermit. for inst. quinine may thus be prevented from producing a sense of stricture, nervous symptoms etc. If you excite the appetite, the stomach must have something to act on Tonics are indicated in some stage or other of all atonic, debilitating diseases They are better understood than any other articles Groups 1st tonica [amara] simplicia Limaronba excelsa (quassia of the shops) Quassia amara. Scutellaria [illegible] Little inferior to quass. & generally preferred by patients pure simple bitters like quassia [chelor??glabra] [illegible] [Hanth???] much used Canadensis like columbo a [???folia] hydrastis Gentiana [illegible] etc. The [illegible] gentians have smaller roots but are as good [illegible] [illegible] is best [chrymoplenum] [apporeti] [colum?] possessing the same smell taste & chem. prin. but pleasanter & preferred by patients [illegible] Canadense allied to Cocculus [illegible] (Columba) Menyanthis trifoliata buck bean Helnium autumnale Gratiola aurea These are mostly amer. articles & as good & cheap as foreign 2nd amara [nervousa] [illegible] G. [ochro???] is good G. saponaria is one of the best G. quinqueflora & other northern species are not so good Tops & roots are used. [lupules] (best) hoarhound Lycopus vulgaris (water hoarhound (L. virginicus is much feebler, but is most used Ballota nigra nearly allied to hoarhound 3d amara narcotici barks of cerasus virg. C. oborata the best of the genus Sorbus oborata & necrocarpa Pernica vulgaris barks of all of them 4th Tonica amara astringentia though some are merely astringent to the taste Cinchonae a large num. of species Corni C. sericea probably best next is probably C. circinata & paniculata C. florida inferior more astringent Querci Q. alba & tinctoria Alcornia latifolia Bodygin (alcorn [oaks]) Alnus serrulata (may be used for cinchona) 5 amara aromatica Galipea off. (angostura) magnolia glanca umbrella cordata etc. etc. valuable (elegant aromatics intensely bitter) Next is siriod. tulip. Ilicum floridanum (both aromatic & bitter) Croton eleutheria & cascarella & aromaticum (cascarilla) Tasmania aromatic similar caryea amara, squamosa, procina & alba (pungent aromatic acrid reminding one of guaiacum) Ptelea trifoliata bark of root & top differ considerably Hanthoxylum fraxinem (less bitter) H. tricarpum & H claraberculis (most valuable) Dryni winteri (winter bark resembles canella more agreeable almost a spice) Drynis of several other species Canella alba (called canella also) 6 Tonic. amara laxative [Federia] cordifolia (much used by the Spanish Americans the fruit) [Grellindina] [illegible] & bond cella Gallindina bondere (nickernut) [illegible] as [illegible] etc. blue & yellow nicker nut # Eupatorium perf. & rotundif. Polygala polyg. or rubellum (purges like aloe) but may be taken as a tonic without being laxative) A good bitter tonic & laxative in dyspepsia 7th metallina. Vinous prep. or iron ox. zinc hyd. bismuth sulph zinc arsen. potash & soda nit. silver Copper sulphate acet. & [nitroguret] (C. ammoniata) # preferred by g. Johnson to peruv bark in tropical climates Habille Carthagena Carthagena bean used in dysp. with torp. of bowels Arsenous acid White oxide of arsenic The word arsenic occurs first in [illegible] & applied to a sulphuret of arsenic used in painting Avicenna first recommended it internally The garlic smell is now known to arise from the dix-oxide which is the substance condensed on the tube & formerly called metallic arsenic Arsenous acid is seldom formed by chemists it is collected by the smelting of ores 77 ¾ parts and soluble in boiling water 1000 parts; in cold water only 2 ½ parts soluble in the 1000 parts. Composition 2 i ars. 7-6 ii 3 ox 24 = 100 In uniform & small doses, repeated acts on circulating system as a tonic increases heat (in a tonic coldness secondarily it increases appetite dig. power & ultimately after removing the disease muscular power Dr Potter (in his monograph) says it acts first on al. can. but its first perceptible effects are upon the sangiferous system No doubt it acts firs on al. can. but so do all remedies Given efficiently it certainly affects the sanguif. syst. before the app. & digestion. When given in nauseating & vomiting doses it of course acts first on al. can. More speedy than any other tonics but less so than the stimulants. It may be made to show its effects in 24 hours. It thus resembles cinchona in its effect on [illegible] & gangrene It has the remarkable fact that it has the power of restoring warmth to the surface though with no distinct relation to its tonic power Prof. T. has witnessed this perhaps 50 times Some patients have thus been saved. It may fail thus as an “analeptic” like other analeptics in extreme last stages This article seems to be an intermediate link between tonics and stimulants In larger doses it acts on the whole sec. & abs. syst. affecting the skin tumours ulcers etc. It is strongly antipsoraic relieves ulcers, cancers It is useful in rheumatism hence redolent Not discutient cholag. sialag. expect. or diaphoretic Acts on the brain & spine more than any other tonic & that too in remedial doses No other metallic preperation produces vertigo tremors etc. This operation has no name nor classification Prof. T. has seen however dilated pupils etc. in domestic animals from oxide & carb. of zinc. Oxide carbonate & ac. of lead act on the nervous system producing colica rhachialgia. Oxide and carb. of zinc have time immemorial been called poisonous and this must result from an operation on the nerves for they will not produce local irritation In large quantities laxative & purgative In larger it is emetic Externally applied it may be made to cure cutaneous diseases & to act as an escharotic. Dr Potter (Baltimore) says that in certain doses it is laxative and emetic It increases force and fullness of pulse without rendering it hard not admissible in phlogistic diathesis changes secretion and absorption is analeptic etc. not diuretic nor diaphoretic children bear larger doses than adults etc. N.Y. Pharm. “tonic, alterative, escharotic” Prof. Frost of M.M. Charleston says it is useful only as a tonic The injurious effects are caused by long continuance, rather than by a large dose so too of ac. lead. In acute diseases the larger quantities are of more consequence long continuance in chronic Antirritants enable larger doses to be taken generally opium in acute and conium in chronic. Veg. acids & aromatics assist it. When used freely conjoin liquid & farinaceous [nutriment] just as with quinine & stimulants The Philadelphians think it resembles tart. em. most not much foundation for this notion except as it vomits and purges Sulph. zinc of iron & of copper resemble tart. em. as much Even cinchona may be given in nauseating doses and all these then given are reducing of course Tart. emet. is of itself a refrigerant. We cannot class together articles which agree only in nauseating. Who would think of curing intermittent with tart. em. Tart. ant. & [illegible] are thought to agree in their antipsoraic power but the former is merely diaphoretic & has no antipsoraic power whatever Prof. T. came to this conclusion from observation before reasoning at all upon the subject. They both act upon the skin, but in different ways. To be sure some practitioners use arsenic in non phlogistic cases as a refrigerant & in the same way might sulph zinc etc. be managed. It is a kind of experimentum crusis that arsenic cannot be used in phlogistic cases Some suppose arsenic acts only by producing its own specific disease but it may be made to cure disease without any thing of this [effect] though this may sometimes be necessary [This] is true of all active medicines & when so pushed they produce diseases more or less specific Some think arsenic acts in a manner incapable of classific. & they call it merely alterative. But every remedy must produce an alterative operation of some sort or other and the alternative operation of arsenic resembles that of sulph. zinc of iron etc. & other tonics. It seems to be fashionable with some to deny the pathological conditions which are the foundations of the classific. of m.m. & they reduce every thing to a specific morbid affection overcome by another specific morbid action. Prof. T. thinks that all the operations of remedies may be classed Entony indicates refrigerants Atony stimulants etc. etc. Rec. [illegible] arsenic is 1st tonic strengthening pulse obviating debity increasing muscular strength etc. 2nd deobstruent curing cutaneous diseases cancerous ulcers resolving topical infl. 3d cath. 4th emetic 5 epispastic in the sort called escharotic & anti psoraic. Prof. T. thinks it far less injurious in its effect than polygala senega ornithogalum squilla & tart. em. (Hive syrup made of these three does more injury in a year than arsenic ever did) Tart. emetic causes many deaths, arsenic never does, when given as a medicine. It is accused of producing in inordinate quantities & when too long continued dyspepsia marasmus etc. But the same accusations have formerly been repeatedly made against cinchona It will never succeed when given rashly by dashing etc. as is so fashionable by larger frequent doses producing unequal excitement When too long continued & in too large doses it produces a puffy swelling of the skin & lips ophthalmia tarsi erythemia tormina etc. Dr Potter Good in his article on headache gives a summary of its ill effects These effects are more easily cured than such effects from tart. emet. An erythema vesiculare is produced by its analagous to that o f mercury. Case of Dr Todd’s pat. metastasis of pneumonitis probably arthritic to the brain took several fl. drams!! with 24 hours of ars. sol. of tinct. opii ([illegible] 120 and 240? tinct. canth [illegible]) & tinct. canth. in the second 24 hours 200 m. SS 120 m. t. canth 120 arsen. solut. In 48 hours hemiplegia cured erythema was produced with puffy swelling etc. In poisonous doses vom. purg ptyalism dysentery, haematuria sunken countenance paralysis convulsions etc. subsultus & death etc. etc. Dr Potter He says mucilages and oils are good for nothing as antidotes neither is sulphuret of potassium He directs to evacuate thoroughly & then treat on general principles Give castor oil etc. # Dr Bartlett gives as sympt. astringent metallic taste naus. vom. fetid breath ptyalism dysentery, distress etc. etc. It seems to be capable of extinguishing vitality without any of these effects in a transcending dose vide Orfila for a case So too vomiting doses will transcend its tonic effect & soon Arsenous acid retains its full powers in every form of combination, so long as its identity as an acid in combination, is preserved; so that, if you give any salt of it, enough to contain a given quantity of the acid, you get the same effects that you would if the acid were given isolated. Hence the folly of giving “chemicals,” as directed by the toxicologists. # The sequelae are dyspepsia, debility paleness, sallowness etc. etc. Pharmac. prep. 1st substance in pill Rx ars. ac. [illegible] fx. soap q.s. ft. massa in pil. 120 div (N.B. the salt thus formed in the same power as the arsenous acid) This is a very convenient prep. In acute diseases the dose varies from 1/24 to 1/12 gr. 3 hours to every hour (acute diseases) In chron. diseases 1/24 gr. 4 times a day is a minimum & 1/12 gr. a max. dose Tests of too large a dose [vertigo] etc. etc. tremors, nausea Either of them should cause the dose to be diminished Test of too much in 24 hours constant vertigo restlessness or tremors or headache general uneasiness sense of inflation at stomach or tormina or a laxative eff or a sense of inflation in epigastrium Test that pat. has taken it long enough puffy swelling under chin or face or ankles or under chin backs of the hands, a stiffness & [illegible] [illegible] slight ophthalmitis tarsi swelling of upper lip slight salivation or moderate tenderness of gums or a little ptyalism sometimes general swelling of body or erythema vesiculare. All go off soon if med. is left off. may exist several days without injury. Any one indicates a discontinuance Generally swelling appears first under chin & on backs of hands or wrists. Prof. T. has know them continue a week with no injury The salts of arsenous acid have the same effect as the acid & in the same quantity of acid 2nd Liquor arsenicalis Arsenite of potassa etc. etc. [Solutio] Fowleri Rx ars. ac. in very fine powder very pure carb. pot. aa 64 grs. distilled water 1 pint compd spt lavander zfs Boil & add the spt. lav. then add water enough to make up the pint. (Better add less than a pint at first say 14z & then fill up to a pint) This is Fowler’s original formula Phil. phar. N.Y. ph. gives arsenic ac. & sub carb. pot. & alcohol!! The compd spt lav has the advantage of giving taste colour & [illegible]. Case a colourless & tasteless sol. of ars. prescribed by Dr [Cogswell] for a [herpetic] patient. He refused to take it longer “as it was nothing but water” Dr C. told her wht it was & she refused to take it! This prep. gives 1 gr. ac. to 2 fl z of liquor hence 10 m. = 1/12 gr. & 15 m. = 1/8 gr. N.B. the solution requires a smaller dose the pill being gradually dissolved The liquid preparations of arsenic must be kept closely stopped & excluded from the light for the dis-oxide is precipitated on the inner surface of the bottle This decomposition will finally take place under any circumstances Pills shd not be given after they become hard Prof. T. has again and again known opium pills pass through unchanged. Pills of iron & conserve of roses may be cut & polished Rx arsenous ac. [illegible] fs sulph. quin zii sil. morph. 15 grs. ol. caps. f zfs. ext. daturae q.s. ft massa in pil. 120 div. N.B. Tonics are combined with advantage and narcotics is advantageously combined with arsenic This pill does not harden It answers extremely well in hemicrania & neuralgia etc. Each pill contains Therap. appl. 1st Pytal. ac. var. hydr. with secondary & advanced stage when it is subchronic very important it frequently arrests also useful in early stages when not too irritable & even in those combined with narcotics A most important article. Dysphagia constricta var. schirrhosa conjoined with conium [Dipsoneus] avens var. [illegible] conjoined with op. conium & capsicum Limosis dyspepsia Prof. T. has always used in various cases So has Dr Todd who combines quassia & ginger sometimes he conjoins conium or conium & veg. acrids So has Dr Reed who adds conium, dandelion capsicum etc. persevering in its use for a long time N.B it may be taken for a long time conjoined with veg. [ton.] conium & capsicum Prof. T. has even accomplished much with it alone preferring the substance Rx ars ac. [illegible] fs sub. quin zii ol. caps. zfs ext. con. q.s. ft. pil 120 often adding more conium or giving conijm in conjunction in short varying the prescrip. pro re nata Limosis sputatoria may always be cured by this article alone or combined Lim. syncoptica (cardialgia syncop.) here acrids are more important in in conjunction Col. rhach. combined with opium will keep the symptoms at bay. Opium is allowed to be the most important article in this disease but will not cure alone It is found that a free use of cal. is necessary corr. sub. better Prof. T. finds red prec. better still. Practitioners tell of given 5 gr corr. sub. every [2] hours!) Prof. T. has given 5 gr. red. prec. Fowlers sol. has been given in z doses without vomiting Arsen. has been given in gr. doses There is something peculiar as to the operation of min. med. in this dis. Dram doses of [illegible] have cured with opium opium shd always be combined Arsen. & strychnine are admirable for the paralytic sequelae with auxiliaries Colica callosa var. schirrhosa Epidemic cholera (it is the fashion to attempt its cure by strong impressions merely The originally incurable cases & the trifling ones shd be excluded) perhaps along with other articles it would answer well when the discharges have been stayed. Helminthia insisted on by Dr Potter the variety of this disease is not specified. It would scarcely be worth while to resort to it in any but H. taenia to improve the cond. of al. can. relying on cath. of ol. pin. to remove the worm helm. fasciola hominis (fluke or gourd seed worm) rather a rare & a very obstinate disease (N.B. in sleep the fasciola [ovis] passes into the liver up the ductus communis & cannot be wholly cured by cathartics may not this be the case with [illegible] case Prof. T. has never known a case of complete cure arsenic does much the most good seems to be by for the most effectual remedy) Helminthia erratica probably Proctica schirrhosa & parabysma schir. parabysma, strumosa arsenic conium acrids quinine cantharis conium & arsen or con. & iodine the best preparations iodine corrosive subl. etc. Bex convulsiva a long known and a well established remedy conjoin ext. con. which has been relied on exclusively Dr Beery has often found ars. pot. alone of the highest service in sequels of hoop. cough Intermittent next after quinine & perhaps the best bark in substance. It may be taken with less in convenience than bark and the latter cannot be given [illegible] to small children Vide Good for its history The instances of supposed derangement with particular doses are merely cases of too large doses for the particular circumstance Give say 8 doses in 24 h. instead of 1, 2 or more as directed by Dr Fowler (N.B. give a med. at the hours of 3, 6, 9, & 12 & but 2 doses will come in the night) Give 10 drops at least of SS. with each dose Trouble not yourself about the bowels they are generally well enough better give injections than cath. if the bowels are not spontaneously moved once in 2 or 3 days. It is well known that metallurgy in a neighborhood cures & prevents intermittents Dr Good’s case of Cornwall is not the only one known The dose shd not be large say 5 to 10 drops nor the quantity as to produce the tests often once in 2 h. never less often than once in 3 h. sometimes once in 1 h. always conjoining opium ( which itself will cure interm.) Periodicus remittens as useful compared with quinine as in intermittent though not as important in the former as in the latter. It is even said to be more unfailing than in inter. Typhus nervosus seems absolutely to be the best tonic better than quinine to be given to check coldness & cold sweat & to change secretions always when mercury seems to be indicated always conjoined with [opiate] & food perhaps with acrids sometimes 2 drops once in 2 hours or 5 drops every 3 hours sometimes more sometimes less. Typhus syncopalis vide Danielson & Mann’s account It has been used in every epidemic Anthrax pruna just as for gangrene Erythema gangrenosum but sul. quin. is of more consequence Erythema anatomicum saved several cases known to Prof. T. before quinine was discovered in one case 10 drops an hour. In but one of several cases which Prof. T. has known was there a puncture all of them resulted from exan. recent subjects one case began by a sensation resembling a sting & a minute discolored spot on the middle & fore side of the fore-arm. Ophthalmitis tarsi & psoriasis palpebrarum (which exists) probably would cure as it affects the eyelids Ancheritis strumosa (glands of neck) Cephalitis strumosa [illegible] [illegible] etc. Arthritic cephalitis highly useful Paristhm. erythem. var. putrida Pneumon. typhodes erythem. & syncopalis & putrida (gangrenous & Pneumonitis arthritis ver. atonica So arthritic carditis, diaphragmitis, & gastritis Cholera infantum Enteritis aphthosa (Prof. T. has seen two p.m. ex. which showed the whole al. can. affected) Dysenteria typhodes in the latter stages with opium even in the early stages Prof T. has known it beneficial combined with opium & used instead of calomel Mesenteriti strumosa (enlarged mesenteric glands) may almost or quite be cured in its early stages Give acrids quinine, iron cantharides, conium & especially arsenic Eryth. infl. of liver (hepat. typh. var. putrida) in secondary and exhausted stages. So to [peritonitis] typhodes var. putrida All the varieties of true rheumatism in some stage (even in the entonic, after depletion & reduction One var. of rheum is phlegmonia another is [erhthematoid] (not mentioned expressly in the books and a very formidable disease prof. T. has known one quarter of surp. of body gas [illegible] after depletion & reduction) opium conium quinine alcohol conium actaea arsenic Subacute rheumatism may often be cured by arsenic alone. Prof. T has known bed rid persons cured this seems to be the best article. The sub-variety of this disease produced by mercury are especially benefitted by arsenic Chronic stage of acute rheum. benefitted by ars. but more especially by aralia [bispida] Podagra larvata (atonic gout (Cull)) a form of rheumatism as resembles this (Theumatism larvatus) Rheumatalgia useful with conium & nux vomica more useful as it is more acute particularly when there is an early tendency to paralysis of extremities but should then be combined with ol. pip. nig. or ol liriodendron ol. caps. etc. [illegible] conium, nux vomica hyoscyamus sciatica useful conjoined with narcotics I have often cured [with] sometimes relieved by mercury when first commence & by other means arsenic one of the best articles where established Secondary & exhausted stages of scarlet fever Erythysmus hydrargyrata & tabes venenata Ricketts I have known it used with beneift in the early stages [illegible] syphilodes & syphilodes (vide Good) with black pepper much used in the east (vide Good) There is no doubt of its efficacy in S. syphilodes. Perhaps there is doubt as to true syphilis Arsenic is peculiarly valuable with quinine and opium in the ulcerations etc. from syphilis & excessive use of mercury Useful in syphilitic eruptions Carcinus vulgaris highly valuable it has sometimes produced sloughing & a cure the difficulty in managing it is that practitioners are too much in a hurry attempting to take the disease by storm and not conjoining supporting remedies & narcotics cancer is a disease always requiring support it is a disease of the abstemious never of the high living & gouty Prof. T. has known it so employed & the health improve. But iodine is better & next after arsenic is corr. sub. arsenic is next to iodine (vide Good) IT is the basis of almost all the secret remedies for cancer. of course caution is required for its use There is no foundation for the notion that the system geta accustomed to this remedy & ceases to be affected by it in such cases the dose should be increased similar assertions are made respecting opium & with no foundation. The great difficulty with authors has been that they supposed they must give it alone & only twice a day Prof. T. has witnessed several cases of unquestioned cure & others of great palliation and mitigation Elephantiasis arabica has been highly successful (vide Good) used in the east, with a considerable quantity of black pepper. “It is proved beyond all doubt that the disease has been cured by arsenic” Prof. T. has known a few cases and all were cured by arsenic alone [B??nemia] Indica Prof. T. has seen several cases and Good has done ill in associating it with spargm. puerp. which is a phlogisticum. His cases were cured by arsenic alone Gangrenous sphacelus arsenic seems preferable, perhaps, to bark though not to quinine Prof. T. has known gangrene or [illegible] [illegible] of paralytic rheumatics cured by arsenic So to of gangrene after typhus Gangrena necrosis (dry gangrene Gangrena []?staliginea] (mildew mortif.) recommended I have known vitiated ulcers highly benefitted Hypochondrias recommended Trismus & tetanus arsenic & datura & opium have cured bad cases. vide N.E. Journal of Medic. Prof. T. has known several cases cured by it. actaea too is often useful Neuralgia faciei [illegible] etc. but generally it is badly managed some cases may be cured by quinine alone arsenic alone, opium alone etc. but generally a combination should be used N.B. keep the pot. under the influence of it all the while not merely during the paroxysm Clonus palpitation & singultus are occasionally relieved by arsenic Singultus of typhus & low pneumonitis typhodes is best relieved by arsenic [illegible] case of 200 drops in one night Chorea sometimes cured by this with strychnous, quinine etc. Lysse canina some cases apparently cured Common convulsions [of infants] occasionally Hysteria epilepsy sometimes are tonic Paralysis one of the most valuable remedies with iron acrids etc. Distortion of face from paralysis Sarcoma schirrhism (curable by extirpation even at an advanced stage Prof. T. has never known a complete cure by extirpation of carcinus vulgaris Dropsy of abdomen after evacuation of water supposed to be be peculiarly appropriate Leprosy (vide Good) peculiarly valuable Lepidosis psoriadis arsen. con. etc. particularly valuable after a very severe disease (vide Good) Ecpyesis impetigo, herpetica (herpes of Cullen & herpetic eruption of authors) always curable by arsenic if persevered in useful also eternally in a weak solution Ecpyesis imp. [lamin.] (salt [illegible]) about the hands cured by a weak ointment of [arsenic] N.B. medicines will not cure when applied only when the disease is so irritable (in a sort of paroxysm) that the phys is sent for they then require only emollients the arsenic shd be applied about 8 grs arsenous ac. to 1 oz simple cerate to commence with first finely pulverizing the arsenic & mixing it with about a dram at first of the cerate to make the mixture homogenous (N.B. not a glass but a Wedgwood’s mortar pulverization cannot be effected in a glass mortar) [Ecpresia] [?origo] galeata Prof. T. has cured cases which had resisted all other remedies internally & externally Punctura venenata (vide S. Coop. Surg. Dict. last Am. ed.) used successfully time immemorial in India In Ohio they cure by laudanum giving enough Dr McBride & Dr Osborn of N. York who had practised at the south, considered alcohol infallible The people sometimes get down a gallon of spirit in 24 hours. [Celsus’] remedy was vinum cum pipera [cernatic] snake pill is Rx arsenous acid root of vella navi of another seed of croton tiglium live quicksilver, black pepper aa equal quantities each pill to contain 6 grains each pill will contain 1 gr to a teaspoonful of Fowler’s solut. and 2 or even four pills are sometimes given Case of Mr. Ireland pat. insensible in 10 min. fl. zii Fowl. [min.] sol. etc. at once. (Dr Hubbard’s case repeated once every half hour until an ounce of Fowl. sol. or 4 grs of arsen. had been given. Four other cases cured in the same manner. Cinchona First introduced into Eur. in 1640 Condamine saw the plant first in 1737. Linnaeus called all the spec. C. offic. (including C. condaminea & pubescens) C. condaminea is believed to be the original “bark” near Soxa a slender shrub 18 ft. high There are now made 8 distinct general 1st cinchona 2d pynchnea exostemena etc. All the species are bitter and tonic but none are remarkably antintermittent but those with hairy & woolly blossoms Decandolle gives 16 species of cinchona Pynchnea has but a single species in S. Car. Nat. Order Cinchonease Three species are made offic. in Brit. phar. 1st cinch. cordif. supposed to produce yellow bark but it is found not to produce it Yellow bark has odour aromatic etc. internally of a yellowish cinnamon the particular species affording it is not known contains 1st [illegible] of quinine & a little [illegible] of cinchonum 2nd tannin (a little) 3d a yellow odorous [adipocere] 4th a yellow colouring matter 5 a red colouring matter 6th [illegible] of calcia 7th fecula Cinchona lancifolia affords the pale bark though by some to be identical with C. condaminea or a variety less bitter than the preceding cinnamon coloured internally. C. condaminea contains [mainly] kinnate of cinchonine with a little kinnate of quinine with other unimportant princ. Cinch. oblongif. supposed to afford the red bark but found not to producing an inferior bark odour and taste similar to the last but more intense bark red 2 Kinnate of quinine & kinnate of cinchoniae in about equal quantities said (doubtful) twice as much of one & 3 times as much of other. The true species which produces red bark is not known. The barks of all the species are collected indiscriminately and afterwards assorted according to colour probably it is impossible to assign the true species. Cinchomine is a white alkaline substance soluble in 7 or 800 pts water decomposed at about the temperature of boil wat. little soluble in ether ([hydric]) made up of carb. nit. ox. & hyd. Quinine is a white flocculent alkali soluble in wat. very soluble in alcohol taste much more bitter than that of cinchona less soluble in water very soluble in hydric ether & thus distinguished First brought into notice in 1820 by [Pellit] & [Cam??ton] Kinnic acid is found only in bark & not medicinal Kinnate of quinine is very soluble in water but less soluble in alcohol Kinnate of cinchonum is more soluble in wat. & is more astringent (if indeed the kin of quin. is astringent at all) Water is incapable of extracting all these salts from the finest powder of bark not more than 1z of the whole hence the dregs are worth saving for the extraction of the quinine & cinch. from them N.B. none of the veg. ac. have as strong attraction for bases, as the mineral acids & generally sulph. ac. has the strongest attraction hence very dilute sul. ac. will dissolve out all the quinine & cinchonium & we have a liquid solution of sul. quin. & cinch. Ammonia will take away the acid # then macerate in alc. & various impurities will be left then distil off the alc. till the liq is muddy then cold distilled water will precipitate the alkalies repeat the process for purification if necessary The [illegible] is not in quantity to act medicinally but will destroy tart. ant. or sulph. iron or gelatine hence too an infus. of nut galls is a test for distinguishing active from inert barks, by forming a precip. of gallate of cinchonium ([illegible] is [art]) Much inert bark is sold [illegible] a pat. took inert bark for 12 weeks then was cured by good bark you cannot tell by the taste All the best bark is now used by the manufacturers of sulph. quin. & the’ poor bark is pushed into the market # and decant off the liquid sulph. amm or use a magnesia in the same way But we should never used the crude bark it is better in no respect whatever And sulph. quin. is now cheaper. Connecticut practitioners know little about the matter not having opportunities from endemic influence. N.B. Some practitioners conjoin tartar emetic with bark the latter destroys the former the former does not injure the latter Tannate of antimony is perfectly inert It is stated that 2 fl. oz of decoc. cinch. (zi to 1 pt. water) renders inert [illegible] I tart. ant. consequently a pint would decompose tart. em. zv So too bark is incompat. with the salts of iron Food is generally required with bark but bark with animal jelly will form leather! in the stomach Gallate of quinine & cinchonium is supposed to be nearly inert Case in which an [illegible] phys. rendered bark palatable by nut galls! the mixture was pleasant but perfectly inert The proportions of acid & base in sulph. quin. & cinchon. are not well known Adding a little sulph. acid renders them much more soluble forming a salt with more acid N.B. if the mixture then becomes acidulous, add a little more sul. quinine. Prof. T. has always found acidulous sulph. quin. more instead of less nauseous Case related Phosphate of quinine is said to be better than sulph quinine said to contain some of the powers of phosphorus doubtful should be attended to Some think the acetab. better others think it worse probably little if any difference much less soluble very liable to precipitate when it grows colder. Tartrate oxalate gallic etc. are insoluble in cold water. The isolated bases (quinine & cinchonium) are less soluble than the sulphates or are insoluble but they are no less active The French to the contrary notwithstanding. Crude bark is very variable in strength offends the stomach etc. In tinct. requires too much alcohol For these and other reasons always use the prox. princ. Cinchoniae & quinine are found by Dr Elliotson to possess precisely the same powers as their salts Montannin has been extracted from C. montana equal to quinine & cinchonium in utility Chlorium bromine & iodine form inert compounds with all these alkaline proc. [prac.] [prin] still they will into decompose their salts The only medicinal operations of the 3 species of cinchona are the same in kind if not in degree They are all permanently & strongly tonic with a moderate degree of astringent power Quinine & cinchonine are not astringent Caventon & Dr. Theodore Woodward (a very susceptible person) have experienced nervine exhiliration from quinine “in large quantities however 30-60 grs a day” Other persons experience this effect. Dr Woodward always experiences exhiliration This is one of the tonics which is felt in the circulating system before it affects the digestive organs. It is by no means remarkable for giving an appetite In some cases where large quantities in a short time are indic. (as in interm.) the appetite is actually diminished. It is inferior to many articles for the appetite & digestion. It may require several days to affect the appetite Called stomachic Called febrifuge by which is meant that it is appropriate for intermittent Called antiseptic i.e. stimulant or tonic The yellow bark is considered best (it is said) in Peru. Some think red bark nauseates more Bark produces no inconvenient effects but nausea & diarrhea in large quantities Dr Th. Woodw. says the only unpleasant effects from the largest quantity of sulph. quinine are a sense of astringency in the stomach & a sense of faintness which however he relieves at present by always giving a little food (milk porridge for instance) A Frenchman (Blonde) is said to have noticed a short continued deafness, produced by a large quantity of sul. quin. Probably he mistook a symptom of the disease for the effect of the medicine Dr Elliottson cured nearly 200 cases of fever with sul. quin. 5-10 gr doses & inferred that it is adapted to phlogistic fever. He meant irritative Equal confusion exists about the use of bark in acute rheumatism Most of our cases of acute rheumatism at the present day are atonic and many of our practitioners give quinine freely in rheumatism & relieve heat, dryness of skin etc. Some of them infer hance that bark is adapted to phlogistic fever It is the fashion to call bark a congesting tonic. It was the fashion long ago to do so. But Sydenham Morton & others denied this No foundation for the notion that this article may accumulate in the system or its effects accumulate upon the system. Arsenic, mercury instead of accumulating in the system produce a slight set of changes which go on increasing Prof. T. does not believe that disease is ever produced by cinchona after health is restored no effect will be produced. Dr Ives is of this opinion He has known it take for a year or more with benefit. Heberden knew it taken for 12 years with advantage etc. Admissible in all atonic contraindicated in entonic diseases Pharmaceutic preparations The salts of quin. & cinch. are sol. in wat. & insol. in alc. Quin. & cinch. by themselves are sol. in alc. & insol. in water Yet is laid down in all the books that alc. is the best menstruum this can hardly be true (probably the mistake has arisen from the utility of the alc. of the tinct. in intermittents) Infusion is better than decoction Boiling almost destroys the properties of cinchona Maceration in cold water extracts but little. Yet the pharmacop. direct to boil 15 to 30 minutes Never boil but about a minute Pour the water boiling hot on the powdered bark than stand scalding hot ½ or ¾ of an hour then boil it up about a min. This gives a decoction [illegible] Troy oz. bark saturates a pint of water Make the infusion in the same way but do not boil up at the end 1 Troy oz (1 oz. of avoirdupois oz. will not being less) saturates 1 pint of proof spirit It is not worth while to give in any form but substance in intermittent in any form but substance in continuous fever, as it will be thrown off or pass off. Therap. applic. 