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■'■  *■'*. 
TREATISE   ^.^
OF THE
MATERIA  MEDICA
AND
THERAPEUTICS
             JOHN EgBJJLE, M.D.
MEMBER OF THE AMERICAN PHILOSOPHICAL SOCIETY J OF THE ACADEMY OF NATURAL
    SCIENCES OF PHILADELPHIA ; CORRESPONDING MEMBER OF THE MED1CO-
            CHIRURG1CAL SOCIETY OF BERLIN, &C. &C.
            IN TWO VOLUMES. /£ (  fQQ / g ^

                VOL. I.     VV^>v-fs-
TOTR-D EDITION, ENLARGED AND CORRECTED
          Pulattclphui,
JOHN GRIGG—9 NORTH FOURTH STREET.
William Brown, Printer.
      1830. 
                                  El St





 Eastern District of Pennsylvania, to wit:
 S-*-*-'■> \   Be it remembered, that on the twenty-sixth day of October, in the
   t  g f  fifty-fifth year of the Independence of the United States of America,
       ' i  A. D.  1830, John Grigg, of the said district,  has  deposited  in this
   «-"v»- '  office the title  of a book, the right whereof he  claims  as proprietor,
 in the words following, to wit:—                                  *

   " A Treatise of the Materia Medica and Therapeutics. By John Eberle, M. D.
     Member of the American Philosophical Society ; of the*i\cademy of Natural
     Sciences of Philadelphia; Corresponding Member of the Medico-Chirurgical
     Society of Berlin, &c. &c.   In two volumes.  Vol. I.  Third edition, en-
     larged and corrected."

  In  c  - ;"• i-mity  to   Act of *h* Congress of the United States, entitled, " An
 "f r   "i en<>oi-  '       '<}f. -IcarnHi .■■, by securing  the copies of maps,  charts,
            tl- ei^L..^a u..»ii piopnutojs oi such copies, during the times therein
mentioned:" and also to the act entitled, "An act supplementary to an act, enti-
tled, 'An act for the encouragement of learning, by securing the copies of maps,
charts, and books, to the authors and proprietors of such copies, during the times
therein mentioned;' and extending the  benefits thereof to the arts' of designing
engraving, and etching historical and other prints."
                                                    D. CALDWELL,
                             Clerk of the Eastern District of Pennsylvania, 
nsnpia®iD¥@^a©^o
   When we fix our attention upon a diversity of
mixed objects, we nafurally,and almost unconscious-
ly, begin our inquiries by separating them into groups
or families, according to their various analogies or
resemblances.   We thus obtain a general  view of
their common and partial relations; and are there-
by better enabled  to investigate  their individual
characters,  as  well as  to retain what we  have
learned  concerning them, by the influence of asso-
ciation.   We become systematic from the very
constitution of the human mind.  To classify our
ideas is  the first step we make towards useful know-
ledge ; and the highest attainments of intellect are
but a  more  extensive  and intimate view of the
various relations which subsist between the objects
of human knowledge.
   As  things are not viewed under the same aspect
by  every observer,  and relations seen by some,
which are  either unimportant or  unnoticed by
others, it follows that arrangements founded on
these  views are exceedingly various and dissimilar.
It is obvious, however, that the classification which
   vol i.—2 
I
INTRODUCTION.
includes the greatest number of the conspicuous
and constant relations of objects, must best answer
the purposes of such arrangement.  The difficul-
ty lies in fixing upon the  strongest, most constant,
and universal points of resemblance, and  to bring
them together under such a scheme of arrangement
as will exhibit them in the order of their most es-
sential and conspicuous affinities.  In arranging
the objects of natural science, as, for instance, those
of botany, zoology,  or chemistry, we bring into
view only those natural relations of conformation
or character, which subsist among the objects them-
selves.   In  medical  science,  however,  we  are
obliged to enter upon  a much more extensive and
perplexing range of  comparison.   Here we must
keep in view not only the  relations  of  external
agents with each other, but those also which they
bear to living matter,—to the effects which they
produce upon the animal economy.  The difficul-
ties which arise from these  complicated relations
are particularly experienced in the classification of
the materia  medica; and hence the great imper-
fection and inadequacy of  all the arrangements that
have hitherto been proposed  in this department of
science.  Some writers, strongly  impressed with
the insurmountable nature of these difficulties, have
thought it  best to reject all systematic  arrange-
ment, and to describe remediate substances in an 
INTRODUCTION.
xi
alphabetical order.   This simple mode of arrange-
ment,  it must be confessed, possesses advantages
which cannot be obtained by more artificial classi-
fication.  We are particularly enabled thereby to
exhibit a connected  view of all the remedial qua-
lities and therapeutic applications of each indivi-
dual article, without  the frequent  repetitions so
unavoidable  under  every other known  system of
classification.  But  to counterbalance this advan-
tage, which, in reality, is of no  essential import-
ance, we lose sight,  by the adoption of such an ar-
rangement, of those general physiological and the-
rapeutic relations between the living body and re-
medies, which, in  themselves highly interesting,
serve  to give to this  department  of  medicine
the character of a science.  A few have arranged
the  articles  of  the  materia  medica  according to
their chemical analogies alone.   Burdach uses this
mode  of classification; but his system is exceeding-
ly complicated and  imperfect.   Arrangements of
the  materia medica founded  exclusively on  the
physical properties of medicine are even more ob-
jectionable,  in  every  point  of  view,  than  the
alphabetical order.  Without  throwing  the least
light  on   their  therapeutic  relations,  they  are
necessarily  very complex in their structure, and
often bring articles  together  of the  most opposite
remedial properties. Cullen's arrangement, which
is principally founded upon the  general  effects of 
xii
INTRODUCTION.
 medicinal agents, and partly also, in its minor sub-
 divisions, upon their physical relations, is still view-
 ed by many, and I believe justly too, as the most
 perfect classification that has hitherto been offered
 upon  this subject.   But  even this  arrangement
 does not bring into view all those general analogies
 which subsist between the effects of medicinal sub-
 stances, and  which  may  be used with peculiar
 propriety as the basis of classic distinctions.   Ob-
 servation teaches us, for instance, that certain re-
 medies direct their action specifically upon certain
 organs or structures in the animal economy. These
 specific affinities between external agents and the
 various parts  of  the living  body are fundamental,
 and  their  notice is  essential to a comprehensive
 and philosophical scheme of arrangement.   Cul-
 len, however, overlooked these  particular views of
 the action of remedies, and founded his system on
 their ultimate medicinal effects alone.  Thus the
 effect of opium in the living system is sleep.  The
 medicine is, therefore, placed in the class of narco-
 tics.  This is well, so far as it goes.   By this ar-
 rangement we at once know the general character
 of the effect; but we are not informed as to the
 particular organ  or structure  which is principally
 influenced, and  by  the peculiar excitement of
 which the more manifest effects are  produced.
If, however,  we place the narcotics, as a genus,
under  the  primary class of "medicines whose ac- 
INTRODUCTION.
xiii
 Hon is specifically directed to the nervous system"
 we exhibit at once, a general  view both of the
 character of the effect, and of the organ principally
 concerned with the  medicine in  its  production.
 Alibert, who saw the propriety of attending to this
 latter object, adopted a  classification founded  en-
 tirely upon  the relations which remedial  agents
 bear  to particular organs or structures, or. in other
 words, on their specific tendencies to affect particu-
 lar parts of the organization.   His arrangement is,
 however, still more objectional than that of Cullen.
 It exhibits, it is true, an  interesting physiological
 view  of the connexions  which subsist  between
 medicinal agents and the various subordinate sys-
 tems  in the living economy; but it is deficient in the
 more useful practical distinctions derived from the
 ultimate effects of remedies, constituting the basis
 of Cullen's classification.
   More recently Dr. Granville, of England, has
 proposed a new classification  of the materia medi-
 ca, which combines, to a  degree,  the advantages
 both of Cullen's and Alibert's arrangements.* His
 primary or  classic  divisions  are founded on the
 specific tendency of medicines to act upon particu-
lar organs, or systems of structure,* and the old di-
visions of tonics, cathartics, &cvare  introduced  as
secondary distinctions.   This plan of arranging the
materia  medica appears  to me  to  be  superior to
   * Vide London Med. and Phys. Journal, for April, 1822. 
xiv
INTRODUCTION.
any that has hitherto been proposed.  Dr. Gran-
ville has not, however, been altogether successful,
I think, in the particular construction of his classi-
fication with  regard to its minor divisions.  He
places stimulants, for instance, in the class of "me-
dicines that act specifically upon the digestive or-
gans;"  whereas this  genus undoubtedly belongs
to his third class, which  comprises those " medi-
cines that act specifically on  the  circulating sys-
tem."   It may be  said, however, that remediate
agents  of  the stimuMht class produce their effects
upon the circulatory system,  by  a specific action
primarily exerted upon the stomach ; and that the
location given to these medicines by Dr. Granville
is, therefore, proper.   But although these reme-
dies do certainly  produce a  primary excitement
in the  stomach, yet .this primary  impression  is
constantly and specifically directed  upon the cir-
culatory system, where alone  it becomes obvious.
It is this ultimate effect alone which we consider
of consequence, or which can  be  regarded  as a
manifestation of the action of the stimulant.  There
are several other objections, of a similar character,
which might be urged against the construction  of
this  classification,  although its general scheme  is
unquestionably very good.  It forms the ground-
work of the arrangement  which I have adopted  in
this  treatise, and of  which, without  any further
comment, I subjoin the following synoptical view: 
INTRODUCTION.
XV
   CLASSIFICATION OF THE MATERIA MEDICA.

A. Medicines that act  specifically on  the  Intestinal  Canal, or
   upon morbific matter lodged in it.
      I. Medicines that excite discharges from  the alimentary
         Canal.
             a. Emetics.
                      ».
             b.  Cathartics.
      II. Medicines  calculated to destroy or counteract the in-
         fluence of Morbific substances lodged in the Alimen-
         tary Canal.
             a. Anthelmintics.
             b.  Antacids.
B. Medicines whose action is principally directed to the Mus-
   cular System.
      I.  Medicines  calculated  to correct certain Morbid con-
         ditions of  the System, by acting on the Tonicity of
         the Muscular Fibre.
                Tonics.
      II. Medicines calculated to correct certain Morbid states
         of the  System, by acting on the Contractility  of the
         Muscular Fibre.
                Astringents.
C. Medicines that act  specifically on the Uterine System.
      I.  Medicines  calculated to promote the  Menstrual Dis-
         charge.
                Emmenagogues.
      II. Medicines  calculated to  increase  the Parturient ef-
         forts of the womb.
                Abortiva.
D. Medicines whose action  is principally directed  upon  the
   Nervous  System.
      I.  Medicines that lessen  the Sensibility and  Irritability
         of the Nervous System.
                Narcotics.
      II. Medicines  that  increase and equalize the  Nervous
         energy. 
  XVI                 INTRODUCTION.

                  An tispas modics.
  E. Medicines whose action  is  principally manifested  in the
     Circulatory System.
      • I. Medicines that increase the action  of the Heart and
           Arteries.
                 Stimulants.
 F.  Medicines acting specifically upon the Organs of Secretion.
       I.  Medicines that act on the Cutaneous Exhalents.
          §. General.
             a. Diaphoretics.
         *§. Topical.
             b. Epispastics.
             c. Errhines.
             d. Emollients.
      II.  Medicines that increase the action  of the  Urinary
          Organs.
                Diuretics.
      III. Medicines that alter the state of the  Urinary Secre-
          tion.
               Antilithics.
      IV. Medicines that promote  the  secretory action of the
         Salivary Glands.
               Sialagogues.
G. Medicines that act specifically upon the Respiratory Organs.
      I.  Medicines calculated to increase the Mucous Secretion
         in  the Bronchia, and  to promote  its discharge.
            a.  Expectorants.
            b.  Inhalations.
     N.  Medicines  whose action is truly Topical.
            a.  Emollients.
            b.  Escharotics. 
                A


              OF THB

MATERIA  MEDICA

               AND

      THERAPEUTICS.
                  CHAPTER I.
 Observations on  the General Modus Operandi  of
                    Medicines.


  The living economy is under the constant influence of
extraneous causes, and subjected, by them, to an infinite
variety of modifications. Concerning the essential nature
of their action, however, it would be in vain to inquire.
All the information which seems to be attainable, in re-
lation to theip modus operandi,  is confirmed, perhaps, to
a knowledge of the organs upon which they primarily
act; the  medium through which their impressions are
conveyed throughout the system, and the  successive
order of the phenomena thence arising.
  The doctrines which prevail on this subject resolve
themselves into the two following positions:
  1. All medicines act primarily on the solids; their im-
pressions being conveyed through the system by  the
agency of sympathy.
  vol. i.—3 
2
OBSERVATIONS, &C.
   2. Medicines are absorbed into the circulation, and
 act on the system through the medium of the blood.
   That the animal body possesses the  faculty of trans-
 mitting impressions from one part to  another, is an in-
 disputable fact.   Such a power is essential to  the pre-
 servation of the living economy.   The circle  of vital
 actions would soon cease to revolve, were it not  for
 some general connecting medium, by which the various
 organs of the body are brought into a mutual harmony
 and  correspondence of action.  From  an examination of
 the different structures of the animal  system,  and the
 functions which they perform, it is evident that the brain
 and  its appendages, the nerves, constitute this medium
 of connexion ; for these alone receive  and  transmit im-
 pressions ; and upon them, therefore,  depend  all those
 phenomena which are  called sympathetic.   The objec-
 tion  which has been made to this opinion,  that  sympa-
 thies exist between parts of the animal body that have
 no direct  nervous communication  with each other,  is
without foundation; for it must be obvious to every one,
 on a  moment's reflection, that the nervous system brings
 every sentient and irritable part,  under the immediate
 influence of the  sensorium  commune, the brain; and
 that, therefore, all the parts of the body have a continu-
 ous  nervous connexion with each, other,  through the
 medium of this common centre of feeling.   That  sym-
 pathetic actions are thus propagated through the system,
 may  be inferred from  the known  laws of nervous ex-
 citement.   An impression made on the nervous extremi-
 ties of a part, is either altogether local  or  insulated  in
 its effects, or it is communicated to the sensorium com-
 mune, whence it is reflected either upon  tlje  part  in
which the primary irritation exists, producing sensation 
OBSERVATIONS, &C.
s
in that part; or upon other parts, exciting in them new
motions and feelings.
  The existence of sympathetic relations, and of their
agency in propagating remediate impressions  through-
out the system, is therefore incontestible.   It  is, how-
ever, no less true, that many medicinal articles are ab-
sorbed into the circulation,  and that they  act  on the
animal economy through the medium of the blood.
  It may not be improper to enter into a particular ex-
amination  of the grounds  upon which  this opinion is
founded, and of the  objections that have been urged
against it;  more especially as it has of  late years been
warmly contested  and rejected as "a relick of the  hu-
moral pathology."
  Before entering more directly upon the proofs of the
admission of remedial substances  into  the circulation
in an indecomposed state ; I shall make a few  observa-
tions concerning the so common  want of success in de-
tecting, in the blood, certain substances received into the
stomach, or otherwise subjected to the action of the ab-
sorbents.   Dr.  Wollaston states, that he gave a person
three and a half grains  of prussiate of potash  repeated
every hour to the third time. The urine being examined
every half hour, was found, in two hours, to be tinged,
and to afford a deep blue at the end of four hours.   But
in the  serum of the blood  which was then drawn, no
prussiate could be detected.   This experiment is ex-
tremely fallacious. In the first place, it is to be observed
that probably but a  small portion of the ten and a half
grains of the prussiate received into the stomach, was
taken up by the lacteals.  But this small portion could not
have entered the circulation at once; it must have been
introduced very gradually into the chyle; and as the kid- 
4
OBSERVATIONS,  &C.
 neys, no doubt, commenced throwing it off, as soon as
 any part of it was present in the circulation, it is obvious
 that but a very minute  quantity  indeed could, at any
 particular time, have existed in the blood.   It is, there-
 fore, not to be  wondered, that he  could not  detect this
 substance in the serum of blood drawn after the greater
 part of that which had been absorbed had already ap-
 peared in the urine, and consequently passed out of the
 circulation; for the portion of the prussiate present  in
 the blood, was  not only very small, but diffased more-
 over through a mass of at least twenty-four pints of fluid.
 The urine, on the contrary, having gradually collected
 the prussiate, held in less,  perhaps, than a pint, a much
greater quantity of this substance than could have been
present at any one time in  the whole  mass of the blood.
Now, from the experiments of professor Macneven, it
appears that it requires  one-eighth of a grain to  two
ounces of serum, before it  can be  detected by the  most
delicate tests.*  It would,  therefore, require more than
ten grains of this substance  in the blood, before it could
be detected, supposing the serum  to amount to about
 twelve pints.    Hence, it is evident, that no inference
 can be drawn from  experiments of this kind, that  can
justly be regarded  as militating against the opinions  I
 am advocating.  I have detected one-sixtieth of a grain
 of the prussiate in  one  ounce of urine; which accounts
for the ease with which this substance is detected in this
 secretion, whilst in the serum it escapes our tests.
   It may also be observed,  that the articles usually  em-

