i-'l'ii'l,' ' . : ; .liljIJM;;!-!.-'..;;1-- : t h h I,, ;;rp ri . « ■' ■hi* »v ill ill (i J(| 1 !lill ■■' i ■■ h ■'■;'! f J ;\tV\'\ Iff'; :' !ff»|.H!i.\. i^ 1001 1019�3 GENERAL THERAPEUTICS AND MATERIA MEDICA: ADAPTED FOR A MEDICAL TEXT-BOOK. BY * ROBLEY DUNGLISON, M. D., PROFESSOR OF INSTITUTES OF MEDICINE, ETC., IN JEFFERSON MEDICAL COLLEGE OF PBILAEELPHIA: FORMERLY PKOFESSOR OF MATERIA MEDICA AND THERAPEUTICS IN THE UNIVERSITIES OF VIRGINIA AND MARYLAND, AND IN JEFFERSON MEDICAL COLLEGE OF PHILADELPHIA. WITH ONE HUNDRED AND EIGHTY-SEVEN ILLUSTRATIONS. FIFTH EDITION, REVISED AND IMPROVED. IN TWO VOLUMES. VOL. II. PHILADELPHIA: BLANCHARD AND LEA. 1853. av d9l6a \85f V.2 Entered according to the Act of Congress, in the year one thousand eight hundred and forty-two, by ROBLEY DUNGLISON, M.D., in the Clerk's Office of the District Court for the Eastern District of Pennsylvania, PHILADELPHIA: T. K. AND P. G. OOLLINS, PRINTERS. CONTENTS OF YOL. II. CHAPTER III. OF MEDICINES. SECTION VI. AGENTS THAT AFFECT VARIOUS ORGANS. PAGE II. Tonics.—Tonics differ from excitants—The former defined—Modus operandi— Tone, and want of tone, on what dependent—Tonics, direct and indirect—Bitter extractive the great tonic principle of vegetables—Tonics given with two great views, to strengthen the system and to break in upon a morbid catenation—Thera- peutical application of tonics—In febrile diseases—In inflammatory disorders— In the neuroses—Mental tonics—Special tonics . . . . .17 Therapeutical application of tonics . . . . . .24 Special tonics ......... 34 1. Simple tonics ........ 34 a. Bitter tonics that owe their tonic virtues to bitter principle singly . 34 b. Aromatic bitter tonics, that possess, along with bitter principle, more or less aromatic property . . . . . .44 c. Astringent bitter tonics, which have an astringent associated with the bitter principle . . . . . . .52 d. Mechanical tonics, or such as seem to act mechanically . . 53 e. Mineral tonics . ...... 55 2. Antiperiodic tonics ........ 78 III. Astringents.—Definition of astringents—Tannic acid, the great vegetable astringent principle—Their modus operandi—Act best on parts with which they come in contact—Bad effects of astringents—Indirect astringents—Therapeutical application—In fevers, inflammations, hemorrhages, &c.—Astringents often used by the surgeon—Styptics—Special astringents ..... Therapeutical application of astringents ..... Special astringents ........ 1. Vegetable astringents ....... 2. Mineral astringents ....... IV. Sedatives.—General observations—Subdivision of sedatives—Definition of se- datives__Modus operandi—Thomson's table of sedatives—Mental sedatives— Bloodletting—Its effects—Cautions respecting its use—Arteriotomy, phlebotomy, local bleeding—Other sedatives—Contra-stimulants—Special sedatives . .158 Special sedatives ...•••••• 190 100 106 123 123 144 VI CONTENTS. V. Refrigerants.—Definition of refrigerants—Modus operandi—External and in- ternal refrigerants—Refrigerant baths—Therapeutical application of refrigerants —In fevers—In the phlegmasise, &c.—Special refrigerants Therapeutical application of refrigerants Special refrigerants ..... 1. Saline refrigerants ..... 2. Topical refrigerants ..... page 213 218 222 222 227 VI. Revellents.—Definition of revellents—Epispastics—Definition of epispastics —Rubefacients—Vesicants—Suppurants—Actual and potential cauterants—Mo- dus operandi—Permanent and intermittent revulsion—Intensity of the revulsion— Blisters, as revellents in fever—Revulsion in the changeable phlegmasise—Choice of situation for the revulsion—Therapeutical application of revellents—In fevers —In the phlegmasise—In hemorrhage—In mental alienation, hysteria, tetanus, &c.—Special revellents ........ 230 Therapeutical application of revellents . . . . . .245 Special revellents ......... 260 a. Rubefacient revellents ....... 260 b. Vesicant revellents ....... 269 c. Suppurant revellents ....... 274 d. Escharotic revellents ....... 279 1. Erodents ........ 279 2. Actual cauterants ....... 282 3. Potential cauterants ....... 284 VII. Eutrophics. —Eutrophics defined—Alteratives—Modify the function of nutri- tion—Sorbefacients—Therapeutical application of eutrophics—Pressure—Friction —Special eutrophics Therapeutical application of eutrophics Special eutrophics . Topical eutrophics 1. Eutrophic ointments . 2. Compressing eutrophics 8. Eutrophic liniments . 290 298 302 369 369 371 373 SECTION VII. AGENTS WHOSE ACTION IS PROMINENTLY CHEMICAL. Antacids.—Definition of antacids—Great generation of acid in dyspepsia—Acids always in the healthy stomach—Morbid acidity, how induced—Predominance of acidity in children—Antacids only palliatives—Special antacids . . .374 Special antacids ......... 331 II. Antalkalies.—Definition of antalkalies—Cannot often be needed—Alkaline state of the habit—Mode of improving defective nutrition—Special antalkalies Special antalkalies ...... 385 III. Disinfectants.—Definition of disinfectants—Antiseptics—Modus operandi of disinfectants—Bad effects of odorous fumigations—Of heat, mineral acid vapours and the chlorides as disinfectants—Use of antiseptics- Special disinfectants .... a. Disinfectants of apartments, clothing, &c. b. Disinfectants of the living body—Antiseptics -Special disinfectants 387 393 393 397 CONTENTS. vii SECTION VIII. AGENTS WHOSE ACTION IS PROMINENTLY MECHANICAL. PAGE Modus operandi of mechanical agents—May affect the vital operations—The least important of our therapeutical resources ...... 401 I. Demulcents.—Definition of demulcents—Of emollients—Not remedies of any activity—Therapeutical application—Are digested in the stomach—Therapeutical use of emollients—Special demulcents ...... 402 Special demulcents ........ 407 a. Internal demulcents ....... 407 b. External demulcents—Emollients ...... 421 II. Diluents.—Necessity for drinks—Therapeutical use—Their absorption pre- vented by certain circumstances—Employment in dropsies, diseases of the urinary organs, &c. ......... 425 III. Inspissants.—Inspissants are antagonistic to diluents—Indirect inspissants— Use of a dry diet in coryza, and where it is necessary to diminish the amount of blood—Doubts whether there are any direct inspissants .... 429 SECTION IX. ON DEOBSTRUENTS, ANTIDOTES AND ANTIPARASITICS. Deobstruents—Are indirect agents. Alteratives—Their modus operandi—Only used in chronic diseases. Antidotes—definition of—Are of two kinds—division of poisonous agents—Therapeutics of poisoning, internal and external—Table of poisons and their antidotes—Antiparasitics I. Deobstruents .... II. Antidotes .... Table of poisons and their antidotes III. Antiparasitics Special antiparasitics 430 430 431 434 442 442 SECTION X. MINERAL WATERS. Table of some of the principal mineral waters ..... 450 SECTION XI. ON THE COMBINATION OF THERAPEUTICAL AGENTS. Importance of a due attention to principles—Value of authority—Professional qualifications may be estimated by the prescription—Evils of complexity in pre- scribing__Rules for prescribing—Table of incompatibles—Doses of medicines— Conclusion ......... 456 Index, remedies ...•••••• 473 Index, diseases and remedies ....... 495 r 1 GENERAL THERAPEUTICS AND MATERIA MEDICA. CHAPTER III. OF MEDICINES. SECTION VI. AGENTS THAT AFFECT VARIOUS ORGANS. II. TON'ICS. Stnon. Confortantia, Corroborantia, Confirmanlia, Roborantia. Tonics differ from excitants—The former defined—Modus operandi—Tone, and want of tone, on what dependent—Tonics, direct and indirect—Bitter extractive the great tonic principle of vegetables—Tonics given with two great views, to strengthen the system and to break in upon morbid catenations—Therapeutical application of tonics—In febrile diseases—In inflammatory disorders—In the neuroses—Mental tonics—Special tonics. The excitants, considered in the last division, are diffusible in their action, and transient in their effects—the stimulation being followed by a degree of depression proportionate to the extent of such stimu- lation. They excite, therefore, beyond what may be considered the healthy standard. The substances, which are now to be investigated, as a general rule operate silently and permanently. They are followed by no undue depression, when discontinued; and they may be em- ployed in states of the system in which the use of Excitants proper might be questionable. Accordingly, when the practitioner is in doubt, whether the case before him will admit of stimulation; and the weight of evidence urges him to that course, he usually prefers com- mencing with a slightly stimulating tonic to beginning at once with VOL. II.—2 18 TONICS. the diffusible excitants;—knowing that the former may be discon- tinued without detriment, whilst the latter can only be cautiously pre- termitted, especially if their employment has been persevered in for some time. Tonics are usually defined to be:—Agents, which give strength and vigour to the body. In this point of view, all strengthening aliments might fall under the division. These are, in reality, tonics; but, as before observed, the consideration of aliments is not comprised in the objects of this work. It has been attended to elsewhere, (Human Health, p. 179.) By many therapeutical writers, tonics have been conceived to act by improving the tonicity of the muscular system; and, in the classifica- tion of Dr. A. T. Thomson, they are separated from excitants proper, and classed with astringents, under the head of—" Vital agents, influ- encing the body generally by operating directly on the muscular and sanguiferous systems." Yet, he subsequently affirms, that tonics " act on the vital principle through the medium of the nerves, and as far as their mode of operating is understood, we may regard them as exci- tants." To elucidate his idea of the modus operandi of tonics, he has the fol- lowing observations:—" When an individual is in good health and in vigour of body, the muscles or moving organs feel firm and tense; they act regularly and powerfully, whether they are involuntary muscles, or those under the control of the will. This is a state of healthful tone. On the contrary, when the muscles feel soft and flabby, when the action of the involuntary muscles is languid, and the voluntary do not rapidly respond to the will; when there is a strong inclination for rest and indulgence; and when the movements of the body or its parts are per- formed with difficulty, this is a state of deficient tone or debility. That both these states are connected with the condition of the muscular fibre may be demonstrated by detaching a muscle from the bodies of two animals in these opposite conditions, and ascertaining its strength by appending weights to it: the muscle taken from the healthy animal, or that in a state of tone, will sustain a much greater weight than that which is in the opposite state. Thence, to a certain extent, tone im- plies a difference in the mechanical condition of muscles; a greater degree of density and cohesion of their component fibres; but this must be also joined with elasticity, that is, the power of resisting extension, and of restoring itself when the extending cause is removed, before the part can be said to be in the state of perfect tone. That this state is truly the result of vital energy is evident; for the same muscle loses the power of sustaining the weight, which is supported when first cut from the body, and this in proportion to the distance of time from that of its separation from the living body,"—and he adds: " medicines or medical agents, which produce this state of healthful tone, and renew tJie tension and vigour of the muscular fibre are thence denominated tonics" Sir Gilbert Blane also asserts, that no muscle, whether voluntary or involuntary, can act unless its fibres are previously in such a state that if divided they would shrink by their own resiliency, leaving an MODUS OPERANDI. 19 interval between the cut extremities; and Dr. Paris—after citing the above remark of Sir Gilbert—observes:—" It appears, that there are certain medicinal bodies, that have the power of effecting this state of tension, and when their effects contribute to its restoration, they are properly denominated tonics." Yet this resiliency, described by Sir Gilbert, is not necessarily even a vital manifestation. It may be in- dependent of the vital properties. It continues for some time after the total extinction of life in all its functions; appears to be connected simply with the physical arrangement of the molecules; and is not affected until the progress of decomposition has become sensible. Hence, it has been properly regarded, by Haller and others, as a vis mortua. Flexibility, extensibility, and elasticity are variously modified, and combined in the different forms of animal matter; and they exist to a greater or less extent in every organ. Elasticity is only exerted under special circumstances. The tissues, in which it is inherent, are so dis- posed through the body as to be kept in a state of extension by the mechanical circumstances of situation, but, as soon as these circum- stances are modified, elasticity comes into play, and produces shrinking of the substance. The gaping wound, produced by a cut across a cooked shoulder of mutton, is an example, familiar to all, of this elas- ticity or resiliency. Previous to the division, the force of elasticity was kept neutralized by the mechanical circumstances of situation, or by the continuity of the parts; but, as soon as this continuity was disturbed, or, in other words, as soon as the mechanical circumstances were altered, the force of elasticity was exerted, and produced recession of the edges. This property of elasticity has been called contractilite de tissu, and also tone or tonicity;—names which have probably sug- gested the modus operandi assigned to tonics, which we have been discussing. That diminished cohesion, like that adverted to, may occur as the result of disease is doubtless. Pathology affords us numerous examples of it, although not so many as is usually supposed; and it is by no means easy to see, that such a pathological condition must always exist, when tonics are indicated, or whenever they prove beneficial. The only way, it would seem, that these agents can act on the muscles, is on their contractility, like excitants ; and indirectly on their nutrition, through the medium of the nerves distributed to the stomach;—the irradiations being conveyed from thence to every part of the nervous system; and therefore to every portion of the frame endowed with nervous influence. Want of tone appears to depend, in the majority of cases, certainly, —on exhaustion of muscular contractility, and on impaired nervous influx. Physiology and pathology afford us numerous examples in support of this position; but it will only be necessary to refer to a few. The ccencesthesis or common feeling of many people is so much influ- enced by the condition of the atmosphere, that they become almost barometers,—feeling light and buoyant when the air is clear and dense; and gloomy, when it is moist and light. Again, if the bowels be loaded, 20 TONICS. the powers of the system are, at times so depressed, that general lan- guor and lassitude prevail; and the individual is incapable of the slightest muscular effort. In like manner, after continued exertion, fatigue is felt, and rest absolutely demanded, until the exhausted excita- bility has been recruited; and, lastly, if a man, previously in perfect health, be struck with the contagion of a malignant fever, he finds his strength dissipated, and that he is incapable of raising as many ounces as, a short time previously, he could raise pounds. In none of these cases, can we presume that the mechanical condition of the muscle is materially changed. In the cases of the varying atmosphere, the loaded bowels, and the impression of malignant fever, the feelings of debility must be regarded as wholly dependent on the condition of the nervous system ; and in that of great fatigue after protracted exercise, on the exhaustion of the muscular contractility under the perpetual excitement produced by the repeated efforts of volition,—the nervous influx exhausts the muscular contractility or excitability like any other stimulus. How strongly want of tone is connected with the state of the nervous system is seen in the depressing influence of nostalgia or homesickness, iii which every voluntary function is carried on in languor and asthenia; and, on the other hand, we are equally struck with the evidences of strength, which the maniac exhibits. In such cases, the delicate muscles of the female execute feats, which the largely developed muscles of the athletic male, under the ordinary or healthy nervous influx, would be incapable of accomplishing. The effects, too, of mental tonics must manifestly be exerted on the brain, in the first instance; and, through the medium of the nerves, on the rest of the body. Under the salutary nervous excitation, which tonics are capable of effecting, the action of the whole system of nutrition is increased and the vis insita elevated to the full healthy standard. It is probable, that all tonics are obscurely stimulant; but they differ, as before remarked, from excitants proper, in not stimulating to a marked degree, and in the excitation not being followed by correspond- ing depression. They exert, however, no perceptible stimulation: their action, though efficacious, is sTlent; and, if they be repeated at proper intervals, a permanent, healthy state of tone results. But all this is produced through the agency of the tonic upon the nervous system; and there does not appear to be any satisfactory reason for believing, with Dr. Chapman, of Philadelphia, that tonics, "like every other class of medicines, are endowed with some properties peculiar and distinct- ive, among the most conspicuous of which is their specific affinity to the muscular fibre." Tonics may be either direct or indirect;—that is, they may be the means of adding directly to the healthy tone of the system, in the mode described; or, in particular conditions of the economy, other sub- stances belonging to different classes of therapeutical agents may exert a tonic effect indirectly. In this way, blood-letting, cathartics, emetics &c, may be indirect tonics. In the state of apparent debility, which accompanies febrile or other irritation, and in that in which the stomach or intestinal canal is loaded, and the nervous system oppressed and GENERAL EFFECTS. 21 depressed, a remedy, which obviates these conditions, will remove the debilitant effects of such conditions, and prove tonic. When, however, we use the term tonic abstractedly, we never apply it to those indirect agents. It has been a question, occasionally agitated by therapeutists, whether there be any such thing in nature as a real tonic; or, in other words, whether any remedial agent can, by virtue of properties inherent in it, communicate tone where tone is defective. It would appear, that no such properties are possessed by any agent; or, in other words, that no principle is infused into an asthenic organ or tissue, which can give strength to it. The whole effect is exerted, directly or indirectly, on the nerves of the stomach; whence it is distributed, by means of the nerves, to every part of the system. It is probable, too, that some of the articles of the class are absorbed, and act upon the organism through the altered character of the blood in the capillary blood-vessels. Such, it has been conceived, is the modus operandi of the preparations of iron in chlorosis and other affections. Some tonics, again, are insoluble, and pass,—apparently unaltered,—through the digestive tube, appearing to exert their influence like certain condiments, which contain no nutri- ment, but which place the chylopoietic organs in a condition for deriving a larger amount of nutriment from alimentary matters taken along with them than they would otherwise have been able to separate. Their precise modus operandi is, however, sufficiently obscure; nor is the ob- scurity lessened by the suggestion of Mr. Simon, that "it seems not unlikely that many of the so-called tonics will be found opposed to the destructive changes of the blood, and that their medical efficiency may relate essentially to this opposition." When a tonic is administered in disease, its speedy operation is not to be expected. This is one of the essential points of difference be- tween tonics and excitants proper. The effects—as already remarked —are gradually, and almost insensibly exhibited ; and they afford as good specimens of the action of what have been termed ' alteratives,'' as any that could be selected. They produce no sensible evacuation. Under their employment, the appetite gradually improves ; the impres- sibility of the nervous system—often induced by long protracted indis- position, or by a rapid reduction of the vital forces, as in acute diseases —lessens; the action of the circulatory system assumes the healthy standard; the general feeling exhibits itself buoyant and elastic; and the muscular powers, under the improved nervous influx, resume their wonted energy. But all this denotes only a restoration to the healthy standard ; hence, the great use of tonics in convalescence; but if ad- ministered in conditions of the system in which they cannot be expected to do good, they are devoid of the injurious consequences, that follow the undue use of excitants proper, and their administration may be arrested at any moment without fear of debility resulting. It has been already seen, that it is the use of diffusible stimuli, which is alone followed by corresponding depression. Bitter extractive appears to be the great tonic principle of most of the vegetable tonics ; aided, in some, by the presence of aromatic oil, which renders them more stimulating; in others, by the presence 22 TONICS. of one or both of the great astringent principles of vegetables. This bitter extractive is not affected by heat; but the aromatic oil is, pro- vided the boiling temperature is maintained for some time. Decoc- tion is, therefore, an improper mode of preparation, where the object is to retain the aromatic property. Infusion is the form most com- monly prescribed ; and hence the pharmacopoeias contain officinal in- fusions of all the principal vegetable tonics. Dr. Thomson asserts, that Dr. Chapman, and, following him, Dr. Paris, attempt to prove, that bitterness is essential to tonics; or, in other words, that it is the tonic principle ; but in this, he does those writers injustice. The latter gentleman affirms, that the tonics, derived from the vegetable kingdom, are generally bitter ;—whilst the former expressly says: " Concerning the element, which gives the tonic power, some difference of opinion has been entertained. Cullen supposed it to be the same quality as that of bitterness. But though it holds to a considerable extent, there would seem to be no necessary connexion in all cases. Exceptions at least are not wanting, as we see very strik- ingly in opium and digitalis, which are bitter, though not tonic; and, conversely, in many of the metallic articles, which, though tonic, are not bitter in the slightest degree." Nor do we think Dr. Thomson more accurate in his opinion, " that part of all the vegetable tonics are [is] digested in the stomach, and the principle, whatever it is, which produces their tonic influence, is thus separated from the other parts; and consequently it is enabled to act with more energy upon the nerves of the stomach:" an explanation that can scarcely apply to infusions of vegetable substances; and still less to the active principles of such substances; nor is it more applicable to them when given in a solid form, as in the state of powder, in which the active principle is, in many cases, combined with little more than lignin or woody fibre. It is but necessary, that the fluids of the stomach, or any fluids, should come in contact with the substance in order to extract its tonic virtue • but nothing like digestion—as applied to the physiological process to which alimentary matters are subjected—is necessary. Bitter extractive, as Dr. Paris has remarked, is a great natural tonic. It appears to pass through the body without suffering any diminution in its quantity, or change in its nature. No cattle will thrive upon grasses, that do not contain a portion of this principle; a fact, which is considered to have been proved by the researches of Mr. Sinclair gar- dener to the Duke of Bedford, who remarks, in his " Hortus Grand- neus Woburnensis" that if sheep be fed on yellow turnips, which con- tain little or no bitter principle, they instinctively seek for and greedily devour, any provender, which may contain it, and if' they cannot obtain it they become diseased, and die. " We are ourselves conscious," Dr. Paris adds, " of the invigorating effects of slight bitters upon our stomach; and their presence in malt liquors not only tends to diminish the noxious effects of such potations by counteracting the indirect debility, which they are liable to occasion," but even to render them, when taken in moderation, promoters of digestion. The custom of infusing bitter herbs in vinous drinks is very ancient and universal • the poculum absinthiatum was regarded in remote ages as a wholesome GENERAL EFFECTS. 23 beverage, and the wormwood was supposed to act as an antidote against drunkenness. The Swiss peasant cheers himself amidst the frigid solitude of his glaciers, with a spirit distilled from gentian, the extreme bitterness of which is relished with a glee, that is quite unintelligible to a more cultivated taste." Tonics may be given with one or two views;—either to make a decided impression on the nervous system, so as to break in upon a chain of morbid phenomena that supervene in paroxysms—as in inter- mittent fever; or to produce their silent but permanent operation for the removal of debility. The same form of preparation is not equally adapted to the two cases. In the former, the lignin or woody matter of the vegetable may not be objectionable. On the contrary, it may assist the operation of the tonic principle, by exciting a new action in the nerves of the stomach; but where the powers of the system, and of the digestive organs as a part, have been prostrated by long protracted indisposition, the vegetable tonics cannot be administered, with pro- priety, in powder,—as they are apt, by reason of the indigestible woody matter, to occasion great derangement of the stomach and bowels, and sometimes irritative fever. At other times, the bark accumulates in such quantity in the alimentary canal as to be discharged by the bowels for several days consecutively. In a case of this kind, that fell under the author's care many years ago, the most disastrous results were pro- duced, apparently by the irritation excited in the system by the pre- sence of this extraneous substance in the bowels. A young lady, of markedly scrofulous temperament, and predisposed somewhat to pul- monary consumption, was attacked with bilious fever, which was ac- tively treated, and, in the course of three or four weeks, yielded: the resulting debility, however, was so great as to induce the practitioner to prescribe a tonic; and the cinchona was selected, and administered in powder. After she had taken it for some days, vomiting and purg- ing occurred, accompanied with occasional chills of the most distressing character. Bark was discharged in quantities in the evacuations; and, under the irregular actions thus excited, tubercles—already pro- bably present in the lungs—proceeded to softening, and this most rapidly ; hectic fever, and every symptom attendant on the confirmed stage of pulmonary consumption, supervened, and she gradually sank under the malady;—yet no signs of phthisis were present prior to this derangement, produced by the bark in powder on a frame already debilitated by a previous malady. Where the object of the practitioner is simply to strengthen the debilitated gastric functions, the powdered tonics should not, therefore, be chosen. Modern chemistry has presented valuable gifts to thera- peutics, by separating the active principles from several of the tonics; and where this has not been done, simple infusion will generally ex- tract all their virtues. The watery infusion is perhaps the best pre- paration ;—the spirituous combining an excitant principle, which may not always be indicated, where tonics are;- and it is well, where their administration has to be persevered in for a length of time, that the tonic should be varied. The system soon becomes habituated to the 24 TONICS. same agent; and, if another be substituted in its place for a few days, the use of the former may be resumed with its pristine advantage. Therapeutical Application of Tonics. In the therapeutical employment of tonics, it is important to inquire whether some may not be better adapted for fulfilling the indications that may suggest themselves than others. Fever.—In febrile diseases, tonics cannot often be needed; and, accordingly, they are not much employed. The remarks made regard- ing the use of excitants in fevers are applicable to tonics, except that the latter do not excite as much as the former, and, when cautiously used, not beyond the healthy standard. Simple tonics can, therefore, be prescribed, when excitants might be of doubtful propriety; and— as before remarked—if the symptoms do not improve under their administration, they can be discontinued at once, without any appre- hension of the evil that might supervene on the sudden discontinuance of excitants. The vital elasticity is generally sufficient to restore the patient from the depression induced by fever; and when it is not, the use of excitants—and the same may be said of tonics—will not often be found effective. They can, indeed, act only on the excitability, that remains in the system. The practitioner, however, will never hesitate to have recourse to them in those malignant forms of typhus, met with in jails, camps, and in the filthy, unventilated houses of the destitute; as well as in every fever, whose symptoms approximate to such a condition. The sulphate of quinia, in the state of supersulphate, formed by the addition of a few drops of diluted sulphuric acid, is one of the most common agents prescribed in these cases; although the watery infusion of many of the tonics,—as columbo, and gentian—is often recommended, and by some preferred. In the apyrexia of intermittents, tonics are the sheet-anchor of the physician, to which he trusts implicitly. Their mode of operation, in preventing diseases characterized by periodicity, is by no means clear. The only plausible theory is, that they produce a new impression upon the nerves of the stomach, and through them on the nervous system generally; and that the new action, thus induced, is sufficient to break in upon the morbid chain that has been established. This view is, at least, strengthened by the fact, that a powerful emotion produces a similar antiperiodic effect with the tonic; may completely prevent an expected attack; and, even after its inception, remove it. Accordingly, fear is ranked, by many practical writers, amongst the antiperiodics to be employed in ague; and the efforts of the tractorizer, and the animal magnetizer, exert their influence in the same manner. It is not easy to explain this effect on the mind, or, indeed the action of any of the class of tonics, under the idea which M. Broussais entertained of the pathology of intermittents; that they are intermit- tent gastro-enterites. " Every regular paroxysm of intermittent fever " he remarks, " is the sign of gastro-enteritis, the irritation of which is afterwards transferred to the cutaneous exhalants, which produce the crisis." Yet this state of gastro-enteritis is removed, and prevented by IN INTERMITTENTS. 25 agents, which would scarcely seem appropriate for such a result;—for example, by the peppers, as well as by the whole class of aromatic tonics. But, whatever objection may be made to the pathological views of M. Broussais on the subject of intermittents, his treatment is rational. It is, indeed, that which experience has shown to be most satisfactory. Intermittents, it is known, may wear themselves out; but, it is a long and tedious process. Antiphlogistics simply have been found to have no effect in breaking in upon them. However useful they may have proved in lessening the duration of one of the stages of the paroxysm, they do not prevent the recurrence of the attacks. The employment of vegetable or mineral tonics is demanded, if the object of the physi- cian be to put an end at once to the disease. The following " propo- sition" conveys aphoristically the ordinary treatment in intermittent fever,—a treatment which is sanctioned by the experience of ages, and is no emanation from the ' physiological doctrine,' but rather opposed to its inculcations. " The surest method for the certain cure of inflam- mations with periodical exacerbations, is, to treat them at first by antiphlogistics during the hot stage, so as to render the apyrexia com- plete; to continue this treatment after the paroxysm, if the apyrexia be not complete; to give the cinchona, or rather the sulphate of qui- nia, and other tonics, during the whole apyrexia; to administer dif- fusible -stimuli at the accession of the rigors, and to return afterwards to cooling drinks when the hot stage is developed." (Broussais.) It is only, however, when the apyrexia is complete, that tonics can be administered, with full advantage, for the cure of intermittents. If plethora exist, or if there be hyperasmia in any organ, these must be removed, before the antiperiodics are had recourse to ; unless, indeed, in those old obstructions of the parenchymatous viscera, which occa- sionally present themselves as evidences of former attacks of malarious disease. In the pernicious intermittents, too, which prevail in some countries to so great an extent, as in the Maremma district of Italy, and in some parts of this country, cinchona seems to be required before there is a complete apyrexia, for the purpose of arresting, as early as possible, paroxysms that might prove fatal, by virtue of the irregular actions, the hyperaamiaa, which they are apt to induce in important organs. It happens, fortunately, that in these cases, there does not appear to be as much mischief induced by the premature administra- tion of cinchona, or its active principle, as is often apprehended; al- though M. Broussais, in the propositions cited, has depicted some of the evils which he considers likely to be produced by it. There are many observing practitioners, who have administered cinchona, even in substance, a form in which it is most likely to disagree, in conse- quence of the quantity of insoluble woody matter, and who have been satisfied, that it has not added even to the intensity of the hot stage. Still less would this be likely to accrue from some of the more advis- able forms of preparation. The author has often administered cinchona in powder in moderate doses, both in the healthy and moderately excited state of the system; 26 TONICS. but without observing any augmentation of organic action induced by it. . . It is a good general rule to lay down,—that prior to the administra- tion of tonics, all local mischief must, if possible, be removed ; for, even should these agents not augment the mischief, they cannot exert the necessary sanative influence upon the morbid catenation that keeps up the fever. In the enlargements of the spleen, however, that accom- pany, or succeed, intermittent fever, sulphate of quinia, and subcarbon- ate of iron, in large doses, have been found excellent remedies. Remittent fevers have to be regarded much in the same light as the continued, in respect to the administration of tonics. Whilst the febrile irritation is nearly constant, or whilst there is no period when fever is almost, if not wholly, absent, they cannot generally effect a cure. The nearer the remittent approaches to an intermittent in its charac- ter, the more beneficial will be their action. During the inflammatory period of the disease, antiphlogistics have to be relied upon exclusively; and as there is generally a strong disposition to hyperemia in some important organ, during the continuance of the irregularity of func- tions that characterizes the remittent forms of fever, antiphlogistics have to be pushed to a greater extent than in simple fever. There are cases, however, of remittent fever occurring in highly malarious districts, which demand the use of the bark, or quinia, comparatively early:—the disease, from the first, not exhibiting any highly phlogistic character; and being apt to be attended with engorgements of internal organs, unless interrupted in its progress at an early period. In such cases, bark, or its active principle, has been found effectual. Inflammations.—It need scarcely be said, that tonics are not indi- cated in inflammatory disorders, unless in those forms, and stages, in which excitants may be advisable. It has, however, been maintained by men of no small distinction in science, that they may be given with advantage in every stage of erysipelatous inflammation, as well as of acute rheumatism. So far as the author's experience goes, these affec- tions differ somewhat according to the climate or locality in which they occur; and hence, in part, the diametrically opposite views of treatment, at one time inculcated in London and in Edinburgh—the antiphlogistic medication being universally adopted in the one place, whilst the tonic was as universally had recourse to in the other. Much also depends upon the habit of the individual,—whether healthy or modified by intemperance, &c. In the latter case, the inflam- mation may be of, what is termed, the most unhealthy character; adynamic fever may be present, with, at times, every sign of absolute typhus, and tendency to gangrene. In such a condition, tonics are indispensable. The practitioner must, however, be always guided by the symptoms that present themselves, and by the nature of the lesion in this way indicated; and if he practices soundly, he will find, that occasionally, it is requisite to push antiphlogistics; whilst at other times the indication may be, to be equally active with tonics. Facts, in this case again, have shown, that tonics, although they may not always be productive of advantage, may still be administered with impunity. The remarks made on erysipelas apply generally to acute rheuma- IN LOCAL DISEASES, ETC. 27 tism, which is essentially arthritis or an inflammatory condition of the fibrous structures surrounding the joints, accompained by a singular anomaly,—that the skin, instead of being hot and dry, as in other fevers, is usually hot and bedewed with copious perspiration. In such case, tonics have been freely exhibited, and have been looked upon, by some practitioners, as more beneficial, from the commencement even, than antiphlogistics. The author has had numerous opportuni- ties for witnessing the exclusive use of both these modes of treatment; and although he cannot agree, that the tonic medication has been always the best, he does not recollect having seen the symptoms, in a single case, aggravated under their prudent administration. A com- bination of the two modes has appeared to him most advantageous;— treating the disease, during the earlier period, by the ordinary anti- phlogistics ; and afterwards endeavouring to modify the condition of the nervous system by the cautious employment of tonics, such as the sulphate of quinia. The whole disease is peculiar. It is not danger- ous whilst the joints remain chiefly affected ; and it only becomes so by the extension or translation of the rheumatic inflammation to more important organs. It has been the opinion of many eminent observers, that copious depletion favours this extension, or metastasis, whichso- ever it may be; but proof is wanting. In our uncertainty, it is advis-, able not to be too officious, where, as already remarked, the disease is not situate in parts of vital importance, and usually terminates favour- ably, except under the supervention of the accidents just mentioned. Hemorrhage.—As in inflammatory diseases tonics are manifestly contra-indicated, so are they in the active forms of hemorrhage, the management of which is essentially that adapted for inflammatory dis- orders ; but in the less active varieties,—in those that have been termed passive, in which there is loosened cohesion of tissue, and, perhaps, modified spissitude of the blood, so that it readily transudes through the coats of the vessels, the aid of all the forms of general excitants may be required. Tonics, on this principle, are employed in scurvy; and in febrile and other affections, accompanied with strong evidences of a passive hemorrhagic tendency. Neuroses.—Many of the neuroses, being attended with considerable debility and mobility of the nervous system, require the employment of tonics. This is the case with epilepsy, which is more frequently dependent on this, than on any inflammatory state of the nervous system. Not unfrequently, however, the disease is organic in its nature; or, in other words, arises from some lesion of the encephalon. In such cases, tonics are not adapted to afford relief, but the cases are not easy of discrimination; and a plan of treatment, adapted to the general condition of the system, is usually had recourse to. This, as the author has said, must generally be of a tonic kind. The vegetable tonics are, in these cases, not equal to the mineral; and, of the latter, the nitrate of silver is to be preferred, perhaps, to any other. The author has succeeded in removing many cases of epilepsy by its means; but it requires to be persevered with for a con- siderable time. It will rarely be found to exert any decided efficacy before the end of the first month. The preparations of zinc, copper, 28 TONICS. and iron, are likewise employed; but they are not usually as effica- cious as the salt of silver. In chorea, the hopes of the practitioner are placed almost entirely on the appropriate use of tonics, combined with cathartics to remove the torpid state of the intestinal canal, that prevails in the disease._ Here, again, the mineral tonics are preferred; as well as in chlorosis, which commonly occurs in those in whom there is much torpor of the sys- tem—characterized by pale and lurid complexion; languor; listless- ness; depraved appetite; indigestion; palpitation, &c. In neuralgia, employed as a generic name for a number of diseases, the principal symptom of which is a very acute pain, exacerbating, or intermitting, following the course of a nervous branch, extending to its ramifications, and seeming, therefore, to be seated in the nerve, the plan of treatment by chalybeates has been found the most satisfactory. In this painful malady, one variety of which has been long known under the name tic douloureux, the greatest diversity of agents has been made use of;—bleeding, general and local; emetics; purgatives; rubefacients; vesicants; cauterants; anodynes; mercurial frictions; electricity; division of the nerve, excision of a portion of it, &c. &c; but one of the most successful is, undoubtedly, the subcarbonate of iron, given in large doses—for instance, thirty or forty grains twice or thrice a day. This course of treatment, continued for a month or two, often relieves, and ultimately removes the much dreaded affection. The mode in which it operates is by no means clear. It is, of course, through the nerves of the stomach, that any new action must be induced in the nervous system generally, and in the nerves affected with neuralgia in particular. Since its first introduction into practice for this purpose, by Dr. Hutchinson, of Southwell, England, upwards of thirty years ago, the author has had repeated opportunities for exhibiting it; and often with the most happy results. A lady had suffered under the most excruciating hemicrania—essentially an inter- mittent neuralgia of one-half the encephalon—for which depletion, anodynes, counter-irritants, &c, had been used in vain. She was con- fined to bed for more than half her time and suffered intensely; yet the affection was completely removed by the use of the subcarbonate, and although it is now more than twenty years since the cure was effected, the symptoms have not recurred. He could allude to many similar cases. Worms.—Bitters, and, indeed, the whole class of tonics, are anthel- mintic, or unfavourable to the generation of entozoa within the body; but this subject occupies a distinct section. See Anthelmintics. Tonics are likewise found to be serviceable in many Chronic cutaneous diseases, unaccompanied by febrile excitement as in some varieties of strophulus, lichen, prurigo, psoriasis, &c, in which their efficacy is mainly, perhaps, exerted through the changes they induce in the blood; and through that fluid on the vessels of the affected parts—acting, therefore, as eutrophics, rather than tonics. Local diseases, &c.—The surgeon, where gangrene is about to take place in any part of the frame, places his main reliance upon the em- ployment of tonics, administered internally, as well as applied to the IN LOCAL DISEASES, ETC. 29 gangrenous part, where this is practicable. For this purpose, cin- chona, or its active principle, is found most effectual. In short, in all cases, in which the powers of the system appear to be below the true standard; or, where the action of the nervous system is particularly impaired; where the skin is pale; the pulse feeble; the solids loosely cohering; and the ordinary indications of cachexia are present, tonics are demanded; and even in cases where the practitioner, owing to evidences of general febrile or local irritation, is doubtful whether they may be productive of advantage, he may venture upon their ad- ministration, when he would be afraid to use excitants. Too much dread is generally inculcated, and entertained regarding them. The remarks of Dr. A. T. Thomson, on this point, are extremely just, and apposite. " Upon the whole," he says, " it is necessary that tonics should not be confounded with stimulants; and although it is proper to prescribe them with caution in any form of fever complicated with local inflammation, yet we ought not to be prevented by the dread of inflammatory symptoms from employing a class of remedies, so well calculated to restore the strength and vigour of the nervous system, essential for carrying on the functions of life. We must recollect, that tone is not excitement, nor strength increased vascular action." The abstraction of caloric from the body, by the application of cold to the surface,—as by Cold Bathing,—has long been ranked amongst tonic agencies—with what propriety the author has considered else- where, (Human Health, p. 361.) The direct effect of such abstraction is certainly sedative; and, therefore, when the vital energies are too strongly exerted, it may, by reducing these, be indirectly tonic; but if it be exhibited, when languor and diminished action pervade the frame; during existing disease; in the state of convalescence; or in feeble infancy, the depressing effects of the application wrill be ren- dered manifest. In this respect, the cold and the hot bath are antagonistic,—the former exerting a sedative, the latter an excitant action. The judgment is often misled by the feeling of glow over the whole surface, which follows immersion in the cold bath, when a healthy individual has recourse to it. This feeling is fallacious; the reaction is not really as great as it appears to be, owing to the mind instinctively contrasting the existing sensation with the one immedi- ately preceding it,—as it does, indeed, on all occasions. If we descend into a cellar in winter, and again in summer, we have, in the former season, the impression of warmth, and, in the latter, that of cold, although the temperature of the cellar may be nearly the same at both seasons,—a comparison being instinctively instituted between the tem- perature felt, in both cases, immediately previous to the descent; and as, in the one case, the air above was colder, and, in the other, warmer than that of the cellar, the feeling experienced in the room was, in the former case, that of augmented, and in the latter of diminished tem- perature. Exercise is likewise a tonic, which may be employed with much advantage in disease. When combined with mental amusement— such as travelling exercise affords—its salutary results are sometimes astonishing. 30 TONICS. When we regard the effects which active exercise is capable of in- ducing, and the degree of effort that is necessarily required, we can appreciate the cases in which it may be found advantageous, or the contrary. It is, of course, singularly inappropriate during acute dis- eases of any kind; and as one of its chief effects is to augment the energy of the circulation, and to cause the blood to circulate through every portion of the capillary system,—if hyperaemia exist in any part of the frame, it may increase it; whilst if obstructions be present to a trifling extent only, the augmented impetus may tend to remove them. But even where active exercise is improper, the passive form ^ may be adopted; and the change of air and scene, thus afforded, unites with the motion in impressing a salutary influence on a frame debilitated by disease. The author has elsewhere entered into the physiology of the different active and passive exercises, in a hygienic point of view, and has suggested the various remedial and injurious results, that may be induced by any and by all of them. He will, therefore, confine himself to a few general observations for the guidance of the therapeu- tical inquirer. It is in the great class of nervous diseases that we find exercise— especially travelling exercise—so beneficial; and it is surprising what an amount a feeble individual, under such circumstances, is capable of enduring without fatigue. Allusion has already been made to the surprising feats of strength executed by the maniac; and by those whose encephalic functions are inordinately exalted. The resistance exhibited by the valetudinarian, whilst toiling over steep ascents in situations new, but of engrossing interest to him, must be accounted for in a similar manner. This has been forcibly illustrated by Dr. James Johnson. " In the month of August, 1823," he says, " the heat was excessive at Geneva, and all the way along the defiles of the mountains, till we got to Chamouni, where we were at once among ice and snow, with a fall of forty or more degrees of the thermometer, experienced in the course of a few hours, between midday at Salenche, and evening at the foot of the glaciers in Chamouni. There were upwards of fifty travellers here, many of whom were females and inva- lids; yet none suffered inconvenience from this rapid atmospheric transition. This was still more remarkable in the journey from Mar- tigny to the great St. Bernard. On our way up through the deep valleys, wre had the thermometer at ninety-two degrees of reflected heat for three hours. I never felt it much hotter in the East Indies. At nine o'clock that night, while wandering about the Hospice of St. Bernard, the thermometer fell to six degrees below the freezing point, and wre were half frozen in the cheerless apartments of the mo- nastery. There wrere upwards of forty travellers there—some of them in very delicate health; and yet not a single cold was caught nor any diminution of the usual symptoms of a good appetite for breakfast next morning." This resistance to deranging influences is more striking than strange It is fortunate, that the condition of the functions, durino- an elevated temperature, still continues for a time after the temperature becomes depressed. Were it otherwise, the worst consequences mio-ht follow IN LOCAL DISEASES, ETC. 31 an immersion in the cold bath, after the system has been violently excited by the application of heat,—as is the practice with the Rus- sians in their vapour baths; as well as the sudden vicissitudes, to which the climate of the United States is liable. The same disadvantage would apply,,although to a less extent, to a change of climate. The excited condition of the capillaries of the surface, induced by excessive heat, subsides gradually when the temperature is suddenly reduced; and in such a manner, that a power of resistance remains for a time; hence it is, that we pass with impunity from a hot room, in the depth of winter, to the external air, the temperature of which may be greatly below the freezing point; and a similar power of endurance continues for some time after a person has quitted a torrid, to reside in a tem- perate or frigid region,—and conversely. It is obvious, from what has been said, that the occupation of the mind by a succession of pleasing objects, constituting amusement, must be regarded as a tonic influence; and many a valetudinarian, who quits the town during the summer, suffering under dyspepsia, or hypochon- driasis, or worn down by some corroding or protracted malady, finds his uneasy feelings disappear, and himself almost renovated, before he reaches the end of his journey towards some of the fashionable water- ing places. A great deal of this effect is owing to simple change of air, so beneficial to the civic resident in a hygienic respect; much, also, to exercise, and to change and appropriate regulation of diet; but the chief part, perhaps, to the mental occupation afforded by varied scenery and society on the way. The whole physical circumstances surround- ing the individual are changed; and he abandons himself to new im- pressions, which break in upon the monotony of the old. " It may be stated, without any risk of being mistaken"—says an able physician and writer, Dr. Forbes, of London—" that there are very few residents in large towns, particularly in our large manufacturing towns and in London, where such a tour as is described in the following pages, will not benefit in a very marked degree. It will enable a large proportion of such persons to lay in a fresh stock of health sufficient to last through the year, in spite of all the exhausting influences of confined air, seden- tary occupations, and that overtaxing of the mind to which so many of them are exposed, and which is the fruitful source of so many dis- « eases. A journey of this kind, properly conducted according to the circumstances of the particular case, will be still more beneficial to that numerous—I had almost said that innumerable—class of invalids who, although unaffected by any fatal or even dangerous disease, are yet so disordered and distressed by chronic and functional derangements of various kinds, and by consequent debility, that their condition is much more to be pitied than that of the victims of the severest diseases of an acute kind. To these unhappy persons, whether their malady be in popular or learned phrase, ' bile,' ' liver,' ' stomach,' dyspepsy,' 'indigestion,' 'mucous membrane,' 'suppressed gout,' 'dumb gout,' 'nerves,' 'nervousness,' 'hypochondriasis,' 'low spirits,' &c. &c, I will venture to recommend such a tour as that described in this little book —mutatis mritandis—ns more effectual in restoring health than any course of medicines, taken under the most skilful supervision at home. 32 TONICS. And to say truth, such a journey may be made to fulfil almost every indication of cure applicable to such cases, which, however varied in appearance, are, in reality, extremely similar in their more essential characters. " A course of travelling of this sort—to speak medically—carried out in the fine season, in one of the healthiest localities of Europe, in a pure and bracing air, under a bright sky, amid some of the most attractive and most impressive scenes in nature, in cheerful company, with a mind freed from the toils and cares of business or the equally oppressive pursuits, or rather no-pursuits, of mere fashionable life— will do all that the best medicines can do in such cases, and much that they can never accomplish. " It is now well known to all experienced and scientific physicians, that chronic functional diseases of long standing can only be thoroughly cured by such general and comprehensive means as act on the whole system, and for a certain period of time influencing the nutrition in its source, not merely by the supply of wholesome elements, but by keep- ing the nutrient function active and vigorous over the entire fabric, by an equable distribution of blood and nervous influence, and conse- quent energetic action of all the secreting organs. When drugs are useful in such cases, they are so only as subsidiary means, calculated to fulfil some special, local or partial indication. It need, therefore, excite no surprise, that a Course of Travelling, calculated as it is, or at least may be made, to fulfil all the foregoing requisites, should be held forth as one of the most important methods of curing many chronic diseases." Confidence and hope must likewise be esteemed valuable tonics. The author has previously described the influence exerted by confi- dence in the physician on the action of his remedial agents,—as well as the great advantage to the patient, in several malignant diseases, that he should not give up hope, ' the sick man's health,' but, on the contrary, should cherish it as one of the most influential agencies in his recovery. It has been properly said by a distinguished poet, him- self a physician, that " whatever cheerful and serene Supports the mind, supports the body too ; Hence, the most vital movement mortals feel Is hope ; the balm and lifeblood of the soul; It pleases, and it lasts." Armstrong. Every practitioner must have observed the tonic effect of hope where it has been enthusiastically indulged; and, on the other hand the blighting results of hope deferred, or lost. It is a common sayino-' that the physician might as well destroy a patient as tell him there°is no hope; and in certain affections this is an approximation to the fact Where the functions are already greatly depressed, such a communica- tion is likely to add to the depression. Perhaps in no case was the cor- roding effect of mental anxiety and doubt more exemplified than in the nostalgia, which wras so common during the domination of Napoleon ■ TRAVELLING EXERCISE. 33 when young conscripts were torn from their families and friends, and forced into foreign and far distant countries;—a disease, which has been said so frequently to affect, also, the Swiss, who have left their homes and their country to dwell in other climes, with little prospect, perhaps, of a return. Rogers has a beautiful allusion to this Heim- w e h or ' Homeache,'1 as well as to the influence of association, in his 1 Pleasures of Memory:'— " The intrepid Swiss, who guards a foreign shore, Condemn'd to climb his mountain cliffs no more, If chance he hear the song so sweetly wild, Which on those cliffs his infant hours beguiled, Melts at the long lost scenes that round him rise, And sinks a martyr to repentant sighs." The effects of mental tonics on the system, especially those of hope and confidence, are well exhibited in the following extract from the work of Dr. A. T. Thomson, to which the author has so often referred. " Were anything requisite to prove the power of mental tonics in dis- ease, it would only be necessary to refer to their influence in sustaining the body under fatigue which could not otherwise be borne. What is it but hope and confidence, which enable a mother, night after night, to wratch at the bedside of a sick infant ? to bear up, even with a weak and delicate frame of body, under fatigues which no stranger could sustain, and yet, if the object of her solicitude recover, to suffer no inconvenience from the exertion:—take away the tonic powers of hope and confidence, or let all her attentions prove unavailing and her infant fall a victim to the malady, then her health will give way, she will feel the exhaustion which naturally follows exertions too powerful for the strength of her body to sustain with impunity, and fall a victim of thv anxiety and watching, under which hope and confidence had so long borne her up, and which could alone sustain her by their tonic powers. Nothing can exceed the truth, as well as the beauty of the passage in Milton's description of the Lazar-house, in which the greatest evil is the absence of hope:— ' A lazar-house it seem'd wherein were laid Numbers of all diseased, all maladies Of ghastly spasm, or racking torture, qualms Of heartsick agony, all fev«rish kinds, Convulsions, epjlepsies, fierce catarrhs, Intestine stone and ulcer, colic pangs, Demoniac phrenzy, moping melancholy, And moonstruck madness, pining atrophy, Marasmus, and wide-wasting pestilence, Dropsies, and asthmas, and joint racking rheums. Dire was the tossing, deep the groans; despair Tended the sick busiest from couch to couch ; And over them triumphant death his dart Shook, but delay'd to strike, though oft invoked With vows, as their chief good and final hope.' Despair, indeed, in every instance where disease falls upon mortality, may be regarded as bearing the standard in the van of death." VOL. II.—3 34 SPECIAL TONICS. SPECIAL TONICS. It has been before remarked, that tonics are given with one of two views,—either to make a decided impression on the nervous system, so as to break in upon a chain of morbid phenomena that supervene in paroxysms,—as in intermittent fever; or to produce a silent but permanent operation for the removal of debility; and, although some of them are capable of acting in both ways, there is convenience in classifying them separately;—into first, simple tonics; and secondly, anti-periodic tonics. The former may admit again of farther sub- division, according to the principles which they contain;—into first, such as owe their tonic virtues to bitter principle singly; secondly, those that posse'ss, along with the bitter principle, more or less aromatic property; thirdly, such as have an astringent associated with the bitter principle; fourthly, such as seem to act mechanically; and fifthly,min- eral tonics. I. Simple Tonics. Fig. 128. Cocculus palmatus. o. Male flowers, b. Calyx, c. Stamen, d. Petal, e. Bract a. Bitter Tonics which owe their tonic virtues to bitter principles singly. 1. COLOM'BA.—COLUM'BO. This is the root of Coc- culus palmatus; Sex.Syst. Dicecia Hexandria; Nat. Ord. Menispermaceae; a climbing plant, which in- habits thick forests on the shores of Oibo and Mo- zambique; and fifteen or twenty miles inland. It has been cultivated both at Madras and the Isle of France. The roots are dug up in the hot season in March; the tubers only being generally removed, without injuring the pri- mary root. These are cut into slices and dried on cords in the shade. Co- lumbo is imported largely into England, but the quantity seems to fluctu- ate greatly in different years. Thus, in 1838, ac- COLOMBA. 35 cording to Dr. Pereira, duty was paid on 19,805 lbs.; and in 1839, on only 9,384 lbs. Columbo or Colomba root, as met with in the shops, is in flat, circu- lar or oval pieces, from half an inch to three inches in diameter, and from one to three or four lines thick. The epidermis is of a yellowish gray or brownish colour; smooth or irregularly wrinkled. The fiat surfaces are of a greenish or grayish yellow colour, depressed in the centre from shrinking during drying, and are frequently marked with concentric circles and lines radiating from the centre. # It readily imparts its principles to alcohol and water. The tonic principle or Columbin is obtained by evaporating an ethereal tincture until crystals are obtained, which are most intensely bitter. The root contains, also, a third of its weight of starch, which renders it an easy prey to insects. On the continent Fis- 129- of Europe, it is said, that the root of Fra- sera Walteri has been sold for Columbo; but they differ so much from each other in appearance that the fraud is readily de- tected. Columbo is one of the very best of the bitter tonics; and is greatly used as a sto- machic in all cases in which a simple bitter is needed. The best form of preparation is the infusion, but should it be desired to administer it in powder, the dose may be from gr. x. to 5ss. and more. INFU'SUM COLOM'BjE, INFU'SION OF COLUMBO. (Colomb. contus. gss.; Aquae bullient. Oj.) Boiling water dissolves some of the starch in which co- lumbo abounds; and, hence, the Edinburgh College directs the infu- sion to be made with cold water, which thoroughly exhausts the root, if used in the way of percolation or displacement; and makes an in- fusion, that keeps longer without becoming mouldy. The infusion, made in the ordinary way, soon spoils. It is often given along with alkalies; and forms the excipient, if not the basis, of numerous tonic mixtures. The dose is fliss. to fSij. TINCTU'RA COLOM'BiE, TINCTURE OF COLUMBO. (Colomb. cont. giv.; Alcohol. dilut. Oij.; made either by maceration or displacement.) This tincture is a good adjunct to bitter infusions, as to the infusion of columbo; and is occasionally taken alone, mixed with water. Its dose is from f3j- to f5iij. Cocculus palmatus. 1, 2. Petals. 3. Ovaries united at the base. 4. Drupes or berries. 7. Spindle-shaped fleshy tubers. 8. Transverse section of the same. 36 special tonics. 2. GENTIA'NA.—GENTIAN. Gentian is the root of Gentiann lutea, common or yellow gentian; Sex. Svst. Pentandria Digynia; Nat. Ord. Gentianame. It maybe regarded as the best of the simple bitters. Accordingly, it is received into the various pharmacopoeias; and its officinal preparations are more numerous than those of any article of the class. The plant is an inhabitant of Alpine grassy slopes and meadows throughout the middle*regions of continental Europe; and abounds in the Pyrenees, the mountains of A^osges and Auvergne, and the Alps of Austria and Switzerland, thriving best at an elevation between 3000 and 5000 feet above the sea. It is said to be particularly abundant on Mount Jura. (Christison.) It is a Fig. 130. beautiful plant, evolv- ing its splendid yellow flowers in July. The root, which is the only officinal part, is brought to this country from Germany. It is said to be imported into England from Havre, Marseilles, &c. In 1839, according to Dr. Pe- reira, duty was paid on 470 cwt. As met with in the shops, gentian is in pieces of various sizes; and, if large, is split lengthwise. It is yel- Gentiana lutea. lowish-brown extern- ally, and of a brown- ish-yellow within; and is tough and flexible; but, when thoroughly dried, is readily reduced to a yellowish-brown powder. Its odour is feeble and peculiar; taste at first sweet, but afterwards intensely bitter. It yields its virtues readily to water, alcohol, and wine, which are, therefore, used as menstrua for certain officinal preparations. When subjected to analysis, it is found to consist mainly of bitter extractive, traces of volatile oil—oil of gentian;—gum, an uncrystallizable princi- ple, and gentisic acid or gentisin. MM. Henry and Caventou believed, that they had succeeded in separating, by means of ether, an active neutral crystalline principle of a yellow colour, in which the bitterness of the root was concentrated, and to which they gave the name Gen- tianin; but this has since been shown to be impure gentisic acid; and when the crystals are entirely free from impurities, they are devoid of bitterness. (Leconte, Trommsdorff.) The bitter principle of gentian has not yet been isolated. Gentian, as already remarked, is one of the bitters most extensively GENTIANA. 37 prescribed. It is, indeed, calculated to fulfil all the objects for which the simple bitter tonics are employed. Accordingly, it may be given in atonic dyspepsia, simple or complicated; as well as in convalescence from acute diseases; and in want of tone, howsoever induced. It is an ingredient of the celebrated Duke of Portland's powder for the Gout, which consisted of equal quantities of the roots of gentian and birth- wort (Aristolochia rotunda), the tops and leaves of germander (Chamce- drys), ground pine (Chamcepitys), and lesser centaury (Chironia centau- rium), powdered, and mixed together. This powder, as well as gentian itself, was at one time thought to possess the power of arresting a paroxysm of gout, and of eradicating the disease; and, as the affec- tion is connected with derangement of the gastro-enteric functions, it may, doubtless, often be serviceable; but it need scarcely be said, that it does not merit the high encomiums which have been passed upon it. The dried root is sometimes used by the surgeon as a tent to dilate apertures. The powder is occasionally employed to promote the dis- charge from issues. INFU'SUM GENTIAN! COMPOS'ITUM, COMPOUND INFUSION OF GENTIAN. (Gen- tian, cont. |ss.; Aurant. corticis cont., Coriandr. cont. aa 3j-; Alcohol. dilut. f 3iv.; Aquae f^xij.) This is really a weak tincture of gentian, with the addition of certain aromatics, which render it a better sto- machic. The alcohol enables the infusion to keep better than if water only were the menstruum. The dose is f sj. to f 3iss. TINCTURA GENTIA'NA COMPOS'ITA, COMPOUND TINCTURE OF GENTIAN. (Gentian. cont. 3ij-; Aurant. cort. 3j.; Cardamom, cont. 3ss., Alcohol, dilut. Oij.; pre- pared either by maceration or displacement.) This is an excellent stomachic, which is either added to bitter infusions like the one above; or is taken alone, mixed with water. The aromatics and alcohol cause it to be excitant; and suggest caution in its employment, where there is hyperaemia of the mucous membrane of the stomach. It is apt to be indulged in by hard drinkers, whose gastric functions become im- paired ; and who, in this manner, without reflection may take consider- able quantities of alcohol. The dose of the tincture is f 3j • or f 3ij- EXTRAC'TUM GENTIA'NJ, EXTRACT OF GENTIAN.—Extract of gentian may be made either by evaporating a decoction of the root, or the cold in- fusion made by percolation or displacement. The latter is the plan recommended in the Pharmacopoeia of the United States. Good gen- tian yields, by the former method, about half its weight of extract. (Brande.) Extract of gentian may be prescribed alone as a tonic; but it is more frequently used as a vehicle for other tonics, as the prepa- rations of iron. When given alone the dose is from gr. x. to gr. xxx. Gentian also forms part of the Tinctura Rhei et Gentiance of the Pharmacopoeia of the United States. 3. Gentia'na Chirayi'ta, Henricea Pharmacearcha, Swertia chi- rayita, Agathotes Chirayita, Chiretta, Chirayita, is a native of India, whence it is imported into England tied up in bundles. It has been lono- in use there. The herb and root are intensely bitter. They strik- ingly resemble officinal gentian, and are employed in the same cases 38 special toxics. either in infusion, (Gent. Chirayit. 5\j.\ Aq. bullient. Oss. Dose, f.5iss.;) or in tincture, (Gent. Chirayit. 3v.; Alcohol, dilut. Oij. Dose, one or two teaspoonfuls.) The dose of the powder is a scruple. Other species of gentian—as Gentiana biloba or G. punctata ; G. purpurea; G. macrophylla ; G. Pannonica, possess properties analo- gous to those of gentiana lutea; and the roots of some of them are occasionally substituted for it. One other species is officinal in the secondary list of the Pharmacopoeia of the U nited States, the 4. Gextia'xa Catesb^'i, Blue Gentian. This species of gentian is indigenous in the swamps of the Carolinas, where it flowers from September to December. Its properties resemble those of Gentiana lutea; and it may be given in the same cases, dose, and forms of pre- paration. 5. QUAS'SIA. Quassia wood was at one time obtained from Quassia amara; Sex. Syst. Decandria Monogynia; Nat. Ord. Simarubacese, a tree, which inhabits Surinam, Kg. 131. Guiana, and Co- lombia ; and is cultivated as an ornamental plant only, in Brazil and the West In- dies. Its wood is light, yet close and tough; of a pale yellowish- white colour, with- out smell, and of an intensely bit- ter taste. It is probable, how- ever, that this— true quassia wood — is never met with in commerce. Dr. Christison states, that he has often tried to ob- tain it from whole- sale dealers in London; but none of the billets sent to him corresponded with true quassia. The quassia now met with in the shops, is the wood Quassia excelsa. 1. Male flower. 2. Flower expanded. 3. Fertile flower. 4. Drupe. SIMARUBA. 39 of a different species—Quassia excelsa or Picrcena excelsa, Lofty Bit- terwood Tree, Bitter Ash—a tall beautiful tree, nearly 100 feet in height, which inhabits Jamaica, and other West India Islands. The wood is generally in cylindrical billets of various sizes ; is very tough ; yellow- ish ; without odour, and of an intensely bitter taste, and is kept in the shops either split into small pieces, or rasped. It is said to be some- times adulterated with other woods; but these are detected by their not possessing the intense bitterness of the genuine article. When subjected to analysis it affords traces of volatile oil; a bitter principle termed quassite or quassin; gummy extractive; pectin ; woody fibre, and various salts. The crystalline principle called quassite, which was discovered by Wiggers in some of the quassia woods, is not—it has been said—contained in the true quassia, although this last has a large amount of bitter principle. Dr. Christison affirms, that he has not been able to obtain it. The virtues of quassia are yielded to alcohol and water. Quassia possesses the medical properties of the simple bitters, and is adapted for all the cases in which the class are indicated; hence, it is largely prescribed, and especially in asthenic conditions of the di- gestive organs. It is often used in place of hops in the preparation of beer, although prohibited by the statutes of certain countries. It does not, however, communicate any noxious property to the beer; but does not preserve it as well as hops, or make as agreeable a beve- rage. Like other bitters, it is best given in the form of infusion. It is extremely difficult to reduce it to powder; and the powder—as re- marked of simple bitter tonics in general—is an objectionable form in cases of gastric debility. If it be desired, however, to exhibit it, the dose may be 9j. to 3j- three or four times a day. INFU'SUM QUAS'SLE, INFUSION OF QUAS'SIA. (Quassia} rasur. 3ij.; Aquae Oj.) Cold water makes a clearer infusion than hot. The dose of the infusion is f Siss. to f 3iij. TINCTU'RA QUAS'SLE, TINCTURE OF QUASSIA. (Quassia rasur. gij.; Alco- hol, dilut. Oij.; prepared either by maceration or displacement.) Alco hoi is said to make a better tincture than the dilute alcohol directed by the pharmacopoeias. This tincture is employed chiefly as an addition to bitter infusions. When given alone, the dose is f 3j. or f 3ij. in a little water. EXTRAC'TUM QUAS'SLE, EXTRACT OF QUASSIA. This preparation is ob- tained by boiling down the cold infusion, made by displacement, to the proper consistence. Its chief use—like the extract of gentian—is as an excipient for the administration of the mineral tonics. In the dose of five grains, it may be prescribed by itself as a bitter tonic. 6. SIMARU'BA. Simaruba is the bark of Simaruba. officinalis, S. amara, Quassia sima- ruba Bitter simaruba, Mountain damson; which is of the same class and 40 SPECIAL toxics. order, and the same natural order, as Quassia amara. The tree is common in Jamaica, and in other West India Islands; and in Guiana and Cayenne. The bark of the root is the officinal portion. As met with in the shops, it is in pieces of various sizes, which are some- times very long, and some inches Fig. 132. in breadth; folded lengthwise; rough externally; warty, and of a grayish-yellow colour; within, of a yellowish-brown, and on the inner surface of the bark of a pale yellowish-white. It is light and tough; devoid of odour, and of a very bitter taste. When sub- jected to analysis, it is found to contain a bitter principle analo- gous to quassite, with a trace of volatile oil, &c. Water and al- cohol extract its virtues. In large quantities, simaruba is said to excite vomiting and purging; but in ordinary medi- cinal doses, it is a bitter tonic, resembling in its properties the article last described. It has, likewise, been given in dysente- ry, and the Germans term it Iiuhrrinde, dysentery bark. It can only, however, be service- able in chronic cases of the dis- ease ; and its action is probably altogether that of an ordinary bitter tonic. It is rarely prescribed in this country. The Pharmacopoeia of the United States contains no officinal preparation of it. The dose of the powder is from a scruple to a drachm. Simaruba amara. 1. Female Flower. 2. Drupes. 3. Male flower. i. Stamen. 7. PRUNUS YIRGINIA'NA.—WILD CHERRY BARK. Prunus Yirginiana, Cerasus serotina or Cerasus Virginiana • Sex. Syst. Icosandria Monogynia; Nat. Ord. Amygdalaceae—an indige- nous tree, which is common throughout the United States—yields offi- cinal Wild cherry bark. On the banks of the Ohio, it is a much larger tree than in the Eastern States. The inner bark—which is the part of Prunus employed in medicine— as met with in the shops, is in pieces of various sizes, of a bright cin- namon colour; brittle and readily reducible to a fawn-coloured pow- der. Its taste is agreeably bitter and aromatic, with the flavour of the bitter almond. Its virtues are readily communicated to hot or cold water; but they are impaired, and the flavour injured by decoction partly in consequence of the volatilization of principles on which they FRASERA. 41 are dependent; and partly of a chemical change effected by the heat. (Wood and Bache.) On distilling the same portion of water succes- sively from several different portions of the bark, a volatile oil, asso- ciated with hydrocyanic acid, was obtained by Mr. Procter, of Phila- delphia, having properties analogous to those of oil of bitter almonds; and, like it, not pre-existent, but resulting from the reaction of water upon amygdalin. The medical virtues of Prunus Virginiana are those of a tonic; and, also, of a sedative, owing to the hydrocyanic acid, which is form- ed ;—the tonic virtue being dependent upon the bitter principle, and— it has been suggested—on phloridzin. In this country, it is much pre- scribed in the debility attending phthisis; in which it has been sup- posed to act as a sedative on the accompanying hectic; whilst at the same time it impresses a tonic influence on the stomach. It need scarcely be said, however, that but little—even temporary—benefit can be expected from it in such cases, which—when in their confirmed stage—generally proceed onward to their fatal termination, but little modified by treatment. In many of our hospitals, Prunus is a routine prescription; but, although the author has carefully watched its effects, he has not been able to say, that any evident relief was afforded by it. lie has certainly never witnessed the sedative action that has been ascribed to it. It may be given in all cases in which a mild unstimu- lating tonic is needed. As in the case of other bitter tonics, the infusion is a better prepara- tion than the powder; but should it be desired to exhibit the latter, the dose may be from 3ss. to 3j. INFU'SUM PRUNI YIRGINIA'NA, INFU'SION OF WILD CIIERRY BARK.—(Prun. Virginian, cont. 3ss.; Aquae Oj.) Cold water is used in the preparation of this infusion, to avoid the disengagement of any volatile matter that may be possessed of activity. The dose is Oiss.—foiij., three or four times a day. SYR'UPUS PRUNI VIRGINIANS, SYRUP OF WILD CHERRY BARK. (Pruni Virginian, in pulv. crass. 3v.; Sacchar. rbij.; Aquce q. s. Pour water gradually on the bark in a percolator until a pint of liquid has passed. Add the sugar and agitate occasionally until it is dissolved. This syrup is much used in pulmonary affections, more especially, however, to allay cough. Dose f3ij to fjss. 8. FRASE'RA.— AMERICAN COLUM'BO. The root of Frasera Walteri, American Columbo or False Columbo ; Sex. Syst. Tetrandria Monogynia; Nat. Ord. Gentianaceae, is officinal in the secondary list of the Pharmacopoeia of the United States. The plant is one of the most beautiful indigenous productions of the vege- table kingdom; flowering from May to July and flourishing in the southern and western portions of the Union, especially in Arkansas 42 SPECIAL TOXICS. and Missouri. The root, it is advised, should be collected in the au- tumn of the second, or the Fig. 133. spring of the third year; and, before being dried, should be cut into transverse slices. (Wood & Bache.) When dried it is generally in transverse circular seg- ments, about an inch in diameter, and an eighth of an inch or more in thick- ness. Some years ago, it was introduced into France, and sold for columbo; but if attention be paid to the pieces, they will be found to be more uniform in their in- ternal structure; and not to have the concentric and ra- diating lines, which are ge- nerally seen on columbo. They are of a purer yellow, too; without a greenish tinge, and contain no sta/ch. Frasera has the same pro- perties as columbo, and other simple bitters, and is applica- ble to the same cases. It is not, however, much used. It may be given in infusion; (Fraser. 3j.; Aquae bullient. Oj. Dose, f.liss.—f^ij.;) or in tincture (Fraser. 3j.; Al- cohol, dilut. Oj. Dose, f3j.— f3iij.,) neither of which is officinal. Should it be de- sired to give the powder, the dose may be gr. xx. to 3j. Frasera Walteri. 9. SABBA'TIA.—AMER'ICAN CENTAURY. Sabbatia angularis; Sex. Syst. Pentandria Monogynia; Nat. Ord. Gentianacese, grows extensively in the Middle and Southern States of the Union, in low grounds especially; flowering in July and August. The herb is collected whilst in flower. It has a strong bitter taste • and its virtues are extracted by both alcohol and water. It may be prescribed in the same cases as gentian; and like all the bitters, has been given in the apyrexia of intermittents; but its powers are not such as to entitle it to be classed amongst the antiperiodic tonics. It is generally given in infusion. (Sabbatice gj.; Aq. bullient. COPTIS. 43 Oj. Dose, fliss.) Should it be desired to prescribe it in powder, the dose may be from 3ss. to 3j. 10. COPTIS.—GOLD-THREAD. Gold-thread is the root of Coptis trifolia; Sex. Syst. Polyandria Polygynia; Nat. Ord. Fls- 134- Eanunculacese; a small indigenous evergreen, resembling the straw- berry, which inhabits the northern parts of America; and is found, likewise, in Asia, Green- land, and Iceland; flow- ering in May. The whole of the plant is bitter; but the root most so. It is, there- fore, the officinal por- tion; and is admitted into the secondary list of the Pharmacopoeia of the United States. As seen in the shops, gold- thread is in loose masses, formed by long filiform, orange yellow roots, fre- quently mixed with the stents and leaves. The taste is purely bitter, and like the other bitters, its virtues are com- municated to water and to alcohol. The bitter extractive is precipi- tated by nitrate of silver, and by acetate of lead. Gold-thread is a simple bitter, which has been compared to quassia; and may be used in all cases, where the simple bitter tonics are indi- cated. Like them, it may be given in infusion (Copt. 3j.; Aquce bul- lient. Oj. Dose, fHiss.—f.lij).; or tincture, (Copt. 3j.; Alcohol, dilut. Oj : dose, f3j.—f3hj)-; but neither of these is officinal. Should it be desired to exhibit the powder, the dose may be from gr. x to 3ss. Coptis trifolia. Besides the simple bitter tonics already described, the secondary list of the Pharmacopoeia of the United States contains the following: 11. Ale'tris, Star-GRASS. The root of Aletris farinosa ; Star-grass, Blazing Star, Mealy Starwort; Sex. Syst. Hexandria Monogynia; Nat. Ord. Asphodeleae; an indigenous plant, which is found in almost all parts of the United States; in fields and about the edges of woods; flowering in June and July. Dr. Bigelow states, that he knows of no plant, which surpasses it in genuine, intense and permanent bitterness. The bitterness is owing to bitter extractive, but the root likewise 44 SPECIAL TOXICS. contains resin; for when water is added to the alcoholic tincture, it becomes milky. It may be given as a tonic in infusion or tincture. large doses, it is said to disturb the stomach. 12 X^XTHORRHI'ZA, Yellow-ROOT. The root oiXanthorrhhaapii- folia or X. tinctoria, Sex. Syst. Pentandria Polygyria; xVvr. Ord. KanunculaceaB—which grows in the Southern and AVesternbtates, flowering in April—is so called in consequence of its colour, wnicn, as well as its bitter taste, it yields to water and to alcohol. It is a simple bitter, resembling columbo; and is prescribed in the same cases It may be given in infusion. (Xanthorrhiz. 3j.; Aquce bullient. Oj. Dose, fgiss. to fliij.) Hydrastis Canadensis, Yellow root. Orange root; an indigenous plant, Nat. Ord. Kanunculacea?, which is found in most parts of the United States, but is most common to the west of the Alleghames, and flowers in April and Mav, possesses the properties of the bitter tonics; out it has not been analyzed. It is best given in infusion. It is said ,o have been used in this form in the Western States as a wrash in ophthalmia; and the Indians employ it as a lotion to chronic ulcers. b. Aromatic Bitter Tonics, which possess, along with bitter principle, more or less aromatic properly. 13. AN'THEMIS.— CHAMOMILE. The most important constituents of chamomile flowers—as elsewhere remarked (i. 159)—are volatile oil, and bitter extractive. They con- tain likewise a little tannic acid. In large doses—as has been seen— the infusion acts as an emetic: in smaller quantities, as an aromatic bitter,—the volatile oil communicating the aromatic or excitant pro- perty ; the bitter extractive and tannic acid, the tonic. In all cases, consequently, that require the union of an excitant and bitter, as in atonic dyspepsia, an infusion of chamomile is a good prescription; and, accordingly, it is largely used both in professional and popular practice. Powdered chamomile—for reasons often referred to—is rarely given as a tonic; but should this be considered advisable, the dose may be from gr. x. to 3ss. or more. An extract, prepared from the decoction, is directed in some of the pharmacopoeias; but it cannot possess the virtues of an aromatic bitter, in consequence of the volatile oil being driven off during the decoction. It has, consequently, been very pro- perly omitted in the edition of the Pharmacopoeia of the United States of 1842,—the extracts of the simple bitters—Gentian and Quas- sia—possessing all its properties. 14. CASCARIL'LA. Cascarilla is the bark of Croton Fleulheria, and other species of Croton ; Sex. Syst. Monoecia Monadelphia; Nat. Ord. Euphorbiacese. ANGUSTURA. 45 Croton Eleutheria is a small tree or shrub, which is indigenous in the West Indies, especially in the Bahama Islands, and in Jamaica; from the former of which it is chiefly exported. In the year 1840, duty, according to Dr. Pereira, was paid in England on 14,490 lbs.; but the whole of this was not used in medicine. It is a constituent of most of the fumigating pastilles, on account of the agreeable aromatic odour exhaled by it when burning. Cascarilla is met with in pieces seldom exceeding from four to six inches in length, which are commonly quilled, but sometimes almost flat; of a gray colour externally, with some portions almost white, and others yellowish-brown; of a brown colour internally, and usually shining. The epidermis is intersected by numerous longitudinal and transverse cracks or fissures. It is compact, hard, and readily reduci- ble to powder. The taste is warm, aromatic, and bitter; and the smell peculiar and agreeable, and increased by heat. Alcohol and water readily extract its medical virtues, which are dependent on a bitter prin- ciple, associated with volatile oil. It is consequently well adapted for cases which require the aromatic tonics,—as asthenic dyspepsia, and, indeed, debility in general. At one time, it was used as an antiperi- odic; but it is now never given with this view. Should it be desired to prescribe powdered cascarilla, the dose may be from 9j. to 3ss. INFU'SUM CASCARILLA, INFUSION OF CASCARIL'LA. (Cascarillce contus. I].; Aquae bullient. Oj.) The dose of this infusion—the form in which cas- carilla is usually prescribed—is f 3iss. to f 3iij. 15. ANGUSTU'RA.— ANGUSTU'RA BARK. Angustura or Angostura or Cusparia Bark, is obtained from Galipea officinalis; Sex. Syst. Diandria Monogynia; Nat. Ord. Eutaceae; which is indigenous in the neighbourhood of the Orinoco. MM. Humboldt and Bonpland, hoAvever, assert, that Galipea Cus- paria, Bonplandia trifoliata, Cusparia febrifuga, yields the bark; and there is reason to believe, that from both trees a bark is obtained much alike in medical virtues. The framers of the edition of the Pharmacopoeia of the United States of 1842 refer the officinal bark to Galipea officinalis. As seen in the shops, the bark is in flat pieces, slightly curved, but rarely entirely quilled; of various sizes; covered by a yellowish-gray, or grayish-white spongy epidermis, which is readily scraped off with the nail; the inner surface is brownish; the transverse fracture short and resinous. The powder is of a pale yellow, some- what like that of rhubarb. The odour is peculiar, and the taste bitter, acrid, and aromatic. Its medical virtues are imparted to water and to alcohol. The bark has been subjected to analysis, and found to contain a volatile oil, to which it owes its acrid aromatic taste; and a peculiar bitter principle called Angosturin and Cusparin, to which it is indebted for its tonic properties. At one time a serious fraud was committed on the continent of Europe, by substituting for it the bark of nux vomica, which was then termed false, spurious, or East India angostura, before its true character wras known. It is now generally 46 SPECIAL TOXICS. admitted by pharmacologists, that it must be referred to strychnos nux vomica. The characteristics of the true and the false barks are given in a tabular form by Dr. Pereira. Angustura bark is a valuable aromatic tonic; but partly in conse- quence of its liability to adulteration with so poisonous an article as the bark of strychnos nux vomica, it has fallen into disuse. More- over, it was found not to possess the febrifuge or antiperiodic virtues for which it had been extolled; and it is now never used except as an aromatic bitter, in cases in which articles of the class are indicated. In very large doses, it is said to prove emetic and cathartic; but it is never prescribed in this country with any other view than as a tonic, nor is it extensively used in that relation. Should it be desired to administer the powder, the ordinary dose is gr. x. to 3ss.; but the most common and the best form of preparation is the following:— INFU'Sm ANGrSTT'R.E, INFU'SION OF ANGUSTU'RA BARK. (Angustur. cont. Sss.; Aq. bullient. Oj.) The dose of this infusion is f^iss. to foij. 16. SERPENT A'RIA.— VIRGINIA SNAKEROOT. Fig. 135. Aristolochia serpentaria. Virginia snakeroot is the root of Aristolochia Serpentaria; Sex. Syst. Gynandria Hexandria; Nat. Ord. Aristolochiaceae—an herba- ceous plant, flowering in May and June, and growing in rich shady woods throughout the Middle, Southern and Western States. It is collected in western Pennsyl- vania and Virginia; in Ohio, In- diana and Kentucky; is usually in bales,-containing one hundred pounds ; and is often mixed with the leaves and stems of the plant, and with dirt from which it had not been well freed at the time when it was collected. The roots of Aristolochia hirsuta, A. hastata, and A. reticulata, which scarcely differ from those of A. serpentaria, contribute indiscriminately to fur- nish the snakeroot of commerce; although the last is the only one received as officinal. The root of aristolochia reticulata has been in- troduced of late, and is now not unfrequently used. It is derived from the west of the Mississippi; and is composed of a knotty cau- dex, whence arise numerous long ABSIXTHIUM. 47 fibres, larger than those of the root of Aristolochia serpentaria. It has been analyzed by Mr. Thomas S. Wiegand, of Philadelphia, who found the same constituents as in the officinal root,—the gum, ex- tractive and volatile oil being in a somewhat greater proportion. Snakeroot, as met with in the shops, consists of the rootstock, whence proceeds a tuft of long, slender, yellowish or brownish fibres. The colour of the powder is grayish; the smell of the root aromatic and agreeable; and the taste warm and bitter. It yields its virtues to water and to alcohol. Its main active constituents are volatile oil, the odour and taste of which have been compared to that of valerian and camphor combined,—and bitter principle; the former being the source of the aromatic and excitant,—the latter that of the tonic pro- perties. Serpentaria has had great reputation as an excitant tonic; and, at one time, was employed to arrest intermittents; but now that we pos- sess more potent agents, it is rarely given except in association with them. It is much prescribed to support the powers in adynamic con- ditions of the frame. Should it be desired to exhibit it in powder, the dose may be from gr. x. to 3ss. and more; but the following pre- parations are to be preferred. INFU'SM SERPENTA'RJJE, INFUSION OF VIRGINIA SNAKEROOT. (Serpentar. gss.; Aquae bullient. Oj.) The dose is f^iss. to fiij. TINCTU'RA SERPENTA'RLE, TINCTURE OF VIRGINIA SNAKEROOT. (Serpentar. contus. 3hj-; Alcohol, dilut. Oij.; prepared either by maceration or by displacement.) The tincture is rarely prescribed alone; but is added to tonic infusions, especially to the infusion of cinchona. The dose is f5j. to f3iij. Serpentaria forms part of the Tinctura cinchonoz composita of the Pharmacopoeia of the United States. 17. ABSINTHIUM.—WORMWOOD. The tops and leaves of Artemisia absinthium, common wormwood, are officinal in the Pharmacopoeia of the United States. The plant is in- digenous in Europe, in the southern part of which it grows abundantly. It is also met with on roadsides and rubbish-heaps in Great Britain; but the druggist is supplied with it from gardens near London. It is raised in the gardens of this,country, and has been naturalized in the mountainous regions of New England. The plant is in flower in July or August, at which time the tops and leaves should be gathered. It has a penetrating, peculiar and disagreeable smell, and a very bitter, aromatic taste. It imparts its virtues to water and to alcohol. Its active constituents are volatile oil, which gives it its aromatic character; and bitter principle, on which its tonic virtues are dependent. Wormwood is a nauseous bitter, not now much employed, although 48 SPECIAL TOXICS. it is adapted for cases in which the aromatic bitters are indicated. It is more used, perhaps, in atonic dyspepsia Fig. 136. than in any other affection. Like all the simple and compound bitters, it was once much given in intermittents. Infusion is the best form of prepara- tion. (Absinth. 3j.; M- bullient. Oj. Dose, f3iss. to fgij.) The dose of the powder is 9j- to 9ij. 18. ARTEMIS'IA VULGARIS.— MUGWORT. All the species belonging to the genus Artemisia possess bitter and aromatic pro- perties. Artemisia vulgaris, Sex. Syst. Syn- genesia Superflua; Nat. Ord. Composite Corymbiferae, was, like the others, employed at one time as an aromatic tonic; but it fell into disrepute, until revived in Germany in modern times as a remedy in epilepsy. It has not, however, been much given as such in other countries of Europe, or in the United States. The root is the part em- ployed, which should be dug up in autumn, after the stalk has become dry; or in the spring before the stalk has shot up. Bur- dach recommends many precautions in its preparation. To remove epilepsy, he found it most efficacious, when given in the dose of a teaspoonful—from fifty to seventy grains—in warm beer; about half an hour Should this be impracticable, it may be ad- ministered as soon as the patient can swallow. He must be put to bed immediately; be covered up warm, and allowed warm small beer to drink, so as to occasion diaphoresis. This plan may be repeated ac- cording to circumstances. Burdach has entered into details on this subject, which the author has given elsewhere. (Nevj Remedies, 6th edit. p. 109.) In general, it may be sufficient to prescribe a drachm of the powder three times a day, gradually increasing the dose; or it may be given in infusion or decoction. (Artemis, vulg. rad. concis. Ij.; Aquas Oiss.; boil for half an hour. Dose, half a teacupful every two hours in cases of epilepsy.) It is to be feared that the assertions of the German physicians are too strong, and that the advantages to be derived from the artemisia in epilepsy have been exaggerated. Where there is no organic dis- ease of the encephalon, substances, which, like artemisia are nause- ous, bitter, and aromatic, may be productive of advantage as tonics and revellents; and the author has seen one or two cases in which beneficial effects have resulted from its use. It has likewise been given Artemisia absinthium. before the paroxysm. COXTRAYERVA. 49 in other diseases, in wdiich aromatic tonics are indicated, but it pos- sesses no virtues over others of the class. Besides the aromatic bitter tonics, above described, the Pharmaco- poeia of the United States has the following in its secondary list. 19. Angel'ica.—The root and herb of Angelica atro-purpurea, pur- ple angelica or masterwort; Sex,Syst. Pentandria Digynia; Nat. Ord. Umbelliferae, a plant which grows between Carolina and Canada, flow^- ering in June and July. The plant has a strong smell, and an acrid and aromatic taste. It is used as an aromatic tonic, like Angelica Arch- angelica or garden angelica, of Europe. Its aromatic powers adapt it for cases of atonic dyspepsia, and flatulent colic. The author has, however, never seen it used. It may be given in infusion (Angelic. §j.; Aq. bullient. Oj. Dose; f§iss. to fSiij.) 20. As'ARUM, Canada snakeroot, ivild ginger. The root of Asarum Canadense; Sex. Syst. Dodecandria Monogynia; Nat. Ord. Aristolo- chiaceae; which grows in old woods and shady places from Canada to Carolina, has an agreeably aromatic taste, considered to be interme- diate between that of ginger and that of serpentaria; qualities, which have given it the names of wild ginger, and snakeroot in different parts of the country. It has also been called CoWs-foot. The properties seem to be dependent upon volatile oil, and a bitter resinous matter; both Fig. 137. of which are extracted by dilute al- cohol. It resembles serpentaria in its pro- perties ; and is sometimes used as a substitute for ginger; so that it might, with propriety, be classed amongst Excitants. 21. Contrayer'va.—The root of Dorstenia Contrayerva; Sex. Syst. Tetrandria Monogynia ; Nat. Ord. Urticacese—a native of Mexico, the West Indies, and certain parts of South America—is imported chiefly from the West Indies, and the Bra- zils. Its odour is aromatic and pe- culiar; taste warm, bitterish and slightly acrid. Its virtues appear to be dependent upon volatile oil, and bitter extractive. Dorstenia contrayerva. It is considered to resemble ser- pentaria ; and has been prescribed in the same cases; but it is rarely used in this country, or indeed anywhere. The dose of the powder is 9j. to 3ss.; but it is best given in infusion: (Contrayerv. 3j.; Aq. bullient. Oj. Dose, foiss.) VOL. II.—4 50 special toxics. 138. Anthemis cotula. Fig. 139. Magnolia glauca* 22. Cot'ula, May- weed.—The herb An- themis Cotula, May- weed, wild chamomile, which grows abund- antly both in the United States and Eu- rope; flowering from the middle of summer till late in the autumn, has properties essen- tially the same as cha- momile ; but its smell is so disagreeable, that it is rarely substituted for it. By the physi- cian, it is seldom or never prescribed. The flowers are less dis- agreeable than the leaves, and may be given in infusion. 23. Eryn'gium, Button snakeroot. The root of Eryn- gium aquaticum, But- ton snakeroot or water 'Eryngo; Sex. Syst. Pentandria Digynia; Nat. Ord. Umbelli- feras, which grows in Virginia and Carolina, flowering in August, has a bitter, aromatic, pungent taste; resem- bling, apparently, in its action, the ordina- ry aromatic tonics.— In large doses it is said to be emetic. The author knows no- thing of its virtues from his own expe- rience; nor is he ac- quainted with many who do. 24. Magxo'lia. This is the bark of Magnolia glauca, White Bay, SweetBay, MAGNOLIA. 51 Swamp Sassafras, Beaver Tree;—of if. acuminata Cucumber tree, and of M tripetala, Umbrella'tree; Sex. Syst. Polyandria Polygynia; Nat. Ord. Magnoliaceae; all of which are indigenous in the Uni- ted States, and admired for the beauty of their foliage, and the size and fragrance of their flow- ers. The bark of the root is considered to be most active; but that of the trunk and branch- es is officinal also. It has a bit- ter, combined with a spicy, pun- gent taste. Dr. Stephen Procter, in an inaugural essay presented in the Jefferson Medical College of Philadelphia, and published in the American Journal of Phar- macy ion July, 1842,'has given, as the principal constituents of the bark of Magnolia Grandiflora, —green resin, volatile oil, (upon which its remedial virtues, he thinks, depend,) and a peculiar crystallizable principle resem- bling liriodendrin. The aromatic property is impaired by drying, and wholly lost when the bark is Magnolia macrophylla. long kept. Magnolia macrophylla—a native of the Southern, and some of the Western, States, and remarkable for the magnificence of its leaves and flowers—has similar remedial properties. Magnolia has been used in intermittents; but it is not so now. It possesses the properties of the class in which it is placed; and may be given as a gently excitant tonic. All its virtues are imparted to dilute alcohol. The infusion is less efficient; but is a good tonic. The dose of the bark, in powder, is from 3ss. to 3j- 25. Marru'bium, Horehound. The herb of Marrubium vulgare, white horehound; Sex. Syst. Didynamia Gymnospermia; Nat. Ord. Labiatae,—which is indigenous in Great Britain, but grows in most parts of Europe and also in Asia and America; flowering in July,— has a strong aromatic odour and a bitter taste; the bitterness depend- ing upon extractive; and the aromatic properties on volatile oil. Boiling water extracts its virtues; and, hence, it is given in infusion (Marrub. 3j.; Aquce bullient. Oj. Dose, fsiss. to fliij.) as a tonic; but it has had more reputation as an excitant expectorant and emmena- gogue. It enters into the composition of a candy—horehound candy— which is much used in catarrh. 52 special toxics. 26. Matricaria, German Chamomile. This belongs to the same family as.lathe mis or Chamomile; and resembles it in all its properties. The flowers are smaller, less agreeable, and feebler; but it may be prescribed in the same cases. 27. Polyg'ala Rubel'la, Bitter Poly gala. Both the root and herb oiPolygala Rubella, P. Polygama; Sex. Syst. Diadelphia Octandna; Nat. Ord. Polvgalea?,—which is indigenous in many parts of the United States; flowering in June and July,—are used. It is a strong and permanent bitter; and has been esteemed tonic and excitant; and in large doses diaphoretic, by virtue of the latter operation. It may be given in infusion or tincture. c. Astringent Bitter Tonics, which have an astringent associated with a bitter principle. 28. GEUM.—WATER A YENS. This is the root of Geum rirale; Sex. Syst. Icosandria Polygynia; Nat. Ord. Rosaceas; which is indigenous in the United States, and is in the secondary list of the Pharmacopoeia. It flourishes in Canada, and in the northern and middle States; sending forth its flowers in June and July. The root, as met with in the shops, is hard and readily reduced to powder; is of a reddish or purplish colour; devoid of smell; and of an astringent and bitter taste. It has not been subjected to analysis; but, doubtless, contains tannic acid and bitter principle on which its medical virtues are dependent. Water avens is tonic and astringent, and is, consequently, indicated in cases where such a joint agency is needed, as in passive hemorrhages, and chronic discharges from mucous membranes. It is, also, used in atonic dyspepsia; and in various adynamic cases. It may be given in the form of infusion or of decoction (Gei sj.; Aquce Oj.; dose, f Siss. to fsiij.); and should it be desired to prescribe the powder, which can never be necessary, the dose may be from 9j. to 3j- A weak decoction is sometimes taken by valetudinarians in New England as a substitute for tea or coffee. 29. PAULLIN'IA. This is an extract from a plant of the same name in Brazil. It is prepared by the Indians. A new alkali has been separated from it which—as well as the extract—is very bitter. Paullinia is prepared from P. sorbilis; Family, Sapindaceae; and its active constituents appear to be tannic acid, and bitter principle. In Brazil, paullinia is mixed with cocoa, and given as a tisane in diarrhoea and dysentery; and it has been used successfully in France in asthenic cases,—as in chlorosis, convalescence from severe mala- dies, &e. According to Martius, an extract is prepared from Paullinia CARBO LIGXI. 53 sorbilis, which is called there Guarana, and is used in simi- lar morbid cases. Fig. 141. The secondary list of the Pharmacopoeia of the United States contains the following articles, which may also be referred to this division of simple tonics. 30. Hepat'ica, Liverwort; —the leaves of Hepatica Ame- ricana, an indigenous plant. They have no aroma; their taste is mucilaginous, some- what astringent, and slightly bitter; and they possess no other properties than those of a demulcent tonic, notwith- standing the clamour that prevailed in their favour, in this country, some years ago, as a valuable remedy in chro- nic bronchitis, hasmoptysis, &c. Infusion is the best form of administration. (Hepatic. % j.; Aq. bullient. Oj. Dose, f Siss. to f Shj.) 31. Prinos, Black Alder. This is the bark of Prinos verticillatus, Black Alder; Sex. Syst. Hexandria Monogynia; Nat. Ord. Ulicineae, (Lindley)—Rhamni, (Jussieu); an indigenous shrub, which grows everywhere in the United States; flowering in June. The dried bark is inodorous; its taste bitter and slightly astringent. It imparts its virtues to boiling water. Black alder has long been used as a popular remedy in intermit- tents ; and in other affections, as a substitute for cinchona. It is rarely, however, prescribed by the physician. The dose of the powder may be stated at from 3ss. to 3j- It may, also, be given in infusion, (Prin. §j.; Aquce bullient. Oj.); decoction, and tincture. The berries have similiar properties with the bark, and are sometimes made into tincture. Lepatica Americana d. Mechanical Tonics or such as seem to act mechanically. 32. CARBO LIGNI.—CHARCOAL. It is obtained by burning wood in such manner as to exclude the access of atmospheric air. It is black, devoid of odour and taste, 54 SPECIAL TOXICS. having the texture of the wood from which it has been obtained. It is easily reduced to powder, and is insoluble. When perfectly dry, it absorbs many times its own bulk of certain gases ; abstracts from liquids, in which they are dissolved or diffused, different colouring and odorous matters; and hence is used as an antiseptic, and also— although to a less extent than animal charcoal—to deprive liquids of their colours. Charcoal.has been administered occasionally in intermittent fever, and has succeeded,—not probably in consequence of its possessing any intrinsic medical virtues,—for it would seem to have none,—but owing to the impression made on the stomach by the insoluble woody matter. It is, also, used as a tonic in dyspepsia; and, when combined with magnesia, is well adapted for cases in, which there is redundant secretion of the gastric acids, and constipation. Probably, as a tonic, its action is mechanical, by the new impression it occasions on the lining membrane of the stomach and intestines, exciting the chylopo- ietic organs to increased activity. In the same manner it proves cathartic in large doses. In addition to this tonic action,—by virtue of its antiseptic properties it corrects nidorous eructations, and the fetid secretions, often evacuated in diarrhoea and dysentery. The dose of charcoal is from gr. x. to 3ss., or more. Ten to fifteen grains, united with ten of magnesia or carbonate of magnesia, may be given in the cases above mentioned, and be repeated two or three times a day, should the case require it. 33. IN'DIGUM.— IN'DIGO. _ The well known colouring material Indigo is obtained by fermenta- tion from several species of the genus Indigofera,—I. tinctoria, I. anil, I. disperma, I. argentea, and I. hirsuta ; Sex. Syst. Diadelphia Decan- dria; Nat. Ord. Leguminosse. During the fermentation, the indigo— which is an educt of the process—is deposited as a feculent matter. It is chiefly brought from the East Indies; but a considerable quantity is derived from Guatemala and other places. As we receive it, it is generally in small, solid, brittle masses, of a deep azure colour, without smell or taste, and assuming a copper colour on being rubbed. _ Indigo has been prescribed in various spasmo- dic diseases, and especially in epilepsy; and many individuals have deposed to the services it has rendered. Others, however, have not testi- fied so favourably. Trials, made with it at the Philadelphia Hospital, were favourable; but others were not at all so. The results are de- tailed in another work. (New Remedies 6th edit. p. 432, Philad. 1851.) It is obvious 'how- & ever, as there stated, that a wide difference must 2>'<& exist amongst cases of epilepsy ; and that where Indigofera tinctoria. the organic modifications are considerable little can be expected from any remedy ; but even in such hopeless cases, the number of paroxysms would seem to have FERRI SALES. 55 diminished under its use. Where the cerebral affection is slight, and more functional than organic, indigo—like artemisia, and some other remedies extolled in epilepsy—may be useful. It certainly,—from the doses in which it may be administered,—appears to be nearly inert, and perhaps its main efficacy consists in the new impression, which it makes, in adequate doses, upon the nerves of the stomach; and through them upon those of the whole system; but to effect the revulsion to the necessary extent, it is important that the dose should be augmented day by day; and the remedy be continued, in large doses, for a suffi- cient length of time. It may be begun with in the dose of 3j-; and this may be doubled daily, until the patient takes 3ij. in the day, which may be continued for weeks. As the powder is very light, it has been proposed to give it in the form of electuary, with simple syrup as the constituent. Some aromatic—as Pulvis aromaticus—may be added to it, to prevent it from exciting nausea, which it probably does from quantity only. e. Mineral Tonics. FERRI SALES.—SALTS OF IRON. The effects of the preparations of iron—commonly called Chalybeates and Ferruginous or Martial preparations—are known to all, professional and lay. In the classification of Dr. Pereira, they constitute an entire order Haematinica—Tonica analeptica — defined by him "Medicines which augment the number of blood corpuscles or the amount of haematin in the blood." They are, in proper doses, tonic; and but few of them are poisonous in any dose. They vary, however, in their precise action on the economy, some possessing, along with a tonic power, decided astringency ; so that they may not be adapted for certain cases in which others of the class may be. In many cases in which they are prescribed—as in the neuroses—their operation seems to place them decidedly under the class of tonics; but in others, where great impoverishment of the blood has taken place, as in different forms of anaemia, and in the defective and perverted nutrition thereon dependent, their action would seem to be on the blood itself, and through it on the tissues; hence they fall properly under the class Eutrophics. Such would be their action in cancer. It has been supposed, indeed, that certain cachexias are con- nected with a deficiency of iron in the system, which the use of chaly- beates is well adapted to supply. Of the use of iron as an emmenagogue, the author has spoken else- where, (vol. i. p. 453.) He has there endeavored to show, that its operation is altogether indirect; and that as amenorrhcea is most com- monly connected with an asthenic condition of the system in general, and of the uterus in particular, chalybeates become proper remedies. In certain of the neuroses, they have been found serviceable,— especially in chorea and neuralgia; and in the latter disease, one of the preparations has been more successful than any other remedy perhaps; 56 SPECIAL TOXICS. yet in all such cases—indeed in all cases—their use has to be persevered in for a length of time. Although none of the preparations of iron are now used as antipen- odic tonics, they have been. They are still prescribed in the sequelae of intermittents, and have exhibited valuable properties in the disper- sion of enlargements of the spleen, which are generally, however, easily removed by the sulphate of quinia. M. Cruveilhier affirms, that by the aid of iron he has obtained the resolution of enlargements which have occupied half, or even two-thirds, of the abdomen. The general properties of the chalybeates adapts them, consequently, for asthenic conditions of various organs, and of the system generally; and some—it will be seen—are possessed of astringent powers which adapt them for chronic diarrhoea and dysentery. The special cases, however, that require their use, will be readily appreciated by an examination of their individual properties. When received into the stomach, the preparations of iron are proba- bly rendered soluble by the gastric acids; and, in the opinion of M. Mialhe, the potent agent in all is the sesquioxicle of the metal. On entering the circulation, they are acted upon, according to him, by the albuminate of soda contained in the blood, and a double decom- position is the consequence. Albuminate of iron is formed—a com- pound which, he says, is the basis of the red corpuscle of the blood; and a new soda salt is produced. He does not, however, affirm, that this is the true and only mode in which iron acts in the production of blood-corpuscles; but refers to the fact of such a decomposition taking place when a persalt of iron is added to the blood; and suggests, that it may have something to do with the modus operandi of iron in the cure of chlorosis; and he thinks, that the view is strengthened by the results of an experiment, which consisted in pouring a neutral persalt of iron into an albuminous solution containing a certain quantity of chloride of sodium, when a copious deposit of the red albuminate of iron, a compound which greatly resembles the matter that composes the blood disks, in being insoluble in saline solutions, but freely soluble in pure water, is copiously deposited. It is probable, however, that the mode in which the ferruginous preparations increase the amount of red corpuscles, is more, as in the case of animal food, by their action on the whole system of nutrition, than in the chemical way suggested by M. Mialhe. Much difference of sentiment has existed in regard to the relative powers of the various chalybeates. Whilst some think the agency of iron is best exerted in the metallic form, others greatly prefer the pro- toxide and the protocarbonate. The author has always found the ses- quioxide exert the full influence of the class to which it belongs • and he, therefore, prescribes it in the form of the Ferri subcarbonas of the Pharmacopoeia of the United States more frequently than any other preparation of the metal. M. Mialhe prefers the tartrate or potassio- tartrate, on account of its ready solubility; its comparative tastelessness • its agreeing well with the stomach; its including the peroxide of iron' its not being decomposed either by the acids of the stomach or by the alkalies of the intestines [?]; and therefore capable of being absorbed in FERRI SUBCARBONAS. 57 every part of the intestinal tract: and he affirms that on getting into the blood, its organic acid is consumed, and the peroxide is precipitated in a state of combination with albumen, which is best adapted for the reproduction of blood-corpuscles. Simon, in his " Animal Chemistry," gives the following table to ex- hibit the remarkable effects on the blood of a chlorotic girl from the use of iron. In seven weeks, she took two ounces of the tincture of iron, and sixty-four grains of metallic iron. Nothing, however, is said of the animal diet, and other analytic agencies to which she was proba- bly subjected. COMPOSITION OF THE BLOOD. Before the use of Iron. Afterwards Water,...... 871.500 806.500 Solid constituents, . 128.500 193.500 Fibrin, ..... 2.080 1.200 Fat,..... 2.530 2.299 Albumen, .... . 79.820 81.230 Globulin, .... 30.860 90.810 Haematin, .... 1.431 4.598 Extractive matters and salts, . . 11.000 9.580 Colouring matter contained in the haemato-globulin, 44° 4.8g When the less soluble chalybeates are taken into the stomach, they are in part absorbed; and the remainder is evacuated by the bowels, giving occasion to a dark or black colour of the fasces. 34. FERRI SUBCAR'BONAS.—SUBCAR'BONATE OF IRON. This preparation, called also Sesquioxide of Iron, red Oxide of Iron, and Carbonate of Iron, is obtained by mixing solutions of sulphate of iron and carbonate of soda together; stirring the mixture, and setting it by, that the precipitate may subside; which is then washed with hot water and dried. When the two solutions are mixed together, the sulphuric acid of the sulphate of iron lays hold of the soda of the carbonate of soda, whilst the carbonic acid of the latter lays hold of the oxide of iron of the former. We thus have carbonate of protoxide of iron ; but, in the process of drying, the protoxide attracts oxygen from the air, and carbonic acid is disengaged, so that there ultimately remains sesquiox- ide of iron, with a trace of carbonic acid. Subcarbonate of iron is a rust-coloured powder, possessing a decided chalybeate taste. It is sometimes adulterated with brick dust, which is detected by exposing it to the action of dilute chlorohydric acid. This dissolves the whole of the subcarbonate; and leaves the im- purities. The subcarbonate is one of the preparations of iron most used. It is, indeed, almost the only one prescribed by the author, as it is adapted 58 SPECIAL TOXICS. for most cases in which chalybeates in general are needed. It w aa much employed by Mr. Carmichael as a remedy in cancer; but although the cachectic condition has appeared to be occasionally bene- fited by it, the results have not been encouraging. In neuralgia, and especially in neuralgia faciei, it was introduced, many years ago, to the notice of the profession, by Dr. Benjamin Hutchinson, who published numerous successful cases of its employ- ment ; and, since that time, many testimonials have been adduced in its favour. In the author's hands, it has proved signally successful in some inveterate cases. The novelty of Dr. Hutchinson's plan was to give it in very large doses;—3ij., and even 3ss. and more, m the course of twenty-four hours. Should it disagree with the stomach, an aromatic may be added—for example, five grains of ginger powder, or of Pulvis aromaticus, to each dose. If signs of polyaemia or hype- rsemia exist, they should be first removed; and, should they supervene on its employment, antiphlogistics may be needed, and the subcarbonate be resumed after their removal. It may, likewise, be necessary to give a brisk cathartic occasionally. The ordinary dose of subcarbonate of iron, as a tonic, is from gr. v. to gr. xx., twice or thrice a day, in honey or molasses. Subcarbonate of iron is used in the preparation of Emplastrum Ferri, Ferri et potassce tartras, and Tinctura ferri chloridi,oi the Pharma- copoeia of the United States. 35. FERRI OX'IDUM HYDRA'TUM.—HY'DRATED OXIDE OF IRON. This preparation—called also Hydrated sesquioxide of Iron, Hydrated peroxide of Iron, Hydrated tritoxide of Iron, Ferrugo—has been intro- duced, within the last few years, as an antidote to arsenic. It is pre- pared by converting common green vitriol, or sulphate of protoxide of iron, into sulphate of the sesquioxide by means of nitric acid, aided by heat. The nitric acid is decomposed ; nitric oxide gas is disengaged; and part of the oxygen of the decomposed nitric acid unites with the protoxide of iron to convert it into sesquioxide. As, however, there is too little sulphuric acid in the sulphate of the protoxide to keep the iron in solution when it becomes sesquioxide, sufficient sulphuric acid is added to form the sulphate of the sesquioxide,—namely, half the amount of acid contained in the sulphate of iron employed. Solution of ammonia is then added in excess to decompose the sulphate of the sesquioxide, by uniting with the sulphuric acid of the sulphate. The precipitated sesquioxide is washed with water, until the washings cease to yield a precipitate with chloride of barium ; or, in other words are freed from sulphuric acid ; and the sesquioxide is kept in close bottles with water sufficient to cover it. This oxide is of a reddish or yellowish brown colour ; and is much more readily dissolved in dilute acids than the anhydrous sesquioxide. It is wholly soluble in chlorohydric acid without effervescence. Hydrated oxide of iron is possessed of the same properties as the subcarbonate or anhydrous sesquioxide, and might be given in the same cases. Dr. Christison considers, that it must be preferable from its su- FERRUM AMMONIATUM. 59 perior solubility. The evidence in favour of its action as an antidote to arsenic, has been given at length elsewhere. (New Remedies, 6th edit. p. 364, Philad. 1851.) It would appear to render the poison insoluble, and would seem to be worthy the reliance of the practitioner. It must be administered, however, in very large doses—a table-spoonful every five or ten minutes, or as often as the patient can swallow it. For ordi- nary cases, as a chalybeate, the dose may be the same as that of the sesquioxide or subcarbonate. 36. FERRI CHLO'RIDUM.—CHLORIDE OF IRON. The only officinal form, in which the chloride, sesquichloride or muriate of iron is used is that of TINCTU'RA FERRI CHLO'RIDI, TINCTURE OF CIILORIDE OF IRON, Tincture of Muriate of Iron, Solution of Muriate of Iron. (Ferri subcarb. Ibss.; Acid. muriat. Oj.; Alcohol. Oiij.) Subcarbonate or sesquioxide of iron dis- solves in chlorohydric or muriatic acid with slight effervescence; and the sesquichloride of iron results; so that the tincture is really a tinc- ture of sesquichloride of iron, and is so named in the London Pharma- copoeia. The tincture is of a reddish brown colour; has a sour styptic taste, from excess of muriatic acid; and an odour of chlorohydric ether, which exists in it in small quantity, owing to the action of the chloro- hydric acid on the alcohol. This excess of acid is necessary for keep- ing the protochloride of iron—of which there is a small portion in the tincture—in solution; as the protoxide of the protochloride, when the tincture is exposed to the air, is converted into sesquioxide; and a part is deposited. Tincture of chloride of iron possesses the general properties of the chalybeates, and is extensively prescribed in asthenic affections. Its virtues as an astringent are referred to elsewhere. The dose is from nix. to ntxxx. gradually increased to f5i. or f3ij., two or three times a day, in Avater. The solution of pernitrate of iron possesses analogous proper- ties ; but it is almost wholly prescribed as an astringent. 37. FERRUM AMMONIA'TUM.—AMMO'NIATED IRON. In the preparation of Ammoniuret of Iron, Ammoniated Chloride of Iron, Ammonio-chloride of Iron, according to the processes of the Phar- macopoeias of London and the United States, subcarbonate of sesqui- oxide of iron is dissolved in muriatic acid, by which means a sesqui- chloride is obtained. A solution of muriate of ammonia, of definite strength, is then added; and the filtered liquor is evaporated to dry- ness. The residue is rubbed to powder, which appears to consist of the two chlorohydrates or muriates, as, notwithstanding the nomen- clature of the London College, no chemical combination seems to take place between them. 60 SPECIAL TOXICS. Ammoniated iron is a yelloAv powder, which is deliquescent, and soluble both in water and alcohol. The quantity of iron in ferrum ammoniatum is much less than in most of the other preparations of iron, and it is by no means the same in all cases. On this account, although it was at one time used exten- sively in asthenic cases, and especially in some of the neuroses as epilepsy and chorea—it is now rarely employed. The dose is from gr. iv. to gr. xii. or more, in pill; or in solution. Astringent vegetable substances decompose it. 38. FERRI ET POTAS'SiE TARTRAS.—TARTRATE OF IRON AND POTAS'SA. Tartrate of Potassa and Iron, Ferro-tartrate of Potassa, Ferric tartrate of potassa or Poiassio-tartrate of Iron, according to the Pharmacopoeias of London and the United States, is made by dissolving subcarbonate or sesquioxide of iron in muriatic acid so as to form a sesquichloride; throwing down the hydrated sesquioxide by caustic potassa; and digesting this in a solution of bitartrate of potassa, so that the excess of acid in the bitartrate may be neutralized by the sesquioxide. This is digested for some time at a moderate heat; and, afterwards, the solution is filtered, and evaporated to dryness. Tartrate of iron and potassa is an olive-brown powder; and has a ferruginous taste. It is slightly deliquescent,—perhaps from the tar- trate of potassa it contains,—and is wholly soluble in water. It is slightly soluble in alcohol. The solution in water is not liable to de- composition for a considerable period. In commerce, an imperfectly prepared compound is frequently met Avith, in which none, or only part, of the sesquioxide of iron is in chemical combination with bitartrate of potassa. The following are the characters of the salt, when properly prepared according to the pro- cess of the Pharmacopoeia of the United States : " Tartrate of iron and potassa is wholly soluble in water. Its solution does not change the colour of litmus ; and at common temperatures does not yield a pre- cipitate with potassa, soda, or ammonia. Ferrocyanuret of potassium does not render it blue unless an acid be added." Tartrate of potassa and iron has all the virtues of the chalybeates, but in a much milder degree. Its taste is, however, more agreeable, and its solubility ready; so that it affords a pleasant chalybeate in diseases of childhood. The dose is from ten grains to half a drachm. As before remarked, M. Mialhe prefers it to all the preparations of iron. 39. FERRI FERROCYANURE'TUM.—FERROCYAN'URET OF IRON PURE PRUS- SIAN BLUE. Ferrocyanuret of Iron, Ferrocyanate of Iron, Percyanide of Iron Ferro- sesquieyanide of Iron, Cyanuret of Iron, is prepared on the large scale for purposes of the arts ; and was, therefore, comprised in the materia FERRI FERROCYAXURETUM. 61 medica list of the first Pharmacopoeia of the United States. In the last revisions, however, a.preparation is given for a pure article, such as is well adapted for medicinal administration. It is prepared as an article of commerce, by fusing animal matters with carbonate of potassa, so as to form cyanuret of potassium ; and treating the solution of the product with sulphate of alumina and potassa, and sulphate of iron. The greenish precipitate, formed in this manner, acquires, under exposure to the air, a beautiful blue colour. In this state, ferrocya- nuret of iron is impure;—containing alumina, sesquioxide of iron, and ferrocyanuret of potassium. To purify it, it is digested in diluted sul- phuric acid. The pure article of the United States Pharmacopoeia is formed by the reaction of ferrocyanuret of potassium on sulphate of sesquioxide of iron, washing the precipitate with boiling water, until the washings pass tasteless; then drying the precipitate, and rubbing it into powder. Pure Prussian blue is of a rich dark blue colour; without smell or taste; and it has been regarded as devoid of action on the animal economy. It is certainly questionable, whether it exert any more in- fluence than indigo. It is insoluble in water and alcohol; and when broken has a bronzed tint, resembling that of indigo, but distinguish- able from it by being removed when rubbed with the nail. The test of its purity—as given in the London and United States Pharmaco- poeias—is, that if it be boiled with dilute chlorohydric acid, and am- monia be added to the filtered liquor, no precipitate is produced. As ordinary Prussian blue contains alumina and sesquioxide of iron, by boiling the article in chlorohydric acid, both substances will be dis- solved, and ammonia be thrown down. Although ferrocyanuret of iron appears to exert no influence on man or animals in health, it has been regarded not only as a simple, but as an antiperiodic tonic. It has, accordingly, been given in atonic conditions in general, especially of the intestinal canal; but, like indi- go, it has been more extolled in epilepsy and chorea; and has been prescribed in intermittent fever, on the recommendation of Dr. Zollic- koffer, of Maryland, and others. It has likewise been found of service in facial neuralgia; and in some cases of scrophulosis. The author has given it in all these cases, but has not been satisfied with its effects. Dr. Zollickoffer considers it to be especially adapted for intermittents and remittents occurring in children, on account of the smallness of the dose required, and its want of taste. The detailed evidences ad- duced in its favour, are given in another work, (New Remedies, 6th edit. p. 346, Philad. 1851.) It has been used in the form of ointment, (Ferri Ferrocyanuret. 3j.; Ung. cetacei 3j.;) to ill conditioned, torpid, and foul ulcers. The dose is five grains, three or four times a day, gradually increased. Ferrocyanuret of iron is used in the preparation of Hydrargyri Cy- anuretum, of the Pharmacopoeia of the United States. 62 SPECIAL TOXICS. 40. FERRI PHOSPHAS.—PHOSPHATE OF IRON. Phosphate of Iron—which is peculiar to the United States Pharma- copoeia—is formed by the double decomposition of Sulphate of Iron and Phosphate of Soda; the sulphuric acid of the sulphate of iron lays hold of the soda of the phosphate of soda; and the resulting sulphate of soda remains in solution, whilst the phosphoric acid of the phosphate of soda combines with the protoxide of iron of the sulphate of iron, and forms phosphate of iron, which is precipitated. It is of a slate colour, and is insoluble in water. It possesses the general virtues of the chalybeates; but, like many others of the preparations of iron, does not appear to have any special virtues to occasion its retention as an officinal preparation. The dose is from gr. v. to gr. x. It is, how- ever, but little used. The cause of its admission into the United States Pharmacopoeia is stated to have been " the suggestion of Dr. Hewson, of Philadelphia, avIio found it, after an extensive experience, to be a valuable chalybeate." (Wood and Bache.) 41. FERRI SULPHAS.—SULPHATE OF IRON. Commercial sulphate of iron, commonly called Green Vitriol or Cop- peras, is usually prepared on a very extensive scale by exposing iron pyrites to the air for several months; moistening it either by rain or artificially; and so arranging the bed on which the pyrites is placed, that the water may run into a reservoir, whence it can be withdrawn, to be evaporated for obtaining the sulphate of iron formed. Iron py- rites is a native sulphuret of iron; and, by the above treatment, the pyrites attracts oxygen, and becomes converted into sulphate of pro- toxide of iron. This is too impure, however, for medicinal use; and, accordingly, the London and United States Pharmacopoeias direct it to be made by the action of dilute sulphuric acid on iron wire or iron filings. When thus prepared, the crystals are transparent, and of a bluish-green colour, but on exposure to air, they effloresce, absorb oxygen, and change colour, by the formation of sulphate of sesquioxide of iron. It is very soluble in water, but insoluble in alcohol, and iron does not produce with its solution a precipitate of copper. It has a strong inky, astringent taste, and reddens litmus. Sulphate of Iron is a powerful chalybeate, possessing, at the same time, astringent properties; and, as will be seen hereafter, employed in many cases on account of these. In very large doses, it acts as an irritant to the stomach and bowels, occasioning nausea, gastrodynia and vomiting; yet it can scarcely be ranked as a poison. As a tonic, it is given in all cases in which chalybeates are indicated. By some, indeed, it is regarded as probably one of the best, as it is the most uniform, of the preparations of iron. The dose is from one to five grains in the form of pill. Sulphate of Iron enters into the formation of Ferri Citras Ferri et Potassce tartras, Ferri Ferrocyanuretum, Ferri Oxldum hydroium Ferri FERRI CARBONAS. 63 Phmphas, Ferri Subcarbonas, Mistura Ferri Composita, Pilulce Ferri Carbonalis, Pilulce Ferri Compositce, and Pilulce Ferri Iodidi, of the Pharmacopoeia of the United States. 42. FERRI CAR'BONAS.—CAR'BONATE OF IRON. When protocarbonate of iron is thrown down from sulphate of iron by carbonate of soda, it readily absorbs oxygen; carbonic acid is given off; and the protocarbonate becomes converted into sesquioxide of iron. It has been long desired, that some mode should be discovered, by Avhich the salt could be maintained in a state of protocarbonate. The addition of sugar was found to effect this object in a great degree, checking the oxidation of the iron, but not wholly preventing it. Accordingly, a preparation was introduced into the Edinburgh Pharmacopoeia under the name Ferri Carbonas Saccharatum, in which the precipitated protocarbonate, obtained by the decomposition above mentioned, is triturated with sugar, and dried at a temperature not much exceeding 120°. The powder, thus obtained, is considered to be carbonate of protoxide of iron in an undetermined state of com- bination A\rith sugar, and sesquioxide of iron. It is of a grayish green colour, and is readily soluble in chlorohydric acid with brisk effervescence. Protocarbonate of iron has been highly extolled in cases in which the chalybeates in general are indicated. It is readily soluble in acids, and in the fluids of the stomach; and is therefore easily absorbed. In the dose of fifteen grains it has produced, in the experience of some, nausea, headache, and a sense of fulness in the head; whilst subcar- bonate of iron or sesquioxide is often given in very large quantities, Avithout any such results. The author has not, however, observed these phenomena in a single instance. Its dose is from gr. v. to 3ss, two or three times a day. PILULE FERRI CARBONA'TIS, PILLS OF CAR'BONATE OF IRON, VALLET'S FER- RU'GINOUS PILLS. These were introduced into the edition of the Pharmacopoeia of the United States of 1842. They are formed of sulphate of iron, carbonate of soda, clarified honey, syrup, and boiling water; the process being essentially that for the formation of protocar- bonate of iron,—the mixture, after the addition of honey, being sub- jected to heat, until it attains a pilular consistence. These pills have been prescribed in most of the diseases in which chalybeates in general are considered to be indicated; and especially in chlorosis and amenorrhoea. The author has given them freely, but has had no reason for assigning them any pre-eminence over the other preparations of the metal. The objection, urged against the prepara- tion to be next described, is, that the protocarbonate becomes converted into sesquioxide, but it remains to be proved A\rhether the objection have any force. It has, indeed, been unhesitatingly affirmed by M. Blaud, that it has not. The dose of the pills—weighing three grains each, and therefore con- 64 SPECIAL TOXICS. taining less than a grain and a half of the protocarbonate—is eight or ten daily. Mr. Donovan advises that protocarbonate of iron should be prepared in the following manner for extemporaneous use. Blue sulphate of iron, in fine poAvder, 3^-; Calcined magnesia 3ij.; Water i5^-; Tincture of quassia f 3ij. Divide into six draughts. One to be given night and morning. MISTURA FERRI COMPOSITA. COMPOUND MIXTURE OF IRON. This mixture was suggested by a preparation, Avhich was long known as Griffith's Mixture, from the name of the physician who introduced it into notice; and it still bears the appellation with many. It is composed as fol- io avs : Myrrh. 3j.; Potassce carbonat. gr. xxv.; Aquce rosce f ^viiss.; Ferri sulph. in pulv. 9j.; Sp. lavandul. fjss.; Sacchar. 3j- This mixture, Avhen recently prepared, is a solution of protocarbonate of iron ; but when exposed to air, it attracts oxygen ; parts with carbonic acid; and deposits sesquioxide of iron. It has been long celebrated as a tonic, and especially in cases of ameriorrhcea,—the myrrh and spirit of lav- ender being added on account of their reputed emmenagogue virtues. It has likeAvise been largely prescribed in anaemia, chlorosis, and nerv- ous affections in general. It is not easy to see on what grounds it has been so often given in the hectic of phthisis, and in chronic catarrh. In such cases, it certainly possesses no virtues over other admixtures of tonics and excitants. The ordinary dose of the mixture is fli. to f^ij. two or three times a day. PILTLl FERRI COMPOSITE, COMPOUND PILLS OF IRON, (Myrrh, pulv. 3ij.; Sodce carbonat, Ferri sulph. aa 3j-; Syrup, q. s. Make into 80 pills.) These pills, called also Griffith's Pills, resemble the last preparation in the circumstance that the same kind of double decomposition takes place; so that, if it be desired to administer the protocarbonate, they should be prepared extemporaneously, and not kept in the shops. The dose is from two to six pills, two or three times a day. A medicine, which resembles Pilulas Ferri Compositae, has acquired great celebrity in the south of France. It is called, from its inventor, Blaud's Pills. In it, carbonate of potassa, or the bicarbonate, is used instead of carbonate of soda. The objection made to these pills—as in the case of Mistura Ferri Composita, and Piluhe Ferri Compositae —is, that the protocarbonate of iron becomes converted into sesqui- oxide; but M. Blaud properly asks—"What signifies it to practi- tioners that my pills contain little or no protoxide of iron, provided they cure chlorosis!" and in testimony that they do so he adduces a long list of cases in which a cure was obtained in three or four weeks. These pills M. Blaud calls his uantichhrotic pills" 43. FERRI IOD'IDUM.—FODIDE OF IRON. Iodide, Protiodirk, loduret, Hydriodate or Iodohydrate of Iron, is made by gradually adding iron filings to a mixture of iodine and water. Heat FERRI IODIDUM. 65 is then applied, through the intervention of which a union takes place between the iodine and the iron, which is denoted by the liquid as- suming a greenish colour. By evaporation to dryness, the iodide is obtained; Avhich must be kept in a closely stopped bottle. It is of an iron-gray colour; foliated texture; brittle, and exhibits a crystalline arrangement similar to metallic antimony, except that it is darker. In the dry state, it is devoid of smell; but when moist it exhales an odour of iodine: when dry, it has a strong styptic chalybeate taste; and when moist, an acrid taste precedes the other. It dissolves in all proportions, in water; making a greenish solution; and, by exposure to air, forms, by the absorption of oxygen, sesquioxide andsesquiio- dide of iron ; the former of which is insoluble ; the latter soluble. To prevent these changes a coil of soft iron wire should be kept im- mersed in it. The iodide is decomposed by heat, with the disengage- ment of violet vapours, and the production of sesquioxide of iron. Iodide of iron has been frequently given by the author in public and in private practice; and he has considered it especially adapted for cases in which there appears to be torpor in the system of nutri- tion,—as in asthenic dropsy, old visceral engorgements, and indeed, in hypertrophy of any kind, accompanied by deficient action in the in- termediate system of vessels. In anaemia or oligaemia, where there is paucity of red globules in the blood, and the fluid is altogether too thin, it would seem to be especially indicated, from the property which it possesses of promoting the coagulation of the blood, and therefore of inspissating it. It appears, indeed, to be the best remedy we pos- sess whenever a eutrophic and tonic is indicated. It has been given with advantage, as a tonic, in chlorosis; in atonic, amenorrhoea; atonic dyspepsia; and, indeed, in all cases that are accompanied by debility. In such affections, Dr. A. T. Thomson conceives the iodide to act more efficiently than any of the other preparations of iron. In atonic gastric dyspepsia, the same gentleman found it ser- viceable, when combined with bicarbonate of potassa, and taken at the moment of admixture, in the dose of three to eight grains or more. In chorea, it has been considered by Dr. C. J. B. Williams to answer better than any other chalybeate. The dose of the iodide is three or four grains two or three times a day. It may be given in the form of Pill, an officinal process for which is contained in the last edition of the Pharmacopoeia of the United States (1851). PILULE FERRI IOD'IDI. PILLS OF IODIDE OF IRON. (Ferri Sulphat. 3i.; Potass. lodid. 9iv.; Tragac. pulv. gr. x.; Sacchar. pulv. 3ss. Beat Avith syrup so as to form a mass to be divided into forty pills.) The iodide of iron is formed here by double decomposition between the sulphate of iron and the iodide of potassium; sulphate of potassa is also formed. There is likewise some iodide of potassium present, as it is in greater quantity than is needed for the decomposition of the sulphate of iron. The sugar is added to prevent the iodide of iron from oxidation. The VOL. 11.—5 66 SPECIAL TOXICS. pills ousrht, however, to be made extemporaneously. They have: the same properties as the solution, which is the better form for exhibiting the iodide. LIQUOR FERRI IOD'IDI, SOLUTION OF IODIDE OF IRON. The preparation of this name, first introduced into the edition of the Pharmacopoeia of the United States of 1842, is founded on the principle, that to protect the solution of the iodide from decomposition, it is advisable to asso- ciate it with sugar or honey; Avhich appears to exert the same pro- tective agency as it does on the protocarbonate of iron. The solution is made after a form proposed by Mr. Procter, of Philadelphia. The first steps of the process, until the liquor assumes a light greenish colour, are the same as for the preparation of Iodide of Iron; honey is then added, and distilled water to make the quantity of solution required. The dose of the officinal solution is ten drops, three times a day. The tests of its purity, according to the Pharmacopoeia of the United States, are, that it is " of a pale greenish colour; but on the addition of sulphuric acid becomes brown, and emits violet vapours if heated. It has little or no sediment, and does not communicate a blue colour to starch." Syrup of iodide of iron, prepared in an analogous manner, is directed in the Edinburgh Pharmacopoeia. 44. FERRI LACTAS.— LACTATE OF IRON. This preparation has only been introduced of late years into medi- cine. It is formed by treating pure iron filings with lactic acid diluted AA'ith Avater. It is in the form of crystalline plates, very white, and changing but little in the air. It is sparingly soluble in water ; red- dens litmus paper; and possesses the ferruginous taste in a tolerable degree. When dissolved in water, it attracts oxygen, and quickly becomes yellow. Lactate of iron has been prescribed in cases in which the protocar- bonate is employed, and chiefly in chlorosis. MM. Gelis and Conte are, indeed, disposed to refer the beneficial effects of the latter to its becoming lactate of iron in the stomach, by uniting with the lactic acid, which, they think, is one of the gastric acids. This idea led them to administer lactate of iron ready formed; but it is doubtful whether in health there is any lactic acid in the stomach. The testimonials in favour of its good effects in chlorosis, and wherever chalybeates are suggested, are numerous. Messrs. Mialhe and Pereira, however, think there is no evidence of its superiority over citrate of iron; and such is the opinion of the author. A chalybeate bread, containing one grain of the lactate to the ounce has been prescribed in anaemic cases,—especially in chlorosis. A similar bread may be made of the-Ferri subcarbonas. which is applica- ble to like cases. It has been frequently prescribed with benefit by the author. FERRI FILUM. 67 45. FERRI CITRAS.—CITRATE OF IRON. Two citrates of iron were introduced some years ago, by M. Beral ■—the citrate of the sesquioxide of iron, percitrate of iron, and the citrate of the protoxide, protocitrate of iron ; the former of which is chiefly used. It is formed by treating hydrated oxide of iron with citric acid dissolved in water; and a formula for its preparation has been introduced into the last edition of the Pharmacopoeia of the United States, (1851.) It is in thin pieces, of a beautiful garnet-red colour; dissolves slowly in cold water, but readily in boiling water, or in cold when a few drops of liquor ammoniae are added, which convert it into ammonio-citrate. Citrate of Iron greatly resembles the tartrate and the lactate in its properties. It is an elegant chalybeate; and has been much and satis- factorily prescribed by the author, where chalybeates in general have been indicated. The dose is from five grains to twenty, either in pill or solution. Ammonio-citrate of Iron, Ferric citrate of ammonia, Ferri ammo- nio-citras of the London Pharmacopoeia, is prepared by neutralizing the excess of acid in preparing the citrate of the sesquioxide by ammonia, and evaporating. It is a much more soluble salt than the citrate of the sesquioxide, and is slightly deliquescent. If the acid of the citrate be neutralized by soda or potassa in place of ammonia, the sodio-citrate or the potassio-citrate of iron is formed, which greatly resem- ble the ammonio-citrate. In ordinary cases of debility, requiring a chalybeate, especially where the stomach is irritable or where the alkaline carbonates are required to be combined, and in strumous affections of children, the ammonio-citrate is regarded as a valuable preparation. Its dose is from five to ten grains. A Citrate of Iron and Quinia, formed by the union of four parts of citrate of iron with one part of citrate of quinia, has been introduced by M. Beral; and is given in the form of pill, AA'here a combination of these tonics is indicated. 46. FERRI FILUM, IRON WIRE; AND FERRI RAMEN'TA, IRON FILINGS. Iron wire and Iron filings are used in pharmaceutical preparations. Iron filings are also given internally; in Avhich case, they may act as mechanical tonics—like other insoluble substances; and, like granular tin, may thus prove indirectly anthelmintic. Some change, however, takes place on iron filings in the stomach. They become oxidized by the decomposition of water, and hydrogen escapes, Avhich gives rise to the unpleasant eructations experienced under their use. Like all the preparations of iron, too, they blacken the alvine discharges. When metallic iron is oxidized in the manner mentioned above, a portion of 68 SPECIAL TOXICS. it is doubtless dissolved by the acids and alkaline chlorides, which are almost always present in the stomach. Iron filings—as obtained from the shop of the blacksmith—are very impure; but they are readily purified by placing a sieve over them, and applying a magnet, so that the filings may be drawn upwards through it. Their dose is from five to twenty grains, in molasses or honey; but they are not often prescribed, as there are preparations of iron, which are more effective. Iron wire is used in the preparation of Liquor Ferri Nitratis, and Ferri Sulphas ; and iron filings in that of Potassii Bromidum, Ferri Iodidum, and Liquor Ferri Iodidi of the Pharmacopoeia of the United States. 47. FERRI PULVIS.—POWDER OF IRON. An impalpable powder of iron has been strongly recommended in chlorosis and in different forms of anaemia. 