2st Intermittent Quinine the most important medicine In all pure and uncomplicated cases of quot. quart. or duplic. types these salts may be considered as infallible remedies. If costive, purge once with calomel (the best agent) Check diarrhea with opium. If stomach is full, vomit with sub. zinc, copp. or turpenth min. or purge with calomel. Perhaps in no disease are emetics & cathartics as much abused as in this It is a routine Sometimes the disease is thus brough back There is generally a natural state of the bowels, no fur on the tongue etc. Sulph. quin. & [illegible] are equally admissible in the cold the hot and the sweating stage & during the apyrexia. Many deny this, and yet give large quantities just before the paroxysm even [the] min. before! The article does not operate all at once but gradually Generally Prof. T. does not interrupt a paroxysm when he is first called Sometimes however he gives a large dose of quinine to cut short the cold stage & bring on the hot, or in the hot to bring on the sweating stage immediately Inappro 3 grs to [illegible] i is the appropriate dose once in 2 to 6 hours Quin., & cinch. require the same quantity as their salts [illegible] i is the smallest quantity with which Prof. T. has ever cured a case more would have been better Prof. T has known 10 grs. once in 2 hours necessary to suspend the paroxysms A writer in the Philad. Journ of large experience in intermittents lays down 20 gr. once in 2 hours as the common dose for all cases Case of a phys. who was much surprised to hear Dr [March] doubt the existence of phlogistic intermittent he took him to see such a case in the hot stage Dr March gave 2 or 3 grams of opium & cut short the parox. in 30 minutes He gave sul. quin. & the pat. had not another paroxysm A timid and inefficient use of sub. quin. will even aggravate the disease Just as with opium Dr March has repeatedly been called in clandestinely to cut an intermittent short at once which had continued under an able phys. 6 weeks! Time of continuance is variable Do not suspend the remedy immediately after the cessation of the paroxysm especially if the pat. is in a very unhealthy situation Perhaps a dram should be considered the minimum quantity to prevent a relapse Under the treatment here recommended not more than one paroxysm (not even a single parox.) after the physic. is called in should be permitted of course in pure & uncomplicated cases Mode of administration Sul. quin. & cinch. may be given either in solution in water or if you want the smallest possible bulk add a little of some acid just enough to render it soluble without giving it an acidulous taste (The combination of sulph. acid & bitter is offensive to taste) or diffused in wine or brandy & water or diffused in syrup of sugar or in pill, when the stomach is irritable pilled with ext. gentian pills made before hand get to be too hard & are to be rejected When the stom. is irritable an acrid is indicated and capsicum is the best (It is not stimulant but [illegible] irrit. to much [illegible] not acting on the blood vessels but on the muc. memb. increasing susceptibility to other remedies) Powder of bark also will cure most intermittents. It too may be given at any period of any stage though it is very liable to be repeated during the paroxysm especially during the hot stage. Sometimes bark in substance cannot be given in suffic. quantity without vom. to enable it to effect a cure Give [illegible] i to about zi 2 to six times a day Give it diffused in some liquid Still it is not worth while to retain this mode. If the stomach is very irritab. pills may be given of alcohol extract give as much as of the powder. Infus. & decoct. are too weak for intermittent Tinct. requires too much alcoh. Tinct. of bark has cured but then it was by the alc. not by the bark. Saffron (canth. tinct. and [rum]! have cured Those who do not live in an intermittent country, are apt to suppose that there are many cases in ‘ which sulph. quin. is inadmissible Prof. T. does not believe so. he has seen many such cases and thinks they were all caused by injudicious management. Some of these physic. suppose cal. & op. is curative in many such cases they talk much of it. But long ago it was settled that cal. & op. are not curative but merely preparatory (vide Good for an interesting experiment when the stock of bark was exhausted on board two ships of war They merely suspended but did not cure the disease) Physic. have more prejudices against quin. than against any other article unless it be opium & alcohol. N.B. The Parisian phys. practice upon the principle of giving large doses of sul. quin. Some suppose the intermittents of the south do not tolerate quinine so well On the contrary much more quinine; required because the disease is more intense. The practit. there use it too inefficiently. Dr. Mac Bride stated this to be wholly true Sometimes the disease will be accompanied with morbid secretions in large quantities, and hence quinine is supposed to be inadmissible. On the contrary give (after purging with cal.) quinine to cure this as it depends on the endemic influence. Sometimes the stomach is so irritable that 32 grs. of quin. will not stay on the stomach and hence it is thought to be inadmissible Give 10 grs. at once to cure the irritab. as it is produced by endemic influence Case of a woman who had long taken sulph. quin. in small doses with this effect certificates from physicians that sulph. quin. disagreed with her She was immediately by pills of 6 or 8 grs. sulph. quin. made up with ol. capsicum. Numerous such cases used to come down the canal to Rochester & be cured by T. [S] M. at Albany But intermittent is often complicated or disguised 1st Interm. accompanied with diarrhea which sometimes continues throughout the disease. Cure these by quinine and opium. They are cured as suddenly as the others If necessary we may conjoined resin of hanthorrhea [hostilis] (so effectual for diarrhea) or tolu or 2nd Intermittent complicated with cholera commending with rigor & an urgent parox. of chol. which terminates in the sweating stage and so continues day after day without a suspicion of the nature of the disease Give acrids in the paroxysm & quinine in the apyrexia 3d Intern. complicated with dysentery physic. will sometimes suppose they must wait and cure the dysentery first Give no mercury unless corr. sub. Given quinine & opium 4th Intermittents complicated with jaundice puzzling to young physicians bilious diarrhoea & akin a deep orange Give at first opium enough to check the diarrhoea & then suspend the paroxysm with quinine You may follow afterwards with conium to remove the yellow colour of skin 5 Interm. complicated with parabysmata coacta (Good) Many suppose that quinine must not be given until the parabysmata have been cured Cure with quinine Prof. T. has had testimony that quinine would cure parabysmata the sequels of intermittents Dr. Bristol said it was cured in Paris by 6 or 7 grs. of quinine 5 or 6 times in 24 hours better than by any other article. Prof. T. has generally used conium in conjunction 6th Intermitt. complic. with delirium a disease more formidable than dangerous. Cure by quinine though perhaps datura etc. might advantageously be used “opium will sometimes cure such cases 7th Intermittent complicated with syncope. Paroxysm comes on with syncope. Pat. obliged to keep his bed in the intermission Cure by quin. 8th Complic. with convulsions especially in children If called in a paroxysm give a large dose of datura then cured by quinine, as soon as possible Often you cannot give the quin. to children on account of its bitter taste Then give arsenic & opium perhaps as often as once in 1 or 2 hours 9th Complic. with epilepsy One of the most frightful & alarming forms Pat. comes out of the fit and sweats A few years ago such cases were always fatal Get down a large dose of datura and if necessary repeat it & follow with quinine Cure by quinine in the [illegible] [etc.] Complic. with catalepsy of no consequence a trifling disease is catalepsy Complic. with lethargy equally unimportant quin. cures Complic. [serous] apoplexy of Cullen (not sanguineous) quinine will cure Dropsy Purge with elaterium & remove the fluid & the cure by quin. If dropsy remains after the cure give digitalis tinct. cantharides tonics etc. Disguised Intermittents 1st Hemicrania severe cured as other intermittent Well known as a disguised form to persons in an intem. country 2nd Neuralgia (facies etc.) (vidd McCullock) cured by [the] remedies for intermittent. Case of Dr Th. Woodw. attack in calf of leg & this repeatedly for years which would be cured by opium but he would be sick the next day it was found afterwards that datura was better It takes the form of nephralgia ophthalmalgia rheumatalgia etc. 3d Dyspepsia mistaken & treated wrong 4th Hypochondrias & mistaken 5 Typhus (but it will not have 2 parox. in 24 hours as true typhus always does ruins on indefinitely) cured by quinine. This has no crisis on the 14th day as typhus has 6th Phthisis Case of a man from Rochester who came back to Connecticut to die of phthisis. Prof. T. was puzzled found opium did well and finally under the use of opium the pat. had a regular attack of intermittents Prof. T. then cured him by arsenic (as he was so afraid of being poisoned that he would take scarcely anything) given clandestinely Case cured by Dr Todd of a young lady who had come to Hartf. to die. # Remittent not time to say any thing upon the subject # Story of a young physician in N. York who detected an intermittent counterfeiting hectic & got into practice [From Savage’s copy of Talcott’s notes To be inserted in the blank space which occurs in the article actaea] “Atonic acute rheumatism rheumatismus The more acute the disease the more successful has Prof. T. been with actaea more successful while the febrile aff. is strongly marked and the topical affect. has a tendency to wander. When called, ascertain if the pat. is costive, if so give a dose of calomel over night & opium sufficient to allay pain give the opium first & if it takes a good deal to allay the pain, why give more Keep by the calomel (12, 15, 20 or 3 grs according to susceptibility & other circumstances) not less than 12 nor more than 18 hours give cal. sufficient a free evacuation. After this commence with actaea & opium at regular & short intervals say f zfs of tinct. act. every 3 hours as a general rule, some requiring more & some less. The test of the quantity is the effect on the brain. Let the brain be moderately affected but not so as to produce a troublesome narcosis. It is necessary in some cases to affect the brain more than others. In some the disease yields before the brain is at all affected, in others Prof. T. has been obliged to produce a troublesome narcosis. Opium must be given in conjunction in quantities sufficient to meet the symptoms & keep them under 1 gr or more every 3 hours may be required. If the pat. has been tampering with medicine, purging with salts etc. often the cal. will not be needed & we may enter at once upon the use of actaea so too if the bowels are free When the disease is fixed upon some particular part as a joint, topical applications will do good & actaea is not so successful though even here it is useful Under this use of actaea all the tumefaction, redness, soreness & pain of the acute form disappears, often in 12 hours sometimes not altogether till 24 or 36 hours the constit. feb. affect. disappearing at the same time in by far the greatest proportion of cases though in some the fever goes on to the next critical period. The remedy shd be continued in diminished doses to prevent a recurrence. Opium alone will sometimes answer but it is better to combine it with a reduced quantity of the deobstruent. The pat. is not perfectly well after the resolution, he is weak, feeble & languid & a little exposure or over exertion will bring on the dis. again unless the medicine is continued Prof. T. has failed with actaea in only two cases of genuine acute atonic rheumatism and then the patients could not be induced to take the remedy longer than while present relief was afforded which was effected in both cases. Dr Woodward of Wethersfield writes (1830) that he has used actaea in subacute rheumatism (meaning that form which I call atonic acute) in catarrhal phthisis in catarrhal cough & in neuralgia. He considers it one of our most valuable deobstruents, combining the powers of digitalis, sanguinaria & colchicum I [illegible] hardly ever saw it do much good till symptoms of narcosis were produced. The following are the effects of a moderate quantity vertigo, headache, impaired vision, dilated pupils. epigastric uneasiness, diminution of frequently of beat in heart & arteries (but it was irritative frequency of pulse) Dr Woodward has seen decided narcotic effects from 15 gtts of tinct repeated every 6 hour, & from teaspoonful doses violent narcotic effects & hypercatharsis (the last effect I never saw & am inclined to think it accidental or produced by something else) this was followed by a rapid subsidence of the rheumatic affection. Dr W. says he has always found it most beneficial in doses of 25 to 30 drops. He has found it very useful to allay cough & also arterial irritation. In two cases of atonic acute rheumatism following rosalia, one was treated with actaea the other with colchicum both were speedily cured Dr Beers has also used it successfully in the same kind of cases Dr Woodward thinks it more manageable & successful in inflammations of an atonic & acute form, than any other article. Dr Tully thinks so too. Dr W. says a popular article in his neighborhood is Wright’s cough drops, which he thinks is a proof spirit tincture of actaea In subacute rheumatism actaea is useful. In [mercurial] rheumatism, which is always subacute it effects as speedy & effectual a cure as in the acute, but we must conjoin opium & follow with tonics Arthritis rheumatalgia such as is unattended with redness swelling etc. chronic rheumatism (popularly so called) characterized by pain, especially on motion, without swelling etc. with no febrile disease, essentially, though there are often febrile paroxysms. Some of these cases are acute the attack is sudden, the dis. of short duration & confined to fixed periods. These are specially benefitted by actaea. When this species is subacute (often met with in boys who have continued too long in the water I formerly failed, but think I should succeed now. In the perfect chronic form of “chronic rheum.” occurring in old men & continuing year after year joints almost paralytic not much is to be expected from actaea though the exacerbations may be palliated A cure will not be effected Arthritis neuralgia neuralgic rheum. (Fothergill’s sciatica) The first symptom of an overdose is felt in the sciatic nerve though this is the peculiar effect of the article yet it will cure this neuralgic affection. Arsenic, opium & actaea will cure sciatica speedily & effectually. I give the arsenic in efficient doses giving a pill of arsen. acid ¼ gr & sulph. morph ¼ gr every three hours, with the actaea Sometimes I give a cathartic of elaterium previously It yields to this course Bucmenia sparganosis Some cases in extreme exhaustion supervening often severe hemorrhage; are often perfectly resolved by actaea The pathology & location of this disease are disputed It seems to affect all parts of the limb except the bone The lymphatics are supposed to be its peculiar seat. They are undoubtedly affected but the dis. depends on the specific nature of the affection, not on the part involved There are different varieties of it & the treatment must vary accordingly When it occurs among the debilitated females of cities, nauseating deobstruents cannot be borne not even calomel. They produce irritation, reduce the patient & aggravate the general symptoms or pass off by the bowels. Among delicate females [illegible] alcohol, & cinchona are required & these are the articles which I have always known to be indicated. But among females in the country & when it does not follow hemorrhage or derangement of the digestive organs (I have never seen such cases) calomel is useful & the more irritative the cases, the better is the actaea Ophthalmitis of this there are several species, depending upon several specific sorts of infl. Of O. conjunctiva, there are 3 varieties 1. common 2. purulent (of infants) 3 epidemic or Egyptian. Perhaps there is also another kind a chronic form with spongy granulations on the inner surface of the eyelids though this is perhaps a degree of the first variety. In the common ophthalmia there is often [chemosis]. In this form actaea is discovered to have great power & is now often used. Dr Noble of Albany gave fzi once an hour, all day long, till severe narcosis was produced at night, when he stopped the article & resumed it next day. Nothing else was used & the cure was effected in 2 days. I think Dr N’s mode of giving freely & suspending at night, the best. The more acute & recent the case the more speedy the cure. If a cath. of cal. is indicated it had better be a slow one. Narcotics are not so manageable in infants, they cannot communicate their feelings; hence this course would not answer for the purulent ophthalmia & we must rely more on topical applications. In Egyptian ophth. I have great confidence in actaea A. corneae specif. ulcerative infl. of the cornea nit. silver, however in conjunction Dr Noble has used it in this way I have since known others use it. This is also an infl. of the sclerotic coat. It is never phlogistic. Those mentioned above are not but are all specific inflammations. All the cases that I have seen of infl. of the sclerotica are rheumatic or arthritic I do not believe Sam. Cooper’s doctrines & I think his cases are not true in fl. of the sclerotic Drs Knight & Woodwd of Vt agree with me. In this infl. of the sclerotica actaea generally succeeds perfectly and sometimes it fails utterly. I can not discriminate the cases Porphyria hemorrh. & nautica I think little of the treatment in the books they proceed on the principle that diet is enough to cure it. It is caused by bad diet etc. but shd be treated on general principles. Stimulants & astringents are required sugar of lead, opium & brandy with farinaceous diet constitute the proper mode of treatm saying to him “I would not trust to that boy” The pat. reposed confidence in Dr I but said to him “I must have counsel called to satisfy my friends” Dr I. called a man 70 years old The pat. says “I believe the boy has done well”! Prof. I. will never forget his sensations he was mortified & grieved. Afterwards he put on a quaker hat! to appear more old! Let judicious clergymen be called Dr when it is proper Dr Rush said “when the earthly M.M. fails apply to the heavenly” Prof. Ives’ paternal lecture 1833 Be especially careful in your primary observations. An [illegible] read in the [pentateuch] “& the tabernacle was covered with beggars’ skins” He turned to his audience & observed; to the audience “You see my friends the difference between the law & the gospel. The poor have the gospel preached to them, but under the law a beggar! could not be seen about but his skin; was immediately taken off to cover the tabernacle!” If a young physician dislikes his profession, the sooner he abandons it the better. It is difficult to distinguish between genius & a fondness for a pursuit. Dr Rush remarked that he would practice medicine as long as he could walk, when he could not walk, he would ride [illegible] he could not ride he would be carried to the bed side “Least than a wise on hi own eyes, there is more hope of a fool than of him” It is a most unfortunate thing for a young man to suppose he knows all that is to be known Diogenes laid him self down to die, saying he knew all that was to be known There came in a beggar boy to borrow fire. Diogenes told him he had nothing to carry it with “Fi you will give me the fire I will find means to carry it” He put some ashes in his hand & a coal of fire upon them! I will not die says Diogenes for a beggar boy has taught me a knew piece of knowledge! The boy understood the fact well though he could not express it in the language of ashes being a nonconductor of heat. Dr Rush remarked that he had learned much from nurses Moral principle A stranger said to Dr Monson “I wish to employ you in a very delicate case & will pay you handsomely” Dr M. replied “Sir you have not money enough” “You know not how rich I am” “If you had ten thousand times as much it would not be enough to pay me for loss of reputation & conscience” Prof. I. has often been called on to produce abortion & that too by men & women of the first standing in society to produce abortion he has been appealed to in the most moving terms “would you sacrifice a family” “I am somebody likewise” must I lose my conscience & character” The person would threaten to commit suicide. “You had better not but if you do I cannot help it” Suicides however are sly about the matter Prof. I. has known many of the infidels of the last generation They were the most bigoted & superstitious set of men he has ever known. They though there was not evidence enough for the bible, but would believe in the most foolish witch stories Franklin A young physician is not put down by the older ones as formerly there is more liberality in the profession ow than formerly. Anecdote of Dr [Birker] “We want more farmers than doctors” Dr Darwin was a large misshapen man stuttered etc. very awkward etc. yet captivating. His works contain a great collection of important facts Anecdote a young man a good scholar, rather awkward & bashful was apprehensive of being cut out by an elegant competitor eloquent in the ballroom etc. advice not to fear! It turned out as Dr I. predicted We are not to give pain to patients who have brought their diseases upon them After we have relieved them, we may endeavour to reform them Anecdote of Dr Monson man intemperate finally took a poisonous dose of laudanum Dr Monson saved his life Afterwards he remonstrated with him upon his guilt “Dr I don’t thank you for what you have done” Dr. M. then turned “I am sure the neighbors will not” An opinion formerly prevailed that it was lawful because it was expedient to tell falsehoods Dr S. has always found it advantageous to appeal to his frank veracity on all occasions Often however, patients have no right to know Secrets should be kept A man may be sued for defamation for saying he has cured a man of venereal disease You will be mortified occasionally in being called a young man. Prof. I attended a man whom friends kept Neuralgia strychnos arsenic & opium ([actaea]?) Itch cured by lotions of digitalis Sciatica arsenic strychnine & (actaea ?) [sul.] morph. have proved highly valuable Hemicrania cured best by ¼ gr. strychnine 3 or 4 times a day combined with morphine Strychnine 1/16 to ¼ of a grain Brucine 1/24 as strong chronic rheumatism best cured by lobelia better than by guaiacum the article commonly relied on 9 materia medica & Dr. Ives’s Paternal lecture (rear) Solanum nigrum Often mistaken (for its name) for atropa belladonna. Smell & taste nauseous moderately narcotic Its narcotic powers are very variable different in different cases Deobstruent also. It is diaphoretic diuretic (more so than conium) laxative slightly Said to be found useful in [diury[ and ischury but said to require to be drank freely Much used by the common people in ointments (of the leaves) for indolent tumours ulcers etc. IN mild cases Prof. T. has often found it answer as well or better than conium It is not worth while to fire a cannon to kill a fly. Med. dos sd to be 10-12 grs shd think this inefficient infuse zfs to oj of water Solanum tuberosum Native in Peru the tubers of the wild plant are as small as a nutmeg & bitter & nauseous. “Root sd to be perennial probably annual” Top only is used in medicine This is too weak to be used in infusion or decoction. The watery extract is found to be slightly narcotic & deobstruent It is diaphoretic, diuretic & cholagogue It will relieve some atonic inflammation cure some cutaneous diseases IT has been used principally for jaundice & dysp. connected with the liver Dose said to be 2 grs. Prof. T. gives zfs to zj Recommended in cough rheumatism hemicrania angina pectoria etc. When pushed too far it produces tremors etc. the symptoms of narcosis Most of our arrow root is made from potatoe roots and if sufficient care is taken to purify it from mucilage it does as well. The activity of these & the following article is a subject of dispute Solanum Dulcamara Possesses the same assemblage of powers as the S. [terb.] & S. nigr. Used in cutaneous affections. Acts on the fluid secretions generally as well as on that of the liver Digitalis purpurea Native of England Nat. ord. scrophulariae Leaves used (stripping from the midrib) leaves good only when of a light green colour when black they are worthless for medicine. No particular odour No good analysis has been made [Digitat??] (drystallizable) is mentioned Decoction injures it. Should be given in infusion. Infus. green, with the odour & taste of the plant Upon no subject is medical testimony so contradictory as upon the medical properties of this article. Some contend that it is stimulating others that it is never so but always the contrary Prof. T. believe it may, like other narcotics, produce an erethism of the brain without any effect upon the circulating system (N.B. This is a state which often precedes an attack of delirium tremens) It is evidently this state which has been mistaken for stimulation produced, as it will be if the article is continued for some time in doses just short of the strong narcotic doses It is from this state that the opinion has been drawn that digitalis is capable of producing an inflammatory fever The secondary operative effects of digitalis are those of other deobstruent narcotics, as actaea cicuta aethusa etc. It has been noticed that when the pulse has been reduced to 40 by digitalis if the patient is raised to a sitting position it will rise to 72 or 100 & this has been considered very strange but it is no more than always occurs in extreme exhaustion from narcotics or in its syncopalis or even from mercury Much mischief has been often done by giving digitalis to reduce frequency of pulse It will relieve none but irritative frequency. It may be made to cure some cases of intermittent pulse Under any management the article is liable to fail to operate, and after some days operate most dangerously The intermission of the pulse may continue along with the quickening of the circulation for 2 weeks after the cessation of the administration of the article Digitalis is diuretic only after nausea is produced by it but too much nausea will prevent its diuretic effect Digitalis is not or not much diuretic in health it is only so when water has accumulated It is capable of relieving some atonic infl. Opium must be conjoined Prof. T. has treated ac. rheum. by it Those who contend for the stimulant power of digitalis say that is contraindicated in phlogistic diathesis. Others say that it will relieve phlogistic cases. Both agree that in some cases it has produced no effect either beneficial or injurious But if digitalis and nothing else is given in a severe case of phlogistic disease it will have no effect and the disease will aggravate of course. In milder cases no change will be observed. The supposed phlogistic cases relieved by it were irritative cases without strength of pulse sub-putrid cases Farriar accordingly, who considers it useful in phlogistic diathesis, still says it is useful only in those cases which do not admit of v.s. and he commonly conjoined it with camphor and opium. It is equally admissible in low atonic cases. Paris supposes that a considerable number of diuretics are adapted to a different set of cases, from digitalis There is something in the general principle e.g. crem. tart. & tinct. canth. But he is entirely wrong in saying that squills and calomel are incompatible with digitalis. He supposed calomel to be a stimulant and digitalis a refrigerant. Blackall is mistaken in a similar manner calling calomel a stimulant etc. Paris supposes languor & nausea are essential to its diuretic effect and hence they must not be prevented Prof. T. has found that there is a certain range within which digitalis acts and hence sometimes aromatics, cath. & opium must be premised and cojoined and in a few cases, tart. antim. & even bleeding must be premised Many among us have lately found that tonics as canella alba are usefully conjoined with digitalis. In such cases Prof. T. conjoins tinct. canth. senega squills & cal. with digitalis yet all are incompatible according to Paris In low cases alcohol will often be needed Calomel generally increases the susceptibility of the system to the operation of this article Pharm. prep. Tinct zii to spirit of dilute alc. med. dose mx 3 or 4 times a day Infusion zii to pt. dose tablespoonful. Therap. appl. 1st Idiopathic cough where there is a leucophlegmatic habit and bloated face But other things are better and at least opium or I. paregoric should be combined say 3 of deg. & 1 of laud. or I. pareg. The opium will tend to prevent its accumulation Bex convulsion Highly recommended used the same combination as above. Prof. T. has never used it in hooping cough Dyspn. exac. & asthma very useful combined with opium. It will cut a paroxysm short as soon as any article Combined with tonics it may be given in the intervals Delirium tremens comparatively but little opium will be needed, if you use digitalis (only however, where the patient has some vigour of constitution left) Puerperal delirium ( a disease nearly allied as in the above disease where opium produces a disposition to sleep without actual sleep digitalis will produce quiet sleep Cauma recommended but Prof. T. thinks it not indicative likely to do neither good nor hurt Phlogotica useful in lotions for various of them particularly erythema vesiculare & E. oedematosum Apply it strong enough to produce a slight sensation. Recommended very highly for the poisonous [rhoes] Scalds and burns lotions highly useful relieving pain, irritability etc. Acute inflam. of brain lungs or other viscera (supposed entonic but really irritative or atonic) by Dr Currie So Ferriar who combined opium & camphor Recommended in croup but is not employed Song recommended in phthisis almost the first disease in which it was employed best adapted for the cases which require iron & myrrh Some think it useful as a diuretic in this disease but excessive urination will exhaust as much almost as excessive sweating. It is principally useful 1st as an antirritant 2nd as a deobstruent both which are indicated I membranous phthisis Digitalis is to be given in phthisis as in other disease, upon general principles Rheumatism useful as a narcotic & deobstruent combined with opium It may be made to cure acute rheumatism premise a purge of calomel & give say 10 drops of the tinct. every hour or 20 drops once in 2 hours until the disease yields, or the head is affected No cancer of a violent action, used in this way combined with opium & with diaphoretic regimen So of aub acute rheumatism but not so useful. Blenorrhea lenodis 25 drops 3 times a day conjoined with decoction of barley Struma recomm. also in the strumous phlogotica this depends on the state of the system Sparganosi puerperanum recommended internally & in lotion conjoin opium but do not adopt this practice in a feeble subject Measles & rosalia probably useful when not too atonic Hemorrhages rec. but it should not be given in the phlogistic (N.B. There are 4 sorts of hem. active phlogistic passive atonic irritative & vicarious) Digitalis will be useful in the irritative kind with a quick wiry pulse irregular throbbing heart etc. Recommended in ill conditioned venereal ulcers topically Mania rec. (said to be useful when the blood is determined to the brain which Prof. T. thinks does not occur) Prof. T. considers mania as a periodical disease & consequently an atonic dis. The paroxysm of mania precedes the disturbance of the circulating system and the effect has been mistaken for the cause. Dr Willis cured 92 per cent Dr Todd has cured 93 pr. ct. It has lately been published by Dr [Willis’s] grandson that his treatment was substantially the same as Dr Todd’s The latter allays with paroxysm by moral means he prescribes quinine etc. as for a periodical disease. Enlargement of the heart good testimony also of the large blood vessels Epilepsy hysteria convulsions (hardly advisable) Dysury of various sorts nothing specific is mentioned. Dysury of a low typhus will be aggravated by narcotics that of cantharides will be relieved. Lithia recom. Most important use is in Dropsy 1st paleness, coldness skin easily [illegible] etc. (vide Withering) Prof. T. has always found it useful but, as Dr With. gives [illegible] so he finds stimulants necessary in conjunction. Irritative cases with a dry skin etc. Digitalis does well in Dropsy of the abdomen with a distinct hard, circumscribed tumour (encysted) etc. will not be benefitted by diuretics Other cases of ascites require jalap and cremor tartar, senega & squills or elaterium Hydrops abdominis (if not encysted) hyd. thoracis etc. benefitted by digitalis Use afterwards, tonics conium & iron, myrrh etc. vide Withering Cutaneous affections impetigo herpetica scabies etc. Prof. T. has lately cured common itch oftener by digitalis than by any thing else Apply the infusion with a sponge to the eruption 1 to 2 oz to 1 pt. It cures in 3 or 4 days to 1 week Impetigo laminosa upon the fingers to relieve the irritability Recommended to prevent threatened abortion combined with opium But then opium alone, with horizontal posture, will certainly cure Poisonous effects relieved by stimulants and opium. This was well established before the springing up of the race of toxicologists! Prof. T. has had several cases where it had been given by mistake History popular in Rays time & since that time. Vide Gerhard Parkinson, Bates, [Valmon] etc. It was used to produce emesis etc. Dr Withering was first to discover and publish its true powers & operations 1785 D. lactea has been used as a substitute said to be more active probably less so as it was used more boldly D. epiglottis is mentioned by [Coxe] but by no botanist whatever. Actaea Racemosa There are 9 very nearly allied plants called by Linnaeus actaea & cimicifuga But one of them may be referred to either & these have been called macratrys by Rafinesque. Provided actaea & cimicufuga are distinct genera macrotrys must be seperated. And upon the same principles A. palmata should be referred to another genus still. [Now] some late botanists have united (judiciously & upon Linnaeus’s own principles) them all into one genus actaea. We have in N. Eur. A. rac. A. rubra & A. pachypoda (A. spiculus is not now acknowledged) The whole genus in three divisions has 1st A. cimicifuga (Siberia) A. simplex (Kamschatka) & 3 others of the division cimicifuga 2nd sub. div. macrotrys. 3d sub. div. A. christophoriana vide [illegible] Decendalles two spec. A. mucrocropa & A. cerulea are mere varieties or mistakes the latter does not differ from A. rubra Actaea racemosa Linnaeus ([illegible] [illegible]) Cimicifuga serpentaria of Pursh Cimicifuga racemosa Nuttall Macrotrys actaeoide Rafinesque Macotrys serpentaria Eaton Botophys actaeoides Rafinesque again Black cohosh. black snake root (which is applied to at least a dozen others e.g. sanicala mar.) square root rich weed rich root snake weed etc. Cornuticis Canada herb christopher Nat. ord. [Ranuncul???] Tribe I aconeae. Grows in woods among rocks in rich places etc. Flowers about July. Monogynous root an irregular tuberous rhizoma with fibrils Often the root of blue cohosh (leontica thalecteoides) is often sold for it but the fibres of this are smaller taste less bitter not virose etc. Roots of sanicula marilandica (called also black snake root) are also collected for it. (So the berries of cornus [illegible] have been found in the shops for buckthorn) But A. rubra & A. pachypoda are most commonly mistaken for it they are inferior Root he only part used Taste first to sweet & aromatic afterwards virose and bitter Tinct. of root is aromatic & bitter It should be collected only after the decay of the top. Attend to this direction, & use care in its preservation & it will retain its full virtues for years. I know of no good analysis. Dr. Meers attempted it, & gave the result of his researches in a dissertation, Tannin, extractive matter, a bitter principle, gallic acid, a gummy principle, starch, woody fibre, all which amounts to just nothing at all. HE said it probably contained an alkaline principle; but I assert positively, from repeated experiments, that it has none but calcid. I tried every means to get an active satisfiable base failed entirely don’t believe it has any. (Here Prof. T. gave the ordinary process for getting salifiable bases.) The article is prominently & decidedly a narcotic antirritant said to be anodyne & soporific; I don’t believe you can employ it for that purpose with advantage; though this, as well as all other narcotics, in certain conditions, do have such an effect. It readily & certainly produces ult. narcosis, which can always be speedily relieved by suspending its exhibition, & at the same time using those means heretofore so often directed especially opium (N.B.B.) # Dr Todd has seen decided & considerable exhiliration Prof. T. thinks it similar to the erethism of datura & conium & which occurs just before an attack of delir. trem. which is often mistaken for entony. In large doses it produces neuralgic lancinating pain in the extremities larger doses make these pains more extensive even affecting the head and eyes. Prof. T. once doubted the existence of these [illegible] but he has seen them many times They are most manifest in the calves of the legs & along the # I believe it is a nervine, though not prominently so. sciatic nerve. Opium counteracts them Cases related. Food also suspends the pains Prof. T. now employs a little food as a gill of milk porridge in conjunction with each dose Besides these neuralgic pains a large dose may produce convulsive action of the heart. Case of Charles Terry dangerously affected with extremely violent neuralgic pains under the upper part of the sternum wandering neuralgic pains soon violent palpitations beats 130 in a minute pain under the left axilla etc. Large quantities of camphor opium capsicum etc. were required. An emetic of sulph. zinc was given to change action Next day, pretty well. These effects happened twice the actaea not being at first suspected. Case related from G. K. Lawrence of the Shakers in which a large dose produced convulsive action of the uterus In both these respects it resembles strychnos nux vomica & false angostura. Some physicians give too large doses and at too long intervals & hence are always complaining of failure & of unkind effects of the narcotics Cases and testimony of physicians about its ecbolic operation. In one of the first cases, it was given as an antirritant, in a case of threatened abortion Abortion was speedily produced Dr March prefers it to clavus being more lasting leaving the uterus less inactive much less liable to destroy the fetus. Drs March and [Dyer] have found it useful in uterine hemor. Dr Dyer finds it the most valuable article for suppressing uterine hemor. not connected with pregnancy. He continues its use for some time Prof. T. thinks this [illegible] operations not specific, but as part of its narcot. He has repeatedly seen it convulse other involuntary muscles. Actaea is especially deobstruent Prof. T.’s attention was first turned to this by observing its effect when given as a diaphoretic in what was thought (by an old surgeon) a fever sores (osthitis gangrenos.) It resolved the infl. and cured the local disease, much to his surprise. He gave it merely to ally irritative heat and dryness of the skin knowing not a great deal about it. Subsequent experience with the resolvent powers of sanguinaria, colchic. varat. etc. led to the investigation of this property of actaea Dr Meers has found it produce an erythema upon the skin. Prof. T. has never experienced this. Dr. [Gasden] thinks it cholagogue Prof. T. has had no positive experience of this. Dr S. Woodward & others, however find it so Found to be emmenagogue also Seems to be expectorant also (as far as an article can be so directly Decidedly diaphoretic so say many physicians. Perhaps however it is only indirectly so as it appears to be so only in febrile (hot & dry) states. Diuretic often considerably so Yet upon the whole it seems not to be suffic. diaph. diur. & expect. to render it valuable for these indications It has been repeatedly called astringent. But it seems not to operate thus. To be sure it contains a little tannin or gallic acid but not enough to be efficient in operation Called tonic Prof. T. once thought so. Dr. Garden thought it tonic 7 reducing both. Prof. T thinks it not reducing bug prostrating merely. Prof. T. & all his friends also find it useless as a tonic. Like every other article of the materia medica this has been called stimulant. Prof. T. has watched carefully for this effect & never could perceive any. The warmth, flushing face etc. are produced merely by cerebral irritation. Very commonly said to be pectoral a term which may mean demulcent antirritant deobstruent etc. Said also to be alexipharmic Also called antiscorbutic this was the earliest quality ascribed to it in any publication. The principles of the cure of scurvy are not very well settled. The cruciferal seem to be well established as the remedies. Actaea is at least useful in restraining hemorrhage. But Prof. T. is an entire sceptic about the prescribed treatment of scurvy. All the cases treated of in the books occur at sea and seem all to be cured upon dietetic principles Concrete citric acid is useless. Lemon juice is useful in furnishing vegetable aliment. Land scurvy (apparently the same as sea scurvy) Prof. T. has found not benefitted by the treatment of the books He has cured it by lead, opium capsicum, and brandy giving food with each dose of medicine & after a few days giving quinine Rx ac. lead 1 gr. op. ¼ gr. every hour tablespoonful of brandy every 15 min. a little food with each dose. This pat. (in Albany) was cured though she was not expected to live an hour. Said to have the power of curing cutaneous eruptions The only testimony is B. Barton’s that it will cure itch Called repellent by which is probably meant discutient Prof. T. knows not that this has been well investigated. Called pellent also! Dr S. B. Woodward has found it cathartic, upon some of his patients. He is the only person who has met with such any effect probably they were anomalous cases G. K. Lawrence thinks the flowers are laxative. But all flowers are laxative unless they possess some other powers. Said to be emetic in a large dose This is very doubtful probably not more emetic than digitalis as a narcotic Darlington calls the root somewhat mucilaginous. It certainly is not so when chewed. Being narcotic it certainly could never be employed as a demulcent. Any considerable degree of phlogistic diathesis, will not admit of this article, until after reduction & evacuation It may be usefully conjoined with opium acrids & tonics Recapitulation 1st moderately nervine 2d actively deobstruent including, resolvent cholag. emmen. diuretic & perhaps diaphoretic 3d powerfully narcotic always antirritant sometimes soporific produces ultimate narcosis. 