  * Experiments for ascertaining" the Permanency  of Chemical
 Compounds in their Passage through ihe Fluids, in the New-York
 Medical and Physical Journal, June, 1822. 
OBSERVATIONS, &C.
5
 ployed in experiments of this kind, have a tendency very
 rapidly to pass off by the kidneys.  It would seem that
 almost as soon as some of them arrive in the  circulation
 they are again eliminated by the emunctories; and hence,
 although the urine may become highly charged with
 such  substances, yet the blood, being so soon deprived
 of them again, shall contain but  a very minute portion,
 diffused too through a large mass of fluid.  Hence, also,
 we have an explanation  of the  fact, that certain sub-
 stances, after having been received into the stomach, or
 injected into the cavity of the abdomen, may be detect-
 ed  in the  mesenteric veins, vena portarum,  splenic
 veins, and thoracic duct, whilst in the blood generally
 no traces of their presence can be discovered.  For, as
 many of the abdominal lymphatics open directly into the
 veins just mentioned, it is evident that the substances
 which these lymphatics absorb and convey into the veins
 in question, must be  in a much less diluted  state than
 they can be after becoming mixed with  the general cir-
 culating mass.  If we admit the existence of venous  ab-
 sorption, an opinion advocated by very high authority,*
 this explanation will  be still more satisfactory.
  Great, however, as are the difficulties connected with
 experiments of this kind, we are not without  many well
 authenticated facts which prove the admission of foreign
 substances into the circulation.   In the  chyle of the
 thoracic duct, Musgrave, Lister, and Blumenbach de-
 tected substances which  had  been  thrown into  the
intestines of animals.   But not to dwell on the testimony
offered upon this subject by the older writers, we have
abundant evidence of the existence of this physiological
* Magendie, Emmert. 
6
OBSERVATIONS, &C.
fact in the researches of many of the most enlightened
physiologists of the present  day.   The experiments  of
Mayer,*  of Home,f of Magendie, J and the more recent
and satisfactory researches of professors Tiedeman and
Gmelin§ do not leave any doubt on this point.  The ex-
periments of the two latter physiologists prove,  in a di-
rect and conclusive manner, that almost all the substan-
ces usually found in the urine, after having been taken
into  the  stomach, may  be  detected also by  proper
management, in the blood of the  venae portse, the sple-
nic and mesenteric veins.   These facts have been lately
confirmed, by an  extensive course  of  experiments on
this subject  by Drs. Harlan, Coates, and  Lawrence  of
this city.   From the interesting  and well-digested re-
port which these gentlemen have just published, it ap-
pears in positive evidence that camphor may, and does
pass through the  circulation.  Having given a tabular
view of sixteen  experiments on living animals,  they
observe:  " It is impossible to look over the above table
without being struck with the obvious manner in which
they indicate the route by which the chemical substance
(prussiate of potass) experimented on, entered the  cir-
culation.  In nearly every instance  in  which  it was
found in the blood, the contents of the thoracic  duct, if
examined, exhibited it  in  a much more obvious de-
gree." ||  Still more recently, professor Macneven,  in

   * In Meckle's Archiv fur die Physiologic
   | Philosoph. Trans, for  1811.
   X Precis Elementaire de Physiologic
   § Versuche Ubur die wege, auf welchen substanzen  aus dem
magen und Darmcanal ins blut gelangen, u. s. w. Von. F. Tiede-
man, M. D. und L. Gmelin, M. D. Heidelberg, 1820.
   ||  Philadelphia Journal of the Medical and Physical  Sciences,
for Feb. 1822. 
OBSERVATIONS, &C.
7
the paper already quoted, has published the  results  of
some experiments,  which are entirely confirmatory  of
those just mentioned.   "I triturated,"  says  he,  "one
drachm of crystalized hydrocyanate of potassa with fresh
butter and crumbs of bread, which being made into a bolus,
the same dog swallowed and retained.   Between three
and four hours after,  Dr. Anderson bled him largely
from the jugular vein.   A dose of hydrocyanic acid was
then administered,  of which he died without pain, and
the abdomen was laid open.  The lacteals and thoracic
duct were  seen well filled with milk-white chyle.  On
scratching the receptaculum, and pressing down on the
duct, nearly half a tea-spoonful of chyle was collected.
Into this were let fall a couple of drops of the solution
of permuriate of iron, and a deep blue was the immedi-
ate consequence."  In  another experiment of this kind
Dr. Macneven found  that, " whenever the mesenteric
vessels, or  the external coats  of the intestines were
lightly scratched with the scalpel and touched with the
solution of permuriate of iron, a strong  blue was imme-
diately exhibited."
   The facts which have already been  detailed, are, I
think, quite conclusive on this point.  It may not, how-
ever, be uninteresting to adduce a few other observations
in evidence of the admission of foreign substances into
the circulation.  Emmert, an  eminent German physi-
ologist, relates an experiment,* in which  he passed  a
ligature round the abdominal aorta of an animal, and in-
serted the  prussic acid  into its legs.  The extremities
became cold, but some portion of contractility and sen-
sibility remained.   In seventy hours after  its applica-

       * Archiv fiir die Physiologie, Von I. F. Meckle. 
8
OBSERVATIONS, &C.
 tion the ligature was  removed, and the effects of the
 poison immediately showed themselves.  Similar experi-
 ments were performed with  the poison woorara,  by
 Mr. Brodie.*   "He  exposed the sciatic  nerve of a
 rabbit in the upper and posterior part of the thigh, and
 passed  under it a tape half an inch wide.   He  then
 made a wound in the leg, and having introduced into it
 some of  the woorara mixed with water, he tied the tape
 moderately tight on the forepart of the thigh.  He thus
 interrupted the communication  between the wound and
 the other parts  of  the body,,by means of the  vessels,
 while  that  by  means  of  the  nerves  still remained.
 After the ligature was tightened, he applied the woorara
 a second time in another part of the leg.  The rabbit
 was not affected, and at the end of an hour, he removed
 the ligature.  Being engaged in some other pursuits,
 he did not watch the animal so closely as he could other-
 wise have done, but twenty minutes after the ligature
 was removed, he found him lying on one side, motion-
 less and insensible, evidently under the influence of the
 poison."   It  appears, therefore, that  the poisons  em-
 ployed in these experiments were not able to affect the
 system until they had entered  the general circulation.
 Brodie's researches render it, indeed, extremely pro-
 bable that woorara, as well as several other poisons, pro-
 duce their deleterious effects on the animal economy, by
acting directly upon the brain, through  the medium  of
the blood, and that they are not injurious unless they are
absorbed into the blood-vessels.
  Besides the evidence of  direct experiment, there are
many other  facts mentioned in the writings of physi-
* Philosophical Magazine, June, 1811. 
OBSERVATIONS, &C.
S
  cians, which go to prove the absorption of foreign sub-
  stances into the circulation.   The  effects of the inter-
  nal use of nitrate of silver on the skin, strikingly illus-
  trates this fact.  A considerable number of cases have
  been  related,  on  the most  respectable authority, in
  which the skin acquired a very dark, and, in some in-
 stances, quite a black colour, from  the long  continued
 use of this medicine.*  It is well known, too, that medi-
 cines taken by  nurses very often produce the same ef-
 fects upon their suckling  infants, as if these had taken
 the medicine directly  into their stomachs.   It is a fact
 equally well known, that the milk of cows becomes im-
 bued  with  the odour and taste of the  vegetables  on
 which they feed.
   I am well aware, that many deny that these facts can
 be regarded as evidence of the transmission of foreign
 substances into the circulation.   It  is said, for instance,
 that the process of  assimilation completely  decomposes
 all substances subjected  to its influence;  that, conse-
 quently elementary  particles only are admitted into the
 blood-vessels; and that these are recombined, and again
 rendered conspicuous when thrown into the secretions.
   That substances taken into the stomach, or otherwise
 subjected to the action of the absorbents, are not neces-
 sarily  decomposed before  they are admitted  into the
 circulation, is fully  demonstrated by what has already
 been said.
   Admitting, however, that the assimilating powers do
decompose the  substances subjected to their action, it
does not, I think, form  any valid  objection to the doc-
trine alleging, that the blood may become imbued  with

         * Lond. Med. Reposit. vol. v. May, 1817.
  VOL. I.--4 
10               OBSERVATIONS, &C.
properties capable of producing  remediate or morbific
impressions, in consequence of the admission of certain
substances into the circulation.  When the milk, urine,
flesh, &c. become impregnated with the peculiar  quali-
ties  of substances  taken into the stomach, the blood,
from which these secretions are formed, must have con-
tained either the substances themselves or their elements.
It is evident, however, that blood which contains such
elements, contains parts which do not belong to it in its
natural and healthy state.   Thus, in the instance given
above, in relation to the discoloration of the skin by the
internal  use  of  the nitrate  of silver, if this substance
were previously decomposed, and again regenerated in
the skin, as has been alleged, we should then have silver,
oxygen, and  azote  floating  in a  separate  state  in the
blood, and without which no nitrate of silver could pos-
sibly be afterwards regenerated in the cutaneous vessels.
  In opposition  to the opinion that remediate substances
enter the circulation in an active state, it is asserted in
a late work on the Materia Medica, that " chyle, how-
ever diversified the materials may be out of which it is
formed, whether animal or vegetable, has essentially an
identity  of nature."  This assertion is  entirely gratui-
tous, and contradicted by direct experiment. Dr.  Mar-
cet found that chyle formed from vegetable food con-
tains nearly three times as much carbon, as that  which
is formed from. animal food; and that the chyle from
animal substances, for the most part, enters into  putre-
faction in three  or four days, whilst that from vegetables
will remain unchanged for weeks, or  even months.   It
moreover appears  from these experiments, that chyle
from animal  food is milky and  on standing, becomes
covered with a  cream-like substance; whilst that from 
OBSERVATIONS, &C.                 11
vegetable  food is generally transparent,  resembling
common serum with a coagulum almost colourless, and
does not collect  a creamy  substance on its  surface.*
There is, therefore, a very striking difference between
the chyle formed from animal and vegetable substances.
  It has also  been objected, "that it is incompatible
with animal life  that such active substances should be
received into the circulation, since milk and other bland
fluids have been known, when injected into the vessels,
to occasion immediate  death."  It cannot be denied
that substances forced into the circulation by a syringe,
and of a reduced temperature, may, and in fact  gene-
rally do, occasion death.   Such violent effects do not,
however, always follow experiments of  this  kind.  Drs.
Smith, Wahrendorf, Borrichius, Magendie, and others,
injected medicines into the  veins of persons, and found
them to produce the same  effects as if they  had been
received into  the stomach.  Sir  E. Home performed
similar experiments, and demonstrated  anew that reme-
diate substances may be thus introduced into the system,
not only without fatal consequences, but with  the same
effects as if they had been taken internally.   The ex-
periments of Dr. Smith and Sir E. Home are published
in the Transactions of the Royal Society of London.
  Although the introduction of foreign substances into
the circulation, by means of an injecting apparatus, often
gives rise to dangerous or fatal consequences, it does not
follow that the same violent effects must ensue from the
introduction of the same articles into the blood, through
the regular route of the absorbents.   In the one case,
the substance introduced is suddenly and forcibly urged
* Medico-Chirurg. Transact, vol. vi. p. 630. 
12
OBSERVATIONS, &C.
 into the blood-vessels; whereas  in the other, it passed
 into the  veins, drop  by drop, without any unnatural
 impetus,  enveloped  in  bland  and  congenial  fluids
 possessing the precise temperature of the  blood.   In
 confirmation of the correctness  of this  view, we need
 only advert to the fact, that  chyle itself, when injected
 into the blood-vessels,  will produce the same  injurious
 effects that follow the introduction of  other  articles in
 the same way.
   It has also been said: " By the medication of the blood,
 were it possible, as is contended for, we must,  in all in-
 stances, do harm.  The whole  mass of the circulating
 fluids is equally charged in this case with the medicinal
 substance, and  therefore,  while an action  is going on
 in a diseased organ which may be salutary as to it, every
 sound part of the system becomes subjected to  a similar
 impression, which could not fail to disturb  the  order of
 health, and create morbid derangements."  To this hy-
pothetical objection, I will oppose the observations  of
 one of the editors of the New-York Medical and Physi-
 cal Journal.   "That every organ in the body," says the
 writer, " has its peculiar and appropriate  stimulus, by
 which it is excited into action, is so universally admit-
 ted as to require no process of reasoning to  establish  it.
 If this be so, then there can be but little difficulty, we
 think, in conceiving that  a substance  dissolved in the
 blood may circulate through the system, without produc-
 ing any particular effects,  until it reaches the organ up-
 on which, from its peculiar properties, it is designed to
 operate.   The reason  why a  medicine acts upon one
 organ in preference to all the  other organs of  the body,
 —why jalap, for instance, operates upon the intestines,
 and not upon the  brain and lungs,—we  can no more 
OBSERVATIONS, &C.
13
 explain than we can the reason why the planets are kept
 revolving in their orbits.   If we are told that the move-
 ment of the planets are the  result of attraction so we
 may say that the determination of medicines to certain
 organs is occasioned by a similar attraction.  This, how-
 ever, explains nothing, and we must, after all, be con-
 tent with the broad fact, that such phenomena do occur,
 and that they are governed by certain laws; but the cause
 why they occur, must for ever remain concealed."
  From the  foregoing observations, therefore, it is,  I
 think, perfectly evident, that medicines may produce re-
medial impressions in both the ways mentioned  in  the
beginning of this chapter.   This,  indeed, is the general-
ly admitted doctrine on this subject, with those who
have kept pace with the progress of medical science. 
CHAPTER II.
A. MEDICINES THAT ACT SPECIFICALLY ON THE INTES-
   TINAL CANAL, OR UPON MORBIFIC MATTERS LODGED
   IN IT.
I.  Medicines that excite Discharges from the Alimen-
                    tary Canal.
EMETICS.
  An emetic is a substance which excites vomiting by a
specific impression on the stomach, independent of mere
distention from quantity, or of nauseous taste or smell.
  With regard to the mechanism of vomiting, experi-
ments, apparently equally correct and conclusive, have
led to very opposite results.  Chirac,* a French physi-
cian of the 17th century, published an account of some
experiments he had performed on living animals, with
the view of ascertaining the particular process of vomit-
ing.   The conclusions which he  drew from his experi-
ments  are;  that in the act of vomiting the stomach is
quiescent, and that its contents are ejected solely by be-
ing forcibly  compressed between the diaphragm and ab-
dominal muscles.   Magendie,  without  alluding to the
experiments of Chirac, has drawn the same conclusions,
from a set of experiments  he has lately performed  on
1' Academie Royale des Sciences, p. 12, an. 1700. 
EMETICS.
15
this subject. The experiments of Haighton, on the con-
trary, seem to prove, very conclusively, that vomiting
is chiefly, if not entirely, effected by the contraction of
the muscular coat of the stomach; and this is the opinion
now almost universally entertained.  There can, how- •
ever,  be but little doubt, that all the powers which have
been mentioned, conspire to produce the act of vomit-
ing.   The stomach contracts;  its peristaltic action is
inverted; the diaphragm  and  abdominal  muscles  are
brought into action, and thus, by the combined agency
of all these powers, emesis is produced.
   How do emetics excite the actions of the stomach and
muscles concerned in the process of vomiting? The spe-
culations of Darwin on  this subject, though,  perhaps,
untenable upon the whole, are not without considerable
plausibility.   He alleges that the excitement of the sto-
mach is greatly diminished by the action  of an emetic;
in consequence of which its peristaltic motion becomes
inverted.  When nausea  is produced, (says he,) the
stomach, as well as the whole  system, is  in a state  of
 temporary debility.  As the nausea increases in intensity,
 the natural powers of  the stomach are more and  more
 diminished, until they cease altogether, and give rise
 to an inverted motion of its muscular fibres.  In confir-
 mation of this  view of the subject, he  refers  to the vo-
 miting produced by causes manifestly  debilitating, such
 as syncope, concussion of the brain, &c.
   It is impossible to ascertain  the precise nature of the
 changes which take place in the living system from the
 operation of extraneous causes.   All  that we can hope
 to arrive at in this respect, is a knowledge of the gene-
 ral character and order of phenomena; a  point, indeed,
 which it is but seldom allowed us to attain.   When  an 
 jg                   EMETICS.