'It is prepared by passing a stream of hydrogen over an oxide of iron in a gun-barrel exposed to a red heat. The hydrogen attracts the oxygen, and leaves the metallic iron in a state of extremely minute division. It is the Fer reduit par Vhydrogene of the French pharmaciens. It is without taste, and of an iron-gray colour. If black, it is not wholly deoxidized, and ought not to be employed. Owing to its great liability to oxidation, it should be kept in a dry, well-stopped bottle. From three to ten or more grains may be given in the course of the day in honey or molasses. It has been introduced into the last edition of the Pharmacopoeia of the United States (1851). ZIXCI SALES.—SALTS OF ZINC. The salts of zinc are not extensively employed as tonics. 48. ZIXCI OX'IDUM.—OXIDE OF ZINC. Oxide of zinc of some of the pharmacopoeias is prepared by decom- posing sulphate of zinc by means of carbonate of ammonia: the sul- phuric acid of the sulphate of zinc lays hold of the ammonia of the carbonate of ammonia, forming sulphate of ammonia, which remains dissolved in the distilled water employed; whilst the carbonic acid unites with the oxide of zinc, and forms carbonate of zinc, Avhich is insoluble, and is precipitated. The carbonic acid is then driven off by exposing the carbonate to a strong heat. The Dublin College prepares the oxide by burning carbonate of zinc in a covered clay crucible at a very low red heat, and the United States, London, and Edinburgh Pharmacopoeias expose precipitated carbonate of zinc to a strono- heat in a shallow vessel, so as to drive off the carbonic acid. Oxide of zinc is a white powder, which is insoluble in water, and devoid of taste and smell, and dissolves in dilute sulphuric and chlorohydric acids- without effervescence; whilst, if carbonate of lead, or carbonate of ZINCI OXIDUM. 69 lime, be present, effervescence ensues. Ferrocyanuret of potassium and sulpho-hydrate of ammonia throw down white precipitates. Oxide of zinc has been used as a tonic in various neuroses,—as epilepsy, chorea, neuralgia, gastrodynia, &c, but especially in the first of these diseases. It is now, however, not much employed. Heller, indeed, affirms, that it traverses the intestinal canal without expe- riencing any change. He has witnessed its exhibition up to two doses of two drachms daily, Avithout finding a trace of it in any other excretion than the faeces; and in them he has found the entire quan- tity taken, and in the very same form as that in which it had been exhibited. Hence, it has been inferred, that it must " obviously be inert;" and Mr. Simon expresses his satisfaction with the results of Heller's observations, and his conviction of its entire inertness. " It is amusing," he adds, " Avith this conviction, to read the following tra- dition of its uses, which I transcribe from one of our most judicious and practical writers. ' Internally, it has been used chiefly as a tonic in epilepsy, and sometimes with advantage. In other convulsive and spasmodic diseases, more especially spasmodic cough, occasional benefit has been derived from it, and favourable reports have been given of its action as a tonic and astringent in chronic catarrh. As an astrin- gent it is also not without use in chronic diarrhoea. Lastly, it is a favourite tonic, Avith some, in various scaly cutaneous diseases, more especially, lepra and psoriasis; in Avhich it is usually given along Avith the solution of potash.'" It must be borne in mind, however, that the therapeutical inferences of Mr. Simon are wholly hypothetical, and founded7on chemical considerations, not on practice; and, it may be added, that, in a recent treatise on Epilepsy, by M. Th. Herpin (Paris, 1852), it is affirmed, that the oxide of zinc was the most efficacious remedy. It was begun with, in quantities of from six to eight grains daily, given in divided doses one hour after each meal. This dose was augmented every week by two grains daily, until forty-five grains Avere taken. It Avas then administered in the same dose for five months longer. In regard to the time when it may be presumed to have had a fair trial, M. Herpin lays down the following rules: In the case of children under one year, a total quantity of seventy-five grains should be administered before it is abandoned. In cases over tAvo years, and in Avhich the prognosis is only moderately favourable, (cases of more than 100 attacks,) as much as four ounces must have been given during the whole period of treatment, before another remedy is had recourse to. After the cessation of the fits, the oxide must not be discontinued, as a relapse may take place. As much of it should be given after they -have ceased as Avas required to arrest them. Of forty-two cases, in Avhich it was prescribed by M. Herpin, there were Cured. Not curable. Cases which had under 100 fits 31 26 5 " " " 500 " o 2 3 more than 500 "6 0 6 The ordinary dose of the oxide is from tAvo to five grains two or three times a day, gradually increased. 70 SPECIAL TOXICS. 49. ZINCI SULPHAS.—SULPHATE OF ZINC Sulphate of zinc is, at times, used as a tonic in dyspepsia; and is, occasionally, associated with antiperiodics—as cinchona or sulphate of quinia—in the treatment of intermittents. It is more frequently, how- ever, prescribed in the same neuroses as the oxide of zinc, over which it possesses no advantages. Its dose is from one to five grains, in the form of pill,—made with the extract of gentian, for example, as an excipient. 50. ZINCI CHLO'RIDUM.—CHLORIDE OF ZINC. Chloride of Zinc or Butter of Zinc is readily formed by adding pure oxide of zinc to any given quantity of pure muriatic or chlorohydric acid, applying a gentle heat until solution is effected, filtering the solution, and evaporating to dryness; rubbing the resulting chloride to powder, and preserving it in a closely stopped bottle. In the Pharmacopoeia of the United States, it is directed to be made by putting metallic zinc in sufficient muriatic acid to dissolve it; then adding a small quantity of nitric acid, and evaporating to dryness; dissolving the dry mass in water; adding chalk to neutralize any acid; filtering; and again eAraporating to dryness. Chloride of zinc is of a whitish colour, deliquescent, and wholly soluble in water, alcohol and ether. It is chiefly used as a caustic; but has been sometimes given internally in the same affections as oxide of zinc. It may be prescribed in the dose of a grain, two or three times a day; or a solution in a spirit of ether may be made. (Zinci chloral. gr. j.; Sp. JEther. sulphuric. f3ij-;—Dose, five drops every four hours in sugared water, gradually increasing the dose to ten drops or more three or four times a day.) 51. ZINCI CYANURE'TUM.—CYAN'URET OF ZINC; and 52. ZINCI FERROCYANURE'TUM.—FERROCYANURET OF ZINC. Neither of these preparations is officinal in the Pharmacopoeias of Great Britain, or of this country. The former is made by the decom- position of sulphate of zinc by cyanuret of potassium, or cyanuret of lime; the latter by the mutual decomposition of boiling hot solutions of sul- phate of zinc, and ferrocyanuret of potassium. They have both been used in the same class of cases as the other preparations of zinc. The dose of the cyanuret is from -Jg to -Vth of a grain several times a day, gradually increasing the dose to a quarter of a grain. Of the ferrocyanuret, the dose is from one to four grains. 53. ZINCI ACE'TAS.—ACETATE OF ZINC. Acetate of zinc is usually formed by the double decomposition of sulphate of zinc and acetate of lead;—the sulphuric acid of the sulphate ARGENTI NITRAS. 71 of zinc uniting with the lead of the acetate of lead, and forming an insoluble compound; whilst the acetic acid of the acetate unites "with the oxide of zinc of the sulphate, and remains dissolved in the distilled water employed. The solution is then evaporated to crystallization. This was the process adopted in former editions of the Pharmacopoeia of the United States; but in the last two, acetate of lead is dissolved in water; and metallic zinc, granulated, is added to the solution, and shaken with it until the liquid yields no precipitate with iodide of potassium. The solution is then evaporated to crystallization. The crystals are white; have a silky lustre, dissolve readily in water, and are slightly efflorescent. It is devoid of odour, and has a bitter me- tallic taste. It is but little prescribed internally, and possesses no advantages over the other salts of zinc already described. It may be given in the same diseases, in the dose of one or two grains, gradually increas- ing the quantity. The excipient may be the extract of gentian. Zinci Valeria'nas.—Valerianate of Zinc was first extolled by some of the Italian physicians as a remedy in several nervous diseases. It is formed by adding protoxide of zinc to the vegetable acid to satura- tion, and then slowly evaporating the solution. A note on the mode of preparing the salt has been published in the American Journal of Pharmacy, for April, 1845, by Mr. Wm. Procter, Jun., Avhich may be consulted with advantage by the pharmacien. It is given in the dose of one or. two grains in the form of pill. It has been used with marked benefit in neuralgia; and has been prescribed in other neuroses. 54. ARGEN'TI NITRAS.—NITRATE OF SILVER. Nitrate of silver,—prepared for the ordinary purposes of pharmacy, by dissolving silver in dilute nitric acid; heating the solution and gradually increasing the heat until the resulting salt is dried; melting this in a crucible; continuing the heat until ebullition ceases, and immediately pouring it into suitable moulds,—is at first white, but becomes dark on exposure to light. This is the ARGENTI MTRAS FUSUS, FUSED NITRATE OF SILVER of the last edition of the Pharmacopoeia of the United States, (1851.) A formula for the ARGENTI NITRAS, NITRATE OF SILVER, NITRATE OF SILVER IN CRYSTALS has been introduced, which is recommended for internal use, as a purer article; although it is ques- tionable whether it possesses any marked advantages over the other. It is prepared in the same manner as the fused nitrate, except that crystals are allowed to form. These are colourless, transparent, rhomboidal plates; soluble in their own weight of cold water, and, when perfectly pure, wholly soluble in distilled water; and the solu- tion yields with chloride of sodium a white precipitate, which is wholly soluble in ammonia. 72 SPECIAL TOXICS. Nitrate of silver has been employed as a tonic in diseases of the nervous svstem; but chiefly in epilepsy and chorea; and the author is disposed to think, that he has seen more efficacy from it in the former disease than from any other agent. Of course, it can only be serviceable, where there is no serious lesion of the nervous centres. There is, however, a striking objection to its use, in the fact, that, when long continued, it has produced a slate colour of the whole cutaneous surface, Avhich has continued for the remainder of existence. In an instance which fell under Dr. Pereira's notice, the patient, a highly respectable gentleman residing in London, was obliged to give up business in consequence of the discoloration, for when he went into the street the boys gathered around him, crying out, " There goes the blue man!" In this instance no perceptible diminution of the colour had occurred for several years; but in some cases it becomes less. In one case, the colour is said to have been diminished by washes of dilute nitric acid. The coloration is rare, for although the author has prescribed the salt largely, and for a long period, he has never witnessed a single case. When it does occur, it would appear to be owing to the nitrate of silver being converted into chloride by the chlorohydric acid of the stomach. The chloride passes into the blood in this state, and is deposited in the corpus papillare. If chloride of silver be moistened, and exposed to the air, it acquires the colour in question. When regard, indeed, is had to the free chlorohydric acid, which is ahvays present in the human stomach during digestion; and to the alkaline chlorides and albuminous matters equally there, it is not easy to see, that it can ever escape conversion, and fail to give rise to the formation of chloride and albuminate of silver; and the analysis, by Heller, of the faeces of persons under the use of the nitrate confirms this view. M. Mialhe affirms, that the preparations of silver, when they reach the stomach, are instantly converted into the chloride; and the chloride, thus formed, unites with another portion of alkaline chloride, and forms a soluble compound, which is readily absorbed. This double chloride circulates with the blood, and becoming exposed to the action of light at the surface of the body experiences the change of colour described above. Such is, doubtless, the fact, although Mr. Simon proclaims, that the absorption of the chloride is impossible, and, therefore, that the nitrate must be inert! In explanation of this coloration of the skin, supposed by some to depend on the decomposition of the tissue, Professor Krause has stated, that if thin cut layers of epidermis, soaked in a solution of nitrate of silver, be exposed to the light, and then made transparent by acetic acid, their texture may be seen to be unaltered; but there are very dark granules from jj^ to ysWh of a line in diameter, on the outside of the larger cells, which are, no doubt, chloride of silver and reduced silver, and to these, not to a decomposed tissue, the change of colour is due. It has been affirmed, that a combination of nitrate of silver with iodine prevents the discoloration; and a formula for the purpose has been prescribed by Dr. Patterson, of Scotland. (R. Argent, iodid. argent, nitrat. aa gr. x. Kub into a subtile powder, and add glycyrrhiz. ARGEXTI OXIDUM. 73 pulv. 3ss.; sacchar. 3'i.; mucilag. acacice q. s. ut fiant pil. xl. Dose,— one, three times a day.) M. Mialhe, who is of opinion, as has been shown, that the coloration of the skin is the result of ordinary chemi- cal action, advises, that during the administration of any preparation of silver, the exposed parts of the patient should be washed daily with a solution of iodide of potassium, so that a compound of silver may be formed, which is more soluble than the chloride, and less likely to be darkened by light. Experience, however, is required to decide Avhe- ther the iodine possesses the property ascribed to it. As the nitrate may possibly induce the colour, it becomes the phy- sician to state this to the patient, especially if a female, in order that if she consent to take it, she may have no cause of discontent afterwards. There is little or no danger, however, of its occurring under tAvo months' use of the article. In chorea, as well as in another neurosis—angina pectoris—this tonic has proved of service; and it has succeeded in allaying morbid sensibility of the stomach, even Avhen this has arisen from cancer. In such cases, it is of course only a palliative. The dose of the salt, as a tonic, is a quarter of a grain, three times a day, gradually increased to four or five grains. It may be made into a pill with extract of gentian or of dandelion. Crumb of bread has been objected to as an excipient on account of its containing chloride of sodium; but this objection is only plausible, inasmuch as the salt must meet with chlorohydric acid and chlorides in the stomach. The disagreeable taste ,of the nitrate prevents it from being given in solution. It has been affirmed by Dr. Branson, of Sheffield, that Avhen nitrate of silver has been given for some time it produces a blue discoloration of the gums similar to that caused by lead. 55. ARGEN'TI OX'IDUM.—OXIDE OF SILVER. Mr. Lane is of opinion, that when the chloride is conveyed to the cutaneous surface, it is converted into an oxide by the action of light and its strong affinity for albumen; and under the vieAv, that the oxide of silver may serve the purposes of the nitrate he has pre- scribed it as a tonic in half grain doses, tAvice a day, especially in car- dialgia, gastrodynia and irritability of the stomach. It does not seem in any of the cases to have caused discoloration of the skin; but suffi- cient trials have not been made to determine that it is less likely to induce it than the nitrate. Sir James Eyre has also highly extolled the oxide, in half grain doses, which, he says, uniformly succeeded in curing pyrosis. This salt has been introduced into the last edition of the Pharmaco- poeia of the United States (1851), in Avhich it is directed to be made by dissolving 'nitrate of silver in distilled water; and adding to the solu- tion solution of potassa so long as it causes a precipitate. The precipi- tate is then washed repeatedly until the Avashings are nearly tasteless. The precipitate, Avhich is an olive-brown poAvder, is dried, and kept from the light in a well stopped bottle. 74 SPECIAL TOXICS. An ointment of the oxide, in the proportion of from five to ten grains to a drachm of lard, has been applied to syphilitic ulcerations; and, smeared on a bougie, to the inflamed membrane of the urethra in blennorrhcea. Chloride of Silver has the same tonic properties as the oxide, and the nitrate. Its dose is from one to three grains or more, two or three times a day. 56. BISMU'THI SUBXFTRAS.—SUBNFTRATE OF BISMUTH. . Subnitrate of Bismuth, White Bismuth, Nitrate of Bismuth, Trini- trate of Bismuth, is prepared by dissolving bismuth in dilute nitric add; and pouring the solution into distilled water. The powder that sub- sides is the subnitrate. In this process, a part of the nitric acid is decomposed, and furnishes oxygen to the bismuth; the oxide of bis- muth is then dissolved by the remainder of the nitric acid. On the addition of water to the solution of this nitrate, it is decomposed into subnitrate and super nitrate,—the former being precipitated, and the latter remaining in solution. The subnitrate is a white powder, without taste or smell, and very slightly soluble in water. It is blackened by sulpho-hydric acid. Should it contain carbonate of lead or earthy carbonates, it will effer- vesce on the addition of nitric acid; and if lead be present, sulphuric acid, added to the solution in nitric acid, will throw down a Avhite precipitate. Subnitrate of bismuth has been employed in various neuroses,—as epilepsy, nervous palpitation, and spasmodic diseases in general. It is most frequently administered, however, in neuropathic affections of the stomach,—as the various forms of cardialgia and gastrodynia, in Avhich it is said to have been found efficacious by many; but it has not ansAArered any very satisfactory purpose in the author's practice. M. Eoyer has employed it with marked advantage in the diarrhoea of phthisis and typhus; and it has been used in the latter disease in children. The dose is five grains gradually increased to a scruple or more, two or three, times a day, in pill, or in honey or molasses. In large doses it is said to induce considerable gastric and encephalic disorder, like that AArhich is caused by aero-narcotic poisons; yet a recent writer, M. Monneret, of Paris,—affirms, that in much larger doses than are usually given, it is of the greatest value in gastro-enteric affections, especially such as are attended with fluxes. " He has never given less than from two to three drachms a day, nor more than twenty; and has never observed the slightest inconvenience from these large doses; and it is stated to be his custom to give it to the children in his hos- pital by spoonfuls or table-spoonfuls, without observing more exacti- tude, so innocuous is it." Dr. Pereira seldom commences it in less than a scruple dose, and has repeatedly given half a drachm without the least inconvenience. CUPRI SULPHAS. 75 It is evidently, therefore, not as potent an article, in its action on the economy, as has been generally imagined. Mr. Headland assumes, that it, as well as hydrocyanic acid, creasote, and some other agents, acts as a " stomach-anaesthetic," or, in other words, " seems to act locally on the sentient nerves of the stomach, in the same Avav that aconite acts on the superficial nerves of the skin." He affirms, that subnitrate of bismuth, which is a very insoluble salt, acts also as an astringent on the mucous surface of the intestine, and, is probably the only astringent which is not absorbed, and that its anae- sthetic action may probably " be in some part mechanical in its nature, and depend upon its affording a mechanical sheath to the irritable and painful surface of the stomach." All this is hypothetical, and, in the author's opinion, by no means probable. CUPRI SALES.—SALTS OF COPPER. Three of the salts of copper are prescribed as tonics, and in analo- gous cases,—the acetate, the sulphate, and ammoniated copper. 57. CUPRI SUBACE'TAS.—SUBACETATE OF COPPER. Subacetate of Copper, JErugo, Verdigris, is an impure subacetate, Avhich is prepared on a large scale in the south of France, by allowing the refuse of grapes, in making wine, to ferment with sour wine, and then placing them between plates of copper. In the course of a fort- night, the plates become covered with subacetate of copper. In Great Britain it is made by interposing, between the plates of copper, cloths steeped in pyroligneous acid. The verdigris used in this country is imported from the south of France. The appearance of verdigris is well known. It is of a pale bluish green colour; has a disagreeable acetous odour, and a coppery taste. It is insoluble in alcohol; and water resolves it into a soluble acetate, and an insoluble subacetate. In consequence of its powerful action in an overdose, subacetate of copper is rarely given as a tonic. It may, however, be prescribed in the same cases as the other salts of copper. Its dose, as a tonic, is from one-eighth to a quarter of a grain, in pill. 58. CUPRI SULPHAS.—SULPHATE OF COPPER. Sulphate of copper has been given as a tonic in the same neuroses as the nitrate of silver, and especially in epilepsy and chorea, in which it would appear to have occasionally rendered essential service. It is not as often prescribed, hoAvever, as the next article. The dope, as a tonic, is a quarter of a grain three times a day, made into a pill with extract of gentian, or extract of dandelion; and the quantity of the sulphate may be gradually increased to a grain and a half, or two grains, so as not to occasion vomiting. 76 SPECIAL TOXICS. 59. CUPRUM AMMONIA'TUM.—AMMO'NIATED COPPER. Ammoniated Copper, Ammonio-sulphate of Copper, Cupro-sulphate of Ammonia, Ammoniuret of Copper, is made by rubbing together Sul- phate of Copper and Carbonate of Ammonia, until effervescence ceases; the ammoniated copper is then dried, and kept in a well-stopped glass bottle,—as, when the salt is exposed to the air, ammonia is given off, and a green powder left, composed of sulphate of ammonia and car- bonate of copper. When sulphate of copper and carbonate of am- monia are rubbed together, a reaction takes place between them; they give out a part of their water of crystallization, so that the mass be- comes moist; and, at the same time, a part of the carbonic acid of the carbonate of ammonia is evolved, which causes effervescence. The precise theory of the process, and character of the product, are not, hoAvever, known; and in their uncertainty the framers of the Pharma- copoeia of the United States have given the preparation the name at the head of this article. It is of a deep blue colour; with a strong odour of ammonia, and a styptic metallic taste. When exposed to the air, it loses ammonia, and becomes of a green colour. It is soluble in Avater; but if the solution be much diluted it is decomposed, and sub- sulphate of copper is thrown down. Ammoniated copper resembles, in its remedial action the sulphate; and has been given in the same cases, especially in epilepsy, and chorea. In the former disease, it has been highly extolled by many. When taken in too great quantity it produces the same effects as the other salts of copper. The dose is from a quarter to half a grain, two or three times a day, gradually increased to four or five grains and more. It is best given in the form of pill made Avith crumb of bread, or Avith the extract of gentian as an excipient. 60. ACIDUM SULPHU'RICUM.—SULPH'URIC ACID. Sulphuric acid is obtained by burning sulphur, united with nitrate of potassa, over water in an appropriate chamber. The sulphur, if burnt alone, would yield sulphurous acid; the nitrate of potassa is added to furnish by its decomposition the oxygen necessary to form sulphuric acid. The precise steps in its preparation, and the theory of the process, belong properly to chemistry. It is always prepared on the large scale by the manufacturing chemists; and, therefore, is in the materia medica list of the Pharmacopoeia of the United States, which directs that it should be of the specific gravity 1.845 • be colour- less ; volatilizable by a strong heat; and, when diluted with distilled water, be not coloured by sulphohydric acid. Should it be so it con- tains sulphate of lead. Sulphuric acid, properly diluted, is used as a tonic in the same cases as nitric acid. It is often given alone, or associated with bitters in convalescence from fever, as well as in the course of long protracted fevers. In cases in which there is a deficiency of acid in the stomach ACIDUM NITRICUM. 77 as in what has been called neutral or alkaline indigestion, it is very often serAdceable, and has even been found of more advantage than the muriatic acid; although the latter is one of the acids secreted by the stomach in health. It is also prescribed in the phosphatie diathesis, in which its tonic agency is, doubtless, of service. The acid, in its state of concentration, being so highly corrosive, a formula is contained in the pharmacopoeias for a diluted acid. ACIDUM SULPHU'RICUM DILU'TUM, DILU'TED SULPHURIC ACID. (Acid, sul- phuric, f Ij.; Aq. destillat. foxiij.) The specific gravity of this acid is 1.09. It may be given in the dose of from ten to thirty ~ drops, three times a day, in a wine-glassful of sweetened water. As the teeth are apt to be injured by the mineral acids, they may be sucked through a glass tube or quill. ACIDUM SULPHU'RICUM AROMAT'ICUM, AROMATIC SULPHURIC ACID, Elixir of Vitriol. (Acid, sulphuric, fsiiiss.; Zingib. contus. Ij.; Cinnam. cont. §iss.; Alcohol. Oij.) The aromatics and the alcohol render the sul- phuric acid more excitant, and greatly more agreeable. Accordingly, it is far more frequently prescribed as a tonic than the diluted sulphu- ric acid. Its dose is from ten to thirty drops, two or three times a day, in a glass of Avater. The other officinal preparations, into which sulphuric acid enters, are Ferri Sulphas, Hydrargyri sulphas flavus, Oleum yEtliereum, Potassce sulphas, Quinice sulphas, Unguentum Sulphuris compositutn, and Zinci Sulphas, of the Pharmacopoeia of the United States. 61. ACIDUM NFTRICUM.—NITRIC ACID. Nitric acid is obtained by the action of sulphuric acid on nitrate of potassa; the sulphuric acid laying hold of the base of the nitrate, and the nitric acid being disengaged, and collected in an appropriate re- ceiver. It is an article, which is always prepared, in this country, by the manufacturing chemist; and, therefore, in the Pharmacopoeia of the United States, is placed in the list of the materia medica, with the direction that it must be of the specific gravity 1.5; be colourless; entirely volatilizable by heat; dissolve copper with the disengagement of red vapours—owing to the escape of binoxide of nitrogen; and when diluted with distilled water, yield no precipitate with nitrate of silver, or chloride of barium;—thus showing, that it contains neither chlorohydric nor sulphuric acid. When in its state of concentration, this acid is so corrosive as not to be very manageable; a formula is, therefore, given in the pharma- copoeias for a diluted acid. It has been much used as a tonic, alone, or associated Avith bitter infusions, in adynamic fever; and in cases of phosphatic depositions from the urine has been supposed to act bene- ficially through its tonic poAvers. Dr. Christison affirms, that the urine 78 SPECIAL TOXICS. has never been rendered acid by it in his hands; so that whatever good it accomplishes must, he thinks, be by some other means than by its rendering the morbid urine acid. He supposes, also, that the benefit ascribed to it in hepatitis may be through its tonic action. It is not much used. The dose of the strong acid is five to ten minims in a Avine-glassful or more of water. ACIDUM NTTRICUI DILU'TUM, DILUTED NITRIC ACID. (Acid, nitric, fsj.; Aq. destillat. f gix.) The dose of this is from forty minims to f 3iss. in Avater. Its specific gravity is 1.08. Nitric acid is used in the preparation of Antimonii et Potassce Nitras, Argenti Nitras, Argenti Nitras Fusus, Bismuthi Subnitras, Ferri Ferro- cuanuretum, Ferri Oxidura Hydratum, Liquor Ferri Nitratis, Ilydrargyri Oxidwm Rubrum, Unguentum Hydrargyri Nitratis, and Zinci CJdoridum,' of the Pharmacopoeia of the United States. In cases in which the British and American practitioners employ sulphuric and nitric acids, the Germans often prescribe phosphoric acid. II. Antiperiodic Tonics. Under this head are comprised tonic agents, which are chiefly em- ployed with the view of preventing those diseases, that are distin- guished by marked periodicity. It has been before observed, that most of the tonics already considered have been occasionally employed as antiperiodics in intermittent fever; but, at the present day, they are rarely given as such; whilst those, that have to be described under this head, are almost exclusively relied on. Again, most of the antiperiodic tonics may be employed in asthenic cases in which tonics in general are indicated; but in this relation they offer, perhaps, no pre-eminence. 62. CINCHO'NA.— PERU'VIAN BARK. The terms Cinchona, Peruvian Bark, Bark, are employed pharma- cologically for the bark of different species of cinchona; Sex. Syst. Pentandria Monogynia; Nat. Ord. Eubiaceae, (Jussieu)—Cinchonacea?, (Lindley,) obtained from the western coast of South America. Of these, the Pharmacopoeia of the United States has admitted three varieties—1. Cinchona flava, Yellow Bark, the variety known in com- merce under the name Calisaya Bark ; 2. Cinchona pallida, Pale Baric: the variety called in commerce Loxa Bark; and 3. Cinchona rubra Red Bark, the variety known in commerce under the latter name'. Each of these requires a separate consideration ; but it may be well to premise a few observations, that are applicable to the whole. Although the botanical history of articles so interesting as the cinchona barks has been attentively studied, it is by no means un- derstood even at the present day: until, recently, indeed the most CIXCHOXA. 79 erroneous views were entertained in regard to it, owing to the jealousy of the Spanish government, who appear to have thrown every obstacle in the way of the inquiring naturalist. Even now, in the London Pharmacopoeia, the three varieties, yellow, pale, and red bark, are re- ferred respectively to Cinchona cordifolia, C. lancifolia, and C. oblongi- folia ; yet it has been sufficiently shown, that we are still ignorant of the source of the first and last varieties, and that the pale barks are derived from different species. Twenty-six species of cinchona are now pointed out by botanists, of which twelve, at least, are thought to furnish a part of the barks that are used. (Lindley.) All the species are either tall shrubs, or large forest trees; are commonly evergreen, and of great beauty, both in foliage and flower. They inhabit the Andes at various elevations from 11° N. L. to 20° S. L. The best bark is said to be obtained from the trees that grow on a dry rocky soil. The bark peelers or Cascarillos commence their operations in May, when the dry season sets in, and end in November. The quantity of bark exported is enormous,—to such an extent, indeed, that a scarcity has been apprehended, and under such a feeling, the government of Bolivia, in 1838, issued a proclamation forbidding the collection of bark in its territory for five years. Cinchona is shipped from various ports of the Pacific,—the most common being Arica, Valparaiso, Lima, Callao, and Payta. The quantity received into England in different years has varied greatly. In 1830, 556,290 lbs. were imported; of which 56,879 lbs. were re- tained for home consumption. This appears to have been the largest quantity imported in any one year. In 1841, according to Dr. Pereira, 81,736 lbs. paid duty. The arrangement of the cinchonas, adopted in the Pharmacopoeia of the United States, is according to the colour of the barks; for although —as has been correctly remarked—dependence cannot be placed upon this property alone, as barks of a similar colour have been found to possess very different virtues, and betAveen the various colours consi- dered characteristic there is an insensible gradation of shade, still the most valuable barks may be arranged in three groups—the yelloio, pale, and red, between Avhich there is, in general, a well-marked distinction. I. Cixchoxa Flava, Yellow Bark.—YelloAv Bark, it has been said, is generally known in commerce under the name Calisaya Bark. The London College refers it to Cinchona cordifolia, but the precise species that yields it is unascertained, It is produced most abundantly, if not exclusively, in the province of La Paz or its neighbourhood in Bolivia, whence it is conveyed to the Pacific and shipped at Arica. Two va- rieties are met with in commerce, the quilled and the flat; the former is in pieces, generally from nine to fifteen inches long, from one to two inches in diameter, and from an eighth to a third of an inch in thick- ness. Some quills are much smaller; but such fine quills are not seen in it as form a considerable proportion of the pale barks. The external surface of the quills is marked by longitudinal AArrinkles and furrows; and by transverse cracks, Avhich cause the external surface of the bark to be very rough. The colour of the epidermis is of a more 80 SPECIAL TOXICS. Fijj. 143. or less light gray. This epidermis yields a dark red poAvder; is taste- less, and possesses none of the virtues of the bark. The outer surface of the bark, Avhere the epidermis is Avanting, is of a brown colour. The flat calisaya or flat yellow bark possesses the characters of the quilled variety, except that the pieces Avhich are stripped of their epidermis have externally the cinnamon-brown colour of their inner surface, and are free from cracks and Avrinkles. They are in pieces either quite flat or but slightly curved. When the epidermis exists, the bark presents the same external appearance as the quilled variety. The inner surface of both varieties is smooth, and of a cinnamon colour. In commerce, the flat variety is divided into the coated and the unrouted. YelloAV bark resembles in taste and smell the pale variety; but it is stronger. It yields more sulphate of quinia than any other kind of cinchona bark, and hence is more largely consumed than any other. In the year 1827, M. Pelletier used 2000 quintals, equal to 200,000 lbs., in the manufacture of 90,000 French ounces of sulphate of quinia, about three drachms of the sulphate to one pound of bark. Chemical analysis would seem to have shown that the flat variety of yellow bark is to be preferred; and it is stated that one French pound of uncoated yelloAV bark yields from 30 to 50 grains more of the sulphate than the coated variety. II. Cinchona Pal- lida, Pale Bark— The finest specimen of this is Crown or Loxa Bark, Crown Bark of Loxa, of commerce, which is referred by the Lon- don College to Cin- chona, lancifolia. It is Cinchona coronce of the Edinburgh Pharmacopoeia; is the bark of Cinchona condaminea, and is collected in the pro- vinces about Loxa. Under the name Loxa Bark, how- ever, in the United States, are included all the pale barks. (Wood and Bache.) As met with in the shops, pale bark is Cinchona Condaminea. in quiUs, which are a. Calyx. ?>. Ovary and style, c. Coroila. d. Capsule split into two cocci. in length from six e. Capsule divided, showing the two colls. /. Seeds in capsule. #. Single nn, ° Beed. to ntteen inches, sin- CINCHONA. 81 gle or double, straight or nearly so, and varying in diameter from the size of a crowquill to that of the thumb, or somewhat larger, and in thickness from one-third of a line to two lines. The epidermis is al- ways on; so that in the case of the pale bark, there are no two varie- ties,—the coated and the uncoated,—as in the case of the yellow bark. The epidermis has numerous transverse cracks. In the fine quills, these are hardly visible; but longitudinal furrows are observable as well as in the larger quills. The external surface of the epidermis is of a grayish colour; owing chiefly to the lichens that cover it, and sometimes inclining to liver-brown. Gray, or grayish-brown is the predominant tint. The inner surface, and the powder, are of a deep cinnamon brown colour ;—the former, in the finer kinds, is smooth; in the coarser, rough occasionally. It has a bitter, aromatic and astrin- gent taste, and a smell somewhat resembling that of tan. The finest quills are most prized; but those of the middle size are considered by Dr. Christison to be really the best. The pale barks differ from the yellow in containing cinchonia in the place of quinia. In this country they are much less used than they were formerly, the red bark being preferred by many physicians, whilst the yellow, as already shown, is employed for the formation of the sulphate of quinia. III. Cincho'na Eubra. Red Bark.—The botanical origin of this variety of cinchona is unknown. The London and Dublin Colleges refer it to Cinchona oblongifolia; but the Edinburgh considers it to be the bark of an unascertained species. Like yellow bark, it is imported in quills, and in1 flat pieces,—the latter being the more common of the two, and occasionally very large, as if taken from the trunk of a tree, from two inches to two feet in length, and one to five inches in breadth, and from one quarter to three quarters of an inch in thickness. It is generally coated, or covered with epidermis, which is rough, wrinkled longitudinally, furrowed, and often warty. The colour is reddish brown, with a grayish hue in the hollows, owing to adhering lichens. The inner surface is of a deep cinnamon brown, inclining to reddish brown; and the colour of the poAvder is so much redder than that of the preceding varieties as to render the epithet red bark appropriate. The taste is bitter, somewhat aromatic, and astringent. The quilled variety is a species of about the same size as quilled yellow bark. These are of a paler reddish brown externally than the flat pieces, and internally of a clearer cinnamon brown colour, ap- proaching that of yelloAv bark. On the epidermis are frequent patches of pale gray efflorescence from lichens. The colour of red bark in general is faint reddish broAvn, and the odour is feebly tan-like. It is distinguished from the varieties already considered by containing both quinia and cinchonia in considerable quantities. This fact ought to cause it to be more largely used ; yet in Europe it is so little employed that it receives scarcely any attention. (Pereira.) Such are the varieties of cinchona that are officinal in the Pharma- copoeia of the United States. There are many other varieties, however, A\rhich are genuine cinchona barks ; and yet have not been considered VOL. II.—6 82 SPECIAL TONICS. worthy of an officinal position. The Edinburgh Pharmacopoeia admits, indeed, Cinchona cinerea, Gray Bark, Silver Bark, or Huanuco Bark, Fig. 144. Cinchona micrantha. which is obtained around Huanuco, in Peru, and belongs to the class of pale barks. Amongst the genuine, but inferior barks, are the Car- ihagena Barks, which are brought from the northern Atlantic ports of South America: the characters of these, and, indeed, of all the cin- chonas, have been well and fully described by-Dr. Pereira. It was to be expected, that so valuable a bark as genuine cinchona should be subject to adulteration. The most important spurious barks are the Piton or St. Lucie Bark, from Exostemma fioribundum of the West Indies ; the Caribbean Bark from Exostemma Caribceum, likewise of the West Indies ; and the Pitaya Bark, also supposed to be the bark of an exostemma. They contain neither quinia nor cinchonia. The most common sophistication is in the case of the powder, which may be adulterated with spurious barks or inert matter, and require a very experienced individual to detect the fraud. The different barks have been classed by Mr. Lindley after their physical characters. cinchona. 83 b. Pale Barks. Crown or Loxa Gray, or Silver, or Huanuco, Ash, or Jaen, White Loxa, Yellow Barks. Yellow, Cinchona condaminea. C. micrantha. Unknown. Unknown. C. lanceolata; also C. hirsuta, and C. nitida. C. lanceolata. C. cordifolia. Unknown. Unknown. C. magnifolia. Calisaya, Carthagena, Cusco, c. Red Barks. Red bark of Lima, Cinchona nova, d. Brown Barks. Huamalies,.....C. purpurea. The barks falsely called Cinchonas, which do not yield the cinchona alkaloids, are, according to Drs. Pereira and Eoyle, St. Lucie bark, Jamaica bark, False Peruvian bark, Brazilian bark (Quina de Pianhy), Pitaya bark, .... Exostemma floribundum. Caribseum. Peruvianum. Souzanum. Malinea (?) racemosa, &c. The chemical investigations in regard to Cinchona are extremely in- teresting; and the results have furnished most valuable aids to-thera- peutics. It is only, however, within a little more than a quarter of a century, that our knowledge of them has been rendered precise; and chiefly through the labours of two skilful French analytical chemists, MM. Pelletier and Caventou. The following, according to Dr. Pereira, may be regarded as the constituents of the three varieties of genuine barks—pale, yellow and red. Pale. Yellow. Red. 1. Kinate of cinchonia,.....-4- + + 2.-------quinia, ...... -j- -f- 4" 3. Soluble red colouring matter, {tannin,) . 4- 4" 4" 4. Insoluble do. (red cinchonic,) . -f- 4" 4" 5. Yellow colouring matter,.....-{- 4- 4- Ci. Green fatty matter, ...... 4- 4" 4~ 7. Kinate of lime,......+ 4" 4" 8. Starch,........4- 4- 4" 9. Gum,........4- 0 0 10. Lignin,........+ 4- + Cinchonia and quinia, the alkalies on which the chief medical vir- tues of cinchona are dependent, exist in the bark in combination with kinic acid. The quantity yielded by the different varieties varies, and it would appear, that the same variety may yield different quantities, which may account for the discrepancy in the results obtained by dif- ferent chemists. Thus, Dr. Christison states that an English manufac- turer informed him, that 100 pounds avoirdupois of good yellow bark afforded him sometimes 50, sometimes only 25 ounces of sulphate of quinia—that is from 31.25 to 15.6 parts in 1000; or from 23.4 to 11.7 of quinia. Besides cinchonia and quinia, another alkali has been discovered in Arica or Cusco cinchona, to Avhich the name Aricina has been given. 84 SPECIAL TONICS. It is not, however, of any therapeutical interest. Other alkaloids are, likewise, said to have been found; but their existence is not considered to be established. The tannic acid which gives the astringency to bark, and which is obtained in greatest quantity in the red variety, is doubtless also concerned in its therapeutical action. Cinchonia and quinia, the latter of which is an officinal preparation, will receive a distinct consideration hereafter. The active ingredients of cinchona are imparted to Avater, alcohol, and dilute acids; and, accordingly, these menstrua are employed in the formation of different officinal preparations. Cold water makes an excellent infusion, but does not extract the virtues—unless by the ope- ration of displacement—as well as hot; but the qualities of the different officinal preparations will require a separate mention. As an evidence of the value of the discovery of quinia, it may be stated, on the authority of a respectable druggist of this city, (Phila- delphia,) that although the best cinchona bark could not be purchased, at the time, for less than a dollar and thirty-seven and a half cents per pound, and in powder for less than one dollar and fifty cents; cinchona powder—so called—could be obtained for ten cents a pound. This consisted of an admixture of false and other barks with cinchona or true barks; and generally, perhaps, not a particle of the latter could be detected in it. Yet the appearance of the true and of the spurious powder was so nearly alike, that no difference could be observed even by an experienced eye. From July 1848, to April 1849, inclusive, Dr. Bailey, inspector of drugs at the port of New York, rejected 34,000 lbs. of spurious and worthless cinchona barks, which contained none, or but a trace, of the alkaloids of the true barks; and he affirms, that the cost of these barks, delivered in that market, was at the time about six cents a pound, whilst the genuine cost eighty cents! Cinchona has been long celebrated as a tonic and antiperiodic; and its efficacy in arresting the paroxysms of intermittents has acquired it the name of a febrifuge. It is not such in reality; for it seems to exert no influence over the excited organic actions as they exhibit them- selves in ordinary fever. Its great power is in the period of apyrexia; in which it seems to act upon the nervous system in the same way as other agencies that affect the nerves in a revellent manner; and thus —as elsewhere remarked of antiperiodic tonics in general—breaks in upon the chain of associated actions, that constitute the disease. But it is not only in intermittent fever that it operates in this beneficial manner. In other diseases, not characterized by any excited condition of the organic actions, it equally destroys the morbid catenation; and therefore the epithet antiperiodic is more appropriate to it than febrifuge. Cinchona is an admirable tonic as well as antiperiodic • and as such is largely employed. Most, however, of its medical virtues are com- prised in the salts of its alkaloids—especially the sulphate of quinia which has, therefore, almost supplanted it. Still, as stated in the gene- ral consideration of tonics, there are cases in which sulphate of quinia fails as an antiperiodic, and in which powdered cinchona succeeds- partly, perhaps, on account of its containing, along with the alkaloid' CINCHONA. 85 an astringent principle; and partly owing to the lignin or woody mat- ter ; all of which combined may impress the nerves of the stomach more powerfully than sulphate of quinia alone. As a tonic, it may be prescribed in the same cases as tonics in general; and the same ob- servations as were applied to them, in regard to the best forms for administration, are equally applicable to it. Of these, the cold infusion is to be decidedly preferred. Like tonics in general, apprehension need not be entertained, in doubtful cases, that cinchona may act in- juriously as an excitant; for when it has been administered in the hot stage of intermittents, it has not appeared to add to the excitement. Before its administration in intermittent fever, it is generally cus- tomary to prescribe an emetic of tartrate of antimony and potassa, or of ipecacuanha, or of both combined, and to follow this up by a brisk cathartic; but in very malignant intermittents, time may scarcely be afforded for the latter. As a general rule, this course appears advisa- ble; the cinchona usually making a more powerful impression, after the alimentary canal has been cleared of its contents. When it ex- cites nausea, or runs off by the bowels, the addition of an excitant—as of five grains of ginger powder, or of Pulvis aromaticus, or a few drops of laudanum—may act as a corrigent. In cases in which it cannot be retained by the stomach, it has been administered in enemata, and in children especially has proved effectual; three times the quantity that Avould be given by the mouth being thrown into the rectum. It was formerly, also, the practice to apply it to the surface of the body in the form of cataplasms, pediluvia, bark jackets, &c, but these are never directed at the present day by the physician. In a simple case of intermittent, cinchona is generally sufficient to prevent the paroxysm. Should the disease, however, be complicated with plethora, hyperaemia of any organ, or gastric or intestinal derange- ment, it becomes necessary to remove these complications, before the remedy can exert its full powers. Intermittent and remittent fevers are not the only diseases in which, as before remarked, cinchona acts beneficially as an anti-periodic. In all affections that observe anything like a distinct periodical character, and recur at regular intervals, it often exhibits its powers most sig- nally ; whilst in those that are very irregular, and Avhere of course it is difficult to anticipate the precise period of attack, little or no reliance can be placed upon it. The dose of powdered cinchona,—which is the most effectual form, when it is desirable to make a decided impression,—is one drachm, re- peated more or less frequently. If half a drachm be given every hour, for eight hours before the anticipated paroxysm, a sufficient quantity may be taken to have a decided antiperiodic effect upon an ordinary ague; and should this not prevent the paroxysm, its repetition in the subsequent interval may wholly arrest the disease. In the generality of cases, indeed, the author has succeeded in preventing the paroxysm by half a drachm given an hour and a half; and repeated an hour, and half an hour before its expected recurrence. In asthenia, either of the stomach or of the system generally, the watery or alcoholic preparations of cinchona are preferable, but if it be 86 SPECIAL TONICS. desired to exhibit the cinchona in powder in these cases, the dose may be from ten to thirty grains. The taste of cinchona, when mixed with milk, is, according to Dr. A. T. Thomson, completely covered, provided the mixture be taken directly; but if not taken immediately, the medicine soon communi- cates its taste to the milk. v INFU'SUM CINCHO'NJ! fUW, INFU'SION OF TELIOW BARK. (Cinchon.flav. cont. Ij.; Aquce bullient. Oj.) This may be prepared by maceration ; or an infusion with cold water may be made by displacement or by mace- ration. Infusion of cinchona contains only a part of the virtues of the drug,—a large portion of the kinates of the active principles re- maining in the mass left on the strainer. It is the form generally used when the remedy is given as a tonic. As an antiperiodic, it is not sufficiently potent. The dose is f^iss. to fjij. three or four times a day. INFU'SUI CINCHO'M RUBRvE, INFU'SION OF RED BARK. (Cinchon. rubr. contus. Ij.; Aquce bullient Oj.) Prepared in the same manner as Infusum Cin- chona} flavce. INFU'SUM CINCHO'NJ COMPOS'ITUM, COMPOUND INFU'SION OF PERUVIAN BARK. (Cinchon. rubr. pulv. Ij.; Acid sulphuric, aromat. f3j.; Aquce Oj.) The addition of sulphuric acid decomposes the kinates of the alkaloids, and probably secures the separation of the greater portion of active matter. Its dose is the same as the last. DECOC'TUM CINCHO'NJI, DECOCTION OF PERU'YIAN BARK. Cinchon. cont. 3j.; Aquce Oj.) If cinchona be boiled for a great length of time, the alka- loids form compounds with other constituents, which are sparingly soluble in hot water, and less so in cold; so that as the decoction cools they are deposited. This would be prevented by the addition of aromatic sulphuric acid, as in the last preparation. The decoction contains much more of the active matter of the cinchona than the simple infusion; still, it is rarely used as an antiperiodic. The dose is f^ss. to f§iij. TINCTU'RA CINCHO'NiE, TINCTURE OF PERU'VIAN BARK. (Cinchon. pulv. 3yj.; Alcohol, dilut. Oij.; prepared either by maceration or displacement.) Tincture of cinchona is rarely given alone, on account of the quantity of alcohol that is combined with an ordinary dose. It may however be prescribed in the dose of from f5j. to f3ss. in cases of atonic dyspepsia; and where the ordinary bitter tinctures are considered to be indicated. Usually, it is added to tonic infusions or decoctions,—as to Infusum cinchonce, or Decoctum cinchonce ; in the proportion of from f5j. or f3ij. to foiss. of either of these preparations. TINCTU'RA CIMWlft COMPOSITA, COMPOUND TINCTURE OF PERUVIAN BARK- (Cinchon. pulv. gij.; Aurant. cortwis contus. giss.; Serpentarice contus. 5iij.; Croci incis., Santal. rasur. aa 5j.; Alcohol dilut. fgxx.; made either QUINIA. 87 by maceration or displacement.) This preparation is commonly sold as Huxham's Tincture of Bark. The addition of orange-peel as an exci- tant, and of Virginia snakeroot as an aromatic bitter tonic, renders it more agreeable and excitant than the simple tincture. It may be given in the same cases. The dose is f3j. to f|ss. EXTRAC'TUM CINCHO'Nl, EXTRACT OF PERU'VIAN BARK. This extract, in the Pharmacopoeia of the United States, is made by exhausting cinchona by means of alcohol, by the process of displacement; distilling off the alcohol; afterwards treating it with water; mixing the infusions, and evaporating to form an extract. The extract contains most of the principles of cinchona; but it is rarely used. The dose is from gr. x. to gr. xxx. or more. QUI'NIA.—QUININE'. Quinia, Quina or Quinine—as already remarked—is one of the alka- loids to which cinchona owes its antiperiodic properties. The mode in which it is obtained will be apparent from considering the process for procuring the sulphate—the only officinal preparation in the Phar- macopoeias of Great Britain and the United States. It is generally in the form of powder; has a very bitter taste, and is very sparingly solu- ble in cold water. It possesses the same virtues as the sulphate; and is, indeed, preferred by some as an antiperiodic. It may be given in the form of pill, in the same dose as the sulphate, or in alcoholic solu- tion. SULPHATE OF QUINIA, Disulphate of Quinia, Subsulphate of Quinia, Sul- phate of Quinine, is prepared from yellow bark by the following pro- cess. The bark is boiled in water and muriatic acid, by which the kinate of quinia is decomposed, and muriate of quinia is formed; the boiling is repeated on the residuum; the decoctions are mixed; and, Avhilst hot, lime is added, which unites Avith the muriatic acid, forming muriate of lime or chloride of calcium: this remains in solution, the quinia being precipitated. The precipitate is well washed with dis- tilled water, pressed, dried and digested in alcohol, in fresh and fresh portions, until the spirit is no longer rendered bitter. The liquors are then mixed, and an alcoholic solution of quinia obtained. The alcohol is now distilled off. Upon the brown viscid mass remaining, distilled water is poured ; and the mixture being heated to the boiling point, as much sulphuric acid is added as is necessary to dissolve the impure alkali. In this Avay, a sulphate of quinia is formed. Animal charcoal is now added to the hot fluid to deprive the salt of any colour- ing matter; and after filtering the liquor Avhilst hot, it is set aside to crystallize. The salt may be rendered still more pure, by dissolv- ing the crystals, thus formed, in boiling water slightly acidulated with sulphuric acid; adding a little animal charcoal; filtering and setting aside to crystallize. From the mother waters, an additional quantity of sulphate of quinia may be obtained by precipitating the 88 SPECIAL TONICS. quinia by solution of ammonia; and treating it Avith water, sulphuric acid, and animal charcoal. The above is the rationale of the process, recommended in the last editions of the Pharmacopoeia of the United States. Sulphate of quinia is in white, filiform, silky crystals, of .a snow- white colour, Avithout smell, and of a very bitter taste. It is soluble in 740 parts of cold, and in 30 of boiling water. It dissolves very readily in alcohol, and in Avater acidulated Avith sulphuric acid, but is insolu- ble in sulphuric ether. It gives a blue tinge to wrater. The quantity of sulphate of quinia prepared is very great. In the year 1826, in two laboratories of Paris, it amounted to 59,000 ounces. In this country, it was formerly imported altogether from France; but the author is informed, that from 40,000 to 50,000 ounces were made in Philadelphia in the year 1845. It is an expensive article; and is, therefore, liable to adulteration. The chief articles, employed for this purpose, are sulphate of lime, sulphate of baryta, mannite, and starch; by digesting, hoAvever, the sulphate in alcohol, the salt is dissolved, whilst the sulphate of lime, the sulphate of baryta, starch and mannite, are left. Sulphate of quinia possesses almost all the medical virtues of cin- chona. It is an excellent tonic, and is the very best of the antiperi- odics. Hence, at the present day, no single article is so much em- ployed in the various diseases that are characterized by periodicity. In impressible individuals, and in others, when given in very large doses, it disorders the gastro-enteric functions; and induces pheno- mena resembling those caused by narcotic agents,—restlessness, ver- tigo, confusion, depravation of vision, tinnitus aurium, and transient deafness—phenomena to Avhich, in the aggregate, the terms Quinism, Quininism, and Cinchonism have been appropriated. In certain cases, ptyalism would seem to have been induced; the saliva being inodorous, and the teeth firm. When calomel has been given along with it, it has been conceived, that ptyalism has ensued sooner than it might otherwise have done. Like narcotics, too, it is decidedly sedative in large doses. It has now taken the place of cinchona in all periodical diseases. In intermittents, it is largely employed. In remittents of the pernicious class, it is often necessary to administer it when the subsidence of symptoms is far from complete. It is one of the best remedies, too, in the engorgements of the spleen, and the dropsical effusions, that are the consequences of intermittents; but in such cases, it must be given in very large doses. It is said likewise, to have been found advanta- geous, in such doses, in the yelloAV fever of the southern parts of this Union; and a recent writer—Dr. T. D. Mitchell—lays down the unten- able position, that all fevers " possess one common property which confessedly under the control of the sulphate of quinia in the case of common ague and fever, is not less so in typhoid, typhus, congestive yellow, and, it may be, all the fevers named in the books •" and he assumes the position, "plainly and boldly," that "there is'but one feature or element in either of the fevers named that is essential to QUINIA. 89 its pathology, and that feature or property or element boAVS before the potent sway of the sulphate of quinia, and for this reason only we cure the patient 1" It is scarcely necessary to say, that in the diseases in which their use, as a general rule, is indicated, quinia and its preparations are not universally applicable. In remittents and intermittents, that are accompanied by hyperasmia of internal organs, such hypersemia ought to be removed before quinia or its salts can be expected to exert their efficacy; and there is truth in the remark of Professor Dickson—that " they deceive themselves who regard quinia as a universal and infal- lible febrifuge, even in malarious fevers." Yet, in maljgnant forms of these fevers, there may not be time to wait; especially as there is evidence, that in inflammatory diseases of malarious regions, the sul- phate of quinia proves often a most efficacious remedy by virtue of its sedative powers. Besides its antiperiodic virtues, it possesses—as already remarked— those of a tonic. There are many, however, who esteem cinchona to be preferable as a tonic to quinia; and who administer the latter to prevent the paroxysms of an intermittent; but prescribe the former, when they are desirous of strengthening the system and preventing a relapse. As an antiperiodic, it may be given in the quantity of from four to ten grains in the twenty-four hours. The author is in the habit, in cases of regular intermittents, of prescribing five grains, dissolved in water, about an hour before the expected paroxysm, and repeating it in the course of half or three quarters of an hour; and, should there be evidences of the return of the paroxysm notwithstanding, he prescribes fifty drops of laudanum. Under the joint action of the tonic and the narcotic, the parox}^sm will generally be prevented, or be so far broken as to yield to a repetition of the treatment before the next expected paroxysm. It has, however, been given in much larger quantity than this, sometimes to the extent of thirty grains or more every hour, until upwards of ninety grains and more have been taken; but it is question- able whether such large doses can be necessary. In the cases of yelloAV fever, before referred to, from a scruple to a drachm was given for a dose with signal success. Like cinchona, sulphate of quinia has been given largely in acute rheumatism—a disease, which is peculiar,—and, in the author's opinion, largely neuropathic. Some years ago, M. Briquet announced, that he had cured acute articular rheumatism, accompanied with violent pain, sAvellingj redness, fever, &c, in tAvo or three days, with sulphate of quinia, in doses of about a drachm and a half daily. Such doses, how- ever, cannot always be given Avith impunity; and whilst they were in vogue in Paris, they proved fatal—it is affirmed—in several cases. The author has often prescribed it in doses of from 20 to 30 grains in the 24 hours with decided advantage. Its febrifuge virtues are marked; and instead of its acting as an excitant, the effects are those of sedation. This has been signally shown by some experiments of M. Briquet, of Paris. In doses of fifteen grains and upwards, the pulse was reduced from eight to forty beats in the minute. It would appear, hoAvever, 90 special tonics. from experiments on dogs, recently instituted by MM. Dumeril, De- marquay, and Lecointe; "that whilst the animal temperature is tie- pressed'at first, under the influence of this agent, it rises subsequently. The sulphate was administered by them tAvice in the dose of fifteen, and thirty grains. During the first tAvo hours, the temperature was lowered some tenths of a degree of the centigrade scale; but, as a final result, there AA'as an augmentation, varying from 1°.5 to 2°.2 of the same scale. It has been given to a great amount in this country. A medical friend of Dr. Dickson assured him, that in Alabama he had adminis- tered ''thirty grains of a solution of sulphate of quinia every hour for seventeen successiAre hours;" and he states farther that he heard authen- tically of a western physician, " who emptied into the stomach of a patient labouring under bilious remittent an ounce bottle in one night." Dr. B. Push Mitchell, in a case of congestive fever, gave thirty-grains every half hour until two hundred and forty-grains were taken in about four hours ; and the patient recovered. Twelve grains are con- sidered to be equivalent to about an ounce of good bark. Solution is a more disagreeable form of administration than pill; but as it is important, that the new nervous impression should be as potent and extensive as possible, it must obviously be advantageous, that the gustatory nerves should be impressed as well as those of the stomach. The experiments of M. Briquet satisfied him, that the solu- tion is more active by one-half. The taste, left by it, is soon annihi- lated by chewing a piece of apple. Like cinchona, it may be administered per anum, and it has the advantage, which cinchona has not, of being capable of employment endermically, when the condition of the stomach forbids its use by the mouth. Three times the ordinary dose may be added to a com- mon enema; and when it is to be exhibited endermically, from four to eight grains may be sprinkled on the surface denuded by a blister. As much as tAvo drachms has been applied in this manner. An oint- ment, composed of 3j- of sulphate of quinia, and 3ij. of lard, has been rubbed into the axilla, Avith success, in cases of ague in children; and it has been affirmed by M. Ducros, that doses of about three quarters of a grain, dissolved in ether and rubbed on the lining membrane of the mouth, cause a stronger and more rapid action than half a drachm given by the stomach. PIL'ULE QlTXUfi SULPHA'TIS, PILLS OF SULPHATE OF QUINIA. (Quinice sulph. 3j.; Acacice pulv. 3ij.; Syrup, q. s. to make 480 pills.) Each pill contains a grain of sulphate of quinia. Besides the sulphate, other salts of quinia have been prescribed. Ac"etate of Qui'nia acts like the sulphate, but deserves no prefer- ence ; and the same may be said of Citrate of Qui'nia, Mu'riate of Qui'nia, and Xitrate of Qui'nia. Ferrocy'axate of Qui'nia, is considered by some to possess antiperiodic properties, superior even to those of the sulphate, yet it is but little used; and Tannates of ACIDUM ARSENIOSUM. 91 Qui'nia and Cincho'nia have been regarded as the most active of the combinations of the alkaloids. None of these are used on this side of the Atlantic. For a farther description of them,—as well as of an impure sulphate of quinia, called in a former edition of the Pharmaco- poeia of the United States, Quinine Sulphas Impurus, formed by evaporating the liquor poured off the crystals of sulphate of quinia to the consistence of a pilular mass, and which has been known for years in Philadelphia, under the name of Extract of Quinine, the reader is referred to another work, (New Remedies, 6th edit. p. 636, Philad. 1851.) Cincho'nia, and Sulphate of Cincho'nia are obtained from pale bark, by a process similar to that by which quinia and sulphate of quinia are obtained from yellow bark. It would appear that sulphate of cinchonia is equally effective as an ordinary and an antiperiodic tonic Avith sulphate of quinia,—a fact which, as Dr. Pereira observes, acquires some importance from the apprehended failure of yellow bark, in which quinia abounds. Yale'rianate of Quinia has been lately introduced by M. Devay as superior to sulphate of quinia. The following is his mode of pre- paring it. To a concentrated alcoholic solution of quinia, valerianic acid in slight excess is added: the solution is diluted Avith tAvice its volume of distilled water; and the whole is well stirred, and then placed in a sand-bath, the heat of which does not exceed 145° Fah. When the alcohol is evaporated, valerianate of quinia presents itself in beautiful crystals, which increase from day to day. As the salt is readily decomposed, M. Devay gives it in the most simple form, generally in a solution of gum arabic. The dose is from 1J to 6 grains during the apyrexia. I'odides of Qui'nia and Cincho'nia, described under Eutrophics, may be useful additions to the Materia Medica,—formed as they are by the combination of a valuable eutrophic and4 a tonic; but their medicinal properties have not yet been fully tested. 63. ACIDUM ARSENIO'SUM.—ARSE'NIOUS ACID. Arsenious Acid, White Arsenic, White Oxide of Arsenic, occurs in na- ture, either tolerably pure, or combined with other metals or metallic oxides. White arsenic of the shops is understood, however, to be obtained from the refuse found in the flues of furnaces where other metallic ores undergo the process of roasting; and more especially from the refuse of the roasting of the arseniuret of cobalt. The im- pure material from the flues is subjected to a second sublimation; which renders it sufficiently pure for medicinal purposes. It is pre- pared in Silesia, Bohemia, Saxony and Cornwall; and the precise pro- cesses adopted in each of these places are described at some length by Dr. Pereira. From Penryn, in the last place, not less than 600 or 800 tons are shipped annually. That which is used in this country comes chiefly from Hamburg and Bremen. (Wood & Bache.) 92 SPECIAL TONICS. 4 Recently sublimed arsenious acid is in masses, which are convex on one side, and concave on the other; taking the shape of the vessel used in the sublimation. The cakes are transparent, and of a vitreous appearance; but they soon become opaque and white externally, the opacity gradually extending from the circumference to the centre. It is entirely volatilized by heat; emits an alliaceous odour when thrown on ignited charcoal, and is completely dissolved by boiling water. It has little or no taste, and is devoid of smell; but if left for some time in contact Avith the lining membrane of the mouth or nostrils, it causes considerable irritation. Boiling water dissolves about one-ninth of its weight, and on cooling to 60° retains l-35th. Temperate water takes up scarcely l-400th of its weight. (Christison.) The presence of organic matters very much impairs the solvent powers of Avater in regard to it, which accounts for arsenious acid not having been found in the liquid contents of the stomachs of those who have been poisoned by it. (Pereira.) The adulterations of arsenic are unimportant. In large doses, arsenious acid is a virulent irritant poison, and is knoAvn as such in almost all parts of the world. Yet it is stated as a fact by Dr. Blake, late of St. Louis, that arsenic, which, it might have been presumed, would be rapidly fatal, "is so inert when introduced into the blood, that it Avill not speedily produce death, unless it is in- jected in quantities sufficient to directly coagulate the blood." " It remains11—he adds—" for future experiments to determine if this is owing to its being isomorphous to one of the elements of the fluids and solids, the phosphorous." (See vol. i., p. 113.) In small doses, and administered for a considerable period, arsenious acid modifies the condition of the fluid of the circulation, and, through it, of the system of nutrition, so as to remove various morbid condi- tions of the same. Hence, it falls also under another head—that of Eutrophics. It is generally likewise regarded as a tonic, and all admit that it is an antiperiodic. Under continued use, a sensation of heat in the throat, oesophagus and stomach, is, at times, experienced, with nausea, pain of the stomach, and occasional vomiting: great lan- guor or depression of spirits is likewise felt, with redness of the eyes, swelling of the eyelids, and oedema of the face:—to the last symptoms the name Oedema Arsenicalis has been given. The practitioner ought to be on the watch for their supervention, as they are the first evi- dences of poisoning; and the remedy should be discontinued, until they have passed aAvay. Arsenic was probably one of the agents employed in the cases of sIoav poisoning, Avhich have been recorded in the annals of turpitude and crime. Recent experiments on dogs by MM. Aug. Dume'ril, Demarquay, and Lecointe, instituted Avith the view of determining the modifica- tions produced by different therapeutical agents on the function of calorification, exhibit that, in small doses, it always induced a slight elevation of temperature; whilst in toxical doses, like other agents, it occasioned great depression. As an antiperiodic, it has been employed in intermittents; and Avith much success. This property has been long known, and is still greatly prized. It succeeds, at times, AAmen both sulphate of quinia and cin- ACIDUM ARSENIOSUM. 93 chona have failed, although it is not perhaps so well adapted for the generality of cases as either; and even were it so, the evils that occa- sionally result from its use would render either of the others prefera- ble. It has, however, its advantages; and a modern Avriter, Dr. Brown, who prescribed it in many hundred cases, considers it superior to cin- chona, but inferior to sulphate of quinia. It is devoid of taste, AArhich is an advantage; and if any apprehension be entertained in regard to the exhibition of the bark, or its alkaloid, during the hot stage of an intermittent, it cannot apply to arsenious acid. At times, too, the acid, in combination with other antiperiodics, is successful, Avhen neither, singly, has arrested the disease. Like sulphate of- quinia, arsenious acid has exhibited its powers in other diseases characterized by regular periodicity, as in hemicrania, and various other forms of neuralgia. In epilepsy, it has not been as efficacious as some of the metallic tonics already considered; but in chorea, in the practice of some, its beneficial agency has been signal. The dose in substance is from one-sixteenth to one-eighth of a grain in the form of pill. Care must, of course, be taken that the arsenic is well divided. With this view, one grain may be rubbed with a little sugar, and then sufficient crumb of bread be added; the whole being well beaten before the division into sixteen or eighteen pills. Most commonly, it is administered in the form of Fowler's solution,—the preparation given beloAv. Some, however, have believed, that the}' cannot be substituted for each other. As arsenious acid is apt to accu- mulate in the system, it may be well to intermit its use for a day or two every fortnight, or three weeks at the farthest; and, to avoid un- pleasant gastric symptoms, it has been advised that it should be taken when food is in the stomach; but it is questionable, whether there be much advantage in this. Dr. Christison thinks, that dilution is a more rational way of preventing any unpleasant immediate action. LIQUOR POTASM ARSENI'TIS, SOLU'TION OF ARS'ENITE OF POTASSA.—This is prepared by boiling arsenious acid and carbonate of potassa in distilled water, until the acid is wholly dissolved. To the solution, when cold, a little spirit of lavender is added to give it colour and flavour, by which it may be distinguished from Avater. The preparation was first pro- posed by Dr. Fowler, and hence was called after him Fowler's solution. It also long bore the name of Tasteless Ague Drop. Each fluidrachm of the officinal preparation of the Pharmacopoeia of the United States contains half a grain of arsenious acid. The usual dose is eight or ten drops two or three times a day. It has been prescribed, however, in larger quantities without any manifest inconvenience. A Liquor Arsen'ici Chlo'ridi, Solution of Chloride of Ar- senic, has been introduced into the last edition of the London Pharma- copoeia (1851), which is prepared as folio ws: Take of Arsenious Acid, broken into small pieces, 3ss.; Hydrochloric Acid, f3iss. (Imperial mea- sure); Distilled Water, Oj. (Imperial measure). Boil the arsenious acid with the hydrochloric acid, mixed with an ounce of the Avater, 94 special tonics. until it is dissolved; then add sufficient water to make the solution a pint (Imperial measure). This is an imitation of the solutio solventis mineralis or arsenical solu- tion of De Valangin, which, for a long time, has had great reputation in London, in the cases in which arsenious acid is indicated. One fluidounce contains a grain and a half of arsenious acid, whilst the same quantity of the liquor potassae arsenitis contains four grains. This, as Dr. Pereira suggests, may be the real explanation of the infrequency of gastric symptoms under its use; especially Avhen it is borne in mind, that the usual dose is less also. It has been highly extolled in chorea, and in cutaneous affections, particularly lepra, psoriasis, &c. The author has recently prescribed it frequently in such cases and with advantage. The dose is from five to ten drops, beginning with the former dose; and gradually increasing it until it reaches the latter. 64. SALIX.— WILLOW. The only species of wiIIoav, introduced into the Pharmacopoeia of the United States, is Salix alba or white willow; Sex. Syst. Dicecia Dian- dria; Nat. Ord. Salicacese. This species is received, also, by the London College; AA'hilst the Edinburgh acknowledges Salix caprea or round-leaved willow; and the Dublin Salix fragilis or crack willow. Dr. Pereira has suggested, that to judge of the therapeutical value of different species of salix, the best practical rule to follow would be,— to select those whose barks possess great bitterness combined Avith astringency; and the same rule is applicable to the species, that are native in this country, and are probably of as much therapeutical value as Salix alba, which is indigenous in Europe; but has been introduced here and is now very common; flowering in April and May. In the dried state, the bark is usually quilled, and devoid of odour. It has a bitter and astringent taste; and yields its virtues to water and alcohol. It is in the secondary list of the Pharmacopoeia of the United States. Willow bark possesses similar virtues to Cornus Florida, and, like it, has been employed not only as an ordinary tonic but as an antipe- riodic. It may be given in the same doses and cases as cinchona. It has acquired more attention in consequence of the separation of its active principle, called Sal'icin. This is prepared by preference from Salix helix, but it is found, likeAvise, in the barks of other willows—as Salix alba, S. vitel- Una, S. purpurea, S. Lambertiana, S. pentandra, S. polyandra, S. fragilis, S. viminalis, &c, and in the leaves and barks of several species of poplar—Populus tremulus, P. tremuloides, P. alba} and P. Grceca. The various modes of preparing it are given by the author in another work, (New Remedies, 6th edit. p. 637, Philad. 1851). It crystallizes in very fine silky masses of white crystals, which have the appearance of mother of pearl. It is devoid of smell; but has a strong enduring bitter taste, with a balsamic flavour like that of the bark of the AA'illow. CORNUS FLORIDA. 95 One hundred parts of cold water dissolve six parts of it. It is more soluble in warm water, and, likewise, in alcohol; but is not soluble either in ether or the essential oils. It has no alkaline reaction. Salicin has been largely employed in intermittent fever, and with very successful results; but sentiments in regard to its antiperiodic powers are discrepant; some placing it far beneath the sulphate of quinia, others above it. By general consent, however, it is regarded as inferior. Comparative trials were directed a few years ago by Surgeon-general Lawson; but the author has not seen the results. Such an investigation was made by Dr. Fenner, of New Orleans, who arrived at the conclusion, that " the average amount of quinia required to cure twenty cases of intermittent fever, and costing twenty-five cents, is fully three times as efficacious as the average amount of salicin required in a like number of cases, and costing seventy-five cents." Dr. Fenner's report has all the appearance of accurate and im- partial observation. The dose as an antiperiodic is four or five grains, repeated accord- ing to circumstances: as a tonic, it is less. 65. PIPERFNA.—PIP'ERIN. Black pepper, infused in whisky, has long been a popular remedy, with sailors, in intermittents; and it is probable, that its virtues, in such cases, are dependent both upon piperin, and acrid oil, which the pepper oontains. Piperin exists in black, white, and long pepper, and also in cubebs. At first it Avas regarded as a vegetable alkali; but M. Pelletier subsequently analyzed it carefully, and showed that it was not such, but bore considerable analogy to resins, and was of a peculiar nature. He farther denied it all medicinal activity ; but in this he was mistaken. He spoke as a pharmacien, not as a therapeutist. When quite pure, piperin forms colourless rhombic prisms, which are insoluble in water, but soluble in alcohol and ether. It is gene- rally described as bland, when quite pure; but Dr. Christison states, that the purest he has been able to obtain, was as acrid as that which Avas broAvnish; and emitted an intensely irritating vapour when thrown on a heated iron plate. Piperin has been given largely by the Italian physicians, especially in intermittent fever; and, they affirm, Avith very great success. Opin- ions, however, in regard to it, have been discrepant. It may be pre- scribed in the same cases as sulphate of quinia, in the dose of from gr. ij. to vj. and more, made into pill with extract of gentian, and repeated according to circumstances. 66. CORNUS FLORIDA.—DOGWOOD. The bark of Cornus Florida, Dogwood, Sex. Syst. Tetrandria Mono- gynia ; Nat. Ord. Caprifoliaceae—an indigenous tree, which flourishes in every part of the United States—is officinal in the Pharmacopoeia of the LTnited States. Dogwood is a well known ornament of the 96 SPECIAL TONICS. American forests, by reason of the multitude of large white flowers, which it sends forth in May. The bark is obtained from every part of the tree; but that of the root is preferred. As met with in the shops, it is in pieces of various sizes, commonly more or less rolled; and, at times, covered with a faAvn-coloured epi- dermis. Its smell is feeble ; taste bitter and astringent. At one time, it was stated to con- Fig. 145. tain a peculiar prin- ciple, to which the name Cor nine was given; but if such exist, it is not used. Like other bitter barks, it yields its virtues to water and to alcohol. Cornus Florida was at one time much given as an antiperiodic, and doubtless still is in many parts of the country. Like most of these agents, how- ever, it has fallen into comparative disuse since the introduction of sulphate of quinia. It possesses tonic vir- tues, and may be given in all cases in which cinchona is indicated, although far inferior to it in efficacy. In intermittent fever, the powder may be pre- scribed in the dose of a drachm, repeated so that an ounce or more may be taken during the apyrexia. As a tonic, it may be given in infusion :—(Cornus Florid. 3j.; Aquce bullient. Oj.) The decoction is the only officinal preparation. DECOC'TUM COR'MS FLOR'IDvE, DECOCTION OF D0GAV00D. (CornHs Florid. 3j.; Aquce bullient. Oj.) The dose, as a tonic, is f^iss. to f^ij. and more. Cornus Florida. 67. Cornus Circina'ta, Round-leaved Dog-wood ; and—68. Cor- nus Seric"ea, Swamp Dogavood, both indigenous in the United States, yield barks which are officinal in the secondary list of the Pharmaco- poeia of the United States; and which possess the same virtues, and are inservient to the same uses as the bark of Cornus Florida. hippocastanum. 97 69. LIRIODEN'DRON.— TULIP THEE BARK. Llriodendron Tvlipifera, Tulip tree or Poplar ; Sex. Syst. Polyandria Polygynia; Nat. Ord. Magnoliacea?, is a AArell known boast of the American forest,—bearing, in May, numerous flowers, which have a resemblance to the tulip; and have hence obtained for it one of its popular names. The bark is officinal in the secondary list of the Pharmacopoeia of the United States. In the shops, it is in pieces of various sizes, of a yellowish white colour, and easily broken. That obtained from the root is generally preferred. Its taste is aromatic, pungent and bitter,—properties which are imparted to water and alcohol. The aromatic and pungent property, however, is injured by decoction. It Avas separated by the author's late friend—Professor Emmet, of the University of Fis-146- Virginia—Avho called it Liriodendrine. It does not resemble quinia in its chemical characters. It unites with neither alkalies nor acids; and appears to hold a place betAveen the resins and essential oils. It has not been used in medicine. Tulip tree bark has been prescribed under the same circumstances as that of dogwood; its dose in the apyrexia of intermittents being, in powder, 3j. As an ordinary tonic, it may be prescribed in infusion. (Liriodendr. 3J.; Aquce bullient. Oj. Dose, f giss. to faiij.) The Pharmacopoeia of the United States contains no officinal preparation of it. Liriodendron tuiipifera. 70. HIPPOCAS'TANUM.—HORSECHESTNUT. AUsculus Hippocastanum, Horsechestnut, Buckeye; Sex. Syst. Heptan- dria Monogynia; Nat. Ord. Hippocastaneae, is indigenous in the mountainous regions of Asia Minor and Persia, and grows in this country as well as in Europe. The bark is the part employed in medi- cine: it has an astringent bitter taste, and contains a considerable quanti- ty of tannic acid. A peculiar principle, JEsculine, is said to have been discovered in it; but this has been contested. The bark has been long used as an astringent; and in modern times has been brought forward as a substitute for cinchona. It would seem to accord most in properties with willow bark,—the latter appearing, however, to be more effective, and to agree better with the digestive organs. It was much used during the A\rars of Napoleon, when cin- chona Avas scarce. It has, likewise, been administered as an astrin- gent tonic when such an agent was indicated. Many of the European pharmacopoeias have an aqueous extract of the bark, which is said to agree better with the stomach than the powder or decoction. The following Factitious Powder of Bark is contained in the Prussian Pharmacopoeia:—R. Cort. Hippocast., Cort. Salicis, Cort. Gentian, rubr., VOL. II.—7 98 SPECIAL TONICS. Calum. Aromat., Caryophyll. aa. 3ij.—M. In this preparation, the wil- low—as already remarked—■ FiS- ]4^- has medical virtues analogous to those of horsechestnut bark; gentian is a simple bitter; and calamus and cloves are exci- tants. Ilufeland affirms, that this powder is an adequate sub- stitute for cinchona in three cases in four. 71. NARCOTI'NA.—NAR'COTIN. Narcotin is obtained either from the aqueous extract of opi- um of the shops by means of ether, which dissolves only the narcotin, and consequently re- quires only to be evaporated to obtain it; or from crude opium, which has been exhausted by cold water. Narcotin crystallizes in white needles; is devoid of taste and smell; neutral; and, of course, very soluble in ether. It is also soluble in hot alcohol. As elsewhere remarked, narcotin was supposed to be the excitant property of opium; morphia the sedative; but subsequent researches have not established this. Although it is insipid, its salts are intensely bitter. The sulphate and the muriate have been used as antiperiodics,—the latter with great success. The following is the mode of preparing the latter salt which was employed by Dr. O'Shaughnessy in India as a substitute for quinia. Take of Bengal opium, two pounds; aIcohol, twenty pounds Rub them in a large mortar, adding the alcohol gradually until the opium is robbed of its soluble portions. The solution is then decanted and the insoluble part pressed. To the alcoholic solution as much ammonia is added as renders the liquid slightly turbid. Fifteen pounds of the alcohol are then distilled from a common alembic • and the fluid in the still is drawn off, and set aside to cool. On coolino- a mass of coloured crystals is deposited, which is composed of narcotin, meconate of ammonia and resin. This is washed with water, which dissolves the meconate; and afterwards with a quart of water and a drachm of muriatic acid, which dissolves the narcotin and leaves the resin The solution is then filtered and evaporated to dryness. The muriate, thus formed, is a transparent, resinous mass, of a rosv colour and brittle vitreous texture. It is very soluble in water, and alcohol; and intensely bitter. It has been prescribed largely in India in intermittents. Sixty cases were treated by Dr. O'Shaughnessy of which all but two Avere successful; and the same gentleman refers to .Esculus hippocastanum. a. Flower, b. Fruit BEBEERINA. 99 one hundred more, which had been treated by his pupils and acquaint- ances, with perfect success, by the same remedy. 72. PHLORIDZFNA.—PHLOR'IDZIN. The bitter principle, to which the name Phloridzin has been given, exists in the bark of both the trunk and the root of the apple, pear, cherry and plum tree. It is obtained by boiling the fresh bark of the root of the apple tree in sufficient water to cover the bark ; decanting the decoction, and boiling again with a little more Avater. On uniting the decoctions, and permitting them to stand for tAventy-four hours, the phloridzin is deposited in granular crystals. One thousand parts of Avater, at a temperature from 32° to 71°, only dissolve about one part; but at from 71° to 212°, water dissolves it in all proportions. It is also very soluble in alcohol at ordinary temperatures. It has no action on test papers. Ten to fourteen grains of phloridzin have occasionally arrested an intermittent after sulphate of quinia had failed. The testimony of many observers is, indeed, in favour of its antiperiodic virtues. It may be given, made into pill with extract of gentian as an excipient. It has also been administered in enema. 73. CETRARFNA.—CET'RARIN. Cetrarin is obtained from Cetraria Islandica, (vol i. p. 284,) by boil- ing it coarsely powdered in four parts of alcohol; filtering the solu- tion when tepid; acidulating with diluted muriatic acid; diluting with three times its volume of Avater, and alloAving crystals to form slowly. The crystals may subsequently be purified. Pure cetrarin—which, it has been affirmed, is a compound of three distinct substances—is of a white colour, and intensely bitter taste. Its best solvent is alcohol. It is very sparingly soluble in water, hot or cold. The acids do not unite Avith it. From a pound of cetraria, 135 grains of pure cetrarin were obtained. It has been given as an antiperiodic in intermittents, in the dose of two grains every two hours during the apyrexia; but it has not been used in this country. It has been suggested, that an alcoholic solution should be prescribed in place of the cetrarin itself; and it may act more speedily, for the same reason that a solution of the sulphate of quinia is more effective than the salt in substance. 74. BEBEERI'NA.— BEBEERINE. In the year 1843, Dr. Douglas Maclagan read a paper on the chemi- cal history of the Bebeeru Tree, of the species Nectandra,—N. Rodicei; Sex. Syst. Dodecandria Monogynia; Family, Lauraceae, which grows in British Guiana. The bark and seeds yield two alkaline bodies, which he calls bebeerine and sipeerine from the Indian and Dutch names of the tree. The sulphate of the former has been proposed as 100 astringents. a substitute for sulphate of quinia; with Avhich, indeed, it appears to possess analogous properties. Of late years, in Edinburgh, a great im- provement has been made in its manufacture, so that it is now pre- pared at less than half the price of the sulphate of quinia. (Christison.) From a scruple to a drachm betAveen the paroxysms of a tertian is generally sufficient to arrest the intermittent. Its antiperiodic virtues are very decided; but judging from its exhibition in a "limited num- ber of cases," Dr. Pepper, of Philadelphia, says " it appears to be less efficacious than the sulphate of cinchonia, or the sulphate of quinia;" and he suggests, that it " may, perhaps, be Avell adapted for many of those cases AArhere constitutional peculiarities render the preparations of bark objectionable." According to Dr. Maclagan, a secret prepara- tion, sold under the name of " Warburg's Fever Drops," appeared, on chemical examination, to be a tincture of bebeeria, made, probably, from the seeds of the bebeeru tree. It is doubtful, however, whether this is the case. An examination of it by a committee of German pharmaciens gave for its chief constituents,—sulphate of quinia, aloes, saffron, camphor, zedoary, and angelica. 75. CHLOROFORM'UM.—CHLO'ROFORM. Chloroform—whose properties are described elsewhere, (vol. 1, p. 423)—according to M. Delioux, Professor of Materia Medica at Roche- fort, France, is a potent succedaneum for cinchona and arsenic. A number of cases of malarious fever, which is very common at Rochefort, were treated at the hospital there with chloroform, and with such regular success, that M. Delioux felt warranted in recommending it as a power- ful antiperiodic; given in the doses of from nine to thirty grains, seve^ ral times before the expected paroxysm. He advises, that it should be first rubbed with syrup, after which it mixes readily with water. III. ASTRINGENTS. Synon. Constringentia, contrahentia, stegnotica, syncritica, adstrictoria. Definition of astringents—Tannic acid the great vegetable astringent principle__Their modus operandi—Act best on parts with which they come in contact__Bad effects of astringents—Indirect astringents—Therapeutical application—In fevers, inflammations, hemorrhages, &c.—Astringents often used by the surgeon—Styptics—Special astringents. Astringents are defined, by Dr. A. T. Thomson, to be substances, which produce contraction and condensation of the muscular tissue • but in his table of classification, he ranges them amongst vital agents that operate on the " muscular and sanguiferous systems." Mr. Head- land, too, in his recent work " On the action of medicines in the system " states, that " Astringents act by passing from the blood to muscular fibre, which they excite to contraction." There is no reason however why their operation should be restricted to those systems. They affect also, as remarked by the Messrs. Schroff, the skin, mucous mem- ASTRINGENTS. 101 branes, cellular tissue, and the glandular, and parenchymatous organs, and a better definition Avould be, simply, " agents, that occasion con- traction, and condensation of the tissues." The inconsistency in the two definitions by Dr. Thomson, given above, is much less, however, than that developed in a subsequent part of his section on astringents, where he proceeds to give his theory on the nature of astringency. By a reference to his table of classification, (vol. i. p. 118), it will be found that he separates Excitants, Sedatives, Refrigerants, Narcotics, and Antispasmodics—which operate directly on the nervous system—from Tonics, and Astringents, which operate on the muscular and sanguiferous systems; yet, the development of his theo- ry, regarding the action of the last class, shows convincingly, that he ought to have referred it to the division, which comprises the various agents that act directly on the nervous system. " I conceive it to be a power," he remarks, "which, through the medium of the motor nerves, acts on the insensible contractility of the muscular fibril, pro- ducing a closer approximation of their component particles; and, by thus augmenting their cohesion, causing a greater and more permanent density, and a corresponding vigour in th,e muscular tissue. This action differs from ordinary muscular contraction, in not being dependent on the nerves of sensation; and, consequently, in not being the result of any communication Avith the sensorium; in not exhausting excitabili- ty ; and in the permanency of its effects. The movements constituting muscular contraction are the consequence of impressions conveyed to the brain through the sensitive nerves, and thence to the motor nerves of the part; the contractions following the application of astringents are the result of direct impressions on the motor nerves themselves, altogether unconnected with those of sensation." It is doubtful, whether any such direct agency on the nerves is exerted by astringents. It is more probable, that the primary effect is upon the intimate tissues of organs, as astringents are capable of pro- ducing condensation and contraction in parts that are deprived of the vital influence; and, although much has been said against the idea, that anything like tanning can be effected upon the living tissues by the operation of this class of medicinal agents, the explanation does not appear to the author as wide of the mark as it has been conceived to be by many. The vital influence prevents the precise chemical changes from being effected,—the requisite union of the gelatin of the skin, for example, with the tannic acid of oak bark,—but it does not prevent the condensation and corrugation of tissue, something similar to which is produced in the dead fibre, as well as in vegetables— organized bodies that are devoid of nerves. Astringents may be used internally, either for the purpose of acting " upon the parts with which they come in contact, or indirectly on distant parts; or externally, particularly with the view of arresting hemorrhage, —when they are called styptics ; and a difference has been made amongst these, according as they act chemically or mechanically;—the chemical styptics coagulating the blood exuding from the part, and at the same time stimulating the tissues to contraction; AArhilst the mechanical—as 102 ASTRINGENTS. felt, agaric, lint, &c—detain the blood in their meshes; or absorb it, until it coagulates, and thus arrest the hemorrhage. Astringents can be readily detected by the taste. They convey a sense of roughness to the palate, which cannot be mistaken; but which is more marked in some substances than in others. It is thus, that the mineral acids,—alum, and the various metallic salts, and vegetables,— are already detected as astringents. The vegetable kingdom furnishes largely to this division of therapeu- tical agents; and the property on which their virtues are mainly de- pendent, is tannic acid—theprincipiumscytodephicum or Gerbestoff of the Germans. This is associated with gallic acid in galls, krameria, tormentilla, uva ursi, &c. The action of astringents, when taken internally, may be altogether local on the tissues with AArhich they come in contact; or the excitant effect,—for it is excitant,—may be communicated to other parts of the frame, as in the case of tonics; so that the action of organs at a distance may be modified ; and immoderate discharges from them be, in this manner arrested. When such is the case, the hemorrhage may be controlled, in consequence of the simple tonic influence exerted by the astringent; for it is not easy to see how the effect of the astrin- gent itself can be extended beyond the part which it immediately touches ;—or, the astringent principle may pass into the mass of blood by absorption; and come in contact Avith the vessels whence the immoderate discharge is proceeding. This may be the case, but it is difficult to conceive, that a small dose of an astringent substance, received into the blood, can proceed to the seat of an undue flow, and there act in sufficient concentration to produce any manifest astringent effect; yet this is the modus operandi according to many Avriters. Dr. Thomson, indeed, asserts, that, "without such a supposition, we should not be able to explain the manner, in which they [astringents] act in stopping hemorrhage, when internally administered, especially when taken into the stomach ;" and he adds :—" Mr. Brodie gave a patient, who had a frightful hemorrhage from the prostate gland, and in whom all other remedies had failed, a dose of Ruspini's styptic, and repeated the dose twice in the course of twelve hours. About half an hour after the first dose was taken, the bleeding ceased, and it never recurred." This styptic is said to consist of gallic acid, a small quan- tity of sulphate of zinc, and opium, dissolved in a mixture of alcohol and rose water; but, as the quantity of sulphate of zinc, and opium, appears too small to influence the medicine, a simple solution of gallic acid in diluted alcohol, it has been conceived, will answer all the pur- poses of the expensive nostrum. The above case, hoAvever, is insuffi- cient to establish the fact of absorption; and, without meaning to deny, that the styptic in it did exert agency in arresting the hemorrhage, the author does not think, that a solitary instance of the post hoc is sufficient to establish the propter hoc. Dr. Thomson, indeed himself admits, that he has not witnessed its influence, as an internal or general astringent; although he has frequently observed its power in checking the most obstinate bleedings from leech bites in children, after all other means had failed. MODUS OPERANDI. 103 Another mode in which astringents may act, in certain cases, is by passing into the mass of blood, and increasing the tendency to coagu- lation of that fluid. It is manifest, that in all increased discharges, Avhich occur from parts that can only be reached through the medium of the circulation, no signal advantage can be expected from the administration of astrin- gents ; on the other hand, where they can come into immediate contact Avith the seat of the disease, they may be more relied on. Accord- ingly, in haematemesis and epistaxis, and in chronic diarrhoea, and dys- entery, their action is more marked than in haemoptysis, immoderate floAV of the menses, or leucorrhcea; inasmuch as, when taken internally, they can only act on the lungs, uterus or vagina, either by the im- pression they make on the general system through the nerves of the stomach, or by being taken into the circulation. Under the view, everywhere embraced by Dr. Chapman, of Phila- delphia, in his " Elements of Therapeutics," that the vital action of parts resists anything like chemical change;—that " so long as vitality en- dures, every chemical action or combination is repelled by powers and resources peculiar to the animated condition," the modus operandi of astringents becomes a weighty stumbling block. " Nevertheless," he remarks, " there would seem, at the first view, to be a class of articles endowed with the property of corrugating or contracting the living fibre. This is especially evinced by the sensation, which they impress upon the tongue and fauces; and, perhaps, still more conspicuously by their efficacy in restraining hemorrhages from wounds. Yet how they operate has never been very intelligibly explained. Their effects are ascribed altogether by Darwin to the power of promoting absorption. Whether they have such a property is exceedingly doubtful. Con- ceding it to them, however, it will not, in the slightest degree, account for their suppression of hemorrhage." This is all that Dr. Chapman says of the general modus operandi of astringents. He offers no view of his OAvn; and, indeed, appears to doubt, whether there be any agents endowed with the property of corrugating or contracting the living fibre; inasmuch as he says, there would " seem at the first view," to be a class of such articles,—leaving the inference to be deduced, that farther examination would exhibit its non-existence. We can have no more doubts, however, of the astringent action of such a class of substances,—modifying the condi- tion of the living fibre, in the mode mentioned,—than we have of the action of cathartics, emetics, or narcotics. In all cases where profuse discharges have to be checked, it is im- portant to inquire, whether they be accompanied by unusual activity of vessels, or, in other words, of the kind generally regarded and de- nominated active,—or whether they be passive. Some have denied, that there can be such a state as passive hemorrhage, but it can be readily understood, that there may be a condition of vessels in which their texture is so loosened as to permit the blood to transude with facility from Avithin to Avithout; and, accompanying, or not, this con- dition, there may be a degree of fluidity and impoverishment of the blood, that may adapt it for a more ready transudation than when it 104 ASTRINGENTS. contains more fibrin, and red corpuscles. The author attended a young female, Avho, in consequence of hyperaemia of the encephalon, had been bled every fortnight for several months, to the extent of a quart or more; and in whom it Avas an object of moment to break in upon the habit thus induced. Her whole appearance was anaemic. _ She was pale, apparently almost exanguious; the pulse was small, indicating the presence of but little blood in the vessels; yet at the usual inter- val of a fortnight, signs of augmented action in the vessels of the head supervened; and it was for a time esteemed indispensable to repeat the blood-letting. The author's endeavour was to gradually break in upon this habit; to cup her, when the encephalic symptoms made their appearance; and, by revellents, to direct the afflux of blood elsewhere. Occasionally, however, it was necessary, in consequence of the super- vention of delirium, to take away a pint of blood, and this was largely composed of serum,—affording the strongest proof of that form of Iwperaemia, which is characterized by impoverishment and deficiency of the circulating fluid. The original mischief was probably in the great nervous centres; and blood-letting was doubtless, in the first in- stance, appropriate; but the frequent repetition of it was well adapted to lay the foundation for periodical irregularities of circulation, like those under which she Avas suffering, and from which she ultimately recovered under the plan recommended by the author. The case is an elucidation of the fact—often referred to in these pages—that hyper- emia may be induced by agencies, that are regarded as best adapted for its removal, provided such agencies be pushed to an inordinate ex- tent ; and it is an additional evidence in favour of the importance of attending to the state of the nervous system, under whose influence hypersemic affections are often developed; and where the indication of cure is less to Avithdraw the circulatory fluid than to allay the nervous irritability, which gives occasion to the excited state of capillary ves- sels, that constitutes most of the varieties of hyperaemia. From what has been said it obviously follows, that in acute inflam- mations of mucous membranes, accompanied by increased discharges, powerful astringents maybe—to say the least—of doubtful propriety; whilst in chronic inflammations, where debility of capillaries exist they may like excitants, be the best class of agents that could be had re- course to. Care, however, has always to be taken Avith regard to their strength. M. Broussais has properly remarked, in one of his "propo- sitions," that " vegetables, Avhich are astringent in small doses, produce gastro-enteritis when taken in large doses." But this does not apply to the gastro-enteric mucous membrane solely. The sudden applica- tion of a powerful astringent condenses and corrugates the mucous tissue, so that the calibre Of the vessels is diminished below the natural; the circulation through them is consequently obstructed; and hence supervenes increased action of the vessels that are continuous with the constricted capillaries. In another proposition, M. Broussais affirms, that, " the mineral astringents, the sulphates of alumina, of zinc, and of iron, act nearly in the same manner as the preparations of lead, except that the latter produce a truly deleterious effect on the nervous system:" " the primary action of all," he adds, " is stimulating; they all contract MODUS OPERANDI. 105 the fibres, and afterwards diminish the innervation." He asserts, too, that when astringents are applied so as to arrest the " serous elimina- tion" of the skin, an internal exhalent action succeeds ; and, as an in- stance of this, he adduces dropsies, that immediately follow the appli- cation of an astringent, which has repelled itch, tetters, and even acute inflammation—as erysipelas. " Similar dropsies have been sometimes induced by frictions with ointments containing sulphate of alumina, sulphuret of potassa, or baths impregnated Avith corrosive sublimate, employed for the cure of prurigo or obstinate itch." Without meaning to deny, that where an accustomed irritation has been suddenly repressed, it may be transferred elsewhere; and that where a long established drain is arrested, exhalation may be produced in other parts of the system,—it is proper to observe, that the author has never witnessed dropsy induced in the manner referred to by M. Broussais; no* is he disposed to admit, that it could readily happen. The surface, in a case of tetter, is so small, and the elimination effected from the skin of the part so trifling, that it appears improbable, that any augmentation of internal exhalation could be induced to such an extent as to give rise to dropsy, by astringent or other agents em- ployed for the removal of the cutaneous eruption. The astringent medication is considered, by many Avriters, under the head of tonics; and some of the substances in the catalogue of the Materia Medica eminently possess tonic or corroborant virtues. Such is the case with cinchona; yet its chief virtues are not dependent upon this astringency, as quinia possesses none of it. It is obvious, that the efficacy of astringents may vary according to the principles that are united with them; and this may give occasion to the exertion of some choice to adapt them to particular conditions of disease. The most potent of the vegetable astringents are indebted for their properties to the tannic acid they contain; but many others have a bitter or an aromatic principle associated with the astringency, and have therefore, been termed respectively, by some of the Germans, ama- ro-adstringentia, and balsamico-adstringentia,—as salix, hippocastanum, juglans regia, the caryophyllaceae, and especially the cinchonaceae, &c. Thus far the author has referred only to the action of direct astrin- gents ; profuse evacuations may, however, be connected with different states of the living system ; so that agents, possessed of no astringent properties, may yet check them ; or produce an astringent operation, indirectly. Hence we have {direcf and 'indirect"1 astringents, as we have direct and indirect t6nics. Opium, for example, by allaying the augmented peristole in diarrhoea, may exert an action of astringency, and diminish the number of discharges ; and, accordingly, it is often had recourse to in such cases. Again, the increased discharges of dysentery are induced by an inflammatory condition of the mucous coat of the intestines. Bleeding, therefore, by allaying this inflamma- tion ; and castor oil, given occasionally so as to gently remove the morbid secretions, by taking away the cause may check the effects. A predominance of acidity in early infancy lays the foundation to many of the bowel complaints which are so common at that age, and keeps 106 ASTRINGENTS. them up when once established. A proper antacid, by neutralizing the acid, takes away the cause, and thus becomes an indirect astringent. In active hemorrhage, A\diere a condition closely allied to inflammation exists, the flow of blood is arrested by antiphlogistic remedies, which thus become astringents; and, lastly, cold is one of the most valuable of the indirect astringents which we possess, especially in hemorrhages of the active kind. Much of this effect is, doubtless, produced by its temperant, antiphlogistic or refrigerant operation, which—it will be seen hereafter—is manifest. Where, hoAvever, cold—as in the form of ice or iced water—can be made to come in contact with the bleeding part, it produces condensation and corrugation of the tissues; diminished calibre of the vessels; and coagulation of the exuding fluid, in the same manner as substances that belong to the class of direct astringents. When properly used, it is really one of the most valuable astringents that we possess. % Therapeutical application of Astringents. Fever.—With regard to the therapeutical application of an astringent medication, it need scarcely be remarked, that it is inadmissible in fevers, unless they should be complicated, in the latter stages, with symptoms especially indicating its employment. In intermittents, they have been frequently used, and often with decided advantage. Gene- rally, however, the astringents that have been employed in such cases, have possessed other properties on which their efficacy was dependent. The author has already observed, that the different varieties of cinchona contain a principle, which is not astringent, along with another that is; yet the former exerts all, or almost all, the astringent power, which the bark in substance is capable of exerting. At times, however, we meet with cases, in which the bark in substance succeeds, when quinia has failed; and it is not improbable, that in such cases the astringent pro- perty may aid the tonic or febrifuge in arresting the disease. The dynamic influence of the tonic on the body is manifestly of a nervous character ; and the author has attempted to show, that astrin- gents are capable of exerting one of a similar kind; so that even when the latter are administered in an uncombined state, they may succeed in putting a stop to intermittents. Astringents are, however, but rarely employed, inasmuch as we possess valuable agents of another kind for effecting all that they can accomplish, and more too; but there may be pathological conditions, during the existence of an intermittent, which may demand their use; as when the ordinary antiperiodic tonics run off by the bowels, or Avhen discharges supervene, which, if allowed to persist, might be attended with injurious consequences. Inflammations.—During the active stage of inflammations the same rule applies to the administration of astringents as to that of excitants. Although occasionally employed with success during the violence of external inflammations or those of the dermoid tissue, their efficacy is more decided after the violence of the inflammation has passed away, and when a state of over-distention of the extreme capillary is the GENERAL EFFECTS. 107 chief pathological condition that keeps up the excited action of the vessel communicating with it. In some inflammations, however, their beneficial agency, like that of excitants, is manifested from the first. Such are inflammations of the tunica conjunctiva, of the tonsils, velum pendulum, and of parts of the mucous mumbrane, which admit of being inspected, as of that which lines the mouth and fauces;—or which can be reached by them in their undiluted state, as the inflam- mations that characterize blennorrhea or gonorrhoea, and leucorrhcea. In conjunctivitis, occasionally from the first, and almost always in what is called the catarrhal variety, after the violence of the action of the vessels has been someAAdiat got under by the employment of appro- priate antiphlogistics, the advantage of the astringent metallic com- pounds, especially of the nitrate of silver, is often signal. As soon as it is dropped in solution into the eye, decomposition occurs, in conse- quence of its meeting with chloride of sodium contained in the tears. It becomes converted into chloride of silver, which is recognizable by its white appearance; but the constringency, exerted by it on the ves- sels, tends to restore them to their wonted calibre. In that sluggish variety of sore throat in Avhich the mucous mem- brane covering the tonsils is of a diffused dusky red; extending over the velum pendulum and the uvula, and giving occasion to tumefaction and relaxation of those parts, excitant and astringent gargles are the best applications that can be used. The vessels are here loosely situ- ate in the parts in AArhich they creep; remora of the fluid circulating within them is consequently facilitated; turgescence results; and this state is not removed until the vessels resume their wonted calibre,—a result, which can be rendered more easy by the appropriate employ- ment of astringents. In the malignant affections of the throat, which are concomitants of some of the forms of scarlatina, the same class of remedies is employed as local applications; some vegetable infusion or decoction, which con- tains tannic acid, being generally used, with or without the addition of one of the mineral acids. The decoction of cinchona, with associated sulphuric or muriatic acid, is a common combination for this purpose. In those affections, too, of the mucous membranes, which are attended with the formation of a pellicle or an exudation from the inflamed mucous surface, and which were first termed by Bretonneau Diphtherites, astringents are found to be extremely useful after the violence of action has been subdued, and the pellicle has formed. The most successful of these, again, is the nitrate of silver. When this salt is applied in solution to the mucous membrane of the mouth in a case of aphtha;, or to the fauces in cases of diphtheritis of the pharynx, larynx or trachea, the new action, induced in the part to which it is applied, is extended to the membrane lower down, and the most salu- tary effect is, at times, exerted. The exudation of coagulable lymph— Avhich the experiments of Schwilgu^ prove to correspond, in its pro- perties, Avith fibrin, and which constitutes the false membrane in cases of diphtheritis,—frequently begins on the surface of the tonsils; and thence spreads along the arches of the palate, and ultimately descends over the internal surface of the pharynx and oesophagus, as well as of the larynx and trachea. The application of a solution of nitrate of 108 ASTRINGENTS, silver to the tonsils, velum palati, and uvula, frequently removes the albuminoid exudation; produces manifest relief of the symptoms; and ultimately dispels them. Dr. Eberle asserts, that he has seen one in- stance in AA'hich this application was made; and the result gave him a very favourable impression of the' practice; but he says it must be confined to cases in AA'hich the fauces are found, on inspection, to pre- sent an irritated and inflamed condition. This is not, however, essen- tial. The astringent effect upon the part of the mucous membrane with which the solution is made to come in contact, may be propagated by continuous sympathy to the part of the trachea lined by the false membrane; a new action may be induced; the albuminoid substance be detached, and ultimately thrown off, although it is obvious, that when a complete adventitious tube is formed in the trachea, and of course, beloAV the rima glottidis, the narrowness of the aperture into the larynx must, in by far the majority of cases, render the evacuation of the tube impracticable. With a similar object, M. Laennec directed the inhalation or insufflation of very finely powTdered alum—and he asserts, that it generally afforded great and speedy relief,—not only in tracheitis, but also in laryngitis, and amygdalitis. Hemorrhage.—The author has more than once referred to the im- portance of examining, in all cases of hemorrhage, Avhether they he active or passive,—characterized, that is, by polyaemia, or hyperaemia, by hypaemia or anaemia. In the former category, the use of astringents can in no Avise be demanded. The fulness or the activity of vessels must be first reduced before the astringent medication can be adopted. In but few of the cases of hemorrhage, perhaps, does the blood flow from rupture of a vessel. It generally passes out by diapedesis or transudation; and this may be of course favoured both by fulness of vessels, and by any causes that induce a remora of blood in them. The bleeding that takes place in this way has been considered as an effort of nature to relieve this condition, inasmuch as it unloads the dis- tended vessels; and, wdien this occurs, the plethora being reduced the hemorrhage generally ceases spontaneously. Of these fancied ' efforts of nature' the author has already spoken (vol. i. p. 37); and this has no more foundation. The fulness of vessels gives occasion to a physical transudation from within to without, and as this transudation removes the cause,—the effect, the hemorrhage, necessarily ceases. It is not easy to see, however, how a transudation of the red corpuscles of the blood can take place wnthout a morbid condition—an impaired cohe- sion—in the parietes of the A'essels or in the parts in which they creep. In the passive state of hemorrhage, where there is such impaired cohesion, often combined with anaemia, or wdth blood poor in fibrin and red particles, and rich in serum—as in sea-scurAy, and in some of the hemorrhages, that supervene in the worst cases of typhus, and other diseases of prostration,—the use of tonics and astringents is absolutely needed; and if the latter can be brought into contact with the A^essels exhaling the fluid, they occasion a condensation and corruo-ation of their parietes, so as to render transudation less easy. TheA^ are, in- deed, the chief resource of the physician. The mineral acids. Avhen added to blood out of the body, coagulate its albumen; and it is pro- IN HEMORRHAGE. 109 bable, that they exert an analogous action, when taken as medicinal agents, in the cases under consideration. Their efficacy, as well as that of creasote, in scurvy, and in passive hemorrhage of every kind, may be greatly owing to their increasing the tendency of the blood to coagulate. Epistaxis is one of the most common varieties of hemorrhage. Generally it occurs in youth, and is of no consequence. There are but few individuals, about the age of puberty, who are not more or less subject »to it. In such cases, it is usually an active hemorrhage, and does not require the use of astringents. In the evolutions, that occur at puberty, and some time afterwards, irregular hyperaemic determina- tions are apt to supervene; and, as the vessels of the Schneiderian membrane are but loosely protected by the parts in wdiich they creep, and therefore yield more readily to any distending force, diapedesis easily takes place through them. The system of medication is here sufficiently simple. If the hemorrhage should recur repeatedly, and not be excessive, the depletion and the revulsion, excited by a dose of a saline cathartic—as sulphate of magnesia—are often enough to rectify the evil; or if it should not yield to these, it frequently will to a repetition of the remedy along with the employment of a dry and spare diet. If much fluid be taken, either in cases of spontaneous hemorrhage, or where abstraction of blood is recommended for the removal of disease,—OAving to the vessels being deprived of their usual quantity of circulating fluid, the activity of absorption is greatly augmented; and the drink passes rapidly through the coats of the vessels to make up for the loss sustained by the accidental or artificial hemorrhage. In this way the same quantity of fluid may soon be in the vessels; but it must necessarily be more tenuous—less rich in fibrin and red corpuscles—and the consequence is, that it soaks through the vessels more readily than it did in the first instance; and thus a foundation is laid for future recurrence of the hemorrhage. This abstinence from drinks is one of the most important practical precepts that can be inculcated in the management of the different hemorrhages. If the hemorrhage from the nose should be so profuse, at any one time—or if it should recur so frequently—as to bring on signs of hypaemia or inanition, it becomes the duty of the physician to have recourse to the class of remedial agents, whose properties are now un- der consideration. It is a common custom to apply cold water to the nape of the neck, or a piece of cold iron—as a key ; and this simple agency often arrests the flow of blood from the Schneiderian membrane. This effect is probably induced by the impression made on the nerves occasioning a diversion of the blood from the vessels of the membrane; and a similar agency may perhaps be exerted, where mental impressions prove haemastatic;—as in the case of charms, employed in such cases, in antiquity more especially, and not wholly abandoned at the present day. The impression on those vessels can, of course, be only of a sympathetic character. In cases of anaemic hemorrhages, however, more direct applications become necessary, and recourse is had to metallic astringent salts, to alum, dilute sulphuric acid, and to plugging 110 ASTRINGENTS, the anterior or posterior nares,—to the former, or to both, as the urgency of the case may require. In this way, both chemical and mechanical styptics are brought to bear; the former coming in con- tact with the vessels whence the flow of blood proceeds; and the lat- ter preventing the escape of the blood by the anterior or posterior outlets of the nostrils, and thus favouring the formation of a coagulum around the bleeding vessel. Dr. Thomson recommends the use of internal astringents, "as the infusion of roses [!] or of kino, or some other of the astringent vegetable substances, acidulated Avith' diluted sulphuric acid," but much benefit cannot be expected from the action of substances on parts at such a distance from the seat of the malady. This, too, is the reason, why astringents are of less efficacy in haemop- tysis ; which may take place from rupture or from diapedesis, oftener, perhaps, from the latter. Like all the other hemorrhages, too, it may be active or passive; but it is not very common to meet with the lat- ter variety, unless Ave regard as such the diapedesis that occurs Avhen the lungs are filled with tubercles, which is the most dangerous kind of hemorrhage from the lungs, inasmuch as its prognosis merges in that of pulmonary consumption, of Avhich it is a symptom. The existence of tubercles interferes with the due circulation of the blood in the pulmonary and bronchial arteries; and the consequence is, that on the application of a slight exciting cause—as any unusual bodily or pulmonary exertion—a vessel gives way, or the blood soaks through its coats. The active hemorrhage, which takes place from the lungs of a per- son of sound constitution,—in no Avise predisposed to phthisis,—is by no means of the dangerous tendency usually conceived. An acci- dental circumstance may give occasion to the hemorrhage, which may be removed by appropriate measures, and may never recur. Whenever haemoptysis is attended with symptoms of vascular ful- ness or activity, indirect astringents are chiefly had recourse to—as blood-letting, and the agents belonging to the classes of sedatives and refrigerants. Little reliance is placed upon any of the articles of the materia medica, which are regarded as direct astringents; for the sim- ple reason, that none of them can be made to come into direct contact, except in a very diluted state, with the vessels that are exhaling blood. There are obviously—as elsewhere stated—two ways in which such articles can act; the one is by sympathetic influence on the affected vessels, through the astringent agency exerted on the stomach; and the other by the astringent getting into the blood-vessels, and proceed- ing, commingled with the circulatory fluid, through the pulmonary artery to the lungs, or through the ramifications of the bronchial artery, if the flow proceeds from the latter vessel. In neither of these ways could any energetic action be exerted; and hence it is, that the scientific physician trusts to general principles in the management of the case; combating it by the agents already referred to, and by a proper attention to the antiphlogistic regimen generally. Usually, Avhen an individual is attacked with haemoptysis, the greatest alarm is felt; and, in all cases, it is expected that the practitioner should have recourse to blood-letting to arrest the flow. Such is the opinion of the IN HEMORRHAGE. Ill vulgar; and occasionally it is that of the professional attendant also. This is not always, however, philosophical. Every one, who has had an opportunity of seeing many cases of haemoptysis, is aware, that the flow of blood may be arrested at a less expense of fluid, when due attention is paid to ventilation and to posture, than when the lancet is used. A coagulum soon forms around the ruptured or transuding vessel, and the hemorrhage ceases. Whether blood-letting has to be used must depend upon other grounds:—upon the results of an inquiry into the state of the circulation, general and capillary, connected with the hemorrhage ; and if there should be signs of polyaemia, or of hyperaemia, it ought to be unhesitatingly practised, otherwise the hemorrhage may recur, care being taken—as has been remarked of all cases of hemorrhage —not to allow too much fluid to be drunk, but rather advising that a small piece of ice should be put into the mouth occasionally, for the purpose of allaying thirst and excitement. The author is satisfied, too, that the repeated abstraction of blood, when there is no sthenic condition present, may lay the foundation of hyperaemia in the lungs, as it does in other organs; and this hyperaemia will be more apt, under such circumstances, to affect the lungs, from their being, owing to a previous attack, predisposed to the pathological condition. Where haemoptysis is produced by the presence of tubercles in the lungs, it is, as already said, of unfavourable prognosis, because it is one of the precursors or concomitants of phthisis. Such cases can, of course, only be palliated by an attention to the general symptoms, and by the appropriate use of sedative and refrigerant remedies. Astrin- gents cannot here be employed with well founded expectation of suc- cess. Occasionally, too, hemorrhage from the lungs supervenes in a more advanced stage of phthisis, owing to the giving way of a vessel in the parietes of cavities in the lungs. The author has attended cases in which the individual was choked by the quantity suddenly dis- charged in this manner. At other times, in this disease, as Avell as in some of the more active inflammations of the pulmonary organs, espe- cially in children, a copious effusion of blood suddenly takes place into the lungs, so as to completely prevent the air from reaching the pul- monary vessels; and the individual dies, owing to the pulmonary apo- plexy, thus induced, occasioning asphyxia, or, in other Avords, com- pletely preventing the requisite aeration of the blood in those organs. Where blood is exhaled from the vessels of the stomach constituting haematemesis, astringents can be employed Avith more advantage, be- cause they come in contact with the vessels whence the hemorrhage proceeds. Here, however, it is of importance to inquire, whether the exhalation of blood may not be dependent upon obstructed circulation or mechanical hyperaemia, in some other organ; and if so, attention must be paid to the idiopathic derangement. The author has seen many cases of haematemesis, and of dropsy of the lower belly, from hy- pertrophy of the spleen, produced by residence in a malarious locality. As a large quantity of blood is sent to the spleen, this state of the viscus prevents the free circulation of blood through it; the conse- quence is turgescence of vessels, which gives occasion to transudation of the watery portion into the cavity of the abdomen so as to produce 112 ASTRINGENTS, ascites, and an engorgement of the vessels of the neighbouring organ —the stomach—ending in hemorrhage by diapedesis. It is not, however, the organs in the vicinity of any infarcted or in- durated viscus, that are alone liable to be the seat of hemorrhage. If the circulation be impeded in any viscus, foundation is laid for irregu- larity of circulation; and under this irregularity, vessels may give way, or admit of transudation in parts that are at a considerable distance from the organ, whose diseased condition is the cause of the pheno- mena. Thus, epistaxis is often symptomatic of visceral infarction; and the same hemorrhage, or haemoptysis, or haematemesis may be esta- blished Avhere the uterine functions are not properly accomplished. The same remarks are applicable to the hemorrhagic discharges from the intestinal canal, which constitute one of the forms of melaena. The lower the seat of the hemorrhage, the more mixed is the astringent be- fore it reaches the diseased part; and, consequently, the less efficacious. Generally, in ordinary cases, of both haematemesis and melaena, the author has found a combination of sulphuric acid with one of the alkaline or earthy sulphates, forming a supersulphate, well adapted for fulfilling every object of the astringent medication, Avhere this is demanded; or metallic or other astringents may be used, under the general precautions previously inculcated. In cases of what are termed open hemorrhoids, or of hemorrhage from the rectum, astringent remedies may be made to come into im- mediate contact with the seat of the hemorrhage by injection. The use of gently astringent or stimulating lotions, and of laxatives, to prevent irritation from indurated faeces, is more beneficial than any other mode of treatment. Occasionally it happens, that the hemorrhage is so alarmingly profuse as to require the employment of the most powerful astringents of the mineral or vegetable kingdoms, and even the actual cautery. These, however, should never be used of such strength as to condense and corrugate the parts so much as to endanger the super- vention of inflammation. Haematuria or hemorrhage from the urinary organs is a variety not directly under the control of astringents. No substance of this class can come in contact with the seat of the mischief, until it has passed into the mass of blood, and been separated by the kidneys. How small, consequently, must be the quantity of the astringent taken into the stomach, which can act at any one time upon the surface affected with hemorrhage! The best mode of managing such cases is to treat them on general principles ;—by perfect quietude; avoiding all irritation; and, if there be excitement, reducing the quantity of the circulating fluid; but if, on the other hand, there be want of tone, administering substances belonging to the class of tonics, or of excitants proper. The author does not knoAv that, in these cases, he has observed any very marked advantage from the use of astringents, except from their tonic agency. Improvement has occasionally followed the employment of some of the metallic and vegetable astringents; but it has been pro- duced apparently, by the general effect, not by any direct astringent action having been exerted on the vessels of the urinary oro-ans • for, even in those cases in which a mineral astringent can be detected in IN UTERINE HEMORRHAGE. 113 the urine, its quantity at any one moment in the urine distilling from the kidneys must be too small to exert any sanative influence. Dr. Thomson, avIio has unbounded faith, and, perhaps, credulity on many points of therapeutics, as connected with the effect of particular medi- caments, places great reliance on the use of certain astringents in he- morrhages from the urinary organs. "Hsematuria, or bleeding from the bladder," he says, "is generally depending upon some organic affection of the urinary organs; but in attending to the primary disease, much immediate advantage is derived from the use of astringents. It was in a case of this kind that Mr. Brodie administered Ruspini's styptic with so much seeming advantage; and I have seen great benefit, in similar cases, from the use of the uva ursi, which appears to pass unaltered through the kidneys. Since the discovery which I have made of the composition of Ruspini's styptic, I am disposed to propose a combina- tion of gallic acid with an infusion of the leaves of uva ursi, obtained by rubbing them in cold Avater." It may be remarked, on this passage, that, like many other articles of the materia medica, UA^a nrsi has been extolled for virtues which it by no means possesses; and already, in the opinion of many of its former supporters, it has sunk to the pro- per level above which it ought never to have been elevated. It was formerly proposed as a remedy for calculous complaints; and for ul- cerations of the urinary organs, and it is still prescribed in such cases. There are few, however, of the present day, who regard the agency it exerts to be anything more than the tonic impression made by it on the stomach. When metrorrhagia or uterine hemorrhage occurs in the unimpreg- nated state, great reliance is placed on the use of sedatives, refrige- rants and astringents,—the former when the hemorrhage is actiAre, and the latter when it is more atonic. Where astringents are indicated, the tonic medication is also required, and cases occasionally occur Avhere the safety of the patient depends upon the effect exerted, through the general system, on the vessels that are pouring out the blood. In a former section the author has referred to an instructive case of this kind. When astringents are demanded in metrorrhagia, they can be made to come in contact Avith the affected vessels by means of the stomach pump. Cold water—ice cold—is in this Avay, a valuable agent; as well as solutions of sulphate of zinc or other saline as- tringents, and infusions or decoctions of vegetable astringents,—as of red oak bark, catechu, &c.—which act as styptics. The tampon is also an excellent agent after these means have failed, by detaining the blood in the vagina, and in contact with the exhaling vessels, until it has coagulated, and thus acting as a mechanical styptic. It is an effi- cacious remedy in cases of hemorrhage occurring during utero-gesta- tion. On the management necessary in these last cases, as well as in uterine hemorrhage occurring during and after delivery, it is unne- cessary to dwell, as it consists in manipulations appertaining to the science of obstetrics. Astringents are but rarely had recourse to, be- cause during utero-gestation, and prior to the delivery of the foetus, they cannot be easily thrown up as high as the seat of the hemorrhage; VOL. II.—8 114 ASTRINGENTS, and because other modes of management can be adopted, Avhich strike more nearly at the root of the mischief. Hemorrhage, when the placenta is not attached over the os uteri, is owing to a partial separation of the placenta from the uterus; and the only effective mode of rectifying the evil is to cause the uterus to con- tract around the foetus and thus to compress the uterine vessels. This is done by discharging the liquor amnii. Where the placenta is seated over the os uteri, the hemorrhage is unavoidable—not accidental, as in the case just described—and there is no safety to the mother or child except in speedy delivery. Again;—in hemorrhage after delivery, cold and astringent fluids might be thrown into the cavity of the uterus; but this plan is rarely had re- course to. The cause of the hemorrhage is here, also, the want of con- traction of the uterus, and the means, found most efficacious, are—if the case be urgent—to introduce the hand into the interior of the organ ; to irritate its inner surface Avith the fingers, and to press, at the same time, on the abdomen. The uterus will generally contract, so as to force the hand out of it; and in ninety-nine cases in the hundred, when the organ can be felt in the hypogastric region contracted to the size of the foetal head, the woman may, under ordinary precautions, be deemed free from all danger of recurrence. At times, the hemorrhage has returned under these very circumstances ; but the instances are rare. When the case is not so urgent, simple pressure on the abdomen over the region of the uterus, continued until it is felt to be contracted, is generally sufficient. In most cases of hemorrhage after delivery, the flow of blood is so profuse, that there is no opportunity for employ- ing any astringent solution or infusion ; but in the more protracted and less alarming varieties, these agents may be employed with much prospect of advantage. They can only be regarded, however, as ad- juvants. The means of primary importance are those obstetrical ma- noeuvres to which allusion has been made. The use, then, of astringents in the different forms of hemorrhage can be easily understood. In none of the active kinds can they be indicated; and in the passive, great reliance can only be reposed on them Avhen they can be made to come into direct contact with the vessels that are discharging their blood, whether by rupture or by trans- udation. Inflammations of the alimentary canal.-^-From the general principles laid doAvn, it can never happen, that the employment of astringents can be looked upon as advisable in any of the more acute varieties of those inflammations of the alimentary tube, that are accompanied by discharges. Accordingly, in inflammation of the lining membrane of the small intestines, characterized by pain in the abdomen on pressure or without; by rednessof the tongue and repeated bloody or slimy discharges; as well as in the same inflammation, when seated in the large intestines, and constituting dysentery,—astringents, durino- the first and active period of the disease, are to be avoided • but when the complaint has persisted for a time, notwithstanding the general anti- phlogistic medication and regimen, and the constant use of small doses IN DIARRHCEA. 115 of castor oil to remove all offensive secretions from the tube, gentle astringents—as has been shown of excitants—may be employed with much prospect of advantage. In very urgent cases, it may even be necessary to have recourse to the more powerful, administered both by the mouth and the rectum; and their agency may be augmented by the addition of opium to allay the irritability of the canal, which the state of erethism of the mucous membrane so largely develops. Of the vegetable astringents employed for this purpose, catechu and kino are the most common:—of the mineral,—alum, dilute sulphuric acid, &c.; and, if these fail, no plan can be adopted Avdth better expectation of success than that of completely changing the whole of the physical circumstances surrounding the individual by travelling exercise, which, at times, removes those chronic affections of the mucous membranes, after the best directed efforts of the physician have been assiduously, but vainly, exerted. The same principles apply to the management of diarrhoea, which is caused by a degree of erethism of the mucous membrane, generally produced by extraneous substances taken by the mouth, and irritating the lining membrane of the intestines. Astringents are here, in the first instance, improper. The cause of the mischief must be first re- moved by gentle evacuants,—as oleum ricini,—and it is not unless the discharges should be frequent, and colliquative, that attempts should be made to check them by astringents. At different periods of medi- cal history, diarrhoea has been viewed in opposite aspects,—at times, as an effort of nature to get rid of morbific matter, and, therefore, not to be interfered with; and, at others, as always injurious, tending to debility and death, and consequently to be arrested as speedily as possible. Both exclusive views are objectionable. The cause of the mischief must be inquired into, and, if possible, removed; and, let it be borne in mind, that an increased number of evacuations may take place in consequence of the retention of indurated fecal matter in some portion of the intestinal tube; the irritation excited by its presence inducing augmented exhalation from the lining membrane, and stimu- lating the muscular coat by contiguous sympathy, so as to increase the natural peristole of the intestines beyond the due bounds. Diarrhoea may be, in this manner, a symptom of constipation, and it is not until this state of fecal retention has been removed, that a cure can be effect- ed. In the diarrhoea, which occurs in phthisis pulmonalis towards its close, and which is occasioned by inflammation of the lining membrane of the ileum and colon more especially, we can employ only palliatives. The diarrhoea is but a symptom of the hectic; and whatever remedies are used, Ave cannot calculate on any important advantage from them. It is usual to exhibit an opiate, which has the effect of allaying the irritation in some degree; and, occasionally, the Mistura Cretce of the pharmacopoeias is made the constituent of the prescription, or the in- fusion of catechu or kino, or some other vegetable astringent; but, for the reasons mentioned, no calculation of positive, permanent benefit can be founded on their administration. Simplicity in the formation of prescriptions is important, in order that we may be able, in all instances, to trace the effects of particular remedial agents on particular 116 ASTRINGENTS, states of disease. The practitioner is often in the habit of combining remedies, taken from different classes of medicinal substances, and ' ex- perience' often leads him to ascribe virtues to the combination, Avhich are perhaps referable to one ingredient of the prescription only. Dr. Thomson gives an instance of this kind. Dr. Fordyce thought he had improved the practice in diarrhoea by combining astringents wdth dia- phoretics, and he recommended a combination of ipecacuanha and tormentilla. " We noAV knoAv that no effect could be ascribed to the ipecacuanha in this combination, as an inert tannate of emetina is formed; and, consequently, that the whole of the benefit must have resulted from the tormentil, which is indeed an excellent astringent in this disease." Blennorrhoea.—In that specific inflammation of mucous membranes, which constitutes gonorrhoea virulenta, much difference of opinion has existed regarding the employment of astringents. When they are used at all, it is in the way of injection; and, whilst they are employed, from the first, by some practitioners, they are altogether discarded by others, on the ground, that they are apt to induce stricture, or orchitis. The author does not think there is much, if any, foundation for these fears. When such affections supervene, it is generally OAving to lesions produced by the protraction and extension of the inflammation; and the practitioner ought not to hesitate to put an end to the specific inflammation at once by an astringent or any other plan which is capable of accomplishing the object. What has been said of the use of excitants and of astringents in inflammations of the mucous membranes in general applies here; and the same difficultyvexists in knowing whether the over-distended state of the extreme capillary, or the ex- cited state of the vessel communicating with it, predominates. When, however, the inflammatory signs are high; the extremity of the urethra is tumid and painful, and chordee urgent, the general antiphlogistic treatment had best be confided in, and astringent injections be post- poned until these phenomena have ceased. When injections are had recourse to, the metallic astringents,—as sulphate of zinc, acetate of zinc, acetate of lead, sulphate of copper, sulphate of alumina and potassa, and nitrate of silver, are usually selected. But whatever hesitancy may exist regarding the use of astringents in the early stages of gonorrhoea, none need be entertained when the inflammatory symptoms have almost wholly disappeared, and a state of gleet alone remains. Here, not only astringents, but excitants are needed; and the bougie often removes the disease when every kind of injection has failed. This is partly owing to the instrument coming in contact with the seat of the discharge, however high up the urethra the morbid surface may be,—which cannot easily be effected by in- jections,—at least, not in the ordinary mode of throwing them up by means of a syringe. They may, however, be directed to any part by a canula,—an ordinary silver or elastic-gum catheter for example which may be passed up until it has nearly reached the seat of the disease, and the fluid of the injection be propelled throuo-h it. IN EPHIDROSIS. 117 Leucorrhoea.—Similar remarks apply to the use of astringent injec- tions in leucorrhoea. Little faith can be placed in the administration of astringents by the mouth, for reasons applicable to hemorrhages from other parts than the alimentary tube,—namely, that the astringent must enter the mass of blood, and can, of course, reach the mucous membrane of the vagina in a state of extreme dilution and admixture only. Leucorrhoea—like other inflammations of mucous membranes— is, sometimes, more inflammatory than at others. It may require the use of powerful antiphlogistics in one case; whilst in another the astringent treatment may be advisable. At times, it is accompanied by considerable remora of fluids in the membrane, and by much re- laxation of parts, and it is in these cases chiefly, that mineral astrin- gents, and the astringent vegetable infusions and decoctions are employed. Where the inflammation and irritation are excessive, soothing topical remedies,—as warm milk and water, flaxseed tea, &c, —are rather indicated; or, if cold and astringent lotions afford more relief, care must be taken not to render the astringency too marked. In such cases, the solutions of the metallic salts, used in inflammation of the mucous membrane of the urethra, are usually chosen; but where the atony and relaxation above mentioned exist to any great extent, infusions or decoctions of catechu, or of red oak bark, or some other vegetable astringent are generally selected. In every case, care must be taken not to make the lotion too astringent: otherwise, as before seen, the inflammation may be augmented. Diabetes Mellitus.—In this singular disease of the function of nutri- tion, characterized by an inordinate discharge of sweet urine, vegetable and mineral astringents, in the ignorance that has prevailed of its pathology, have been largely prescribed; but wdthout any benefit. The disease does not consist simply of a profuse secretion of urine. This is the smallest part of the evil. It is the formation of saccharine matter at the expense of the system, AA'hich is the main source of mis- chief; and this can scarcely be touched by astringents. Ephidrosis.