3th ecbolic Not stimulant tonic nor astringent etc. etc. vide supra This is supposed to resemble lycophus virginicus but the latter is merely nervine & tonic Most resembles digitalis but differs thus viz it does not accumulate on the system not continuing long after exhibition or returning in paroxysms does not exhaust the system like digitalis its narcotic effect is more easily relieved. Digitalis is not ecbolic & is less deobstruent It is more speedy & active than conium has most resol. power in acute conium most in chronic infl. conium more cholagogue & not diaphoretic nor diuretic Possesses the conveniences of sanguinaria & colchicum without disordering the stomach etc. like them Sources of failure are bad preparations not pushing the article far enough nor repeating [illegible] enough In many cases 2 hours is a better interval than 3 hours Another source of failure is preparatory bleeding or purging Pharm. prep. 1st very fine powder 20 to 30 grs. 2nd infusion coarse powd. zi boil. wat. 1 pt. [illegible] 1 hour & strain Tincture 4 oz coarsely powdered root to 1 pt. off. alc. macerate 10 days & strain. This is a saturated tinct. & is the only one needed for common use. It is the only preparation which will succeed in acute rheumatism Probably the active principle is perfectly soluble only in alcohol as water causes a turbidness or cloudiness though nor precipitate The powder is too inconvenient because it must be very recent & fine Medium full dose is about 30 m. Tinct. of the flowers is made by G. K. Lawrence 4 oz. to 1 pt dil. alc. He says it is cath. & less narcotic Diseases 1st dyspepsia irritable cases greatly palliated, by Drs Hale & others. Dyspepsia with a dry symptomatic cough very useful Dr Knight has found it very useful in 50 drop doses, conjoined with opium in dyspepsia with pain it cured when opium would not Diarrhoea thought highly useful by many. Colica ileus var. rhematalgica (primary rheumatic affections of the colon is known by the habits of the pat.) Dr Hooker gives 1 fl. z every hour until pain is relieved or narcosis produced & the pain is sure to be relieved. It will probably be found useful in common colic as it excites the involuntary muscles Bex dyspnoica often highly useful relieving in combination with opium when the latter alone failed Case related mistaken for [illegible] & haemoptysis (as there was oozing from the throat, caused by atony) Hooping cough much & successfully employed by Dr Woodw. of Vt. arresting the convulsive cough when pushed to narcosis Dyspn. exac. & asthma It generally cuts short the exacerbation give with the 1st dose the exacerbation of laudanum (sometimes 2 grs. op.) give a teaspoonful every 5 min. or a dessert spoonful at once or if this fails repeat it and in some cases a tablespoonful In this disease, a mixture of several narcotics give datura Prof. T. has succeeded well by equal parts tinct. actaea lobelia & datura Prof. T. at firs knew no better than to puke with tartar emetic this was worse than the disease. Next he tried ipecac. this failed. Next he tried syr. of [illegible] of squills this he thought did well but he found it always disordered the digestive function Nex the tried tinct. lobel. And one case in his own family he cured radically by anticipating the paroxysm with lobelia & laudanum Colchicum will break up the paroxysm but disorders the stomach worse than squills. Coxe’s hive syrup is much used but is one of the worst articles for disordering the al. can. Dr Mears recom. actaea for curing intermittent fever. Prof. T. tried it. He found it would suspend the paroxysm, but would not cure the disease & he would be compelled to resort to quinine Prof. T. considers this a disease of atony & has cured it only by tonics & stimulants The articles which suspend the paroxysm and do not give tone seem not to cure the disease. Slight cases may be cured by tricks of various sorts. Idiopathic hectic useful at least as an auxiliary Phlogotica apostema communis (common diffused superficial abscess generally about the hip) case related fo a cure by actaea Paristhmitis typhodes var. sub putrida (fever a synochus not scarlet fever a very rare disease most cases of malignant sore throat are cases of scarlet fever) good testimony of the utility of actaea as a gargle probably by its deobstruent effect. Perhaps it is also discutient it cures itch Pneumonit. typh. var. sub putrida (fever a synochus) Probably it might be used in most of the atonic & subputrid phlogotica & even in simple fevers of this type, if not too low Pneum. typh. var. nervosa probably it would be useful rousing nervous susceptibilities & acting as a deobstruent Pneum. typh. var. notha (which appears to be a spec. infl. of the bronch. memb.) highly useful. Arthritic infl. of the lungs misplaced gout useful especially if acute Sub acute pneumonitis (of Rush & others) (which appears to be an aff. of the bronch. mem. without an aff. of the schneiderian) precedes membraneous phthisis often should be treated with deobstruents, narcotics, nervines & diaphoretics e.g. marrubium etc. Phthisis membraneum var catarrhalis much used even by those who know nothing of its general use Vide Eberle’s practice Phthisis membranea var. dyspeptics highly useful. Remarkable case of Dr Hotchkins related at full length (Incidental remarks of Prof. T. he had hemorrhage which was checked by tartar emetic in nauseating doses left extremely weak “no wonder if tartar emetic was continued thus for some time” could not take tonics “because he too no antirritants with them, opium for instance”) cured when in the very last stages by actaea A. rubra failed in this case (it is greatly weaker) [Galium] circaezans proved a valuable expectorant. # [illegible] [illegible] drops were used Another very instructive case of Dr Hotchkins’s failed because it was not persevered in long enough This is apt to be the case with long continued diseases e.g. chronic diarrhoea & opium Scarce any remedy will do as much in phthisis as this even if given alone Yet it ought not to be given alone but combine with opium tonics etc. In m any cases actaea has prolonged life for years in desperate cases. N.B. consumptives cannot be cured by residing at the south in the winter only they must reside there for life to be permanently cured Phthisis tubercularis supposed to have cured. Laennec’s anatomical investigations Prof. T. thinks show unequivocal cures if tubercular phthisis All arthritic infl. are benefitted by it’ especially rheumatismus Prof T. has seem cases of arthritic carditis cured by actea others not. # American cough drops are equal parts elixir. pareg. & [tinct.] digitalis Cholera infantum (An infl. of muc. memb. of al. can.) has been cured Dysentery has been cured admirably by actaea. Dr Peabody has cured by 40 drops so have others Hysteritis membranifica has been found useful in many cases by Woodward of Vt etc. Prof. T. has not had an opportunity to try it in acute gout. He would give actaea once in 3 hours until narcosis was produced 30 drops or ½ tspfsful conjoining opium enough to drive off pain once in 3 hours IN this way Prof. T. has cured with verat. vir. lob. sang. & colch. # Arthritis rheumatismus atonica acute If pat. is costive give opium enough to relieve pain follow with cal. enough to purge in 12 or 18 hours After the purgation give actea once in 3 hours f zfs more or less # but the purgation from colch. is highly mischievous enough to affect the head conjoin opium 1 gr. or more or less once in 3 hours to relieve pain. When Prof. T. first began to treat atonic acute rheumatism in this way, he conjoined other articles, as ipecac but he finds them useless. The topical heat redness, soreness, swelling etc. will be relieved in 24 or 36 hours & often the fever disappears with them Dr Woodward of Vt cured 10 cases of acute rheum. in one winter all the cases he had. Dr S. B. Woodw. used it always in rheumat. he gives 25 or 30 drops (alc. tinct.) about once in 4 hours To prevent a relapse continue the actea in diminished doses Vide page next after the end of the article cinchona Ophthalmitis Hemorrhagia irritativa & [passivea] from any part Prof. T. knows it to be highly useful Porphyra haemorrhagica & [illegible] first employed to cure this disease in a large quantity of cider probably the cider had most effect It may be useful in this as in hemorrhage Neuralgia successfully with opium or arsenic by Drs Tully (he finds strychnine & opium better) & S. R. Woodward (in neuralgia of feet & legs of broken down convicts) Dr Knight has been succesful with it in neuralgic toothache Prof. T. has succeeded better with strychnus and arsenic or opium Hysteria Prof. T. used [illegible] successfully early in his practice now he uses nothing but datura. Epilepsy Dr Parrot of Western considers this article as peculiarly valuable in epilepsy from intemperance Others value it in other cases of epilepsy Carus paralysis it will probably be found useful from its resemblance to strychnos It has been found remarkably useful in palsy from lead colic camphor & arsenic may be joined Chorea from analogy Prof. T. was led to use it 15 yrs ago general testimony it its favour Vide also Am. journ. med. scien. No. 18. for interesting cases of surprising cures. Dr Hooker has used it with the most beneficial effects in chorea Tried chloroferrate of iron ([illegible] veneris) & conium & iron & various tonics with no benefit tinct. of horse warts (a powerful nervine) etc. Actea cured her Paramenia obstructionis found highly valuable. P. difficilis found useful in relieving pin, obviating irritability etc. Prof. T. uses datura Parodynia atonici lingering parturition Prof. T. now uses it instead of clavus with as much efficacy & without danger to the child Retention of placenta repeatedly used by Prof. T’s friends with good success Hydrops cellularis especially with an erythematic diathesis not used by Prof. T. but by several practitioners as a substitute for digitalis Leucorrhoea in a case which seemed to be the joint result of blenorrhoea & mercury cured other cases Ecpyesis scabies itch said to cure by lotion Prof. T. has often cured itch by lotions of digitalis. Sprains Prof. T. has often used it with advantage Bites of rattlesnakes popular alcohol & opium must be better Old chronic cases of swollen joints arising partly from injury & partly from rheumatism was proved very useful Very useful in murrain of cattle vide B. S. Barton. History. Lond. phil. trans. Petiver 1697 used in [Mariland] for scurvy. B. S. Barton various (among others the U.S. Dispens.) have copied from him. Actea rubra Distinct from A. spicata Considerably used in some places Powers similar to A. rac. but far weaker and more uncertain & less valuable Actea pachypoda A. alba (Big.) A. spicata var. alba A. rubra var. alba! etc. Necklace weed, coral & pearl etc. Mentioned in several irregular works. Used as an efficient emmenagogue by Dr McClure. Berries of this & the preceding (i.e. dry capsules!) said by Rafinesque to be poisonous Used by Dr Collins as a substitute for A. rac. but weaker Used by him with advantage topically in ophthalmia used for dysentery etc. Not worth substituting for A. rac. As the roots cannot be distinguished these are often sold for those of A. rac. hence frequent disappointments A. spicata Christopheriana herb christopher [Bane] berries berries said to be highly poisonous (vide Withering) Root and leaves acrid berries have caused delirium useful in nervous diseases as a repellent etc. Prof. I would infer that is is more active than A. rubra & less so than A. racemosa Actea Cimicifuga Linn. Cimicifuga foetida Linn. Liberian bug [bane] N.W. coast of Am. & Liberia An almost insupportable smell Used in Liberia as a bug bane Vide Good art. hydrops abd. (drastic i.e. active it is not cathartic) Abundant testimony that it is a powerful narcotic. Little doubt that it has the same powers as A. rac. but more powerful Strychnos nux vomica Nux vom. officinarum Caniram etc. nux. metalli Nat. ord. Apocyneal ([illegible] Luridae Linn) Habit. Coromandal Cochin China Fruit a berry about as big as an apple with a hard orange coloured skin seeds imbedded Seeds only used Bark said to be nearly as active. Seeds orbicular & depressed size of a dime Active principles strychnine & Brucine (brucine by mistake brucea being merely a bitter tonic) Strychnine most abundant exists combined with strychnic acid White, crystalline etc. said to be highly alkaline will it change blues? Combines with all the acids & is separated by all the min. alkalies When recovered from some combinations the alkali is changed (This is true of various veg. acids also a different acid being formed) Operative effects in ordinary doses these are so moderate and show that they can be no better distinguished than those of cinchona when properly administered & in a suitable disease, we merely perceive an amendment of disease. Diminishes morbid irritability & susceptibility & restores healthy susceptibility & tone. In its slowness it agrees with conium but disagrees with actea digitalis and lobelia It is mentioned as a peculiar property that it strengthens the voluntary muscular power. This is merely the erethism of the brain produced by all the narcotics It is more easily & more powerfully produced by this than by most narcotics Said to be anodyne is probably less so than many narcotics. It has great power however over neuralgic pain Said to be tonic & Prof. T. is satisfied that it is so Supposed to be deobstruent. Prof. T. thinks it is so though more equivocally so than some other articles. It cures gout rheumatism leucorrhoea etc. but little definite is known Not known to be cholagogue, anti psoraic etc. but has not been thoroughly investigated Said to be febrifuge (probably anti intermittent is meant). It seems to be capable of curing intermittent Said to be anthelmintic probably it is so Its slow operation adapts it more especially for chronic diseases Inconvenient effects cardialgia vertigo staggering appearance of drunkeness stiffness of [lims] & general coldness. These effects indicate a reduction or suspension of the remedy In a sufficient dose said to be capable of producing these effects in an hour & ultimately to produce stiffness of voluntary muscles i.e. tetanic spasms Ultimately it convulses the invol. mus. Noxious effects said to come on with pricking of the limbs coldness ultimately spasms & complete ultimate narcosis Paralytic parts more speedily & powerfully experience its effects viz. the pricking, local perspiration & tetanic spasms the contrast being remarkable between the two sides being affected vide Magendie Even the two halves of the tongue will be differently affected Magendie is probably correct in saying that it may affect the spinal marrow without affecting the brain Prof. T. has found strychnine more efficacious than any other preparation. Strychnine is said to be the most active principle known & the most speedy next after prussic acid Effects1st acrid narcotic 2nd tonic ([illegible] 3d deobstruent 1st resolvent others not investigated Entonic diathesis strictly prohibits this article, more indeed than it does most other narcotics The British practitioners are mostly afraid of this article yet it is more easy to manage than colchicum etc. This article, like all narcotics, gives warning of mischief. The refrigerants do not Orfila knows no antidote he directs emetics, cath. vinegar etc. tracheotomy and artificial respiration! Pharm Pres. 1st Fine powder rasp the seeds then pulverize & sift through muslin. Dose about 4 grs. 4 or 6 times a day. or dose 5 to 10 grs. Push it until moderate tetanic spasms are produced. Prof. T. pushes it until some slight startings of a paralytic limb. Sometimes 1 gr. 4 times a day has been enough 2nd Alcoh. tinct. strong alc. 1 pt? 2z of rasped seed. Dose 20 or 30 minim 3d Alc. ext. begin with 1 gr. or once a day (Magendie) But one dose a day will require too large a dose The effects of one dose will not last 24 hours For a slight effect ½ a gr. to 1 gr. pr. diem will be enough (Magendie) Dose of pure strychnine said to be ¼ to ½ a gr. 2 or 3 times per day too large a dose Some patients will not tolerate more than 1/16 of a grain. The doses must not be so large as to produce vertigo nor the quantity in the day so great as to produce tetanus Diseases 1st dyspepsia more especially where there is want of tone in the stomach but in almost all varieties Prof. T. has found it useful Diarrhoea vulgaris reported as very valuable Lead cholic especially in its secondary stages & sequel Helminthia not said what species Dyspnoea chronica like galvanism Dispnoea exacerbans. Prof. T. thinks it obviates the relaxed thickened & spongy state of the muc. memb. also relieves the paresis of the nerves etc. Sternalgia ambulantium Intermittent fever dose directed is too small. Said to succeed when quinine fails. (Prof. T: & several friends never fail to cure by quinine enough & unqualified Cases related of cure by quinine after quinine had been said to fail utterly) Typhus pustis (Levant plague) said to be specific seems to be useful Dysenteria typhodes has been used wiuth great success Arthritis podagria Said to be capable of curing if steadily administered So of rheumatism & rheumatalgia, in all their varieties either be cured or proved valuable Sciatica arsenic, sulph. strych & sulph. morphium in combination have proved highly valuable Ecphronia mania rec. in the books. Halusia hypochondrias (apparently a combination of a moderate degree of dyspepsia & of melancholia) said to be valuable Cephalia hemicrania (idiopathic not when a disguised intermittent) ¼ gr. 3 or 4 times a day usually in the required quantity. Combine also morphine. Prof. T. has succeeded better by this plan than by any other He now employs it exclusively. Case of Prof. Knight’s Neuralgia one of the best articles Prof. Knight has employed is successfully in many cases of nervous pains [Clo??] palpitatio Used with great success Chorea. Cured cases of long standing Dr Beers has found it highly successful So has Dr Woodw. of Vt Prof. T. has used it but little & that with success Hysteria said to cure Prof. T. never tried it but once & then it failed. It might be useful between the paroxysms Epilepsy recommended might be useful Dr Woodw. of Vt has used it with decided advantage Carus lethargus has been cured Carus paralysis more celebrated for this than for all others 10 to 40 grs in 24 hours It should be pushed so far as to produce some spasms in the paralytic limb Adapted to all cases caused by intemperance by venery passion etc. Has been used successfully in pregnancy (for hemiplegia) without injury to the fetus. Case quoted showing that palsy may be cured without producing any thing more than tingling no spasms. Magendie states that is now externally applied, in form of tincture Paropsis amaurosis Agenesia impotentia (probably a partial paralysis though an affection of the mind oftenest hinders this cure of the disease) Spermorrhea atonica Magendie Paruria retentionis & incontinens successful see Magendie Leucorrhea communis cured Bite of reptiles said to be cured Emaciation of extremities cured or relieved by Magendie It must be remembered that all these cases may be incurable and that the article may apparently fail Hist. Said to have been employed ever since the time of Gesner 15- Introduced into England in 17.. by Woodville Revived in France by Magendie in consequence of observint its tetanic effect on animals Strychnos psead augostura Called improperly angostura with various trivial names Always found as an adulterating article of Angostura bark 7 hence it probably grows in S. America. It is not known however, with certainty where its habitat is. Magendie Paris etc. attribute it to brucia antydysenterica [illegible] with probability attribes it to a species of strychnos Two species of strychnos grow in S. Am. Bark comes in pieces broader than long ½ inch thick covered with small warts fracture [illegible] small aromatic and nauseous, disgustingly bitter to the taste powder bright yellow Concentrated infusion muddy disgustingly bitter etc. Lat. tinct. pale rendered opaline by water? It is important to distinguish this adulteration of galipaea off. or angostura Severe accidents have happened even in this town Absolute tests said to be 1st a drop of nit. acid on the inner surface produce speedily a blood red spot (by the [brucia]) 2nd a drop of nit. ac. applied to the lichens on the outer surface, produces a deep emerald green color It is much to be regretted that the active principle is called brucine this brucine poisons as effectually as strychnine Th bark in powder [illegible] grs. killed a dog in an hour A child was killed by mistake cold extremities senses retained to the last Brucine is formed in Strychnos nux vom. said to be a bigallate in false angostura. Description of brucine vide chemistries. Taste bitter & acrimonious Nit. acid produces a deep yellow colour hence it can be detected when in combination with strychnine Wide discrepancy between the results of the ultimate analysis of brucine Andral considers 1 gram of strychnine equal to 24 gr of brucine Hence 6 grs. will be equivalent to ¼ gr of strychnine q.v. 4 grs. killed a rabbit Andral has given it in single doses of ½ gr. to 5 grs Magendie 1/8 gr. 6 times a day Operative effects differ only in degree from those of strychnine Strychnous pseud ang. is now considerably used in medicine Strychos [illegible] is the most active of all the strychnia (strychnoes) L. ignatii is next in activity. It was called ignatia by Linn. Called also faba sancti ignatii recommended in intermittents It vomits purges and produces spasms 2 grs said to be a medium dose of the seed. Strychnos colubrina posses the same sort of powers. The wood of the root is used against bites of snakes hence its name. In doses of ½ dram it has been used in intermittent. It vomits, sweats, diuretic cath. This is one of the plants called [illegible] [illegible] The other plant is the following Toxicaria macassariensis Ripa antear Antearia toxicaria etc. This is said to be the most active of all the narcotics not] excepting hyd. acid. The proxi Lobelia Inflata Said to be annual, persistent, and biennia. It seems to be biennial Rapuritium inflatum lobelia emetica. Indian tobac. eye bright etc. Nat. ord lobeliae Canada & the whole U.S. [Ra??.] & Sch. describe 15 species most of them are highly active Taste much like green tobacco It has never been analysed Operation 1st warmth in the stomach proceeding to cardialgia universal glow tremors some nausea vertigo salivation Larger doses cause more vertigo emetic diuresis more salivation expectoration Poisonous doses produced convulsions, delirium & death. Said also to produce increased secretion of bile diuresis & diaphoresis A valuable deobstruent though more adapted to atonic cases Valuable diuretic etc. Useless as a mere emetic It is too harsh and distressing. It would probably prove emmenagogue. Some think it cath. Prof. T. denies this except indirectly as an antirritant & cholagogue Seems not to be stimulant It will not prove restorative in exhaustion but rather increase it It may excite an irritative bounding of the pulse in low torpid cases. It is acrid & locally irritant not stimulant. It resembles to nicotiana tabacum but is more diffusible more sudden, mor transient, less permanent more manageable Though not stimulant yet it is contraindicated in entonic diathesis Pharmac prep. 1st powder of leaves 2nd powder of the seed 3d infusion but this has no standard strength [4th] tinctl zii to 1 pt dil. alc. 5th Tinct. of seeds by the Shakers Diseases 1st Dyspepsia with great [irritability] with wandering pains like disguised gout very beneficial in conjunction with capsicum & nit. sil. Limosis gastrodynia vide Eberle’s practice He finds it superior to opium Idiopathic cough either before or after expectoration found to be very valuable Bex dyspnoica Case related of an apparently desperate case cured by lobelia and opium f zi tinct. lob. with 2 or 3 grs op. at a dose each article failed by itself Another case related in which a large secretion of bile was produced Hooping cough found useful after the convulsive cough has begun by numerous practitioners A physician gives 10 to 60 m occasionally vomiting with it and he thinks it better [emetic] for the disease than ant. or ipecac undoubtedly because it is deobstruent Many physicians have succeeded with it Prof T. has done so sometimes conjoining opium or conium Dyspnoea exac. f zi of tinct every 5 or 10 min. until full vomiting or narcosis is produced. The certainty of the operation will be enhanced by premising opium Give it in the intervals of the paroxysms in conjunction with tonics Asthma best article for this disease as well for the preceding Still this medicine is so nauseous that many patients will not persevere with it Typhus nervosus has been used Dr Hyde of Enfield employed a powder of lobelia, or sanguinaria & of [????triphyllum] as a stimulant diaphoretic in typhus. It must be remembered that deobstrents are useful in typhus. Prof’s T & Beers used lobelia in typhus, when medical student & found it a most efficient diaphoretic Catarrhus communis & epidemicus Prof. T. has used it with great benefit Croup Dr Barney employs it in croup in the commencement and in the progress of the disease 30 m to ½ fz Croup is sometimes perfectly paroxysmal & resembles dyspnoea exacerbans & has been mistaken for asthma, as shown by Dr March’s p.m. examinations For this form lobelia is peculiarly adapted Pneum. typhodes was found a most valuable expectorant whenever squills could be tolerated does not answer well for when the stomach is irritable Acute rheumatism It has been used with success. Prof. T. has used it often with success in subacute rheumatism Case related cured in 24 hours by lobelia & opium Yet this patient had often had such attacks before which always lasted for a fortnight A. rheumatalgia var. chronica (chronic rheuma) Prof. I finds it the most valuable article much superior to guaiacum which is the article commonly depended on. Case related cured by lobelia and opium after arsenic blisters guaiacum alcohol capsicum etc. had failed Leucorrh. comm. valuable in some cases generally best conjoined with cantheris & nit. sil. Hernia recommended as a substitute for tobacco by enema Said to be nearly as effectual and not dangerous like that article Lobelia tupa Peru 6 ft. high root is 1/1/2 ft. long odour in a close room produces vomiting Juice so acrid as to produce speedily topical infl. when applied to a tender surface L. longifolia W.I. said to inflame the hands said to produce an incurable purging. Prof. T. has known several deaths by this actually incurable purging hydragogue from colchicum! L. urens most active also]L. syphilytica throughout U.S. all parts [lac] 1st deobstruent 2nd emetic 2d hydragogue cathartic apparently not narcotic 1st expectorant & emmenag. 3d diuretic 4th diaphoretic First employed as a specific for syphilys Just about as active as senega and adapted to a similar set of case. It seems to have the advantage of being less liable to leave the stomach in a deranged condition than senega As to its curing syphilys Prof. T. thinks the matter not settled when it was tried the notion prevailed that syphilytic patients should be salivated and that too before the constitution became affected It is never worth while to give mercury internally when the disease has proceeded no further than a chancre & bubo You will merely protract the cure The const. aff. also Prof. T. has cured by gold. It may be cured by various articles# Lobelia Dortmanna of similar powers to the preceding Lobelia Cardinalis supposed to be similar power It is a popular remedy in dropsy & will cure used as in vermifuge for [asc. lumb] L. claytoniana still weaker most common with us and apt to be confounded with L. pallida # Some cases will prove incurable under any treatment Sanguine temperament & scrofulous habits [illegible] mercurias dulcis sublimatum dulce (Sydenham) A. [illegible] A. [maligala] [Draco] mitigatus marina metallorum [illegible] metallorum Calomel Most modern & best name is Hydrargyri dichloridum The atomic weight of mercury was formerly called [200]. It is the general principle to take the smallest weight though it is not very strictly adhered to It does not appear but that the # persons who first pitched upon 200 + 8 for the black oxide, did it at haphazard and did not investigate the subject nor give any reasons “That compound which is with most difficultly decomposed, must be presumed to be a binary one Ms. Dalton vide Henry Prof. T. knows no exception. Hence says Mr. Alison? we must suppose the peroxide of merc. and perchloride to be binary compounds We find also that black oxide is very readily reduced by heat by agitation almost by pilling to red precipitate and metallic mercury. We find the same true of the cyanides. The sp. gr. likewise of the vapour leads to the same conclusion. The sp. gr. multiplied by .555 must give in combining weight. Hence we have 100. Another argument founded on the sp. I have [shown] elsewhere that if we divide the number .376 by the spec. heat the quot. will be then atonic [illegible] of that body [illegible] the spec. heat up [illegible] .03 & 376 / .03 = 12.533+ Berzelius advances similar arguments and gives the same no. 100. Thompson sometimes uses “sub” instead of di. Sub is a vague term It was found after the discovery of def. prop. that sub carb. pot. was 1 of each! other examples of its being misapplied before the discov. of def. prog. Formerly called proto chloride This would answer if it was still the case that proto was applied to the least compound Hydrayg: chlorid. mite. Phil. ph. an unexceptable name in pharmacy muriate of mercury Sub murieta (very exceptionable because it was considered neutral) then mild muriate) Called calomelas in 1616 But this name had been previously applied to the disulphuret (Ethiops mineral) Its discoverer is not now known The alchemists were acquainted with it. Sometimes found native & called horn quicksilver & mercurial horn ore a rare mineral Dull white yellowish heavy cake crystallized in 4 sided prism terminated by 4 sided Buff coloured when finely levigated. The only way to obtain it pure is to buy it in form of crystals The powdered in the shops is variable sp. gr. 7.2. [illegible] primary operation when taken internally 1t deobstruent 2nd cathartic 3d emetic 1st sialag. 2nd expect. 3d diuret. 4th cholag. 5th emmenag 6th antipsoraic resolvent 7th diaph. From the very situation of the salivary glands the operation on them attracts more attention Next to its dialag. are its cholag. Next its expectorant Next is its antipsoraic Next its diapohoretic, diadretic & emmenagogue in the order mentioned As a cathartic it is useful 1st as a mere reducing agent (a moderate one in moderate entony unless after bleeding) 2nd it may be used much more to make a shock or strong impression & interrupt disease 3d to increase susceptibility to other remedial agents & to equalize excitement Of little value to remove effused fluids as in dropsy it is slow & not hydrag. or to remove offending matter It may be made to operate as an eccoprotic, a laxative, a purgative a drastic cathartic It cannot long be used as an eccoprotic or laxative on acc. of ptyalism Most useful as a purgative. Inferior as a [illegible] cathartic Equally copragogue & cholagog. When suffered to remain in the bowels it is always deobstruent cholag. sialag. The gall bladder will always be found distended with bile or gall after it has been freely given in acute disease. This is often attributed to a spasm of the ducts [Emalging] the liver is supposed to be the only use of giving calomel in fever but then it [opens] the skin and promotes all the secretions It acts on the stomach and upper int. when given in a purging dose Its vomiting power is little valuable but as a cathartic it more nearly resembles an emetic than any other cath. in its operation, & may often be used as a perfect substitute where emet. are indicated. When given as a deobstruent opium shd be combined with it to keep it in the bowels. But when we desire a long continued deobstruent effect give it in small doses but it will always salivate sooner or later A man in health or in vigour is salivated with less diffic than in low atonic diath. or when very feeble or in enton. diath Sometimes it does nothing but salivate This is important to distinguish Sometimes it merely purges without any deobstruent eff. But Prof. T. has always found such cases to have been recently salivated or to have an excessively irritable stomach & al. can. in which it produces vomits Given with diuretics, or emmenag. or diaph. etc. it will prove more especially diuretic etc. Hence the “dirigens” part of the ancient prescriptions Naturally a very slow cathartic dose 5 to 10 grs N.B. we determine the nat. effect of a cath. by the smallest quantity that will produce its full effects When hurried through the al. can. almost all its deobstruent effects are lost. It must also be remembered that its cath. operation is generally its least important operation Prof. T. & his friends have always experienced its good effects upon themselves before the purging began Calomel has been called a stimulant perhaps because it produces irritation sometimes & a mercurial fever which is merely irritation A single author has called it tonic This is still more absurd A large proportion of our medicines do not either stimulate or reduce Mr. Abernethy says there are some patients whose mouths will not be affected & yet the system be under a mercurial action. Prof. T. has not observed such cases The system may be above or below the grade of excitement proper for salivation There may also be certain states of the system in atonic diseases which will not admit of salivation until the state of the system is changed Case const. syph. mercurialised in N.Y. without success also in Phil. also in Botson utterly without success. [went] to Charleston and there some one recc. Dr Todd Dr Todd put him upon a bottle of wine a day & a free use of bark for a week Then gave him mercury and salivated him in 3 days Prof. T. never met with a case which he could not salivate Perhaps by bark & wine, sometimes by combining capsicum with the mercury There is no foundation for the dogma that stimulants must never be combined with mercury his use of opium & bark to bring on salivation from mercury has been long known in Connecticut It has lately been brought forward as a new discovery [illegible] & soreness are more easily cured of syphilis [because] [illegible] can be confined confine your pat. to the house better to the bed. This with opium & diaph. treatment has succeeded in giving action to merc. when otherwise it wd have failed” Most of the baneful effects of mercury in syphilis are probably owing to not giving the proper corrigent etc. Paris seems to be the only author who is aware of the necessity after of reducing the system to the point of susceptibility And even he knows nothing of the necessity of raising the system There seem to be two sorts of injurious effects 1st acute 2nd chronic The dichloride disoxide & diprotonitrate produce the acute more commonly While the proto chloride protonitrate & protoxide produce the chronic They symptoms which show the system to be under mercurial influence are 1st symptoms (previous to ptyalism) cupreous taste more or less swelling of gums sloughy whiteness of gums margins trifling soreness & a feeling of looseness of the teeth A peculiar fetor of the breath Called mercurial A peculiar fleecy appearance of the tongue Then comes the dis Ptyalismus acutus var. hydrargyratus which begins as above vide Good When cal. begins to produce heat, soreness swelling ptyalism sloughing of the inside of mouth and cheek etc. with the mercurial eruption the system is labouring under a severe disease a poisonous effect. Actual salivation is never necessary though it may be convenient to produce a slight one Caries of jaw perhaps with exhaustion & death total loss of teeth fetid breath stiffness and incarnation of limbs etc. may be the emaciation, debility, loss of appetite ultimate results more rarely a lingering death Severe ptyalism is apt to be treated as a light disease very improperly We are not to expect any specific antidote. Yet upon the notion of the absorption of mercury sulphur is proposed Sul. has 2 compd scarlet red & jet black! both are insoluble & no emenctory will the row off a [illegible]! Many suppose that repeated purging with neutral salts is useful in this disease. Another man in Ohio Dr Findley says he cures by tart. emet. “as a gargle & I believe internally” “Perhaps it may be useful topically as an irritant like nit silver.” Prof. T. has repeatedly seen antiphlogistic treatment tried and with no benefit Sarsaparilla (a weak deobstruent supposed to promote secretion is more especially for the kidnies & skin) Prof T. has often tried it for [weeks] with no benefit whatever So have others Lotions and gargles generally fail entirely in the early stages though they are useful in the advanced stage to obviate [atony] and relaxation The frequent gargling of cold water has often been of very high utility Diluted mineral acids have been found especially useful But lotions of the decoction of batesia tinctoria (acrid narcotic deobstruent emetic and cathartic) has proved one of the very best remedies in a strong solut. [illegible] I to zi water and been very popular with those who have tried it Lotions of nit. sil. are very useful (sometimes on account of the irritability, a strong sol. suits better than a weak one Arsenitis of potassa externally & internally useful Prof. T. 2 fz ol. turp. with z fz muc. gum arabic Prof. I. has found very beneficial Very strong inf. of lycopus vulg. has been very useful (bitter & nervine) Coptis trifolia has been employed & is useful Mucilages, acac. astragalus [illegible] [althaea] hibiscus typhus latefolia (root) viola pedati split twigs of [illegible] [sassaf???] [ulmus] [fulva] (rather inferior) but perhaps decoctions of rice and barley boiled long and strained are as good as any mucilages. All these are very grateful to the patient Qinine is often indicated internally to keep up the strength of the patient But the watery solution of opium is the best applic. and op. shd be given internally Milk porridge has always been preferred for diet The next inconvenient effect is Called very improperly erethismus hydrargyratis but has no other name Great exhaustion of strength anxiety frequent sighing epigastric distress vomiting irregular action of heart & arteries pulse small quick frequent sometimes intermittent tongue seldom furred cold extremities perhaps sudden death upon exertion Occurs in the feeble Treat by perfect quiet and opium tonics arsenic etc. It may occur before salivation in the feeble Eryth. vesic var. hydrargyratum Perhaps not distinct from E. [corrosivum] Called improperly eczema & hydrargyria [sepoa] etc. Prof. T. thinks it clearly an erythema vide Good Perhaps his var. corrosivum is identical with this a better description could not be given than his description of E. ves. corrosivum N.B. in erythema you may always see vesicles in a sunlight by a magnifier hence erythema is not a rash. Bateman criticized [erysipelas] & erythema are synonymous Bateman says E. v. hyd. is produced by other causes as cold but that from mercury has some peculiarities N.B. The effects of fire, frost, sun burns, an eruption caused by arsenic etc. are varieties of erythema Preceded by sense of stiffness, itching etc. about a side of thighs and scrotum or about the neck and arms next comes a redness and minute microscopic papula. The redness spreads in large patches over the body The pimples run into each other become large emit an ichorous, corroding discharge The whole body becomes raw, excoriated chapped, stiff etc. In severe cases recovery scarcely comes on in less than [illegible] weeks and may continue 8 or 10 Sometimes the hair and nails come off. The whole epidermis comes off and as is the case with other such eruptions As skin may give off 2 or 3 successive crops of scales. This Bateman’s description and a very good one Prof. T. has witnessed 3 distinct grades 1st merely local in the bands of the joints etc. caused by ointment of mercury 2nd an ulceration in the mouth in children who have used mercurial escharotics too long 3d covering the whole body attended with an irritative fever & general exhaustion Caused only by mercury internally. “It can be cured notwithstanding Bateman’s opinion to the contrary Treatment palliative (Bateman) warm mucilages in lotion poultices mild cerate after excoriation Antimonials & opium and finally mineral acids 7 bark Prof. T. dissents from this treatment (the merc. dries on) He applies at first simple ointment of datura and in the latter stages adds carb. zinc (lap. calam.) He also uses infusion of digitalis just about strong enough to create some irritation (perhaps upon a medium ½ oz to the pint) Infusions of the seeds of datura are useful also Prof T. finds the poultices & fomentations keep up the disease by relaxation The tepid bath may occasionally be advantageous Let the diet be light and nutritious Prof. T. has generally found quinine necessary. He could always give opium moderately Arsenous acid he uses in some way internally. As the appetite is generally small, so that the pat lives principally on liquid food the opium will not be apt to constipate, and if it does castor oil may be given but Prof. I has not found laxatives necessary Min. acids sometimes agree and sometimes disagrees producing tormina etc. in the bowels Prof. T. can lay down no rule Dysenteria acuta var. hydrargyrata It has the general characters of dysentery but there is more irritation & exhaustion. In adults I have seen it in all cases produced by the external Application of [illegible] inordinate quantities commonly called “roasting it in” In children I have seen it more generally brought on by by internal use in repeated doses All that is necessary commonly is the abstraction of the calomel & the vigorous employment of opium. For the exhaustion tonics & stimulants with opium may be needed (Sometimes give calomel hair of the same dog (Osgood)!) 4th Sub acute mercurial rheumatism Liable to degenerate into a chronic state and into paralysis Resembles the idiopathic Attack gradual & insidious little redness or soreness much pain on motion local aff. generally about the larger joints moderate tumefact. no supp sympathetic & irritative fever erratic pains always attended with sweats exac. at night & in stormy weather. Brought on by exposure to cold & rain etc. taking cold In the acute diseases of mercury the physician generally gets the ill? credit. But the chronic diseases have more importance attributed to them even than they deserve many cases are falsely attributed to mercury. 