 agent is applied to the system, a longer or shorter train
 of actions occurs intermediately between its application
 and its ultimate or characteristic effect.   In proportion
 as we trace the successive links in the chain of actions
• which results from the operation of a remedy, so do we
 succeed in obtaining a knowledge of its modus operandi.
 With regard to the operation  of emetics,  therefore, we
 may trace, I think, the following series of actions.  The
 emetic, in the first place,  makes an impression on the
 sentient extremities of the stomach.   This impression
 is immediately referred to the sensorium  commune; in
 consequence of which its natural energies  are diminish-
 ed, as is evinced by the languor of both the intellectual
and corporeal  powers.   But as the sensation of an irri-
tated organ depends, in reality, directly on a peculiar
excitement in  the sensorium commune, so we may infer,
that the sensation of nausea is the immediate and neces-
sary result of the diminished and peculiar excitement of
the brain referred to the stomach.  That this is, in fact,
the case, is demonstrated by  the vomiting and nausea
which are sometimes excited, at the sight, smell, taste, or
even the thought of a disgusting object.   Here,  how-
ever, our progress is arrested.    For  we can trace no
necessary connexion between nausea  and the mechani-
cal process of vomiting.   We know not why a certain
degree of nausea produces contractions of the organs
concerned in this act any more than we know, why  a
certain degree of venereal excitement calls into action
the muscles concerned in ejectione seminis.   These are
mysteries, locked up  in the bosom of our Creator,
concerning which it would be idle to speculate.
  When an emetic is taken, an uneasy sensation is first
experienced, which is sooner or later followed by nausea; 
EMETICS.
17
this gradually grows stronger and stronger,  while  the
pulse becomes feeble, frequent, and  irregular ; the face
turns pale, and the skin becomes cold and shrunk;  vo-
miting finally comes on, during which  the  face is  red
and turgid with blood.   On the cessation of  the vomit-
ing the sickness goes off, leaving the system in a state
of temporary languor, from which it soon recovers.
  Contrary to what takes place with the operation of
other articles on the animal economy, emetics  increase
by repetition, the susceptibility of the stomach to their
impressions.  Cullen states  that he knew a person so
accustomed to excite vomiting in himself, that the one-
twentieth of  a grain of tart, antim. was sufficient to ex-
cite a convulsive action of the stomach.
  The evacuation produced by  an emetic is  not con-
fined  to the stomach, but  extends occasionally also to
the duodenum ; and even further.  During the  act of
vomiting, there must be a considerable pressure exerted
upon the liver and gall-bladder,  by the contraction of
the diaphragm and abdominal muscles.  In consequence
of this, a more copious discharge of bile into the duode-
num takes place;* and this  effect is promoted by the
relaxation produced in the  common duct  by the pre-
vious nausea.  Being thus more copiously  thrown into
the duodenum, during the first efforts of vomiting, the
bile is readily conveyed to the stomach, both by the in-
verted motion of the intestine, and the pressure of the
abdominal  muscles.  It is obvious from this, that al-
though  the contents  of  the stomach may  at first be
thrown off free from any admixture of bile; yet  after
one or two acts of vomiting, by  which the   contents of

                * Cullen's Materia Medica.
   VOL I.--5 
13
EMETICS.
 the duodenum are forced  into  the  stomach, this  fluid
 may be copiously discharged.   When,  therefore, we
 do not observe any bile in the fluid thrown off,  until
 several full evacuations have occurred, we may  con-
 clude that it did not previously exist  in the stomach,
 but was brought into it by the preceding acts of vomiting.
  In cholera, we generally find no bile in the discharges,
 until vomiting has continued for  some time.   In this
 case, the bile is  probably furnished from the gall-blad-
 der, which being compressed by the action  of the dia-
 phragm and abdominal muscles, during vomiting, pours
 its contents into the intestines, and thence into the sto-
 mach.   From this circumstance, we  derive a caution
against the imprudent repetition of vomits,  on finding
bile in  each  succeeding discharge, under the fallacious
idea of expelling the whole of it from the primse vise.
Besides discharging the contents of the stomach,  vomits
are  useful also by agitating and compressing the abdo-
minal viscera; and thereby giving an impulse to the cir-
culation in the portal vessels.  They  are,  on this  ac-
count,  advantageously  employed in  diseases attended
either by internal congestions, or where the  circulation
in the abdominal organs is morbidly sluggish.  Vomits
are  moreover beneficial, by the general shock  which
they give to the nervous system.  It is by an influence
of this  kind, perhaps,  that they are sometimes capable
of arresting fevers, when administered in  their forming
stages.
  It has been satisfactorily  ascertained, that  effused
 fluids are often rapidly diminished during the operation
 of emetics, and  hence  it is inferred that they increase
 either  in a direct or indirect manner, the activity of the
absorbents.   Dr.  Chapman  supposes  that   there is a 
EMETICS.
19
  kind of antagonising power between the absorbents and
  the blood-vessels; in consequence of which the activity
  of the former set of vessels,  is indirectly increased by
  the operation of emetics in consequence of the  reduc-
  tion of the arterial action which they create.   The cir-
  cumstance of a more rapid disappearance of effused fluid,
  during the employment of emetics, admits, however, of
  ah explanation, I  think, more philosophical  and satis-
  factory.   The morbid accumulation of an effused fluid
  must be owing either to too rapid an exhalation from the
  arteries, or to too slow an absorption by the lymphatics.
  Whichever be the case, it is certain that if we lessen the
  action of the exhalent vessels, the quantity of the effused
 fluid will diminish, although  the  action of the  absorb-
 ents remains unaltered.   It is in  this way, I presume,
 that emetics act when they diminish dropsical accumu-
 lations.  They lessen the action of the  heart and arte-
 ries, and thereby  diminish  exhalation.   If the lympha-
 tics preserve but their ordinary  powers, they  will
 diminish  the  quantity of  collected  fluid, or at least
 greatly retard the progress of its increase.   This effect,
 namely diminished exhalation into the internal cavities,
 and consequent diminution of the fluids already collect-
 ed, may be further  enhanced by the tendency  which
 emetics have to determine the circulation from the in-
 ternal to the external surface.
   With regard to the influence of emetics on the  brain,
 I have already stated, that they appear to  have an  im-
 mediate power of diminishing  its energies.  They are,
 therefore, useful in diseases of  the mind, attended by a
 morbid irritability  of the brain,  from their immediate
 influence in repressing this condition.  They are, how-
ever, equally useful in mental diseases  of an  opposite 
£0
EMETICS.
character, where the brain is in  a state of torpor, as
in hypochondriasis.  But, as  this disease is,  for  the
most part, attended, and greatly influenced by abdomi-
nal congestions, as well as a sluggishness of the portal cir-
culation, emetics would seem to  produce their good
effects in it chiefly by the agitation which they give to
the body, and the activity they thereby impart to the
abdominal circulation.  They, however, undoubtedly
also produce a new  excitement in the  brain, by the
more direct influence which they excite upon this organ
through the medium of the gastric nerves.
   In prescribing emetics, care must  be taken that we
do not administer them when there  is much fulness of
the vessels of the head, or where symptoms of general
plethora exist, without premising  an adequate detrac-
tion  of blood, lest by the exertions  during the act of
vomiting, some  blood-vessel  burst,  and apoplexy or
dangerous haemorrhage be induced.
   From the extensive influence of this class of remedies
on the  animal economy, it may be readily conceived,
that their remediate application  must be various and
important.   In a great number of  diseases, indeed, they
are indispensable, at some period or other of their pro-
gress.   I now, therefore, proceed  to give a more  par-
ticular detail of  their practical application.
   Emetics constitute a very important class of remedies
in febrile diseases.  In the treatment of typhus, when
exhibited in the forming stage of the disease, they often
arrest its progress in a very  prompt manner.  " Anti-
monial emetics," says Dr. Armstrong, " have been very
generally recommended in typhus fever, and, according
to my observation, are serviceable when the fever is of
the least complicated form, commonly producing an im- 
EMETICS.
21
provement in the condition of the skin, respiration, and
pulse  in  particular; and, perhaps, it is on the power
which they possess of determining the blood to the sur-
face, and of changing the morbid states of the circula-
tion, that their efficacy depends."
   In typhus pneumonica I have derived much advantage
from emetics, in every stage of the disease.   They ap-
peared to be particularly serviceable where much dis-
tress and pain in the thorax, with signs of internal con-
gestion, were present.   In such cases  they  promoted
expectoration, and tended to re-establish the equilibrium
of the circulation.  They appeared, moreover, to render
the system more susceptible to the  operation of stimu-
lants.  " In the typhoid and typhus pneumonica," says
professor Potter, " that occasioned such lamentable mor-
tality, of late  years, throughout  the  United States,
emetics, judiciously  employed, were  more  beneficial
than any other remedy.   It was, indeed, a novel specta-
cle to those who were accustomed to unsheath the  lancet
in almost every  thoracic affection, to behold a pneumo-
nic fever, perhaps an hemoptoe, removed by the incanta-
tion of a single  emetic."
   Emetics  have also  been recommended in the various
forms of malignant fever.  In  the beginning  of some
fevers of this character, they may occasionally  prove
beneficial, though, as a general  rule, they are of doubt-
ful propriety even in the  earlier stages of such  fevers ;
and, in their advanced periods, for the most part, in-
jurious.
   In intermittents vomits  are a very common remedy.
They,  indeed,  not unfrequently put a stop to the dis-
 ease, without the employment  of any  other medicine.
There exists some  difference of opinion  with regard to 
  H-2                    EMETICS.

  the importance of exhibiting emetics, as  a preparative
  to tonic remedies.  Judging from my own experience,
  I am led to believe, that an emetic will, in general, ren-
  der the subsequent employment of bark more certainly
  suceessf'il : and this seems to be in accordance with the
  sentiments of many of  the best  writers on  this subject.
  Independent of the general impression which emetics
  produce on the system, and which, of itself, must aid in
  breaking through the chain of morbid associations,, they
 appear to  render  the stomach more sensible to  the im-
  pression of other remedies, and  consequently to give
 them a greater chance of displaying their full powers.
   In some of the  exanthemata,  emetics are often of es-
 sential service.   They are especially useful in the early
 stage of scarlatina, both in its simple and malignant form.
 When aided by the warm bath,  they tend to "free the
 system from the pressure of the plethora of the internal
 blood-vessels, so frequently observed in the commence-
 ment of this disease, and by thus  equalizing the whole
 circulation, to render the  future  case most commonly
 mild and manageable."*
  Emetics   have also  been  strongly recommended  in
 some varieties of erysipelas.   In the bilious erysipelas,
 which Desault regards as the common and genuine form
 of this disease, he trusted entirely to antimonial emetics.
 Renauldin, author of the article  Erysipele, in the Dic-
 tionaire des Sciences, Medicates, also  adds his testimony
 in favour of the use of emetics in this affection.
  In the first stages of measles and small-pox, attended
with strong internal congestions, the  operation  of an
emetic will often prove decidedly beneficial.  " In the
* Armstrong on Scarlet Fever, p. 35. 
EMETICS.
23
 beginning of measles," says Dr. Armstrong, "when the
 lungs have been exceedingly oppressed, and particularly
 when vomiting has been  absent, 1  have often  seen the
 most striking relief follow an antimonial emetic,  which
 may fairly be  ranked among the most efficacious reme-
 dies in pulmonic congestions."*
   Emetics constitute an important auxiliary in the treat-
 ment of many of the phlegmasiae.   In puerperal fever
 they were at one time in high repute.   Where there
 is nausea and bilious vomiting in the beginning  of the
 disease, one or two gentle  emetics may  be employed
 with advantage.   They  cannot, however, under any
 circumstances, be  relied on  as a principal remedy in
 this  dangerous affection,  and  may, I  think, be always
 omitted with propriety, except where the indications for
 their employment just mentioned are present.
   In the treatment of croup, emetics are of unquestion-
 able advantage. They are, indeed, altogether indispen-
 sable in managing this formidable malady, and will often
 procure effectual relief without any other  remedy.   In
 slight attacks,  vomits, assisted by  the warm bath, and
 the application of rubefacients  to the throat, often suf-
 fice to  put a speedy termination to the disease.  But
 where the febrile symptoms run high, and the breathing
 is very difficult, bleeding is our sheet anchor.  When-
 ever, therefore, vomiting  and the warm bath do not af-
 ford  effectual  and  speedy relief,  immediate recourse
 ought to be had to the lancet.   The bleeding should be
 carried to  the extent of producing a decided impression
 on the system.   "In all the cases of croup," says Dr.
 Ferriar, " which I have seen, I have found it necessa-