—Immoderate sAveating is rather an unpleasant symptom of certain morbid conditions of the system than a disease itself. One or two singular epidemics, of which ephidrosis was a prominent phe- nomenon, have occurred from time to time in Europe. The Sudor Anglicus or ' sweating sickness"1 Avas a very severe epidemic disease, Avhich appeared in England in 1486; and recurred at different times until about the middle of the 16th century. It was accompanied by cold- ness; excessive prostration of strength; palpitation; frequency and irregularity of pulse; and generally terminated favourably or unfavour- ably in the course of tAventy-four hours. The Suette de Picardie is another epidemic malady, which has appeared several times in the province of Picardy in France. The principal symptoms were profuse sweats, accompanied by a miliary eruption. The disease recurred in 1821, and has been described at length by M. Rayer, in a Avork, which he did the author the honour to transmit to him. M. Rayer considers the Suette miliaire of 1821 to consist of simultaneous inflammation of 118 ASTRINGENTS, various tissues; and proposes to class it Avith variola, rubeola, and scarlatina. In these two epidemics, the state of the organism appears to have been essentially different. Increased exhalation from the cutaneous surface may, indeed, take place in two opposite conditions of the vas- cular system. In the one, the vital forces may be exalted; in the other, depressed ; and hence the warm, genial perspiration of health, induced by exercise or by excitants of any kind;—and the cold, clammy exuda- tion, which accompanies enfeebled powers, and is the precursor of dis- solution. Phthisis.—In confirmed phthisis, colliquative sweating is one of the accompaniments of hectic fever, and cannot of course be removed, unless the condition of the lungs, which gives rise to the hectic, can be rectified. As this is impossible, no signal advantage can be derived from the employment of astringents; although the physician is, at times, led to attempt the palliation of an evil—which he cannot remove or prevent—in consequence of the complaints of the sufferer. There is nothing better adapted for this end, than a combination of tincture of opium, and diluted sulphuric acid,—or the acidum sulphuricum aromaticum. Relaxations of parts.—In all relaxations of parts, Avith which astrin- gent solutions can be made to come into immediate contact, they are the remedial agents, that are clearly indicated; hence, they are em- ployed in procidentia ani, and procidentia vaginae, with the best effects;—these pathological conditions being usually dependent upon a state of atony of the parts concerned. Topical diseases.—Lastly, the surgeon has recourse to astringents in many of the morbi externi, that fall under his province. Of their use in ophthalmia, aphthae, and in erysipelatous and phlegmonous inflam- mations, the author has already spoken, as well as of the particular morbid states in which their employment seems to be indicated. In chronic ulcers of an indolent character, they are used like excitants, to induce a new action in the ulcerated surface; and are often beneficial. As styptics—chemical as well as mechanical—they are likewise em- ployed where the hemorrhage is insufficient to demand the use of the ligature ; or where the ligature cannot be easily applied. Upwards of twenty years ago a styptic was reintroduced into notice in Italy, which astonished the surgical world for a time, but the operation of which, like that of many agents equally strongly recommended, has been found to far exceed its powers. This was the " new hcemastatic," as it Avas termed,—Acqua Binelli, so called after Dr. Fidele Binelli the in- ventor. This liquid is perfectly transparent; almost tasteless; having a slightly empyreumatic odour, in which neither salt, earth, alkali, nor acid can be perceived by the senses. The first public trials, to test its efficacy in arresting hemorrhage, were instituted at Turin, in 1797 by order of the government; the results of which were regarded favoura- ble. Soon after this Binelli died, and the secret for makino- the pre- IN TOPICAL DISEASES. 119 paration is said to have died with him; but in the years 1829 and 1830, the successors of Binelli affirmed, that they had found it, and fresh experiments Avere instituted, and repeated in Germany. Various blood-yessels Avere divided on animals,—the"femoral and carotid arte- ries and the internal jugular veins; and the cuts were made in every direction, some longitudinally; some obliquely; others completely across, and in all cases the hemorrhage yielded as soon as charpie or lint, steeped in Acqua Binelli, was applied and pressed gently against the wound for five or ten minutes. Encouraged by the results of the experiments on animals, its effects were tried on man. First. Before the assembled class in Berlin, in the operating theatre, after amputation of a finger, the arteries of which emitted blood very freely. Secondly. In the case of a wound of the hand, caused by a cutting instrument, which entered deeply between the metacarpal bones of the thumb and index finger, and in which the hemorrhage could not be arrested by com- pression or the tourniquet, without fear of causing gangrene. Thirdly. After the removal of an indurated inguinal gland, accompanied by hemorrhage; and, fourthly, after amputation of the thigh on account of a scrofulous knee joint, when the blood issued with great force, on the least relaxation of the tourniquet, from the crural, perforating, and other muscular arteries, as well as from the veins. In all these cases, the hemorrhage was speedily and permanently arrested by the appli- cation of Acqua Binelli, without any other aid. It did not cause the least pain on its application, nor did it produce any discoloration on the surface of the wound, or eschar, or any local or general effect of a disagreeable character. But the experiments of Dr. John Davy have proved, that the boasted Acqua Binelli is only another example of the numerous remedial agents, which have given occasion to inferences not confirmed by farther in- vestigations. They completely overthrow the fancied haemastatic poAvers ascribed to the liquid by the German and Italian experiment- ers. "I first examined"—says Dr. Davy,—"into its physical and chemical qualities. It proved of the same specific gravity nearly as distilled water. It was neither acid, alkaline, nor saline. Its odour A\-as not unlike that of coal-gas, not purified, which is lost by boiling. Its taste Avas rather pungent, not in the slightest degree astringent; in brief, it appeared to be merely water, containing a little volatile oil or naphtha, and Avas probably prepared by the distillation of Avater from petroleum, or some kind of tar. I next made trial of it as a styptic. I scratched the back of the hand with a lancet till the blood floAved. The Avater applied to the scratch rather increased the bleed- ing than stopped it. The folloAving morning, in shaving, the razor inflicted a slight cut: the Acqua Binelli Avas again applied, and the re- sult was the same. These few and simple trials were made in January 1831, just after I received the water; and they of course convinced me that the thing was an imposition on the public, and deserving of no further investigation. A short time since, my attention was recalled to the subject by a medical practitioner of this island, who had studied at Naples, inviting me with others to Avitness the effects of a prepara- tion made in imitation of the Acqua Binelli, and which he maintained 120 ASTRINGENTS. was identical with it in composition and virtues. The experiment he invited us to Avitness appeared an unobjectionable one, namely,—the partial division of the carotid artery of a goat, the bleeding of Avhich he undertook to stop by means of his fluid. He allowed us to expose the vessel and cut it across; about one-half of the circumference of the artery was divided, and the bleeding was most profuse. He stood ready Avith compresses moistened Avith the fluid, Avhich he instantly applied one over the other, and secured them by rolling a bandage about the neck, making moderate pressure on the wounded vessel. A little oozing of blood followed, AA'hich soon ceased. He said that in three hours the bandage and compresses might be removed, without any renewal of the hemorrhage. Accordingly, at the end of three hours they were removed; but when the last compress Avas raised, the bleeding broke out as furiously as at first, and, to save the life of the animal, the artery Avas secured by ligature. On examining the last compress, a small coagulum of blood was found adhering to it, just the size proper to close the Avound in the carotid; thus accounting for the ceasing and renewal of the bleeding. Reflecting on this result, and considering the chemical nature of the fluid employed to moisten the compresses, Avhich appeared analogous to that of Binelli, the con- clusion I arrived at Avas obvious—namely, that had the compresses used been moistened merely with common water, the effect Avould have been the same,—the bleeding would have been stopped; and it also appeared very probable, that, had the compresses been allowed to remain undisturbed, there would have been no reneAval of the bleed- ing. " To ascertain the truth of these inferences, the following experi- ments were made. On the same day, February 8th, in the presence of several medical officers, I divided partially, transversely, the carotid artery of two dogs; one small and feeble, the other of moderate size and strong. In each instance the bleeding was most profuse, till com- presses dipped in common water had been applied and secured by a bandage, which, as in the case of the goat already given, completely stopped the hemorrhage. The small dog, from the proportionally large quantity of blood Avhich it lost, was very feeble immediately, and appeared to be dying; but it presently rallied, and for several days seemed to be doing Avell. It unexpectedly died on the 15th, seven days after the infliction of the Avound. The bandage during this time had not been touched, and no application had been made. Now on exposing the neck, the wound was found covered with coao-ulable lymph discharging pus ; and, on dissecting out the artery and°eighth nerve contiguous to it, a mass of coagulable lymph appeared lying over the wound in the vessel, extending about half an inch above and beloAV it. This mass of coagulable lymph ha\dng been carefully re- moved, and the artery slit open, the vessel was found quite pervious, not in the least contracted. The wound in the fibro-cellular tissue or external coat, Avas closed by a minute portion of dense coacnilable lymph. But not so in the middle and inner coats; in these there v/as a gaping aperture, across which, on minute inspection, two fine threads apparently of coagulable lymph, (as if the commencement of the heal- HJEMASTATICS. 121 ing process,) were observable. The cause of the dog's death Avas not discovered. The other dog did not appear to suffer from the AYOund. The bandage and compresses were removed on the 15th February without the occurrence of any bleeding. On the 20th of the same month, the wound in the neck was nearly closed by granulations. The artery was now exposed by incision; and the portion that had been wounded taken out, between tAvo ligatures preAaously applied. On careful examination of this excised part, it was found free from coagulable lymph; at least there was not the same thickening or tumour from lymph deposited, as in the former case; it was probably absorbed. When the external loose cellular tissue was dissected away, a very minute elevation, about the size of a pin's head, appeared on the site of the wound, the remains of the cicatrix externally. The artery was completely pervious, and not at all contracted where it had been Avounded. Slit open for internal examination the wound in the inner coat was marked by a red line interrupted by two white spots; there was no gaping; the edges adhered together, excepting at one point; elsewhere the union was complete. The white spots resembled the natural lining membrane; and had the whole AA'ound been similarly healed, I believe it would have been impossible to have traced it. " The general results of these experiments, (if I may be allowed to speak of so small a number,) are not without interest in application to surgery. They show how a hemorrhage from the Avound of a large artery, which by itself would be speedily fatal, may be easily arrested by moderate compression through the means merely of several folds of linen or cotton moistened with water; and they further show how, under this moderate compression, the wound in the artery heals, the vessel remains pervious, and without the formation of an aneurism; and how, after a time, only slight traces of the wound are discoverable. Under this moderate pressure the healing of the wounded artery seems to be very analogous to that of a wounded vein, and apparently by means of the same natural process. Whether similar results could be obtained, were trial made of the same means in the wounds of arteries in the human subject, can only be ascertained positively by judicious experiments. The probability is, that the result Avould be the same. The analogy is very complete, and some facts well known in surgery accord with it, not to mention the experience of the effects of the Acqua Binelli, as certified by men of high respectability. " It wras my intention to have giAren a selection of the certified cases in favour of the Acqua Binelli, brought forward in the pamphlet Avhich is furnished Avith the Avater. But on reconsidering them, it appeared a superfluous labour, as the results, (giving them credit for correctness,) hoAvever excellent in a curative point of view, are no more than the en- lightened surgeon of the present time may readily admit to be OAving to Avater dressings alone, without the aid of pressure,—the majority of instances adduced being examples of gunshot Avounds and contused wounds, from which there Avas no profuse bleeding, and no necessity, according to the ordinary mode of surgical treatment, for securing Avounded vessels. I have laid stress on the effect of the pressure afforded by the Avet compresses applied in the experiments related, be- 122 ASTRINGENTS. lieving that the virtue of the means consists in the pressure,—of course not in the water, excepting so far as it renders the compresses better fitted for adaptation to the wound to produce the degree of resistance requisite to counteract the heart's impulse in the vessel; and also better fitted to exclude atmospheric air. I would also lay stress on the mode- rate degree of pressure that is produced in the manner described,— alloAving the blood to pass through the canal of the artery, and, as be- fore observed, doing little more than resisting the momentum of the blood in its passage from the moving source. The importance of this moderate degree of pressure, which has the effect of reducing as much as possible the wounded artery to the condition of a wounded vein, is, if I do not deceive myself, very considerable. When I have pressed with the fingers forcibly on the compresses applied to the wound, ex- pecting at the moment to arrest the bleeding, I have been disappointed. The hemorrhage has continued; and it only ceased when the com- presses have been secured, and not tightly, by a roller passed around the neck of the animal. And, further, in illustration, I may remark, that I have been equally disappointed in using graduated compresses, insuring considerable pressure on the wound. This means has failed, Avhen general moderate pressure effected by compresses about two inches long and one Avide, succeeded. On considering the comparative circumstances of these tAvo modes of applying compression, therefore, the difference of result is perhaps what might be expected. The severe pressure can hardly arrest the bleeding except by pressing the sides of the vessel together and closing the canal, the accomplishment of which requires a most nice adaptation, and a force which cannot easily be ap- plied with steadiness except by mechanical means, and in situations affording firm support beneath. Should the expectation which I have ventured to form of this method of stopping the bleeding of wounded arteries of a large size in man be realized on trial, I need not point out how very useful it may prove in military surgery,—how very available it will be in the field and in battle, especially in great actions, when, however numerous and well-appointed the medical staff of an army, the number of Avounds requiring attention must always exceed the means of affording adequate surgical relief, according to the plan of treating them at present in use, of suppressing hemorrhage by ligature. I have said nothing of the boasted efficacy of the Acqua Binelli' given inter- nally. I trust it is as little necessary to make any comments on it nowadays, as on the tar-water of Bishop Berkeley, so very analogous in nature and reputation. Both the one and the other in some cases may be serviceable; but their principal recommendation appears to be, that in doubtful cases they are innocent." Dr. Davy's observations have been given at some length, because they contain interesting information, as regards the physiology, patho- logy and therapeutics of wounded vessels, and convey a useful lesson to the inquirer,—not to deduce inferences from inadequate data, Avith- out haAdng investigated every collateral circumstance that may bear upon the question. Were this course pursued, we should not have so many examples of the experientia falsa as Ave are daily doomed to wit- ness. It has been suggested that Acqua Binelli may be indebted for SPECIAL ASTRINGENTS. 123 its fancied haemastatic property to creasote in some form; but Dr. DaAry's explanation appears all-sufficient to account for the phenomena. (For other testimony, in regard to the Acqua Binelli, see the author's New Remedies, 6th edit. p. 82, Philad. 1851.) To the same work the author may refer for information in regard to the Acqua Brocchieri and other haemastatic waters, on which much Avas said in this country and elsewhere, a few years ago, but to which the unbiased observer is compelled to consider the remarks made on the Acqua Binelli to be equally applicable. Neither the Acqua Broc- chieri, nor the Eau hemastatique de Tisserand;—nor—as will be seen hereafter—the Ergotin or Extrait hemastatique de Bonjean, is possessed of the haemastatic virtues that have been assigned to them. Such is a general view of the modus operandi of astringents in the principal diseased conditions of the frame. AVhen properly employed, they are by no means the least useful of our medicinal agents. SPECIAL ASTRINGENTS. I. Vegetable Astringents. 1. ACIDUM TAN'NICUM.— TANNIC ACID, TANNIN. Tannic acid or tannin—as before remarked—is the great active principle of vegetable astringents. It became desirable, consequently, to separate it, in order that it might be administered in a state of purity. Different processes have been recommended for this purpose, but that of M. Pelouze appears to have superseded others, and has been adopted into the Pharmacopoeia of the United States. It consists in extracting it from galls by ether, by the process of displacement. When thus prepared, tannic acid is of a yellowish white colour, of a strongly astringent taste; and is soluble in water, alcohol and ether, reddening litmus paper, and forming salts with bases. Tannic acid is a very powerful astringent, and may be employed in all cases in Avhich astringents are considered necessary. One advan- tage is the minuteness of the dose in which it can be given. It has been much employed by the Italian physicians especially, bot^i in ex- ternal and internal hemorrhages. When applied to the mucous mem- branes, it appeared to Cavarra to cause such a condensation and con- traction of tissue, that the glands or follicles could no longer afford passage for the mucus Avhich they secreted. It has been used in dis- charges from mucous membranes; and in the colliquative sweats of' hectic fever. The dose is from a quarter of a grain to two or three grains, gene- rally given in the form of pill. It may, also, be used as an enema in chronic diarrhoea and dysentery, or in prolapsus ani; and has been injected into the urethra by M. Ricord, in cases of blennorrhoea viru- lenta, in the quantity of 9ij. of tannic acid to 3viij of aromatic wine of the French Codex, or of red wine; and in a less proportion in cases of 124 SPECIAL ASTRINGENTS. chronic blennorrhcea or gleet. In blennorrhcea of the female, he doubles the quantity of tannic acid; and even carries it still further. Mr. Druitt is of opinion, that in any case in which a vegetable astringent is indicated, tannic acid should have the preference. A simple solution of it in distilled water, he says, is much more easily and quickly prepared, as well as much more elegant, than the ordinary decoctions or infusions of oak bark, catechu, &c. Moreover, it may be prepared of uniform strength, and free from foreign inert matter; and is not liable to decompose quickly. It has, in fact, he considers, all the advantages which the other simple vegetable principles have over crude preparations from the herbs or extracts in which they are contained. In sore nipples, Mr. Druitt has found it invaluable. He employs it in solution—five grains to the fluidounce of distilled water—on lint covered with oiled silk. He has also found it of great service in toothache. The gum around the tooth is first scarified with a fine lancet, and then a little cotton wool, embued with a solu- tion of a scruple of tannic acid, and five grains of mastich in tAvo drachms of ether, must be put into the cavity, " and if the ache is to be cured at all, this plan will put an end to it in nine cases out of ten." 2. ACI"DUM GAL'LICUM.—GALLIC ACID. This acid is by no means so abundant as the tannic, and appears to be produced by an alteration of the latter. A solution of tannic acid in water exposed to the air gradually absorbs oxygen, and deposits crystals of gallic acid, formed by the destruction of tannic acid. The formula for its preparation, introduced into the last edition of the Pharmacopoeia of the United States, reposes on these circum- stances. Galls are mixed Avith a sufficient quantity of distilled water to form a thin paste, A\rhich is exposed to the air in a shallow glass or porcelain vessel, in a warm place, for a month, occasionally stirring it with a glass rod, and adding, from time to time, enough distilled water to preserve its semifluid consistence. The paste is then subjected to ex- pression ; the expressed liquor is rejected; the residue boiled in a gallon of distilled vjater for a few minutes, and filtered, whilst hot, through purified animal charcoal. The hot liquor is set aside, that crystals may form, which are dried on bibulous paper. Gallic acid is in thin, silky needles ; requires one hundred parts of cold Avater to dissolve it, and three of boiling water. It is very solu- ble in alcohol; and, to a slight extent, in ether. The solution in water has an acid and astringent taste, and is gradually decomposed by keeping. It has been recently much extolled as a valuable astringent. It has already been remarked (p. 113) that the successful operation of Rus- pini's styptic in haematuria has been ascribed to it. In some cases of menorrhagia, this acid has been employed by Professor Simpson, and by Dr. Stevenson of Edinburgh, Avith the most successful results. The former gave it during the intervals, as well as during the discharge, in doses of from 10 to 20 grains in the day, made into pills; ancf it CATECHU. 125 appeared to him to have the advantage over most other anti-hemor- rhagic medicines, that it had no constipating action. He was first in- duced to prescribe it from finding a case of very obstinate monor- rhagia get well under the use of Ruspini's styptic. Professor Simp- son suggests, whether the anti-hemorrhagic properties of some others of the astringent drugs may not be dependent upon the gallic acid as much as, or even more than, upon the tannic acid Avhich they contain, —or upon the tannic acid becoming changed into gallic acid within the body. Its value in uterine hemorrhage and haematuria has been confirmed by others, and Messrs. Ballard and Garrod declare it to be one of the most powerful astringents that the art of chemistry has derived from the vegetable kingdom; and that a tolerably extensive experience enables them to declare it to be an invaluable remedy in most forms of passive hemorrhages and fluxes. They affirm, how- ever, that if its use be prolonged beyond two or three days, it mani- fests some constipating tendency. This is opposed to the observation of Professor Simpson ; but is probably accurate. They affirm, more- over, that the excessive sweats and expectoration of phthisis ; and the copious expectoration of chronic bronchitis are much influenced by it; which is less probable, as these phenomena are dependent upon pathological conditions of which they can only be regarded as expres- sions. They found the acid highly useful as an injection in leucorrhoea. . The ordinary dose of gallic acid is from two grains to five or more in the form of pill. An injection may consist of from a scruple to a drachm to the pint of water. 3. CAT'ECHU. Catechu is an extract prepared from the wood of Acacia catechu, Mimosa catechu; Sex. Syst. Polygamia Monoecia; Nat. Ord. Legumi- nosse, which is indigenous in various parts of the East Indies, and is now common in Jamaica. (Pereira.) The Edinburgh Fis- 148- College considers it to be not only the extract of the wood of Acacia cate- chu, but of the kernels of Areca catechu, Betel nut tree, Catechu palm; Sex. Syst. Monoecia Hexan- dria; Nat. Ord. Palmae; which inhabits most of the Indian continent and islands; and of the leaves of Uncaria gambir or Nau- clea gambir; Sex. Syst. Pentandria Monogynia; Nat. Ord. Rubiaceae,— Cinchonaceae, (Lindley,) Acacia catechu. Which is a native Of Ma- 1. Stamens. 2. Legume. 126 special astringents. lacca, Sumatra, Prince of Wales Island, Cochinchina, and other parts of Eastern Asia. It would appear, however, that the extract obtained from the last two sources is rarely, or never, seen in European or American commerce. Catechu is supposed, also, to be obtained from Buteafrondosa or Dhak tree, of the East Indies; Sex. Syst. Diadelphia Decandria; Nat. Ord. Leguminosae. The number of catechus described by pharmacologists is consider- able. At least as many as thirteen varieties have been admitted; but, although these may be of commercial and pharmaceutical interest, they are of less moment to the therapeutist. They are described at length by some of the best modern pharmacologists. In this country, we are not troubled with varieties. The drug is procured either directly from Calcutta or from London. Catechu, formerly termed Terra Japonica—as met with in the shops —is in masses of different shapes and sizes; of a rusty brown colour externally, and internally of a colour varying from a pale reddish to a dark liver. It is devoid of smell, and has an astringent bitter taste. That which is preferred in this market is of a dark colour, and easily broken into small angular fragments, with a smooth, glossy surface, bearing some resemblance to kino. (Wood & Bache.) It is often mixed with various impurities; and, with the exception of these, is soluble in water. Small, successive portions of cold water remove chiefly the astringent part; and a much larger proportion of water is required to dissolve the remainder, which is principally an extractive resinoid matter with acid properties. (Christison.) Hot water dissolves both principles; but if the infusion be made very strong, a reddish extractive matter is deposited on cooling. Alcohol and diluted alcohol dissolve it more readily than water. When subjected to analysis, it is found to consist of about 50 per cent, of tannic acid, peculiar extractive mu- cilage, and insoluble matter. This is one of the most powerful of the vegetable astringents; and is as well adapted for cases in which such agents are demanded as any article belonging to the class. In atonic conditions of the mucous membrane of the mouth and fauces; in the chronic forms of diarrhoea and dysentery; in asthenic hemorrhages; and in chronic mucous dis- charges from the genito-urinary organs, it has been prescribed with much success. It has also been used as a wash, in the form of infu- sion; and in that of ointment to atonic ulcers, in which an astringent is indicated. A small piece of it, held in the mouth, and allowed to dissolve in the saliva, has been beneficial in relaxation of the uvula; and it has been added to other substances, as to powdered cinchona, to form a dentrifice for spongy gums. The dose in powder is from gr. x. to 3j., which may be given in bolus, or rubbed up with sugar, gum arabic and water. INFUSUM CATECHU C0MP0S1TUM, COMPOUND INFUSION OF CAT'ECHU. (Cate- chu pulv. Sss.; Cinnam. cont. 3j.| Aquce bullient. Oj.) Cinnamon adds aromatic virtues to catechu; and the infusion is much used in chronic discharges from the mucous membranes, especially of the alimentary KINO. 127 canal,—at times alone; at others, associated Avith opium. It ought not to be given along with preparations of iron. The dose is f^j. to f Jiij., repeated according to circumstances. TINCTU'RA CAT'ECHU, TINCTURE OF CATECHU. (Catechu Siij.; Cinnam. cont. §ij.; Alcohol, dilut. Oij.) The same remarks apply to the composition of this tincture as to that of the infusion. It is rarely given alone, the alcohol being so often an objection; but is often added to chalk mix- ture, and occasionally to the infusion of catechu. Its dose is from f3j. to f3iij-, in sugared water, or in Port wine and water. 4. KINO. In the Pharmacopoeia of the United States, kino is said to be an extract obtained from an uncertain plant; whilst in the London Phar- macopoeia it is assigned to Pterocarpus erinaceus, Hedgehog Pterocarpus : Sex. Syst. Diadelphia Decandria; Nat. Ord. Leguminosae, a tree which inhabits the woods on the Gambia and Senegal. The Edinburgh College assigns it to the same, and to other undetermined genera and species. Different varieties are described in pharmacological works. Accord- ing to Dr. Pereira, two substances are met with in English commerce Fig. 149. Pterocarpus marsupium. under the name,—the one called Botany Bay kino, which is the inspis- sated juice of Eucalyptus resinifera; the other, apparently an extract imported from Bombay and Tellicherry, and which he terms East India kino. The latter is presumed to be the substance referred to in the Pharmacopoeias, as it is always regarded in commerce as genuine gum. kino. Many years ago, (1839,) it was affirmed by Dr. Gibson of the Bombay service, that this kino is the produce of Pterocarpus marsu- 128 SPECIAL astringents. pium; and the subsequent observations of Drs. Royle, Pereira and Wright, according to Dr. Christison, have established the fact, that all the kino of British commerce is prepared at Anjarakandy, near Telli- cherry in Malabar, from that tree, Avhich is one of the most magnificent in the forests of India. When longitudinal incisions are made into it, a great quantity of red juice exudes, which, on being simply dried in the sun, cracks into little irregular angular masses constituting the kino of the shops. As met with in the shops, kino is in small, angular, shining frag- ments ; of a dark brown or reddish brown colour, affording a powder Avhich is of a lighter hue. It is brittle, but softens in the mouth; and colours the saliva red. It is devoid of smell, and has a very astrin- gent taste. Cold water dissolves a portion of it, and hot water a larger quantity; whilst alcohol dissolves the greater part. When sub- jected to analysis, it is found to consist of tannic acid, and peculiar extractive, 75 per cent.; red gum; and insoluble matter. Kino is closely allied, both in its chemical and medical virtues, to catechu, A\dth which it has, indeed, been considered by some to be identical. It is given in the same affections. The dose of the powder is from ten to thirty grains. An infusion, made by pouring eight fluidounces of boiling water on two drachms of kino, may be given under the same circumstances as Infusum catechu compositum. The dose of this may be f 3j. to f siij. TINCTU'RA KINO. TINCTURE OF KINO. (Kino in pulv. 3yj. Alcohol, dilut. q. s. Mix the kino with an equal bulk of lard; place the mixture in a percolator, and pour diluted alcohol upon it gradually until eight fluidounces have passed.) The tincture* very frequently becomes gela- tinous if kept, and, at length, from some chemical change, not yet understood, entirely loses its astringency. It should, therefore, be renewed frequently, and be kept in well-stopped bottles. For these reasons, it has been excluded from the Pharmacopoeia of the United States, until on the occasion of the last revision, when it found a place. It is used under the same circumstances, and in the same doses, as Tincture of Catechu, (p. 127.) 5. GALLA.—GALLS. Galls are morbid excrescences on Quercus Infectoria; Sex. Syst. Monoecia Polyandria; Nat. Ord. Cupuliferae; which abounds through- out Asia Minor, and especially along the coasts of the Mediterranean. The young twigs of the plant are liable to be punctured by an insect of the Gallicolce or Diploleparice tribe, called Cynips gallce tinctorice, C. quercusfolii or Diplolepis gallce tinctorixx, which deposites its eggs and gives rise to so much irritation, that the nutrition of the part becomes modified, and a tumour or excrescence is formed which is termed a gall. In the interior of this, the young insect finds food during its transformation; and ultimately attains the state of fly, when it pene- trates the gall, and escapes. This usually occurs about the end of GALLA. 129 July; but, as the galls are of finest quality just before the escape of the insect, they are generally gathered about the middle of July. Those that are exported from Aleppo—hence called Aleppo galls—are the best. Those from Smyrna contain a larger admixture of white galls; and are, therefore, less prized. Others, brought from India, termed East India galls, closely resemble those from the Mediterranean. They are said to grow in Persia, and to be taken thence by the Arab merchants to Calcutta. (Ainslie.) Large quantities of these were introduced into the United States some years ago. The galls of Asia Minor and Syria are chiefly brought to this country from the ports of Smyrna and Trieste. (Wood & Bache.) In English commerce, three kinds of galls are distinguished—the black or blue, the green, and the white; no essential difference, however, exists between the first two. They are the best, and are gathered before the insect has issued; whilst the white galls are collected for the most part after the insect has escaped, and hence they are found to be perforated with a circular hole. They are all devoid of odour; and have a styptic and powerfully astringent taste. The white kind, however, possesses these qualities in an inferior degree. They yield their astringent properties to water, alcohol and ether. Water seems to be the best menstruum; and, next to it, dilute alcohol. When analyzed by Sir Humphry Davy they were found to consist of 26 per cent, of tannic acid; 63 of lignin; 6.2 of gallic acid; 2.4 of gum, united with insoluble tannin; and 2.4 of saline matters. It has been found, however, that the tannic acid is contained in larger quan- tity than was estimated by Sir Humphry,—more recent and exact processes shomng, that it amounts to 40 or even 60 per cent. (Christison.) Galls are an excellent and powerful astringent, possessing at least as much tannic acid as catechu; but they are not by any means so often prescribed internally. They may be used, however, in the same affections. An infusion, prepared of 3iv. of the galls to f 3yj. or f §viij. of boiling water, may be given internally in the dose of f 3ss. to f 5ij.; but it is more frequently used as an astringent wash, and is occasion- ally prescribed as an injection in chronic diarrhoea and dysentery, and in leucorrhoea,—or wherever a topical astringent is needed. The dose of the powder, which is rarely prescribed, is from ten to twenty grains. TINCTU'RA GAM, TINCTURE OF GALLS. (Gall. cont. liv.; Alcohol, dilut Oij. Prepared either by maceration or by displacement.) This is a powerfully astringent preparation; and when diluted with water, makes a good wash or gargle. It is rarely given internally; its chief use, indeed, is as a chemical test. UNGUEN'TUM GALLJ1, OINTMENT OF GALLS. (Gall. pulv. gj.; Adipis gvij.) This has been a favourite application with many practitioners in hemorrhoids, after the inflammatory stage has passed away. Some have employed it in the same cases much stronger,—the ointment VOL. n.—9 130 SPECIAL ASTRINGENTS. being formed of equal parts of powdered galls and lard or butter. The Edinburgh College has an Unguentum Gall,e et Opii, formed of Galls, in very fine powder, 3ij- 5 Opium, powdered, 3j-; Lard^ 3j. The author has often used this ointment in hemorrhoidal affections with marked advantage. From Galls are obtained Acidum Gallicum, and Acidum Tannicum, of the Pharmacopoeia of the United States. 6. KRAME'RIA.—RHAT'ANY. The root of Krameria Triandra, Rhatany; Sex. Syst. Tetrandria Monogynia; Nat. Ord. Polygaleae,—Krameriaceae, (Lindley,) is offici- nal in all the Pharmacopoeias of Great Britain and in that of the United States. The plant inhabits the mountainous parts of Peru, especially in the district of Huanuco and other localities in which cinchona flourishes. According to Tschudi, most of the Rhatany which is ex- ported to Europe is obtained in the southern provinces of Peru, par- ticularly in Arica and Islay. As met with in the shops, it consists of a short root-stock, from half an inch to two inches in diameter; and of numer- ous roots proper, which are simple or branched, one or two feet in length, and varying in thickness from that of a Avriting quill to that of the thumb. The bark is of a dark brown- ish-red colour, wrinkled and warty on the root- stock, but smoother on the branches. The central woody portion is of a yel- lowish or pale red colour. As the bark contains the largest amount of astrin- gent matter, the smaller branches are preferred. It is devoid of smell, and of a very bitter astringent taste. The virtues of the root are readily yielded to water and to alcohol. When subjected to ana- lysis, it has been found to contain about 40 per cent, of tannic acid; and, according to M. Peschier, a peculiar acid, called by him kramerk; the properties of which are but little known; and to which, as well as to the tannic acid, the astringency has been ascribed. Rhatany is an excellent astringent, well adapted for all cases in which that class of remedies is needed. In chronic diarrhoea and Krameria triandra. QUERCUS TINCTORIA. 131 dysentery, it is frequently administered, both by the mouth and rectum. It is sometimes used as a tooth-powder, mixed Avith equal parts of orris root and charcoal; and a tincture is not unfrequently made by the dentists as an astringent tooth-wash in looseness of the gums. The dose of the powdered root is from gr. x. to 3ss.; but it is not so often prescribed as the infusion or extract. A tincture may be formed by digesting three ounces of the bruised root in a pint of proofspirit; and a compound tincture is formed by add- ing to this one or tAvo ounces of cinnamon, or half an ounce of Vir- ginia snakeroot. Both these are astringent stomachics. A syrup of rhatany is sometimes prepared by making a saturated cold infusion and adding sufficient sugar. A teaspoonful of this is a dose in the chronic profluvia of children. INFU'SFM KRAME'RLE, INFU'SION OF RHATANY. (Kramerice contus.sSJ.; Aquce bullient. Oj.) The dose of this is f 3j. to f|ij. TINCTU'RA KRAME'RLE, TINCTURE OF RHATANY. (Kramer, pulv. .?vj.; Al- cohol, dilut. Oij.; made by maceration or by displacement.) This tinc- ture may be added to astringent infusions or mixtures, or may be taken alone mixed with water. Dose f3j. to f3iij- EXTRAC'TUM KRAME'RLE, EXTRACT OF RHATANY. This is prepared by eva- porating an infusion made by displacement. It is also occasionally imported, ready made, from South America. The dose is gr. x. to 9j. SYR'UPUS KRAME'RLE, SYRUP OF RHATANY. (Extract.kramer. gij.; Sacchar. fibiiss.; Aquce Oj.) This is a pleasant astringent syrup in the diseases of childhood, in which it may be given in the dose of a teaspoonful. It may also be added to astringent mixtures. 7. QUERCUS ALBA.—AYHITE OAK BARK; AND 8. QUERCUS TINCTORIA.—BLACK OAK BARK. Of the numerous oaks,—Sex. Syst. Monoecia Polyandria; Nat. Ord. Cupuliferae, (Lindley,)—that flourish in our forests, these two are alone officinal; and the former is conceived to resemble most Quercus pedun- culata, Common British Oak. White Oak is met with in every part of the United States, but is more common in the Middle States. Its bark is of a whitish colour, which distinguishes it from the other species. As we meet Avith it deprived of its epidermis, it is of a light brown colour, of a coarse texture, and not readily reduced to powder. Its taste is astringent and bitterish. It imparts its properties to water and to alcohol. These are mainly dependent upon tannic and gallic acids. Black Oak has a furrowed bark of a dark colour, which is more bitter than the bark of the white oak: it is distinguished by its stain- ing the saliva yellow, a»d is used, under the name of Quercitron, to dye V 132 SPECIAL ASTRINGENTS. silken and woollen fabrics yellow. It contains a considerable amount of tannic acid. Oak bark is a powerful astringent, and is adapted for all cases in which astringents Fig. 151. are needed; yet it is rarely given in- ternally. In de- coction, it is often employed extern- ally, both by the profession and the laity, in relaxation of parts—as in elongation of the uvula, relaxed sore throat, prolapsus ani, &c, and in chronic discharges from the bowels and vagina. It is said to have been used with advan- tage in certain dis- eases of childhood, —as a bath, for example, in ma- rasmus, scrofula, cholera infantum, &c, where the sto- mach would not receive tonic and astringent remedies kindly; but it is not easy to see how any considerable benefit could be derived from it. It has even been affirmed to cure intermittents in children, when administered in this manner. It has also been used beneficially, as a wash, in flabby ill-conditioned ulcers. Like alum, finely powdered bark has been inhaled in cases of phthisis pulmonalis, and especially in laryngeal phthisis. The dose of the powder is from 3ss. to 3j.; but it is scarcely ever given in this form. The bark of the white oak is always preferred as an internal remedy, in consequence of that of the black oak seeming to irritate the boAvels. Quercus pedunculata. a. Male catkins, b. Stamens, c. Female involucre and stigmas, d. Young fruit, e. The same magnified. /. A cotyledon with the radicle. DECOC'TUM QUERCUS ALB1, DECOCTION OF WHITE OAK BARK. (Querc. alb. contus. gj.; Aquce Oiss.; boiled to a pint.) The dose of this is f 3ij. to f^iv.; but it is rarely used except as an injection or lotion. 9. H.EMATOX'YLON.—LOGWOOD. Logwood, Campeachy Wood, is the wood of Hcematoxylon Campe- chianum; Sex. Syst. Decandria Monogynia; Nat. Ord. Leguminosae; a tree, which is indigenous in Central America, and grows wild in Jamaica and other West India Islands. '-' H^IMATOXYLON. 133 Logwood, as an article employed by dyers, is well known in com- merce. It is imported Fig. 152. in billets, the bark and white sap-wood being chipped off, and the in- ner wood or duramen sent abroad. This is of a deep red colour, but it becomes dark by expo- sure to the air, and of a blackish brown colour. In the shops, it is kept in chips, or rasped into coarse powder. It has a peculiar, rather agreeable smell; and a sweetish, astringent, and subse- quently bitterish taste. When chewed, it colours the saliva violet. The colouring matter is ex- tracted by both water and alcohol, so as to form deep purple solutions. When subjected to analysis, it has been found to contain volatile oil; a red crystalline substance of a slightly bitter, acrid, and astringent taste, called hcema- tin or hcematoxylin; a fatty or resinous matter; a brown substance containing tannin; glutinous matter; acetic acid; woody fibre, and various salts. ^. Hiematoxylon campechianum. 1. Style. 2. Legume. It is a gentle astringent and tonic; and is prescribed occasionally in chronic diarrhoea and dysentery, and other profluvia in which a mild astringent is indicated. It is often given in cholera infantum after the active stage has passed away. It is always administered in one or other of the following officinal preparations. DECOC'TOI HMATOX'YLL DECOCTION OF LOGWOOD. (Hcematoxyl. 1].; Aquce Oij.—boiled to a pint.) The London and Dublin Colleges add a drachm of Pulv. Cinnamom. towards the end of the boiling. The dose of this is flj. to flij. to adults; and f3ij. to flss. to children. EXTRAC'TUM HMATOX'YLI, EXTRACT OF LOGWOOD. (The decoction evapo- rated.) This extract appears to possess all the virtues of the wood. It is given in the dose of gr. x. to 3ss. in solution. When made into pills, and kept for any length of time, it becomes so hard as to pass, at times, through the bowels undissolved. 134 SPECIAL ASTRINGENTS. 10. TORMENTH/LA.—TOR'MENTIL. Tormentil is the root of Potentilla Tormentilla, Tormentilla erecta, Common tormentil or Septfoil; Sex. Syst. Icosandria Polygynia; Nat. Ord. Eosaceae;—a small perennial plant common throughout Europe. The root—which is officinal in the secondary list of the Pharmacopoeia of the United States—as met with in the shops, is of very irregular shape ; generally of about the thickness of the first joint of the fore- finger. Its colour is deep brownish-red externally, and flesh-red within. It has a slightly aromatic odour, and a very astringent taste; and yields its virtues to water and to alcohol. When subjected to analysis, it has been found to contain a trace of volatile oil; 17.4 per cent, of tannin; 20 of colouring matter; about 28 of gum; and 7.70 of ex- tractive. Tormentil is a powerful astringent,—one of the most so of the class; yet it is not much used, although applicable to all cases in which as- tringents are needed. Its dose, in powder, is from 3ss. to 3j-; but it is more frequently prescribed in decoction, (Tormentil. 3ij.; Aquce Oiss. Boil to a pint. Dose, f 3j. to f 3ij. repeated three or four times a day.) 11. UVA URSI. The general and medical properties of uva ursi are described under Antilithics, (Vol. i. p. 339,) and it is there stated, that all its medi- cinal agency is probably as a tonic and astringent. It is unquestionably a good astringent, and is adapted for all the cases in which the other vegetable astringents appear to be required; but does not seem to pos- sess any peculiar properties, or superior efficacy. It is in chronic cys- tirrhcea, that it has been most celebrated; and its use has been sug- gested in chronic bronchitis. The dose of the powder is from 9j. to 3j.; but it is more generally given in the form of the DECOC'TUM WE URSI, (Yol. i. p. 340.) The dose of this is from f I], to f 3ij. three or four times a day. 12. GERA'NIUM.— CRANESBILL. This is the root of Geranium maculatum; Sex. Syst. Monadelphia Decandria; Nat. Ord. Geraniaceae; a plant, which is indigenous through- out the United States, flowering from May to July. The root is offi- cinal, and is collected in autumn. This, when dried, is in pieces from one to three inches in length, and from a quarter to half an inch in thickness; somewhat flattened, twisted, wrinkled, tuberculated, and beset with slender fibres; of an amber brown colour externally; in- ternally of a reddish gray. It is a pure astringent; its active consti- tuent being tannic acid. It yields its virtues to water and to alcohol. ROSA GALLICA. 135 Geranium is used in the same cases as other astringents; and, owing to its being devoid of bitterness, or other disagreeable flavour, it is adapted for infants, or for adults whose stomachs are Fig. 153. delicate. It is sometimes used as an astringent injec- tion in chronic diarrhoea and dysentery, leucorrhoea, &c, and as a wash in mer- curial ptyalism, and to in- dolent ulcers. The dose of the powder is gr. xx. to 3ss.; but it is rarely given. It is most commonly pre- scribed in decoction, (Geran. Ij.; Aquce Oiss; coque ad Oj. Dose,f|j. tofgij.) It is occasionally given boiled in milk to children. 13. GRANA'TI FRUCTUS COR- TEX.—POMEGRANATE RIND. This is the rind of the fruit of Punica granatum, already referred to. (Vol. i. 247.) It is met Avith in the shops, in irregular, arched, dry, brittle pieces, which are devoid of odour, very astringent and slightly bitter; of a brown colour externally, and yellow Avith- in. It contains about 19 per cent, of tannic acid. Geranium maculatum. Pomegranate rind has been used as an astringent, chiefly in the form of decoction,—(Granat.fruct. cort. 3ij.; Aquce destillat. Oiss.; boil to a pint. Dose, f 3j.;)—in chronic diarrhoea and dysentery; and in the colliquative sweats of hectic fever. It has, likewise, been prescribed as an astringent injection in leucorrhoea; as a gargle in re- laxed sore throat, and as a wash in loose flabby ulcers,—in the very cases in which astringents in general are indicated,—but it is not much used on this side of the Atlantic. The powdered rind has been given in the dose of gr. xx. to 3ss. and more. 14. ROSA GAL'LICA.— RED ROSES. The petals of Rosa Gallica,—red, French or Provins rose, Sex. Syst. Icosandria Polygynia; Nat. Ord. Eosaceae—a native of the south of 136 SPECIAL ASTRINGENTS. Europe, but introduced into the gardens of the United States—is ex- tensively cultivated for medicinal purposes. The petals are gathered before the flower has blown; are separated from their white claws or heels, and dried; they have a velvety appearance ; purplish red colour, and bitterish and astringent taste. Their chief constituents, for which they are valued in medicine, are tannic and gallic acids, and colouring matter. Eed roses were, at one time, more employed in medicine than at present. They are more largely used, too, in Great Britain than in this country. Their astringent powers are certainly slight; but, OAving to their colour, Avhich they impart readily to water, they form elegant vehicles for the administration of other remedies. Hence, the infusion of roses, although astringent, is a common vehicle for sulphate of mag- nesia, Avhich is a cathartic. INFUSUM ROSiE COMPOS'ITUM, COMPOUND INFU'SION OF ROSES. (Rosce Gallic. §ss.; Aquce bullient. Oijss.; Acid, sulphuric, dilut. i^iij.; Sacchar. oiss.) The astringency of the red rose is imparted to the water; but the main agency is that of the sulphuric acid. As above remarked, it is used, especially in Great Britain, as a vehicle for sulphate of magnesia, the taste of which it partly covers. Sulphate of quinia may, likeAvise, be given in it,—the sulphuric acid dissolving the sulphate, and, at the same time, preventing the tannic acid of the roses from precipitating the quinia. Like sulphuric acid itself, it may be taken in hemorrhages that require the use of astringents, and in the colliquative sweats of hectic. It is also used occasionally as a gargle, associated with alum, tincture of capsicum, &c. The dose is from f3j. to f^iij. and more. CONFECTIO mM, CONFECTION OF ROSES, Conserve of Roses. (Ros. Gallic, pulv. oiv.; Sacchar. pulv. 3xxx-5 Mel. despumat. 3vj.; Aquce rosce f3viij.) This confection is slightly astringent; but it is now rarely employed except as an agent in the formation of pills of active remedies, as calomel, sulphate of quinia, &c. Rubbed up with syrup, almond or olive oil, and dilute sulphuric acid, it forms a linctus, which is an excellent demulcent expectorant where such is needed. (See Oleum Amygdalae, Vol. i. 274.) It enters into the composition of the Pilulce hydrargyri of the pharmacopoeias. MEL ROSJE, HONEY OF ROSES. (Rosce Gallic. 3ij.; Mel. despumat. Oij.; Aquce bullient. Oiss., reduced to specific gravity 1.32 by evaporation.) This is a very old remedy, employed in sore throat, and ulcerations of the lining membrane of the mouth. It is a mild astringent, and is occasionally used as a vehicle for more active applications. It is some- times added to astringent gargles. 15. MONE'SIA. It is only of late years, that this substance has been known in this country. It was introduced from France A\dth high encomiums from several distinguished physicians and pharmaciens of Paris. It is im- MATICO. 137 ported into France from South America in cakes or loaves weighing upwards of tAventy pounds, which consist of an extract, prepared in South America from the bark of a tree, whose botanical name is un- known. The bark is said to be called, by some travellers, Goharem, and by others, Baranhem; and the botanists who have examined it in South America, think that it is derived from a Chrysophyllum,— Ch. glycyphlceum, a tree of middling size, which grows in the forests near Rio Janeiro and elsewhere in Brazil. The bark is smooth and grayish, like that of the plane tree, except that it is much thicker; its sweet taste, too, contrasts greatly with the bitterness of the thin laminae of the plane tree. Monesia—the extract—is of a deep brown colour; very soluble in water; and of a taste at first like liquorice, but soon becoming astrin- gent ; and leaving behind a well marked and enduring acrid impres- sion, which is experienced especially in the tonsils. When subjected to analysis by M. Persoz, it was found to contain tannic acid, render- ing iron blue, 52 per cent.; gum or mucilage, 10 per cent.; sweet matter, 36 per cent. The bark and extract of monesia resemble those of Quillaia Saponaria ; but they are sensibly different. Its action on the economy is that of an excitant and astringent, and as such it may be adapted for many pathological conditions in which agents of the kind are indicated. It has accordingly been prescribed in various profluvia of an atonic character,—in chronic bronchitis, and bronchorrhcea; chronic diarrhoea and dysentery; leucorrhoea, blennor- rhcea ; and in asthenic hemorrhages—haemoptysis, metrorrhagia, &c. The powdered extract, or an ointment made of it, has been applied to ulcers of a flabby and unhealthy character; and, like every new substance brought forward with lofty pretensions, it has been em- ployed in a variety of heterogeneous affections. It is unquestionably entitled to attention as an astringent; but, already, it has almost passed into disuse. Monesia is generally given in pills, in the quantity of from 12 to 40 grains in the twenty-four hours,—the medium dose being 15 or 20 grains taken at tAvice or thrice. Syrup of Monesia, which is adapted for children, may be made of six grains to the ounce of simple syrup^ Tincture of Monesia, (Mones. gr. xxxij.; Alcohol, dilut. f^j.;) may be given in the dose of f 3j. to f 3ij. in any bitter or astringent infusion. It may also be prescribed as an injection in the quantity of f 3j. to f 3iss. to six fluidounces of water. An Ointment of Monesia, to be ap- plied to ulcers, may be composed of 3j- oi Monesia to 3vij. of Lard or Simple ointment. 16. MATFCO. At the meeting of the Provincial Medical and Surgical Association) held at York in August 1841, Dr. Jeffreys, of Liverpool, introduced to the profession an herb called Medico, used in South America as a styp- tic; a short account of which appeared in the London Lancet for Jan. 1839. Since its introduction into England, it has been frequently used, especially as a styptic; and often with apparent success. In * 138 SPECIAL ASTRINGENTS. Fig. 154. diseases of the mucous membranes and in hemorrhages it has been prescribed internally with advantage. So long ago as 1834, the author's friend, Dr. Ruschenberger, of the Navy, brought a specimen from South America to the United States. It is there called Yerba del Soldado, Soldier's weed. In Peru, according to a statement kindly furnished the author by Dr. Ruschenberger, it has a po- pular reputation of being a wonderfully powerful styp- tic ; and it is said, that sol- diers, on going to battle, carry with them a supply to stanch blood when they re- ceive wounds. The leaf is moistened in the mouth, and then applied. Matico is Artanthe elongata, Piper angustifolium of Ruiz and Pavon. It is said to contain resin and volatile oil; but its exact chemical con- stituents have not been de- termined. The specimens examined by the author had certainly no marked sensible properties. It is chiefly given in infu- sion of one ounce of the leaves to a pint of boiling wa- ter; of which a fluidounce and a half is a dose;—and in Tincture — two ounces and a half of the leaves to a pint of dilute alcohol; of which the dose is from one to three fluidrachms, two or three Artanthe elongata. times a day. Both solutions may be used as external astringents; or, to stop hemorrhage, the inner side of the leaf may be pressed upon the bleeding vessel. As the author has remarked elsewhere, however, the difficulty of establishing the action of styptics is considerable, as is sufficiently exemplified in the history of the Acqua Binelli and the Acqua Brocchieri, (p. 118.) The same diffi- culty exists in regard to the determination of its powers as an internal astringent. After the discharge of an uncertain amount of blood, hemorrhage generally ceases spontaneously; and hence any article, that may have been administered, may acquire a haemastatic reputa- tion. This probably is the history of the employment of chloride of sodium to check the flow of blood in haemoptysis. Doubtless, how- matias or MALAMBO. 139 ever, matico is worthy of more extensive trials, although its sensible properties, taken alone, would not encourage us to place more faith in it than in the overrated " haemastatic waters" referred to. (New Re- medies, 6th edit., p. 506. Philad. 1851.) 17. MATIAS or MALAM'BO. Malambo bark, the source of which has not been positively deter- mined, has been long known to, and examined by the French pharma- ciens. Air. Ure is of opi- nion, that the Matias bark received by him from South America is identical Avith it. It is described by him as three or four lines thick, brittle, although somewhat fibrous; of a brown colour, and covered Avith an ash-coloured tuber- culated epidermis; has an aromatic smell, and a bit- ter pungent taste, which it yields to water and to alco- hol,—the former being an agreeable bitter infusion, and the latter a powerful bitter tincture. Malambo bark was ana- lyzed by M. Cadet, and subsequently by M. Vau- quelin, who found it to contain resin; a light vola- tile oil, and an extract very soluble in water. No tannic acid was, however, found in it; scarcely any gallic acid; and none of the alkalies of the cinchonas; yet in New Granada, where the tree grows, it is held in high repute as an antiperiodic and stomachic. Mr. Ure affirms, that he has frequently administered Matias bark, with good effect, as a substitute for cinchona; and Dr. Mackay states, that he has witnessed good results from its employment in cases in which an aromatic tonic was needed. An infusion may be made of two drachms of the bark to a pint of water ; the dose of which is one or two fluidounces, repeated two or three times a day, in cases where a bitter stomachic is needed. Fig. 155. Diospyros Virginiana. 140 SPECIAL ASTRINGENTS. Besides agents already described, the Pharmacopoeia of the United States has admitted into its secondary list the following astringents. 18. Dios'pyros, Persimmon. Fig. 156. This is the bark of Diospyros Virgini- ana; Sex. Syst. Dicecia Octan- dria; Nat. Ord. Ebenaceae; an indigenous tree, well known in the southern and middle States; flowering in May or June; and producing a berry, which, in the green state, is exceedingly astrin- gent; but, when ripe, is sweet, mawkish, and cloying. The un- ripe fruit has been recommended in infusion, syrup, and in vinous and acetous tinctures, by Dr. Mettauer, of Virginia. The bark, Avhich is the officinal portion, is astringent and very bitter; and is adapted for cases in which a combination of astringent and bitter agents is needed. 19. Geum, Water Avens—the root of Geum- rivale, described under Tonics as indigenous in the United States—is often used as an astringent in the cases so often mentioned already, as re- quiring astringents. The dose of the powdered root is from 9j. to 3j.; but it is usually employed in DECOCTION; (Gei Sj.; Aquce Oj. Dose, f gj. or f gij.) 20. Heuche'ra, Alum root— the root of Heuchera cortusa, H. Americana, American Sanicle; Sex. Syst. Pentandria Digynia; Nat. Ord. Saxifrageae; a plant found in the middle States, Aoav- ering in June or July. The root has a powerfully astringent taste, and—as well as the roots of other species of Heuchera—may be given in the same cases as vegetable astringents in general. 21. Rhus Glabrum, Sumach. This is the fruit or berries of Rhus glabrum, Smooth sumach, Upland sumach; Sex. Syst. Pentandria Tri- gynia; Nat. Ord. Terebinthaceae; found everywhere in the United Heuch«ra acerifolia. STATICE. 141 States. It is astringent, and is sometimes used in infusion as a gargle in sore throat. The inner bark of the root, which also possesses astringent virtues, may be used as a collutory in mercurial ptyalism, and various forms of stomatitis. 22. Rubus Trivia'lis, Dewberry Root; and 23, Rubus Villo'sus, Blackberry Root; Sex. Syst. Icosandria Polygynia; Nat. Ord. Rosa- ceae; are the roots of well knoAvn plants, whose berries are much used as food. The main bitterness and astringency appear to reside in the bark of the root. It is rarely given in substance; but, if this be de- sired, the dose may be twenty or thirty grains. It is commonly, how- ever, prescribed in decoction, (Rub. trivial, vel Rub. villos. 3j.; Aquce Oiss. Boil to a pint.) Dose, foj. to f 3ij., repeated according to circum- stances, in chronic diarrhoea and dysentery, and wherever vegetable astringents are indicated. 24. Rumex Britan'nica, Water Dock; and 25, Rumex Obtusifo'- LIUS, Blunt-leaved Dock; Sex. Syst. Hexandria Trigynia; Nat. Ord. Polygonaceae. The root alone of these docks is officinal. The plants are common in the United States; and the roots are possessed of astringent and tonic properties. They may be given in decoction, (Rumicis 3j.; Aquce Oj. Dose, f3j. to flij.) but are rarely employed. Rumex crispus, a common species, is possessed »f similar properties. Dr. N. S. Davis, of New York, is satisfied, from his experiments and observations, that the chief value of dock root " consists in its altera- tive and gently laxative qualities." As an alterative he esteems it to be " fully equal to the far-famed sarsaparilla." — Quod est demon- strandum/ 26. Spir^e'a, Hardhack. The root of Spiraea tomentosa; Sex. Syst. Icosandria Pentagynia; Nat. Ord. Rosaceae. It is astringent and tonic, and is employed in the same cases as the last. The best form perhaps of administration is the decoction, (Spircece Ij.; Aq. bullient. Oj. Dose, f 3j. to f 3ij.) 27. Stat'ice, Marsh Rosemary. The root of Statice Caroliniana; Marsh Rosemary or Sea Lavender; Sex. Syst. Pentandria Pentagynia; Nat. Ord. Plumbagineae; is a powerful astringent; and although not much used in Philadelphia, and scarcely to be found in the shops, is regularly kept by the druggists in Boston, and other parts of New England, where large quantities of it are sold annually. It is cer tainly, according to all testimony, a valuable astringent, and well adapted for cases in which the vegetable astringents are prescribed It has been analyzed by Mr. Edward Parrish, of Philadelphia, and found to contain, amongst other less important matters, 12.4 per cent. of tannic acid—a much smaller quantity than exists in many other astringents; with extractive matter, to which its bitterness is due. Decoction Avould appear to be the best form of preparation. 142 SPECIAL ASTRINGENTS. 28. CREASO'TUM.—CRE'ASOTE. Creasote, whose main properties have been described elsewhere (Vol. i. 540), owing to its power of coagu- lating albumen, as well as of excit- ing the vessels, with which it comes in contact, to contraction, has been employed as an indirect astringent in cases of hemorrhage; and is said to have been beneficial in haemop- tysis. In haematemesis, too, it has succeeded after the remedies, ordi- narily prescribed, had been employed without effect. It has been given, also, with apparent advantage, as an internal remedy, in leucorrhoea, and bronchorrhcea; and Dr. Elliotson accomplished a cure in two cases of chronic glanders, in the course of a few weeks, by the sedulous use of an injection of a dilute solution, (one drop to a fluidounce of water,) thrown up the affected nostril— combined with the internal use of the remedy. In vomiting, not arising from in- flammation or other organic disease of the stomach, creasote has been very efficacious; and even in Asia- tic cholera and sea-sickness, it ap- peared to allay the vomiting. In the vomiting of the pregnant female, and in that originating from nervous excitability, it was equally benefi- cial. The testimony in regard to it has, however, been discordant. Drs. Elliotson, Shortt, A. T. Thomson, and Christison, consider it to be a valuable means of arresting vomit- ing. Drs. McLeod and Pereira speak doubtfully of it; and Avith Dr. Paris it entirely failed. The author's success has been by no means striking. Frequently, it has been devoid of efficacy, and in many cases it developed irritability of the stomach, when this did not previously exist. To very impressible persons, indeed, its pdour and taste are extremely repulsive, and apt to produce nausea and vomiting. Exter- nally applied, creasote is a valuable styptic. It was discovered at a time when Acqua Binelli enjoyed more confidence as a styptic than it does noAV ; and the fancied probability, that the nostrum was indebted to creasote for its virtues, gave rise to many experiments Avith the latter in cases of hemorrhage. When placed in contact with a bleed- Statice Caroliniana. CREASOTUM. 143 ing vessel, it coagulates the albumen of the blood, forms a clot, and at the same time causes contraction of the bleeding vessel. It has been used extensively as a haemastatic in epistaxis, bleeding from leech bites, and hemorrhage from large wounded surfaces; as an astringent in profu'se suppuration, and in excoriations of children, as well as in those induced by lying; in gonorrhoea and leucorrhoea, in ophthalmia tarsi, and in prolapsus vaginae, besides the various morbi externi men- tioned under Excitants, (Vol. i. p. 541,) in which its remedial agency was rather excitant than astringent. The dose of creasote, as an astringent, is one or two drops, several times a day, Avell diffused through mucilage of gum arabic. It is proper to remark, that a fluidrachm contains one hundred and fifty drops of creasote. It is best given in the form of pill, with crumb of bread and mucilage as the excipients. As a topical application, it may be mixed with water, with or without the addition of alcohol. Crea- sote water, as it is termed, is usually made with one part of creasote to eighty of ivater, and it is sufficiently strong for most purposes as a lotion or injection ; if not, the strength must be increased. An injection of a drachm of creasote to twelve ounces of starch, administered every night, has been extolled in camp dysentery. , A few articles, not in the Pharmacopoeia of the United States, have been supposed to owe a portion of their medicinal efficacy to creasote, viz:— 29. Fuli'go, Wood Soot.—A decoction of this has been used as an astringent in the form of injection, in cases of cystirrhoea; and, it is said, Avith advantage. M. Andr£ Gibrin took from the chimney two ounces of compact soot, broke it up, washed it, and boiled it in a pint of water. After filtration, this was injected into the bladder tAvice a day. It has likewise been used as an injection in cases of chronic inflammation of the mucous membrane of the vagina. 30. Ac"idum Ace'ticum Empyreumat'icum, Pyroligneous Acid, is prepared in chemical laboratories by the dry distillation of wood. The chief constituent of this is vinegar. It has been occasionally used in affections of the mucous membranes accompanied by discharges ; but is more employed as an antiseptic. 31. Aqua Picis Liq'uid^, Tar water; at one time so much extolled by Bishop Berkeley, and of late recommended in phthisis, but more especially in chronic bronchitis ; in the latter of which affections it is found to act like the generality of excitant expectorants. (See Vol. i. p. 269.) It may be made by digesting an ounce of tar in a quart of water for eight days, and then filtering. This may be taken with milk, to the extent of from eight to twelve fluidounces in the day. It has likewise been used with advantage, as an injection into the bladder, in cystirrhoea, along with pills of turpentine. The injection was made by infusing for a night, in the cold, a pound of tar in ten 144 SPECIAL ASTRINGENTS. pints of spring water; filtering and warming the solution before using it. Large quantities were injected through an elastic gum catheter, which was forthwith withdraAvn, and the patient directed to retain the injection as long as possible. This was repeated daily. For further particulars in regard to the preparation and properties of these agents, see the author's "New Remedies." II. Mineral Astringents. 32. ALU'MEN.—ALUM. Alum, Potash alum, Sulphate or Supersulphate of alumina, is a double salt, consisting of sulphate of alumina and sulphate of potassa. It is found native as an efflorescence from certain rocks and soils princi- pally in volcanic countries; and is termed Native alum ; but is chiefly prepared artificially from Alum slate,—a rock which contains, in con- siderable proportion^ sulphur, iron and alumina. Either by sponta- neous decomposition, or by roasting, the sulphur receives oxygen and is converted into sulphuric acid, whence result sulphate of iron and sulphate of alumina. These are obtained in solution by lixiviation; and, to the liquor, sulphate of potassa is added. The sulphate of iron is got rid of by repeated crystallization. Alum is manufactured in this manner to a great extent in various parts of Europe ; whence it was, at one time, exported in considera- ble quantities to this country. Of late years, however, it has been made on an extensive scale by the chemists of the United States; and is sufficiently pure, as furnished by them, for medicinal purposes. It is, consequently, placed in the materia medica list, not only of the Pharmacopoeia of the United States, but of those of Great Britain. The method of preparation generally adopted in this country consists in the direct combination of sulphuric acid with clay. It is made, however, in Baltimore on an extensive scale by burning an ore, found at Cape Sable on the Magothy River, Maryland, which consists of lignite, clay, sulphuret of iron and sand. To the solution, obtained by lixiviating the ashes, sulphate of potass is added; and crystals are obtained by evaporation. (Wood & Bache.) As met -with in the shops, it is generally in broken fragments of crystals; which are transparent; colourless ; of a sweetish astringent taste, and slightly efflorescent. It usually crystallizes in regular octo- hedrons, frequently Avith truncated edges and angles, and sometimes in cubes. The size of the crystals is at times very large. Dr. Christi- son states, that at Hurlet, near Paisley, which has been long celebrated for the manufacture of this salt, it has sometimes crystallized in columns two feet in length, weighing fifteen pounds, and consisting of a pile of octohedrons of great size. It dissolves in from fifteen to eighteen times its weight of cold water, and in less than its own weight of boiling water. Such are the main characters of the alum of the shops. A variety of alum from Italy, called Roman alum, is covered Avith a rose-coloured efflorescence containing oxide of iron; and another called Roche or ALUMEN. 145 Rock alum, from Roccha in Syria, is coloured with rose-pink. These are not used in medicine. The only impurity, which alum is apt to contain, is oxide of iron: the presence of this is detected by precipitating the solution Avith potassa, and redissolving the alumina by an excess of the alkali;— sesquioxide of iron is left. Alum is a powerful astringent in small doses, and as such is used both internally and externally. In large doses, it acts both as an emetic and a cathartic. In haematemesis, and haemoptysis, it has been given in large doses, and, in the former affection especially, with great advantage, inasmuch as it can come in contact with the vessels ex- haling the blood, and act as a styptic. It has been prescribed in all forms of internal hemorrhage; and in all increased discharges from mucous membranes, especially from those of the stomach and bowels. In one disease of the bowels,—lead colic,—it has been recommended; but it is not easy to see on what principle. As, however, it appears pretty generally to have opened the boAvels, it has been treated of in this relation elsewhere (vol. i. p. 222.) By some, it has been supposed to act on the lead presumed to be in the stomach, so as to form an inert sulphate of lead; but this is altogether hypothetical. On the same principle, sulphuric lemonade has been advised. One observer, —M. Gendrin—affirms, that he has cured more than three hundred cases by administering daily from a drachm to a drachm and a half of sulphuric acid diluted in three or four pints of water; and it is said to have been an efficacious prophylactic against the disease in the la- boratories of Paris. The experience of M. Gendrin has been cor- roborated by that of others; but by others, again, the same agent has been found entirely useless. The truth would seem to be, that the disease, in many cases, terminates in health under very simple ma- nagement. Of thirty-one cases, in which nothing but the ordinary tisane of the French hospitals was given for twelve days, three were cured by the fourth day; tAvo between the fifth and eighth days; ten between the eighth and twelfth days, and one on the thirteenth day. The remaining cases were subjected, after the twelfth day, to purga- tive treatment, under which they were speedily cured. Alum is said to have wonderful influence in allaying the tormina, and the nausea and vomiting that attend upon the disease. It has, likewise, been given freely in the colliquative sweats of phthisis, and in diabetes; but in neither case can it be presumed to act more than as a palliative. It appears to be adapted for all affections in which powerful astringents are deemed necessary. Its efficacy in hooping-cough has been highly extolled by Dr. Davies of London. After a long trial, he says, he is disposed to attach more importance to it as a remedy in that disease " than to any other form of tonic or antispasmodic." He has often been surprised at the speed with which it arrests the severe spasmodic fits of coughing, and it has seemed to him to be equally applicable to all ages, and almost to all conditions of the patient. The fittest state for its administration is " a moist condition of the air-passages, and freedom from cerebral con- VOL. II.—10 146 SPECIAL ASTRINGENTS. gestion; but an opposite condition would not preclude its use, should this state not have yielded to other remedies. It generally keeps the bowels in proper order,—no aperient being required during its use." As a topical application, also, it is in extensive use. It enters into the composition of astringent gargles and collutories, injections, and lotions for the treatment of relaxation of mucous membranes. It is an excellent styptic to constringe vessels that are alloAving blood to escape from them, either by division or transudation; hence it is used as a styptic in hemorrhage from the nose, rectum or vagina,—a solu- tion being injected; or lint, or rags, or sponge moistened with it being introduced into those outlets. In the first and last affection, the author has found it necessary, more than once, to dip moistened lint in pow- dered alum and introduce it. A saturated solution forms a good application to leech-bites; but where the bleeding is obstinate, it may be necessary to apply the powdered alum itself. As a collyrium, it is often prescribed, and as a wash in inflamma- tions in general. When unsuccessful in the early stages it may even augment the inflammation; but after the inflammation has become chronic, its agency becomes gradually beneficial, and is exerted in the manner elsewhere mentioned of excitant applications. It may likeAvise be used as an astringent wash to ulcers that are attended with too copious a secretion; or that are flabby and ill-con- ditioned ; and it is frequently of service in various forms of stomatitis. The insufflation of alum has been recommended in cases of diphthe- ritis. About a drachm of the fine powder is placed in a tube, and blown into the patient's throat. It is, also, occasionally applied by means of a mop to the pharynx and larynx, when affected with chronic forms of inflammation and ulceration. It appears to possess the property of dissolving false membranes, whilst, at the same time, it induces a new action in the parts beneath. The ordinary dose, as an internal remedy, is from gr. x. to Bij.; but in lead colic it is sometimes prescribed in the dose of 3ss. to 3ij- It may be given in pill, Avith extract of gentian as an excipient. In hooping-cough, Dr. Davies gives it to an infant in the dose of two grains three times daily; and to older children in the dose of four, five, and up to ten or twelve grains, mixed Avith Syrupus Rhceados— whose virtues do not differ from those of simple syrup—and water. It is seldom disliked. It is sometimes prescribed in the form of Alum whey, which is made by boiling 3ij. of powdered alum in a pint of milk, and straining. The dose of this is a Avine-glassful. As a collyrium, it may be used in the quantity of one to eight grains dissolved in a fluidounce of rose-water; and in injections and lotions the strength must vary according to the object which the practitioner has in view. It is occasionally applied in ophthalmia in the form of Cataplasma Aluminis of the Dublin Pharmacopoeia, which is made by briskly agitating two whites of eggs with a drachm of alum. In cases of chronic and purulent ophthalmia it is placed between folds of linen and applied to the eye. It has also been recommended as a good application to unbroken chilblains. A plumbi acetas. 147 poultice, made of the curd resulting from coagulating milk by means of alum, is sometimes used. 83. PLUMBI ACE'TAS.—ACETATE OF LEAD. Acetate of lead, Sugar of lead, Acetated Cerusse, Superacetate of lead, SaccJiarum Saturni, is made on the large scale by the manufacturing chemist; and is, therefore, with much propriety, placed in the materia medica list of the Pharmacopoeia of the United States. The pharma- copoeias of London, Edinburgh and Dublin, however, contain formulae for its preparation, which consist in dissolving litharge or protoxide of lead, or carbonate of lead, in diluted acetic acid, and crystallizing. On the large scale, it is made by hanging lead plates in distilled vine- gar or diluted pyroligneous acid. A saturated solution of protoxide of lead may be formed in this way; and the acetate is obtained by evaporation and crystallization. Acetate of lead of the shops appears as a mass of needle-like crys- tals, wrhich are transparent, colourless, and belong to the oblique prismatic system. (Pereira.) The taste is at first sweet, and afterwards astringent; and has an acetous odour. In a dry and warm atmosphere, it slightly effloresces; and is apt to be decomposed by the carbonic acid of the air, and to become partially insoluble. Temperate water dissolves about four-fifths of its weight, according to one observer, (Turner;) two-fifths, according to another. It is soluble, likewise, in alcohol. When dissolved in water,—owing to the fluid containing carbonic acid, a carbonate of lead is formed, which renders it turbid. This may be prevented, however, by the addition of a few drops of acetic acid. It is not often adulterated. The salts of lead, when taken internally, are probably all acted on by the alkaline chlorides contained in the gastric and intestinal secre- tions ; and the metal, according to M. Mialhe, attains the circulation in the form of a double chloride of lead and alkali; and he states, that those persons, who make use of a large quantity of common salt— chloride of sodium—are very liable to the poisonous influence of the preparations of lead. The albuminous substances, contained in the stomach, doubtless, also, affect the salt of lead, for it has been found, when any soluble compound of that metal is applied to the surface of the body, it combines with the albuminous elements of the tissues, and forms a coagulum, which is subsequently absorbed, through the sol- vent action of the alkaline chlorides contained in the animal fluids. In large doses, acetate of lead is a violent poison of the irritant class. In smaller doses, when continued for any length of time, it may give rise to the peculiar symptoms of lead-poisoning. Yet it has been re- peatedly prescribed by the author, and by a large number of respect- able therapeutists, in considerable quantities, without the supervention of any such results. Its effect upon the system is preceded by a nar- row leaden blue line, which is seated at the edges of the gums, where they are attached to the neck of two or more of the teeth of either jaw. Dr. Burton has pointed out this symptom; and Dr. Pereira states, that in every case of lead colic that has fallen under his care, 148 SPECIAL ASTRINGENTS. he has observed it, and in most of the cases it was accompanied by abdominal pain. The view of Dr. A. T. Thomson is, that acetate of lead becomes poisonous by being converted into carbonate in the sto- mach, and he affirms that 'if it be associated Avith vinegar, it may be administered freely, and with safety. Dr. C. G. Mitscherlich, however, has shown, that acetate of lead is a poisonous salt; and that when mixed with acetic acid, it is more energetic than when given in the neutral state. In all cases of lead-poisoning it is assumed, by M. Melsens—and Dr. Wm. Budd, of the Bristol Royal Infirmary, thinks "no doubt rightly"— that the metallic substance is in actual union with the affected part or parts, and is retained there in the form of some insoluble compound; and they are of opinion, that iodide of potassium, administered inter- nally, combines with the metallic poison, and forms a new and soluble salt, thus " liberating the poison from its union with the injured part, dissolving it out, so to speak, from the damaged fibre; and setting it' once more afloat in the circulation," to be eliminated by the kidney:— all of which is sufficiently plausible, but not the less hypothetical. Acetate of lead is much employed as a sedative astringent in various forms of hemorrhage; and alone, or associated with opium, is highly esteemed by several practitioners, although in many cases the good effects are more ascribable to the general treatment combined Avith it. It has, also, been freely precribed in chronic diarrhoea and dysentery, as well as in cholera, cholera morbus, and cholera infantum. Some practitioners have extolled it highly in the first of these affections. In phthisis, it has been used, of course, only as a palliative, for checking colliquative sweats, and diarrhoea; and both in that disease and in chronic bronchitis, it has seemed, according to some, to diminish pro- fuse expectoration. In the irritability of stomach, that sometimes forms part of the phenomena of remittent and yellow fever, sugar of lead has succeeded when other remedies had failed. As a topical application it is much employed. It has been used as a wash to check profuse ptyalism induced by mercury, and in aphthous stomatitis,—care being taken to wash the mouth well afterwards, to prevent the teeth from being blackened. It is, likewise, applied to in- flamed parts—to phlegmonous and erysipelatous inflammation, con- junctivitis, &c.; and is used as an injection in gonorrhoea, leucorrhoea and gleet. Cautions have been given against its use in ulcerations of the cornea, that attend purulent and pustular conjunctivitis, as it forms a white compound, which is deposited in the ulcer, to which it adheres tenaciously, and in the healing becomes permanently imbedded in the structure of the cornea. The dose of acetate of lead is from one or two grains to six or eight, repeated several times a day, in the form of pill, or, as suggested by Dr. A. T. Thomson, in diluted distilled vinegar, to prevent its con- version into carbonate. It is often associated with opium, both for internal and external exhibition; and Dr. Christison affirms, that for erythema and erysipelas, one of the best forms of application is a lotion composed of four grains of acetate of lead and four of opium to every fluidounce of water. A decomposition always takes place,—meconate PLUMBI ACETAS. 149 of lead being deposited, and acetate of morphia remaining in solution. The author has seen sulphuric acid prescribed as an astringent along with acetate of lead, which must have been OAAdng to ignorance or in- advertence, inasmuch as the sulphate of lead formed is wholly inert. It is proper to remark, however, that M. Mialhe asserts, that sul- phuric acid does not prevent the preparations of lead from being acted upon by the alkaline chlorides contained in the alimentary canal, and, with such impression, he condemns the use of sulphuric acid, lemonade, and of all alkaline sulphates, as preventives of, or antidotes to, lead poisoning; yet the testimony in favor of the lemonade, in such cases, in large lead manufactories, appears to have been most satis- factory. When acetate of lead is used as a collyrium, the strength may be from one to five grains to a fluidounce of water or rose water. This may be dropped between the eyelids, or be applied by means of an appropriate eye-glass;—or rags constantly wet with it, or a cataplasm of crumb of bread, to which it has been added, may be applied to the inflamed part. In inflammations of the cutaneous surface it may be applied in the same way; but the lotion may be made much stronger, —for example, ten to twenty grains to the fluidounce; and it may be used in the same proportion, as an injection, in cases of chronic diar- rhoea and dysentery, and in leucorrhoea. In gonorrhoea, the strength may vary from gr. v. to 3ss. and more to the ounce. LIQUOR PLUMBI SUBACETA'TIS, SOLUTION OF SUBACETATE OF LEAD, Solution of Diacetate of Lead. (Plumb, acetat. §xvi.; Plumb, oxid. semivitr. pulv. lixss.; Aq. destillat. Oiv. Boil for half an hour, adding distilled water so as to preserve the quantity. Filter.) Semivitreous oxide of lead, commonly called litharge, is a protoxide of lead; so that when it is boiled with acetate of lead, a large quantity of it is dissolved, and the subacetate results. This has been long known under the name of Gou- lard's Extract. As directed by the Pharmacopoeia of the United States, it is a colourless liquid ; s. g. 1.267. Carbonic acid—even that Avhich is contained in water—occasions a precipitate of carbonate of lead, and the same result ensues from exposing it to air; hence it is properly directed to be kept in closely stopped bottles. Solution of subacetate of lead is used externally only, and in the same cases as a solution of acetate of lead. It is rarely employed ex- cept in cases of external inflammation, such as that which characterizes sprains, burns, or ordinary phlegmonous or erysipelatous inflammation. It is always, however, diluted; and is also directed to be kept in the shops in the form of LIQUOR PLUMBI SUBACETA'TIS DILU'TUS, DILUTED SOLUTION OF SUBACETATE OF LEAD, LEAD WATER. (Liq. plumbi subacetat. f 3ij.; Aq. destillat. Oj.) This is Goulard's Vegeto-mineral water, Goulard, and is used in the cases above mentioned,—cloths being kept constantly wetted, and ap- plied to the inflamed parts. Acetate of lead is used in the preparation of Zinci acetas, of the Pharmacopoeia of the United States. 150 SPECIAL ASTRINGENTS. 34. PLUMBI CHLO'RIDUM.—CHLORIDE OF LEAD. Chloride of lead is formed when oxide of lead is digested in muriatic acid. It falls, also, as a white precipitate, when a salt of lead is added to any soluble chloride. In the London Pharmacopoeia, it is directed to be formed from acetate of lead and chloride of sodium. It is a white crystalline powder, soluble, according to the London College—who have admitted it into their Pharmacopoeia, as one of the substances employed in the preparation of morphia—in 30 parts of water at 60°, and in 22 parts at 212°. Chloride of lead acts locally on the tissues as an astringent and caustic; and according to some as an anodyne. Mr. Tuson employed it Avith some success, both in the form of ointment and lotion, in can- cerous ulcerations. As a lotion, he says, it is of use in producing a healthy surface of the sore, removing foetor and relieving pain; and when the ulcer has not been extensive, it has healed under its applica- tion. In painful neuralgic tumours, it proved very beneficial in re- lieving pain. When applied to any great extent by rubbing it over the part in the form of ointment, it has produced a numbness of the arm; and, from the observations made by Mr. Tuson in watching the effect of the application, he was induced to think, that the pain was removed by paralyzing the nerves of the adjacent parts. He is in- clined to believe, that when combined with other applications and appropriate internal treatment, it may be of considerable service in certain cancerous affections. A solution may be made of one drachm of the chloride to a pint of water;—an ointment, of one drachm of the chloride to an ounce of simple cerate. 35. ACIDUM SULPHU'RIC UM.—SULPH'URIC ACID. Sulphuric acid—whose properties^ are detailed under the head of Tonics, (Vol. ii. 76,)—is possessed of astringent virtues; and, as such, is frequently prescribed in atonic hemorrhages, especially in those that proceed from the lining membrane of the intestines, singly or combined Avith sulphate of magnesia, and under the views given elsewhere, (Vol. i. 215.) It is also prescribed in the colliquative sweats of phthisis as a palliative, often associated with opium, (Acid, sulphur, dil., Tinct. opii, aa partes aequales. Dose, ten drops every three or four hours.) In chronic diarrhoea and dysentery, it has been administered; but is not had recourse to frequently. It is prescribed in the form of ACIDUM SULPHU'RICUM DILU'TUM, DILUTED SULPHURIC ACID, (Vol. ii. 76,) of which the dose is ten drops, three or four times a day, in water, or of ACIDUM SULPHU'RICUM AROMAT'ICUM, AROMATIC SULPHURIC ACID, ELIXIR OF VITRIOL, (Vol. ii. 77). The dose of this is the same as that of the last. ARGENTI NITRAS. 151 Diluted sulphuric acid is sometimes applied externally to arrest capillary hemorrhage, as in wounds, epistaxis, &c. It is likewise em- ployed, when properly diluted, as an astringent gargle in relaxed sore throat, in ulcerations of the mouth and throat, and in ill-conditioned ulcers in general,—as well as to check ptyalism when profuse. 36. ARGEN'TI NITRAS.—NITRATE OF SILVER. Nitrate of silver, whose properties have been described under Tonics, (Vol. ii. 71,) is rarely given internally as an astringent. It is sometimes, however, prescribed in chronic diarrhoea and dysentery; and in the follicular affection of abdominal typhus—the typhoid form of adynamic fever ; and, it is said, with benefit. The author has used it, but has not been satisfied that it possessed any special advantage in such cases. It may be given either alone or associated with opium. It was elsewhere remarked, that whenever nitrate of silver comes in contact with chlorohydric acid, or a chloride, it is decomposed,—and that as the acid exists in health in the stomach, and chloride of sodium is present in most of the secretions, chloride of silver must be formed in the stomach; and perhaps the beneficial effects, ascribed to the nitrate as an internal remedy, may properly belong to the chloride. Under this idea, chloride of silver was given in the wards of the Philadelphia Hospital by one of the resident physicians, Dr. Perry, and, in his opi- nion, with advantage. The author has also frequently prescribed it; and on the whole it has appeared to him to be equal to the nitrate in chronic diarrhoea and dysentery, and in other cases in which the latter is indicated as an astringent. It is, however, as an external astringent that nitrate of silver is most employed. Independently of its action as a caustic and powerful topi- cal excitant, to be referred to hereafter, it is used as a gently excitant astringent in local inflammation, especially of the conjunctiva. It may be applied as a collyrium in the strength of a grain or two to the fluid- ounce of distilled water; and may be employed even in the acute stage of the inflammation, although it is most decidedly beneficial in the chronic stage. It is sometimes used in similar cases in the form of ointment,—from two to ten grains of the nitrate to an ounce of lard, or simple ointment,—a piece, the size of a pin's head, and even larger, being introduced between the eyelids by means of a camel's hair pen- cil. Warm fomentations are used at the same time, and the applica- tion of the ointment is repeated every third day. It is not often em- ployed, however, in this mode, in ordinary ophthalmia. In the puru- lent variety, it is prescribed both in the acute and chronic stage; but especially in the latter. In the variety of ophthalmia that affects the tarsi, this ointment is often highly beneficial, applied by means of a camel's hair pencil to the tarsal cartilages. A lotion, consisting of from five grains to twenty of the nitrate to a fluidounce of water, is often of great advantage in stomatitis and pharyngitis accompanied by ulcerations: the solid nitrate is even re- quired at times; and it has been passed over the tongue so as to reach the lining membrane of the larynx in chronic laryngitis, and that of the 152 SPECIAL astringents. pharynx in diphtheritic pharyngitis. In cases of chronic diarrhoea or dysentery, which appear to be dependent upon ulceration of the rec- tum, the lotion may be thrown up in the way of injection. In gonor- rhoea and leucorrhaea of the female, nitrate of silver has been used both in solution (gr. iij—xx. to a fluidounce of Avater) and in the solid state; but at times, serious inflammation results from the latter form of application. In the gonorrhoea of the male, the solution may be used: and occasionally an ointment proAres effectual, applied around a bougie; but inflammation of the urethra sometimes results from it. (Pereira.) By Dr. MacDonnell, of Montreal, a solution has been thrown into the bladder in chronic inflammation of that organ and Avith much success. The strength of the solution had seldom to be increased beyond five grains to the fluidounce.. It can be readily understood, that in a variety of ulcers, and chronic cutaneous diseases, the excitant effects of this poAverful* agent may be advantageous. The dose, as an internal astringent, is from an eighth to half a grain, gradually increased to three or more, tAvice or thrice a day. Extract of gentian may be the vehicle. 37. ARGEN'TI OX'IDUM, OXIDE OF SILVER. Oxide of silver (p. 73,) has been given by Mr. Lane with success in uterine hemorrhage both in the impregnated and unimpregnated state; and Sir James Eyre has strongly recommended it in the treatment of profuse menorrhagia. It has likewise been given in leucorrhoea and dysmenorrhea, haemoptysis, haematemesis, hemorrhage from the intes- tinal canal and obstinate chronic diarrhoea, and in the profuse purulent expectoration and perspiration of phthisis. Much benefit could scarcely however be expected from it in the last-mentioned cases. According to the experience of Sir James, it is superior to ergot, gallic acid, and, indeed, all other remedies. Mr. Lane esteems it to be essentially se- dative, and employs it both internally and externally. He recommends it in irritable ulcer; chronic ophthalmia; ulceration of the cornea, with thickening of the eyelids; applied in the form of ointment by means of a camel's hair pencil. Although neither Mr. Lane nor Dr. Golding Bird observed any coloration from its internal use after it had been continued for several weeks, it is doubtless liable to occasion it. Dr. Pereira suggests, that it may be continued for five or six weeks with safety. The dose is half a grain three times a day, gradually augmented to one or two grains or more. An ointment may be made of from twenty grains to a drachm of the oxide to an ounce of lard. 88. CUPRI SULPHAS.—SULPHATE OF COPPER. Sulphate of copper, whose general properties are described elsewhere, (Vol. i. 75,) has been advised as an astringent in chronic diarrhoea and dysentery, and it is said to have proved successful when the ordinary vegetable astringents had failed. Dr. Pereira states, that he has em- ployed it with excellent effects in chronic diarrhoea of infants in doses TINCTURA FERRI CHLORIDI. 153 of one twelfth of a grain. It has likewise been given in increased discharges from other mucous membranes. As an external agent, it is used in the same cases as nitrate of silver, and especially in inflammation of the conjunctiva, of the mucous mem- brane of the mouth and fauces, and of the genito-urinary apparatus both of the male and female. In gangrenous stomatitis, commonly called cancrum oris, it has been highly recommended by Dr. B. H. Coates, of Philadelphia. Solid, or in solution, it is an excellent stim- ulant to ill-conditioned ulcers ; and superficial ulcerations often heal very readily by a single application, either of the sulphate of copper, or of the nitrate of silver in substance. This is strikingly the case in the superficial ulcerations often caused by stomatitis. A strong solution (gr. xx. to xxx. to the fluidounce of water) is em- ployed as a styptic in cases of capillary hemorrhage, as from leech bites; and sometimes the poAvdered salt is required to repress the flow. The dose of sulphate of copper, as an internal astringent, is an eighth or a quarter of a grain, made into pill Avith crumb of bread or extract of gentian, and given two or three times a day. A grain or two to the fluidounce of distilled water forms a good excitant astringent colly- rium ; and lotions may vary in strength from two to fifteen grains or more. The lotion used by Dr. Coates in gangrenous stomatitis, con- sists of sulphate of copper 3ij.; powdered bark §ss.; water f 3iv. 39. TINCTU'RA FERRI CHLO'RIDL—TINCTURE OF CHLORIDE OF IRON. Tincture of chloride or muriate of iron, described elsewhere as a tonic, (Vol. ii. 59,) is likewise a powerful astringent, both when ad- ministered internally and externally. In cases of haematemesis, it comes in contact with the vessels that exhale the blood, and may therefore act as an external styptic; but it has likeAvise been extolled in hemorrhage of the asthenic kind from other parts, as from the uterus and urinary organs. It has also proved beneficial in cystirrhoea, and in gleet; and some have presumed, that it may have a 'specific' in- fluence over the whole of the urinary apparatus, " for on no other sup- position can we explain the remarkable effects Avhich it sometimes pro- duces in affections of the kidneys, bladder, urethra, and even of the prostate gland;" yet Dr. Pereira, from whose excellent pharmacological work this quotation is made, shows, that such is not the verdict of the profession, and it would be strange if it Avere. It may be averred with confidence, that we have not in the lists of the Materia Medica any therapeutical agent, Avhich possesses such influence on any organ. Dr. Pereira affirms, that he has found the tincture occasionally successful, when given in conjunction with tincture of cantharides, in the latter stage of gonorrhoea; after a variety of other remedies had failed. It is likeAvise used as an external styptic in capillary hemorrhage, and as a local astringent in bleeding ulcers, as Avell as in those that are accom- panied by profuse secretion. The dose is from ten to thirty minims, Avhich may be gradually aug- mented to f 3j- or f 3ij- twice or thrice a day, in some diluent. 154 SPECIAL ASTRINGENTS. 40. LIQUOR FERRI NITRA'TIS.— SOLU'TION OF NITRATE OF IRON. A solution of nitrate of iron, Solution of pernitrate or persesquinitrate of Iron, Solution of ternitrate of sesquioxide of Iron, has been introduced into notice chiefly as an astringent, and has been admitted into the last edition of the Pharmacopoeia of the United States (1851), in which it is directed to be made as follows: Take of Iron wire, cut in pieces, §j.; nitric acid (sp. grav. 1.42), f 3iij.; Distilled water, a sufficient quan* tity. Mix the acid Avith a pint of distilled water; add the iron ; and agitate occasionally, until gas ceases to be disengaged; filter the solu- tion, and add sufficient distilled water to make it measure thirty fluid- ounces. The solution is transparent; of a dark red colour, and a very astrin- gent taste. It is apt to become turbid by keeping, and to deposit ses- quioxide of iron; to obviate which, Mr. Kerr, who first proposed it, added a small portion of muriatic acid. With the same view, it has been proposed to keep it in the form of syrup. It resembles tincture of chloride of iron in its medical properties, and has been used as an astringent in chronic diarrhoea; and in affections of the mucous membranes that are accompanied by discharges. It has been advised in cases of aphthous sores, and is said even to have relieved toothache. It is, unquestionably, a powerful astringent; but it is doubtful whether it possesses any advantage over tincture of chloride of iron. The dose of the solution, prepared according to the form given above, is ten or fifteen drops, gradually increased to twenty or twenty-five drops, three or four times a day. It has been con- sidered to be especially adapted for diminishing irritability and tender- ness of the mucous membranes with which it comes in contact. 41. FERRI SULPHAS.—SULPHATE OF IRON. Sulphate of iron—whose chief properties are described under To- nics, (Vol. ii. 62,) is an astringent, and as such has been prescribed in the cases in which tincture of chloride of iron is indicated. It is given internally in all forms of asthenic discharges from mucous membranes; and externally is employed in collyria, lotions to inflamed parts in general, and injections. The dose of the sulphate, as an astringent, is from one to five grains, in the form of pill. If administered in solu- tion, the water should be boiled to expel the air contained in it, the oxygen of which would convert the salt into a persulphate. As a col- lyrium, a grain or two may be dissolved in a fluidounce of water. Lo- tions may, of course, be made of various strengths to suit the particu- lar case: as a general rule, however, from four to ten grains to the fluidounce of water will be sufficient. In leucorrhoea and prolapsus ani, the quantity of the sulphate may be doubled or trebled. It is not very much employed, either as an external or internal astringent. CRETA. 155 42 ZINCI SULPHAS.—SULPHATE OF ZINC. Sulphate of zinc—whose general properties have been described under the head of Emetics, (Vol. i. 142,)—is occasionally given inter- nally, as an astringent,, in the same cases as acetate of lead; but it is not very frequently prescribed. It is more often, perhaps, used in chronic mucous discharges, especially chronic catarrh, chronic gonor- rhoea and leucorrhoea; and Dr. Christison affirms, that lie has often pre- scribed it with the best effects in obstinate chronic gleet, in doses varying from three to six grains, twice or thrice a day. It is most frequently used as an external astringent, and as such forms a convenient collyrium, more especially in cases of chronic, or purulent ophthalmia. It is likewise prescribed, as an injection, in gonorrhoea, leucorrhoea, and gleet; and is applied as a lotion in aph- thous affections of the mouth, and in relaxation of the uvula, and of the mucous membrane of the isthmus faucium; but its disagreeable and enduring taste prevents it being much used in the last cases. A solution of sulphate of zinc is often applied in external inflammation, and as a wash to ulcers attended with too copious a discharge. The dose, as an internal astringent, is from gr. j. to gr. vj. in the form of pill. As a collyrium, the proportion may be gr. j. to gr. x. to a fluidounce of water;—as an injection in gonorrhoea, gr. v. to gr. x.; and in leucorrhoea, from gr. x. to gr. xx. As a wash to ulcers and to external inflammations, the proportion may be the same. 43. CRETA.—CHALK. Chalk or native friable carbonate of lime is met with in abundance in various parts of Europe; whence it is exported to this country. It is not found native, however, in a state fit for medical purposes; but requires washing to separate it from the gritty particles which it con- tains. It then forms CRETA PRvEPARA'TA of the pharmacopoeias. When pure, it is wholly soluble in dilute chlorohydric acid with efferves- cence ; and the solution yields no precipitate with ammonia. It is de- void of taste and smell; is almost insoluble in water, and much more soluble in carbonated water. When applied to the tongue, it adheres slightly to it. The last edition of the Pharmacopoeia of the United States (1851) has a form for the preparation of CALCIS CAR'BONAS PRJICIPITA'TUS, Avhich consists in mixing together boiling solutions of chloride of calcium and carbonate of soda in distilled water ; washing the precipitate repeatedly with distilled water and drying it. In the process, an interchange takes place; chloride of sodium remains in solution, and carbonate of lime is deposited. The creta prseparata is sufficiently pure for medicinal use; and the last process appears to be unnecessary, as it is more expensive. Chalk is used as an indirect astringent to the intestinal canal, proba- bly on account of its absorbent properties. It certainly diminishes 156 special astringents. the number of ahine discharges: and, like argil, seems to form Avith the gastric acids salts that arebinding. It is much used for checking diarrhoea, either alone or combined Avith opium, or with true as- tringents.—as kino and catechu. As a local application, it is dusted on inflamed parts, whose surface it coA-ers and protects from the desiccative and irritating action of the air. Dusted on excoriations, ulcers, burns, scalds, &c, it appears to be beneficial by absorbing ichorous or other discharges. When given in powder, the dose is gr. x. to 5SS- or 3j-, frequently repeated. MISTURA CRET.E, CHALK MIXTURE. (Cretce prceparat. sss.: Sacchar.. Aca- cioe pulv. aa 5ij-; Aquce Cinnam., Aquce aa f^iv.) This preparation is very much used in diarrhoea accompanied Avith predominance of acid. Tincture of opium, or infusion of kino or catechu is frequently asso- ciated Avith it. The dose is fSss. to f oij. Chalk is used in the preparation of Ammonice Carbonas and Calcii Chloridum, of the Pharmacopoeia of the United States. 44. TESTA PR-EPARA'TA.— PREPARED OYSTER-SHELL. This is made by freeing oyster shells from extraneous matters, wash- ing them with boiling water, and reducing them to powder by leviga- tion. Prepared oyster-shell is really only carbonate of lime, intimately associated with animal matter. It does not differ, consequently, in its medical properties from chalk. The animal matter is supposed, by some, to render the carbonate of lime more acceptable to the stomach; but it is doubtful whether it possesses any such agency. It is still re- tained in the Pharmacopoeia of the United States: but has been ex- punged from that of Edinburgh; and Dr. Christison states, that there is no other reason for any British college retaining it, than that in some places it is more easily obtained than other forms of carbonate of lime. 45. LIQUOR CALCIS.—LIME WATER. Lime water—which is prepared by pouring a gallon of water on four ounces of quicklime, preserving the solution in stopped glass bot- tles—is a solution of lime in water; and the object of protecting it from the air is to prevent the access of carbonic acid, which would unite Avith the lime, and form a carbonate of lime, that Avould be depo- sited. Like chalk, lime water possesses the power of diminishing the num- ber of alArine evacuations: and is therefore employed in cases of diar- rhoea, especially when accompanied by acidity. It has, likeAvise, been prescribed in diabetes, and in other cases in which an internal astrin- gent is needed. It possesses the power of corrugating and indurating animal matters. In vomiting, induced by irritability of the stomach, and perhaps OAving to too much secretion of acid, lime water mixed ARGILLA PURA. 157 with an equal quantity of milk has been one of the best remedies; and Dr. Wood, of Philadelphia, states, that he has found a diet ex- clusively of lime water and milk more effectual than any other plan of treatment in dyspepsia, accompanied Avith A*omiting of food. In this case, one part of lime water to two or three parts of milk is usu- ally sufficient. It is used as an injection in gonorrhoea after the actiAre inflammation has passed away; and in ulcerations or increased discharges from the bladder. It is, likewise, employed occasionally as a Avash to flabby ulcers, and to chronic eruptions,—as scabies and porrigo. LINDIEX'Tni CALCIS. LINIMENT OF LIME. (Aquce Calcis, 01. Lini, aa fsj.) Liniment of Lime Water, Carron Oil—as it Avas called in consequence of having been first used at the Carron works in Scotland—has long been a favourite application in cases of recent burns and scalds. The oil and lime form a soap, which, when smeared OA7er the burnt sur- face, prevents the irritating influence of the air; or if it be applied by means of a rag, the areolae of the rag are filled up by it, and the same object is accomplished. Lime water probably exerts none of its ordinary remedial agency in those cases, the effect being mainly mechanical. 46. ARGH/LA PURA.—PURE ARGIL. Pure argil, Alumina, Oxide of Aluminum, was formerly known under the names Armenian Bole, Terra sigillata, kc, and was much employed as an astringent in hemorrhages, diarrhoea, dysentery, &c.; but it had fallen into oblivion, when it was again brought forward as an effica- cious astringent. It is usually prepared by drying sulphate of alumina and ammonia, and exposing it for twenty or twenty-fiATe minutes to a red heat in a crucible. Sulphuric acid and ammonia are driven off, and the argil remains behind in the form of a white powder. It is devoid of smell or taste, but communicates a feeling of astringency to the tongue. When breathed upon, it exhales an earthy odour. It is insoluble in water; but attracts moisture greedily from the air, and forms with it a gelatiniform mass. Argil is absorbent; and, therefore, perhaps, an indirect astringent as regards the intestinal canal. It certainly diminishes the number of alvine eA'acuations. With the gastric acids, it seems to form salts that are binding; and hence it has been giA*en in the \~omiting and diarrhoea of children in which there is usually a predominance of acidity. It has been associated in such cases with decoction of logwood, (Argil. 5ij.; Decoct. Htematoxyl. f^iy. Dose, a teaspoonful.) The dose of pure argil for a very young child, in the twenty-four hours, is from 3ss. to 5j-; for older children, from 5j- to 5\j- It may be administered in an emulsion. 158 SEDATIVES. IV. SED'ATIVES. Stnon. Sedantia. General observations—Subdivision of sedatives—Definition of sedatives—Modus operandi —Thomson's table of sedatives—Mental sedatives—Blood-letting—Its effects—Cautions respecting its use—Arteriotomy, phlebotomy, local bleeding—Other sedatives—Contra- stimulants—Special sedatives. Under the head of Sedatives are included such agents as diminish action directly or indirectly. The division comprises some of the most important classes of remedies we possess; and such as are especially adapted for most of the numerous cases of acute disease that prove so fatal to mankind. On some of them, indeed,—in violent inflammatory cases,—entire confidence is reposed; and if they fail, farther efforts are not likely to be of much service. It may be said that many of the local excitants already considered may be employed for the purpose of producing an indirectly sedative effect; and such is the case with many;—hence they are used in febrile and inflammatory affections; but their sedative operation is not as evident from the commencement as those that are ranked under the division of sedatives. In the case of the narcotics classed by the author as sedatives, an excitant operation is observable when the agent is administered in a small dose; and, perhaps, even when given to a larger amount, there is always some degree of excitation perceptible on careful examination ; but this is succeeded so rapidly and predo- minantly by the depressing agency, that the excitant property is dis- regarded, and recourse is had to them in the same manner as if they were sedatives proper. These last may be defined—" agents that directly depress the vital forces." They are employed, consequently, whenever it is necessary to diminish preternaturally increased action. By many therapeutical Avriters, the class is not admitted; but there are certain remedial agents that cannot be brought under any other head;—blood-letting, for example. Their main effect is, doubtless, exerted, directly or indirectly, on the nervous system; and through this, on other parts of the body." The best evidence of the modus operandi of sedatives is afforded by the most powerful agent of the class with which we are acquainted— hydrocyanic acid. As before remarked, if a drop of pure hydrocyanic acid be placed on the tongue of an animal, its poisonous effects are so rapidly exerted, that the animal, at times, ceases to breathe almost before it can be removed from the lap of the experimenter. Yet it would not appear, that the heart and intestines, or even the voluntary muscles, have their contractility destroyed in poisoning by this agent; and Professor A. T. Thomson thinks, that this is true also as regards other sedatives. We might, consequently, understand, that if the deleterious agency of any sedative were extremely fugitive or evanes- cent, provided we could maintain artificial respiration—effect, that is, the conversion of venous into arterial blood—and keep up the circu- division of sedatives. 159 lation, time might be allowed for the system to recover from the deadly influence, and resume its wonted action. There are other circumstances, which confirm—were any confirma- tion needed—the position, that sedatives exert a direct influence on the nervous system. When hydrocyanic acid is applied to one limb only of a frog, the member becomes paralyzed, whilst the other limbs remain unaffected. Eobiquet, in executing experiments on the tension of the vapour of hydrocyanic acid, after having exposed his fingers to it for some time, felt a numbness in them, which lasted for several days; yet he experienced no effect from the acid on his system. Of the precise nature of the impression made on the nerves by seda- tives, we know nothing. The most careful examination exhibits no physical alteration of their tissue. It is manifestly not one of excite- ment; but the contrary: all the phenomena, as Dr. Thomson has remarked, prove that there are powers which destroy excitability and life without previous excitement, or, at least, without any signs of it being discoverable. The author just mentioned divides sedatives, from the nature of their effects, into two distinct classes;—' direct sedatives' or those which operate immediately on the nerves,—and ' indirect sedatives' or those which operate through the medium of the vascular system,—as in the following table:— "A. DIRECT SEDATIVES. * Organic products. a.— Cyanogen—combined with hydrogen, in Hydrocyanic acid. Laurel water. Volatile oil of bitter almonds. combined with potassium, in Cyanide of potassium. b.—Empyreumatic volatile oil. Tobacco smoke. c.—Nicotina—contained in the leaves of Nicotiana. Tabacum. ** Inorganic substances. d.—Sulphur—combined with hydrogen, in Sulphuretted hydrogen gas. ' Hydrosulphuret of ammonia. e.— Carbon—combined with hydrogen, in Uarburetted hydrogen gas. B. INDIRECT SEDATIVES. /.— Carbon—combined with oxygen, in Carbonic acid gas. g.—Blood- letting. 160 SEDATIVES. To this table might be added the sedation produced by a residence in certain localities, combined or not Avith the use of mineral Avaters, especially of the sulphurous kind,—as at the Red Sulphur Springs of Virginia, the waters of which are reputed to have a wonderful effect in reducing the pulse; and hence the place is a common resort, during the summer season, for the phthisical valetudinarian. To the same agency might, perhaps, be referred—a residence in mountain gorges, and in other situations, where there is a paucity of light, and an ab- sence of excitants of all kinds; and certain emotions, which are of a depressing or sedative cast, and of Avhich Ave have so marked an ex- ample in the nostalgic sadness, which, as before observed, exerts so deleterious an agency on the Swiss, especially when absent from their native land. Although there may be doubt entertained as regards the action of certain sedatives,—whether, that is, the sedative influence be or be not preceded by excitation,—there can be none as respects blood-letting. Even hydrocyanic acid has been supposed, by M. Magendie and others, to produce a transient excitement in the first instance, folloAved, how- ever, immediately afterwards, by an opposite state; but closer examina- tion, added to experiments on animals, seems to exhibit these views to be hypothetical. Indeed, there is scarcely sufficient time, in most cases, to note any excitation, so rapid is the transition from life to death, when the sedative is administered in a state of concentration; and, when more diluted, the effects are clearly of a depressing character. In the modus operandi of blood-letting, however, there is nothing equivocal. There can be no presumption of excitation before the depressing effects are perceptible; yet Ave can readily comprehend, that there may be states of the system, in Avhich the abstraction of blood, instead of being followed by signs of sedation, may give occasion to greater activity of vessels, and to a manifestation of greater tone of the system than was apparent prior to the operation. Such is signally the case in the fevers termed congestive, where the, powers of life appear to be depressed, in consequence of the accumulation of blood in the internal organs; but if the oppressing or depressing cause be removed by the abstraction of a due amount of blood, the powers of life develope new energy; the blood is regularly distributed through the different tissues and organs, and every sign of asthenia disappears. The immediate effects of blood-letting on the system are readily appreciable The impression is, from the first, one of sedation ; and, accordingly, it is one of the sedative agents on which our main reliance is placed in diseases of excitement. Carried too far, however, it is well calculated to develope capillary excitement, in the mode to be mentioned presently. At one time, this was an eAal which was never apprehended; and if, after excessive loss of blood, hyperaemia occurred in any organ, or was augmented if it had previously existed, the blood- letting Avas repeated, until the patient sank ; the practitioner, not sus- pecting the cause of death, but consoling himself with the reflection, that the disease wras irremediable, and that he had adopted the only judicious course for its removal. When an animal is bled to death, it is observed—as the blood flows BLOOD-LETTING. 161 —to become uncertain in its attitude; and, if it attempts to move, it staggers, and ultimately falls. This state is soon succeeded by convul- sions, Avhich, in death from hemorrhage, ahvays precede dissolution. The same thing happens to the human subject, when death results from a rapidly fatal hemorrhage. The rationale of these phenomena would appear to be as follows.—As the blood Aoaa^s from the vessels, the great nervous centres cease to receive that supply, Avhich is requisite for the due performance of their functions; hence, the proper amount of nervous energy is no longer transmitted to the muscles; their con- traction cannot be energetically maintained; alternate contractions and relaxations in the form of tremors become marked ; and, if the flow of blood continues, there is not enough nervous influx transmitted to keep the extensors in a state of contraction; the animal consequently falls, and, unless the hemorrhage be now arrested, death is inevitable. The same inadequate supply of blood to the brain gives rise to irregularity of action in the cerebro-spinal axis ; and hence convulsions. Where hemorrhage takes place, naturally or artificially, to a less extent than this, and the individual recovers, a chain of analogous phenomena supervenes, Avith which it is important for the therapeutist to be acquainted. It would seem, indeed, that Avhenever the vital fluid is lost beyond a certain amount,—and in particular habits this amount need not be large,—a series of phenomena present themselves, or are apt to present themselves, of a nervous kind, or dependent upon the loss of balance between the nervous and sanguiferous systems. Uterine hemorrhage affords the best example of the effects of great loss of blood in the human subject; although too many cases of mis- chief from the lancet of the practitioner are met with. When blood is discharged to an inordinate extent from the uterus, a feeling of faintness is sooner or later experienced; impaired vision and depraved audition,—in the form of tinnitus aurium, or other unusual noises,— supervene; and, if the hemorrhage be not arrested, fatal syncope en- sues ; generally preceded by more or less convulsive movement. If the patient recovers, it rarely happens that restoration is effected with- out symptoms presenting themsehres, Avhich are referable to the effect produced by the loss of blood on the nervous system. In the course of a few hours, although the female may have been, to all appearance, exanguious, she may be found complaining of violent headache, suffused face, with throbbing of the temporal and carotid arteries; yet these symptoms, as elsewhere remarked, are certainly not refer- able to a condition of the blood, or of the blood-vessels, which farther blood-letting is capable of remedying. The mischief has been in- duced by loss of blood, and farther abstraction of that fluid could scarcely fail to add to the morbid condition. A case, exhibiting the difficulty of distinguishing, without extreme care, Avhether the state of reaction be one of sthenia or asthenia, Avas exhibited, not many years ago, in an institution of Avhich the author Avas one of the physicians. A man, Avhose leg had been amputated, Avas found one morning almost exanguious from the gi\dng way of an artery. In a few hours, however, he recovered, and wTas seen by an experienced colleague, now no more, in the state of reaction, AArho Avas VOL. II.—11 162 SEDATIVES. unacquainted Avith the history of the case, and, as soon as he placed his hand upon the pulse, inquired why the surgeon did not bleed him! It may be laid doAvn, perhaps, as a general law, that Avhen blood is lost to a considerable amount, the great nervous centres receiving an inadequate—and the rest of the nervous system an irregular—supply, their excitability becomes largely and irregularly developed; so that, under this impressible condition of the nerves, the blood-vessels, whose functions are modified by them, assume augmented action; and if, owing to the previous existence of hyperaemia in any organ, the nerves proceeding to that organ are in a morbidly excitable condition, a fresh development of excitability may ensue after the bleeding; and the hypersemic condition, instead of being relieved by the loss of blood, may be augmented by it. In individuals, whose nervous sys- tem is very impressible, the same effects may be induced by a full bleeding as have been described to result from excessive discharges from the uterus ; and, accordingly, where hyperaemic conditions occur in such individuals, the practitioner is cautious in the use of the lan- cet ; and if he employs it, he does not carry the depletion so far as to depress too much the poAvers of the system,—aware, that if he should do so, under the nervous irritability or neuropathia, which he devel- opes, reaction might succeed to such an extent as to reproduce the exaltation of organic actions in the part, and perhaps to a greater de- gree than before the operation. It is in such impressible habits, that advantage is found in the adoption of other sedative agents; and that a combination of blood-letting, short of inducing syncope, with a full sedative dose of opium, is often so serviceable;—the bleeding dimi- nishing the exaltation of the vital manifestations, by acting on the nerves through the blood-vessels; and the opium preventing the sub- sequent development of nervous excitability. In strong individuals, the same plan, pushed to a still greater extent, is equally successful and not the less philosophical, Avhen employed for the removal of in- ternal inflammations. It is the plan which, as before observed, is adopted with so much success, in acute peritonitis;—the bleeding being carried so far as to make a decided impression on the system, and the opium administered in a full dose; a sedative influence is thus exerted on the body generally, and on the inflamed tissue in particular, under which the hyperaemia is effectually subdued. Along with his friend, Professor N. R. Smith, of the University of Maryland, the author attended a case, in which many of the ordinary signs of inflammation of the encephalon Avere present; yet both Avere satisfied, that great mischief would have resulted from copious ab- straction of blood. The patient was a nervous female, who, soon after delivery, was attacked with excruciating cephalalgia, Avith the greatest intolerance of light and sound, so that every precaution Avas necessary to shut off those irritants. Along Avith this great impressibility, how- ever, the tongue Avas moist; and the circulation, though hurried, not augmented in force. She was bled; but the symptoms were in no re- spect relieved. The operation was repeated to a trifling extent: so mueh palpitation and nervous turmoil were, hoAvever, induced by it, EFFECTS OF LOSS OF BLOOD. 163 that it was not practised a third time; but leeches were subsequently applied to the epigastric region for the removal of accidental gastro- enteritic symptoms. This state of excitability of the encephalon con- tinued for wreeks; and at length yielded to time and quiet, rather than to any particular system of medication; and under the cautious reap- plication of light and noise to the optic and auditory organs, they be- came gradually accustomed to the stimulus, and the recovery was ultimately complete. Had depletion been carried to a greater extent in this case^—as it would most certainly have been, by those practi- tioners, who believe that blood-letting is the only agent, that can be relied on as an antiphlogistic—great mischief would have, doubtless, resulted. Long, indeed, before Dr. Marshall Hall published his " Re- searches on the effects of loss of blood," the author had been deeply im- pressed Avith Avhat appeared to him to be the faulty views, entertained both as regards the pathology and the therapeutics of such cases as those mentioned; and had satisfied himself, that the maxim, inculcated by many practitioners as applicable to internal inflammations in gene- ral—" Avhen you have bled in inflammation to such an extent, that you are doubtful, owing to the persistence of the symptoms, Avhether you should bleed again,'—bleed"—was unphilosophical; and often, it Avas to be feared, attended Avith disastrous consequences. As a general rule, the author would say, on such occasions of doubt and difficulty, —" do not bleed, but have recourse to some other appropriate sedative, or revulsive agent, until your doubt is removed." Every practitioner, much engaged Avith the diseases of Avomen, must have met Avith cases of peritoneal inflammation in the puerperal state, in which, after bleeding has been practiced as far as he has esteemed it safe, the effects of a sedative dose of opium have been signally salutary. The irrita- bility of the nervous system has been allayed ; whilst there has been great reason to believe, that if the bleeding had been repeated, it might have been formidably developed. It is only in comparatively late years, that the attention of therapeu- tists has been directed to a pathological condition giving rise to phe- nomena of ordinary occurrence, which, in one of the cases, ought to have been suspected earlier, from the effects, which Ave see developed, by loss of blood, on animals as Avell as on man. This occurs in cer- tain encephalic affections, Avhich were at one time—and are even now, by many therapeutists—considered to require imperatively loss of blood, generally or locally, or both. Coma and convulsions Avere once regarded as invariable evidences of congestion of the encephalic vessels; although AA'hat was precisely meant by the term, as employed by many Avriters, is not apparent;—Avhether, for example, the congestion was looked upon as an accumulation of blood in the vessels of the brain, produced by too great activity of the encephalic arteries; or as a re- mora of blood in the veins, OAving to some asthenic or mechanical cause, seated in the veins themselves, or in the parts in which they creep. Both conditions Avere, however, considered to indicate blood-letting;— Avhether the turgescence, in other Avords, Avas active or passive, the abstraction of fluid Avas thought to be demanded. It is noAV known, that coma may exist independently of any fulness of the vessels of the 164 SEDATIVES. encephalon; that it occasionally appears to be induced by a condition the opposite to this; and that the administration of excitants may be required for the removal of symptoms, closely resembling such as are cured by bleeding and by ordinary depletives. The precise condition of the brain during sleep has been an interest- ing topic of discussion Avith the physiologist, and is yet sub lite; but it may, perhaps, be unhesitatingly determined, that it is not directly dependent upon a modified circulation in the encephalon; and that it is altogether a phenomenon of the neurine itself. Coma, being morbid sleep, cannot be wholly likened to that Avhich occurs naturally. It is frequently the result of pressure made on the cerebral substance by vascular turgescence, or effusion; but it may, and doubtless, does, occur from conditions of the cerebral structure itself; and it by no means follows, that these must be conditions of turgescence or excite- ment. Dr. Grooch has an excellent chapter on this subject in his Avork on ' Some Diseases Peculiar to Women.' It is entitled, " Of some symp- toms in children erroneously attributed to congestion of the brain;" Avhich he regards as dependent rather upon loss of nervous power. " I am anxious," he says, " to call the attention of medical men to a disorder of children, which I find iiiA'ariably attributed to, and treated as, congestion or inflammation of the brain, but which, I am convinced, often depends on, or is connected Avith, the opposite state of circula- tion. It is chiefly indicated by heaviness of head and drowsiness; the age of the little patients whom I have seen in this state, has been from a few months to two or three years; they have been rather small of their age, and of delicate health ; or they have been exposed to de- bilitating causes. The physician finds the child lying on its nurse's lap, unable or unwilling to raise its head, half asleep, one moment opening its eyes, and the next closing them again, Avith a remarkable expression of languor. The tongue is slightly white; the skin is not hot; at times the nurse remarks that it is colder than natural; in some cases there is at times a slight and transient flush; the bowels I have always seen already disturbed by purgatives, so that I can scarcely say what they are Avhen left to themselves ; thus the state which I am describing is marked by heaviness of the head and drowsiness, without any signs of pain, great languor, and a total absence of all active febrile symptoms. The cases Avhich I have seen have been invariably attri- buted to congestion of the brain, and the remedies employed have been leeches and cold lotions to the head, and purgatives, especially calomel. Under this treatment they have gradually become worse, the languor has increased, the deficiency of heat has become greater and more per- manent, the pulse quicker and Aveaker, and at the end of a few days, or a Aveek, or sometimes longer, the little patients have died with symptoms apparently of exhaustion." " The children, AArho were the subjects of this affection, and were thus treated," says Dr. Grooch, " died, not with symptoms of oppressed brain, but with those of exhaustion; and, on examining the head after death, the blood-vessels were unusually empty, and the fluid in the ventricles rather in excess; in tAvo instances, death Avas preceded by symptoms of effusion, viz., blindness, a dilated pupil, coma and con- EFFECTS OF LOSS OF BLOOD. 165 vulsions; and after death the ventricles were found distended with fluid to the amount of several ounces, the sinuses and veins of the brain being remarkably empty. I believe the prevalent notion of the profession is, that all sudden effusions of Avater into the brain are the result of inflammatory action; but, putting aside for a moment this dogma of the schools, consider the circumstances of this case. For several days before death, all that part of the circulating system, which was cognizable to the senses, was at the lowest ebb consistent with life, and after death the blood-vessels of the brain were found remark- ably empty of blood, and the ventricles unusually full of Avater. From such facts I can draw no other inference than this, that this sudden effusion was a passive exudation from the exhalants of the ventricles, occasioned by a state of the circulation the very opposite to congestion or inflammation. This is corroborated by the dissection of animals which have been bled to death. Drs. Saunders and Seeds, of Edin- burgh, found that in animals bled to death, whether from veins or arteries, there was found more or less of serous effusion within the head, and Dr. Kellie thus expresses himself:—"If instead of bleeding usque ad mortem, we Avere to bleed animals more sparingly and repeat- edly, I have no doubt that Ave should succeed in draining the brain of a much larger quantity of its red blood; but in such experiments we shall, I think, find a larger effusion of serum." " It is surely impossible"—he adds—" for the reader to mistake me so far as to suppose that I am denying the important practical truths, that heaviness of head and drowsiness of children commonly depend on congestion, and are to be. relieved by depletion, and that acute hy- drocephalus is a serous effusion, the result of inflammation, and capa- ble of being cured only in the inflammatory stage by bleeding and purging. These vital truths I would state as strongly as any man, but there are opposite truths. All that I mean is, that these symptoms sometimes depend, not on congestion, Avhich is to be relieved by bleed- ing, but on deficient nervous power, which is to be relieved by sus- taining remedies. All I advise is, that not only the heaviness of head and drowsiness should be noticed, but the accompanying symptoms also, and that a drowsy child, who is languid, feeble, cool, or even cold, with a quick, Aveak pulse, should not be treated by bleeding, starving, and purging, like a drowsy child Avho is strong, plethoric, has a flushed face, perhaps swelled gums, and a heated skin. The cases Avhich I have been describing ' may not improperly be compared to certain species of plants, by no means uncommon, which are liable to be con- founded Avith others by an inattentive observer.'" These remarks are cited at some length, in consequence of their signal accordance with the views, Avhich the author has been led to entertain in Avhat have appeared to him to be similar pathological con- ditions ; and, he is satisfied, that both in children and adults, an ana- logous state of the brain is often met Avith, especially in scarlatina. In the disturbed state of the encephalic functions, which so often attends that anomalous disease, there may be recognized—it has appeared to him—a condition very different from that Avhich is produced by active inflammation or congestion of the encephalon. Under the great ex- 166 SEDATIVES. penditure of nervous energy, which takes place over the Avhole system, the cerebro-spinal nervous centre appears at times to be in a state very different from that of inflammation or active congestion. It is rather exhausted; and accordingly, in many such cases, the use of diffusible excitants has been found serviceable,—the delirium or the coma gradually disappearing as the system begins to feel their com- pensating influence. This practice Avas adopted in scarlatina, when accompanied by such signs of encephalic disorder, with great success, by Dr. Baer, of Baltimore ; and it has been followed by happy results in some cases that have fallen under the author's own care. Under the vigorous use of depletives, the symptoms have not been mitigated; at times, indeed, they have seemed to be aggravated; but on changing the system of treatment, and having recourse to tonics or excitants, a marked amelioration has ensued. Convulsions were, at one time universally referred to the same con- dition of the encephalon as was presumed to prevail in cases of coma: blood-letting was, therefore, the remedy almost always deemed proper; yet some misgivings ought to have been produced by the well known fact, already referred to, that death from hemorrhage is preceded by convulsions. Amongst the immediate effects of loss of blood, Dr. Marshall Hall enumerates,—syncope, convulsions, delirium, coma, and sudden disso- lution ;—and, amongst the more remote, excessive reaction, sometimes with,—first, delirium, mania; secondly, coma, amaurosis, or deafness, and the sinking state. Convulsion he properly considers to be, after syncope, the most familiar effect. " It constitutes," he says, " one spe- cies of puerperal convulsion; and should be accurately distinguished from other forms of this affection, arising from intestinal or uterine irritation, and an immediate disease of the head." The fact of the copious effusion of blood, with the attendant signs of exhaustion, will enable the practitioner to discriminate these cases, and not to pretermit the use of those energetic agents, which are in- dispensable for the safety of the patient, when the convulsions are induced by the condition of the gravid uterus modifying the due cir- culation of blood in the brain. It is not in such cases, that the use of the lancet does harm; on the contrary, it is the anchor of safety, and cannot be postponed. The mischief is here owing to the circulation in the brain being modified, so that the nervous system is thrown into irregular excitement; and nothing will obviate this condition, except diminishing the circulatory current. Far different, however, the author is satisfied, is the case in the generality of convulsions, which happen during early childhood. Prior to the period of the first detention, owing to certain evolutions of organs, the nervous system—as previously shoAvn—is unusually impressible, so that intense irritation, existing any where, may be the occasion of irritative irradiations proceeding in all directions, until the parts of the cerebro-spinal axis have their func- tions deranged; and sensation, volition, and mental and moral mani- festations become, for the time, suspended. In this manner, the irri- tation produced by the pressure of a tooth against the gum, or any source of excitation in the intestinal canal, may become the cause of EFFECTS OF LOSS OF BLOOD. 167 convulsions; and after the functions of the cerebro-spinal axis have been once deranged as they are during convulsions, they are extremely prone to reassume the morbid condition; until, ultimately, organic disease of the encephalon supervenes; or the little sufferer is wrorn out by continued irritation. In such a case, the predisposition to the dis- ease is the period of life; and the exciting cause is the irritation in the alimentary tube. Great impressibility of the nervous system is present even in health; and this impressibility only requires the application of a sufficient exciting cause to have convulsions developed. In addition to the general predisposition derived from time of life, there is doubtless an organization obtained from progenitors, which predisposes to concisions. It is not very unusual for a whole family to be subject to them during childhood; and, on inquiry, it may be found that one of the parents was liable to the same disease in child- hood. In such cases, a less energetic exciting cause is able to develope the mischief,—possessing, as the subjects do, a double source of pre- disposition. In them, we cannot suspect the existence of polyaemia, or hyperaemia of the encephalon. The phenomena are Avholly neuro- pathic. The predisposition is unusual nervous impressibility; the ex- citing cause is often situate in the digestive tube; and very frequently the source of irritation is food of an improper character, or an inflam- matory or other morbid condition of the mucous or lining membrane. The indication cannot, consequently, be to diminish the quantity of blood in the system, Avith the view of removing any supposititious con- gestion of the encephalon. Blood-letting, in such a state, could hardly fail to add to the impressibility of the nervous system; and it has often appeared to the author to be followed, too manifestly, by augmenta- tion of the symptoms. The convulsions have recurred; the surface has become cool, and pale,—almost exanguious; the circulatory forces have exhibited, that their action was enfeebled; the child has con- tinued in a state of coma between the fits, or has had but short inter- vals of conciousness ; and has gradually sunk, Avith no signs of hyperae- mia,—unless we consider the convulsions and the coma to indicate such a condition; for, on dissection, no morbid appearances have been met Avith in the brain, or an effusion of serum has been discoverable, which, as before shown, is present, when a healthy animal is bled to death. Proceeding on those pathological principles, the author has not often considered it proper to abstract blood in the convulsions of infancy; in almost all cases, he has found it but necessary to clear the alimentary tube by a gentle emetic, followed by a mild cathartic; to keep the child from every source of irritation, that might act injuriously on the organs of sensation from without, or on the nerves of the intestinal mucous membrane from within; to equalize, as far as practicable, the excitability of the cutaneous surface by the use of frictions or of the warm bath; and, under this plan of management, he has almost always found the affection eventuate favourably. At the same time, it is pro- per to remark, that there are cases of convulsions accompanied by every sign of vascular excitement; and where a true polyaemic or hy- peraemic condition of the brain exists. In these, of course, blood- 168 SEDATIVES. letting is the main agent to be relied on. If encephalitis be present, it must be treated as such; but, in all cases, careful attention must be paid to discriminate, Avhether the convulsions be accompanied or pro- duced by a redundancy, or by a deficiency, of nervous and vascular energy. If blood-letting, then, be capable of exerting a sedative agency on the organism; and yet, if carried too far, or not appropriately prac- tised, may give rise to all those mischiefs that folloAv excessive loss of blood, it becomes an interesting topic of inquiry how to regulate the operation, where it is needed, so as to have the sedative agency Avith- out any of its unpleasant concomitants, and sequelae. When blood is draAvn in cases of internal inflammation, the great object is, by diminishing the amount of fluid circulating in the Aressels, to depress the vital manifestations. But the effect of copious blood- letting, it has been seen, is exerted greatly upon the nervous system. Moreover, as already remarked, when loss of blood takes place—either naturally or artificially—to too great an extent, irregular actions are apt to supervene; and as, where hyperaemia exists, there is a part of the nervous system morbidly impressible, the vessels of the inflamed part resume their inordinate action, and the hyperaemia, after a full bleeding, is speedily reproduced; and, perhaps, to an equal degree. We have obviously, therefore, to be careful not to carry the abstrac- tion of blood, in such cases, to an extent that may develope irregu- larity of nervous action. But this excitability varies materially according to individual organ- ization ; and to the character and intensity of the hyperaemia. There are some persons Avho faint at the sight of blood; and who are throAvn into nervous erethism by an ordinary bleeding; Avhilst others bear the loss of a large amount of blood without the supervention of syncope, or seeming to suffer materially. In certain diseased conditions, again, the toleration is considerable; and a delicate female often bears a large loss of the vital fluid, when a few ounces in health, or in a different affection, Avould have developed great nervous impressibility. The. toleration, too, varies someAvhat in the same individual. Dr. Thomson says he has witnessed cases of decided inflammation, in Avhich syncope occurred after three or four ounces of blood Avere taken; yet, on re- peating the operation a few hours afterwards, from twenty to thirty ounces were abstracted without the least evidence of its approach. The author has more than once had occasion to confirm this; and it is a therapeutical fact of importance,—because if we were to be deterred from repeating the blood-letting, owing to the want of toleration at the first attempt, we might deprive ourselves of the use of a most valuable, indeed, often indispensable, antiphlogistic; yet, it appears scarcely philosophical, that in a case of excited organic actions of a part,—say, of the pleura, or peritoneum,—Ave should take aAvay blood from the arm; or, in other Avords, from the whole system, in order to reduce the overaction of a part. We have no mode how- ever, of reaching the affected vessels,—no mode of applying our reme- dies to the parts concerned,—and are compelled to act on the diseased organ through the influence which wre are capable of producing on the EFFECTS OF LOSS OF BLOOD. 