2 cases related of permanent lameness reported to have been treated with mercury neither of whom had taken a particle of mercury one of then had been purged a long time with brimstone & rum It is well known that sulphur will produce similar effects e.g. as perfect a dysentery as that of mercury though more generally it produces the chronic effects. Both mercury & sulphur will produce paralysis etc. Opium capsicum alcohol etc. are important remedies in the treatment of this subacute rheumatism If [illegible] the disease is pretty manageable. The nearer they approach to acute the more useful will actaea be otherwise conium Fowlers sol. Harthrytum [illegible] Digitalis guaiacum If a pat. has got out and is in great danger give him great quantity of alcohol 5th Marasmus tabes (vide. Good) General extenuation with debility, with languor, exhaustion, hectic (Neither Cullen’s nor Good’s hypotheses are worthy of consideration being mechanical)The assimilating capillaries are probably principally affected, owing to derangement of digestive functions. (The stuff about the absorption of oils mucilages, and alkalies, is poor enough) Prof. T. has found opium of more consequence (in tabes venenata) than any other remedy next conium & iron with acrids also cinchona etc. Narcotics must be in small doses frequently repeated, to obviate lesion of the nervous function. Prof. T. has known a disease closely resembling strumous cephalitis which does not exist the effusions being a mere sequel in the latter stages effusions somewhere are the common result of acute disease e.g. in the pericardium etc.) produced in children by excessive quantities of calomel 2 to 4 times a day so long as the sickness lasts and then much large quantities of calomel, would be given & produce a mercurial dysentery for which still larger doses of calomel would be given & finally the parents would refuse to allow their children to receive mercury & consequently the practitioners themselves would see that children would get well without cal. & then conclude that cal was improper for children altogether case of a distinguished teacher in a large town who holds this opinion led in this way When this affection begins, stop your mercury & give narcotics # Prof. T. has seen the same effects (not hydroc. [illegible]?) from mercurial itch ointment An irritative internal haemorrhage is often rarely but sometimes produced “Said to have happened in Eng “said to have been caused by corr. sub Abortion is often produced by a continued mercurial course said to have been produced in France by calomel Fevers treated with mercury in grain doses as a stimulant made hopeless irritation uncontrollable diarrhoea. Mercury often does more hurt by its inconvenient effects than good by its desirable Many practitioners now employ the vegetable deobstrents & use mercury almost only as a slow cathartic. # A [most] [illegible] aff. [illegible] syncopalis is sometimes produces more often by the external use of it for the itch but by the internal use in irritable subjects” Ac. lead is often preferable. it is liable to only one inconvenience viz. [illegible] Sanguinaria is often preferable Actaea is often preferable Conium is preferable, for jaundice chronic liver affections etc. The pneumonitides are better treated without mercury at least as the principal remedy (The rash & careless use, eve of narcotics even of opium, is far less dangerous than that of refrigerants, tart. em. mercury etc.) It is a rule of naval & military practitioners that mercury shd not be used where it can be avoided as it leaves the patients more exposed, for years, to injury from exposure to cold, & wet etc. This applies to all cases of persons liable to exposure i.e. seamen, blacksmiths & manufacturers No remedy is applicable to a greater variety of cases, than merc. exc. opium opium (Dr Chapman says none whatever) It is not in the latter, but in the earlier stages of disease that calomel is especially useful Hence Dr Bond’s rule (vide Chapman’s therap.) always to try mercury as a dernier reasort, as a pernicious one Therapeutic application Dyspepsia it is almost a matter of course to treat dyspepsia with di-chlor & dis-ox. merc. Prof. T. has never seen any benefit except that of an eccoprotic or a laxative and even these other articles are generally better. They are also extremely liable to produce tenderness in region of liver, stomach etc. Let this tenderness exist of itself & even be relieved by merc. they debilitate irritate etc. Yet they are occasionally proper for a short time. Occasionally proper as a slow and moderate cath. It should be employed in but a small proportion of cases Colica ileus important often in large quantities especially in the early stages “Cal. & opium are equally important auxiliaries shd be used” Large quantities shd not be pursued into the secondary stages C. rhachialgia useful in the same way as 3 or 4 dose zi [illegible] are often necessary in the course of 3 or 4 days But Prof. T. thinks corr. sub. & still more red prec. is preferable Coprostasis (idiopathic) large doses in the early stages but if it fails give other remedies Diarrhoea vulgaris moderate diar. may be broken up by vom. by purg. by almost any strong impression Sometimes cal. cures in the earlier stages by its deobstruent effect It shd not be given in the latter stages. Dr Johnson thinks the fashionable British practice of purging protracts the disease Colliquative (tropical, & intemperance & puerperal diarrh. also that of old men contraindicate calomel Cholera vulgaris generally, though a severe not a dangerous disease often protracted by treatment often broken up like diarrhoea by a strong impression as by puking Cal. may cure it by its deobstruent effect. “[illegible] doses of cal. may be good before the vom. & purg. is begun It is of no use as a cathartic nerely because more purging is useless It is of no use unless in an extraordinary dose while the evacuations are large It is not indicated as a sialogogue, nor as a stimulant, tonic etc. It is good to change the [secernents] particularly the liver & al. can. but before giving it check evacuations with opium and produce reaction by stimulants Give it in quantities short of the purging point often combined with stim., etc. Helminthia one of the best articles # Icterus vulgaris may be made to cure purge at first then in alterative doses combined as the symptoms indicate. But conium will cure more speedily and better. Though even with this a purge of calomel may be given at first though not for purging Parabysma eractum conium is better than calomel quinine is better still. Give conium & quinine. All [illegible] the cases that are the primary effect of malaria are best cured by quinine The [illegible] cure the sequel of intermittents by quinine alone Prof T. gives in such cases conium & quinine Anti corysa (often a troublesome disease) an attack may be broken up by a slow cathartic of calomel at night We should not keep repeating it however Intermittent If a cath. is needed at the commencement cal. is the best & is better than an emetic Previous to the use of quinine cal. was often necessary to obviate the inconvenient effects of the pure bark often a sub ptyalism was necessary to be kept up No inconveniences however result from the use of quinine Remittent cal. is of more importance than in intermittent purging & often a subptyalism is needed after which quinine will cut the disease short Typhus infantum very important T. nervosus perhaps only in non-malignant typhus is calomel advantageous. N.B. This is the most common fever all over the U.S. (even at the south testimony of Dr McBride etc.) Employ in the very commencement of an attack say 3 grains once in 3 hours conjoined with a diaphoretic regimen so as to produce a sub ptyalism or in one or 2 large full doses, with opium if necessary in order to keep it from purging under 15 or 18 hours the very best mode of breaking up fever. If we are a little too late, or if the cal. passes immediately off by the bowels, then give enough to produce a submercurial action for a few days and conjoin mild tonics the disease will be [mitigated] & shortened N.B. we do not wish much purging but the universal deobstruent effect of the calomel. Hurried through the al. can. it is no better than any other cath. Even if the disease is completely broken up, yet the patient shd be carefully attended to & treated like a sick person. Prof. T. has resolved 8 cases out of 10 even when the disease has been fully formed. Some of his friends think they have resolved a greater proportion Dr Todd, Dr S. B. Woodward etc. But if the disease is malignant or if the pat. has tampered with medicine, or put off the employment of a physician we cannot succeed thus Delirium tremens sometimes cal. is important where there is insusceptibility A single full dose in conjunction with opium will produce sleep with more certainty. But in the exhausted and broken down it will not answer Yellow fever agreed to be important difference of opinion as to mode of management Prof. T. finds neither purging nor salivation necessary It is agreed that there is not generally time to salivate. Useful in those cases in which there is great torpor & insusceptibility of the system with nearly a total suspension of peristaltic motion If the case is one of exhaustion and one which begins with diarrhoea cal. will be useless. In the other sort of cases tropical writers have given 1000 grs in 4 days without saliv. or purg. Prof. T. has given 400 grs in 4 days without either sal. or purg. In the same case he applied a 7 by 9 blister on the epigastrium one half as large between the shoulders blisters a quarter as large above the ankles 400 grs in molasses a teaspoonful once an hour Patient extremely delighted with the effects of both Stomach would probably have rejected a tablespoonful of bals tea. But in other cases a grain of cal. would pass off in half hour. In this case subsequently to the first 4 days quinine and a moderate use of brandy In the secondary stages of yell. fev. cal. is generally injurious Typhus putridis sometimes useful as in t. nervosus Synochus calomel is sometimes needed for purging oftener as a deobstruent Most practitioners bleed puke and purge and have to stimulate or have protracted and relapsing stages Entonic phlegmonous phlogotica Depletion & neutral salts at first afterwards use cal. for a mercurial action. Dr Rush’s compound of cal. tart. ant. & nit. potas. is the very best compound vary the proportions to suit the case. Determine the proportions just as if you were giving each separately Especially important is this practice in cephalitis still more so in pneumonitis In enteritis bleeding is still more necessary neutral salts will be rejected Calomel is the article for purging give your calomel clear to keep it from being rejected. This is the only cath. you will succeed well with. Atonic phlegm. phlogotica Calomel is very important no bleeding not so much purging s use blistering. Prof. T. has seen no atonic phleg. infl. of brain he has seen only strumous or arthritic or erythematic Atonic phlegomonous pneumonitis purging with a large quantity a strong mercurial action just as in the at. phl. hepatitis of tropical countries N.B. you must be more in a hurry to produce a mercurial action in these atonic infl. than in the others. Prof. T. thinks the weight of testimony among the tropical writers is against bleeding & drastic purging against J. Johnson Phlegmonoid erythematic erythem. known by the fever’s being [synoch] or gravior phlogotica Purge with cal. follow with calomel to produce a mercurial act. followed by serpentaria cinchona etc. Pure erythematic or gangrenous phlogotica (e.g. of fauces) calom. is injurious eryth. cephalitis & pneumonitis cal. is of more importance unless they are gangrenous Eryth. enterities is apt to have a diarrhoea generally has a diarrhoea cal. apt to purge corr. sub & especially red precipitate are better Of late years Prof. T uses conium even in some cases in dram doses Arthritic phlogotica calomel of high importance of late years Prof. T. has often gone back to the calomel practice. Case extreme pain in joints with redness & swelling extreme pain all over Cal. & opium until the pain was relieved it took 10 grs of opium with a diaphoretic regimen next op. & ipecac then a little castor oil to bring away the al. Finally alcohol & cinchona No case lasted longer than a fortnight under this practice. Next Prof. T. employed veratrum viride. Next he employed colchicum but it was inconvenient he has known persons cured of the rheumatism by colch but killed by subsequent diarrhoea Actaea is the best Sanguinaria digitalis Some conjoin calomel with these membranific phlogotica Croup hysteritis cystitis Calomel is universally agreed upon except in croup but even here though vomiting will cure cal. is better or rather both. Prof. T. has ceased to vomit in his own croupy family Strumous phlogotica more useful in the acute according to the general rule that cal. is more applicable to acute phlogotica Several phlogot. not referrible to these divisions Influenza Pneumonitis notha Cholera infantum Dysentery different modes of practice some [illegible] with large others with small doses both are proper in different cases In some epidemics calomel is inadmissible Case of the epid. at Midd. a grain of cal. or of ipecac would bring back the dysentery when it took 40 grs of opium a day to keep the disease under trouble with counsellors Epidemic (Egyptian) ophthalmia a bad disease It is the common practice to bleed the patient almost to death bad Purge with calomel give cal. & op. Bring the system immediately under mercury Treat like tropical hepatitis Conjoin actaea Sparganosis puerperar. Prof. T. has never met with a case in which it was admissible he does not doubt that they do exist Synochous exanthematica (Phlogistic exanth. are talked of but not described authors do not even suppose them phlogistic except a short time at the commencement) Typhus exanthematica contraindicate it Lues syphilis While it exists as chancre and bubo only it is purely a local disease and may be cured topically. 3 to 6 weeks ore even 3 mo saliv. is necessary to cure it through the constitution. Some use both but the topical are those that cure, even in this case But some claim that the absorption is prevented by the const. treat. Now medication cannot be thus [prevented] by anticipating the period of absorption according to the regular laws of the disease Mercury will not relieve the topical disease, without a sub salivation. Many practitioners suffer the pat. to run on a long time without sub salivation. But this may be produced in 24 hours by conjoining opium or perhaps wine & quinine Prof. T. has never known the constit. eff. follow when the disease had been cured topically. Even if they do it will be time enough to treat them when they occur Mercury will even hinder the healing of the topical affection When the father or mother infect their offspring without having symptoms of the disease left on themselves, and the children have a fatal syphiloid affection the affection of their subsequent children may be prevented by mercurializing the parents a curious fact! Prof. T. has sometimes cured such children by conium & corr. sub. The new way of treating syphilis has yet to encounter great prejudice When the const. symph. have appeared perhaps cal. is the best remedy. The others (cor. sub. & red prec.) do not produce ptyalism & a sub ptyalism is necessary The above is a very imperfect account of the therapeutic application of cal. It would require a volume to exhaust the subject Pneumonitis notha is or common pneumonitis always synochous or typhus. Atonic phlegmonous pneumonitis has a nervous fever accompanying it. N.B. Edema of the lungs (of Dr Hooker) is not a pneumonitis Erythematic cephalitis is the disease described as a fatal erysipelas of the head but the eruption comes not out till 3 or 4 days have elapsed and there is light generally on the face. Other erythematic empresmata are attended with eruptions somewhere that of the lungs (liver?) is on one or both extremities. Fever varies from synochous to t. gravior “I have never known calomel thrown up when put into the mouth & swallowed with the saliva” From [Savage’s] notes Tonics Produce increased strength of action in subordinate parts of the system e.g. appetite, digestion, pulse, muscular & mental action removes morbid mobility & irritability of atony Mr Abernethy says all strength depends on strength of digestion. But some tonics increase strength of art. act. (e.g. arsenic & cinchona) before they increase appl. & digest others first increase appetite & digestion & subsequently general strength. Hence an important rule for selecting tonics to suit a case e.g. Intermittent does not require those which act by increasing appetite Prof. T. has found the above true of cinchona, liliodendron & magnolia Tonics do not act rarely on the muscular system they certainly increase the contractility of the cell. fibre All tonics increase art. energy those articles which act on parts of the system without strength the arterial syst. are not tonic. Prof.’s I. & T. deny entirely that tonics produce ultimate debility They have known bark iron used many years with increase of strength Bark for 12 yrs vide Heberden Bitters are not necessarily tonics metallic articles are not bitter Some tonics, as cascarilla? bark of croton tiglium? etc. cinchona quinine require liquid food to make them sit well upon the stomach. So alc. requires food in exhaustion of fatigue Case of a traveller or laborer. The above tonics approximate to stimulants. Much depends on a knowledge of this principle in intermit. for inst. quinine may thus be prevented from producing a sense of stricture, nervous symptoms etc. If you excite the appetite, the stomach must have something to act on Tonics are indicated in some stage or other of all atonic, debilitating diseases They are better understood than any other articles Groups 1st tonica [amara] simplicia Limaronba excelsa (quassia of the shops) Quassia amara. Scutellaria [illegible] Little inferior to quass. & generally preferred by patients pure simple bitters like quassia [chelor??glabra] [illegible] [Hanth???] much used Canadensis like columbo a [???folia] hydrastis Gentiana [illegible] etc. The [illegible] gentians have smaller roots but are as good [illegible] [illegible] is best [chrymoplenum] [apporeti] [colum?] possessing the same smell taste & chem. prin. but pleasanter & preferred by patients [illegible] Canadense allied to Cocculus [illegible] (Columba) Menyanthis trifoliata buck bean Helnium autumnale Gratiola aurea These are mostly amer. articles & as good & cheap as foreign 2nd amara [nervousa] [illegible] G. [ochro???] is good G. saponaria is one of the best G. quinqueflora & other northern species are not so good Tops & roots are used. [lupules] (best) hoarhound Lycopus vulgaris (water hoarhound (L. virginicus is much feebler, but is most used Ballota nigra nearly allied to hoarhound 3d amara narcotici barks of cerasus virg. C. oborata the best of the genus Sorbus oborata & necrocarpa Pernica vulgaris barks of all of them 4th Tonica amara astringentia though some are merely astringent to the taste Cinchonae a large num. of species Corni C. sericea probably best next is probably C. circinata & paniculata C. florida inferior more astringent Querci Q. alba & tinctoria Alcornia latifolia Bodygin (alcorn [oaks]) Alnus serrulata (may be used for cinchona) 5 amara aromatica Galipea off. (angostura) magnolia glanca umbrella cordata etc. etc. valuable (elegant aromatics intensely bitter) Next is siriod. tulip. Ilicum floridanum (both aromatic & bitter) Croton eleutheria & cascarella & aromaticum (cascarilla) Tasmania aromatic similar caryea amara, squamosa, procina & alba (pungent aromatic acrid reminding one of guaiacum) Ptelea trifoliata bark of root & top differ considerably Hanthoxylum fraxinem (less bitter) H. tricarpum & H claraberculis (most valuable) Dryni winteri (winter bark resembles canella more agreeable almost a spice) Drynis of several other species Canella alba (called canella also) 6 Tonic. amara laxative [Federia] cordifolia (much used by the Spanish Americans the fruit) [Grellindina] [illegible] & bond cella Gallindina bondere (nickernut) [illegible] as [illegible] etc. blue & yellow nicker nut # Eupatorium perf. & rotundif. Polygala polyg. or rubellum (purges like aloe) but may be taken as a tonic without being laxative) A good bitter tonic & laxative in dyspepsia 7th metallina. Vinous prep. or iron ox. zinc hyd. bismuth sulph zinc arsen. potash & soda nit. silver Copper sulphate acet. & [nitroguret] (C. ammoniata) # preferred by g. Johnson to peruv bark in tropical climates Habille Carthagena Carthagena bean used in dysp. with torp. of bowels Arsenous acid White oxide of arsenic The word arsenic occurs first in [illegible] & applied to a sulphuret of arsenic used in painting Avicenna first recommended it internally The garlic smell is now known to arise from the dix-oxide which is the substance condensed on the tube & formerly called metallic arsenic Arsenous acid is seldom formed by chemists it is collected by the smelting of ores 77 ¾ parts and soluble in boiling water 1000 parts; in cold water only 2 ½ parts soluble in the 1000 parts. Composition 2 i ars. 7-6 ii 3 ox 24 = 100 In uniform & small doses, repeated acts on circulating system as a tonic increases heat (in a tonic coldness secondarily it increases appetite dig. power & ultimately after removing the disease muscular power Dr Potter (in his monograph) says it acts first on al. can. but its first perceptible effects are upon the sangiferous system No doubt it acts firs on al. can. but so do all remedies Given efficiently it certainly affects the sanguif. syst. before the app. & digestion. When given in nauseating & vomiting doses it of course acts first on al. can. More speedy than any other tonics but less so than the stimulants. It may be made to show its effects in 24 hours. It thus resembles cinchona in its effect on [illegible] & gangrene It has the remarkable fact that it has the power of restoring warmth to the surface though with no distinct relation to its tonic power Prof. T. has witnessed this perhaps 50 times Some patients have thus been saved. It may fail thus as an “analeptic” like other analeptics in extreme last stages This article seems to be an intermediate link between tonics and stimulants In larger doses it acts on the whole sec. & abs. syst. affecting the skin tumours ulcers etc. It is strongly antipsoraic relieves ulcers, cancers It is useful in rheumatism hence redolent Not discutient cholag. sialag. expect. or diaphoretic Acts on the brain & spine more than any other tonic & that too in remedial doses No other metallic preperation produces vertigo tremors etc. This operation has no name nor classification Prof. T. has seen however dilated pupils etc. in domestic animals from oxide & carb. of zinc. Oxide carbonate & ac. of lead act on the nervous system producing colica rhachialgia. Oxide and carb. of zinc have time immemorial been called poisonous and this must result from an operation on the nerves for they will not produce local irritation In large quantities laxative & purgative In larger it is emetic Externally applied it may be made to cure cutaneous diseases & to act as an escharotic. Dr Potter (Baltimore) says that in certain doses it is laxative and emetic It increases force and fullness of pulse without rendering it hard not admissible in phlogistic diathesis changes secretion and absorption is analeptic etc. not diuretic nor diaphoretic children bear larger doses than adults etc. N.Y. Pharm. “tonic, alterative, escharotic” Prof. Frost of M.M. Charleston says it is useful only as a tonic The injurious effects are caused by long continuance, rather than by a large dose so too of ac. lead. In acute diseases the larger quantities are of more consequence long continuance in chronic Antirritants enable larger doses to be taken generally opium in acute and conium in chronic. Veg. acids & aromatics assist it. When used freely conjoin liquid & farinaceous [nutriment] just as with quinine & stimulants The Philadelphians think it resembles tart. em. most not much foundation for this notion except as it vomits and purges Sulph. zinc of iron & of copper resemble tart. em. as much Even cinchona may be given in nauseating doses and all these then given are reducing of course Tart. emet. is of itself a refrigerant. We cannot class together articles which agree only in nauseating. Who would think of curing intermittent with tart. em. Tart. ant. & [illegible] are thought to agree in their antipsoraic power but the former is merely diaphoretic & has no antipsoraic power whatever Prof. T. came to this conclusion from observation before reasoning at all upon the subject. They both act upon the skin, but in different ways. To be sure some practitioners use arsenic in non phlogistic cases as a refrigerant & in the same way might sulph zinc etc. be managed. It is a kind of experimentum crusis that arsenic cannot be used in phlogistic cases Some suppose arsenic acts only by producing its own specific disease but it may be made to cure disease without any thing of this [effect] though this may sometimes be necessary [This] is true of all active medicines & when so pushed they produce diseases more or less specific Some think arsenic acts in a manner incapable of classific. & they call it merely alterative. But every remedy must produce an alterative operation of some sort or other and the alternative operation of arsenic resembles that of sulph. zinc of iron etc. & other tonics. It seems to be fashionable with some to deny the pathological conditions which are the foundations of the classific. of m.m. & they reduce every thing to a specific morbid affection overcome by another specific morbid action. Prof. T. thinks that all the operations of remedies may be classed Entony indicates refrigerants Atony stimulants etc. etc. Rec. [illegible] arsenic is 1st tonic strengthening pulse obviating debity increasing muscular strength etc. 2nd deobstruent curing cutaneous diseases cancerous ulcers resolving topical infl. 3d cath. 4th emetic 5 epispastic in the sort called escharotic & anti psoraic. Prof. T. thinks it far less injurious in its effect than polygala senega ornithogalum squilla & tart. em. (Hive syrup made of these three does more injury in a year than arsenic ever did) Tart. emetic causes many deaths, arsenic never does, when given as a medicine. It is accused of producing in inordinate quantities & when too long continued dyspepsia marasmus etc. But the same accusations have formerly been repeatedly made against cinchona It will never succeed when given rashly by dashing etc. as is so fashionable by larger frequent doses producing unequal excitement When too long continued & in too large doses it produces a puffy swelling of the skin & lips ophthalmia tarsi erythemia tormina etc. Dr Potter Good in his article on headache gives a summary of its ill effects These effects are more easily cured than such effects from tart. emet. An erythema vesiculare is produced by its analagous to that o f mercury. Case of Dr Todd’s pat. metastasis of pneumonitis probably arthritic to the brain took several fl. drams!! with 24 hours of ars. sol. of tinct. opii ([illegible] 120 and 240? tinct. canth [illegible]) & tinct. canth. in the second 24 hours 200 m. SS 120 m. t. canth 120 arsen. solut. In 48 hours hemiplegia cured erythema was produced with puffy swelling etc. In poisonous doses vom. purg ptyalism dysentery, haematuria sunken countenance paralysis convulsions etc. subsultus & death etc. etc. Dr Potter He says mucilages and oils are good for nothing as antidotes neither is sulphuret of potassium He directs to evacuate thoroughly & then treat on general principles Give castor oil etc. # Dr Bartlett gives as sympt. astringent metallic taste naus. vom. fetid breath ptyalism dysentery, distress etc. etc. It seems to be capable of extinguishing vitality without any of these effects in a transcending dose vide Orfila for a case So too vomiting doses will transcend its tonic effect & soon Arsenous acid retains its full powers in every form of combination, so long as its identity as an acid in combination, is preserved; so that, if you give any salt of it, enough to contain a given quantity of the acid, you get the same effects that you would if the acid were given isolated. Hence the folly of giving “chemicals,” as directed by the toxicologists. # The sequelae are dyspepsia, debility paleness, sallowness etc. etc. Pharmac. prep. 1st substance in pill Rx ars. ac. [illegible] fx. soap q.s. ft. massa in pil. 120 div (N.B. the salt thus formed in the same power as the arsenous acid) This is a very convenient prep. In acute diseases the dose varies from 1/24 to 1/12 gr. 3 hours to every hour (acute diseases) In chron. diseases 1/24 gr. 4 times a day is a minimum & 1/12 gr. a max. dose Tests of too large a dose [vertigo] etc. etc. tremors, nausea Either of them should cause the dose to be diminished Test of too much in 24 hours constant vertigo restlessness or tremors or headache general uneasiness sense of inflation at stomach or tormina or a laxative eff or a sense of inflation in epigastrium Test that pat. has taken it long enough puffy swelling under chin or face or ankles or under chin backs of the hands, a stiffness & [illegible] [illegible] slight ophthalmitis tarsi swelling of upper lip slight salivation or moderate tenderness of gums or a little ptyalism sometimes general swelling of body or erythema vesiculare. All go off soon if med. is left off. may exist several days without injury. Any one indicates a discontinuance Generally swelling appears first under chin & on backs of hands or wrists. Prof. T. has know them continue a week with no injury The salts of arsenous acid have the same effect as the acid & in the same quantity of acid 2nd Liquor arsenicalis Arsenite of potassa etc. etc. [Solutio] Fowleri Rx ars. ac. in very fine powder very pure carb. pot. aa 64 grs. distilled water 1 pint compd spt lavander zfs Boil & add the spt. lav. then add water enough to make up the pint. (Better add less than a pint at first say 14z & then fill up to a pint) This is Fowler’s original formula Phil. phar. N.Y. ph. gives arsenic ac. & sub carb. pot. & alcohol!! The compd spt lav has the advantage of giving taste colour & [illegible]. Case a colourless & tasteless sol. of ars. prescribed by Dr [Cogswell] for a [herpetic] patient. He refused to take it longer “as it was nothing but water” Dr C. told her wht it was & she refused to take it! This prep. gives 1 gr. ac. to 2 fl z of liquor hence 10 m. = 1/12 gr. & 15 m. = 1/8 gr. N.B. the solution requires a smaller dose the pill being gradually dissolved The liquid preparations of arsenic must be kept closely stopped & excluded from the light for the dis-oxide is precipitated on the inner surface of the bottle This decomposition will finally take place under any circumstances Pills shd not be given after they become hard Prof. T. has again and again known opium pills pass through unchanged. Pills of iron & conserve of roses may be cut & polished Rx arsenous ac. [illegible] fs sulph. quin zii sil. morph. 15 grs. ol. caps. f zfs. ext. daturae q.s. ft massa in pil. 120 div. N.B. Tonics are combined with advantage and narcotics is advantageously combined with arsenic This pill does not harden It answers extremely well in hemicrania & neuralgia etc. Each pill contains Therap. appl. 1st Pytal. ac. var. hydr. with secondary & advanced stage when it is subchronic very important it frequently arrests also useful in early stages when not too irritable & even in those combined with narcotics A most important article. Dysphagia constricta var. schirrhosa conjoined with conium [Dipsoneus] avens var. [illegible] conjoined with op. conium & capsicum Limosis dyspepsia Prof. T. has always used in various cases So has Dr Todd who combines quassia & ginger sometimes he conjoins conium or conium & veg. acrids So has Dr Reed who adds conium, dandelion capsicum etc. persevering in its use for a long time N.B it may be taken for a long time conjoined with veg. [ton.] conium & capsicum Prof. T. has even accomplished much with it alone preferring the substance Rx ars ac. [illegible] fs sub. quin zii ol. caps. zfs ext. con. q.s. ft. pil 120 often adding more conium or giving conijm in conjunction in short varying the prescrip. pro re nata Limosis sputatoria may always be cured by this article alone or combined Lim. syncoptica (cardialgia syncop.) here acrids are more important in in conjunction Col. rhach. combined with opium will keep the symptoms at bay. Opium is allowed to be the most important article in this disease but will not cure alone It is found that a free use of cal. is necessary corr. sub. better Prof. T. finds red prec. better still. Practitioners tell of given 5 gr corr. sub. every [2] hours!) Prof. T. has given 5 gr. red. prec. Fowlers sol. has been given in z doses without vomiting Arsen. has been given in gr. doses There is something peculiar as to the operation of min. med. in this dis. Dram doses of [illegible] have cured with opium opium shd always be combined Arsen. & strychnine are admirable for the paralytic sequelae with auxiliaries Colica callosa var. schirrhosa Epidemic cholera (it is the fashion to attempt its cure by strong impressions merely The originally incurable cases & the trifling ones shd be excluded) perhaps along with other articles it would answer well when the discharges have been stayed. Helminthia insisted on by Dr Potter the variety of this disease is not specified. It would scarcely be worth while to resort to it in any but H. taenia to improve the cond. of al. can. relying on cath. of ol. pin. to remove the worm helm. fasciola hominis (fluke or gourd seed worm) rather a rare & a very obstinate disease (N.B. in sleep the fasciola [ovis] passes into the liver up the ductus communis & cannot be wholly cured by cathartics may not this be the case with [illegible] case Prof. T. has never known a case of complete cure arsenic does much the most good seems to be by for the most effectual remedy) Helminthia erratica probably Proctica schirrhosa & parabysma schir. parabysma, strumosa arsenic conium acrids quinine cantharis conium & arsen or con. & iodine the best preparations iodine corrosive subl. etc. Bex convulsiva a long known and a well established remedy conjoin ext. con. which has been relied on exclusively Dr Beery has often found ars. pot. alone of the highest service in sequels of hoop. cough Intermittent next after quinine & perhaps the best bark in substance. It may be taken with less in convenience than bark and the latter cannot be given [illegible] to small children Vide Good for its history The instances of supposed derangement with particular doses are merely cases of too large doses for the particular circumstance Give say 8 doses in 24 h. instead of 1, 2 or more as directed by Dr Fowler (N.B. give a med. at the hours of 3, 6, 9, & 12 & but 2 doses will come in the night) Give 10 drops at least of SS. with each dose Trouble not yourself about the bowels they are generally well enough better give injections than cath. if the bowels are not spontaneously moved once in 2 or 3 days. It is well known that metallurgy in a neighborhood cures & prevents intermittents Dr Good’s case of Cornwall is not the only one known The dose shd not be large say 5 to 10 drops nor the quantity as to produce the tests often once in 2 h. never less often than once in 3 h. sometimes once in 1 h. always conjoining opium ( which itself will cure interm.) Periodicus remittens as useful compared with quinine as in intermittent though not as important in the former as in the latter. It is even said to be more unfailing than in inter. Typhus nervosus seems absolutely to be the best tonic better than quinine to be given to check coldness & cold sweat & to change secretions always when mercury seems to be indicated always conjoined with [opiate] & food perhaps with acrids sometimes 2 drops once in 2 hours or 5 drops every 3 hours sometimes more sometimes less. Typhus syncopalis vide Danielson & Mann’s account It has been used in every epidemic Anthrax pruna just as for gangrene Erythema gangrenosum but sul. quin. is of more consequence Erythema anatomicum saved several cases known to Prof. T. before quinine was discovered in one case 10 drops an hour. In but one of several cases which Prof. T. has known was there a puncture all of them resulted from exan. recent subjects one case began by a sensation resembling a sting & a minute discolored spot on the middle & fore side of the fore-arm. Ophthalmitis tarsi & psoriasis palpebrarum (which exists) probably would cure as it affects the eyelids Ancheritis strumosa (glands of neck) Cephalitis strumosa [illegible] [illegible] etc. Arthritic cephalitis highly useful Paristhm. erythem. var. putrida Pneumon. typhodes erythem. & syncopalis & putrida (gangrenous & Pneumonitis arthritis ver. atonica So arthritic carditis, diaphragmitis, & gastritis Cholera infantum Enteritis aphthosa (Prof. T. has seen two p.m. ex. which showed the whole al. can. affected) Dysenteria typhodes in the latter stages with opium even in the early stages Prof T. has known it beneficial combined with opium & used instead of calomel Mesenteriti strumosa (enlarged mesenteric glands) may almost or quite be cured in its early stages Give acrids quinine, iron cantharides, conium & especially arsenic Eryth. infl. of liver (hepat. typh. var. putrida) in secondary and exhausted stages. So to [peritonitis] typhodes var. putrida All the varieties of true rheumatism in some stage (even in the entonic, after depletion & reduction One var. of rheum is phlegmonia another is [erhthematoid] (not mentioned expressly in the books and a very formidable disease prof. T. has known one quarter of surp. of body gas [illegible] after depletion & reduction) opium conium quinine alcohol conium actaea arsenic Subacute rheumatism may often be cured by arsenic alone. Prof. T has known bed rid persons cured this seems to be the best article. The sub-variety of this disease produced by mercury are especially benefitted by arsenic Chronic stage of acute rheum. benefitted by ars. but more especially by aralia [bispida] Podagra larvata (atonic gout (Cull)) a form of rheumatism as resembles this (Theumatism larvatus) Rheumatalgia useful with conium & nux vomica more useful as it is more acute particularly when there is an early tendency to paralysis of extremities but should then be combined with ol. pip. nig. or ol liriodendron ol. caps. etc. [illegible] conium, nux vomica hyoscyamus sciatica useful conjoined with narcotics I have often cured [with] sometimes relieved by mercury when first commence & by other means arsenic one of the best articles where established Secondary & exhausted stages of scarlet fever Erythysmus hydrargyrata & tabes venenata Ricketts I have known it used with beneift in the early stages [illegible] syphilodes & syphilodes (vide Good) with black pepper much used in the east (vide Good) There is no doubt of its efficacy in S. syphilodes. Perhaps there is doubt as to true syphilis Arsenic is peculiarly valuable with quinine and opium in the ulcerations etc. from syphilis & excessive use of mercury Useful in syphilitic eruptions Carcinus vulgaris highly valuable it has sometimes produced sloughing & a cure the difficulty in managing it is that practitioners are too much in a hurry attempting to take the disease by storm and not conjoining supporting remedies & narcotics cancer is a disease always requiring support it is a disease of the abstemious never of the high living & gouty Prof. T. has known it so employed & the health improve. But iodine is better & next after arsenic is corr. sub. arsenic is next to iodine (vide Good) IT is the basis of almost all the secret remedies for cancer. of course caution is required for its use There is no foundation for the notion that the system geta accustomed to this remedy & ceases to be affected by it in such cases the dose should be increased similar assertions are made respecting opium & with no foundation. The great difficulty with authors has been that they supposed they must give it alone & only twice a day Prof. T. has witnessed several cases of unquestioned cure & others of great palliation and mitigation Elephantiasis arabica has been highly successful (vide Good) used in the east, with a considerable quantity of black pepper. “It is proved beyond all doubt that the disease has been cured by arsenic” Prof. T. has known a few cases and all were cured by arsenic alone [B??nemia] Indica Prof. T. has seen several cases and Good has done ill in associating it with spargm. puerp. which is a phlogisticum. His cases were cured by arsenic alone Gangrenous sphacelus arsenic seems preferable, perhaps, to bark though not to quinine Prof. T. has known gangrene or [illegible] [illegible] of paralytic rheumatics cured by arsenic So to of gangrene after typhus Gangrena necrosis (dry gangrene Gangrena []?staliginea] (mildew mortif.) recommended I have known vitiated ulcers highly benefitted Hypochondrias recommended Trismus & tetanus arsenic & datura & opium have cured bad cases. vide N.E. Journal of Medic. Prof. T. has known several cases cured by it. actaea too is often useful Neuralgia faciei [illegible] etc. but generally it is badly managed some cases may be cured by quinine alone arsenic alone, opium alone etc. but generally a combination should be used N.B. keep the pot. under the influence of it all the while not merely during the paroxysm Clonus palpitation & singultus are occasionally relieved by arsenic Singultus of typhus & low pneumonitis typhodes is best relieved by arsenic [illegible] case of 200 drops in one night Chorea sometimes cured by this with strychnous, quinine etc. Lysse canina some cases apparently cured Common convulsions [of infants] occasionally Hysteria epilepsy sometimes are tonic Paralysis one of the most valuable remedies with iron acrids etc. Distortion of face from paralysis Sarcoma schirrhism (curable by extirpation even at an advanced stage Prof. T. has never known a complete cure by extirpation of carcinus vulgaris Dropsy of abdomen after evacuation of water supposed to be be peculiarly appropriate Leprosy (vide Good) peculiarly valuable Lepidosis psoriadis arsen. con. etc. particularly valuable after a very severe disease (vide Good) Ecpyesis impetigo, herpetica (herpes of Cullen & herpetic eruption of authors) always curable by arsenic if persevered in useful also eternally in a weak solution Ecpyesis imp. [lamin.] (salt [illegible]) about the hands cured by a weak ointment of [arsenic] N.B. medicines will not cure when applied only when the disease is so irritable (in a sort of paroxysm) that the phys is sent for they then require only emollients the arsenic shd be applied about 8 grs arsenous ac. to 1 oz simple cerate to commence with first finely pulverizing the arsenic & mixing it with about a dram at first of the cerate to make the mixture homogenous (N.B. not a glass but a Wedgwood’s mortar pulverization cannot be effected in a glass mortar) [Ecpresia] [?origo] galeata Prof. T. has cured cases which had resisted all other remedies internally & externally Punctura venenata (vide S. Coop. Surg. Dict. last Am. ed.) used successfully time immemorial in India In Ohio they cure by laudanum giving enough Dr McBride & Dr Osborn of N. York who had practised at the south, considered alcohol infallible The people sometimes get down a gallon of spirit in 24 hours. [Celsus’] remedy was vinum cum pipera [cernatic] snake pill is Rx arsenous acid root of vella navi of another seed of croton tiglium live quicksilver, black pepper aa equal quantities each pill to contain 6 grains each pill will contain 1 gr to a teaspoonful of Fowler’s solut. and 2 or even four pills are sometimes given Case of Mr. Ireland pat. insensible in 10 min. fl. zii Fowl. [min.] sol. etc. at once. (Dr Hubbard’s case repeated once every half hour until an ounce of Fowl. sol. or 4 grs of arsen. had been given. Four other cases cured in the same manner. Cinchona First introduced into Eur. in 1640 Condamine saw the plant first in 1737. Linnaeus called all the spec. C. offic. (including C. condaminea & pubescens) C. condaminea is believed to be the original “bark” near Soxa a slender shrub 18 ft. high There are now made 8 distinct general 1st cinchona 2d pynchnea exostemena etc. All the species are bitter and tonic but none are remarkably antintermittent but those with hairy & woolly blossoms Decandolle gives 16 species of cinchona Pynchnea has but a single species in S. Car. Nat. Order Cinchonease Three species are made offic. in Brit. phar. 1st cinch. cordif. supposed to produce yellow bark but it is found not to produce it Yellow bark has odour aromatic etc. internally of a yellowish cinnamon the particular species affording it is not known contains 1st [illegible] of quinine & a little [illegible] of cinchonum 2nd tannin (a little) 3d a yellow odorous [adipocere] 4th a yellow colouring matter 5 a red colouring matter 6th [illegible] of calcia 7th fecula Cinchona lancifolia affords the pale bark though by some to be identical with C. condaminea or a variety less bitter than the preceding cinnamon coloured internally. C. condaminea contains [mainly] kinnate of cinchonine with a little kinnate of quinine with other unimportant princ. Cinch. oblongif. supposed to afford the red bark but found not to producing an inferior bark odour and taste similar to the last but more intense bark red 2 Kinnate of quinine & kinnate of cinchoniae in about equal quantities said (doubtful) twice as much of one & 3 times as much of other. The true species which produces red bark is not known. The barks of all the species are collected indiscriminately and afterwards assorted according to colour probably it is impossible to assign the true species. Cinchomine is a white alkaline substance soluble in 7 or 800 pts water decomposed at about the temperature of boil wat. little soluble in ether ([hydric]) made up of carb. nit. ox. & hyd. Quinine is a white flocculent alkali soluble in wat. very soluble in alcohol taste much more bitter than that of cinchona less soluble in water very soluble in hydric ether & thus distinguished First brought into notice in 1820 by [Pellit] & [Cam??ton] Kinnic acid is found only in bark & not medicinal Kinnate of quinine is very soluble in water but less soluble in alcohol Kinnate of cinchonum is more soluble in wat. & is more astringent (if indeed the kin of quin. is astringent at all) Water is incapable of extracting all these salts from the finest powder of bark not more than 1z of the whole hence the dregs are worth saving for the extraction of the quinine & cinch. from them N.B. none of the veg. ac. have as strong attraction for bases, as the mineral acids & generally sulph. ac. has the strongest attraction hence very dilute sul. ac. will dissolve out all the quinine & cinchonium & we have a liquid solution of sul. quin. & cinch. Ammonia will take away the acid # then macerate in alc. & various impurities will be left then distil off the alc. till the liq is muddy then cold distilled water will precipitate the alkalies repeat the process for purification if necessary The [illegible] is not in quantity to act medicinally but will destroy tart. ant. or sulph. iron or gelatine hence too an infus. of nut galls is a test for distinguishing active from inert barks, by forming a precip. of gallate of cinchonium ([illegible] is [art]) Much inert bark is sold [illegible] a pat. took inert bark for 12 weeks then was cured by good bark you cannot tell by the taste All the best bark is now used by the manufacturers of sulph. quin. & the’ poor bark is pushed into the market # and decant off the liquid sulph. amm or use a magnesia in the same way But we should never used the crude bark it is better in no respect whatever And sulph. quin. is now cheaper. Connecticut practitioners know little about the matter not having opportunities from endemic influence. N.B. Some practitioners conjoin tartar emetic with bark the latter destroys the former the former does not injure the latter Tannate of antimony is perfectly inert It is stated that 2 fl. oz of decoc. cinch. (zi to 1 pt. water) renders inert [illegible] I tart. ant. consequently a pint would decompose tart. em. zv So too bark is incompat. with the salts of iron Food is generally required with bark but bark with animal jelly will form leather! in the stomach Gallate of quinine & cinchonium is supposed to be nearly inert Case in which an [illegible] phys. rendered bark palatable by nut galls! the mixture was pleasant but perfectly inert The proportions of acid & base in sulph. quin. & cinchon. are not well known Adding a little sulph. acid renders them much more soluble forming a salt with more acid N.B. if the mixture then becomes acidulous, add a little more sul. quinine. Prof. T. has always found acidulous sulph. quin. more instead of less nauseous Case related Phosphate of quinine is said to be better than sulph quinine said to contain some of the powers of phosphorus doubtful should be attended to Some think the acetab. better others think it worse probably little if any difference much less soluble very liable to precipitate when it grows colder. Tartrate oxalate gallic etc. are insoluble in cold water. The isolated bases (quinine & cinchonium) are less soluble than the sulphates or are insoluble but they are no less active The French to the contrary notwithstanding. Crude bark is very variable in strength offends the stomach etc. In tinct. requires too much alcohol For these and other reasons always use the prox. princ. Cinchoniae & quinine are found by Dr Elliotson to possess precisely the same powers as their salts Montannin has been extracted from C. montana equal to quinine & cinchonium in utility Chlorium bromine & iodine form inert compounds with all these alkaline proc. [prac.] [prin] still they will into decompose their salts The only medicinal operations of the 3 species of cinchona are the same in kind if not in degree They are all permanently & strongly tonic with a moderate degree of astringent power Quinine & cinchonine are not astringent Caventon & Dr. Theodore Woodward (a very susceptible person) have experienced nervine exhiliration from quinine “in large quantities however 30-60 grs a day” Other persons experience this effect. Dr Woodward always experiences exhiliration This is one of the tonics which is felt in the circulating system before it affects the digestive organs. It is by no means remarkable for giving an appetite In some cases where large quantities in a short time are indic. (as in interm.) the appetite is actually diminished. It is inferior to many articles for the appetite & digestion. It may require several days to affect the appetite Called stomachic Called febrifuge by which is meant that it is appropriate for intermittent Called antiseptic i.e. stimulant or tonic The yellow bark is considered best (it is said) in Peru. Some think red bark nauseates more Bark produces no inconvenient effects but nausea & diarrhea in large quantities Dr Th. Woodw. says the only unpleasant effects from the largest quantity of sulph. quinine are a sense of astringency in the stomach & a sense of faintness which however he relieves at present by always giving a little food (milk porridge for instance) A Frenchman (Blonde) is said to have noticed a short continued deafness, produced by a large quantity of sul. quin. Probably he mistook a symptom of the disease for the effect of the medicine Dr Elliottson cured nearly 200 cases of fever with sul. quin. 5-10 gr doses & inferred that it is adapted to phlogistic fever. He meant irritative Equal confusion exists about the use of bark in acute rheumatism Most of our cases of acute rheumatism at the present day are atonic and many of our practitioners give quinine freely in rheumatism & relieve heat, dryness of skin etc. Some of them infer hance that bark is adapted to phlogistic fever It is the fashion to call bark a congesting tonic. It was the fashion long ago to do so. But Sydenham Morton & others denied this No foundation for the notion that this article may accumulate in the system or its effects accumulate upon the system. Arsenic, mercury instead of accumulating in the system produce a slight set of changes which go on increasing Prof. T. does not believe that disease is ever produced by cinchona after health is restored no effect will be produced. Dr Ives is of this opinion He has known it take for a year or more with benefit. Heberden knew it taken for 12 years with advantage etc. Admissible in all atonic contraindicated in entonic diseases Pharmaceutic preparations The salts of quin. & cinch. are sol. in wat. & insol. in alc. Quin. & cinch. by themselves are sol. in alc. & insol. in water Yet is laid down in all the books that alc. is the best menstruum this can hardly be true (probably the mistake has arisen from the utility of the alc. of the tinct. in intermittents) Infusion is better than decoction Boiling almost destroys the properties of cinchona Maceration in cold water extracts but little. Yet the pharmacop. direct to boil 15 to 30 minutes Never boil but about a minute Pour the water boiling hot on the powdered bark than stand scalding hot ½ or ¾ of an hour then boil it up about a min. This gives a decoction [illegible] Troy oz. bark saturates a pint of water Make the infusion in the same way but do not boil up at the end 1 Troy oz (1 oz. of avoirdupois oz. will not being less) saturates 1 pint of proof spirit It is not worth while to give in any form but substance in intermittent in any form but substance in continuous fever, as it will be thrown off or pass off. Therap. applic. 2st Intermittent Quinine the most important medicine In all pure and uncomplicated cases of quot. quart. or duplic. types these salts may be considered as infallible remedies. If costive, purge once with calomel (the best agent) Check diarrhea with opium. If stomach is full, vomit with sub. zinc, copp. or turpenth min. or purge with calomel. Perhaps in no disease are emetics & cathartics as much abused as in this It is a routine Sometimes the disease is thus brough back There is generally a natural state of the bowels, no fur on the tongue etc. Sulph. quin. & [illegible] are equally admissible in the cold the hot and the sweating stage & during the apyrexia. Many deny this, and yet give large quantities just before the paroxysm even [the] min. before! The article does not operate all at once but gradually Generally Prof. T. does not interrupt a paroxysm when he is first called Sometimes however he gives a large dose of quinine to cut short the cold stage & bring on the hot, or in the hot to bring on the sweating stage immediately Inappro 3 grs to [illegible] i is the appropriate dose once in 2 to 6 hours Quin., & cinch. require the same quantity as their salts [illegible] i is the smallest quantity with which Prof. T. has ever cured a case more would have been better Prof. T has known 10 grs. once in 2 hours necessary to suspend the paroxysms A writer in the Philad. Journ of large experience in intermittents lays down 20 gr. once in 2 hours as the common dose for all cases Case of a phys. who was much surprised to hear Dr [March] doubt the existence of phlogistic intermittent he took him to see such a case in the hot stage Dr March gave 2 or 3 grams of opium & cut short the parox. in 30 minutes He gave sul. quin. & the pat. had not another paroxysm A timid and inefficient use of sub. quin. will even aggravate the disease Just as with opium Dr March has repeatedly been called in clandestinely to cut an intermittent short at once which had continued under an able phys. 6 weeks! Time of continuance is variable Do not suspend the remedy immediately after the cessation of the paroxysm especially if the pat. is in a very unhealthy situation Perhaps a dram should be considered the minimum quantity to prevent a relapse Under the treatment here recommended not more than one paroxysm (not even a single parox.) after the physic. is called in should be permitted of course in pure & uncomplicated cases Mode of administration Sul. quin. & cinch. may be given either in solution in water or if you want the smallest possible bulk add a little of some acid just enough to render it soluble without giving it an acidulous taste (The combination of sulph. acid & bitter is offensive to taste) or diffused in wine or brandy & water or diffused in syrup of sugar or in pill, when the stomach is irritable pilled with ext. gentian pills made before hand get to be too hard & are to be rejected When the stom. is irritable an acrid is indicated and capsicum is the best (It is not stimulant but [illegible] irrit. to much [illegible] not acting on the blood vessels but on the muc. memb. increasing susceptibility to other remedies) Powder of bark also will cure most intermittents. It too may be given at any period of any stage though it is very liable to be repeated during the paroxysm especially during the hot stage. Sometimes bark in substance cannot be given in suffic. quantity without vom. to enable it to effect a cure Give [illegible] i to about zi 2 to six times a day Give it diffused in some liquid Still it is not worth while to retain this mode. If the stomach is very irritab. pills may be given of alcohol extract give as much as of the powder. Infus. & decoct. are too weak for intermittent Tinct. requires too much alcoh. Tinct. of bark has cured but then it was by the alc. not by the bark. Saffron (canth. tinct. and [rum]! have cured Those who do not live in an intermittent country, are apt to suppose that there are many cases in ‘ which sulph. quin. is inadmissible Prof. T. does not believe so. he has seen many such cases and thinks they were all caused by injudicious management. Some of these physic. suppose cal. & op. is curative in many such cases they talk much of it. But long ago it was settled that cal. & op. are not curative but merely preparatory (vide Good for an interesting experiment when the stock of bark was exhausted on board two ships of war They merely suspended but did not cure the disease) Physic. have more prejudices against quin. than against any other article unless it be opium & alcohol. N.B. The Parisian phys. practice upon the principle of giving large doses of sul. quin. Some suppose the intermittents of the south do not tolerate quinine so well On the contrary much more quinine; required because the disease is more intense. The practit. there use it too inefficiently. Dr. Mac Bride stated this to be wholly true Sometimes the disease will be accompanied with morbid secretions in large quantities, and hence quinine is supposed to be inadmissible. On the contrary give (after purging with cal.) quinine to cure this as it depends on the endemic influence. Sometimes the stomach is so irritable that 32 grs. of quin. will not stay on the stomach and hence it is thought to be inadmissible Give 10 grs. at once to cure the irritab. as it is produced by endemic influence Case of a woman who had long taken sulph. quin. in small doses with this effect certificates from physicians that sulph. quin. disagreed with her She was immediately by pills of 6 or 8 grs. sulph. quin. made up with ol. capsicum. Numerous such cases used to come down the canal to Rochester & be cured by T. [S] M. at Albany But intermittent is often complicated or disguised 1st Interm. accompanied with diarrhea which sometimes continues throughout the disease. Cure these by quinine and opium. They are cured as suddenly as the others If necessary we may conjoined resin of hanthorrhea [hostilis] (so effectual for diarrhea) or tolu or 2nd Intermittent complicated with cholera commending with rigor & an urgent parox. of chol. which terminates in the sweating stage and so continues day after day without a suspicion of the nature of the disease Give acrids in the paroxysm & quinine in the apyrexia 3d Intern. complicated with dysentery physic. will sometimes suppose they must wait and cure the dysentery first Give no mercury unless corr. sub. Given quinine & opium 4th Intermittents complicated with jaundice puzzling to young physicians bilious diarrhoea & akin a deep orange Give at first opium enough to check the diarrhoea & then suspend the paroxysm with quinine You may follow afterwards with conium to remove the yellow colour of skin 5 Interm. complicated with parabysmata coacta (Good) Many suppose that quinine must not be given until the parabysmata have been cured Cure with quinine Prof. T. has had testimony that quinine would cure parabysmata the sequels of intermittents Dr. Bristol said it was cured in Paris by 6 or 7 grs. of quinine 5 or 6 times in 24 hours better than by any other article. Prof. T. has generally used conium in conjunction 6th Intermitt. complic. with delirium a disease more formidable than dangerous. Cure by quinine though perhaps datura etc. might advantageously be used “opium will sometimes cure such cases 7th Intermittent complicated with syncope. Paroxysm comes on with syncope. Pat. obliged to keep his bed in the intermission Cure by quin. 8th Complic. with convulsions especially in children If called in a paroxysm give a large dose of datura then cured by quinine, as soon as possible Often you cannot give the quin. to children on account of its bitter taste Then give arsenic & opium perhaps as often as once in 1 or 2 hours 9th Complic. with epilepsy One of the most frightful & alarming forms Pat. comes out of the fit and sweats A few years ago such cases were always fatal Get down a large dose of datura and if necessary repeat it & follow with quinine Cure by quinine in the [illegible] [etc.] Complic. with catalepsy of no consequence a trifling disease is catalepsy Complic. with lethargy equally unimportant quin. cures Complic. [serous] apoplexy of Cullen (not sanguineous) quinine will cure Dropsy Purge with elaterium & remove the fluid & the cure by quin. If dropsy remains after the cure give digitalis tinct. cantharides tonics etc. Disguised Intermittents 1st Hemicrania severe cured as other intermittent Well known as a disguised form to persons in an intem. country 2nd Neuralgia (facies etc.) (vidd McCullock) cured by [the] remedies for intermittent. Case of Dr Th. Woodw. attack in calf of leg & this repeatedly for years which would be cured by opium but he would be sick the next day it was found afterwards that datura was better It takes the form of nephralgia ophthalmalgia rheumatalgia etc. 3d Dyspepsia mistaken & treated wrong 4th Hypochondrias & mistaken 5 Typhus (but it will not have 2 parox. in 24 hours as true typhus always does ruins on indefinitely) cured by quinine. This has no crisis on the 14th day as typhus has 6th Phthisis Case of a man from Rochester who came back to Connecticut to die of phthisis. Prof. T. was puzzled found opium did well and finally under the use of opium the pat. had a regular attack of intermittents Prof. T. then cured him by arsenic (as he was so afraid of being poisoned that he would take scarcely anything) given clandestinely Case cured by Dr Todd of a young lady who had come to Hartf. to die. # Remittent not time to say any thing upon the subject # Story of a young physician in N. York who detected an intermittent counterfeiting hectic & got into practice [From Savage’s copy of Talcott’s notes To be inserted in the blank space which occurs in the article actaea] “Atonic acute rheumatism rheumatismus The more acute the disease the more successful has Prof. T. been with actaea more successful while the febrile aff. is strongly marked and the topical affect. has a tendency to wander. When called, ascertain if the pat. is costive, if so give a dose of calomel over night & opium sufficient to allay pain give the opium first & if it takes a good deal to allay the pain, why give more Keep by the calomel (12, 15, 20 or 3 grs according to susceptibility & other circumstances) not less than 12 nor more than 18 hours give cal. sufficient a free evacuation. After this commence with actaea & opium at regular & short intervals say f zfs of tinct. act. every 3 hours as a general rule, some requiring more & some less. The test of the quantity is the effect on the brain. Let the brain be moderately affected but not so as to produce a troublesome narcosis. It is necessary in some cases to affect the brain more than others. In some the disease yields before the brain is at all affected, in others Prof. T. has been obliged to produce a troublesome narcosis. Opium must be given in conjunction in quantities sufficient to meet the symptoms & keep them under 1 gr or more every 3 hours may be required. If the pat. has been tampering with medicine, purging with salts etc. often the cal. will not be needed & we may enter at once upon the use of actaea so too if the bowels are free When the disease is fixed upon some particular part as a joint, topical applications will do good & actaea is not so successful though even here it is useful Under this use of actaea all the tumefaction, redness, soreness & pain of the acute form disappears, often in 12 hours sometimes not altogether till 24 or 36 hours the constit. feb. affect. disappearing at the same time in by far the greatest proportion of cases though in some the fever goes on to the next critical period. The remedy shd be continued in diminished doses to prevent a recurrence. Opium alone will sometimes answer but it is better to combine it with a reduced quantity of the deobstruent. The pat. is not perfectly well after the resolution, he is weak, feeble & languid & a little exposure or over exertion will bring on the dis. again unless the medicine is continued Prof. T. has failed with actaea in only two cases of genuine acute atonic rheumatism and then the patients could not be induced to take the remedy longer than while present relief was afforded which was effected in both cases. Dr Woodward of Wethersfield writes (1830) that he has used actaea in subacute rheumatism (meaning that form which I call atonic acute) in catarrhal phthisis in catarrhal cough & in neuralgia. He considers it one of our most valuable deobstruents, combining the powers of digitalis, sanguinaria & colchicum I [illegible] hardly ever saw it do much good till symptoms of narcosis were produced. The following are the effects of a moderate quantity vertigo, headache, impaired vision, dilated pupils. epigastric uneasiness, diminution of frequently of beat in heart & arteries (but it was irritative frequency of pulse) Dr Woodward has seen decided narcotic effects from 15 gtts of tinct repeated every 6 hour, & from teaspoonful doses violent narcotic effects & hypercatharsis (the last effect I never saw & am inclined to think it accidental or produced by something else) this was followed by a rapid subsidence of the rheumatic affection. Dr W. says he has always found it most beneficial in doses of 25 to 30 drops. He has found it very useful to allay cough & also arterial irritation. In two cases of atonic acute rheumatism following rosalia, one was treated with actaea the other with colchicum both were speedily cured Dr Beers has also used it successfully in the same kind of cases Dr Woodward thinks it more manageable & successful in inflammations of an atonic & acute form, than any other article. Dr Tully thinks so too. Dr W. says a popular article in his neighborhood is Wright’s cough drops, which he thinks is a proof spirit tincture of actaea In subacute rheumatism actaea is useful. In [mercurial] rheumatism, which is always subacute it effects as speedy & effectual a cure as in the acute, but we must conjoin opium & follow with tonics Arthritis rheumatalgia such as is unattended with redness swelling etc. chronic rheumatism (popularly so called) characterized by pain, especially on motion, without swelling etc. with no febrile disease, essentially, though there are often febrile paroxysms. Some of these cases are acute the attack is sudden, the dis. of short duration & confined to fixed periods. These are specially benefitted by actaea. When this species is subacute (often met with in boys who have continued too long in the water I formerly failed, but think I should succeed now. In the perfect chronic form of “chronic rheum.” occurring in old men & continuing year after year joints almost paralytic not much is to be expected from actaea though the exacerbations may be palliated A cure will not be effected Arthritis neuralgia neuralgic rheum. (Fothergill’s sciatica) The first symptom of an overdose is felt in the sciatic nerve though this is the peculiar effect of the article yet it will cure this neuralgic affection. Arsenic, opium & actaea will cure sciatica speedily & effectually. I give the arsenic in efficient doses giving a pill of arsen. acid ¼ gr & sulph. morph ¼ gr every three hours, with the actaea Sometimes I give a cathartic of elaterium previously It yields to this course Bucmenia sparganosis Some cases in extreme exhaustion supervening often severe hemorrhage; are often perfectly resolved by actaea The pathology & location of this disease are disputed It seems to affect all parts of the limb except the bone The lymphatics are supposed to be its peculiar seat. They are undoubtedly affected but the dis. depends on the specific nature of the affection, not on the part involved There are different varieties of it & the treatment must vary accordingly When it occurs among the debilitated females of cities, nauseating deobstruents cannot be borne not even calomel. They produce irritation, reduce the patient & aggravate the general symptoms or pass off by the bowels. Among delicate females [illegible] alcohol, & cinchona are required & these are the articles which I have always known to be indicated. But among females in the country & when it does not follow hemorrhage or derangement of the digestive organs (I have never seen such cases) calomel is useful & the more irritative the cases, the better is the actaea Ophthalmitis of this there are several species, depending upon several specific sorts of infl. Of O. conjunctiva, there are 3 varieties 1. common 2. purulent (of infants) 3 epidemic or Egyptian. Perhaps there is also another kind a chronic form with spongy granulations on the inner surface of the eyelids though this is perhaps a degree of the first variety. In the common ophthalmia there is often [chemosis]. In this form actaea is discovered to have great power & is now often used. Dr Noble of Albany gave fzi once an hour, all day long, till severe narcosis was produced at night, when he stopped the article & resumed it next day. Nothing else was used & the cure was effected in 2 days. I think Dr N’s mode of giving freely & suspending at night, the best. The more acute & recent the case the more speedy the cure. If a cath. of cal. is indicated it had better be a slow one. Narcotics are not so manageable in infants, they cannot communicate their feelings; hence this course would not answer for the purulent ophthalmia & we must rely more on topical applications. In Egyptian ophth. I have great confidence in actaea A. corneae specif. ulcerative infl. of the cornea nit. silver, however in conjunction Dr Noble has used it in this way I have since known others use it. This is also an infl. of the sclerotic coat. It is never phlogistic. Those mentioned above are not but are all specific inflammations. All the cases that I have seen of infl. of the sclerotica are rheumatic or arthritic I do not believe Sam. Cooper’s doctrines & I think his cases are not true in fl. of the sclerotic Drs Knight & Woodwd of Vt agree with me. In this infl. of the sclerotica actaea generally succeeds perfectly and sometimes it fails utterly. I can not discriminate the cases Porphyria hemorrh. & nautica I think little of the treatment in the books they proceed on the principle that diet is enough to cure it. It is caused by bad diet etc. but shd be treated on general principles. Stimulants & astringents are required sugar of lead, opium & brandy with farinaceous diet constitute the proper mode of treatm saying to him “I would not trust to that boy” The pat. reposed confidence in Dr I but said to him “I must have counsel called to satisfy my friends” Dr I. called a man 70 years old The pat. says “I believe the boy has done well”! Prof. I. will never forget his sensations he was mortified & grieved. Afterwards he put on a quaker hat! to appear more old! Let judicious clergymen be called Dr when it is proper Dr Rush said “when the earthly M.M. fails apply to the heavenly” Prof. Ives’ paternal lecture 1833 Be especially careful in your primary observations. An [illegible] read in the [pentateuch] “& the tabernacle was covered with beggars’ skins” He turned to his audience & observed; to the audience “You see my friends the difference between the law & the gospel. The poor have the gospel preached to them, but under the law a beggar! could not be seen about but his skin; was immediately taken off to cover the tabernacle!” If a young physician dislikes his profession, the sooner he abandons it the better. It is difficult to distinguish between genius & a fondness for a pursuit. Dr Rush remarked that he would practice medicine as long as he could walk, when he could not walk, he would ride [illegible] he could not ride he would be carried to the bed side “Least than a wise on hi own eyes, there is more hope of a fool than of him” It is a most unfortunate thing for a young man to suppose he knows all that is to be known Diogenes laid him self down to die, saying he knew all that was to be known There came in a beggar boy to borrow fire. Diogenes told him he had nothing to carry it with “Fi you will give me the fire I will find means to carry it” He put some ashes in his hand & a coal of fire upon them! I will not die says Diogenes for a beggar boy has taught me a knew piece of knowledge! The boy understood the fact well though he could not express it in the language of ashes being a nonconductor of heat. Dr Rush remarked that he had learned much from nurses Moral principle A stranger said to Dr Monson “I wish to employ you in a very delicate case & will pay you handsomely” Dr M. replied “Sir you have not money enough” “You know not how rich I am” “If you had ten thousand times as much it would not be enough to pay me for loss of reputation & conscience” Prof. I. has often been called on to produce abortion & that too by men & women of the first standing in society to produce abortion he has been appealed to in the most moving terms “would you sacrifice a family” “I am somebody likewise” must I lose my conscience & character” The person would threaten to commit suicide. “You had better not but if you do I cannot help it” Suicides however are sly about the matter Prof. I. has known many of the infidels of the last generation They were the most bigoted & superstitious set of men he has ever known. They though there was not evidence enough for the bible, but would believe in the most foolish witch stories Franklin A young physician is not put down by the older ones as formerly there is more liberality in the profession ow than formerly. Anecdote of Dr [Birker] “We want more farmers than doctors” Dr Darwin was a large misshapen man stuttered etc. very awkward etc. yet captivating. His works contain a great collection of important facts Anecdote a young man a good scholar, rather awkward & bashful was apprehensive of being cut out by an elegant competitor eloquent in the ballroom etc. advice not to fear! It turned out as Dr I. predicted We are not to give pain to patients who have brought their diseases upon them After we have relieved them, we may endeavour to reform them Anecdote of Dr Monson man intemperate finally took a poisonous dose of laudanum Dr Monson saved his life Afterwards he remonstrated with him upon his guilt “Dr I don’t thank you for what you have done” Dr. M. then turned “I am sure the neighbors will not” An opinion formerly prevailed that it was lawful because it was expedient to tell falsehoods Dr S. has always found it advantageous to appeal to his frank veracity on all occasions Often however, patients have no right to know Secrets should be kept A man may be sued for defamation for saying he has cured a man of venereal disease You will be mortified occasionally in being called a young man. Prof. I attended a man whom friends kept Neuralgia strychnos arsenic & opium ([actaea]?) Itch cured by lotions of digitalis Sciatica arsenic strychnine & (actaea ?) [sul.] morph. have proved highly valuable Hemicrania cured best by ¼ gr. strychnine 3 or 4 times a day combined with morphine Strychnine 1/16 to ¼ of a grain Brucine 1/24 as strong chronic rheumatism best cured by lobelia better than by guaiacum the article commonly relied on 9 materia medica & Dr. Ives’s Paternal lecture (rear) Solanum nigrum Often mistaken (for its name) for atropa belladonna. Smell & taste nauseous moderately narcotic Its narcotic powers are very variable different in different cases Deobstruent also. It is diaphoretic diuretic (more so than conium) laxative slightly Said to be found useful in [diury[ and ischury but said to require to be drank freely Much used by the common people in ointments (of the leaves) for indolent tumours ulcers etc. IN mild cases Prof. T. has often found it answer as well or better than conium It is not worth while to fire a cannon to kill a fly. Med. dos sd to be 10-12 grs shd think this inefficient infuse zfs to oj of water Solanum tuberosum Native in Peru the tubers of the wild plant are as small as a nutmeg & bitter & nauseous. “Root sd to be perennial probably annual” Top only is used in medicine This is too weak to be used in infusion or decoction. The watery extract is found to be slightly narcotic & deobstruent It is diaphoretic, diuretic & cholagogue It will relieve some atonic inflammation cure some cutaneous diseases IT has been used principally for jaundice & dysp. connected with the liver Dose said to be 2 grs. Prof. T. gives zfs to zj Recommended in cough rheumatism hemicrania angina pectoria etc. When pushed too far it produces tremors etc. the symptoms of narcosis Most of our arrow root is made from potatoe roots and if sufficient care is taken to purify it from mucilage it does as well. The activity of these & the following article is a subject of dispute Solanum Dulcamara Possesses the same assemblage of powers as the S. [terb.] & S. nigr. Used in cutaneous affections. Acts on the fluid secretions generally as well as on that of the liver Digitalis purpurea Native of England Nat. ord. scrophulariae Leaves used (stripping from the midrib) leaves good only when of a light green colour when black they are worthless for medicine. No particular odour No good analysis has been made [Digitat??] (drystallizable) is mentioned Decoction injures it. Should be given in infusion. Infus. green, with the odour & taste of the plant Upon no subject is medical testimony so contradictory as upon the medical properties of this article. Some contend that it is stimulating others that it is never so but always the contrary Prof. T. believe it may, like other narcotics, produce an erethism of the brain without any effect upon the circulating system (N.B. This is a state which often precedes an attack of delirium tremens) It is evidently this state which has been mistaken for stimulation produced, as it will be if the article is continued for some time in doses just short of the strong narcotic doses It is from this state that the opinion has been drawn that digitalis is capable of producing an inflammatory fever The secondary operative effects of digitalis are those of other deobstruent narcotics, as actaea cicuta aethusa etc. It has been noticed that when the pulse has been reduced to 40 by digitalis if the patient is raised to a sitting position it will rise to 72 or 100 & this has been considered very strange but it is no more than always occurs in extreme exhaustion from narcotics or in its syncopalis or even from mercury Much mischief has been often done by giving digitalis to reduce frequency of pulse It will relieve none but irritative frequency. It may be made to cure some cases of intermittent pulse Under any management the article is liable to fail to operate, and after some days operate most dangerously The intermission of the pulse may continue along with the quickening of the circulation for 2 weeks after the cessation of the administration of the article Digitalis is diuretic only after nausea is produced by it but too much nausea will prevent its diuretic effect Digitalis is not or not much diuretic in health it is only so when water has accumulated It is capable of relieving some atonic infl. Opium must be conjoined Prof. T. has treated ac. rheum. by it Those who contend for the stimulant power of digitalis say that is contraindicated in phlogistic diathesis. Others say that it will relieve phlogistic cases. Both agree that in some cases it has produced no effect either beneficial or injurious But if digitalis and nothing else is given in a severe case of phlogistic disease it will have no effect and the disease will aggravate of course. In milder cases no change will be observed. The supposed phlogistic cases relieved by it were irritative cases without strength of pulse sub-putrid cases Farriar accordingly, who considers it useful in phlogistic diathesis, still says it is useful only in those cases which do not admit of v.s. and he commonly conjoined it with camphor and opium. It is equally admissible in low atonic cases. Paris supposes that a considerable number of diuretics are adapted to a different set of cases, from digitalis There is something in the general principle e.g. crem. tart. & tinct. canth. But he is entirely wrong in saying that squills and calomel are incompatible with digitalis. He supposed calomel to be a stimulant and digitalis a refrigerant. Blackall is mistaken in a similar manner calling calomel a stimulant etc. Paris supposes languor & nausea are essential to its diuretic effect and hence they must not be prevented Prof. T. has found that there is a certain range within which digitalis acts and hence sometimes aromatics, cath. & opium must be premised and cojoined and in a few cases, tart. antim. & even bleeding must be premised Many among us have lately found that tonics as canella alba are usefully conjoined with digitalis. In such cases Prof. T. conjoins tinct. canth. senega squills & cal. with digitalis yet all are incompatible according to Paris In low cases alcohol will often be needed Calomel generally increases the susceptibility of the system to the operation of this article Pharm. prep. Tinct zii to spirit of dilute alc. med. dose mx 3 or 4 times a day Infusion zii to pt. dose tablespoonful. Therap. appl. 1st Idiopathic cough where there is a leucophlegmatic habit and bloated face But other things are better and at least opium or I. paregoric should be combined say 3 of deg. & 1 of laud. or I. pareg. The opium will tend to prevent its accumulation Bex convulsion Highly recommended used the same combination as above. Prof. T. has never used it in hooping cough Dyspn. exac. & asthma very useful combined with opium. It will cut a paroxysm short as soon as any article Combined with tonics it may be given in the intervals Delirium tremens comparatively but little opium will be needed, if you use digitalis (only however, where the patient has some vigour of constitution left) Puerperal delirium ( a disease nearly allied as in the above disease where opium produces a disposition to sleep without actual sleep digitalis will produce quiet sleep Cauma recommended but Prof. T. thinks it not indicative likely to do neither good nor hurt Phlogotica useful in lotions for various of them particularly erythema vesiculare & E. oedematosum Apply it strong enough to produce a slight sensation. Recommended very highly for the poisonous [rhoes] Scalds and burns lotions highly useful relieving pain, irritability etc. Acute inflam. of brain lungs or other viscera (supposed entonic but really irritative or atonic) by Dr Currie So Ferriar who combined opium & camphor Recommended in croup but is not employed Song recommended in phthisis almost the first disease in which it was employed best adapted for the cases which require iron & myrrh Some think it useful as a diuretic in this disease but excessive urination will exhaust as much almost as excessive sweating. It is principally useful 1st as an antirritant 2nd as a deobstruent both which are indicated I membranous phthisis Digitalis is to be given in phthisis as in other disease, upon general principles Rheumatism useful as a narcotic & deobstruent combined with opium It may be made to cure acute rheumatism premise a purge of calomel & give say 10 drops of the tinct. every hour or 20 drops once in 2 hours until the disease yields, or the head is affected No cancer of a violent action, used in this way combined with opium & with diaphoretic regimen So of aub acute rheumatism but not so useful. Blenorrhea lenodis 25 drops 3 times a day conjoined with decoction of barley Struma recomm. also in the strumous phlogotica this depends on the state of the system Sparganosi puerperanum recommended internally & in lotion conjoin opium but do not adopt this practice in a feeble subject Measles & rosalia probably useful when not too atonic Hemorrhages rec. but it should not be given in the phlogistic (N.B. There are 4 sorts of hem. active phlogistic passive atonic irritative & vicarious) Digitalis will be useful in the irritative kind with a quick wiry pulse irregular throbbing heart etc. Recommended in ill conditioned venereal ulcers topically Mania rec. (said to be useful when the blood is determined to the brain which Prof. T. thinks does not occur) Prof. T. considers mania as a periodical disease & consequently an atonic dis. The paroxysm of mania precedes the disturbance of the circulating system and the effect has been mistaken for the cause. Dr Willis cured 92 per cent Dr Todd has cured 93 pr. ct. It has lately been published by Dr [Willis’s] grandson that his treatment was substantially the same as Dr Todd’s The latter allays with paroxysm by moral means he prescribes quinine etc. as for a periodical disease. Enlargement of the heart good testimony also of the large blood vessels Epilepsy hysteria convulsions (hardly advisable) Dysury of various sorts nothing specific is mentioned. Dysury of a low typhus will be aggravated by narcotics that of cantharides will be relieved. Lithia recom. Most important use is in Dropsy 1st paleness, coldness skin easily [illegible] etc. (vide Withering) Prof. T. has always found it useful but, as Dr With. gives [illegible] so he finds stimulants necessary in conjunction. Irritative cases with a dry skin etc. Digitalis does well in Dropsy of the abdomen with a distinct hard, circumscribed tumour (encysted) etc. will not be benefitted by diuretics Other cases of ascites require jalap and cremor tartar, senega & squills or elaterium Hydrops abdominis (if not encysted) hyd. thoracis etc. benefitted by digitalis Use afterwards, tonics conium & iron, myrrh etc. vide Withering Cutaneous affections impetigo herpetica scabies etc. Prof. T. has lately cured common itch oftener by digitalis than by any thing else Apply the infusion with a sponge to the eruption 1 to 2 oz to 1 pt. It cures in 3 or 4 days to 1 week Impetigo laminosa upon the fingers to relieve the irritability Recommended to prevent threatened abortion combined with opium But then opium alone, with horizontal posture, will certainly cure Poisonous effects relieved by stimulants and opium. This was well established before the springing up of the race of toxicologists! Prof. T. has had several cases where it had been given by mistake History popular in Rays time & since that time. Vide Gerhard Parkinson, Bates, [Valmon] etc. It was used to produce emesis etc. Dr Withering was first to discover and publish its true powers & operations 1785 D. lactea has been used as a substitute said to be more active probably less so as it was used more boldly D. epiglottis is mentioned by [Coxe] but by no botanist whatever. Actaea Racemosa There are 9 very nearly allied plants called by Linnaeus actaea & cimicifuga But one of them may be referred to either & these have been called macratrys by Rafinesque. Provided actaea & cimicufuga are distinct genera macrotrys must be seperated. And upon the same principles A. palmata should be referred to another genus still. [Now] some late botanists have united (judiciously & upon Linnaeus’s own principles) them all into one genus actaea. We have in N. Eur. A. rac. A. rubra & A. pachypoda (A. spiculus is not now acknowledged) The whole genus in three divisions has 1st A. cimicifuga (Siberia) A. simplex (Kamschatka) & 3 others of the division cimicifuga 2nd sub. div. macrotrys. 