  * Practical Observations on Scarlet Fever, Measles, and Pulmo-
nary Consumption, p. 130. 
24
EMETICS.
rv to bleed immediately, and when I have seen the pa-
tients sufficiently early to  entertain hopes  of saving
them, I have directed the evacuation to  be continued,
so as nearly to produce fainting.  This is the essential
point of the cure, without which no relief can be effect-
ed.  Even if the patient should not be seen till the day
succeeding the attack, it is proper to bleed ad deliqui-
um, if the subject  be plethoric, and the difficulty of
breathing and restlessness be great."*  Independent of
the relaxation which  a decisive bleeding produces in
the glottis, and the  favourable  impression  it  makes on
the tracheal inflammation, it has the effect also of greatly
facilitating the operation of emetics, by removing the
cerebral congestion, and consequent  insensibility of the
stomach to the action of remedies.   The emetics should
be continued at intervals until the disease is completely
subdued.  In  the latter stages of the complaint, they are
useful by promoting the discharge of the viscid mucus
secreted in the bronchia.
   Emetics are also  very useful in the other species of
cynanche.   In the commencement of cynanche maligna,
an emetic will often afford evident relief, and sometimes
at once arrest the  progress of the disease.   By this
practice  "we never fail  to bring  off  a considerable
quantity of acrid matter,  which, by  getting  into the
bowels,  might induce a diarrhoea;  an  affection  to be
avoided by every possible means, as always  adding to
debility, and endangering the life of the  patient."
   In cynanche laryngea, undoubtedly the most fatal va-
riety of anginose disease, vomits  have been known to
act with decided benefit.   Dr.  Armstrong recommends
                 /
   * Ferriar's Medical  Histories and  Reflections, p. 137.   Phila-
delphia edition, 1816. 
EMETICS.
25
the employment of emetics in this fatal affection, as one
of the most effectual means we possess  for arresting its
progress.   He states, that in five  cases of this disease,
he exhibited "tartarized antimony, sometimes combined
with ipecacuanha, in repeated doses, until free and fre-
quent vomiting took  place.  No  circumstance of my
professional life," he  continues,  "ever  gratified me
more than the great and sudden relief which  the vo-
miting afforded; in reality it removed all  the urgent
symptoms at the time, and being excited as soon as ever
the slightest signs  of stricture in  the larynx returned,
at last completed the recovery."*
  Emetics may be very  beneficially employed in the
treatment of peripneumonia notha.   Where the inflam-
matory condition has been in some degree subdued, or
where the stage  of excitement has never developed
itself fully from oppressive venous  congestions,  emetics,
in repeated but gentle doses, are among our most efficient
remedies.  Large quantities of  viscid phlegm  are usu-
ally thrown up, and in many instances immediate relief
is obtained.  After the operation of the emetic, suita-
ble stimulants, such as  small doses  of opium and cam-
phor, with some gentle diaphoretic  drinks, should be
given.f  Of course blisters to the chest are never to be
neglected.   They are indispensable  to relieve the local
pulmonary affection.
  Emetics are no less useful in  the treatment  of pneu-
monia biliosa,  than in the preceding variety of pulmonic
inflammation.  Richter% says, that they will often remove

  * Armstrong's Practical Illustrations on Typhus Fever.  First
American edit. p. 336.
  | Richter's Speciell© Therapie, vol. i. p. 427.
  | Ibid. vol. i. p. 404.
   VOL. I.—6 
26                   EMETICS.

the excruciating pain in the thorax, as by enchantment.
Stoll* also speaks in the  highest terms of the utility of
emetics in this form of pleurisy.   Professor  Potter,  of
Baltimore, in an interesting  paper  published  in the
Medical Recorder, adds his testimony in favour of this
practice.   " Experience has taught us," says he, " that
they (emetics) are  eminently  useful after the violence
of inflammatory action shall have been abated, as well as
in all the milder degrees with which this disease so fre-
quently commences."f   Since the first edition of this
work was published, I have met with cases of strongly
marked bilious pneumonia; and in these emetics afforded
unequivocal benefit.
   In the treatment of some  varieties of acute ophthal-
mia vomits have been recommended as particularly ser-
viceable.
   Many respectable writers have  spoken very  favour-
ably of the powers of emetics in the cure of acute rheu-
matism.  HornJ states, that in his hands emetics were
more useful in this disease than any other remedy.   He
repeated them every day, until from fifteen  to  twenty
were taken.   The result of this practice, he informs  us,
was exceedingly happy.  There  is a form  of rheuma-
tism, which occurs in low and marshy situations, and
which Richter calls rheumatismus acutus  gastricus,
depending, according to Stoll, on an irritation from  vi-
tated or redundant bile in  the  primse viae.$   In this
form of the  disease emetics  are generally  decidedly

   * Ratio Medend. vol. i.
   | American Medical Recorder, vol. iv. p. 418.
   JUber die heils. wirk. der Brechmittel  in hitzigen  rheumat
D. Archiv. b. viii. st. 2.
   § Ratio Med. torn. ii. p. 25. 
EMETICS.
27
 beneficial.   Lentin*  speaks of rheumatism connected
 with a bilious form of fever, in which vomits produced
 very  beneficial  effects.   Scudamore,  also, speaks fa-
 vourably of the employment of vomits in  this disease.
 "If the patient be seized," says he, "in consequence
 of exposure, shortly after some  convivial occasion, on
 which he has  indulged in improper diet,  the present
 remedy should not, on any account, be neglected."f   I
 have occasionally met with cases of acute rheumatism,
 attended with  manifest bilious symptoms, and in these  I
 have employed emetics with advantage.  In the purely
 inflammatory form of this disease, uninfluenced by marsh
 miasmata, I have, however, never  resorted to emetics,
 and can, therefore,  say nothing from my own experi-
 ence of their value in such cases.
   Emetics have also been strongly recommended in gout.
 Scudamore thinks that they should not be used, " unless
 an evacuation of the stomach in  a full  degree is  obvi-
 ously  indicated."  He  mentions a  case, however, in
 which the good effects of an emetic were strongly ex-
 emplified.  Mr. Alexander Small, surgeon at Minorca,
 speaks very favourably  of the efficacy of tart, antim. in
 his own  case of gout.  He sometimes gave it with bark,
 in which combination it acted as a mild aperient, f
   Mr. Saunders^ was in the habit of employing tartar-
 ized antimony so as to excite nausea, or full  vomiting in

  * De aere et morb. clausthal. p. 30.
  f A Treatise on the Nature and Cure of Gout and Rheumatism,
p. 298.
  J Observations on the Gout, by A. Small, late surgeon to the
ordnance in the island of Minorca, in the Med. Observ. and In-
quiries, vol. vi. p.  199L
  § A Treatise on some Practical Points relating to Diseases of
the Eye, by I. C. Saunders. 
28
hMETICS.
acute ophthalmia, with great success.  In that variety of
inflammation of the eyes, called Egyptian ophthalmia,
Sir W. Adams speaks of the use of emetics in the strong-
est terms of praise.
  In gutta serena, also, emetics have been administered
with very considerable advantage.  Richter, who con-
sidered the cause of this disease as seated in the abdomi-
nal viscera, employed them  much in  conjunction with
the deobstruent pills which will be hereafter mentioned,
under the head of antispasmodics.*
  Of the propriety of employing emetics in hemoptysis,
I have great doubts, although very respectable testimony
in favour of this practice may be adduced.  When we
attend to what  takes place during the operation  of an
emetic, it is difficult,  I apprehend, to enter upon the
employment of vomits in the cure of this variety of hae-
morrhage, as recommended by Dr.  Bryan Robinson,
without considerable fears as to the result.  During the
process of vomiting there is a  strong  impulse given to
the circulation; a full  inspiration is  made, by which
the lungs become expanded, and a greater facility given
to the escape of blood from the bleeding orifice.!  Be-
sides these effects,  there is  undoubtedly some impedi-
ment created to the passage  of the blood  through  the
abdominal aorta, in consequence of the action of the ab-
 dominal  muscles and  diaphragm; and of course there
 will be a greater impetus given to the blood through the
 superior arteries.   It is true,  that both before and after
 the act of vomiting, a very considerable languor  in the
 circulation occurs, which might favour the  suppression
 of the haemorrhage; and if these remedies be exhibited

   * Richter's Medical and Surgical Observations, p. 254.
   t An Essay on the Materia Med. by J. Moore, p. 320. 
EMETICS.
29
only to the extent of inducing nausea, there can be no
doubt of their being, in some degree, advantageous. The
agitation and straining,  however, during the efforts  of
Vomiting,  are calculated to produce  much  more mis-
chief, than could be compensated by any advantage to
be derived from the subsequent languor.   Cullen,  in-
deed, who tried this practice, states, that  in  one in-
stance  it  increased  the haemorrhage to  a great and
alarming degree.
   In haemorrhages from the uterus there are, I think,
much better grounds for expecting useful effects from
the operation of this class of remedies.
   Independent of every respectable testimony in favour
of the use of emetics in this variety of haemorrhage, we
have a  good anatomical reason, both for the advantages
of vomits in menorrhagia, and for their  occasional irijif-
rious effect in  haemoptysis.  During the act of vomit-
ing, the abdominal muscles and diaphragm  are thrown
into a state of violent contraction.  The natural conse-
quence of this is a degree of pressure on the abdominal
aorta, both where it passes through the crura of the di-
aphragm, by the contraction of this muscle, and in its
course through the  abdomen, by  being compressed in
common with the other contents of this cavity.   Hence
there will be a slight impediment to the passage of the
blood to the lower portions of the body, whilst it will be
more forcibly driven into the vessels which pass off from
the aorta within the thorax.   The reason is, therefore,
obvious why vomiting will sometimes not only increase,
but give rise to an haemorrhage from the lungs; whilst, on
 the contrary, its effects in menorrhagia, so far as expe-
 rience has taught us, are not only free from dangerous con-
 sequences, but are very often of unquestionable service. 
 30                   EMETICS.
   The only case in  which I have had recourse to this
 practice, was recently in a delicate  female, who, with
 menorrhagia, suffered under symptoms indicating the
 use of a gentle emetic.   I ordered her eighteen grains
 of ipecacuanha, which brought on several copious bilious
 discharges from the  stomach; and 'had  the effect be-
 sides, of giving a very decided check to the haemorrhage.
   In the  treatment  of dysentery, emetics are often  of
 very great  advantage.   Where there is a redundancy
 of vitiated bile present in the primae viae,  as is frequently
 the case in the dysenteries of hot climates and  marshy
 districts, vomits would seem to be  indispensable.   Sir
 John Pringle speaks  very favourably of this practice ;
and Mr. T. Clark assures us, that he derived the great-
est advantage  from the employment  of emetics in this
disease, when administered  in the form of enemata.*
Cleghorn,  too, gives  his testimony in  favour of emetics
in this disease.f   In  cases unattended with high febrile
excitement,  I have  sometimes given an ipecacuanha
puke, when first called to the patient, and  I believe,
always with advantage.  It is evident, however,  that
where there is much  fever, emetics should not be used
until the arterial excitement is adequately reduced by
direct depletory measures.   In the treatment of diarr-
hoea also, this class of remedies will often prove very
serviceable.   In this and the former intestinal disease,
vomits are useful, not so much by evacuating the con-
tents of the  stomach, as by their  tendency to  equalize
the circulation, and to determine it to%ie surface.
   In that species of mania which arises from  the intem-

  * Observations on the  Nature and Cure of the Diseases of the
East and West Indies.
  t Cleghorn's Observat. on the Epidem. of Minorca, p. 146. 
EMETICS.
31
 perate use of ardent spirits, emetics are sometimes de-
 cidedly  efficacious.  This practice was introduced a
 few years ago, by Dr. Joseph Klapp, of this city, who
 has published the result*  of his very extensive experi-
 ence on  this subject, exhibiting strong evidence of the
 utility of emetics in this very singular variety of mania.
 The late Dr. Albers, of Bremen,  in a letter written a
 short time before his death, gave me an account of three
 cases of this disease, in which  emetics were employed
 with evident advantage.   The result was such at least,
 as to induce him to express a determination to adopt a
 similar treatment in future.
   The stomach, in this disease, is often  extremely in-
 sensible  to the operation of emetics.  It is, therefore,
 in general, necessary to employ very large doses before
 vomiting can be excited.   Where full emesis is produ-
 ced, the mental hallucinations are commonly much cor-
 rected, and in mild cases, sometimes  entirely suspended,
 by a single emetic.   It will most frequently be neces-
 sary, however, to repeat the emetic  two, three, four, or
 even five or six times, at such intervals as the particu-
 lar circumstances of the  case  may require.   In  the
 course of this treatment,  the bowels must be  kept re-
 laxed by aperients, if the emetics do not  produce
 this effect.  Dr. Klapp does not think, it necessary or
 even proper, to employ opium along with the emetic
 treatment, unless, extreme  exhaustion or hypercatha-
 ris is induced by the emetic.
  Emetics have iso been much recommended in other
varieties of maniaj and in hypochondriasis.  In the lat-
ter complaint I have employed  them with evident ad-

 * Vide Eclect.  Repertory, vol. vii. p. 251.  Also  American
Medical Recorder, vol. ii. and iii. 
32
EMETICS.
vantage.  An emetic will often rouse the hypochondriac
patient from that state of mental and physical torpor with
which he is pressed down, and render his system more
sensible to  the  operation of other  remedies.   Emetics
are particularly advantageous in this disease, when al-
ternated with alterative doses of blue pill, and an occa-
sional saline purgative.  Whatever be our notions con-
cerning the pathology of hypochondriasis,  observation
has fully demonstrated the intimate  connexion of its
symptoms with the particular condition of the abdominal
viscera.  In this disease there  generally exists  much
congestion in the portal vessels, with  torpor and func-
tional derangement of the liver.  By  the employment
of these remedies, therefore, we not only evacuate the
alimentary canal of its vitiated contents, but also invigo-
rate the circulation in  the  portal system, both by the
mechanical agitation of the vomiting,  and the specific
influence of the mercury  upon the vascular extremities
of the hepatic system.  In a case of  puerperal mania,
I derived the most decided benefit from the employment
of emetics.   The patient  had been  delivered of her
first child four days, when she began to manifest symp-
toms of mental derangement.   She would neither speak
nor take nourishment unless  greatly  urged.   After
using a variety of means to induce her to speak, she re-
plied, that she was talking to good spirits from the other
world, and was determined to have nothing to do with
the beings of this wicked place.   She declared she was
perfectly well, and stood in no need  ot any medicines.
In this state she continued for three days, and then, all
at once, became extremely loquacious.  Her pulse was
small  and frequent, and the pupils of  her  eyes  much
contracted.  Under these circumstances, I ordered her 
EMETICS.
S3
an antimonial emetic, which brought on pretty copious
vomiting.  She became evidently much tranquillized by
its operation, and seemed, at short intervals, to be sen-
sible of her real  situation.   On the evening  after the
vomiting I gave her an anodyne draught, which, how-
ever, did not procure her the rest  I anticipated.   On
the next day,  I gave her  another emetic, which again
operated well; and from this period she rapidly recover-
ed the full possession of her mental faculties.
   In hysteria also, emetics are often of unequivocal ad-
vantage.   They are, perhaps, to be employed usefully
in every variety of the disease; but in that form which
is attended with complete suspension of the animal func-
tions, bringing on a state resembling syncope, I have
found  them to be particularly useful.*   Dr. Dean, a
highly respectable practitioner in the  interior of this
state, adds his testimony in favour of the employment of
emetics in hysteric affections.  His experience has led
him to regard them as decidedly the most effectual re-
medy we possess  in  the chronic form of  this disease.
" It is in the chronic variety of this complaint," says
Dr. Dean, " in which the common routine of what are
improperly termed  antispasmodic medicines, produce
no other than transient relief to the patient, that I have
experienced the most permanent good  effects from the
administration of emetics.   In cases of this description,
where the patients had laboured under this disease for
ten years, and during that time, by the advice and di-
rection  of respectable  physicians, exhausted, with at
most but temporary benefit, the whole class of remedies
which are usually prescribed, I have, by the continued
exhibition of vomits,  either  entirely removed  the com-