169 nervous system generally, as well as through the diminution in the supply of fluid to the inflamed part, Avhich must necessarily result from the operation. From the great amelioration of the symptoms of inflammation, gene- rally observed when syncope is induced from any cause, it has been deemed important, that blood-letting should always be pushed so far as to make this decided impression on the system; and there are some who regard its supervention as an evidence that the operation has exerted its full effect, although a few ounces only may have been ab- stracted. The author recollects a case in which fainting Avas occasioned by the awkward and abortive attempts of a bungling provincial practi- tioner in France; yet it Avas regarded by him to be as effectual for the removal of the hyperaemia, for Avhich it was employed, as if tAventy or thirty ounces had been taken before the occurrence of syncope. The state of fainting is one of suspended animation,—of suspension of the great vital functions,—and, therefore, one in Avhich there must be a truce to the various excited actions, that may be going on in any part of the organism; but the effect is only temporary; and, as soon as the functions of respiration, circulation, and innervation are restored to the normal condition, the signs of hyperaemia may be as manifest as before. By many, indeed, syncope has been compared to the cold stage of an intermittent; and reaction, it is conceived, is as sure to follow as the hot stage succeeds to the cold stage of a paroxysm of that disease. " The morbid effects of large depletions," says an able writer and observer, Dr. Copland, " will necessarily vary with the nature of the disease in which they are employed. When carried too far, in case of excitement, where the nervous or vital power is not depressed, and the blood itself rich or healthy, reaction generally follows each large de- pletion, and thus often exacerbates or brings back the disease for which it was employed, and which had been relieved by the primary effects of the evacuation. This is more remarkably the case in acute inflam- mations of internal viscera, particularly of the brain or its membranes. Thus, every observing practitioner must often have noticed, that a large depletion, when carried to deliquium, will have entirely re- moved the symptoms of acute inflammation when the patient has re- covered consciousness; and that he expresses the utmost relief. But it generally happens that the inordinate depression—the very full syncope that is thought essential to the securing of advantage from the depletion—is folloAved by an equally excessive degree of vascular reaction, Avith which all the symptoms of inflammation return; and the general reaction is ascribed entirely, but erroneously, to the return of the inflammation, instead of the latter being imputed to the former, Avhich has rekindled or exasperated it, when beginning to subside. The consequence is, that another very large depletion is again pre- scribed for its removal; and the patient, recollecting the relief tempo- rarily afforded him, readily consents. Blood is taken to full syncope, —again relief is felt,—again reaction returns,—and again the local symptoms are reproduced; and thus large depletion, full syncope, re- action, and the supervention on the original malady of some or all of 170 SEDATIVES. the phenomena described above as the consequence of excessive loss of blood, are brought before the practitioner, and he is astonished at the obstinacy, course, and termination of the disease; which, under such circumstances, generally ends in dropsical effusion in the cavity in which the affected organ is lodged; or in convulsions, or in delirium running into coma; or in death, either from exhaustion or from one of the foregoing states; or, more fortunately, in partial subsidence of the original malady, and protracted convalescence. Such are the con- sequences which but too often result,—Avhich I have seen on numer- ous occasions to result,—when blood-letting has been looked upon as the only or chief means of cure—the ' sheet-anchor' of treatment, as it too frequently has been called and considered during the last twenty years." To prevent this reaction, Dr. Copland directs the following course of practice, when large blood-lettings are required in the treatment of visceral inflammation. The patient should be either in bed or on a sofa, and in the sitting or semi-recumbent posture, supported by seve- ral pillows. The blood is to be abstracted in a good-sized stream; and the quantity should have some relation to the intensity and seat of the disease, and the habit of body and age of the patient, but chiefly to its effects: it should flow until a marked impression is made upon the pulse, and the countenance begins to change. Farther depletion must not now be allowed; but the finger should be placed on the orifice of the vein, the pillows be removed from behind the patient, the recumbent posture be assumed, and the arm secured. " Thus, a large quantity of blood may be abstracted, when it is required, with- out producing full syncope, which should always be avoided: and when a large loss of this fluid is either unnecessary, or might be hurt- ful, the speedy effect produced upon the pulse and countenance by the abstraction of a small quantity will indicate the impropriety of carry- ing the practice farther. In this manner I have often removed about forty ounces of blood, wdiere large depletion was urgently required, before any effect was produced upon the pulse, but always carefully guarding against syncope; and by the subsequent means used to pre- vent reaction, no farther depletion has been required." The " means" alluded to consisted of contra-stimulant doses of tar- trate of antimony and potassa ; of full doses of calomel, antimony, and opium; or opium singly, &c. &c. There can be little doubt, that the course here recommended is judi- cious. The author has already remarked, that in many nervous indi- viduals, syncope may be induced, even before the blood flows, or when a very small quantity has been discharged. In such case, everything is favourable for the occurrence of violent reaction; and no good is to be expected from the temporary sedation effected during the syncope. The exaltation of the vital forces, to be permanently subdued, generally requires a copious abstraction of fluid from the vessels, and by keep- ing the patient in the horizontal attitude, and waiting for a time,— pressing the finger on the vein when signs of syncope appear, and, after they have passed away, removing the finger from the bleeding orifice,—blood enough can generally be withdraAvn to produce the TOLERANCE OF LOSS OF BLOOD. 171 necessary effect. At other times, the loss of very large quantities of blood is borne without the supervention of any evidences of syncope, and when there has been great reason to believe, that the tolerance would continue, until a slight additional abstraction of blood might induce a state of irretrievable collapse, or—what Dr. Marshall Hall has called—" the sinking state." In the lectures of Mr. Lawrence, as given in the London " Lancet," is contained the case of a young female, of slender habit, from whom eight-and-forty ounces of blood were taken away without fainting. The blood still continued running in a vigorous stream without touching the surface of the arm; and it Avas stopped at that amount only because the quantity seemed to Mr. Law- rence to be so very great. In a case like this, it would not be right to continue to bleed until signs of syncope ensue. When the practi- tioner has bled to thirty, or at the farthest, to forty ounces, it would, perhaps, be wise to tie up the arm; to pursue the sedative system by a full dose of opium,—and there is none so good in the vast ma- jority of cases, where patients tolerate it,—or of some other sedative agent; and if, in the course of three or four hours, the mischief, for which the blood-letting was practised, be not subdued, to repeat it. The interesting fact was pointed out by Dr. Marshall Hall, that in inflammatory disease, a much larger amount of blood may be draAvn without inducing syncope than can be done in health, or in other dis- eases. The folloAving table is the result of that observer's investiga- tions in regard to the tolerance of blood-letting in different maladies. The numbers represent the mean quantity of blood which Aoavs before incipient syncope in the sitting or erect attitude. I. AUGMENTED TOLERANCE. Congestion of the brain . . . 3x1.—1. Inflammation of serous membranes "} Inflammation of synovial membranes > 3xxx.—xl. Inflammation of fibrous membranes J Inflammation of the parenchyma of or- ) ? _ • gans (brain, lung, liver, mamma, &c.) ) Inflammation of skin and mucous mem- "j branes (erysipelas, bronchitis, dysen- V 3xvj. tery, &c.)......J II. HEALTHY TOLERANCE. This depends on the age, sex, strength, "j &c, and on the degree of thickness of V Sxv. the parietes of the heart, and is about J III. DIMINISHED TOLERANCE. Fevers and Eruptive Fevers ( . . Ixij.—3xiv. Delirium tremens and Puerperal Delirium Ix.—xij. 172 SEDATIVES. Laceration or concussion of the brain" Accidents before the establishment of in flammation Intestinal irritation Dyspepsia, Chlorosis Cholera .... 3viij.—x. gviij. 5vj. The explanation of the increased tolerance of blood in inflamma- tion—Dr. C. J. B. Williams apprehends—is to be found in the increased excitability of the heart, and tonicity of the arteries, Avhich maintain a sufficient force and tension to preserve the circulation, especially through the brain, even when much blood is lost. " In asthenic or atonic diseases, on the other hand, the arteries being lax, and ill-fitted to transmit the blood, a smaller loss is felt, and syncope may result. The variations between inflammations occupying different seats must be referred to the arterial tone being less augmented in some than in others, and are therefore indications of the more or less sthenic cha- racter of the inflammation. The quantity of blood in the whole sys- tem will affect the heart's action, and arterial tension in a similar way; and no doubt the more stimulating quality of the blood may contri- bute to the same results." The extent to which blood-letting should be carried, in cases of violent internal inflammation, is often a matter of great difficulty Avith the discriminating, but of none whatever with the reckless and unin- formed. In his state of blissful ignorance, the latter continues to bleed; and consoles himself, when the fatal result has been hastened—■ perhaps mainly induced—by his agency, that the sufferer has fallen a victim to an incurable malady. Many have laid down a rule, before referred to, that when blood- letting has been carried to such an extent, and so often, that we are in doubt Avhether it should be repeated, the decision should be in the affirmative. But with the disposition, which prevails so generally,— and Avhich prevailed a few years ago, to a much greater extent than it does evep at present,—to bleed without due consideration, such a doubt will rarely be felt, without good ground at the same time exist- ing for staying the hand; and, therefore, the decision, according to the author's experience, ought generally, as before said, to be in the negative. The argument, commonly urged for the further abstraction of blood, is, that the inflammation manifestly persists, and that it must inevitably destroy if it be not arrested;—that blood-letting is more likely to subdue it than any other therapeutical agent; and that, if it should not, the physician will have the consolation of knowing, that he has done everything in his power to avert the melancholy termina- tion. Were the abstraction of blood in all cases, and to any extent, devoid of danger, this mode of viewing the subject might be logical; but mischiefs result in these and similar cases, which are fairly refera- ble to it; and are equally serious in their results with the disease for Avhich it may have been employed. Often, too, wjiilst the practitioner is taking away blood, he allows the patient to drink freely of water or other fluid, and, under the augmented absorbent agency induced EFFECTS OF LOSS OF BLOOD. 173 by the diminution of the quantity of blood in the vessels, a state of anaemia or oligaemia supervenes; and the blood is rendered so thin, that if the disease, for which repeated blood-letting Avas adopted, be hemorrhagic, and the hemorrhage be OAving to transudation through the parietes of the vessels—as is almost universally the case—the recurrence of the hemorrhage is greatly facilitated. In an early part of this volume, the author has referred to an interesting case of anaemia, produced by excessive bleeding in what Avas supposed to be periodical encephalitis; and to the 'mischiefs so manifestly referable to an inadequate quantity of blood circulating in the vessels, as Avell as to the impoverished condition of that fluid; and, to a minor extent, similar evils are often found to result from the same causes, although they are too frequently not appreciated, or, if appreciated, regarded as inevitable. Whenever anoainia of the kind referred to exists, the excitability of the nervous s}Tstem is irregularly developed; hype- raemic affections are apt to arise in various parts, which seem formida- ble, and yet require a very different mode of management from such as are met with in those Avho are plethoric, or Avhose blood is rich in fibrin and red corpuscles. It must be borne in mind, too, that the researches of MM. Andral and Gavarret and others, have established the fact, that the chief effect of loss of blood is to diminish the ratio of the corpuscles to the fibrin, —a statement, Avhich the researches of MM. Simon, Becquerel and Rodier, and others have confirmed. As blood is abstracted, the fluid becomes impoverished, and more watery; whence the density of de- fibrinated blood diminishes notably. The albumen also decreases; but usually only slightly; hence the diminution in the density of the serum is small. The fibrin is uninfluenced by venesection; the extractive matters and free salts are unaltered ; the fatty matters are slightly les- sened ; the serolin, always variable in quantity, is decidedly increased in some cases; the cholesterin appears to be but slightly so; the chloride of sodium and other salts remain unchanged; and the iron is diminished slightly in the same proportion with the corpuscles. It Avould appear, therefore, that blood-letting influences but little the main morbid condition of the blood in inflammation,—the increase in the ratio of fibrin to red corpuscles. It has been affirmed, indeed, by Mr. .Simon, that it frequently, and even usually, increases under this debilitating treatment; and in speaking in his " Lectures on General Pathology," of endocarditis arising in the course of rheumatic fever, he assures his hearers of the " pathological fact, that you may bleed a patient to death without altering—except probably to increase—the proportion of fibrin in his blood." The highest figure for the fibrin given by Andral, 10.2, Avas at a fourth bleeding; and Scherer found it as high as 12.7, at a third bleeding in a case of pneumonia. The beneficial effect of blood-letting must consist in reducing the density of the fluid, and, therefore, facilitating its circulation through the obstructed or hyperaemic vessels. It was a remark of the distinguished Laennec, that the strength of the pulsation of the heart under the stethoscope is an excellent guide for the use of the lancet. " In all cases," he says, " in which the pul- 174 SEDATIVES. sations of the heart are proportionately more energetic than those of the arteries, Ave may bleed fearlessly; and be certain of an improvement in the state of the pulse. But if the heart and the pulse be alike feeble, blood-letting will almost always precipitate the patient into a state of complete prostration;"—and he adds:—"the certainty and facility with which the stethoscope affords or excludes the indications for blood-letting appears one of the greatest advantages conferred by this instrument." This is doubtless a good general rule; but account must be taken of exceptions in nervous and hysterical subjects, in whom pal- pitations may exist, and a temporary increase of force be detected under the instrument. It must be recollected, too, that in certain serious maladies, as enteritis, the pulse may be slow and feeble; whilst in inflammatory affections of infinitely less moment—as amygdalitis,— it may be strong and bounding; and again, as previously remarked, in reaction from positive exhaustion, as after loss of blood, the excited state of the heart and arteries may deceive at first the experienced practitioner. « Mere quickness of pulse, taken singly, can never be regarded as a positive indication for the use of the lancet, inasmuch as it occurs in diseases which are highly neuropathic, especially where they are ac- companied -at the same time by debility; and it is almost always pre- sent in approaching dissolution. The practitioner, consequently, who expects, under such circumstances, to diminish the velocity of the cir- culation by blood-letting, will find himself mistaken. In scarlatina, quickness of pulse is one of the most marked functional phenomena, and in the most malignant cases this quickness is often most striking; yet blood-letting can rarely be employed in such cases; and if it were, it would generally be found, that the quickness of pulse would be in- creased rather than diminished by it. Formerly—not many years ago, indeed—it was laid down, by many, as a rule of guidance, that in a case of internal inflammation, blood- letting ought to be repeated so long as the blood drawn exhibits a buffy coat; but this is a rule now properly abandoned. It is clear, indeed, from what has been said of the results of observation, that, in some cases, it would exhibit this character immediately before the occurrence of fatal syncope. But the buff is not perceptible in cases of high in- ternal inflammation only; it is met with in acute rheumatism, in the pregnant condition, in chlorosis, and, at times, in persons of great nerv- ous excitability. In the first of these cases, there is no disorganizing inflammation present,—none, that requires the same activity of treat- ment to preserve life, which pleurisy, for example, does; and, in the second, the buff appears Avhen the female is in health. (Vol. i. p. 65.) Perhaps, however, the most important of the facts to be borne in re- membrance is the third,—that we observe it in the blood of persons of high nervous excitability, even when no inflammatory condition is present; and when, on the contrary, the blood is watery,—or does not contain the healthy proportion of solid constituents. Such cases oive rise to great hesitancy and difficulty in the mind of the practitioner, Avhen signs of hyperaemia exist in an internal organ. The author attended a case of the kind in company with Dr. Gibson, of Baltimore. BUFFY COAT AS INDICATING BLOOD-LETTING. 175 The subject was an amiable and gifted young lady, whose temperament might be regarded as eminently nervous or impressible. She had been labouring under pain on breathing; but without much cough: the skin Avas, at the same time, hotter than natural,—decidedly so at some periods of the twenty-four hours; and the mucous membrane of the tongue, although moist, was coated, and indicated the existence of in- ternal hyperaemia. She had been judiciously treated: blood had been taken; and counter-irritation established, both on the region of the chest and in the secretory system in general; for the mouth had been slightly affected by mercury. A day or two before the author saw her, she had expectorated blood in the morning, which was florid, but not frothy, and was not brought up by any effort of coughing. At his first visit Avith Dr. Gibson, it was proposed that blood should be drawn, not so much in consequence of the presence of urgent symptoms, but from the apprehension, that the affection, which ap- peared to exist mainly in the pleura costalis, might extend; whilst, at the same time, a knowledge of her temperament, and the character of her symptoms, suggested, that the abstraction should be practised with caution. The blood, previously drawn, was buffed; and this was re- garded as one element in the decision that a farther abstraction should be made. She was accordingly bled; the blood was again buffed; but the crassamentum Avas small in quantity, and very thin; so that it could be laid hold of, and separated from the large amount of serum in which it was placed, and be held up like a piece of leather. Only a small quantity of blood was taken; and yet the depression produced by it was urgent, and sufficiently demonstrated the propriety of the great caution that had been exercised in the employment of the lancet. The pain Avas, however, entirely relieved; and, by keeping up a centre of irritation, by means of the ointment of tartrate of antimony and potassa applied on the exterior of the chest, the symptoms were entirely re- moved. For this fortunate termination she Avas mainly indebted to the discrimination of her attending physician; for had he carried the blood- letting farther, prostration would have ensued to a much greater extent; a corresponding reaction would have been established, and any hyperae- mia that might have existed would probably have been increased; yet, if the buffy coat of the blood were to be regarded, in all cases, as une- quivocal evidence that a farther abstraction of that fluid should be made, it ought assuredly to have been practiced in this case. In the case, too, of affection of the encephalon, Avhich the author described as having attended with Professor Smith, (p. 162,) the blood exhibited the buffy coat; yet its abstraction, even in small quantity, induced violent palpitation and other nervous phenomena that prevented its repetition. It may be affirmed, then, as a rule, that the appearance of the buffy coat cannot, when taken singly, be esteemed a sufficient reason for the farther abstraction of blood; that the propriety of a repetition must depend upon other symptoms taken along with the buffy coat; and farther that such a coat may be present, AA-hen there is no concomitant inflammatory condition, or when it is by no means to a dangerous extent. 176 SEDATIVES. The general vieAVs that have been laid doAvn with regard to the use of blood-letting will have demonstrated the value of this therapeutical agent in inflammatory affections; and the circumstances that must be taken into consideration in judging of the extent to AAdiich the abstrac- tion of blood must be carried, and of the best mode of after manage- ment for reaping full advantage from it, where it may have been employed as far as the practitioner has deemed prudent, and yet hyperaemia may still exist. Such cases require the nicest discrimi- nation; yet blood-letting has been so much the fashion in all dis- eases of an inflammatory character, and—it may be said—in all sudden diseases, that the public voice calls loudly for the lancet; and the practitioner, led aAvay by popular clamour, and not sufficiently fortified by the possession of sound pathological and therapeutical principles, falls in too frequently Avith the Avishes of bystanders, who are commonly totally ignorant of the proper course to be pursued. If, too, he be not possessed of right presence of mind, he may adopt measures of Avhich his better judgment may by no means approve. On a public occasion some years ago, in an address delivered to the Graduates in Medicine at the annual commencement of the University of Maryland, the author had an opportunity of adverting to some cases of this kind, that are of daily occurrence. A man falls from a height, bruised—stunned perhaps—and the general call is for a surgeon to bleed him; yet, in many such accidents, a shock is given to the great nervous centres—the brain and spinal marrow—the effects of Avhich bleeding is well calculated to augment—and augment fatally— if employed immediately after the receipt of the injury, and before reaction has taken place. In like manner, if a person, when vehe- mently addressing an auditory, falls down suddenly deprived of ani- mation, the impression immediately is, that he has had an apoplectic seizure. A vein in the arm or neck, or the temporal artery, is imme- diately opened, and the state of suspended animation may thus be con- verted into one of death. The heart, in such cases, has ceased to act, and the free abstraction of blood from the general circulation may not be well adapted to restore it. When a person is attacked with apoplexy, it rarely happens that he dies instantaneously. A train of phenomena, characterized by loss of sensation, volition, and mental and moral manifestation, succeeds for a time; and is the precursor of dissolution. Circulation and re- spiration, in the meanAvhile, continue; but, Avhere the heart dies first, the circulation ceases; respiration is no longer accomplished, and the state of suspended'animation becomes converted, almost instantaneous- ly, into positive death. This view has been confirmed by the cases of instantaneous death, Avhich the author has had an opportunity of ex- amining. In most of them, the state of the heart has indicated, that the cessation of its action was the first link in the chain of phenomena. The satisfaction often felt at the exhibition of energy on the part of the practitioner is well exemplified by an anecdote, which an illustrious native of this country—now no more—Avho had filled the hio-hest office in the gift of a free people, and whom the author had the°honour of ranking amongst his personal friends—Avas in the habit of recounting. BLOOD-LETTING. 177 Travelling from Virginia towards the north, he rested for a night at a tavern on the road. Soon after his arrival, the hostess came in from a neighbouring house with the females of her family,—all exhibiting marks of deep distress. He Avas informed, that they had been Avitness- ing the parting scene of a young friend, Avho had died of some acute affection. " But, thank God!" observed the contented matron, " every- thing Avas done for him that Avas possible, for he was bled seven-and- twenty times." " It is not"—says the inimitable Moliere, who Avas un- sparing in his appropriate philippics against the profession, and the public of his day—"it is not, that, after all, your daughter may not die; but, at all events, you will have done something, and you will have the consolation that she died according to form." After the lecture, to which allusion has been made, was delivered, the author's friend, Dr. Wright, of Baltimore, put into his hands a work published by him nearly forty years ago, which, in an appendix, contains views so strikingly like those which the author promulgated on that occasion, that they might be regarded as the prototypes of his. Dr. Wright's excellent ' sketch' had not previously, however, fallen under his observation; the coincidence of vieAvs is, therefore, accidental, and it afforded the author no little satisfaction to find, that his senti- ments accorded so strikingly with those of so excellent an observer. The appendix contains a masterly critique of the views of Dr. Rush, as contained in his 'Defence of Blood-letting.'—'"We must do some- thing,' is the most unfortunate and pernicious maxim," says Dr. Wright, " which has ever been introduced into the policy of medicine. At the moment, when it received the sanction of professional reputation, pro- fessional imposture was legalized, and ignorance and artifice acquired confidence from feeling security. I refer to no particular authority for the inculcation of this sentiment. It has unhappily been stamped with the approbation, and received the connivance of numbers, who could have wanted nothing but reflection to have refused it their assent. Its adoption has never wanted advocates; it has been eagerly received, and amply exercised; and the profession is to this day disgraced by the admission, that ' mankind must be amused.' Had half the pains been taken to acquire professional understanding, Avhich have been practised to impose on society, this maxim might long since have been commuted for the more honourable sentiment, that mankind must be instructed. It is under the covert of this professional mask, that the prejudices of the Avorld have been pressed into the service of the prac- titioner, and its ignorance arrayed against its security. It is thus that a convenient resource has been provided against that false shame, which dreads a candid avowal; and the physician, armed with imple- ments, for whose use or consequence he apprehends no responsibility. Among the Aveapons of this licensed Avarfare against decorum and in- tegrity^ the lancet holds a distinguished rank. Like the SAVord of Alexander, it is the universal solvent of every difficulty; and has often been made to sever the gordian knot, which defective ingenuity was incompetent to unravel. Justice would be violated Avere those remarks pointed solely at the worthless herd, Avhose business is impos- ture : Avho openly repose their claims upon the hopes and fears, the vol. ii.—12 178 SEDATIVES. follies and the weakness of their fellow-creatures. They reach even him to AA'hom contingent circumstances have opened a more ample and elevated range in professional relation; Avho, without an effort to improve that profession, is solicitous to enjoy, by other means, the benefits of its exercise." The whole of Dr. Wright's remarks on the subject of blood-letting as a therapeutical agent are judicious; and it is a matter of regret, that, OAving to the exhaustion of the copies, the Avork is not available to the profession. It has been long hoped, that he might find leisure to lay before it the substance of the appendix to Avhich the author has re- ferred, with the modifications—if any—that have been suggested by his subsequent observation and reflection. Allusion has more than once been made to the induction of syncope, as marking the effect produced by blood-letting on the functions; and this is the criterion established by many practitioners, as to the requi- site quantity of blood to be abstracted in cases of internal inflamma- tion. In general, no harm may arise from the rule, but there are ex- ceptions to this, as Avell as to all other rules. Fortunately, the condi- tion of inflammation impresses a degree of tolerance on the system, which, in the vast majority of cases, enables it to withstand the abstrac- tion of blood, even when carried to an injudicious extent; but in ex- treme ages—in early infancy, and in advanced life—the frame does not rally so readily from the sedation; and the author is satisfied, from actual observation, that many persons at those ages have had their deaths hastened—if not mainly occasioned—by the too vigorous use of blood-letting. This is especially apt to occur in diseases, in which the degree of inflammatory irritation is not so great as to com- municate to the system the full tolerance; and especially in those cases of coma or convulsions in early childhood, to which reference was previously made, as being presumed to depend on " congestion," and, therefore, to require blood-letting. In these unhappy cases, the fancied signs of congestion increase after the operation; the farther abstrac- tion of blood is, therefore, determined upon ; the powers of life fail; effusion takes place into the ventricles, and the child dies from exhaus- tion,—that exhaustion having been partly induced by the means adopted for the removal of the malady. Such is not, however, in all probability, the opinion of the practitioner. He consoles himself Avith the reflection, that the fatal event has been occasioned by the intensity of the disease. When a similar state of affairs occurs, he has, consequently, recourse to the same management, with like re- sults ; and, at the end of a long life, he is perhaps ready to exclaim, —that he has never had occasion to regret the employment of blood- letting, but has often reproached himself for not having pushed it farther. All this has arisen from the indiscriminate faith, placed in this valu- able agent—valuable only when appropriately employed—by others besides the Sangrado of Le Sage. " With regard towage," says Pro- fessor A. T. Thomson,—"in infancy, the laxity of the solids, and the relative proportion of the serum or watery part of the blood to the crassamentum or clot, which consists of fibrin, and colouring matter, BLOOD-LETTING. 179 are more considerable than in adult age : blood-letting, by increasing this greater proportion of serum, proves hurtful; and a state of syncope in infants is always one of great danger. The first effect of exhaus- tion in such young subjects is an increased degree of irritability, which leads to stupor, and generally terminates in convulsions; the pulse is quickened, the pupil of the eye dilates, and symptoms closely resem- bling those which precede the effusion of water in the ventricles present themselves. I have seen this more than once occur in children in whom symptoms resembling those of inflammation of the brain, accom- panying irritation of teething, have displayed themselves: and leeching or cupping has been resorted to; but, instead of affording relief, a state of evident defective stimulus supervened; and, in one case, snoring, stertor, and other appearances of apoplexy having folloAved the bleed- ing, more leeches Avere applied, and the infant died. This state is detected readily by attention to the state of the breathing, Avhich seems to be performed almost wholly by the diaphragm; and is always accom- panied with the evolution of much flatus; both circumstances denoting a very low state of the nervous energy. It is best obviated by white wine whey, opium and ammonia, administered warm, in small quanti- ties, and frequently repeated. In youth, and in the vigorous and robust, on the contrary, reaction takes place, and is especially marked after re- peated venesections. The most favourable age for bearing blood-letting is from eighteen to forty-five. In old people the reaction is extremely feeble; and, during the flow of the blood, exhaustion often steals on so insidiously and imperceptibly, that when nothing injurious is antici- pated, syncope appears; no reaction can be induced, or it is defective, and gives Avay to a state of positive sinking. The risk in such a case is extreme." The dangers conceived to arise from general blood-letting, in early childhood, are considered by some so great, that they ne\7er have re- course to it, preferring leeches or cupping; but provided it be care- fully practised, it is safe, and the impression made upon the diseased condition—if one of active inflammation—is usually more decidedly salutary. The abstraction should not, hoAvever, be carried so far as to induce syncope. Owing to one or more fatal events having succeeded to the operation in Edinburgh, the Professors,—during the author's attendance on the lectures there,—Avere in the habit of inculcating excessive caution in regard to its use at that early age. " The expe- rience of fifteen years, and some of it of a sorroAvful kind," says Dr. Casper Morris, of Philadelphia, " has convinced me fully, that children bear bleeding illy, and in asserting my convictions that as many chil- dren have sunk under the ill-judged use of depletion as from incurable disease, I would not cast censure upon others without taking to myself a full share of it." In his "Essays on Infant Therapeutics," Professor J. B. Beck has urged great caution in the use of this agent in such cases; first, on account of the young subject not bearing the loss of considerable quantities of blood as well as the adult; secondly, on ac- count of the nervous system being more powerfully affected b3r the loss of blood ; thirdly, on account of the repetition of blood-letting not being so Avell borne ; and fourthly, because the effects of local blood- 180 SEDATIVES. letting, especially leeching, on the child are different from what they are on the adult. In the latter, the effect of leeching is in -a great measure local, and it is not usually resorted to, until after general blood-letting is considered inadmissible. In a child, on the contrary, it produces very much the same effect as general blood-letting. Of the propriety of caution in advanced life, the author had a strik- ing instance soon after he commenced practice. It Avas, indeed, of so alarming a nature, that it could not easily be forgotten. An elderly gentleman was directed to be bled for chronic bronchitis, and the author was requested to perform the operation. After the abstraction of a few ounces, syncope rapidly supervened; and it was so long before the vital functions were restored, that he became seriously apprehensive the patient Avould die under his hands. He ultimately recovered; but a considerable period elapsed in this stage of examina- tion or transition between life and death. The same caution is requi- site in taking away blood when there is chronic disease of the heart or great vessels. The author has known two cases, in which the syn- cope, induced by blood-letting practised for the removal of symptoms of internal hyperaemia, became the syncope of death ; the irritability of the heart seemed to be suddenly destroyed, and it never resumed its pulsations. In one of the cases, the existence of organic disease of the heart was known; but the individual seemed as if he could tole- rate a copious abstraction of blood; before, however, a few ounces had been taken, he fell from his chair and expired. In such doubtful cases, the patient should be placed in the horizontal posture, and the flow of blood be arrested, before any decided effect appears to be ex- erted upon the functions of innervation or circulation. Such are some of the main points to be borne in view in the employ- ment of general blood-letting as a therapeutical agent, in inflammatory affections especially. There are cases, however, in which our object is to bleed to positive syncope—to relaxation—and where we have no fears of reaction; as where we are desirous of resolving forcible mus- cular contraction, or of reducing strangulated hernia. With this view, the patient is placed in a sitting posture, and the blood is made to floAV from a free orifice in one or both arms. Again, there may be cases,—as already remarked,—in which gene- ral bleeding may be unadvisable; and yet where topical bleeding may be advantageous. There was a time—indeed, the feeling still exists with a few—when it was maintained, that there can be no case in which topical blood-letting appears to be required, which could not be relieved, and more effectually, by blood drawn from the general sys- tem ; and certain practitioners have gone so far as to express their regret, that such agents as a leech, or a scarificator and cupping-glass were ever known. There is, here, probably, defective observation— modified, perhaps, by the existence of ancient and preconceived opinions —which interferes with the correct reflection and deductions of the practitioner. The author has repeatedly satisfied himself, that local abstraction of blood has produced the most beneficial results, Avhen general blood-letting had been—or would, to all appearance, have been BLOOD-LETTING. 181 —entirely ineffectual. In many of these cases, however, the beneficial result was probably not owing so much to the blood draAvn, as to the attendant revulsion,—a modus operandi of blood-letting, general as well as topical, Avhich is considered elsewhere. (See Revellents.) It has been a common remark, that local blood-letting—Avhen not used as a revellent, but simply with the view of diminishing the quan- tity of circulating fluid, and of acting, in this way, on the powers of the system—is inefficient, and cannot be relied on when internal in- flammation is present; but this is an erroneous position. By multi- plying the number of cups or leeches, we can as certainly, although not always as effectually, reduce the organic actions, as by opening a vein; but the blood flows more gradually, and is, consequently, adapted for cases where venesection might not be appropriate. Every practi- tioner, who has employed leeches freely, must have met with cases in which the most decided effects Avere produced by the depletion, which they occasioned. Each good American leech, if Ave reckon the quan- tity of blood that may be encouraged to flow from the leech-bites, may be regarded as withdraAving a third of a fluidounce of blood; and, consequently, if we apply as many leeches as some of the modern French practitioners Avere in the habit of prescribing in gastro-enteritic, and other inflammatory diseases, we may take away a larger quantity of fluid from the vessels than we could do with impunity from the vein of the arm. Twenty or thirty ounces constitute a large bleeding; and it will rarely happen that the lesser quantity can be taken from a vein without the supervention of syncope, and the inconveniences, which in particular habits, are apt to follow that state; Avhilst a much larger quantity can be abstracted under the gradual flow that takes place either when leeches or cups are the agents. An experienced leecher of Baltimore informed the author, that there is not much dif- ference in the quantity of blood, which the American, the Turkish, the German or the Spanish leech can contain. This may be estimated at about a quarter of a fluidounce; but they differ essentially as re- spects the flow they occasion from the bites. By the Turkish and the German, a fluidounce may be lost, including the quantity swallowed by the leech; and by the Spanish, half an ounce; whilst we can scarcely calculate on more than a third of an ounce from the American. It has fallen to the author's lot to witness some alarming cases of ex- haustion, especially in children, where leeches had been applied: in two, indeed, the result was fatal. In both, due attention had not been paid, and a large amount of blood Avas lost before the cause of the sink- ing was discovered; and in one, every attempt to arrest the flow of blood failed. These cases are rare; but they constitute objections to the use of leeches, which do not apply to cupping,—the flow from the wounds made by the scarificator being more readily arrested. When practicable, the leeches should be placed over bone, in order that pres- sure may be conveniently made on the bleeding vessels, should such a course be requisite. " From the greater vascularity of the skin"—says Dr. J. B. Beck—" the amount of blood lost by a leech, applied to a young subject, is much greater than in the adult, and it is frequently much more difficult to arrest the hemorrhage from it. The general 182 SEDATIVES. effect, then, of leeching on the young subject, is much greater than upon the adult. Hence it is, that cases are so frequently" [?] " occur- ring in which children die from leeching. Of this we have numerous cases on record." " When leeches are applied to soft parts,"—says Dr. A. T. Thom- son—« fOT instance, to the abdomen, it is truly astonishing how much blood sometimes is detracted; particularly when a poultice is applied over the bites, and the patient is kept Avarm in bed: to prevent, there- fore, injurious symptoms of exhaustion from such a circumstance, the poultice should be frequently examined. This is more likely to occur in children than in adults; and in children it not unfrequently happens that the bleeding cannot be stopped Avithout encircling the orifice with a ligature. On this account leeches should never be applied late at night on children; for, as the application of leeches in infancy must be re- garded as a species of general blood-letting, the precise number Avhich will regulate not only the quantity, but be equivalent to rapidity in the detraction of the blood should be determined; but the bites should be instantly closed, on observing that the system is brought under the in- fluence of loss of blood." In all cases of hyperaemia, occurring in the child, or in the adult, the therapeutist Avill have to exercise the best of his judgment as to the propriety of the adoption of general or local blood-letting, or both. It is not a true position, then, that general can always be substituted for local blood-letting with equal advantage;—nor does the converse of the proposition hold good. Both general and local blood-letting diminish the quantity of fluid circulating in the vessels; they are both, therefore, adapted for cases of polyaemia or plethora, although the former is more available than the latter Avhere copious abstraction of fluid is necessary; but general blood-letting is not adapted to every case of hyperaemia. In some cases, a small quantity of blood, obtained from the inflamed part itself, affords instantaneous relief, when general bleeding has been used in vain; and there are cases, again—as has been shoAvn, when treating of Excitants—that are relieved by stimulating the vessels to contraction, after both local and general blood-letting have failed. It must be borne in recollection, that inflammation is not caused directly by the condition of the general circulation, but by a morbid state of the system of nutrition of a part. Inflammation may attack the arteries and veins themselves; and even this is not, or need not be, connected Avith the state of the blood in the inflamed vessels, but is de- pendent upon a morbid condition of the tissues and vessels that form their coats. Blood-letting, consequently, even in this case, can be but an indirect agent. By diminishing the amount of circulating fluid, it may reduce the activity of the capillary vessels, and thus remove the hyperaemia; but it exerts no direct sedative agency on the vessels them- selves. Such is the fact in every case of inflammation. The action of the capillaries is distinct from that of the heart; and—as before re- marked—inasmuch as inflammation is connected with a morbid condition of the capillaries, the most philosophical plan of medication would be, to direct our remedial agents to those vessels; but as this cannot ahvays be effected, AAre are compelled to have recourse to the only sue- LOCAL BLOOD-LETTING. 183 cedaneum Ave possess—the abstraction of blood from the general sys- tem, and the sedation which this is capable of effecting. In diseases of certain parts of the organism, Ave have a choice of ves- sels so as to enable us at times to empty the affected capillaries, or to reduce the quantity of blood, or, in other words, the amount of stimu- lus in them, more effectually; but our sphere of action, in these cases, is extremely limited; and perhaps in internal inflammation null. It can be understood, that if hyperaemia were present in the hand,— blood, taken from the bend of the corresponding arm, would empty the vessels concerned more freely than if it were taken from the other arm, or from the external jugular; but in hyperaemia of an internal organ, we have no mode of opening a vein passing between the inflamed part and the heart. It has, indeed, been recommended, under the views here laid doAvn, that blood should be taken, either from the temporal artery, or from the external jugular vein, in cases of inflammatory affec- tions of the encephalon; yet slight reflection will show, that no great advantage can be expected from this course; and, indeed, plausible arguments might be advanced to prove, that the disadvantages might overbalance the presumed benefits. For example, blood, in every case of the kind, where the artery is opened, must come from the external carotid—a vessel which does not supply the encephalon—and, conse- quently, it cannot be supposed, that any benefit could accrue from selecting that vessel in a case of encephalitis. It may be argued, hoAvever, that if more blood be solicited into the temporal artery, less will pass along the internal carotid; but this argument, again, might be combated—and philosophically—under the view, that as both the internal and external carotids arise from one trunk, any cause, that A\rould solicit blood into the one, might attract a larger afflux along the common trunk; and, therefore, augment the flow into the other. The same reasoning applies to phlebotomy practised upon the exter- nal jugular vein in head diseases. If we could open the internal jugular, we might assuredly materially affect the state of the encephalic vessels, by emptying the sinuses, which, by their union, constitute that vessel, or rather supply it with blood; but this is impracticable; and, as the external jugular conveys the blood back to the subclavian from the exterior of the head only, no advantage can accrue from selecting it, where the encephalon is in a morbid condition. It has been proposed by many, that a branch of the temporal artery should be opened in cases of violent ophthalmia; but the proposition has probably been hazarded without due examination. If we could always take blood from the ramifications that proceed toward the eye; and, after the blood-letting, destroy them by cutting them across, the plan might be advantageous; but unless we divide those very branches, the effect may be anything but salutary. By obliterating some of the arterial ramifications, more blood may be distributed to the others; and, in this way the ophthalmic branches may become developed, and more mischief than good accrue from the operation. Owing to these objec- tions arteriotomy is not often had recourse to in such cases: it is rarely, indeed, employed, except in sudden seizures, as in apoplexy; and then rather on account of the ease with Avhich it can be accomplished—in 184 SEDATIVES. the absence of bandages, &c.—than in consequence of any therapeuti- cal preference, Avhich should be given to this mode of abstracting blood. It is an important fact, moreover, connected Avith this inquiry, that the experiments of M. Poiseuille Avith his haemadynamometer have shown conclusively, that the pressure of the blood in the different vessels is alike, and consequently, that the tension can be relieved as effectually by taking blood from one vessel as from another. The essential difference, after all, between topical and general blood- letting, is, that by the one we abstract blood from the capillaries; by the other, from the larger vessels. Now, in internal inflammation, topical blood-letting cannot be employed on the vessels of the part: it must be effected at a distance from the seat of the mischief; and, ac- cordingly, its operation is of a mixed character—combining depletion and revulsion; but in external inflammation, we can make our deplet- ing agents affect the vessels themselves, that are morbidly implicated. With this intent, cupping is rarely used. The operation cannot Avell be borne on an inflamed surface, OAving to the pressure of the cups. Scarifying the part is, however,—in diffusive inflammation especially, —a most energetic agent; and half an ounce of blood, discharged from the over-distended vessels, is followed by more benefit than all other remedies together. Mr. Lawrence has well shown the marked utility of free scarifications through the integuments in the diffusive inflamma- tion of the skin, which constitutes erysipelatous inflammation ; and, in the varieties of erythematous inflammation of the fauces, Avhich are attended by deep dusky redness, and very painful deglutition, Avithout any great degree of swelling of the mucous membrane of the fauces or of the subjacent parts, signal relief is afforded by deeply scarifying the membrane. The pain on deglutition is often almost instantaneously removed; and the cure is rapid. In all such cases, the scarification should be free. The blood generally flows readily from the divided vessels; retraction of their extremities takes place; and a new recu- perative action is substituted for the more sluggish and asthenic that constituted the original affection. Similar good effects supervene on scarification of the tunica conjunctiva, in inflammation of that mem- brane. Blood is sometimes abstracted from the capillaries of an inflamed part by means of leeches; but it has been made a question Avith the reflecting, whether leeches are not likely to occasion more mischief than benefit, owing to the irritation excited by their bites, and the afflux of blood to the part caused by their sucking. Apprehensive that such may be the consequence, many therapeutists are in the habit of applying them on the sound parts in the vicinity of the seat of in- flammation ; but here, again, it may be a question Avhether there may not be evils attending the practice that are Aveighty. * When leeches are applied over an inflamed surface, they obtain the blood immediately from the affected capillaries. This, of itself ouo-ht to be salutary. But it is asserted, that their bites become centres of irritation, and that they may augment the phlogosis. This may be the case; but in the generality of instances the new action, thus excited, has perhaps an opposite effect:—accompanying, as it does, the evacua- LOCAL BLOOD-LETTING. 185 tion of the dilated capillaries, it may increase their tone; prevent sub- sequent distension; and thus remove the hyperaemia. When, hoAveArer, leeches are applied near the inflamed part, they cannot empty the affected capillaries; and by attracting blood into the neighbouring ves- sels, they may occasion a greater afflux towards those morbidly impli- cated. The author is not in the habit of applying leeches immediately on the part in external inflammation; but Avhere he has done so, they have not seemed to him to be followed by the aggravation of symp- toms anticipated by some; and in many cases marked relief has been experienced. Where applied at all, it appears to him, that they should be placed over the inflamed vessels rather than in the vicinity. The conflicting views, above mentioned, have been, and are, fre- quently entertained in cases of mastitis occurring after delivery. Whilst some recommend general blood-letting, and revulsion effected by pow- erful emetics and cathartics; others advise the application of leeches; and others, again, are of opinion, that their employment is not produc- tive of any advantage. The author has used them in such cases more than once; and it has appeared to him with benefit; but he has seen more from the employment of agents of the excitant kind. The loose texture of the mammae alloAvs the capillary vessels to be readily over- distended ; an asthenic condition is thus induced in them, which is the source of excitation in the arterial ramifications continuous with the asthenic capillaries; and this asthenic condition is best removed by the application of excitants—as of heat considerable greater than that of the body—to the inflamed part. Where we are desirous of obtaining a larger quantity of blood than would flow spontaneously from leech-bites, even when encouraged by the application of cloths wrung out of Avarm Avater, or by that of a warm cataplasm, cups are sometimes placed over the bites. A con- siderable quantity of blood may be thus abstracted; and Ave have the advantage of the revulsion, which the cupping-glass is capable of ef- fecting, should the propriety of such revulsion be indicated. It has long been a custom at the commencement of the cold stage of intermittents to apply ligatures to the extremities; Avhich in many cases, have given occasion to a mild hot stage, and abridged the dura- tion ©f the whole paroxysm. Their modus operandi has been a matter of question. By some it has been supposed, that the obstruction to the venous circulation in the extremities causes an accumulation of blood in the superficial veins ; and a consequent increase in the action of the heart. The true explanation is probably the one suggested by Dr. Mackintosh : the detention of blood in the superficial vessels cuts off, as it Avere, a certain quantity of fluid from the circulation, so long as the detention continues; and in this manner exerts an analogous effect to the withdraAval of the same quantity of fluid from the vessels. This is illustrated by the folloAving case, cited by Sir George Lefevre from Dr. Wilson, in which the disposition to swooning in an erect attitude appeared to be owing to varicose veins of the lower extremities robbing the brain of its usual quantity of blood. A lady, past the middle a^e, Avas so subject to faint Avhen in the erect posture, that, 186 SEDATIVES. although otherwise in good health, she Avas confined to her bed and sofa. As soon as she attempted to rise, she felt faint or even swooned. The cause of this phenomena for a long time baffled the skill of her medi- cal attendant, until by some accident, he discovered that she had im- mense varicose veins in both legs ; and in the erect posture these be- came reservoirs for the blood, which accumulated too much in them to be propelled forward; hence, the balance of the circulation Avas de- ranged; and the brain, robbed of its usual quantity of blood, manifested symptoms of Aveakness. By the application of proper bandages, which supported the vessels when she Avas in the erect posture, the distress- ing affection was overcome. Haemostasis—as this mode of arresting the blood in the vessels by ligatures has been termed—has been recommended by Dr. Thomas Buck- ler of Baltimore as a sedative agent, especially in internal hyperaemia or inflammation; and there can be no doubt that it may be extensively available. "It is capable," he remarks, "of exerting, under given conditions, a more powerful control over the circulation than the lancet, antimony, or digitalis, and controls the heart's action without exhaust- ing the vital forces, or giving rise to the ill consequences, which the protracted use of most of the sedative agents is likely to do; and, finally, haemostasis in the hands of judicious practitioners must prove the means of saving an incalculable amount of blood ; to say nothing of the incredible benefits, which would be derived from its adoption by those Sangrados of our art, Avho bleed empirically in all conditions, and who, in many cases, like the fabled vampire, suck the living cur- rent until the vital powers are spent." ILemospasia, described under Revellents, acts sedatively in a similar manner to haemostasis. Under the head of sedatives may be included a set of therapeutical agents, now much used in Italy more especially; but also adopted in France and in Great Britain,—rarely in this country,—which, by re- moving excitation, might be termed sedatives, but by their propounders, have been called contro-stimulants or contra-stimulants ; and the theory Avhich suggests them, the theory of contra-stimulus, the new medical doc- trine of Italy, La nuova Dottrina, &c. Prior to the termination of the last century, the doctrines of Brown were universally embraced in Italy; and they continued in vogue until Rasori, on the occasion of a petechial fever making its appearance in Genoa, subjected the prevalent views to considerable modification ; and, as in most similar cases, ended by embracing others diametrically opposite. Rasori maintained, that most diseases are owing either to an augmentation of excitability, or to an excess of stimulus; and he con- ceived, that there are certain medicinal agents, which possess a pecu- liar debilitant power; and which act upon the excitability of the frame in a manner directly opposed to that in which stimulus acts upon it. To this power he gave the name contra-stimulus. The mode in which the different contra-stimulants have acquired CONTRA-STIMULANTS. 187 their reputation appears to have been as simple as it must frequently have been fallacious. Every agent, which succeeded in removing a sthenic disease, could do so only, it was presumed, by diminishing the excitability, or removing the stimulus: accordingly, it was a contra- stimulant. Substances Avere therefore classed together, which bore no relation to each other—as regarded the physiological phenomena they induced—either in their immediate properties, or in their secondary effects. In the lists are to be found emollients—as milk and gum; astringents—as acetate of lead; tonics;—as gentian, simarouba, iron, and, according to some, even cinchona; excitants—as turpentine, squill, and arnica; emetics—as tartrate of antimony and potassa, and ipecacuanha; narcotics—as stramonium and belladonna; acrid poi- sons—as arsenic, nux vomica, cantharides; and a host of other animal, vegetable, and mineral substances, which have no kind of analogy to each other. It has been properly observed, that this manner of regard- ing the effects of medicines tends essentially to bring together the most dissimilar substances, as well as to separate such as are closely allied; and, consequently, to confound all. It may be said of this theory, however, as of every other, that the practice built upon it has added valuable facts to therapeutics; and not the least of these is the knowledge, that tartrate of antimony and potassa may be administered in large doses, in inflammatory affections, not only with impunity, but with advantage. This potent emetic may be given to the extent of ten or twenty grains or more, in divided doses, during the day, Avithout either producing vomiting or purging; or, if the first doses prove emetic, a tolerance may be soon acquired ; and the subsequent doses be followed by no manifest effect, except the diminution of the febrile symptoms. At other times, the urinary and cutaneous depurations appear to be largely augmented, and rapid ema- ciation succeeds to its administration. The contra-stimulant physicians maintain, that the exaltation of the vital manifestations, in febrile and inflammatory diseases, enables the system to bear the large doses of this and other contra-stimulants ; and they say, that the tolerance van- ishes with the disorder that communicated it;—but this assertion is not confirmed by experience. There is, certainly, a greater resistance to the action of these agents, as there is to blood-letting, when all is exalt- ation ; but the power of resistance does not cease, although it is dimi- nished, when the exaltation ceases. Some individuals, too, never possess the necessary tolerance; so that, with them, tartrate of anti- mony and potassa does not produce contra-stimulant effects; and it would seem, that there are, also, what the French term " medical con- stitutions," or " epidemic conditions," which forbid its employment. Thus, according to M. Bricheteau, although it was so successfully used in 1831, it could not be beneficially administered at the end of 1832, and the beginning of 1833. Not until the autumn of the last year could it be resumed advantageously. On one occasion it Avas given in the hospital by an Eleve de garde, during the choleric epidemy. The most violent symptoms supervened, and the patient died of cholera morbus no sign of which existed before the tartrate Avas taken. Of the different phlegmasia?, acute rheumatism and pneumonia are 188 SEDATIVES. those that are considered to have been most successfully combated by this agent in a large dose. "Emetic tartar," says M. Bricheteau, " should generally be preceded by blood-letting; and commonly it is advisable not to have recourse to the former unless the latter is insuf- ficient, except in cases in Avhich blood-letting is contra-indicated, or impossible, owing to some special circumstances,—as happened to me once in the case of a rickety individual, Avho had no veins adapted for phlebotomy. The medical constitution of the season is, also, occa- sionally opposed to the abstraction of blood: in such cases, tartrate of antimony and potassa is a valuable agent. Recourse may, like- wise, be had unhesitatingly to it at the very first, when the patient is exhausted by age or other causes, and appears to be too Aveak to bear the abstraction of blood; or, Avhere a positive refusal is given to the proposition for phlebotomy." " This agent," he adds, " must also be of great advantage, and of convenient employment, in country situations, Avhere the physician can rarely pay his visits at an early period. It may be practicable, by this method, and Avith the aid of an intelligent person, to regulate the treatment of a case of pneumonia or of rheu- matism for several days after having premised a copious abstraction of blood, if it be considered desirable." The fact, however, referred to by M. Bricheteau—that it is not every one who presents the necessary tolerance—Avould render this agent by no means as easy of application by the laity as he presumes. Experiments, recently instituted on dogs by MM. Dume'ril, Demar- quay, and Lecointe, to determine the modifications impressed on the function of calorification, by the introduction into the economy of dif- ferent therapeutical agents, have shown, as the result of several careful observations, that, Avhen injected into the veins in small quantities—as a grain dissolved in water—it constantly induced an elevation of tem- perature, varying from some tenths of a degree to 1°.3 centigrade. When introduced into the stomach in the quantity of four grains, it still caused an elevation, but less decided, the mercury not being af- fected more than 0°.6. When, however, the dose was carried to seven grains, the temperature fell rapidly,—in one case as much as two degrees in two hours. Granting, then, that tartrate of antimony and potassa, in a large dose, is a sedative agent, it becomes interesting to inquire into the mode in which such agency is exerted. It is, as is well known, one of our best suppurants, when we are desirous of establishing a centre of fluxion on a part of a cutaneous surface, Avith the view of removing an internal disease. Experience, too, has sufficiently shown, that, when given in large doses, it produces pustulation in the mouth and fauces, if not lower down the alimentary tube. In a case which occurred under the author's care in the Baltimore Infirmary, this effect of the antimonial was strikingly evidenced. M. Bricheteau—who has administered it largely, as a contra-stimulant—says, its local action is exerted more particularly on the mouth, tongue, and pharynx, where false mem- branes and pustules are occasioned by it; but these lesions, he thinks, are by no means common. The oesophagus, he says, never partici- pates ; and they are more frequent in the intestinal canal than in the CONTRA-STIMULANTS. 189 stomach; and, in the former, the lower part of the small intestines, and the commencement of the large, exhibit themselves more sensible to the action of the antimony than other portions of the tube; but it cannot be said, that sufficient opportunities have occurred for testing the effects of the remedy, and for diagnosticating the morbid appearances which have presented themselves from such may have proceeded from other causes. He is of opinion that the lesions, Avhich may be referred, Avith the greatest probability, to the use of tartrate of antimony and potassa,—although he admits, they are frequently OAving to other inap- preciable causes,—are, injection or infiltration of the submucous tis- sue of the intestines, and softening of the mucous membrane. In the mouth considerable inflammation—either pustular or ulcerous—is sometimes ^ observed, which speedily disappears after the discontinu- ance of the antimony. Many facts and arguments tend to the conclusion, that the contra- stimulant virtues of tartrate of antimony and potassa may be depend- ent upon its revulsive properties; that this revulsion is exerted in the lining membrane of the alimentary canal; and that when it is accomplished, the excited actions, going on elsewhere, become di- minished, and more or less nervous and vascular concentration takes place towards the seat of the artificial revulsion, Avhilst the general effect is one of sedation. Rasori thought that the remedy lessens stimulation, or augmented excitability, directly: Laennec first main- tained, that it acts as a revellent by irritating the stomach; but the followers of Broussais having made this a ground of opposition to the remedy, he latterly maintained, that it invigorates the activity of the absorbents; wdiilst Dr. C. J. B. Williams suggests that the most rea- sonable view to take of its operation is, that it acts chiefly by di- minishing the tonicity of the vascular system. He considers, in other words, that antimony—and some other remedies—" reduce directly the tone of the vascular fibre, acting as relaxants." " Small doses," he adds, " certainly relax the pulse and the skin, and Avhen there is no fever produce perspiration Avithout stimulating. They also seem to in- crease the biliary and intestinal secretion. In inflammation and fever, larger doses are required to produce the same result; and as soon as the excessive arterial tension is relaxed, the chief part of the fever is removed. By thus reducing the increased tonicity of the arteries, the circulation is equalized and quieted, and the determination to, and dis- tension of the inflamed part are diminished; and the vessels generally are placed in the condition for their natural offices of secretion, which their extreme tension had before interrupted." " This view," he pro- perly remarks, " is at present no more than hypothetical, and might Avith advantage be tested by experiments on the lower animals." The explanation of M. Mialhe, although hypothetical, is plausible; and it has the apparent merit of resting on chemical grounds. He supposes, that Avhen the tartrate of antimony and potassa is given in considerable quantities, there is not enough chlorohydric acid present in the stomach to displace the tartaric acid, and to produce the irritating compound—the chlorohydrate of chloride of antimony; whilst there may be enough to do so when the article is given in small doses. 190 SPECIAL SEDATIVES. MM. Trousseau and Reveil think "there is nothing mysterious in the benefits of tolerance: when tartar emetic is not rejected by vomiting it is absorbed in larger proportion. The efficacious dose is larger. This accounts for the whole. ( Voila tout.)" They admit, however, it is stated, that the salt is not capable under such circumstances of being detected in the urine; but the statement—in their opinion—requires confirmation. SPECIAL SEDATIVES. 1. ACIDUM HYDROCYAN'ICUM DILUTUM.—DILUTED HYDROCYANIC ACID Hydrocyanic, Prussic, or Cyanohydric Acid, combined Avith essential oils in certain vegetables, has been long employed as a therapeutical agent; but it was not much recommended in a separate state until about thirty years ago. It exists in the distilled water of Laurocerasus, and of bitter almond, as well as in the expressed juice of the leaves of Laurocerasus, the peach, &c. Its chief source, however, is in animal matters subjected to heat in contact with alkaline substances. The Pharmacopoeia of the United States, of 1842, adopted the process of the London Pharmacopoeia for the formation of the acid, which consists in separating it by the reaction of dilute sulphuric acid on ferrocyanuret of potassium. When Avanted for immediate use, it is directed to be prepared by the action of dilute muriatic acid on cyanuret of silver. By the double decomposition that ensues, hydrocyanic acid is formed, Avhich dissolves in the water, and the chloride of silver sub- sides. The clear liquor is then poured off, and kept for use. Acidum hyclrocyanicum dilutum, of the Pharmacopoeia of the United States, of 1851, is Acidum hydrocyanicum, of that of 1842. Dilute hydrocyanic acid, is colourless; of a peculiar odour, and wholly volatilizable by heat. One hundred grains produce with solution of nitrate of silver a white precipitate, Avhich, when washed and dried, weighs 10 grains, and is readily dissolved by boiling nitric acid. It contains 2 per cent, of pure anhydrous acid, and has a cha- racteristic odour. This must not be confounded with that of the oil of bitter almonds, which is decidedly different, and is much more depend- ent upon a true essential oil than on the concomitant hydrocyanic acid. (Christison.) It should be kept in closely stopped bottles, from Avhich the light is excluded. Some have supposed that glass stoppers are absolutely necessary for its preservation; but this has been denied. Hydrocyanic acid is usually classed amongst narcotic poisons; yet there is reason to believe, that its ordinary effects are purely sedative. Whilst agents belonging to the class of narcotics produce, first of all, excitation in the organic actions, followed, sooner or later, Avhen the agent is in sufficient dose, by signs of sedation; this acid occasions ACIDUM HYDROCYANICUM. 191 the latter results only. Of the rapidity of its action, in highly poison- ous doses, mention has already been made. When given in rather too strong a dose, or, if in proper doses, at too short intervals, it produces headache, and vertigo, which go off, hoAV- ever, in a few minutes. With regard to the parts of the economy that are primarily acted upon by it, most observers have had no hesitation in designating the nervous system. In no other way, it has been conceived, can we readily explain the extreme rapidity of its operation in fatal cases; yet when the extreme velocity of the circulation is borne in mind, many of the difficulties in the way of the belief, that it may pass with the blood to the vital organs for which the poison has a special affinity, are removed. (See vol. i. p. 96 and p. 375). That it exerts a toxical influence on the blood is shown by the fact that when mixed with it out of the body, it altogether changes the character of that fluid, and opposes its coagulation. From what has been said of its action, it is easy to infer the morbid cases in Avhich the acid may be indicated. It is decidedly sedative, allaying nervous irritability and vascular action ; and, there- fore, adapted for all cases in which these are unusually excited. Yet its power, as a medicinal agent, is not as great as was at one time presumed, and is still presumed, by many. The great objections that have been urged against it are,—its dangers, even in a small dose, if not cautiously administered; the difficulty of having it always of the same strength.; the impracticability of administering it undiluted; and the danger of giving too strong a dose, in consequence of its rising to the surface of water. More than once, too, the difference in the strength of the acid prepared by different methods Avould seem to have given rise to unfortunate results. The case of a sick person is mentioned by M. Orfila, who had used it for a length of time, in in- creasing doses, with advantage; but, being compelled to send her prescription to another apothecary, the acid returned Avas so strong as to produce death with all the symptoms of poisoning by hydro- cyanic acid. For these and other reasons, many of the German phy- sicians prefer cherry-laurel water and water of bitter almonds, which, although in other respects not less objectionable, are less dangerous. Sir George Lefevre, indeed, affirms, that cherry-laurel water—Aqua Lavrocerasi—is a far more effective preparation than hydrocyanic acid. In many nervous affections, as palpitation, hysteria, &c, he generally prescribes the following draught: R. Aquas lauro-cerasi tt\,xx. -----flor. aurantii f^j. Syrup, tolut. fgj. M. The draught to be taken pro re nata. The author has frequently employed hydrocyanic acid and its com- pounds, where a sedative agent has appeared to be needed, but the results have not satisfied him that they Avere owing to the remedy ad- ministered. It has been conceived to be especially appropriate in diseases that depend upon increased irritability of the nervous system, and in those connected Avith excessive sensibility. In fevers—inter- mittent or continued—it is rarely used. It is affirmed by Dr. A. T. 192 SPECIAL SEDATIVES. Thomson, that in no kind of idiopathic fever has it been employed; but in this he is mistaken. There are practitioners, who have preseribed, and continue to prescribe it, in such affections. By many it has been esteemed beneficial in hectic fever; but here, again, its agency is doubtful. In all the phlegmasiae, and in every kind of hyperaemia, simple or accompanied Avith hemorrhage, it has been tried, and numer- ous testimonials have been offered in its favour. Even in the formi- dable disease, phthisis, it has been extolled as a moderator of the cough, and a diminisher of the hectic. It is, however, in diseases belonging to the class spasmi of Cullen, that its powers are looked upon as most conspicuous,—in diseases, it must be admitted, in Avhich it is difficult to appreciate therapeutical agencies. In asthma, even when the pulse Avas small, irregular, and often not easily distinguishable, it is said to have acted almost like a charm,—removing the oppressed breathing, and restoring the free play of the respiratory organs; and in hooping- cough it has been conceived by Dr. Roe to possess almost a ' specific' power. " I do not think," says another observer, Dr. A. T. Thomson, " I am stretching my praise of it too far, in affirming that few cases of this disease Avould prove fatal, were the hydrocyanic acid early resorted to, and judiciously administered. After emptying the stomach with an emetic, and purging briskly, the use of the acid should be begun, and the prescription never altered, except to increase the dose of the acid. When thus treated, the disease seldom continues more than a month or- five weeks." " It is necessary," he adds, " to confine the little patients to a graduated temperature, and to keep them altogether upon a milk and vegetable diet." The author has often used hydrocyanic acid in hooping-cough, and endeavoured to observe its effects carefully; but the results have not been such as to enable him to place reliance upon it. It certainly has not ansAvered, in his hands, in the very cases mentioned by Dr. Thom- son, half as well as narcotics given so as to produce a sedative influence. In various neuropathic disorders of the stomach, especially in those in Avhich pain at the epigastrium was the leading symptom; in every form, indeed, of gastrodynia, and in painful affections of the bowels of a similar character, it has been found useful; as well as in chronic vomiting, connected or not Avith organic disease. It has, likeAvise, been given in neuralgia Avith great benefit. Externally, it has been employed in numerous cases;—as a soothing agent in severe pain,—as in toothache; diluted, as a lotion in painful wounds ; as an injection in fistula; and, associated with belladonna, as a cataplasm in neuralgia. In various forms of cutaneous disease, it has allayed irritation: associated Avith infusion of belladonna, it has been throAvn into the vagina in cases of uterine pain from scirrhus; and has been used as an injection in blennorrhcea. It is almost im- practicable, however, to enumerate the different morbid conditions in Avhich it has been prescribed. If the practitioner will bear in mind the effects, which it is capable of inducing upon healthy man, Avhen the dose is carried to the requisite extent, he will have no difficulty in deciding upon the cases in Avhich its agency may be appropriate. If not a true sedative, it is the nearest approach to one in the lists of the POTASSII FERROCYANURETUM. 193 materia.medica; and its employment is, therefore, clearly suggested m all diseases in which there is erethism,—administered alone, or along with other agents of the same class. The dose is one or two drops in a table-spoonful of any simple men- struum, increasing the dose gradually by one drop, until some effect is perceptible, either on the patient or the disease. The most com- mon on the patient is a peculiar impression in the back of the throat, with sluggishness in the movements of the tongue. " There is no dis- tinct evidence of its being a cumulative poison, though this has been at times suspected. Its operation must be diligently watched at first, till the proper dose be ascertained. This is the only secret for using it with safety and confidence." (Christison.) The ordinary strength of a lotion for cutaneous affections and painful ulcers is one part of the acid to two hundred of water; but the strength may be increased to twice or thricethis amount. Sometimes rectified spirit is added to it. A lotion of f5i. to f 3iv. of the acid to a pint of the decoction of com- mon ^ mallow has been used in acne and impetigo to diminish itching; and in ulcerated cancer to allay pain. It is important to bear in mind| that in these cases it affects the system, inducing giddiness and faint- ness ; so that great caution is needed. 2. POTAS'SII FERROCYANUHE'TUM.—FERROCYAN'URET OF FOTAS'SIUM. Ferrocyanuret of potassium, Ferrocyanide of potassium, Prussiate of potassa, Ferroprussiate of potassa, is prepared on the large scale, by calcining animal matters with pearlash in a redhot iron crucible; dis- solving the cold calcined mass in water; concentrating, and crystalliz- ing. It may, likewise, be prepared by boiling purified Prussian blue in solution of potassa, till the blue colour disappears; and then crystal- lizing. The salt, thus formed, is a double cyanuret of potassium and iron. It is in crystals of a lemon colour, which are Avholly soluble in four parts of temperate, and two parts of boiling water; but is insoluble in alcohol. It is in the materia medica list of the Pharmacopoeia of the United States. Ferrocyanuret of potassium is very rarely used in medicine. It would seem, indeed, to be inert or nearly so. Half a pound of a solu- tion of it has been swallowed; and a drachm, and two drachms have been given without any inconvenience. (Christison.) On the other hand, one writer,—Dr. Smart, of Maine,—regards it as a valuable sedative in febrile and inflammatory cases. He ascribes astringent powers to it in the colliquative sweats of phthisis; and affirms that it sometimes induces ptyalism, unattended with the fcetor which forms part of mercurial ptyalism. He, likewise, found it of service in neu- ralgia, and in hooping-cough. In an overdose, it occasioned giddi- ness, coldness, and numbness, Avith sense of sinking in the epigastric region. Notwithstanding, however, the recommendation of Dr. Smart, it is scarcely ever prescribed. The author has watched its effects in the SAveating of phthisis, but has never witnessed the slightest benefit VOL. II.—13 194 SPECIAL SEDATIVES. from it. The dose recommended by Dr. Smart is ten or fifteen grains dissolved in water, repeated every four or six hours. The salt is chiefly used for the preparation of 3. POTAS'SII CYANURE'TUM.— CYAN'URET OF POTAS'SIUM. Cyanuret or Cyanide of potassium—received into the edition of the Pharmacopoeia of the United States, for 1842, as one of the prepara- tions—is made by exposing Ferrocyanuret of potassium—the salt last mentioned—to a moderate heat until it becomes nearly white. It is then exposed to a red heat until gas ceases to be disengaged; distilled water is now added to it when cold, and it is evaporated to dryness. In this process, the cyanuret of iron is decomposed, and that of the potassium remains. It is soiled, however, by the iron, and the char- coal belonging to the cyanuret of iron. When the mass is dissolved in water, the iron and charcoal are deposited; the cyanuret of potas- sium is dissolved, and is obtained by evaporating to dryness. The dry salt obtained, must be kept in a closely stopped bottle. It is a white powder, having a sharp, somewhat alkaline and bitter almond taste, and an alkaline reaction. It deliquesces in moist air; is very soluble in Avater, and sparingly so in alcohol. Cyanuret of potassium has all the properties of hydrocyanic acid for Avhich it has been recommended as a substitute. Dr. Letheby states, as the result of his experiments on animals, that with the ex- ception of hydrocyanic acid of the strength of four per cent., cyanuret of potassium is the most virulent and active of all the compounds into which cyanogen enters. It has been advised, that it should be dissolved in eight times its weight of distilled wrater; and to this solu- tion M. Magendie gives the name ' medicinal hydrocyanate of potassa,' and advises, that it should be prescribed under the same circumstances and in the same doses, as medicinal hydrocyanic acid. He farther suggests, that to render it wholly independent of the action of the small portion of alkali contained in the cyanuret, a feAV drops of some vegetable acid may be added; or it may be prescribed with an acid syrup. The dose is a quarter of a grain, which may be gradually in- creased to a grain or more. It has been employed advantageously as an external application in facial, sciatic and other forms of neuralgia; in the form of lotion, (Potass. Cyanur. gr. i—iv.; Aquce f.SJ.;) and of ointment, (Potass. Cyanur. gr. ij.—iv.; Adipis 3j.) Added to poultices, it is affirmed to have relieved the pain of Avhite swelling. M. Andral employed it with complete success in a case of intense cephalalgia, which, for ten months, had resisted the most powerful remedies,—as bleeding, a seton in the neck, blisters and sinapisms. It Avas used in solution in the proportion of six or eight grains to the fluidounce of distilled water; and compresses, wet with it, were applied, for eight days, to the forehead and temple. 4. OLEUM AMYG'DALJE AMA'R.E.—OIL OF BITTER ALMONDS. This oil, obtained by distilling with water the kernels of the fruit of Amygdalus communis—variety amara—has been admitted into the DIGITALIS. 195 Materia Medica list of the last edition of the Pharmacopoeia of the United States, (1851.) It does not pre-exist in the almond, and is produced by the reaction of water upon amygdalin through the intervention of emulsin, both of which are contained in it. It is procured also by distilling the leaves of the cherry laurel, peach blos- soms, &c. The oil is of a golden yellow colour; bitter, acrid taste; and an agreeable odour, but not much like that of hydrocyanic acid. It is of greater density than water, and is soluble in alcohol and ether. Oil of bitter almonds is a most virulent poison, acting as rapidly as hydrocyanic acid, and with similar phenomena. Sir B. Brodie having accidentally touched his tongue with a probe, which had been dipped in the oil, was affected almost instantaneously with an indescribable sensation at the pit of the stomach, debility of the limbs, and loss of power over the muscles; Avhich, however, speedily passed away. Many cases of poisoning by it are recorded. It is about four times the strength of the hydrocyanic acid; and the dose is, consequently, from a quarter of a drop to a drop, given in the form of emulsion. It is not employed in medicine in Great Britain. Dr. Wood, however, suggests that it might probably be substituted with advantage for medicinal hydrocyanic acid; as the acid, contained in it, is much less liable to decomposition, remaining for several years unaltered, if the oil be preserved in Avell-stopped bottles. It has been employed ex- ternally, as a lotion, in prurigo senilis, and in other cases of trouble- some pruritus—one drop to a fluidounce of Avater—the oil being pre- viously dissolved in spirit. AQUA AMYG'DALE iWM, BITTER AIMOND WATER. (01. amygdal, amar. "Ixvj.; Magnes. carbon. 3j.; Aquce Oij. Rub the oil with the carbonate of magnesia; then Avith the water, gradually added, and filter through paper.) This preparation, introduced into the last edition of the Pharmacopoeia of the United States, ought to be prepared in small quantities, and as it is wanted, for it is liable to decomposition. The dose, in cases Avhere it is suggested, is about f |ss. It may be used alone, or as a vehicle for other medicines, in cases where hydrocyanic acid is indicated. It must not be confounded with a distilled water of bit- ter almonds, directed in many of the pharmacopoeias of continental Europe, which is much stronger. SULPHO-CYAN'URET OF POTAS'SIUM, POTAS'SII SULPHO-CYANURE'- tum, has been proposed by SSmmering as a substitute for hydrocyanic acid'and cyanuret of potassium,—on the ground, that it possesses the same therapeutical virtues Avithout the inconveniences. 4. DIGITA'LIS.— FOXGLOATE. The leaves of Digitalis purpurea—the pharmacological history of which has been given elsewhere, (Vol. i. p. 321,) are unquestionably referable to the class of acro-narcotic poisons, Avhen administered in a 196 SPECIAL SEDATIVES. large dose. In ordinary doses, their effect on the circulation is seda- tive,—diminishing its force and frequency, and acting as a diuretic. In larger doses, they affect the alimentary canal, inducing nausea and vomiting; and also the cerebro-spinal system, causing stupor; and in very large doses, coma, convulsions, and death. A slow, feeble, and irregular pulse results, with cold sweats. Their operation on the nervous and circulatory organs has been observed by some to be preceded by manifest excitement; by others, however, this has not been witnessed. The author has watched attentively during their administration, but has not been able to satisfy himself of the existence of any precursory excitement. " The publications of Rush, Rasori, and Tommasini," says a recent writer—Dr. Billing—" would, I think, satisfy any per- son that digitalis is a sedative, (' contra-stimulant,') though, up to this time, not a year passes in which the pages of periodicals are not loaded with attempts to prove it a stimulant." At times, the pulse is reduced by it as low as 35 beats in the minute. Along with this re- duction, when the remedy has been given for some days, there is generally a feeling of great languor, often with anxiety, nausea, ver- tigo, dimness of vision, headache and delirium; and if the doses be still continued, these symptoms may be followed by those of true poisoning. Some experiments on dogs, instituted recently by MM. Aug. Du- meril, Demarquay and Lecointe, with the view of testing the effects of certain remedial agents on the function of calorification are not Avithout interest in this relation. Four Avere made with digitaline, and five with extract of digitalis, which was introduced into the stomach, three times, in the dose of fifteen grains; and twice, in that of a drachm, dissolved in warm water. The doses of digitaline were respect- ively 4th, fths, and fths of a grain. The general and final result was always, except in a single case, in which the toxical effects super- vened very promptly, an elevation of temperature. In a period of eleven to twelve hours, with the extract of digitalis, it Avas only once as little as 0°.7 centigrade: three times it slightly exceeded a degree; and, in one experiment, reached even to 1°.8. In one case, however, with 15 grains, and in another with a drachm, it was preceded by a depression of 0°.5 and 1°.4, but, at the end of about two hours and a half, this depression had ceased, and there was an augmentation of heat. The identity of these results with those furnished by digitaline was striking. Not only are the effects of digitalis induced when the remedy is taken by the mouth, but they equally supervene when it is injected into the rectum or the venous system. It has often been remarked, that after digitalis has been given in ordinary doses for a time, without producing any constitutional effect, and certainly none of poisoning, it may suddenly explode as it were, and produce alarming consequences: hence the caution usually incul- cated against administering it too vigorously, even when its effects are not apparent. Death, we are told, has resulted in numerous instances from its employment. Yet there are several authenticated instances DIGITALIS. 197 in which it has been given to a great extent with entire impunity. The author recollects being struck with the freedom with which the tincture was directed by Professor James Hamilton, jun., of the Uni- versity of Edinburgh, in diseases of women and children which are attended with much vascular excitement; and there are practitioners who give fgss. or fj£j. with much less effect than might be supposed. Dr. Pereira cites the following communication from an old preceptor of his own, as well as of the author—Dr. Clutterbuck—in illustration of this point. " My first information on this subject was derived from an intelligent pupil, who had been an assistant to Air. King, a highly respectable practitioner at Saxmundham, in Suffolk, who, on a subse- quent occasion, personally confirmed the statement. This gentleman assured me, that he had been for many years in the habit of adminis- tering the tincture of digitalis, to the extent of from half an ounce to an ounce at a time, not only with safety, but with the most decided advantage, as a remedy for acute inflammation,—not, however, to the exclusion of blood-letting, which, on the contrary, he previously uses with considerable freedom. To adults he gives an ounce of the tinc- ture, (seldom less than half an ounce,) and awaits the result of twenty- four hours; when, if he does not find the pulse subdued, or rendered irregular by it, he repeats the dose; and this, he says, seldom fails to lower the pulse in the degree Avished for; and when this is the case, the disease rarely fails to give way, provided it has not gone the length of producing disorganization of the part. He has given as much as two drachms to a child of nine months. Sometimes vomiting quickly fol- lows these large doses of the digitalis, but never any dangerous symp- tom, as far as his observation has gone, which has been very extensive. In less acute cases, he sometimes gives smaller doses, as thirty drops, several times in a day. ' Such,' adds Dr. Clutterbuck, ' is the account I received from Mr. King himself, and which was confirmed by his assist- ant, who prepared his medicines. I do not see any ground for question- ing the faithfulness of the report. I have myself exhibited the tincture to the extent of half an ounce (never more) in not more than two or three instances, (cases of fever and pneumonia.) To my'surprise there was no striking effect produced by it, but I did not venture to repeat the dose. In numerous instances I have given two drachms, still more frequently one drachm; but not oftener than once in twenty-four hours, and not beyond a second or third time. Tavo or three exhibitions of this kind I have generally observed to be followed by slowness and irregularity of pulse, when I have immediately desisted.'" When the effects of digitalis on the circulatory system Avere first ob- served, it was fancied that a substitute had been found for the lancet in febrile and inflammatory diseases; and some time even after that period, it was highly extolled as a contra-stimulant by Rasori and his followers. It is rarely, however, employed in simple fever; and neither in it nor in inflammation can it be substituted for the lancet. It may, however, be used with advantage after blood-letting, and especially when inflammation has gone on for some time, and terminated in serous effusion. As a mere antiphlogistic, it is rarely trusted to in those cases. The circumstances that guide us in its administration in inflammation 198 SPECIAL SEDATIVES. apply equally to hemorrhages, in which it is very commonly directed after antiphlogistics; yet but little faith is placed in its remedial agency, in these cases, by Dr. Christison. It certainly ought not to interfere with the employment of other remedies. It has been highly extolled in haemoptysis; but in no disease is there more difficulty in deciding as to the precise effect of any particular remedy; as the hemorrhage generally ceases, after a time, of itself, and hence so many internal astringents are recommended, Avhich often certainly can have but little influence, the curative effect being mainly, and perhaps altogether, in- duced by the treatment on general principles pursued along with them. In diseases of the heart, accompanied by augmented action, digitalis would appear to be indicated, and it is, accordingly, much prescribed in hypertrophy of that organ, both when simple and accompanied by dilatation, as well as in the various affections in Avhich the heart's action is irregularly exerted,—as in angina pectoris, neuralgia, &c, or where there is an accompanying dropsical effusion, when its diuretic action also becomes serviceable. At one time, in phthisis, it Avas considered to be capable of arrest- ing the disease; and, when its constitutional influence is induced, the symptoms often appear to be suspended; but in every case that has fallen under the author's notice, they have subsequently recurred. It has the power of diminishing the velocity of the circulation; but it must be borne in mind, that this velocity is a mere symptom of the pathological condition—the tuberculosis. In some of the neuroses it has been prescribed freely, as in mania, epilepsy, and even in delirium tremens; as well as in certain spas- modic diseases, as asthma and hooping-cough; in some of which it has, undoubtedly, been given empirically. It is not easy, for example, to see on what principle it has been prescribed in very large doses in de- lirium tremens. After all, the effects which it is knoAvn to exert, and which vhave been described above, will suggest the pathological states in which it is most likely to prove of service. The ordinary dose of the powder is a grain or a grain and a half, repeated three times a day, gradually increasing the dose—under the precautions already laid down—until some constitutional effect is per- ceptible. The dose of INFUSUM DIGITALIS, (Vol. i. p. 324,) is f 3ss. to Oj.; and of TINCTURA DIGITALIS, (Ibid.) "ix. to *lxx. three times a day. From numerous experiments, Dr. Munk has recommended the tincture as acting with the greatest certainty and effect upon the heart. Digitalis has been applied locally to scrofulous ulcers, and especially to ulcers that are attended Avith an excess of inflammatory action, in the form of a liniment made with the powdered leaves and honey. In such cases the sedative action of the drug is exerted, and an improve- ment seems to be effected in the system of nutrition of the part, as manifested by the improvement in the discharge and appearance of the ulcer. COLCHICI RADIX ET SEMEN. 199 Digitalin—the active principle of digitalis—described elsewhere (Vol. i. p. 325,) as having been separated by MM Homolle and Que- venne, is a most energetic sedative. Those gentlemen found its action on the derma denuded by a blister to be so irritating as to forbid its endermic use. In experiments on their own persons, the action of digi- talin on the heart was always manifest, and was commonly exhibited by a progressive diminution in the number of its pulsations, which Avere lowered in some cases to 40, and generally to 50 or 55 in the minute. Its influence on the circulation appeared to continue for seve- ral days after its administration had been discontinued. It appears to possess all the active properties of digitalis. Its action, however, is most energetic; and, consequently, it requires to be given Avith the greatest circumspection. MM. Homolle and Quevenne have found, from comparative trials, that four milligrammes (gr. .0616) of digitalin correspond in energy of action to about eight French grains (gr. 6.56) of digitalis;—M. Bouchardat says to gr. 6.176 Troy. It is a hundred-fold stronger than the most active preparation of digitalis. (New Remedies, 6th edit. p. 289, Philad. 1851.) Fie. 158. 5. COL'CHICI RADIX.—COL'CHICUM ROOT. AND 0. COL'CHICI SEMEN.—COL'CHICUM SEED. The cormus and seeds of Colchicum autumnale, Meadow Saffron; Sex. Syst. Hexandria Trigynia; Nat. Ord. Colchicaceae,—Melantha- ceae, (Lindley,) are officinal in the Pharmacopoeia of the United States. The plant inhabits moist, rich mea- dows, in many parts of England and in various parts of Europe, and is an autumnal ornament of the gardens,— the flowers appearing in September, and the fruit in the following spring or summer. Yarious attempts have been made to introduce its culture into this country, Avith no great suc- cess, although small quantities of the bulb raised here, apparently of good quality, are said to have been brought to market. (Wood & Bache.) The bulb is considered to be most active in June or July; at which time it is fully developed, and has not been exhausted by the production of the flower. The seeds must be ga- thered when ripe. The fresh cormus or root is about the size of a chestnut, and resembles in shape and size that of the tulip; but differs from it in the latter being in scales; whilst that of Colchicum autumnale. 1. Closed Capsule. 2. Open do. 3. Styles. 4. Section of Capsules. 5. Seed. 200 SPECIAL SEDATIVES. colchicum is solid. It is convex on one side, and flattened on the other, where the germ of a new cormus is perceptible, Avhich, if it be allowed to grow, shoots into a stem, and bears the flower; the old cormus, in the mean time, wastes away and becomes inert. This germ, , in the opinion of Dr. J. R. Coxe, distinguishes the cormus of colchicum from all others; but it is affirmed that it is not always present. Inter- nally, the cormus is white and fleshy; contains a milky juice; and has an acrid, bitter taste. To dry the root, it has been recommended, that the dry coats should be removed; that it should be cut transversely in thin slices, and be quickly dried in a dark airy place, at a temperature not exceeding 150° or 170°. These slices—if the drug be in good preservation—are firm; dry; of a grayish white colour, and an amylaceous appearance. Colchicum seeds are about the size of white mustard seeds; devoid of smell; and of a bitter, acrid taste. The flowers are not officinal. They are the mildest part of the plant; and have been successfully administered by several English physicians. Colchicum imparts its virtues to Avater and to alcohol; but still better to vinegar, and wine, or to diluted spirit of the same strength. Hence, distilled vinegar and wine are used as menstrua for two offici- nal preparations that are much employed. The cormus has been analyzed by different chemists. At one time, it was believed by MM. Pelletier and Caventou to contain veratria, but from the examination of Messrs. Geiger and Hesse, it appeared, that the active principle was seated in an alkaloid closely analogous to, but not identical with vera- tria, to which they gave the name Colchicine or Colchicia. This is found in every part of the plant, crystallizing in slender needles; in- odorous ; and of a very bitter, and afterwards biting taste. Introduced into the nose, it does not, like veratria, induce sneezing. In its effects upon the system, it seems to resemble somewhat digi- talis ;—rendering the pulse less frequent. In excessive doses, it is a poison of the acro-narcotic class. It is avoided by cattle, and its active poisonous properties have been long known; fatal cases, indeed, occur every now and then from its use, not only in animals, but in man, owing to its too profuse employ- ment in the treatment of gout. Reynolds—the inventor of the wine of colchicum, commonly called Reynolds's Specific—is said to have killed himself by an overdose; and other fatal cases are recorded. It is affirmed to excite occasionally profuse ptyalism. It appears to be the hermodactyl of the ancients, and was extensively employed by them; but had fallen into almost entire neglect, when its use was revived in Great Britain, in the first quarter of the present century, as an efficacious agent in gouty and rheumatic affections; and it is now introduced into almost every pharmacopoeia. In gouty and rheumatic cases, its action has been regarded by some as "specific;" others have ascribed its efficacy in these cases to its action on the kidneys. It is most probable, that its agency is mainly exerted on the nervous system; although it certainly is not easy to explain the precise modus operandi. The Eau medicinale dHussonwSiS COLCHICI RADIX ET SEMEN. 201 long a celebrated gout remedy; and Avas extensively used as such by men of the first scientific eminence. Many trials were, consequently, made to discover its constituents. These are now considered to be colchicum root, macerated in wine:—the Vinum colchici, to be described presently; and it is singular, connected with this discovery made by Mr. Want, that whilst he was directing attention to colchicum, another investigator had satisfied himself that veratrum album was the basis. It has been since shown, that the active principles of the two sub- stances are analogous. In the last edition of his " New Remedies," (1851), the author re- marked, that he had often exhibited the different preparations of col- chicum in gout, and frequently with decided advantage, but very often it had failed altogether. In his own person, it had never appeared to prevent or to modify the paroxysm. His trials had then been made with the vinous tincture of the dried root only. Since then, he has imported the Vinum colchici of the London Pharmacopoeia, made at Apothecaries' Hall of the fresh root; and, at the same time, has taken it in a somewhat larger dose. At the onset of an attack, he commences, at times, with fifty or sixty drops; and afterwards takes thirty drops three times a day. In the course of four or five days, he has generally been able to go abroad if urgent business required him to do so. In these doses, it has never excited nausea or vomiting; but occasionally has caused painful catharsis of short duration, and demanding no treat- ment ; to prevent which he usually associates four or five drops of the tinctura opii with each dose. When its good effects are exhibited, he discontinues it in a few days by gradually diminishing doses. It has been imagined, that the effects of colchicum, given to prevent or cure gout, are injurious to the organism. This has, perhaps, arisen from the vulgar idea, that a paroxysm of gout is salutary, and wards off other diseases. When, however, regard is had to the severe and prolonged suffering in many gouty attacks, it is not easy to see, that serious morbid derangement is not more likely to be produced by it than by the remedy. In his oavii experience, the author has not wit- nessed a single morbid phenomenon, of consequence, which he could unhesitatingly refer to colchicum. In acute rheumatism, and in various inflammatory diseases, colchi- cum was proposed and extensively used by the author's valued and able friend, the late Mr. C. T. Haden, of London, as an excellent seda- tive to reduce excited organic actions, which he thought it was capable of effecting to such an extent that blood-letting might generally be rendered unnecessary in febrile and inflammatory disorders; and the views of Mr. Haden have been in some degree confirmed by others. The author has often exhibited the different preparations of colchicum in gout; and, frequently, with decided advantage; but very often it has Avholly failed. In acute and chronic rheumatism, its advantages have not seemed to him so marked: as they have to some. Like other acro-narcotics—cimicifuga for example, Avhen carried to the extent of slightly affecting the system, as shoAvn by nausea, Avith cerebral con- fusion__it has, at times, effected a revulsion, Avhich has broken the chain in acute rheumatism. In chronic rheumatism, it has exhibited less 202 SPECIAL SEDATIVES. marked results; yet there is no agent, perhaps, Avhich is so much em- ployed in rheumatic affections. In none of these cases, according to most observers, need any sensible evacuation be produced by it; although some have affirmed—and such certainly is the result of the author's observation—that it is more efficient, Avhen it evinces its influ- ence upon the skin or alimentary canal. Dr. AV"igan asserts, that he gives it in rheumatic gout in the dose of eight grains every hour, until "active vomiting, profuse purging, or abundant perspiration takes place, or at least until the stomach can bear no more;" and, Avhen thus administered, he pronounces it to be " the most easily managed, the most universally applicable, the safest, and the most certain spe- cific [?] in the whole compass of our opulent pharmacopoeia." Colchicum has, likewise, been given in tetanus of Avarm climates, chronic bronchitis, leucorrhoea, scarlatina, ischuria, prurigo, erysipelas; and it is said to have been prescribed successfully in tape-Avorm. It is sometimes used externally as a liniment to rheumatic joints, in the form of the tincture of the seeds or bulb. The dose of the powdered root is from three grains to ten, given several times a day. Dr. Holland affirms, that he knows no preparation more certain in effect, or better capable of fulfilling the peculiar purposes of the medi- cine than the EXTRAC'TUM COLCHICI ACE'TICUM, ACE'TIC EXTRACT OF COLCHICUM. (Colchic. rad. in pulv. crass. Ibj.; Acid. acet. f£iv.; Aquce q. s. A pint of water is added to the acetic acid, and the result is mixed with colchicum root. The mixture is transferred to the percolator, and Avater is gradually poured upon it until it passes through with little or no taste. The liquid is then eAraporated to the proper consistence.) The acetic extract of colchicum is preferred to the other preparations by some practitioners. Its ordinary dose is one or two grains, given two or three times a day. TINCTU'RA COL'CHICI SEM'IMS, TINCTURE OF COLCHICUM SEED. (Cotchic. semin. contus. giv.; Alcohol, dilut. Oij.—prepared either by maceration or displacement.) The dose of this preparation is from gtt. x. to f 3j. Dr. Pereira states, that he has often given f 5ij. at a dose without any violent effect; and Dr. Barlow, Avho prefers this to the other prepara- tions of colchicum, advises that in gout f3j., f3iss. or f3ij. of the tinc- ture should be given, at night, and repeated in the 'following morning. If this quantity fail to purge briskly, a third dose is administered on the following night. The tincture is sometimes used externally in gout. For this purpose, it has been recommended to mix two fluidrachms of it with four fluid- ounces of a spirit lotion; but it is affirmed, that the local use of mor- phia had the same effect,—the part being bathed in hot water for a minute, and then lint applied spread with simple cerate, on Avhich about three grains of acetate of morphia were distributed. More recently, the tincture of the root has been advised as an external application in VERATRIA. 203 rheumatism,—alone, or combined with tinctura camphorce. It was much used at the author's Clinique in the Philadelphia Hospital, and often Avith advantage; but whether much or any benefit was produced by the colchicum, the author was unable to decide. WM COLXHICI R1DITIS, WINE OF COLCHICUM ROOT. (Colchic. radic. con- tus. Ibj.; Vini albi Oij—prepared by maceration or displacement.) This is intended to be a saturated tincture. The dose is from ten minims to a fluidrachm; repeated until some effect is induced. Sir Everard Home ascribed much of the griping and nausea that sometimes follow the use of this and other tinctures of colchicum, which have not been carefully filtered, to the sediment that forms in them, and which may be removed without injury to the desired effect of the remedy. It would appear, however, that this sediment is inert. VINUM COL'CHICI SEM'INIS, WINE OF COL'CHICUM SEED. (Colchic. Sem.con- tus. 3iv.; Vini albi Oij.) This is in none of the British Pharmacopoeias. It is the wine which was so much used by Dr. Williams in gout. The dose is f 3j. to f3ij. ACE'TUM COL'CHICI, VIN'EGAR OF COL'CniCUM. (See Yol. i. p. 290.) This preparation is more frequently given as a diuretic in dropsy; and in gouty and rheumatic cases. The acetic acid unites Avith the alkaloid and forms Acetate of colchicia, which is supposed by some to be equally active with colchicia itself. Sir C. Scudamore, hoAvever, combines it Avith magnesia, in order that an acetate of magnesia may be formed, and the colchicia be left in the most favourable condition for adminis- tration. The mixture, proposed by him for gouty cases, which has received the name of Scudamore's mixture, is thus made—(Magnes. sulphat. |j.—.?ij.; solve in Aq. menth. crisp, f 5x.; adde Acet. colchic. f^j.— §iss.; Syrup. Croci f.lj.; Magnes. Dviij. M. Dose, fliss., so that from four to six evacuations may be produced in twenty-four hours.) 7. VERA'TRIA. Yeratria is the active principle of the seeds of Veratrum Sabadilla, V officinale, Helonias officinalis, and Asagrcea officinalis, which are known in commerce under the names Cebadilla, Cevadilla, or Sabadilla, and are imported from Yera Cruz and Mexico. They usually occur in com- merce mixed with the fruit of the plant; are two or three lines long; of a black colour, and are shining, flat, shrivelled, winged and elastic seeds. Veratrum Sabadilla belongs to Sex Syst. Polygamia Monoecia; Nat. Ord. Colchicaceae— Melanthacea3 of Lindley; and Asagrcea offi- cinalis, to Sex Syst. Hexandria Trigynia; Nat. Ord. Melanthaceae. Although cevadilla is applicable to all the cases in Avhich veratria is used it is still rarely employed. A saturated tincture of the seeds is occasionally prescribed as a rubefacient liniment in chronic rheumatism and paralysis; and is rubbed over the heart in nervous palpitation. 204 SPECIAL SEDATIVES. Fig. 159. Asagrcea officinalis. a. Fruit-bearinu; stem. b. Root, bulb, aud leaves. The rationale of the process for obtaining ArERA;TRiA, Ver'atrine, or SabadilVin, in the Pharmacopoeia of the United States, is as follows. Bruised Cevadilla is boiled in fresh portions of alcohol for three times ; the ce- vadilla is then pressed; and the alcoholic solutions, containing veratria, united with a vegetable acid, are mixed. The alcohol is distilled off; and the residue is boiled three or four times in water adul- terated Avith sulphuric acid, by which means an im- pure solution of sulphate of veratria is obtained. The liquors are mixed, strained, and evaporated to the consistence of syrup. Magnesia is noAV added in slight excess, \Arhich decomposes the salts of ve- ratria ; and sets the veratria at liberty. The dried residuum is digested repeatedly in alcohol, which dissolves the veratria. The alcohol of the different digestions is mixed and distilled off. The residue is boiled in water with a little sulphuric acid and animal charcoal, the second of which unites with the veratria, whilst the third removes the colour- ing matter. The liquor is strained, and the residue thoroughly washed; the washings being mixed with the strained liquor. It is then evaporated to the consistence of syrup, and as much solution of ammonia dropped in as may decompose the sul- phate of veratria, and precipitate the veratria. The precipitate is lastly separated, and dried. Yeratria is of a grajdsh white colour; pulverulent; devoid of odour; and of a bitter acrid taste, producing a feeling of numbness and ting- ling when applied to the tongue. It is sparingly soluble in water, but readily so in alcohol, ether, and especially in Aveak acids, which it neu- tralizes. On account of its very high price, and the want of Avell de- fined external characters, the veratria of the shops is said to be very subject to adulteration ; and there would not seem to be any good cri- terion for ascertaining its degree of purity. (Christison.) Yeratria is a most virulent acro-narcotic poison. Minute doses in- jected into the venous system have induced fatal tetanus. When taken internally in medicinal doses, it causes heat in the mouth, nausea, and feeling of heat in the stomach and bowels,—at times, diarrhoea and headache, with depression of the heart's action. Applied externally, it excites a singular sense of pricking in the part, and occasionally the same cephalic heat and cardiac phenomena as result from its internal administration. Only in a few cases has any eruption followed its ap- plication. The endermic use of the remedy has always excited so much irritation as to prevent its repetition. Owing to its presumed effects on the nervous system, and especially on the spinal marrow and the nerves connected with it, the use of vera- tria was suggested in nervous diseases, particularly in neuralgia, proso- palgia, and ischias. A single friction is said to have been sufficient to remove the disease Avithout relapse. Some advantage has likewise been VERATRUM ALBUM. 205 experienced from its employment in chorea, hypochondriasis, hysteria and paralysis, as well as in rheumatism and gout. Dr. Turnbull found it useful in glandular SAvellings, goitre, SAvellings of the mammary glands unaccompanied by pain, buboes, and scrofulous tumours, even in cases where iodine had failed. Farther experience is, perhaps, needed in regard to its virtues; but the author must confess, that his own obser- vation has by no means confirmed the high-strained eulogies of Dr. Turnbull; and this is the general sentiment of the profession. It has often been used externally by the author, as well as by many other American physicians ; but has generally disappointed his expectations. Dr. Bardsley thinks it has the properties of colchicum, and may be used with equal advantage in the same cases. It may be given in pill, or in spirituous solution,—the dose being from one-tAvelfth to one-sixth of a grain several times a day. A Tinc- ture may be made of four grains to the fluidounce of alcohol; and of this, ten to tAventy drops may be given for a dose in a glass of Avater. Externally it is best used in the form of Ointment ;—( Vera trice gr. v., x., xx.; Adipis sj.) A piece of the size of a hazel-nut to be carefully rubbed in, morning and evening, or oftener, for from five to fifteen minutes. SULPHATE OF VERATRIA, made by the combination of veratria with sul- phuric acid, has the same virtues as veratria. M. Magendie has pro- posed the folloAving solution as a substitute for Eau medicinale d'Husson in gout. (Veratrice sulphat. gr. i.; Aquce destillat. i51]. M. Dose, f3j. to f 3iv.) Fig. 160. 8. VERA'TRUM ALBUM.—WHITE HEL'LEBORE. White hellebore is the rhizoma of Veratrum album; Sex. Syst. Polygamia Monoecia; Nat. Ord. Colchicaceaa,—Melanthaceae, (Lindley;) a plant which grows in the mountainous re- gions of Europe, abounding in the Alps and Pyrenees, but is not a native of Britain. The root is brought to this country from Germany in the dried state; and, as met Avith in the shops, is from two to four inches long, by an inch in diameter, having the shape of a cylinder, or more frequently of a truncated cone. It is rough; rugous; and of a gray- ish or blackish brown colour externally; internally, whitish; and usually has portions of the root fibres detached from it: at times, the fibres remain attached. These are of a yelloAvish colour, and of the size of a crow's quill. The odour of the fresh root is disa- greeable ; that of the dried feeble. The taste is at first bitter, and afterAvards acrid. On analysis, white hellebore yields vera- tria, the properties of which have been just Veratrum Album. Linn. Var. Albiflorum. 206 SPECIAL SEDATIVES. considered. Another substance has, likewise, been announced in it, termed Jervin,—from Jerva, the Spanish name for a poison obtained from the root of white hellebore, the properties of which haA*e not been accurately investigated. It is a poAverful acro-narcotic poison ; and an active irritant; hence it is one of the most potent errhines. In medicinal doses, unless very cautiously administered, it is apt to induce excessive irritation of the gastro-enteric mucous membrane. It is said, indeed, to have produced these effects when the rhizoma has been placed in contact with the cutaneous surface; and especially when the cuticle has been removed. It appears to resemble greatly, in its effects, sabadilla and colchicum. In consequence of the occasional severity and uncertainty of its ope- ration, it is rarely given internally. Formerly, it was prescribed so as to induce its effects on the stomach and bowels in mania, melancholia, and other diseases of the nervous system, and, doubtless, at times acted beneficially as a revellent; but it is now never prescribed. When great efforts were made to discover the composition of the celebrated gout remedy—Eau medicinale d'Husson—it was announced by Mr. Moore, that white hellebore was the chief ingredient; but about the same time Mr. Want established, that a kindred plant—colchicum—was entitled to the credit. At that period, it was often prescribed in gout and rheumatism; but, of late, has been almost wholly abandoned in favour of colchicum. Its chief use, at the present time, is as an external agent—an antiparasitic—in scabies, and to destroy pediculi. It is also used in porrigo, lepra, &c. The dose ought not, at first, to exceed one or two grains; but it may be gradually increased. HNUM VERA'TRI ALBI, WINE OF WHITE HEL'LEBORE. (Veratri albi contus. liv.; Vini albi Oj.) This is the form in which white hellebore has been generally given in gout and rheumatism; but it is not much used. The dose is nix. two or three times a day,—gradually increasing the quan- tity until it exhibits some effect upon the constitution. 9. VERATRUM VIR'IDE.— AMERICAN HEL'LEBORE. This is the rhizoma of Veratrum Viride, Indian poke, poke root, and swamp hellebore, an indigenous plant, which is found in SAvamps and wet meadoAVS, and on the banks of small streams, in almost all parts of the United States; flowering from May to July. The root is collected in autumn, and ought not to be kept long. Its taste is bitter and acrid; and its properties are probably dependent upon veratria. The medical properties of this rhizoma resemble those of colchicum and veratrum album. It is acro-narcotic in large doses; and reduces , the force and frequency of the circulation in medicinal doses. Pro- fessor Tully, of New Haven, who has paid much attention to the vir- tues of indigenous plants, and especially to those of active poAvers, recommends it strongly as a substitute for colchicum. It has been chiefly given in gouty and rheumatic cases. The author can say but CIMICIFUGA. 207 little of it from his own experience. It is said to prove emetic in the dose of from four to six grains of the powder; but, as a sedative, the object is to give it short of inducing emesis, and yet to produce nausea or an approximation to it. The proper dose for this purpose will be two grains. It has been prescribed in the form of tincture and of ex- tract. Like veratrum album, it is used externally as an antiparasitic. 10. CIMICLF'UGA.— BLACK SNAKEROOT. Black snakeroot—the root of Cimicifuga, racemose;, C. serpentaria, Actcea racemosa, Macrotrys racemosa, Cohosh, Cohort, Bugbane—has been elevated in the last editions of the Pharmacopoeia of the United States, from the secondary to the primary list. The plant is indigenous in the United States; growing in shady and rocky woods from Canada to Florida. It belongs to Sex. Syst. Polyandria Di- Fig. 161. pentagynia; Nat. Ord. Ea- nunculaceae. It yields its virtues to boiling water and to alcohol; and was found by Mr. Tilghman, of Philadel- phia, to contain gum, starch, sugar, resin, wax, fatty mat- ter, tannic and gallic acids, a black and green coloring matter, lignin, and salts of potassa, lime, magnesia and iron. Cimicifuga, in large doses, unquestionably belongs to the division of acro-narcotic poisons ; but the author has had difficulty in deciding as to what class of therapeutical agents it ought to be referred. It has appeared to him, how- ever, to exert an action ana- logous to that of colchicum; and under this impression, he has placed it after that agent. The testimony of pharma- cological writers, in regard to its action, is sufficiently im- precise, and this is shown by the following views of one of the most respectable of them, Dr. Wood, of Philadelphia. " Cimicifuga unites, with a tonic power, the property of stimulating the secretions, particularly those of the skin, kidneys, and pulmonary Cimicifuga racemosa. 208 SPECIAL SEDATIVES. mucous membrane. It is thought, also, by some to have a particular affinity for the uterus, and probably exerts some influence over the nervous system, of a nature not exactly understood. Its common name was probably derived from its supposed power of curing the disease arising from the bite of the rattlesnake. Till recently, it has been employed chiefly in domestic practice, as a remedy in rheumatism, dropsy, hysteria, and various affections of the lungs, particularly those resembling consumption." Some years ago, cimicifuga was largely employed in the author's wards in the Philadelphia Hospital, by two zealous resident physicians —Drs. E. A. Anderson, of Wilmington, N. C. and Alexander Yedder, of Schenectady, New York—who published cases illustrative of its powers in the treatment of rheumatism, in the 'American Medical In- telligencer,' for January 1, 1838, of which the author was editor; and like other aero-narcotics, when pushed so as to produce catharsis, and even slight narcosis, it certainly appeared to be of service in the acute forms; and these results are confirmed by the observations of Dr. N. S. Davis. In its action on that disease it strongly resembled colchicum. It is probably by virtue of similar powers, that it has been found beneficial in chorea. In some successful cases, published by Dr. Kirkbride, of Philadelphia, purging was premised; and general frictions with salt or the flesh brush, and pustulation with croton oil over the spine, are considered by him of much value in the chronic cases. All these agents operate as revellents. The author has pre- scribed it repeatedly in chorea, but has not had sufficient evidence of its having exerted any beneficial agency. In many of these cases a combined hygienic and therapeutic tonic treatment was subsequently followed by the disappearance of the disease. A modern writer, Dr. E. J. Wheeler, affirms, that by some eminent physicians it has been thought a good substitute for the ergot in par- turition. It is stated, however, by him to be dissimilar in its mode of action, relaxing the parts and thereby rendering labour short and easy; but evidence is required of its possessing such powers; and still more of its being of any service in incipient phthisis, or in " acute phthisis, uncomplicated with much inflammation in the vesicular structure or pulmonary mucous or serous membranes;" as has been affirmed by a recent writer. The dose of the powdered root may be half a drachm to a drachm, two or three times a day. It is most commonly, however, prescribed in decoction (Cimicifug. contus. 3*j.; Aquae Oj. To be boiled for a short time. Dose, f Ij. to f |ij. several times a day.) The tincture is also given, (Cimicifug. contus. 3*iv.; Alcohol. Oj. Dose, gtt. xx. three or four times a day.) 11. ER'GOTA.—ergot. The effects produced by ergot—whose general properties are described under Parturifacients, (Yol. i. 465,) Avhen eaten as food, are extremely injurious,—the aggregate of the symptoms having been termed Ergot- ism. At times, these are limited to vertigo, spasms, and convulsions, ERGOTA. 209 with a peculiar tingling or sense of formication in the arms and legs, which has given the affection, among the Germans, the name Krie- belkrankheit, "creeping disease." Most commonly, the limbs waste away, lose sensation and the power of motion; and separate from the body by dry gangrene—constituting gangrenous erethism or mildew mor- tification. Yarious experiments have been made by feeding animals on ergot, and, although the results have been discordant, and, in many cases, none have been perceptible, there can be little doubt, that it exerts a poisonous influence on many animals, when mixed with their food. _ In another place, it is stated, that in his experiments on healthy in- dividuals, Jorg found, that symptoms of acro-narcosis were induced by ergot, Avhen given in large doses ; and that he explains the parturifa- cient effects of the drug by the violence done to the system of the mother. Some time ago, the author caused various experiments to be instituted on healthy persons as to the effects of ergot, in doses of half a drachm, and a scruple of the poAvder, and in the form of an oily preparation pointed out by Professor C. Hooker, of New Haven. These experiments were made on both males and females; and the general effects were those described by Jiirg. When the dose was too large, nausea or vomiting often resulted with signs of narcosis. A case of narcosis, produced by the drug, in the dose of thirty grains, adminis- tered with the view of restraining a real or supposed tendency to hemorrhage after the expulsion of the placenta, was also communicated to the author by Dr. Beckwith, of Kaleigh, North Carolina. Elsewhere, (Yol. i. 469,) reference has been made to certain experi- ments by Professor Hooker, of New Haven, who digested ergot in ether, and evaporated the solution, until an oleaginous fluid was left, which consisted of a lighter supernatant oil, and a heavier. The lighter oil was found to be possessed of decidedly narcotic properties; and in certain experiments, made by Dr. McKee, at the author's sug- gestion, it was found, that in every case, when given in doses of from ten to forty drops, it at first produced slight exhilaration of spirits, with increase of the circulation ; but these symptoms were soon followed by sedation, and, in larger doses, by nausea also. It is, perhaps, by reason of those narcotic properties, that ergot has seemed to be serviceable in leucorrhoea, gonorrhoea, dysentery, and other diseases of the mucous membranes, and in various hemorrhages, — epistaxis, haemoptysis, haematemesis, haematuria, &c. The author has often administered it in such cases, but has never had reason to believe that it exerted any efficacy; and such has been the case with other observers. It is proper, however, to remark, that Dr. Wright found it, in the form of powder, very serviceable in arresting hemorrhage, and not simply in a me- chanical manner as was proved by experiment. Even in the form of infusion, it possessed the power to an extraordinary degree. Dr. Wright affirms, that he has several times divided the external jugular, and the saphena major veins, and has never failed to arrest the flow of blood by an infusion of ergot, although with arteries he was generally less successful. In the greater number of experiments, he used a dilute solution of ergot, in place of Avarm water, to sponge the bruised parts, VOL. ii.—14 210 SPECIAL sedatives. and alwa}Ts succeeded in preventing that continued floAV, which is often a serious obstacle to the safe direction of the knife. He, consequently, recommends it as a valuable means of preventing troublesome hemor- rhage from small vessels in the course of surgical operations; and, upon the same principle, believes the injection of a similar solution into the uterus, in cases of flooding, will be found to answer every practical end that can be desired. Some years ago, M. Bonjean highly extolled a watery extract of ergot—to which he gave the name Ergotine—as a powerful haemastatic; and a solution of it was known under the name Eau hemastatique de Bonjean. M. Bonjean affirmed, contrary—as has been elsewhere shown—to the opinions of other observers, and to probability, that whilst ergotine contains the medicinal property of ergot, the oil and the resin contain the poisonous properties. He announced it as a real 'specific' in hemorrhage in general. It Avas employed as a styptic in wounds of the capillary and larger vessels; but the same fallacies appear to have existed as in the case of the matico, and the haemastatic waters already described, (Yol. ii. p. 137); and Drs. J. L. Smith and S. D. Sinkler, of Charleston, inferred from the results of a trial of the so-called ' ergotin,' on the divided carotid of a sheep, that it depends greatly, if not altogether, upon the manner in which the lint is applied to the wound of the artery, whether the hemorrhage be arrested or not. If placed immediately upon the orifice of the cut vessel, success is certain; if, however, the vessel shrinks from contact with the lint, the animal is almost certain to bleed to death. M. Bouchardat, in his Annuaire for 1848, after having done much, in his former volumes, to disseminate the views of M. Bonjean, re- marks ;—that " unhappily the facts, which he has adduced as supporting his discovery, are still far from presenting the characters of satisfactory demonstration. As regards the success on animals, it is well known how plastic their tissues are, and with what ease they are repaired after serious injuries; and as respects the effects of ergotin on wounds in individuals of the human species, those that have been published hitherto may be attributed, with probability, to the circumstances that were associated with the application of the remedy, almost as much as to the action of the remedy itself." Ergot is said to have been serviceable in hypertrophy of the uterus, and has been supposed to act as an excitant to the spinal marrow: ac- cordingly, it has been administered in paraplegia, and in retention of urine, and, it has been conceived, with benefit. It has even been given to effect the expulsion of fragments of calculi after the operation of lithotrity! Farther observation is, however, needed before we can regard all these statements to be accurate. The usual dose of the powder—the form generally chosen in these cases—is ten to fifteen grains three or four times a day. 12. Tobacco, (Yol. i. p. 157,) and 13, Lobelia, (Yol. i. p. 155,) are likewise sedatives; but their properties as nauseant sedatives are so fully described under Emetics, that it is unnecessary to add anything here. ACIDUM HYDROSULPHURICUM. 211 14. ACIDUM HYDROSULPHU'RICUM.—HYDROSULPH'URIC ACID. Hydrosulphuric Acid, Sulphohydric Acid, Hydrothionic Acid or Sulphu- retted Hydrogen, is not officinal in the pharmacopoeias of Great Britain or of this country; but it is admitted into many of those of continental Europe as a sedative agent. It is an important ingredient, also, in sulphureous mineral waters. This gas is.extremely deleterious; killing instantly when breathed pure, and so powerfully penetrant, that it is sufficient to place an ani- mal in a bag of it, without any of the gas entering the mouth, for it to act fatally. Even when mixed with a considerable portion of air, it may prove destructive. Birds perished immediately in air containing one thousandth part of it; a dog died in air containing one hundredth part, and a horse in air containing one hundred and fiftieth part. When breathed in a more diluted state, it produces powerfully sedative effects —the pulse being rendered extremely small and weak, the contractility of the muscular organs greatly enfeebled, with stupor, and more or less suspension of the encephalic functions; and if the person should recover, he regains his strength very tardily. It is the gas which is so dangerous to nightmen, when they descend into the pits of privies. It has been advised in the way of inhalation to diminish excitement in pulmonary affections, and especially in phthisis pulmonalis. It has been employed, also, successfully, in a case of obstinate cough that re- mained after an attack of pneumonia. It may be disengaged by pour- ing dilute sulphuric acid on sulphuret of potassium in a cup, and breathing the vapour cautiously through a funnel,—always bearing in mind its extremely deleterious properties. Another form is to dissolve half an ounce of sulphuret of lime in a pint of water, and to addto this two drachms of weak chlorohydric or muriatic acid,—the bottle in which the mixture is made being allowed to remain open for a feAV hours in the patient's chamber. Liquid hydrosulphuric acid may be made by disengaging sulphuretted hydrogen from a mixture of one of the sulphurets with dilute sulphuric acid, and causing it to pass into water to saturation. This may be diluted with four times its weight of water. It has been prescribed occasionally as a sedative in pulmonary affections; but is now rarely or never used. A former edition of the Pharmacopoeia of the United States had a formula for Liquor Ammo'nije Hydrosulpha'tis, Solution of Hydro- sulphate of Ammonia, Hydrosulphuret of Ammonia, which was formed by passing sulphuretted hydrogen through solution of ammonia. It is powerfully sedative, and has been given in diabetes mellitus for the purpose of lessening the morbid appetite, so common in that disease; but it is noAV scarcely ever prescribed, and has accordingly been omitted in the last editions of the pharmacopoeia. 212 SPECIAL SEDATIVES 15. SEDATIVE GASES. Certain of the gases have been used in the way of inhalation as sedative agents, but they are not much employed at the present day. Of the effects of one of them—Sulphuretted Hydrogen—mention has just been made. a. gas hydrogen'ium.—hy'drogen gas. This gas is procured by the action of dilute sulphuric acid on iron or zinc; but as a little acid vapour may possibly be diffused through it, it has been esteemed preferable to obtain it, when it is designed to be breathed, by passing water in vapour over iron at the temperature of ignition. Hydrogen gas appears to act altogether negatively,—proving seda- tive in consequence of the absence of oxygen, which is the exciting constituent of atmospheric air. It can be breathed Avith safety when diluted Avith an equal portion of air; but, for medicinal purposes, is usually mixed with four or five parts. It has been chiefly used in pulmonary catarrh, haemoptysis and phthisis. b. gas hydrogen'ium carbure'tum.—car'buretted hy'drogen gas. Carburetted hydrogen, employed in medicine, is made by passing the vapour of water over charcoal at the temperature of ignition in an iron tube. The oxygen of the water unites Avith one part of the charcoal, forming carbonic acid; and the hydrogen combining with another part of it forms carburetted hydrogen. The carbonic acid is removed by agitating the gas with lime water. In its undiluted state, it can scarcely be breathed. Sir Humphry Davy found, that at the third respiration total insensibility ensued; and symptoms of great debility continued for a considerable time. It was, at one time, thought to be a useful sedative in phthisis, and to have arrested the disease in some cases; but the results were by no means uniform: caution, too, was needed in its administration, and— what is applicable to the inhalation of all gases in pulmonary affections —its employment was inconvenient, and often distressing. It has been usually diluted Avith twenty parts of atmospheric air at first,—the pro- portion of the gas being slowly increased, and care being taken not to induce much vertigo, or muscular debility. C. GAS AC"lDUM CARBON'lCUM.—CARBON'lC ACID GAS. Carbonic acid gas—procured by the action of dilute sulphuric or chlorohydric acid on carbonate of lime ; or, what is preferable, by decom- posing carbonate of lime by exposing it to a strong heat in an iron bottle, and collecting the gas over water—Avhen undiluted, is altogether irrespirable, occasioning a spasmodic closure of the glottis and death; REFRIGERANTS. 213 but, when diluted with atmospheric air, it appears to possess decidedly sedative properties. Formerly, it was much employed in phthisis, and great expectations were entertained that it might be at least a valuable palliative in that disease. It seemed, at times, to lessen expectoration, diminish hectic fever, and act as an anodyne. When employed, it was diluted with four or six parts of atmospheric air. In the irritable state of the bron- chial mucous membrane, in which cough and dyspnoea are induced by the application of cold, it has been found of advantage when breathed in a dilute state. The following has "been advised as an easy mode of employing it with this view. Put a mixture of chalk or marble Avith dilute sulphuric acid and water into a large glass bottle, so that it shall occupy the depth of only a few inches. Carbonic acid gas is extricated, and forms an atmosphere mixed with atmospheric air in the upper part of the vessel, which may be breathed by introducing a glass tube to about the middle of the bottle, and inhaling from it. It has been employed externally as a local application to cancerous and painful ulcerations. A stream of it is directed on the part, taking care that the gas is previously transmitted through water, if it has been procured by the action of a mineral acid on carbonate of lime, and confining it for some time over the sore by a funnel connected with the tube. Yeast Cataplasm—Cataplas'ma Fermen'ti of the London and Dub- lin Pharmacopoeias—owes its virtues in part to carbonic acid. It is generally, however, esteemed as an excitant; and Dr. Pereira affirms, that he has often heard patients complain of the great pain it occasions. When applied to fetid ulcers, it corrects the fcetor, and promotes the separation of sloughs. It is made of Flour Ibj.; Yeast of Beer Oss.; a gentle heat being applied until the mass begins to swell. Of late years, carbonic acid gas has been sent into the vagina in cases of amenorrhcea, and in uterine pains, which precede and accompany the menstrual discharge; and it is said Avith success. The fumigations are applied by receiving into the vagina the free extremity of a gum elastic canula, surmounted by a nipple-like end, through which the gas is passed. The gas is disengaged by means of dilute sulphuric or chlorohydric acid poured on carbonate of lime. It does not appear, that any excitant effect is induced by the acid vapour that may pass over Avith the gas. Still, to avoid all risk, the gas may be first passed through a Woulfe's apparatus, as suggested by an intelligent* corre- spondent of the author, the late Prof. W. E. Fisher. V. REFRIGERANTS. Synon. Psyctica, Temperants. \ Definition of refrigerants—Modus operandi—External and internal refrigerants—Refrige- rant baths—Therapeutical application of refrigerants—In fevers—In the phlegmasise, &c.—Special refrigerants. Refrigerants may be defined,—agents that diminish the morbid heat of the body. 214 REFRIGERANTS. The author in another Avork, (Human Physiology, 7th edit., p. 226, Philad. 1850,) has entered at large into the interesting subject of the physiology of calorification, and has there attempted to show, that it is accomplished in every part of the system of nutrition,—not exclusively in the lungs, as was at one time imagined, and still is by many. But, although not effected exclusively in those' organs, the experiments of Le Gallois, as well as those since instituted by others, have led to the inference, that there is always a general ratio between heat and respira- tion in cold-blooded and warm-blooded animals; and in hibernating animals, in the periods of torpidity and of full vital activity. When the eighth pair of nerves is cut in the young of the mammalia, a con- siderable diminution is produced in the opening of the glottis, so that, in puppies recently born, or one or two days old, so little air enters the lungs, that when the experiment is made in ordinary circumstances, the animal perishes as quickly as if it was entirely deprived of air. It lives about half an hour. But if the same operation be performed on puppies of the same age, benumbed with cold, they live a whole day. In the first case,—M. Edwards thinks, and plausibty,—the small quan- tity of air is inadequate to counteract the effect of the heat; whilst, in the other, it is sufficient to prolong life considerably; and he deduces the following practical inferences, applicable to the adult age, and par- ticularly to man. " A person,"—M. Edwards observes,—" is asphyxied by an excessive quantity of carbonic acid in the air which he breathes; the beating of the pulse is no longer sensible, the respiratory move- ments are not seen; his temperature is, however, still elevated. How should we act to recall life ? Although the action of the respiratory organs is no longer visible, all communication with the air is not cut off. The air is in contact Avith the skin, upon which it exerts a vivify- ing influence; it is also in contact with the lungs, in which it is renewed by the agitation which is constantly taking place in the atmosphere, and by the heat of the body, which rarefies it. The heart continues to beat, and maintains a certain degree of circulation, although not perceptible by the pulse. The temperature of the body is too high to allow the feeble respiration to produce upon the system all the effect of which it is susceptible. The temperature must then be reduced; the patient must be withdraAvn from the deleterious atmosphere; stripped of his clothes, that the air may have a more extended action upon his skin; exposed to the cold, although it be Avinter, and cold water thrown upon his face, until the respiratory movements reappear. This is precisely the treatment adopted in practice to revive an indi- vidual in a state of aphyxia. If, instead of cold, continued warmth were to be applied, it Avould be one of the most effectual means of ex- tinguishing life. This consequence, like the former, is confirmed by experience. In sudden faintings, Avhen the pulse is weak or imper- ceptible, the action of the respiratory organs diminished, and sensation and voluntary motion suspended, persons the most ignorant of medi- cine are aware, that means of refrigeration must be employed, such as exposure to air, ventilation, and sprinkling with cold water. The efficacy of this plan of treatment is explained on the principle before laid down. Likewise, in violent attacks of asthma, AA'hen the extent MODUS OPERANDI. 215 of respiration is so reduced that the patient experiences suffocation, he courts the cold even in the most severe weather; opens the Avindows; breathes the frosty air, and finds himself relieved." Were the function of calorification wholly accomplished by the lungs, our refrigerants ought to be applied to those organs to exert their fuU effect; but, as the evolution of heat takes place in the system of nutrition of every part of the body, they are made to impress only a portion of that system, whence the impression is conveyed to every partj by virtue of the intimate sympathy which is known to exist between them. To the extent of this sympathy, both in its therapeutical and pathological relations, the author has had occasion to allude repeatedly. In the healthy state of the frame, it is evinced by the morbific influence of cold and moisture, Avhen applied even to a small portion of the cutaneous surface, which had been previously shielded from their action. If a healthy person expose his feet to these agencies, the capillary function becomes modified, and there is not a part of the capillary system, which does not feel the effects; but disease is not induced in the whole, unless the whole is, at the time, predisposed to assume the morbid condition. Generally, there is some portion of the system of nutrition more disposed at the time to take on diseased action than another; and under the irradiations that occur, OAving to the modified organic actions in the feet, disease in such por- tion results. A similar action takes place, when we apply cold and moisture therapeutically, as is done in febrile affections Avhenever the skin is steadily hot and dry. We find it is not necessary, that these agents should be applied over the whole of the cutaneous surface, but only over- a comparatively small portion,—as of the hands and arms. The sedative influence of the cold is exerted upon the parts with which it is made to come in contact; the function of calorification has its activity diminished; and, soon afterwards, we discover that the heat of the Avhole system has been manifestly lowered by the appli- cation. The temperature of the human body is rarely raised beyond 106° of Fahrenheit's scale. Professor James Gregory, of the University of Edinburgh, was wont to say, that he doubted the accuracy, of any thermometer, Avhen a higher temperature Avas indicated under the tongue or in the axilla. There can be no doubt, that the degree at Avhich Fahrenheit has placed fever-heat on his scale —112°—is too elevated. There may be cases in which it has reached that point, but the ordinary temperature of the blood in fever is far below this. In one of the hottest remittent fevers which the author ever attended, it never rose higher than 102°, under the tongue. M. Edwards alludes, in his work on 'Physical Agents' to a case of tetanus, communicated to him by M. Prdvost, of Geneva, in which the temperature rose to 110° 75' Fahrenheit. It was before remarked, that there is a general ratio between heat and respiration; yet to this there are many exceptions. In the case of a man at St. George's Hospital, London, labouring under a lesion of the cervical vertebrae, Sir B. Brodie observed the temperature rise 216 REFRIGERANTS. to 111°, at a time when the respirations were not more than five or six in a minute; and other cases of a like kind are on record. To reduce excessive heat, external agents, of a suitable temperature, are most effectual. Damp cold, of all external means of refrigeration, tends best to diminish the activity Avith which heat is developed. Hence its value as a refrigerant in fevers,—a point now universally acknowledged. But if damp cold cannot be sufficiently prolonged, sponging with water of any temperature below that of the body occa- sions abundant evaporation, and a salutary refrigeration, the effect of which is extended to every part of the frame, in the manner already mentioned. Cool air is, likewise, a valuable refrigerant ; and its admission in febrile affections is generally grateful and salutary. There was a time when it was altogether excluded; when the temperature of the cham- ber was kept elevated, and hot fluids were administered, Avith the view of concocting or maturating some fancied peccant humour, and aiding its expulsion from the body. Since the time of Sydenham more espe- cially, these notions have passed away,—although we can yet discover some relics of their existence,—and, fortunately for the patient, the instinctive desire for cold drinks is now no longer opposed. Indeed, the use of cold fluids internally, and the free admission of cool air into the apartment, when the weather and the feelings of the patient admit of it, may be looked upon as amongst the most important and salutary elements in our management of febrile cases. When the ventilation of an apartment is properly attended to, the quantity of febrile heat is diminished,—both by the contact of fresh portions of cool air, and by the increased evaporation that necessarily ensues. When cold fluids are taken into the stomach, they produce an effect there, analogous to what occurs Avhen they are brought into contact Avith a portion of the cutaneous surface. They are, indeed, the best internal refrigerants; and, of these, cold water—ice cold—and iced lemonade, are entitled to the preference. Every one must have ob- served how rapidly and copiously perspiration breaks out over the surface x>f the body, during the heats of summer, after a glass of cold water has been taken. This must be OAving to the refrigerant influ- ence of the low temperature reducing the erethism that exists in the mucous membrane of the stomach, as it does in every part of the der- moid surface, whenever the temperature is extremely elevated. By depressing this erethism to the healthy standard, the sedative influ- ence is propagated at once to every portion of the capillary system; and the cutaneous transpiration is augmented by the diminution of the exalted actions of the cutaneous exhalants. This is the only mode in which, it seems, the phenomenon can be rationally explained. It is impossible for us to admit, that the fluid can pass so rapidly into the vessels by imbibition as to account for it. The perspiration, in such cases, breaks out almost instantaneously after the fluid has reached the stomach, and impressed the lining membrane. Writers on materia medica have admitted, besides those refrigerants to which allusion has been made, a number of agents, Avhose operation MODUS OPERANDI. 