3d sub. div. A. christophoriana vide [illegible] Decendalles two spec. A. mucrocropa & A. cerulea are mere varieties or mistakes the latter does not differ from A. rubra Actaea racemosa Linnaeus ([illegible] [illegible]) Cimicifuga serpentaria of Pursh Cimicifuga racemosa Nuttall Macrotrys actaeoide Rafinesque Macotrys serpentaria Eaton Botophys actaeoides Rafinesque again Black cohosh. black snake root (which is applied to at least a dozen others e.g. sanicala mar.) square root rich weed rich root snake weed etc. Cornuticis Canada herb christopher Nat. ord. [Ranuncul???] Tribe I aconeae. Grows in woods among rocks in rich places etc. Flowers about July. Monogynous root an irregular tuberous rhizoma with fibrils Often the root of blue cohosh (leontica thalecteoides) is often sold for it but the fibres of this are smaller taste less bitter not virose etc. Roots of sanicula marilandica (called also black snake root) are also collected for it. (So the berries of cornus [illegible] have been found in the shops for buckthorn) But A. rubra & A. pachypoda are most commonly mistaken for it they are inferior Root he only part used Taste first to sweet & aromatic afterwards virose and bitter Tinct. of root is aromatic & bitter It should be collected only after the decay of the top. Attend to this direction, & use care in its preservation & it will retain its full virtues for years. I know of no good analysis. Dr. Meers attempted it, & gave the result of his researches in a dissertation, Tannin, extractive matter, a bitter principle, gallic acid, a gummy principle, starch, woody fibre, all which amounts to just nothing at all. HE said it probably contained an alkaline principle; but I assert positively, from repeated experiments, that it has none but calcid. I tried every means to get an active satisfiable base failed entirely don’t believe it has any. (Here Prof. T. gave the ordinary process for getting salifiable bases.) The article is prominently & decidedly a narcotic antirritant said to be anodyne & soporific; I don’t believe you can employ it for that purpose with advantage; though this, as well as all other narcotics, in certain conditions, do have such an effect. It readily & certainly produces ult. narcosis, which can always be speedily relieved by suspending its exhibition, & at the same time using those means heretofore so often directed especially opium (N.B.B.) # Dr Todd has seen decided & considerable exhiliration Prof. T. thinks it similar to the erethism of datura & conium & which occurs just before an attack of delir. trem. which is often mistaken for entony. In large doses it produces neuralgic lancinating pain in the extremities larger doses make these pains more extensive even affecting the head and eyes. Prof. T. once doubted the existence of these [illegible] but he has seen them many times They are most manifest in the calves of the legs & along the # I believe it is a nervine, though not prominently so. sciatic nerve. Opium counteracts them Cases related. Food also suspends the pains Prof. T. now employs a little food as a gill of milk porridge in conjunction with each dose Besides these neuralgic pains a large dose may produce convulsive action of the heart. Case of Charles Terry dangerously affected with extremely violent neuralgic pains under the upper part of the sternum wandering neuralgic pains soon violent palpitations beats 130 in a minute pain under the left axilla etc. Large quantities of camphor opium capsicum etc. were required. An emetic of sulph. zinc was given to change action Next day, pretty well. These effects happened twice the actaea not being at first suspected. Case related from G. K. Lawrence of the Shakers in which a large dose produced convulsive action of the uterus In both these respects it resembles strychnos nux vomica & false angostura. Some physicians give too large doses and at too long intervals & hence are always complaining of failure & of unkind effects of the narcotics Cases and testimony of physicians about its ecbolic operation. In one of the first cases, it was given as an antirritant, in a case of threatened abortion Abortion was speedily produced Dr March prefers it to clavus being more lasting leaving the uterus less inactive much less liable to destroy the fetus. Drs March and [Dyer] have found it useful in uterine hemor. Dr Dyer finds it the most valuable article for suppressing uterine hemor. not connected with pregnancy. He continues its use for some time Prof. T. thinks this [illegible] operations not specific, but as part of its narcot. He has repeatedly seen it convulse other involuntary muscles. Actaea is especially deobstruent Prof. T.’s attention was first turned to this by observing its effect when given as a diaphoretic in what was thought (by an old surgeon) a fever sores (osthitis gangrenos.) It resolved the infl. and cured the local disease, much to his surprise. He gave it merely to ally irritative heat and dryness of the skin knowing not a great deal about it. Subsequent experience with the resolvent powers of sanguinaria, colchic. varat. etc. led to the investigation of this property of actaea Dr Meers has found it produce an erythema upon the skin. Prof. T. has never experienced this. Dr. [Gasden] thinks it cholagogue Prof. T. has had no positive experience of this. Dr S. Woodward & others, however find it so Found to be emmenagogue also Seems to be expectorant also (as far as an article can be so directly Decidedly diaphoretic so say many physicians. Perhaps however it is only indirectly so as it appears to be so only in febrile (hot & dry) states. Diuretic often considerably so Yet upon the whole it seems not to be suffic. diaph. diur. & expect. to render it valuable for these indications It has been repeatedly called astringent. But it seems not to operate thus. To be sure it contains a little tannin or gallic acid but not enough to be efficient in operation Called tonic Prof. T. once thought so. Dr. Garden thought it tonic 7 reducing both. Prof. T thinks it not reducing bug prostrating merely. Prof. T. & all his friends also find it useless as a tonic. Like every other article of the materia medica this has been called stimulant. Prof. T. has watched carefully for this effect & never could perceive any. The warmth, flushing face etc. are produced merely by cerebral irritation. Very commonly said to be pectoral a term which may mean demulcent antirritant deobstruent etc. Said also to be alexipharmic Also called antiscorbutic this was the earliest quality ascribed to it in any publication. The principles of the cure of scurvy are not very well settled. The cruciferal seem to be well established as the remedies. Actaea is at least useful in restraining hemorrhage. But Prof. T. is an entire sceptic about the prescribed treatment of scurvy. All the cases treated of in the books occur at sea and seem all to be cured upon dietetic principles Concrete citric acid is useless. Lemon juice is useful in furnishing vegetable aliment. Land scurvy (apparently the same as sea scurvy) Prof. T. has found not benefitted by the treatment of the books He has cured it by lead, opium capsicum, and brandy giving food with each dose of medicine & after a few days giving quinine Rx ac. lead 1 gr. op. ¼ gr. every hour tablespoonful of brandy every 15 min. a little food with each dose. This pat. (in Albany) was cured though she was not expected to live an hour. Said to have the power of curing cutaneous eruptions The only testimony is B. Barton’s that it will cure itch Called repellent by which is probably meant discutient Prof. T. knows not that this has been well investigated. Called pellent also! Dr S. B. Woodward has found it cathartic, upon some of his patients. He is the only person who has met with such any effect probably they were anomalous cases G. K. Lawrence thinks the flowers are laxative. But all flowers are laxative unless they possess some other powers. Said to be emetic in a large dose This is very doubtful probably not more emetic than digitalis as a narcotic Darlington calls the root somewhat mucilaginous. It certainly is not so when chewed. Being narcotic it certainly could never be employed as a demulcent. Any considerable degree of phlogistic diathesis, will not admit of this article, until after reduction & evacuation It may be usefully conjoined with opium acrids & tonics Recapitulation 1st moderately nervine 2d actively deobstruent including, resolvent cholag. emmen. diuretic & perhaps diaphoretic 3d powerfully narcotic always antirritant sometimes soporific produces ultimate narcosis. 3th ecbolic Not stimulant tonic nor astringent etc. etc. vide supra This is supposed to resemble lycophus virginicus but the latter is merely nervine & tonic Most resembles digitalis but differs thus viz it does not accumulate on the system not continuing long after exhibition or returning in paroxysms does not exhaust the system like digitalis its narcotic effect is more easily relieved. Digitalis is not ecbolic & is less deobstruent It is more speedy & active than conium has most resol. power in acute conium most in chronic infl. conium more cholagogue & not diaphoretic nor diuretic Possesses the conveniences of sanguinaria & colchicum without disordering the stomach etc. like them Sources of failure are bad preparations not pushing the article far enough nor repeating [illegible] enough In many cases 2 hours is a better interval than 3 hours Another source of failure is preparatory bleeding or purging Pharm. prep. 1st very fine powder 20 to 30 grs. 2nd infusion coarse powd. zi boil. wat. 1 pt. [illegible] 1 hour & strain Tincture 4 oz coarsely powdered root to 1 pt. off. alc. macerate 10 days & strain. This is a saturated tinct. & is the only one needed for common use. It is the only preparation which will succeed in acute rheumatism Probably the active principle is perfectly soluble only in alcohol as water causes a turbidness or cloudiness though nor precipitate The powder is too inconvenient because it must be very recent & fine Medium full dose is about 30 m. Tinct. of the flowers is made by G. K. Lawrence 4 oz. to 1 pt dil. alc. He says it is cath. & less narcotic Diseases 1st dyspepsia irritable cases greatly palliated, by Drs Hale & others. Dyspepsia with a dry symptomatic cough very useful Dr Knight has found it very useful in 50 drop doses, conjoined with opium in dyspepsia with pain it cured when opium would not Diarrhoea thought highly useful by many. Colica ileus var. rhematalgica (primary rheumatic affections of the colon is known by the habits of the pat.) Dr Hooker gives 1 fl. z every hour until pain is relieved or narcosis produced & the pain is sure to be relieved. It will probably be found useful in common colic as it excites the involuntary muscles Bex dyspnoica often highly useful relieving in combination with opium when the latter alone failed Case related mistaken for [illegible] & haemoptysis (as there was oozing from the throat, caused by atony) Hooping cough much & successfully employed by Dr Woodw. of Vt. arresting the convulsive cough when pushed to narcosis Dyspn. exac. & asthma It generally cuts short the exacerbation give with the 1st dose the exacerbation of laudanum (sometimes 2 grs. op.) give a teaspoonful every 5 min. or a dessert spoonful at once or if this fails repeat it and in some cases a tablespoonful In this disease, a mixture of several narcotics give datura Prof. T. has succeeded well by equal parts tinct. actaea lobelia & datura Prof. T. at firs knew no better than to puke with tartar emetic this was worse than the disease. Next he tried ipecac. this failed. Next he tried syr. of [illegible] of squills this he thought did well but he found it always disordered the digestive function Nex the tried tinct. lobel. And one case in his own family he cured radically by anticipating the paroxysm with lobelia & laudanum Colchicum will break up the paroxysm but disorders the stomach worse than squills. Coxe’s hive syrup is much used but is one of the worst articles for disordering the al. can. Dr Mears recom. actaea for curing intermittent fever. Prof. T. tried it. He found it would suspend the paroxysm, but would not cure the disease & he would be compelled to resort to quinine Prof. T. considers this a disease of atony & has cured it only by tonics & stimulants The articles which suspend the paroxysm and do not give tone seem not to cure the disease. Slight cases may be cured by tricks of various sorts. Idiopathic hectic useful at least as an auxiliary Phlogotica apostema communis (common diffused superficial abscess generally about the hip) case related fo a cure by actaea Paristhmitis typhodes var. sub putrida (fever a synochus not scarlet fever a very rare disease most cases of malignant sore throat are cases of scarlet fever) good testimony of the utility of actaea as a gargle probably by its deobstruent effect. Perhaps it is also discutient it cures itch Pneumonit. typh. var. sub putrida (fever a synochus) Probably it might be used in most of the atonic & subputrid phlogotica & even in simple fevers of this type, if not too low Pneum. typh. var. nervosa probably it would be useful rousing nervous susceptibilities & acting as a deobstruent Pneum. typh. var. notha (which appears to be a spec. infl. of the bronch. memb.) highly useful. Arthritic infl. of the lungs misplaced gout useful especially if acute Sub acute pneumonitis (of Rush & others) (which appears to be an aff. of the bronch. mem. without an aff. of the schneiderian) precedes membraneous phthisis often should be treated with deobstruents, narcotics, nervines & diaphoretics e.g. marrubium etc. Phthisis membraneum var catarrhalis much used even by those who know nothing of its general use Vide Eberle’s practice Phthisis membranea var. dyspeptics highly useful. Remarkable case of Dr Hotchkins related at full length (Incidental remarks of Prof. T. he had hemorrhage which was checked by tartar emetic in nauseating doses left extremely weak “no wonder if tartar emetic was continued thus for some time” could not take tonics “because he too no antirritants with them, opium for instance”) cured when in the very last stages by actaea A. rubra failed in this case (it is greatly weaker) [Galium] circaezans proved a valuable expectorant. # [illegible] [illegible] drops were used Another very instructive case of Dr Hotchkins’s failed because it was not persevered in long enough This is apt to be the case with long continued diseases e.g. chronic diarrhoea & opium Scarce any remedy will do as much in phthisis as this even if given alone Yet it ought not to be given alone but combine with opium tonics etc. In m any cases actaea has prolonged life for years in desperate cases. N.B. consumptives cannot be cured by residing at the south in the winter only they must reside there for life to be permanently cured Phthisis tubercularis supposed to have cured. Laennec’s anatomical investigations Prof. T. thinks show unequivocal cures if tubercular phthisis All arthritic infl. are benefitted by it’ especially rheumatismus Prof T. has seem cases of arthritic carditis cured by actea others not. # American cough drops are equal parts elixir. pareg. & [tinct.] digitalis Cholera infantum (An infl. of muc. memb. of al. can.) has been cured Dysentery has been cured admirably by actaea. Dr Peabody has cured by 40 drops so have others Hysteritis membranifica has been found useful in many cases by Woodward of Vt etc. Prof. T. has not had an opportunity to try it in acute gout. He would give actaea once in 3 hours until narcosis was produced 30 drops or ½ tspfsful conjoining opium enough to drive off pain once in 3 hours IN this way Prof. T. has cured with verat. vir. lob. sang. & colch. # Arthritis rheumatismus atonica acute If pat. is costive give opium enough to relieve pain follow with cal. enough to purge in 12 or 18 hours After the purgation give actea once in 3 hours f zfs more or less # but the purgation from colch. is highly mischievous enough to affect the head conjoin opium 1 gr. or more or less once in 3 hours to relieve pain. When Prof. T. first began to treat atonic acute rheumatism in this way, he conjoined other articles, as ipecac but he finds them useless. The topical heat redness, soreness, swelling etc. will be relieved in 24 or 36 hours & often the fever disappears with them Dr Woodward of Vt cured 10 cases of acute rheum. in one winter all the cases he had. Dr S. B. Woodw. used it always in rheumat. he gives 25 or 30 drops (alc. tinct.) about once in 4 hours To prevent a relapse continue the actea in diminished doses Vide page next after the end of the article cinchona Ophthalmitis Hemorrhagia irritativa & [passivea] from any part Prof. T. knows it to be highly useful Porphyra haemorrhagica & [illegible] first employed to cure this disease in a large quantity of cider probably the cider had most effect It may be useful in this as in hemorrhage Neuralgia successfully with opium or arsenic by Drs Tully (he finds strychnine & opium better) & S. R. Woodward (in neuralgia of feet & legs of broken down convicts) Dr Knight has been succesful with it in neuralgic toothache Prof. T. has succeeded better with strychnus and arsenic or opium Hysteria Prof. T. used [illegible] successfully early in his practice now he uses nothing but datura. Epilepsy Dr Parrot of Western considers this article as peculiarly valuable in epilepsy from intemperance Others value it in other cases of epilepsy Carus paralysis it will probably be found useful from its resemblance to strychnos It has been found remarkably useful in palsy from lead colic camphor & arsenic may be joined Chorea from analogy Prof. T. was led to use it 15 yrs ago general testimony it its favour Vide also Am. journ. med. scien. No. 18. for interesting cases of surprising cures. Dr Hooker has used it with the most beneficial effects in chorea Tried chloroferrate of iron ([illegible] veneris) & conium & iron & various tonics with no benefit tinct. of horse warts (a powerful nervine) etc. Actea cured her Paramenia obstructionis found highly valuable. P. difficilis found useful in relieving pin, obviating irritability etc. Prof. T. uses datura Parodynia atonici lingering parturition Prof. T. now uses it instead of clavus with as much efficacy & without danger to the child Retention of placenta repeatedly used by Prof. T’s friends with good success Hydrops cellularis especially with an erythematic diathesis not used by Prof. T. but by several practitioners as a substitute for digitalis Leucorrhoea in a case which seemed to be the joint result of blenorrhoea & mercury cured other cases Ecpyesis scabies itch said to cure by lotion Prof. T. has often cured itch by lotions of digitalis. Sprains Prof. T. has often used it with advantage Bites of rattlesnakes popular alcohol & opium must be better Old chronic cases of swollen joints arising partly from injury & partly from rheumatism was proved very useful Very useful in murrain of cattle vide B. S. Barton. History. Lond. phil. trans. Petiver 1697 used in [Mariland] for scurvy. B. S. Barton various (among others the U.S. Dispens.) have copied from him. Actea rubra Distinct from A. spicata Considerably used in some places Powers similar to A. rac. but far weaker and more uncertain & less valuable Actea pachypoda A. alba (Big.) A. spicata var. alba A. rubra var. alba! etc. Necklace weed, coral & pearl etc. Mentioned in several irregular works. Used as an efficient emmenagogue by Dr McClure. Berries of this & the preceding (i.e. dry capsules!) said by Rafinesque to be poisonous Used by Dr Collins as a substitute for A. rac. but weaker Used by him with advantage topically in ophthalmia used for dysentery etc. Not worth substituting for A. rac. As the roots cannot be distinguished these are often sold for those of A. rac. hence frequent disappointments A. spicata Christopheriana herb christopher [Bane] berries berries said to be highly poisonous (vide Withering) Root and leaves acrid berries have caused delirium useful in nervous diseases as a repellent etc. Prof. I would infer that is is more active than A. rubra & less so than A. racemosa Actea Cimicifuga Linn. Cimicifuga foetida Linn. Liberian bug [bane] N.W. coast of Am. & Liberia An almost insupportable smell Used in Liberia as a bug bane Vide Good art. hydrops abd. (drastic i.e. active it is not cathartic) Abundant testimony that it is a powerful narcotic. Little doubt that it has the same powers as A. rac. but more powerful Strychnos nux vomica Nux vom. officinarum Caniram etc. nux. metalli Nat. ord. Apocyneal ([illegible] Luridae Linn) Habit. Coromandal Cochin China Fruit a berry about as big as an apple with a hard orange coloured skin seeds imbedded Seeds only used Bark said to be nearly as active. Seeds orbicular & depressed size of a dime Active principles strychnine & Brucine (brucine by mistake brucea being merely a bitter tonic) Strychnine most abundant exists combined with strychnic acid White, crystalline etc. said to be highly alkaline will it change blues? Combines with all the acids & is separated by all the min. alkalies When recovered from some combinations the alkali is changed (This is true of various veg. acids also a different acid being formed) Operative effects in ordinary doses these are so moderate and show that they can be no better distinguished than those of cinchona when properly administered & in a suitable disease, we merely perceive an amendment of disease. Diminishes morbid irritability & susceptibility & restores healthy susceptibility & tone. In its slowness it agrees with conium but disagrees with actea digitalis and lobelia It is mentioned as a peculiar property that it strengthens the voluntary muscular power. This is merely the erethism of the brain produced by all the narcotics It is more easily & more powerfully produced by this than by most narcotics Said to be anodyne is probably less so than many narcotics. It has great power however over neuralgic pain Said to be tonic & Prof. T. is satisfied that it is so Supposed to be deobstruent. Prof. T. thinks it is so though more equivocally so than some other articles. It cures gout rheumatism leucorrhoea etc. but little definite is known Not known to be cholagogue, anti psoraic etc. but has not been thoroughly investigated Said to be febrifuge (probably anti intermittent is meant). It seems to be capable of curing intermittent Said to be anthelmintic probably it is so Its slow operation adapts it more especially for chronic diseases Inconvenient effects cardialgia vertigo staggering appearance of drunkeness stiffness of [lims] & general coldness. These effects indicate a reduction or suspension of the remedy In a sufficient dose said to be capable of producing these effects in an hour & ultimately to produce stiffness of voluntary muscles i.e. tetanic spasms Ultimately it convulses the invol. mus. Noxious effects said to come on with pricking of the limbs coldness ultimately spasms & complete ultimate narcosis Paralytic parts more speedily & powerfully experience its effects viz. the pricking, local perspiration & tetanic spasms the contrast being remarkable between the two sides being affected vide Magendie Even the two halves of the tongue will be differently affected Magendie is probably correct in saying that it may affect the spinal marrow without affecting the brain Prof. T. has found strychnine more efficacious than any other preparation. Strychnine is said to be the most active principle known & the most speedy next after prussic acid Effects1st acrid narcotic 2nd tonic ([illegible] 3d deobstruent 1st resolvent others not investigated Entonic diathesis strictly prohibits this article, more indeed than it does most other narcotics The British practitioners are mostly afraid of this article yet it is more easy to manage than colchicum etc. This article, like all narcotics, gives warning of mischief. The refrigerants do not Orfila knows no antidote he directs emetics, cath. vinegar etc. tracheotomy and artificial respiration! Pharm Pres. 1st Fine powder rasp the seeds then pulverize & sift through muslin. Dose about 4 grs. 4 or 6 times a day. or dose 5 to 10 grs. Push it until moderate tetanic spasms are produced. Prof. T. pushes it until some slight startings of a paralytic limb. Sometimes 1 gr. 4 times a day has been enough 2nd Alcoh. tinct. strong alc. 1 pt? 2z of rasped seed. Dose 20 or 30 minim 3d Alc. ext. begin with 1 gr. or once a day (Magendie) But one dose a day will require too large a dose The effects of one dose will not last 24 hours For a slight effect ½ a gr. to 1 gr. pr. diem will be enough (Magendie) Dose of pure strychnine said to be ¼ to ½ a gr. 2 or 3 times per day too large a dose Some patients will not tolerate more than 1/16 of a grain. The doses must not be so large as to produce vertigo nor the quantity in the day so great as to produce tetanus Diseases 1st dyspepsia more especially where there is want of tone in the stomach but in almost all varieties Prof. T. has found it useful Diarrhoea vulgaris reported as very valuable Lead cholic especially in its secondary stages & sequel Helminthia not said what species Dyspnoea chronica like galvanism Dispnoea exacerbans. Prof. T. thinks it obviates the relaxed thickened & spongy state of the muc. memb. also relieves the paresis of the nerves etc. Sternalgia ambulantium Intermittent fever dose directed is too small. Said to succeed when quinine fails. (Prof. T: & several friends never fail to cure by quinine enough & unqualified Cases related of cure by quinine after quinine had been said to fail utterly) Typhus pustis (Levant plague) said to be specific seems to be useful Dysenteria typhodes has been used wiuth great success Arthritis podagria Said to be capable of curing if steadily administered So of rheumatism & rheumatalgia, in all their varieties either be cured or proved valuable Sciatica arsenic, sulph. strych & sulph. morphium in combination have proved highly valuable Ecphronia mania rec. in the books. Halusia hypochondrias (apparently a combination of a moderate degree of dyspepsia & of melancholia) said to be valuable Cephalia hemicrania (idiopathic not when a disguised intermittent) ¼ gr. 3 or 4 times a day usually in the required quantity. Combine also morphine. Prof. T. has succeeded better by this plan than by any other He now employs it exclusively. Case of Prof. Knight’s Neuralgia one of the best articles Prof. Knight has employed is successfully in many cases of nervous pains [Clo??] palpitatio Used with great success Chorea. Cured cases of long standing Dr Beers has found it highly successful So has Dr Woodw. of Vt Prof. T. has used it but little & that with success Hysteria said to cure Prof. T. never tried it but once & then it failed. It might be useful between the paroxysms Epilepsy recommended might be useful Dr Woodw. of Vt has used it with decided advantage Carus lethargus has been cured Carus paralysis more celebrated for this than for all others 10 to 40 grs in 24 hours It should be pushed so far as to produce some spasms in the paralytic limb Adapted to all cases caused by intemperance by venery passion etc. Has been used successfully in pregnancy (for hemiplegia) without injury to the fetus. Case quoted showing that palsy may be cured without producing any thing more than tingling no spasms. Magendie states that is now externally applied, in form of tincture Paropsis amaurosis Agenesia impotentia (probably a partial paralysis though an affection of the mind oftenest hinders this cure of the disease) Spermorrhea atonica Magendie Paruria retentionis & incontinens successful see Magendie Leucorrhea communis cured Bite of reptiles said to be cured Emaciation of extremities cured or relieved by Magendie It must be remembered that all these cases may be incurable and that the article may apparently fail Hist. Said to have been employed ever since the time of Gesner 15- Introduced into England in 17.. by Woodville Revived in France by Magendie in consequence of observint its tetanic effect on animals Strychnos psead augostura Called improperly angostura with various trivial names Always found as an adulterating article of Angostura bark 7 hence it probably grows in S. America. It is not known however, with certainty where its habitat is. Magendie Paris etc. attribute it to brucia antydysenterica [illegible] with probability attribes it to a species of strychnos Two species of strychnos grow in S. Am. Bark comes in pieces broader than long ½ inch thick covered with small warts fracture [illegible] small aromatic and nauseous, disgustingly bitter to the taste powder bright yellow Concentrated infusion muddy disgustingly bitter etc. Lat. tinct. pale rendered opaline by water? It is important to distinguish this adulteration of galipaea off. or angostura Severe accidents have happened even in this town Absolute tests said to be 1st a drop of nit. acid on the inner surface produce speedily a blood red spot (by the [brucia]) 2nd a drop of nit. ac. applied to the lichens on the outer surface, produces a deep emerald green color It is much to be regretted that the active principle is called brucine this brucine poisons as effectually as strychnine Th bark in powder [illegible] grs. killed a dog in an hour A child was killed by mistake cold extremities senses retained to the last Brucine is formed in Strychnos nux vom. said to be a bigallate in false angostura. Description of brucine vide chemistries. Taste bitter & acrimonious Nit. acid produces a deep yellow colour hence it can be detected when in combination with strychnine Wide discrepancy between the results of the ultimate analysis of brucine Andral considers 1 gram of strychnine equal to 24 gr of brucine Hence 6 grs. will be equivalent to ¼ gr of strychnine q.v. 4 grs. killed a rabbit Andral has given it in single doses of ½ gr. to 5 grs Magendie 1/8 gr. 6 times a day Operative effects differ only in degree from those of strychnine Strychnous pseud ang. is now considerably used in medicine Strychos [illegible] is the most active of all the strychnia (strychnoes) L. ignatii is next in activity. It was called ignatia by Linn. Called also faba sancti ignatii recommended in intermittents It vomits purges and produces spasms 2 grs said to be a medium dose of the seed. Strychnos colubrina posses the same sort of powers. The wood of the root is used against bites of snakes hence its name. In doses of ½ dram it has been used in intermittent. It vomits, sweats, diuretic cath. This is one of the plants called [illegible] [illegible] The other plant is the following Toxicaria macassariensis Ripa antear Antearia toxicaria etc. This is said to be the most active of all the narcotics not] excepting hyd. acid. The proxi Lobelia Inflata Said to be annual, persistent, and biennia. It seems to be biennial Rapuritium inflatum lobelia emetica. Indian tobac. eye bright etc. Nat. ord lobeliae Canada & the whole U.S. [Ra??.] & Sch. describe 15 species most of them are highly active Taste much like green tobacco It has never been analysed Operation 1st warmth in the stomach proceeding to cardialgia universal glow tremors some nausea vertigo salivation Larger doses cause more vertigo emetic diuresis more salivation expectoration Poisonous doses produced convulsions, delirium & death. Said also to produce increased secretion of bile diuresis & diaphoresis A valuable deobstruent though more adapted to atonic cases Valuable diuretic etc. Useless as a mere emetic It is too harsh and distressing. It would probably prove emmenagogue. Some think it cath. Prof. T. denies this except indirectly as an antirritant & cholagogue Seems not to be stimulant It will not prove restorative in exhaustion but rather increase it It may excite an irritative bounding of the pulse in low torpid cases. It is acrid & locally irritant not stimulant. It resembles to nicotiana tabacum but is more diffusible more sudden, mor transient, less permanent more manageable Though not stimulant yet it is contraindicated in entonic diathesis Pharmac prep. 1st powder of leaves 2nd powder of the seed 3d infusion but this has no standard strength [4th] tinctl zii to 1 pt dil. alc. 5th Tinct. of seeds by the Shakers Diseases 1st Dyspepsia with great [irritability] with wandering pains like disguised gout very beneficial in conjunction with capsicum & nit. sil. Limosis gastrodynia vide Eberle’s practice He finds it superior to opium Idiopathic cough either before or after expectoration found to be very valuable Bex dyspnoica Case related of an apparently desperate case cured by lobelia and opium f zi tinct. lob. with 2 or 3 grs op. at a dose each article failed by itself Another case related in which a large secretion of bile was produced Hooping cough found useful after the convulsive cough has begun by numerous practitioners A physician gives 10 to 60 m occasionally vomiting with it and he thinks it better [emetic] for the disease than ant. or ipecac undoubtedly because it is deobstruent Many physicians have succeeded with it Prof T. has done so sometimes conjoining opium or conium Dyspnoea exac. f zi of tinct every 5 or 10 min. until full vomiting or narcosis is produced. The certainty of the operation will be enhanced by premising opium Give it in the intervals of the paroxysms in conjunction with tonics Asthma best article for this disease as well for the preceding Still this medicine is so nauseous that many patients will not persevere with it Typhus nervosus has been used Dr Hyde of Enfield employed a powder of lobelia, or sanguinaria & of [????triphyllum] as a stimulant diaphoretic in typhus. It must be remembered that deobstrents are useful in typhus. Prof’s T & Beers used lobelia in typhus, when medical student & found it a most efficient diaphoretic Catarrhus communis & epidemicus Prof. T. has used it with great benefit Croup Dr Barney employs it in croup in the commencement and in the progress of the disease 30 m to ½ fz Croup is sometimes perfectly paroxysmal & resembles dyspnoea exacerbans & has been mistaken for asthma, as shown by Dr March’s p.m. examinations For this form lobelia is peculiarly adapted Pneum. typhodes was found a most valuable expectorant whenever squills could be tolerated does not answer well for when the stomach is irritable Acute rheumatism It has been used with success. Prof. T. has used it often with success in subacute rheumatism Case related cured in 24 hours by lobelia & opium Yet this patient had often had such attacks before which always lasted for a fortnight A. rheumatalgia var. chronica (chronic rheuma) Prof. I finds it the most valuable article much superior to guaiacum which is the article commonly depended on. Case related cured by lobelia and opium after arsenic blisters guaiacum alcohol capsicum etc. had failed Leucorrh. comm. valuable in some cases generally best conjoined with cantheris & nit. sil. Hernia recommended as a substitute for tobacco by enema Said to be nearly as effectual and not dangerous like that article Lobelia tupa Peru 6 ft. high root is 1/1/2 ft. long odour in a close room produces vomiting Juice so acrid as to produce speedily topical infl. when applied to a tender surface L. longifolia W.I. said to inflame the hands said to produce an incurable purging. Prof. T. has known several deaths by this actually incurable purging hydragogue from colchicum! L. urens most active also]L. syphilytica throughout U.S. all parts [lac] 1st deobstruent 2nd emetic 2d hydragogue cathartic apparently not narcotic 1st expectorant & emmenag. 3d diuretic 4th diaphoretic First employed as a specific for syphilys Just about as active as senega and adapted to a similar set of case. It seems to have the advantage of being less liable to leave the stomach in a deranged condition than senega As to its curing syphilys Prof. T. thinks the matter not settled when it was tried the notion prevailed that syphilytic patients should be salivated and that too before the constitution became affected It is never worth while to give mercury internally when the disease has proceeded no further than a chancre & bubo You will merely protract the cure The const. aff. also Prof. T. has cured by gold. It may be cured by various articles# Lobelia Dortmanna of similar powers to the preceding Lobelia Cardinalis supposed to be similar power It is a popular remedy in dropsy & will cure used as in vermifuge for [asc. lumb] L. claytoniana still weaker most common with us and apt to be confounded with L. pallida # Some cases will prove incurable under any treatment Sanguine temperament & scrofulous habits [illegible] mercurias dulcis sublimatum dulce (Sydenham) A. [illegible] A. [maligala] [Draco] mitigatus marina metallorum [illegible] metallorum Calomel Most modern & best name is Hydrargyri dichloridum The atomic weight of mercury was formerly called [200]. It is the general principle to take the smallest weight though it is not very strictly adhered to It does not appear but that the # persons who first pitched upon 200 + 8 for the black oxide, did it at haphazard and did not investigate the subject nor give any reasons “That compound which is with most difficultly decomposed, must be presumed to be a binary one Ms. Dalton vide Henry Prof. T. knows no exception. Hence says Mr. Alison? we must suppose the peroxide of merc. and perchloride to be binary compounds We find also that black oxide is very readily reduced by heat by agitation almost by pilling to red precipitate and metallic mercury. We find the same true of the cyanides. The sp. gr. likewise of the vapour leads to the same conclusion. The sp. gr. multiplied by .555 must give in combining weight. Hence we have 100. Another argument founded on the sp. I have [shown] elsewhere that if we divide the number .376 by the spec. heat the quot. will be then atonic [illegible] of that body [illegible] the spec. heat up [illegible] .03 & 376 / .03 = 12.533+ Berzelius advances similar arguments and gives the same no. 100. Thompson sometimes uses “sub” instead of di. Sub is a vague term It was found after the discovery of def. prop. that sub carb. pot. was 1 of each! other examples of its being misapplied before the discov. of def. prog. Formerly called proto chloride This would answer if it was still the case that proto was applied to the least compound Hydrayg: chlorid. mite. Phil. ph. an unexceptable name in pharmacy muriate of mercury Sub murieta (very exceptionable because it was considered neutral) then mild muriate) Called calomelas in 1616 But this name had been previously applied to the disulphuret (Ethiops mineral) Its discoverer is not now known The alchemists were acquainted with it. Sometimes found native & called horn quicksilver & mercurial horn ore a rare mineral Dull white yellowish heavy cake crystallized in 4 sided prism terminated by 4 sided Buff coloured when finely levigated. The only way to obtain it pure is to buy it in form of crystals The powdered in the shops is variable sp. gr. 7.2. [illegible] primary operation when taken internally 1t deobstruent 2nd cathartic 3d emetic 1st sialag. 2nd expect. 3d diuret. 4th cholag. 