       * American Medical  Recorder, vol. iv. p- 124.
  XVL. I.--7 
',4
EMETICS*
plaint, or so far interrupted the habits of diseased action
in the stomach, that antispasmodic and tonic medicines
would, in general, complete the cure/'*   Dr. Joseph
Smith, of New-York, has published  some interesting
observations on the employment of emetics in spasmodic
diseases.   " The experience I have had," says he, " of
the utility of emetics in hysteria  and  epilepsy, enables
me to assert, with confidence, that they are more effica-
cious than any remedy ordinarily  employed."!
  In asthma emetics are highly useful.   They not only
assist materially in expelling the viscid mucus from the
bronchia, but operate in a direct  manner in facilitating
the transmission of the blood from the right to the left
side of the heart, the impeded  course of which forms,
perhaps, the chief source of distress in  this and other
similar affections.   That the operation of an emetic pro-
duces this effect, is  evident from  the circumstances
which take place during the act of  vomiting.   During
this process the diaphragm is  drawn downwards, by
which the thoracic cavity is enlarged, and  the lungs
are in a full state  of inspiration, and therefore expand-
ed to the utmost degree.  The necessary consequence
of this is, that  the blood  which  had  congested in the
pulmonary arteries, right side of the heart, and large
venous trunks, in consequence of the previous inadequate
expansion of the lungs, is now, during the act of vomit-
ing, permitted to pass on with freedom to the right side
of the heart.  And hence, in part, the temporary relief
almost invariably obtained from full vomiting  in  this
disease.

  *  American Medical Recorder, vol. iv. p.  259.
  t  Transactions of the New-York Physico-Medical Society, vol. i. 
F.METICS.
35
  Iii the treatment of hooping-cough also,  emetics, in
general, afford  very considerable  relief.  Where the
disease is attended with much arterial excitement, they
are, however,  inadequate  of themselves to  do much
good, and should be assisted by prompt and decisive ve-
nesection.
  Much  dispute  existed at one time concerning the
propriety of administering emetics in apoplexy.  This
subject is amply and warmly discussed in the fifth and
sixth volumes  of  the London  Medical and Physical
Journal.   As  the  power  of  vomiting to  propel the
blood to the superior parts of the body, from  the causes
which I have already mentioned in this chapter, is very
considerable, I am entirely convinced that, in general,
this class of remedies cannot be safely employed in apo-
plexy.  This disease may, however, occur  under cir-
cumstances of gastric irritation, which will not only ren-
der the employment of an  emetic useful, but absolutely
indispensable.  When, for instance, apoplexy comes on
immediately after  eating a full meal, it would be exceed-
ingly unwise to suffer the stomach to remain oppressed
and over-distended by what had been eaten.   But even
under such circumstances,  a copious abstraction of blood
should always be premised, for the apoplectic symptoms
may as yet depend simply  on turgescence of the vessels
of the brain, which from the further impetus given to
the blood by the  efforts of vomiting,  may become rup-
tured, and  bring  on fatal  extravasation.   The occur-
rence of this event will be rendered much less probable,
if we lessen, to a considerable degree, the general mass
of the circulatory fluid previous to  administering the
emetic.   Where there is no strong reason to suspect an
irritation  in the stomach, either from over-distention or 
S6
EMETICS.
 from the presence of some irritating substance, I cannot
 conceive what advantage could result from the adminis-
 tration of an emetic.  If apoplexy be essentially connect-
 ed with an  engorgement  of the  cerebral vessels, it is
 obviously wrong to resort to a treatment which has a
 direct tendency to increase the fulness of these vessels.
   Of the effects of emetics in epilepsy, the records of
 medicine furnish us with very  contradictory evidence.
 As in the treatment of apoplexy, so in that of epilepsy,
 their employment has been on the one hand as extrava-
 gantly praised, as it has been inordinately censured on
 the other.  It  may be observed  that, perhaps, in all
 cases where we  have  contradictory evidence, from re-
 spectable sources, in relation to the remediate powers of
 a remedy, it arises from its having been given either in
 different stages of the same complaint, or in  different
 varieties dependent on a difference in the remote caus-
 es.   We may, therefore, safely conclude,  that although
 as a general rule, emetics may not be proper in epilepsy,
 yet occasionally this disease may present itself under
 circumstances which will render them decidedly bene-
 ficial.
  In the epilepsy of children, when there does not ap-
 pear to be much fulness of the vessels of the head,  and
 symptoms of gastric irritalion are  present, such as nau-
 sea, flatulency,  disturbed sleep, and other marks of in-
 digestion, emetics are of essential importance.   Dr. J.
 Clark advises, for this purpose, a solution of the sul phate
 of zinc in an aqueous infusion of ipecacuanha, to be re-
peated in six, eight, or ten days,  according to circum-
 stances. Dr. Thomas says, that when an attack of idio-
pathic epilepsy can be  foreseen,  there is, perhaps, no
remedy which will be  more likely to prevent the parox- 
EMETICS.
57
 ysm, than an emetic administered about an hour before
 its accession.   In a child, which had been about eigh-
 teen months  affected with  occasional epileptic  con-
 vulsions, I succeeded in removing the disease entirely,
 by a long course of emetic remedies, administered every
 third  day.  The disease  came  on after  an  attack  of
 ague, which was cured by arsenic, and was probably at
 last kept up from habit.   I employed ipecacuanha.
   Of the utility of emetics in the early stages of indi-
 gestion there can be no doubt.   In the advanced peri-
 ods of the complaint,  however,  when the disease no
 longer consists, simply, in functional derangement of the
 stomach, but has extended to the neighbouring viscera,
 they are, in general, either useless or improper.  In
 recent attacks of indigestion, attended with distressing
 pains of the stomach, or symptoms of an oppressed state
 of the  brain,  an emetic  will often procure  the most
 prompt relief.   In persons whose digestive organs are
 much debilitated, food, which in  the healthy state of the
 stomach is perfectly innocent  and nutritious, will some-
 times produce  " great general distress, numbness of the
 scalp, violent colic, acute pain in the side and  bladder,
 vertigo,  apoplexy, and convulsions."   In  affections of
 this  kind, emetics are obviously the proper remedies ;
 Dr.  Revere, of Baltimore, relates several cases in wh'ch
 their efficacy  was promptly  and conspicuously  mani-
 fested.*
   But although an occasional  vomit may be useful or
even indispensable, in obviating the ordinary symptoms
of indigestion,  yet experience has shown the propriety
of employing them with caution ; and only when evident
symptoms of gastric impurities are present.
* American Medical Recorder, vol. iv. p. 50. 
38
EMETICS.
  In dropsical diseases emetics have been much employ-
ed.   They have been prescribed in  every variety of
dropsy, but they appear to be more particularly applica-
ble to the treatment of  anasarca and  ascites.  Their
beneficial action in these affections has been ascribed to
a power which they are supposed to possess of increas-
ing the activity of the absorbents.  I have already ex-
pressed my doubts with regard to this supposed influ-
ence of emetics on the  absorbent system, and  stated,
what appears to me to be  the correct explanation of
their modus operandi in this respect.  By the nausea
they create, they lessen the momentum of the blood in
the capillary vessels, as is evinced by the paleness  and
shrunken appearance of the skin during this state. The
momentum of blood in the  extreme vessels being thus
diminished, exhalation, which  depends on the activity
of these vessels, must, we may presume, receive a simul-
taneous check.  The absorbents, however, not being
under the same influence, pursue their functions uninter-
ruptedly, and  thus gain on the antagonizing, but weak-
ened, exhalents.  Emetics may also do good by promot-
ing the return of blood  through the portal  system of
vessels, and by thus removing congestion in the capilla-
ries of the peritoneum and lower extremities.
  Emetics have also been  recommended  in  diabetes.
Richter relates several cases that were effectually cured
by them.  Where it is evidently connected with  gas-
tric irritation,  as in the cases mentioned by Richter,
vomits will, no doubt, do much good. This writer men-
tions  an instance of this  disease, where an  emetic
brought  up a very great quantity of  bilious matter;
"and I can assert with truth," says  he,  "that next
morning there was not a vestige of diabetes  or of  any 
EMETICS.
39
other complaint  present."*   We have also  the testi-
mony of  Frank, in favour of  the employment  of this
class of remedies in the present disease.   Emetics are,
indeed, a very common remedy in the treatment of dia-
betes with the  German  physicians ;  and many cases
may be found in their writings illustrative of their be-
neficial effects.
  In the treatment of jaundice emetics are often of es-
sential service.   They are particularly  calculated to
promote the  passage of gall-stones through the common
duct.   By the nausea they create, they relax the duct,
whilst the mechanical pressure and agitation  caused by
vomiting tend to push the calculus forward in the re-
laxed tube.
   Emetics often act  very beneficially in hernia humo-
ralis.  I have, in  several instances, witnessed  the good
effects of strong  antimonial  vomits  in  reducing these
painful swellings.   Emetics have also been a good deal
recommended to  reduce indolent  buboes ;  but  their
effects in this way do not appear to be considerable.
   For obstinate constipation,  emetics have  been very
highly recommended.  The  Greek and  Roman physi-
cians appear to have frequently resorted to  this prac-
tice.  It is  recommended by  Hippocrates,! Praxago-
ras,J Caelius  Aurelianus,^ Alexander Trallianus;|| and
among the moderns, by Stoll,l[ Sims,** Sumeire,!!

  * Medical and Surgical Observations, p. 84.
  | Tlt^t Hov<rm, III. v. Opp. p. 491.
  % Apud. Cad. Aurel. p. 243.
  § Ibid. p. 529—532.
  || L. iii. C. 44.
  IT Rat. Med. P. ii. p. 135-138.
  ** Observations, p. 20, et seq.
  ft Journal de M6d6cine, T. LXI. p. 369, 
40
EMETICS.
 andDeplace.*   Quite recently Professor Hosack has
 published his  experience upon this subject.   He de-
 tails seven cases of this kind, from which it appears,
 " that in the commencement of constipation, or in its
 more advanced stage, when the symptoms of inflamma-
 tion have been  subdued by the lancet, emetics may be
 very advantageously exhibited, both for the purpose of
removing the hepatic obstructions, and of counteracting
the spasmodic constriction and pain ordinarily attendant
upon this disease."!
              CALLICOCCA IPECACUANHA.

  This plant was first discovered about the middle of
the seventeenth century.  It is a native of South Ame-
rica, and has been well described by M.  Brotero, pro-
fessor at the University  of Coimbre, in the Memoirs of
the Linnean Society of  London.   It  appears  to  be a
species of the genus Callicocca, of  Shreber, and is  ac-
cordingly described in  the books under the  name of
Callicocca Ipecacuanha.   It has been  ascertained that
the ipecacuanha root,  as it is brought to us from Brazil,
is not always  taken  from the same plant, namely  the
Callicocca Ipecacuanha.  According to Linnaeus it is
not unfrequently obtained from the psycntria emetica;
and DecandoJle asserts that the ipecacuanha, as it is
found in our shops, is  very often a mixture of the  ge-
nuine root with the roots of some  species  of violets,

 *  Ledellot. Jour. T. XXXYI.
 t  New-York Medical and  Physical Journal, vol. i. No. I. p. 60. 
CALLICOCCA IPECACUANHA.
41
apocynse, euphorbia, &c.  It is also said to be occasion-
ally mixed with the roots of several species of the genus
Ionidum.*   To what  degree  these adulterations may
deteriorate the value of the ipecacuanha, I am unable to
say.   It is certain, however, that they  must interfere
with its peculiar virtues, and tend more or less to mo-
dify and render uncertain its effects.
   The ipecacuanha root consists of very tortuous branch-
es, of the thickness of a goose-quill, surrounded by nu-
merous prominent rings, separated by  deep  grooves.
Externally its colour is brownish or blackish grey ;  in-
ternally it is white or  faintly yellow.   It  has a faint
disagreeable smell, and a bitter subacrid taste.
   Magendie and  Pelletier have ascertained that  ipeca-
cuanha contains a peculiar  principle,  to which they
have given the name of emetin,\  and upon which  the
emetic properties of the root seem entirely to  depend.
This substance appears to reside principally in  the cor-
tical part of the root.