217 is much less unequivocal. " There are," says a modern writer—Dr. Paris—" certain saline substances, which, by undergoing a rapid solu- tion, and acquiring an increased capacity for caloric, produce a diminu- tion of temperature, and if this takes place in the stomach, the sensa- tion of cold, which it produces, is equivalent to a partial abstraction of stimulus; this being extended by sympathy to the heart occasions a transient reduction in the force of the circulation, and by this, or by a similar sympathetic affection, causes a sensation of cold over the whole body." It is obvious, however, that such substances, according to this theory, can be refrigerant only Avhilst undergoing rapid solution; and that, therefore, to produce their full effect, they should be given, either so as to undergo their solution wholly or partly in the stomach, or im- mediately after they are dissolved. Yet how trivial must be the opera- tion of cold thus produced, compared with that which can be accom- plished in fevers by a draught of iced water. And accordingly, as before remarked, iced drinks maybe regarded as amongst the febrifuga magna,—the most important refrigerants; and they are now employed to the exclusion of nitrate of potassa, borate of soda, &c, &c, on which reliance was at one time placed. There is a circumstance, by the way, connected with the use of these refrigerant salts, which is full of interest to the therapeutist, and exhi- bits that wandering from the true track, of which philosophy has to deplore the existence of so many examples in the history of medical science. The author has remarked, that internal refrigerants have been made to comprise—in many definitions—saline substances, which, by undergoing a rapid solution, produce a diminution of temperature in the stomach or elsewhere; and the definitions have been so worded, and intended, as to include these substances only. Yet, strange to say, the attention of the therapeutist has strayed from the circum- stances, that occasion such substances to be refrigerant; and we often observe a mixture, containing nitrate of potassa in solution, directed to be administered at intervals throughout the day. In this mode of administration, the whole refrigerant effect according to the above ex- planation, must necessarily be lost. The mixture must attain the temperature of the chamber; and if nitrate of potassa produces any effect, it must be of an excitant character. The practitioner, notwith- standing, places great reliance, perhaps, on his febrifuge mixture; and this at least is fortunate, for whilst he is administering it, he is not likely to be officiously irritating the intestinal canal by repeated ca- thartics. In this way, the use of an inert and negative compound may be followed by positive advantage. Dr. Spillan, however, after citing the above observations of the author, adds, that " the refrigerant effects of nitrate of potassa, as a sedative, when given dissolved in even tepid drinks, such as Avhey, are known to every one." The whole object of the preceding remarks is to show, that they certainly are not known to the author; yet he has watched most carefully for them: nor have others been more fortunate. Dr. A. T. Thomson states, that " the dose of the salt should not be dissolved until the instant in which it is to be sAvallowed;" and Dr. Pereira accords with him; whilst Dr. Christi- son in his 'Dispensatory,' expresses himself in a manner that still 218 REFRIGERANTS. more strongly corroborates the views of the author. " Its refrigerant action," he remarks, "generally admitted by systematic writers on materia medica, and by many practitioners, is of doubtful existence, —having probably been inferred rather from the coldness it occasions while dissolving in water, than from actual evidence of its effects in disease. The sedative action ascribed by some to it has been probably inferred from its supposed refrigerant property, and not from observa- tion." In addition to the internal refrigerants, that come under the definition of Dr. Paris, certain others have been enumerated, which are presumed to exert a temperant effect,—independently of simple abstraction of heat. Thus, acetic acid, it is said, when properly diluted, renders the pulse, in a febrile state of the habit, slower; the animal temperature less, and improves the secretions. The same has been observed of all the vegetable acids, as well as of borate of soda, and boracic acid; but there does not appear to be any strong evidence in favour of their pos- sessing this property. Acids and subacids are always grateful in febrile affections, and by proving agreeable to the palate they may tend to allay irritation; but this applies equally to mineral acids ; and, accord- ingly, mineral lemonades are often prescribed beneficially in continental Europe. A modern writer, Dr. A. T. Thomson, excludes them, al- though he classes among the refrigerants,—acetic, oxalic, citric, tartaric, and malic acids. Of borate of soda, and boracic acid,—although the latter was at one time termed sal sedativus Hombergi,—it is unnecessary to say much. Common consent has led to their total exclusion from the catalogue of internal refrigerants in this country and in Great Britain; although they are still prescribed in some parts of Germany, whose pharmaco- poeias have exhibited too many relics of prejudices, and irrational practices, prevalent in times that have long passed away. Therapeutical Application of Refrigerants. On the therapeutical application of refrigerants much need not be said. They are obviously proper, whenever the vital manifestations are exalted beyond the healthy standard: yet they may not all be equally appropriate; and the practitioner has to consider, whether other influences may not be exerted by them, independently of mere abstraction of heat;—whether, in other words, their refrigerant ope- ration be simple, or combined with some other, that may modify their influence on the economy. This is well exemplified in the cases of the cold affusion and cold ablution, when employed at the commence- ment of Fevers, with a view of arresting their course. Whilst the former may be successful, the latter may totally fail. The object is, here, to excite a new impression on the totality of the nervous system, as well as to diminish febrile action; and, accordingly, that form of applying the cold medium ought to be selected, Avhich communicates a powerful shock, and thus breaks in upon the morbid chain, which constitutes the disease. As simple sponging of the hands and arms Avith cold water THERAPEUTICAL APPLICATION. 219 communicates no such shock, it is manifestly not calculated to cut short fever; whilst, on the other hand, the cold affusion becomes inappro- priate whenever the morbid phenomena that constitute continued fever have persisted so long, that all hope of cutting the disease short has vanished; and when any poAverful impression is likely to give rise to irregularity of action, and, therefore, to hyperaemia in some internal organ. In these cases it is, that cold, tepid, or even warm ablution is employed so advantageously. It tempers the organic actions of the part to which it is directed, and thence extends its'benign influence to every part of the organism. A practical rule for the use of external and internal refrigerants in fever is—to observe, whether the skin be steadily hot and dry. If so, cold ablution may be practised ; cool air be admitted; the quantity of bed-clothes be diminished, and cold fluids be freely indulged in ; but whether all, or any of these, may be applicable to particular cases has to be left altogether to the discrimination of the practitioner. In the different stages of the paroxysm of an intermittent, conditions are present, that modify materially the employment of agents belonging to the class under consideration. In the cold stage, the hot stage, and the sweating stage, we are guided by rules, which are applicable to similar conditions occuring in other morbid states. In the cold stage, the functions are oppressed and depressed; and there is more or less congestion internally: this is dependent upon modified innervation,— such modification consisting in diminished action: fluids, therefore, which are of a temperature equal to, and above, that of the body, are needed to excite the nervous and vascular systems to a proper play of the functions: as soon as this has been accomplished, and reaction has taken place, general excitement is substituted for the previous state of diminished action, and all the phenomena of synochal or inflammatory fever are present. Cold drinks noAV become grateful and appropriate; they reduce the exalted organic actions and hasten the supervention of the sweating stage, during which the heat is undergoing resolution, and cold drinks are, consequently, not advisable: tepid drinks are accordingly substituted. That which applies to cold drinks, during the paroxysm of an inter- mittent, applies equally to the admission of cool air, and the regulation of the coverings of the patient. In the cold stage, warmth is advisable; in the hot, the Avhole system of refrigeration has to be adopted; whilst, in the sweating, care must be taken in the application of cold, lest the cutaneous capillaries be morbidly impressed so as to excite irregular action in some important part of the organism, and consequent hyperae- mic or other mischief. Allusion has already been made to the prejudice, at one time univer- sal, against the use of cold drinks in fever. This existed as long as, and even longer than, the doctrine of concoction, which taught, that a certain amount of febrile heat Avas necessary to maturate the peccant matter—the materies morbi. Fortunately for the patient, the prejudice is now daily yielding; and we rarely meet AArith it except amongst those whose minds have not been enlightened by the more modern, and more correct views of therapeutists. The author has likewise referred to a 220 REFRIGERANTS. similar prejudice, as regards the use of iced drinks, when calomel has been given. The prejudice is unfortunate, as it often causes the denial of the very best febrifuge Ave possess; and suggests an opposite plan of treatment, Avhich can scarcely fail to aggravate the disease. Were the idea, indeed, well founded, an interesting and important question would arise, whether the calomel or the iced Avater should give place ? and no doubt, in the author's opinion, ought to exist in the mind of the reflecting practitioner, that it should be the former, in most cases. To this decision he may be led universally, where calomel is given as a simple cathartic. The lists of the materia medica contain such a va- riety of those agents, that sufficient room is left for selection. Where, also, the mercury is administered as a revellent in fever, or to produce a neAV action in the system, cold Avater, in moderation, may be per- mitted with impunity, and even with advantage. The author has been, for years, in the habit of administering mercurial cathartics, and mercurial revellents in febrile and inflammatory affections, and has never wholly restricted the patient from the use of ice; yet, in no case, has he seen the slightest inconvenience from the association. The notion of detriment from this course is now, indeed, abandoned by the intelligent physician; but it still clings with pertinacity to the extra-professional. In fevers accompanied with eruptions, the cooling regimen is not less important than in the simple continued, and remittent varieties. There was a time, when the eruption of smallpox and of scarlatina Avas supposed to be injuriously checked by the free admission of cool air; but it is now acknowledged, that the use of refrigerants is attended Avith better effects than that of any other class of medicinal agents; and, in the generality of cases, the efforts of the judicious physician are confined to the admission of cool air ; sponging the body with cold or tepid water—especially during the eruptive fever, and the use of cold water internally; keeping the alimentary canal clear, at the same time, by the employment of gentle cathartics. Allusion has already been made to the peculiar character of scarlatina; and to the fact, that, although the organs concerned in calorification are inordinately ex- cited—yet, it is an excitement originally more nervous than vascular— and, that copious blood-letting, instead of mitigating, often adds to, its violence. In all cases, however—except, perhaps, in the most malig- nant typhous forms—the application of cold to the surface, either by means of cold water or cool air, or both, may be had recourse to ad- vantageously. Where such agency is improper, the fact will be indi- cated by the feelings of the patient. He will be rendered chilly, and the powers of the system will be depressed by it; but there are few cases in which the admission of fresh air will not be grateful and sal- utary. Inflammation and hemorrhage.—It has been conceived that cold spong- ing, and other forms of external refrigerants are not as serviceable, where hyperaemia exists in an internal organ, as where the case is uncomplicated. This is true; but it by no means follows, that they should do harm. In certain internal inflammations, indeed, we are in the habit of employing them freely as remedial agents, and the author THERAPEUTICAL APPLICATION. 221 thinks—and it is generally thought, with advantage. In inflammation of the encephalon—primary, or occurring in the course of fever—the practitioner does not hesitate to have the head shaved, and to apply ice freely to it. " In no disease," says Dr. A. T. Thomson, " does the powerful sedative influence it possesses display itself so conspicuously as in phrenitis. The most furious delirium is quickly subdued by allowing cold water to drop on the vertex, whilst the rest of the scalp is covered Avith cloths moistened with vinegar and water." Much, however, of the effect, in this case, is revellent rather than refrigerant. The author has before attempted to show, that every form of the cold douche produces its chief influence by the nervous abstraction it occa- sions ; and not only is this the case in the ordinary hyperaemiae of inflammation, but in those of an analogous nature, that accompany hemorrhage. The cold key, applied to the nape of the neck in epis- taxis, produces its effect in .arresting the hemorrhage, less by refrige- ration than by revulsion. In active hemorrhage, hoAvever, the re- frigerant effect of cold is a most valuable agency; and, where ice can be procured, it may be taken internally, without the inconveniences that result from the too free nse of cold water. It has been elsewhere remarked, that where hemorrhage takes place, absorption is more active; and, if fluid be largely allowed, it soaks readily through the coats of the blood-vessels, so that in a short space of time there may be the same quantity of blood circulating in the vessels as before the hemorrhagic attack; and as the blood is rendered more watery, a re- currence of the flow follows more easily. But, by taking a small piece of ice into the mouth, the full refrigerant influence is exerted; whilst there is no danger whatever of much imbibition, and consequent repletion of vessels. The utility of cold applications in hemorrhages was referred to under Astringents. Whenever, indeed, it is necessary to produce a dimi- nution in the amount of fluid in the capillary vessels of a part, their employment is indicated ; and hence, in topical inflammations, stran- gulated hernia, &c, they are greatly prescribed. In the first of these affections, they act much in the same manner as hot applications. Both cold and heat, indeed, occasion diminished calibre of the capillary vessels. Pulmonary diseases.—In diseases of the respiratory organs, which interfere with the due aeration of the blood in the lungs, exposure of the body to cool air—under precautions to be suggested by the indi- vidual case—is a useful agent; and its propriety is indicated by the instinctive desire which is felt for the free admission of air under such circumstances. The function of haematosis is not confined to the lungs, although chiefly accomplished there. It takes place, but to a slight extent only, over the whole cutaneous surface; and the author has before alluded to the marked connexion, that exists between the functions of calorification and respiration; so that if the latter be im- peded, it is requisite that the former should be reduced likeAvise. It is unnecessary to dwell on all the cases in which refrigerants may be beneficial. The reflecting practitioner will easily understand those, in which they may be demanded; and, in this, he is fortunately guided, 222 SPECIAL REFRIGERANTS. in most instances, by the sensations of the patient. When the ab- straction of heat is attended Avith disagreeable sensations, it can rare- ly, or never, be proper; even in fevers, where the employment of refrigerants is most clearly indicated, we are greatly guided by the feelings of the patient; and if the free admission of cool air, cold ablu- tion, and cold drinks excite chilliness, or any uncomfortable feeling, their application has to be regulated accordingly. SPECIAL REFRIGERANTS. In the preceding remarks, enough has been said of the acidulous and other refrigerants that are usually employed in febrile and inflam- matory affections. It may be proper to add, however, that in these diseases, no single refrigerant is more agreeable than the soda or mine- ral water of the shops, kept in ounce vials in ice, and given from time to time when the thirst is urgent. In the absence of this, the artificial soda powders may be used; which are made by dissolving in water twenty-five grains of tartaric acid, and thirty grains of bicarbonate of soda, adding the two together, and drinking the mixture in a state of effervescence:—or, what is better, dissolving each of the powders in half a tumblerful of water, which must be kept cold, and a wineglass- ful of each solution be taken whilst effervescing, every two or three hours, or oftener. In this manner, the stomach is not loaded, nor is the tartrate of soda formed in sufficient amount to affect the bowels ; for it must be recollected that, in the artificial soda-water, the patient takes a solution of that salt in place of carbonated water, which con- stitutes the soda-water of the shops. Effervescing draughts are likewise made with lemon juice. (Succ. limon. Oss.; Sodce carb. 3ss.; vel Potassce carb. gr. xxv.) The neutral or saline mixture, hereafter referred to (p. 225), is a composition of this kind, given either in effervescence, or after the effervescence has passed away. When it is desirable to unite a refrigerant and cathartic, the Seidlitz powders, described elsewhere, (Yol. i. p. 218,) may be given. 1. Saline Refrigerants. Almost all the neutral salts are refrigerant when properly adminis- tered ; but the saline substances that have been regarded as more de- cidedly so are the folloAving, which will not, however, require much consideration after the remarks already made in regard to them. 1. LIMON.—LEMONS. The fruit of Citrus Limonum, described elsewhere (Yol. i. p. 502), yields an acid juice of a most grateful kind, Avhich owes its acidity to the citric acid. It does not keep, however, OAving to the mucilage and LI M 0 N. 223 extractive mixed with it; and an artificial lemon juice is sometimes made, which consists of an ounce of citric acid, dissolved in a pint of water, with the addition of a little oil of lemons. Lemon juice—especially iced—forms a most pleasant refrigerant drink in febrile and inflammatory affections; and, in the form of lemon- ade, made by adding water and sugar and a little of the rind of the lemon to it, is largely employed for this purpose. It is, also, added to barley water, infusion of flaxseed, &c, to give them flavour; and is, occasionally, used to form the effervescing draughts administered in fever; or to allay irritability of the stomach. SYR'UPUS IIMO'NIS, SYRUP OF LEMOXS. (Limon. Succ. colat. Oj., Sacchar. Sbij.: make into a syrup.) A grateful addition to cold drinks, where much thirst exists, as in febrile diseases, as well as to conceal the taste of saline cathartics given in solution. Lemon juice is used also to form ACI'DUM CIT'RICUM, CITRIC ACID. Citric acid is obtained from lemon or lime juice by saturating it, when boiling, with carbonate of lime, so as to form citrate of lime, Avhich is washed repeatedly with water, and de- composed by diluted sulphuric acid: an insoluble sulphate of lime is deposited, and the citric acid remains in solution. This is then eva- porated, and the acid allowed to crystallize. It is prepared on the large scale, and is, therefore, in the materia medica list of the United States, London and Dublin Pharmacopoeias. In Philadelphia, citric acid is made in the usual manner from the juice of limes and lemons; and the imported juice is said to furnish from four to six ounces of the pure crystallized acid to the gallon. Citric acid crystallizes in right rhombic prisms terminated by four planes. It has an intensely acid taste, and is permanent in dry air, but becomes moist in damp. It is soluble in less than its own weight of cold, and in half its weight of boiling water; and is soluble in alco- hol and ether. It is liable to be adulterated with lime; and tartaric acid has been not unfrequently sold for it. It is known by its taste, the shape of its crystals, and by its forming an insoluble salt with lime, and a deliquescent salt with potassa. Tartaric acid is detected by add- ing a solution of carbonate of potassa to one of the suspected acid; and if tartaric acid be present, a crystalline precipitate of bitartrate of potassa Avill be thrown down. Lime will be detected by incineration. According to the Pharmacopoeia of the United States, 100 grains of citric acid saturate 150 grains of bicarbonate of potassa. Citric acid has the refrigerant properties of lemon juice, and is chiefly used for making a substitute for it, and for forming effervescing mixtures. The cheaper tartaric acid is, however, generally substituted for it in the latter case. The " citrated kali, citrated effervescing pow- ders and lemonade powder of the shops," according to Dr. Christison, never" contain any other acid than the tartaric; and, he adds, " the truth is, that citric acid might, without injury, be expunged from the Pharmacopoeias, because, for every medicinal purpose, tartaric acid is quite as convenient, and it is not above a third of the price." 224 SPECIAL REFRIGERANTS. Citric acid is used in the formation of Ferri citras, Liquor magnesice citratis, Liquor potassce citratis, Potassce citras, and Syrupus acidi citrici of the Pharmacopoeia of the United States. SYR'l PUS ACIDI CIT'RICI, SYRUP OF CITRIC ACID. (Acid, citric, in pulv. 3ij.; 01. Limon. '"liv.; Syrup. Oij. Rub the citric acid and oil of lemons Avith a fluidounce of the s}Trup; add this to the remainder of the syrup, and dissolve with a gentle heat.) This may be used as a substitute for Sy- rup of Lemons, but it is not so agreeable. It keeps, however, better, and may be used like it. It enters into the composition of the Liquor Magnesice Citratis of the Pharmacopoeia of the United States. 2. POTAS'SiE NITRAS.—NITRATE OF POTAS'SA. The general characters of this salt have been given under the head of Diuretics, (Yol. i. p. 314,) and its title to be esteemed a refrigerant has been canvassed in the general observations on the present class of medicines. In protracted fevers, it is not unfrequently given in this country, associated with tartrate of antimony and potassa, and mild chloride of mercury (see Yol. i. p. 348); but it is obvious that in such a combina- tion it is impracticable to infer anything positive in regard to the action of the nitrate. The dose, in which it is usually prescribed, is from five to fifteen grains, every three or four hours; and it is well to bear in mind the remark before made, that it ought to be dissolved in water immedi- ately before being taken. It is sometimes used as a gargle in inflammatory sore throat, (Potass. nitrat. 3iss.; Mellis 3iij-; Aquce f Ivj.;) and it occasionally forms part of frigorific mixtures, that are applied as topical refrigerants. Of late, it has been given in large doses in acute rheumatism, as it had been in the last century by Dr. Brocklesby—a distinguished phy- sician of the British army, and medical writer. The testimonies in its favour are not few; but it must be borne in mind, that the disease is self-limited in many instances,—in other words, appears to run a defi- nite course greatly uninfluenced by medicine. From six drachms to two ounces have been given in the twenty-four hours dissolved in sweetened barley-water, in the proportion of half an ounce of the nitrate to a pint and a half or two pints of the barley-water. It is said, under such circumstances, to act as a sedative, decreasing the force and frequency of the pulse, perhaps indirectly by its revulsive action on the stomach; but farther observations are needed to establish its efficacy, before we attempt to explain the modus operandi. A former Edinburgh Pharmacopoeia contained a formula for Troches of Nitrate of Potassa, composed of one part of nitrate to three parts of sugar ; which were used in inflammatory sore throat, and in excessive ptyalism; but it does not exist in the last pharmacopoeias. The Germans, according to Sir George Lefevre, consider nitrate of soda more antiphlogistic than nitrate of potassa. SOD^E BORAS. 225 3. POTAS'SJE CITRAS.—CITRATE OF POTAS'SA. Citrate of potassa is rarely kept in the shops. It is readily made by saturating the potassa of carbonate of potassa Avith citric acid; but the salt is deliquescent, and crystallizes with difficulty. A process for it is given in the last edition of the Pharmacopoeia of the United States (1851). It is in the form of a white granular powder; in- odorous, and of a saline slightly bitterish taste. The dose is from tAventy to thirty grains or more; but it is most frequently given in solution, often formed extemporaneously. The Pharmacopoeia of the United States contains two formulae for the LIQUOR POTAS'SJI CITRA'TIS, SOLU'TION OF CITRATE OF POTAS'SA; the one made Avith fresh lemon-juice, and the other with citric acid. (Succ. limon. recent. Oss.; Potassce bicarbonat. q. s.;—or, Acid, citric. 3ss.; 01. limon. fllij.; Aquce Oss.; Potassce carbonat. q. s.) These formulae are properly, perhaps, introduced—seeing that the mixture is so often prescribed—in order that uniformity may be ob- served in its preparation. It is the Avell-known "neutral mixture," which, in one form or other, has been employed in febrile cases for ages. When accurately prepared, it is merely a solution of neutral citrate of potassa flavoured with lemon-peel; and has no more diapho- retic A'irtue than a similar solution of any of the neutral salts. Yet it is constantly administered in febrile cases; and as these generally do Avell under the observance of a course, which avoids all unnecessary irritation, and removes, as far as possible, disturbing influences Avhen they occur, a portion of the good effects is very apt to be ascribed to any agent which is administered at the same time. The neutral mix- ture—saline mixture, as it has been likewise called—has been exten- sively used by the author; but he has long abandoned its employment, except Avhere it was necessary to carry out a temporizing method of treatment; and, in these very cases, it is much preferable to give the mixture in a state of effervescence, in order that the gently excitant influence of the carbonic acid may be exerted on the stomach. Still, for this purpose, the use of the mineral water or soda water of the shops is to be preferred. When kept cold—ice cold—it is an admirable re- frigerant, and exceedingly grateful, much more so than the neutral mixture, no matter how well the latter may be prepared. 4. SODvE BORAS.—BORATE OF SODA. Borax,—Biborate, Borate, or Subborate of Soda, is probably no more entitled to the reputation of a refrigerant than nitrate of potassa, It is an abundant natural production in Persia, and especially in Thibet, being contained in the waters of various lakes, on the borders of Avhich it is left during the dry season in impure crystals. In this state it is called in commerce Tincal or Crude Borax, and is usually imported from Calcutta. It is in flattened, six-sided prisms, coloured with a greasy substance which has been considered by M. Yauquelin to be a vol. ii.—15 226 SPECIAL REFRIGERANTS. fatty matter saponified by soda. Different methods have been recom- mended for purifying it. At one time, the purification of it Avas alto- gether in the hands of the Dutch, and Avas kept a profound secret; but in 1818, MM. Robiquet and Marchand made known a process, Avhich is now generally followed by manufacturers. It consists in rinsing tincal in lime Avater, so as to decompose the alkaline soap on its surface, and convert it into an insoluble calcareous soap,—dissolv- ing the salt in water, and decomposing any remains of the alkaline soap in the solution by a little muriate of lime,—finally evaporating and crystallizing by very slow cooling. (Christison.) This is refined borax. A great part of the refined borax of commerce is now made by the direct combination of boracic acid Avith soda. The boracic acid is an abundant natural production of certain lagoons and hot springs in Tuscany; and the mode of separating it is described at length by Dr. Pereira. The manufacture is now so extensive, that one single indi- vidual is said to fabricate the enormous quantity of 2,400,000 pounds annually, for the supply of most parts of Europe and America. (Buch- ner, cited by Christison.) Borate of soda of the shops is in large crystals, Avhich are oblique rhombic prisms. It occurs, also, in octohedrons, but is generally seen in irregular-shaped masses, of a saline, cooling and somewhat alkaline taste. It effloresces sloAvly in the air, and is wholly soluble in Avater, the solution having an alkaline reaction. It requires twelve parts of cold water, and two of hot to dissolve it. When added to bitartrate of potassa, it renders the latter soluble—forming soluble cream of tartar. This may be effected by boiling six parts of cream of tartar and tAvo of borax in sixteen of Avater for five minutes. Borax has generally been considered refrigerant, yet this has been probably OAving to the cooling taste of the salt rather than to correct observation of its effects: when used locally, it is admitted to be a mild excitant, causing smarting Avhen applied to sores. It is never given internally in this country as a refrigerant, but is often employed in cases of stomatitis,—particularly of the follicular form; and has been occasionally used as an injection in gonorrhoea and leucorrhoea. In these cases it probably acts as a gentle excitant. As a gargle, it is often used in association with honey, (Sodce borat. 3i.; Mellis 3iij.; Aquce f 3vj.) in sole throat, and ptyalism. Honey of Borax, Mel Bora'cis is officinal in the British pharmaco- poeias, (Sodce borat. 3i.; Mellis Ii.) It is used in aphthous affections of children; and, dissolved in water, in stomatitis and cynanche. Boracic Acid—formerly termed Sal Sedativus Hombergi—is never used, at the present day, as a sedative. It is nearly, if not Avholly inert. It has been given in very large doses without producing any sensible effect on the functions. TOPICAL REFRIGERANTS. 227 2. Topical Refrigerants. In another part of this work, (Yol. i. 549,) as well as elsewhere, (Human Health, p. 364,) the author has alluded to the marked differ- ence—which ought never to be lost sight of—between the effects of a bath some degrees lower than the temperature of the body, and ^ those of one that approaches or exceeds it. Whilst the former is ' markedly refrigerant, the other is powerfully excitant. The two are adapted, consequently, for very opposite conditions. A difference, again, exists, between immersion, affusion, and ablu- tion,—the first two being attended Avith a shock or powerful impression on the nervous system. When, therefore, the object is to diminish febrile heat,—ablution or sponging a part of the cutaneous surface, as of the upper or loAver extremities, is preferred to general baths, and to affusion—as the shoAver-bath, or any variety of the douche; but if the object be to excite a revulsive effect,—to break in upon a morbid chain, as to cut short a fever,—then the form of application is chosen which produces the greatest shock, or, in other words, the most poAver- ful impression upon the nervous system. The shower-bath is well adapted for such cases; it acts, in the main, like the ordinary bath, as regards temperature, producing sedative effects, when cold; stimu- lating, when hot. OAving, however, to the shock produced by it, it is not suitable for those of great nervous susceptibility. For such as are predisposed to certain head affections, the shock and refrigeration of the cold shower bath applied directly 'to the head, whilst derivatives are applied to the lower extremities, often proves most salutary. The effects of the douche or dash are dependent mainly on the shock; but partly, also, on the temperature of the fluid. They are, hoAvever, modified by the size of the stream, and the force Avith which it is made to impinge on the part. It is a valuable tamer of the furious maniac. The most violent paroxysm can generally be speedily brought to a close by it; and the impression made upon the nervous system is so overAvhelming, that tranquillity succeeds rapidly to the state of cere- bral excitement and turmoil. It is proper to remark, however, that even the cold affusion is highly recommended by Professor Dick- son, of Charleston, in remittent fever. " The particular indications"— he says—"which demand the resort to it unhesitatingly, are found in the youth and general vigour of the patient, and the heat and dryness of the surface. The local determination, which it controls most promptly, is that of the brain, shown by headache, flushed face, red eye, delirium, &c, Avith a full, hard, bounding pulse. Seat your patient in a convenient receptacle, and pour over his head and naked body, from some elevation, a large stream of cold water; continue this until he is pale or his pulse loses its fulness, or his skin becomes corrugated, and he shivers. On being dried and replaced in bed, a genial sense of comfort and refreshment will attest the benefits derived from the process, AA'hich, as I said above, may be repeated whenever the symptoms are renewed, which it is so well adapted to remove." In yellow fever he greatly prefers the cold bath to the 228 SPECIAL REFRIGERANTS. Fig. 162. Perforated bottom of shower-bath. lancet. "If I do not deceive myself"—he remarks—"it is equally effectual in subduing morbid excitement, and controlling irritation, without any positive expenditure of, or subtraction from, the vital forces;"—and he adds, that he has never seen any unpleasant conse- quences from it. The contraindications to its use are great age and debility, and " the rather unfrequent determination to the lungs and bowels shown by dyspnoea and diarrhoea." Should it produce pro- tracted chilliness or other discomfort, he, of course, does not repeat it. In an ordinary case of hysteria or in cerebral affections for Avhich a ' small stream of water is sufficient, the douche may be formed from the spout Of a tea-pot held at such a distance above the head as to regulate the force with which the water is made to impinge upon it. An excellent shower-bath for children—which may be used also by the adult—has been in- vented, and is described by Dr. A. T. Thomson. It consists of a holloAV vessel made of tin with a perforated bottom as in Fig. 162. The body of the vessel is of a bell-shape a, Avith a hollow tube b, Fig. 163, rising from the top, and terminating in a broad perforated rim c. When the bath is to be used, it must be sunk in a bucket of water, until it is completely submerged; the air is thus driven out of the bath, through the tube b c, and the bath filled with water. The thumb of an attendant is then to be placed on the opening in the centre of the rim c, and the bath is raised from the bucket of water. The pressure of the air on the holes in the bottom retains the water in the bath; and on raising the thumb from the upper orifice, the whole is rapidly discharged. In using it, the child must be placed in an empty tub, and the bath, being held over his head, is then to be discharged. Immediately afterwards he must be dried with fric- tion. Almost the only form of bath now employed in febrile cases is simple ablu- tion, and the warm pediluvium or foot- bath. It might seem that, in these very cases, a more powerful refrigerant influence would be exerted by the cold pediluvium; and, as regards the mere abstraction of ealoric, this would, doubtless, be the case; but the shock or impression made upon the nervous system is so powerful, when we first immerse our feet in a cold fluid, that the cold pediluvium becomes liable to the same ob- jections as the cold affusion or the cold douche, when employed with simple refrigerant vieAVS. On the other hand, the warm pediluvium Shower-bath for children. TOPICAL REFRIGERANTS. 229 is devoid of those objections; whilst the ultimate refrigerant effects are scarcely perhaps less. After the remarks already made, it is unnecessary to dwell on the topical use of cold applied to the surface of the body. It is the abstrac- tion of caloric, which is the main agency; and the degree to which this shall be carried must depend upon the particular case. It may be proper to add here, that where the local abstraction of heat is de- manded, and ice cannot be had, it becomes important to apply sub- stances—as to the head in cases of encephalitis—which by their evapo- ration may induce cold: hence, ether and alcohol are employed; and, in ordinary practice, cloths steeped in whisky, which are changed when they become warm. A common mixture for the purpose consists of equal parts of Whisky, Liquor Ammoniac Acetatis, and Water; but it possesses no virtues over simple Avhisky. In the application of topical refrigerants, the part should be covered with a single layer of thin linen or cotton or muslin, which should be frequently Avetted with the cold fluid; or a sponge, holding it, should be squeezed over the rag, Avithout removing it from the head. Dr. James Arnott has recommended what he esteems to be a per- fect mode of applying cold. He covers the part with a very thin bladder of the requisite dimensions, containing a small quantity of Avater of the desired temperature, which is constantly renewed by es- tablishing a current through the bladder, by means of two peAvter tubes,—one connected Avith a reservoir, and having a stopcock at its end to regulate the stream,—the other leading to a waste vessel. The elevation of the waste-pipe regulates the quantity of water in the bladder; and as, from the change of position of the patient, this ele- vation must be frequently altered, it is convenient to rest the extremity of the pipe on a sliding ring of a common retort stand. By this appa- ratus, he says, the temperature can be regulated with the greatest pre- cision, and with such a test as a guide, Avater can be chosen of the temperature that may be most agreeable to the feelings of the patient. If sudden and severe cold be desirable, very cold Avater passed rapidly through the bladder will reduce the temperature more speedily than the application of ice. And where great cold is required in the absence of ice, or where the temperature of 32° is not sufficiently depressed, frigorific mixtures may be substituted, of which the folloAving are amongst the most available: 1. Ammon. muriat.; Potassce nit rat. aa p. v.; Aquce p. xvj. This depresses the temperature from 50° to 10°. 2. Ammon. muriat.; Potassce nitrat. aa p. v.; Sodce sulphat. p. viij.; Aquae p. xvj. Depresses from 50° to 4°. 3. Ammon. nitrat.; Aquce aa p. j. Depresses from 50° to 4°. 4. Ammon. nitrat.; Sodce carbon.; Aquce aa p. j. Depresses from 50° to 7°. 5. Sodce sulphat. p. iij.; Acid, nitric, dilut. p. ij. Depresses from 50° to 3°. 230 revellents. 6. Sodce phosphat. p. ix.; Acid, nitric, dilut. p. iA\ Depresses from 50° to 12°. 7. Sodce sulphat. p. viij.; Acid, chlorohydric. p. v. Depresses from 50° to0°. 8. Sodce sulphat. p. v.; Acid, sulphur.; Aquce aa p. ij. Depresses from 50° to 3°. VI. REVEL'LENTS. Synon. Antispastics, Derivatives, Counter-irritants, Revulsives. Definition of Revellents—Epispastics—Definition of Epispastics—Rubefacients—Vesicants —Suppurants—Actual and Potential Cauterants—Modus Operandi—Permanent anil Intermittent Revulsions—Intensity of the Revulsion—Blisters, as Revellents in Fever —Revulsion in the Changeable Phlegmasise—Choice of Situation for the Revulsion— Therapeutical Application of Revellents—In Fevers—In the Pblegmasiae—In Hemor- rhage—In Mental Alienation, Hysteria, Tetanus, &c.—Special Revellents. Revellents are agents, which, by producing modified action in an organ or texture, derive from the morbid condition of some other organ or texture. The effect, thus induced, is termed revulsion, anti- spasis, or derivation, and it is said, by Conradi, to be exerted, "when a topical congestion, or stimulation, or other affection of a part leaves that part, and is drawn towards another, and usually less important part." The author has more than once referred to the value of this agency in the treatment of disease; and has remarked, that much of the good effects produced by local stimulants, of every kind, is ascribable to this principle of action. The effect, indeed, of almost every variety of re- vellent, is ascribable to the exaltation of vital manifestation it produces in the parts with which it is made to come in contact. " Next to direct debilitation," says a modern therapeutical Avriter—M. Bdgin—" there is no medicinal agency more certain, and that ought to be more fre- quently resorted to, than revulsion. It is induced by stimulating sub- stances, which elevate the organic actions in the parts to Avhich they are applied, or towards which their action is directed, and which are more or less remote from the inflamed organs. The remedies, em- ployed in this medication, have been called, by some, 'indirect debili- tants;' but such a denomination is inexact, for all revulsives exert a stimulating impression; and if their object be to allay irritations ex- isting at a distance, their inopportune use, or their too great activity is followed, in many cases, by contrary results:"—and he adds in a subsequent page—" The phenomena of revulsion have hitherto been viewed in too limited a manner. Physicians have not properly attended to the fact, that every medicinal operation by means of Avhich the vital actions are excited in other parts than those affected, also belongs to the class. It would seem, that the rubefacient, suppurative, or escharotic cutaneous revellents have alone occupied the attention of practitioners, and that frictions, baths, cataplasms,—in a word, all agents, calculated RUBEFACIENTS. 231 to solicit organic activity, concentrated internally, to the external parts of the body, are not esteemed revulsives; and reciprocally, the effects of a multitude of stimulants on the digestive organs, heaped in during the most serious acute diseases, and whose impression is not always mortal, are inexplicable to a great number of physicians, because they do not recognize in them the revulsive effect, which such agents occa- sionally produce. This medication, when properly investigated, ought to become the object of more extensive and useful consideration in practice, until the whole extent of its influence, and the astonishing variety of which it is susceptible in its applications, shall be better understood." Under the history of the separate divisions of remedial agents, already considered, the author has adverted to their revulsive operation; and it has been seen, that all local stimulants are possessed of more or less. It Avill, therefore, be only necessary, under this head, to make some general observations on their application in disease, and to describe especially those agents that are usually employed as cutaneous revel- lents ; or, in other Avords, that are generally classed by therapeutical writers under the head of epispastics and escharotics, whenever the latter are employed to do more than act chemically on the parts with Avhich they come in contact, and to affect organs or tissues, that are at a greater or less distance from the seat of their impression. Epispastics occasion inflammation, vesication, suppuration, or sloughing when applied to the cutaneous surface. Dr. A. T. Thomson has subdivided them into rubefacients, vesicants, suppuranis, and actual cauterants. To these, his division of escharotics may be appropriately added; for although the articles belonging to this division are generally employed for mere local action on the part with which they are placed in contact, they, like the rest of the class of epispastics, are often used for acting revulsively on other parts of the system. Rubefacients, as the name imports, are substances that redden the surface, by exciting the action of the capillaries, and giving occasion to an afflux of vascular and nervous power to the part on which they are applied; hence pain is a usual consequence of their employment. The most common rubefacient, in acute affections more especially, is the sinapism or mustard cataplasm; but every stimulating applica- tion,—every liniment, of which capsicum, turpentine, ammonia, &c, form the basis,—is rubefacient. The same may be said of friction with the dry hand, and of the application of heat. Everything, in short, Avhich,: by irritating the cutaneous surface, attracts the nervous and vascular influxes to the irritated part, and reddens it, is a rube- facient. If the rubefacient be sufficiently powerful, it may, besides inducing redness, be folloAved by an effusion of serum beneath the cuticle, so as to form a blister. The rubefacient then becomes a Vesicant. The first effect of ordinary vesicants is to produce rubefaction; and the action may he arrested at this point, if the practitioner be desirous that it should not extend farther. It may be laid doAvn as a general 232 REVELLENTS. rule, that blisters do not act by the discharge they excite: their de- pleting effect, in this way, can obviously be but trifling, unless in very debilitated states,, of the system,—and in such case, the loss of fluid, thus incurred, may be disadvantageous. Counter-irritation is the great sanative agency; and this can be obtained without vesication, although the production of the latter condition may be an evidence, that the former has been carried to the necessary extent. In the case of many of the vesicants, too, it is difficult to obtain the requisite amount of counter-irritation without vesication resulting at the same time; and therefore the practitioner rarely attempts to arrest their action at sim- ple rubefaction. Of the various agents, used for exciting vesication, cantharides are the chief; but where it is desired to excite sudden vesication, the ap- plication of boiling water, or of the redhot iron, is, at times, had recourse to. Vesication or counter-irritation, thus induced, is rarely, however, as efficacious in changing certain morbid conditions as Avhere it is more general. Hence, time has been regarded, in many cases, as a useful element, in the action of revellents. The inflammation of the skin, caused by vesicants, is occasionally attended Avith fatal consequences. It is of the erysipelatous kind, and, under particular circumstances—as regards age, condition of the sys- tem, &c.—the inflammation eventuates in gangrene and death. In very young children, great irritation is apt to be induced by blisters, and, if they be labouring under any morbid condition of the dermoid tissues,—such, for example, as is present in measles or scarlatina, the inflammation may terminate in sloughing or gangrene. To ob- viate this, when vesicants are esteemed necessary in the diseases of infants, they should not be permitted to remain too long on the part. From two to six hours will generally be sufficient; and a piece of fine gauze or tissue paper may be placed betAveen the plaster and the skin, if cantharides be used, in order that no particle of the flies may ad- here to the vesicated surface. An occurrence more disagreeable to the philanthropist can hardly be imagined, than that of a patient dying in consequence of the application of an agent from which he expects a cure, or at least a mitigation of the symptoms : great caution is therefore necessary in the use of these agents in very early life, especially in the diseases referred to. The author has known several cases of death manifestly caused by the use of blisters under such circumstances, although it is probable, that in most of them death might have ultimately resulted from the disorganization produced by the mischief for which the blister was recommended. Many fatal events have been referred to by Professor J. B. Beck, in his "Essays on Infant Therapeutics'.' The result has produced, at times, so powerful an impression on the mind of the practitioner as to prevent him from ever afterwards applying blisters in the diseases of child- hood. There is another inconvenience attendant upon the employment of vesicants composed of cantharides,—the absorption of the canthara- din, which enters the circulation, and proceeds to the urinary organs, giving rise to strangury, and, at times, to intense vesical irritation. SUPPURANTS. 233 That this is the mode in which the effect is induced is demonstrated by the fact, that the intervention of tissue paper, or of gauze, although it may not prevent vesication, effectually obviates strangury;—the tissue paper or gauze preventing the absorption of the cantharides. Some have referred the strangury from blisters to sympathy. Were this explanation correct, the tissue paper or gauze ought not to pre- vent it, as a vesication is accomplished through them. At timSs, it becomes necessary to apply the blistering plaster over a surface, which has been scarified in the operation of cupping, or over leech- bites: the only precaution, here requisite, is to cover the wounds made by the scarificator, Avith tissue paper. Suppurants produce a deeper degree of inflammation than the epispastics mentioned thus far. Their effect extends to the areo- lar membrane, thus involving the whole of the common integuments. Issues and setons belong to this class, as well as the pustulation in- duced by friction of the surface Avith the ointment of tartrate of antimony and potassa—a remedy which has been much employed of late years. It is a somewhat singular circumstance, that when this ointment is rubbed upon the skin, instead of its producing simple in- flammation of a diffusive or erysipelatous character, it should excite inflammatory irritation, more especially in the areolar membrane be- neath ; and that this irritation should exhibit itself in the form of a crop of pustules, not very much unlike those of variola. In this country, issues and setons are still greatly used, but they are by no means as much so in Europe as they were formerly. They are uncleanly by reason of the discharge they excite, and great atten- tion to them is necessary; whilst it is extremely doubtful, whether any of the benefit derived from them is ascribable to the discharge that accompanies them. On these accounts the author rarely has recourse to them, preferring repeated blisters, and a succession of revulsions, to a more permanent irritation; seeing that to this latter the system soon accommodates itself, so that, after an issue or seton has been long esta- blished, it becomes, as it were, a part of the healthy condition; and can- not even be healed without danger of evil consequences. At one time, it was the universal belief—much encouraged by the arguments of Mr. Pott—that the discharge is an important adjuvant to the counter- irritation caused by issues or setons; but, since his time, the belief has gradually faded aAvay, and there have been many surgeons— amongst Avhom may be mentioned Baron Larrey—who think it better to produce counter-irritation without discharge; hence, when they use moxa, for example, they endeavour to restrict its effects to rubefaction. Still, there are cases—as in spinal disease—Avhere it is easier to insert a seton, or to establish an issue, than to apply a succession of other counter-irritants; and, consequently, issues and setons are noAvhere banished from practice; although they are more sparingly used by the most distinguished practitioners in many countries. In the perpetual blister—as it is called—we have an example of a protracted suppurant agency. An irritating salve is applied to the sur- face denuded by a blister, Avhich excites suppurative inflammation; and 234 REVELLENTS. this may be kept up, as in the ordinary issue, of AA'hich the perpetual blister is of course a variety,—but it is liable to the same objections as the issue, and may be advantageously replaced by repeated blisters, which establish a succession of centres of fluxion or of revulsion, so that the system never becomes habituated to them; and more influence is, therefore, exerted upon the morbid condition for the removal of which they may be employed. It is to substances, that are capable of producing an eschar or slough, that the term Escharotics has been given. They are, consequently, most commonly had recourse to for the formation of issues, the escha- rotic being applied to the skin, so as to chemically disorganize it, or destroy its vitality; after which a new action is set up in the vessels beneath the slough, so as to cause it to be thrown off; the excavation is then kept open by inserting some irritant—as an issue pea—which maintains a copious secretion of pus from the ulcerated surface. In the ordinary division of escharotics, as adopted in the books, a separation is made into those which operate more powerfully, destroying the life of the part under all circumstances, and which are arranged under the head of cauterants; and those that act with less energy, and are chiefly employed to destroy diseased and fungous growths, and which are classed as erodents. Cauterants may be either actual or potential; that is, they may either produce their effect by the agency of caloric, or by virtue of chemical poAvers, which are capable of destroying, or disorganizing, the living solid. The effect of the actual cauterant differs according to the form in which the caloric is applied—whether, for example, by heated metal, or the moxa, or by heated vapour, water, or other fluid. It differs, also, when the metal is used, according to the degree of heat;—at the white heat producing immediate disorganization of the parts with which it comes in contact; and at the red heat, a state which may admit of the parts being restored, without much, if any loss of substance. The less degree of heat is, therefore, attended with more pain and inflammation; because the vitality of the part is not extinguished. Whenever actual cauterants are employed as counter-irritants, the excitement they occasion is rapidly effected;—at once, by the applica- tion of heated metal or water,—more gradually, by the moxa; but still, even in the latter case, almost instantaneously, compared Avith the action of many of the class of potential cauterants, Avhich require a long time before the eschar is formed. This is the case with caustic potassa,—the potential cauterant most frequently employed. It is not until after the lapse of several days, that the eschar made by rubbing potassa over the skin separates, or gives unequivocal evidence of dis- organization. As the effects of actual cauterants are rapid and severe,— accompanied with intense pain, heat and redness,—they are adapted for cases, in which it is necessary to make, at once, a powerful impres- sion upon the nervous system. Accordingly, the use of moxa has occa- sioned a salutary abstraction of the nervous influence; and many deep- seated pains have yielded to it, which had resisted the action of the ordinary counter-irritants, although repeatedly applied. In long con- ACTUAL CAUTERANTS. 235 tinued neuralgic pains, whether seated in the cerebro-spinal centres, or in the nerves emanating from them, the morbid catenation is often sud- denly and effectually broken in upon by severe and rapid revulsions. Of the value of moxa, as a therapeutical agent, in these and similar cases, numerous examples are recorded on the authority of Baron Larrey, and of many other practitioners of France and the continent of Europe more especially. The remedy Avas introduced to the notice of British practitioners by the author, in the first English monograph on the subject; and since then it has been treated by Messrs. Wallace, Boyle, and others. (" On the use of the moxa as a therapeutical agent ; from the French of Baron Larrey, Avith notes, and an introduction, con- taining the history of the substance," by Robley Dunglison, etc., etc. London, 1822.) All the forms, then, of epispastics are indebted, for their efficacy as remedial agents, mainly to the counter-irritation or revulsion which they effect; and the choice of such as are adapted to particular circumstances of disease must greatly depend upon convenience, &c, of application, which certain articles of the class may possess more than others; and as there are generally fewer objections to vesicants and rubefacients than to the others, they are more frequently employed, Avhenever the revulsion, which epispastics in general are capable of effecting, is deemed necessary or expedient. In the employment of revulsives in general, it is an interesting inquiry to determine the extent of surface, which it is desirable to affect by their direct application. This is a difficult matter to decide. It is obvious, hoAvever, that if we have the vital manifestations modi- fied over a very limited compass, but little beneficial agency may be exerted on the morbid catenation, Avhich it is designed to break up; whilst on the other hand, if a large surface be irritated, the disease may be aggravated by the irritative irradiations proceeding from it. Moreover, it is probable, that if an extensive surface Avere inflamed in this manner, the same disastrous consequences might ensue as in cases of extensive burns. In these it has been considered, that death Avill almost surely occur, if they implicate one-eighth part of the cutaneous surface. M. Bdgin affirms, that the extent of the Surfaces, receiving the impression destined to become revulsive, exerts great influence. Thus, the same pediluvium, which proves inefficacious AArhen applied to the feet, may often produce the desired effect if the whole leg be immersed; and he adds, that an extensive though moderate rubefaction may produce greater effects than a violent inflammation limited to a small portion of integuments. This is true, hoAvever, only Avithin cer- tain limits. In many affections, as the author has remarked in reference to moxa especially, a violent degree of irritation, excited over a very trifling extent of surface, may effect what other varieties of epispastics, although repeatedly employed, have totally failed to accomplish. Cus- tom has established a magnitude for the ordinary blister, as well as for the extent of surface to be implicated in the formation of an issue; and although it is possible and probable, that the size might often be varied 236 REVELLENTS. with advantage, it is a point, as already observed, on AA'hich it is extremely difficult to decide. A similar remark applies to the length of time, during Avhich coun- ter-irritation should be maintained, in order to produce the greatest amount of benefit;—whether, for example, a mere momentary irritation, however violent, can occasion as salutary results as one that is more prolonged; and again, whether a permanent or an intermittent revul- sion is, as a general rule, more effective for the removal of disease, especially of disease of any continuance. In the case of moxa, the revulsion is temporary; yet, we have seen, it has been often useful. The revulsion from moxa is not, however, in general, as well adapted for the removal of inflammatory and many other morbid conditions, as that which can be effected by vesicants, and by certain of the rube- facients. It is chiefly when the diseased action has been prolonged for a considerable period, and in affections which belong to the neural- gic class, that sudden and violent revulsions are productive of the most marked advantage. When diseases are of an acute character— as the different phlegmasise—revellents, which implicate a greater ex- tent of surface, and are more prolonged in their action, are decidedly preferable. In answering the question, whether a permanent or an intermittent revulsion be more efficacious?—the author does not think, that much difference uoav exists among therapeutists. The majority are un- equivocally in favour of the latter plan, although circumstances may often induce them, in practice, to have recourse to the former. The reasons, in favour of this preference, are cogent. When an artificial irritation, accompanied or not by increased secretion from the part, has been established for a time, it ceases, in a great measure, to be a morbid condition, and becomes, as it were, a part of the healthy func- tion ; so that it cannot be arrested without inconvenience being apt to result, and Avithout danger of a centre of fluxion being established in some internal organ, that may at the time be more disposed than others to assume the morbid condition. In this way, many discharges, the result of morbid action, may become at length healthy; and cannot be officiously interfered with. On the other hand, if a succession of irritations be produced, the system never becomes habituated to them; and the repetition of the irritation, after the lapse of a short period, occasions the same beneficial impression, as on its first employment. Hence it is, that—as before remarked—a succession of vesicants, and, indeed, of every varietyof epispastic, is to be preferred to a more per- manent application; and that issues and setons lose much of their beneficial influence in the latter periods of their employment, their good effects, as revellents, being in an inverse ratio with the short- ness of the period, during which they have been in action. The intensity of the artificial irritation induced by a revellent is worthy of consideration in a therapeutical point of vieAV. H it be but trifling, it may be insufficient to break in upon the internal morbid catenation; and, on the other hand, if too violent, irritative irradiations may proceed in various directions, and even add to the internal mis- chief. Every practitioner must ha\fe occasionally witnessed an aggra- PERMANENT AND INTERMITTENT REVULSIONS. 237 vation of symptoms from this cause, especially in those whose nerves are unusually impressible. In such, no variety of epi spastic can, at times, be used. There are some Avho are throAvn into the most violent nervous agitation by the application of the smallest blister; and blis- ters have occasionally been knoAvn to induce convulsions. Certain individuals, too, suffer excessively from the vesication caused by can- tharides, and, yet, they may not be—what would be called—extremely nervous. Their cutaneous nerves are, however, unusually impressible. In such persons, vesicants Avould necessarily fail in their effects, owing to the general disorder Avhich would follow the high degree of erethism of the dermoid structure; and in them, therefore, blisters are never found to exert their ordinary salutiferous agency:—on the contrary, the irritation they produce is reflected to every part of the economy, and too often the diseased action, for the removal of which they Avere ap- plied, is, in this way, augmented. In like manner, where the powers of the system have been greatly reduced, and much nervous irritability has been developed, blisters are apt to cause mischief. M. Broussais has made this fact the foundation of one of his " propositions,"—re- stricting it, however, to cases of gastro-enteritis. The character and period of the disease have much to do Avith the action of revellents. Every practitioner must have observed, that in phlegmasiae, when the disordered actions run high, but little effect is usually produced by them. The author had an opportunity of wit- nessing, for a long time, the practice of an individual, much engaged with the duties of his profession, who always had recourse to blisters from the first onset of inflammatory affections, and often'not only with impunity but with advantage. Such is the practice pursued by M. Gendrin of Paris,—the greater part of his treatment in pneumonia and other acute inflammations consisting in the application of very large blisters; and it is affirmed by two foliowers of his service at La Piti£, that their repeated application, Avith a very moderate use of blood- letting, was attended with very successful results. It is an inter- esting question, however,—whether the inflammation induced by large and repeated blisters may not augment the ratio of the fibrinous element of the blood ? Experiment can alone determine this. " A large blister," says M. Andral, " takes from the blood a certain quan- tity of its serum; but some fibrin is deposited at the same time at the surface of the sore caused by the action of the cantharides. Where there exists in the blood a superabundant proportion of fibrin, Avould this be the means of diminishing the excess of that principle in the blood ? Or rather, if the action of the cantharides be exerted over a pretty large surface, or the inflammation resulting from it be intense,— if, especially, it augment the febrile movement already existing, may there not thus arise a new cause for a superabundant formation of fibrin; and may not this cutaneous plegmasia, artificially induced to diminish the intensity of another phlegmasia, by the kind of influence which it may exercise upon the blood, have the effect of augmenting the morbid condition, which represents in the blood the inflammatory state, and marks the intensity of it?" Theoretically, it Avould seem, that if the organic actions are already 238 REVELLENTS. largely exalted, any source of irritation ought to add to such exalta- tion : the principle, however, that two irritations do not easily exist, at the same time, in the body, in the like intensity, applies even here; and the author can say, from extensive observation, that although the bene- ficial effects of revellents is not as marked as where remedies have been premised to allay in some measure the tumult, they have not ahvays appeared to him to aggravate the disease; and have often been followed by a mitigation of the morbid action. He cannot, therefore, subscribe to the opinion of M. Bdgin, that " in very strong subjects affected Avith intense irritations accompanied with considerable febrile excitement, and having their seat in viscera important to life, or propagated to larger surfaces, revulsion is next to impossible, and cannot even be attempted without danger." The danger does not appear to the author to rest so much on the employment of revellents, as on the neglect of more effective measures, which such cases imperiously demand. It has been maintained by M. Broussais, that revulsive irritations must always be stronger than those they are intended to replace, other- wise they turn to the benefit of the latter; but this appears to be a mere gratis dictum; and it has, accordingly, been dissented from by many of his followers. Upon the principle of action, which the author has endeavored to lay doAvn, it would seem, that good must always be derived from a revulsive irritation in appropriate cases, even should such irritation fall someAvhat short of the precise degree necessary for completely putting an end to the morbid action for the removal of Avhich it was adopted. He cannot see how the morbid action must necessarily be augmented by it. There was a time, when blisters were much employed at a particular period of adynamic fever—in the very cases, indeed, in which, accord- ing to M. Broussais, they do not render the services expected of them. The practice has gone out of vogue in Europe, but it is still followed in this country. It consists in applying blisters to the arms and legs in protracted fever, when the poAvers of life have become so far reduced, that stimulants appear to be clearly indicated. It has been before re- marked, that epispastics are not advisable stimulants in fever; but, as revellents, they may be had recourse to, occasionally, with advantage. When, for example, the disordered actions, constituting fever, have gone on for weeks, without the existence of any considerable local mischief, the revulsive irritation, induced by epispastics, becomes a centre of fluxion, so that the mischief is, as it Avere, localized ; and the morbid chain is broken in upon. Accordingly, in this way, epispas- tics may be used advantageously in febrile complaints; but care must be taken, that the irritation induced by them is not too intense, so as to be reflected to every part of the system, and thus add to, rather than detract from, the disorder of functions. In like manner, in chronic irritations of different organs and tissues, epispastics frequently break in upon the habitual derangement of action, and succeed in inducing a salutary revulsion, after every other medication has failed. It Avould be a matter of moment were we enabled to point out the parts of the system, Avhich sympathize with each other, in such sort, that if revellents Avere applied to the one, they might certainly detract MODUS OPERANDI. 239 from the morbid actions going on in the other; but this is a difficult subject of investigation, and we are not sufficiently masters of the physiology of the animal economy to pronounce Avith much satisfaction upon it. Often, too, we find, that although sympathetic movements may be established between different organs, they are by no means of the antithetic or revulsive kind; and hence the rule—difficult of exe- cution—has been laid down, that artificial irritants should be made to operate upon such parts as perform functions contrary to those of the irritated organ; and always at a distance from those that may sympa- thize with that organ. In elucidation of this, it has been remarked, that the skin may be irritated Avith advantage in pulmonary catarrh, owing to the balance of action existing between it and the mucous coat of the bronchia, but this does not apply to gastritis, as its over-excita- tions are too readily communicated to the stomach. These rules are, however, too exclusive ; and every therapeutist must have discovered their inaccuracy in the good effects which he has found to be produced by revellents, where the lining membrane of the stomach has been more or less inflamed. The severe vomiting, which accompanies such affec- tions, often resists every other remedy, and is ultimately arrested by epispastics. The true explanation of the action of revellents appears to be the one already offered,—that two irritations do not readily exist, at the same time, in the system; so that, if, under proper conditions, during the existence of any morbid irritation in an internal organ, an artificial irritation be excited at a due distance from it, the morbid process may subside in the internal organ, and the vital energies be concentrated towards the part artificially irritated. Farther than this Ave cannot go with mu effects on 542 cases are reported. From these it appears, that in about. vol. ii.—22' 338 SPECIAL EUTROPHICS. 63 per cent, the symptoms improved; in 18 per cent, the disease Avas arrested; and in 19 per cent, it went on unchecked. One of the most striking effects was an increase in the weight of the patient; which in some cases Avas astonishing. The oil noAV used in that hospital is straw-coloured, transparent and free from offensive smell. Cod-liver oil has been brought forward with high encomiums in scrofula, rickets, and in every form of chronic rheumatism, tuberculous cachexia, chronic cutaneous diseases,—wherever, indeed, a modification is required in the system of nutrition generally or locally. It has like- wise been used externally in opacities of the cornea,—a drop or two being placed on the cornea with a camel's hair pencil; and in various chronic cutaneous diseases. In some troublesome affections of the skin, especially of the hands, conjoining the characters of impetigo with erysipelatous redness and swelling, and inducing severe suffering, Dr. Marshall Hall speedily succeeded in restoring the textures to a healthy condition by its external use, after other remedies had been tried fruitlessly. For rhagades and chaps, he says, it is a preventive and a speedy cure; and it is productive of great benefit in eczema, and other affections accompanied by excoriation and fissures of the skin. The dose is from a dessert spoonful to three spoonfuls two or three times a day. To children it is given by tea-spoonfuls. Its unpleasant taste can scarcely be corrected by admixture with other agents; for Avhich reason it is preferred by some to give it in its pure state, and to take peppermint lozenges afterwards. It is also recommended that it should be given with milk, froth of porter, coffee, lemon-juice, warm table beer, or in emulsion. The taste may be disguised by chewing a piece of dried orange peel immediately before and after swalloAving it. 40. CARBO ANIMA'LIS.—AN'IMAL CHARCOAL. Animal charcoal may be prepared from any animal substance; but, as directed in the Pharmacopoeia of the United States, it is obtained from bones, and constitutes Ivory black of commerce. This is, how- ever, in an impure state, and accordingly, a process for CARBO ANIMA'LIS PURIFICA'TUS is contained in the Pharmacopoeia of the United States, which consists in pouring muriatic acid, previously mixed with water gradually upon charcoal, and digesting Avith a gentle heat for two days| occasionally stirring the mixture. The charcoal, which subsides is washed frequently with water, until it is entirely freed from acid • and is then dried. Animal charcoal is an ancient remedy, which Dr. Christison erro- neously affirms to be now entirely abandoned. It is much used in Germany, at the present day, as a eutrophic in scrofulous and can- cerous affections; and like burnt sponge —although it contains no iodine—has been employed with success in goitre. It has been sug- gested, that farther trials might show, that it may be used in the place of iodine; but it is doubtful, whether the properties of the two sub- stances can be regarded as at all analogous; and whether animal char- CALCII CHLORIDUM. 339 coal be possessed of any other properties than those usually ascribed to charcoal. It is given in doses of from half a grain to three grains tAvo or three times a day, mixed with sugar or liquorice powder. It has, also, been sprinkled on the callous edges of cancerous ulcers; and has been used in the form of ointment, as a discutient, in scrofulous swellings. It is employed in many processes of pharmacy as a deco- lorising agent. 41. CAL'CII CHLO'RIDUM.—CHLORIDE OF CAL'CTUM. Chloride of calcium, Hydrochlorate or Muriate of lime, which—as its name imports—is a compound of chlorine and calcium, is made by saturating muriatic or chlorohydric acid with carbonate of lime; dry- ing the salt; exposing it to heat, and keeping it in well-stopped ves- sels. It is not in the list of preparations, but in that of the Materia Medica of the Pharmacopoeia of the United States. It exists in sea water, and in many mineral springs; in some of which it is considered to constitute the active ingredient, as in the springs of Airthrey, Pit- eaithley, and Dumblane in Perthshire, Scotland. (Christison.) It is also obtained from the residuum of certain officinal preparations__as from the manufacture of carbonate of ammonia, solution of ammonia and spirit of ammonia; from which, indeed, it is usually procured by the manufacturing chemist. It is colourless; slightly translucent; solid; hard; friable; deli- quescent; and wholly soluble in water. Its taste is bitter,' acrid, and saline. In large doses, it appears to be an irritant poison; but in small doses, it has been administered, and with advantage, as a eutrophic, in scrofulous cases. With this view, it must be continued for some time. It has been considered as one of the most important ingredients in many mineral waters, that have seemed to be beneficial as alteratives. It is generally given in the form of LIQUOR CAL'CII CHLO'RIDI, SOLUTION OF CHLORIDE OF CALCIUM, Solution of Muriate of lime. (Marmor. in frustul. six.; Acid, muriat. Oj.; Aq. des- tillat. q. s. The acid is mixed with half a pint of water, and the marble gradually added; chloride of calcium is formed in the manner pre- viously mentioned, which is dissolved in its weight and a half of distilled Avater, and the solution is filtered.) The dose is from f 3ss. to f3j. gradually increased. It may be taken in sugared water or milk. It is sometimes also used as a Avash to scrofulous sores and chronic cutaneous affections, (Galcii chlorid.^,}.—3ij-5 Aquce destillat. f^viij.•) and, also, in the form of ointment, (Calcii chlorid. 3j.; Adipis 3j.;) in similar cases. Chloride of calcium enters into the preparation of Calcis carbonas prcecipitatus, of the Pharmacopoeia of the United States. 340 SPECIAL EUTROPHICS. 42. BA'RII CHLO'RIDUM.—CHLORIDE OF BA'RIUM. Chloride of barium, Muriate of baryta, Baryta murias, is made by gradually adding carbonate of baryta to dilute muriatic acid, to satura- tion ; filtering the solution, and evaporating, so as to form crystals, which are right rhombic plates or tables; sometimes double eight-sided pyramids. Its density is 2.82 ; taste disagreeable and bitter. It is wholly soluble in water,—100 parts at 60° dissolving 43.5 of the crys- tallized salt; at 222°, 78 parts. It is slightly soluble in alcohol of the pharmacopoeia; but is said to be insoluble in pure alcohol. In large doses, the chloride acts like acro-narcotic poisons, and may induce death. In small medicinal doses, its effects appear to be analo- gous to those of chloride of calcium, and it has been given in the same cases. It has been chiefly prescribed in scrofula; but, at times, in other dyscrasies; and in chronic cutaneous diseases, bronchocele, &c. It has been used as a topical application in chronic cutaneous affections; as a collyrium in strumous ophthalmia, and in opacities of the cornea ; and as an ointment (Barii chlorid. gr. iv.; Adipis sj.) it has been applied to strumous sores, and to chronic cutaneous affections. It is usually administered in the form of LIQUOR BA'RII CHLO'RIDI, SOLU'TION OF CHLORIDE OF BA'RIUM, Solution of Muriate of Baryta. (Barii chlorid. S*j.; Aqua?, destillat. f S"iij.) The dose of this is five drops three times a day, gradually increased till it in- duces nausea or vertigo ; when it should be diminished. It is much employed in pharmacy as a test for sulphuric acid and sulphates. ARSEN'ICI PRjEPARA'TA.—PREPARATIONS OF AR'SENIC. The various preparations of arsenic are possessed of eutrophic vir- tues, and when continued for a proper length of time they so alter the function of nutrition as to remove diseased actions, which may have been persisting unmodified by other agents. In chronic cutaneous diseases,—for example, lepra, psoriasis, impetigo, &c, arsenic has been found a most valuable agent; and often the beneficial results have occurred without any other manifest effects having been produced by the remedy. In all cases, however, the results should be watched; and if any of the phenomena that have been referred to elsewhere, (Vol. ii. p. 92,) and that are fairly ascribable to the administration of arsenic be observed, it must be discontinued, or the dose be diminished, as the case may seem to require. This, indeed, applies to all cases in which arsenic is given as a eutrophic; inasmuch as—like every other remedy belonging to the class—a protracted use of it is necessary to break in upon the vice in the system of nutrition. It is as a eutrophic, too, that arsenic has been recommended in syphilis, syphiloid and rheumatic affections; and in cancer, in which it would seem to have occasionally rendered service. QUINIA ARSENIS. 341 43. ACIDUM ARSENIO'SUM.—ARSE'NIOUS ACID. Arsenious acid—whose properties have been detailed elsewhere, (Vol. ii. p. 92,)—is the form in which arsenic is generally administered in the above mentioned diseases. It may be given in the dose of one- tenth to one-eighth of a grain, made into a pill with crumb of bread; or LIQUOR POTAS'SA ARSENI'TIS (Vol. ii. p. 93,) may be given in the dose of eight or ten drops two or three times a day. Pilulce Asiaticce, Asiatic pills are made of Arsenious acid gr. Iv.; Black pepper powder 3ix.; Gum arabic sufficient to make 800 pills, each of which contains about one-twelfth of a grain of arsenious acid. They are much employed in India in cases of syphilis, elephantiasis, and other cutaneous diseases. 44. AMMO'NLE ARSE'NIAS.— ARSE'NIATE OF AMMO'NIA. This preparation is made by taking arsenic acid one part, dissolving it in water, and adding pure or carbonated ammonia sufficient to satu- rate it;—or, as follows:—take of arsenious acid, one part; nitric acid, four parts ; muriatic acid, half a part,—saturate the solution with car- bonate of ammonia, and let the arsenical salt crystallize. This salt has been employed in several obstinate cutaneous diseases, and especially in psoriasis inveterata. One grain may be dissolved in a fluidounce of distilled water; and 20 to 25 drops of the solution be begun with daily; gradually increasing the dose, until it reaches a drachm or more in the twenty-four hours. Arse'niate of soda—in solution termed Aqua arsenicalis Pearsonii, and by the French, Solution de Pearson—is possessed of the same pro- perties as arseniate of ammonia. Of the virtues of Iodide of Arsenic, and Iodide of Mercury and Arsenic, the author has already treated, (Vol. ii. p 332.) 45. FERRI ARSE'NIAS.—ARSE'NIATE OF IRON. Arseniate of iron—which occurs naturally as scorodite, and is pre- pared artificially by double decomposition, according to a process given elsewhere—(New Remedies, 6th edit. p. 336, Philad. 1851,) has been recommended both as an internal and external remedy in cancerous formations. Its external application has been given already, (Vol. ii. p. 289.) It has been prescribed internally in the form of pill, (Ferri arseniat. gr. iij.; Extract, gentian. 3iss-5 Syrup, vel Aquce q. s. ut fiat massa in pilulas xlviij. dividenda. Dose, one three times a day.) 46. QUI'NLE AR'SENIS.—AR'SENITE OF QUINIA. Arsenite of quinia has been recommended by Dr. Kingdon as a eutrophic, in chronic cutaneous affections especially. It is formed by dissolving arsenious acid and subcarbonate of potassa in distilled 342 SPECIAL EUTROPHICS. water, boiling and adding sulphate of quinia, previously dissolved in boiling distilled water. The precipitate is arsenite of quinia, AA'hich is washed and dried on a filter. It is uncrystallizable; and insoluble in water, but soluble in alcohol. The dose is one-third of a grain twice a day, gradually increased to three or four times a day in the form of pill, or powder, mixed with a little sugar or gum. 47. AURI PRjEPARA'TA.— PREPARATIONS OF GOLD. The preparations of gold have long been used in medicine; but they had been wholly abandoned, Avhen they were revived upAvards of forty years ago by M. Chrestien; since which time they have been much employed; and certain of them are received into the pharma- copoeias of continental Europe. They all agree in their action on the economy. When received into the stomach, they form, with the alka- line chlorides of the gastric secretions, soluble double chlorides of the metal and the alkalies, which pass by endosmose into the veins of the stomach. These preparations are corrosive in large doses; but in medicinal doses, they have exhibited valuable eutrophic virtues. The secretions appear to be increased; and occasionally actual salivation ensues, which differs from that induced by mercury,—being always slow in appearing, and by no means so exhausting; nor do troublesome ulcera- tions occur: the saliva is thinner, and not so tenacious: an aural fever, like the mercurial, can also be caused by them. Possessed of these properties, it is not surprising, that the prepara- tions of gold should have been prescribed in the same diseases as mer- cury. The testimony of many observers is recorded in their favour in syphilis. It would seem, that their action is slow. In some forms of scrofula, too,—as strumous ophthalmia, and strumous porrigo,—they would seem to have been efficacious. Experiments, however, have been discordant, even in regard to the activity of some of the prepara- tions,—the chloride or muriate of gold having been given in large doses by MM. Baudelocque and Velpeau, without inducing any irritant effects. They have, likewise, been prescribed in scirrhous and can- cerous affections, rubbed upon the gums; or in cancer of the uterus, rubbed on the labia pudendi. In every form of cachexia, they have been given; but they are not much used now; and one weighty objec- tion to them—in the absence of any decided superiority over other agents—is, that they are very expensive. 48. AURUM METAL'LICUM.—METAL'LIC GOLD has been given largely, and, according to some, successfully ; but in the opinion of others, it has no action on the economy. It Avould be strange, indeed, if a substance, so difficult of oxidation, should have any effect. It has been prescribed in the dose of from a quarter of a grain to a grain. Gold powder—Pulvis auri—may be obtained by amalgamating gold and quicksilver; and driving off the latter by heat. AURI IODIDUM. 343 It may also be prepared by throwing it down from a dilute solution in nitro-muriatic acid by means of green sulphate of iron. From one to three grains, mixed with powdered starch, have been rubbed on the tongue. 49. AURI CHLO'RIDUM.—CHLORIDE OF GOLD. This preparation, called also Muriate of gold and Terchloride of gold, is received into several of the European pharmacopoeias. It is made by digesting one part of gold leaf in three parts of nitro-muriatic acid, in a sand bath, and evaporating gently to dryness. It is one of the most active salts of gold, greatly resembling corro- sive chloride of mercury in its operation on the economy. Even a tenth of a grain, according to M. Orfila, has induced unpleasant gastric irritation; yet, we have seen, it has been given to a much greater extent without inconvenience. It has been prescribed, both internally and externally, in syphilitic, hydropic, strumous and other cachexiae. Its dose is from one-sixteenth to one-twelfth of a grain, gradually but slowly increased; or it may be rubbed on the gums. It has also been applied externally in the form of ointment, (Auri chlorid. gr. iv.; Adipis 3j.;) or as a collyrium in scrofulous ophthalmia, (Auri chlorid. gr. ij.; Aquce fS*vj.) 50. AURI ET SO'DII CHLO'RIDUM.—CHLORIDE OF GOLD AND SO'DIUM. This salt—called also Muriate of gold and sodium, and Auro-terchlo- ride of sodium—is likewise in some of the pharmacopoeias of Conti- nental Europe. It may be prepared by dissolving four parts of gold in aqua regia, and evaporating the solution to dryness; adding thirty-two parts of water, and one part of chloride of sodium, and evaporating to one-half. On cooling, crystals form. It is milder than the last prepa- ration ; but may be employed in similar cases, doses, and modes of administration. 51. AURI CYANURE'TUM.—CYAN'URET OF GOLD. Cyanuret, Cyanide, or Tercyanide of gold may be prepared by care- fully adding a solution of cyanuret of potassium to one of chloride of gold, until a precipitate—cyanuret of gold—ceases to fall. It has been given in powder, mixed with gum arabic powder or sugar, in the dose of from one-sixteenth to one-tenth of a grain and more; or rubbed on the gums, associated with orris powder, in syphilis and scrofula. It may, likewise, be prescribed in solution. (Auri cyanuret. gr. iij.; Aquce fS"viiss.; Alcohol, i^ss.) Dose, a tea-spoonful twice a day; gradually increased. 52. AURI IOD'IDUM.—I'ODIDE OF GOLD. Iodide of gold is directed, in the French Codex, to be made by add- ing a solution of pure iodide of potassium to a solution of chloride of 344 SPECIAL EUTROPHICS. gold. The iodide of gold, which is precipitated, is collected on a filter and washed AAith alcohol to remove the excess of iodine precipitated Avith it. It has been used in the same cases as the other active prepa- rations of gold, in the dose of from one-fifteenth to one-tenth of a grain. It may also be made into an ointment, and be applied to syphilitic ulcers. 53. AURI OX'IDUM.—OXIDE OF GOLD. Oxide, Teroxide or Peroxide of gold, Auric acid, is directed in the French Codex to be prepared by boiling four parts of calcined, magnesia with one part of terchloride of gold, and forty parts of distilled water. The oxide is then washed, first with water to remove the chloride of magnesium, and afterwards Avith dilute nitric acid to dissolve the excess of magnesia. It has been administered in the dose of from one-tenth of a grain to a grain in the same cases as the other prepara- tions of gold. These are the chief preparations of gold that have been employed in medicine. For a more detailed account of their reputed virtues, see the author's New Remedies, edit. cit. p. 116. 54. ARGEN'TI PR^PARA'TA.—PREPARATIONS OF SILVER. Various preparations of silver have been introduced into practice as eutrophics in the same diseases as the preparations of gold, and espe- cially in syphilis. M. Serre, Professor of Surgical Clinics at Montpel- lier, employed the chloride, cyanuret, and iodide; divided metallic silver; the oxide, and the chloride of ammonia and silver. At first, these were administered iatraleptically; the chloride, the cyanuret, and the iodide in the quantity of one-twelfth of a grain; the chloride of silver and ammonia in the quantity of one-fourteenth of a grain; and the oxide of silver, and divided silver in the dose of one-eighth and one-quarter of a grain. These doses were often found, however, to be too small; he, therefore, raised those of the chloride and the iodide to one-tenth and one-eighth of a grain. The other ^preparations were augmented in the same proportion, with the exception of the chloride of silver and ammonia, "which required more precautions than any of the others. M. Serre gave them internally, also. The results of the observations of others have not confirmed those of M. Serre. M. Ricord employed the various preparations, made ac- cording to the formulae of M. Serre, in the same doses; but not being able to observe any effect that could be fairly ascribed to them he ventured upon considerably larger doses,—as much, for example, as twelve grains a day of the iodide and cyanuret,—but without any marked results. In this country, the preparations of 'silver have been but little used in syphilis, nor do they appear to merit special attention. For the testimony adduced in their favour, and the mode of preparing and exhibiting them, see the author's New Remedies, 6th edit. p. 92. ALKALIA. 345 55. The Preparations of Plat'inum, it is affirmed, possess pro- perties analogous to those of gold and silver. When received into the stomach, they form with the alkaline chlorides contained in the gastric secretions soluble double chlorides of the metal and alkalies, which pass by endosmose into the veins. 56. FERRI PR^EPARA'TA.—PREPARATIONS OF IRON. The various preparations of iron are employed occasionally in can- cerous and other cachexias, as well as in lupus, and chronic cutaneous diseases; but subcarbonate of iron, (Vol. ii. p. 57,) is calculated to answer all the purposes of the other chalybeates. It has been pre- scribed, in very large doses, and often with excellent effect, in enlarge- ments of the spleen, that accompany or succeed intermittents. It may be given in dose of from gr. x. to 3j. and more, three times a day. 57. ALKA'LIA.— AL'KALIES. Alkalies have long been employed under the idea that they ren- dered the blood thinner, and might soften obstructions, and remove tumours; hence they have been freely exhibited in all hypertrophied conditions of the glandular organs; but they are not much relied upon at the present day, although they doubtless have considerable power in modifying the condition of the circulating fluid, and consequently that of the tissues bathed by it. In various cachexias—the syphilitic and the strumous especially—they are considered by many to have proved extremely serviceable. Like mercurials, too, when given in diphtheritic inflammations, or those that are apt to end in the exuda- tion of an albuminoid secretion, they are presumed to exert a liquefa- cient action on the blood. Hence, they have been administered in croup, and in diphtheritis in general. In his Gulstonian Lectures for 1834, Dr. G. Burrows attributes their agency in promoting absorption to their affecting the materials to be absorbed as they affect them out of the body, by rendering them more soluble, and consequently more readily absorbed; but there is no positive evidence of this. Recent observations by Dr. Gplding Bird and others, on the urin- ary secretion, have corroborated the idea, that potassa, and some of its salts, have the power of dissolving animal matters, and thus of in- creasing the amount of solids in the urine; and hence their employ- ment has been urged whenever it is desired to remove from the system products of a low degree of vitality. " In chronic visceral ailments," says Dr. Bird, " in cases where albuminous deposits have occurred in glands, as in some forms of struma, and particularly in old rheumatic cases (carefully distinguishing them from mere neuralgic actions), where much of the suffering is kept up by the formation of an undue proportion of acid urates in the system, much good promises to be effected by the remedies in question. The acetate of potassa at one time enjoyed a high reputation as a remedy in the treatment of gland- ular deposit." Under similar views in regard to the powers of alkalies as eutro- 346 SPECIAL EUTROPHICS. phics, they have been prescribed in chronic cutaneous diseases; and wherever it has been desirable to excite a neAV action in the system of nutrition, generally or partially. Any of the alkalies may be given; but Liquor Potassa is most frequently chosen. It may be prescribed in the dose of ten drops, gradually increased to f 3j. or more. 58. AC'IDA MINERA'LIA.—MIN'ERAL ACIDS. In. treating of the action of acids and alkalies on the organism, M. Mialhe remarks, that there is, in his opinion, much greater danger in administering acids than alkalies, as the natural secretions of the sys- tem are generally alkaline; and should they become neutralized, and, still more, be made acid, functional disorders would be inevitable, owing to the necessary interstitial changes being arrested, and hence debility, atrophy, with pyrosis, gravel, gout, scurvy, or diabetes be the result. These are theoretical considerations only, but still worthy of being borne in mind. Nitric Acid, (Vol. ii. p. 77,) does not perhaps possess any proper- ties A\rhich especially adapt it as a eutrophic; yet it is the acid which, by common consent, appears to be selected. It has been extensively used in syphilitic cachexia as a substitute for mercury; and has un- questionably been of service, especially where mercury has not agreed. It may not, however, have exerted any energetic action on the dis- ease ; for it is now admitted, that syphilis can, in the generality of cases, be cured without the use of mercury. Much reliance is not now placed in it, however, although it is still occasionally prescribed. It has, likewise, been given internally, especially in India, in chronic liver disease; but it is not clear, that its beneficial agency in such cases may not be owing to its tonic influence on the stomach. It is not unfrequently used as a tonic in chronic disease, and in convales- cence from acute diseases, either alone or associated with bitter infu- sions. The dose of the diluted acid of the Pharmacopoeia of the United States is from gtt. xx. to gtt. xl. three times a day. An ointment of nitric acid, (Vol. ii. p. 347,) is used in various chro- nic cutaneous diseases, especially in porrigo and scabies, and as an ap- plication to syphilitic sores. ACIDUM MTRO-MURIAT'ICUM, NITRO-MURIATIC ACID. (Acid, nitric, fsiv.; Acid. Muriat. f SViij.) This acid has been introduced into the Pharma- copoeia of the United States. It is also termed Nitro-hydrochloric acid, and Aqua regia. It has been used as a eutrophic in the same cases as nitric acid, and is employed also externally in syphilis and chronic liver affections. It is applied in the form of pediluvia,—the legs, thighs, and body being, at the same time, sponged with it. A fluid- ounce and a half of the acid may be .added to a gallon of water and the patient may keep his feet in the bath for twenty or thirty minutes. It produces more or less pricking of the surface, and is said at times to cause soreness of the mouth and increased flow of saliva. The effects of the bath have been ascribed to the chlorine evolved. CHLORINIUM. 347 The dose of nitro-muriatic acid, in the above mentioned cases, may be ten or fifteen drops diluted with water, two or three times a day. 59. AC'IDA VEGETABIL'IA.—VEG"ETABLE ACIDS. The vegetable acids, and especially lemon or lime juice, (see Vol. ii. p. 222,) have been long celebrated as excellent eutrophics in the prevention of scurvy. That their virtues are not, however, wholly dependent upon the citric acid, which they contain, is shown by the gene- ral belief, that the acid cannot be substituted for it as an antiscorbutic with equal advantage. There is no other article that can take its place except the fresh vegetables of the cruciform family, more especially the raw potato. On long voyages, an ounce or an ounce and a half of lime juice daily is given as a preventative, and when the disease appears, four to six ounces a day will generally arrest it. Of late years, lemon juice has been brought forward, by Dr. 0. Rees as a remedy for acute rheumatism and rheumatic gout; under the be- lief, that the vegetable acids, probably owing to the excessive quan- tity of oxygen entering into their composition, contribute to effect the transformation of the tissues generally, [?] and lemon juice was selected by Dr. Rees as the most palatable form in which this class of reme- dies could be applied. He seems to regard retained uric acid as the materies morbi in rheumatism; and is of opinion, that the citric acid of the lemon juice yields oxygen, which, with the elements of water, con- verts uric acid into urea and carbonic acid,—an hypothesis, which is, however, by no means admitted. Many cases have been published of acute rheumatism, which have done well under the use of this as of other remedies; but it is by no means shown, that it is possessed of any potent efficacy. When suffer- ing under a severe rheumatic affection of the muscles of the neck, the author took ten fluidounces a day, without any relief to the pain ; and at the expiration of two days he was attacked severely Avith gout in the ankle. The dose may be a fluidounce to two fluidounces three times a day. Lemon juice has been used with advantage as a local application in prurigo scroti, and other forms of pruritus. 60. CHLORIN'IUM.—CHLORINE. Chlorine is most commonly prepared by mixing intimately three parts of dried chloride of sodium with one part of oxide of manganese; and then, in a retort, adding as much sulphuric acid, previously mixed with its own weight of water, as will form a mixture of the consistence of cream. By applying a gentle heat, chlorine gas is copiously evolved and may be collected over water. In this process, the chloride of sodium is decomposed and the oxide of manganese parts Avith a por- tion of its oxygen to convert the sodium into soda; with which, as well as with the oxide of manganese, the sulphuric acid unites, and the chlorine is set free in the form of gas. Chlorine gas is of a greenish-yellow colour, of a peculiar strong, dis- 348 SPECIAL EUTROPHICS. agreeable, stifling odour; and is irrespirable, except when very largely diluted with air. Of its effects when inhaled, mention has been made under Expectorants, (Vol. i. p. 289.) Fumigations of this gas were particularly recommended, upwards of thirty years ago, by Dr. Wallace, of Dublin. They would seem to resemble, in their action, the nitric and nitro-muriatic acid baths; the latter of which has been supposed to owe its efficacy to chlorine. It has been used advantageously in chronic liver diseases, especially where there is disordered secretion of the liver; and in many other morbid conditions, as hypochondriasis, cachexias, and in all affections in which a prolonged excitation of the skin, and a restoration of its sup- pressed or impaired functions could be esteemed serviceable;—hence in old cases of syphilis, scrofula, chronic rheumatism, chronic cutaneous affections,—as lepra, psoriasis and scabies;—and in many of these it has been highly beneficial. Liquor seu Aqua Chlorin'ii, Solution of chlorine, Liquid oxymuriatic acid, is contained in many pharmacopoeias. It is in those of London, Edinburgh and Dublin. In the Edinburgh it is directed to be pre- pared as follows:—Take of chloride of sodium, gr. 60 ; sulphuric acid, (commercial,) f 3ij.; red oxide of lead, gr. 350; water f sViij. Triturate the chloride of sodium and oxide together; put them into the water contained in a bottle with a glass stopper; add the acid; and agitate occasionally till the red oxide becomes almost white. Allow the in- soluble matter to subside before using the liquid. Chlorine water has been occasionally given internally in chronic dis- eases of the liver ; in many chronic cutaneous affections; and in various cachexias, especially the syphilitic and the strumous. When received into the stomach, it doubtless, like iodine and bromine, unites with the alkalies contained in the gastric and intestinal secretions, and in this way is received into the circulation. In a dilute state, it has been used as a wash in skin complaints, and in atonic and malignant ulcers,—partly, however, with the view of correcting the foetor; in which cases, as will be seen hereafter, it often serves a highly useful purpose; with this object, however, some of the chlorinated preparations are most frequently employed. It has been used, also, like nitro-muriatic acid, as a bath in hepatic and syphilitic diseases. It is very liable to be decomposed; and therefore ought never to be prescribed in quantity larger than is needed for twenty-four hours, as, by frequently opening the vial in which it is contained, decomposition readily ensues. The vial should be put into a dark place, and be sur- rounded by black paper. The dose of Solution of Chlorine of the British pharmacopoeias is f3ss. to fs*ss. An ointment is sometimes prepared of it; (Liq. chlorin. p. j.; Adipis p. vij.;) which is used in scabies. It is made, also, into a liniment, (Liq. chlorin. 3j.; 01. oliv. S*j.;) which is used in scabies, porrigo and herpes ; and, at times, is prescribed as a gargle in ulceration and chronic inflammation of the mouth and fauces. LIQUOR SODJ1 CHLORINATE. 349 61. CALX CHLORINA'TA.-CHLO'RINATED LIME. Chlorinated lime, Chloride of lime, Hypochlorite, Chlorite or Oxymu- riate of lime, bleaching powder, is a compound resulting from the action of chlorine on hydrate of lime. It is prepared on a very large scale for the use of bleachers; and, therefore, is amongst the list of articles of the materia medica in the Pharmacopoeia of the United States. The London College has a form for its preparation, which consists in pass- ing the vapour of chlorine into lime, until it is saturated. The chlo- rine is disengaged by the action of chlorohydric acid on oxide of man* ganese. The nature and composition of this chemical is a subject of dispute; and hence the term chlorinated lime, which has been adopted by the London, Edinburgh, and United States Pharmacopoeias, in place of chloride of lime. It is of a grayish white appearance; pulverulent; dry, or but slightly moist; and wholly dissolved by chlorohydric acid Avith the disengagement of chlorine. It is often of very inferior quality, either owing to the lime having been insufficiently charged with chlo- rine, or to its having been exposed to the air, so that chloride of cal- cium and carbonate of lime result. Chlorinated lime—like chlorine, on which its virtues are really de- pendent—has been administered in scrofulous cachexia, and especially in scrofulous swellings; it is rarely, howeA^er, given internally as a eutrophic. Externally, it is applied in many cases,—in torpid ulcers of various kinds—the phagedenic, scrofulous, syphilitic, cancerous, gangrenous, &c, in which it acts as an excitant or antiseptic. It is employed, also, in strumous swellings of the glands, joints, &c, in goitre, and in various chronic diseases of the skin. Dr. Christison affirms, that he never uses any other remedy in itch. "A solution, containing between a fortieth and sixtieth part of chlorinated lime, applied five or six times a day, or continuously with Avet cloths, allays the itching in the course of twenty-four hours, and generally accom- plishes a cure in eight days." When given internally, the dose may be gr. j. to gr. iv., two or three times a day, in pill or solution. When applied externally, it may be dissolved in water in various proportions, (f3j. to fs"ss., to f Iviij. of water.) In cases of itch, the strength has sometimes been—chlorinated lime siij., water Oj. In the form of ointment, (Calcis Chlorinat. 3j-; Adipis S~j.,)it has been rubbed on scrofulous swellings, goitre, &c, and has been occasionally applied as a cataplasm, (Calcis chlorin.; Sodii chlorid. aa S*ss.; Aquce destillat. Oss.; Farince sem.lin. q. s.,) to scrofulous tumefactions of the joints. Chlorinated lime enters into the formation of the next preparation, as well as of Chloroformum, of the Pharmacopoeia of the United States. 62. LIQUOR SOVJE CHLORINA'TiE.—SOLU'TION OF CHLO'RINATED SODA. This preparation, called also Hypochlorite of soda, Labarraque's Soda disinfecting liquor, Oxymuriate of soda, is made by dissolving carbonate of 350 SPECIAL EUTROPHICS. soda and chlorinated lime separately in water; setting the latter aside until the dregs subside ; then decanting the liquor, and mixing the two solutions; again decanting the clear liquor from the precipitated car- bonate of lime by passing it through a linen cloth, and keeping it in bottles secluded from the light. The solution—thus prepared, according to the directions of the Phar- macopoeia of the United States—is a colourless liquid, having a slight odour of chlorine. Its taste is astringent; and like chlorine, and all the chlorinated preparations, it destroys vegetable colours. In regard to its chemical constitution, the same remarks are applicable as were made on chlorinated lime. In its therapeutical properties, chlorinated soda resembles chlori- nated lime, and has been prescribed, internally and externally, in the same cases. It is preferred, however, for internal, whilst chlorinated lime is generally chosen fc^r external, use. The dose is from ten drops to a fluidrachm in plain or sugared water. When used externally, it is generally diluted with from five to ten parts of water, as an application to chronic cutaneous diseases, ulcers of various kinds, burns, &c. 63. SULPHUR. The general properties of sulphur have been described before, (Vol. i. p. 185.) As a eutrophic, it is mainly used in chronic cutaneous dis- eases, and especially in scabies, in which it is employed internally and externally. Associated with guaiacum, it is sometimes prescribed in gout and acute rheumatism, (Vol. i. p. 357,) in which it is presumed to act as an excitant diaphoretic. Dr. Pereira states, that after an at- tack of acute rheumatism, when the joints were left in a swollen and painful state, he saw sulphur prove highly useful; but this was only in one case. The popular form in which it is taken, mixed with ardent spirit, would adapt it rather—if it be adapted at all—for the chronic form of those diseases. It certainly passes through the cutaneous ca- pillaries, and is disengaged from them, as is evidenced by a silver watch becoming blackened, when sulphur or a sulphuret is taken; but the quantity passing through a particular portion of the capillaries, at any one time, must be exceedingly minute; and incapable, perhaps, of ex- erting much medicinal agency on cutaneous or other local affections. Hence, the external use is always, in such cases, combined with the internal. It is probable, that when it becomes mixed in the stomach and intestines Avith the alkaline matters present there, it is resolved into soluble compounds—sulphurets, and hyposulphites—which on- reaching the circulation, become oxidized into sulphates, in which form they are found in the urine. But if, according to M. Mialhe the sul- phurets or hyposulphites are not completely oxidized whilst they remain in the blood, they will reach the surface of the body be decomposed by the acid cutaneous secretions, and be resolved 'into sulphur, sulphurous acid, and sulphuretted hydrogen; and, in this way he accounts for the fact, that the use of sulphur internally always gives SULPHUR. 351 rise to the formation of sulphur and sulphuretted hydrogen upon the surface of the skin. Under chlorinated lime, (Vol. ii. p. 329,) it was stated, that Dr. Chris- tison had found it an adequate substitute for sulphur in scabies; but, on the whole, sulphur is the most certain application. It is, hoAvever, so offensive, and its odour is generally considered to reveal so com- pletely the nature of the disease for Avhich it is used, that every endea- vour has been made to discover some agent that may be equally sure, and less objectionable. The discovery of the itch insect-*-Acarus scabiei —led to the supposition, that the modus operandi of sulphur, in the cure of scabies, may consist in its destroying the parasite. The precise con- nexion, however, of the insect with the itch, is not yet clearly ascer- tained; and, moreover, sulphur—as already remarked—has been found efficacious in other chronic cutaneous diseases. Sulphur has long been regarded by the people as a great eutrophic or purifier of the blood, and even at this day it is a popular remedy, with this view, at spring and fall. Either SULPHUR or SULPHUR PRUCIPITATDI (Vol. i. p. 187,) may be prescribed in the dose of 3ss. to 3j-, and more, in milk; or it may be mixed with an equal quantity of molasses, and a tea-spoonful be taken night and morning. Bitartrate of potassa is often added to it. As elsewhere remarked, sulphur, when converted into sulphurous acid by burning, and applied to the cutaneous surface in the form of an air bath, is often a valuable remedy. As such it has been used in various diseases, in which an excitant influence to the skin is indicated. In cutaneous diseases of an inveterate kind, as scabies, impetigo, and the different squamous affections, it has succeeded when other remedies had failed. The gas is exceedingly irritating, and, therefore, must be prevented from entering the air passages. Sulphur is, however, most frequently employed externally, in one of the following forms. UNGUENTUM SULPH'URIS, SULPHUR OINTMENT. (Sulphur rbj.; Adipis rbij.) This ointment, called also Itch Ointment, Brimstone Ointment, is the mildest form that is used, and is especially applicable to scabies in children. Both it and the next preparation may be rubbed over the affected parts, before the fire, night and morning, for five or six days; the patient continuing to wear the same clothes. He may then be thoroughly washed, and have an entire change of clothes. In the generality of cases, three or four thorough inunctions will be sufficient; and, according to some, only one,—proAaded the body be covered all over with it. Some essential oil, as oleum limonis or oleum bergamii, is added at times; but the smell of the sulphur is predominant. UNGUENTUM SULPH'URIS COMPOSITUM, COMPOUND SULPHUR OINTMENT. (Sul- phur. ,?j.; Hydrarg. ammon. ; Acid. Benzoic, aa 3j-; 01. Bergamii, Acid. Sulphuric, aa f3j.; Potassce nitrat. 3ij.; Adipis Boss.) This is a more irritating itch ointment than the last. Compound sulphur ointment, of the London Pharmacopoeia, is formed 352 SPECIAL EUTROPHICS. of Sulphur S"iv.; Veratr. alb. pulv. 3x.; Potass, nitrat. 9ij.; Sapon. mollis siv.; Adipis Ibj.; 01. Bergamii "Ixxx. 64. POTASS'II SULPHURE'TUM.-SULPH'URET OF POTAS'SIUM. Sulphuret of potassium, Tersulphuret of potassium, Potassii tersulphu- retum., Hepar sulphuris, Liver of sulphur is made by rubbing carbon- ate of potassa, previously dried, with sulphur, in due proportions; melting the mixture in a covered crucible over the fire; pouring it out; and, when cold, keeping it in a well-stopped bottle. This is the mode of preparation adopted in all the British Pharmacopoeias, as well as in that of the United States. It is of a brownish-yellow colour Avhen freshly broken ; its taste is acrid, bitter, and alkaline ; it is devoid of smell when perfectly dried ; but, when moistened, acquires the odour of sulphohydric acid. Under exposure to the air, it takes oxygen, and undergoes changes which end ultimately in the formation of sul- phate of potassa, and free sulphur. It is soluble in water, to which it imparts an orange-yellow colour, and a strong sulphureous odour. The stronger acids decompose it, throwing down sulphur, and disen- gaging sulphohydric acid. In large doses, sulphuret of potassium is an acro-narcotic poison; but in medicinal doses, it has been administered in chronic cutaneous dis- eases. It is supposed, also, to be possessed of eutrophic powers in diphtheritic affections; and in glandular enlargements of a scrofulous character. It has, likewise, been used externally in various skin dis- eases, especially in scabies, in which sulphur is so beneficial. The dose may be three to ten grains, made into pill and given three times a day; or it may be dissolved in syrup. In the form of bath, it has been used in skin complaints in the proportion of one part of the sulphuret to one thousand of water. A lotion, (Potass. Sulph. 3ij.; Aquce Oj.); and an ointment, (Potass, sulphur. 3ss.; Adipis Sj.,) are sometimes used. 65. SOD.E HYPOSULPH'IS.—HYPOSULPH'ITE OF SODA. There are several modes of preparing this salt, which is largely used for photographic purposes. One of the best is to form neutral sulphite of soda by passing a stream of sulphurous acid gas into a strong solu- tion of carbonate of soda, and then to digest the solution with sulphur at a gentle heat for several days. By careful evaporation, at a moderate temperature, the salt is obtained in large and regular crystals Avhich are very soluble in water. Hyposulphite of soda is said to have been administered, with constant success, by physicians of Paris, Avho are the most versed in the treat- ment of chronic cutaneous diseases. It was first employed by MM. Chaussier and Biett under the name sulfite sulfure de soude • but it had fallen into neglect, when its use was revived by M. Quesneville and the results have been entirely conformable to those obtained by MM. Chaussier and Biett It has been highly extolled in chronic cutaneous and scrofulous affections ; and is said to be a most efficacious auxiliary ANTHRAKOKALI. 353 to external sulphurous preparations. It is best given in syrup, made of one ounce of the hyposulphite to twelve ounces of water, and twenty- three ounces of sugar; the dose of which is f sj. to f 3*ij. The salt may also be prescribed in solution in the dose of from two scruples to a drachm. It has been occasionally used as an artificial sulphur bath; from S"j. to 3iv. being dissolved in a sufficient quantity of water. If a small portion of dilute sulphuric acid or vinegar be added to the bath, whilst the patient is immersed, sulphurous acid and sulphur are set free. 66. OLEUM CA'DINUM.—OIL OF CADE. Cade oil, Juniperi oleum empyreumaticum, Huile de Cade ou de Ge- nevrier is obtained by the combustion of the wood of Juniperus phoenicea and J. oxycedrus, Cade oxycedre. It has long been a popular reme- dy in France for worms, and Avas given internally by some of the French and German physicians as an antiscrofulous and antiscorbutic remedy; and in certain cutaneous affections, as scabies and eczema. Recently, its use, in the former of these affections, has been revived; and, by M. Serres, it is employed altogether in that disease,—three or four frictions with it being generally sufficient in recent cases. He affirms, too, that various cutaneous diseases, eczematous, papular, liche- noid, &c. are cured by its external application every other day. In scrofulous ophthalmia, he found it especially beneficial, and in obsti- nate cases that had resisted other remedies. In infants, he applies it on the forehead, temples, or cheeks, and on the outer surface of the eyelids; and at times, in addition, introduces a drop into each nostril. It has been found, moreover, to be an excellent antiparasitic, where the hairy scalp is infested with vermin. It may be prescribed, internally, in the dose of twenty or thirty drops in molasses, or in sugar and water; and, externally, in the form of liniment, composed of f Ij. to fs"iss., to fs*ij. of lard, to which a few drops of the oil of aniseed or oil of bergamot may be added. 67. ANTHRAKOK'ALI. This article was introduced in 1837. Two forms are employed, the simple and the sulphuretted. The former is prepared by dissolving car- bonate of potassa in 10 or 12 parts of boiling water, and adding as much slaked lime as will separate the potassa. The solution, thus obtained, contains only caustic potassa. The filtered liquor is placed on the fire in an iron vessel, and suffered to eA^aporate until neither froth nor effer- vescence occurs, and the liquid presents a smooth surface like oil. To this is added the levigated coal in the proportion of 160 parts to 192 parts of potassa. The mixture is stirred, and removed from the fire; and the stirring is continued until a black homogeneous powder results. This is kept in a dry place. To obtain sulphuretted anthrakokali, 16 parts of sulphur must be ac- curately mixed with the coal, and the mixture be dissolved in the potassa as directed above. vol. ii.—23 354 SPECIAL EUTROPHICS. Anthrakokali has been prescribed as a eutrophic in chronic cuta- neous affections. It is also said to have been given beneficially in scrofula and chronic rheumatism. The dose of the simple and sulphuretted preparations is a gram and a half three times a day. 68. FULIGOK'ALI. This is a substance analogous to the last. It is prepared by boiling for an hour 20 parts of potassa, and 100 parts of shining soot in pow- der, in a sufficient quantity of water. The decoction is then suffered to cool. It is diluted with water, so that filtration may be better ac- complished ; is filtered, evaporated, and dried, and then enclosed in dry and warm bottles. Sulphurettedfuligokaliis prepared of fuligokali 60 parts; potassa 14 parts; sulphur 5 parts. The sulphur and potassa are dissolved in a little water; the fuligokali is then added, and the whole evaporated,— the residuum being dried and enclosed in dry and warm bottles. Fuligokali has been prescribed both internally and externally, but chiefly in the latter mode, in various chronic cutaneous diseases. An . ointment may be made of either the simple or the sulphuretted article, by mixing one or two parts with thirty of lard. M. Gibert ascribes to them resolvent, detergent, and slightly excitant virtues. Mr. E. Wilson thinks it probable, that both anthrakokali and fuligokali owe much of their therapeutic agency to the alkali which forms their basis. He has employed fuligokali in several cases, and especially in psoriasis palmar is, and with more success than he has obtained from the usual remedies. What might be regarded as a weak solution of fuligokali was used by Drs. Physick, Dewees, and others, under the names of medical lye, soot-tea, alkaline solution, and dyspeptic lye. 69. POTAS'SA CHLORAS.—CHLORATE OF POTAS'SA. Chlorate, oxymuriate or hyperoxymuriate of potassa may be prepared by passing chlorine gas slowly through a cold solution of potassa placed in a Woulfe's bottle. The liquid is allowed to stand for twenty-four hours in a cool place; and is then found to have deposited crystals of chlorate of potassa; which are drained, washed with water, dissolved in hot water, and recrystallized. Professor Graham advises, that car- bonate of potassa should be mixed intimately with an equivalent quantity of dry hydrate of lime, and the mixture be exposed to chlo- rine gas. The products are carbonate of lime, chlorate of potassa, and chloride of potassium. Chlorate of potassa may be separated by crys- tallization. It crystallizes in nearly rhomboidal plates; and has a cool taste, somewhat similar to that of nitre. One hundred parts of water at 59° Fah. dissolve six parts. This salt was at one time largely prescribed in consequence of its presumed action as a eutrophic, by imparting oxygen to the blood. Experiments have, however, shown, that it has been detected in the urine of patients, which, of course, negatives the presumption. Find- CANTHARIS, 355 ing that the salt gives a beautiful arterial hue to venous blood, Dr. Stevens prescribed it in fever, cholera, and other malignant diseases, in Avhich there appeared to be a deficiency of saline matter in the blood; but the testimony in its favour is by no means potent. Dr. Henry Hunt has extolled it in cancrum oris—gangrenous stomatitis— given in solution, or divided doses, to the extent of from 20 to 60 grains in the twenty-four hours, according to the age of the child. It lessens—he says—the fcetor and salivation, and promotes the granula- tion of the sores. The experience of others has corroborated the state- ments of Dr. Hunt. Dr. Watson says, that he has been in the habit of directing a solu- tion of the salt in water, in the proportion of a drachm to the pint, as a drink for patients in scarlet fever, and in the typhoid forms of con- tinued fever. The remedy Avas suggested to him by Dr. Hunt, who stated that he had long given it with advantage. Under the use of a pint, or a pint and a half, of the solution daily, Dr. Watson noticed, in many instances, a speedy improvement of the tongue, which, from being furred, or brown, or dry, became cleaner and moist. By Dr. Scruggs, of Germantown, Tennessee, the chlorate has been extolled both internally, and as a collutory in the erysipelatous inflammation of the mouth and fauces that occurs in the "black tongue" of the Western States. It has been considered, also, to be diuretic and re- frigerant, and to resemble nitrate of potassa, than which it is probably not possessed of greater, or of other virtues. The dose is from ten grains to half a drachm. As a mouth wash, a drachm may be dis- solved in four fluidounces of water. In another work—(New Remedies, 6th edit. p. 584, Philad., 1851)— the author has remarked, that, " from the results of his numerous trials Avith it he was disposed to accord Avith Dr. Christison, that no sufficient evidence has yet been published of such a nature as to entitle it to admission into the pharmacopoeias; yet it is officinal in the London and Dublin Pharmacopoeias, and has been admitted into the last edi- tion (1851) of the Pharmacopoeia of the United States. 70. CAN'THARIS.—SPANISH FLIES. Cantharides—elsewhere described (Vol. i. p. 316)—have been occa- sionally prescribed internally in chronic cutaneous diseases—as lepra, psoriasis, chronic eczema, and squamous diseases of the skin. MM. Biett and Rayer recommend it strongly; but an objection to it is the irrita- tion which it is apt to induce in the gastric and urinary organs. Its good effects are perhaps owing in part to the revellent influence thus effected; but they may also be dependent upon the modification in- duced by it in the blood, and through it. in the morbid actions going on in the tissues. With this view, small doses, not exceeding a grain, two or three times a day, in the form of pill; or ten or fifteen drops of Tinctura cantharidis, may be given. 356 SPECIAL EUTROPHICS. 71. SAC'CHARUM.—SUGAR. The main properties of sugar Avere described in the first volume of this work, under Demulcent Expectorants, (p. 277.) It is as an agent, capable of modifying the functions of nutrition, that it has now to be regarded; and the author is prepared to say, from an experience of many years, that it is one of the most important for this purpose that we possess. In the first edition of his " General Therapeutics," (1836,) he stated, that in many forms of cachexia he had succeeded in pro- ducing a thorough revolution in the system of nutrition, by alloAving the patient a certain quantity of sugar, formed into syrup, and given to the adult in such quantity, that three or four ounces of the sugar might be taken daily, and for a long period ;—five or six weeks at the least. Under this diet or medicine,—for it is better, in order to infuse confidence, to give it as a medicine, and to medicate it by the addition of a little rose-water, or some aromatic oil,—the patient has rapidly gained weight, and the action of the system of nutrition has been so much changed, that the cachexia, induced by poor living, and a resi- dence in confined, unhealthy situations, as well as that Avhich charac- terizes atrophy without any manifest cause, has been removed; a complete renovation has taken place; inveterate cutaneous diseases have disappeared, and old ulcers have filled up, and cicatrized. The sugar, in these cases, appears to act as a substantive and adjective ali- ment,—that is, it furnishes a richer and more abundant chyle; and, moreover, like a condiment, puts the digestive organs in a condition to derive a larger quantity of nutriment from the food than they would otherAvise do. It is in consequence of this altered condition of the circulating fluid, that the action of the vessels of nutrition into which it passes is modified; and the pathological catenation that constitutes the cachexia is broken in upon. If sugar be added to venous blood out of the body, it changes it to a bright arterial hue. When the functions of nutrition are morbidly affected, as in chronic cutaneous eruptions, there are two great methods in which we may reach the disease;—the one is by the application of• external reme- dies to the diseased tissues,—the other, by changing the impression made upon them internally by the fluid that circulates within them. Sugar—like arsenic, creasote, iodine, and other eutrophics—acts in the latter way. _ The great success which the author has met with in the removal of inveterate eruptions from the administration of sugar, has induced him to infer, that many of the alterative syrups—officinal and empirical—may be mainly, and some of them wholly, indebted for their efficacy to the sugar which they contain; especially as he has not noticed the same good effects, when the other ingredients of many of these syrups have been given without the sugar. In the number of the American Medical Intelligencer for April 15, 1837, he published the case of a lady, from a distant city, who visited Philadelphia to place herself under the care of an eminent professional friend, who advised her to consult the author. Four years previously, her husband, who was a dissolute character, had contracted syphilis, and communicated SACCHARUM. 357 it to her. She had applied to several physicians; but without experi- encing much relief. Ulcerations existed on various parts of the body. There were nodes on the tibia and forehead; added to which she had been unable to sleep, in consequence of severe pains in the bones, for the eighteen months prior to her arrival in Philadelphia. In order that full opportunity might be afforded for her recovery, she took a house; had her furniture sent to her, and determined to reside during the Avinter in Philadelphia. She had already taken various forms of mercurials, and amongst the rest corrosive chloride of mercury, in the use of which she had persisted for a long time. It was, however, directed again by the author, so that she should take one-sixteenth part of a grain three times a day; and in addition to this, she was ordered to dissolve a pound of rock-candy in a pint of water, and take a wine-glassful four times a day. Under this course, the ulcers soon began to heal; the nodes disappeared; the pains in the bones ceased ; her nights were passed in comfort; and at the end of five Aveeks, she was so much restored, that she determined to rejoin her family; quitted her house; removed her furniture, and went away with feel- ings of perfect recovery. She was recommended, however, to perse- vere in the plan advised. Since then, the author has not heard from her. Many similar cases have occurred to the author in which he has found the eutrophic influence of the saccharine treatment most signally manifested. The remecby, however, is so simple, that it may be diffi- cult to induce practitioner or patient to place much confidence in it; but if the former Avill reflect upon the indications which he desires to fulfil, and on the effect which sugar is capable of inducing, like other eutrophics—as cod-liver oil—whose properties have been considered, he ought not to hesitate to prescribe it, and the result will often gratify, and astonish him. At the recommendation of the author, it has been pre- scribed by several physicians, and with results analogous to those he has depicted. A case of almost hopeless cachexia in a child has been published by Mr. Rowbotham in the London Lancet, in which a diet of fruits and saccharine matter,—as honey, sugar, and treacle—" snatched from the grave, and from a state, which perhaps no mortal was ever in before, and restored to health and life;" and according to the British and Foreign Medical Review, for Oct. 1842, a treatise on rheumatic diseases appeared at Leipzig in 1841, by Dr. Greiner, in which there is a " AArarmth of eulogium on sugar as one of the direct means of im- proving the blood,'.' which "somewhat surprised" the reviewer. Dr. Greiner, it appears, strongly recommended it in both acute and chronic rheumatism, where sthenic excitement prevails, and antiphlogistic means are indicated; but to be useful—he states—it must be taken in doses of from one to two ounces, three or four times daily, in syrups, conserves,—or plain. In the different diseased conditions for which the author administers it to modify the action of the system of nutrition, he is in the habit of recommending it in the form of syrup—either the officinal syrup of the pharmacopoeia, or one made extemporaneously by dissolving a pound of rock-candy in a pint of water. Of this, a wine-glassful may 358 SPECIAL EUTROPHICS. be taken three or four times a day, between meals, and the quantity be gradually increased. It is proper that the individual should take animal food along Avith it, otherAvise scorbutic cachexia may be in- duced ; but the quantity of vegetable food may be diminished. The only accident that is apt to arise during its administration is diarrhoea; which soon, hoAvever passes off, if the sugar be discontinued for a short time. It need scarcely be said that in morbid states, that have endured for a length of time, no great benefit can be derived except from a long persistence in the use of any remedy. Accordingly, much effect may not be perceived until four or five weeks have elapsed, Avhen, if advan- tage is to be derived, it Avill begin to appear. 72. SARSAPARIL'LA. This much employed root is referred, in the United States Pharma- copoeia, to Smilax officinalis, and other species of Smilax; Sex. Syst. Dicecia Hexandria; Nat. Ord. Smilaceaj; a genus of creepers growing on moist river banks and Avoods in the hotter parts of North and South America, especially in Mexico, Columbia, Guiana, Brazil, and the Southern States of the Union. At least three species seem to be made out as furnishing the sarsaparilla or sarza of commerce:—1. Smilax officinalis, which groAvs in New Granada, on the banks of the Magda- lena, and is transmitted in large quantities to Carthagena and Mompox, Avhence it is shipped to Jamaica and Spain. 2. Smilax syphilitica, Avhich was found by Humboldt and Bonpland in New Granada, and by Von Martius in the Brazils, and which is exported to Europe from the ports of Brazil. 3. Smilax medica, Avhich grows on the Eastern slope of the Mexican Andes, and is carried to Vera Cruz and Tampico for exportation. There are still other species of smilax;—for example, Smilax sarsa- parilla, which is a native of the Southern States; but there is no evi- dence that it yields any of the sarsaparilla of the shops; and the root would assuredly be dug up, and introduced into the market, if it had been found to possess the same properties as the imported article. (Wood and Bache.) Another species has been mentioned by Pb'ppig, under the name Smilax cordato-ovata. It grows in Brazil, and supplies, in that country, a part of the root which is used in medicine. All the species of sarsaparilla plant have a rhizoma, which sends out numerous long horizontal roots or runners, and these roots constitute the sarsa- parilla of the shops. Several varieties of sarsaparilla are met with in European commerce, all of which have been described by recent pharmacologists. Of these, the most important are the following:— 1. Jamaica Sarsaparilla, Red or Red-bearded Sarsaparilla, which is probably the root of Smilax officinalis, and is made up in bundles of about a foot, or a foot and a half long, and four or five inches broad, the roots scarcely equalling in thickness a goose-quill, and distinguished from the other varieties by the red colour of the epidermis. It receives the name Jamaica sarsaparilla, owing to its being sent thither from SARSAPARILLA. 359 Honduras. Occasionally, it is exported from Guatemala. This is the most esteemed variety in English pharmacy. 2. Honduras Sarsa- parilla, Mealy Sarsaparilla, is exported directly from Honduras Bay, Fig. 166. Fig. 167. Jamaica Sarsaparilla. Hondm-as Sarsaparilla. a. Cuticle. 6. Subcuticular tissue. c. Hexagonal cellular tissue. d. Cellular ring. e. Wood}- zone. f. Medulla. The hexagonal cellular tissue abounds in starch.—(Christison.) and some of it scarcely differs from Jamaica sarsaparilla. Generally, the roots are folded, and formed into bundles two or three feet long, in which roots are found of inferior quality, with stones, pieces of wood, &c. The colour is dirty or grayish-brown. The epidermis is thin, and within it is a thick, white, amylaceous layer, which gives it a mealy appearance when broken,—whence one of its names. Its botanical source is not accurately determined. It is the variety most commonly used in this country. 3. Brazil Sarsaparilla, Lisbon, Portugal, Rio Negro sarsaparilla, strongly resembles the last variety in form, colour, and mealiness, but it is generally exported unfolded, and tied in cylin- drical bundles, three to five feet long, and about a foot in diameter. It has fewer radicles or rootlets than either of the other varieties. It is supposed to be the produce of Smilax syphilitica, and perhaps, also of S. ovato-cordata, and is exported from Maranham chiefly. Being sent to Portugal, and especially to Lisbon, it obtains a name from those places. 4. Lima^ or Valparaiso Sarsaparilla Avas originally ex- ported from Lima, but is now frequently obtained from Valparaiso ; and at times from Costa Rica. Dr. Pereira states, that he knew of one importation of 99,000 lbs. from the last place. It is an inferior variety, commonly imported in large bundles, and resembles somewhat the Jamaica or Honduras variety. It is imported folded in bundles of about three feet long and nine inches in diameter, with the rhizoma or chump in the interior of the bundle. Its colour is brown or grayish- broAvn. Its botanical source is not known ; but it has been presumed to be from Smilax officinalis. 5. Vera Cruz Sarsaparilla indicates by its name the place whence it is exported ; but it is said not to be often met Avith. The roots are not folded, and have the rhizoma or chump attached. They are thin; tough; of a light grayish-brown 360 SPECIAL EUTROPHICS. colour, and devoid of starch in the cortex. It is the produce of Smilax medica. ' Besides these chief varieties, other minor sarsaparillas are described by pharmacologists, but they are not of much interest to the physician. Smilax China, China root, a native of Japan, has been employed in the same cases as sarsaparilla. As met with in the shops, sarsaparilla is almost devoid of odour, but possesses a mucilaginous slightly bitter taste, and, when chewed for some time, causes a sensation of acridity in the mouth and fauces, which persists for a considerable period. According to Dr. Hancock, the Rio Negro sarsaparilla, which in his opinion is the only kind that possesses any activity, has a peculiar nauseous acrimony, which no other sarsaparilla possesses; but if Dr. Hancock be right, large quan- tities of the other varieties, which are alone prescribed by many physi- cians—who are notwithstanding ready to depose to its valuable pro- perties—must have been devoid of action on the economy; and if, as has been thought, the root is efficient in proportion as it possesses the acrimony described above, which is said to be a volatile, easily destruc- tible principle, then almost all the preparations, so long given, and im- plicitly relied on by many, must—as regards the sarsaparilla—have been wholly inoperative. Such should be the case with Decoctum sar- saparillce compositum, and Syrupus sarsaparillce compositus of the Phar- macopoeia of the United States, and with the decoctions and extracts of other pharmacopoeias in which heat is employed. According to Dr. Hancock, if the sarsaparilla be really of good quality—which, how- ever, he adds, is very seldom the case Avith what is to be got in Europe —^the only correct preparations of it are—an infusion of the bruised root made by keeping it for some hours at 212° without boiling; and one prepared sloAvly without heat at all. These facts would of themselves throw strong doubts in regard to much of the testimony that has been brought forAvard in favour of this article of the Materia Medica; nor is any light thrown on the subject by the investigations of the chemical analyst. It has been repeatedly examined; but discrepant statements of its composition have been the result. It seems to contain Volatile oil of sarsaparilla, which has the odour and acrid taste of the root; Smilacin, called also Pariglin, Sal- separin, and Parallinic acid, which appeared to Palotta to act as a sedative in doses of two to thirteen grains; resin, and extractive—on which it has been thought a part at least of the medicinal properties de- pend, and starch. Smilacin is procured by decolorising a concentrated hot alcoholic tincture of sarsaparilla by animal charcoal. On cooling, the tincture deposits impure smilacin, which can be purified by repeated solution and crystallization. The active principles of sarsaparilla reside chiefly in the cortical por- tion. They are imparted to water and dilute alcohol. The quantity consumed is very great. In the year 1840, duty was paid in England on 121,814 lbs.; and the countries from which it was obtained in 1831 are thus stated by Dr. Pereira from a parliamentary return:— SARSAPARILLA. 361 Portugal, Italy and -the Italian Islands British Northern Colonies, . 16,110 lbs. 107 71 British West Indies, United States of America, . 45,063 ... . 29,122 Mexico, . 43,254 Guatemala, Brazil, .... 14 . 31,972 Peru, .... . 11,141 Total import, . . . . . 176,854 Retained for home consumption, . . . 107,410 Dr. Christison quotes the statement of Dr. Pereira in regard to the quantity consumed in Great Britain in 1831; and adds that in 1821 the apothecary of one of the great London Hospitals informed him, that he had paid at that time £1,500 for a single year's consumption of it. In April 1849, Dr. Bailey, inspector of drugs at the port of New York, rejected 1450 lbs. of Sarsaparilla from Tampico. Were we to be guided by the quantity consumed, sarsaparilla ought to be esteemed a most valuable therapeutical agent; yet the author has much difficulty in speaking positively on the subject. Were he to judge from the results of his own observation, he would say, that it is inert; and a consideration of the remarks already made in regard to the different varieties of the drug, and forms of preparation, would tend to a similar conclusion ; yet when he observes so many persons offering their testimony in its favour, he is not prepared to decide, as Dr. Cullen did, that it is totally devoid of medicinal efficacy. Much, doubtless, is to be ascribed to the diet and regimen generally asso- ciated with it; much, in syphilitic and syphiloid diseases, to its fre- quently leading to the exclusion of mercury; and much, the author is disposed to think, to the substances that are associated with it. " No doubt"—say Messrs. Ballard and Garrod—" chronic cutaneous affections, glandular swellings, enlargements and painful diseases of the joints, bones, fasciae, &c, sometimes disappear under its use; but still we must suspend our judgment respecting the part which it takes in their cure, until the influence of time, regulated diet, and other medicinal agencies usually combined shall have been correctly ascertained." In public and in private practice, the author has carefully watched the effects of sarsaparilla, given singly, in infusion and in extract, but he is not prepared to say that he has, in a single instance, observed effects that could be fairly referred to it. Such has not been the case when syrup of sarsaparilla has been exhibited largely; but here a considerable quantity of saccharine matter was taken along with it, to which the author is disposed, for reasons before given, to refer the therapeutical agency. The remark of Mr. Lawrence, that phy- sicians have no confidence in it, but surgeons a great deal, is not 362 SPECIAL EUTROPHICS. sufficiently explained by the circumstance mentioned by Dr. Pereira, that physicians are much less frequently called in to prescribe for those forms of disease, in the treatment of which surgeons have found sarsaparilla so efficacious. Moreover, Dr. Christison remarks, that if the fact be applicable to London, it does not apply elseAvhere, and not to Edinburgh certainly, Avhere some of the most eminent surgeons have abandoned it except as a placebo. " My own opinion," he says, " deduced from not unfrequent opportunities of practice in the Edin- burgh Infirmary, Avhere syphilitic and mercurio-syphilitic cases come under the cognizance of the physician chiefly, is, that the question —confessedly a difficult one, like that relative to the action of altera- tive remedies in general—is still far from being satisfactorily decided; that more careful observations are required, more especially in refer- ence to the now acknowledged efficacy of simple non-mercurial treat- ment in secondary, pseudo, and mercurial syphilis; and that the probability is much in favour of the drug turning out very inferior in virtue to what its admirers imagine:"—and he adds, that the question is not unimportant in an economical point of view, seeing that so much of it is consumed. Perhaps there is no article of the Materia Medica which is employed so lavishly, and so frequently had recourse to in chronic diseases, when the practitioner is in doubt what to do. As a eutrophic, it has been chiefly had recourse to in cachexia of various kinds, but especially in the syphilitic; and is, at times, associated with mercury, especially Avith the corrosive chloride. When employed alone, it offers an exemplifi- cation of the simple mode of treating syphilis, in contradistinction to the revellent by mercury, iodine, &c. It has, likeAvise, been freely given in syphiloid affections, and in chronic cutaneous diseases; and, in the form of syrup, has been fre- quently efficacious, in the last affections especially. Whenever, indeed, a modified action in the system of nutrition generally has appeared to be indicated, it has been prescribed. It may be given in powder in the dose of 5ss. to 3j., three or four times a day; but it is not often prescribed in this form. When fresh, the root is said to induce nausea and vomiting; and signs of narcosis have resulted from it, but in the state in which it is met with in the shops, it rarely or never disagrees except from quantity. A fact, men- tioned by Dr. Pereira, may render the practitioner cautious in pre- scribing the powder,—viz., that some druggists employ, in its prepa- ration, the roots from which the extract has been obtained. This powder is, of course, almost devoid of taste. _ INFU'SOI SARSAPARIL'LJ, INFU'SION OP SARSAPARILLA. (Sarsaparill. contus. oj.; Aquce bullient. Oj.;—prepared either by maceration or by displace- ment with cold water.) The dose of the infusion is f 3iv. to f 3vj. two or three times a day. 1)EC0C'TDI SARSAPARIL'LA COMPOSITUM, COMPOUND DECOCTION OF SARSAPA- RIL'LA. (Sarsap. incis. et contus. 5vj.; Sassafras, incis., Guaiac. lig. rasur., Glycyrrhiz. contus. aa 5j.; Mezer. incis. 3iij.; Aquce Oiv. Boil SARSAPARILLA. 