5th emmenag 6th antipsoraic resolvent 7th diaph. From the very situation of the salivary glands the operation on them attracts more attention Next to its dialag. are its cholag. Next its expectorant Next is its antipsoraic Next its diapohoretic, diadretic & emmenagogue in the order mentioned As a cathartic it is useful 1st as a mere reducing agent (a moderate one in moderate entony unless after bleeding) 2nd it may be used much more to make a shock or strong impression & interrupt disease 3d to increase susceptibility to other remedial agents & to equalize excitement Of little value to remove effused fluids as in dropsy it is slow & not hydrag. or to remove offending matter It may be made to operate as an eccoprotic, a laxative, a purgative a drastic cathartic It cannot long be used as an eccoprotic or laxative on acc. of ptyalism Most useful as a purgative. Inferior as a [illegible] cathartic Equally copragogue & cholagog. When suffered to remain in the bowels it is always deobstruent cholag. sialag. The gall bladder will always be found distended with bile or gall after it has been freely given in acute disease. This is often attributed to a spasm of the ducts [Emalging] the liver is supposed to be the only use of giving calomel in fever but then it [opens] the skin and promotes all the secretions It acts on the stomach and upper int. when given in a purging dose Its vomiting power is little valuable but as a cathartic it more nearly resembles an emetic than any other cath. in its operation, & may often be used as a perfect substitute where emet. are indicated. When given as a deobstruent opium shd be combined with it to keep it in the bowels. But when we desire a long continued deobstruent effect give it in small doses but it will always salivate sooner or later A man in health or in vigour is salivated with less diffic than in low atonic diath. or when very feeble or in enton. diath Sometimes it does nothing but salivate This is important to distinguish Sometimes it merely purges without any deobstruent eff. But Prof. T. has always found such cases to have been recently salivated or to have an excessively irritable stomach & al. can. in which it produces vomits Given with diuretics, or emmenag. or diaph. etc. it will prove more especially diuretic etc. Hence the “dirigens” part of the ancient prescriptions Naturally a very slow cathartic dose 5 to 10 grs N.B. we determine the nat. effect of a cath. by the smallest quantity that will produce its full effects When hurried through the al. can. almost all its deobstruent effects are lost. It must also be remembered that its cath. operation is generally its least important operation Prof. T. & his friends have always experienced its good effects upon themselves before the purging began Calomel has been called a stimulant perhaps because it produces irritation sometimes & a mercurial fever which is merely irritation A single author has called it tonic This is still more absurd A large proportion of our medicines do not either stimulate or reduce Mr. Abernethy says there are some patients whose mouths will not be affected & yet the system be under a mercurial action. Prof. T. has not observed such cases The system may be above or below the grade of excitement proper for salivation There may also be certain states of the system in atonic diseases which will not admit of salivation until the state of the system is changed Case const. syph. mercurialised in N.Y. without success also in Phil. also in Botson utterly without success. [went] to Charleston and there some one recc. Dr Todd Dr Todd put him upon a bottle of wine a day & a free use of bark for a week Then gave him mercury and salivated him in 3 days Prof. T. never met with a case which he could not salivate Perhaps by bark & wine, sometimes by combining capsicum with the mercury There is no foundation for the dogma that stimulants must never be combined with mercury his use of opium & bark to bring on salivation from mercury has been long known in Connecticut It has lately been brought forward as a new discovery [illegible] & soreness are more easily cured of syphilis [because] [illegible] can be confined confine your pat. to the house better to the bed. This with opium & diaph. treatment has succeeded in giving action to merc. when otherwise it wd have failed” Most of the baneful effects of mercury in syphilis are probably owing to not giving the proper corrigent etc. Paris seems to be the only author who is aware of the necessity after of reducing the system to the point of susceptibility And even he knows nothing of the necessity of raising the system There seem to be two sorts of injurious effects 1st acute 2nd chronic The dichloride disoxide & diprotonitrate produce the acute more commonly While the proto chloride protonitrate & protoxide produce the chronic They symptoms which show the system to be under mercurial influence are 1st symptoms (previous to ptyalism) cupreous taste more or less swelling of gums sloughy whiteness of gums margins trifling soreness & a feeling of looseness of the teeth A peculiar fetor of the breath Called mercurial A peculiar fleecy appearance of the tongue Then comes the dis Ptyalismus acutus var. hydrargyratus which begins as above vide Good When cal. begins to produce heat, soreness swelling ptyalism sloughing of the inside of mouth and cheek etc. with the mercurial eruption the system is labouring under a severe disease a poisonous effect. Actual salivation is never necessary though it may be convenient to produce a slight one Caries of jaw perhaps with exhaustion & death total loss of teeth fetid breath stiffness and incarnation of limbs etc. may be the emaciation, debility, loss of appetite ultimate results more rarely a lingering death Severe ptyalism is apt to be treated as a light disease very improperly We are not to expect any specific antidote. Yet upon the notion of the absorption of mercury sulphur is proposed Sul. has 2 compd scarlet red & jet black! both are insoluble & no emenctory will the row off a [illegible]! Many suppose that repeated purging with neutral salts is useful in this disease. Another man in Ohio Dr Findley says he cures by tart. emet. “as a gargle & I believe internally” “Perhaps it may be useful topically as an irritant like nit silver.” Prof. T. has repeatedly seen antiphlogistic treatment tried and with no benefit Sarsaparilla (a weak deobstruent supposed to promote secretion is more especially for the kidnies & skin) Prof T. has often tried it for [weeks] with no benefit whatever So have others Lotions and gargles generally fail entirely in the early stages though they are useful in the advanced stage to obviate [atony] and relaxation The frequent gargling of cold water has often been of very high utility Diluted mineral acids have been found especially useful But lotions of the decoction of batesia tinctoria (acrid narcotic deobstruent emetic and cathartic) has proved one of the very best remedies in a strong solut. [illegible] I to zi water and been very popular with those who have tried it Lotions of nit. sil. are very useful (sometimes on account of the irritability, a strong sol. suits better than a weak one Arsenitis of potassa externally & internally useful Prof. T. 2 fz ol. turp. with z fz muc. gum arabic Prof. I. has found very beneficial Very strong inf. of lycopus vulg. has been very useful (bitter & nervine) Coptis trifolia has been employed & is useful Mucilages, acac. astragalus [illegible] [althaea] hibiscus typhus latefolia (root) viola pedati split twigs of [illegible] [sassaf???] [ulmus] [fulva] (rather inferior) but perhaps decoctions of rice and barley boiled long and strained are as good as any mucilages. All these are very grateful to the patient Qinine is often indicated internally to keep up the strength of the patient But the watery solution of opium is the best applic. and op. shd be given internally Milk porridge has always been preferred for diet The next inconvenient effect is Called very improperly erethismus hydrargyratis but has no other name Great exhaustion of strength anxiety frequent sighing epigastric distress vomiting irregular action of heart & arteries pulse small quick frequent sometimes intermittent tongue seldom furred cold extremities perhaps sudden death upon exertion Occurs in the feeble Treat by perfect quiet and opium tonics arsenic etc. It may occur before salivation in the feeble Eryth. vesic var. hydrargyratum Perhaps not distinct from E. [corrosivum] Called improperly eczema & hydrargyria [sepoa] etc. Prof. T. thinks it clearly an erythema vide Good Perhaps his var. corrosivum is identical with this a better description could not be given than his description of E. ves. corrosivum N.B. in erythema you may always see vesicles in a sunlight by a magnifier hence erythema is not a rash. Bateman criticized [erysipelas] & erythema are synonymous Bateman says E. v. hyd. is produced by other causes as cold but that from mercury has some peculiarities N.B. The effects of fire, frost, sun burns, an eruption caused by arsenic etc. are varieties of erythema Preceded by sense of stiffness, itching etc. about a side of thighs and scrotum or about the neck and arms next comes a redness and minute microscopic papula. The redness spreads in large patches over the body The pimples run into each other become large emit an ichorous, corroding discharge The whole body becomes raw, excoriated chapped, stiff etc. In severe cases recovery scarcely comes on in less than [illegible] weeks and may continue 8 or 10 Sometimes the hair and nails come off. The whole epidermis comes off and as is the case with other such eruptions As skin may give off 2 or 3 successive crops of scales. This Bateman’s description and a very good one Prof. T. has witnessed 3 distinct grades 1st merely local in the bands of the joints etc. caused by ointment of mercury 2nd an ulceration in the mouth in children who have used mercurial escharotics too long 3d covering the whole body attended with an irritative fever & general exhaustion Caused only by mercury internally. “It can be cured notwithstanding Bateman’s opinion to the contrary Treatment palliative (Bateman) warm mucilages in lotion poultices mild cerate after excoriation Antimonials & opium and finally mineral acids 7 bark Prof. T. dissents from this treatment (the merc. dries on) He applies at first simple ointment of datura and in the latter stages adds carb. zinc (lap. calam.) He also uses infusion of digitalis just about strong enough to create some irritation (perhaps upon a medium ½ oz to the pint) Infusions of the seeds of datura are useful also Prof T. finds the poultices & fomentations keep up the disease by relaxation The tepid bath may occasionally be advantageous Let the diet be light and nutritious Prof. T. has generally found quinine necessary. He could always give opium moderately Arsenous acid he uses in some way internally. As the appetite is generally small, so that the pat lives principally on liquid food the opium will not be apt to constipate, and if it does castor oil may be given but Prof. I has not found laxatives necessary Min. acids sometimes agree and sometimes disagrees producing tormina etc. in the bowels Prof. T. can lay down no rule Dysenteria acuta var. hydrargyrata It has the general characters of dysentery but there is more irritation & exhaustion. In adults I have seen it in all cases produced by the external Application of [illegible] inordinate quantities commonly called “roasting it in” In children I have seen it more generally brought on by by internal use in repeated doses All that is necessary commonly is the abstraction of the calomel & the vigorous employment of opium. For the exhaustion tonics & stimulants with opium may be needed (Sometimes give calomel hair of the same dog (Osgood)!) 4th Sub acute mercurial rheumatism Liable to degenerate into a chronic state and into paralysis Resembles the idiopathic Attack gradual & insidious little redness or soreness much pain on motion local aff. generally about the larger joints moderate tumefact. no supp sympathetic & irritative fever erratic pains always attended with sweats exac. at night & in stormy weather. Brought on by exposure to cold & rain etc. taking cold In the acute diseases of mercury the physician generally gets the ill? credit. But the chronic diseases have more importance attributed to them even than they deserve many cases are falsely attributed to mercury. 2 cases related of permanent lameness reported to have been treated with mercury neither of whom had taken a particle of mercury one of then had been purged a long time with brimstone & rum It is well known that sulphur will produce similar effects e.g. as perfect a dysentery as that of mercury though more generally it produces the chronic effects. Both mercury & sulphur will produce paralysis etc. Opium capsicum alcohol etc. are important remedies in the treatment of this subacute rheumatism If [illegible] the disease is pretty manageable. The nearer they approach to acute the more useful will actaea be otherwise conium Fowlers sol. Harthrytum [illegible] Digitalis guaiacum If a pat. has got out and is in great danger give him great quantity of alcohol 5th Marasmus tabes (vide. Good) General extenuation with debility, with languor, exhaustion, hectic (Neither Cullen’s nor Good’s hypotheses are worthy of consideration being mechanical)The assimilating capillaries are probably principally affected, owing to derangement of digestive functions. (The stuff about the absorption of oils mucilages, and alkalies, is poor enough) Prof. T. has found opium of more consequence (in tabes venenata) than any other remedy next conium & iron with acrids also cinchona etc. Narcotics must be in small doses frequently repeated, to obviate lesion of the nervous function. Prof. T. has known a disease closely resembling strumous cephalitis which does not exist the effusions being a mere sequel in the latter stages effusions somewhere are the common result of acute disease e.g. in the pericardium etc.) produced in children by excessive quantities of calomel 2 to 4 times a day so long as the sickness lasts and then much large quantities of calomel, would be given & produce a mercurial dysentery for which still larger doses of calomel would be given & finally the parents would refuse to allow their children to receive mercury & consequently the practitioners themselves would see that children would get well without cal. & then conclude that cal was improper for children altogether case of a distinguished teacher in a large town who holds this opinion led in this way When this affection begins, stop your mercury & give narcotics # Prof. T. has seen the same effects (not hydroc. [illegible]?) from mercurial itch ointment An irritative internal haemorrhage is often rarely but sometimes produced “Said to have happened in Eng “said to have been caused by corr. sub Abortion is often produced by a continued mercurial course said to have been produced in France by calomel Fevers treated with mercury in grain doses as a stimulant made hopeless irritation uncontrollable diarrhoea. Mercury often does more hurt by its inconvenient effects than good by its desirable Many practitioners now employ the vegetable deobstrents & use mercury almost only as a slow cathartic. # A [most] [illegible] aff. [illegible] syncopalis is sometimes produces more often by the external use of it for the itch but by the internal use in irritable subjects” Ac. lead is often preferable. it is liable to only one inconvenience viz. [illegible] Sanguinaria is often preferable Actaea is often preferable Conium is preferable, for jaundice chronic liver affections etc. The pneumonitides are better treated without mercury at least as the principal remedy (The rash & careless use, eve of narcotics even of opium, is far less dangerous than that of refrigerants, tart. em. mercury etc.) It is a rule of naval & military practitioners that mercury shd not be used where it can be avoided as it leaves the patients more exposed, for years, to injury from exposure to cold, & wet etc. This applies to all cases of persons liable to exposure i.e. seamen, blacksmiths & manufacturers No remedy is applicable to a greater variety of cases, than merc. exc. opium opium (Dr Chapman says none whatever) It is not in the latter, but in the earlier stages of disease that calomel is especially useful Hence Dr Bond’s rule (vide Chapman’s therap.) always to try mercury as a dernier reasort, as a pernicious one Therapeutic application Dyspepsia it is almost a matter of course to treat dyspepsia with di-chlor & dis-ox. merc. Prof. T. has never seen any benefit except that of an eccoprotic or a laxative and even these other articles are generally better. They are also extremely liable to produce tenderness in region of liver, stomach etc. Let this tenderness exist of itself & even be relieved by merc. they debilitate irritate etc. Yet they are occasionally proper for a short time. Occasionally proper as a slow and moderate cath. It should be employed in but a small proportion of cases Colica ileus important often in large quantities especially in the early stages “Cal. & opium are equally important auxiliaries shd be used” Large quantities shd not be pursued into the secondary stages C. rhachialgia useful in the same way as 3 or 4 dose zi [illegible] are often necessary in the course of 3 or 4 days But Prof. T. thinks corr. sub. & still more red prec. is preferable Coprostasis (idiopathic) large doses in the early stages but if it fails give other remedies Diarrhoea vulgaris moderate diar. may be broken up by vom. by purg. by almost any strong impression Sometimes cal. cures in the earlier stages by its deobstruent effect It shd not be given in the latter stages. Dr Johnson thinks the fashionable British practice of purging protracts the disease Colliquative (tropical, & intemperance & puerperal diarrh. also that of old men contraindicate calomel Cholera vulgaris generally, though a severe not a dangerous disease often protracted by treatment often broken up like diarrhoea by a strong impression as by puking Cal. may cure it by its deobstruent effect. “[illegible] doses of cal. may be good before the vom. & purg. is begun It is of no use as a cathartic nerely because more purging is useless It is of no use unless in an extraordinary dose while the evacuations are large It is not indicated as a sialogogue, nor as a stimulant, tonic etc. It is good to change the [secernents] particularly the liver & al. can. but before giving it check evacuations with opium and produce reaction by stimulants Give it in quantities short of the purging point often combined with stim., etc. Helminthia one of the best articles # Icterus vulgaris may be made to cure purge at first then in alterative doses combined as the symptoms indicate. But conium will cure more speedily and better. Though even with this a purge of calomel may be given at first though not for purging Parabysma eractum conium is better than calomel quinine is better still. Give conium & quinine. All [illegible] the cases that are the primary effect of malaria are best cured by quinine The [illegible] cure the sequel of intermittents by quinine alone Prof T. gives in such cases conium & quinine Anti corysa (often a troublesome disease) an attack may be broken up by a slow cathartic of calomel at night We should not keep repeating it however Intermittent If a cath. is needed at the commencement cal. is the best & is better than an emetic Previous to the use of quinine cal. was often necessary to obviate the inconvenient effects of the pure bark often a sub ptyalism was necessary to be kept up No inconveniences however result from the use of quinine Remittent cal. is of more importance than in intermittent purging & often a subptyalism is needed after which quinine will cut the disease short Typhus infantum very important T. nervosus perhaps only in non-malignant typhus is calomel advantageous. N.B. This is the most common fever all over the U.S. (even at the south testimony of Dr McBride etc.) Employ in the very commencement of an attack say 3 grains once in 3 hours conjoined with a diaphoretic regimen so as to produce a sub ptyalism or in one or 2 large full doses, with opium if necessary in order to keep it from purging under 15 or 18 hours the very best mode of breaking up fever. If we are a little too late, or if the cal. passes immediately off by the bowels, then give enough to produce a submercurial action for a few days and conjoin mild tonics the disease will be [mitigated] & shortened N.B. we do not wish much purging but the universal deobstruent effect of the calomel. Hurried through the al. can. it is no better than any other cath. Even if the disease is completely broken up, yet the patient shd be carefully attended to & treated like a sick person. Prof. T. has resolved 8 cases out of 10 even when the disease has been fully formed. Some of his friends think they have resolved a greater proportion Dr Todd, Dr S. B. Woodward etc. But if the disease is malignant or if the pat. has tampered with medicine, or put off the employment of a physician we cannot succeed thus Delirium tremens sometimes cal. is important where there is insusceptibility A single full dose in conjunction with opium will produce sleep with more certainty. But in the exhausted and broken down it will not answer Yellow fever agreed to be important difference of opinion as to mode of management Prof. T. finds neither purging nor salivation necessary It is agreed that there is not generally time to salivate. Useful in those cases in which there is great torpor & insusceptibility of the system with nearly a total suspension of peristaltic motion If the case is one of exhaustion and one which begins with diarrhoea cal. will be useless. In the other sort of cases tropical writers have given 1000 grs in 4 days without saliv. or purg. Prof. T. has given 400 grs in 4 days without either sal. or purg. In the same case he applied a 7 by 9 blister on the epigastrium one half as large between the shoulders blisters a quarter as large above the ankles 400 grs in molasses a teaspoonful once an hour Patient extremely delighted with the effects of both Stomach would probably have rejected a tablespoonful of bals tea. But in other cases a grain of cal. would pass off in half hour. In this case subsequently to the first 4 days quinine and a moderate use of brandy In the secondary stages of yell. fev. cal. is generally injurious Typhus putridis sometimes useful as in t. nervosus Synochus calomel is sometimes needed for purging oftener as a deobstruent Most practitioners bleed puke and purge and have to stimulate or have protracted and relapsing stages Entonic phlegmonous phlogotica Depletion & neutral salts at first afterwards use cal. for a mercurial action. Dr Rush’s compound of cal. tart. ant. & nit. potas. is the very best compound vary the proportions to suit the case. Determine the proportions just as if you were giving each separately Especially important is this practice in cephalitis still more so in pneumonitis In enteritis bleeding is still more necessary neutral salts will be rejected Calomel is the article for purging give your calomel clear to keep it from being rejected. This is the only cath. you will succeed well with. Atonic phlegm. phlogotica Calomel is very important no bleeding not so much purging s use blistering. Prof. T. has seen no atonic phleg. infl. of brain he has seen only strumous or arthritic or erythematic Atonic phlegomonous pneumonitis purging with a large quantity a strong mercurial action just as in the at. phl. hepatitis of tropical countries N.B. you must be more in a hurry to produce a mercurial action in these atonic infl. than in the others. Prof. T. thinks the weight of testimony among the tropical writers is against bleeding & drastic purging against J. Johnson Phlegmonoid erythematic erythem. known by the fever’s being [synoch] or gravior phlogotica Purge with cal. follow with calomel to produce a mercurial act. followed by serpentaria cinchona etc. Pure erythematic or gangrenous phlogotica (e.g. of fauces) calom. is injurious eryth. cephalitis & pneumonitis cal. is of more importance unless they are gangrenous Eryth. enterities is apt to have a diarrhoea generally has a diarrhoea cal. apt to purge corr. sub & especially red precipitate are better Of late years Prof. T uses conium even in some cases in dram doses Arthritic phlogotica calomel of high importance of late years Prof. T. has often gone back to the calomel practice. Case extreme pain in joints with redness & swelling extreme pain all over Cal. & opium until the pain was relieved it took 10 grs of opium with a diaphoretic regimen next op. & ipecac then a little castor oil to bring away the al. Finally alcohol & cinchona No case lasted longer than a fortnight under this practice. Next Prof. T. employed veratrum viride. Next he employed colchicum but it was inconvenient he has known persons cured of the rheumatism by colch but killed by subsequent diarrhoea Actaea is the best Sanguinaria digitalis Some conjoin calomel with these membranific phlogotica Croup hysteritis cystitis Calomel is universally agreed upon except in croup but even here though vomiting will cure cal. is better or rather both. Prof. T. has ceased to vomit in his own croupy family Strumous phlogotica more useful in the acute according to the general rule that cal. is more applicable to acute phlogotica Several phlogot. not referrible to these divisions Influenza Pneumonitis notha Cholera infantum Dysentery different modes of practice some [illegible] with large others with small doses both are proper in different cases In some epidemics calomel is inadmissible Case of the epid. at Midd. a grain of cal. or of ipecac would bring back the dysentery when it took 40 grs of opium a day to keep the disease under trouble with counsellors Epidemic (Egyptian) ophthalmia a bad disease It is the common practice to bleed the patient almost to death bad Purge with calomel give cal. & op. Bring the system immediately under mercury Treat like tropical hepatitis Conjoin actaea Sparganosis puerperar. Prof. T. has never met with a case in which it was admissible he does not doubt that they do exist Synochous exanthematica (Phlogistic exanth. are talked of but not described authors do not even suppose them phlogistic except a short time at the commencement) Typhus exanthematica contraindicate it Lues syphilis While it exists as chancre and bubo only it is purely a local disease and may be cured topically. 3 to 6 weeks ore even 3 mo saliv. is necessary to cure it through the constitution. Some use both but the topical are those that cure, even in this case But some claim that the absorption is prevented by the const. treat. Now medication cannot be thus [prevented] by anticipating the period of absorption according to the regular laws of the disease Mercury will not relieve the topical disease, without a sub salivation. Many practitioners suffer the pat. to run on a long time without sub salivation. But this may be produced in 24 hours by conjoining opium or perhaps wine & quinine Prof. T. has never known the constit. eff. follow when the disease had been cured topically. Even if they do it will be time enough to treat them when they occur Mercury will even hinder the healing of the topical affection When the father or mother infect their offspring without having symptoms of the disease left on themselves, and the children have a fatal syphiloid affection the affection of their subsequent children may be prevented by mercurializing the parents a curious fact! Prof. T. has sometimes cured such children by conium & corr. sub. The new way of treating syphilis has yet to encounter great prejudice When the const. symph. have appeared perhaps cal. is the best remedy. The others (cor. sub. & red prec.) do not produce ptyalism & a sub ptyalism is necessary The above is a very imperfect account of the therapeutic application of cal. It would require a volume to exhaust the subject Pneumonitis notha is or common pneumonitis always synochous or typhus. Atonic phlegmonous pneumonitis has a nervous fever accompanying it. N.B. Edema of the lungs (of Dr Hooker) is not a pneumonitis Erythematic cephalitis is the disease described as a fatal erysipelas of the head but the eruption comes not out till 3 or 4 days have elapsed and there is light generally on the face. Other erythematic empresmata are attended with eruptions somewhere that of the lungs (liver?) is on one or both extremities. Fever varies from synochous to t. gravior “I have never known calomel thrown up when put into the mouth & swallowed with the saliva” From [Savage’s] notes Tonics Produce increased strength of action in subordinate parts of the system e.g. appetite, digestion, pulse, muscular & mental action removes morbid mobility & irritability of atony Mr Abernethy says all strength depends on strength of digestion. But some tonics increase strength of art. act. (e.g. arsenic & cinchona) before they increase appl. & digest others first increase appetite & digestion & subsequently general strength. Hence an important rule for selecting tonics to suit a case e.g. Intermittent does not require those which act by increasing appetite Prof. T. has found the above true of cinchona, liliodendron & magnolia Tonics do not act rarely on the muscular system they certainly increase the contractility of the cell. fibre All tonics increase art. energy those articles which act on parts of the system without strength the arterial syst. are not tonic. Prof.’s I. & T. deny entirely that tonics produce ultimate debility They have known bark iron used many years with increase of strength Bark for 12 yrs vide Heberden Bitters are not necessarily tonics metallic articles are not bitter Some tonics, as cascarilla? bark of croton tiglium? etc. cinchona quinine require liquid food to make them sit well upon the stomach. So alc. requires food in exhaustion of fatigue Case of a traveller or laborer. The above tonics approximate to stimulants. Much depends on a knowledge of this principle in intermit. for inst. quinine may thus be prevented from producing a sense of stricture, nervous symptoms etc. If you excite the appetite, the stomach must have something to act on Tonics are indicated in some stage or other of all atonic, debilitating diseases They are better understood than any other articles Groups 1st tonica [amara] simplicia Limaronba excelsa (quassia of the shops) Quassia amara. Scutellaria [illegible] Little inferior to quass. & generally preferred by patients pure simple bitters like quassia [chelor??glabra] [illegible] [Hanth???] much used Canadensis like columbo a [???folia] hydrastis Gentiana [illegible] etc. The [illegible] gentians have smaller roots but are as good [illegible] [illegible] is best [chrymoplenum] [apporeti] [colum?] possessing the same smell taste & chem. prin. but pleasanter & preferred by patients [illegible] Canadense allied to Cocculus [illegible] (Columba) Menyanthis trifoliata buck bean Helnium autumnale Gratiola aurea These are mostly amer. articles & as good & cheap as foreign 2nd amara [nervousa] [illegible] G. [ochro???] is good G. saponaria is one of the best G. quinqueflora & other northern species are not so good Tops & roots are used. [lupules] (best) hoarhound Lycopus vulgaris (water hoarhound (L. virginicus is much feebler, but is most used Ballota nigra nearly allied to hoarhound 3d amara narcotici barks of cerasus virg. C. oborata the best of the genus Sorbus oborata & necrocarpa Pernica vulgaris barks of all of them 4th Tonica amara astringentia though some are merely astringent to the taste Cinchonae a large num. of species Corni C. sericea probably best next is probably C. circinata & paniculata C. florida inferior more astringent Querci Q. alba & tinctoria Alcornia latifolia Bodygin (alcorn [oaks]) Alnus serrulata (may be used for cinchona) 5 amara aromatica Galipea off. (angostura) magnolia glanca umbrella cordata etc. etc. valuable (elegant aromatics intensely bitter) Next is siriod. tulip. Ilicum floridanum (both aromatic & bitter) Croton eleutheria & cascarella & aromaticum (cascarilla) Tasmania aromatic similar caryea amara, squamosa, procina & alba (pungent aromatic acrid reminding one of guaiacum) Ptelea trifoliata bark of root & top differ considerably Hanthoxylum fraxinem (less bitter) H. tricarpum & H claraberculis (most valuable) Dryni winteri (winter bark resembles canella more agreeable almost a spice) Drynis of several other species Canella alba (called canella also) 6 Tonic. amara laxative [Federia] cordifolia (much used by the Spanish Americans the fruit) [Grellindina] [illegible] & bond cella Gallindina bondere (nickernut) [illegible] as [illegible] etc. blue & yellow nicker nut # Eupatorium perf. & rotundif. Polygala polyg. or rubellum (purges like aloe) but may be taken as a tonic without being laxative) A good bitter tonic & laxative in dyspepsia 7th metallina. Vinous prep. or iron ox. zinc hyd. bismuth sulph zinc arsen. potash & soda nit. silver Copper sulphate acet. & [nitroguret] (C. ammoniata) # preferred by g. Johnson to peruv bark in tropical climates Habille Carthagena Carthagena bean used in dysp. with torp. of bowels Arsenous acid White oxide of arsenic The word arsenic occurs first in [illegible] & applied to a sulphuret of arsenic used in painting Avicenna first recommended it internally The garlic smell is now known to arise from the dix-oxide which is the substance condensed on the tube & formerly called metallic arsenic Arsenous acid is seldom formed by chemists it is collected by the smelting of ores 77 ¾ parts and soluble in boiling water 1000 parts; in cold water only 2 ½ parts soluble in the 1000 parts. Composition 2 i ars. 7-6 ii 3 ox 24 = 100 In uniform & small doses, repeated acts on circulating system as a tonic increases heat (in a tonic coldness secondarily it increases appetite dig. power & ultimately after removing the disease muscular power Dr Potter (in his monograph) says it acts first on al. can. but its first perceptible effects are upon the sangiferous system No doubt it acts firs on al. can. but so do all remedies Given efficiently it certainly affects the sanguif. syst. before the app. & digestion. When given in nauseating & vomiting doses it of course acts first on al. can. More speedy than any other tonics but less so than the stimulants. It may be made to show its effects in 24 hours. It thus resembles cinchona in its effect on [illegible] & gangrene It has the remarkable fact that it has the power of restoring warmth to the surface though with no distinct relation to its tonic power Prof. T. has witnessed this perhaps 50 times Some patients have thus been saved. It may fail thus as an “analeptic” like other analeptics in extreme last stages This article seems to be an intermediate link between tonics and stimulants In larger doses it acts on the whole sec. & abs. syst. affecting the skin tumours ulcers etc. It is strongly antipsoraic relieves ulcers, cancers It is useful in rheumatism hence redolent Not discutient cholag. sialag. expect. or diaphoretic Acts on the brain & spine more than any other tonic & that too in remedial doses No other metallic preperation produces vertigo tremors etc. This operation has no name nor classification Prof. T. has seen however dilated pupils etc. in domestic animals from oxide & carb. of zinc. Oxide carbonate & ac. of lead act on the nervous system producing colica rhachialgia. Oxide and carb. of zinc have time immemorial been called poisonous and this must result from an operation on the nerves for they will not produce local irritation In large quantities laxative & purgative In larger it is emetic Externally applied it may be made to cure cutaneous diseases & to act as an escharotic. Dr Potter (Baltimore) says that in certain doses it is laxative and emetic It increases force and fullness of pulse without rendering it hard not admissible in phlogistic diathesis changes secretion and absorption is analeptic etc. not diuretic nor diaphoretic children bear larger doses than adults etc. N.Y. Pharm. “tonic, alterative, escharotic” Prof. Frost of M.M. Charleston says it is useful only as a tonic The injurious effects are caused by long continuance, rather than by a large dose so too of ac. lead. In acute diseases the larger quantities are of more consequence long continuance in chronic Antirritants enable larger doses to be taken generally opium in acute and conium in chronic. Veg. acids & aromatics assist it. When used freely conjoin liquid & farinaceous [nutriment] just as with quinine & stimulants The Philadelphians think it resembles tart. em. most not much foundation for this notion except as it vomits and purges Sulph. zinc of iron & of copper resemble tart. em. as much Even cinchona may be given in nauseating doses and all these then given are reducing of course Tart. emet. is of itself a refrigerant. We cannot class together articles which agree only in nauseating. Who would think of curing intermittent with tart. em. Tart. ant. & [illegible] are thought to agree in their antipsoraic power but the former is merely diaphoretic & has no antipsoraic power whatever Prof. T. came to this conclusion from observation before reasoning at all upon the subject. They both act upon the skin, but in different ways. To be sure some practitioners use arsenic in non phlogistic cases as a refrigerant & in the same way might sulph zinc etc. be managed. It is a kind of experimentum crusis that arsenic cannot be used in phlogistic cases Some suppose arsenic acts only by producing its own specific disease but it may be made to cure disease without any thing of this [effect] though this may sometimes be necessary [This] is true of all active medicines & when so pushed they produce diseases more or less specific Some think arsenic acts in a manner incapable of classific. & they call it merely alterative. But every remedy must produce an alterative operation of some sort or other and the alternative operation of arsenic resembles that of sulph. zinc of iron etc. & other tonics. It seems to be fashionable with some to deny the pathological conditions which are the foundations of the classific. of m.m. & they reduce every thing to a specific morbid affection overcome by another specific morbid action. Prof. T. thinks that all the operations of remedies may be classed Entony indicates refrigerants Atony stimulants etc. etc. Rec. [illegible] arsenic is 1st tonic strengthening pulse obviating debity increasing muscular strength etc. 2nd deobstruent curing cutaneous diseases cancerous ulcers resolving topical infl. 3d cath. 4th emetic 5 epispastic in the sort called escharotic & anti psoraic. Prof. T. thinks it far less injurious in its effect than polygala senega ornithogalum squilla & tart. em. (Hive syrup made of these three does more injury in a year than arsenic ever did) Tart. emetic causes many deaths, arsenic never does, when given as a medicine. It is accused of producing in inordinate quantities & when too long continued dyspepsia marasmus etc. But the same accusations have formerly been repeatedly made against cinchona It will never succeed when given rashly by dashing etc. as is so fashionable by larger frequent doses producing unequal excitement When too long continued & in too large doses it produces a puffy swelling of the skin & lips ophthalmia tarsi erythemia tormina etc. Dr Potter Good in his article on headache gives a summary of its ill effects These effects are more easily cured than such effects from tart. emet. An erythema vesiculare is produced by its analagous to that o f mercury. Case of Dr Todd’s pat. metastasis of pneumonitis probably arthritic to the brain took several fl. drams!! with 24 hours of ars. sol. of tinct. opii ([illegible] 120 and 240? tinct. canth [illegible]) & tinct. canth. in the second 24 hours 200 m. SS 120 m. t. canth 120 arsen. solut. In 48 hours hemiplegia cured erythema was produced with puffy swelling etc. In poisonous doses vom. purg ptyalism dysentery, haematuria sunken countenance paralysis convulsions etc. subsultus & death etc. etc. Dr Potter He says mucilages and oils are good for nothing as antidotes neither is sulphuret of potassium He directs to evacuate thoroughly & then treat on general principles Give castor oil etc. # Dr Bartlett gives as sympt. astringent metallic taste naus. vom. fetid breath ptyalism dysentery, distress etc. etc. It seems to be capable of extinguishing vitality without any of these effects in a transcending dose vide Orfila for a case So too vomiting doses will transcend its tonic effect & soon Arsenous acid retains its full powers in every form of combination, so long as its identity as an acid in combination, is preserved; so that, if you give any salt of it, enough to contain a given quantity of the acid, you get the same effects that you would if the acid were given isolated. Hence the folly of giving “chemicals,” as directed by the toxicologists. # The sequelae are dyspepsia, debility paleness, sallowness etc. etc. Pharmac. prep. 1st substance in pill Rx ars. ac. [illegible] fx. soap q.s. ft. massa in pil. 120 div (N.B. the salt thus formed in the same power as the arsenous acid) This is a very convenient prep. In acute diseases the dose varies from 1/24 to 1/12 gr. 3 hours to every hour (acute diseases) In chron. diseases 1/24 gr. 4 times a day is a minimum & 1/12 gr. a max. dose Tests of too large a dose [vertigo] etc. etc. tremors, nausea Either of them should cause the dose to be diminished Test of too much in 24 hours constant vertigo restlessness or tremors or headache general uneasiness sense of inflation at stomach or tormina or a laxative eff or a sense of inflation in epigastrium Test that pat. has taken it long enough puffy swelling under chin or face or ankles or under chin backs of the hands, a stiffness & [illegible] [illegible] slight ophthalmitis tarsi swelling of upper lip slight salivation or moderate tenderness of gums or a little ptyalism sometimes general swelling of body or erythema vesiculare. All go off soon if med. is left off. may exist several days without injury. Any one indicates a discontinuance Generally swelling appears first under chin & on backs of hands or wrists. Prof. T. has know them continue a week with no injury The salts of arsenous acid have the same effect as the acid & in the same quantity of acid 2nd Liquor arsenicalis Arsenite of potassa etc. etc. [Solutio] Fowleri Rx ars. ac. in very fine powder very pure carb. pot. aa 64 grs. distilled water 1 pint compd spt lavander zfs Boil & add the spt. lav. then add water enough to make up the pint. (Better add less than a pint at first say 14z & then fill up to a pint) This is Fowler’s original formula Phil. phar. N.Y. ph. gives arsenic ac. & sub carb. pot. & alcohol!! The compd spt lav has the advantage of giving taste colour & [illegible]. Case a colourless & tasteless sol. of ars. prescribed by Dr [Cogswell] for a [herpetic] patient. He refused to take it longer “as it was nothing but water” Dr C. told her wht it was & she refused to take it! This prep. gives 1 gr. ac. to 2 fl z of liquor hence 10 m. = 1/12 gr. & 15 m. = 1/8 gr. N.B. the solution requires a smaller dose the pill being gradually dissolved The liquid preparations of arsenic must be kept closely stopped & excluded from the light for the dis-oxide is precipitated on the inner surface of the bottle This decomposition will finally take place under any circumstances Pills shd not be given after they become hard Prof. T. has again and again known opium pills pass through unchanged. Pills of iron & conserve of roses may be cut & polished Rx arsenous ac. [illegible] fs sulph. quin zii sil. morph. 