  * Nouveaux Elemens de Therapeutique, par. I. L. Alibert,  t. i.
  t The following is the formula  introduced into the new codex
of Paris, for the preparation of this substance.   " Let  gi. of the
powder of ipecacuanha be macerated in ^ii. of ether, with a gentle
heat, for some  hours, in  a distilling apparatus;  let the  portion
which remains be triturated and boiled with 5iv. of alcohol, it having
been previously macerated in it; filter, and let the  remainder be
treated with fresh portions of alcohol, as long as any thing is taken
up from the root; mix these alcoholic  solutions and evaporate to
dryness ; let this alcohol extract be macerated in cold distilled  wa-
ter, in order that every thing soluble in that menstruum may be  dis-
solved; filter, and evaporate to dryness; this extract is emetin; in
this state, however, it contains a small quantity  of gallic acid, but
which   is too  inconsiderable to affect  its  medicinal  qualities."
Paris's Pharmacologia.
   VOL. I.—3 
4 'J
CALLICOCCA IPECACUANHA.
   It consists, when pure, of little transparent laminae,
 of a brownish red colour, possessing  very little odour,
 and a taste resembling that of the powdered ipecacuanha.
 Emetin is decomposed in a heat of about 212°.  Water
 dissolves it in every  proportion, without affecting it9
 composition in the least.  It deliquesces in a moist air*
 Alcohol dissolves it readily, but ether has no action on
 it.   " JVitricaciddissolves  it, but at the same time de-
 composes it; dilute sulphuric acid has no action on it;
 muriatic acid and phosphoric acid dissolve it without
 altering its nature ;  acetic acid dissolves it with facility;
 corrosive sublimate precipitates it from its solutions ; but
 tartarized antimony has no effect upon it.  Gallic acid,
 the infusion of galls, and acetate  of lead precipitate
it."* According to the analysis of Pelletier, ipecacuan-
ha contains sixteen  parts of emetin,  two of oil, six of
wax, ten of gum,  forty of starch, and twenty of woody
fibre.
  Of a hundred parts of ipecacuanha, alcohol takes up
 about twenty-one; proof spirits somewhat  more than
 thirty-two, and boiling water nearly forty-seven.
  This substance is,  undoubtedly,  the most important
 vegetable emetic we possess, and in many instances pre-
 ferable to every other article belonging to this class.  It
 is mild  in its operation,  and may be safely exhibited
 under circumstances of general exhaustion, or intestinal
 irritation, which would render the employment of anti-
 monial emetics injurious.  In all cases where the sto-
 mach is irritable or debilitated, the ipecacuanha is de-
 cidedly the best emetic.   It seems to have less tendency
 to weaken  the digestive powers of the stomach than
* Paris'a Pharmacologic. 
CALLICOCCA IPECACUAJfm.
4"
 any other article of this class; it would appear even to
 exert some tonic power upon this organ, when given in
 very minute doses, as I have more than once observed
 in my own  person, and it unites moreover to its emetic
 virtues, no inconsiderable powers as an antispasmodic,
 as well as  a tendency to allay nervous irritation.   It
 possesses another advantage over antimonial  emetics,
 which in many cases is of great importance; it is much
 less apt to aet upon the bowels, and to pass off by copi-
 ous and exhausting stools, than the preparations of anti-
 mony.  This is of immense  consequence in many dis-
 eases; for we often find it useful  to procure  emesis,  in
 cases where a rapid catharsis would prove highly  inju-
 rious.   It is, nevertheless, not destitute of properties
 capable of exciting the peristaltic action of the intes-
 tines.   It will, in general, after having acted upon the
 stomach, prove gently aperient,  and excite, moreover,
 in a very particular manner, the cutaneous exhalents;—
 circumstances which render it peculiarly adapted to the
 treatment of several intestinal diseases.
   Its powers as an antidysenteric, was  indeed the very
 first circumstance which  brought this remedy into no-
 tice.  Piso, as early as 1649, and before any of it had
 been brought to Europe,  mentioned the ipecacuanha as
 a common remedy for  dysentery in  the Brazils.  Its
 character in this respect, though not equal to  what  it
 once enjoyed,  appears to be well deserved, since, by
 the most eminent writers who treat of this disease, it  is
 mentioned as a principal remediate article.  Ipecacu-
anha is given in dysentery, with a view either to its
emetic or sudorific operation, though the latter is, in
general, the principal intention for which it is employed.
On this account,  therefore,  it is commonly given in 
44
CALLICOCCA IPECACUANHA.
combination with other substances,  which have  the
effect of increasing its tendency to excite the cutaneous
emunctories.
  Moseley, who adopted the sudorific plan of treating
this disease, gave small doses of ipecacuanha in combi-
nation with opium.   There can be no  doubt that  this
treatment will sometimes cure  dysentery, but the expe-
rience of the profession would  seem to show that it can-
not be safely relied on as a principal part of the treat-
ment of such cases.  In the dysenteries of this country,
at least, more promptly evacuant measures are necessary,
and if ipecacuanha be used in the early stage, it should,
perhaps, always be given in the first place, to the extent
of inducing full vomiting.   Sir John Pringle was in the
habit of giving it in small doses, and repeating it until
both vomiting and purging were produced.  To insure
its operation on the bowels, Cleghorn gave it in union
with the  cerated glass of antimony,  in such doses as to
produce  a full emeto-cathartic effect.
  In the latter stages of the complaint, however, when
the  arterial excitement has been considerably subdued,
there is no remedy which is so well calculated  at once
to mitigate the distressing  tormina, and to keep up an
agreeable and salutary moisture of the surface, as ipe-
cacuanha and opium combined.   If calomel be united
with these two articles, we heighten, still  more, the cu-
rative effects of the composition ; for, of all the articles
 in the materia medica, the latter substance appears to
 be the most powerful in equalizing the circulation.
   Mr. Playfair, in a paper published in the tenth volume
 of  the Edinburgh Medical and  Surgical Journal, has
 given an account of a new mode of  using ipecacuanha
 in this disease;  and which he states  to have proved ex- 
CALLICOCCA IPECACUANHA.
45
eeedingly successful.   He gave from half a drachm to a
drachm of this article, in union with from thirty to sixty
drops, of laudanum, keeping the patient for some time
after in a horizontal position.  When the medicine was
rejected, he repeated  the  dose.   He  states  that this
practice is applicable only to the early stage of the dis-
ease.   He practised in Bengal.  The ipecacuanha has
also been administered in the form of an enema,  in dy-
sentery ; and its effects, when thus employed, have been
much praised.*  For this purpose, three drachms of the
bruised root are to be boiled in a quart of water down  to
a pint.  This is to be administered as an enema, all at
once, to an adult.   This injection is also greatly extolled
for the relief it affords in internal piles.   In a  case of
this kind I have myself had  an opportunity of witnessing
its good effects.
   Ipecacuanha, given in  small doses so as  to puke
gently, has been much praised for its effects in the cure
of chronic diarrhcaa, and more  particularly if the dis-
 ease  be attended with symptoms of gastric impurities.
 Dr. Samuel Pye has published a number of cases illus-
 trative of the good effects of the  ipecacuanha  in this
 disease.  He administered  it in  small  doses,  sufficient,
 however, to produce vomiting,  and repeated the me-
 dicine from day to  day, with  an occasional anodyne
 mixture,  until the  disease disappeared.!  The same
 practice is recommended by Dr. Fothergill, and may,
 indeed, be found in perhaps every work that treats  on
 this  disease.
   Much has been said of the efficacy of nauseating doses

   * Observations on Fevers and other Diseases of the Indies.  By
 Thomas Clark.  London, 1801.
   * Medical Observations and Inquiries, vol. i. p. 2. 
46
CALLICOCCA IPECACUANHA.
 of ipecacuanha in hemorrhages.  Dr. A. N. Aasheim,
 a Danish physician, has published some interesting ob-
 servations on the employment of this remedy in haemop-
 tysis.   He gave one-fourth of a grain every three hours
 during the day, and every four hours during the night.
 The third dose, in  general,  excited  slight vomiting.
 By  this treatment, Aasheim remarks,  the bleeding was
 put a stop to;  the cough became less severe,  and the
 skin, which before was dry,  was rendered moist,  and
 soft to the feel.*  Richter observes, that when haemop-
 tysis is attended with cold  extremities,  anxiety, rest-
 lessness, pale urine, and a small, tense, and quick pulse,
 great advantage may in general be derived from quarter
 grain doses of ipecacuanha, repeated every fifteen mi-
 nutes ;! and Meza asserts, that under circumstances of
 this  kind, it is the most effectual of all remedies when
 given in this way. J  The good effects of this article in
 haemorrhage, depend  no doubt on the  restraint which
it exercises over the action of the heart  and arteries,
 by the nausea it creates, and still more,  perhaps, on its
power of equalizing the circulation and exciting the cu-
taneous emunctories.   In uterine haemorrhage, this arti-
cle has been found still more beneficial than  in  the
other haemorrhages, and this may, perhaps, be account-
 ed for in the way I have already attempted to  do,  when
speaking of the general application of this class of  re-
medies to the cure of diseases.  It was first particular-
ly recommended as a remedy in menorrhagia, by Dahl-
berg;$  and its  efficacy was afterwards confirmed  by

 *  Alibert Mat. Med.  torn. i. p. 248.
 f Speciell Therapie.
 %  Samml. Auserles. Abhand. Bd. 15. p. 259.
 §  Specielle Arzneimittellchre. Von  G. A. Richter—Berlin, 1827. 
CALLICOCCA IPECACUANHA.
47
  Plink, Loeffler, and others.  Bergius  relates a violent
  case  of  uterine haemorrhage,  which  he successfully
  cured by giving half a grain of  this remedy every half
  hour.  I have never used the ipecacuanha in cases of
  this kind, but I can well  conceive of the propriety of
  the practice.
   Ipecacuanha vomits have been thought peculiarly ser-
 viceable in asthma.  Bang, Percival, and Joerdens, men-
 tion its use in this affection with  particular commen-
 dation.   Vomiting, by whatever article  excited,  must
 of itself, simply from its mechanical operation, be useful
 in the asthmatic paroxysm.   By the contraction of the
 diaphragm, it augments  the cavity of the thorax, and
 allows the  lungs to expand more fully,  by which the
 transmission of blood through these organs  is greatly
 facilitated, and a principal source of uneasiness in this
 disaase temporarily  removed.   Besides  this  effect, it
 aids, in no  inconsiderable degree,  to expel the viscid
 mucus from the bronchia, and thereby gives a greater
 opportunity for the  oxygenation  of the blood.   But in-
 dependent of these general effects, ipecacuanha has been
 supposed  to possess  antispasmodic  or other  peculiar
 powers calculated to act beneficially in this disease.   Il
 appears to me, however, that in this respect it possesses
 no advantages over the other emetics generally employ-
 ed, except in its acting more mildly, and not being apt,
 like the antimonial preparations,  of passing off rapidly
 by the bowels, and debilitating the digestive organs.   It
must not be concealed, however, that Akenside, who
published  a paper on the use of this article, in the pre-
sent  disease,* states,  that he found it equally useful,

       * Memoirs of the London College of Physicians. 
48
CALLICOCCA IPECACUANHA.
whether given to the extent of producing vomiting or
only in nauseating doses.  It must, however, also be ob-
served, that in the paroxysm he administered it so as to
produce vomiting, whilst, after the paroxysm had passed
off, he continued its use  every morning  in nauseating
portions.
  In the Memoirs of the  Medical Society of Copenha-
gen, there arc  some very interesting remarks on  the
employment of  ipecacuanha  as an anti-emetic, by Dr.
Schonheyder.  He relates the history of a case of ileus,
in which small  doses of this  article proved successful,
after  every other means  of relief had  been fruitlessly
employed.  In this  case the stomach was extremely
irritable, and  fecal matter was thrown up, very frequent-
ly for several  days.   The thirst was extremely urgent;
the abdomen, however, was  neither hard, nor tumid,
nor painful.  Small  doses of  ipecacuanha v/ere finally
given.  The  second dose  removed the disposition to
vomit;  and by continuing the medicine, the disease was
entirely subdued.*
   Burdach states, that it is very useful in habitual vomit-
ing from morbid  irritability  of the stomach.  In  such
ca.se s, however, it must be given in very small doses.
   Alibert mentions, on the authority of J .W. Guldbrand,
a Swedish physician, that ipecacuanha has been found
to manifest important  emmenagogue powers.   He re-
fers  to two obstinate  cases of amenorrhcea effectually
 cured by it.
   Ipecacuanha has also been applied to the cure of indi-
 gestion.   Daubentou gave it in doses just sufficient " to
 excite  a slight sensation of  vermicular  motion of the

           *  Alibert Matiere Medicale, t. i. p.  249. 
CALLICOCCA IPECACUANHA.
49
 Stomach, without carrying it to the point of nausea."*
 I have used it in my own case, in doses of one-fourth of
 a grain every morning, noon, and evening, with evident
 advantage. Hufeland recommends the use of one-fourth of
 a grain every two hours, in cases of indigestion, attended
 with much flatulency,  tension, and fulness in the epigas-
 trium, together with constipation and a sense of fulness in
 the head.!
   With regard to  the proper dose of this article, we
 should find it difficult to  arrive at any definite conclu-
 sion, from a reference  to authorities.  Dr. Pye records
 upwards of one hundred and fifty cases, in all of which
 vomiting was produced effectually, and in by far the
 greatest majority repeatedly, by two, three, and  four
 grain doses.   Cullen expresses his doubts with regard
 to the correctness of this statement;  but we have the
 testimony of Chaumenton and others in confirmation of
 the vomitive power of small doses.  Those who are in
 the  habit of prescribing  the Dover's powder, or the
 more simple combination of ipecacuanha and opium, for
 diaphoretic purposes, know how apt they are to excite
 vomiting, although  the quantity of ipecacuanha be but
 very small.   It would  appear, indeed, as if the opium
 which  enters into  these  compositions, enhanced  the
 emetic  properties  of the  ipecacuanha.   The  medium
 dose of powdered  ipecacuanha as an  emetic  is about
 twenty  grains;  although  much larger doses  may be
given  without detriment, as  the  greater part of it is
commonly thrown up by the first discharges.  I am in-

  * Alibert.
  t Hufeland's Journal, Bd. 29. St. xi. p. 121.
  VOL.  I.---9 
50
CALLICOCCA irECACUAXUA.
formed by Dr. Joseph Hartshorne, of this city, that the
addition  of  powdered gum arabic, destroys almost en-
tirely the peculiar nauseous taste of ipecacuanha.   The
officinal preparations are the  pulvis ipecacuanha com-
posite, and the vinum ipecacuanha.   The powder be-
comes inert by long exposure  to the air and light.   AH
vegetable astringents, as infusion of galls, &c. vegeta-
ble acids, especially the acetic, weaken its power.  Dr.
Irvine found that gr. xxx. administered in §ii. of vine-
gar, produced only some loose stools.
   Emetin  is  a powerful preparation  of ipecacuanha.
One-sixth part of it is considered  equivalent  to about
one  part of the powdered root?   It is apt to produce
very active vomiting, but its  tendency to create irrita-
tion  of the mucous membrane of the stomach and  bow-
els appears to be very considerable, and renders it alto-
gether a much less useful medicine than the ipecacuanha
in substance.   Ten grains of  this preparation were suf-
ficient to destroy animals in 24 hours;  and on dissection
the mucous membrane of the whole tract of  the aliment-
ary canal, as well as the respiratory passages, exhibited
marks of strong irritation.   It is said  also to manifest
narcotic powers.  When given so as to excite vomiting,
it generally leaves the patient in a very drowsy disposi-
 tion.
                       Formulae.
   R-—Pulv. ipecac.  gr. x..;
      Pulv. opii     gr. v.;
      Calomel      gr. v.;
      Pulv. camph.  gr. viii.—M.   Divide into  10 equal parts.
 One of these taken every two or  three hours will often procure
 much relief in dysentery, after proper evacuations  have been pro-
 cured. 
CALLICOCCA IPECACUANHA.
"it
  R.—Pulv. nitrat. potas. 31. ;
      Calomel         gr, vi.;
      P. opii           gr. iii.;
      P. ipecac.        gr. vi.—M.  Divide  into G equal parts.
One to be taken every two hours.  This combination is an ex-
cellent expectorant in pulmonary catarrh.

  R.—Pulv. ipecac.   gr. viii.;
      Massae hydrarg. gr. xxiv.;
      Pulv. capsici   gr. vi.—M.  Divide into 6 pills.  One to
be taken at night, as an alterative, in indigestion from mere debility
of the stomach.
                  LOBELIA INFLATA.