363 for a quarter of an hour and strain.) This preparation is an imitation of the Lisbon Diet Drink, which Avas long celebrated in all cases in Avhich sarsaparilla was indicated,—its powers being enhanced—it Avas conceived—by the addition of the sassafras, guaiacum, and mezereum, Avhich Avere supposed to possess analogous properties. If the objec- tions made to the application of a boiling heat be well founded—as they are generally admitted to be—decoction must be an imperfect mode of preparation. The dose of this preparation is fjiv. to f ovj. three or four times a day. The syrup or extract is often associated Avith it. SYRUPUS SARSAPARILLA COMPOSTTUS, COMPOUND SYRUP OF SARSAPARILLA. (Sarsaparill. contus. Tbij.; Guaiac. tig. rasur. siij.; Ros. centifol., Sennce, Glycyrrhiz. contus. aa §ij.; 01. Sassafras, 01. anisiHa, "I v.; 01. gaultherice TrLiij-; Alcohol, dilut. Ox.; Sacchar. fbviij. The first five articles are ma- cerated in the alcohol for a certain length of time, and by means of a Avater-bath the filtered tincture is evaporated to four pints; to the fil- tered liquor the sugar is added, so as to form a syrup; the oils being added last. It may also be made by displacement, according to the formula in the United States Pharmacopoeia.) Dr. Christison considers the simple syrup of sarsaparilla to be " an unnecessary addition to the list;" and Dr. Thomson remarks, that it can be better and more easily supplied by rubbing up a feAv grains of the extract Avith some simple syrup. The preparations of the British College are probably inert as regards the sarsaparilla, as the boiling cannot fail to destroy any virtues that it may possess. This objection does not apply so much to the process of the United States Pharmaco- poeia ; yet, the heat of the water-bath may affect its virtues. The roses and volatile oils are added for the sake of flavour. There is no ques- tion Avhatever that this syrup has been productive of good effects in many cachexioe; but the author is not prepared to say how much of this is ascribable to the sarsaparilla and guaiacum, and hoAV much to the saccharine matter, which is sometimes given very freely. The ordinary dose is, however, fSss. to foj. three or four times a day. It may be substituted for the Sirop de Cuisinier. EXTRAC'TUM SARSAPARIL'LA, EXTRACT OF SARSAPARIL'LA. (Prepared, ac- cording to the Pharmacopoeia of the United States, by displacement, by means of diluted alcohol and Avater, evaporating the filtered liquor to the proper consistence.) It is very questionable AA'hether any ex- tract of sarsaparilla can be possessed of much virtue. If the proper- ties reside in volatile matter it must be driven off by the long coction. The Edinburgh and Dublin Colleges have a Fluid extract of sarsaparilla, in Avhich the concentration is not carried so far. A little dilute alcohol is added to make it keep. The dose of the extract of sarsaparilla of the Pharmacopoeia of the United States is from ten to tAventy grains, three or four times a day. Dr. Pereira, contrary to most observers, states his belief, that Avhen the ordinary extract of sarsaparilla of the London and Dublin Pharmaco- poeias is properly prepared from Jamaica sarsaparilla, it is a most 364 SPECIAL EUTROPHICS. valuable and efficient remedy. He recommends, that, when given, it should be rubbed down with water, and flavoured by the tincture of orange-peel, or by some volatile oil, as oil of cloves, allspice, lemon or cinnamon. The author has used it extensively, but he cannot accord with that gentleman in his high appreciation of it. Compound extract of sarsaparilla is kept in the shops. It is made by mixing with Extract of sarsaparilla, an Extract of mezereon bark, Liquo- rice root, and Guaiacum shavings, adding a small quantity of Oil of sas- safras. Three quarters of an ounce of this to a pint of water are con- sidered to equal in virtues a pint of the compound decoction of the British Pharmacopoeias. In the last edition of the Pharmacopoeia of the United States (1851) there has been admitted an EXTRACTUM SARSAPARIL'LJI FLU'IDUM, FLUID EXTRACT OF SARSAPARIL'LA, in- tended to represent in a concentrated form the compound decoction of sarsaparilla, excepting, that it does not contain the guaiacum wood. It is formed as folloAvs:—Sarsaparilla, sliced and bruised, gxvj.; Liquo- rice Root, bruised; Bark of Sassafras Root, bruised, each §ij.; Mezereon, sliced, 3vj.; Sugar, gxij.; Diluted Alcohol, Oviij. Macerate all together except the sugar for fourteen days; express and filter; and evaporate by means of a water-bath to f |xij.; add the sugar while hot and dis- solve. Dose f3j., which is considered to be equivalent to 3j- of the root. 73. GUAFACI LIGNUM.—GUAFACUM AVOOD. The general properties of guaiacum wood have been described under Excitant Diaphoretics, (Vol. i. p. 355:) As a eutrophic, it has been given, like sarsaparilla, in syphilitic and syphiloid diseases; and in most forms of cachexia. It is less relied on, however, than sarsaparilla, and is usually associated Avith it. It has also been freely administered in chronic cutaneous affections. It is probably possessed of very little efficacy. There is no separate preparation of it in the Pharmacopoeia of the United States; but the Edinburgh and Dublin Colleges have a De- coctum Guaiaci, which is considered to be the relic of the old Decoc- tion of the woods. In the Pharmacopoeia of the former, it is made as follows:—Guaiacum trimmings I iij.; Sassafras, rasped 3*j.; Liquorice root bruised s"j.; Raisins 3*ij.; Water Ox. Boil the guaiacum and rai- sins with the water to five pints, adding the liquorice and sassafras towards the close; then strain. The dose of this is fsiv. to f 3*viij. and more, three or four times a day. Guaiacum wood enters into the composition of Decoctum sarsajia- rillce compositum, and Syrupus sarsaparillce compositus of the Pharma- copoeia of the United States. ARALIA NUDICAULIS. 365 74. MEZE'REUM.—MEZE'REON. Mezereon belongs, like guaiacum wood, to the excitant diaphoretics; and its general properties have, consequently, been described else- where (Vol. i. p. 357). It is given in the form of decoction—Decoc- tum Mezerei of the Edinburgh Pharmacopoeia, which is made as fol- lows :—Mezereon bark in chips 3ij-; Liquorice root bruised |ss.; Water Oiij.; boil gently to Oij. The dose is f|iv. to flviij., three or four times a day. Mezereon enters into the same officinal preparations as guaiacum wood, and is seldom given alone. 75. ARA'LIA NUDICAU'LIS.— FALSE SARSAPARILLA. This is the root of Aralia nudicaulis, False sarsaparilla, Wild sarsa- parilla, Small spikenard; Sex. Syst. Pentandria Pentagynia; Nat. Ord. Araliaceae; an indige- nous perennial plant, Fig. 168. which grows through- out the greater part of the United States, floAvering in May and June. It is officinal in the secondary list of the Pharmacopoeia of the United States ; is about as thick as the little finger; more or less contorted; of a yelloAvish broAvn colour externally; of a fragrant odour, and an aromatic saccharine taste. False sarsaparilla has not been analyzed, but appears to pos- sess properties that might entitle it to rank with guaiacum and mezereum amongst excitant diaphoretics. Aralia nudicaulis. The common belief is, that, like them and sarsaparilla, it may be employed also as a eutrophic in syphilitic and syphiloid diseases, and in chronic cutaneous affections especially. The author has never prescribed it, nor has he seen it prescribed. 366 SPECIAL EUTROPHICS. The root of Aralia raremosa, American spikenard, is said to resemble that of Aralia nudicaulis in properties. 70. SAS'SAFRAS RADI'CIS CORTEX.—BARK OF SASSAFRAS ROOT. This agent—like guaiacum wood and mezereon—Avas at one time supposed°to be possessed of poAverful eutrophic virtues, especially in syphilitic and chronic cutaneous diseases; and it is still associated Avith the articles above mentioned, and Avith sarsaparilla, in some officinal preparations (p. 362 and 364), of the Pharmacopoeia of the United States. Its properties—both diaphoretic (Vol. i. p. 359,) and eutro- phic—are probably altogether dependent upon the volatile oil Avhich it contains; but its agency is very limited, and it is now never given alone in the very cases in which it was formerly so much extolled. Oil of sassafras forms part of Syrupus Sarsaparillce Compositus of the Pharmacopoeia of the United States. 77. DULCAMA'RA.—BIT'TERSWEET. Bittersweet, of the Pharmacopoeias, is the stalks of Solanum dulca- mara, Woody nightshade or Bittersweet; Sex. Syst. Pentandria Mono- gynia ; Nat. Ord. Solanaceae;—a perennial climbing plant, Avhich is common in Europe, and in this country, both Avild and cultivated: flowering from June to August. The stalks—which are the only offi- cinal portion—are collected in autumn, after the leaves have fallen off. When bruised in their fresh state they have a disagreeable odour, which is lost by drying. The taste is at first bitter, and afterAvards sweet, which gives occasion to their name. As Ave meet with the dried stalks in the shops, they are rugous externally, having a green- ish-gray epidermis, an interior light woody portion, and a central light and spongy pith. It imparts its properties to water and to alcohol; but the tincture is never employed. It has been subjected to analysis, and found to con- tain a sweetish bitter extract—to which, from these qualities, the name Picroglycion, Duhamarin, or bittersAveet principle, has been given— an alkaloid of narcotic properties, termed Solania or Solanina; besides other unimportant ingredients. Bittersweet has been used in the same class of cases as sarsaparilla, mezereum, guaiacum and sassafras; and is probably not possessed of more powers than the feeblest of these. Were the author to be guided by the results of his own experience, he would say that it is almost devoid of action on the economy. He has seen it chewed by boys in large quantities; and has cheAved it himself when a boy, without obserA-ing any effect from it, except what was caused by its saccharine and gummy matter. The decoction, the extract and the fruit have all been given in large quantities, with no more effect; yet solania, which has been separated from it, is said to have killed a rabbit in the dose JUGLANS CINEREA. 367 of two grains. Certainly, more testimony is needed, before it can be regarded as possessed of much efficacy; especially when we are told, by Chevallier, that an article, having, according to all, little or no narcotic power, occasioned narcotism in a young man, when he merely carried a bundle of it on his head ! Dr. Wood of Philadelphia—who considers that its use is now nearly confined to the treatment of cuta- neous eruptions, particularly those of a scaly character, as lepra, psori- asis, and pityriasis, in which he thinks it is often decidedly beneficial, especially when combined with minute doses of antimonials—states, that he has observed, in several instances; when the system Avas under its influence, a dark purplish colour of the face and hands ; and, at the same time, considerable languor of the circulation. Such effects have not been observed by the author, nor are they recorded by others; but whatever rests on the authority of Dr. Wood is deserving of considera- tion ; and may lead to farther investigation. Dulcamara is given in the form of the officinal decoction; and is administered in all the cachectic conditions that require the employment of the vegetable agents last described. The cachexias in which it is now mainly pre- scribed, however, are those accompanied by chronic diseases of the skin. DECOCTUM DULCAMA'RJI, DECOCTION OF BITTERSWEET. (Dulcamar. contus. 5j.; Aquce 'Oiss: to be boiled to a pint.) The dose may be foij. to f §iv. three or four times a day. 78. STILLING'IA.—QUEEN'S ROOT. Stillingia, in the secondary list of the Pharmacopoeia of the United States, is the root of Stillingia aquatica, Queen's delight; Sex. Syst. Monoecia Monadelphia; Nat. Ord. Eupborbiaceae; which groAvs in pine barrens from Virginia to Florida; flowering in May and June. It has been highly extolled by Dr. Thomas Y. Simons, of Charleston; who regards it as the best vegetable alterative known; and believes that it will ultimately supersede sarsaparilla, or be esteemed as a most use- ful adjuvant to it. With the views, which the author possesses in re- gard to the eutrophic virtues of sarsaparilla, he cannot consider this to be high praise. It may be given in powder in the dose of fifteen or twenty grains. Or, an ounce of the bruised root may be boiled slowly in a pint and a quarter of water to a pint; and one or two fluidounces of this may be given three times a day. A tincture is sometimes made of two ounces of the root to a pint of diluted alcohol, the dose of which is a fluid- drachm. Dr. Frost, of Charleston, thinks, that the active principle is somewhat volatile ; and if such be the case, decoction must be an ob- jectionable form of preparation. 79. JUGLANS CINEREA.—WALNUT. The leaves of Avalnut have been highly extolled by M. Negrier as superior to all other antiscrofulous remedies. He found the extract 368 SPECIAL EUTROPHICS. of the leaves, which may be ranked in the class of slightly aromatic bitters, to be almost always efficacious in scrofulous affections, and in no case did it appear to exert any unpleasant action on the eco- nomy. Their efficacy is doubtless, hoAvever, overrated by him; and their main virtues would appear to be those of the aromatic bitter tonics. 80. HELIAN'THEMUM.—FROSTWORT. The herb Helianthemum Canadense ; Sex. Syst. Polyandria Monogy- nia ; Nat. Ord. Cistaceae; has been introduced, on no strong grounds, into the secondary list of the last edition of the Pharmacopoeia of the United States, (1851.) It grows in every part of the Union, flowering in the Middle States in June. It has an astringent, slightly aromatic, and bitter taste ; and has been recommended as a potent remedy in scrofula, secondary syphilis, &c. It has been given in powder, decoc- tion, tincture, syrup and extract, and in considerable quantity; but it is questionable whether it has any other properties than those of a tonic and astringent. i 81. LAPPA—BURDOCK. The root of Lappa minor; Sex. Syst. Syngenesia aeqrralis; Nat. Ord. Compositae Cinareae:—Cynaraceae, Lindley, is introduced at a late date (1851), into the Pharmacopoeia of the United States. This plant is a native of Europe, but is abundant in this country. The root is spindle-shaped, a foot or more long, brown externally, and white and spongy within. Its odour is weak and disagreeable; taste mucilagin- ous and sweetish, bitterish and slightly astringent. Burdock has been advised in various diseases—scorbutic, scrofulous, syphilitic, arthritic, rheumatic and cutaneous. It is given in decoction,— two ounces of the fresh bruised root boiled in three pints of water to tAvo ; and a pint taken in the day. The seeds have been used in the same affections, and particularly in lepra, psoriasis, and other cutaneous diseases, in the form of the saturated tincture. Dose of the powder, a drachm. 82. MUDAR. Under the name Mudar or Madar a medicine was imported into Europe from India, Avhich is the bark of the root of Calotropis gigantea, Asclepias gigantea; Nat. Ord. Asclepiadaceae, which is a native of Hindostan, but it has been introduced into the West Indies where it is now naturalized. It appears to have been used in India in' the same cases as sarsaparilla; for example, in syphilitic and syphiloid diseases chronic cutaneous affections, &c. The powdered root__mudar__is given in doses of from gr. iij. to gr. x., three times a day, gradually increased until it induces some degree of nausea and vomiting It is not employed in American practice. EUTROPHIC OINTMENTS. 369 83. HEMIDES'MUS IN'DICUS.—COUNTRY SARSAPARILLA, (OF INDIA.) This plant, called also Periploca Indica, Asclepias pseudo-sarsa, Indihn or scented sarsaparilla; Nat. Ord. AsclepiadaceEe, is likewise a plant of Hindostan, which has been erroneously referred to Smilax aspera. (Pereira.) The root has been employed as a substitute for sarsaparilla. It is given in infusion, (Hemidesm. Indie. Sij.; Aq. bullient. Oj.; to be taken in the course of the twenty-four hours.) The decoction, extract and syrup have been used ; but the heat necessary for their prepara- tion is said to injure the medicine. The author knows nothing of it from his own observation. Topical Eutrophics. 1. Eutrophic Ointments. In the general remarks on eutrophics, it was stated, that there are various external agencies, which give occasion to modification in the functions of nutrition of a part, and which must, therefore, be regarded as belonging to this division of medicinal substances. Every local ex- citant is capable of effecting this to a greater or less extent; and hence the various excitant applications, that are made to ulcerated surfaces, and to chronic cutaneous affections, must be regarded as eutrophics,— for example, Ceratum resince, (i. 526;) Ceratum resince compositum, (i. 526;) Ceratum sabince, (ii. 369;) Unguentum cantharidis, (ii. 278;) Unguentum creasoti, (i. 542;) U. cupri subacetatis, (ii. 483;) U. Gallce, (ii. 129 ;) U. hydrargyri, (ii. 311;) IT. Hydrargyri ammoniati, (ii. 317 ;) U. hydrargyri nitratis, (ii. 321;) U hydrargyri oxidi rubri, (ii. 314;) U. iodinii, (ii. 329 ;) U. iodinii compositum, (ii. 329 ;) U. mezerei, (ii. 279;) U. sulphuris, (ii. 351;) U. sulphuris compositum, (ii. 369.) There are a few officinal preparations which have not yet been described, and which belong to this division of the subject. 84. UXGUEATUM PICIS LIQ'UIDJ], TAR OINTMBST. (Picis liquid., Sevi, aa ftj. melted together.) This ointment is a common application in chronic cutaneous affections, especially in porrigo and psoriasis. It may be applied several times in the day;—the good effects of most ointments of the kind being greatly dependent upon their repeated application. Oil of Tar, obtained from tar by distillation, is sometimes used in the same cases. 85. UNGUEN'TUM TAB'ACI, TOBACCO OINTMENT. (Tabac. recent, concis. 3j.; Adipis Ibj. The tobacco is boiled in the lard until it becomes friable, and is then strained.) This ointment is officinal only in the Pharmacopoeia of the United States. It is used on account of its seda- tive properties in irritable ulcers; but it is also employed in various chronic cutaneous diseases, especially in scald head. Great caution is, however, needed, inasmuch as the constitutional effects of the remedy VOL. n.—24 370 SPECIAL EUTROPHICS. may be induced by the topical application. (See Tabacum, Vol. i. p. 157.) 86. UNGUEN'TUM VERA'TRI ALBI, OINTMENT OF WHITE HEL'LEBORE. (Veratri albi pulv. Iij.; 01. limon. "Ixx.; Adipis Iviij.) On account of the disagreeable qualities of sulphur ointment, this preparation is substi- tuted for it in cases of scabies; but it is by no means so effective; and it is affirmed, that when applied to raw surfaces, danger exists of the system being affected by the absorption of the poisonous principle— veratria, (Vol. ii. p. 203). Hence, especial care is needed when this or the last preparation is given to children. 87. UNGUEN'TUM ZINCI OX'IDI, OINTMENT OF OXIDE OF ZINC. (Zinci oxid. §j.; Adipis Ivj.) This ointment is frequently used as a mild applica- tion to various chronic cutaneous diseases, as well as in cases of oph- thalmia, especially the form which affects chiefly the tarsus. It is often applied, also, to excoriations; and occasionally as a dressing to ordi- nary ulcers, although not by any means as frequently as the 88. Zlnci Car'bonas, Car'bonate of Zinc, Avhich is the native impure carbonate, commonly called Lapis Calaminaris and Calamine. CALAMUNA of the last Pharmacopoeia of the United States (1851). ZINCI CAR'BONAS PRJIPARA'TUS, PREPARED CAR'BONATE OF ZINC, CALAMUNA PR^PARA'TA of the last Pharmacopoeia of the United States (1851), Prepared Cala- mine, is made by heating carbonate of zinc to redness, and afterwards pulverizing it in the same manner as prepared chalk. 89. Zinci Car'bonas Prjecipita'tus, Precipitated Car'bonate OF Zinc, (Zinci Sulphat.; Sodce Carbonat. aa Ibj.; Aquce destillat. bullient. cong. Dissolve each of the salts in four parts of the water; mix the solutions; stir, and set by till the powder subsides. Pour off the fluid; wash the precipitate, and dry it Avith a gentle heat.) In this preparation, which is introduced into the last pharmacopoeia of the United States (1851), for the purpose of having a purer carbonate of zinc, a double decomposition occurs between the salts, which results in the formation of sulphate of soda in solution, and of carbonate of zinc, which is precipitated. Precipitated carbonate of zinc is in the form of a soft loose powder, AAmich resembles magnesia. It is used to form the Ceratum zinci car- bonatis of the Pharmacopoeia of 1851 mentioned below. 90. CERA'TUM ZINCI CARBONA'TIS, CERATE OF CiR'BONATE OF ZINC. (Zinci carbon, prceparat., Cerce flavce aa Ibss.; Adipis Ibij.) This is an imitation of an old and popular dressing for ulcers, recommended by Turner and termed generally Turner's cerate. It is commonly used as a ' heal- ing salve;' and is applicable to the same cases as Unguentum zinci oxidi. It is the CERA'TUM CALAMUNA, CAL'AMINE CERATE of the last Phar- macopoeia of the United States, the process for which has been slightly modified. Calamin. prceparat, Cerce flavce aa I iij.; Adipis Ibj.- melt emplastrum resins. 371 the wax and lard together; and when on cooling they begin to thicken, add the calamine, and stir constantly until the mixture is cool. The CERATUM ZINCI CARBONATIS, CERATE OF CARBONATE OF ZINC of the Pharmacopoeia of the United States of 1851, is made by mixing two drachms of precipitated carbonate of zinc, described above, with ten drachms of simple ointment. It was introduced as a substitute for the other, in consequence of the frequent falsification of the calamine. 91. CERA'TUM PLUMBI SUBACETA'TIS, CERATE OF SUBACETATE OF LEAD, (Liq. plumbi subacetat. f^iiss.; Cerce albce liv.; 01. Oliv. fjix.; Cam- phor. 3ss.) This is the old Ceratum Saturni, Goulard's Cerate, which has been most commonly used as a cooling dressing to wounds and ulcers; as a dressing to burns, scalds, and blistered surfaces; and like- wise as an application to irritable cutaneous diseases. The following ointment is used in similar cases. 92. LA'GUEN'TCM PLUMBI CARBONATIS, OINTMENT OF CAR'BONATE OF LEAD. (Plumbi carbon, in pulv. subtiliss. Iij.; Unguent, simplicis Ibj.) 2. Compressing Eutrophics. The effects of compression in modifying the function of nutrition have be'en referred to in the general considerations on eutrophics. This is accomplished either by appropriate bandages methodically applied—methodical compression, as it has been termed—or by adhesive plasters. Of the latter, the folloAving are generally used. 1 93. EMPLAS'TRUM PLUMBI.—LEAD PLASTER. Lead plaster, Litharge plaster, Diachylon, is made by boiling semi- vitrified oxide of lead or litharge, in very fine powder, Avith olive oil and water, until the oil and oxide of lead unite into a plaster. The water appears to be riecessary to favour the union of the oleic and margaric acids Avith the oxide of lead,—the plaster itself seeming to be a mix- ture of oleate and margarate of lead. It is the most unirritating of adhesive plasters, and can be borne by those on whom emplastrum resinse excites great irritation. It is much used by the surgeon in cases of wounds, to bring the edges together; to protect the parts from the air, and to exert methodical compression in cases of ulcers, tumours, &c, and of orchitis and other inflamma- tions in which it is desirable to employ pressure. It is by no means, however, as adhesive as the next plaster, which is, accordingly, more employed for the formation of strapping. 94. EMPLAS'TRUM RESI'NiE.— RESIN PLASTER. (Resin, pulv. Ibss.; Emplastr. plumbi Ibiij.; melted together.) The resin occasions this plaster to be more adhesive; and hence its com- mon name of Adhesive plaster. It is used for the same purposes as Emplastrum plumbi. It sometimes irritates the skin so much as to 372 SPECIAL EUTROPHICS. occasion excoriation and ulceration. In such cases, lead plaster to be substituted. Besides the above plasters, there are some others that are employed as " discutients," to dispel morbid growths, either of the integuments or of internal organs. In both cases, they act as eutrophics,—modifying the nutrition of the part with which they are placed in contact,— partly by pressure, and partly by exciting a new action in the system of nutrition. In cases of internal tumours, their main efficacy is pro- bably in the latter mode. The officinal plasters employed as discu- tients are the folloAving:— 95. EMPLAS'TRUM AMMONI'ACL—AMMO'NIAC PLASTER. (Ammoniac. Iv.; Aceti Oss.; made into a plaster by solution, and evaporation.) The therapeutical properties of ammoniacum have been described elsewhere, (Vol. i. p. 259.) This plaster is excitant, and is much used as a discutient in scrofulous and other tumours. It is often prescribed by the surgeon, ' as a very useful application to the house- maid's swollen knee.' (Pereira.) It occasionally excites considerable irritation of the cutaneous surface, and has to be removed. EMPLAS'TRUM AMMONI'ACI CUM HTDRAR'GYRO, PLASTER OF AMMO'NIAC WITH MER'- CURY. A complex process for this plaster has been introduced into the last Pharmacopoeia of the United States (1851). It may be made more simply and satisfactorily by the Edinburgh process, which consists in mixing four ounces oi ammoniac plaster with eight ounces of mercurial plaster. Emplastrum Galbani Compositum, (Vol. i. p. 446,) and Emplas- trum Hydrargyri, (Vol. ii. p. 312,) are used in analogous cases. The following plasters are employed chiefly to give support; but they may also act as discutients. 96. EMPLAS'TRUM FERRI.—IRON PLASTER. Iron plaster, Emplastrum roborans, Strengthening plaster was long supposed to give tone by virtue of the iron which it contains. It is composed of Subcarbonate of iron 3iij.; Lead plaster ibij.; Burgundy pitch tbss. It is questionable, however, whether the iron be of any advantage. This plaster gives support to weakened parts; and, by the new action which it excites in the vessels of the skin, it may be serviceable in dispersing tumours. The simple Burgundy pitch plas- ter possesses probably all its virtues. 97. EMPLAS'TRUM SAPO'NIS.—SOAP PLASTER. (Sapon. incis. 3iv.; Emplastr. plumbi rbiij.) This plaster is fre- quently applied to tumours of various kinds as a discutient; and like- wise to afford mechanical support. The same may be said of TINCTURA SAPONIS CAMPHORATA. 373 98. CERA'TUM SAPO'NIS.—SOAP CERATE. (Liquorplumbi subacetat. Oij.; Saponis §vj.; Cerce albce Ix.; 01. oliv. Oj.; made into a plaster by proper evaporation and admixture.) 3. Eutrophic Liniments. It was before remarked, (Vol. ii.p. 301,) that many of the liniments —those which are wholly oleaginous—are indebted for their eutrophic virtues to the rubbing; and that friction with the dry hand, methodi- cally used, is capable of accomplishing whatever liniments can. Some of them, hoAvever, contain exciting ingredients, which enable them to act as revellents ; but there is this objection, that friction with them cannot be sufficiently long continued; for it is an important matter, Avhenever a liniment is directed to remove any morbid formation or exudation, that the friction should be continued as long as the skin Avill well bear it; and, as before mentioned, under such circumstances, friction even Avith the dry hand dipped in flour is capable Of producing surprising results. The officinal liniments, most frequently had recourse to as discu- tients, are the following: 99. LINIMEN'TUM CAM'PHOR^E.—CAMPHOR LIN'IMENT. (Camphor. 3ss.; 01. oliv. f §ij.) This is frequently used in glandular and other swellings; the camphor communicating excitant properties to the oil. 100. LINIMEN'TUM SAPO'NIS CAMPHORA'TUM.—CAMPH'ORATED SOAP LINI'MENT. (Sapon.vulgar. 3iij.; Camphor, oj.; 01. rosmarin.; 01.origan, aa f3j.; Alcohol. Oj.) This is well known under the name Opodeldoc, and is used as an application to sprains, bruises, and as a revellent in cases of rheumatic pains. Where there is much effusion of fluid in the first cases, the friction occasions its absorption. The camphor and essential oils communicate excitant properties to it. It is rubbed on glandular swellings to promote their discussion. 101. TINCTU'RA SAPO'NIS CAMPHORA'TA.—CAMPH'ORATED TINCTURE OF SOAP. (Saponis. rasur. liv.; Camphor, oij.; 01. rosmarin. flss.; Alcohol. Oij.) This is the Soap liniment of the shops. It is much used in the same cases as the last preparation. 102. ELECTRICITY, GAL'VANISM, ELECTRO-MAG'NETISxM. Acupuncture and Gala^axopuxcture, considered under Ex- citants, (Vol. i. 554,) act also as local eutrophics. The last has been 374 CHEMICAL AGENTS. highly recommended by Dr. Shuster, who maintains, that " galvanic electricity and the electro-magnetic fluid, when employed by acupunc- ture, constitute at once the most powerful and inoffensive medicinal agents that we possess." He recommends it in hydrocele, ascites, (idiopathic or symptomatic of curable lesions,) hydrothorax, and ar- ticular dropsies * and thinks its use may be extended to chronic hy- drocephalus, dropsy of the pericardium, and the greater part of drop- sical effusions;—also to lipomatous, steatomatous, atheromatous and melicerous tumours; to serous and synovial cysts; congestions and indurations,—chiefly those of the lymphatic glands, of the testes and epididymis; indurations of the areolar tissue ; in the vicinity of certain kinds of ulcers; to the parietes of fistulous tracts; certain indolent tumefactions—and he conceives there would be nothing irrational in attacking cancerous affections in the same way,—and lastly to goitre. There can be no doubt, that the function of nutrition may be modi- fied by these excitants, and that, in some of the cases mentioned, a marked sorbefacient agency may be exhibited. SECTION VII. AGENTS WHOSE ACTION IS PROMINENTLY CHEMICAL. The agents, which have thus far been considered, produce their effects altogether by the impression they make on the vital properties of the tissues. It is on this account that the epithet vital has been applied to them. Those, which have to be examined under this division, act chemically upon the substances with Avhich they come in contact; and, in this manner, they may modify the vital properties indirectly. There are some, likewise, that effect chemical changes on parts en- dowed with vitality, and in this way produce as marked an influence on the vital manifestations, as many of the agents to which the epithet vital is attached. The author has before observed, that so long as the tissues, which compose the body, are possessed of vital endowments, they resist the changes that would inevitably occur, were this influence withdraAvn. The animal body is composed of materials, which are extremely prone to decomposition ; but, so long as it is alive, the tendencies to change are controlled by the force of life, so that putrefaction cannot take place. In like manner, a resistance is presented by it to the influence of chemical agents, unless these' agents are in such concentration as to be powerful irritants, or to disorganise the parts with which they are brought in contact. But this resistance is only within certain limits. We have most unquestionable evidence that changes may be effected even in the circulating fluid,—changes which are palpable to the senses; and we must consequently admit, that if modifications can be produced chemically in a fluid, whence every tissue of the body is formed a greater or less change may be occasioned in those agents whose func- CHEMICAL AGENTS. 375 tion it is to form such tissues, and by which the functions of calorifica- tion and secretion are accomplished. Of the changes, produced in the blood by chemical agents, we have marked examples in the different tints occasioned by exposing it to A'-arious gases; as well as in the appearance which that fluid presents after certain solutions have been throAvn into the veins. It has been said, indeed, that any one, who believes in such changes, must consent to be ranked amongst the humoral pathologists,—the beings of a by- gone period; but this reproach, at the present day, has lost all its terrors. Pathologists have discovered, that in flying from humorism to solidism, they have, as in all similar cases, wandered from the paths of true observation; and they have exhibited the triumph of judgment and candour over folly and prejudice, by amalgamating the two doc- trines, where amalgamation was practicable ; and rejecting from each such views as had not borne the test of experience and reflection. The present period may be termed eminently eclectic; for, although exclusives occasionally arise amongst us, they are rare; and have— when we take the world at large—but few followers. Many of those, too, who would blush to be esteemed humorists, still believe in criti- cal discharges, and efforts of nature, although they would, at the same time, spurn the idea, that any substance could get into the blood, Avithout occasioning the most disastrous results. Yet the phenomena of exan- thematous fevers must be, with such individuals, a source of intense difficulty. In any view of the subject, they are sufficiently difficult of comprehension; but, in the one we are canvassing, the difficulties are overwhelming. In smallpox inoculation, a minute portion of variolous matter is inserted under the cuticle,—brought in contact, in other words, Avith the corpus papillare, and with the divided vessels of that body; and we can predict that, in a proper subject, a fever will break out in a certain number of days after inoculation; and that after a definite period an eruption Avill make its appearance, which will go through its regular stages of increment, maturation and declension, leaving the patient, after a time—which, in favourable cases, equally admits of prognostication—well. It is assuredly not easy to conceive how this extensive secretion of morbid poison can take place, without presuming, that the action of the system of nutrition has become modi- fied by the condition of the circulating fluid; and that this fluid has had its condition changed by the reception of the variolous matter into it. Still, although Ave admit this, there is much to be explained,—both as regards exanthematous fevers and those that are unaccompanied by cutaneous affections. Of late years, a much greater degree of attention has been paid to morbid conditions of the blood, and to the effects of therapeutical agents upon it; and noAV, that the horror of the humoral pathology has abated, and indeed almost vanished, fresh investigations are made into its varying condition in disease, and into the best methods for re- storing it to the healthy state. In the case, assumed above, the smallpox taint must evidently have been received into the blood, and by the action of this fluid on the tissues, and on the nerves distributed to them, the exanthematous 376 ANTACIDS. fever resulted. In other cases, the tissues and the nerves connected with them may be first morbidly impressed; and, successively, the condition of the circulating fluid may be modified. Of this we have examples in all the active hyperaBmiae, and in every febrile irritation which is the consequence of derangement in any portion of the inter- mediate system of vessels. In one or other of these modes, all fevers —miasmatic or common—are probably induced. The different classes of chemical remedies are not all as important as certain of the divisions of vital agents, that have been considered. Yet some of them are deeply interesting, although generally but little understood by the student, in consequence of their consideration seem- ing to require a greater amount of chemical knowledge than is actually the case. When iodide of iron or creosote is added to blood out of the body, it coagulates the albumen of the blood, and renders it solid; and when administered therapeutically, it is probable, that effects somewhat analo- gous may be produced on the blood whilst circulating in the vessels, and that, by increasing its tendency to coagulate, these may be efficient agents in scurvy, and in hemorrhages, especially of the passive kind. , Certain chemical agents operate altogether upon the contents of or- gans, in the same manner as if they were placed in contact Avith such contents out of the body; and it is, therefore, but necessary to know the chemical character of those contents to adapt the remedy accord- ingly. This is the case with antacids. Others, again, as disinfectants or antiseptics, are of more complex operation. Escharotics,—defined to be ' agents, which destroy the vitality of the part to which they are applied, and erode or decompose the animal solid,' — are ranked by therapeutists under this division; but as they are often employed to exert their effects upon distant parts of the organism, in the same manner as epispastics in general, the author considered it advisable not to separate the discussion of their opera- tion, as chemical agents, from that of their dynamic or vital. It will, consequently, be unnecessary to recur to them under this division. I. ANTACIDS. Definition of antacids—Great generation of acid in dyspepsia—Acids always in the healthy stomach—Morbid acidity, how induced—Predominance of acidity in children__Antacids only palliatives—Special antacids. These may be defined—" Agents that obviate acidity in the sto- mach or elsewhere, by combining Avith the acid, and neutralizing it." Where acids are present in the stomach, antacids affect them as they would out of the body; but where conditions exist, which are depend- ent upon the formation of acid elsewhere than in the stomach or Avhere the acid has to be acted upon through the medium of the circu- lation—as in the calculous diathesis of one kind, before referred to ANTACIDS. 377 (Vol. i. p. 329,)—the precise modus operandi is not so simple. We should hardly be right perhaps on this account in deducing, that the whole operation of antacids is of a purely chemical character. Al- though their immediate action may be such, they may likeAvise, when taken into the circulation, so modify the action of the organs con- cerned in nutrition as to produce an alteration even in the tissue of organs ; and, along with change of air and other physical and moral influences, be the means of restoration to health, where the gouty or lithic acid diathesis exists. The generation of an unusual quantity of acid in the stomach is one of the most ordinary symptoms of dyspepsia. It is indicated by acid eructations; violent heartburn ; and marked effervescence, when a carbonated alkali is taken;—the acid in the stomach laying hold of the alkaline base, and the carbonic acid being given off in such quan- tity, occasionally, as to sting the nose,—much in the same manner as champagne or any brisk fermented liquor does. In a state of health, two acids are always present in the stomach after food has been received into the organ, or indeed when any sub- stance—not entitled to the name of aliment—is present there. They are the chlorohydric or muriatic, and the acetic ; and the quantity of the latter is considerable. Now, if these acids accumulate from any cause, they may give rise to all those signs, that indicate the existence of an undue quantity of acid in the organ. In such case an antacid can obviously only palliate the symptoms, although it may do this successfully for the time. From an early period of life, the author has been very subject to this painful affection,—so much so, that he has generally carried a carbonated alkali about with him,—and although, after errors in regimen, the suffering has occasionally been to such an extent as to approach vomiting, in no instance has he failed to allay the uneasy sensation by an adequate quantity of the alkali; and it has not usually been necessary to repeat the dose. To effectually remove the complaint, we must inquire narrowly into the causes that may have occasioned the unusual generation of acid, and attack them; the presence of acid, in undue quantity, can only be regarded as the symptom of some morbid condition. Now, we observe heartburn under two very opposite aspects. In one, the lining mem- brane of the stomach is inflamed, and we have a true case of chronic gastro-enteritis: in the other, there is sufficient evidence of the different functions being affected asthenically. In the former state, the organs, whose office it is to secrete the gastric fluid, are inordinately excited, and this excitation has to be allayed by the appropriate employment of depletives and revellents: in the latter, we have to remove the atonic condition of the mucous and muscular coats, which gives occasion to the too long detention of the food in the stomach, and to a tardy action of the gastric secretions and functions upon it. A Avant of attention to the existence of these two pathological condi- tions, which give rise to very similar symptoms and require a patient diagnosis, is the cause of much of that empiricism, which prevails in the treatment of dyspepsia. Under any circumstances, it is often ex- 378 ANTACIDS. tremely difficult of management; but the difficulty is largely augmented by ignorance of those points. At one time, it was—and still is, by many—conceived, that when- ever there is a predominance of acidity in the stomach, it is owing^ to the elements of the food reacting upon each other ;—to the food being detained so long in the organ, that its elements enter into new affinities; and, accordingly, that the acid is the direct product of the aliment em- ployed ; and, as saccharine substances generally produce the effect most markedly, the position has been considered to be confirmed. A slight examination of pathological facts will show the fallacy of this view. Every dyspeptic, liable to heartburn, must have observed,_ that when particular articles of diet have been taken, he has felt uneasiness almost immediately after they have reached the stomach; and when it has been impossible for time to have been afforded for their transition through the vinous and acetous fermentations. This transition is not effected in an instant; yet almost instantaneously, after a weak sac- charine solution has been taken, the dyspeptic experiences cardialgia: and if he has recourse to his carbonated alkali, the presence of an acid is unequivocally demonstrated. The fact of the generation of acid being favoured by particular arti- cles of diet rather than by others has been noticed by every dyspeptic; and has been a puzzling circumstance to them as well as to the medi- cal attendant. As acid is equally evinced, Avhether certain animal matters—as melted or empyreumatic butter—or saccharine substances be taken, it has been an interesting question to determine the precise character of the acid formed;—which, on the idea of its being produced from the reaction of the elements of the food on each other, ought to differ in these different cases. This perplexity is strikingly exhibited in a well told case of dyspepsia, complicated with other affections, by Dr. Paris. The following are the patient's own words—" I find that the perpetual recurrence of my old headaches leaves me nothing for it but to turn them into a subject of amusement. I have been reading some speculations about muriatic acid in the human stomach, and Avould like very much to know what acid is in mine ; and I wish you would put me in the way of testing it, for I can obtain any quantity. If it is a vegetable acid, how does it get into giblet soup, or salt beef, or fresh butter, cum multis aliis f If it is an animal acid, I know of none except the phosphoric, and I have no idea of making a match-box out of my viscera, so I vote at once it is not that: if it is a vegetable acid, how comes it I may eat a dozen ripe peaches, and be none the worse for them; but wo to me if I eat a buttered muffin ! Ergo, I infer that it is not wholly the acetic acid; and if not what else can make sweet tea, or anything like ale, beer, or porter, perfect poison to me ? " As for an animal acid, there is no poison for me like strong broth, or soup; ergo, there must be some villany in that. I was told, the other day, that baked meat Avould disagree with me, and I find this to be the case. Noav, for the muriatic acid, which I strongly suspect to be the one under which I suffer, for the action on my teeth, when I am sick, is too _ sharp for anything less pungent, I find that if I eat salt meat, an acid is immediately formed in my stomach, and yet I can take ANTACIDS. 379 any quantity of salt Avith my meat, Avithout being the worse for it; how can this happen ?" The true explanation of these morbid phenomena would appear to be, that there are certain articles of diet which—when they come in contact with the lining membrane of the stomach of a dyspeptic—ex- cite the organs, Avhose office it is to secrete the gastric acids, so that a larger amount of those acids is formed; and in this way acidity is pro- duced, but not from the reaction of the elements of the food on each other. Under this view of the subject, the acids, met with in the stomach, ought to be the same, whatever may be the character of the food; and this is probably the case;—the chlorohydric acid always, perhaps, predominating, as it does in health; and giving rise to the strongly acid effect occasionally produced on the teeth by eructations, which every dyspeptic must have experienced. This is generally—if not universally the case—in dyspepsia; but there are articles of diet, which, under particular circumstances, may become so suddenly acid, that acidity may be induced by them, Avith- out the supposition of undue secretion of the proper gastric acids. Milk is one of them. This fluid, it is well'known, becomes almost in- stantaneously acid when the air is highly charged Avith electricity ; and there is reason to believe, that something similar may occur in the stomach of children particularly. The predominance of acidity is so great in infancy, that, as elsewhere remarked, most of the diseases of childhood have been ascribed to it: such predominance may be partly OAving to the cause just assigned, and partly to augmented secretion of those acids, which, as has been shoAvn, always exist in the stomach in a state of health. In children, the presence of unusual acid is easily detected :—the smell of the breath; the odour and taste of the regur- gitations ; the smell of the alvine evacuations, and their green colour, sufficiently indicate it. This greenness is owing to an admixture of acid Avith healthy bile, although it has been invoked to demonstrate the existence of disorder in the biliary system. If we take healthy bile and add nitric acid to it out of the body, a green colour is produced by the union. It is obvious, then, that, in this case, we should be egregiously in error, were we to give remedies which are conceived to modify the condition of the biliary organs, and that all our endeavours should be confined to the removal of the condition of the gastric appa- ratus, which occasions the acid predominance. In adults, a certain degree of acidity is perhaps present, when not indicated by the ordinary symptom—heartburn. It may be the cause of that irritability of the stomach characterized by vomiting whenever food is received into the organ, as well as of the headache, and sleep- lessness, which are relieved by full doses of carbonated alkalies. In those cases of gastric irritability, and in the sleeplessness in question— which consists of watching without any apparent bodily indisposition —half a drachm or two scruples of bicarbonate of soda act, at times, with surprising efficacy; the vomiting ceases in the one case; sleep follows in the other; and all the uneasy feelings, in both, speedily vanish. From what has been said, it will be manifest, that antacids can be 380 ANTACIDS. regarded merely as palliatives. When administered to neutralize acid in the stomach, they can act only on that which is in the organ : they cannot prevent the formation of more. To cure the cardialgia radi- cally, the morbid condition, that gives occasion to the undue secretion of the acids, must be obviated. This, we have seen, is sometimes in- flammatory, but, in the majority of cases, the excited condition of the organs, by which the gastric acids are secreted, is accompanied by a state of asthenia of other parts of the-stomach. The muscular coat has its energy impaired; and, by restoring the balance by the appropriate administration of tonics and gentle excitants—singly or combined- accompanied by the adoption of an appropriate regimen, the symptoms are relieved, and, if the plan be properly persisted in, often entirely removed; but no course of treatment, that does not combine an atten- tion to diet and regimen can prove effectual. As the pathological cause of cardialgia is commonly asthenic, it can be understood, why the union of antacids with tonics—as of magnesia or bicarbonate of soda with charcoal, or bitters—is so generally useful in that affection. Amongst the different alkalies and alkaline earths, the therapeutist has ample choice to adapt his remedies to the various complications that may arise. If he desires a simple antacid, to be administered singly, or along with some vegetable bitter, he chooses liquor potassce, liquor calcis, or bicarbonates or carbonates of potassa or soda: but if he wishes, at the same time, to produce some degree of excitation in the mucous coat of the stomach, and through it on the muscular coat, he selects ammonia or its carbonate. The carbonates are the milder pre- parations ; but, occasionally, uneasiness is felt from the extrication of the carbonic acid gas, which is given off as soon as the alkali meets Avith the gastric acids; the gas, at times, instead of passing off through the upper orifice of the stomach, proceeding into the small intestines; and giving rise to colic, and to much intestinal disturbance. No such effect can be produced by the exhibition of the pure alkalies, Avhich may be given in proper dilution. The same thing, of course, applies to the alkaline earths; and for this reason, pure magnesia, or that from Avhich the carbonic acid has been driven off by heat, and lime water, which, when pure, contains no carbonic acid, are to be preferred. As regards these earths, too, the practitioner has a ground of preference, that cannot be lost sight of. The salts formed by the union of the gastric acids with magnesia are laxative; whilst those, formed by the union of lime with the same acids, are of a contrary character. If, therefore, the predominance of acidity be accompanied with constipa- tion, or appear to demand the use of laxatives, the former earth is selected; whilst the latter may be indicated under opposite circum- stances. With respect to the diet and regimen, especially the former, that may be advisable in these cases, much will depend on the individual. Substances, which are easily managed by the digestive powers, and which individual experience has shown not to be ' dyspeptic,' must be taken; and as for other articles, that may not have been made the sub- ject of experiment in the individual case, the author must refer to SOD^E BICARBONAS. 381 another work for details regarding their comparative digestibility. (Human Health, p. 179, Philada. 1844.) Of the proper regimen he has spoken, partly in that work, and partly under the head of ' Revel- lents,' in the present volume. Nothing is so markedly salutary, in these cases, as a thorough change of all the physical and moral circumstances surrounding the individual; and every dyspeptic must have noticed the freedom from his usual ail- ments, which he has experienced during the exercise of body and mind which travelling affords. Of course, the more varied the scenery and the atmospheric conditions, the greater the revulsion produced by tra- velling; but in countries not possessed of all those advantages, mere travelling exercise, with due attention to diet, is perhaps the most beneficial agency that can be invoked by the dyspeptic. This is a subject, however, which belongs more particularly to Special Thera- peutics, and has, therefore, been canvassed elsewhere. (Practice of Medicine, 3d edit. vol. i.'p. 85, Philad. 1848.) Independently of the presence of acidity in the stomach, a condition of the system may exist, which may require the use of antacids; but this matter has been treated under the head of Antilithics. SPECIAL ANTACIDS. 1. SOD.E BICAR'BONAS.—BICAR'BONATE OF SODA. Bicarbonate of soda is prepared by causing a stream of Carbonic acid, obtained from marble by the addition of dilute sulphuric acid, to pass into an appropriate box containing Carbonate of soda, until this is fully saturated. It is a white opaque salt,—the crystals, Avhen perfect, being oblique rectangular prisms. As generally met Avith, however, it is a white crystalline mass, or a whitish powder. Its taste is slightly alkaline. It is wholly soluble in water. It has the same properties as bicarbonate of potassa, but it is more prescribed as an antacid. It is certainly much less disagreeable than either carbonate of potassa or carbonate of soda, and the stomach is likely to suffer less from its protracted use than from that of either of those salts. " It is often resorted to," says Dr. F. Bache, " in calculous cases, characterized by predominant uric acid; and from its higher neutralizing power, on account of the smaller equivalent of soda, it may be considered preferable as an antacid to the corresponding salt of po- tassa." Its dose, as an antacid, is from gr. x. to 3j. It may be taken in water, or in the mineral water of the shops, in which case it resembles Liquor Sod^e Effervescens of the London Pharmacopoeia. TROCHIS'CI SODJ! BICARDONA'TIS.—TROCHES OP BICAR'BONATE OF SODA. (Sodce bicarbon. siv.; Sacchar. pulv. Ibj.; Mucilag. Tragac. q. s. Make into troches, each weighing ten grains.) 382 SPECIAL ANTACIDS. These lozenges can be used in all cases in which the bicarbonate of soda, in moderate doses, is indicated. 2. SOD.E CAR'BONAS.—CAR'BONATE OF SODA. Carbonate of soda is manufactured on a large scale, and, therefore, has been classed amongst the articles of the Materia Medica in the Pharmacopoeia of the United States. It may be procured from Barilla, an impure carbonate of soda obtained by burning plants of the order Chenopodiaceae; from Kelp, obtained by burning plants of the order Algacese; and from the decomposition of sulphate offeoda. Freshly prepared carbonate of soda is in colourless crystals, which slightly effloresce in dry air, and dissolve in twice their weight of water at 60°, and in less than their own weight at 212°. The crystals are generally large, and are oblique rhombic prisms. They have a cooling, alkaline, disagreeable taste. It possesses medical virtues identical Avith those of the carbonates of potassa, and the salt last mentioned; but it is not so often employed as the bicarbonate, which is less disagreeable, whilst it is equally effi- cacious as an antacid. The dose may be from gr. x. to 5ss. SODJ CAR'BONAS EXSICCA'TUS, DRIED CAR'BONATE OF SODA. (Prepared by exposing Carbonate of soda to heat in a clean iron vessel, until it is thoroughly dried; and rubbing it into powder.) The only advantage in this preparation is, that it admits of being made into pills, when it is advisable to combine it Avith tonics. It is about tAvice the strength of the carbonate. 3. POTAS'SiE BICAR'BONAS.—BICAR'BONATE OF POTAS'SA. Bicarbonate of potassa, Sal aeratus, often improperly called Sal ceratus—is made by dissolving Carbonate of potassa in Distilled water, and passing Carbonic acid through the solution until it is fully satu- rated. The liquor is then filtered, and evaporated by a gentle heat, until crystals form. The carbonic acid is obtained from marble by the action of dilute sulphuric acid. Bicarbonate of potassa is in white crystals, which are wholly soluble in water. It has a slightly alkaline taste, is soluble in four times its weight of water at 60°, but insoluble in alcohol. It undergoes no change on exposure to air. This salt may be used as an antacid in the dose of gr. x. to 5j.; but it is by no means as often prescribed as bicarbonate of soda. Bicarbonate of potassa enters into the composition of Liquor Potassce Citratis, Potassce Carbonas Purus, and Potassce Citras, of the Pharmaco- poeia of the United States. 4. POTAS'SiE CAR'BONAS.—CAR'BONATE OF POTAS'SA. Impure carbonate of potassa—mnnM CAR'BONAS MPU'RUS—is knoAvn in commerce under the name Pearlash. It is principally obtained from LIQUOR POTASSCE. 383 the lixiviation of wood ashes. To prepare the carbonate of potassa, pearlash is dissolved in water, and filtered; and the solution is evapo- rated in an iron vessel, until the salt granulates. It is generally kept in this granular state, owing to the difficulty of crystallizing it. It is often called Subcarbonate of potassa and Salt of tartar; although the latter term is more appropriate to Potassce Carbonas Purus. It has a strongly alkaline urinous taste; is very soluble in water, but insoluble in alcohol; and attracts water freely from the air, so as to become liquid, and form Oleum tartari per deliquium. The dose, as an antacid, is from gr. x. to Jss. in sweetened water. It is, hoAvever, more disagreeable than the bicarbonate; and, owing to its more active alkaline character, it is apt to do more injury to the lining membrane of the stomach when used very frequently. It is, therefore, not so often employed as an antacid as the bicarbonates of soda and potassa. Pure Carbonate of Potassa—POTAS'SJl CAR'BONAS PURUS—Salt of tartar, more properly so called—is directed in the Pharmacopoeia of the United States to be made by rubbing Bitartrate of potassa and Nitrate of potassa separately into powder; then mixing and throAving them into a brass vessel heated nearly to redness, that they may ex- perience combustion. From the residue, the pure carbonate is formed in the same manner as the carbonate. In regard to its medical virtues, they are precisely the same as those of the carbonate. Pure carbonate of potassa enters into the preparation of Liquor Potassce Arsenitis. LIQUOR POTAS'SE CARBONA'TIS, SOLU'TION OF CAR'BONATE OF POTAS'SA. (Potass. carbonat. Ibj.; Aquce destillat. f^xij.) This is a simple solution of an ounce of carbonate of potassa in a fluidounce of distilled water; and is hardly worthy of its place as an officinal preparation. The dose is ftlx. to f5j., in water or milk. Carbonate of Potassa enters into the preparation of Extractum Spigelian et Sennce Fluidum, Liquor Potassce, Liquor Potassce Arsenitis, Mistura Ferri Composita, Potassce Acetas, Potassce Bicarbonas, Potassce Tartras, Potassii Bromidum, Potassii Cyanuretum, Potassii Sulphuretum and Spiritus Ammonice Aromaticus, of the Pharmacopoeia of the United States. 5. LIQUOR POTAS'SiE.—SOLU'TION OF POTAS'SA. Solution of potassa or Soap lye—Lixivium saponarium—is prepared by dissolving carbonate of potassa in distilled water; slaking lime with another portion of water; mixing the hot liquors; boiling for a short time; setting aside, and pouring off the supernatant clear liquor, which must be kept in well-stopped bottles of green glass. If not preserved from the contact of air, it becomes converted into a solution of carbon- ate of potassa, OAving to the absorption of carbonic acid: the direc- tion to keep it in green glass bottles is required because of its acting slightly on white flint glass. 384 SPECIAL ANTACIDS. The specific gravity of liquor potassas of the Pharmacopoeia of the United States is 1.056. It is limpid, colourless and devoid of smell; but has an acrid taste. When rubbed betAveen the fingers, it has a soapy feel, owing to its partly dissolving the epidermis. Solution of potassa is used, at times, as an antacid; but OAving to its causticity it is not so often prescribed as the carbonates of soda and potassa, which are equally effective as neutralizers of acid. The dose is from ten to thirty drops, given in infusion of orange-peel, veal broth, or in table beer that is not acid. Like all the alkalies, it is often asso- ciated Avith the vegetable tonics, under the compound view referred to in the general consideration of antacids. (Vol. ii. p. 380.) Solution of potassa is employed in the preparation of Antimonii Sulphuretum Prcecipitatum, Argenti Oxidum, and Oleum jEthereum, of the Pharmacopoeia of the United States. 6. LIQUOR AMMO'NLE.—SOLUTION OF AMMO'NIA. This preparation, whose general properties are described elsewhere, (Vol. i. p. 543,) may be given as an antacid, whenever it is desirable not only to neutralize redundant acid, but likewise to stimulate the stomach to greater energy. Its dose may be from gtt. v. to gtt. xx. in a Avine-glassful of water. 7. AMMO'NLE CAR'BONAS.—CAR'BONATE OF AMMO'NIA. Carbonate of ammonia (Vol. i. p. 545,) is possessed of the same properties as the last preparation. It may be given, in the dose of from five to ten grains, in the form of pill, or in solution. A good vehicle for the pilular form, in cases of atonic dyspepsia, is extract of gentian. 8. MAGNE'SIA. Magnesia, Calcined magnesia, (Vol. i. p. 187,) is an excellent antacid; —the salt, resulting from the union of the gastric acids with it, being laxative. It is, hence, well adapted for cases in which too great a secretion of gastric acids exists along with constipation, or a tendency thereto. It is devoid of irritating properties, and is calculated for most cases in which there is a predominancy of acid. It may be given , in the dose of from gr. x. to gr. xxx. When very frequently used, it is said to have accumulated in the bowels, so as to give rise to ileus ■ but these cases must be exceedingly rare. The best vehicle for its administration is milk. TROCHIS'CI MAGNE'SLE, TROCIIES OF MAGNE'SIA. (Magnesice 3iv • Sacchar rbj.; Mynstic. pulv. 3j.; Mucihg. Tragacanth. q. s.; to be made into troches, each weighing ten grains.) These lozenges are beneficial in acidity of the stomach accompanied by constipation. The same pro- perties belong to r ANTALKALIES. 385 9. MAGNE'SLE CAR'BONAS—CAR'BONATE OF MAGNE'SIA, the dose of Avhich is likewise the same. 10. CRETA.—CHALK. CRETA PR.EPARA'TA, PREPA'RED CHALK, (Vol. ii. p. 155,) is an excellent antacid, especially—as before remarked—where it is desirable that the resulting compound, from the union of the acid with the antacid, should be possessed of an astringent action. The dose, as an antacid, may be from ten to forty grains or more, three or four times a day, in sugared water, or in any vehicle. TROCHIS'CI CRETJE, TROCHES OF CHALK. (Cretce prceparat. giv.; Acacia pulv. Sj.; Myristic. pulv. 3j.; Sacchar. puh'. ovj. To be made into troches each weighing ten grains.) These lozenges may be used wherever chalk is indicated as an antacid. 11. LIQUOR CALCIS.—LIME WATER. Lime-Avater (Vol. ii. p. 156,) is often an efficient antacid, in the same cases as chalk; the compound, formed Avith it and Avith chalk by the gastric acids being identical. It may be taken either alone, or mixed with milk; and, in this form, is serviceable, especially where acidity exists along with diarrhoea or a tendency thereto. Its dose is from flij. to f giv., or more, several times a day. II. ANTAL'KALIES. Definition of antalkalies—Cannot often be needed—Alkaline state of the Habit—Mode of improving defective nutrition—Special antalkalies. This class of medicines is unimportant, inasmuch as circumstances but rarely arise that can be conceived to indicate their use. "Free alkalies," it has been asserted by Dr. A. T. Thomson, " are rarely present in the stomach." It may be questioned, whether they be ever met with in that organ, in health. It is not, indeed, easy to conceive of their presence there, unless we consider, that the gastric solvent varies materially in character, so that at one time it shall be the very antithesis to what it is at another. In the case of fistulous opening into the stomach, to which the author has more than once referred, opportunity was afforded for examining the gastric secretions under various circumstances of sickness and health. In every case, the acid character Avas marked. The chlorohydric and acetic or lactic acids Avere ahvays contained in it in considerable quantity. The idea that free alkalies may exist in the stomach doubtless rests vol. ii.—25 386 ANTALKALIES. mainly on the affirmations of Dumas and others, who have asserted, that the 'gastric juice' was acid or alkaline, according as the dog—the animal experimented on—Avas fed on animal or on vegetable diet. But these experiments were made on dogs; and on the mixed secretions from the lining membrane of the supra-diaphragmatic portion of the alimentary tube, from the salivary glands, and the stomach itself; and, besides, they do not seem to have been performed with care or accu- racy, as the best testimony certainly is in favour of the gastric secretions —in the case of man—being always acid. Should, however, the acid secretion be arrested from any cause, neutral indigestion may super- vene, Avhich may require the use of acids for its removal. In the absence of all secretion of acids, we can understand, that there may be an alkaline condition of the secretions in the stomach, derived from the sahVa. It has been long maintained, that an alkaline state of the Avhole habit may exist, and this is considered to be indicated by " the chemical quality of the urine, accompanied Avith paleness of the countenance, lassi- tude, irregular bowels,—sometimes costive, sometimes too relaxed,— and a tendency to hysteria in females." Mental as Avell as corporeal causes, diseases affecting the spinal cord, whether in the loins, back, or neck, and whether paralysis be present or not, it is said, produce an alkaline state of habit, Avhich is displayed in the urine. But the infer- ences, deducible from the condition of that fluid, are not as clear as they might appear to be. Its character varies from numerous causes, and, even in health, we notice the greatest difference. At times, it may be acid,—at others, alkaline. Except as regards its colour, transparency, and deposits, we cannot say much; and, indeed, great obscurity rests on the causes of these qualities. On this account it is, that uroscopy is not as much attended to at the present day as it was formerly, or as it ought to be. Of late, its microscopic characters in health and disease have been more studied, but we have yet much to learn in regard to it. The condition of the urine differs materially according to the varying condition of the functions of nutrition, and a state of the system may be present, which might, perhaps, be esteemed of an alkaline character, and is capable of being best rectified by the administration of acids. Professor Chaussier, of Paris, in a letter to M. Broussais, .has affirm- ed, that in all states of disease or of prolonged irritation the secretions become alkaline. He observes :—" From a great number of researches and experiments, Avhich I formerly made, it has appeared to me: First. That in general, in a state of health, all the soft'parts and the greater proportion of the fluids of the animal body are more or less acid; or, if it be preferred, have a tendency to redden test papers: Secondly. That others appear to be neither acid nor alkaline : Thirdly and finally: that some (as the semen) are alkaline. But, in a state of disease or prolonged irritation, all contract an alkaline quality, which renders them capable of changing the test papers to a green colour; thus, the perspiratory humour, which in a state of health is always acid, sometimes assumes an alkaline character. The urine Avhich in health immediately reddens litmus paper becomes evidently alkaline, DISINFECTANTS. 387 if the kidneys or bladder are in a state of irritation or inflammation: in some cases it even contracts a strong ammoniacal odour, which is perceptible at some distance. It is the same with all the excretions, which are augmented by any grade of irritation. Thus, in some cases of coryza, the humour, which flows from the nostrils, is so acrid as to occasion the swelling of the upper lip, which is generally regarded as a sign of a scrofulous constitution. It is the same as regards the ex- cretions from the bronchia or lungs, which always, Avhen the irritation or the disease becomes violent, assume an alkaline character, and give a green colour to test papers. The humour, which flows from ulcer- ated cancer or other analogous affections, is also more or less alkaline; it has even appeared to me, that in a healthy subject, having a suppu- rating wound, the pus of which is laudable, this pus will not, or at least will only feebly, redden test papers, but if the suppurating sur- face be wiped several times, or if it be irritated in any other way, it soon furnishes a clear serosity, which then changes the papers to a green colour." It was from views, similar to those of Chaussier, that many of the older pathologists considered those cases of inveterate cachexia, which exhibit so strongly a firmly implanted vice in the nutritive functions of every part of the frame, to be evidences of a predominant alkales- cency, that could only be removed by the administration of acids. These views have almost passed away; but we ought not to lose sight of the pathological fact, that such a vice may be accompanied by an alkaline condition of the urine, in the same manner as one form of the calculous diathesis—also dependent upon faulty nutrition—is indi- cated by deposits of the phosphates from the urine. It is, however, to the removal of the derangement of the function of nutrition, that our attention as pathologists and therapeutists has to be directed. SPECIAL ANTALKALIES. The remedies adapted for the removal of alkalescency are Acids— mineral and vegetable—associated with various tonic and revulsive agencies, described under the head of Antilithics. (See Vol. i. p. 326.) III. DISINFECTANTS. Stnon. Antipestifera, Anliputrescents. Definition of disinfectants—Antiseptics—Modus operandi of disinfectants—Bad effects of odorous fumigations—Of heat, mineral acid vapours and the chlorides as disinfectants — Use of antiseptics—Special disinfectants. The term disinfectants has been restricted by Dr. A. T. Thomson to those agents, that are capable of neutralizing morbific effluvia; but 388 DISINFECTANTS. as he has used it synonymously with antiseptics, the definition is manifestly not sufficiently comprehensive. Under this head will, therefore, be considered, in addition, substances that may be esteemed Antiseptics—or agents that are capable of removing any incipient or fullv formed septic condition of the living body, or of any part of it. To inquire fully into the subject of disinfection, it might be advisa- ble to investigate every form of atmospheric vitiation, whether it con- sist in the presence of some knoAvn noxious gas; of those terrestrial emanations that give rise to intermittent fever; or of the effluvia that appear to proceed from one labouring under a disease presumed to be communicable, and are capable of producing the same disease in one exposed to their influence. The author has entered pretty fully, how- ever, in another work, into the history of physical agents ft at influence human health; and he will, consequently, confine himself chiefly, in this place, to some observations on the mode of disinfecting or purify- ing any confined space from morbific miasmata—terrestrial or animal. (Human Health, p. 61, Philad., 1811.) It is manifest, that every such disinfecting agent must be capable of chemically combining with the effluvia, and depriving them of their morbific properties. In no other way can we conceive that disinfect- ants can act. Although we are entirely unaware of the precise charac- ter of the terlium quid—if it may be so called—which emanates from a body labouring under a contagious disease, and produces a like affec- tion in another body exposed to it, Ave have the best possible evidence, that such an emanation or misasm is disengaged; and should this come in contact with a fit recipient, disease will result. The emana- tion must, therefore, have its very nature destroyed by disinfectants, and the product of the decomposition be rendered altogether harmless. This is not the place to enter into a discussion as to what diseases are unquestionably contagious. Much that is erroneous has doubtless been conceived and Avritten on the subject. It is sufficient to knoAV, that a locality is considered from any cause, to require disinfection, to render it important to inquire into the means for accomplishing this object. There are no agents, which can be employed Avith well founded expectations of success as disinfectants. Many that are used are posi- tively injurious, exerting no destructive effect on the noxious emana- tions, Avhilst they interfere with the purity of the air, and thus favour their pestiferous agency. Of these, burnt sugar may be regarded as one. It is often employed Avith the view of removing other odours; but it can obviously act merely by its odour overpowering them; whilst the amount of adventitious matter in the air of the apartment is augmented by it, Avhere proper ventilation is not adopted; and, where it is, the ventilation is more effective, when these presumed disinfectants are not employed. Even where true disinfectants are used, it is highly necessary, that the air of the sick chamber should be changed by thorough ventilation. Every such agent adds a material to the air of the apartment, that ought not to be suffered to remain, and is, consequently, so far deteriorating; Avhilst many of them are so penetrating as to induce much irritation in the respiratory organs, and DISINFECTANTS. 389 under certain circumstances, their employment may be followed with marked disadvantage. Even Avere they able to disinfect the air, they might occasion mischief from their own irritating qualities. What has been said, regarding the effect of burnt sugar, applies equally to many other substances, that were, and still are, much used as disinfectants,—such as benzoin, camphor, and different aromatic substances. They are not more efficacious, and are equally liable to the disadvantages attendant upon its employment. Heat has long been esteemed a powerful disinfectant; but its reputation has chiefly reposed upon certain notions connected Avith its power of changing the condition of the atmosphere during epidemics. Hence, in times of spreading sickness, it has been advised to light large fires with the view of destroying effluvia supposed to exist in the air. The coinci- dence that occurred between the last visitation of the plague in Lon- don, in 1665, and the great fire in 1666, has been esteemed, by some, to favour this view; but the presumed cause is insufficient to account for the effect. Although the heat might have destroyed the morbific miasms—which in the case in question is doubtful—it could not have prevented the recurrence of the evil. Its subsequent non-appearance seems to have been owing to other causes:—a better system of venti- lation and draining Avas adopted; the streets were widened; common * sewers were established ; and paving was everywhere introduced;— circumstances that are adequate—even without sanitary regulations, which were rigidly enforced, but Avhose agency was more than doubt- ful—to account for the change. But, although heat can scarcely be used with advantage for purify- ing districts suffering under epidemic or contagious maladies, it may perhaps be capable of disinfecting confined spaces, and bodies imbued Avith morbific miasms. In experiments by Dr. Henry, of Manchester, England, he found, that substances, impregnated with the matter of contagion, and exposed to temperatures of from 200° to 201°, for a considerable length of time, were rendered incapable of communicating disease, even when they consisted of clothes that had been worn during the whole period of a contagious malady. He inclosed the substances to be disinfected in air-tight canisters, and exposed them to dry heat for a certain time; and he esteems this process to be su- perior to exposing them to gases, inasmuch as gases may be arrested in their course by compressed materials, whilst no arrangement can prevent the transmission of caloric. The agent he employs is steam, passed between the sides of a tin copper box, and an outer case of the same material. The most delicate goods cannot be injured by the application of the degree of heat disengaged by this means. At one time, mineral acid vapours—mnriatic, nitric, and 'oxymu- riatic'—as it was then termed—were almost solely employed as disin- fectants. For the discovery of the powers of nitric acid vapours, Dr. Carmichael Smythe received the disproportionate reward of ten thou- sand pounds, according to some, (A. T. Thomson,)—five thousand, according to others, (Pereira,)—from the British Parliament;—yet chlorine, in some form, has so completely taken its place, that we rarely hear, at the present clay, of its employment. Acid gases are 390 DISINFECTANTS. liable to the objection, that they are extremely irritating when respired: indeed, in a state of concentration they are irrespirable. They cannot, therefore, be used in the sleeping apartments of the sick, but may be beneficially employed after patients have been withdrawn, and the object is to disinfect the chamber. They ruin polished metallic surfaces; but this can be obviated by painting them with a compost of starch. The inconveniences, attendant upon the use of acid gases, and of chlorine disengaged in the ordinary way, are obviated by using the chlorinated preparations—of lime and soda especially-—for the disco- vering of the disinfecting properties of which we are indebted to M. Labarraque, an ingenious French pharmacien, who, in the year 1824, fully established their title to the reputation of being our best disin- fecting materials. In these preparations, the chlorine is retained by such a feeble affinity, that even the carbonic acid of the air is sufficient to displace it. Chlorine is, in this Avay, gradually given off, and the base unites with the carbonic acid to form a carbonate. All that is necessary to be done, is—to expose the chlorinated lime, or the solu- tion of chlorinated soda, in flat shallow vessels, in the sick room, as occasion \may require. Indeed, aspersions with a solution, not con- taining more than one two-hundredth part of chlorinated lime, have been esteemed adequate to the disinfection of the wards of a large hospital. AYhere bodies, Avhich have remained for some time in the earth, have to be exhumed, the strength of the solution must be increased, and it may be well to dip a cloth in the liquid, and envelop the body in it; moistening the cloth occasionally Avith the solution. There is no ob- ject requiring disinfection for which the chlorinated preparations are not appropriate. Where excrementitious matters have to be retained in the bed chamber, the offensive odpur is neutralized by throwing one of them into the vessel and around the chamber; and the great advantage of this mode of disinfection is, that it may be used in the chambers of the sick without the disengaged chlorine exciting any inconvenience. The chief disinfecting agents employed at the present day are— chlorinated soda, chlorinated potassa, and chlorinated lime ; nitrate of lead, and chloride of zinc. Almost all disinfecting solutions are com- posed of one or other of these salts. All these are antibromics or de- odorizers ; the question is, whether any of them is the destroyer of the material agent that causes spreading disease. They have all been largely extolled as preventives of epidemic and contagious maladies; but the evidences in favour of such prevention ought to be closely sifted, inasmuch as it is easy for an article to attain celebrity as a pre- ventive of a disease, which may attack one in a hundred of a com- munity, provided only thirty or forty take the article, and escape. Hence, the reputation of tincture of camphor, and of various empirical cholera preventives, of the present and former periods. It is well, therefore, to bear in mind the probability, that chemical and other agents may merely act as antibromics, deodorizers or de- stroyers of smells; and that the miasm, which occasions disease, may not be destroyed by them or be rendered innocuous. ANTISEPTICS. 391 Several metallic salts are useful in destroying odours. They react on sulphuretted hydrogen and the hydrosulphurets, forming insoluble, inodorous metallic sulphurets; and they unite with animal matters and check putrefaction. They are, consequently, said to act as disinfect- ants by fixation. Nitrate of lead, and chloride of zinc are examples of these. A solution of a persalt of iron is said to constitute Ellerman's deodorizing fluid. Sulphate of copper and sulphate of iron have also been used. Thus much as regards the disinfection of the air of confined situa- tions, or of substances that have imbibed contagious effluvia. It re- mains to touch briefly on such as are esteemed capable of removing any incipient, or fully formed septic condition in the living body, or in any part of it. Connected with this subject, it is important to bear in mind the re- sults of experiments instituted by Dr. Stark, which show, that Avhen pieces of cloth, of different colours, are exposed to odorous particles emanating from bodies, some absorb a larger amount than others. His experiments exhibit, that black and dark blue absorb twice as much as white; and he infers, with probability, that contagious emanations may be subject to similar laws with odorous emanations; and that, ac- cordingly, in times of contagious maladies, black is the worst colour that could be worn. " Next, therefore," he says, " to keeping the walls of hospitals, prisons, or apartments, occupied by a number of individu- als, of a white colour, I should suggest that the bedsteads, tables, seats, &c, should be painted white, and that the dresses of the nurses and hospital attendants should be of a light colour. A regulation of this kind would possess the double advantage of enabling cleanliness to be enforced, at the same time that it presented the least absorbent surface to the emanations of disease." The humorists of old believed, that the animal body can undergo putrefaction or a septic change, even Avhilst the vital force is still per- vading it; and many of their pathological notions were based upon the belief of such a conversion having taken place in the humours; but, in the sudden change from humorism to solidism, these notions were exploded; and it was considered the height of absurdity to be- lieve such a change possible. The force of life was conceived to coun- teract every septic tendency. Within certain limits, these views are accurate. We can scarcely imagine a condition of the living body in which all its parts shall be putrid. Putrefaction cannot be fully formed unless the principle of life is extinct; but that a putrescent state may be present in the living body is evidenced by numerous facts. The condition of the organism in those fevers that have been called putrid, in the worst cases of scurvy, and where individuals have been exposed for a sufficient length of time to a putrid atmosphere, sufficiently ex- hibits, that a septic change may be effected, between which and putre- faction the same relation may be conceived to exist as between gangrene and sphacelus:—in the former, the part may be considered in a state of suspended animation, admitting of resuscitation ; whilst, in the latter, the principle of life is extinct, and the mischief irretrievable. The 392 DISINFECTANTS. analogy holds good, too, in a therapeutical point of view. _ The reme- dies that are appropriate in a case of gangrene are equally indicated in putrescency of the system; whilst in fully developed putrefaction—as in sphacelus or true mortification or death of a part—no therapeutical agent can be possessed of any efficacy. Of the various signs of death —many of Avhich are so equivocal—putrefaction is the most satisfac- tory; and when the ordinary signs have been Avanting, it has been ad- vised to keep the body above ground, until there could be no doubt, from the evidence of the senses, that its elements were beginning to yield to the play of new affinities. Granting, that such a septic tendency may exist in the organism under particular circumstances, we can conceive, that antiseptics may be needed in two contingencies -.—first, to obviate such septic tendency; and secondly, to correct the offensive character of the tissues or secre- tions that may have become putrid, and thus prevent them from react- ing on the system. For fulfilling the first object, the most opposite plans of management may be requisite in different cases. If Ave in- quire into the causes of the positive death of parts, to which the name mortification has been given, Ave find them to be numerous: they may consist in excessive action of vessels ; in great irregularity of circula- tion, and innervation; in the use of certain agents as food,—ergot of rye, for example, &c. &c.; and, accordingly, as the causes are various, the means to be adopted for their removal must be equally so. Hence, antiphlogistics may, in one case, be antiseptics; Avhilst in another, tonics and stimulants may prove so. It is not, however, to the agents just mentioned that we ordinarily apply the term antiseptics. Its acceptation is usually confined to agents that are employed when signs of putrescency or of decomposition have already manifested themselves; and Avhen the object is both to destroy the offensive character of the tissues or secretions, and to arouse the vital energies, so as to enable the function of nutrition to take fresh activity, and throw off the morbid and morbific degeneration. For this purpose, different vegetable tonics, and especially cinchona with mine- ral acids, are generally exhibited, with the view of inducing a new action in the function of innervation, and, through improved hsematosis, of enriching the vital fluid, so that, Avhen it reaches the capillaries,—under the amelioration, occasioned by these combined changes,—the organs of nutrition may assume fresh activity, and if a portion of the organism has become dead, and consequently extraneous, a separation of the dead from the living portions may be more readily accomplished. It is in this Avay, probably, that most internal antiseptics act; whilst by passing into the mass of blood, and being exhaled through the different emunc- tories, they may, at the same time, correct any septic condition or tend- ency, which the different tissues or fluids may have acquired. There are some antiseptics, hoAvever, whose action cannot be ex- plained in this manner. It can obviously be only the modus operandi of such as enter the blood-vessels—wholly or in part. Charcoal pro- bably exerts its efficacy altogether on the first passages, and through them on the rest of the frame. It is difficult to conceive, that it can act in any manner through the medium of the circulation; 'whilst chlo- SPECIAL DISINFECTANTS. 393 rides, mineral acids, creasote, &c, produce their effect in the compound mode above described. In like manner, when these and other agents are applied externally to gangrenous or gangrenoid parts, their operation is equally complex. They first of all act chemically on the organic matters with which they come in contact; and as a general rule, stimulate the vital energies of the tissues, until these assume a neAV action, and throAV off the morbid condition and degenerations. It is Avith this view, that antiseptics are employed in gangrene, sphacelus, foul ulcers, &c. &c. Some of them would seem to act merely as antibromic disinfectants. Such is pro- bably the case with charcoal. AVhen applied to a gangrenous or spha- celated part, it scarcely, perhaps, retards the progress of putrefaction. It merely destroys the putrid emanations, and thus prevents them from reacting injuriously on the'system. Dr. Pereira has thus summed up the action of various antiseptics. 1. Some abstract water from the organic matter, as sugar. 2. Some act by forming with the organic matters compounds less susceptible of decay,—as sulphuric acid, alum, arsenious acid, bichloride of mercury, chloride of zinc, sulphates of iron and copper, tannic acid and creasote. Alcohol, pyroxylic spirit, common salt, nitrate of potassa, and some other substances seem to act in a twofold capacity; they both abstract water from, and form chemical compounds with, the organic matter. 3. Some act as deoxidizing agents; as sulphurous acid. 4. Some ap- pear to act by their destructive influence on cryptogamic plants and infusory animals,—as arsenious acid and bichloride of mercury, which likewise act chemically, as before mentioned. To these may probably be added the volatile oils. SPECIAL DISINFECTANTS. In considering the different disinfectants, it may be convenient to divide them into two classes :—the first, including those that are em- ployed to disinfect apartments, clothing, &c.; and the second, disinfect- ants of the living body or antiseptics. a. Disinfectants of apartments, clothing, &c. 1. CIILORIN'IUM OR CHLO'RINUM.—CHLORINE. Fumigations of chlorine have long been used for the purpose of de- stroying the matter of contagion, and of preventing the spread of contagious diseases. Towards the close of the last century, they were proposed by M. Guyton de Morveau; and hence have been called Guytonian or Guyton-Mm eau fumigations. The following method Avas employed by Dr. Faraday for disinfect- ing the General Penitentiary at Milbank, Westminster. One part of common salt Avas intimately mixed Avith one part of the black oxide of 394 SPECIAL DISINFECTANTS. manganese; the mixture was placed in a shallow earthen pan; and two parts of oil of vitriol, previously diluted with two parts by measure of water, were poured upon the mixture,—the whole being stirred with a stick. Chlorine continued to be liberated for four days. The quan- tities of ingredients employed were 700 pounds of common salt; the same amount of oxide of manganese, and 1400 pounds of sulphuric acid. Chlorine is supposed to act by abstracting hydrogen from miasmata; but we are not yet sufficiently instructed in the nature of the miasmata themselves to enable us to pronounce positively on this matter. Were they proved to consist of sulphuretted hydrogen, we could readily com- prehend the agency of the chlorine, which speedily decomposes that gas; but we are yet altogether in the dark in regard to the nature of malaria of all kinds; although ready to admit, that an unusual quan- tity of sulphuretted hydrogen may occasionally be found in the air of malarious regions, as we know it is in places which are certainly not malarious. As disengaged in the mode described above, chlorine is extremely irritating when breathed, and cannot, therefore, be used in the sleeping apartments of the sick, although it may be employed after they have been Avithdrawn, and the object is to disinfect the chamber. It cer- tainly has great power as an antibromic. It decomposes sulphuretted hydrogen, ammonia, hydrosulphuret of ammonia, pfyosphuretted hy- drogen, and some other fetid vapours; but, as remarked of chlorinated lime, it has yet to be proved whether it be capable of preventing the extension of spreading diseases. Not many years ago, Professor Daniell, of King's College, London, inferred, that the essence of the febrific miasms of the river Niger, in Africa, was sulphuretted hydro- gen ; and, as this is decomposed by chlorine, he also inferred, that it Avas but necessary for a ship navigating the pestilential waters of that river to be provided Avith an apparatus, that could disengage a suffi- cient quantity of chlorine to continue there with impunity. Ships were accordingly furnished by the British GoArernment with an ex- pensive apparatus for the evolution of the reputed disinfectant; but the fallacy of fact and inference was fatally demonstrated by the results of the subsequent expedition, which suffered more disastrously from the endemic of the country than any previous one. Chlorine was found to possess no disinfecting power over febrific malaria. At the Small Pox Hospital, London, chlorine was employed with the view of arresting the progress of erysipelas in the wards, and therefore in a restricted space, which ought to have favoured its action. The offen- sive smell was as usual removed, but the propagation of the disease appeared to be unaffected; and during the progress of cholera in Europe in 1831 and 1832, extensive trials were made Avith it, which led to the conclusion, on the part, not only of the medical practitioners, but of all who had an opportunity of witnessing them, " that there does not exist between chlorine and the agent that causes cholera any com- bination calculated to neutralize the influence of that deleterious agent." At the time when the cholera hospital at Moscow was filled with clouds of chlorine, the greatest number of attendants was attacked; and simi- ACIDUM MURIATICUM. 395 lar facts were noted by distinguished observers in Berlin and else- where. Aqua Chlorinii, (Vol. ii. p. 348,) is occasionally sprinkled in the sick chamber to purify the atmosphere during the prevalence of con- tagious or other diseases. 2. CALX.—LIME. AND CALX CITLORINA'TA.—CHLO'RINATED LIME. Lime absorbs carbonic acid, sulphuretted hydrogen, and perhaps other noxious matters ; and with this view it is thrown into wells and privies, and is used in the form of lime wash for the walls of buildings. Chlorinated lime, chloride of lime—whose main properties nave been described under Eutrophics, (Vol. ii. p. 349,) has bpen much used for purifying the air of the wards of hospitals, jails and ships,—a little of a solution (Calcis chlorinat. 5j.—5iv.; Aquce Oj.; being sprinkled, from time to time, on the floor; or shallow vessels, containing the chlo- ride, being placed in different parts of the room. It is used, also, for disinfecting clothing, furniture, &c, care being taken that due ventilation is practised. In anatomical investigations, this agency has been most useful, especially where a body has been exhumed after having been a long time buried. Some time before dissection, the body may be enveloped in a cloth wetted with the solu- tion mentioned above, which must be kept wet by sprinkling it from time to time. It is doubted, and even denied, that its use is productive of any advantage in preventing the spread of infectious, contagious or epidemic diseases. It has, indeed, been affirmed to be positively in- jurious, by deteriorating the atmosphere; and in this there may be truth, unless the precautions before mentioned, for due ventilation, be taken. In various cases, in which such diseases have prevailed, it has destroyed all offensive odour, but the extension of the malady has not been prevented. Chlorinated lime has, likewise, been used as an antibromic in privies, and to destroy the unpleasant smell from sewers, drains, and from those occupations in which putrid animal substances are employed. 3. LIQUOR SOD.E CHLORINA'T-E.—SOLU'TION OF CHLO'RINATED SODA. Chloride of Soda, Labarraque's Soda Disinfecting Liquid,—whose gene- ral properties have been described elsewhere, (Vol. ii. p. 349,) has been used as a disinfectant in the same cases as chlorinated lime. It may be diluted Avith water, in the proportion of one fluidounce of the solu- tion to a pint. 4. ACIDUM MURIAT'ICUM.— MURIAT'IC ACID. Gaseous muriatic, chlorohydric or hydrochloric acid is procured, for the purpose of disinfecting, by mixing tAvelve parts of muriatic acid with 396 SPECIAL DISINFECTANTS. fifteen parts of chloride of sodium moistened before the acid is added. In this process, the Avater is decomposed,—its oxygen going to the sodium and forming soda, and the hydrogen uniting with the chlorine, and escaping as muriatic acid gas. The sulphuric acid unites with the soda formed, and remains as sulphate of soda. Muriatic acid gas has a pungent odour, an acid taste, and is very irritating to the respiratory passages when inhaled. It is a colourless, invisible gas; but fumes in the air OAving to its affinity for aqueous vapour. This gas has been much employed as a disinfectant, but its beneficial influence has been doubted; and it is certainly less used than chlorine. When it is desired to disinfect an apartment, portions of the mixture, mentioned above, may be placed in shallow vessels about the room. 5. ACIDUM NI'TRICUM.— NI'TRIC ACID. The vapour of nitric acid, may be employed as a disinfecting agent; but although—as before remarked—(Vol. ii. p. 389,) the first proposer of it, Dr. Carmichael Smythe, received an exorbitant reward, it has now almost wholly given way to chlorine, to which it is supposed, by most persons, to be inferior. A recent writer, hoAvever, Dr. Christison, thinks it probably the best of the disinfecting gases or vapours; " for," he remarks, " it may be disengaged throughout the air of an apartment without the previous removal of the sick ; and as the acid destroys all animal textures and principles with which it comes in contact, its vapour can scarcely fail to destroy equally all invisible animal effluvia." It may be set free by mixing equal parts of nitrate of potassa and sul- phuric acid—placing the mixture in shallow vessels about the room. Half an ounce of nitrate of potassa, and the same quantity of sul- phuric acid, are said to be sufficient to disinfect a cubic space of ten feet. 6. ACIDUM SULPHURO'SUM.— SULPH'UROUS ACID. Sulphurous acid is sometimes used as a disinfectant of chambers and clothes. It is prepared by simply setting fire to sulphur, and intro- ducing the vessel containing it into the room to be purified. It is em- ployed to fumigate clothes that have been used by one affected with itch, and is very effective. 7. ZINCI CHLO'RIDUM.—CHLORIDE OF ZINC. This salt, the general properties of which have been described else- where, (Vol. ii. p. 70,) is possessed of powerful antiseptic virtues. It is the basis of the "Disinfecting fluid of Sir William Burnett,"—a patent preparation for preserving timber, canvas, &c, from dry-rot, mil- dew, &c. The solution consists of twenty-five grains of zinc to the fluidrachm; and in using it, one pint is" mixed Avith five gallons of Avater. It has been largely employed in the anatomical rooms of this country and Europe, but it does not give off any antiseptic vapour: ALUMINA SULPHAS. 397 consequently, its action is restricted to the substances with which it is brought into immediate contact. Its disinfectant and antibromic vir- tues appear to be dependent on its power of decomposing hydrosul- phate of ammonia. 8. PLUMBI NITRAS.—NITRATE OF LEAD. Nitrate of lead—officinal in the United States, Edinburgh, and Dublin Pharmacopoeias—is formed by dissolving litharge in dilute nitric acid; filtering, and setting aside to crystallize. It dissolves in Avater; and the solution is sweet and austere. It is the basis of ' Le- doyen's disinfecting fluid,' Avhich attained so much reputation, some years ago, that the British government directed experiments to be instituted with it for disinfecting the subjects of spreading disease, as well as infected localities. It is a solution of one drachm of nitrate of lead in a fluidounce of water; and it certainly destroys, most effectually, the unpleasant odour of animal and vegetable substances that are evolving sulphuretted hydrogen and hydrosulphate of ammonia; but there is no evidence to show, that it has any power of destroying the emanations that give occasion to disease. In the year 1847, along with Col. Calvert, Mr. Ledoyen visited Canada, for the purpose of testing, under the sanction of the British government, the disinfecting virtues of his fluid on the subjects of typhus or ' ship fever,' and on the locali- ties in which it prevailed. Col. Calvert, in full belief of its disinfect- ing power, fell a victim to the disease; and it was generally, if not universally, admitted there, that, as a destroyer of febrile miasmata, it was useless; although possessed of efficacious properties as a destroyer of offensive odours. Nitrate of Lead has been occasionally applied to excoriated surfaces ; and a solution, in the proportion of ten grains to an ounce of Avater, and coloured probably with alkanet, is said to have been used on the European continent, as a secret remedy in cases of sore nipples, chapped hands, cracked lips, &c. 9. CALOR'IC. Enough has been said on the method of employing heat as a disin- fecting agent in the general remarks at the head of this section, (Vol. ii. p. 389). b. Disinfectants of the Living Body.—Antiseptics. 10. ALU'MIN^l SULPHAS.—SULPHATE OF ALU'MINA. M. Gannal discovered, that the aluminous salts are eminently pos- sessed of the property of preserving animal matters; " their bases combining with geline to form a special compound, the acid being set free." He found the aluminous deliquescent salts to be of all saline substances those that afforded the most satisfactory results. Acetate of alumina and chloride of aluminum succeeded with him perfectly; and a mixture of equal parts of these tAvo salts proved to be an excellent 398 SPECIAL DISINFECTANTS. injection to preserve dead bodies. He gives, however, the preference to simple sulphate of alumina, AA'hich is of ready preparation, and mode- rate price. It maybe made by the direct combination of alumina and sulphuric acid. The salt contains 30 per cent, of the former to 70 of the latter. A kilogramme—about two pounds, eight ounces and a drachm and a half, Troy—dissolved in two quarts of water, was sufficient in winter to preserve a body fresh by injection for three months. To preserve it for a month or six weeks, it was not necessary to inject the blood-vessels,—an enema of one quart, and the same quantity in- jected into the oesophagus, were sufficient for this purpose. In hot weather, the solution must be stronger or in greater quantity, and it may be injected into the carotids. It has been chiefly to prevent putrefaction in the dead body, that the salts of alumina have been employed; but they might, doubtless, be used with great advantage as external applications in all cases that * require the topical employment of antiseptics. At the author's sugges- tion, they were so used in the Philadelphia Hospital, and were found to have an excellent effect in ulcers requiring an antiseptic and de- tergent application. Two drachms of the sulphate to half a pint of water forms a good wash in such cases; but it may be made much stronger than this. After handling pathological specimens, the author has found a saturated solution of the salt remove the offensive odour more speedily and effectually than any other antiseptic. 11. CHLORIN'IUM or CHLO'RINUM.-CHLORINE. The vapour of chlorine has been recommended to be inhaled in cases of gangrene of the lungs, in which it has been found decidedly beneficial, correcting the fcetor of the breath and expectoration, and, therefore, calculated to obviate not only the local but the constitu- tional symptoms. Aqua chlorinii, (Vol. ii. p. 348,) has been given in various diseases as an antiseptic,—for example, in typhus fever; malig- nant anthrax; scarlatina maligna; malignant dysentery; cancrum oris; gangrene of the lungs, &c. &c. Owing to the facility with which it experiences decomposition, it should not be prescribed in larger quan- tity than is necessary for twenty-four hours. The average dose in this time may be f 3j. It has also been used as an ablution to prevent venereal infection; to foetid ulcers to correct the unpleasant odour, and excite a new action in the parts, and as a gargle in putrid sore throat. Baths of chlorine have been advised as an excellent means for pre- venting plague. 12. CALX CHLORINA'TA.—CHLO'RINATED LIME. Chlorinated lime has been given in various affections in which chlo- rine as an antiseptic has been indicated. Both internally and exter- nally, it has been employed in gangrenous ulcers; fcetor oris; gan- grene, and other affections of the lungs, accompanied by offensive breath and expectoration; foetid eructations; malignant dysentery and ACIDUM MURIATICUM. 399 typhus. It may be administered in the form of pill, or dissolved in sugared Avater,—the dose being from gr. j. to gr. vj., several times a day. Externally, it has been employed in various cases;—in foetid atonic ulcers ; ozsena; cancrum oris ; gangrene—both common and hospital; offensive conditions of the mouth, no matter whence arising; putrid sore throat; and wherever an antiseptic has appeared to be demanded. It may be employed as a lotion of varied strength, from 3j. to Iss. to Oss. of water, the solution being decanted to remove the particles of lime from it; unless where it is considered advisable to permit the lime to remain, and be deposited upon the surface to which the solu- tion is applied. In cases of very offensive discharges from the bowels, it may be added to an enema, in the quantity of ten or fifteen grains or more. Dentifrices are likewise made of it, and lozenges. 13. LIQUOR SOD.E CHLORINA'TzE.— SOLU'TION OF CHLO'RINATED SODA. This solution is used as an antiseptic in the same cases as chlori- nated lime, and has been, like it, prescribed both internally and ex- ternally. It is preferred by many for internal administration. The dose may be from ten drops to f 3j. in plain or sugared water. When applied externally, as an antiseptic to ulcers, &c, it may be diluted with from five to ten parts or more of Avater. 14. ACIDUM MURIAT'ICUM.—MURIAT'IC ACID. Liquid Muriatic, Chlorohydric or Hydrochloric acid, is obtained by subjecting a mixture of Chloride of sodium and Sulphuric acid to dis- tillation, and condensing the chlorohydric acid gas in water contained in the receiver. The rationale of the process is the same as that for chlorohydric acid gas, (p. 395). It is, indeed, an aqueous solution of that gas; and, in the Pharmacopoeia of the United States, is directed to be of the specific gravity 1.16. When pure, it is colourless, and is entirely volatilized by heat. When diluted with distilled water, it yields no precipitate with chloride of barium, Avhich throws down a white precipitate if sulphuric acid be present; and it does not dissolve gold leaf even with the aid of heat, as it would do if chlorine were there. It is used in the preparation of Acidum nitro-muriaticum, Barii chloridurn, Calcii chloridum, Carbo animalis puriflcatus, Ferrv.m ammoniatum, Liquor calcii chloridi, Morphice murias, Quinice sulphas, Strychnia, Sulphur prcecipitatum, Tinctura Ferri Chloridi, and Zinci chlo- ridum, of the Pharmacopoeia of the United States. Muriatic acid has been given internally in affections exhibiting a septic tendency, as in cynanche maligna, typhus, and cancrum oris; when it is usually associated with tonics, as cinchona or quassia. As a topical application, it has been used in cancrum oris, ulcerated sore throat, and foul ulcers. In the first case, it is sometimes applied slightly diluted; in the latter, more largely so. The proportion in a gargle may be from f 5ss. to f 3ij- of the acid to f ovj. of Avater. Inter- nally, it may be given in the dose of from "lv. to reixx. properly diluted with Avater. 400 SPECIAL DISINFECTANTS. ACTDDI MURIAT'ICUM DILD'TOI, DILUTED MURIATIC ACID. (Acid, muriat. fgiv.; Aquce destillat. f3xij.) The specific gravity of this acid is 1.046. Sulphuric and Nitric Acids, properly diluted, are used in similar cases. 15. CARBO LIGNL—CHARCOAL. Charcoal—Avhose general properties have been described already, (Vol. ii. p. 53,)—is possessed of strong antiseptic powers, by absorbing putrescent effluvia; and, likewise, exerts a decided tonic influence on the organism: hence it has been prescribed in dyspepsia, accompanied Avith fetid eructations; but has not been given internally to correct a septic tendency elseAvhere than in the alimentary tube, as it is wholly insoluble. It is added to dentifrices, partly on account of its power of correcting fcetor, and partly because it is well adapted, as a gritty powder, for cleansing the teeth. To fetid and putrescent ulcers it is most commonly applied in the form of poultice, mixed Avith crumb of bread and linseed meal. The dose of charcoal is. from twenty grains to a drachm or more, given in syrup and water, or in the mineral Avater of the shops sweetened. 16. CREASO'TUM.—CRE'ASOTE. The name creasote, (*pta$, "flesh," and autw, "preserver,") suffi- ciently indicates the antiseptic powers which it possesses. It is rarely or never given, however, internally, for this purpose; but is sometimes applied to foul indolent ulcers, in which it both stimulates the parts to a better action, and prevents the putrefaction of secreted matters. It may, also, be used as a wash for the mouth in cancrum oris, and putrid sore throat. Its strength may vary from two to six drops to the fluidounce of Avater. A creasote wash is sometimes used for the mouth to correct fetid breath, especially when it arises from detention of the secretions and of extraneous matters in carious teeth. Empyreumatic Acetic or Pyroligneous Acid, (Vol. ii. p. 143) is of unquestioned efficacy as an antiseptic,—the creasote which it con- tains being, doubtless, a main agent. It has been used in gangrene and sphacelus; in sloughing offensive sores; cancrum oris; in all cases of offensive discharges, and where antiseptics are indicated. It may be given internally in the dose of from five to thirty drops, three or four times a day, in water. Externally, it may be applied pure, or diluted. It is also employed, at times, in the way of cataplasm, as an ordinary antiseptic solution. The strength may be f 5ij. of the acid to f 3vj. of water. In cancrum oris, it may be used of double the strength, or even pure. MECHANICAL AGENTS. 401 17. CINCHO'NA, SULPHATE OF QUI'NIA, AND TONICS AND ASTRINGENTS IN GENERAL. The different tonics have been given internally; and—as well as most of the astringents—have been applied externally to foul ulcers, and to gangrenous conditions. A poultice of powdered cinchona is a common application in such cases. The decoction of cinchona Avith acid is frequently used as a gargle to ulcerated sore throat. (Decoct. cinchon. f gwj.; Acid, muriatic. f3ss.) 18. CEREVIS'LE FERMENT'UM.—YEAST. When an infusion of malt or wort is subjected to fermentation, a dirty grayish-broAvn substance gradually separates, forming a frothy scum and sediment, which constitutes Yeast or Barm. This appears to possess chemically many of the properties of gluten. It has been prescribed internally in the dose of f |j. to f oij. in typhus fever, and in scarlatina maligna, as a tonic and antiseptic, either alone or mixed Avith camphor water. It has, also, been given in the way of injection in typhoid tympanitis; but it is not much employed. Of the Yeast Cataplasm, as an application to foul, ill-conditioned ulcers, mention has been made under another head. (See Vol. ii. p. 213.) SECTION VIII. AGENTS WHOSE ACTION IS PROMINENTLY MECHANICAL, Modus operandi of mechanical agents—May affect the vital operations—The least im- portant of our therapeutical resources. Similar general remarks to those that were made under the head of chemical agents are applicable here. Although the classes, com- monly ranked under the head of mechanical agents, may exert many of their properties in a purely mechanical manner, they still affect dynamically the vital properties of the tissues, and often in a decided Avay. In no other way, indeed, can we explain the effect of a demul- cent, when given to allay irritation of the lining membrane of the air passages. The substance can only come in contact Avith that part of the pulmonary or gastro-pulmonary mucous membrane, which invests the top of the larynx. The portion of the membrane, actually affected with inflammatory irritation, cannot be reached by it; yet its effects are unequivocal; a soothing influence is exerted, and the cough, which is often nothing more than a symptom of bronchitic affection, is allayed. Many of the other agencies of demulcents, when used for the removal of internal disease, are equal exemplifications of the modifica- tion impressed upon the vital operations; and, therefore, in strictness vol. ii.—26 402 DEMULCENTS. of language, neither of the classes of remedial agents, usually ranked under this division, ought to be exclusively assigned to it, notwith- standing that some of their operations may be wholly mechanical;—as where a demulcent is used to shield or varnish an inflamed part; or a diluent to render less irritating a morbid secretion or deleterious sub- stance. Mechanical agents are generally esteemed the least important of our therapeutical resources; and perhaps they may be so. There are many morbid conditions, however, which admit of relief from them; and, occasionally, our therapeutical endeavours are restricted to their em- ployment. I. DEMUL'CENTS. Synon. Emollients, Relaxants. Definition of demulcents—Of emollients—Not remedies of any activity—Therapeutical application—Are digested in the stomach—Therapeutical use of emollients—Special demulcents. By most writers on therapeutics, the class of Demulcents has been separated from that of Emollients ;—the former being made, by Dr. Paris, to comprise agents " which are capable of shielding sensible sur- faces from the action of acrid matter, by involving it in a mild and viscid medium;" whilst the latter includes—" substances, whose appli- cation diminishes the force of cohesion in the particles of the solid matter of the human body, and thereby renders them more lax and flexible." Their consideration, however, embraces so many points in common, that it may be well to keep them united; bearing in mind, at the same time, that they are capable of producing the effects com- prised in both the above definitions, and are often employed accord- ingly. Dr. A. T. Thomson uses the word demulcents synonymously Avith emollients and relaxants; and defines them " substances, Avhich diminish the vital tension of tissues and lessen acrimony by lubricat- ing, softening, and rendering more flexible the solid part of the body." Demulcents—as employed for the first of the purposes referred to by Dr. Paris—are not remedies of any activity; but they are agents, that may be employed Avith advantage in various forms of disease to which the French have appropriated the name catarrh;—that is, in in- creased discharges dependent upon inflammatory or other irritation of mucous membranes. Yet, their efficacy must obviously differ some- what, according to^the facility with which they may be made to come in contact with the seat of the increased discharge, or of the inflamma- tory irritation. Accordingly, in gastro-enteritic affections, they are perhaps most beneficially employed; and since the views of Broussais have been before the medical world, demulcents have been more fre- quently used in those affections than formerly. It has been a reproach indeed, against the medical practice of that celebrated systematist, that his remedial efforts were too frequently confined to shielding or var- MODUS OPERANDI. 403 nishing the lining membrane of the stomach, by substances belonging to the class under consideration; but whatever doubt may be had, re- specting the effects of demulcents in such cases, there can be but little, that their use occasionally prevents the practitioner from the adoption of more perturbating means; and therefore that the demulcent medica- tion is often, negatively, of essential utility. Even where the enteritic affection is seated lower down the tube than in the portion which suffers under gastro-enteritis, demulcents may be useful. When it is the mucous membrane of the stomach, the na- ture and action of the demulcent is at first unchanged; but when the seat of the disease is lower, the agent undergoes either stomachal or duodenal digestion, or both; and therefore its modus operandi must be materially modified. In the latter case, the soothing effect is exerted on the membrane lining the supra-diaphragmatic portion of the tube and the stomach; and by continuous sympathy the effect is propagated along the membrane to the portion affected by inflammatory irritation. It is in this mode, that dietetic demulcents may be serviceable in enteritis, even when it is far down the tube—as in the mucous mem- brane of the large intestines in dysentery. They exert an immediately soothing influence on the gastric mucous membrane, and in addition, the excrementitious portion which is sent on through the canal is as devoid of irritating qualities as any faecal matter can be. Hence, the farinaceous decoctions—as of arroAvroot, sago, tapioca, &c.—become not only dietetic, but medicinal agents belonging to the class under consideration; and are therefore placed by pharmacologists amongst demulcents. These are cases, in which the remedial agent is made to come in contact—directly or indirectly—with the diseased part; and it will be readily understood, that the remarks apply to every condition of the gastro-pulmonary mucous membrane, or, indeed, of any mucous mem- brane, where similar circumstances exist; but, not unfrequently, demul- cents are prescribed for affections of mucous membranes with which they cannot be brought into immediate contact, or, perhaps, into con- tact at all, inasmuch as they must previously pass into the blood, and be eliminated by some emunctory, before they can attain the seat of the disease. Such must be the case, where demulcents are administered by the mouth for the cure of diseases of the urinary organs. To produce any effect, they must enter the circulation unchanged. This, it has been seen, cannot be the case ; and, much as it conflicts with vulgar belief, and even with the sentiments of many practitioners, it may be laid down as a fact, that the different mucilaginous drinks—gum water, flaxseed tea, &c, administered in gonorrhceal and other inflammatory irritations of the urinary organs—exert no more remedial agency than so much pure water. They act altogether as diluents. Such is the inference which the author has deduced from repeated examination of the urine, when mucilaginous drinks have been freely taken ; and the same de- ductions have been made from similar observations by Dr. Paris. "In parts," he observes, " beyond the reach of the first passages, and to which no fluid can arrive but through the medium of the secretions, it is very difficult to explain the principle upon which their beneficial 404 DEMULCENTS. operation can depend; and it seems indeed highly probable, that they act in such cases as simple diluents, for the process of digestion must necessarily deprive them of their characteristic viscidity. The adminis- tration of demulcent drinks in gonorrhoea is probably of no further service in assuaging the ardor urince than an equivalent quantity of pure water; although Dr. Murray observes, ' it is sufficiently certain that many substances, which undergo the powers of digestion, are after- wards separated in their entire state from the blood by particular secre- ting organs; and there is,'continues he, 'no gland which has the power more particularly than the kidneys; substances, received into the stomach and digested afterwards, passing off in the urine with all their peculiar properties.' This is undoubtedly true; but mucilaginous sub- stances rarely or never pass off in this manner; if they evade the assimilative functions, they pass through the alimentary canal, and are thus eliminated. I can state, as the result of experiment, that the urine undergoes no change, except in the relative proportion of its water, by the copious and repeated administration of mild mucilages." Dr. Saunders has very justly remarked, that " the long list of ptisans, de- coctions, &c, usually prescribed upon these occasions, generally owe their virtues to the watery diluent itself." Yet it is hard to abandon opinions that have been cherished for ages, and apparently supported by experience ; and hence we occasionally witness attempts made to support the practice by the suggestion that a part of every demulcent may escape digestion, and enter the current of the circulation. "Substances," says Professor Thomson, "that pro- duce a demulcent effect are taken into the stomach, and apparently act upon distant organs. A question arises, suggested by the nature of the substances,—what effects has digestion upon them ? Undoubtedly, a large portion of almost every demulcent taken into the stomach is digested; but some part of them, at least, escapes this process, and is carried into the system." But even if we admit, that a small portion of the demulcent may pass into the system—of which, however, we need evidence—we are amply justified in inferring, that the quantity must be too minute to exert any influence upon distant organs; that, consequently, whatever effect is induced must be through the agency of the water with which the demulcent is combined; and that the demulcent itself acts, in such cases, as a simple nutrient only. Next to affections of the lining membrane of the digestive apparatus, those of the membrane lining the air passages are most frequently treated by demulcents combined with other agents, according to the greater or less urgency of the case. In these affections, it would not seem, that much advantage ought to be expected from such agents, unless the inflammatory irritation be seated so high up the larynx, that the demulcent can come in contact with it; but experience shows,' that here, as in inflammatory irritations of the lower part of the intestinal tube, benefit may be derived through the means of continuous sym- pathy—that is, by soothing the top of the larynx, the salutary in- fluence may extend lower doAvn, and may relieve the cough, although the seat of the pathological affection, which occasions it, may be in the EMOLLIENTS. 405 minute bronchial ramifications. Hence it is, that emulsions, mucilages, syrups, troches, &c., are so commonly prescribed with benefit, in cases of cough. But the action of these substances has already been fully treated of. (See Vol. i. p. 271.) As regards Emollients, or agents whose application diminishes the force of cohesion in the particles of the solid matter of the body, and thereby renders them more lax and flexible, much of their operation must obviously be mechanical. When we rub an emollient substance into a part that is unusually rigid, the substance insinuates itself between the particles of the tissue, which thus becomes softened and relaxed. Yet, even here, some degree of dynamic action may be caused by the remedial agent, and a soothing influence be exerted, which may, in some measure, reduce tension by modifying the func- tions of innervation and circulation of the part. One of the most common cases for the employment of emollients is during a natural process. When the perinaeum, in parturition, is more than usually rigid, and does not yield readily to the pressure of the head of the child, the obstetrical practitioner recommends, that lard should be freely rubbed on the perinaeum, or that the female should sit over the steam of hot water. Often, perhaps, not much effect is exerted by this course ; but, at times, relaxation of the parts, and delivery Avould seem to be expedited by it. In like manner, when severe sprains have been received, recourse is had to the application of warmth and moisture. It is well known, that where swelling speedily succeeds any violent torsion of the joints, the pain is by no means as severe as when the same extent of mechanical injury is inflicted without an equal amount of tumefaction. It would seem, therefore, that if we could facilitate the tumefaction in any manner, we might afford relief. Ac- cordingly, in severe sprains of the ankle, if we advise that the extremity be kept for some time in warm water, we are often gratified to dis- cover, that the agony is rapidly mitigated. It has been properly remarked by Dr. Paris, that although we may be disposed to consider the principal—if not the whole—of the opera- tion of emollients, in the cases alluded to, to be of a mechanical cha- racter, the beneficial effects of cataplasms and fomentations cannot be so explained; "for, in these instances, none of the materials can be absorbed through the entire cuticle; and yet the relaxation and con- sequent ease, which such warm applications produced on inflamed surfaces, is very considerable, but it must be wholly attributed to the relaxing effects of warmth and moisture upon the extreme vessels of the surface, propagated by contiguous sympathy to the deeper seated organs." In previous parts of this work, reference has been made to the effects which caloric of different intensity is capable of producing; and it was then remarked, that its agency is various according to the de- gree •—b.eat5 greater than that of the human body, stimulating; whilst, when lower than that of the body, it is soothing and sedative. Ac- cording, therefore, to the amount of heat will be'the effect produced on the vital functions. In inflammations of deep-seated organs—as of 406 DEMULCENTS. the peritoneal coat of the intestines, a hot fomentation, although it may excite the organic actions of the part with Avhich it is made to come in contact, may act as a revellent; and, in this way, be beneficial like other revellents; whilst a warm fomentation, by virtue of the soothing and relaxing influence of the warmth and moisture, may— through the extensive sympathy that exists between every part of _ the system of nutrition—have its soothing influence extended to portions that are under inflammatory excitement. It may be asked, however, whether, in this case, the inflammation be relieved by contiguous sympathy, or by the general effect, which the relaxant application exerts on the Avhole system of nutrition. It is probable, that the result is produced in both ways. It has been seen, that the sedative influence, occasioned by the abstraction of caloric from a part of the frame,—in cases of that excited condition of organic actions, Avhich constitutes fever,—is as effectually and surely exerted, as when the cooling medium is made to come in contact with the whole cutaneous surface. In internal inflammations, the use of soothing fomentations and cataplasms may have a like agency; but a part of the effect is, doubtless, also produced on the suffering organ, through the sympathy of contiguity, although this may not be so much concerned in the cura- tive operation as has been imagined. In the case assumed—of inflam- mation of the peritoneal coat of the intestines—the tissues, affected by the disease, and by the local application, have nothing in common. The whole of the anatomical elements are as different as if the remedy were placed upon one of the extremities, and yet the effect is often signal: the main result is manifestly one of revulsion,—the new im- pression, made on the organic actions of the part, detracting from the concentration of the vital manifestations elsewhere. Lastly,—in the modus operandi of emollient cataplasms in external inflammation, we have an example of a more complex agency than might, at first sight, appear. Although the warmth and moisture doubtless act mechanically, and diminish the cohesion of the parts, the sanative effect is not owing to this circumstance, but to the soothing in- fluence before referred to. Hence, a warm cataplasm or fomentation is a valuable remedy in many cases of external phlegmasia, even from their very inception. When such inflammation is apt to terminate in suppuration, those applications are universally had recourse to; and as they seem to favour suppuration, they have—by the unprofessional especially—been esteemed improper in ordinary cases of external inflammation, in which suppuration is not threatened, or not to be encouraged. The opinion is, however, erroneous. The effect of the warmth and moisture of the cataplasm is, in both cases, soothing. In the commencement, therefore, of inflammation, it is a useful agent; and, Avhen the organic actions of the part are so over excited as to threaten some of the less favourable terminations of inflammation, it reduces them to that point, which is requisite for the existence of sup- purative action. The vulgar believe, that a cataplasm, in such case, is "drawing," and that it thus expedites the pointing of the abscess. The cataplasm, or the fomentation, acts merely by virtue of its warmth and moisture. Both lessen organic actions, when inordinately exalted- SPECIAL DEMULCENTS. 407 both diminish cohesion in the parts to which they are applied; and by virtue of this relaxant property, if their application be too long con- tinued, they often occasion sloughing of the integuments and extensive scars. This is not unfrequently the case in inflammation of the mam- mae ending in suppuration; and, therefore, it is Avise to be careful as regards their too protracted use;—otherwise, the tone of the blood- vessels may be destroyed; the inconveniences, above depicted, be ex- perienced, and convalescence be tedious and distressing. SPECIAL DEMULCENTS. a. Internal Demulcents. 1. ACA'CIA.—GUM AR'ABIC. Gum Arabic—whose properties as a demulcent expectorant have been described elsewhere, (Vol. i. p. 270,)—is one of the demulcents most commonly employed whenever any of the class are indicated; and since the introduction of the doctrines of Broussais, it _ has been given not only as a nutrient, but as a therapeutical agent in inflamma- tory affections of the stomach and intestines. The common mode of exhibiting it is to dissolve an ounce of the gum in a pint of water, and to allow this gum water to be taken ad libitum. It is well adapted for inflammatory affections of the gastro-intestinal mucous membrane, not only on account of its sheathing the inflamed surface, but of its afford- ing a slight and unirritating excrement. 2. LINUM.— FLAXSEED. Flaxseed tea—INFC'SUI LIM—is much prescribed by _ the profession in all cases in which demulcents are considered to be indicated ; and is greatly used by the laity. It possesses the ordinary virtues of de- mulcents, and may be employed in the manner advised under Demul- cent Expectorants, (Vol. i. p. 281.) 3. SES'AMUM.—BENNE. Benne leaves—whose properties are described under Demulcent Ex- pectorants—are much used, in the southern States especially, to form a mucilaginous infusion, which is a popular remedy in diarrhoea, dysentery, cholera morbus and cholera infantum; as well as in other cases which appear to require the employment of demulcents. It pos- sesses no virtues, hoAvever, not equally possessed by gum arabic, and other mucilaginous demulcents. The mode of preparing the mucilage is given in the first Arolume, (p. 282.) 408 SPECIAL DEMULCENTS. 4. ULMUS.—SLIP'PERY ELM BARK. Slippery elm bark is a demulcent much used in diarrhoea, dysen- tery, cholera morbus and cholera infantum; and in all diseases in which demulcents are considered to be appropriate. It is given in the form of infusion, described elsewhere, (Vol. i. p. 283.) 5. ALTH.E'A.—MARSHMALLOW. Decoction of marshmallow, (Vol. i. p. 273,) is used in the same cases as gum arabic. The formula for Mistura Alth^e^e, of the Edinburgh Pharmacopoeia, is as follows :—Althaea root, dried, liv.; Raisins, freed from the seeds, oij.; Boiling water Ov.; to be boiled down to three pints and strained. It may be taken as a drink, in the dose of a pint or more, in the twenty-four hours. 6. SAS'SAFRAS MEDUL'LA.—SAS'SAFRAS PITH. The pith of Laurus sassafras—as elsewhere remarked, (Vol. i. p. 283,)—contains a large quantity of gummy matter, which is imparted to water, so as to form a mucilaginous solution; and has been used as a demulcent drink in all cases in which those drinks are required. It may be used in the form of INFU'SUM SAS'SAFRAS MEDUL'ML 7. TRAGACAN'THA.—TRAG'ACANTH. Tragacanth, whose properties are fully described elsewhere, (Vol. i. p. 281,) is possessed of demulcent properties; but is very rarely, or never, prescribed as such. 8. GLYCYRRHI'ZA.— LIQ'UORICE ROOT. Liquorice root, whose demulcent properties as an expectorant have been fully described already, (Vol. i. p. 279,) is occasionally employed in diarrhoea and dysentery; and in affections of the urinary organs, which seem to require the use of a demulcent. It is also added to acrid substances, as mezereon, with the view of covering their acri- mony, and of rendering them more palatable. It is not often employed, however, as a demulcent; and is of very restricted efficacy. It may be given in decoction, (Glycyrrhiz. Ij.; Aquce Oj., boiled for a few minutes.) The extract—EXTRAC'TDM GlYCYRRRTZJl—may be used for the same purpose. The different varieties of sugar possess analogous properties, and the same may be said of 9. UVA PASSA.—RAISINS. Raisins or dried grapes are the fruit of Vitis vinifera__the vine grape-vine; Nat. Fam. Sarmentaceas, of Decandolle,—Vitacese, of Lind- HORDEUM. 409 ley; Sex. Syst. Pentandria Monogynia. They are chiefly prepared in Spain; and in the Levant; whence they have been called Valentias and Smyrnas; and also in Affghan- istan, whence they are taken to In- Fig- 169- dia. The Malaga raisins are es- teemed the best of those that are imported into this country. The larger dried grapes go by the name of raisins; the smaller—obtained chiefly from the Ionian Islands— are termed currants, an abbrevia- tion of Corinthians. They have been often called respectively in the phar- macopoeias, Passulce majores and Passulce minores. All contain a con- siderable portion of grape sugar— glucose—which differs from cane sugar in being less soluble in water or alcohol, and less sweet. It is con- sidered by the chemist to be identi- cal with that produced by the action of sulphuric acid on starch. Raisins are rarely or never given alone. They are possessed of de- Vitis vmifera. mulcent properties; and are added to preparations having those characters,—as the Mistura Althcece, the Decoctum Hordei compositum, &c, of British pharmacopoeias. They also enter into the composition of Tinctura cardamomi composita, and Tinctura Rhei et Sennce, of the Pharmacopoeia of the United States. 10. CETRA'RIA.—ICELAND MOSS. So much has been said of the general and demulcent properties of Iceland moss, (Vol. i. p. 284,) that it is unnecessary to do more in this place than remark, that it has been employed as a demulcent and nutrient in diarrhoea and dysentery, as well as in affections of the air passages. The same remarks apply, also, to 11. CHONDRUS.—IRISH MOSS, which is used in similar cases, (Vol. i. p. 285,) and to 12. FUCUS AMYLA'CEUS.— CEYLON MOSS. (See Vol. i. p. 286.) 13. HOR'DEUM.— BARLEY. Barley—in the Pharmacopoeia of the United States—means the de- corticated seeds of Hordeum distichon, Common or long-eared barley; 410 SPECIAL DEMULCENTS. Sex. Syst. Triandria Digynia; Nat. Ord. G-ramineae ; which is a na- tive of Tartary, but is cultivated in different parts of the world. Fig. 170. When deprived of its integuments by a particular process, it consti- tutes Pearl barley—Hordeum perlatum: and when this is ground to powder it forms patent barley. Ground barley is barley meal. Pearl barley is officinal in the Pharmacopoeia of the United States, as well as in the pharmacopoeias of Great Britain. Ripe barley-corns, according to Einhof, consist of 18.75 per cent, of husk; 70.05 of meal, and 11.20 of water. The husks are said to be slightly acrid and laxative: when deprived of these, barley forms a nutritious aliment, and one that is easy of di- gestion. In the form of barley vjater, which is made by boiling it in water, it is much used as a demulcent drink in febrile and inflamma- tory diseases; especially in various inflammatory conditions of the mucous membrane of the air tubes and alimentary canal. The Phar- macopoeia of the United States contains a form for DECOC'TM HOR'DEI, DECOCTION OF BARLEY. (Hordei %i].; Aquce Oivss. The extraneous matters that adhere to barley are directed to be first Avashed away with cold water ; half a pint of the water is then poured upon it, and boiled for a short time. Having thrown away this water, the remainder is poured, boiling hot, on the barley; and the liquid is boiled down to two pints and strained.) The barley is washed with cold water, and boiled for a short time, to remove any extraneous sub- stance or flavour which it may possess. It may be used ad libitum as a nutritive and demulcent drink. The London and Dublin Pharmacopoeias have a Decoctum hordei compositum,—termed "compound," OAving to the addition of figs, liquorice-root and raisins,—Avhich is employed in the same cases as the simple decoction. maranta. 411 14. MARAN'TA.—AR'ROWROOT. Arrowroot is the fecula of Maranta arundinacea, West India arrow- root; Sex. Syst. Monandria Monogynia; Nat. Ord. Marantacese; a plant, which is a native of South America and the West Indies, where it is largely cultivated in gardens and provision grounds. The tubers or roots are beaten into a pulp, stirred with cold water, removing the fibres with the hand; the milky juice is passed through a fine sieve, and the starch is allowed to subside in the strained fluid. The fecula is then washed, and dried Avithout heat. This is Arrowroot. It is imported from the West Indies, and the northern and western parts of South America, in tin cases, and in barrels and boxes. Ber- muda arrowroot is considered to be the best. The quantity, according to Mr. M'Culloch, entered in England for home consumption, on an ave- rage of three years ending with 1831, amounted to 441,556 pounds per annum. It is snow-white, faintly glistening, and devoid of odour and taste; is in powder, or in small pulverulent masses, which, Avhen pressed between the fingers, cause a slight crackling noise. When examined by the microscope, it is found to consist of minute particles, Avhich are generally elliptical, or irregularly shaped, having small mammillary processes occasionally projecting from some portion of the surface. Many are only l-2000th part of an inch in their longest diameter; others are twice as long; and a few attain 1-750th of an inch; but none are larger. The breadth is generally two-thirds of their length. M. Raspail describes their form as that of a half, a fourth, or a third of a solid sphere, which by no means corresponds with the true form of the granule of West Indian arrowroot. Dr. Carson, of Philadelphia, is of opinion that Raspail examined Florida arrowroot, the granules of which are of the shape he mentions. Dr. Pereira states, on the autho- rity of Payen, that Raspail has depicted the grains of the fecula of Convolvulus Batatas, Sweet Potato, for arrowroot. West India arroAvroot is said to be often counterfeited by the substi- tution of the East India variety, or of the potato-starch, or of the starch of Canna edulis, introduced not long ago into commerce under the name of Tous-les-mois. The readiest mode of detecting these frauds, according to Dr. Christison, is by means of a good microscope. The globules of potato-starch are very unequal in size, for the most part elliptical, many of them 1-500th or l-400th of an inch in length ; and some even as large as l-300th. The globules of tous-les-mois are generally elliptical; many of them l-300th of an inch in length, and some even as much as 1-200th. On account of the greater size of the globules of these tAvo varieties, they present to the naked eye a much more glistening appearance than arrowroot; and this character is said to be sufficient to distinguish them in the hand of an experienced person. It is apt to acquire the odour of the ship, Avhich, together Avith damp- ness, gives it occasionally a rnust}^ taste and smell, that render it unsale- able. These objectionable qualities can be removed by washing in cold water, and drying it. 412 special demulcents. Fig. 171. ArroAvroot presents all the chemical characters of wheaten starch, than which it is considered by Dr. Prout to be a lower variety of starch. It makes, how- ever, a much firmer jelly with the same quan- tity of boiling water,—nine parts of arrow- root being equivalent, in this respect, to fourteen of wheaten starch. As an aliment, it is considered to be less nutritive than Avheaten starch, but more pa- latable and digestible. No sufficient com- parisons have, however, been made between them. Boiled in water or milk, it is a very common, and favourite aliment in febrile and inflammatory affections; in chronic diseases, and in convalescence from the acute. Lemon- juice, or wine or spirit, according to circum- stances, is added to the watery decoction. In all cases in which demulcents are indicated, it is especially appropriate as an article of diet. Opinions differ in regard to the action of arrowroot and milk on the digestive function: whilst some believe its tendency is to constipate, others ascribe to it an opposite action. Its effects in this respect are not marked. ArroAvroot enters into the composition of Trochisci Ipecacuanhas of the Pharmacopoeia of the United states. Tacca pinnatifida. Fig. 172. Different forms of fecula have received the name of arrowroot. Portland arrowroot or Port- land sago is obtained from Arum maculatum; Brazilian arrowroot is the fecula of Jatropha manihot; and Tahiti arrowroot or Tahiti or Otaheite salep is the fecula of Tacca pinnatifida'. Particles of Tahiti Ar- rowroot. (Pereira.) 15. EAST INDIAN ARROWROOT is the fecula of the tubers of Curcuma angustifolia, Narrow-leaved turmeric; Sex. Syst. Monandria Monogynia; Nat. Ord. Zingiberacese; a plant, which is indigenous in the East Indies. It is commonly white, sometimes pale yelloAV ; less crepitating between the fingers than the best West India arrowroot; more frequently mixed with impurities, and composed of larger granules, which are unequal in size, egg-shaped, compressed, often with a very short neck or nipple-like projection. Its composition is not ascertained. It does not make so firm a jelly with boiling water as the West India variety. Dr. Christison states that a sample, sent to him from Liverpool, and represented to have been obtained from the West India plant cultivated in Bengal, exactly resembled Bermuda arrow* root, and presented the very same appearance Fig. 173. Particles of AVbite India Arrowroot. reira.) East (Pe- under the microscope. MARANTA. 413 The commercial value of East India arrowroot is far below that of the West India. Fig. 174. u Q_ P^ ? 5 / 9 ICE 0 a o y rr ^ H Q \ ~A T~ Particles of Arrowroot, Potato-starch and Tous-les-mois as seen through the microscope on a micrometer, whose squares measure one-thousandth of an inch.—(Christison.) 1. Globules of West India and East India Arrowroot. 2. Those of Potato-starch, prepared in Dr. Christison's laboratory. 3. Those of Tous-les-mois from St. Kitts. Fig. 175. 16. Florida arrowroot has generally been referred to Maranta arundinacea, the plant that affords Bermuda arrowroot; but Dr. Carson has shown that this is an error, and that it is de- rived from Zamia integrifolia, or Z. pumila ; Nat. Ord. Cycadaceae, which appear to be only found in Florida. The tubers also contain large quan- tities of a feculent substance, and are used as an article of food by the Seminole Indians. They are prepared by roasting ; and were eaten by the white inhabitants, and the army of Florida, as a substitute for potatoes. The fecula is obtained from the tubers in the same manner as arroAvroot from the tubers of maranta arundinacea. Coarse specimens of the farina of the saw palmetto—chamcerops serru- lata, were presented to the author some years ago. It was evidently impure, and this may account for its inducing bowel complaints in the Indians who use it as a diet. Of the rude mode in which they pre- pare it, the author has given an account in the American Medical In- telligencer for August 1, 1838, on the authority of General Persifor F. Smith in a letter to C. Roberts, Esq., of Philadelphia. Florida arrowroot, as well as the farina, is known in the Southern Particles of West India Arrowroot. (Pereira.) 414 SPECIAL DEMULCENTS. Fig. 176. Particles of Tous-les-mois. (Pereira.) States by the name coonti or coontie. When compared with Bermuda arrowroot, it has a more mealy ap- pearance and feel; and is of a duller white colour, with less of the crys- talline lustrous hue. If carefully prepared, however, it is pure white; but is apt to be lumpy, like the fe- cula obtained from tapioca root. (Car- son.) Its main characters under the microscope have been already de- scribed. 17. Tous-les-mois. Under this name a fecula has been introduced into commerce, which is obtained from Canna edulis, but, according to the Edinburgh Pharmacopoeia, it is the fecula of the root of an imperfectly determined species of canna. It is exported from St. Kitts, and is prepared from the root of the plant. It is distinguished under the microscope by the large size of its gra- nules, and by the other characters mentioned under arrowroot. Tous-les-mois has a slightly satiny appearance, and is devoid of the dead Avhite or opaque character presented by certain amylaceous substances. According to Dr. Fig. 177. Pereira, it approaches most near- ly to potato-starch; but its parti- cles are larger. It makes a stiffer jelly than arrowroot; for which it may be substituted in all cases. 18. English arrowroot, Com- mon arrowroot, French sago, Potato- starch, is the fecula obtained from the tubers of solanum tuberosum, common potato. It is prepared much in the same manner as other varieties of fecula. The appearance of its granules under the microscope has been referred to under arrowroot. When care- fully prepared, it is equally agree- able with, and probably as nutri- tious as Bermuda arroAvroot. It is often, indeed, substituted for it; and, Avhen boiled in milk or water, the difference is not easily distin- guishable. Particles of Potato-starch seen by the mi- croscope. (Pereira.) a. Normal Starch particle. (Fritzsche.) 6. Irregul ar ditto. c. d. Particles each having two hila. e. /. g. Particles broken by pressure and water ; the internal matter remains solid. (Payen.) 19. TAPIO'CA. Tapioca is the fecula of the root of Jatropha manihot or Janipha manihot; Sex. Syst. Monoecia Monadelphia; Nat. Ord. Euphorbiaceae • which is indigenous in Brazil. It is the Cassava plant of the West SAGO. 415 Indies. The tuberous root is rasped and pressed, to separate the milky poisonous juice, which deposits a fecula; this, when washed and dried in the air, is exported, and is pro- bably the Brazilian arrowroot of commerce. Fig. 178. When the fecula is dried on hot plates, it acquires a granular character, and is then termed Tapioca. The compressed pulp is dried in the chimney, exposed to smoke, and afterwards powdered, when it forms Cassava powder or flour ; and when baked in cakes, Cassava or Cassada bread. Tapioca is met with in the shops either in lumps or granules, or in powder; and is imported from Bahia and Rio de Janeiro. It is an excellent nutrient and demulcent, Janipha Manihot. and is adapted for the same cases as arrow- root. It makes a firmer jelly Avith boiling water than most feculaceous substances, and requires longer boiling. A factitious tapioca is met Avith in the shops, which is in very small, smooth, spherical grains, and is supposed to be prepared from potato- starch. It is sold under the name oi pearl tapioca. (Wood and Bache.) Fig. 179. 20. SAGO. Particles of Tapioca as seen by the microscope. (Pereira.) Fig. 180. Sago is the prepared fecula of the pith of Sagus Rumphii, — Malay or Rumphius's sago palm; Sex. Syst. Monoecia Polyan- dria; Nat. Ord. Palmae; which is in- digenous in Malacca, and the islands eastward of the Bay of Bengal. It is also obtained from Sagus kevis, Un- armed sago palm; and Saguerus Rum- phii, Rumphius's wine sago palm. The farina is procured from the pith in the same manner as the feculse already considered. When first obtained by subsidence in cold water, it is called raw sago meal. The finest portions of this are mixed with water, so as to form a paste, which is rubbed into small grains. Three kinds of sago are met with in the shops,—sago meal, common sago, and pearl sago. Sago meal is in the form of a fine amylaceous pow- Sagus Rumphii. a. The tree. b. The shrub. c. Fruit-bearing spadix. d. Ripe fruit. 416 SPECIAL DEMULCENTS. Fig. 181. der, of a whitish colour, with a buffy or reddish tint, and has a feeble peculiar odour. Common or broAvn sago is in grains of about the size of pearl barley; but Dr. Pereira states that he has seen some as large as green peas. It is of a whitish or brownish- AA'hite colour. Pearl sago is in small hard grains, of about the size of a pin's head, which are of a pale Particles of Sago meal. yelloAvish-white, reddish-white, or grayish-white co- (Pereira.) lour, or are translucent. It is sometimes bleached with chlorinated lime. When the different varieties are examined by the microscope, they appear to consist of oval or more or less ovate particles, many of which are more or less broken in sago meal; in common sago, they are someAvhat Fig. 182. more broken and less regular in their shape; and .in pearl sago they are ruptured,—peculiarities ^Sll^^iP which are considered to be produced by the pro- cess of granulation. (Pereira.) Sago possesses the ordinary properties of starch, and is used as a demulcent and nutrient in the same cases as arrowroot and the other feculaceous sub- stances already considered. A table-spoonful gives the proper consistence to a pint of milk or water. Particles of potato sago. (Pereira.) Several species of Cycadaceae, which are allied to the Palmae, con- tain in the cellular structure Avithin Fis-183- their stem, an abundance of starch, which may be separated in the same manner as sago. These species are Cycas circinalis, C. revoluta, and C. inermis. They furnish Japan sago, which, perhaps, never reaches Great Britain or this country. (PeYeira.) Cycas revoluta or the Japan Sago tree. 21. Salep is not admitted into the pharmacopoeias of Great Britain or into that of the United States. It is the prepared roots of several orchi- deae, and is sometimes sold in pow- der. The salep of Cachmere is pro- duced from a species of Eulophia; that of Europe from native plants—Orchis mascula, 0. latifolia, &c. It is possessed of similar properties Avith tapioca. Certain powders—termed Castillon Powders, from the name of the physician Avho first employed them—have been prescribed in this coun- try, in cases of diarrhoea and dysentery; and, as demulcents, have been productive of advantage. They are formed of sago, in powder; salep, 99931 AVENJ3 FARINA. 