15 grs. ol. caps. f zfs. ext. daturae q.s. ft massa in pil. 120 div. N.B. Tonics are combined with advantage and narcotics is advantageously combined with arsenic This pill does not harden It answers extremely well in hemicrania & neuralgia etc. Each pill contains Therap. appl. 1st Pytal. ac. var. hydr. with secondary & advanced stage when it is subchronic very important it frequently arrests also useful in early stages when not too irritable & even in those combined with narcotics A most important article. Dysphagia constricta var. schirrhosa conjoined with conium [Dipsoneus] avens var. [illegible] conjoined with op. conium & capsicum Limosis dyspepsia Prof. T. has always used in various cases So has Dr Todd who combines quassia & ginger sometimes he conjoins conium or conium & veg. acrids So has Dr Reed who adds conium, dandelion capsicum etc. persevering in its use for a long time N.B it may be taken for a long time conjoined with veg. [ton.] conium & capsicum Prof. T. has even accomplished much with it alone preferring the substance Rx ars ac. [illegible] fs sub. quin zii ol. caps. zfs ext. con. q.s. ft. pil 120 often adding more conium or giving conijm in conjunction in short varying the prescrip. pro re nata Limosis sputatoria may always be cured by this article alone or combined Lim. syncoptica (cardialgia syncop.) here acrids are more important in in conjunction Col. rhach. combined with opium will keep the symptoms at bay. Opium is allowed to be the most important article in this disease but will not cure alone It is found that a free use of cal. is necessary corr. sub. better Prof. T. finds red prec. better still. Practitioners tell of given 5 gr corr. sub. every [2] hours!) Prof. T. has given 5 gr. red. prec. Fowlers sol. has been given in z doses without vomiting Arsen. has been given in gr. doses There is something peculiar as to the operation of min. med. in this dis. Dram doses of [illegible] have cured with opium opium shd always be combined Arsen. & strychnine are admirable for the paralytic sequelae with auxiliaries Colica callosa var. schirrhosa Epidemic cholera (it is the fashion to attempt its cure by strong impressions merely The originally incurable cases & the trifling ones shd be excluded) perhaps along with other articles it would answer well when the discharges have been stayed. Helminthia insisted on by Dr Potter the variety of this disease is not specified. It would scarcely be worth while to resort to it in any but H. taenia to improve the cond. of al. can. relying on cath. of ol. pin. to remove the worm helm. fasciola hominis (fluke or gourd seed worm) rather a rare & a very obstinate disease (N.B. in sleep the fasciola [ovis] passes into the liver up the ductus communis & cannot be wholly cured by cathartics may not this be the case with [illegible] case Prof. T. has never known a case of complete cure arsenic does much the most good seems to be by for the most effectual remedy) Helminthia erratica probably Proctica schirrhosa & parabysma schir. parabysma, strumosa arsenic conium acrids quinine cantharis conium & arsen or con. & iodine the best preparations iodine corrosive subl. etc. Bex convulsiva a long known and a well established remedy conjoin ext. con. which has been relied on exclusively Dr Beery has often found ars. pot. alone of the highest service in sequels of hoop. cough Intermittent next after quinine & perhaps the best bark in substance. It may be taken with less in convenience than bark and the latter cannot be given [illegible] to small children Vide Good for its history The instances of supposed derangement with particular doses are merely cases of too large doses for the particular circumstance Give say 8 doses in 24 h. instead of 1, 2 or more as directed by Dr Fowler (N.B. give a med. at the hours of 3, 6, 9, & 12 & but 2 doses will come in the night) Give 10 drops at least of SS. with each dose Trouble not yourself about the bowels they are generally well enough better give injections than cath. if the bowels are not spontaneously moved once in 2 or 3 days. It is well known that metallurgy in a neighborhood cures & prevents intermittents Dr Good’s case of Cornwall is not the only one known The dose shd not be large say 5 to 10 drops nor the quantity as to produce the tests often once in 2 h. never less often than once in 3 h. sometimes once in 1 h. always conjoining opium ( which itself will cure interm.) Periodicus remittens as useful compared with quinine as in intermittent though not as important in the former as in the latter. It is even said to be more unfailing than in inter. Typhus nervosus seems absolutely to be the best tonic better than quinine to be given to check coldness & cold sweat & to change secretions always when mercury seems to be indicated always conjoined with [opiate] & food perhaps with acrids sometimes 2 drops once in 2 hours or 5 drops every 3 hours sometimes more sometimes less. Typhus syncopalis vide Danielson & Mann’s account It has been used in every epidemic Anthrax pruna just as for gangrene Erythema gangrenosum but sul. quin. is of more consequence Erythema anatomicum saved several cases known to Prof. T. before quinine was discovered in one case 10 drops an hour. In but one of several cases which Prof. T. has known was there a puncture all of them resulted from exan. recent subjects one case began by a sensation resembling a sting & a minute discolored spot on the middle & fore side of the fore-arm. Ophthalmitis tarsi & psoriasis palpebrarum (which exists) probably would cure as it affects the eyelids Ancheritis strumosa (glands of neck) Cephalitis strumosa [illegible] [illegible] etc. Arthritic cephalitis highly useful Paristhm. erythem. var. putrida Pneumon. typhodes erythem. & syncopalis & putrida (gangrenous & Pneumonitis arthritis ver. atonica So arthritic carditis, diaphragmitis, & gastritis Cholera infantum Enteritis aphthosa (Prof. T. has seen two p.m. ex. which showed the whole al. can. affected) Dysenteria typhodes in the latter stages with opium even in the early stages Prof T. has known it beneficial combined with opium & used instead of calomel Mesenteriti strumosa (enlarged mesenteric glands) may almost or quite be cured in its early stages Give acrids quinine, iron cantharides, conium & especially arsenic Eryth. infl. of liver (hepat. typh. var. putrida) in secondary and exhausted stages. So to [peritonitis] typhodes var. putrida All the varieties of true rheumatism in some stage (even in the entonic, after depletion & reduction One var. of rheum is phlegmonia another is [erhthematoid] (not mentioned expressly in the books and a very formidable disease prof. T. has known one quarter of surp. of body gas [illegible] after depletion & reduction) opium conium quinine alcohol conium actaea arsenic Subacute rheumatism may often be cured by arsenic alone. Prof. T has known bed rid persons cured this seems to be the best article. The sub-variety of this disease produced by mercury are especially benefitted by arsenic Chronic stage of acute rheum. benefitted by ars. but more especially by aralia [bispida] Podagra larvata (atonic gout (Cull)) a form of rheumatism as resembles this (Theumatism larvatus) Rheumatalgia useful with conium & nux vomica more useful as it is more acute particularly when there is an early tendency to paralysis of extremities but should then be combined with ol. pip. nig. or ol liriodendron ol. caps. etc. [illegible] conium, nux vomica hyoscyamus sciatica useful conjoined with narcotics I have often cured [with] sometimes relieved by mercury when first commence & by other means arsenic one of the best articles where established Secondary & exhausted stages of scarlet fever Erythysmus hydrargyrata & tabes venenata Ricketts I have known it used with beneift in the early stages [illegible] syphilodes & syphilodes (vide Good) with black pepper much used in the east (vide Good) There is no doubt of its efficacy in S. syphilodes. Perhaps there is doubt as to true syphilis Arsenic is peculiarly valuable with quinine and opium in the ulcerations etc. from syphilis & excessive use of mercury Useful in syphilitic eruptions Carcinus vulgaris highly valuable it has sometimes produced sloughing & a cure the difficulty in managing it is that practitioners are too much in a hurry attempting to take the disease by storm and not conjoining supporting remedies & narcotics cancer is a disease always requiring support it is a disease of the abstemious never of the high living & gouty Prof. T. has known it so employed & the health improve. But iodine is better & next after arsenic is corr. sub. arsenic is next to iodine (vide Good) IT is the basis of almost all the secret remedies for cancer. of course caution is required for its use There is no foundation for the notion that the system geta accustomed to this remedy & ceases to be affected by it in such cases the dose should be increased similar assertions are made respecting opium & with no foundation. The great difficulty with authors has been that they supposed they must give it alone & only twice a day Prof. T. has witnessed several cases of unquestioned cure & others of great palliation and mitigation Elephantiasis arabica has been highly successful (vide Good) used in the east, with a considerable quantity of black pepper. “It is proved beyond all doubt that the disease has been cured by arsenic” Prof. T. has known a few cases and all were cured by arsenic alone [B??nemia] Indica Prof. T. has seen several cases and Good has done ill in associating it with spargm. puerp. which is a phlogisticum. His cases were cured by arsenic alone Gangrenous sphacelus arsenic seems preferable, perhaps, to bark though not to quinine Prof. T. has known gangrene or [illegible] [illegible] of paralytic rheumatics cured by arsenic So to of gangrene after typhus Gangrena necrosis (dry gangrene Gangrena []?staliginea] (mildew mortif.) recommended I have known vitiated ulcers highly benefitted Hypochondrias recommended Trismus & tetanus arsenic & datura & opium have cured bad cases. vide N.E. Journal of Medic. Prof. T. has known several cases cured by it. actaea too is often useful Neuralgia faciei [illegible] etc. but generally it is badly managed some cases may be cured by quinine alone arsenic alone, opium alone etc. but generally a combination should be used N.B. keep the pot. under the influence of it all the while not merely during the paroxysm Clonus palpitation & singultus are occasionally relieved by arsenic Singultus of typhus & low pneumonitis typhodes is best relieved by arsenic [illegible] case of 200 drops in one night Chorea sometimes cured by this with strychnous, quinine etc. Lysse canina some cases apparently cured Common convulsions [of infants] occasionally Hysteria epilepsy sometimes are tonic Paralysis one of the most valuable remedies with iron acrids etc. Distortion of face from paralysis Sarcoma schirrhism (curable by extirpation even at an advanced stage Prof. T. has never known a complete cure by extirpation of carcinus vulgaris Dropsy of abdomen after evacuation of water supposed to be be peculiarly appropriate Leprosy (vide Good) peculiarly valuable Lepidosis psoriadis arsen. con. etc. particularly valuable after a very severe disease (vide Good) Ecpyesis impetigo, herpetica (herpes of Cullen & herpetic eruption of authors) always curable by arsenic if persevered in useful also eternally in a weak solution Ecpyesis imp. [lamin.] (salt [illegible]) about the hands cured by a weak ointment of [arsenic] N.B. medicines will not cure when applied only when the disease is so irritable (in a sort of paroxysm) that the phys is sent for they then require only emollients the arsenic shd be applied about 8 grs arsenous ac. to 1 oz simple cerate to commence with first finely pulverizing the arsenic & mixing it with about a dram at first of the cerate to make the mixture homogenous (N.B. not a glass but a Wedgwood’s mortar pulverization cannot be effected in a glass mortar) [Ecpresia] [?origo] galeata Prof. T. has cured cases which had resisted all other remedies internally & externally Punctura venenata (vide S. Coop. Surg. Dict. last Am. ed.) used successfully time immemorial in India In Ohio they cure by laudanum giving enough Dr McBride & Dr Osborn of N. York who had practised at the south, considered alcohol infallible The people sometimes get down a gallon of spirit in 24 hours. [Celsus’] remedy was vinum cum pipera [cernatic] snake pill is Rx arsenous acid root of vella navi of another seed of croton tiglium live quicksilver, black pepper aa equal quantities each pill to contain 6 grains each pill will contain 1 gr to a teaspoonful of Fowler’s solut. and 2 or even four pills are sometimes given Case of Mr. Ireland pat. insensible in 10 min. fl. zii Fowl. [min.] sol. etc. at once. (Dr Hubbard’s case repeated once every half hour until an ounce of Fowl. sol. or 4 grs of arsen. had been given. Four other cases cured in the same manner. Cinchona First introduced into Eur. in 1640 Condamine saw the plant first in 1737. Linnaeus called all the spec. C. offic. (including C. condaminea & pubescens) C. condaminea is believed to be the original “bark” near Soxa a slender shrub 18 ft. high There are now made 8 distinct general 1st cinchona 2d pynchnea exostemena etc. All the species are bitter and tonic but none are remarkably antintermittent but those with hairy & woolly blossoms Decandolle gives 16 species of cinchona Pynchnea has but a single species in S. Car. Nat. Order Cinchonease Three species are made offic. in Brit. phar. 1st cinch. cordif. supposed to produce yellow bark but it is found not to produce it Yellow bark has odour aromatic etc. internally of a yellowish cinnamon the particular species affording it is not known contains 1st [illegible] of quinine & a little [illegible] of cinchonum 2nd tannin (a little) 3d a yellow odorous [adipocere] 4th a yellow colouring matter 5 a red colouring matter 6th [illegible] of calcia 7th fecula Cinchona lancifolia affords the pale bark though by some to be identical with C. condaminea or a variety less bitter than the preceding cinnamon coloured internally. C. condaminea contains [mainly] kinnate of cinchonine with a little kinnate of quinine with other unimportant princ. Cinch. oblongif. supposed to afford the red bark but found not to producing an inferior bark odour and taste similar to the last but more intense bark red 2 Kinnate of quinine & kinnate of cinchoniae in about equal quantities said (doubtful) twice as much of one & 3 times as much of other. The true species which produces red bark is not known. The barks of all the species are collected indiscriminately and afterwards assorted according to colour probably it is impossible to assign the true species. Cinchomine is a white alkaline substance soluble in 7 or 800 pts water decomposed at about the temperature of boil wat. little soluble in ether ([hydric]) made up of carb. nit. ox. & hyd. Quinine is a white flocculent alkali soluble in wat. very soluble in alcohol taste much more bitter than that of cinchona less soluble in water very soluble in hydric ether & thus distinguished First brought into notice in 1820 by [Pellit] & [Cam??ton] Kinnic acid is found only in bark & not medicinal Kinnate of quinine is very soluble in water but less soluble in alcohol Kinnate of cinchonum is more soluble in wat. & is more astringent (if indeed the kin of quin. is astringent at all) Water is incapable of extracting all these salts from the finest powder of bark not more than 1z of the whole hence the dregs are worth saving for the extraction of the quinine & cinch. from them N.B. none of the veg. ac. have as strong attraction for bases, as the mineral acids & generally sulph. ac. has the strongest attraction hence very dilute sul. ac. will dissolve out all the quinine & cinchonium & we have a liquid solution of sul. quin. & cinch. Ammonia will take away the acid # then macerate in alc. & various impurities will be left then distil off the alc. till the liq is muddy then cold distilled water will precipitate the alkalies repeat the process for purification if necessary The [illegible] is not in quantity to act medicinally but will destroy tart. ant. or sulph. iron or gelatine hence too an infus. of nut galls is a test for distinguishing active from inert barks, by forming a precip. of gallate of cinchonium ([illegible] is [art]) Much inert bark is sold [illegible] a pat. took inert bark for 12 weeks then was cured by good bark you cannot tell by the taste All the best bark is now used by the manufacturers of sulph. quin. & the’ poor bark is pushed into the market # and decant off the liquid sulph. amm or use a magnesia in the same way But we should never used the crude bark it is better in no respect whatever And sulph. quin. is now cheaper. Connecticut practitioners know little about the matter not having opportunities from endemic influence. N.B. Some practitioners conjoin tartar emetic with bark the latter destroys the former the former does not injure the latter Tannate of antimony is perfectly inert It is stated that 2 fl. oz of decoc. cinch. (zi to 1 pt. water) renders inert [illegible] I tart. ant. consequently a pint would decompose tart. em. zv So too bark is incompat. with the salts of iron Food is generally required with bark but bark with animal jelly will form leather! in the stomach Gallate of quinine & cinchonium is supposed to be nearly inert Case in which an [illegible] phys. rendered bark palatable by nut galls! the mixture was pleasant but perfectly inert The proportions of acid & base in sulph. quin. & cinchon. are not well known Adding a little sulph. acid renders them much more soluble forming a salt with more acid N.B. if the mixture then becomes acidulous, add a little more sul. quinine. Prof. T. has always found acidulous sulph. quin. more instead of less nauseous Case related Phosphate of quinine is said to be better than sulph quinine said to contain some of the powers of phosphorus doubtful should be attended to Some think the acetab. better others think it worse probably little if any difference much less soluble very liable to precipitate when it grows colder. Tartrate oxalate gallic etc. are insoluble in cold water. The isolated bases (quinine & cinchonium) are less soluble than the sulphates or are insoluble but they are no less active The French to the contrary notwithstanding. Crude bark is very variable in strength offends the stomach etc. In tinct. requires too much alcohol For these and other reasons always use the prox. princ. Cinchoniae & quinine are found by Dr Elliotson to possess precisely the same powers as their salts Montannin has been extracted from C. montana equal to quinine & cinchonium in utility Chlorium bromine & iodine form inert compounds with all these alkaline proc. [prac.] [prin] still they will into decompose their salts The only medicinal operations of the 3 species of cinchona are the same in kind if not in degree They are all permanently & strongly tonic with a moderate degree of astringent power Quinine & cinchonine are not astringent Caventon & Dr. Theodore Woodward (a very susceptible person) have experienced nervine exhiliration from quinine “in large quantities however 30-60 grs a day” Other persons experience this effect. Dr Woodward always experiences exhiliration This is one of the tonics which is felt in the circulating system before it affects the digestive organs. It is by no means remarkable for giving an appetite In some cases where large quantities in a short time are indic. (as in interm.) the appetite is actually diminished. It is inferior to many articles for the appetite & digestion. It may require several days to affect the appetite Called stomachic Called febrifuge by which is meant that it is appropriate for intermittent Called antiseptic i.e. stimulant or tonic The yellow bark is considered best (it is said) in Peru. Some think red bark nauseates more Bark produces no inconvenient effects but nausea & diarrhea in large quantities Dr Th. Woodw. says the only unpleasant effects from the largest quantity of sulph. quinine are a sense of astringency in the stomach & a sense of faintness which however he relieves at present by always giving a little food (milk porridge for instance) A Frenchman (Blonde) is said to have noticed a short continued deafness, produced by a large quantity of sul. quin. Probably he mistook a symptom of the disease for the effect of the medicine Dr Elliottson cured nearly 200 cases of fever with sul. quin. 5-10 gr doses & inferred that it is adapted to phlogistic fever. He meant irritative Equal confusion exists about the use of bark in acute rheumatism Most of our cases of acute rheumatism at the present day are atonic and many of our practitioners give quinine freely in rheumatism & relieve heat, dryness of skin etc. Some of them infer hance that bark is adapted to phlogistic fever It is the fashion to call bark a congesting tonic. It was the fashion long ago to do so. But Sydenham Morton & others denied this No foundation for the notion that this article may accumulate in the system or its effects accumulate upon the system. Arsenic, mercury instead of accumulating in the system produce a slight set of changes which go on increasing Prof. T. does not believe that disease is ever produced by cinchona after health is restored no effect will be produced. Dr Ives is of this opinion He has known it take for a year or more with benefit. Heberden knew it taken for 12 years with advantage etc. Admissible in all atonic contraindicated in entonic diseases Pharmaceutic preparations The salts of quin. & cinch. are sol. in wat. & insol. in alc. Quin. & cinch. by themselves are sol. in alc. & insol. in water Yet is laid down in all the books that alc. is the best menstruum this can hardly be true (probably the mistake has arisen from the utility of the alc. of the tinct. in intermittents) Infusion is better than decoction Boiling almost destroys the properties of cinchona Maceration in cold water extracts but little. Yet the pharmacop. direct to boil 15 to 30 minutes Never boil but about a minute Pour the water boiling hot on the powdered bark than stand scalding hot ½ or ¾ of an hour then boil it up about a min. This gives a decoction [illegible] Troy oz. bark saturates a pint of water Make the infusion in the same way but do not boil up at the end 1 Troy oz (1 oz. of avoirdupois oz. will not being less) saturates 1 pint of proof spirit It is not worth while to give in any form but substance in intermittent in any form but substance in continuous fever, as it will be thrown off or pass off. Therap. applic. 2st Intermittent Quinine the most important medicine In all pure and uncomplicated cases of quot. quart. or duplic. types these salts may be considered as infallible remedies. If costive, purge once with calomel (the best agent) Check diarrhea with opium. If stomach is full, vomit with sub. zinc, copp. or turpenth min. or purge with calomel. Perhaps in no disease are emetics & cathartics as much abused as in this It is a routine Sometimes the disease is thus brough back There is generally a natural state of the bowels, no fur on the tongue etc. Sulph. quin. & [illegible] are equally admissible in the cold the hot and the sweating stage & during the apyrexia. Many deny this, and yet give large quantities just before the paroxysm even [the] min. before! The article does not operate all at once but gradually Generally Prof. T. does not interrupt a paroxysm when he is first called Sometimes however he gives a large dose of quinine to cut short the cold stage & bring on the hot, or in the hot to bring on the sweating stage immediately Inappro 3 grs to [illegible] i is the appropriate dose once in 2 to 6 hours Quin., & cinch. require the same quantity as their salts [illegible] i is the smallest quantity with which Prof. T. has ever cured a case more would have been better Prof. T has known 10 grs. once in 2 hours necessary to suspend the paroxysms A writer in the Philad. Journ of large experience in intermittents lays down 20 gr. once in 2 hours as the common dose for all cases Case of a phys. who was much surprised to hear Dr [March] doubt the existence of phlogistic intermittent he took him to see such a case in the hot stage Dr March gave 2 or 3 grams of opium & cut short the parox. in 30 minutes He gave sul. quin. & the pat. had not another paroxysm A timid and inefficient use of sub. quin. will even aggravate the disease Just as with opium Dr March has repeatedly been called in clandestinely to cut an intermittent short at once which had continued under an able phys. 6 weeks! Time of continuance is variable Do not suspend the remedy immediately after the cessation of the paroxysm especially if the pat. is in a very unhealthy situation Perhaps a dram should be considered the minimum quantity to prevent a relapse Under the treatment here recommended not more than one paroxysm (not even a single parox.) after the physic. is called in should be permitted of course in pure & uncomplicated cases Mode of administration Sul. quin. & cinch. may be given either in solution in water or if you want the smallest possible bulk add a little of some acid just enough to render it soluble without giving it an acidulous taste (The combination of sulph. acid & bitter is offensive to taste) or diffused in wine or brandy & water or diffused in syrup of sugar or in pill, when the stomach is irritable pilled with ext. gentian pills made before hand get to be too hard & are to be rejected When the stom. is irritable an acrid is indicated and capsicum is the best (It is not stimulant but [illegible] irrit. to much [illegible] not acting on the blood vessels but on the muc. memb. increasing susceptibility to other remedies) Powder of bark also will cure most intermittents. It too may be given at any period of any stage though it is very liable to be repeated during the paroxysm especially during the hot stage. Sometimes bark in substance cannot be given in suffic. quantity without vom. to enable it to effect a cure Give [illegible] i to about zi 2 to six times a day Give it diffused in some liquid Still it is not worth while to retain this mode. If the stomach is very irritab. pills may be given of alcohol extract give as much as of the powder. Infus. & decoct. are too weak for intermittent Tinct. requires too much alcoh. Tinct. of bark has cured but then it was by the alc. not by the bark. Saffron (canth. tinct. and [rum]! have cured Those who do not live in an intermittent country, are apt to suppose that there are many cases in ‘ which sulph. quin. is inadmissible Prof. T. does not believe so. he has seen many such cases and thinks they were all caused by injudicious management. Some of these physic. suppose cal. & op. is curative in many such cases they talk much of it. But long ago it was settled that cal. & op. are not curative but merely preparatory (vide Good for an interesting experiment when the stock of bark was exhausted on board two ships of war They merely suspended but did not cure the disease) Physic. have more prejudices against quin. than against any other article unless it be opium & alcohol. N.B. The Parisian phys. practice upon the principle of giving large doses of sul. quin. Some suppose the intermittents of the south do not tolerate quinine so well On the contrary much more quinine; required because the disease is more intense. The practit. there use it too inefficiently. Dr. Mac Bride stated this to be wholly true Sometimes the disease will be accompanied with morbid secretions in large quantities, and hence quinine is supposed to be inadmissible. On the contrary give (after purging with cal.) quinine to cure this as it depends on the endemic influence. Sometimes the stomach is so irritable that 32 grs. of quin. will not stay on the stomach and hence it is thought to be inadmissible Give 10 grs. at once to cure the irritab. as it is produced by endemic influence Case of a woman who had long taken sulph. quin. in small doses with this effect certificates from physicians that sulph. quin. disagreed with her She was immediately by pills of 6 or 8 grs. sulph. quin. made up with ol. capsicum. Numerous such cases used to come down the canal to Rochester & be cured by T. [S] M. at Albany But intermittent is often complicated or disguised 1st Interm. accompanied with diarrhea which sometimes continues throughout the disease. Cure these by quinine and opium. They are cured as suddenly as the others If necessary we may conjoined resin of hanthorrhea [hostilis] (so effectual for diarrhea) or tolu or 2nd Intermittent complicated with cholera commending with rigor & an urgent parox. of chol. which terminates in the sweating stage and so continues day after day without a suspicion of the nature of the disease Give acrids in the paroxysm & quinine in the apyrexia 3d Intern. complicated with dysentery physic. will sometimes suppose they must wait and cure the dysentery first Give no mercury unless corr. sub. Given quinine & opium 4th Intermittents complicated with jaundice puzzling to young physicians bilious diarrhoea & akin a deep orange Give at first opium enough to check the diarrhoea & then suspend the paroxysm with quinine You may follow afterwards with conium to remove the yellow colour of skin 5 Interm. complicated with parabysmata coacta (Good) Many suppose that quinine must not be given until the parabysmata have been cured Cure with quinine Prof. T. has had testimony that quinine would cure parabysmata the sequels of intermittents Dr. Bristol said it was cured in Paris by 6 or 7 grs. of quinine 5 or 6 times in 24 hours better than by any other article. Prof. T. has generally used conium in conjunction 6th Intermitt. complic. with delirium a disease more formidable than dangerous. Cure by quinine though perhaps datura etc. might advantageously be used “opium will sometimes cure such cases 7th Intermittent complicated with syncope. Paroxysm comes on with syncope. Pat. obliged to keep his bed in the intermission Cure by quin. 8th Complic. with convulsions especially in children If called in a paroxysm give a large dose of datura then cured by quinine, as soon as possible Often you cannot give the quin. to children on account of its bitter taste Then give arsenic & opium perhaps as often as once in 1 or 2 hours 9th Complic. with epilepsy One of the most frightful & alarming forms Pat. comes out of the fit and sweats A few years ago such cases were always fatal Get down a large dose of datura and if necessary repeat it & follow with quinine Cure by quinine in the [illegible] [etc.] Complic. with catalepsy of no consequence a trifling disease is catalepsy Complic. with lethargy equally unimportant quin. cures Complic. [serous] apoplexy of Cullen (not sanguineous) quinine will cure Dropsy Purge with elaterium & remove the fluid & the cure by quin. If dropsy remains after the cure give digitalis tinct. cantharides tonics etc. Disguised Intermittents 1st Hemicrania severe cured as other intermittent Well known as a disguised form to persons in an intem. country 2nd Neuralgia (facies etc.) (vidd McCullock) cured by [the] remedies for intermittent. Case of Dr Th. Woodw. attack in calf of leg & this repeatedly for years which would be cured by opium but he would be sick the next day it was found afterwards that datura was better It takes the form of nephralgia ophthalmalgia rheumatalgia etc. 3d Dyspepsia mistaken & treated wrong 4th Hypochondrias & mistaken 5 Typhus (but it will not have 2 parox. in 24 hours as true typhus always does ruins on indefinitely) cured by quinine. This has no crisis on the 14th day as typhus has 6th Phthisis Case of a man from Rochester who came back to Connecticut to die of phthisis. Prof. T. was puzzled found opium did well and finally under the use of opium the pat. had a regular attack of intermittents Prof. T. then cured him by arsenic (as he was so afraid of being poisoned that he would take scarcely anything) given clandestinely Case cured by Dr Todd of a young lady who had come to Hartf. to die. # Remittent not time to say any thing upon the subject # Story of a young physician in N. York who detected an intermittent counterfeiting hectic & got into practice [From Savage’s copy of Talcott’s notes To be inserted in the blank space which occurs in the article actaea] “Atonic acute rheumatism rheumatismus The more acute the disease the more successful has Prof. T. been with actaea more successful while the febrile aff. is strongly marked and the topical affect. has a tendency to wander. When called, ascertain if the pat. is costive, if so give a dose of calomel over night & opium sufficient to allay pain give the opium first & if it takes a good deal to allay the pain, why give more Keep by the calomel (12, 15, 20 or 3 grs according to susceptibility & other circumstances) not less than 12 nor more than 18 hours give cal. sufficient a free evacuation. After this commence with actaea & opium at regular & short intervals say f zfs of tinct. act. every 3 hours as a general rule, some requiring more & some less. The test of the quantity is the effect on the brain. Let the brain be moderately affected but not so as to produce a troublesome narcosis. It is necessary in some cases to affect the brain more than others. In some the disease yields before the brain is at all affected, in others Prof. T. has been obliged to produce a troublesome narcosis. Opium must be given in conjunction in quantities sufficient to meet the symptoms & keep them under 1 gr or more every 3 hours may be required. If the pat. has been tampering with medicine, purging with salts etc. often the cal. will not be needed & we may enter at once upon the use of actaea so too if the bowels are free When the disease is fixed upon some particular part as a joint, topical applications will do good & actaea is not so successful though even here it is useful Under this use of actaea all the tumefaction, redness, soreness & pain of the acute form disappears, often in 12 hours sometimes not altogether till 24 or 36 hours the constit. feb. affect. disappearing at the same time in by far the greatest proportion of cases though in some the fever goes on to the next critical period. The remedy shd be continued in diminished doses to prevent a recurrence. Opium alone will sometimes answer but it is better to combine it with a reduced quantity of the deobstruent. The pat. is not perfectly well after the resolution, he is weak, feeble & languid & a little exposure or over exertion will bring on the dis. again unless the medicine is continued Prof. T. has failed with actaea in only two cases of genuine acute atonic rheumatism and then the patients could not be induced to take the remedy longer than while present relief was afforded which was effected in both cases. Dr Woodward of Wethersfield writes (1830) that he has used actaea in subacute rheumatism (meaning that form which I call atonic acute) in catarrhal phthisis in catarrhal cough & in neuralgia. He considers it one of our most valuable deobstruents, combining the powers of digitalis, sanguinaria & colchicum I [illegible] hardly ever saw it do much good till symptoms of narcosis were produced. The following are the effects of a moderate quantity vertigo, headache, impaired vision, dilated pupils. epigastric uneasiness, diminution of frequently of beat in heart & arteries (but it was irritative frequency of pulse) Dr Woodward has seen decided narcotic effects from 15 gtts of tinct repeated every 6 hour, & from teaspoonful doses violent narcotic effects & hypercatharsis (the last effect I never saw & am inclined to think it accidental or produced by something else) this was followed by a rapid subsidence of the rheumatic affection. Dr W. says he has always found it most beneficial in doses of 25 to 30 drops. He has found it very useful to allay cough & also arterial irritation. In two cases of atonic acute rheumatism following rosalia, one was treated with actaea the other with colchicum both were speedily cured Dr Beers has also used it successfully in the same kind of cases Dr Woodward thinks it more manageable & successful in inflammations of an atonic & acute form, than any other article. Dr Tully thinks so too. Dr W. says a popular article in his neighborhood is Wright’s cough drops, which he thinks is a proof spirit tincture of actaea In subacute rheumatism actaea is useful. In [mercurial] rheumatism, which is always subacute it effects as speedy & effectual a cure as in the acute, but we must conjoin opium & follow with tonics Arthritis rheumatalgia such as is unattended with redness swelling etc. chronic rheumatism (popularly so called) characterized by pain, especially on motion, without swelling etc. with no febrile disease, essentially, though there are often febrile paroxysms. Some of these cases are acute the attack is sudden, the dis. of short duration & confined to fixed periods. These are specially benefitted by actaea. When this species is subacute (often met with in boys who have continued too long in the water I formerly failed, but think I should succeed now. In the perfect chronic form of “chronic rheum.” occurring in old men & continuing year after year joints almost paralytic not much is to be expected from actaea though the exacerbations may be palliated A cure will not be effected Arthritis neuralgia neuralgic rheum. (Fothergill’s sciatica) The first symptom of an overdose is felt in the sciatic nerve though this is the peculiar effect of the article yet it will cure this neuralgic affection. Arsenic, opium & actaea will cure sciatica speedily & effectually. I give the arsenic in efficient doses giving a pill of arsen. acid ¼ gr & sulph. morph ¼ gr every three hours, with the actaea Sometimes I give a cathartic of elaterium previously It yields to this course Bucmenia sparganosis Some cases in extreme exhaustion supervening often severe hemorrhage; are often perfectly resolved by actaea The pathology & location of this disease are disputed It seems to affect all parts of the limb except the bone The lymphatics are supposed to be its peculiar seat. They are undoubtedly affected but the dis. depends on the specific nature of the affection, not on the part involved There are different varieties of it & the treatment must vary accordingly When it occurs among the debilitated females of cities, nauseating deobstruents cannot be borne not even calomel. They produce irritation, reduce the patient & aggravate the general symptoms or pass off by the bowels. Among delicate females [illegible] alcohol, & cinchona are required & these are the articles which I have always known to be indicated. But among females in the country & when it does not follow hemorrhage or derangement of the digestive organs (I have never seen such cases) calomel is useful & the more irritative the cases, the better is the actaea Ophthalmitis of this there are several species, depending upon several specific sorts of infl. Of O. conjunctiva, there are 3 varieties 1. common 2. purulent (of infants) 3 epidemic or Egyptian. Perhaps there is also another kind a chronic form with spongy granulations on the inner surface of the eyelids though this is perhaps a degree of the first variety. In the common ophthalmia there is often [chemosis]. In this form actaea is discovered to have great power & is now often used. Dr Noble of Albany gave fzi once an hour, all day long, till severe narcosis was produced at night, when he stopped the article & resumed it next day. Nothing else was used & the cure was effected in 2 days. I think Dr N’s mode of giving freely & suspending at night, the best. The more acute & recent the case the more speedy the cure. If a cath. of cal. is indicated it had better be a slow one. Narcotics are not so manageable in infants, they cannot communicate their feelings; hence this course would not answer for the purulent ophthalmia & we must rely more on topical applications. In Egyptian ophth. I have great confidence in actaea A. corneae specif. ulcerative infl. of the cornea nit. silver, however in conjunction Dr Noble has used it in this way I have since known others use it. This is also an infl. of the sclerotic coat. It is never phlogistic. Those mentioned above are not but are all specific inflammations. All the cases that I have seen of infl. of the sclerotica are rheumatic or arthritic I do not believe Sam. Cooper’s doctrines & I think his cases are not true in fl. of the sclerotic Drs Knight & Woodwd of Vt agree with me. In this infl. of the sclerotica actaea generally succeeds perfectly and sometimes it fails utterly. I can not discriminate the cases Porphyria hemorrh. & nautica I think little of the treatment in the books they proceed on the principle that diet is enough to cure it. It is caused by bad diet etc. but shd be treated on general principles. Stimulants & astringents are required sugar of lead, opium & brandy with farinaceous diet constitute the proper mode of treatm saying to him “I would not trust to that boy” The pat. reposed confidence in Dr I but said to him “I must have counsel called to satisfy my friends” Dr I. called a man 70 years old The pat. says “I believe the boy has done well”! Prof. I. will never forget his sensations he was mortified & grieved. Afterwards he put on a quaker hat! to appear more old! Let judicious clergymen be called Dr when it is proper Dr Rush said “when the earthly M.M. fails apply to the heavenly” Prof. Ives’ paternal lecture 1833 Be especially careful in your primary observations. An [illegible] read in the [pentateuch] “& the tabernacle was covered with beggars’ skins” He turned to his audience & observed; to the audience “You see my friends the difference between the law & the gospel. The poor have the gospel preached to them, but under the law a beggar! could not be seen about but his skin; was immediately taken off to cover the tabernacle!” If a young physician dislikes his profession, the sooner he abandons it the better. It is difficult to distinguish between genius & a fondness for a pursuit. Dr Rush remarked that he would practice medicine as long as he could walk, when he could not walk, he would ride [illegible] he could not ride he would be carried to the bed side “Least than a wise on hi own eyes, there is more hope of a fool than of him” It is a most unfortunate thing for a young man to suppose he knows all that is to be known Diogenes laid him self down to die, saying he knew all that was to be known There came in a beggar boy to borrow fire. Diogenes told him he had nothing to carry it with “Fi you will give me the fire I will find means to carry it” He put some ashes in his hand & a coal of fire upon them! I will not die says Diogenes for a beggar boy has taught me a knew piece of knowledge! The boy understood the fact well though he could not express it in the language of ashes being a nonconductor of heat. Dr Rush remarked that he had learned much from nurses Moral principle A stranger said to Dr Monson “I wish to employ you in a very delicate case & will pay you handsomely” Dr M. replied “Sir you have not money enough” “You know not how rich I am” “If you had ten thousand times as much it would not be enough to pay me for loss of reputation & conscience” Prof. I. has often been called on to produce abortion & that too by men & women of the first standing in society to produce abortion he has been appealed to in the most moving terms “would you sacrifice a family” “I am somebody likewise” must I lose my conscience & character” The person would threaten to commit suicide. “You had better not but if you do I cannot help it” Suicides however are sly about the matter Prof. I. has known many of the infidels of the last generation They were the most bigoted & superstitious set of men he has ever known. They though there was not evidence enough for the bible, but would believe in the most foolish witch stories Franklin A young physician is not put down by the older ones as formerly there is more liberality in the profession ow than formerly. Anecdote of Dr [Birker] “We want more farmers than doctors” Dr Darwin was a large misshapen man stuttered etc. very awkward etc. yet captivating. His works contain a great collection of important facts Anecdote a young man a good scholar, rather awkward & bashful was apprehensive of being cut out by an elegant competitor eloquent in the ballroom etc. advice not to fear! It turned out as Dr I. predicted We are not to give pain to patients who have brought their diseases upon them After we have relieved them, we may endeavour to reform them Anecdote of Dr Monson man intemperate finally took a poisonous dose of laudanum Dr Monson saved his life Afterwards he remonstrated with him upon his guilt “Dr I don’t thank you for what you have done” Dr. M. then turned “I am sure the neighbors will not” An opinion formerly prevailed that it was lawful because it was expedient to tell falsehoods Dr S. has always found it advantageous to appeal to his frank veracity on all occasions Often however, patients have no right to know Secrets should be kept A man may be sued for defamation for saying he has cured a man of venereal disease You will be mortified occasionally in being called a young man. Prof. I attended a man whom friends kept