  This is a biennial plant, and indigenous to the United
States, in many parts  of which it grows in great abund-
ance.  For a particular  description of this  species  of
lobelia, the reader is referred to Dr. Bigelow's Ameri-
can  Medical Botany, and  to  Dr. Barton's  Vegetable
Materia Medica of the United States, where accurate
figures are given of the plant.  The leaves and capsules
of this plant are exceedingly acrid, and when " held in
the mouth for some time, they  produce giddiness and
pain  in  the  head, with a trembling  agitation of the
whole body; at length they bring on extreme nausea and
vomiting.  The taste resembles that of tartar emetic."*
  As an emetic  the lobelia inflata is extremely active,
producing, in strong  doses, " great relaxation, debility,
and perspiration."  Concomitant with  its emetic opera-
* Bigelow's Medical Botany, vol. i. p. 179. 
52
LOBELIA IN PLATA.
  tion, it sometimes acts on the bowels and produces purg-
  ing.  Shoepf merely notices this plant as " astringent
  and used in ophthalmia," without saying any thing fur-
  ther concerning its medicinal powers.   Our knowledge
  of its virtues  as a medicine has been chiefly derived
  from the account given of its effects by the Rev. Dr. M.
  Cutler, whose  experience  with it appears to have been
  very considerable.   He has found it particularly ser-
 viceable in asthmas.   " It has been my misfortune," says
 he, " to be an asthmatic for about ten years.   I have
 made  trial  of  a great variety of the  usual remedies
 with very little benefit.   In several  paroxysms I found
 immediate relief more frequently than from any thing
 else, from the skunk-cabbage, (pothos fostidum.)   The
 last summer I had the severest attack I ever experienced.
 It  commenced early  in  August, and continued  about
 eight weeks.  Dr. Drury, of Marblehead, also an asth-
 matic, had made use of a tincture of  the Indian tobacco
 (lobelia inflata) in a severe paroxysm,  early in the
 spring.   It gave him  immediate relief, and he has been
 entirely free from the complaint from that time.  I had
 a tincture made of the fresh plant, and took care to have
 the spirit fully saturated, which I think is important. In
 a paroxysm, which, perhaps, was as severe as I ever ex-
 perienced, the difficulty of breathing  extreme, and after
 it had continued for a considerable time, I took a table-
 spoonful.  In three or four minutes  my breathing was
 as free as it ever  was.  In  ten minutes I took another
spoonful, which occasioned sickness.  After ten minutes
I took the third, which produced sensible effects on the
stomach, and a very little moderate puking,  and a kind
of prickly sensation through the whole system, even to
the extremities  of the fingers  and  toes.   Since that 
LOBELIA INFLATA.
53
 time I have enjoyed as  good health as, perhaps, before
 the first attack."*   Other practitioners have employed
 this article with decided advantage in asthmatic affec-
 tions.  Dr.  W. P. C. Barton mentions a case of  this
 kind in which he exhibited a tea-spoonful of the tinc-
 ture every two hours, with speedy and obvious benefit.
 Dr. Stewart also, as I am  informed by Dr. Barton, has
 obtained unequivocal advantages from the employment
 of this  remedy in a case  of spasmodic asthma.   Dr. Cut-
 ler has found it a very useful pectoral " in consumptive
 and other coughs depending on  mucus accumulated in
 the bronchial vessels."
   Since the publication  of the first edition of this work
 I  have had several very striking  examples of  the good
 effects  of this article in asthma.  Its operation is indeed
 often surprisingly prompt  and effectual in this disease.
 I  have  known the most  frightful paroxysm completely
 allayed in less than fifteen  minutes.
   As an  emetic, I  have employed it in one  case of
 croup, with very great benefit.  I have also used it ef-
 fectually instead  of  tobacco, in the form  of an  enema,
 to facilitate  the  return  of a  strangulated hernia.!  I
 have also within the last  four years employed it in a
 number of cases of whooping-cough,—and  in  several
 instances with the most unequivocal advantage.   From
 fifteen to  twenty drops  in union  with ten or  twelve
 drops of the syrup of squills may be given every two
 or three hours to a child  of between one and two years
old.
   The plant should be collected in August, and plucked

 * Thacher's Dispensatory.
 f Barton's Vegetable Materia Medica, vol. i. p. 197-9. 
54               LOBELIA  INFLATA.

up by the roots.   Every part of the plant possesses ac-
tive qualities, but the roots and the inflated capsules are
decidedly the most powerful.  It may be  given either
in the form of powder or tincture.  The latter is, how-
ever, the most convenient  mode of exhibiting. this re-
medy.   The formula adopted in the American Phar-
macopoeia, for making the tinctura lobelise, is given be-
low.*   As an  emetic, we may give from ten to twenty
grains of the powdered  leaves, to an adult.  In smaller
doses its effects are expectorant.  The saturated tinc-
ture is administered in the dose of from twenty to forty
drops, to children of one or two  years old.
                     ANTIMONY.

  Antimony is a  hard and brittle metal,  of a  bluish
white colour, resembling tin in its lustre.  It is of a lamel-
lated texture, and when handled imparts a peculiar smell
to the fingers.   It  enters into fusion at a degree of heat
a little above red, and  when suffered to  cool presents a
stellated appearance on the surface.
  This substance was  known to the ancients under the
name of stibium, but  was not employed as an internal
remedy until about the middle of the sixteenth century.
About this period Basil Valentinus published his Currus
Triumphalis,  in which we find various preparations of
this metal mentioned, and their internal employment en-
thusiastically recommended.

  * R.   Lobelias uncias duas.
        Alcoholis diluti octantem unum.
    Digere per dies decern, et per chartam cola. 
ANTIMONY.
55
  Paracelsus became its warm advocate, and announced
it as a powerful and efficacious remedy in plague.   In
the plague which ravaged Bohemia in 1562, antimony
was extensively employed. But as its virtues were imper-
fectly understood,  it was frequently administered  im-
properly, and occasionally attended with violent  and
dangerous consequences.* It was, therefore, soon de-
nounced by  the Medical Faculty of Paris as a fatal
poison ; in consequence of which the  French parlia-
ment issued a severe decree against its internal employ-
ment in  1566.  In 1603, the celebrated Theodore Tur-
quet  de Mayerne was prosecuted  for having  sold
antimonial preparations, contrary to the decree of  par-
liament ; and Besnir, an eminent physician of that time,
was expelled the Medical Faculty of  Paris, for having
employed this proscribed remedy.  After  this decree
had been suffered to stand for more than half a century,
it was at last repealed, and antimony  soon became  one
of the most boasted and popular articles of the materia
medica.
   In pursuit of an universal remedy, the alchemists of
the sixteenth and seventeenth  centuries subjected  this
metal  to an  infinite variety of chemical processes,  from
which has resulted an astonishing number of  prepara-
tions,  differing, however, more in the degree than in the
quality of their remedial powers.
   The pure metallic antimony is  entirely insoluble in
water and alcohol.  Vegetable acids act upon it though
but feebly ;  and hence cups of this metal were formerly
employed to impart an emetic quality to wine.

    *  Matthiol. Comment, in Dioscorid. lib. v. c 59. p. 83S. 
56
ANTIMONY.
    Crude Antimony.—Sulphuret of Antimony.—In this
 state of combination, antimony is at present not frequent-
 ly employed in medicine, and never as an emetic.  As
 an alterative, however, it has been much  praised by
 some writers of eminence;  and it is not improbable that,
 in some cutaneous, and  other  chronic disorders, its
 powers are too much neglected.  In the Transactions of
 the Society of Copenhagen, Dr. J. W. Guldbrand has
 published a paper on the anti-arthritic virtues of crude
 antimony, and he declares it to be a most valuable re-
 medy in chronic rheumatism.  Quarin gave  it in this
 disease, in combination with three parts of sulphur; and
 Stoll, who speaks highly of its employment in affections
 of this kind, recommends it to be  used in union with
 myrrh.   One of the general effects of antimonial reme-
 dies, when given in minute doses, appears to be, an exci-
 tation of the capillary vessels throughout the whole sys-
 tem, but more  especially of those of the cutaneous sur-
 face.  Such  an operation has a direct tendency, not
 only to equalize the general circulation, and to remove
 congestions in the capillary system, but also to excite a
 new action in the extreme vessels of the skin, and con-
 sequently to relieve those disorders of the  cutaneous
 surface which depend on deranged  functions of its ves-
 sels.  Antimony is,  indeed, one of the most important
remedies we possess, in  the  treatment  of many of the
 diseases of the skin.   In its crude state it has been much
 employed for this purpose, both by itself and in union
 with other substances, such as cicuta, guaiac, dulcamara,
 &c.   It is, notwithstanding, confessedly inferior in this
respect to the more  active preparations of the metal. In 
ANTIMONY.
57
  the treatment of plica polonica, Lafontaine regards it as
  almost an infallible remedy.*
    In scrofulous affections the sulphuret of antimony is
  much extolled by some writers.   It appears to be parti-
  cularly applicable to cases that are attended with cuta-
  neous eruptions, or ulcerations.   Richter cured a  case
 of scrofulous fistula lachrymalia by means of  the inter-
  nal employment of the sulphuret of antimony.  Kotrum
 recommends it in union with equal portions of burned
 sponge, sulphur, cicuta and pulverized oyster-shell, as a
 valuable remedy for goitre.
    This substance is given in powder, in the dose of from
 ten to thirty grains.   If it act as an emetic in  conse-
 quence of meeting with an acid in the stomach, it ought
 to be given in combination with an alkali or absorbent.
   Anlimonii Sulphuretum  Prsecipitatum.—This  is a
 bright orange-coloured, stypic, inodorous powder.  It
 is composed  of about thirty parts of sulphur, fifty-five
 of sub-oxide of antimony, and  fifteen  of sulphureted
 hydrogen.  It is entirely insoluble in water.  This pre-
 paration is diaphoretic, cathartic, or emetic, according
 to the dose in which it is exhibited.   In the cure of cu-
 taneous diseases, this medicine has been more generally
 recommended than any other antimonial  preparation.
 It has unquestionably considerable claims to  attention
 for its powers in this respect;  although it is, upon the
 whole,  perhaps, less efficacious in these affections than
 the black  sulphuret of antimony already noticed.  In
 eruptions  depending on a  syphilitic taint, it  may be
very  advantageously  employed in combination  with
mercury.   For this purpose 1 have been much in the

           * Burdach's Mat. Med. vol. ii. p. 376.
  VOL. 1.--10 
58
ANTIMONY.
habit of prescribing Plummer's pill,* which is, indeed,
a very useful remedy in almost every variety of chronic
disease of the skin.
  The precipitated sulphuret of antimony has been re-
commended as peculiarly serviceable in chronic rheu-
matism.   In this disease it is given in union with cam-
phor, opium, or guaiac!
  The dose of this preparation is from two to six grains,
three or four times daily.   It is  to be  gradually aug-
mented until it excites  slight nausea; and ought never
to be given with acids or acidulous salts, if it be employ-
ed with a view to its alterative  effects, as  these sub-
stances have the power of very considerably increasing
its emetic properties.   Where there is reason to suspect
the existence of an acid in  the primae viae, it ought to
be administered in union with  soap, magnesia, or aroma-
tic confection.^
  Antimonii Tartarizatum.—This is in all respects
by far the most important antimonial preparation. With
regard to its chemical composition, opinion is as yet un-
settled.   By some it is considered as a triple salt, con-
sisting of tartaric acid, oxide of  antimony, and potass.
Others hold it to be a bi-tartrate of antimony.
  There exists also much difference of opinion in relation

  * R. Calomel,
       Antim. sulph. praecipit. 2a    3ii.
       Pulv. guaiac.               3iv.
       Sapo. venet.               3iii.
    M. F. pil. aa gr. iii.   Take from two to four, morning and
evening.
  ! Burdach's Mat. Med. vol. ii. p. 407.  Phil. Conrad.  Fabri-
cius,Diss. de Sulphuris Antimonii Aurant: eximio usu in Arthritide.
Helmot, 1759.
  X Park's Pharmacologia. 
ANTIMONY.
59
 to its degree of solubility.  According to Dr. Duncan
 it is soluble in three times its weight of water, at 212°,
 and in fifteen at 60°.
   The Mineral acids, alkalies, and their carbonates,
 and many of the  metals, soaps, hydro-sulphurets,  and
 many infusions and decoctions of bitter and astringent
 vegetables, decompose this salt, and render it inert, or
 at least  destroy its peculiar powers.  " One ounce of
 the decoction of yellow bark is capable  of completely
 decomposing di. of this salt."*  Rhubarb also destroys
 its powers; it is said,  that  the  infusions of gentian
 or wormwood do not decompose it.  The alkaline sul-
 phates,  if  perfectly  neutral, do  not  affect this  salt.
 When, however,  " there is an excess of acid, as in alum
 and bi-sulphate of potass, &c. then its decomposition is
 effected, and a  white  insoluble  sulphate of antimony is
 precipitated."  "It appears, therefore," adds Dr. Paris,
 " that the  famous ' emeto purgative' of the French
 school,  consisting of sulphate of soda and tartarized an-
 timony,  in solution,  is by  no means  the unchemical
 mixture  which  some have considered it to be, and  that
 it really produces its  effects from  the  operation of  its
 original  ingredients, and not from that of the compounds
 (sulphate of antimony, tartrate of soda, and sulphate
 of potass) which  have been erroneously  supposed to
 result."
   Its effects on the living economy are various, accord-
 ing to the  dose  administered.   Given  in  very minute
 doses, as one-sixteenth or one-twelfth of  a grain, it in-
 creases pulmonary secretion,  and promotes expectora-
 tion.   Exhibited in the dose of one-quarter or one-third

  * Paris's Pharmacologia: from which work chiefly I have taken
the chemical  and pharmaceutical character of this  salt, 
60
ANTIMONY.
 of a grain, it augments the cutaneous transpiration, as
 well as the secretion of urine.   In the dose of one half
 to one grain, it increases the secretion of the saliva, the
 gastric and intestinal mucus, and occasions nausea and
 alvine discharges.   In a still stronger dose, from two to
 four  grains, it speedily excites  nausea, and  full  and
 perfect emesis.   If  it be given  in  an over-dose,  it pro-
 duces inflammation  of the  stomach and bowels.   Ma-
 gendie states that he  found the mucous coat of  the di-
 gestive and pulmonary organs of those who had died of
 excessive doses of this substance, to exhibit  marks of
 inflammation.*   It also affects the nervous system, pro-
 ducing  vertigo,  anxiety, insensibility,  and  delirium.
 Brodie thinks that tartrate of antimony acts directly on
 the brain.   In some  experiments he performed with
 this substance on living animals, he saw paralysis, insen-
 sibility, and torpor produced, unattended by any other
 effects to  which  these symptoms  could be ascribed as
 secondary results.!   Its most important operation, how-
 ever,  independent of  its emetic effects, is  to diminish
 the force and  frequency of the pulse.   The control
 which it  exercises over the action of the heart is some-
 times  so great as to produce syncope, and even  death.