417 in powder; tragacanth, in powder, of each, four parts ; prepared oyster shells, one part; cochineal, half a part;—divided into powders of one drachm each ; one of which is given three or four times a day. The prepared oj^ster shells adapt them for certain forms of diarrhoea, (see "Vol. ii. p. 156,) and the cochineal is a mere colouring agent. One of these powders, mixed with a little milk or water, and added to a pint of boiling milk or water, forms an article of diet as well as of medicine in these cases; but it need scarcely be said that there is no special vir- tue in the combination. Fig. 184. 22. AVE'NiE FARFNA.—OATMEAL. Oatmeal is the meal prepared from the seed of Avena sa.tiva, common oat; Sex. Syst. Triandria Digynia; Nat. Ord. Gramineae, the native country of AA'hich is unknown; but it appears to grow wild in several places throughout Europe, and is cultivated there and in this country. Deprived of their covering, oats are termed groats; and, Avhen crushed, Embden groats. According to the analysis of Dr. Christison, oatmeal consists of 72.8 per cent, of starch; 5.8 of saccharo- mucilaginous extract of a feebly sweet- ish taste; 3.2 of albumen; 0.3 of oleo- resinous matter ; 11.3 of lignin, in the form of coarse bran; and Q.Q of mois- ture. Scotch oatmeal, consequently, appears to contain nearly five-sixths of nutriment; and the proportion must be greater when the seeds are careful- ly freed from the husk and integu- ments before being ground. As a bland farinaceous nutriment, oatmeal is often made into gruel, and taken in cases of sickness—especially in fevers and inflammatory affection^. It is generally termed water gruel, and may be made by boiling three ounces of oatmeal or groats in three pints of water doAvn to a pint and a half; and straining. It is a favourite domestic article of diet in sickness. In Scotland and the north of England, oatmeal is stirred into boiling water, until it has the proper consistence on cooling; when it bears the name of porridge, and is eaten with milk as an article of diet. When the husks, removed from the oats before they are ground, are infused in hot water, and allowed to become sourish, a mucilaginous liquid is obtained by expression, which, when concentrated, forms a firm jelly called sowins, also used as an article of diet. Gruel is a common drink after cathartics, to assist their operation, and it is an excipient for emollient and cathartic enemata. vol. ii.—27 Avena. a. The white oat. b. Siberian or Tartarian oat. 418 special demulcents. In the United States, especially in the southern and western portions, an excellent gruel is made from the farina of Zea mays, Indian or corn meal. 23. AM'YLUM.—STARCH. Starch is the fecula of the seeds of Triticum vulgare, common wheat ; Sex. Syst. Triandria Digynia; Nat. Ord. Gramineae; Avhich is said Fiff. 185. Triticum.—Wheat. a. T. vulgare, *• festivum. 6. T. vulgare. @. hybernum. c. T. turgidum (compositum). d. T. turgidum. e. T. polonicum. /. T. Spelta. g. T. monococcum. Fig. 186. to be a native of the country of the Baschkirs, but is cultivated in Eu- rope and this country. It is contained, also, in various plants, but is especially abundant in the seeds of the cerealia, of which it forms between sixty and seventy- five per cent. ArroAvroot, sago, tapioca, tous- les-mois, potato-starch, &c, are varieties of it. It is never prepared by the apothecajy. When pure, wheaten starch is of a white colour; devoid of odour, and almost of taste. It is not soluble in alcohol, ether, or in cold water; but with boiling water forms the De- coctum Amyli or Mucilago Amyli of the British pharmacopoeias, which is made by boil- ing 4 or 6 drachms of starch in a pint of water for a short time, and is chiefly used as an enema, and an excipient for opium administered in that manner. It is rarely or never given in- ternally. Starch powder or hair powder is occasionally dusted on parts to ab- sorb acrid secretions, and prevent excoriation. Particles of Wheat Starch. a. A particle seen edgeways. (Pereira.) CERA ALBA. 419 24. AMYG'DALA.— ALMONDS. Almonds, when formed into an emulsion—MISTU'RA AMYG'DALA of the Pharmacopoeia of the United States, (Vol. i. 274,) is used in all cases in which demulcents are indicated; but most frequently as a de- mulcent expectorant. It is often prescribed in diseases of the urinary organs, with the vieAV of diminishing the acrimony of the urine, in which, however, it is probably devoid of all efficacy. An emulsion is sometimes made of OLEUM AMYGDALA, (Vol. i. p. 274,) which is employed in the same cases. It may also be prescribed in the dose of a tea spoonful, mixed or not, with syrup; and the same may be said of OLEUM OLIVJ], (Vol. i. p. 275). 25. CETA'CEUM.—SPERMACET'I. Spermaceti, (Vol. i. p. 276,) possesses the properties of the fixed oils; and, besides its employment as a demulcent expectorant, it has been occasionally prescribed in diarrhoea and dysentery; but it has fallen into disuse, and is now never given except in the preparation of oint- ments. When used internally, it is in the form of emulsion, as de- scribed in the part of this work above referred to. 26. SEVUM.—SUET. Sevum of the Pharmacopoeia of the United States is the prepared suet of Ovis aries, the sheep. It is obtained from the neighbourhood of the kidney, and is prepared by melting it over a slow fire, and strain- ing through linen or flannel to separate the solid portions. It resembles lard in its properties, but is firmer, and requires a higher temperature to melt it. It has been used in domestic practice, boiled Avith milk, in diarrhoea and dysentery; but is almost wholly employed in pharmacy, to give a greater degree of consistence than lard to ointments and plasters. 27. CERA FLAVA.—YELLOW WAX; AND 28. CERA ALBA.—WHITE WAX. Wax was at one time supposed to be a secretion from plants, which was simply transferred to the body of Apis Melliflca, the bee; but it has since been proved to be formed by the insect itself. A vegetable Avax is, however, occasionally secreted by plants. The wax of the bee is intended to construct the comb. It is obtained for medical use, by alloAving the honey to drip from the comb; or by subjecting the latter to pressure; melting it in water, so that the impurities may subside; and alloAving the wax to cool in moulds. This constitutes Cera Flava, Yellow Wax, which has a grayish-yellow colour; a 420 SPECIAL DEMULCENTS. peculiar and rather agreeable odour; scarcely any taste; considerable firmness and tenacity, but no greasiness to the touch. It is apt, hoAV- ever, to be adulterated by suet, which gives it a fatty feel and a disa- greeable taste. Adulteration with resin is recognised by its solubility in cold alcohol; and with bean meal or pea meal, starch or any other amylaceous matters, by its insolubility in oil of turpentine. The druggists of this city, (Philadelphia,) are supplied chiefly from the Western States and North Carolina,—especially the latter,—and from Cuba. Some of an inferior quality is imported from Africa, (Wood and Bache.) Cera Alba, White Wax, is prepared by exposing yellow wax, in thin layers or ribands, to air, sunshine and moisture, and thus bleach- ing it; by which process it loses also, in a great measure, its odour. As met with in the shops, it is of a white or yellowish-white colour;— the whitest varieties having spermaceti mixed Avith them, which is added by the dealers to improve its colour. It is generally in circular cakes; solid; brittle; devoid of smell, or nearly so; and tasteless. Dr. Christison describes two commercial varieties—one called Ger- man wax, and imported into Great Britain from Hamburg. It is rather yellower, somewhat more translucent, harder, and less easily fusible than the English wax, or that which is prepared in Britain. The Ger- man variety is said to be the more esteemed of the two, especially by dentists and others for moulding, on account of its superior hardness. The greater softness of the English wax appears to be owing to the addition of spermaceti and fatty matters to increase its whiteness. (Christison.) Wax is insoluble in water, cold alcohol and ether; but dissolves in about twenty parts of ether at the boiling temperature. It is readily soluble in the fixed and volatile oils; and combines, by fusion, Avith fats and resins, so as to form several most valuable topical applica- tions. It is now almost wholly used for the formation of cerates, ointments and plasters, Avith the view of giving them tenacity and consistence; but it has been prescribed as a demulcent in diarrhoea and dysentery. It may be melted Avith olive or almond oil, and when in the melted state may be rubbed up with yolk of egg or mucilage, so as to form an emulsion; but it is scarcely, ever given at the present day. Myrtle Wax.—A vegetable Avax is obtained from Myrica cerifera, a plant belonging to Nat. Ord. Myriceae, which is found in almost all parts of the United States. The fruit is coated with wax, which is separated by boiling the berries in water, and skimming off and strain- ing the melted wax that floats on the surface;—or, it is allowed to concrete as _ the fluid cools, and is removed in the solid state. To purify it, it is remelted and strained, and cast into large cakes. It is collected in New Jersey, but more copiously in the New Eng- ADEPS. 421 land States, especially in Rhode Island, from Avhich it is sent to other parts of the country. Myrtle wax is of a pale grayish-green colour, and is more brittle and unctuous to the feel than beeswax; it has a feeble odour and bitterish taste; and, in its chemical relations, bears a close resemblance to bees- wax. This variety of wax has been prescribed in dysentery ; a tea-spoon- ful of the powder being mixed with mucilage or syrup, and given re- peatedly through the day. b. External Demulcents.—Emollients. 29. ADEPS.—LARD. Lard, in the Pharmacopoeia of the United States, is the prepared fat of Sus scrofa, the hog, free from saline matter. The fat of the omen- tum, mesentery and loins is generally selected for medical use. To separate it from the membranes in Avhich it is contained, or—to render it, as it is sometimes termed—it is melted over a slow fire; strained through linen or flannel, and is often poured, Avhilst liquid, into a bladder, Avhere it solidifies on cooling. Salt is sometimes added to preserve it; but this has to be separated from it to adapt it for medi- cal use. It may be freed from the salt, by melting it in boiling water. The sensible properties of lard are so well known as not to require description. It ought to have little taste or smell. It is insoluble in Avater; sparingly soluble in alcohol, but more so in ether and the vola- tile oils. When melted, it dissolves wax and resin ; and is, therefore, much used in the formation of ointments. It is composed of three neutral fatty principles, stearin, margarin, and olein ; the first of which is the concrete principle. Recently, lard oil has been made from it. Its chief use is pharmaceutical—as a constituent of cerates and ointments. It is sometimes, however, employed as an emollient—for example, rubbed on the perinaeum in cases of parturition, with the view of relaxing it; or over the affected muscles when they are rigid, as in cases of contractura. In eleemosynary institutions, it is often used as a substitute for simple or spermaceti ointment to dress blisters; but owing to its containing salt, and being rancid, it is said to have occasioned irritation and ulceration. It is added, at times, to laxative and emollient enemata, under the same circumstances as fixed vege- table oils; and, like the different pomatums, is used by the accoucheur to smear the finger, on making his examinations per vaginam, and by the surgeon for the same purpose in examining the rectum, as well as to smear his instruments. CERA'TUM SIMPLEX, SIMPLE CERATE, (Adipis Iviij.; Cerce albce giv.) This is a common emollient dressing to blisters and ulcers, Avhere it is desirable to preserve them moist and free from the contact of air, and of extraneous bodies floating in it. UNGUEN'TUM SIMPLEX, SIMPLE OINTMENT. (Cerce albce 3bj.; Adipis fibiv.) Employed in the same cases as the last. 422 SPECIAL DEMULCENTS. 30. O'LEUM AMYG'DALiE.— OIL OF ALMONDS. The general properties of almond oil have been given elsewhere, (Vol. i. p. 274,) as well as those of Olive Oil, (Vol. i. p. 275,) which are analogous. It is a frequent addition to enemata—emollient and laxative; and a common constituent of plasters, cerates, ointments and liniments. It is sometimes rubbed on the skin with the vieAV of relax- ing parts; and is applied to inflamed surfaces, to sheathe them from the irritating influence of the air, and extraneous bodies. It has been recommended to smear it over the body as a protection against plague; but it is not probable that it is of any efficacy; as there is little reason for believing that the morbific impression is made through the skin. v In surgery and obstetrics, it is used, like lard, to smear fingers or instruments that have to be introduced into outlets. UNGUEN'TUM A0.LE R0SJ1, OINTMENT OF ROSEWATER. (Aquce rosce, 01 amygdal. aa f |ij.; Cetacei %ss.) Cerce albce 3j.) This ointment is sold as cold cream, and is much used as a lip salve, and as an application to chapped and excoriated surfaces. 31. CETA'CEUM.— spermaceti. Spermaceti, (Vol. i. p. 276,) like fixed oils, is an ingredient of ce- rates and ointments, which are employed as emollients. CERA'TUM CETA'CEI, SPERMACETI CERATE. (Cetaceily Cerce albce l\\y 01. oliv. f Ivj.) This cerate is a common and mild emollient dressing for blisters, and for simple sores. 32. LINUM.—FLAXSEED. Linseed or flaxseed meal, formed either from the ground seed of Linum usitatissimum, or from the oil cake, which remains after the expression of linseed oil, ground to powder, (Vol. i. p. 281,) is much employed as an emollient poultice. It requires but to be mixed Avith boiling water until it has the proper consistence. The meal, obtained from oil cake, is preferred by many to the ground seeds, on account of the latter being more apt to become rancid. Others, however, assign a preference to the former. OLEUM LINI, FLAXSEED OIL, is the oil of the seed expressed sometimes Avith heat; at others without,—or cold drawn; at others, again, the seeds are roasted before being subjected to pressure, with the view of destroying the gummy matter contained in their exterior coating. (Wood and Bache.) Where heat is applied, the oil is less bland; but it would appear to become sooner rancid than oil expressed at a steam heat of about 200 degrees. From eighteen to twenty pounds of oil, according to Mr. Brande, are obtained by cold expression from one hundred weight of the bruised seed. As usually met with in the shops, it is of a yellowish-broAvn colour, but it may be rendered quite TRITICI FARINA. 423 colourless; it has a peculiar smell and taste; is soluble in 40 parts of cold alcohol, in 5 of boiling alcohol, and in about 1\ of ether. Exposed to the air, it thickens, and gradually dries into a varnish, which gives occasion to many useful applications in the arts. The drying property is much increased, either by boiling it alone, or with litharge, or sugar of lead, or common white vitriol; when it is called drying oil or boiled oil, and is much used by painters. It readily becomes rancid. Linseed oil possesses no virtues as an emollient over olive oil and almond oil; nor is it often substituted for them, except in burns, in Avhich it has acquired an accidental reputation, either applied alone or in conjunction with lime-water, as in Linimentum Calcis of the Phar- macopoeia of the United States. (Vol. ii. p. 157). This liniment acts by keeping the parts in a soft state, through the emollient properties of the soap, which the liniment really is; and chiefly, perhaps, by de- fending the burnt surfaces from the desiccative and irritating influence of the air,—the liniment filling up the areolae of the rag on which it is applied, and completely protecting the inflamed parts, in the same manner as if so much raw cotton had been placed over them. 33. SES'AMUM.— BENNE. The leaves of benne are sometimes used in the formation of emol- lient cataplasms. O'LEUM SES'AMI, Benne oil— obtained by ex- pression from the seeds—(Vol. i. p. 282,) possesses the general properties of olive oil, and may be used as an emollient in the same cases. It does not readily turn rancid. 34. TRIT'ICI FARI'NA.—WHEAT FLOUR. Bread—made of wheaten flour, (Vol. ii. p. 418,)—boiled in milk, forms the common bread and milk poultice; to this a little lard or oil is generally added to prevent its adhering to the surface to which it is applied. It is much used to promote suppuration, and as an emollient application to irritable ulcers. Bread is also employed alone, at times, as a vehicle for other applications ; for example, moistened Avith lead water, and placed within gauze as an application in ophthal- mia and other local inflammations. A decoction or infusion of bran is some- times used as an emollient pediluvium; and internally as a demulcent in catarrhal affections especially. Fis. 187. Zea May a. Male flowers. b, b, b, b. Female flowers. (The styles which project beyond the en- veloping sheaths form a kind of tassel, popularly called the silks.) 424 SPECIAL DEMULCENTS. In many parts of the United States, a common emollient cataplasm is made of Indian meal—the farina of Zea Mays—boiled with water (mush,) or milk. 35. AVE'N.E FARI'NA.—OATMEAL. Oatmeal (Vol. ii.p. 417,) is frequently used as a poultice, in countries where it is more eaten as food than it is in the United States. ^ It forms, when boiled with Avater, a good emollient poultice; and, with linseed oil cake, the Pulvis pro cataplasmate of the Dublin Pharmaco- poeia. 36. ULMUS.—SLIP'PERY ELM BARK. This bark (Vol. i. p. 283,) is sometimes employed as an emollient application in external inflammation;—the powder being made into a poultice with hot water; or the bark itself is applied, after having been previously softened by boiling. 37. Sas'safras Medul'la, Sassafras Pith. (See Vol. i. p. 283.) 38. Cydonium, Quince ' Seed. (See Vol. i. p. 283.) 39. O'LEUM BU'BULUM.— NEATS' FOOT OIL. Neats' foot oil is officinal in the Pharmacopoeia of the United States only. It is prepared from the bones of Bos domesticus, the ox; by boiling the feet of the animal, deprived of the hoof, for a long time in water; skimming the fat and oil from the surface, and putting them into Avater heated to the boiling point. " The impurities having sub- sided, the oil is drawn off, and, if required to be very pure, is again introduced into water, which is kept for twenty-four hours sufficiently Avarm to enable the fat which is mixed Avith the oil to separate from it. The liquid being then allowed to cool, the fat concretes, and the oil is removed, and strained or filtered through layers of small fragments of charcoal free from powder." (Wood and Bache.) This oil congeals with difficulty; and has been introduced into the Pharmacopoeia of the United States as an ingredient in Unguentum hydrargyri nitratis. 40. GLYCERFNA.—GLYCERIN. Glycerin, hydrated oxide of glyceryl, sweet principle of oils, forms the base to the stearic, margaric, and oleic acids of fat oils and tallow, and is separated when these acids are made to combine with an alkali or any metallic oxide in the saponification of the oils. It is obtained by heating together olive or other suitable oil, oxide of lead, and Avater, as in the manufacture of common lead plaster : the oil is decomposed and its oily acids unite with the oxide of lead to form the plaster, and the glycerin, previously united with the oily acids to form the 'oil is DILUENTS. 425 set free, and glycerin remains in the aqueous fluid. A formula for its preparation has been introduced into the last edition of the Phar- macopoeia of the United States (1851), based on these conditions. It consists in mixing recently prepared and yet fluid lead plaster with boiling water, stirring briskly for fifteen minutes, allowing the mix- ture to cool, and pouring off the supernatant liquid, which contains the glycerin. This is evaporated until it attains the specific gravity 1.15, Avhen a current of sulpho-hydric acid is slowly passed through it, until a black precipitate—sulphuret of lead—is no longer produced. The liquid is filtered to separate the sulphuret; and boiled to free it from sulphuretted hydrogen, and to expel the water, which is known to be removed when it ceases to lose Aveight. In a pure state, it forms a nearly colourless and very viscid liquid, of the specific gravity 1.25 (Pharmacopoeia of the United States); has an intensely sweet taste, and mixes with water and alcohol in all pro- portions ; but is insoluble in either. Glycerin has been introduced, as a remedy for the cure of certain cutaneous diseases. It resists evaporation when exposed to an elevated temperature. Mr. Startin, indeed, who first recommended it, affirms, that a common plate, wetted with it, may be kept in an oven, side by side with a joint of meat, until the meat is cooked, without any sensi- ble diminution occurring in the quantity of the liquid. Hence, when applied 'to the skin, it remains moist, forming a coating or varnish, which is not distinguishable from the ordinary secretion of the part. A lotion, composed of half an ounce to ten fluidounces of water, effectually prevents the skin from becoming dry; when employed in its pure state, it makes the part stiff and uncomfortable; and conse- quently answers best when diluted. It is also added with advantage to poultices, and even to baths. Mr. Startin speaks of its use chiefly in psoriasis, pityriasis, lepra, and ichthyosis; in all Avhich diseases he describes it as producing excellent palliative effects. In a case of porrigo, it proved very valuable in the hands of the author, after the ordinary topical applications had failed, and he has used it with good results in psoriasis and other cutaneous affections, in Avhich there was erethism of the skin. It is probable, that glycerin might be used with much advantage in burns, and erysipelas,—whenever, indeed, it is desirable to prevent the desiccative influence of the air from irritating an exposed surface. II. DILUENTS. Necessity for drinks—Therapeutical use—Their absorption prevented by certain circum- stances—Employment in dropsies, diseases of urinary organs, &c. A slight observance of the habits and instincts of man sufficiently shows, that drinks or liquids are more imperiously demanded by him than solids. This is owing to the constant drain of fluid from the sys- tem by the various secretions—the pulmonary and cutaneous transpira- 426 DILUENTS. tions, urine, &c.—and of the large proportion Avhich the fluids compos- ing the animal body bear to the solids. The necessity for the ingestion of fluids is indicated by thirst,—an internal sensation, in its essence resembling hunger, although not re- ferred to precisely the same organs. The desire, however, can be much modified by habit; for whilst some individuals require several gallons a day to satisfy their wants; others, who, by resistance, have acquired the habit of using very little liquid, enjoy good health; and do not experience the slightest inconvenience from its privation. This privation, it is obvious, cannot be absolute, or pushed beyond a certain extent. There must always be fluid enough taken to administer to the necessities of the system. That the sensation of thirst is often greatly dependent upon the quantity of fluid circulating in the vessels is shown by the fact, men- tioned by M. Dupuytren, that he succeeded in allaying the thirst of animals, by injecting milk, whey, water, and other fluids into the veins; and M. Orfila states, that, in his toxicological experiments, he frequently quenched, in this way, the excessive thirst of animals to which he had administered poison; and which were incapable of SAval- lowing liquids, owing to the oesophagus having been tied. He found, also, that the blood of animals was more and more deprived of its watery portions, as abstinence from liquids was more prolonged. Generally, however, the desire for liquid is, within certain limits, an artificial appetite ; and, like the desire for solid food, is greatly regu- lated by the habits of the individual. So powerful, indeed, is the force of custom, that if a person were to habituate himself to take a glass of water every day at a certain hour, the desire would recur daily with all the force of a primitive instinct. Often, too, thirst is present in conditions of the system, where we have no reason to presume that there is a want of fluid, and where it is produced by morbid influences of a totally different character. It becomes, under such circumstances, a symptom of disease, and is one of the most prominent evidences of every kind of febrile and inflammatory indisposition ; although, like each of the most marked symptoms of such indisposition, it may be occasionally wanting. The value of drinks, in such cases, is not de- pendent upon their action as diluents; and, consequently, in this point of view, they do not belong, in strictness, to this division of therapeu- tical agents. The thirst is owing to the excitement of the organic actions in the mucous membrane of the digestive tube; and the good effects of the fluid taken are dependent upon its possessing a tempera- ture calculated to allay such excitement. Hence it is, that cold drinks are greedily sought after, and that warm do not furnish the same marked relief. In this way, cold Avater or any cold drink acts as a refrigerant, and its modus operandi has accordingly been considered under another head. Water—the chief constituent of all drinks—is an essential com- ponent of every circulating fluid; and modern experiments have shown, that it penetrates most, if not all, animal tissues better than any other liquid; and, consequently, passes through them readily, to accumulate in any of its own solutions,—as the blood; but whenever there is a DILUENTS. 427 high degree of exaltation of organic actions, or of hyperaemia in the mucous membrane of the alimentary canal, absorption is by no means readily effected ; even the physical phenomenon of imbibition appears to be materially retarded. Hence—as previously shown—it is difficult to bring the system under the influence of mercury, in adynamic con- ditions, m which there is hyperaemia of the lining membrane of the intestines. The same remark has been made regarding the function of intestinal absorption in malignant cholera. Although attempts have been frequently made to affect the system with mercury; and, by administering saline solutions, to produce some change in the condi- tion of the circulating fluid, it is doubtful, whether, during the violence of the disease, any absorption has been effected ; and, in many cases, the agents would seem to have remained in the intestinal canal until the disease had become somewhat mitigated; after which, absorption was resumed, and their effects then became apparent. In other—and the generality of—instances they have passed through the bowels un- changed. A medical gentleman informed the author, that a practi- tioner was speaking to him, during the prevalence of cholera in 1832, of the very great extent to which he had given calomel in that dis- ease. " Well," said the gentleman, " and what became of this enor- mous quantity of the mercurial?" "Why, it passed through the bowels like so much corn-meal!" Now, it is not easy to see what could have been the salutary agency expected from large doses of a substance, which was visible in the evacuations in such quantity. The fact, however, demonstrates the truth of the remark just made,—that absorption is, in these cases, almost null; and that calomel, like other agents, may produce no effect upon the system, until some degree of recuperative energy has been aAvakened. If, however, the passage of diluents into the blood-vessels be retarded by hyperaemia or a powerfully excited condition of the mucous mem- brane, it is largely facilitated by any circumstances that give occasion to a diminution in the quantity of the circulating fluid. On this, so much has been said under the head of Eutrophics, that it is not neces- sary to dwell upon it here. It may be remarked, however, that the deficiency of the serous portions of the blood in most cases of malig- nant cholera, and the consequent inspissation of the remainder, has suggested the injection of saline solutions into the blood-vessels; but the remedy has not answered the purpose. It diluted the blood, but did not remove the more important mischief,—the cause that gave occasion to the profuse separation of the fluid. The introduction of large quantities of diluents into the blood, either by absorption or injection, diminishes the density of the liquor san- guinis, and promotes the action of the great depuratory organs ;—the kidneys, and the cutaneous and pulmonary surfaces. The diminution of the specific gravity of the liquor sanguinis gives occasion to disten- tion and enlargement of the blood corpuscles, OAving to the endosmose of the fluid into their interior. It has been a question of some importance, whether diluents ought to be freely allowed in cases of dropsy. Without repeating what Avas 428 DILUENTS. before said on the pathology of that affection, it may be remarked, that it would seem proper not to allow fluid too freely, unless as a vehicle for diuretics. Where increased exhalation occurs into any cavity, a corresponding diminution must take place in the mass of the circulat- ing fluid; and if tenuous drinks be freely permitted, the amount may be speedily made up, and the dropsical accumulation favoured. It is consequently, better to allow the patient for common drink a solution of bitartrate of potassa, which, when flavoured Avith lemon-peel, and sweetened, proves a grateful diuretic drink; and yet, as it is medi- cated, there is not so much danger of its being taken to an injurious extent. Great difference—irrational difference—of sentiment has existed in regard to the proper quantity of drink or diluents most favourable to digestion. In strictness, this is a question of hygiene; but it interests the dyspeptic therapeutically also. Where the salivary and other se- cretions are too sparing to communicate to solid food the due digestive texture, liquids, in proper quantity, favour the gastric operations; but, if they be taken freely during a meal, the texture is rendered too soft; and the gastric secretions are so much diluted, that digestion is more difficult. Hence it appears, that an error in quantity, at either ex- tremity of the scale, should be avoided. In many places, it is the cus- tom to hand round lemonade, wine, toddy, punch, &c, before dinner; but the dyspeptic should carefully eschew them. With many, they cause acidity; and before the individual sits down to his repast, the stomach is in a very unfit state for the reception of the various articles received into it at a fashionable dinner party. Where acrid or poisonous substances have been swallowed, dilution is generally indicated; but discrimination is here required. Some substances act more violently Avhen in a state of solution, and hence dry vomiting is advisable to get rid of them; or, if diluents be per- mitted, they must be removed again as speedily as possible by the stomach-pump, or by one of the direct emetics; but, where the poison is a simple acrid, no doubt can exist regarding the propriety of dilu- tion, and we generally have recourse to agents belonging to the class last considered,—demulcents—which not only dilute the deleterious article, but shield the parts from its injurious contact. In diseases of the urinary organs—especially such as are of an in- flammatory nature—diluents are largely employed. The author has before remarked, that in such cases demulcents act as mere diluents ; but their use is universal. By weakening the saline compound, which constitutes the urine, diluents prevent the irritation that would other- Avise be produced in the inflamed parts, during the passage of that fluid ; and hence they are much used in ardor urince, which term—as stated before—is appropriated to a symptom,—the disease consisting in an inflammatory state of the lining membrane of the urethra, on which the urine, although in a healthy condition, acts as an irritant. INSPISSANTS. 429 III. INSPIS'SANTS. Inspissants are antagonists to diluents—Indirect inspissants—Use of a dry diet in coryza, and where it is necessary to diminish the amount of blood—Doubts whether there are any direct inspissants. The action of these agents is antagonistic to that of diluents. What- ever deprives the blood of the normal ratio of its aqueous constituent must increase its density. Accordingly, restriction to dry diet, or a diminution in the usual amount of drinks, must have this effect. An increase in the density of the liquor sanguinis gives occasion to exosmose of the watery contents of the blood corpuscles, which be- come diminished in size, and may be more or less shrivelled. The importance of abstaining from the free use of drinks in cases of hemorrhage, and whenever it is deemed necessary to diminish the amount of the circulating fluid has been elsewhere adverted to. Hence, when blood-letting is practised in febrile * and inflammatory cases ; or when powerful cathartics, or other evacuants, are given as depletives, thirst should be allayed by ice, or ice water, in small quantities, rather than by the free ingestion of liquids, which, under such circumstances Avould readily pass through the parietes of the blood-vessels in conse- quence of the quantity of blood in them having been diminished. Whenever, too, inordinate secretion of fluids takes place, as in dropsy; or excessive secretion as in diabetes, restriction from drinks is properly advised; and in coryza a total abstinence from liquids has been recom- mended by Dr. C. J. B. Williams as a most efficient method of treat- ment. " To those," he remarks, " who have the resolution to bear the feeling of thirst for thirty-six or forty-eight hours, we can promise a pretty certain and complete riddance of their colds; and, what is per- haps more important, a prevention of those coughs which commonly succeed to them. Nor is the suffering from thirst nearly so great as might be expected. This method of cure operates by diminishing the mass of fluid in the body to such a degree that it will no longer supply the diseased secretion. Anything that may contribute to reduce the quantity of fluid in the body will assist in the plan of cure, and shorten the time necessary for it to take effect. It is therefore expe- dient to begin the treatment with an aperient followed by a diapho- retic, as is usual; and this is the more necessary when any fever attends; but beyond this no further care need be taken, and the indi- vidual can devote himself to his usual employments Avith much greater impunity than under the ordinary treatment. The coryza begins to be dried up about twelve hours after leaving off liquids; from that time the flowing to the eyes and fulness in the head become less and less troublesome; the secretion becomes gelatinous, and between the thirtieth and the thirty-sixth hour ceases altogether. The whole period of abstinence needs scarcely ever exceed forty-eight hours." A dry diet has also been advised in hypertrophy and valvular disease of the heart when it is considered advisable to reduce the amount of the circulating fluid, and in aneurism of the great vessels to promote the coagulation and deposition of the fibrin of the blood 430 DEOBSTRUENTS, ETC. within the aneurismal sac, by increasing the specific gravity of the liquor sanguinis. This indication is, however, founded on theoretical considerations ; and its correctness is not easily, subjected to a positive test. It is obvious that in all these cases the inspissation of the blood is an indirect result; and it may admit of a question whether such agent as a direct inspissant exists. Creasote and other articles that coagu- late the albuminous portions of the blood out of the vessels have been advised in cases of hemorrhage, Avith the view of preventing the ready transudation of the blood through the parietes of the vessels; but it is doubted, whether they exert much influence on the circulating fluid, and, accordingly, not much reliance is placed on them. SECTION IX. OF DEOBSTRUENTS, ANTIDOTES, AND ANTIPARASITICS. Deobstruents—Are indirect agents. Alteratives—Their modus operandi—Only used in chronic diseases. Antidotes—Definition of—Are of two kinds—Division of poisonous agents—Therapeutics of poisoning, internal and external—Table of poisons and their antidotes—Antiparasitics. I. DEOBSTRUENTS. Synon. Dcphractica, Deoppilantia, Deoppilativa. When the humoral pathology was universally in vogue, the deob- struent medication prevailed everywhere. It was believed, that, OAving to altered consistence of the blood and humours, the small vessels might become obstructed; and that certain agents, by modifying the spissitude of the circulating fluid, might remove such obstruction, and be entitled to the appellation of Deobstruents. It is clear, however, that all such remedies must be relative agents only. Obstructions in the ca- pillary system of vessels must depend upon so many causes, that no exclusive plan of medication can be appropriate; and, accordingly, at the present day, the term ' deobstruent' is almost banished from medi- cal language; and, when we meet with it, it is too often employed without any precise ideas being attached to it. Formerly, it corresponded to the term ' aperient' in its general—-not in its restricted—acceptation. Now, it is more commonly used conven- tionally,—to express the agent, whatever may be its nature, which renders parts pervious that may have been obstructed. To exhibit the indefinite manner in which it is employed by those who yet retain it, it is sufficient to refer to recent and valuable works on the materia medica, in which we are told that sulphate of potassa " is deobstruent and cathartic," and carbonate of soda " antacid and deobstruent." From what we know of the effect of alkalies in augmenting the tenuity of the blood, we might understand,—if that fluid were too viscid and ANTIDOTES. 431 obstructions were caused by such Adscidity,—that a deobstruent effect might be exerted by carbonate of soda; but even if we admit the possibi- lity of such stasis of the fluid of the circulation in the capillary system of vessels, we have no means of detecting it; and we could not, conse- quently, pronounce Avhen the remedy is indicated. It is well knoAvn, however, that obstructions are generally—if not always—induced by a morbid action of the cells of nutrition, which gives occasion to new depositions—to morbid formations, in other words—over which the agents in question can have but little control. But if we admit the deobstruent agency of carbonate of soda, it is not so easy for us to understand how sulphate of soda can accomplish a similar result; or why this salt should be considered entitled to the merit of being a deobstruent more than any other of the class of saline agents; and it would not be an easy matter, for those who ascribe such action to sulphate of potassa, to explain distinctly what they themselves mean by the term deobstruent as contradistinguished from cathartic. The German writers, and some of the British, have a division of resolvents (auflosendeMittel,)or liquefacients (verfliis- sigende Mittel,) which seem to have, in some respects, the signi- fication of deobstruents. " We understand," say the Messrs. Schroff, " by resolvents (auflbsende Mittel,) those therapeutical agents, that act upon the plastic life of the human organism in such a manner, that they either moderate excessive formative impulse, (Bildungs- t r i e b;) or diminish the too firm consistence or cohesion of organic matters, and reduce them to the fluid condition." Under this head are reckoned mercurials, iodine, alkalies, and other agents, which modify the condition of the fluid, and, through it, that of the system of nutri- tion ; and which have, therefore, been considered, in this work, under the head of Eutrophics. II. ANT'IDOTES. Synon. Alexicaca, Alexipharmaca, Alexiteria, Theriaca, Counierpoisons. The days of secret poisoning have passed away; and with them the use of alexipharmics, alexiterics, and theriacs, which encumbered the works on materia medica and pharmacy; and although it may be ad- mitted, that a Toffania and a Brinvillier might prepare arsenical and other combinations of such a degree of strength, that, when regularly exhibited, they might ultimately exert a deleterious agency on the system, such cases, if they ever occur, must be looked upon as rare. The term antidote is now employed in the sense of counterpoison. It means an agent, which has the power of counteracting, neutralizing, or destroying—more or less—the deleterious properties of poisonous sub- stances in the stomach or out of it. A modern toxicologist, (Christison,) divides' them into two kinds; the one taking away the deleterious quali- ties of the poison, before it comes within the sphere of vital action, by altering its chemical nature; the other controlling the poisonous action 432 ANTIDOTES. after it has commenced, by exciting a contrary action in the system. The former are decidedly the most important in a therapeutical point of view. A reference to the table of poisons and their antidotes, given hereafter, will show that there are few agents which can be ranked under the latter. Perhaps, all poisonous articles may admit of classification under the three heads of—irritants, narcotics, and acro-narcotics or narco- tico-ACRIDS. This is the division that has been employed by Dr. Christison, and by Dr. Beck in his valuable work on Medical Juris- prudence. These terms convey to the mind the main phenomena that may be expected from the individual agents belonging to the respect- ive divisions, as well as their modus operandi. The first,—irritants, —under which may be ranged the vegetable ACRIDS of the classifica- tions of Foddr6 and Orfila, as well as the corrosives of the same toxicologists—inflame the lining membrane of the digestive tube, and destroy by the violent action they excite in that expansion. Some of the class, however, act also on organs more remote ; but still—as Dr. Christison has observed—the most prominent feature is the inflamma- tion they excite wherever they are applied. The second—narcotics— act but insignificantly on the part Avith which they are placed in con- tact. Their influence is exerted on the great nervous centres,—either through the impression they make on the nerves of the part,—on the nerves distributed to the lining membrane of the blood-vessels of the part, or through the agency of the circulation ;—all which has been investigated under the section on narcotics;—and lastly, the ACRO- narcotics or narcotico-acrids combine the agencies of the other two divisions. They are acrid and narcotic;—that is, they not only irritate and inflame the lining membrane of the first passages, but affect the great nervous centres injuriously—causing narcosis. Some of the most deadly poisons belong to this division of toxical agents. It fortunately happens, that, therapeutically, the same mode of ma- nagement is applicable, whatever may be the poisonous agent taken. The great object is to remove the poison as soon as possible,—by the stomach pump, if it be at hand; and, if not, by mechanical irritants applied to the fauces, or by one of the direct emetics; and here we have to bear in mind the remark, made under diluents, that if the poi- sonous agent be soluble, dry vomiting should be induced ; for if a large quantity of fluid be allowed, and it be not removed from the stomach on the instant, the deleterious effects of the poison may be exerted with more energy than if fluid had been denied. When the stomach pump is at hand, the organ can be well washed out, without the fluid remain- ing long enough to admit of the solution of the poison, and its subse- quent absorption. The removal of the poison is the object, then, of primary moment; but, along with this, or subsequently, agents should be employed, which are known to modify the chemical condition of the poison, by render- ing it insoluble or nearly so,—not only in water, but in the gastric se- cretions. Such are 'true antidotes' and alone to be trusted to. " It is chiefly," says Dr. Christison, " among the changes induced by chemi- cal affinities, that the practitioner must look for counter-poisons • and antidotes. 433 the ingenuity of the toxicologist has thence supplied the materia medica with many of singular efficacy. When given in time, magnesia or chalk is a complete antidote for the mineral acids, and oxalic acid; albumen for corrosive sublimate and verdigris ; bark for tartar emetic ; common salt for lunar caustic ; sulphate of soda or magnesia for sugar of lead and muriate of baryta; chloride of lime or soda for liver of sulphur; vinegar or oil for the fixed alkalies; and these substances act either by neutralizing the corrosive power of the poison, or by forming with it an insoluble compound." It need scarcely be said, that any therapeutical agents, which add to the activity of absorption, must be improper whilst a soluble poison is in the stomach, or is applied to any solution of continuity on the sur- face of the body. Blood-letting, being one of the most energetic sorbe- facients, ought to be carefully avoided; except where the poison is a purely local irritant. In cases of external poisoning, a cupping-glass is applied to the wound, or a ligature put round the limb, above the seat . of injury, on similar principles. The cupping-glass not only prevents absorption, but draws the blood from the wound, and Avith it the poison. Lastly:—the practitioner may have to attend to the effects of the poison upon the functions, and to remove morbid phenomena that may have been induced by it. These have to be treated on general princi- ples. In the state of exhaustion, occasioned by hydrocyanic acid, dif- fusive stimulants are given: in narcosis, induced by opium, the cold douche may be needed; and, where inflammatory symptoms appear, after the poison has been removed from the stomach, blood-letting and the whole class of antiphlogistics may be demanded. The following Table was prepared for the first edition of the General Therapeutics, at the author's request, by Dr. Wm. E. Fisher,—at the time a resident of Baltimore,—a gentleman Avhose scientific attainments Avere ample, and whose attention had been zealously and usefully directed to the chemical and other relations of Toxicology; some of the results of which are contained in the pages of the "American Jour- nal of Pharmacy" Soon afterwards, he was appointed Professor of Chemistry in the University of Maryland: and subsequently in the College of Pharmacy in Philadelphia; which situation he resigned in order to commence the study of divinity preparatory to taking holy orders. Desirous of affording Dr. Fisher an opportunity for revising the table, the author corresponded Avith him on the subject; and a few days after he received what proved to be Dr. Fisher's last suggestions, the author had the regret to learn that an attack of apoplexy had ter- minated his brief but useful career. \ VOL. II.—28 434 POISONS AND THEIR ANTIDOTES. TABLE OF POISONS AND THEIE ANTIDOTES. CLASS FIRST.— INORGANIC POISONS. 1. Acids. 2. Alkalies and their compounds. 3. Bromine. 4. Earths and their compounds. 5. Empyreumatic Oils. 6. Ethers. 7. Gases. 8. Glass or Enamel, pounded. 9. Iodine. 10. Metals and their compounds, 11. Phosphorus. 12. Vapours. CLASS SECOND.—ORGANIC POISONS. A. VEGETABLE. B. ANIMAL. 1. Aero-Narcotics. 2. Irritants. 3. Narcotics. 4. Proximate Principles of Vegetables. 1. By change in constitution, or disease. 2. Fishes. 3. Insects. 4. Serpents. N.B. Irritant poisons are marked thus.f Indigenous plants* Exotic plants introduced into this country 4 Where no antidote is placed opposite an article, it means, that there is no established antidote for it. CLASS I.—INORGANIC POISONS. POISONS. ■j- Acidum Aceticum. Acetic Acid. | Acidum Arsenicum. Arsenic Acid. ■j- Acidum Arseniosum. Arsenious Acid. ACIDS. ANTIDOTES. Magnesia. Carbonate of Magnesia. Hydrated Sul- ■j- Acidum Botulinicum. Botulinic Acid. See Sausage Poison. Acidum Carbonicum. Carbonic Acid. See Hydrated Oxide of Iron. phuret of Iron. f Acidum Chlorohydricum. Chlorohydric Carbonate of Soda Acid. ■j- Acidum Citricum. Citric Acid. Acidum Hydrocyanicum. Hydrocyanic Acid. f Acidum Muriaticum. Muriatic Acid. ■j- Acidum Nitricum. Nitric Acid. f Acidum Oxalicum. Oxalic Acid. \ Acidum Phosphoricum. Phosphoric Acid. Aeidum Prussicum. Prussic Acid. | Acidum Sulphuricum. Sulphuric Acid. Acidum Sulphurosum. Sulphurous Acid. See Gases. f Acidum Tartaricum. Tartaric Acid. Carbonate of Potassa. Carbonate of Lime. Ammonia. Chlorine, (liquid.) See Acidum Chlorohydricum. Carbonate of Lime. Magnesia. of Magnesia. Lime Water. Magnesia. Carbonate of Lime. See Acidum Hydrocyanicum. Magnesia. Carbonate of Magnesia. bonate of Lime. Carbonate Car- Carbonate of Lime—Carbonate of Potassa. TABLE OF POISONS AND THEIR ANTIDOTES. 435 II. ALKALIES AND THEIR COMPOUNDS. POISONS. f Ammonite Liquor. Solution of Ammonia. f Ammonise Arsenias. Arseniate of Am- monia. f Ammonise Arsenis. Arsenite of Ammonia. f Ammonias Murias. Muriate of Ammonia. f Potassa. Caustic Potassa. f Potassa; Arsenias. Arseniate of Potassa. f Potassas Arsenis. Arsenite of Potassa. f Potassse Bichromas. Bichromate of Pot- assa. f Potassse Carbonas. Carbonate of Potassa. f Potassse Hydrobromas. Eydrobromate of Potassa. f Potassse Hydriodas. Hydriodate of Pot- ANTIDOTES. Fixed Oils. Vinegar. Lemon Juice. Fixed Oils. Vinegar. Lemon Juice. Carbonate of Potassa. Carbonate of Soda. Lemon Juice. Vinegar. f Potassa) Nitras. Nitrate of Potassa. f Potassii Sulphuretum. Sulphuret of Pot- Chloride of Sodium. Chlorinated Soda. assium. f Soda. Caustic Soda. Fixed Oils. Vinegar. Lemon Juice. HI. BROMINIUM. Bromine. f Potassii Bromidum. Bromide of Potas- sium. IV. EARTHS AND THEIR COMPOUNDS Chloride of Barium. f Barii Chloridum. f Baryta. Barytes. f Barytse Carbonas. Carbonate of Baryta. f Barytas Nitras. Nitrate of Baryta. Calx. Quicklime. Sulphate of Soda. Sulphate of Magnesia. Dilute Sulphuric Acid. Dilute Sulphuric Acid. Sulphate of Magnesia. Mineral or Soda Water (artificial) ? vescing draught? Sulphate of Soda. Effer- V. EMPYREUMATIC OILS. Creasote. Oleum Adipis Empyreumaticum. Empy- reumatic Oil from Lard. Oleum Cornu Cervi Empyreumaticum. Oil of Hartshorn—Dippel's Animal Oil. Oleum Picis Liquidae. Oil of Tar. Oleum Tabaci Empyreumaticum. Empy- reumatic Oil of Tobacco. Oleum Terebinthinae. Oil of Turpentine. Fusel Oil. Albumen ? Fixed Oils. Vinegar. Lemon Juice. VI. ETHERS. JEther Nitricum. Nitric Ether. ^Ether Sulphuricum. Sulphuric Ether. VII. GASES. f Ammoniacal. t Arseniuretted Hydrogen. Carbonic Acid. Carburetted Hydrogen. 436 POISONS AND THEIR ANTIDOTES. POISONS. f Chlorine. f Muriatic or Chlorohydric Acid. f Nitric Oxide. •j- Nitrons Acid. f Oxygen Sulphuretted Hydrogen. f Sulphurous Acid. ANTIDOTES. Inhalation of Ammonia or Ether. Inhalation of Ammonia cautiously. Inhalation of Ammonia cautiously. Inhalation of Chlorine cautiously. Inhalation of Ammonia cautiously. VIII. fGLASS, OR ENAMEL, POUNDED. IX. flODINIUM. Iodine. f Potassii Iodidum, Potassse Hydriodas. Iodide of Potassium, Hydriodate of Potassa. Gluten. Wheat Flour. Starch. X. METALS AND THEIR COMPOUNDS. Antimonium. Antimony. t Antimonii Chloridum, A. Murias. Chlo- ride of Antimony, Muriate of Antimony. f Antimonii Oxidum. Oxide of Antimony. } Antimonii et Potassse Tartras. Tartrate of Antimony and Potassa. •)■ Antimonii Vitrum. Glass of Antimony. Argentum. Silver. f Argenti Nitras. Nitrate of Silver. •j- Arsenicum. Arsenic. f Arsenias Ammonise. Arseniate of Am- monia. ■f- Arsenias Potassse. Arseniate of Potassa. f Arsenias Sodse. Arseniate of Soda. ■j- Arsenis Ammonise. Arsenite of Ammonia. f Arsenis Cupri. Arsenite of Copper. f Arsenis Potassse. Arsenite of Potassa. f Arsenici Oxidum Album. IWiite Oxide of Arsenic. f Arsenici Oxidum Nigrum. Black Oxide of Arsenic. f Arsenici Sulphuretum Flavum. Yellow Sulphuret of Arsenic. f Arsenici Sulphuretum Rubrum. Bed Sul- phuret of Arsenic. Aurum. Gold. f Auri Nitro-Murias. Gold. Bismuthum. Bismuth. \ Bismuthi Subnitras. Subnitrate of Bis- muth. Chromium. Chrome. j Bichromas Potassse. assa. Cuprum. Copper. ■j- Cupri Acetas. Acetate of Copper. ■j- Cupri Arsenis. Arsenite of Copper. Carbonate of Copper Oxide of Copper. Sulphate of Copper. Astringent Infusions. Astringent Infusions. Astringent Infusions. Chloride of Sodium. (See Acidum Arseniosum.) (See Acidum Arseniosum.) Nitro-Muriate of Sulphate of Iron. Milk—Mucilaginous Drinks. Bichromate of Pot- Carbonate of Potassa—Carbonate of Soda. ■j- Cupri Carbonas. | Cupri Oxidum. f Cupri Sulphas. Ferrum. Iron. | Ferri Chloridum. Chloride of Iron. f Ferri Sulphas. Sulphate of Iron. Hydrargyrum. Mercury. Albumen—Sugar—Iron. Hydrated Oxide of Iron. Albumen—Iron. Albumen—Iron, Albumen—Iron. Carbonate of Soda. Carbonate of Soda. TABLE OF POISONS AND THEIR ANTIDOTES. 437 POISONS. ANTIDOTES. f Hydrargyri Chloridum Corrosivum. Cor- rosive Chloride of Mercury. f Hydrargyri Cyanuretum. Cyanuret of Mercury. ■j- Hydrargyri Nitras. Nitrate of Mercury. } Hydrargyri Oxidum Rubrum. Red Oxide of Mercury. | Hydrargyri Sulphas Flavus. Yellow Sul- phate of Mercury. \ Hydrargyrum Ammoniatum. Ammoniated Mercury. Osmium. Osmium. ■j- Osmii Chloridum. Chloride of Osmium. ■j- Palladium. Palladium. ■j- Palladii Chloridum. Chloride of Palla- dium. Platinum. Platina. ■j- Platini Chloridum. Chloride of Platina. Muriate of Ammonia. Plumbum. Lead. ■j- Plumbi Acetas. Acetate of Lead. Albumen—Gluten—Gold finely divided in dust, with fine iron filings. ■j- Plumbi Carbonas. Carbonate of Lead. | Plumbi Oxidum Rubrum. Bed Oxide of Lead. | Plumbi Oxidum Semivitreum. Semivitri- fied Oxide of Lead. t Stannum. Tin. f Stanni Chloridum. Chloride of Tin. Zincum. Zinc. f Zinci Chloridum. Chloride of Zinc. j- Zinci Oxidum. Oxide of Zinc. \ Zinci Sulphas. Sulphate of Zinc. Sulphate of Magnesia—Sulphate of Soda— Phosphate of Soda. Dilute Sulphuric Acid ? Milk. Carbonate of Magnesia—Carbonate of Soda. f Antimonial. f Arsenical. f Bromine. f Iodine. Lead. Mercurial. XI. f PHOSPHORUS. Copious draughts containing Magnesia. XII. VAPOURS. CLASS II.—ORGANIC POISONS. A. VEGETABLE. I. ACRO-NARCOTICS. * ^Ethusa Cynapium. Common Fool's Bromine—Chlorine—Iodine. \ * Aconitum Napellus. Monkshood. Bromine—Chlorine—Iodine. * Agaricus, 5 species. Mushrooms (poison- ous.) * Amanita Muscaria. Truffles (poisonous.) § Bromine, Chlorine, and Iodine are said to be antidotes to the alkaloids genefally, and they are' therefore affixed to all those plants which are known to contain such a principle. 438 POISONS AND THEIR ANTIDOTES. POISONS. * Anagallis Arvensis. Meadow Pimpernell. Anda Gomesii. * Apocynum Androssemifolium. Dogsbane. * Aristolochia Clematitis. Birthwort. Arnica Montana. Leopardsbane. * Asclepias Syriaca. Swallowwort. % Atropa Belladonna. Deadly Nightshade. * iEsculus Ohioensis. Buckeye. Brucea Antidysenterica. False Angustura Bark. Cerbera, 3 species. Cerbera. Chasrophyllum Sylvestre. Bastard Hemlock. Chaillotia Toxicana. Ratbane. * Chenopodium Murale. Wormseed. * Cicuta Madulata. American Hemlock. \ Cicuta Virosa. Water Hemlock. Cissus. Cissus. Cocculus Indicus. Fish Berries. Colchicum Autumnale. Meadow Saffron. * Conium Macula turn. Hemlock. Coriaria Myrtifolia. Myrtle-leaved Sumach. Curare. Indian War Poison. Cynanchum Erectum. Cynanchum. Cytisus Laburnum. Laburnum. * Datura Stramonium. Thorn Apple. J Digitalis purpurea. Foxglove. Ergot. See Secale. * Ervum Ervilia. Bitter Vetch. * Gaultheria Procumbens. Wintergreen, (oil of.) Hsemanthus Toxicarius. Helleborus Niger. Black Hellebore. Hypophyllum Sanguinaria. Puddock Stool. Ipecacuanha. Ipecacuanha. Lathyrus Cicera. Lathyrus. Laurus Camphora. Camphor. * Lobelia Inflata. Indian Tobacco. * Lolium Temulentum. Darnel. * Melia Azedarach. Pride of China. Mercurialis Perennis. Mountain Mercury. Nerum Oleander. Common Oleander. * CEnanthe Crocata. Hemlock Dropwort. * Nicotiana Tabacum. Tobacco. * Passiflora Quadrangularis. Barbadine. Piscidia Erythrina. Jamaica Dogwood. Polygala Venenosa (of Java.) * Rhus Radicans. Poison Vine. j- Rhus Toxicodendron. Poison Oak or Sumach. * Robinia Pseudo-acacia. Locust Tree. * Ruta Graveolens. Rue. * Sanguinaria Canadensis. Blood Root. Scilla Maritima. Squill. Sea Onion. J Secale Cornutum. Ergot, Spurred Rye. * Sium Latifolium. Procumbent Water- Parsnip. * Spigelia Marilandica. Pink Root. Strychnos Ignatii. St. Ignatius's Bean. Strychnos Nux Vomica. Nux Vomica. * Symplocarpus Foetida. Skunk Cabbage. Ticunas. Extract of Various Plants of South America. Tieute. Upas Tieute Tree (of Java.) J Triticum Hybernum. Wheat (diseased.) ANTIDOTES. Bromine—Chlorine—Iodine. Bromine—Iodine. Bromine—Chlorine—Iodine. Bromine—Chlorine—Iodine. Br omine—Chlorin e—Iodine. Bromine—Chlorine—Iodine. Common Salt—Sugar. Bromine—Chlorine—Iodine. Bromine—Chlorine—Iodine. Infusion of Yellow Bark. Bromine—Chlorine—Iodine. Infusion of Galls. Bromine—Chlorine—Iodine. Bromine—Chlorine—Iodine. Bromine—Chlorine—Iodine. TABLE OF POISONS AND THEIR ANTIDOTES. POISONS. Upas Antiar. Tree in Java. Veratrum Album. White Hellebore. * Veratrum Viride. American Hellebore. Woorara. War Poison of Guiana. * Zea Mays. Maize (diseased.) ANTIDOTES. Bromine—Chlorine—Iodine. Bromine—Chlorine—Iodine. II. IRRITANTS. * Anemone Pulsatilla. Wind Flower. * Arum Maculatum. Wake Robin. Bryonia Dioica. Bryony. * Calladium Seguinium. Dumbcane. * Calla Palustris. Water Arum. * Caltha Palustris. Marsh Marigold. \ Chelidonium Majus. Celandine. * Clematis Vitalba. Virgin Bower. Convolvulus Jalapa. Jalap. Convolvulus Scammonia. Scammony. Croton Tiglium. Purging Croton. X Cucumis Colocynthis. Colocynth. Cyclamen Europaeum. Sow Bread. Daphne Gnidium. Spurge Flax. Daphne Mezereum. Mezereon. f Delphinium Staphisagria. Stavesacre. Doica Palustris. Swamp Leather Wood. * Equisetum Hyemale. Scourgrass. Euphorbia Officinarum. Euphorbium Spurge. * Gratiola Officinalis. Hedge Hyssop. Hippomane Mancinella. Manchineel. Hura Crepitans. Sand Box. * Hydrocotyle Vulgaris. Marsh Pennywort. Jatropha Curcas. Indian Nut. Jatropha Manihot. Cassada. * Juniperus Sabina. Savin (oil of.) * Juniperus Virginiana. Red Cedar (oil of.) Momordica Elaterium. Squirting Cucum- ber. % Narcissus Pseudo-Narcissus. Daffodil. Pastinax Sativa. Common Parsnip. * Pedicularis Palustris. Marsh Lousewort. * Phytolacca Decandra. Poke. Piper Cubeba. Cubebs. Plumbago Europaea. Toothwort. * Ranunculus Acris, and other species. Crowfoot. Rhododendron Chrysanthemum. Oleander. X Ricinus Communis. Castor Oil Plant. Sambucus Ebulus. Elder. X Sedum Acre. Stone Crop. Stalagmitis Cambogioides. Gamboge. X Tanacetum Vulgare. Tansy (oil of.) Bromine—Chlorine—Iodine. Bromine—Chlorine—Iodine. Bromine—Chlorine—Iodine. Bromine—Chlorine—Iodine. Bromine—Chlorine—Iodine. Bromine—Chlorine—Iodine. Bromine—Chlorine—Iodine. III. NARCOTICS. * Actaea Spicata. Baneberry. Amygdalus Communis. Bitter Almond. % Amygdalus Persica. Peach. Gelseminum Nitidum. Yellow Jessamine. Helonias Erythrosperma. Fly Poison. Hyoscyamus Albus. White Henbane. Bromine—Chlorine—Iodine. 440 POISONS AND THEIR ANTIDOTES. POISONS. ANTIDOTES. * Hyoscyamus Niger. Black Henbane. Bromine—Chlorine—Iodine. * Kalmia Latifolia. Mountain Ivy. Lactuca Virosa. Strong Scented Lettuce. Opium, and proximate principles. Infusion of Galls. X Papaver Somniferum. Poppy. See Opium. Paris Quadrifolia. Herb Paris. * Prunus Caroliniana. Wild Orange. X Prunus Lauro-Cerasus. Cherry Laurel. Prunus Nigra. Black Cherry. X Prunus Padus. Cluster Cherry. * Prunus Virginiana. Wild Cherry. * Solanum Dulcamara. Bitter Sweet. Bromine—Chlorine—Iodine. * Sorbus Acuparia. Mountain Ash. * Taxus Baccata. Yew. IV. PROXIMATE PRINCIPLES OF VEGETABLES. Aconita, see Aconitum. Atropia, see Atropa. Brucia, see Brucea. Codeia, see Opium. Colocynthin, see Cucumis. Daturia, see Datura. Delphinia, see Delphinium. Elatin, see Momordica. Emetia, see Ipecacuanha. Hyoscyamia, see Hyoscyamus. Morphia, and Salts, see Opium. Narcotin, see Opium. Picrotoxin, see Cocculus. Strychnia, see Strychnos. Veratria, see Colchicum. B. ANIMAL. I. BY CHANGE IN CONSTITUTION OR DISEASE. f Bacon. f Cheese. Crabs. f Eels. f Glanders, (infection from horses labouring under.) Mackerel. Milk. f Oily Matter from Kipper or dried Salmon. t Oysters. f Pustule Maligne [flesh of animals labouring under.] Putrid Blood, Bile, or Brain. Saliva of the Rabid Dog. j Sausage Poison {bloody and white.] II. FISHES. f Ballistes Monoceros. Old Wife. f Cancer Astacus. Crawfish. f Cancer Ruricolus. Land Crab. f Clupea Thryssa. Yellow Billed Sprat. f Coracinus fuscus Major. Gray Snapper. f Coracinus Minor. Hyne. f Coryphajna Splendens. Dolphin. TABLE OF POISONS AND THEIR ANTIDOTES. 441 POISONS. ANTIDOTES. f Mormyra. Blue Parrot Fish. f Muraena Major. Conger Eel. f Mytilus Edulis. Mussel. f Ostracion Globellum. Smooth Bottle-fish. f Perca Major. Barracuda. f Perca Venenata. Rockfish. f Perca Venenosa. Grooper. f Physalia. Portuguese Man-of- War. f Scomber Cseruleus. Spanish Mackerel. f Scomber Maximus. King fish. f Scomber Thynnus. Bonetta. , f Sparus Chrysops. Porgee. f Tetrodon Ocellatus. Bloicer. ■j- Tetrodon Sceleratus. Tunny. III. INSECTS. f Apis Mellifica. Bee. Solution of Ammonia. f Cantharis Vesicatoria. Spanish Fly. f Culex Pipiens. Gnat. f Lytta Vittata. Potato Fly. f CEstrus Bovis. Gad Fly. f Scorpio. Scorpion. f Tarantula. Tarantula. f Vespa Crabro. Hornet. , Solution of Ammonia. f Vespa Vulgaris. Wasp. Solution of Ammonia. IV. SERPENTS. f Boa Crotaloides. Copperhead. ■j- Cenchus Mockeson. Mockeson. f Coluber Berus. Viper. f Crotalus, (5 species.) Rattle Snake. f Scytale Piscivorus. Water Viper. 442 SPECIAL ANTIPARASITICS. III. ANTIPARASITICS. Syn. Antiphthiriaca. Almost all animals and vegetables are subject to parasites; and many are infested not only with parasitic animals, but parasitic plants. Recent researches favour the conclusion, that vegetable growths may be connected with certain diseased conditions of the cutaneous surface in man and animals; and daily observation shows us, that plants are infested both with parasitic insects and vegetables. Of late years, as elsewhere remarked, the idea has been revived, that scabies or common itch is owing to an insect burrowing in the skin, and exciting great irritation and itching; and it has been con- ceived, that sulphur, veratrum, and the other remedies that may be employed for its cure, may act by destroying the " cutaneous vermina- tion;" and thus be antiparasitics. In cases in which but few pediculi exist, the best antiparasitic is cleanliness. In our public eleemosynary institutions and prisons, the hair is cut short, and the new comer is sent to the bath, and well washed with soap and water. Attention of this kind, for a short period, is sufficient. In the present mode of wearing the hair, there is no difficulty in removing them; but formerly, when it was plastered down daily by greasy applications, it was so common for parasites to make their nidus there, that the hair-dresser always added some anti- parasitic, as the red oxide of mercury, to his pomatum to destroy them. The best antiparasitic course is to brush the head daily; and to use a fine-toothed comb. SPECIAL ANTIPARASITICS. The antiparasitics of the materia medica, most commonly employed, are red oxide of mercury, which may be used either in the form of Un- guentum hydrargyri oxidi rubri, of the Pharmacopoeia, (Yol. ii. p. 314,) or mixed with ten or twenty parts of hair-powder, a small quantity of which may be rubbed into the hair ;—ammoniated mercury, in the form of Unguentum hydrargyri ammoniati, or mixed with starch in the pro- portions just mentioned;—Unguentum hydrargyri;—or Hydrargyri chloridum mite, mixed with starch powder, which is regarded by some as the best antiparasitic in cases of pediculus pubis. Unguentum veratri albi, (Vol. ii. p. 370,) is used for the same purpose; and, at times, a decoction of tobacco; but the preparations above-mentioned are less likely, when cautiously employed, to affect the system injuriously; and are therefore preferred. STAPHISAGRIA. 443 COCCULUS. Cocculus Indicus of the shops is the fruit of Anamirta cocculus, Coc- culus suberosus, Cocculus Indicus plant; Sex. Syst. Dioecia Monadel- phia; Nat. Ord. Menispermaceae—a native of Malabar, and the eastern isles of India. The dried fruit is officinal in the Pharmacopoeias of Edinburgh and Dublin. It resembles the bayberry, and consists ex- ternally of a thin, rugous, dark-coloured bitter coat, enveloping a thin bivalve shell or endocarp, within which is a whitish, oily, or bitter kernel, which does not fill the whole shell: this distinguishes it from the bayberry. (Pereira.) It was formerly brought from the Levant; and was, therefore, called Coque du Levant, Levant shell; but it is now imported altogether from India, chiefly for illegal purposes. Dr. Pe- reira states, that he found, from a druggist's private books, that, in 1834, about 2500 bags were entered; and this, he thinks, was probably much below the quantity imported. The poisonous principle of cocculus is a peculiar bitter matter called picrotoxin, which is very soluble in alcohol and ether, and may be sepa- rated by triturating the watery extract of the seeds with pure magne- sia, and treating ,it with alcohol, which dissolves the picrotoxin: this may be obtained in an impure state by evaporation. Cocculus is an acro-narcotic, and has long been known as a poison for taking fish, which it stupefies. It is, also, employed by fraudulent brewers, with the view of rendering beer more intoxicating, and at the same time bitter, without the employment of hops. In these cases, it is used in the form of extract; so that the fraud is not readily de- tected. As an antiparasitic to destroy pediculi, it is employed in the form of powder or of ointment. In India, it is applied in scabies; and Dr. Christison recommends it as one of the best applications to ring- worm of the scalp. The Edinburgh Pharmacopoeia has a formula for Unguentum Cocculi, which is made as follows:—Take any convenient quantity of Cocculus Indicus; separate and preserve the kernels; beat them well in a mortar, first alone, and then with a little lard; and add lard till it amounts altogether to five times the weight of the kernels. It is used to destroy pediculi, and occasionally as a local application in obstinate chronic cutaneous diseases. In the same cases, an ointment of picrotoxin has been prescribed,—Picrotox.gr. x.; Adipis sj.; but some caution is necessary, as the system may become affected both when the picrotoxin is used, and the cocculus itself. STAPHISA'GRIA.—STAVES'ACRE. Stavesacre is the seed of Delphinium Staphisagria, stavesacre; Sex. Syst. Polyandria Trigynia; Nat. Ord. Ranunculaceae; a native of the south of Europe. The seed is about the size of a grain of wheat; of a somewhat triangular shape; rough, and of a dark brown colour exter- nally ; of a slight, but disagreeable odour; and of a bitter, acrid, hot, and nauseous taste. Its main active principle has been separated from 444 MINERAL WATERS. it, and is termed Delphinia or Delphinine; it also contains a volatile oil, which in small doses is a powerful emetic. Stavesacre is an active acro-narcotic; and, like cocculus, has been much used to destroy pediculi, which are readily killed by a wash made of an infusion of the bruised seeds in vinegar, or by an ointment of the powdered seeds well mixed with four or five times their weight of lard. An ointment might, also, be made of delphinia, and be used for the same purpose; but it is so virulent a poison as to require much caution in its employment. The preparations of delphinia have been used in the same cases as those of veratria. SECTION X. • MINERAL WATERS. When we reflect on the multitude of persons who, during the proper seasons, frequent the mineral springs of this and other countries, it must be apparent, that although much good may result, in individual cases, from their employment in appropriate affections, a large amount of evil must result from their indiscriminate use in diseases for which they are not adapted: accordingly, every intelligent resident plrysician at fashionable watering places has deplored the ignorance of invalids and their medical advisers, which has doomed many a hopeless case to a most inconvenient pilgrimage; for although the accommodations at such places ought to be adapted expressly for the comfort of valetudi- narians, attention appears to be paid rather to the healthy, who are able to enjoy the pleasures of the table; and to minister, therefore, more to the interests of the proprietors. Nothing, indeed, can be more forlorn than the condition of a sojourner at the best of these watering places, when his disease is beyond the resources of art; and when he is far from all those comforts, that home, and home alone can afford him. A weighty responsibility, consequently, rests on the medical adviser, who is unpardonable, if he has not previously made himself •acquainted, as far as practicable, not only with the exact pathological condition of his patient, but with the remedial powers of the mineral waters; and the accommodations of the sanitarium to which he recom- mends him. In the large mass of cases, perhaps, in which he is con- sulted, the remedy that is clearly indicated is a thorough change of air and of all the circumstances that surround the invalid; but this is rarely a sufficient ultimate object with the patient; and it becomes important —in order to induce him to travel—to hold out prospects of advantage from a course to be pursued at the end of his journey. In another work {Human Health, p. 125, Philad. 1844,) the author has dwelt upon the eminent advantages to health from simple change of air; and in the present volume he has taken occasion to refer to its MINERAL WATERS. 445 value as a revulsive and tonic agency in numerous diseases. To this, and to a change of diet and regimen, he has been disposed to ascribe much of that benefit which proverbially results from a journey, in the summer season, to any of the sites of our mineral springs. The mul- titudes of valetudinarians who annually leave their habitations to visit the watering-places of this country and of Europe, and who return to their homes in the enjoyment of health, and full of confidence in the virtues of the waters near which they have resided, but of which they may or may not have partaken, afford ample evidence of this beneficial agency. Long before the citizen of one of the Atlantic towns of this country reaches the Trans-Alleghany Springs of Virginia, he has an earnest of the advantage he is about to derive from change of air; and many a valetudinarian finds himself almost restored during the jour- ney, fatiguing as it is, through the mountain regions, which have to be crossed before he reaches the White Sulphur, in Greenbrier county. Many persons, too, cannot drink that water with impunity, and, con- sequently, are indebted for their improvement chiefly to change of air; but somewhat, also, to varied scenery and society; absence from cares of business; and to greater regularity of living than they have been, perhaps, accustomed to. In making these observations, the author does not mean to affirm that mineral waters, as in the case of the valua- ble spring in question, are not occasionally important agents in the cure of disease; but, taking invalids in general, he is satisfied, that more is dependent upon change of air and habits than upon the waters. The inhabitant of an Atlantic city, and of most of the districts to the east of the Blue Ridge, removes from a hot atmosphere to one which is comparatively cool, and where all the diseases that are common to hot and malarious climates are extremely unfrequent, and many of them unknown. The advantage is obvious. He escapes the diseases which might have attacked him, had he remained through the summer in his accustomed locality; and hence many of the wealthy families of the lower country are in the habit of spending those months in the mountain regions, in which they are especially liable to disease in their own malarious districts. We can thus understand the reputation ac- quired by the inert Bath, and the Matlock waters of England, the latter of which has scarcely any solid ingredient; and yet what crowds flock to these agreeable watering-places; to the former for the perpetual amusements that keep the mind engaged, and cause it to react bene- ficially on the corporeal or mental malady;—to the latter, for the en- joyment of the beauties of nature for which Derbyshire is so celebrated. It is obvious that were such waters bottled, and sent to a distance, so that the invalid might drink them at his own habitation, the charm would be dissolved. The garnitures—more important, in this case, than the dish—would be wanting, and the banquet would be vapid, and without enjoyment or benefit. Less than twenty years ago, amidst the bubbles that were engaging the minds and money of the English public, it was proposed to carry sea-water by pipes to London, in order that the citizens might have the advantage of sea-bathing without the inconvenience of going many miles after it. Had the scheme been carried into effect, the benefits from metropolitan sea bathing would 446 MINERAL WATERS. not have exhibited themselves comparable in any respect to those of the same agent employed at Brighton or at Margate. It is manifest, then, from what has been said, that neither the waters drunk at a distance, as in Philadelphia, nor any artificial waters, can be taken with the same advantage as the water at the springs; and if the artificial mineral waters were sent from Philadelphia, and taken at the source, they would, doubtless, in many cases, produce the same effects as the native water, especially if the invalid did not know that he was taking an artificial preparation. Again: when an inquiry is made into the character of the diseases that are most benefited by a visit to watering-places, it is found, that the large mass of them are really such as are removable by simple change of air. Both change of air and the use of the waters are inad- missible during the existence of acute affections; but when the vio- lence of the disease has passed away; and the inflammation—especially if it be seated in the mucous textures—has become chronic, the bene- ficial influence of change of air, under proper precautions, is marked. Hence it is that travelling, which combines a modification of the atmo- spheric influences surrounding the patient, with proper exercise, is so salutary in chronic irritation of the mucous membrane of the intestines and of the bronchia. Many of the cases, indeed, that have been looked upon as phthisis, removed by this course, have been chronic bronchitis; and one of our mineral waters has gained a reputation for the cure of pulmonary affections, which ought rather, perhaps, to be referred to the change of air, and other physical and moral circumstances that impress the patient. That change of air and of habits is capable, indeed, of accomplishing all that our mineral waters can do, is exhibited \>j Hydropathy—the Wassercu r—in which no article of the materia medica, and nothing but the pure element, is used; and it is found that the cures are mainly effected upon such patients as are in the habit of being sent to water- ing-places. The hydropathist proposes to cure all diseases, that are not in such a stage as to be absolutely incurable, by cold water used externally and internally;—along with constant exposure to mountain air; active exercise; total abstinence from all distilled and fermented liquors; plain coarse food; hard straw matresses; and in the establish- ment of Priessnitz—the founder of the system—at Grafenberg, we are told, the patient inhaled an atmosphere not of the purest,—being contaminated by a smell, in part arising from the cows which are kept in stables beneath the house, in part from cabinets d'aisance upon the staircase, and from the kitchen beneath the common room which opened into it by a trap-door, through which the cooked food, as well as the various odours find entrance. Priessnitz lived in the mountains of Silesia; and when we take into consideration the entire change that must have been experienced by his patients in their journey thither; and, in the case of the better classes, in their mode of life when they were there we need hardly be surprised that all those affections which are capable of being removed by revellents should have yielded to his efforts. The Leintuch, or the application of the wet sheet; the Abreibung, or rubbing down with the same; the use of the sweating blanket, the MINERAL WATERS. 447 patient being packed up in a blanket, feather-bed, and wadded counter- pane until he sweats ; the different forms of baths and wet bandages ; the drinking of eight to twelve glasses of water daily, each glass hold- ing nearly three quarters of a pint; the coarse hard fare, and the regulated exercise already referred to, are well calculated to induce a new action m the functions, and to afford relief in a multitude of chronic cases. Of the use of cold water externally and internally, the therapeutist has availed himself in all ages, and has ever been impressed with its important agency m a variety of morbid cases; but a systematic ap- plication of cold water in a distinct establishment, with an enforced diet and regimen, is the offspring of modern times only. In a letter to the Rev. Mr. Cole, dated in 1775, Horace Walpole says:—" Dr He- berden, as every physician, to make himself talked of, will set up some new hypothesis, pretends, that a damp house, and even damp sheets, which have ever been reckoned fatal, are wholesome: to prove his faith, he went into his new house, totally unaired, and survived it;" and he adds,—" at Malvern,"—the seat, by the way, of an extensive hydropathic establishment at the present day, conducted by Dr. Gully, a regularly educated member of the profession—" they certainly put patients into sheets just dipped in the spring." It matters not that this method may have originated in, and been sustained by, empiricism, and for the vilest and most mercenary pur- poses, the good which philosophy can select from it should be care- fully separated, and unhesitatingly embraced. " The absurdity of the 'hydropathic'treatment"—says a recent writer, Dr. Carpenter—"con- sists in its indiscriminate application to a great variety of diseases; no person, who has watched its operation, can deny, that it is a remedy of a most powerful kind; and if its agency be fairly tested, there is strong reason to believe, that it will be found to be the most valuable curative means we possess for various specific diseases, which depend upon the presence of a definite ' materies morbi' in the blood, espe- cially gout and chronic rheumatism; as well as for that depressed state of the general system, which results from the ' wear and tear' of the bodily and mental powers." But although in the mass of cases, a journey to, and residence at, any of our mineral springs or at the sea side would prove effective in restoring the invalid, whether the waters were taken or not, it cannot be doubted, that many of them are excellent therapeutical agents, when judiciously employed. The thermal springs, for example, have the important advantage, that whilst the patient is immersed in them, they continue of the same temperature; and hence their value over any artificial thermal bath, the temperature of which, under every precaution, must vary; but it may be questioned, and has been ques- tioned, whether the sulphurous, the saline, the chalybeate, the alka- line, or the ioduretted waters, really possess much more virtue than any analogous artificial solutions. It is a common remark, that the small quantity of saline matter contained in mineral waters produces a much greater effect than would result from an artificial solution of the same strength; but this is questionable. The visiter at the Saratoga 448 MINERAL WATERS. Springs takes several tumblerfuls of the water at the fountain before breakfast; but it would not be an easy matter to persuade a patient to drink as much of the artificial water; and until this is done, we have not the necessary elements for a fair comparison. Where many springs are seated near each other, personal interest is energetically exerted, and is often sufficient to induce a trial of them all. One spring is reported to be valuable in a particular disease, or class of diseases; and another in another ; and it becomes the routine —as in the case of the Trans-Alleghany Springs, of Virginia,—to make a regular tour; so that before the invalid quits the region, he must have sojourned for a while at the Warm Springs, then at the Hot Springs; and must stay in turn at the Red Sulphur, the Salt Sulphur and the White Sulphur, finishing with the Sweet Springs, which is a carbonated water. In this manner, it is difficult to arrive at any cor- rect appreciation of the virtues of any of them. It is rare, too, for a physician to practise at all of them in turn: he generally establishes himself at some one spring; and is, consequently, unable to make a comparison between it and others. Too commonly, moreover, his object is merely to practise his profession amongst the assembled visiters; and he may be incapable, either for want of ability, opportu- nity, or inclination, to enter upon the task. In the Pyrenees, there are, it appears, upwards of fifty sulphurous springs, to each of which some special virtue is ascribed. The waters of Bonnes are reputed to be best for diseases of the chest; but those of Chaudes are preferred by some; Cauterets, and Bagneres de Luchon by others. All sulphurous waters, as has been observed by recent therapeutical writers, Messrs. Trousseau and Pidoux, are considered everywhere to exert marvellous powers over phthisis. The Red Sul- phur Springs of Virginia have had this reputation for a long time. The White Sulphur waters, and those of the Salt Sulphur, are doubt- less as beneficial; but the fogs, to which the White Sulphur are subject, render it by no means a fitting sojourn for the phthisical valetudina- rian. Aix in Savoy, Aix-la-Chapelle and Enghien, enjoy the anti- phthisical reputation of sulphurous waters in general. Perhaps—so far as the waters go—the sulphohydric acid causes the good effects, if such effects be referable to the waters, which may admit of doubt; and if this be the sanative agent, it can be prepared artificially, and ought to exhibit some power over phthisical cases treated at home; yet who would place confidence in it without the revulsion which is its accompaniment when drunk hundreds of miles away from home ? From the prominent ingredients of mineral waters, we can readily pronounce as to their general therapeutical virtues. . Some of them are cathartic; others diuretic; others tonic, and others eutrophic. Most of them increase the urinary secretion, but this may be often dependent upon the quantity of water taken, which passes into the mass of blood, and is separated by the kidneys. It is by thus entering the blood- vessels, that they produce those eutrophic effects to which reference has been made already, (Vol. ii. p. 291,) and that old morbid cachexies disappear under their prolonged use. Still, as regards this very ac- tion, it is probable that an equally beneficial result would ensue upon MINERAL WATERS. 449 the employment, equally prolonged, of an artificial water of a similar kind, if it had the same extrinsic circumstances associated with it; hence the conclusion to which the therapeutists, already quoted, have arrived, can scarcely be esteemed wide of the truth. " We believe," they observe, " that mineral waters are very efficacious; we think their power is considerably aided by the change in the hygienic condition of the patient; we are satisfied, that artificial mineral waters are as efficacious as, and, at times, more efficacious than, natural waters, when the patient will take them in the same manner; but as we cannot pre- vail upon him to submit at home to the same abnegation, the same change in all his habits, and the same perseverance as at the natural springs, we shall still send, and everybody will send, patients to drink, on the spot, waters, which but few will consent to drink anywhere else." MM. Trousseau and Pidoux ought, however, to have added, that even should patients consent to take the remedy freely at home, and submit to the same change of regimen, still, the mutation of atmospheric influences, and the travelling exercise in a journey to the springs, especially if at a considerable distance, and in a more elevated region—as is the case with the mountain-springs of this and other countries—are therapeutical agencies of the greatest influence. Under Mineral Waters are classed all those that contain saline or gaseous substances, or both, in sufficient quantity to be possessed of medicinal properties; or whose temperature differs from that of the ordinary springs of the region. The following table exhibits the tem- perature and active mineral ingredients of the chief waters. vol. ii.—29 450 MINERAL waters. TABLE OF SOME OF THE PRINCIPAL MINERAL WATERS. Springs. Acqui, Aix, Aix-la-Chapelle, Aix, in Provence, Aries, Audinac, Ax, Baden, in Aargau, Baden, in Swabia, Bagnferes de Bigorre, Bagneres de Luchon, Bagnoles, Bagnols, Balaruc, Balston Spa,—Sans Souci Spring, Where situate. Bareges, Bath, Bedford,—Ander- son's Spring. Bonnes, Booklet, Bourbon-Lancy, Bourbon-l'Archam- bault, Bourbonne-les-Bains, Bristol, Bruckenau, Bussang, Buxton, Piemont. Piemont, Savoie. Germany. France, (Bouches du Rhone.) France, (Pyr6n. Ori- ent.) France, (Arriege.) France, (Arriege.) Switzerland. G ermany. France, (H. Pyr£n.) France, (H. Garonne.) France, (Orne.) France, Lozere. France, Herault. United States, New York. Temperature. France, ren.) England. (Hautes-Py- United States, Penn- sylvania. France, (Bass-Pyr6n.) Bavaria. France, (Saone et Loire.) France, (Allier.) France, (Haute Marne.) England, Bavaria. France, (Vosges.) 167° 98 134 91 103 to 145 67 Thermal. 167 112 to 145 129 69 to 148 78 to 82 109 116 85 to 112 112'to 116 78 to 98 132 136 to 140 Cold. 82 Active constituents. Sulphohydric acid and chlo- ride of sodium. Sulphohydric acid. Sulphohydric acid, chloride of sodium, and carbonate of soda. Traces of carbonic acid. Sulphohydric acid. Sulphohydric acid, sulphate of magnesia. Sulphohydric acid. Sulphohydric acid. Sulphohydric acid, chloride of sodium, sulphate of soda. Sulphate of magnesia. Sulphohydric acid. Sulphohydric acid, carbonic acid, chloride of sodium. Sulphohydric acid. Chloride of sodium, chloro- hydrate of magnesia, car- bonic acid. Chloride of sodium, bicar- bonates of soda and mag- nesia, carbonate of iron, and iodide of sodium. Sulphohydric acid. Chloride of sodium, sulphate of soda and carbonic acid; chiefly calcareous salts. Carbonic acid, sulphate of magnesia, chlorides of so- dium and calcium, carbon- ate of iron. Sulphohydric acid. Carbonic acid, iron. Chloride of sodium, carbonic acid. Sulphohydric acid, carbonic acid, iron. Chloride of sodium. Sulphate of soda, chlorides of sodium and magne- sium. Carbonic acid, iron. Carbonic acid, carbonate of soda, iron. SPECIAL MINERAL WATERS. 451 Springs. Where situate. Temperature. Active constituents. Cambo, France, (Basses-Py- f 69° 162 Sulphohydric acid. r6n.) Carbonic acid, iron. Campagne, France, (Aude.) 80 Sulphate of magnesia, chlo-rohydrate of magnesia. Carlsbad, Bohemia. 121 to 167 Carbonic acid, sulphate of soda, carbonate of soda, chloride of sodium. Cauterets, France, (H. Pyre"n.) 123 Sulphohydric acid. Chateldon, France. (Puy de Dome.) Carbonic acid, iron. Chaudes-Aigues, France, (Cantal.) 191 Carbonic acid, carbonate of soda, chloride of sodium. Cheltenham, England. Chloride of sodium, sulphate of soda, sulphate of mag-nesia, carbonic acid, car-bonate of iron. Contrexeville, France, (Vosges.) Carbonic acid, a little sul-phate of magnesia, chlo-ride of sodium, and iron. Creuznach, Germany. Iodine, bromine, chlorides of sodium and calcium. Dax, France, (Landes.) 76 to 133 A little chlorohydrate of magnesia, sulphate of soda. Dunblane, Scotland. Sulphate of soda, chlorides of sodium and calcium, and carbonate of iron. Ems, Germany. 83 to 115 Carbonic acid, bicarbonate of soda, chloride of sodium. Enghien-Montmo- France, (Seine et Sulphohydric acid. rency, Oise.) Epsom, England. Sulphate of magnesia. Forges, France, (Seine infer.) Iron. Franzensbad, Bohemia, Eger. Sulphate of soda, carbonate of iron, carbonic acid gas. Furnas, St. Michael's, Azores. Thermal. Carbonic acid, carbonate of Gastein, Austria, Noric Alps. 118 iron. Greoulx, France,(Basses-Alpes.) 85 to 96 Sulphohydric acid. Hall, Upper Austria. Iodine. Harrowgate, England. Carbonic acid, sulphohydric Hot Springs, United States, Va. 107 Carbonate of magnesia, chlo-rides of sodium, and mag-nesium. Ischl, Upper Austria. Iodine, bromine. Kilburn, Carbonic acid, sulphohydric acid; carbonates of lime, magnesia and iron; sul-phates of soda, lime, and magnesia; chloride of so-dium. Kissengen, Bavaria. Carbonic acid, chloride of sodium. La Mar^querie, France, (Seine infer.) Iron. Lamotte, France, (Isere.) 184 La-Roche-Posay, France, (Vienne.) Sulphohydric acid. 452 MINERAL WATERS. Springs. Where situate. Temperature. Active constituents. Leamington, England. Chloride of sodium, sulphate of soda, chlorides of cal-cium and magnesium. L'Epinay, France, (Seine infer.) Iron. Lucca, Italy. 94 to 130° Carbonic acid, sulphates of alumina, soda, magnesia and iron. Luxeuil, France, (Haute-Saone.) 125 Chloride of sodium, car-bonate of soda. Malvern, England. Carbonates of soda and iron, sulphate of soda, chloride of sodium. Matlock, England. 66 Marienbad,—Kxeuz- Bohemia. Sulphate of soda, carbonate brunn, of iron, carbonic acid gas. Moffat, Scotland. Carbonic acid, sulphohydric acid and azote; chloride of sodium. Mont-Dore, France, (Puy de 112 Carbonic acid, bicarbonate Dome.) of soda, chloride of so-dium, sulphate of soda. Ne"vis, France, (Allier.) 136 to 148 Niederbronn, France, (Bas-Rhin.) Cold. Chloride of sodium, sulphate of magnesia, carbonic acid. Niton, England, Isle of Wight. Iron, sulphate of alumina and potassa. Passy, France, (Seine.) Iron. Pfeffers, Swiss Alps. 100 Pitcaithley, Scotland. Chlorides of sodium and cal-cium. Plombieres, France, (Vosges.) 132 to 166 Carbonate of soda, sulphate of soda, and chloride of sodium. Pougues, France, (Nievre.) Carbonic acid, carbonate of soda. Provins, France, (Seine et Marne.) Carbonic acid, iron. Piillna, Bohemia. Sulphates of soda and mag-nesia, chloride of magne-sium, iron. Pyrmont, Westphalia. Carbonic acid, carbonate of magnesia. Rennes, France, (Aude.) 103 to 121 Carbonic acid, chlorohydrate of magnesia. RoisdorfF, Germany. Carbonic acid, carbonate of, soda. ' Waters. Carbonic acid, sulphohydric acid. St. Amand, France, (Nord.) 64 to 82 - Deposit, (Boue.) Sulpho-hydric acid, salts of iron St. Nectaire, France, (Puy de Dome.) 75 to 103 and magnesia. Carbonic acid, bicarbonate of soda, chloride of so-dium.. St. Pardoux, France, (Allier.) Carbonic acid, iron. St. Sauveur, France, (Hautes-Py-ren.) 76 to 93 Sulphohydric acid. MINERAL WATERS. 453 Springs. Where situate. Temperature. Active constituents. Saratoga,— Congress United States, New Carbonic acid, chloride of Spring, York. sodium, iodide of sodium; bicarbonates of soda and magnesia; carbonate of iron, bromide of potas-sium. ------Walton or Io- United States, New Chloride of sodium, carbon- dine Spring, York. ate of magnesia, iodide of sodium. Sea water, Chlorides of sodium, magne-sium and calcium; sul- Scarborough, England. phate of magnesia. Sulphate of magnesia, iron. Schlangenbad, Germany. 86° A little carbonic acid and carbonate of soda. Schwalbach, Germany. Carbonic acid, iron. Seidlitz, Bohemia. Sulphate, and carbonate, of magnesia, chloride of mag-nesium, carbonic acid. Seltzer, Germany. Carbonic acid, chloride of sodium. Seidschiitz, Bohemia. Sulphate of magnesia, car-bonic acid. Spa, Belgium. Iron, carbonic acid. Tarascon, France, (Arriege.) Iron, carbonic acid. Toplitz, Bohemia. 114 to 122 Carbonate of soda, chloride of sodium, sulphate of soda. Tunbridge, England. Carbonic acid, carbonate of iron, sulphate of magnesia. Ussat, France, (Arriege.) 93 to 98 Carbonic acid, chlorohydrate * of magnesia. Vals, France, Ardeche. 96 Bicarbonate of soda, car-bonic acid. Vichy, France, Allier. 90 to 112 Bicarbonate of soda, car-bonic acid. Warm Springs, United States, Virgi- 97 White Sulphur, United States, Va. Sulphohydric acid, carbonic acid, sulphate of magnesia. Wisbaden, Germany. 158 to 160 | Chloride of sodium. It is impracticable to make a well defined classification of mineral waters, except where they contain—which, as will be seen by the table, is rarely the case—but a single mineralizing ingredient. In many it is difficult to say, which exerts the predominant influence. It is the custom to range them into certain classes, which admit of-a more ready appreciation of their general properties. Perhaps, the least objectionable division is the following: — 1. Simple thermal waters; 2. Saline aperient waters; 3. Alkaline ivaters; 4. Sulphurous waters; 5. Ioduretted waters; 6. Chalybeate waters; and 7. Carbonated waters. The chief thermal springs of the United States are the Warm Springs and Hot Springs of Virginia; the Warm Springs of Buncombe county, North Carolina (94° to 104,) and the Hot Springs of Arkansas, 454 MINERAL WATERS. (167° to 210); in England, those of Bath, Bristol, and Buxton. In France, Germany and Italy, they are numerous; but, as seen by the tables, are rarely simple; containing, at the same time, various mine- ral impregnations. On these, their virtues as internal agents are alto- gether dependent. When applied externally, their effects may vary according to the character of the impregnation: those of simple ther- mal waters are dependent upon temperature and moisture. They are the same, in other words, as those of warm water and hot water baths, whose properties have been mentioned in another part of this work, (see Vol. i. pp. 365 and 549.) They have the great advantage, how- ever, already alluded to—in rheumatic and other diseases—that their temperature continues the same, whatever may be the duration of the' immersion. 2. Saline aperient waters contain chiefly sulphate of soda, sul- phate of magnesia, chloride of sodium, and chloride of magnesium, singly or associated. Most of these are cold springs—as those of Kissengen, Marienbad, Franzensbad, Cheltenham, Leamington, Har- rowgate, and Scarborough; and in this country, the White Sulphur, Salt Sulphur and Red Sulphur-of Virginia. Thermal saline waters are found at Wisbaden, and Baden Baden in the neighbourhood of Wisbaden. The Hot Springs and Warm Springs of Virginia contain but little saline impregnation. All these waters act as cathartics and diuretics; but they require to be taken with caution; for if used too freely, they bring on fever with gastro- enteric irritation, and a sense of fulness in the head. Their protracted use, too, may be of great advantage in diseases that require the em- ployment of saline eutrophics. o. The important ingredients in the alkaline waters are bicar- bonate of soda and carbonic acid. Vichy is the most celebrated of these. It is thermal-alkaline; and so are Mont-Dore, Ems, Toplitz, Schlan- genbad, and Roisdorff. The alkaline springs of this country are cold. Those of Saratoga and Balston are the most celebrated. 4. In the sulphurous waters, the characteristic ingredient is sulpho-hydric acid; generally associated with saline substances, but sometimes existing alone, or nearly so, as in the thermal waters of Bareges, the Warm Springs and the Hot Springs of Virginia. &c. The main sulphuro-saline waters are the thermal springs of Aix-la-Chapelle, Acqui, Audinac, &c, the cold springs of Moffat, and Harrowgate; and the White Sulphur, Red Sulphur, Salt Sulphur, &c, of Virginia. These waters are laxative and eutrophic, and adapted, therefore— both when used internally and externally—for all the cases in which sulphur is needed as a iaxative (Vol. i. p. 185,) or as a eutrophic, (Vol. ii. p. 350.) 5. Ioduretted waters always contain a salt of iodine associated with chloride of sodium. The chief springs of this kind are those of Saratoga and Balston in this country: of Woodhall near Ashby de la Zouch in England; and of Creuznach in Germany. The properties of these waters are therefore dependent upon the joint influence of iodine and chloride of sodium; and their prolonged use is beneficial in MINERAL WATERS. 455 scrofula, and in other cases, in which the eutrophic agency of iodine, or of chloride of sodium, or of both, is indicated. 6. Chalybeate waters are numerous everywhere. As is shown by the table, many of the saline aperient waters contain iron in the form of carbonate or sulphate. The most celebrated of the decided chalybeates abroad, are Spa, Pyrmont, Schwalbach, Marienbad, Tun- bndge Wells, &c.; in this country, Balston, Saratoga, &c. As the iron is associated with free carbonic acid in most of the springs, the virtues which the waters enjoy must be dependent upon both. A simple chalybeate water is adapted for all cases in which chalybeates in a great state of dilution appear to be required: the carbonic acid, in addition, acts as an excitant; and, with some, produces exhilaration and an approach to intoxication. Carbonated chalybeates have, therefore, to be used with caution, especially in highly impressible individuals. 7. Simple carbonated waters are altogether indebted to carbonic acid for their efficacy. The Sweet Springs in Monroe county, Virginia, are the best specimen in this country. The temperature is 73°. Most of them contain either carbonate of soda or iron, or both ; and their medical efficacy is, of course, partly dependent upon the amount of these ingredients. The carbonic acid always, however, communicates decided qualities to them. It gives them their sparkling briskness and piquant taste; their excitant agency upon the stomach, and their ex- hilarating effect upon the whole system. The water at Pyrmont in Westphalia, which contains iron, and is highly charged with carbonic acid, is said to be drunk by the country people, partly as a medicine, and partly on account of the kind of intoxication it induces. Congress and other waters of Saratoga, and Seltzer are mainly indebted for their agreeable qualities to the carbonic acid they contain. This, too, is the pleasant ingredient in the effervescing draught; in soda powders, and in mineral waters from the fountain;—and it is to it, that these prepara- tions owe their power of arresting vomiting, when not dependent upon inflammation of the stomach; and that soda water, and Seltzer water aid digestion, when taken during a repast. As a refrigerant, carbon- ated water has been treated of already. (Vol. ii. p. 222.) The United States Pharmacopoeia has a formula for AQUA ACIDI CARBON'ICI, CARBONIC ACID WATER, Artificial Seltzer water, which is formed by throwing into a suitable receiver nearly filled with water, by means of a forcing pump, a quantity of carbonic acid equal to five times the bulk of the water. The carbonic acid is obtained from marble by means of dilute sulphuric acid. This is the soda water or mineral water of the shops. In regard to the external use of mineral Avaters, much need not be said. They produce their effects partly by their temperature, and partly by the particular mineral impregnation which they contain. The effects of these will be understood by comprehending those of the impreonations themselves. Saline and sulphurous waters stimulate the skin more than pure water of the same temperature; and the latter 456 COMBINATION OF THERAPEUTICAL AGENTS. exert a valuable agency in chronic cutaneous and other affections in which sulphur is beneficial. The Boue des Faux or deposit from the sulphurous waters is often an excellent application to various invete- rate cutaneous diseases. SECTION XL OF THE COMBINATION OF THERAPEUTICAL AGENTS. Importance of a due attention to principles—Value of authority—Professional qualifica- tions may be estimated by the prescription—Evils of complexity in prescribing—Rules for prescribing—Table of incompatibles—Doses of medicines—Conclusion. The main admitted classes of therapeutical agents, or of those which ought perhaps to be admitted, have now been examined. It is rare, however, for the practitioner to draw his resources, in the manage- ment of disease, from one class only. Even in the treatment of febrile and inflammatory diseases—for which sedatives are so admirably adapted—he not unfrequently has recourse to some of the classes of excitants. Thus he prescribes emetics, cathartics, diaphoretics, and revellents ; and often—when appropriately directed—with marked advantage; but, under other circumstances, with decidedly evil con- sequences. Yet, it is obvious, that they cannot be esteemed direct or true antiphlogistics. The actual immediate operation of these evacu- ants is the opposite of that produced by sedatives or true antiphlo- gistics : their antiphlogistic effect is only secondary; and, at times, they cause inflammation of the tissues on which their action is immediately exerted, without inducing their specific operation. This is, doubtless, one of the modes in which these ' local stimulants' prove injurious; but—to take the case of cathartics—even if they excite the secretion of the lining membrane of the intestinal canal, and produce evacuation after evacuation, as is too often done in febrile diseases, the perturbation, which they induce in the economy, may be attended with results anything but antiphlogistic; and, accordingly, they are now generally employed in the ordinary fevers of our coun- try, chiefly with the view of keeping the intestinal canal free from morbid secretions and accumulations,—not so much as depletives; whilst the trust of the practitioner is reposed rather in the proper use of sedatives,—as blood-letting, general or local, or both, as the case may require; refrigerants; nauseants and narcotics; with a strict in- culcation of mental and corporeal quietude,—than in the mixed seda- tive and perturbating plan of management, which was at one time universal; and still lingers with many of the older practitioners es- pecially. To one who has been taught, that the old method of management is essentia], and who has employed no other, the success that attends this milder, more soothing, and more philosophical treatment may appear COMBINATION OF THERAPEUTICAL AGENTS. 457 incredible. The author can affirm, however, from the results of both public and private experience, that it is so generally successful, that a death from bilious fever, is—in his observation—a not very common event. Similar testimony is afforded by an experienced observer, Professor Jackson, of Philadelphia, in favour of a mode of manage- ment perhaps even less active than the one which the author has in- culcated,—so far as regards the employment of local stimulants of the kind referred to._ "Typhoid fever, typhoid remittent, and bilious fever, I find to be infinitely more manageable when treated with occasionally local depletion, as it may be indicated by local symptoms, the expect- ant method, and alterative doses, than by the perturbating and evacu- ant plan. _ Under this course, I rarely see them fatal." The antiphlogistic or sedative treatment is, doubtless, the main stay of the practitioner in febrile maladies; but still, as shown under the proper heads, mild evacuants are necessary throughout their whole course; and, when they become protracted,—upon the principle of revulsion, agents may be demanded, the propriety of whose use in the earlier periods might be more questionable. In all cases of disease, the physician must investigate the nature of the morbid action. This—as elsewhere remarked—must be the point of departure for his therapeutical indications; and a wise knowledge of the properties of his medicinal agents will enable him to Carry into effect those indications;—but he must, not vacillate. Let his thera- peutics be guided by great general principles; and let him not fly from one indication to another, because the morbid condition may not be— or may not seem to be—yielding. If his principles be accurate, his indications will correspond ; and if not satisfied with his indications, there can be but little safety for the patient in the empiricism that must necessarily be the rule of conduct under such circumstances. It is an unfavourable index of the attainments of a physician, when he places undue store on some formula or agent for the cure of special morbid conditions. It is p>rim& facie evidence of faulty observation, and defective induction. It indicates a mind that searches after facts —too often ' false'—rather than after great principles ;—that is swayed by prepossessions rather than by true experience,—and that ought not to be trusted on trying or unusual occasions. To the possessor of such a mind, the advice of Swift to a young author,—if he had written anything which he thought particularly fine, to strike it out,—might not be inappropriate. The loss of the result of the practitioner's ob- servation—true or false—would be but trifling; whilst the reception of a false fact, and its admission as a ground of action, might be unfor- tunate. Primerose, in his work ' On common errors in physic,' {De Vulgi Erroribus in Uedicind, Amstelod. 1639,) has a chapter, entitled lNon esse mutanda remedia etiamsi curatio statim non succedat,'—that remedies are k not to be changed, although a cure may not immediately follow,— and the remark is as applicable at the present day as it was in his time. If due attention have not been paid to the investigations of the dis- ease__if any uncertainty exist as to its nature, or as to the powers of the therapeutical agents had recourse to,—or if the physician be thrown 458 COMBINATION OF THERAPEUTICAL AGENTS. off his balance by unreasonable expectations, or by petulance on the part of the patient,—he is apt to fly from one plan of treatment, or from one remedy to another; and, in this manner, to become bewildered. On all these accounts, it will be understood, that this fault ought to be more observable in young practitioners than in old ; and so striking is it apt to be in them, and so fraught with multitudinous evils, that it has been regarded by the author as a solemn duty yearly to caution the student against it;—inculcating, at. the same time, the necessity for inquiring strictly into the precise nature of the morbid phenomena which present themselves in any case that may fall under his attention, and for well comprehending the effects which his remedial agents are capable of exerting on the vital properties in health and disease; and when, after an ample investigation, he has laid down his indication of treatment, and decided upon the therapeutical agents that are adapted for fulfilling such indication, that he should not be disheartened, if he find his patient in the same condition at his subsequent visits; but persevere in his plan of treatment, unless some new and more philo- sophical view should present itself, which may lead him to infer, that the indication previously embraced and followed had been defective. There is no circumstance, which is so much calculated to render the young practitioner dissatisfied with the practice of his profession as this vacillation from one remedy to another without adequate reason. In- stead of daily adding to his stock of valuable practical knowledge, his experience becomes the result of incessant empirical trials with various articles of the materia medica, and is almost constantly false;—the danger being, in all such cases, that the agent last prescribed may ab- sorb the whole credit of the cure; whilst in many instances it may have been inoperative, and the successful result been owing to that instinctive action of recuperation which is seated in all organized bodies—vegetable as well as animal—and which is capable of repair- ing injuries, when such injuries do not overstep certain limits. The proper course for the physician to pursue in the treatment of chronic diseases—for to such these remarks are more especially applicable— is well expressed by Hippocrates in his aphorism:—' Omnia secundum rectam rationem facienti, si secundum rationem non succedat, non est ad aliud transeundum, quamdiu id manet quod ah initio visum fait' ' He who does everything in accordance with sound reason need not pass to any- thing else—provided the thing does not succeed according to reason— so long as everything is in the state it appeared to be in the beginning.' It may be* requisite, however, at times, to alter the form of a medicine, where, as in chronic diseases, the patient has become wearied of so long employing the same form; and for the reason, also that—without such variation—the remedy may lose its intrinsic powers in conse- quence of the system having become habituated to it. Connected with this subject. Professor Bigelow, of Boston, has some judicious remarks, which strikingly exhibit the fallacious mode of reasoning adopted by too many, in their investigation of disease, and of the proper adaptation of remedies. " The foundation of all know- ledge is truth. For truth, then, we must earnestly seek, even when its developments do not flatter our professional pride, nor attest the infalli- COMBINATION OF THERAPEUTICAL AGENTS. 459 Sty i0f -°Ur art' To discover truth in science is often extremely difficult; in no science is it more difficult than in medicine. Independ- ently of the common defects of medical evidence, our self interest, our i self-esteem, and sometimes even our feelings of humanity, may be ar- rayed against the truth. It is difficult to view the operations of nature, divested of the interferences of art, so much do our habits and partiali- ties incline us to neglect the former, and to exaggerate the importance of the latter. The mass of medical testimony is always on the side of art. Medical books are prompt to point out the cure of diseases. The young student goes forth into the world, believing that if he does not cure diseases, it is his own fault. Yet when a score or two of years have passed over his head, he will come at length to the conviction, that some diseases are controlled by nature alone. He will often pause at the end of a long and anxious attendance, and ask himself, how far the result of the case is different from what it would have been under less officious treatment than that which he has pursued; how many in the accumulated array of remedies, which have supplanted each other in the patient's chamber, have actually been instrumental in doing him any good. He will also ask himself, whether, in the course of his life, he has not had occasion to change his opinion, perhaps more than once, in regard to the management of the disease in question, and whether he does not, even now, feel the want of additional light ?------We are seldom justified in concluding, that our remedies have promoted the cure of a disease, until we know that cases, exactly similar in time, place, and circumstances, have failed to do equally well under the omis- sion of those remedies; and such cases, moreover, must exist in suffi- cient numbers to justify the admission of a general law on their basis. Nothing can be more illogical than to draw our general conclusions, as we are sometimes too apt to do, from the results of insulated and remarkable cases; for such cases may be found in support of any ex- travagance in medicine; and if there is any point in which the vulgar differ from the judicious part of the profession, it is in drawing prema- ture and sweeping conclusions from scanty premises of this kind. Moreover, it is in many cases not less illogical to attribute the removal of disease, or even of their troublesome symptoms, to the means which have been most recently employed. It is a common error to infer that things which are consecutive in the order of time, have necessarily the relation of cause and effect. It often happens that the last remedy used bears off the credit of having removed an obstruction, or cured a dis- ease, whereas in fact the result may have been owing to the first remedy employed, or to the act of nature uninfluenced by any of the reme- dies.-------In the study of experimental philosophy, we rarely admit a conclusion to be true, until its opposite has been proved to be untrue. But in medicine we are often obliged to be content to accept as evi- dence the results of cases which have been finished under treatment, because we have not the opportunity to know how far these results would have been different, had the cases been left to themselves. And it too frequently happens, that medical books do not relieve our diffi- culties on this score, for a great deal of our practical literature consists in reports of interesting, extraordinary, and successful results, pub- 460 COMBINATION OF THERAPEUTICAL AGENTS. lished by men who have a doctrine to establish, or a reputation to build. ' Few authors,' says Andral, ' have published all the cases they have observed, and the greater part have only taken the trouble to present to us those facts, which favour their own views. A prevailing error among writers on therapeutics proceeds from their professional, or per- sonal, reluctance to admit that the healing art, as practised by them, is not, or may not be, all sufficient in all cases; so that on this subject they suffer themselves, as well as their readers to be deceived.—Hence we have no disease, however intractable or fatal, for which the press has not poured forth its asserted remedies.-------It is only when, in connection with these flattering exhibitions, we have a full and faithful report of the failures of medical practice, in similar, and in common cases, setting forth not only the truth, but the whole truth, that we have a basis sufficiently broad to erect a superstructure in therapeutics, on which dependence may be placed." The present is a period eminently characterized for the accumulation of clinical observations; and much valuable information has been col- lected ; yet it is to be feared, the advantages, in this way obtained, have not been without countervailing results; and there are too many evidences of the minds of observers having been narrowed down to simple observation of occurrences, instead of being devoted to great general views. Facts have occupied the mind in place of induction. The senses have been engaged, whilst the higher powers of the intel- lect have, too often, been permitted to remain dormant. The cases published in the various periodicals, with the ex professo treatises on medical clinics, are so numerous and diversified, that the searcher after great principles of pathology and therapeutics scarcely knows at what point to commence his investigations. Were all the recorded facts' registered, and detailed by observers of adequate talent and discrimination, the severity of the task would be greatly dimi- nished ; but, unhappily, this is not the case ; and, hence, the difficulty, with the searcher after truth, is often extreme. If, indeed, we reflect on the mass of published cases, and the few—very few—that are alluded to as authorities on any point, we might have our medical ardour somewhat damped; and justly fear that all our labour might be fruitless, and that, in a few short years, the results might be con- signed to that oblivion which has shrouded those of our predecessors. That many—perhaps most—of the clinical cases, which have been emanations of recent and present periods, will meet with this fate, is doubtless; but still, many must remain; and a spirit of accurate ob- servation, and faithful registration of the results of such observation, emanating from distinguished teachers of the day, and ramifying amongst their pupils, in every quarter of the globe, will persist after they have passed away, and cannot fail to develope useful results. In an _ early part of this work, it was remarked, that where the pathological lesion is understood, the therapeutical indication will be clear ; and, in general, more easily fulfilled. No necessity will exist for complex combinations of different classes of medicinal agents * or of different agents of the same class. In every case, before prescribing, COMBINATION OF THERAPEUTICAL AGENTS. 461 all agents should be rejected, Avhose modus operandi has not been well settled by careful, repeated, and unbiased observation. It has been well remarked, that a medicinal prescription should carry upon its very face an air of energy and decision, and speak intelligibly the indication it is destined to fulfil;—and it may be laid down as a position, not in much danger of being controverted, that where the intention of a medical compound is obscure, its operation will be imbecile :—' Medi- cus vir prudens nihil praescribat, nisi cujus sufficientem queat reddere rationem, quum requiritur; hinc nunquam tumultuario, sed semper ex indication^ prms rite deducta agat.' (Gaubius.) There is, doubtless, truth, too, m the opinion entertained by some, that a practitioner's professional abilities may be estimated somewhat by the character of his prescription,—the scientific physician not permitting any agent to enter without a satisfactory reason. Where no such reason can be adduced, there is usually cloudiness in the mind of the practitioner. What can the philosophic individual—professional or lay—think of the reasoning—if reasoning it may be called—of the country practi- tioner in England, who was celebrated for the complexity of the medi- cines which he gave to his patients—a complexity which was always, as might be expected, in a direct ratio with the obscurity of the case ? "If," said he, "I fire a great profusion of shot, it is very extraordinary if some do not hit the mark!" Or, of the subject of a similar anecdote, related by Sir Gilbert Blane, who, being asked by his patient, why he put so many ingredients into his prescription, answered, " in order that the disease may take that which it likes best;"—a feeling, which would have readily enabled him to range himself under the ' good men and true' of homoeopathy, the believers in which—as has been elsewhere shown—maintain that there is a marked affinity between every morbid phenomenon and some particular article of the materia medica. Un- like, however, the practitioner in question, they endeavour to discover such agent; and administer it alone in the disease for the removal of which it is considered to be specially adapted. Where complexity is indulged, it is obviously impracticable to test, by any kind of experience, the properties of therapeutical agents, or to discriminate between the main sanative ingredients and such as are of no efficacy, or may even counteract them. "It is an opinion," says Sir Henry Holland, not unfrequent among medical men, that the multiplication of medicines in our hands adds in the same ratio to the power and facilities of practice. This view is admissible only in a very qualified sense. It is, in truth, as correct to say, that the addition of new medicines or preparations, which do not expressly accomplish new purposes, or fulfil more advantageously those already attained, becomes an incumbrance to the practitioner, and an impediment to the progress of science. It may be alleged, and must be fully admitted, that combinations have often effects not resulting equally from any of their ingredients. This is true as respects many vegetable medicines of powerful action, whe- ther narcotic, purgative, diuretic or alterative. It is especially true as regards chemical remedies, where changes of combination may occa- sionally be calculated upon favouring the effects desired; though much more frequently the facts by which their use is determined are merely 462 ART OF PRESCRIBING. empirical in kind. The observation of these facts is obviously one of the most important objects to the practitioner; but, it must be added, one of the most difficult also; for even in the simpler combinations we can rarely obtain that precise estimate of effects, which is so essential to the success and certainty of practice;—still less can we do so in those qf a complicated kind. Each new ingredient added to a medicine in- creases in a higher ratio the chances of error, and obscures the evidence by which such error may be detected and removed. And the applica- tion of other science to this subject, though never to be lost sight of, is here made so uncertain by being subjected to vital actions, that it must ever be admitted with great caution, and wholly in subordination to experience. Several compound medicines of undoubted efficacy con- tradict chemical laws, even in the points where it might seem of greatest moment to maintain them." In forming an extemporaneous or magistral formula or prescription, the physician makes use of either the articles of the materia medica, or preparations that are kept in the shops of the apothecary, the formulae for which are directed in the National Pharmacopoeia, or—in other words—are officinal. At times, one of these articles will answer every purpose which the prescriber has in view; at other times, it is esteemed advisable to add some agent that may aid its operation; or, it may pos- sess objectionable qualities which may require the addition of some ingredient to obviate or correct them; and lastly, it rarely happens, that medicines are in a form the most advisable for exhibition; and, ac- cordingly, they require some material to give them the necessary con- stitution. Hence, it has been laid down, by most writers on Thera- peutics, that every compound formula ought to consist of a basis or principal ingredient; an adjuvant or aid to the principal ingredient; a corrigent to modify any objectionable qualities of the base or com- pound ; and a constituent or excipient to give form to the medicine—the formgebende Mittel of the Germans. The basis and the excipient are the most essential components of a magistral formula, and must almost always, consequently, be present; yet the latter need not always form part of the prescription as sent to the apothecary. For example, twenty grains of rhubarb may be pre- scribed as a cathartic; without giving any directions as to the excipient or constituent. Occasionally, the constituent requires an intermedium, as where copaiba is directed in the form of emulsion: yolk of egg or mucilage in such case is the intermedium;—water the constituent. In the following prescription, all these ingredients are contained: R.—Copaib. f^ij. Basis. 01. Tereb. f £j. Adjuvant. Mucilag. Acaciae f^iij. Intermedium. 01. Menth. pip. n\x. Corrigent. Aquae f^vj.—M. Constituent. yet both the adjuvant and corrigent might be omitted. Frequently, with the view of augmenting the action of the base or principal ingredient, the prescriber adds other preparations of the same ART OF PRESCRIBING. 463 agent, which may thus take the place both of adjuvant, corrigent, and constituent; for example, in the following prescription for a cathartic R.—Infusi Rhei f gxj. Tincturse Rhei fgj.— M. The rhubarb is here the basis in both articles; the water of the offi- cinal infusion is the main constituent; and the dilute alcohol of the tincture may act as a corrigent; whilst the tincture itself is unquestion- ably an adjuvant. In like manner, tincture of senna is added to in- fusion of senna; tincture of catechu to infusion of catechu; tincture of cinchona to infusion or decoction of cinchona, &c. &c. In the gene- rality of cases, however, the prescriber combines different agents which are possessed—as he conceives—of similar powers, in order that he may induce a more potent result than the basis alone might be capable of effecting. Combinations of this kind require judgment and accurate observation; the want of which is a great cause of the confusion per- ceptible in many extemporaneous formulae, and from which certain officinal preparations are not altogether free.—Take, for example, Flec- tuarium opiatum polyphar.macum of the Parisian ' Codex,' which was re- tained as the lineal descendant of the ancient Theriac, with even an additional number of ingredients: it contained acrid substances, 5; astrin- gent, 5; bitter, 22; indigenous aromatics, 10; umbelliferous aromatics, 7 • balsams and resinous substances, 8; fetid ingredients, 6; narcotic, 1; earthy substance, 1; gummy or amylaceous, 4; saccharine, 3; total, 72 ; and one of these the flesh of the viper / —a little more than a grain of opium, which may be regarded as a principal effective ingredient, being con- tained in a drachm of the compound. Yet, when the question arose in the London College of Physicians, as to what should be the fate of this " many-headed monster," and when it was proposed to eject it from the Pharmacopoeia, it was found that the college was divided, and that fourteen members were for the measure, and thirteen against it; so that it was discarded by a majority of one only. (See the Preface to the author's New Remedies, 6th edit. Philad. 1851.) Its place in the Pharmacopoeias is now taken by CONFECTIO OPII, which, as elsewhere shown, (Vol. i7 p. 393,) consists of opium—a narcotic,—cinnamon, ginger, cardamom, nutmeg—aromatic excitants, and clarified honey— the excipient. Of the combination of agents that are possessed of similar powers, we have examples in common purgative mixtures; as where sulphate of magnesia, infusion of senna, and tincture of senna are associated in the same prescription;—in the ordinary emetic com- bination of tartrate of antimony and potassa, and ipecacuanha;—in the officinal preparation, EXTRACTUM COLOCYNTHIDIS COMPOSITUM, (Vol. i. p. 226,) which is composed of colocynth, aloes, and scammony—cathartic ingredients; in CONFECTIO SEMI, (Vol. i. p. 207,) composed of senna, liquorice root, figs, pulp of prunes, pulp of tamarinds, pulp of purging cassia, &c—mild cathartics; and in the PILULJ CATHARTICS COMPOSITE, (Vol. i. p. 226,) composed of compound extract of colocynth, extract of jalap, mild chloride of mercury, and gamboge;—all cathartics. The action of the basis or principal ingredient is often, also, aided 464 ART OF PRESCRIBING. by the addition of some agent, which may not possess the same pro- perties as the basis, and yet may make its operation more certain. The addition of tartrate of antimony and potassa, for example, to a cathartic, renders the intestinal canal more impressible to the action of the latter; and the addition of a tonic has frequently a similar effect. In selecting his agents with the view of correcting the action of the basis or principal remedy, it is necessary for the prescriber to be well acquainted with its ordinary qualities and effects. Many cathartics, for example, cause tormina or nausea, which may be prevented by the addition of an aromatic, or of a small quantity of opium. The same corrigents are demanded when tonics, as cinchona in powder, or ferri subcarbonas, disagree, from quantity, with the stomach. Mild chloride of mercury, or mercurial pill, when administered with the view of causing the peculiar effects of mercurials on the system, is apt to pass off by the bowels, and thus defeat the wishes of the prescriber. He adds, therefore, a small quantity of opium to each dose to prevent this. Often, too, a disagreeable medicine, which might, otherwise, cause nausea and vomiting, may be retained by combining it with substances that mask its unpleasant character, and at the same time induce a different impression on the stomach. Turpentine, for exam- ple, is often rejected when merely dropped on sugar, or mixed with molasses; but it may be retained, if made into an emulsion with yolk of egg, or mucilage as the intermedium; and,peppermint water, which is an aromatic excitant, as the excipient or constituent. The same remarks apply to copaiba, which, at times, resists all the ingenuity of the physician, and is invariably rejected. The discovery of the mode of enveloping it in gelatin capsules (Vol. i. p. 530,) was therefore valu- able ; for in many cases, doubtless, it is the disagreeable and enduring taste of the copaiba that occasions its rejection. In an early part of this work, the author has dwelt upon the import- ance of laying down proper indications for the treatment of disease; and has dwelt at some length upon the extensive information in every department of his profession that is required of the competent thera- peutist. If his indications be erroneous, and his information defective, so must be his practice. Especially liable to error is he, when the case seems to require separate and distinct indications, and he feels it, in consequence, necessary to combine substances which, individually, may seem adapted for the fulfilment of an indication; and yet, when combined, may not answer for any. Cases repeatedly arise, where the indication, may be, first, to evacuate the bowels, and, secondly, to pro- duce a tonic effect upon the digestive organs, and the system generally; hence, tonics and cathartics are associated with much propriety • ca- thartics, again, may require an association with opiates, as in cases of colic, and enteritis of the peritoneal coat,—a full dose of an opiate acting as asedative, and relieving spasm of the muscular coat, whilst the cathartic acts upon the mucous coat, and augments the secretion from it. On this principle, calomel and opium are so often combined in the same formula. In the combination of substances that act chemically upon each other, care is required, that the resulting compound may not defeat LIST OF INCOMPATIBLES. 465 the intentions of the prescriber. " It should be remembered," says M. Mialhe, " that when we administer several remedies at the same time, one of three things will happen; either each of the medicines will act in its own proper manner, as if it had been administered alone, or one of the substances will augment the action of the other, or the associated bodies will diminish or even annihilate each other's action." It is important, consequently, for the physician to be acquainted with the therapeutical agents, that are incompatible in the same pre- scription, before he can combine his medicines with thorough under- standing. He may then escape the application of the satire of the late Professor James Gregory, of Edinburgh, that " it is easier to prescribe than to think." The following list of ' Incompatibles' was prepared with considerable care by Dr. James Hamilton, of Baltimore, now of the United States Navy, and was kindly placed at the author's dis- posal. It has the advantage of the incompatible substances being in alphabetical order. LIST OF CHEMICAL INCOMPATIBLES. Absinthium, Wormwood.—Iron, sulphate of. Lead, acetate of. Zinc, sulphate of. Acacia, Gum Arabic.—Acids. Alcohol. Ammonia. Ether, sulphuric. Iron, tincture of chloride of. Lead, acetate of. Soda, borate of. Acidum Arseniosum, Arsenious Acid.—-Bark, decoction of. Copper, sulphate of. Lime water. Silver, nitrate of. Potassium, iodide of. Potassa, sulpho-hydrate of. Acidum Citricum, Citric Acid.—Acetates, alkaline. Acetates, metallic. Acid, nitric. Acid, sulphuric. Carbonates, alkaline. Carbonates, earthy. Carbonates, metallic. Po- tassa, tartrate of. Sulphurets, alkaline. Sulphurets, earthy. Soaps. Acidum Hydrocyanicum, Hydrocyanic Acid.—Acids, mineral. Antimony, oxides of. Chlorine. Iron, salts of. Mercury, oxides of. Oxides generally. Silver, nitrate of. Sul- phurets. Acidum Muriaticum, Muriatic Acid.—Alkalies. Carbonates. Earths. Lead, acetate of. Oxides. Potassa, sulphate of. Potassa, tartrate of. Silver, nitrate of. Acidum Nitricum, Nitric Acid.—Alcohol. Alkalies. Carbonates. Earths. Iron, pro- tosulphate of. Lead, acetate of. Oils, essential. Oxides. Potassa, acetate of. Sulphu- rets. Zinc, sulphate of. Acidum Oxalicum, Oxalic Acid.—Lime, salts of. Acidum Sulphuricum, Sulphuric Acid.—Alcohol. Barium, chloride of. Calcium, chlo- ride of. Carbonates. Chlorohydrates. Nitrates. Oils, essential. Organic substances. Oxides. Sulphohydrates. Vegetable astringent infusions. Acidum Tartaricum, Tartaric Acid.—Alkalies. Carbonates, alkaline. Carbonates, earthy. Earths. Lead, salts of. Lime, salts of. Lime water. Mercury, salts of. Potassa, salts of. Vegetable astringents. Adeps, Lard.— Alcoholic preparations. Decoctfons. Infusions. Tinctures. Athens Nitrici Spiritus, Spirit of nitric Ether.—Guaiac, tincture of. Iron, sulphate of. Aloe, Aloes.—Mercury, nitrate of. Silver, nitrate of. Tin, protochloride of. Aloes, Decoctum Compositum, Compound Decoction of Aloes.—Acids, strong. Antimony and potassa, tartrate of. Lead, acetate of. Mercury, chloride of. Zinc, sulphate of. Alumen, Alum.—Alkalies. Aikaline salts. Ammonia, carbonate of. Ammonia, chlo- rohydrate 'of. Galls. Kino. Lead, acetate of. Lime water. Magnesia, carbonate of. Mer- cury, salts of. Potassa, tartrate of. Ammonias Acetatis Liquor, Solution of Acetate of Ammonia.—Acids. Alkalies. Alum. Copper, sulphate of. Iron, sulphate of. Lime water. Lead, acetate of. Magnesia, sul- phate of. Mercury, bichloride of. Silver, nitrate of. Zinc, sulphate of. VOL. II.—30 466 LIST OF IN COMPATIBLES. Ammoniae Liquor, Solution of Ammonia.—Acids. Alum. Salts, metallic. Ammonia3 Carbonas, Carbonate of Ammonia.—Acids. Alkalies, fixed. Alum. Carbon- ates, alkaline. Iron, sulphate of. Lead, acetate of. Lime. Lime, chloride of. Magnesia. Magnesia, sulphate of. Mercury, acetate of. Mercury, bichloride of. Mercury, protochlo- ride of. Potassa, bitartrate of. Salts, acidulous. Zinc, sulphate of. Ammoniae Murias, Muriate of Ammonia.—Acid, sulphuric. Acid, nitric. Alkalies, fixed. Carbonates, alkaline. Iron, sulphate of. Lead, acetate of. Lime. jNIagnesia. Magnesia, sulphate of. Potassa. Potassa, carbonate of. Salts, metallic. Silver, nitrate of. Zinc, sulphate of. Ammoniae Spiritus Aromaticus, Aromatic Spirit of Ammonia.—Acids. Lime water. Salts, earthy. Salts, metallic. Salts, with excess of acid. Amygdalae Oleum, Oil of Almonds.—Acids. Mercury, bichloride of. Oxymel. Poppies, syrup of. Potassa, bisulphate of. Potassa, bitartrate of. Potassa, tartrate of. Resins. Squill, syrup of. Water, hard. Angustura, Angustura Bark.—Acids, mineral. Antimony and potassa, tartrate of. Cinchona, infusion of. Copper, sulphate of. Galls, infusion of. Iron, sulphate of. Lead, acetate of. Lead, triacetate of. Mercury, bichloride of. Potassa. Silver, ni- trate of. Antimonii et Potassas Tartras, Tartrate of Antimony and Potassa.—Acids, mineral. Al- kalies. Carbonates, alkaline. Decoctions, bitter. Earths. Sulphohydrates. Infusions, bitter. Metals. Soaps. Antimonii Sulphuretum Auratum, Golden Sulphuret of Antimony.—Acids. Salts, acidu- lous. Anthemis, Chamomile.—Cinchona, infusion of. Iron, preparations of. Isinglass, solu- tion of. Lead, acetate of. Lead, triacetate of. Mercury, bichloride of. Silver, ni- trate of. Argenti Nitras, Nitrate of Silver.—Acid, arsenious. Acid, chlorohydric and salts. Acid, sulphuric and salts. Acid, tartaric and salts. Alkalies, fixed. Earths, alkaline. Sul- phohydrates. Soaps. Vegetable astringent infusions. Water, common. Armoracia, Horseradish.—Carbonates, alkaline. Cinchona, infusion of. Galls, infusion of. Mercury, bichloride of. Silver, nitrate of. Arnica, Leopard's Bane.—Acids, mineral. Iron, sulphate of. Lead, acetate of. Zinc, sulphate of. Aurantii Cortex, Orange-peel.—Cinchona, infusion of. Iron, sulphate of. Lime water. Auri Chloridum, Chloride of Gold.—Alkalies. Vegetable juices. Barii Chloridum, Chloride of Barium.—Carbonates. Nitrates. Phosphates. Sul- phates. Bistorta, Bistort.—Gelatin. Iron, sulphate of. Calamus, Sweet Flag.—Lead, acetate of. Calcis Liquor, Lime water.—Acids. Borates. Citrates. Infusions, astringent. Salts, alkaline. Salts, metallic. Sulphur. Tartrates. Tinctures. Calx Chlorinata, Chlorinated Lime.—Acid, sulphuric. Alkalies, fixed. Ammonia, car- bonate of. Carbonates, alkaline. Sulphates. Capsicum, Cayenne Pepper.— Alum. Ammonia. Carbonates, alkaline. Copper, sul- phate of. Galls, infusion of. Iron, sesquisulphate of. Lead, acetate of. Mercury, bichloride of. Mercury, nitrate of. Potassa, carbonate of. Silver, nitrate of Zinc, sul- phate of. Cardamomum, Cardamom.—Acids. Iron, sulphate of. Mercury, chlorides of. Caryophyllus, Cloves.—Cinchona. Antimony and potassa, tartrate of. Iron, sulphate of. Lead, acetate of. Lime water. Silver, nitrate of. Zinc, sulphate of. Cascarilla, Cascarilla.—Same as the preceding. Catechu, Catechu.—Acid, chlorohydric. Acid, sulphohydric. Albumen. Alkalies. Baryta, solutions of. Gelatin. Lime water, and salts of lime. Salts, alkaline. Salts' metallic. Centaurea Benedicta, Blessed Thistle.—Lead, acetate of. Silver, nitrate of. Cinchona, Peruvian Bark.— Antimony and potassa, nitrate of. Carbonates, alkaline. Catechu, infusions of. Chamomile, infusions of. Columbo, infusions of. Iron salts of Lime water. Mercury, bichloride of. Rhubarb, infusion of. Silver nitrate of. Zinc Bulphate of. LIST OF INCOMPATIBLES. 467 Coccus, Cochineal—Iron, sulphate of. Lead, acetate of. Zinc, sulphate of. Colchicum, Colchicum.—Acids. Colocynthis, Colocynth.— Alkalies, fixed. Iron, sulphate of. Lead, acetate of. Lead, triacetate of. Lime water. Mercury, bichloride of. Silver, nitrate of. Conium, Hemlock.—Vegetable acids. Cupri Sulphas, Sulphate of Copper.—Alkalies. Ammonia, acetate of. Calcium, chloride of. Carbonates, alkaline. Lead, acetate of. Lead, triacetate of. Lime water. Mercury, bichloride of. Potassa, tartrate of. Silver, nitrate of. Soda, biborate of. Vegetable astringent infusions. Vegetable astringent tinctures. Cuprum Ammoniatum, Ammoniated Copper.—Acids. Alkalies, fixed. Lime water. Digitalis, Foxglove.—Cinchona, infusion of. Iron, sulphate of. Lead, acetate of. Diosma, Buchu.—Galls, infusion of. Iron, sulphate of. Ferri Chloridi Tinctura, Tincture of Chloride of Iron.— Alkalies. Carbonates, alkaline. Mucilage. Vegetable astringent infusions. Ferri et Potassse Tartras, Tartrate of Iron and Potassa.—Acids. Lime water. Potassa, sulpho-hydrate of. Vegetable astringent infusions. Ferri Sulphas, Sulphate of Iron.—Alkalies. Ammonia, acetate of. Ammonia, chloro- hydrate of. Carbonates, alkaline. Earths. Lead, acetate of. Lead, triacetate of. Potassa, nitrate of. Potassa and soda, tartrate of. Salts, with base forming insoluble sulphates. Silver, nitrate of. Soap. Soda, biborate of. Vegetable astringent infusions. Ferrum Ammoniatum, Ammoniated Iron.—Alkalies. Carbonates, alkaline. Lime water. Vegetable astringents. Galla, Galls.—Acid, chlorohydric, Acid, sulphuric. Antimony and potassa, tartrate of. Copper, sulphate of. Gelatin. Iron, salts of. Lead, acetate of. Lime water. Mercury, bichloride of. Mercury, nitrate of. Potassa, carbonate of. Salts, generally. Silver, nitrate of. Soda, carbonate of. Zinc, sulphate of. Guaiaci Resina, Guaiac.—Acids, mineral. Gentiana, Gentian.—Iron, sulphate of. Lead, acetate of. Haematoxylon, Logwood.—Acid, acetic. Acid, chlorohydric. Acid, nitric. Acid, sul- phuric. Antimony and potassa, tartrate of. Copper, sulphate of. Iron, sulphate of. Lead, acetate of. Humulus, Hops.—Acids, mineral. Iron, salts of. Lead, salts of. Mercury, salts of. Silver, salts of. Hydrargyri Chloridum Corrosivum, Corrosive Chloride of Mercury.—Almond mixture. Alkalies, fixed. Ammonia. Antimony and potassa, tartrate of. Bismuth. Carbonates, alkaline. Copper. Iron. Lead. Lead, acetate of. Lime water. Mercury. Oils, vola- tile. Potassium, sulphuret of. Silver, nitrate of. Soap. Sulphur. Zinc. Chamomile, infusions of. Cinchona, infusions of. Columbo, infusions of. Horseradish, infusions of. Oak bark, infusions of. Senna, infusions of. Simaruba, infusions of. Tea, infusions of. Hydrargyri Chloridum Mite, Mild Chloride of Mercury.—Acid, nitric. Alkalies. Anti- mony, golden sulphuret of. Carbonates, alkaline. Chlorine. Copper. Iron. Lead. Lime water. Potassium, sulphuret of. Soaps. Hyoscyamus, Henbane.— Acids, vegetable. Iron, sulphate of. Lead, acetate of. Silver, nitrate of. Ipecacuanha, Ipecacuanha.—Acids, vegetable. Galls, infusion of. Kermes Mineralis, Kermes Mineral.—Acids. Kino, Kino.—See Galla. Krameria, Rhatany.—Acids, mineral. Gelatin. Iron, salts of. Lavandula, Lavender.—Iron, sulphate of. Limonis Cortex, Lemon Peel.— Acid, nitric. Acid, oxalic. Acid, sulphuric. Acid, .tar- taric. Lime water. Liquor Arsenici et Hydrargyri, Solution of Arsenic and Mercury.— Laudanum. Sulphate, muriate and acetate of Morphia. Lupulina, Lupulin.—lvon.. Mercury, salts of. Platinum, salts of. Tin, salts of. Magnesiae Carbonas, Carbonate of Magnesia.— Acids. Alkalies. Alum. Copper, sul- phate of Iron, sulphate of. Lead, acetate of. Mercury, acetate of. Mercury, bichlo- ride of. Potassa, bitartrate of. Salts, acidulous. Salts, neutral. Silver, nitrate of. Zinc, sulphate of. 468 LIST OF INCOMPATIBLES. Magnesiae Sulphas, Sulphate of Magnesia.—Alkalies, fixed. Ammonia, muriate of. Barium, chloride of. Calcium, chloride of. Carbonates, alkaline. Lead, acetates of. Silver, nitrate of. Marrubium, Horehound.—Iron, sulphate of. Melissa, Balm.—Iron, sulphate of. Lead, acetate of. Silver, nitrate of. Morphia, Morphia.—Oxides, metallic. Morphia, Salts of.—Alkalies. Carbonates, alkaline. Decoctions of vegetable astringents. Infusions of vegetable astringents. Lime. Magnesia. Silver, nitrate of. Moschus, Musk.—Cinchona, infusion of. Iron, sulphate of. Mercury, bichloride of. Silver, nitrate of. Mucilago, Mucilage.—Alcohol. Ammonia. Acids, strong. Ether, sulphuric, compound spirit of. Iron, chloride of, tincture of. Salts, metallic. Opium, (solid,) Opium.—Alkalies. Cinchona. Galls. Lead, acetate of. Mercury, bichloride of. Opium, (Infusion of, &c.)—Ammonia. Carbonates, alkaline. Copper, sulphate of. Galls, infusion of. Iron, sulphate of. Lead, acetate of. Mercury, bichloride of. Silver, nitrate of. Zinc, sulphate of. Pimenta, Pimento.—Cinchona, infusion of. Iron, nitrate of. Iron, sulphate of. Piper, Black Pepper.—Galls, infusion of. Plumbi Acetas, Acetate of Lead.—Acids, Alkalies. Alum. Ammonia, solution of, acetate of. Antimony and potassa, tartrate of. Carbonates, alkaline. Earths, alkaline. Chlorohydrates. Iron, ammoniated. Iron and potassa, tartrate of. Soaps. Soda, biborate of. Sulphates. Sulphurets. Water, common. Plumbi Subacetatis Liquor, Solution of Subacetate of Lead.—Alkalies. Carbonates, alkaline. Mucilage. Soap liniment. Sulphates, alkaline. Sulphurets of alkaline metals. Potassae Acetas, Acetate of Potassa.—Fruits, acid. Acids, mineral. Tamarinds. Salts, acid. Salts, alkaline. Salts, metallic. Potassae Arsenitis Liquor, Solution of Arsenite of Potassa.—Cinchona, infusion of. Cop- per, salts of. Lime water. Potassa, sulphohydrate of. Silver, nitrate of. » Potassse Carbonas, Carbonate of Potassa.—See Potassse bicarbonas. Potassae Bicarbonas, Bicarbonate of Potassa.—Acids. Alum. Ammonia, acetate of. Ammonia, carbonate of. Ammonia, muriate of. Antimony and potassa, tartrate of. Cop- per, acetate of. Copper, sulphate of. Iron, chloride of. Iron and potassa, tartrate of. Iron, sulphate of. Lead, acetate of, Lime water. Magnesia, sulphate of. Mercury, bichloride of. Mercury, protochloride of. Silver, nitrate of. Salts, acidulous. Soda, biborate of. Zinc, sulphate of. Potassse Nitras, Nitrate of Potassa.—Acid, sulphuric. Alum. Copper, sulphate of. Iron, sulphate of. Magnesia, sulphate of. Soda, sulphate of. Zinc, sulphate of. Potassae Sulphas, Sulphate of Potassa.—Acid, chlorohydric. Acid, nitric. Lead, acetate of. Lime and compounds. Mercury, bichloride of. Silver, nitrate of. Potassae Tartras, Tartrate of Potassa.—Acids. Barium, chloride of. Lead, acetates of. Lime. Magnesia. Salts, acidulous. Silver, nitrate of. Tamarinds. Vegetables, acid. Potassae Bitartras, Bitartrate of Potassa.—Acids, mineral. Alkalies. Earths, alkaline. Potassii Sulphuretum, Sulphuret of Potassium.—Salts, metallic. Water. Quassia, Quassia.—Lead, acetate of. Silver, nitrate of. Quercus, Oak Bark.— Alkalies. Carbonates, alkaline. Cinchona, infusion of. Iron, salts of. Isinglass, solution of. Lead, acetates of. Lime water. Mercury, bichloride of. Zinc, sulphate of. Quiniae.Sulphas, Sulphate of Quinia.—Alkalies. Earths, alkaline. Infusion of orange- peel, compound. Infusion of Roses. Solutions, astringent. Tincture of cinchona. Rheum, Rhubarb.— Acids, strong. Antimony and potassa, tartrate of. Angustura, infusions of. Catechu, infusions of. Cinchona, infusions of. Galls, infusions of. Iron, sulphate of. Lead, acetate of. Mercury, bichloride of. Silver, nitrate of. Zinc sul- phate of. Rosa Gallica, Red Roses.—Gelatin. Iron, sulphate of. Lime water. Zinc, sulphate of. Salix, Willow.— Ammonia, carbonate of. Gelatin. Iron, sulphate of. Lime water. Potassa, carbonate of. Zinc, sulphate of. Salvia, Sage.—Iron, salts of. ART OF PRESCRIBING. 469 Copper' tmn^t?' r A? ammoniated. Iron and potassa, tart- 3 M^TbffljSS ^ad'acetateof- Magnesia, sulphate of. Me/cury, acetate of Ve^hl.S ■ <■ fU.ercnvy> protochloride of. Salts, acidulous. Silver, nitrate oi. Vegetable astringent infusions. Zinc, sulphate of. Sarsaparilla, Sarsaparilla.-Lead, acetate of. Lime water. Mercury, nitrate of. Scammonium, Scammony.—Acids. Scilla, Squill.— Alkalies. nfST,fl^LAfidST'- Str°ng; An*imony and P°tassa, tartrate of. Cinchona, infusion of. Lead, acetate of. Lime water. Mercury, bichloride of. Silver, nitrate of. Serpentaria, Virginia Snake Root.—Lead, acetate of." Simaruba, Simaruba.-Cwhonntes, alkaline. Catechu. Cinchona. Galls. Lead, acetate of. Lime water. Mercury, bichloride of. Silver, nitrate of. Soda] Boras Borate of Soda.—Ante. Ammonia, chlorohydrate of. Ammonia, sulphate of. Chlorohydrates, earthy. Potassa. Sulphates, earthy. Sodse Carbonas, Carbonate of Soda.—See Potassae Carbonas. Sodas et Potassae Tartras, Tartrate of Soda and Potassa.—Acids. Ammonia, muriate of. Baryta salts of. Lead acetates of. Lime, salts of. Magnesia, sulphate of. Potassa, sulphate of. Salts, acidulous. Soda, sulphate of. Tamarinds. Sodae Phosphas, Phosphate of Soda.— Acid, chlorohydric. Acid, nitric. Acid, sulphuric Barium, chloride of. Lime. Magnesia. Sodae Sulphas, Sulphate of Soda.—See Magnesias Sulphas. Stramonium, Stramonium.— Acids, mineral. Lvon, salts of. Lead, salts of. Mercury salts of. Silver, salts of. ' Tamarindus, Tamarinds.— Antimony and potassa, tartrate of. Carbonates, alkaline. Lime water. Potassa, salts of. Taraxacum, Dandelion.—Galls, infusion of. Iron, sulphate of. Lead, acetate of. Mer- cury, bichloride of. Silver, nitrate of. _ Tormentilla, Tormentil.—Alkalies. Earths, alkaline. Iron, salts of. Isinglass, solu- tion of. Valeriana, Valerian.—Iron, salts of. Zinci Sulphas, Sulphate of Zinc.—Alkalies. Earths. Milk. Sulphohydrates. Vege- table astringent infusions. The prescriber, who is well acquainted with chemistry, may throw together in the same prescription substances that are really incom- patible, and act upon and modify each other; but he does this under- standing^ ; and with the view of obtaining a new compound. The Pharmacopoeia of the United States contains formulae for various pre- parations produced by double decomposition. MISTURA FERRI COMPOSITA has been considered an unchemical compound, because carbonate of potassa and sulphate of iron are ingredients; and it would be objec- tionable, were the prescriber to believe, that each of these agents exerts its own powers when the compound is taken. Such is not, however, his belief. He is desirous of administering an oxide of iron, and he knows that this must be the result of the mutual decomposition of those salts. Hence, the formula is chemical and philosophical. The same remarks apply to PILULJE FERRI COMPOSITE of the pharmacopoeias: and to black wash, (Yol. ii. p 313,) and yellow wash, (Vol. ii. p. 314,) the former made by the admixture of lime water and mild chloride of mercury, and the latter of lime water and corrosive chloride of the same metal. In all these cases, the physician is desirous of producing, 470 COMBINATION OF THERAPEUTICAL AGENTS. by chemical decomposition, a resulting agent, which he knows by ex- perience to be capable of exerting definite powers. Such are the chief points for the guidance of the young practitioner in the " art of prescribing." In works on therapeutics, the whole sub- ject is so clogged with difficulties and cautions, that he is apt to regard it as a hopeless task; and if he were to take those works as his guides, it would not be easy for him to proceed. The matter is really, how- ever, more simple. At the outset of his career, when he has examined fully into the history and nature of any case that presents itself to his notice;—laid down his indications, and taken into consideration all those circumstances that modify the indications, he decides upon the agent which he considers best adapted for fulfilling them, and upon the dose in which he thinks it ought to be given. He then reflects, whether it require the addition of any other agent that may add to its powers, and whether there be any unpleasant action apt to be induced by it, which may demand an addition to the prescription to obviate it. In making these additions he must be careful, that there is no result- ing incompatibility—therapeutical or chemical—unless he is desirous of producing a third substance from the action of the ingredients upon each other, which may possess different properties from those of either article taken singly. Throughout the preceding pages, it has been seen, that the form in which a therapeutical agent is prescribed is not ahvays a matter of indifference. In many cases, powders disagree;—at times, in conse- quence of the unpleasant impression made by them on the nerves of taste; at others, owing to their exciting nausea or vomiting, or both, by the impression they make on the stomach. Hence, in cases of atony of that organ, owing either to convalescence from acute diseases, or to chronic diseases,—as chronic dyspepsia,—the physician prefers to ad- minister tonics in the form of infusion, by which he gets rid of the insoluble woody matter. Where, however, he is desirous of making a powerful impression on the stomach, and through it on the organism —as in a case of intermittent fever, to break in upon the chain of as- sociated actions, that give occasion to the recurrence of the paroxysms —he prefers to administer cinchona in powder; and often finds that it succeeds, when other forms of preparation, and sulphate of quinia had failed. The pilular form is generally chosen, where the article is of nauseous taste, and—in the case of cathartics—where it is not de- sired that the operation should be speedy. There are substances, too, which, like mild chloride of mercury, are so heavy that they could not be taken in any ordinary thin vehicle; but even these may be administered in thick fluids, as molasses or syrup. "Where it is de- sirable, that the medicine should produce its effects soon; and, a fortiori, that it should impress powerfully the gustatory nerves as well, the form of mixture is always chosen. Many cathartics are accordingly given in mixture; nauseous antispasmodics are prescribed in the same form; and—as has been remarked under the appropriate head—sulphate of quinia acts more satisfactorily in solution than in substance. Throughout this work, the doses of medicines have been given as they apply to the adult male; but various circumstances materially ART OF PRESCRIBING. 471 modify these, and in modes that have been referred to under the dif- ferent classes, or under individual articles. Those circumstances, too, which have been described as modifying the therapeutical indications, as age, sex, original conformation, habit, climate, mental affections, way of life, causes, seat, period, &c, of the disease,—may equally modify them. (See Vol. i. p. 61.) A great difficulty with the young practitioner is to apportion the dose to the age. As a general rule, the dose diminishes in an inverse ratio with the age; children requiring a much smaller quantity of most medicines. In old age, again, the doses may usually be smaller; yet, owing to the blunted sensibility, certain agents require to be administered in larger quanti- ties. The following tables of doses by Gaubius, and Dr. Thomas Young may be regarded as approximations, which may serve to a certain extent as guides. The estimates of Gaubius, were made from the results of observation. Those of Dr. Young are based upon a formula, the results of which correspond closely with those of Gaubius. " The doses of most medicines for children under twelve years of age," he observes, " must be diminished in the proportion of the age to the age increased by 12 ; thus, for example, at two years— 2 . 2 + 12 = ■ 1 " 7" Dose for an adult, from 20 Gaubius. Young. to 60 years of age, 3j. or gr. 60. jj. or gr. 60. For a child under one year, 1-15 to 1- gr. 4 to 5. 1-13 gr. 4f " two years old, 1-8 gr. 7J 1-7 gr. 8 4-7 it three years, 1-6 gr. 10. 1-5 gr. 12. u four years, 1-4 gr. 15. 1-4 gr. 15. <( seven years, 1-3 gr. 20. gr. 22. u fourteen years, 1-2 gr. 30. gr. 32. For a mar l twenty years old, 2-3 gr. 40. gr.37£ Yet numerous exceptions occur to any rule of this kind. For exam- ple, children under two years of age are not very susceptible to the action of mercury. It is, indeed, exceedingly difficult to salivate them at this age, even when large doses of calomel are given; yet, at the age of three or four, they are very readily influenced by mercurials. The ordinary dose of calomel, again, for a child of the age last men- tioned, is generally enough to operate on the adult. In infancy, on the other hand, the susceptibility to the action of narcotics is great, so that the dose has to be reduced below the ordinary average applicable to other remedies;—but these are points that have been referred to else- where. . . In the different formulas, and in apportioning the doses of medicines, the weights and measures used are those of the Pharmacopoeia of the United States of America; but it is not uncommon to direct modes of apportionment that are liable to vary in consequence of the want of uni- formity in the size of the instruments employed for the purpose. Still they are presumed to average as follows:—a cupful (Cyathus,) con- tains f.5ivss.; &WW&GLASSFUL (Cyathus vinarius,)hom fgiss.to fgij.; a table-spoonful (Cochleare amplum,) f 3ss.; a dessert-spoonful (Coch- leare medium,) about f3ij.; a teaspoonful (Cochleare parvum,) about 472 combination of therapeutical agents. f 5j- None of these measures can be used, where great exactitude is required. Many teacups, for example, contain six fluidounces; and the breakfast cups twelve. Wine-glasses, too, are of various sizes, as well as spoons. When great nicety is not required, the physician often directs important articles to be given by drops; but this is an unsatis- factory method compared with that of dispensing them by the minim measure. A fluidrachm is divided into 60 portions, and each of these is termed a minim. The minim must, therefore, always be of the same size, whatever may be the character of the fluid; but this cannot be the case with the drop, which differs materially according to the lip of the vessel, nature of the fluid, &c. The great difference between the size of the minim and the drop of various fluid preparations is exhibited in the following table. The re- sults were obtained by Mr. Durand, a skilful Pharmacien of Philadel- phia under circumstances, as regards the different articles, as nearly identical as possible. One fluidrachm of Acid, acetic (crystallizable,) ---- hydrocyanic, (medicinal,) ---- muriatic, ---- nitric, diluted, (1 to 7,) sulphuric, aromatic, diluted, (1 to 7,) Alcohol, (rectified spirit,) ------diluted, (proof spirit,) Arsenite of potassa, solution of, Ether, sulphuric, Oils of aniseed, cinnamon, cloves, peppermint, sweet almonds and olives, Solution of ammonia, (strong,) -----------------(weak,) Tinctures of assafetida, foxglove, guaiac and opium, -------of muriate of iron, Vinegar, distilled, . ------of colchicum, ------ of opium, {black drop,) ------- of squill, Water, distilled, Wine, (Teneriffe,) -----antimonial, -----of colchicum -----of opium, Drops. contains 120 45 54 84 51 90 120 51 138 120 57 150 120 54 45 120 132 78 78 78 78 45 75 INDEX OF REMEDIES. A. Ablution, ii. 227. Absinthium, ii. 47. Abstraction, i. 436. Acacia, ii. 270. Acetone, i. 275. Acetum, i. 288. cantharidis, ii. 271. colchici, i. 325, ii. 203. destillatum, i. 289. opii, i. 394. scilke, i. 153, 259, 310. Acid, acetic, i. 289, ii. 268, 281. diluted, i. 289. empyreumatic, ii. 400. arsenious, ii. 91, 288, 341. benzoic, i. 265, 330. boracic, ii. 226. chromic, ii. 288. citric, ii. 211. gallic, ii. 124. hydrocyanic, ii. 190. hydrosulphuric, ii. 211. lactic, i. 334. muriatic, i. 333, ii. 288, 395, 399. diluted, ii. 395. nitric, i. 333, ii. 77, 277, 287, 346, 396. diluted, ii. 78. nitro-muriatic, ii. 346. pyroligneous, ii. 143, 400. succinic, i. 532. sulphuric, i. 333, ii. 76, 150, 268, 277, 288, 400. aromatic, ii. 77, 150. diluted, ii. 77, 150. sulphurous, ii. 396. tannic, ii. 123. Acida mineralia, i. 333, ii. 277, 281, 287, 346. vegetabilia, i. 298, ii. 347. Acids mineral, i. 333, ii. 277, 281, 287, 346. vegetable, i. 333, ii. 347. Acidum aceticum, i. 289, ii. 268, 281. dilutum, i. 289. empyreumaticum, ii. 143. arseniosum, ii. 91, 288, 341. benzoicum, i. 265. Acidum chromicum, ii. 288. citricum, ii. 211. gallicum, ii. 124. hydrocyanicum, ii, 190. hydrosulphuricum, ii. 211. muriaticum, i. 333, ii. 288, 395, 399. dilutum, ii. 395. nitricum, i. 333, ii. 77, 268, 277, 287, 346, 396. dilutum, ii. 78. nitro-muriaticum, ii. 346, 399. sulphuricum, i. 333, ii. 76,150, 268, 277, 288, 400. aromaticum, ii. 77, 150. dilutum, ii. 77, 150. sulphurosum, ii. 396. tannicum, ii. 123. Aconite, i. 410. Aconitia, i. 413. Aconitum, i. 410. Acqua Binelli, ii. 118. Acqua Brocchieri, ii. 123. Acupuncture, i. 554, ii. 269, 373. Adeps, ii. 421. .Ether, i 420, 448, 538. Mtherea,, i. 447. Affusions, ii. 227. Alcohol, i. 533. dilutum, i. 533. Aldehyde, i. 420. Alder, black, n. 53. Aletris, ii. 43. Alkalia, ii. 345. Alkalies, ii. 345. Allium, i. 268, ii. 262. cepa, ii. -262. porrum, ii. 262. Allopathy, i. 100. Almonds, i. 273, ii. 419. Aloe, i. 199, 455. Aloes, i. 199, 455. Alteratives, ii. 290. renal, i. 305. Althseae flores, i. 272, ii. 408. radix, i. 272, ii. 408. Alum, i. 143, 222, ii. 144. dried, i. 222, ii. 144, 281. 474 INDEX OF REMEDIES. Alum root, ii. 140. Alumen, i. 148, 222, ii. 144. ' • exsiccatum, i. 222, ii. 144, 281. Alumina, sulphate of, ii. 397. Aluminae sulphas, ii. 397. Amaro-adstringentia, ii. 105. Amber, i. 450, 531. Ammonia, i. 335, 542. arseniate of, ii. 341. carbonate of, i. 335, 352, 544, ii. 384. citrate of, i. 353. muriate of, i. 545. preparations of, i. 447, ii. 262, 273. Ammoniac, i. 259. Ammoniacum, i. 259. Ammoniated lotions, i. 544, ii. 262. Ammoniae arsenias, ii. 341. carbonas, i. 335, 352, 544, ii. 384. citras, i. 353. murias, i. 545. praeparata, i. 447, ii. 262, 273, Ammonium, iodide of, ii. 333. Amygdala, i. 273, ii. 410. Amylum, ii. 448. Anaesthetics, i. 380. Anaesthetization, i. 380. Angelica, ii. 49. tree bark, i. 361. Angustura, ii. 45. Angustura, false, i. 428. Anise, i. 488. Anisum, i. 488. Antacids, ii. 376. modus operandi of, ii. 377. special, ii. 381. Antalkalies, ii. 385. special, ii. 387. Anthelmintics, i. 236. cathartic, i. 239. mechanical, i. 239, 251. preventive, i. 240. special, i. 241. true, i. 238, 241. Anthemis, i. 159, ii. 44. Anthrakokali, ii. 353. sulphuretted, ii. 353. Antidotes, ii. 431. table of, ii. 434. Antilithics, i. 326. acid, i. 333. alkaline, i. 334. special, i. 333. therapeutics of, i. 329. tonic, i. 336. Antimonials, i. 347. Antimonii chloridum, ii. 287. et potassae tartras, i. 144, 348, ii. 274. sulphuretum praecipitatiim, i. 349. Antimony and potassa, tartrate of, i. 144, 348, ii. 274. chloride of, ii. 287. Antimony, sulphuret of, precipitated, i. 349. Antiparasitics, ii. 442. special, ii. 442. Antipathy, i. 100. Antiperiodic tonics, ii. 78. Antiseptics, ii. 391, 397. Antispasmodics, i. 434. excitant, i. 441. mental, i. 436. modus operandi of, i. 435. special, i. 441. therapeutics of, i. 438. Apocynum androsaemifolium, i. 161. cannabinum, i. 235. Aqua acidi carbonici, ii. 455. amygdalae amarae, ii. 195. arsenicalis Pearsonii, ii. 341. Binellii, ii. 118. Brocchierii, ii. 123. calcis, i. 335, ii. 156, 385. camphorae, i. 508. chlorini, i. 289, ii. 348, 395. cinnamomi, i. 487. foeniculi, i. 493. laurocerasi, ii. 191. menthae piperitae, i. 494. viridis, i. 495. picis liquidae, i. 269, ii. 143. Aralia nudicaulis, ii. 365. racemosa, ii. 365. spinosa, i. 361. Argenti chloridum, ii. 74. nitras, ii. 71, 151, 273, 279, 286. fusus, ii. 71. oxidum, ii. 73, 152. praeparata, ii. 344. Argil, pure, ii. 157. Argilla pura, ii. 157. Aristolochics, i. 464. Armoracia, i. 301, 520. Arnica, i. 432. Arrowroot, ii. 411. Brazilian, ii. 412. East Indian, ii. 412. English, ii. 414. Florida, ii. 413. Portland, ii. 412. Tahiti, ii. 412. West India, ii. 412. Arsenic and mercury, iodide of, ii. 332. iodide of, ii. 91, 332. preparations of, ii. 340. Arsenici iodidum, ii. 332. praeparata, ii. 340. Artemisia vulgaris, ii. 48. Arteriotomy, ii. 183. Arum, i. 361. Asarabacca, i. 297. Asarum, ii. 49. Europaeum, i. 297. Asclepias, flesh coloured, i. 161. incarnata, i. 161. Syriaca, i. 426. tuberosa, i. 359. Ash, prickly, i. 360. Assafetida, i. 267, 441, 458. INDEX OF Astringents, ii. 101. in blennorrhcea, ii. 116. in diabetes, ii. 117. in diphtheritis, ii. 106. direct, ii. 105. in ephidrosis, ii. 117. indirect, ii. 105. in fever, ii. 106. in hemorrhage, ii. 108. in inflammation, ii. 106. of the stomach, &c. ii. 114. in leucorrhoea, ii. 117. mineral, ii. 144. modus operandi, of, ii. 101. in phthisis, ii. 118. in relaxation of parts, ii. 118. special, ii. 123. therapeutics of, ii. 106. in topical diseases, ii. 118. vegetable, ii. 123. Atropia, i. 401. Aurantii cortex, i. 504. Auri chloridum, ii. 343. cyanuretum, ii. 343. iodidum, ii. 343. oxidum, ii. 344. praeparata, ii. 342. et sodii chloridum, ii. 343. Aurum metallicum, ii. 392. Avenae farina, ii. 417. Avens, water, ii. 52, 140. Azedarach, i. 249. Azote, protoxide of, i. 556. B. Bachelor's buttons, i. 428. Ballota lanata, i. 313. Balm, i. 359. tea, i. 359. Balsam of Peru, i. 260. of Tolu, i. 261, 289. Balsamico-adstringentia, ii. 105. Balsamum Peruvianum, i. 260. Tolutanum, i. 261, 289. Barii chloridum, ii. 340. Barium, iodide of, ii. 332. chloride of, ii. 340. Bark, pale, ii. 80. Peruvian, ii. 78. red, ii. 80. Winter's, i. 510. yellow, ii. 79. Barks, spurious, ii. 83. Barley, ii. 410. Bassora gum, i. 271. Bath, air, hot, i. 548. air, warm, i. 363. airpump, ii. 267. _ airpump vapour, ii. 267. arm, i. 366. cold, ii. 29. foot, i. 366. REMEDIES. Bath, hand, i. 366. hip, i. 366. shower, ii. 227. vapour hot, i. 548. warm, ii. 363. Russian, i. 364. warm, i. 365. warm, partial, i. 366. water, hot, i. 548. water, warm, i. 365. Bathing, cold, ii. 29. Bay, sweet, ii. 50. white, ii. 50. Bearberry, i. 339, ii. 134. Bear's whortleberry, i. 339, ii. 134. Bebeerina, ii. 99. Bebeerine, ii. 99. Belladonna, i. 400. Benne, i. 282, ii. 407. Benzin, i. 426. Benzoin, i. 264, 287. Benzoinum, i. 264, 287. Bismuth, subnitrate of, ii. 74. Bismuthi, subnitras, ii. 74. Bittersweet, ii. 366. Blackberry root, ii. 141. Black drop, i. 394. Bleeding, revulsive, ii. 245, 250. Blisters, ii. 231, 269. Blisters, perpetual, ii. 233. Bloodletting, ii. 160. local, ii. 180. Bloodroot, i. 159. Borax, i. 316, 470, ii. 225, 381. Bran, ii. 423. Brandy, i. 533. Brayera anthelmintica, i. 248. Bread, dyspeptic, i. 166. Bromide of iron, ii. 335. Bromidum potassii, ii. 335. Bromine, ii. 334. Brominium, ii. 334. Broom, i. 309. Brucia, i. 432. Buchu, i. 336. Bugleweed, i. 427. Burdock, ii. 368. Butterflyweed, i. 359. Butternut, i. 208. C. Cabbage, skunk, i. 447. Cainca root, i. 312. Caincae radix, i. 312. Calamina, ii. 370. Calamina praeparata, ii. 370. Calamus, i. 300, 511. Calcii chloridum, ii. 339. Calcis carbonas praecipitatus, ii. 156. Calcium, chloride of, ii. 339. Calomel, i. 210, ii. 314. Caloric, i. 363, 548, ii. 266, 274 397. 476 INDEX OF REMEDIES. Calx, ii. 395. Calx chlorinata, ii. 349, 395, 398. (Samphor, i. 354, 451, 506. Camphora, i. 354, 451, 506. Canella, i. 509. Cannabis indica, i. 417. Cantharidal collodion, ii. 272. Cantharis, i. 316, ii. 263, 269, 278, 355. atrata, i. 318. cinerea, &c. i. 318. marginata, i. 318. vittata, i. 318, ii. 273. Capsicum, i. 514, ii. 262. Caraway, i. 489. Carbo animalis, ii. 338. purificatus, ii. 338. ligni, ii. 53, 400. Carbon, bisulphuret of, i. 426. sesqui-iodide of, ii. 332. Carbonic acid gas, ii. 212. Carburetted hydrogen, ii. 212. Cardamom, i. 490. Cardamomum, i. 490. Carmina, i. 474. Carminatives, i. 474. Carota, i. 320. Carrageenin, i. 285. Carrot seed, i. 320. Carthamus, i. 362. Carum, i. 489. Caryophyllus, i. 492. Cascarilla, ii. 44. Cassia fistula, i. 189. Marilandica, i. 207. - purging, i. 189. Cassise fistulae pulpa, i. 189. Castor, i. 443, 458. Castoreum, i. 443, 458. Cataplasm, emollient, ii. 423. mustard, ii. 260. yeast, ii. 213. Cataplasma fermenti, ii. 213. Cataria, i. 532. Catechu, ii. 125. • Cathartics, i. 162. in abdominal inflammation, i.178 brisk, i. 192. in colic, i. 180. in constipation, i. 180. defined, i. 162. drastic, i. 223. in dropsies, i. 183. in dyspepsia, i. 179. in eruptive fevers, i. 178. in fever, i. 175. in head affections, i. 181. in hemorrhage, i. 180. in hemorrhoids, i. 181. in hepatic diseases, i. 179. in intermittents, i. 177. in mania, i. 181. mental, i. 171. mild, i. 184. modus operandi of, i. 167. in the neuroses, i. 182. Cathartics, in pregnancy, i. 181. saline, i. 214. special, i. 184. therapeutics of, i. 175. in thoracic inflammation, i. 178. in worms, i. 183. Catnep, i. 532. Caustique-Filhos, ii. 285. Cauterants, ii. 234. actual, ii. 234, 282. potential, ii. 234, 284. Cayenne pepper, i. 514, ii. 262. Cedar, red, i. 458. Centaury, American, ii. 42. Cera alba, ii. 420. flava, ii. 420. Cerate of arsenic, ii. 289. calamine, ii. 370. carbonate of lead, ii. 371. subacetate of lead, ii. 371. resin, i. 526. compound, i. 526. savine, ii. 279. simple, ii. 421. soap, ii. 373. of Spanish flies, ii. 271. spermaceti, ii. 422. of carbonate of zinc, ii. 370, 371. Ceratum arsenici, ii. 289. calaminae, ii. 370. cantharidis, ii. 271. cetacei, ii. 422. plumbi carbonatis, ii. 371. subacetatis, ii. 371. resinae, i. 526, ii. 369. compositum, i. 526, ii. 369. sabinae, ii. 279, 369. saponis, ii. 373. simplex, ii. 421. zinci carbonatis, ii. 370, 371. Cerevisiae fermentum, ii. 213. Cetaceum, i. 276, ii. 419. Cetraria, i. 284, ii. 409. Cetrarin, ii. 99. Cetrarina, ii. 99. Chalk, ii. 155, 385. prepared, ii. 155, 385. Chalybeate bread, ii. 66. Chalybeates, ii. 55. Chamomile, i. 159, ii. 44. German, ii. 52. Charcoal, ii. 53, 400. animal, ii. 338. Charms for cramp, i. 437. Chemical agents, ii. 374. Chenopodium, i. 242. Cherry bark, wild, ii. 40. Chestnut, horse, ii. 97. Chimaphila, i. 310. China root, ii. 360. Chirayita, ii. 37. Chloride of olefiant gas, i. 426. Chlorine, i. 289, ii. 349, 381, 398. Chlorinium, i. 289, ii. 347, 381, 398. Chloroform, i. 423, ii. 100. INDEX OF REMEDIES. 477 Chondrus, i. 285, ii. 409. Cimicifuga, ii. 207. Cinchona, ii. 78. flava, ii. 79. pallida, ii. 80. - rubra, ii. 81. Cinchonia, ii. 91. iodide of, ii. 91, 333. sulphate of, ii. 91. Cinnamomum, i. 486. Cinnamon, i. 486. Classification, author's, i. 122. Barbier's, i. 118. Pereira's, ii. 119. A. T. Thomson's, i. 118. Cloves, i. 492. Cocculus, ii. 433. Codeia, i. 387. Colchici radix, i. 325, ii. 199. semen, i. 325, ii. 199. Colchicum root, i. 325, ii. 199. seed, i. 325, ii. 199. Collodion, i. 539. cantharidal, ii. 272. Colocynth, i. 225. Colocynthis, i. 225. Colomba, ii. 34. Columbo, ii. 34. American, ii. 41. Combination, art of, ii. 456. Compression, methodical, ii. 301. Confectio aromatica, i. 488. aurantii, i. 505. opii, i. 393. rosae, ii. 136. sennae, i. 207. Confection, aromatic, i. 488. of opium, i. 393. of orange peel, i. 505. of roses, ii. 136. of senna, i. 207. Confidence, ii. 32. Conium, i. 406. Contra-stimulants, ii. 186. Contrastimulus, doctrine of, ii. 186. Contrayerva, ii. 49. Convolvulus panduratus, i. 235. Coontie, ii. 414. Copaiba, i. 266, 320, 526. Copper, ammoniated, ii. 76. salts of, ii. 75. subacetate of, ii. 75, 280. sulphate of, i. 143, ii. 75, 152, 280. Coptis, ii. 43. Coriander, i. 490. Coriandrum, i. 490. Cornine, ii. 96. Cornus circinata, ii. 96. florida, ii. 95. sericea, ii. 96. Corylus rostrata, i. 252. Cotton, i. 470. Cotula, ii. 50. Cowhage, i. 251. Cranesbill, ii. 134. Cream of tartar, i. 219, 314. soluble, ii. 226. taraxacum, i. 320. Creasote, i. 250, 269, 292, 540, ii. 142, 290; 400. Creasotum, i. 250, 269, 292, 540, ii. 142, 290, 400. Creta, ii. 155, 385. praeparata, ii. 155, 385. Critical discharges, i. 37, ii. 375. Crocus, i. 362. Crowfoot, ii. 273. Cubeba, i. 320, 516. Cubebs, i. 320, 516. Cucumber tree, ii. 51. Cupping, ii. 180, 267. dry, ii. 267. Cupri sales, ii. 75. subacetas, ii. 75, 280. sulphas, i. 143, ii. 75, 152, 280. Cuprum ammoniatum, ii. 76. Cups, cut, ii. 267. Cusparia, ii. 45. bark, false, i. 428. Cydonium, i. 283, ii. 424. D. Dandelion, i. 318. Dash, ii. 227. Decoction of barley, ii. 410. of bittersweet, ii. 367. of dandelion, i. 319. of dogwood, ii. 96. of guaiacum, i. 356. of Iceland moss, i. 284. of logwood, ii. 133. of mezereon, i. 358. of white oak bark, ii. 132. of Peruvian bark, ii. 86. of pipsissewa, i. 312. of sarsaparilla, compound, ii. 362. of seneka, i. 258. of uva ursi, i. 340, ii. 134. Decoctum cetrarias, i. 284. chimaphilae, i. 312. cinchonae, ii. 86. cornus floridse, ii. 96. dulcamarse, ii. 367. guaiaci, i. 356. hasmatoxyli, ii. 133. hordei, ii. 410. mezerei, i. 358. quercus albae, ii. 152. sarsaparillas compositum, ii. 362. scoparii compositum, i. 310. senegas, i. 258. taraxaci, i. 319. uvas ursi, i. 340, ii. 134. Delphinium, i. 321. Demulcents, ii. 402. external, ii 405, 421. internal, ii. 407. 478 INDEX OF REMEDIES. Demulcents, special, ii. 407. Deobstruents, ii. 430. Dewberry root, ii. 141. Diaphoretics, i. 340. excitant, i. 352. modus operandi of, i. 341. sedative, i. 347. special, i. 347. topical, i. 363. Digitalin, i. 325, ii. 199. Digitalis, i. 321, ii. 195. Diluents, ii. 425. in dropsy, ii. 427. modus operandi of, ii. 426. Diospyros, ii. 140. Disinfectants, ii. 387. special, ii. 393. Diuretics, i. 302. in dropsies, i. 307. excitant, i. 308. in febrile inflammatory affections, i. 307. modus operandi of, i. 305. in rheumatic affections, i. 308. sedative, i. 321. special, i. 308. therapeutics of, i. 307. Dock, blunt-leaved, ii. 141. water, ii. 141. Dog's bane, ii. 161. Dogwood, ii. 95. round-leaved, ii. 96. swamp, ii. 96. Dose, black, i. 207. Doses, mode of estimating, ii. 471. vary according to age, &c. &c, ii. 471. Douche, ii. 227. Dracontium, i. 447. Dragon root, i. 361. Drastics, i. 166. Draught, black, i. 207. Drop, black, i. 394. Drops, fever, Warburg's, ii. 99. Dulcamara, ii. 366. Dyers' saffron, i. 362. E. Eau hemastatique de Bonjean, ii. 210. medicinale d'Husson, ii. 205. Efforts of nature, i. 37, ii. 375. Elaterium, i. 232. Elder flowers, i. 362. Elecampane, i. 269. Electricity, i. 461, 463, 549, ii. 269, 373. galvanic, i. 461. magnetic, i. 461, 553. Electro-magnetism, i. 461, 463. Electro-puncture, i. 554, ii. 269, 373. Elixir of opium, McMunn's, i. 397. of vitriol, ii. 77. Elm, slippery, i. 283, ii. 424. Emetia, i. 157. Emetic, Tartar, i. 144. Emetics, i. 128. in diseases of the alimentary canal, i. 138. in amaurosis, i. 137. in bubo, i. 138. in cholera, i. 138. direct, i. 142. in diarrhoea, i. 139. in dropsy, i. 142. in dysentery, i. 139. in dyspepsia, i. 138. indirect, i. 144. in diseases of the chest, i. 136. in diseases of the encephalon, i. 137. in fevers in general, i. 135. in gallstone, i. 141. in gout, i. 139. in hemorrhage, i. 139. in inflammations, i. 136. in intermittent fevers, i. 134. in jaundice, i. 140. in the neuroses, i. 141. in orchitis, i. 138. in phthisis, i. 138. in remittent fevers, i. 135. in rheumatism, i. 139. special, i. 142. therapeutics of, i. 134. Emmenagogues, i. 451. cathartic, i. 455. excitant, i. 458. modus operandi of, i. 452. special, i. 455. Emollients, ii. 421. Emplastrum ammoniaci, ii. 372. ammoniaci cum hydrargyro, ii. 372. assafoetidae, i. 404, 443. belladonnae, i. 404. calefaciens, ii. 265. cantharidis compositum, ii. 272. ferri, ii. 372. galbani compositum, i. 446, ii. 372. hydrargyri, ii. 312, 372. opii, i. 394. picis Burgundicas, ii. 265. picis cum cantharide, ii. 265. plumbi, ii. 371. resinaa, ii. 371. saponis, ii. 372. Emulsion, almond, i. 274. Enantiopathy, i. 100. Enemata, i. 172. Epispastics, ii. 231. Ergot, i. 462, 465, ii. 208. Ergota, i. 462, 465, ii. 208. Ergotin, ii. 208, 210. Erigeron Canadense, i. 321. heterophyllum, i. 321. Philadelphicum, i. 321. Erodents, ii. 279. INDEX OF REMEDIES. 479 Errhines, i. 294. special, i. 296. therapeutics of, i. 295. Eryngium, ii. 50. Erythronium, i. 161. Escharotic revellents, ii. 279. Escharotics, ii. 234, 376. Essence of mustard, Whitehead's, ii. 264. de petit grain, i. 504. of peppermint, i. 494. of spearmint, i. 495. Ether, i. 420, 448, 538. chloric, strong, i. 425. compound, i. 425. hydrochloric, i. 426. nitric, i. 420. pyroacetic, i. 270. sulphuric. See Ether. Eupatorium, i. 353. teucrifolium, i. 354. Euphorbia corollata, i. 161. ipecacuanha, i. 162. Euphorbium, i. 298. Eutrophic liniments, ii. 313. Eutrophics, ii. 290. compressing, ii. 301, 371. indirect, ii. 299. modus operandi of, ii. 293. special, ii. 302. therapeutics of, ii. 298. topical, ii. 369. Excitants, i. 471. in constipation, i. 479. in collapse, i. 476. in delirium tremens, i. 482. in fever, i. 479. in gastric affections, i. 477. in hypertrophy of the heart, i. 481. in inflammation, i. 481. in local inflammation, i. 483. mental, i. 484. modus operandi of, i. 473. in the neuroses, i. 482. in paralysis, i. 482. special, i. 486. in surgical affections, i. 484. therapeutics of, i. 477. Exercise, ii. 29. Expectorants, i. 253. demulcent, i. 270. direct, i. 254. emetic and nauseant, i. 287. excitant, i. 257. special, i. 257. topical, i. 287. Extract of aconite, i. 412. alcoholic, i. 412. ammoniated, i. 412. of belladonna, i. 404. alcoholic, i. 404. of black pepper, i. 514. of butternut, i. 209. acetic, of colchicum, ii. 202. of colocynth, compound, i. 226. Extract of cubebs, fluid, i. 518. of dandelion, i. 319. of gentian, ii. 37. Goulard's, ii. 149. of hellebore, black, i. 457. of hemlock, i. 409. alcoholic, i. 410. of hemp, i. 417, 470. of henbane, i. 400. alcoholic, i. 400. of jalap, i. 224. of krameria, ii. 131. of liquorice, i. 279. of logwood, ii. 133. of May apple, i. 210. of nux vomica, i. 429. of opium, i. 392. of Peruvian bark, ii. 87. of pinkroot and senna, fluid, i. 245. of quassia, ii. 39. of rhatany, ii. 131. of rhubarb, i. 197. fluid, i. 197. of sarsaparilla, ii. 363. fluid, ii. 365. of senna, fluid, i. 206. of stramonium leaves, i. 406. seed, i. 406. of valerian, fluid, i. 445. Extractum aconiti, i. 412. alcoholicum, ii. 412. belladonnae, i. 404. alcoholicum, i. 404. cannabis, i. 417, 470. cinchonae, ii. 87. colchici aceticum, ii. 202. colocynthidis compositum, i. 226. conii, i. 409. alcoholicum, i. 410. cubebae fluidum, i. 518. gentianae, ii. 37. glycyrrhizae, i. 279, ii. 408. haematoxyli, ii. 133. hellebori, i. 457. hyoscyami, i. 400. alcoholicum, i. 400. jalapae, i. 224. juglandis, i. 209. krameriae, ii. 131. nucis vomicae, i. 429. opii, i. 392. pareirae, i. 339. piperis fluidum, i. 514. podophylli, i. 210. quassiae, ii. 39. rhei, i. 197. fluidum, i. 197. sarsaparillae, ii. 363. fluidum, ii. 364. sennae fluidum, i. 206. spartii scoparii, i. 310. spigeliae et sennae fluidum, i. 245. stramonii foliorum, i. 406. 480 INDEX OF REMEDIES. Extractum stramonii seminis, i. 406. taraxaci, i. 319. Valerianae fluidum, i. 445. F. Fear, i. 436. Fennelseed, i. 493. Fern, male, i. 245. Ferri ammonio-citras, ii. 67. arsenias, ii. 341. carbonas, ii. 63. chloridum, ii. 59. citras, ii. 67. et potassae tartras, ii. 60. et quinae citras, ii. 67. ferrocyanuretum, ii. 60. filum, ii. 67. iodidum, ii. 64, 331. lactas, ii. 66. nitras, ii. 159. oxidum hydratum, ii. 58. pernitras, ii. 154. phosphas, ii. 62. praeparata, ii. 55, 345. pulvis, ii. 68. ramenta, ii. 67. sales, ii. 55. subcarbonas, ii. 57. sulphas, ii. 62, 154. Ferruginous preparations, ii. 55. Ferrum ammoniatum, ii. 59. Fever root, i. 236. Ficus, i. 188. Figs, i. 188. Filix mas, i. 245. Firing, ii. 284. Flag, sweet, i. 300, 511. blue, i. 236. Flaxseed, i. 280, ii. 407. Fleabane, Canada, i. 321. Philadelphia, i. 321. various leaved, i. 321. Flies, potato, i. 318. Spanish, i. 316, ii. 263, 269, 278, 355. Flour, wheat, ii. 423. Fceniculum, i. 493. Foxglove, i. 321, ii. 195. Fomentations, warm, i. 367. Frasera, ii. 41. Friction, i. 368, ii. 266, 301. Frostwort, ii. 368. Fucus amylaceus, i. 286, ii. 409. helminthocorton, i. 249. Fuligo, ii. 143. Fuligokali, ii. 354. sulphuretted, ii. 354. G. Galbanum, i. 268, 446, 458. GaUa, ii. 128. Galls, ii. 128. Galvanism, i. 461, 463, 552, ii. 269, 373. Galvanopuncture, i. 554, ii. 373. Gamboge, i. 226. Gambogia, i. 226. Garlick, i. 268, ii. 262. Gas, acidum carbonicum, ii. 212. ammoniacal, i. 542. hydrogenium, ii. 212. carburetum, ii. 212. nitrous oxide, i. 556. oxygen, i. 555. Gases, excitant, i. 555. sedative, ii. 212. Gaultheria, i. 501. Gentian, ii. 36. blue, ii. 38. Gentiana, ii. 36. Catesbaei, ii. 38. chirayita, ii. 37. Geranium, ii. 134. Geum, ii. 52, 140. Gillenia, i. 152. Ginger, i. 302, 518. Glycerina, ii. 424. Glycyrrhiza, i. 279, ii. 408. Glysters, i. 172. Gold, chloride of, ii. 343. cyanuret of, ii. 343. iodide of, ii. 343. metallic, ii. 342. nitro-muriate of, ii. 290. oxide of, ii. 344. and sodium, chloride of, ii. 343. powder, ii. 342. preparations of, ii. 342. Golden rod, i. 533. Goldthread, ii. 43. Gossypium, i. 470. Goulard, ii. 149. Goulard's extract, ii. 149. Goulard's vege to-mineral water, ii. 149. Granati fructus cortex, ii. 135. radicis cortex, i. 247. Grass, star, ii. 43. Guaiac, i. 355, 462. Guaiaci lignum, i. 355, ii. 364. resina, i. 356, 462. Guaiacum, i. 355. wood, i. 355, 462, ii. 364. Gum Arabic, i. 270, ii. 307. Bassora, ii. 271. Senegal, ii. 271. tragacanth, i. 281. Gutta Percha, dissolved in chloroform, 1. 540. H. Haematoxylon, ii. 132. Hamamelis Virginica, i. 427. Haemospasia, ii. 186, 267. Haemostasis, ii. 186. Hardhack, ii. 141. Hartshorn and oil, ii. 263. INDEX OF REMEDIES. 481 Haschisch, i. 418. Haustus niger, i. 207. Hazel, beaked, i. 252. witch, i. 427. Heated metal, ii. 282. Hedeoma, i. 458, 495. Helianthemum, ii. 368. Hellebore, American, ii. 206. black, i. 456. white, i. 296, ii. 205. Helleborus, i. 456. Hemidesmus Indicus, ii. 369. Hemlock, i. 406. gum, ii. 266. Hemp, Indian, i. 235. Henbane, i. 398. Hepatica, ii. 53. Heracleum, i. 532. Hermodactyl, ii. 199. Heteropathy, i. 100. Heuchera, ii. 140. Hiera picra, i. 203. Hilarity, i. 484. Hippocastanum, ii. 97. Hive syrup, Coxe's, i. 154, 259. Homoeopathy, i. 100. Honey of borax, ii. 226. roses, ii. 136. Hope, ii. 32. Hops, i. 415. Hordeum, ii. 410. Horehound, ii. 51. wild, i. 354. Horse-chestnut, ii. 97. mint, i. 495. radish, i. 301, 520. Hot iron, ii. 282. Humulus, i. 415. Hydrargyri et arsenici iodidum, ii. 332. bromidum, ii. 335. chloridum corrosivum, ii. 289, 316. mite, i, 210, ii. 314. cyanuretum, ii. 320. iodidum, ii. 317, 318. rubrum, ii. 289. nitras acidus, ii. 289. oxidum nigrum, i. 213, ii. 313. rubrum, ii. 289, 313. pernitratis liquor, ii. 289. praeparata, ii. 362. sulphas flavus, i. 143, 297, ii. 322. sulphuretum nigrum, ii. 319. rubrum, ii. 320. Hydrargyrum, ii. 309. ammoniatum, ii. 317. cum creta, ii. 311. cum magnesia, ii. 311. Hydrastis canadensis, ii. 44. Hydriatria, ii. 446. Hydrogen gas, ii. 212. sulphuretted, ii. 212. carburetted, ii. 212. Hydropathy, ii. 446. Hyoscyamus, i. 398. VOL. II.—'SI Iceland moss, i. 285, ii. Immersion, ii. 227. Impetuosity, i. 484. Incompatibles, ii. 465. Indian physic, i. 152. tobacco, i. 155. Indications modified by by by by by by by by 409. age, i. 61. climate, i. 75. conformation, i. 65. causes, &c, of dis- ease, i. 91. habit, i. 73. idiosyncrasy, i. 70. mental affections, i. 80. professions, &c, i. by races, i. 89. by seasons, i. 75. by sex, i. 63. by temperament, i. 68. by way of life, i 89. therapeutical, i. 61. Indigo, ii. 54. Indigum, ii. 54. Infusion of angustura bark, ii. 46. of buchu, i. 337. of cascarilla, ii. 45. of catechu, compound, ii. 126. of chamomile, i. 160. of cayenne pepper, i. 516. of wild cherry bark, ii. 41. of cloves, i. 492. of columbo, ii. 35. of dandelion, i. 319. of flaxseed, i. 281, ii. 407. of foxglove i. 324, ii. 198. of gentian, compound, ii. 37. of ginger, i. 520. of hops, i. 416. of horseradish, i. 301, 520. of Peruvian bark, ii. 86. compound, ii. 86. of pink root, i. 245. of quassia, ii. 39. of red bark, ii. 86. of rhatany, ii. 131. of rhubarb, i. 198. of roses, compound, ii. 136. of sarsaparilla, ii. 362. of sassafras pith, i. 283. of senna, i. 206. of slippery elm bark, i. 283. of snakeroot, Virginia, ii. 47. of thoroughwort, i. 354. of tobacco, i. 158. of valerian, i. 445. of yellow bark, ii. 86. Infusum angusturae, ii. 46. anthemidis, i. 160. armoraciae, i. 310, 520. buchu, i. 337. caryophylli, i. 492. 482 INDEX OF REMEDIES. Infusum cascarillae, ii. 45. catechu compositum, ii. 126. cinchonae rubrae, ii. 86. flavae, ii. 86. capsici, i. 516. compositum, ii. 86. colombae, ii. 35. digitalis, i. 324, ii. 198. eupatorii, i. 354. gentianae compositum, ii. 37. humuli, i. 416. krameriae, ii. 131. lini, i. 281, ii. 407. pareiras, i. 339. pruni Virginianae, ii. 41. quassiae, ii. 39. rhei, i. 198. rosae compositum, ii. 136. sarsaparillae, ii. 362. sassafras medullae, i. 283. scoparii, i. 310. sennas, i. 206. serpentariae, ii. 47. spigeliae, i. 245. tabaci, i. 158. taraxaci, i. 319. ulmi, i. 283. Valerianae, i. 445. zingiberis, i. 520. Inhalations, i. 255, 287. excitant, i. 287. sedative, i. 293. Injections of warm water, i. 367. Inspissants, ii. 429. Instinctive actions, i. 34. Inula, i. 269. ' Iodide of ammonium, ii. 333. of arsenic, ii. 332. of barium, ii. 332. of cinchonia, ii. 91, 333. of gold, ii. 343. of iron, ii. 64, 331. of b?ad, ii. 331. of mercury, ii. 318. red, ii. 289, 318. and arsenic, ii. 332. of potassium, ii. 329. of quinia, ii. 91, 333. of starch, ii. 333. of sulphur, ii. 333. Iodidum auri, ii. 343. ferri, ii. 64, 331. hydrargyri, ii. 318. rubrum, ii. 289, 318. plumbi, ii. 331. potassii, ii. 329. sulphuris, ii. 333. Iodine, i. 291, 462, ii. 322. paint, ii. 329. preparations of, ii. 322. Iodinii praeparata, ii. 322. Iodinium, i. 291, 462, ii. 322. Ipecacuanha, i. 147, 350, ii. 275. American, i. 162. spurge, i. 162. Iris, Florentina, i. 298. versicolor, i. 236. Irish moss, i. 285, ii. 409. Iron, ammoniated, ii. 59. ammonio-citrate of, ii. 67. arseniate of, ii. 289, 341. bromide of, ii. 335. carbonate of, ii. 63. chloride of, ii. 59. citrate.of, ii. 67. and quinia, citrate of, ii. 67. ferrocyanuret of, ii. 60. filings, ii. 67. hot, ii. 282. iodide of, ii. 64, 331. lactate of, ii. 66. nitrate of, ii. 154. oxide of, hydrated, ii. 58. pernitrate of, ii. 154. phosphate of, ii. 62. and potassa, tartrate of, ii. 60. potassio-tartrate of, ii. 60. preparations of, ii. 55, 345. salts of, ii. 55. sodio-citrate of, ii. 67. subcarbonate of, ii. 57. sulphate of, ii. 62, 154. wire, ii. 67. Issue peas, i. 505, ii. 277. Issues, ii. 277. J. Jalap, i. 223. Jalapa, i. 223. Jervin, ii. 206. Joy, i. 484. Juglans, i. 208. cinerea, ii. 367. Juniper, i. 309, 502. Juniperus, i. 309, 502. Virginiana, i. 458. K. Kermes mineral, i. 350. Kino, ii. 127. Kousso, i. 248. Krameria, ii. 130. Kyapootie oil, i. 451, 530, ii. 264. L. Lac sulphuris, i. 187. Lactuca, i. 415. Lactucarium, i. 414. Lappa, ii. 368. Lard, ii. 421. Larkspur, i. 321. Laudanum, i. 393. liquid, i. 393. Laughter, i. 484. INDEX OF REMEDIES. 483 Lavandula, i. 298, 448, 499. Lavemens, i. 172. Lavender, i. 298, 448, 499. Laxatives, i. 166, 184. Lead, acetate of, ii. 147. chloride of, ii. 150. iodide of, ii. 331. nitrate of, ii. 397. water, ii. 383. Leeching, ii. 180. Leek, ii. 262. Lemon-juice, ii. 222. Lemon-peel, i. 502. Lemonade, magnesian, i. 216. Lemons, ii. 222. Leopard's bane, i. 432, Lettuce, i. 415. Lignum colubrinum, i. 428. Lime, ii. 395. carbonate of, precipitated, ii. 156. chlorinated, ii. 341, 395, 398. water, i. 335, ii. 156, 385. juice, ii. 222. Limon, ii. 222. Limonis cortex, i. 502. Liniment of ammonia, ii. 263. camphor, i. 509, ii. 373. of lime water, ii. 157. of mercury, ii. 312. compound, ii. 312. nux vomica, i. 429. of St. John Long, ii. 264. soap, camphorated, i. 509, ii. 373. of Spanish flies, ii. 263. of turpentine, i. 525, ii. 264. Liniments, eutrophic, ii. 373. Linimentum ammoniae, ii. 263. calcis, ii. 157. camphorae, i. 509, ii. 373. cantharidis, ii. 263. hydrargyri compositum, ii. 312. saponis camphoratum, i. 509, ii. 373. terebinthinae, i. 525, ii. 264. Linum, i. 280, ii. 407. Liquefacients, ii. 434. Liqueur antisyphilitiquede Chaussier, ii. 320. Liquor ammoniae, i. 353, 543, ii. 289, 384. fortior, i. 543. acetatis, i. 352. hydrosulphatis, ii. 211. anodyne, Hoffman's, i. 448. arsenici chloridi, ii. 93. arsenici et hydrargyri iodidi, ii. 332. barii chloridi, ii. 340. calcii chloridi, ii. 339. calcis, i. 335, ii. 156, 385. chlorinii, ii. 348, 395. ferri iodidi, ii. 66, 331. nitratis, ii. 154.^ hydrargyri pernitratis, ii. 289. hydrargyri bichloridi, ii. 317. iodini compositus, ii. 330. magnesiae citratis, i. 216. effervescens, i. 216. Liquor morphiae citratis, i. 397. sulphatis, i. 397. opii sedativus, i. 397. plumbi subacetatis, ii. 149. dilutus, ii. 149. potassae, i. 335, ii. 383. arsenitis, ii. 93, 341. carbonatis, ii. 383. citratis, ii. 225. sodae chlorinate, ii. 349, 395, 399. Liquors, malt, i. 536. Liquorice root, i. 279, ii. 408. Liriodendron, ii. 97. Lithics, i. 326. Lithonthryptics, i. 332. Liverwort, ii. 53. Lobelia, i. 155, ii. 210. Logwood, ii. 132. Lotions, ammoniated, i. 544, ii. 262. Granville's, i. 544, ii. 262. Lozenges, cough, Wistar's, i. 280. Lupulina, i. 415, 416. Lycopus, i. 427. M. Mace, i. 497. Madar, i. 368. Madder, i. 460. Magnesia, i. 187, 335, ii. 384. carbonate of, i. 188, 335, ii. 385. citrate of, i. 215. effervescing, Moxon's, i. 215. fluid, i. 188. muriate of, i. 215. sulphate of, i. 214. Magnesiae carbonas, i. 188, 335, ii. 385. citras, i. 215. murias, i. 215. sulphas, i. 214. Magnesii chloridum, i. 215. Magnesium, chloride of, i. 215. Magnesian lemonade, i. 216. Magnolia, ii. 50. Magnetic electricity, i. 461, 463, 553. Magnetism, ii. 269. animal, i. 380. Malambo, ii. 139. Malt liquors, i. 536. Manna, i. 184. Mannite, i. 185. Manganese, sulphate of, i. 222. Manganesii sulphas, i. 222. Maranta, ii. 411. Marjoram, common, i. 496. sweet, i. 298. Marrubium, ii. 51. Marshmallow, i. 272, ii. 408. Masterwort, i. 532. Matias, ii. 139. Matico, ii. 137. Matricaria, ii. 52. May apple, i. 209. Mayweed, ii. 50. 484 INDEX OF REMEDIES. Meal, Indian, ii. 418. Mechanical agents, ii. 401. Medicina expectans, i. 37. Medicines, i. 93. classification of, 116. defined, i. 93. modus operandi of, i. 94. Mel, i. 278. boracis, ii. 226. despumatum, i. 278. rosae, ii. 136. Melissa, i. 359. Mentha piperita, i. 494. pulegium, i. 495. viridis, i. 495. Mercury, ii. 309. acid nitrate of, ii. 289. ammoniated, ii. 317. chloride of, corrosive, ii. 316. chloride of, mild, i. 210, ii. 314. cyanuret of, ii. 320. deutobromide of, ii. 335. iodide of, i. 317, 332. red, ii. 318, 332. oxide of, black, i. 213, ii. 313. red, ii. 313. preparations of, ii. 302. protobromide of, ii. 335. sulphate of, yellow, i. 143, 297, ii. 322. sulphuret of, black, ii. 319. red, ii. 320. and arsenic, iodide of, ii. 332. with chalk, ii. 311. Mesmerism, i. 380. Mezereon, i. 300, 357, ii. 279, 365. Mezereum, i. 300, 357, ii. 279, 365. Milkweed, i. 426. Mineral waters, ii. 444. table of, ii. 445. Mint, horse, i. 495. pepper, i. 494. spear, i. 495. Mistura ammoniaci, i. 260. althaeae, i. 273. amygdalae, i. 274, ii. 419. assafcetidae, i. 268, 443. cretse, ii. 156. ferri composita, ii. 64. glycyrrhizag composita, i. 280. guaiaci, i. 357. spiritus vini gallici, i. 536. Mixture, almond, i. 274, ii. 419. ammoniac, i. 260. assafoetida, i. 268, 443. brandy, i. 536. brown, i. 280. chalk, ii. 156. frigorific, ii. 229. Griffith's, ii. 64. guaiacum, i. 357. Hope's, i. 397. of iron, compound, ii. 64. of liquorice, compound, i. 280 neutral, ii. 222, 225. Mixture, saline, ii. 222, 225. Scudamore's, ii. 203. Monarda, i. 495. Monesia, ii. 136. Morphia, i. 394. acetate of, i. 394. bimeconate of, i. 397. muriate of, i. 396. nitrate of, i. 397. sulphate of, i. 396. tartrate of, i. 397. Morphias acetas, i. 394. murias, i. 396. nitras, i. 297. sulphas, i. 396. Moschus, i. 448. Moss, Ceylon, i. 286, ii. 409. Iceland, i. 284, ii. 409. Irish, i. 285, ii. 409. Marine, i. 286. Moxa, ii. 234, 283. electric, ii. 278. Mucilage of gum arabic, i. 272. of tragacanth, i. 282. Mucilago acaciae, i. 272. tragacanthae, i. 282. Mucuna, i. 251. Mudar, ii, 368. Mugwort, ii. 48. Music, i. 379. Musk, i. 448. Mustard, i. 155, 191, ii. 260, 274. Myristica, i. 497. Myrrh, i. 266. Myrrha, i. 266. N. Naphtha, i. 270. light coal tar, i. 426. Naphthaline, i. 269. Narcotics, i. 368. in fevers, i. 381. in inflammation, i. 381. in intermittents, i. 381. mental, i. 379. modus operandi of, i. 371. in spasmodic diseases, i. 382. special, i. 383. therapeutics of, i. 381. Narcotin, i. 387, ii. 98. Narcotina, i. 387, ii. 98. Nature, efforts of, i. 37, ii. 375. Nauseants, i. 125. in constipation, i. 126. in internal inflammation, i. 125. in obstetrical cases, i. 126. in surgical cases, i. 126. therapeutics of, i. 125. Nightshade, deadly, i. 400. Nitrogen, protoxide of, i. 556. Nutmeg, i. 497. Nux vomica, i. 428. INDEX OF REMEDIES. 485 0. Oak bark, black, ii. 131. white, ii. 131. poison, i. 433. Oatmeal, ii. 417. Oil of almonds, i. 191, 274, ii. 422. of amber, i. 532. rectified, i. 450, 532. animal, i. 241, 451. of anise, i. 488. benne, i. 282, ii. 423. of bergamot, i. 504. of bitter almonds, ii. 194. of cade, i. 241, ii. 353. cajuput, i. 451, 530, ii. 264. of caper spurge, i. 231. of caraway, i. 489. Carron, ii. 157. of Cassia, i. 487. castor, i. 192. of cinnamon, i. 487. of cloves, i. 492. codliver, ii. 336. of copaiba, i. 527, 529. croton, i. 229, ii. 276. Dippel's, i. 241, 451. of ergot, i. 466. empyreumatic, of Chabert, i. 242. of fennel, i. 493. flaxseed, ii. 422. of garlic, ii. 262. of horsemint, i. 495. of juniper, i. 309, 502. kyapootie, i. 451, 530, ii. 264. of lavender, i. 500. of lemons, i. 503. of mace, i. 498. of marjoram, i. 496. of mustard, volatile, ii. 261. neatsfoot, ii. 424. neroli, i. 505. olive, i. 191, 275, ii. 422. of origanum, i. 496. of black pepper, i. 514. of peppermint, i. 494. of pimento, i. 512. of rosemary, i. 501. of sassafras, i. 359, 499. of savine, i. 459. of spearmint, i. 495. of spurge, i. 231. of star anise, i. 489. of tar, ii. 369. of thyme, i. 496. of tobacco, i. 157. of turpentine, i. 241, 320, 451, 523, ii. 264. of valerian, i. 445. of wormseed, i. 244. Ointment, antimonial, ii. 275. of belladonna, i. 404. of subacetate of copper, ii. 280. of creasote, i. 542. of galls, ii. 129. Ointment of hellebore, white, ii. 370. of iodide of potassium, ii. 331. of iodine, ii. 329. compound, ii. 329. of carbonate of lead, ii. 376. mercurial, ii. 311. of mercury, ammoniated, ii. 317. nitrate of, ii. 321. red oxide of, iL 314. mezereon, ii. 279. nitric acid, ii. 288, 347. of rosewater, ii. 422. simple, ii. 421. of Spanish flies, ii. 278. of stramonium, i. 406. of sulphur, ii. 351. compound, ii. 351. tar, ii. 369. tobacco, ii. 369. veratria, i. 326, ii. 205. of zinc, oxide of, ii. 370. Ointments, eutrophic, ii. 369. Oleum amygdalae, i. 191, 274, ii. 422. amarae, ii. 194. animale, i. 241. anisi, i. 488. badiani, i. 489. bergamii, i. 504. bubulum, ii. 424. cadinum, i. 241, ii. 353. cajuputi, i. 451, 530, ii. 264. cari, i. 489. caryophylli, i. 492. cetaceum, ii. 336. chenopodii, i. 244. cinnamomi, i. 487. copaibae, i. 527, 529. cubebae, i. 516, 517. euphorbiae lathyridis, i. 231. foeniculi, i. 493. gaultheriae, i. 502. hedeomae, i. 496. jecoris aselli, ii. 336. juniperi, i. 309, 502. empyreumaticum, ii. 353. lavandulae, i. 500. limonis, i. 503. lini, ii. 422. menthae piperitae, i. 494. viridis, i. 495. monardae, i. 495. morrhuae, ii. 336. myristicae, i. 498. olivae, i. 191, 275, ii. 423. origani, i. 496. pimentae, i. 512. ricini, i. 192. rosmarini, i. 501. sabinae, i. 459. sassafras, i. 359, 499. sesami, i. 282, ii. 423. sinapis, i. 518, ii. 261. succini, i. 532. rectificatum, i. 450, 532. tabaci, i. 157. 486 INDEX OF REMEDIES. Oleum terebinthinae, i. 241, 320, 451, 523, ii. 264. tiglii, i. 229, ii. 276. Valerianae, i. 445. Onion, ii. 262. Opium, i. 351, 383. lettuce, i. 414. Opodeldoc, i. 509, ii. 373. Oranges, Curacoa, i. 505. Orange peel, i. 504. root, ii. 44. Origanum, i. 496. majorana, i. 298. Orris. Florentine, i. 298. Oxygen gas, i. 555. Oxymel scillae, i. 154, 259. of squill, i. 154, 259. Oystershells, prepared, ii. 156. P. Palliative treatment, i. 100. Papaver, i. 398. Pareira, i. 337. brava, i. 337. Parsley, i. 321. Partridge berry, i. 501. Parturifacients, i. 462. special, i. 465. Paste, Vienna, ii. 285. Paullinia, ii. 52. Peas, issue, i. 505, ii. 277. Pellitory, i. 300. Pennyroyal, i. 458, 495. Pepper, black, i. 512. Cayenne, i. 514, ii. 2C2. mint, i. 494. Persimmon, ii. 140. Perkinism, i. 84. Petroselinum, i. 321. Phloridzin, ii. 99. Phloridzina, ii. 99. Phosphorus, i. 547. Phytolaccae radix, i. 162. Picrotoxine, ii. 443. Pills of aloes and assafoetida, i. 202, 443. and canella, i. 203. and myrrh, i. 203. aloetic, i. 202. Asiatic, ii. 341. assafoetida, i. 443. Bacher's, i. 457. Blaud's ii. 64. blue, i. 213. cathartic, compound, i. 226. of copaiba, i. 530. galbanum, compound, i. 446. Griffith's, ii. 64. of carbonate of iron, ii. 63. of iodide of iron, ii. 65. of iron, compound, ii. 64. of mild chloride of mercury, i. 212. mercurial, i. 213, ii. 311. of opium, i. 392. Pills, Plummer's, i. 349. of sulphate of quinia, ii. 90. of rhubarb, i. 198. compound, i. 198. Rufus's, i. 456. of soap, compound, i. 392. of squill, compound, i. 259. Vallet's, ii. 63. Pilulae aloes, i. 202. et assafoetidae, i. 202, 443. canellae, i. 203. myrrhae, i. 203, 456. Asiaticse, ii. 341. assafoetidae, i. 443. catharticae compositae, i. 226. copaibae, i. 530. digitalis et scillae, i. 324. ferri carbonatis, ii. 63. compositae, ii. 64. iodidi, ii. 65. galbani compositae, i. 446. ex helleboro et myrrha, i. 457. hydrargyri, i. 213, ii. 311. chloridi compositae, i. 349. mitis, i. 212. iodidi, ii. 318. ipecacuanhae compositae, i. 260. opii, i. 392. quiniae sulphatis, ii. 90. rhei, i. 198. compositae, i. 198. saponis compositae, i. 392. scillae compositae, i. 259. Pimenta, i. 512. Pimento, i. 512. Pink root, i. 244. Piper, i. 512. Piperin, ii. 95. Piperina, ii. 95. Pipsissewa, i. 310. Pitch, Burgundy, ii. 264. Canada, ii. 266. hemlock, ii. 266. Pix abietis, ii. 264. Canadensis, ii. 266. Plaster, ammoniac, ii. 372. of ammoniacum with mercury, ii. 312, 372. of assafoetida, i. 443. . of belladonna, i. 404. Burgundy pitch, ii. 265. galbanum, compound, i. 446. iron, ii. 372. lead, ii. 371. mercurial, ii. 312. opium, i. 394. pitch, ii. 265. of pitch with Spanish flies, ii. 265. resin, ii. 371. soap, ii. 372. warm, ii. 265. Platinum, preparations of, ii. 345. Pleurisy root, i. 359. Plumbi acetas, ii. 147. chloridum, ii. 150. INDEX OF Plumbi iodidum, ii. 331. nitras, ii. 397. Podophyllum, i. 209. Poison oak, i. 433. Poisons, ii. 432. acro-narcotic, ii. 437. anfimal, ii. 440. corrosive, ii. 432. inorganic, ii. 434. irritant, ii. 439. narcotic, ii. 439. narcotico-acrid, ii. 437. organic, ii. 437. table of, ii. 434. vegetable, ii. 437. Poke root, i. 162. Polygala, bitter, ii. 52. rubella, ii. 52. Pomegranate rind, ii. 135. root, bark of, i. 247. Pommade ammoniacale, i. .544, ii. 262. Poppyheads, i. 398. Potassa, ii. 284. acetate of, i. 221, 315. bicarbonate of, ii. 382. bisulphate of, i. 221. bitartrate of, i. 394. carbonate of, ii. 335, 382. impure, ii. 382. pure, ii. 383. chlorate of, ii. 354. citrate of, ii. 225. cum calce, ii. 284. with lime, ii. 284. nitrate of, i. 310, ii. 224. sulphate of, i. 220. salts of, i. 314. supersulphate of, i. 220. tartrate of, i. 219. and soda, tartrate of, i. 219. Potassae acetas, i. 221, 315. bicarbonas, ii. 382. bisulphas, i. 220. bitartras, i. 219, 314. carbonas, ii. 335, 382. impurus, ii. 382. chloras, ii. 354. citras, ii. 225. nitras, i. 314, ii. 224. sulphas, i. 220. tartras, i. 219. Potassii bromidum, ii. 335. cyanuretum, ii. 194. ferrocyanuretum, ii. 193. iodidum, ii. 329. iodohydrargyras, ii. 319. sulphocyanuretum, ii. 195. sulphuretum, ii. 352. Potassium, cyanuret of, ii. 194. bromide of, ii. 335. ferrocyanuret of, ii. 193. iodide of, ii. 329. iodohydrargyrate of, ii. 319. sulphocyanuret of, ii. 195. sulphuret of, ii. 352. REMEDIES. 487 Potato, wild, i. 235. Poultices, warm, i. 367. Powder of aloes and canella, i. 203, 456. antimonial, i. 349. aromatic, i. 488. of bark, factitious, ii. 98. Dover's, i. 350. gold, ii. 342. of ipecacuanha and opium, i. 350. of iron, ii. 68. of jalap, compound, i. 224. of tin, i. 252. Vienna, ii. 285. Powders, Castillon, ii. 416. nitrous, i. 348. soda, ii. 222. Seidlitz, i. 218. ii. 222. Pressure, ii. 301. Prinos, ii. 53. Prunes, i. 190. Pruni pulpa, i. 191. Prunum, i. 190. Prunus Virginiana, ii. 40. Prussian blue, pure, ii. 61. Pulp of prunes, i. 191. of purging cassia, i. 189. of tamarinds, i. 190. Pulvis antimonialis, i. 349. aromaticus, i. 488. aloes et canellae, i. 203, 456. asari compositus, i. 297. auri, ii. 342. ipecacuanhae et opii, i. 350. jalapae compositus, i. 224. parturiens, i. 467. stanni, i. 252. tragacanthae compositus, i. 282. Purgatives, i. 166, 192. Pyrethrum, i. 300. Q. Quassia, ii. 38. Queen's root, ii. 367. Qiiercus alba, ii. 131. tinctoria, ii. 131. Quince seeds, i. 283. Quinia, ii. 87. acetate of, ii. 91. arsenite of, ii. 341. citrate of, ii. 91. ferrocyanate of, ii. 90. muriate of, ii. 91. nitrate of, ii. 91. iodide of, ii. 91, 333. salts of, ii. 87. sulphate of, ii. 87. impure, ii. 91. valerianate of, i. 446, ii. 91. and cinchonia, tannate of, ii. 91. Quiniae sulphas, ii. 87. impurus, ii. 91. arsenis, ii. 341. 488 INDEX OF REMEDIES. R, Raisins, ii. 409. Ranunculus, ii. 273. Refrigerants, ii. 213. in fevers, ii. 218. in hemorrhage, ii. 220. in inflammation, ii. 220. modus operandi of, ii. 215. in pulmonary affections, ii. 221. saline, ii. 222. special, ii. 222. therapeutics of, ii. 218. topical, ii. 227. Resin, i. 525. vapour of, i. 292. Resina, i. 525. Resolvents, ii. 431. Revellents, ii. 230. in arthritis, ii. 254. cutaneous, ii. 260. in dropsy, ii. 259. escharotic, ii. 279. in exanthematous fevers, ii. 249. in fevers, ii. 248. in hemorrhage, ii. 255. in hypertrophy, ii. 259. in inflammation, ii. 249. in intermittents, ii. 245. mental, ii. 257. modus operandi, ii. 239. in nervous diseases, ii. 256. in the changeable phlegmasiae, ii. 240. in remittents, ii. 248. rubefacient, ii. 260. special, ii. 260. suppurant, ii. 274. therapeutics of, ii. 245. vesicant, ii. 269. where to be applied, ii. 243. Revulsion, i. 100. permanent and intermittent, i; 236. Rhatany, ii. 130. Rheum, i. 194. Rhubarb, i. 194. Rhus glabra, ii. 140. Root, yellow, ii. 44. Rosa Gallica, ii. 135. Rosemary, i. 298, 501. marsh, ii. 141. Roses, red, ii. 135. Rosin, i. 525. Rosmarinus, i. 248, 501. Rubbing, dry, ii. 302. Rubefacients, ii. 231. Rubia, i. 460. Rubus trivialis, ii. 141. villosus, ii. 141. Rue, i. 460. Rumex Britannica, ii. 141. obtusifolius, ii. 141. Rumex crispus, ii. 141. Ruta, i. 460. S. Sabadillin, ii. 205. Sabbatia, ii. 42. Sabina, i. 459, ii. 279, 281. Saccharum, i. 277, ii. 281, 356. Saffiower, i. 362. Saffron, i. 362. bastard, i. 362. Dyer's, i. 362. Sago, ii. 415. Portland, ii. 412. Sal volatile, i. 447. Salep, ii. 416. Salicin, ii. 94. Salix, ii. 94. Saloop, i. 499. Sambucus, i. 362. Sanguinaria, i. 159. Santonici Semen, i. 242. Santonin, i. 242. Sarsaparilla, ii. 358. country, ii. 369. false, ii. 365. Sassafras medulla, i. 283. pith, i. 283. radicis cortex, i. 359, 499, ii. 366. root, bark of, i. 359, 499, ii. 366. Savine, i. 459, ii. 279, 281. Scammonium, i. 227. Scammony, i. 227. Scilla, i. 152, 259, 310. Scoparius, i. 309. Sedatives, ii. 159. modus operandi of, ii. 160. special, ii. 190. Semen contra, i. 242 Senegal gum, i. 270. Senega, i. 257. Seneka, i. 257. Senna, i. 203. American, i. 207. Serpentaria, ii. 40. Sesamum, ii. 282. Setons, ii. 277. Setaceum, ii. 277. Sevum, ii. 419. Sialogogues, i. 299. special, i. 300. therapeutics of, i. 299. Silkweed, common, i. 426. Silver, chloride of, ii. 74. nitrate of, ii. 71, 151, 273, 279, 286. fused, ii. 71. oxide of, ii. 73, 152. preparations of, ii. 344. Simaruba, ii. 39. Sinapis, i. 155, 191, 518, ii. 260, 274. Sinapism, ii. 260. INDEX OF REMEDIES. 489 Skunk cabbage, i. 447. Snakeroot, black, ii. 207. button, ii. 50. Canada, ii. 49. Virginia, ii. 46. Snakewood, i. 428. Soda, arseniate of, ii. 341. bicarbonate of, i. 316, 335. borate of, i. 316, 470, ii. 225, 381. carbonate of, i. 316, 335, ii. 882. dried, ii. 382. chlorinated, ii. 349, 395, 399. hyposulphite of, ii. 352. muriate of, i. 160, 221. nitrate of, ii. 224. phosphate of, i. 219, 330. powders, ii. 222. sulphate of, i. 217. salts of, i. 314. and potassa, tartrate of, i. 217. water, i. 334, ii. 222. Sodae bicarbonas, i. 316. boras, i. 316, 470, ii. 225, 381. carbonas, i. 316, 335, ii. 382. exsiccatus, ii. 382. hyposulphis, ii. 352. phosphas, i. 219, 330. sulphas, i. 219. et potassaa tartras, i. 217. Sodii chloridum, i. 160, 221, 250. Sodium, chloride of, i. 160, 221, 250. Solidago, i. 533. Solutio solventis mineralis, ii. 93. Solution of acetate of ammonia, i. 353. of ammonia, i. 543, ii. 384. strong, i. 543. of arsenite of potassa, ii. 93. arsenical, of De Valangin, ii. 93. of hydrosulphate of ammonia, ii. 211. . of chloride of arsenic, ii. 93. of chloride of barium, ii. 340. of calcium, ii. 339. of chlorinated lime, ii. 349. soda, ii. 349, 395, 399. of chlorine, ii. 348. Fowler's, ii. 93. of iodide of arsenic and mercury, ii. 332. of iodide of iron, ii. 66. of iodine, compound, ii. 330. of lead, subacetate of, ii. 149. diluted, ii. 149. Lugol's, ii. 330. of citrate of magnesia, i. 216. effervescing, i. 216. of nitrate of iron, ii. 154. of sulphate of morphia, i. 397. de Pearson, ii. 341. Plenck's, ii. 311. of potassa, i. 335, ii. 383._ of carbonate of potassa, ii. 383. Solution of citrate of potassa, ii. 225. Soot, wood, ii. 143. Sorbefacients, modus operandi of, ii. 293. Spanish flies, i. 316, ii. 263, 269, 278, 355. Spearmint, i. 495. Specific, Reynolds's, ii. 200. Spermaceti, i. 276, ii. 419. Spigelia, i. 244. Spikenard, American, ii. 365. Spiraea, ii. 141. Spirit of ammonia, i. 544. aromatic, i. 447, 544. of chloroform, i. 425. of ether, compound, i. 426, 448, 539. of juniper, compound, i. 309. of lavender, i. 500. compound, i. 448, 500. of nitric ether, i. 313, 354, 448, 539. of nutmeg, i. 498. of pimento, i. 512. pyroacetic, i. 270. pyroxylic, i. 270. of rosemary, i. 501. of sulphuric ether, compound, i. 426, 448, 539. Spirits, ardent, i. 533. Spiritus ammoniae, i. 544. ammoniae aromaticus, i. 447, 544. aetheris nitrici, i. 313, 354, 448, 539. sulphurici compositus, i. 426, 448, 539. juniperi compositus, i. 309. lavandulae, i. 448. compositus, i. 500. myristicae, i. 498. pimentae, i. 512. pyroxilicus, i. 270. rosmarini, i. 501. vini gallici, i. 533. Sponge, burnt, ii. 335. Spongia usta, ii. 335. Spurge, blooming or large flowering, i. 161. ipecacuanha, i. 162. Squill, i. 152, 259, 310. Staphisagria, ii. 443. Starch, ii. 448. iodide of, ii. 333. Star-grass, ii. 43. Statice, ii. 141. Stavesacre, ii. 443. Steam, ii. 274. Stillingia, ii. 367. Stimulants, i. 471. Storax, i. 262. Stramonium, i. 293, 404. Strychnia, i. 429, 462. salts of, i. 431. Styptics, ii. 101. Styrax, i. 262. purificata, i. 263. Succinum, i. 450, 531. Suet, ii. 419. Sugar, i. 277, ii. 356. Sulphur, i. 185, ii. 281, 350. iodide of, ii. 233. 490 INDEX OF REMEDIES. Sulphur, precipitated, i. 187, ii. 350. praecipitatum, i. 187, ii. 350. Sulphuris iodidum, ii. 233. Sumach, ii. 140. Suppositories, i. 174. Suppurant revellents, ii. 233. Suppurants, ii. 233. Sympathetic powder, i. 35. Syrup, i. 278. hive, Coxe's, i. 154, 259. of almonds, i. 274. of buckthorn, i. 202. of citric acid, ii. 224. of garlic, i. 268. of ginger, i. 520. of gum Arabic, i. 272. of ipecacuanha, i. 150. of lemons, ii. 223. of orange peel, i. 505. of rhatany, ii. 131. of rhubarb, i. 198. aromatic, i. 198. of sarsaparilla, compound, ii. 363. of seneka, i. 258. of senna, i. 207. of squill, i. 154, 259. compound, i. 154. of tolu, i. 262. of wild cherry, ii. 41. Syrupus, i. 278. acidi citrici, ii. 224. acaciae, i. 272. allii, i. 268. amygdalae, i. 274. aurantii corticis, i. 505. ipecacuanhae, i. 150. kramerias, ii. 131. limonis, ii. 223. pruni Virginianae, ii. 41. rhei, i. 198. aromaticus, i. 198. sarsaparillae compositus, ii. 363. scillae, i. 154, 259. compositus, i. 154, 259. senegae, i. 258. sennae, i. 207. tolutani, i. 262. zingiberis, i. 520, Tabacum, i. 157, 293, 298, 302. Tamarindi pulpa, i. 190. Tamarinds, i. 190. Tamarindus, i. 190. Tanacetum, i. 250, 461. Tannin, ii. 123. Tansy, i. 250, 461. Tapioca, ii. 414. Tar, boiling, vapour of, i. 292. oil of, ii. 369. water, i. 269, ii. 143. Tartar emetic, i. 114. Taraxacum, i. 318. Terebinthina, i. 520. canadensis, i. 521. Testa praeparata, ii. 156. Tetanies, i. 427. special, i. 428. Therapeutics, denned, i. 33. general considerations on, i. 33. Thornapple, i. 404. Thoroughwort, i. 353. Thridace, i. 414. Tin, powder of, i. 252. Tinctura aconiti foliorum, i. 412. radicis, i. 412. aloes, i. 203. et myrrhae, 203, 456. assafoetidae, i. 443. belladonnae, i. 404. benzoini compositi, i. 265. buchu, i. 337. camphorae, i. 509. cantharidis, i. 318. capsici, i. 516. cardamomi, i. 491. . cardamomi composita, i. 491. castorei, i. 444. catechu, ii. 127. cinchonae, ii. 86. composita, ii. 86. cinnamomi, i. 488. composita, i. 488. colchici seminis, ii. 202. colombae, ii. 35. conii, i. 410. cubebae, i. 517. digitalis, i. 324, ii. 198. aetherea, i. 324. ferri chloridi, ii. 59, 153. gallas, ii. 129. gentianae composita, ii. 37. guaiaci, i. 357. ammoniata, i. 357. hellebori, i. 457. humuli, i. 416. hyoscyami, i. 400. iodinii, ii. 328. composita, ii. 328. jalapae, i. 224. kino, ii. 128. krameriae, ii. 131. lobeliae, i. 155. lupulinae, i. 417. myrrhae, i. 267. nucis vomicae, i. 429. olei menthae piperitae, i. 494. viridis, i. 495. opii, i. 393. acetata, i. 393. camphorata, i. 393. quassiae, ii. 39. rhei, i. 198. et aloes, i. 198. et gentianae, i. 199. et sennae, i. 199. sanguinariae, i. 159. INDEX OF REMEDIES. 491 Tinctura saponis camphorata, i. 509, ii. 37 scillaj, i. 153, 310. sennae et jalapae, i. 207. serpentariae, ii. 47. stramonii, i. 406. tolutana, i. 262. Valerianae, i. 445. ammoniata, i. 446. veratriae, i. 326, ii. 205. zingiberis, i. 520. Tincture of aconite, i. 412. ammoniated, i. 412. of aloes, i. 203. and myrrh, i. 203, 456. of arnica, i. 433. of assafoetida, i. 443. of belladonna, i. 404. of benzoin, compound, i. 265. of bloodroot, i. 159. of buchu, i. 337. of camphor, i. 509. of cardamom, i. 491. compound, i. 491. of castor, i. 444. of catechu, ii. 127. of cayenne pepper, i. 516. of chloride of iron, ii. 59, 153. of chloroform, i. 425. of cinnamon, i. 488. compound, i. 488. c of colchicum seed, ii. 202. of columbo, ii. 35. of cubebs, i. 517. of digitalis, i. 324, ii. 198. of foxglove, i. 324, ii. 198. of galls, ii. 129. of gentian, compound, ii. 37. of ginger, i. 520. of guaiac, i. 357. ammoniated, i. 357. of hellebore, black, i. 457. of hemlock, i. 410. of hemp, i. 420. of henbane, i. 400. of hops, i. 416. of iodine, ii. 328. compound, ii. 328. of jalap, i. 224. of kino, ii. 128. of lobelia, i. 155. of lupulin, i. 417. of myrrh, i. 267. of nux vomica, i. 429. of oil of peppermint, i. 494. spearmint, i. 495. of opium, i. 393. acetated, i. 393. camphorated, i. 393. of Peruvian bark, ii. 86. compound, ii. 8 of quassia, ii. 39. of rhatany, ii. 131. of rhubarb, i. 198. and aloes, i. 198. and gentian, i. 199. !. Tincture of rhubarb and senna, i. 199. of senna and jalap, i. 207. of snakeroot, Virginia, ii. 47. of soap, camphorated, i. 509, ii. 373. of Spanish flies, i. 318. of squill, i. 153. of stramonium, i. 406. of tolu, i. 2G2. of valerian, i. 445. ammoniated, i. 446. of veratria, i. 325, ii..205. Tobacco, i. 157, 298, ii. 210. Indian, i. 155, 302. Tonics, ii. 17. antiperiodic, ii. 78. bitter, ii. 34. aromatic, ii. 44. astringent, ii. 52. in chlorosis, ii. 28. in chorea, ii. 28. in chronic cutaneous diseases, ii. 28. in epilepsy, ii. 27. in fever, ii. 24. in hemorrhage, ii. 27. in inflammation, ii. 26. in intermittents, ii. 24. in local diseases, ii. 28. mechanical, ii. 53. mental, ii. 32. mineral, ii. 55. modus operandi of, ii. 23. in neuralgia, ii. 28. in the neuroses, ii. 27. in remittents, ii. 26. simple, ii. 34. special, ii. 34. therapeutics of, ii. 24. in worms, ii. 28. Toothache tree, i. 361. Tormentil, ii. 134. Tormentilla, ii. 134. Touch, royal, i. 83. Tous-les-mois, ii. 414. Toxicodendron, i. 433. Tragacanth, i. 281, ii. 408. Tragacantha, i. 281, ii. 408. Transfusion of blood, ii. 292. Travelling, ii. 31. Triosteum, i. 236. Tritici farina, ii. 423. Troches of chalk, ii. 385. of ipecacuanha, i. 287. of liquorice and opium, i. 280. of magnesia, ii. 884. of nitrate of potassae, ii. 224. of peppermint, i. 495. of bicarbonate of soda, ii. 381. ). Trochisci cretae, ii. 385. glycyrrhizae et opii, i. 280. ipecacuanhae, i. 287. magnesiae, ii. 384. menthae piperitae, i. 495. sodae bicarbonatis, ii. 381. 492 INDEX OF REMEDIES. Tulip tree bark, ii. 97. Turnip, Indian, i. 361. Turpentine, i. 520. Canada, i. 521. U. Ulmus, i. 283, ii. 424. Umbrella tree, ii. 50. Unguentum acidi nitrici, ii. 268, 288, 347. sulphurici, ii. 268. antimonii, ii. 275. belladonnae, i. 404. aquae rosae, ii. 422. cantharidis, ii. 278, 369. creasoti, i. 542, ii. 369. cupri subacetatis, ii. 280, 369. gallae, ii. 129, 369. hydrargyri, ii. 311, 369. ammoniati, ii. 317, 369. biniodidi, ii. 319. iodidi, ii. 318. nitratis, ii. 321, 369. oxidi rubri, ii. 314, 369. iodinii, ii. 329, 369. compositum, ii. 329,369, mezerei, ii. 279, 369. picis liquidae, ii. 369. plumbi carbonatis, ii. 371. iodidi, ii. 332. potassii iodidi, ii. 331. simplex, ii. 42. stramonii, i. 406. sulphuris, ii. 351, 369. compositum, ii. 351, 369. sulphuris iodidi, ii. 333. tabaci, ii. 369. veratri albi, ii. 370. veratriae, i. 326, ii. 205. zinci oxidi, ii. 370. Uva passa, ii. 408. ursi, i. 339, ii. 134. Valerian, i. 444. Valeriana, i. 444. Valerianate of quinia, i. 446. of zinc, i. 446. Veratria, i. 296, 325, ii. 203. sulphate of, ii. 203. Veratrum album, i. 296, ii. 205. viride, ii. 206. Vesicant revellents, ii. 269. Vesicants, ii. 231. Vinegar, i. 288. of cantharides, ii. 271. of colchicum, i. 325, ii. 203. distilled, i. 289. of opium, i. 394. Vinegar of squill, i. 153, 259. Vinum, i. 534. album, i. 535. aloes, i. 203, 456. antimonii, i. 147, 349. colchici radicis, ii. 203. seminis, ii. 203. ergotae, i. 470. ipecacuanhae, i. 150, 351. opii, i. 393. rhei, i. 199. rubrum, i. 535. tabaci, i. 158. veratri albi, ii. 206. Viola, i. 286. Violet, i. 286. dog's tooth, i. 161. Violine, i. 286. Vis medicatrix naturae, i. 34. W. Wake robin, i. 361. Walnut, ii. 867. Wash, black, ii. 313. phagedenic, ii. 314. yellow, ii. 314. Wassercur, ii. 446. Water, acidulous, simple, i. 334, ii. 455. of ammonia, i. 353, 543. * of bitter almonds, ii. 191, 195. boiling, ii. 273. camphor, i. 508. carbonic acid, ii. 455. cherry-laurel, ii. 191. cinnamon, i. 487. fennel, i. 493. Goulard's vegeto-mineral, ii. 149. lavender, i. 500. lead, ii. 149. lime, i. 335, ii. 156, 385. mineral, ii. 222. orange flower, i. 505. peppermint, i. 490. Queen of Hungary's, i. 501. Seltzer, artificial, ii. 455. soda, i. 334, ii. 222. spearmint, i. 495. tar, i. 269, ii. 143. Vichy, i. 336. Watercure, ii. 446. Waters, mineral, ii. 444. table of, ii. 450. Wax, myrtle, ii. 420. white, ii. 420. yellow, ii. 419. Wet sheet, i. 367. Wheat flour, ii. 423. Whortleberry, bear's, i. 339, ii. 134. Willow, ii. 94. Wine, i. 534. of aloes, i. 203, 456. antimonial, i. 147, 349. of colchicum seed, ii. 203. INDEX OF REMEDIES. 493 Wine, root, ii. 203. of ergot, i. 470. ipecacuanha, i. 150, 351. of opium, i. 393. of rhubarb, i. 199. of tobacco, i. 158. of white hellebore, ii. 206 Wines, i. 534. Wintera, i. 510. Winter's Bark, i. 510. Wool, burning, i. 292. Wormseed, i. 242. Wormweed, Corsican, i. 249. Wormwood, ii. 47. X. Xanthorrhiza, ii. 44. Xanthoxylum, i. 360. Y. Yeast, ii. 401. Yellowroot, ii. 44. Z. Zea mays, ii. 423. Zinc, acetate of, ii. 70. carbonate of, ii. 370. precipitated, ii. 370. prepared, ii. 370. chloride of, ii. 70, 285, 396. cyanuret of, ii. 70. ferrocyanuret of, ii. 70. oxide of, ii. 68. salts of, ii. 68. sulphate of, i. 142, ii. 70, 155. valerianate of, i. 446, ii. 71. Zinci acetas, ii. 70. carbonas, ii. 370. praecipitatus, ii. 370. praeparatus, ii. 370. chloridum, ii. 70, 285, 396. cyanuretum, ii. 70. ferrocyanuretum, ii. 70. oxidum, ii. 68. sales, ii. 68. sulphas, i. 142, ii. 70, 155. valerianas, i. 446, ii. 71. Zingiber, i. 302, 518. INDEX OF DISEASES AND REMEDIES. A. Abdominal affections, chronic, pitch plaster, ii. 265. emplastrum hydrargyri, ii. 313. hipbath, i. 366. hop poultice, i. 432. oleum tiglii, ii. 277. s inflammation, cathartics, i. 178. tumours, pressure, ii. 301. Abrasions, collodion, i. 540. opium, i. 392. Abscess of the prostate, cubeba, i. 517. Absorbents, inflamed, iodinium, ii. 327. Acidity, alkalies, ii. 381. alkaline earths, ii. 384. ammoniae carbonas, ii. 384. argilla, ii. 157. carbo ligni, ii. 53. creta praeparata, ii. 385. liquor ammoniae, ii. 384. liquor calcis, ii. 385. liquor potassae, ii. 383. magnesia, ii. 384. magnesiae carbonas, ii. 385. potassae bicarbonas, ii. 383. potassae carbonas, ii. 382. sodae bicarbonas, ii. 381. sodae carbonas, ii. 382. trochisci cretae, ii. 385. trochisci magnesiae, ii. 384. Acne, acidum hydrocyanicum, ii. 193. collodion, i. 540. sulphuris iodidum, ii. 333. Adynamia, alcohol, i. 536. ale and porter, i. 538. geum, ii. 52. hot vapour bath, i. 548. phosphorus, i. 547. wine, i. 538. Albuminuria, diuretics, i. 307. Alkalescency, antalkalies, ii. 386. Alkaline condition, antalkalies, ii. 385. Amaurosis, acupuncture, i. 554. electricity, i. 552. emetics, i. 137. Amaurosis, galvanism, i. 553. haemospasia, ii. 268. strychnia, i. 430. veratrum album, i. 296. Amenorrhcea, aloes, i. 455. assafoetida, i. 458. castoreum, i. 458. cataria, i. 532. cathartics, i. 181. colocynth, i. 456. croton oil, i. 456. electricity, i. 461. emmenagogues, i. 451. ergot, i. 462. ferri iodidum, ii. 65. ferri sales, ii. 55. footbath, i. 366. galbanum, i. 458. gamboge, i. 456. gas acidum carbonicum, ii. 213. guaiacum, i. 462. haemospasia, ii. 268. hedeoma, i. 458. helleborus, i. 456. inula, i. 269. iodine, i. 462. juniperus virginiana, i. 458. liquor ammoniae, i. 543. marrubium, ii. 51. mistura ferri composita, ii. 64. oleum terebinthinae, i. 525. pilulae aloes et myrrhae, i. 203. pilulae ferri carbonatis, ii. 63. rhubarb, i. 456. rosmarinus, i. 501, rubia, i. 460. ruta, i. 460. sabina, i. 459. sodae boras, i. 470. strychnia, i. 462. tanacetum, i. 461. warm water bath, i. 366. Amygdalitis, astringents, ii. 107. 496 INDEX OF DISEASES AND REMEDIES, Amygdalitis, emetics, i. 136. Anaemia, ferri iodidum, ii. 65. ferri sales, ii. 55. mistura ferri composita, ii. 64. oxygen, i. 556. Aneurism of the great vessels, inspissants, ii. 429. Angina pectoris, argenti nitras, ii. 73. digitalis, ii. 198. galvanism, i. 553. magnetism, ii. 269. Anthrax, iodinium, ii. 327. malignant, aqua chlorini, ii. 398. Anxiety, extractum cannabis, i. 419. Aphonia, armoracia, i. 381. oleum tiglii, ii. 276. strychnia, i. 430. Aphrodisia, camphora, i. 506. conium, i. 406. Aphthae, astringents, ii. 107. ferri pernitras, ii. 154. honey of borax, ii. 226. plumbi acetas, ii. 147. zinci sulphas, ii. 155. Apoplexy, arteriotomy, ii. 183. cathartics, i. 180. elaterium, i. 232. emetics, i. 137, 139. oleum tiglii, i. 229. revellents, ii. 256. sinapis, ii. 260. Ardor urinae, diluents, ii. 428. Arsenic, antidote to, ferri oxidum hydratum, ii. 58. Arthritic dyscrasy, lappa, ii. 344. Arthritis, revellents, ii. 254. Ascarides lumbricoides, mucuna, i. 251. pulvis stanni, i. 252. sodii chloridum, i. 250. Ascites, electricity, ii. 374. iodinium, ii. 326. pressure, ii. 301. Asphyxia, acupuncture, i. 554. galvanism, i. 553. galvanopuncture, i. 555. from drowning, hot air bath, i. 548. liquor ammoniae, i. 543. Asthenia, cinchonia, ii. 85. ferrum ammoniatum, ii. 59. paullinia, ii. 52. tinctura ferri chloridi, ii. 59. Asthma, acidum hydrocyanicum, ii. 192. aetherea, i. 447. antispasmodics, i. 439. chloroform, i. 423. digitalis, ii. 198. emetics, i. 137. galvanism, i. 553. humoral, sulphuris iodidum, ii. 334. inhalations, i. 255. inhalation of belladonna, i. 404. inhalation of benzoin, i. 287. Asthma, inhalation of ether, i. 421. inhalation of stramonium, i. 293, 405. inhalation of vinegar, i. 288. nervous, magnetism, ii. 269. oleum tiglii, ii. 276. tabacum, inhaled, i. 293. Atony, general, ferri ferrocyanuretum, ii. 61. of the genito-urinary organs, cantha- rides, i. 318. of mucous membranes, catechu, ii. 126. Atrophy, saccharum, ii. 356. B. Bedsores, creasotum, ii. 250. Bile, defective, electricity, i. 552. Biliary derangements, taraxacum, i. 319. Bites of insects and serpents, liquor ammo- niae, i. 543. of rabid animals, acidum nitricum, ii. 287. liquor ammoniae, ii. 290. acidum nitricum, ii. 287. Black tongue, potassae chloras, ii. 355. Bladder, diseases of the, buchu, i. 337. uva ursi, i. 340. inflammation of the, chronic, oleum terebinthinae, i. 523, 524. cubeba, i. 517. irritability of the, buchu, i. 337. irritation of the, belladonna, i. 404. neck of the, spasm of the, bella- donna, i. 404. neuralgic and spasmodic diseases of the, belladonna, i. 403. paralysis of the, strychnia, i. 430. ulceration, &c, of the liquor calcis, ii. 157. Bleeding from leech bites, ii. 143. alumen, ii. 144. creasotum, ii. 143. cupri sulphas, ii. 153. ulcers, tinctura ferri chloridi, ii. 153. Blennorrhcea, acidum hydrocyanicum, ii. 192.' acidum tannicum, ii. 123. argenti oxidum, ii. 74. astringents, ii. 107, 116. cubeba, i. 517. geum, ii. 52. monesia, ii. 137. oleum terebinthinae, i. 524. piper, i. 514. virulenta, acidum tannicum, ii. 123. Blistered surfaces, adeps, ii. 421. ceratum sabinae, ii. 279. INDEX OF DISEASES AND REMEDIES, 4H7 Blistered surfaces, unguentum cantharidis, ii. 278. unguentum mezerei, ii T>V 279- Blisters, ceratum plumbi subacetatis,ii.371 ceratum simplex, ii. 421. cetaceum, ii. 422. Boils, iodinium, ii. 327. mel, i. 278. Bones, diseases of the, sarsaparilla, ii 361 Bothriocephalus latus, filix mas, i. 245 Bowels, erethism of the mucous'membranes of the, oleum ricini, i. 194. offensive discharges from the, calx chlorinata, ii. 399. painful affections of the, acidum hy- drocyanicum, ii. 192. Bronchitis, demulcents, ii. 404. narcotics, i. 370. chronic, allium, i. 268. _ ammoniacum, i. 260. ammoniae murias, i. 546. chronic, aqua picis liquidae, ii. 143. assafoetida, i. 268. balsam of peru, i. 261. balsam of tolu, i. 262. chlorine inhalation, i. 290. colchicum, ii. 202. copaiba, i. 266. creasote, i. 269. emetics, i. 137. excitants, i. 481. gas acidum carbonicum, ii. 213. hepatica, ii. 53. inhalations, i. 256. inula, i. 269. iodine inhalations, i. 291. monesia, ii. 137. naphtha, i. 270. naphthaline, i. 270. plumbi acetas, ii. 148. senega, i. 258. storax, i. 264. strychnia, i. 431. tar water, i. 143. uva ursi, ii. 134. Bronchocele, see Goitre. Bronchorrhoea, creasotum, ii. 142. monesia, ii. 137. Bruises, alcohol, i. 533. ammoniae murias, i. 546. electricity, i. 549. linimentum saponis camphoratum, ii. 373. tinctura camphorae, i. 509. tincture of arnica, i. 433. Bubo, emetics, i. 138. emplastrum hydrargyri, ii. 313. iodinium, ii. 327. veratria, ii. 205. Burns, alcohol, i. 537. ceratum plumbi subacetatis, ii. 371. collodion, i. 540. VOL. II.—32 Burns, compression, ii. 301. creasote, i. 542. creta, ii. 156. excitants, i. 483. glycerina, ii. 425. iodinum, ii. 327. linimentum calcis, ii. 157. linimentum terebinthinae, i. 525. liquor plumbi subacetatis, ii. 149. liquor sodae chlorinatce, ii. 350. oleum lini, ii. 423. oleum terebinthinae, i. 524. pressure, ii. 301. C. Cachexia, alkali, ii. 345. aqua chlorini, ii. 348. auri praeparata, ii. 342. barii chloridum, ii. 340. calculous, antilithics, i. 326. cancerous, iodinum, ii. 326. chlorinum, ii. 348. dulcamara, ii. 367. ferri iodidum, ii. 331. ferri praeparata, ii. 345. ferri sales, ii. 55. guaiaci lignum, ii. 364. hydrargyri praeparata, ii. 308. mercurial, iodinium, ii. 326. mineral waters, ii. 445. potassii iodidum, ii. 330. saccharum, ii. 356. sarsaparilla, ii. 358. scrofulous, calx chlorinata, ii. 349. syphilitic, see Syphilis. syrupus sarsaparilhe compositus, ii. 363. tubercular, iodinium, ii. 326. oleum morrhuae, ii. 338. Calculi, alternating, treatment of, i. 331. bihary, inhalation of ether, i. 421. expulsion of, ergot, ii. 210. solvent of, pareira, i. 337. solvents of, i. 332. urinary, inhalation of ether, i. 421. Calculous depositions, pareira, i. 337. antilithics, i. 328. Calculus, sodae bicarbonas, ii. 381. Cancer, acidum arseniosum, ii. 288, 289. aconitum, i. 411. arseniate of iron, ii. 289. arsenici praeparata, ii. 340. auri praeparata, ii. 342. carbo animalis, ii. 338. chloroform, i. 423. conium, i. 406. electricity, &c, ii. 374. ferri arsenias, ii. 341. ferri iodidum, ii. 331. ferri praparata, ii. 345. ferri sales, ii. 55. ferri subcarbonas, ii. 58. 498 INDEX OF DISEASES AND REMEDIES, Cancer, hydrargyri praeparata, ii. 308. iodinium, ii. 326. pressure, ii. 301. of the stomach, argenti nitras, ii. 71. ulcerated, acidum hydrocyanicum, ii. 190. of the uterus, auri praeparata, ii. 342. creasote, i. 549. iodinium, ii. 326. Cancerous growths, zinci chloridum, ii. 286. sores, humulus, i. 416. tumours, &c, nitro-muriate of gold, ii. 290. ulcerations, hydrargyri iodidum rubrum, ii. 313. plumbi chloridum, ii. 150. creasote, i. 542, ii. 290. gas acidum carboni- cum, ii. 212. hydrargyri nitras acidus, ii. 289. Cancrum oris, acidum muriaticum, ii. 399. calx chlorinata, ii. 399. chlorinium, ii. 398. cupri sulphas, ii. 153. potassae chloras, ii. 355. Carbuncle, sloughing, creasote, ii. 290. Cardialgia. See Acidity. bismuth subnitras, ii. 74. oxide of silver, ii. 73. Caries, scrofulous, creasote, ii. 290. Catalepsy, strychnia, i. 430. Cataract, belladonna, i. 402. Catarrh, acidum tannicum, ii. 123. allium, i. 268. almond mixture, i. 274. almond oil, i. 274. althaea, i. 272. ammoniacum, i. 260. asclepias tuberosa, i. 360. assafoetida, i. 442. balsam of tolu, i. 262. of the bladder, diosma, i. 336. bran tea, ii. 423. chronic, mistura ferri composita, ii. 64. storax, i. 263. zinci sulphas, ii. 155. demulcents, ii. 402. diaphoretics, i. 347. excitants, i. 481. footbath, i. 366. inula, i. 269. marrubium, ii. 51. melissa, i. 359. oleum terebinthinae, i. 525. opium, i. 391. pulmonary, gas hydrogenium, ii. 212. pulvis ipecacuanhae et opii, i. 351. sassafras radicis cortex, i. 359. ulmus, i. 283. Catarrhal affections, bran, ii. 423. linum, i. 280. sugar, i. 277. Cephalalgia, errhines, i. 294. obstinate, hydrargyri sulphas fla- vus, i. 297. potassii cyanuretum, ii. 194. Cerebral affections, douche, ii. 227. Cerumen, deficiency of, creasote, i. 542. oleum terebinthinae, i. 524. Chafing, creasote, i. 542. Chancres, argenti nitras, ii. 280. Chapped lips, plumbi nitras, ii. 397. nipples, collodion, i. 539. Chaps, oleum morrhuae, ii. 338. plumbi nitras, ii. 397. unguentum aquae rosae, ii. 422. Chest, affections of the, conium, i. 408. chronic affections of the, emplastrum picis Burgundicae, ii. 264. diseases, emetics in, i. 136. painful affections of the, belladonna, i. 403. Chilblain. See Pernio. alumen, ii. 146. ammoniae murias, i. 546. creasote, i. 542. iodinium, ii. 327. Chlorine inhalation in phthisis, i. 289. Chlorosis, ferri iodidum, ii. 65. ferri lactas, ii. 66. haemospasia, ii. 268. hydrargyri praeparata, ii. 308. mistura ferri composita, ii. 64. oxygen, i. 556. paullinia, ii. 52. pilulae ferri carbonatis, ii. 63. pilulae ferri compositae, ii. 64. tonics, ii. 28. Cholelithus, cathartics, ii. 179. emetics, i. 141. Cholera, and cholera morbus,acidum nitricum, ii. 268. creasotum, ii. 142. capsicum, i. 515, 516. cathartics, i. 179. chlorinium,ii.394. disinfectants, ii. 394. emetics, i. 138. hot air bath, i. 548. hydrargyri chlo- ridum mite, ii. 315. hydrargyri prae- parata, ii. 309. pyroligneous acid, ii. 400. morphiae acetas, i. 396. mustard, i. 157. DEX OF DISEASES AND REMEDIES. 499 Cholera, and cholera morbus, opium, i. 391. phosphate of so- da, i. 218. plumbi acetas, ii. 148. potassae chloras, ii. 355. revellents, ii. 246. sesamum, ii, 407. sodii chloridum, i. 160. strychnia, i.431. warm air bath, i. 363. infantum, alumen, ii. 148. oleum monardae, i. 495. plumbi acetas, ii. 147. quercus, ii. 132. sesamum, ii. 407. ulmus, ii. 408. morbus, opium, i. 391. plumbi acetas, ii. 148. Chordee, belladonna ointment, i. 404. camphora, i. 508. unguentum belladonnae, i. 404. Chorea, acidum arseniosum, ii. 91. antispasmodics, i. 439. argenti nitras, ii. 72. assafoetida, i. 442. belladonna, i. 402. cathartics, i. 182. cimicifuga, ii. 208. cupri sulphas, ii. 75. cuprum ammoniatum, ii. 76. electricity, i. 552. excitants, i. 482. ferri ferrocyanuretum, ii. 61. ferri iodidum, ii. 65. ferri sales, ii. 55. ferrum ammoniatum, ii. 60. liquor arsenici chloridi, ii. 94. moschus, i. 450. revellents, ii. 259. * strychnia, i. 430. tonics, ii. 28. veratria, ii. 205. zinci oxidum, ii. 69. Chronic cutaneous affections, ammoniae mu- rias, i. 546. sulphurous wa- ters, ii. 454. diseases, acida mineralia, ii. 346. arrowroot, ii. 412. change of air, ii. 447. hydrargyri praeparata, ii. 309. hydrargyrum cum creta, ii. 311. hydropathy, ii. 446. Cinchonism, ii. 88. Colds, foot bath, i. 367. Colic, antispasmodics, i. 440. calomel and opium, i. 212. Colic, cataria, i. 532. cathartics, i. 180. flatulent, angelica, ii. 49. anisum, i. 489. assafoetida, i. 442. confectio opii, i. 393. excitants, i. 474, 478. oleum cajuputi, i. 531. lead, alumen, i. 197, ii. 145. tobacco, i. 157. Colica pictonum, opium, i. 373. Colitis, chronic, copaiba, i. 529. Collapse, excitants, i. 476. Coma, blood-letting, ii. 167. of fever, capsicum, i. 515. oleum terebinthinae, i. 523, 525. terebinthina, i. 524. Concretions, bilious, warm water bath, i. 365. urinary, warm water bath, i. 365. Condylomata, creasote, ii. 290. hydrargyri iodidum rubrum, ii. 319. Congestions, electricity, &c, i. 374. Conjunctivitis, argenti nitras, ii. 151. astringents, ii. 107. chronic, alcohol, i. 537. cupri sulphas, ii. 153. excitants, i. 483. plumbi acetas, ii. 148. purulent, plumbi acetas, ii. 148. pustular, plumbi acetas, ii. 148. scarification, ii. 184. vinum opii, i. 394. Constipation, carbo ligni, ii. 54. cathartics, i. 180. emetics, i. 139. excitants, i. 479. hydrargyrum, ii. 310. laughter, i. 484. magnesia, i. 187. nauseants, i. 126. oleum tiglii, i. 231. tobacco, i. 157. Consumption, cimicifuga, ii. 207. inhalation of tar vapour, i 256, 292. Contagion, chlorinium, ii. 393. disinfectants, ii. 389. aqua chlorinii, ii. 395. calx chlorinata, ii. 395. Contractura, adeps, ii. 421. Contusions. See Bruises. Convalescence, acida mineralia, ii. 346. arrowroot, ii. 412. . acidum sulphuricum, ii. 76. gentian, ii. 37. paullinia, ii. 52. Convulsions, acupuncture, i. 554. assafoetida, i. 442. blood-letting, ii. 167. emetics, i. 141. 500 INDEX OF DISEASES AND REMEDIES. Convulsions, magnetism, ii. 259. moschus, i. 450. oleum succini, i. 450. revellents, ii. 259. of children, emetics, i. 141. cathartics, i. 182. warm water bath, i. 365. Cornea, opacities, barii chloridum, ii. 340. iodinium, ii. 327. oleum morrhuae, ii. 338. specks of the, saccharum, ii. 281. ulceration of the, oxide of silver, ii. 152. plumbi acetas, ii. 148. Corneitis, iodinium, ii. 327. Corns, acida mineralia, ii. 281. argenti nitras, ii. 280. Coryza, inspissants, ii. 429. Cough, acacia, i. 270. almond mixture, i. 274. assafoetida, i. 267. conium, i. 408. expectorants, i. 253. extractum cannabis, i. 419. glycyrrhiza, i. 279. lactucarium, i. 414. lycopus, i. 427. sugar, i. 277. tinctura opii camphorata, i. 393. nervous, emetics, i. 137. obstinate, acidum hydrosulphuri- cum, ii. 211. spasmodic, chloroform, i. 423. syrupus pruni Virginianae, ii. 41. Cramp, acidum aceticum, ii. 268. antispasmodics, i. 436. extractum cannabis, i. 419. magnetism, i. 437, ii. 269. Croup, alkali, ii. 345. alum, i. 143. astringents, ii. 107. emetics, i. 136. hasmospasia, ii. 268. hydrargyri praeparata, ii. 307. hydrargyri sulphas flavus, i. 144. hysteric, creasotum, i. 451. squill, i. 153. syrupus scillae compositus, i. 154. Cutaneous diseases, chronic, acida mineralia, ii. 346. acidum arsenio- sum, ii. 341. acidum hydro- cyanicum, ii. 292. alkalia, ii. 346. ammoniae arse- nias, ii. 341. ammoniae muri- as, i. 546. anthrakokali, ii. 354. Cutaneous diseases, chronic, aqua chlorinii,ii. 348. aralia nudicau- lis, ii. 365. argenti nitras, ii. 152, 280. arsenici praepa- rata, ii. 340. barii chloridum, ii. 340. boue des eaux, ii. 450. calx chlorinata, ii. 349. cantharis, ii. 355. ceratum plumbi subacetatis, ii. 371. chlorinium, ii. 348. cocculus, ii. 443. collodion, i. 540. creasote, i. 542. cupri subacetas, ii. 280. dulcamara, ii. 367. eutrophic oint- ments, ii. 369. ferri praeparata, ii. 345. fuligokali, ii. 354. glycerina,ii.425. guaiaci lignum, ii. 364. hot air bath, i. 548. hydrargyri chlo- ridum corro- sivum, ii. 317. hydrargyri chlo- ridum mite, ii. 315, 316. hydrargyri cya- nuretum, ii. 321. hydrargyri iodi- dum, ii. 318. hydrargyri sul- phas flayus,ii. 322. hydrargyri sul- phuretum ni- grum, ii. 320. hydrargyrum ammoniatum, ii. 317. hydrargyri sul- phuretum ni- grum, ii. 320. iodide of ammo- nium, ii. 333. INDEX OF DISEASES AND REMEDIES, 501 Cutaneous diseases, chronic, iodide of mercu- ry and arse- nic, ii. 332. iodinium,ii. 327. lappa, ii. 368. liquor arsenici chloridi, ii. 94. liquor calcis, ii. 157. liquor calcii chloridi, ii. 339. liquor sodae chlorinatae, ii. 350. mezereum, i. 358. mudar, ii. 368. oleum cadinum, ii. 353. oleum morrhuae, ii. 338. opium, i. 392. potassii bromi- dum, ii. 335. potassii sulphu- retum, ii. 352. quiniae arsenis, ii. 341. sabina, ii. 281. saccharum, ii. 356. sarsaparilla, ii. 361. sassafras radicis cortex, ii. 366. sodae hyposul- phis, ii. 352. spongia usta, ii. 336. sulphur, ii. 350. sulphuris iodi- dum, ii. 333. tonics, ii. 28. unguentum cre- asoti, ii. 369. unguentum hy- drargyri am- moniati, ii. 309. unguentum hy- drargyri ni- tratis, ii. 321. unguentum hy- drargyri ox- idi rubri, ii. 369. unguentum picis liquidae, ii. 369. unguentum sul- phuris, ii. 369. unguentum sul- phuris com- positum, ii. 369. Cutaneous diseases, chronic, unguentum ta- baca, ii. 309. unguentum acidi nitrici, ii. 288. unguentum zinci oxidi, ii. 370. warm air bath, i. 363. warm vapour bath, i. 364. warm water bath, i. 365, 366. Cynanche, astringents, ii. 108. honey of borax, ii. 226. oleum terebinthinae, i. 524. maligna, astringents, ii. 107. acidum muriaticum, ii. 399. capsicum, i. 515, 516. emetics, i. 136. pulvis ipecacuanhae et opii, i. 351. Cystirrhoea, aqua picis liquidae, ii. 143. argenti nitras, ii. 152. fuligo, ii. 143. liquor calcis, ii. 156. tinctura ferri chloridi, ii. 153. chronic, uva ursi, ii. 134. copaiba, i. 529. buchu, i. 336. pareira, i. 338. Cysts, serous, electricity, &c, ii. 374. synovial, electricity, &c, ii. 374. D. Deafness, creasote, i. 542. haemospasia, ii. 268. nervous, electricity, i. 552. Debility, cascarilla, ii. 45. cinchona, ii. 84. ferri iodidum, ii. 65. ferri sales, ii. 55. geum, ii. 52. serpentaria, ii. 46. chronic, oxygen, i. 555. nervous, lavandula, i. 500. of phthisis, prunus Virginiana, ii. 41. Delirium of fever, capsicum, i. 515. tremens, alcohol, i. 537. emetics, i. 141. digitalis, ii. 198. excitants, i. 482. narcotics, i. 382. opium, i. 391. tinctura humuli, i. 416. Depositions, morbid, galvanopuncture, i. 555. hydrargyri praeparata, ii. 309. Depression, spiritus lavandulae compositus, i. 500. spiritus rosmarini, i. 501. Diabetes, alumen, ii. 145. inspissants, ii. 429. 502 INDEX OF DISEASES AND REMEDIES. Diabetes, liquor calcis, ii. 156. mellitus, astringents, ii. 117. creasote, i. 542. liquor ammoniae hydro- sulphatis, ii. 211. Diarrhoea, argilla pura, ii. 157. astringents, ii. 115, 117. calomel and opium, i. 212. carbo ligni, ii. 54. castillon powders, ii. 416. cathartics, i. 179. cera, ii. 420. cetraria, ii. 409. cetaceum, ii. 419. confectio opii, i. 393. creta, ii. 156. emetics, i. 139. excitants, i. 481. glycyrrhiza, ii. 408. oleum gnultheriae, i. 502. oleum terebinthinae, i. 524. opium, i. 391. paullinia, ii. 52. rhubarb, i. 197. sesamum, ii. 407. sevum, ii. 419. strychnia, i. 431. ulmus, ii. 408. acid, liquor calcis, ii. 156. mistura cretse, ii. 156. chronic, acidum sulphuricum, ii. 150. acidum tannicum, ii. 123. argenti chloridum, ii. 151. argenti nitras, ii. 151. catechu, ii. 126. cupri sulphas, ii. 152. erigeron canadense, i. 321. excitants, i. 481. ferri pernitras, ii. 154; ferri sales, ii. 56. galla, ii. 129. geranium, ii. 135. granati fructus cortex, ii. 135. haematoxylon, ii. 133. krameria, ii. 131. Hope's mixture, i. 397. monesia, ii. 137. morphiae acetas, i. 396. oleum terebinthinae, i. 524. oxide of silver, ii. 152. plumbi acetas, ii. 148. rhatany, ii. 131. rubus trivialis, ii. 141. of children, argilla pura, ii. 157. colliquative, plumbi acetas, ii. 148. of phthisis, bismuthi subnitras, ii. 74. of typhus, argenti nitras, ii. 152. bismuthi subnitras, ii. 74. Digestion, torpor of, friction, ii. 266. Digestive organs, atony of the, i. 393. Diphtheritis, alkalia, ii. 146, 345. alumen, ii. 145. astringents, ii. 107. excitants, i. 484. hydrargyri praeparata, ii. 307. potassii sulphuretum, ii. 352. of the throat, saccharum, ii. 281. Discharges, ichorous, creta, ii. 156. Diseases of the alimentary canal, emetics, i. 138. chest, emetics, i. 136. encephalon, emetics, i. 136. head, cathartics, i. 181. self-limited, ii. 459. Dropsy, acetate of potassa, i. 315. auri chloridum, ii. 343. ballota lanata, i. 313. caincae radix, i. 312. carota, i. 323. cathartics, i. 183. chimaphila, i. 311. cimicifuga, ii. 207. colchicum, i. 325. colocynth, i. 225. digitalin, i. 325. digitalis, i. 323, ii. 198. diluents, ii. 427. diuretics, i. 307. elaterium, i. 232. electricity, &c, ii. 374. emetics, i. 142. erigeron canadense, i. 321. erigeron heterophyllum, i. 321. ferri iodidum, ii. 65, 331. gamboge, i. 226. hydrargyri praeparata, ii. 30^. inspissants, ii. 429. iodinium, ii. 326, 327. jalapa, i. 224. juniperus, i. 309. oleum terebinthinae, i. 320. petroselinum, i. 321. potassae acetas, i. 315. potassae bitartras, i. 314. pressure, ii. 301. sulphate of quinia, ii. 88. revellents, ii. 259. scilla, i. 310. scoparius, i. 310. sodae boras, i. 316. sorbefacients, ii. 298. spiritus aetheris nitrici, i. 313. taraxacum, i. 319. veratria, i. 326. articular, electricity, &c., ii. 374. asthenic, ferri iodidum, ii. 65. infusum armoraciae, i. 301. dependent upon liver disease, ta- raxacum, i. 319. Dysentery, argilla pura, ii. 157. astringents, ii. 114. calomel and opium, i. 212. INDEX OF DISEASES AND REMEDIES. 503 Dysentery, carbo ligni, ii. 54. castillon powders, ii. 416. cathartics, i. 179. cera, ii. 420. cetaceum, ii. 419. cetraria, ii. 409. demulcents, ii. 403. emetics, i, 139. ergot, ii. 209. erigeron canadense, i. 321. excitants, i. 481. glycyrrhiza, ii. 408. granati fructus cortex, ii. 135. monesia, ii. 137. myrtle wax, ii. 421. opium and calomel, i. 391. paullinia, ii. 52. plumbi acetas, ii. 148. rhubarb, i. 197. rubus trivialis, ii. 141. sesamum, ii. 407. sevum, ii. 419. simaruba, ii. 40. strychnia, i. 430. ulmus, ii. 408. malignant, chlorinium, ii. 398. calx chlorinata, ii. 398. camp, creasotum, ii. 142. chronic, acidum sulphuricum, ii. 150. acidum tannicum, ii. 123. argenti chloridum, ii. 151. argenti nitras, ii. 151. catechu, ii. 126. cupri sulphas, ii. 152. excitants, i. 481. ferri sales, ii. 56. galla, ii. 129. geranium, ii. 134. haematoxylon, ii. 133. krameria, ii. 131. plumbi acetas, ii. 147. oleum terebinthinae, i. 524. rhatany, ii. 131. Dysmenorrhcea, inhalation of ether, i. 421. guaiacum, i. 462. oxide of silver, ii. 152. sodas boras, i. 470. warm bath, i. 366. Dyspepsia, alcohol, i. 536. _ ale and porter, i. 538. antacids, ii. 380. carbo ligni, ii. 400. cathartics, i. 179. change of air, &c, ii. 381. emetics, i. 138. excitants, i. 475, 477, 485. fuligokali, ii. 354. liquor calcis, ii. 156. sulphate of potassa, i. 220. strychnia, i. 430. Dyspepsia, taraxacum, i. 319. vinum album Hispanicum, i. 538. warm water bath, i. 365. zinci sulphas, ii. 70. Dyspepsia, atonic, absinthium, ii. 48. aetherea, i. 447. ammoniae carbonas, i. 384. angelica, ii. 49. anthemis, ii. 44. bisulphate of potassa, i. 220. carbo ligni, ii. 54. capsicum, i. 515. cascarilla, ii. 45. tinctura cinchonae, ii. 87. columba, ii. 33. ferri iodidum, ii. 65. gentian, ii. 37. geum, ii. 52. heracleum, i. 533. laughter, i. 484. quassia, ii. 39. Dysphagia, mezereum, i. 300. Dysphonia, armoracia, i. 301. Dyspnoea, nervous, aetherea, i. 447. E. Ear, middle, diseased, iodinium, ii. 327. diseases of the, errhines, i. 295. Eczema, chronic, cantharis, ii. 355. oleum cadinum, ii. 353. oleum morrhuae, ii. 338. Effluvia, morbific, disinfectants, ii. 387. Elephantiasis, acidum arseniosum, ii. 341. Emissions, nocturnal, lupulin, i. 417. Encephalic affections, ammoniae murias, i. 546. elaterium, i. 234. emetics, i. 137. gamboge, i. 227. jalapa, i. 224. antimonii et potassas tartras, i. 348. Encephalitis, cathartics, i. 181. cold applications, ii. 221,229. emetics, i. 137. opium, i. 391. Enteralgia, oleum cinnamomi, i. 487. Enteritis, acacia, ii. 407. calomel and opium, i. 211. chronic, copaiba, i. 528. demulcents, ii. 402. Ephemera, emetics, i. 135. Ephidrosis, astringents, ii. 117. Epidemic diseases, calx chlorinata, ii. 395. plumbi nitras, &c, ii. 397. Epididymis, indurated, electricity, &c, ii. 374. Epilepsy, acidum arseniosum, ii. 93. antispasmodics, i. 439. argenti nitras, ii. 72. 504 INDEX OF DISEASES AND REMEDIES. Epilepsy, artemisia vulgaris, ii. 48. belladonna, i. 4.02. bismuthi subnitras, ii. 74. cathartics, i. 182. cupri sulphas, ii. 75. cuprum ammoniatum, ii. 76. digitalis, ii. 198. emetics, i. 141. excitants, i. 482. ferri ferrocyanuretum, ii. 61. ferrum ammoniatum, ii. 60. galvanism, i. 553. heracleum, i. 533.. indigo, ii. 54. liquor ammoniae, i. 543. magnetism, ii. 269. moschus, i. 450. revellents, ii. 259. strychnia, i. 430. tonics, ii. 27. zinci oxidum, ii. 69. Epistaxis, acidum sulphuricum aromaticum, ii. 151. alumen, ii. 147. astringents, ii. 109. cathartics, i. 180. creasotum, ii. 143. emetics, i. 139. ergot, ii. 209. Erection, blennorrhagic, camphora, i. 508. painful, lupulina, i. 417. Erethism, acidum hydrocyanicum, ii. 191. Ergotism, ii. 209. Eructations, fetid, calx chlorinata, ii. 398. nidorous, carbo ligni, ii. 54, 400. Erysipelas, alcohol, i. 537. argenti nitras, ii. 273. blisters, ii. 243. colchicum, ii. 202. compression, ii. 301. excitants, i. 483. glycerina, ii. 425. iodinium, ii. 327. opium, i. 392. plumbi acetas, ii. 147. tonics, ii. 27. scarification, ii. 184. local, creasote, i. 542. Erythema, opium, i. 392. plumbi acetas, ii. 148. Exanthemata, major, carthamus, i. 362. crocus, i. 362. emetics, i. 135. warm water bath, i. 365. Excoriations, amylum, ii. 418. creasotum, ii. 143. creta, ii. 156. plumbi nitras, ii. 397. unguentum aquae rosae, ii. 422. unguentum oxidi zinci, ii. 370. of children, creasotum, ii. 143. of the skin, oleum morrhuae, ii. 338. Excrescences, iodinium, ii. 327. Expectoration, of bronchitis, acidum gnlli- cum, ii. 125. of phthisis, acidum gallicum, ii. 125. profuse, oxide of silver, ii. 152. plumbi acetas, ii. 147. Eyelids, thickened, oxide of silver, ii. 152. Eyes, diseases of the, errhines, i. 295. Fainting, ammoniae carbonas, i. 545. liquor ammoniae, i. 543. nervous, spiritus lavandulae com- positus, i. 500. spiritus ammoniae aromaticus, i. 544. spiritus lavandulae compositus, i. 500. spiritus rosmarini, i. 501. Fasciae, diseases of the, sarsaparilla, ii. 361, Fauces, inflamed, aqua chlorinii, ii. 349. scarification, ii. 184. Favus, unguentum tabaci, ii. 369. Febrile affections, arrowroot, ii. 412. diaphoretics, i. 347. diuretics, i. 307. digitalis, ii. 197. excitants, i. 480. hordeum, ii. 410. lemon juice, ii. 223. potassii ferrocyanuretum, ii. 193. vinum ipecacuanhae, i. 351. Febres algidae, emetics, i. 134. Fetid secretions, carbo ligni, ii. 53. Fever, ablution, ii. 227. acidum hydrocyanicum, ii. 191. antimonii et potassae tartras, i. 145. astringents, ii. 106. avenae farina, ii. 417. belladonna, i. 402. blisters, ii. 238. cathartics, i. 175. cold ablution, ii. 227. cold affusion, ii. 227. contrastimulants, ii. 186. diaphoretics, i. 347. emetics, i. 135. excitants, i. 479. hydrargyri praeparata, ii. 307. iced drinks, ii. 219. liquor ammoniae acetatis, i. 352. liquor potassae citratis, ii. 225. mild treatment of, ii. 457. nauseants, i. 135. nitrous powders, i. 348. opium, i. 391. pediluvium, ii. 228. potassae chloras, ii. 355. nitras, ii. 224. refrigerants, ii. 218. INDEX OF DISEASES AND REMEDIES, 505 Fever, revellents, ii. 248. shower bath, ii. 228. spiritus aetheris nitrici, i. 354 tartrate of potassa, i. 219. tonics, ii. 24. topical refrigerants, ii. 227. adynamic, acidum nitricum, ii. 78. alcohol, i. 536. ammoniae carbonas, i. 352. blisters, ii. 238. camphora, i. 354, 507. capsicum, i. 515. oleum terebinthinae, i. 523, ii. 264. pulvis ipecacuanhae et opii, i. 351. Rhine and Moselle wines, i. 536. sinapis, i. 518. spiritus aetheris nitrici, i. 354. arthritic, revellents, ii. 254. ataxic, ammoniae carbonas, i. 352. camphora, i. 354. pulvis ipecacuanhae et opii, i. 351. aural, ii. 342. congestive, hot air bath, i. 363. sulphate of quinia, ii. 88. warm air bath, i. 363. continued, narcotics, i. 382. convalescence from, acidum sulphuri- cum, ii. 77. eruptive, cathartics, i. 178. oleum terebinthinae, i. 524. warm water bath, i. 365. exanthematous, revellents, ii. 248. hectic, acidum hydrocyanicum, ii. 192. intermittent. See Intermittent. cathartics, i. 177. emetics, i. 134. narcotics, i. 381. nauseahts, i. 125. low, moschus, i. 450. oleum monardae, i. 495. malignant, chlorine, ii. 398. protracted, ammoniae carbonas, i. 545. acidum sulphuricum, ii. 75. camphora, i. 507. oleum cajuputi, i. 531. oleum terebinthinae, i. 528, ii. 265. wine, i. 537. puerperal, oleum terebinthinae, i. 524. refrigerants, ii. 218. remittent. See Remittent. cold affusion, ii. 228. emetics, i. 135. narcotics, i. 381. oleum terebinthinae, i. 524. plumbi acetas, ii. 148. Fever, rheumatic. See Rheumatism, acute. scarlet, potassae chloras, ii. 354. typhoid, argenti nitras, ii. 151. oleum terebinthinae, i. 523, 524. sulphate of quinia, ii. 88. potassae chloras, ii. 355. typhus, aqua chlorini, ii. 399. ammoniae carbonas, i. 545. cerevisiae fermentum, ii. 401. sulphate of quinia, ii. 88. yellow, cold affusion, ii. 227. oleum terebinthinae, i. 524. plumbi acetas, ii. 148. sulphate of quinia, ii. 88. Fissures of the skin, creasotum, i. 542. oleum morrhuae, ii. 338. Fistula, acidum hydrocyanicum, ii. 192. electricity, &c, ii. 374. Fistulous openings, iodinium, ii. 327. Flatulence, aether, i. 539. antispasmodics, i. 440. cinnamon, i. 487. creasote, i. 541. emplastrum assafoetidae, i. 443. excitants, i. 477. heracleum, i. 532. > oleum cinnamomi, i. 487. piper, i. 513. solidago, i. 533. spiritus ammoniae aromaticus, i. 544. gouty, tincture of rhubarb and senna, i. 199. gastric, zingiber, i. 519. intestinal, zingiber, i. 519. Flux, passive, acidum gallicum, ii. 125. Fcetor oris, chloroform, i. 424. calx chlorinata, ii. 398. creasotum, ii. 400. Follicular disease, collodion, i. 540. Fracture, ununited, iodinium, ii. 327. Fungous growths, argenti nitras, ii 280. cupri subacetas, ii. 280. cupri sulphas, ii. 280. saccharum, ii. 281. in ulcers, alumen exsicca- tum, ii. 281. unguentum cu- pri subaceta- tis, ii. 280. Fungoid disease, chloroform, i. 424. G. Gallstone, cathartics, i. 179. emetics, i. 141. Gangrene, cinchona, ii. 401. calx chlorinata, ii. 399. disinfectants, ii. 393. oleum terebinthinae, i. 524. local, ale and porter, i. 538. of the lungs, chlorinium, ii. 328. 506 INDEX OF DISEASES AND REMEDIES. Gangrene, of the lungs, calx chlorinata, ii. 398. pyroligneous acid, ii. 400. tonics, ii. 28. Gangrenoid parts, disinfectants, ii. 393. Gastric affections, excitants, i. 477. Gastritis, acacia, ii. 407. Gastrodynia, acidum hydrocyanicum, ii. 192. aether, i. 539. alcohol, i. 536. antispasmodics, i. 440. bismuthi subnitras, ii. 74. creasote, i. 541. oleum cinnamomi, i. 487. oxide of silver, ii. 73. zinci oxidum, ii. 69. Gastro-enteric affections, bismuthi subnitras, ii. 74. of children, sul- phate of potassa, i. 220. Gastro-enteritis, acacia, ii. 407. demulcents, ii. 402. emetics, i. 138. Genito-urinary organs, diseases of, copaiba, • i. 528. cupri sulphas, ii. 153. Glanders, chronic, creasotum, ii. 142. Glandular enlargements, painful, belladon- na, i. 408. swellings, alkalia, ii. 345. calx chlorinata, ii. 349. hydrargyri iodidum rubrum, ii. 319. iodide of barium, ii. 333. iodinium, ii. 327. linimentum cam- phorae, ii. 373. linimentum saponis camphoratum, ii. 373. potassii sulphuretum, ii. 352. sarsaparilla, ii. 361. sesqui-iodide of car- bon, ii. 332. sorbefacients, ii. 299. veratria, ii. 205. syphilitic, hydrargyri iodidum rubrum, ii. 319. diseases, hydrargyri chloridum mite, ii. 315. hydrargyri sulphure- tum nigrum, ii. 320. Gleet, acidum tannicum, ii. 123. astringents, ii. 116. cubeba, i. 517. geum, ii. 52. plumbi acetas, ii. 148. tinctura ferri chloridi, ii. 153. Gleet, zinci sulphas, ii. 155. Goitre, barii chloridum, ii. 340. calx chlorinata, ii. 349. carbo animalis, ii. 338. electricity, &c, ii. 374. hydrargyri iodidum rubrum, ii. 319. iodinium, ii. 325. potassii bromidum, ii. 335. spongia usta, ii. 336. unguentum potassii iodidi, ii. 331. veratria, ii. 205. Gonorrhoea, acidum tannicum, ii. 123. ammoniae murias, i. 546. argenti nitras, ii. 152. astringents, ii. 107, 116. copaiba, i. 528. creasotum, ii. 143. cubeba, i. 517. demulcents, ii. 403. ergot, ii. 210. excitants, i. 481. liquor calcis, ii. 107. oleum cubebae, i. 517. piper, i. 514. plumbi acetas, ii. 148. sodae boras, ii. 226. tinctura cubebae, i. 517. tinctura ferri chloridi, ii. 153. zinci sulphas, ii. 155. Gout, aconitia, i. 413. aconitum, i. 411. acupuncture, i. 554. air pump vapour bath, ii. 267. blisters, ii. 242. colchicum, ii. 201. creasote, i. 542. dry cupping, ii. 267. emetics, i. 139. gentian, ii. 37. guaiacum, i. 357. iodinium, ii. 327. lappae, ii. 368. mezereum, i. 358. oleum tiglii, ii. 276. revellents, ii. 254. rheumatic, lemon juice, ii. 347. sulphate of veratria, ii. 205. sulphur, ii. 350. veratria, ii. 205. veratrum viride, ii. 206. vinum veratri albi, ii. 206. vinum album Hispanicum, i. 535. atonic, capsicum, i. 515. chronic, wet sheet, i. 368. retrocedent, moschus, i. 450. Gouty indigestion, calamus, i. 511. piper, i. 514. swellings, iodinium, ii. 327. Gravel, buchu, i. 337. Growths, malignant, hot iron, ii. 282. hydrargyri chloridum corrosivum, &c, ii. 289. zinci chloridum, ii. 286. INDEX OF DISEASES AND REMEDIES. 507 Growths, morbid, emplastrum ammoniaci, ii. 372. emplastrum galbani com- positum, ii. 372. emplastrum hydrargyri ii. 372. emplastrum ferri, ii. 372. emplastrum saponis, ii. 372. ceratum saponis, ii. 373. pressure, ii. 301. unguentum hydrargyri, ii. 312. Gums, spongy, catechu, ii. 126. iodinium, ii. 327. krameria, ii. 130. H. Haematemesis, alumen, ii. 145. astringents, ii. 111. cathartics, i. 181. creasotum, ii. 142. emetics, i. 139. ergot, ii. 209. oxide of silver, ii. 152. tinctura ferri chloridi, ii. 153. Haematuria, acidum gallicum, ii. 124. astringents, ii. 112. cathartics, i. 181. ergot, ii. 209. tinctura ferri chloridi, ii. 153. Haemoptysis, alumen, ii. 145. astringents, ii. 110. cathartics, i. 181. creasotum, ii. 142. digitalis, ii. 198. emetics, i. 139. ergot, ii. 209. gas hydrogenium, ii. 212. hepatica, ii. 53. lycopus, i. 427. monesia, ii. 187. oxide of silver, ii. 152. revellents, ii. 256. Headache, nervous, oleum lavandulae, i. 500. Head affections, douche, ii. 227. errhines, i. 295. issues and setons, ii. 277. sialogogues, i. 300. chronic, veratrum album, i. 296. Heartburn, ammoniae carbonas, i. 545. See Cardialgia. Heart diseases, digitalis, ii. 198. hypertrophy of the, aconitum, i. 411. conii, i. 408. digitalis, ii. 198. excitants, i. 481. inspissants, ii. 429. valvular disease of the, inspissants, ii. 429. Hectic, mistura ferri composita, ii. 64. Hemicrania, acidum arseniosum, ii. 93. Hemiplegia, excitants, i. 482. hydrargyri praeparata, ii. 309. strychnia, i. 430. Hemorrhage, acidum hydrocyanicum, ii. 192. acidum tannicum, ii. 123. acqua Binelli, ii. 121. acqua Brocchieri, ii. 123. alcohol, i. 537. alumen, ii. 145. argilla pura, ii. 157. astringents, ii. 108. cathartics, i. 180. creasotum, i. 542, ii. 142. digitalis, ii. 198. eau hemastatique de Tisserand, ii. 123. emetics, i. 139. ergot, ii. 209. ergotin, ii. 210. extrait hemastatique de Bonjean, ii. 210. infusum rosae compositum, ii. 136. inspissants, ii. 429. lycopus, i. 427. matico, ii. 138. plumbi acetas, ii. 148. refrigerants, ii. 220. revellents, ii. 254. tinctura ferri chloridi, ii. 153. tonics, ii. 27. asthenic, catechu, ii. 126. monesia, ii. 137. atonic, acidum sulphuricum, ii. 150. from the bowels, acidum sul- phuricum, ii. 150. alumen, ii. 146. bisulphate of potassa, i. 220. capillary, acidum sulphuricum aromaticum, ii. 151. collodion, i. 540. cupri sulphas, ii. 153. tinctura ferri chlo- ridi, ii. 153. from the intestines, oxide of silver, ii. 152. passive, acidum gallicum, ii. 125. geum, ii. 52. from the stomach and bowels, supcrsulphate of magnesia, i. 215. uterine, acidum gallicum, ii. 124. argenti oxidum, ii. 152. astringents, i. 113. 50 S INDEX OF DISEASES AND REMEDIES, Hemorrhage, uterine, cannabis indica, i. 418. emetics, i. 140. tinctura ferri chlo- ridi, ii. 153. from the vagina, ii. 146, Hemorrhoids, aloes, i. 201. astringents, ii. 112. cathartics, i. 181. copaiba, i. 529. cubeba, i. 517. extractum hyoscyami, i. 400. unguentum gallae, ii. 129. stramonii, i. 406. Ward's paste, i. 514. external, aciduA chromicum, ii. 288. Hepatic disease, cathartics, i. 179. Hepatitis, acidum nitricum, ii. 77. hydrargyri praeparata, ii. 307. chronic, emplastrum hydrargyri, ii. 313. Hernia, strangulated, tobacco, i. 157. warm water bath, i. 365. Herpes, aqua chlorinii, ii. 348. sulphuris iodidum, ii. 333. unguentum hydrargyri nitratis, ii. 321. phagedenic, arsenici iodidum, ii. 332. , zoster, argenti nitras, ii. 286. Hiccough, inhalation of ether, i. 421. moschus, i. 450. spasmodic, magnetism, ii. 269. Hoarseness, althaea, i. 273. armoracia, i. 301. chronic, oleum tiglii, ii. 276. Hooping-cough, acidum hydrocyanicum, ii. 192. alumen, ii. 145. antispasmodics, i. 440. assafoetida, i. 442. belladonna, i. 402. digitalis, ii. 198. emetics, i. 137. emplastrum assafoetida, i. 443. oil of cloves, i. 493. oleum succini, i. 450. oleum tiglii, ii. 276. potassii ferrocyanuretum, ii. 193. Housemaid's knee, emplastrum ammoniaci, ii. 372. Hydrocele, alcohol, i. 537. electricity, &c, ii. 373. iodinium, ii. 326, 327. Hydrocephalus, iodinium, ii. 326. acute, oleum terebinthinae, i. 320. chronic, electricity, &c, ii. 374. Hydrophobia, cannabis indica, i. 418. morphiae acetas, i. 395. Hydrophobia, opium, i. 391. revellents, ii. 259. Hydropic affections, see Dropsy. Hydrothorax, electricity, &c, ii. 374. iodinium, ii. 826. potassae acetas, i. 315, Hygroma, iodinium, ii. 326. Hyperaemia, acidum hydrocyanicum, ii. 192. ammoniae praeparata, ii. 262. local blood-letting, ii. 182. internal, revellents, ii. 252. warm fomentations and poultices, i. 369. warm water bath, i. 366. visceral, hydrargyri praeparata, ii. 309. Hyperaesthesia, acidum hydrocyanicum, ii. 191. Hypertrophy, hydrargyri praeparata, ii. 309. pressure, ii. 301. revellents, ii. 259. asthenic, ferri iodidum, ii. 65. glandular, alkali, ii. 845. of the heart, excitants, i. 481. of the uterus, ergot, ii. 210. Hypochondriasis, assafoetida, i. 442. chlorinium, ii. 348. emetics, i. 141. excitants, i. 484. spiritus lavandulae compo- situs, i. 500. strychnia, i. 430. veratria, ii. 205. Hysteria, antispasmodics, i. 440. aqua lauro-cerasi, ii. 191. assafoetida, i. 442. belladonna, i. 402. castor, i. 444. cathartics, i. 182. chloroform, i. 423. cimicifuga, ii. 207. creasotum, i. 451. douche, ii. 227. emetics, i. 142. excitants, i. 482. moschus, i. 450. oleum lavandulae, i. 500. revellents, ii. 259. spiritus aetheris sulphurici compo- situs, i. 448. spiritus ammoniae aromaticus, i. 447. spiritus lavandulae compositus, i. 500. strychnia, i. 430. tinctura Valerianae ammoniata, i. 446. valerian, i. 445. veratria, ii. 205. Hysteric affections, spiritus lavandulae com- positus, i. 448. nymphomania, camphora, i. 507. INDEX OF DISEASES AND REMEDIES. 509 Hysteroid affections, spiritus aetheris sulphu- rici compositus, i. 448. valerian, i. 445. Ichthyosis, glycerina, ii. 425. Impetigo, arsenici praeparata, ii. 340. unguentum hydrargyri nitratis, ii. 321. acidum hydrocyanicum, ii. 192. iodide of arsenic, ii. 332. iodinium, ii. 327. oleum morrhuae, ii. 338. sulphur, ii. 351. Impotence, iodinium, ii. 327. phosphorus, i. 547. strychnia, i. 430. Incontinence of urine, buchu, i. 337. iodinium, ii. 327. Indigestion, alkaline, acidum sulphuricum, • ii. 77. atonic, calamus, i. 511. capsicum, i. 515. confectio opii, i. 393. heracleum, i. 532. piper, i. 513. solidago, i. 533. neutral, acidum sulphuricum, ii. 77. Induration, electricity, &c, ii. 374. of areolar tissue, electricity, &c, ii. 374. Inflammation, alumen, ii. 145. astringents, ii. 107. contrastimulants, ii. 186. diaphoretics,'i. 347. diffusive, scarification, ii. 184. emetics, i. 136. emollients, ii. 406. excitants, i. 481. hydrargyri praeparata, ii. 307. narcotics, i. 382. oleum amygdalae, ii. 422. opium, i. 391. refrigerants, ii. 220. revellents, ii. 249. tonics, ii. 26. abdominal, warm water bath, i. 366. acute, iodinium, ii. 327. of the alimentary canal, as- tringents, ii. 114. chronic, warm water bath, i. 365. enteric, calomel and opium, i. 373. opium, i. 391. erysipelatous, plumbi acetas, ii. 148. pressure, ii. 301. Inflammation, external, astringents, ii. 106. argenti nitras, ii. 273. . blisters, ii. 243. creta, ii. 156. emollients, ii. 406. emplastrum plumbi, ii. 371. ferri sulphas, ii.154. leeches, ii. 184. liquor plumbi suba- cetatis, ii. 149. scarification, ii. 184. ulmus, ii. 424. zinci sulphas,ii. 155. internal, blisters, ii. 241. caloric, ii. 266. hsemospasia, ii. 186, 267. haemostasis, ii. 186. nauseants, i. 125. oleum terebinthinae, ii. 264. chronic, oleum tiglii, ii. 276. opium, i. 391. revellents, ii. 252. warm fomentations and poultices, i. 367. warm water bath, i. 365. local, alcohol, i. 537. argenti nitras, ii. 151. excitants, i. 483. sassafras radicis cortex, i. 359. tritici farina, ii. 423. minor, pulvis ipecacuanhae et opii, i. 350. phlegmonous, argenti nitras, ii. 273. compression, ii. 301. plumbi acetas, ii. 148. thoracic, asclepias, i. 360. warm water bath, i. 365. visceral, hydrargyri praepa- rata, ii- 307. Inflammatory affections, antimonii et potas- sae tartras, 179. arrowroot, ii. 412. avenae farina, ii. 417. blood-letting, ii. 168. diaphoretics, i. 347. digitalis, ii. 197, 201. diuretics, i. 307. haemospasia, ii. 267. 510 INDEX OF DISEASES AND REMEDIES. Inflammatory affections, hordeum, ii. 410. lemon juice, ii. 223. potassii ferrocya- nuretum, ii. 193 pressure, ii. 301. vinum ipecacuan- hae, i. 350. slight, warm va- pour bath, i. 364. Influenza, infusum eupatorii, i. 354. Insanity, conium, i. 408. music, i. 379. Intermittents. See Fevers, intermittent. absinthium, ii. 47. acidum arseniosum, ii. 92. astringents, ii. 106. bebeerina, ii. 99. capsicum, i. 515. carbo ligni, ii. 54. cetrarina, ii. 99. chloroformum, ii. 100, cinchona, ii. 85. cinchonia, ii. 91. cornus Florida, ii. 95. ferri ferrocyanuretum, ii. 61. ferri sales, ii. 55. hippocastanum, ii. 97. ligatures, ii. 185. liriodendron, ii. 97. magnolia, ii. 51. narcotina, ii. 98. phloridzina, ii. 99. piperin, ii. 95. prinos, ii. 53. quercus, ii. 132. quinia and its salts, ii. 87. sulphate of quinia, ii. 87. refrigerants, ii. 219. revellents, ii. 245. sabbatia, ii. 42. salicin, ii. 94. salix, ii. 94. serpentaria, ii. 46. tonics, ii. 24. valerianate of zinc, ii. 71. zinci sulphas, ii. 70. cold stage of, hot water bath, i. 549. of children, ferri ferrocyanu- retum, ii. 61. congestive, hot air bath, i. 548. obstinate, confectio opii, i. 393. Intertrigo, creasote, i. 542. Intestines, atony of the, ferri ferrocyanure- tum, ii. 61. Intestinal disease, warm water injections, i. 367. Intussusception, hydrargyrum, ii. 310. Iodism, ii. 324. Iodosis, ii. 324. Iritis, belladonna, i. 402. iodinium, ii. 327. Irritability of stomach, excitants, i. 478. lemon juice, ii. 223. oxide of silver, ii. 73. plumbi acetas, ii. 148. Irritation, camphora, i. 507. lycopus, i. 427. opium, i. 391. Ischias, veratria, ii. 204. Ischuria, colchicum, ii. 202. Isthmitis, astringents, ii. 107. zinci sulphas, ii. 155. Isthmus faucium, relaxation of, pyrethrum, i. 300. zinci sulphas, ii. 155. Issues, ceratum sabinae, ii. 279. unguentum cantharidis, ii. 279. unguentum mezerei, ii. 279. Itch, calx chlorinata, ii. 349. hydrargyrum, ii. 310. See Scabies. Jaundice, cathartics, i. 179. emetics; i. 140. Joints, affections of the, hot vapour bath, i. 548. chronic affections of the, linimentum hydrargyri compositum, ii. 312. diseases of the, argenti nitras, ii. 273. inflamed, iodinium, ii. 327. stiffness of, warm air bath, i. 363. swelled, calx chlorinata, ii. 349. sarsaparilla, ii. 361. Kidneys, diseases of the, uva ursi, i. 340. Kriebelkrankheit, ii. 209. L. Lachrymal gland, inflamed, iodinium, ii. 327. Languor, extractum cannabis, i. 419. Laryngitis, astringents, ii. 107. emetics, i. 136. chronic, argenti nitras, ii. 151. alumen, ii. 146. inhalation of benzoin, i. 287. vapour of boiling tar, i. 292. Laryngo-tracheitis, emetics, i. 136. Leech bites, bleeding from, alumen, ii. 146. cupri sulphas, ii. 153. Lepra, arsenici praeparata, ii. 340. cantharis, ii. 355. sesqui-iodide of carbon, ii. 333. chlorinium, ii. 348. INDEX OF DISEASES AND REMEDIES. 511 Lepra, dulcamara, ii. 367. glycerina, ii. 425. iodide of arsenic, ii. 332. ammonium, ii. 333. mercury and arsenic, ii. 332, lappa, ii. 368. liquor arsenici chloridi, ii. 94. naphthaline, i. 270. sulphuris iodidum, ii. 333. unguentum hydrargyri nitratis, ii. 321. veratrum album, ii. 206. Lethargic cases, capsicum, i. 515. Leucorrhoea, acidum gallicum, ii. 125. ammoniae murias, i. 546. argenti nitras, ii. 152. oxidum, ii. 152. astringents, ii. 107, 117. colchicum, ii. 202. copaiba, i. 528. creasotum, ii. 142, 143. cubeba, i. 517. ergot, ii. 209. ferri sulphas, ii. 154. galla, ii. 129. geranium, ii. 134. granati fructus cortex, ii. 135. iodinium, ii. 327. monesia, ii. 137. plumbi acetas, ii. 148. oxide of silver, ii. 152. sodae boras, ii. 226. oleum terebinthinae, i. 524. zinci sulphas, ii. 155. chronic, liquor ammoniae, i. 543. Lichen, tonics, ii. 28. Lithiasis. See Calculous diathesis. Lithic acid diathesis, antilithics, i. 328. depositions, alkaline antilithics, i. 334. ammonia, and carbonate of ammonia, i. 335. ammonia, phosphate of, i. 330. benzoic acid, i. 330. carbonates of potassa andsoda,i.335,381. lime water, i. 335. liquor potassae, i. 335. magnesia and carbon- ate of magnesia, i. 335. soda, phosphate of, i. 330. Vichy water, i. 336. Lithuria, antilithics, i. 328. buchu, i. 337. Liver disease, chronic, acida mineralia, ii. 346. hydrargyri chloridum mite, ii. 315. hydragyri praeparata, ii. 307. taraxacum, i. 219. chronic, acidum nitro-muri- aticum, ii. 346. Liver disease, chronic, aqua chlorini, ii. 348. chlorinium, ii. 348. enlargement, hydrargyri iodidum ru- brum, ii. 319. iodinium, ii. 326. Local diseases, tonics, ii. 28. Lumbago, cantharides, i. 317. diuretics, i. 308. linimentum ammoniae, ii. 263. oleum terebinthinae, i. 320. Lupus, acidum arseniosum, ii. 289., creasote, i. 542, ii. 290. unguentum creasoti, i. 542. ferri praeparata, iij 345. unguentum hydrargyri nitratis, ii. 321. hydrargyri iodidum, ii. 318. iodide of mercury and arsenic, ii. 332. iodinium, ii. 327. sulphuris iodidum, ii. 333. zinci chloridum, ii. 286. phagedenic, hydrargyri chloridum corrosivum, &c, ii. 317. Luxations, antispasmodics, i. 437. nauseants, i. 126. warm water bath, i. 365. M. Malaria, chlorine, ii. 394. Malignant diseases, potassae chloras, ii. 355. Mammae, enlarged, iodinium, ii. 326. veratria, ii. 205. Mania, belladonna, i. 402. cathartics, i. 182. digitalis, ii. 198. douche, ii. 227, 258. elaterium, i. 234. opium, i. 391. revellents, ii. 257. veratrum album, ii. 206. furious, music, i. 379. Marasmus, quercus, ii. 132. Mastitis, emollients, ii. 407. excitants, i. 483. leeches, ii. 185. revellents, ii. 251. Measles, cathartics, i. 178. Melaena, astringents, ii. 112. excitants, i. 484. Melancholia, music, i. 379. veratrum album, ii. 206. Meningitis, tubercular, oleum terebinthinae, i. 320. Menorrhagia, acidum gallicum, ii. 124. argenti oxidum, ii. 152. cathartics, i. 181. profuse, oxide of silver, ii. 152. Mental alienation, emetics, i. 141. revellents, ii. 379. Mercurial cachexia, iodinium, ii. 327. Mercurio-syphilitic diseases, sarsaparilla, ii. 302. 512 INDEX OF DISEASES AND REMEDIES. Mesenteric glands, enlarged, hydrargyrum cum creta, ii. 311. iodinium, ii. 326. Meteorism, oleum terebinthinae, i. 523,525. Metrorrhagia, astringents, ii. 113. monesia, ii. 137. Miasmata, chlorine, ii. 394. Morbi externi, creasotum, ii. 143. Mortification, disinfectants, ii. 391. mildew, ii. 209. Mouth, erysipelatous inflammation of the, (black tongue), ii. 355. inflamed. See Stomatitis. ■ ulceration of the, acidum sulphuri- cum aromaticum, ii. 150. aqua chlorini, ii. 348. Mucous discharges, chronic, quercus, ii. 132. geum, ii. 52. inflammation, ammoniae murias, i. 546. copaiba, i. 529. cubeba, i. 517. piper, i. 514. chronic, oleum tere- binthinae, i. 523. membranes, catarrh of, alumen, ii. 143. oleum terebinthiaae, i. 525. discharges from, acid- um tannicum, ii. 128. alumen, ii. 145. cupri sulphas, ii. 153. ferri pernitras, ii. 154. sulphas, ii. 154. diseases of the, acidum aceticum empyreu- maticum, ii. 143. zinci sulphas, ii. 155. Mucous membranes, diseases of the, matico, ii. 138. diseases of the, terebin- thina, i. 522. irritability of, ferri pernitras, ii. 154. relaxed, alumen, ii. 146. tenderness of, ferri pernitras, ii. 154. Mucous membrane of the mouth and fauces, atonic states of the, catechu, ii. 126. Mumps, see Parotitis. Muscoe volitantes, emetics, i. 137. Myodesopsia, emetics, i. 137. N. Noevi materni, zinci chloridum, ii. 286. Nausea, alcohol, i. 536. piper, i. 514. Nervous debility, lavandula, i. 500. Nervous depression, spiritus rosmarini, i. 501. diseases, ammoniae praeparata, ii. 263. aqua lauro-cerasi, ii. 191. argenti nitras, ii. 72. assafoetida, i. 442. dracontium, i. 447. electricity, i. 552. iodinium, ii. 327. magnetism, ii. 269. mistura ferri composita, ii. 64. oleum rosmarini, i. 501. phosphorus, i. 547. revellents, ii. 256. spiritus ammoniae aroma- ticus, i. 447. spiritus lavandulae com- positus, i. 500. valerianate of zinc, ii. 71. veratria, ii. 204. veratrum album, ii. 206. faintness, spiritus lavandulae com- positus, i. 500. irritability, acidum hydrocyanicum, ii. 191. Neuralgia, acidum arseniosum, ii. 93. acidum hydrocyanicum, ii. 192. aconitia, i. 413. aconitum, i. 411. ammoniae praeparata, ii. 262. belladonna, i. 401. caloric, ii. 266. cannabis indica, i. 418. cantharides, i. 317. capsicum, i. 515. chloroform, i. 424. conium, i. 408. creasotum, i. 451. electropuncture, i. 554. emetics, i. 142. emplastrum opii, i. 394. excitants, i. 482. ferri ferrocyanuretum, ii. 61. sales, ii. 57. subcarbonas, ii. 58. friction, ii. 266. galvanism, i. 553. galvanopuncture, i. 555. hot air bath, i. 548. vapour bath, i. 548. water bath, i. 549. hydrargyri chloridum corrosiv- um, ii. 317. praeparata, ii. 309. hyoscyamus plaster, i. 400. inhalation of ether, i. 421. liquor ammoniae, i. 543. linimentum ammoniae, ii. 263. magnetism, ii. 269. morphiae acetas, i. 395. oleum cajuputi, ii. 264. oleum terebinthinae, i. 524 ii 264. INDEX OF DISEASES AND REMEDIES. 513 Neuralgia, opium, i. 391. pitch plaster, ii. 265. potassii cyanuretum, ii. 194. ferrocyanuretum, ii. 93. revellents, ii. 259. sinapis, ii. 261. strychnia, i. 430. tinctura aconiti, i. 412. tonics, ii. 28. valerianate of zinc, ii. 71. veratria, ii. 204. warm air bath, i. 363. zinci oxidum, ii. 69. of the head and face, pyrethrum. i. 300. of the heart, digitalis, ii. 198. magnetism, ii. 269. Neuralgic pains, belladonna, i. 402. plaster, i. 404. capsicum, i. 515. tinctura camphorae, i. 509. pulmonary magnetism, ii. 269. tumour, plumbi chloridum, ii. 150. Neuropathic affections, tobacco, i. 158. diseases, wet sheet, i. 367. disorders of the stomach, acid- um hydrocyanum, ii. 192. bismuthi subnitras, ii. 74. Neuroses, antispasmodics, i. 439. argenti nitras, ii. 72. belladonna, i. 402. cathartics, i. 182. digitalis, ii. 198. electricity, i. 552. emetics, i. 141. excitants, i. 482. ferri sales, ii. 55. ferrum ammoniatum, ii. 60. hydrargyri praeparata, ii. 309. inhalation of ether, i. 421. moschus, i. 449. oleum succini, i. 450. opium, i. 391. tonics, ii. 27. valerianate of zinc, ii. 71. zinci sulphas, ii. 70. oxidum, ii. 69. Neurotic diseases, morphiae acetas, i. 395. Nipples, sore, acidum tannicum, ii. 124. argenti nitras, ii. 280. collodion, i. 540. creasote, i. 542. plumbi nitras, ii. 397. Nose, discharges from the, iodinium, ii. 327. Nostalgia, mental tonics, ii. 32. Nutrition, diseased, ferri sales, ii. 55. torpor of, ferri iodidum, ii. 331. Nymphomania, hysteric, camphora, i. 508. vol. ii.—33 o. Obstetrical cases, nauseants, i. 126. Obstruction of the bowels, hydrargyrum, ii. 310. Odontalgia, see Toothache. mezereum, i. 300. oleum tiglii, ii. 276. ffidema arsenicalis, ii. 192. GEsophagitis, emetics, i. 136. CEsophagus, stricture of the, argenti nitras, ii. 286. Offensive discharges, antiseptics, ii. 391. pyroligneous acid, ii. 400. Oligaemia, ferri iodidum, ii. 65. Onychia maligna, acidum arseniosum, ii. 289. Opacities of the cornea, barii chloridum, ii. 340. iodinum, ii. 327. oleum morrhuae,ii. 337. Ophthalmia, alumen, ii. 146. ammoniae murias, i. 546. argenti nitras, ii. 151. arteriotomy, ii. 183. belladonna, i. 402. cydonium, i. 283. emetics, i. 137. ferri sulphas, ii. 154. hydrargyri sulphas flavus, i. 297. hydrastis canadensis, ii. 43. issue, ii. 278. opium, i. 392. plumbi acetas, ii. 147. sassafras medulla, i. 283. tritici farina, ii. 423. unguentum zinci oxidi, ii. 370. zinci sulphas, ii. 155. chronic, argenti nitras, ii. 151, cataplasma aluminis, ii. 146. hydrargyri sulphas fla- vus, i. 297. iodinium, ii. 327. oxide of silver, ii. 152. purulent, alumen, ii. 146. argenti nitras, ii. 151. zinci sulphas, ii. 155. scrofulous, auri chloridum, ii. 343. auri praeparata, ii. 342. barii chloridum, ii. 340. oleum cadinum, ii. 353. syphilitic, hydrargyri chlorid- um corrosivum, ii. 317. tarsi, argenti nitras, ii. 151. creasote, i. 542, ii. 143. creasotum, i. 542, ii. 143. cupri subacetas, ii. 280. unguentum hydrargyri nitratis, ii. 321. 514 INDEX OF DISEASES AND REMEDIES. Ophthalmia tarsi, unguentum hydrargyri oxidi rubri, ii. 313. Orchitis, compression, ii. 301. emetics, i. 138. emplastrum plumbi, ii. 371. iodinium, ii. 327. Os uteri, rigidity of, belladonna, i. 403, 404. Otalgia, oleum tiglii, ii. 276. Ovarian dropsy, pressure, ii. 301. enlargement, pressure, ii. 301. Oxalatic diathesis, antilithics, i. 328. Oxyures, sodii chloridum, i. 250. mucuna, i. 251. Ozaena, calx chlorinata, ii. 399. Pain, anaesthetics, i. 380. animal magnetism, i. 380. opium, i. 388. Pains, anomalous, iodinium, ii. 327. chronic, oleum monardae, i. 495. deep-seated, argenti nitras, ii. 273. caloric, ii. 266. tinctura camphorae, i. 509. friction, ii. 266. sinapis, ii. 261. rheumatic, linimentum saponis cam- phoratum, ii. 373. severe, acidum hydrocyanicum, ii. 190. ammoniae praeparata, ii. 262. Pained parts, belladonna in fomentation, i. 400. Painful affections, belladonna plaster, i. 400. conium, i. 409. emplastrum opii, i. 394. humulus, i. 416. oleum cajuputi, i. 531. sinapis, ii. 260. deep-seated, opium, i. 383. tumefactions, hyoscyamus, i. 391. stramonium, i. 404. ulcers, unguentum stramonii, i. 404. Palsy, Bell's, excitants, i. 482. mercurial, ii. 310. partial, excitants, i. 482. Palpitation, aqua lauro-cerasi, ii. 191. creasotum, i. 451. magnetism, ii. 269. nervous, bismuthi subnitras, ii. 74. Paralysis, acupuncture, i. 554. air pump vapdur bath, ii. 267. arnica, i. 433. brucia, i. 432. capsicum, i. 515. dry cupping, ii. 267. electricity, i. 552. excitants, i. 482. hydrargyri praeparata, ii. 309. infusum armoraciae, i. 520. mustard, i. 157. nux vomica, i. 429. oleum cajuputi, i. 531. Paralysis, oleum succini, i. 532. terebinthinae, i. 524. tiglii, i. 229. oxygen, i. 556. protoxide of nitrogen, i. 556. revellents, ii. 256. sinapis, ii. 260. strychnia, i. 430. tetanies, i. 428. toxicodendron, i. 433. veratria, ii. 205. zinci chloridum, ii. 286. of the bladder, cantharides, i. 318. strychnia, i. 430. encephalic, hydrargyri praepara- ta, ii. 309. facial, strychnia, i. 430. of the limbs, strychnia, i. 430. local, oleum cajuputi, i. 531. strychnia, i. 430. of muscles of deglutition, meze- reum, ii. 279; pyrethrum, i. 300; zingiber, i. 301,302. of the rectum, strychnia, i. 430. of the tongue, armoracia, i. 301. oleum cajuputi, i. 531. piper, i. 514. pyrethrum, i. 300. sialogogues, i. 299. zingiber, i. 302. Paraplegia, ergot, ii. 210. excitants, i. 482. galvanism, i. 553. strychnia, i. 430. Paronychia, blisters, ii. 243. excitants, i. 483. Parotitis, blisters, ii. 240. Parturition, adeps, ii. 421. aether, i. 421. anaesthetics, i. 381. cannabis, i. 471. chloroform, i. 425. cimicifuga, ii. 208. ergot, i. 462. gossypium, i. 470. Pediculi, antiparasitics, ii. 442. cocculus, ii. 443. hydrargyrum ammoniatum, ii. 317. staphisagria, ii. 443. veratrum album, ii. 206. Pelvic diseases, hip bath, i. 366. Pericardial dropsy, electricity, &c, ii. 374. Periodical diseases, cinchona, ii. 84. sulphate of quinia, ii.87. Peritoneal diseases, warm water enemata, i. 367. Peritonitis, cathartics, i. 178. opium, i. 351. puerperal, oleum terebinthinae, i. 524, ii. 264. Pernio, copaiba, i. 529. excitants, i. 483, (see Chilblain.) Phagedenic ulcerations, argenti nitras, ii. 286. INDEX OF DISEASES AND REMEDIES. 515 Pharyngitis, cupri sulphas, ii. 153. emetics, i. 136. scarification, ii. 184. chronic, alumen, ii. 146. diphtheritic, argenti nitras, ii. 151. ulcerated, argenti nitras, ii. 151. Phlegmasiae, acidum hydrocyanicum, ii. 192. emetics, i. 136. hydrargyri praeparata, ii. 307. narcotics, i. 382. opium, i. 351. revellents, ii. 249. warm water bath, i. 365. changeable, blisters, ii. 241. Phlegmon, iodinium, ii. 327. Phlegmonous inflammation, argenti nitras, ii. 273. Phosphatic depositions, acid antilithics, i. 328. mineral acids, i. 333. vegetable acids, i. 333. acidum nitricum, ii. 77. acidum sulphuri- cum, ii. 77. • antilithics, i. 328. Phrenitis, conium, i. 408. Phthisis, acidum hydrocyanicum, ii. 192. acidum sulphuricum, ii. 150. acidum hydrosulphuricum, ii. 211. aqua picis liquidae, ii. 143. astringents, ii. 118. balsam of Peru, i. 261. cetraria, i. 284: cimicifuga, ii. 208. creasotum, i. 269. digitalis, ii. 198. emetics, i. 138. gas acidum carbonicum, ii. 212. hydrogenium, ii. 212. hydrogenium carburetum, ii. 212 haemospasia, i. 268. inhalation of benzoin, i. 287. creasote, i. 292. iodine, inhalation, i. 291. issues and setons, ii. 277. lactucarium, i. 414. mineral waters, ii. 444. naphtha, i. 270. oleum morrhuae, ii. 337. oleum tiglii, ii. 276. plumbi acetas, ii. 148. prunus Virginiana, ii. 40. revellents, ii. 256. tar vapour, i. 292. laryngeal, quercus, ii. 132. emetics, i. 137. prunus Virginiana,ii.40. tubercular, iodinium, ii. 326. Piles, internal bleeding, acidum nitricum, ii. 287. Pityriasis, dulcamara, ii. 367. glycerina, ii. 425. Plague, disinfectants, ii. 398. oleum amygdalae, ii. 422. Pleurisy, ammoniae murias, i. 546. asclepias tuberosa, i. 359. Pneumonia, ammoniae murias, i. 544. contrastimulants, ii. 187. emetics, i. 136. inhalation of chloroform, i. 425. iodinium, ii. 327. opium, i. 383. Poisoning, antidotes, ii. 431. diluents, ii. 428. zinci sulphas, i. 142. narcotic, mustard, i. 157. sodii chloridum, i. 160. Polyaemia, local bloodletting, ii. 182. Porrigo, acida mineralia, ii. 346. aqua chlorinii, ii. 348. auri praeparata, ii. 342. cupri subacetas, ii. 280. glycerina, ii. 424. iodinium, ii. 327. liquor calcis, ii. 157. sesqui-iodide of carbon, ii. 333. sulphuris iodidum, ii. 333. unguentum acidi nitrici, ii. 288. creasoti, i. 542. hydrargyri nitratis, ii. 321. oxidi rubri, ii. 314. picis liquidae, ii. 369. tabaci, ii. 369. veratrum album, ii. 206. favosa, sabina, ii. 281. Pregnancy, aloes, i. 199. aloes and hyoscyamus, i. 400. cathartics, i. 181. confection of senna, i. 207. Profluvia, haematoxylon, ii. 132. atonic, monesia, ii. 137. Prolapsus ani, acidum tannicum, ii. 123. ferri sulphas, ii. 154. quercus, ii. 132. vaginae, creasote, i. 542, ii. 143. Prosopalgia, veratria, ii. 204. Prostate, abscess of the, cubeba, i. 517. disease of the, buchu, i. 337. Prurigo, colchicum, ii. 202. tonics, ii. 28. senilis, oleum amygdalae amarae, ii. 195. Pruritus, oleum amygdalae amarae, ii. 195. Pseudo syphilis, sarsaparilla, ii. 362. Psora, see Scabies. Psoriasis, ammoniae arsenias, ii. 341. arsenici praeparata, ii. 88, 340. cantharis, ii. 355. chlorinium, ii. 348. dulcamara, ii. 367. 516 INDEX OF DISEASES AND REMEDIES. Psoriasis, fuligokali, ii. 354. glycerina, ii. 425. iodide of ammonium, ii. 333. mercury and arsenic, ii. 332. lappa, ii. 368. liquor arsenici chloridi, ii. 94. naphthaline, i. 269. sulphuris iodidum, ii. 333. tonics, ii. 28. unguentum hydrargyri nitratis, ii. 321. picis liquidae, ii. 369. Ptyalism, sodae boras, ii. 226. excessive, potassae nitras, ii. 224. mercurial, geranium, ii. 134. plumbi acetas, ii. 148. rhus glabra, ii. 140. profuse, acidum sulphuricum, aromaticum, ii. 77. Pulmonary disease, acidum hydrosulphuri- cum, ii. 211. antimonii et potassae tartras, ii. 275. argenti nitras, ii. 275. cimicifuga, ii. 207. lactucarium, i. 414. mineral waters, ii. 444. refrigerants, ii. 221. revellents, ii. 256. unguentum antimonii, ii. 275. inflammation, senega, i. 257. Putrefaction, disinfectants, ii. 391. Pyrosis, oxide of silver, ii. 73. Quininism, ii. Quinism, ii. 8i R. Rectum, affections of the, confection of sen- na, i. 207. chronic affections of the, Ward's paste, i. 514. chronic inflammation of the, i. 529. neuralgic and spasmodic diseases of the, belladonna, i. 403. painful affections, opium, i. 392. Relaxation of parts, astringents, ii. 118. of the uvula, zinci sulphas, ii. 155. zingiber, i. 518. Remittents, cinchona, ii. 85. See Fever, remittent. cold affusion, ii. 227. sulphate of quinia, ii. 88. revellents, ii. 248. tonics, ii. 26. of children, ferri ferrocyanure- tum, ii. 61. Remittents, congestive, hot air bath, i. 648. Restlessness, camphora, i. 507. Retention of urine, buchu, i. 387. ergot, ii. 210. tobacco, i. 158. Retina, sensibility of, stramonium, i. 404. Rhachitis, hydrargyri praeparata, ii. 308. Rhagades, oleum morrhuae, ii. 338. Rheumatic pains, linimentum ammonise, ii. 263. linimentum saponis cam- phoratum, ii. 373. tinctura camphorae, i. 509. swellings, iodinium, ii. 322. Rheumatism, aconitia, i. 413. tinctura aconiti, i. 412. aconitum, i. 411. acupuncture, i. 554. air-pump vapour bath, ii. 267. ammoniae carbonas, i.352,545. arnica, i. 433. arsenici praeparata, ii. 340. belladonna, i. 401. blisters, ii. 242. cimicifuga, ii. 208. colchicum, ii. 201. creasote, i. 542. • diaphoretics, i. 347. diuretics, i. 308. dry cupping, ii. 267. electropuncture, i. 554. emetics, i. 139. extractum cannabis, i. 419. friction, ii. 266 galvanopuncture, i. 555. hot vapour bath, i. 548. hot water bath, i. 549. hydrargyri chloridum corro- sivum, ii. 317. lappa, ii. 368. lemon juice, ii. 347. linimentum ammoniae, ii. 263. terebinthinae, ii. 264. liquor ammoniae, i. 543. magnetism, ii. 269. mezereum, i. 358. oleum terebinthinae, ii. 264. tiglii, ii. 276. potassii iodidum, ii. 330. revellents, ii. 254. saccharum, ii. 357. succinic acid, i. 532. sulphur, ii. 350. thermal springs, iL 454. tonics, ii. 27. veratria, ii. 205. veratrum album, ii. 206. viride, ii. 206. vinum veratri albi, ii. 206. warm vapour bath, i. 363. warm water bath, i. 365. acute, aconitum, i. 411. INDEX OF DISEASES AND REMEDIES. 517 Rheumatism, acute, ammoniae carbonas, i. 352. colchicum, ii. 201. compression, ii. 301. contrastimulants, ii. 187. eupatorium, i. 354. extractum aconiti alco- holicum, i. 412. guaiacum, i. 356. iodine, ii. 327. opium, i. 391. potassae nitras, ii. 224. pressure, ii. 301. pulvis ipecacuanhae et opii, i. 350. sulphate of quinia, ii. 89. sulphur, ii. 350. tonics, ii. 27. chronic, aconitum, i. 411. alkalia, ii. 345. anthrakokali, ii. 354. aralia spinosa, i. 361. chlorinium, ii. 348. cubeba, i. 516. diaphoretics, i. 347. electricity, i. 552. eupatorium, ii. 354. guaiacum, i. 356, 357. hot air bath, i. 548. hydropathy, ii. 446. infusum armoraciae, i. 520. iodinium, ii. 327. morphiae acetas, i. 394. oleum cajuputi, i. 531, ii. 264. oleum morrhuae, ii. 338. oleum succini, i. 532. oleum terebinthinae, i. 524, 525. opium, i. 392. pitch plaster, ii. 265. sassafras radicis cor- tex, i. 359. tinctura aconiti foli- orum, i. 412. warm air bath, i. 363. warm vapour bath, i. 364. warm water bath, i. 366. wet sheet, i. 368. xanthoxylum, i. 360. deep seated, ammoniae praeparata, ii. 262. Rickets, oleum morrhuae, ii. 238. Ringworm of the scalp, cocculus, ii. 443. cupri subacetas, ii. 280. Salivation, mercurial, iodinium, ii. 327. Scabies, acida mineralia, ii. 346. ammoniae murias, i. 546. aqua chlorinii, ii. 348. calx chlorinata, ii. 349. chlorinium, ii. 348. cocculus, ii. 443. hydrargyri iodidum rubrum, ii. 319. hydrargyri sulphuretum nigrum, ii. 320. liquor calcis, ii. 157. oleum cadinum, ii. 353. sabina, ii. 281. Bulphur, ii. 350. potassii sulphuretum, ii. 352. unguentum acidi nitrici, ii. 288. sulphuris, ii. 351. sulphuris compositum, ii. 351. veratri albi, ii. 370. veratrum album, ii. 206. Scalds, alcohol, i. 637. ceratum plumbi subacetatis, ii. 371. creta, ii. 156. iodinium, ii. 327. linimentum calcis, ii. 147. linimentum terebinthinae, i. 525. oleum terebinthinae, i. 524. Scalp, follicular disease of the, sulphuris iodidum, ii. 333. Scarlatina, belladonna, i. 403. cathartics, i. 178. colchicum, ii. 202. excitants, ii. 166. refrigerants, ii. 220. maligna, aqua chlorinii, ii. 398. capsicum, i. 515. cerevesiae fermentum, ii. 401. potassae chloras, ii. 355. Sciatica, cantharides, i. 317. diuretics, i. 308. linimentum ammoniae, ii. 263. oleum terebinthinae, i. 320, 524. Scirrhous enlargements, painful, belladonna, i. 403. Scirrhus, see Cancer. aconitum, i. 411. auri praeparata, ii. 342. belladonna plaster, i. ^04. hyoscyamus plaster, i. 398. pressure, ii. 301. uteri, acidum hydrocyanicum, ii. 192. Sclero-iritis, iodinium, ii. 327. Sclerotitis, iodinium, ii. 327. Scorbutus, acida vegetabilia, ii. 347. ferri iodidum, ii. 331. hydrargyri praeparata, ii. 308. lappa, ii. 368. oleum cadinum, ii. 353. sea, astringents, ii. 108. 33* 518 INDEX OF DISEASES AND REMEDIES. Scrofula, alkalia, ii. 345. See Scrofulosis. anthrakokali, ii. 354. aqua chlorini, ii. 348. auri chloridum, ii. 343. cyanuretum, ii. 343. praeparata, ii. 342. barii chloridum, ii. 340. calcii chloridum, ii. 339. calx chlorinata, ii. 349. carbo animalis, ii. 338. chlorinium, ii. 348. ferri iodidum, ii. 331. guaiacum, i. 356. helianthemum, ii. 368. hydrargyri iodidum, ii. 318. iodide of barium, ii. 332. mercury and arsenic, ii. 332. ioduretted waters, ii. 454. juglans cinerea, ii. 368. lappa, ii. 368. oleum cadinum, ii. 353. morrhuae, ii. 338. plumbi iodidum, ii. 331. potassii bromidum, ii. 335. quercus, ii. 132. sodae hyposulphis, ii. 352. spongia usta, ii. 336. Scrofulosis, ferri ferrocyanuretum, ii. 61. hydrargyri praeparata, ii. 308. iodinium, ii. 326. in children, ammonio-citrate of iron, ii. 67. See Scrofula. Scrofulous caries, creasote, ii. 290. tumours, emplastrum ammoniaci, ii. 372. iodides of quinia and cinchona, ii. 333. potassii sulphuretum, ii. 352. veratria, ii. 205. of glands, iodinium, ii. 326. Scurvy, see Scorbutus. Sea-sickness, alcohol, i. 536. creasotum, ii. 142. Sensibility, excessive, acidum hydrocyani- cum, ii. 191. of the stomach, morbid, argenti nitras, ii. 71. Skin, inflammation of the, excitants, i. 483. Sloughing of cellular membrane, iodinium, ii. 327. ulcers, chloroform, i. 423. Smallpox, cathartics, i. 178. refrigerants, ii. 220. pustules, collodion and gutta percha, i. 540. Sores, aphthous, ferri pernitras, ii. 154. indolent, unguentum hydrargyri oxidi rubri, ii. 314. scrofulous, liquor calcii chloridi, ii. 339. simple, cetaceum, ii. 422. Sores, sloughing, offensive, pyroligneous acid, ii. 400. strumous, barii chloridum, ii. 340. syphilitic, acida mineralia, ii. 346. black wash, ii. 313. hydrargyri chloridum mite, ii. 316. unguentum hydrargyri oxidi rubri, ii. 314. Sorethroat, alumen, ii. 144. haemospasia, ii. 268. linimentum ammoniae, ii. 263. mel rosae, ii. 136. oleum terebinthinae, ii. 264. rhus glabra, ii. 149. sodae boras, ii. 226. asthenic, capsicum, i. 515. inflammatory, excitants, i. 483. opium, i. 391. potassae nitras, ii. 224. malignant, capsicum, i. 515. putrid, chlorinium, ii. 398. calx chlorinata, ii. 399. creasotum. ii. 400. relaxed, acidum sulphuricum aromaticum, ii. 151. granati fructus cortex, ii. 135. quercus, ii. 132. zingiber, i. 519. sluggish, capsicum, i. 515. syphilitic, hydrargyri chloridum mite, ii. 315. hydrargyri chloridum corrosivum, ii. 316. hydrargyri cyanure- tum, ii. 321. hydrargyri sulphure- tum rubrum, ii. 320. ulcerated, acidum muriaticum, ii. 399. cinchona, ii. 401. chloroform, i. 424. venereal, hydrargyri chloridum corrosivum, ii. 316. Spasm, muscular, extractum cannabis, i. 419. Spasmi, acidum hydrocyanicum, ii. 192. Spasmodic diseases, acupuncture, i. 554. aether, i. 448. ammoniae praeparata, ii. 262. antispasmodics, i. 436. belladonna, i. 403. bismuthi subnitras, ii. 74. creasotum, i. 451. indigo, ii. 54. magnetism, ii. 269. moschus, i. 448. opium, i. 391. tobacco, i. 158. warm water bath, i. 365. INDEX OF DISEASES AND REMEDIES, 519 Spasms, magnetism, ii. 269. of the stomach, caloric, ii. 274. Specks of the cornea, excitants, i. 484. saccharum, ii. 281. Spermatorrhoea, lupulina, i. 417. strychnia, i. 430. Sphacelus, disinfectants, ii. 393. pyroligneous acid, ii. 400. Spinal disease, iodinium, ii. 327. issues and setons, ii. 277. Spleen, enlarged, ferri praeparata, ii. 345. ferri sales, ii. 56. hydrargyri iodidum rub- rum, ii. 289. iodinium, ii. 327. potassii bromidum, ii. 335. Splenic engorgements, sulphate of quinia, ii. 89. Sprains, alcohol, i. 533. ammoniae murias, i. 546. electricity, i. 549. friction, ii. 301. linimentum saponis camphoratum, ii. 373. liquor plumbi subacetatis, ii. 149. opium, i. 392. tincture of arnica, i. 433. tinctura camphorae, i. 509. Stings of wasps, iodinium, ii. 327. Stomach, irritability of the, plumbi acetas, ii. 147. See Irritability of sto- mach. neuropathic disorders of the, aci- dum hydrocyanicum, ii. 192. bismuthi subnitras, ii. 74. spasm of the, caloric, ii. 275. Stomatitis, alumen, ii. 146. aqua chlorinae, ii. 348. argenti nitras, ii. 151. cupri sulphas, ii. 153. honey of borax, ii. 226. rhus glabra, ii. 140. sodae boras, ii. 226. aphthous, plumbi acetas, ii. 148. gangrenous, argenti nitras, ii. 151, 286. cupri sulphas, ii. 153. potassae chloras, ii. 355. Strangury, camphor, i. 507. Stricture, gentian, dried, ii. 37. of the oesophagus, argenti nitras, ii. 286. _ iodinium, ii. 327. of the urethra, argenti nitras, ii. 286. potassa, ii. 284. Strophulus, tonics, ii. 28. Submaxillary gland, enlarged, iodinium, ii. 326. Sudor Anglicus, astringents, ii. 117. Suette de Picardie, astringents, u. 117. miliaire, astringents, ii. 117. Suppuration, emollients, ii. 406. profuse, creasotum, ii. 143. Surgical affections, excitants, i. 484. nauseants, i. 126. operations, animal magnetism, i. 380. inhalation of ether, i. 421. Sweating sickness, astringents, ii. 117. Sweats, colliquative, plumbi acetas, ii. 148. of phthisis, acidum tan- cum, ii. 123. acidum galli- cum, ii. 125. acidum sulphu- ricum, ii. 150. alumen, ii. 145. astringents, ii. 118. granatifructus, cortex, ii. 135. infusum ros3e compositum, ii. 136. oxide of silver, ii. 152. potassii ferro- cyanuretum, ii. 193. Swellings, glandular, hyoscyamus plaster, i. 400. unguentum potassii io- didi, ii. 331. veratria, ii. 205. indolent, plumbi iodidum, ii. 332. scirrhous, hyoscyamus plaster, i. 400. scrofulous, calx chlorinata, ii. 349. carbo animalis, ii. 339. iodide of barium, ii. 332. iodide of lead, ii. 332. iodide of quinia, ii. 333. • unguentum potassii iodidi, ii. 331. Synovitis, compression, ii. 301. Syphilis, acida mineralia, ii. 346. acidum arseniosum, ii. 341. acidum nitricum, ii. 346. acidum nitro-muriaticum, ii. 346. alkalia, ii. 345. aqua chlorinii, ii. 348. aralia nudicaulis, ii. 365. argenti praeparata, ii. 344. arsenici praeparata, ii. 340. auri chloridum, ii. 343. cyanuretum, ii. 343, praeparata, ii. 342. chlorinium, ii. 348, 398. 520 INDEX OF DISEASES AND REMEDIES. Syphilis, guaiaci lignum, i. 356. guaiacum, i. 356. hydrargyri chloridum corrosivum, ii. 316. chloridum mite, ii. 316. cyanuretum, ii. 321. iodidum, ii. 318. oxidum rubrum, ii. 314. praeparata, ii. 308. sulphas flavus, ii. 322. hydrargyrum cum creta, ii. 311. iodide of mercury and arsenic, ii. 332. iodinium, ii. 326. lappa, ii. 368. mercurial, sarsaparilla, ii. 362. mezereum, i. 358. mudar, ii. 368. pilulae hydrargyri, ii. 311. potassii iodidum, ii. 330. saccharum, ii. 356. sarsaparilla, ii. 361. sassafras radicis cortex, i. 359, 366, ii. 366. secondary, helianthemum, ii. 368. Syphilitic affections of the throat, hydrar- gyri sulphuretum rubrum, ii. 320. tumours, emplastrum hydrargyri, ii. 313. ulcers, hydrargyri cyanuretum, ii. 320. oxidum nigrum, ii. 313. unguentum hydrargyri, ii. 312. Syphiloid diseases, aralia nudicaulis, ii. 365. arsenici praeparata, ii. 340. guaiaci lignum, ii. 364. guaiacum, i. 356. mezereum, i. 358. mudar, ii. 368. potassii iodidum, ii. 330. sarsaparilla, ii. 361. sassafras radicis cortex, i. 499, ii. 366. T. Taenia, brayera anthelmintica, i. 248. colchicum, ii. 202. creasote, i. 250. filix mas, i. 245. granati radicis cortex, i. 247. oleum terebinthinae, i. 241. solium, pulvis stanni, i. 252. Testes, enlarged, iodinium, ii. 326. indurated, electricity, &c, ii. 374. Tetanus, antispasmodics, i. 438. cannabis indica, i. 419. cathartics, i. 183. colchicum, ii. 202. excitants, i. 482. Tetanus, moschus, i. 450. opium, i. 391. revellents, ii. 259. tobacco, i. 158. algidus, revellents, ii. 259. traumatic, strychnia, i. 430. Thoracio diseases, oleum tiglii, ii. 277. chronic, pitch plaster, ii. 265. inflammation, cathartics, i. 178. Throat, relaxed, capsicum, i. 514. ulcerations of the, acidum sulphu- > cum aromaticum, ii. 150. Tic douloureux, tonics, ii. 28. See Neuralgia. Tinea capitis, piper, i. 514. See Porrigo. Tongue, ulcerated, iodinium, ii. 327. Tonsils, inflamed, see Amygdalitis. ulcerated, iodinium, ii. 327. Toothache, acidum hydrocyanicum, ii. 192. tannicum, ii. 124. allium, ii. 262. creasote, i. 542. excitants, i. 483. ferri pernitras, ii. 154. hydrargyri sulphas flavus, i. 297. mezereum, i. 300. oleum cajuputi, i. 530. cinnamomi, i. 487. monardae, i. 495. origani, i. 497. opium, i. 392. pyrethrum,i. 300. sialogogues, i. 299. tobacco, i. 302. Tooth, carious, opium, i. 383. Tophaceous enlargements, iodinium, ii. 327. Topical diseases, astringents, ii. 118. Tormina, aniseed tea, i. 488. oleum cajuputi, i. 531. zingiber, i. 518. Torpor of the bowels, assafoetida, i. 443. intestines, figs, i. 188. liver, laughter, i. 484. system, tonics, ii. 28. Tracheitis, astringents, ii. 107. Trembling, mercurial, ii. 310. Tremors, magnetism, ii. 269. mercurial, ii. 310. Trismus nascentium, cathartics, i. 183. Tuberculosis, ferri iodidum, ii. 331. hydrargyri praeparata, ii. 308. iodinium, ii. 326. oleum morrhuae, ii. 336. Tumours, emplastrum ammoniaci, ii. 372. ferri, ii. 372. hydrargyri, ii. 313. plumbi, ii. 371. saponis, ii. 372. eutrophics, ii. 299. linimentum camphorae, &c, i. 509, ii. 373. hydrargyri composi- tum, ii. 313. Baponis camphora turn. ii. 373. INDEX OF DISEASES AND REMEDIES. 521 Tumours, pressure, ii. 301. tinctura camphorae, i. 509. atheromatous, electricity, &c, ii. 374. glandular, belladonna plaster, i. 404. veratria, ii. 203. indolent, ammoniae murias, i. 546. electricity, i. 552, ii. 374. emplastrum galbani com- positum, i. 446. lipomatous, electricity, &c, ii. 374. melicerous, electricity, &c, ii. 374. neuralgic, plumbi chloridum, ii. 150. painful, stramonium, i. 406. scrofulous, emplastrum ammoni- aci, ii. 372. steatomatous, electricity, &c, ii. 374. syphilitic, emplastrum hydrargy- ri, ii. 313. vascular, acidum nitricum, ii. 287. veratria, ii. 205. Twitching of the muscles, toxicodendron, i. 433. Tympanitis, typhoid, cerevisaB fermentum, ii. 401. Typhoid fever, argenti nitras, ii. 151. Typhus, acidum muriaticum, ii. 399. antimonii et potassae tartras, i. 349. diarrhoea of, bismuthi subnitras, ii. 74. malignant, calx chlorinata, ii. 398. wine, i. 538. U. Ulcerated surfaces, sabina, ii. 279. Ulceration of bladder, liquor calcis, ii. 156. cancerous, gas acidum carboni- cum, ii. 213. plumbi chloridum, ii. 150. of the cornea, oxide of silver, ii. 152. plumbi acetas, ii. 147. cutaneous, opium, i. 392. internal and external, balsam of Peru, i. 261. malignant, conium, i. 406. zinci chloridum, ii. 285. of the intestines, oil of turpen- tine, i. 523. larynx, alumen, ii. 146. mouth, acidum sulphuri- cum aromati- cum, ii. 150. mel rosae, ii. 136. Ulceration, painful, hyoscyamus, i. 398. opium, i. 392. of the rectum, argenti nitras, ii. 152. superficial, cupri sulphas, ii. 153. of the throat, acidum sulphuri- cum aromaticum, ii. 150. Ulcerative process, iodinium, ii. 327. Ulcers, argenti nitras, ii. 152, 286. ceratum plumbi carbonatis, ii. 371. ceratum plumbi subacetatis, ii. 371. ceratum resinae, ii. 369. compositum, ii. 369. sabinae, ii. 369. ceratum simplex, ii. 421. zinci carbonatis, ii. 370. collodion, i. 540. copaiba, i. 529. creta, ii. 156. cupri sulphas, ii. 280. electricity, &c, ii. 374. emplastrum plumbi, ii. 371. eutrophic ointments, ii. 369. hydrargyrum ammoniatum, ii. 317. liquor sodae chlorinatae, ii. 350. pressure, ii. 301. sabina, ii. 281. tincture of benzoin, i. 265. unguentum cantharidis, ii. 369. creasoti, ii. 369. cupri subacetatis, ii.369. gallae, ii. 369. hydrargyri, ii. 369. hydrargyri ammoniati, ii. 369. nitratis, ii, 369. oxidi rubri, ii. 369. iodinii, ii. 369. composita, ii.369. mezerei, ii. 369. sulphuris, ii. 369. oxidi zinci, ii. 370. zinci sulphas, ii. 155. atonic, acidum nitricum, ii. 287. aqua chlorinii, ii. 348. catechu, ii. 126. creasote, ii. 290. sulphuris iodidum, ii. 334. unguentum cantharidis, ii.278. zinci chloridum, ii. 285. bleeding, tinctura ferri chloridi, ii. 153. cancerous, arseniate of iron, ii. 341. calx chlorinata, ii. 349. carbo animalis, ii. 339. ceratum arsenici, ii. 289. creasote, ii. 290. hydrargyri iodidum ru- brum, ii. 289, 319. hydrargyri nitras acidus, li. 289. nitro-muriate of gold, ii. 290. 522 INDEX OF DISEASES AND REMEDIES. L leer?, chronic, hydrastis canadensis, ii. 44. chronic, astringents, ii. 118. fetid, cataplasma fermenti, ii. 213. chlorinium, ii. 398. carbo ligni, ii. 400. flabby, alumen, ii. 146. granati fructus cortex, ii. 135. liquor calcis, ii. 157. monesia, ii. 137. quercus, ii. 132. foul, acidum nitricum, ii. 287. acidum muriaticum, ii. 399. aluminae sulphas, ii. 397. cinchona, ii. 401. creasote, i. 542, ii. 290, 400. cupri subacetas, ii. 280. disinfectants, ii. 393. ferri ferrocyanuretum, ii. 61. liquor sodae chlorinatae, ii. 399. unguentum hydrargyri nitratis, ii. 321. zinci chloridum, ii. 285. fungous, alumen exsiccatum, ii. 281. cupri sulphas, ii. 280. saccharum, ii. 281. gangrenous, calx chlorinata, ii. 349, 398. creasote, i. 540. linimentum terebinth- inae, i. 525. ill-conditioned, acidum sulphuricum, aromaticum, ii. 150. cupri sulphas, ii. 153. ferri ferrocyanuret- um, ii. 61. quercus, ii. 132. indolent, alumen exsiccatum, ii. 281. excitants, i. 484. geranium, ii. 134. sabina, ii.' 281. irritable, oxide of silver, ii. 152. stramonium, i. 406. tritici farina, ii. 423. unguentum tabaci, ii. 369. malignant, aqua chlorinii, ii. 348. hydrargyri chloridum cor- sivum, &c, ii. 289. nitras acidus, ii. 289. obstinate, unguentum acidi nitrici, ii. 288. old, saccharum, ii. 356. offensive, creasote, ii. 290. painful, acidum hydrocyanicum, ii. 190. calx chlorinata, ii. 349. gas acidum carbonicum, ii. 213. iodinium, ii. 327. opium, i. 392. phagedenic, argenti nitras, ii. 230. Ulcers, painful, unguentum hydrargyri bi- niodidi, ii. 319. unguentum stramonii, i. 406. unguentum hydrargyri ni- tratis, ii. 321. putrescent, carbo ligni, ii. 400. scrofulo-venereal, hydrargyri iodid- um rubrum', ii. 289. scrofulous, calx chlorinata, ii. 349. hydrargyri iodidum, ii. 318. sloughing, ale and porter, i. 538. antimonii murias, ii. 287. chloroform, i. 424. linimentum terebinthinae, i. 525. sluggish, creasotum, i. 542. hydrargyri oxidum ru- brum, ii. 314. yellow wash, ii. 314. suppurative, tinctura ferri chloridi, ii. 153. zinci sulphas, ii. 155. calx chlorinata, ii. 399. syphilitic, argenti oxidum, ii. 72. auri iodidum, ii. 343. hydrargyri chloridum cor- rosivum, ii. 317. hydrargyri cyanuretum, ii. 321. hydrargyri iodidum, ii. 318. hydrargyri oxidum ni- grum, ii. 313. hydrargyri oxidum rub- rum, ii. 314. hydrargyrum ammoniat- um, ii. 317. unguentum acidi nitrici, ii. 288. unguentum hydrargyri, ii. 312. unguentum hydrargyri nitratis, ii. 321. yellow wash, ii. 314. of tongue, &c, iodinium, ii. 322. torpid, calx chlorinata, ii. 349. ferri ferrocyanuretum, ii. 61. Urethra, diseases of the, buchu, i. 337. neuralgic and spasmodic diseases of the, belladonna, i. 403. stricture of the, argenti nitras, ii. 286. potassa, ii. 285. Urethritis, argenti nitras, ii. 151. Uric acid calculus, sodae bicarbonas, ii. 335. Urinary organs, affections of the, carota, i. 320. amygdala, ii. 419. buchu, i. 337. demulcents, ii. 403. diluents, ii. 428. glycyrrhiza, ii. 408. INDEX OF DISEASES AND REMEDIES. 523 Urinary organs, pareira, i. 337. petroselinum, i. 321. tinctura ferri chloridi, ii. 153. terebinthina, i. 522. Urine, incontinence of, buchu, i. 337. Urine, iodinium, ii. 827. Uterine diseases, warm water injections, i. 367. irritation, chloroform, i. 423. pains, acidum hydrocyanicum, ii. 192. gas acidum carbonicum, ii. 213. Uterus, cancer of the, creasotum, i. 542. iodinium, ii. 326. hypertrophy of the, ergot, ii. 208. painful affections of the, opium, i. 392. torpor of the, errhines, i. 295. ulcers of cervix of the, hydrargyri nitras acidus, ii. 289. Uvula, elongation of the, quercus, ii. 132. relaxed, capsicum, i. 515. catechu, ii. 126. pyrethrum, i. 300. zingiber, i. 302, 519. zinci sulphas, ii. 155. Vagina, chronic inflammation of the, fuligo, ii. 143. neuralgic and spasmodic diseases of the, belladonna, i. 403. Variola, argenti nitris, ii. 286. Variolous pustules, iodinium, ii. 327. Vascular tumour, acidum nitricum, ii. 287. Vermin, antiparasitics, ii. 442. hydrargyrum, ii. 309. oleum cadinum, ii. 353. Vesaniae, narcotics, i. 382. Visceral engorgements, alkalies, ii. 345. ferrri, iodidum, ii. 65. Vomiting, creasotum, ii. 142. excitants, i. 478. of blood cathartics, i. 181. Vomiting, of children, argilla pura, ii. 157. chronic, chloroform, i. 423. irritable, acidum hydrocyanicum, ii. 192. liquor calcis, ii. 156. nervous, creasotum, ii. 142. of pregnancy, creasotum, ii. 142. spontaneous emetics, i. 138. strychnia, i. 431. W. Wakefulness, tinctura humuli, i. 416. Warts, acida mineralia, ii. 281. acidum muriaticum, ii. 281. nitricum, ii. 281, 287. sulphuricum, ii. 281. argenti nitras, ii. 279. charms, ii. 299. cupri subacetatis, ii. 280. cupri sulphas, ii. 280. sabina, ii. 281. syphilitic, sabina, ii. 281. Wen, sorbefacients, ii. 299. White swelling, potassii cyanuretum, ii. 195. Worms, see Anthelmintics. cathartics, i. 183. hydrargyrum, ii. 309. oleum cadinum, ii. 353. tonics, ii. 28. Wounds, ceratum plumbi carbonatis, ii. 371. subacetatis, ii. 371. emplastrum plumbi, ii. 371. resinae, ii. 371. matico, ii. 137. contused, iodinium, ii. 327. dissection, iodinium, ii. 327. hemoi'riiage from, acidum sulphu- ricum aromaticum, ii. 151. lacerated, iodinium, ii. 327. painful, acidum hydrocyanicum, ii. 190. poisonous, acidum nitricum, ii. 287. antimonii murias, ii. 287. potassa, ii. 285. punctured, iodinium, ii. 327. THE END. HPR2 1958 Mb NLM031929253