   * De l'Influence de I'Emetique sur l'Homme et les Animaux.
 A Paris, 1315, 8vo.
   ! Orfila  gives the following general symptoms of poisoning by
 tartar emetic,  " Rough metallic taste, nausea, copious  vomitings,
frequent hiccup, cordialgia, burning heat  in the epigastrium, pains
 of the stomach, abdominal colic, inflation, copious stools, syncope,
 small, contracted, and accelerated pulse, skin cold, sometimes in-
 tense heat, breathing difficult, vertigoes, loss of sense, convulsive
 movements, very painful cramps in the legs, prostration of strength,
 death." To these symptoms difficulty of swallowing is sometimes
 joined. 
ANTIMONY.
61
 Brodie, after having  given large doses of  this salt to
 animals, found on opening them, that the heart beat ex-
 ceedingly feeble, and  although artificial respiration was
 kept up, it soon ceased to act.
   As a vomit, tartar emetic is the most important  arti-
 cle  we  possess.   Its effects are certain, prompt,  and
 energetic.   It occasions  more  complete agitation and
 a stronger impression  upon the whole nervous  system,
 than ipecacuanha; and is not apt, like this latter  sub-
 stance, to leave  the bowels in  a constipated state.  It
 acts also with greater  certainty in producing diaphore-
 sis ; and finally, it operates in smaller doses, and is less
 disagreeable to the taste.
   Tartarized antimony,  either as an emetic, or  as a
 means to curb the action  of the heart and arteries,  or to
 induce diaphoresis, is  one of the most useful remedies in
 febrile diseases.   Cullen,  who was particularly fond of
 prescribing this article in  fevers, thought that its good
 effects in this respect  depended mainly  on  the nausea
 which it produces when given  in  minute doses.  This
 opinion  is,  however,  controverted by Fordyce,  and
 more recently by Balfour, Lanthois, and others.   It is
 contended by these writers, that this medicine is most
 efficacious in  fevers, when it produces  little or no  sen-
 sible effects on the stomach.   The two latter  writers
 especially, bring forward  strong evidence of its possess-
 ing sedative powers, independent of its  diaphoretic or
 nauseating effects.  The experiments of Brodie, already
 mentioned, are also in evidence of the correctness of  this
opinion.
  Upon this  subject Dr.  Chapman observes,  " Medi-
cines seem to do good in  the cure of fever by exciting
their own specific or  peculiar action, and when they 
62                   ANTIMONY.

disorder the stomach by sickness, they depart from this,
and, if they do not act as poisons, always become nuga-
tory, or more or less mischievous."
  That tartar emetic  has a tendency to lessen febrile
excitement, independent of its nauseating effect, appears
to be beyond a doubt; yet the declaration that the nau-
sea which it creates, renders its anti-febrile effects " nu-
gatory or mischievous," is wholly unsupported  by expe-
rience.  All that can be correctly said  upon this point
is, that the good effects of this remedy in acute diseases
are not confined to nauseating doses; just as  the anti-
syphilitic powers of mercury are not confined to its sali-
vating effects.
  The idea  that tartar emetic " departs from its specific
or peculiar  action when it  creates nausea?'  is  to me
altogether incomprehensible   Nausea is but  an inter-
mediate link in the chain of  effects produced by this
remedy; and to say that  its peculiar operation ceases
when this effect supervenes, appears to me to carry with
it its  own contradiction, and  certainly is without the
shadow of a proof.   We  might, with just as much pro-
priety, assert that when mercury produces ptyalism, it
departs from its peculiar or specific action, and becomes
" nugatory or mischievous."
   It appears to be beyond a doubt, that tartar emetic
has a  specific  power  of moderating  the action of the
heart  and arteries; and upon this power, there is much
reason to believe, its good effects in acute diseases main-
ly depend.   Although this effect of the remedy, namely,
the reduction  of arterial excitement,  may  take  place,
independent of nausea, yet there are no facts which can
lead us to believe that it ceases when  the nausea  comes
 on.  Every thing, on the contrary, clearly demonstrates, 
ANTIMONY.
65
that when nausea does supervene, the action of the san-
guiferous system  is still  more prostrated.  From what
I have  observed of the operation of antimonials in the
cure of fevers, I am of opinion that its good effects will
be most decidedly manifested, when it is given in doses
just sufficient to create and sustain  very slight nausea.
  Much of the advantage of this, as perhaps of all other
remedies, depends, I conceive, on keeping up an equa-
ble impression upon the system.  If the degree of the
action be greatly varied, irregular  and fluctuating de-
terminations must take place in the body.  For it must
be observed, that, in proportion as the action of a reme-
dy rises in degree, so does it successively  bring  under
its more especial influence particular organs of the gene-
ral system ;  and hence, if its impressions fluctuate in
intensity, there will be a corresponding fluctuation in the
excitement of the  organs upon  which the peculiar
powers of the remedy determine  it  to act.   Thus a
dose of tartarized antimony acts first upon the nerves
and brain, whose influence, according to the experiments
of Brodie, it diminishes.  As a necessary consequence
of this, the capillaries, being more immediately under
the nervous influence, fall into a corresponding state of
relaxation, and give rise  to a freer discharge of the per-
spiratory fluid.   If the  action of the remedy rise  still
higher in  intensity,  it brings under  its influence the
stomach,  giving rise to the sensation of nausea;  this
effect being the result of a greater degree of sedative
operation  than the preceding ones, is attended with an
augmented relaxation of the cutaneous capillaries, and
consequently with a more profuse  discharge of perspi-
ration.  A still  higher degree of the  influence of the
remedy directs its action more especially upon the mus- 
 64                   ANTIMONY.

 cular fibres of the stomach,  diaphragm, and upon the
 abdominal muscles,  all of which it brings into violent
 and simultaneous contraction.  From all this  it is evi-
 dent that, by frequently varying the degree of action of
 our remedy, we keep up an irregular fluctuation of the
 excitement of the organs which it affects, a circumstance
 which I conceive must interfere very considerably with
 its salutary operation.
  It is upon this principle, therefore, that I would ob-
ject to the employment of nauseating doses of antimo-
 nial remedies, and not upon  the supposition  that their
 febrifuge effects are incompatible with their nauseating
 operation.   In order to obtain the full advantages of
these remedies, their action  must be kept up for a con-
siderable time.  'But it is often extremely difficult to
keep up a nausea for any length of time, in consequence
of its distressing effects upon the patient.   It is, there-
fore, not frequently sustained  with  uniformity, and ge-
nerally  often interrupted.   Hence we have  its chief
action at one time concentrated upon the stomach and
cutaneous  capillaries, and again  suddenly withdrawn
from these, to be directed exclusively upon other parts.
These disadvantages  are avoided by exhibiting the re-
 medy in doses insufficient  to excite  nausea;  since, in
such under-doses, its effects are confined exclusively to
the  nervous and sanguiferous  systems,  whose  actions it
moderates without producing any fluctuations in the ex-
citement of particular organs.  If in prescribing anti-
monials, we can keep up a continued and uninterrupted
nausea, for an adequate length of time, we shall, I am
persuaded, obtain  the full advantages of the  remedy.
But as  there  is a difficulty in effecting this, it will, I
think, be best either never to  carry it to the point of 
ANTIMONY.
65
 producing nausea, or perhaps, as I have already said,
 just far  enough to excite this  sensation in a very slight
 degree.   This may be further illustrated by the effects
 which mercury produces on the system.   Thus, while
 we keep up a uniform ptyalism,  we fully obtain the pe-
 culiarly sanative effects of  this substance, in perhaps as
 short a period as is possible.  If, however, it becomes
 frequently  interrupted, and again renewed, we derive
 much less benefit from  it  than we do either from a
 course of continued salivation, or from  one in which the
 mercury is  never carried to the extent of producing
 this effect.
   I conceive, therefore, that the antiphlogistic operation
 of the antimonial preparations depend upon their seda-
 tive effects; first on  the nervous system, and consecu-
 tively on the heart and  arteries; and that  these effects
 will be the more advantageous as they are more equably
 diffused throughout the whole system.
   The sedative, or  contra-stimulant operation of tartar
 emetic, has indeed of late years been  incontestibly es-
 tablished by Tommasini and Rasori.   So  powerful in-
 deed are its  effects, in this respect, that it may, it is said,
 be advantageously substituted  for venesection in phleg-
 masia! affections.  I have  myself seen a few instances
 in which the extraordinary sedative operation of this
 article in large doses  was strikingly illustrated.  It ap-
 pears from the observations that have been published on
 this subject in  Italy and in  France, that in  febrile dis-
 eases the stomach will generally bear very large  doses
of tartar emetic without being excited  to nausea or vo-
 miting.  Dr. Fontanailles of  Milan,  asserts that the
power of the system to sustain large doses of this article,
depends almost entirely on the system being in a morbid
   vol. i.—11 
66
ANTIMONY.
condition;  for  in  health, or after a febrile disease is
partly subdued, the ability of taking very large doses of
this antimonial  does not exist.*
  Dr. Balfour,  in a late work  on the sedative effects of
tartar emetic, speaks in the highest terms of small doses
of this remedy  in febrile affections.  " Tartar emetic,"
he says, " is eminently  efficacious in chronic as well as
acute disorders; in topical affections as well as in gene-
ral derangement;  and its  efficacy in either case is not
confined to nauseating doses.   From its  natural and
powerful tendency to equalize the nervous power, it can-
not fail, even where  blood-letting is necessary in  the
first instance, to supersede the necessity of recurring to
it so often, and  carrying it to that degree which is found
necessary when the lancet alone is trusted to, for the re-
moval of inflammatory complaints."!
  M. Lanthois, of Montpelier,  has lately published a
work, in which he adduces strong testimony in favour
of the salutary  operation of very minute doses of this re-
medy in phthisis  pulmonalis.   His mode of employing
it is as follows: a grain of tartar emetic is to be dissolved
in eight table-spoonfuls of distilled water.  This  is to
be mixed with  six or eight pints of water, but never
more than twelve, nor less than six.   "This is to be
used  for drink, either  alone  or  with other  drink, at
meals, or with  wine at all seasons  and hours, and with-
out any limited time, it being attended with no  inconve-
niency."
   In the treatment of some of the phlegmasial  diseases,

  * Archives Generalis, Feb. 1824.
  ! Observations Illustrative  of the Sedative Effects of Emetic
Tartar, p. 8—12. 
ANTIMONY.                   67
 much reliance  is placed on the sedative effects of this
 preparation by many eminent physicians of the present
 day.   In Italy it has in a great measure taken the place
 of blood-letting in inflammatory diseases, and its  very
 decided and   prompt  antiphlogistic tendency,  when
 given in very strong doses, has been verified by the ex-
 perience  of  many  eminent  physicians in  France and
 Germany.  It  has been found particularly beneficial in
 pneumonia,  in whieh it is usually  given by the advo-
 cates of the Italian doctrine, to the extent of from a scru-
 ple to  several  drachms in  the course of  twenty-four
 hours.   M.  Laennec speaks  decidedly  in favour of
 large doses of  tartar emetic in pneumonic affections;
 and-he asserts that when the disease is treated by bleed-
 ing, chiefly, the pulmonary engorgement continues much
 longer  than in cases that  have been  treated by large
 doses tartar emetic.  Given to the extent of from twelve
 to twenty grains during the day, this article, he says, acts
 specifically in  subduing inflammation, and powerfully
 promotes absorption.   It appears from the  observations
 of M.  Fontaneilles,  that  the power  of bearing large
 doses of tartar  emetic  without much nausea and vomit-
 ing varies  in different stages of the disease.  It is the
 greatest, he says, at the acme, .and decreases in propor-
 tion as the disease disappears. He generally gives about
 twelve  grains  per day in  the first stage;  when it has
 arrived at its acme, from a scruple to half a drachm are
 given during the same  period.   If the medicine pro-
 duces  active vomiting  the  dose  must be  diminished.
   For the reduction of enlarged and indurated spleen,
so common after protracted intermittents, tartar emetic,
taken in small,  but frequent doses, sometimes proves de-
cidedly beneficial.   It is equally useful for the  remo- 
68
ANTIMONY.
  val of that  dry and jaundiced state  of the skin, with
  oedema of the feet, which is apt to remain after protract-
  ed  miasmatic  fevers.   One grain of this antimonial,
  dissolved in three pints of water, or some mild and
  pleasant ptisan, and used as common  drink for two  or
  three  weeks, will seldom  fail  to clear the skin of its
  icterode hue, and to keep up a regular action of the
  bowels and cutaneous exhalents.
    Given in  this way I have also known this article to
  act very beneficially in subacute rheumatic affections,
  more especially in those instances  of rheumatic muscu-
  lar pains and oedema, which are apt to occur from cold,
  during convalescence from scarlatina and measles.
   I have already mentioned  the employment  of eme-
 tics in  hernia humoralis.  In this affection the  tartrate
 of antimony is decidedly more efficacious than the other
 emetics.   It should be given so as  to  produce  full vo-
 miting.
   James' powder, a preparation which approaches very
 nearly  to  the character of tartar emetic, is said to be
 highly  useful in hydrocephalic  affections.  Dr.  Wil-
 liam Stoker  of Dublin, who  speaks particularly in fa-
 vour of its efficacy in affections of the head, has also
 published some very favourable results  of  its  use in
 apoplectic cases.  He affirms that it has an obvious ten-
 dency to  diminish the determination of the blood to the
 head;  and that a continued use  of  it,  in small  doses,
 has generally a decided tendency to remove the disposi-
 tion to apoplexy.*
   Tatar emetic  is sometimes employed,  in  nauseating

  * Dublin Medical Essays, anno 1806.  See also vol. ii.  p. 43, of
the « Transactions of the King and Queen's College of Physicians,
Ireland.''                                      J 
ANTIMONY.
6&
  doSes, to bring on  relaxation of the muscles, in order
  to facilitate  the  reduction of dislocated joints.  Dr.
  Chapman says, that he has known it to be advantageous-
  ly administered in  the form of an enema, for the pur-
  pose  of  evacuating the  stomach, in order " to remove
  poison which had been swallowed."  He has also used
  the remedy in this way, in a caseof tetanus, "withsuch
  complete success," that he  entertains "the hope that,
  under this  treatment, the disease may hereafter be di-
  vested of some portion of its terrors and mortality."
 This  practice has,  I  believe, never been resorted to
 by any other physician.
   Dr. Witzman,  a Russian physician, has lately recom-
 mended the employment of  tartar  emetic for removing
 opacity of  the cornea.   The remedy is to be  applied
 in the form of an ointment,  composed of fresh  butter
 and castor oil aa 3i.  tart,  antim. gr. iv. and  afterwards
 gradually increased  to twenty grains.   A small  portion
 of this ointment is to be put into the eye every morning
 and evening ; and  a  warm  compress  applied  pretty
 firmly to it, for two  or three hours after  the introduc-
 tion of the ointment, in order to allay the pain which
 it sometimes creates.*. For an account of the employ-
 ment of tartar emetic as a  counter-irritant, the reader is
 referred to the chapter on rubefacients  in the  second
 volume of this work.
   Tartar  emetic, as  has already been  stated,  is capable
of acting with great violence ; and when the quantity
taken is enormous, its effects are eminently deleterious.
If it excites great vomiting, with cramp in the stomach,
the patient should  be directed to take copious draughts

 * Russian Physico-Medical Repository, &c. edited by E. Martini. 
70
ANTIMONY.
of sugar and water.   "If the vomiting  do not cease af-
ter  the tartar emetic may be supposed to  have been
ejected, and the pain is augmented, a grain of opium
may be given, and repeated at an interval of a  quarter
of an hour, for two or three times, if the symptoms be
not calmed.'7  When the symptoms continue still to in-
crease, leeches should be applied to the abdomen and
throat.  If the individual who has taken the antimonial
preparation does  not  vomit, and yet suffers from the
other symptoms,  several  glasses of sugar  and water
should be taken ;  if, in spite of this, vomiting do not oc-
cur, the following should be given at  repeated doses:
" put four or five gall-nuts into two quarts of water, let
them be boiled together for ten minutes, and then strain-
ed.  Experience has proved that gall-nuts are to be pre-
ferred to any other astringent; but, in  default of them,
two ounces of Peruvian bark, or the bark of oak or wil-
low, may be employed."*   If,  notwithstanding these
applications, the symptoms continue, we must resort to
general and local  depletions, blisters, or fomentations to
the region  of the  abdomen,  together with  copious
draughts of mucilaginous drinks, warm bath, &c.
  M.  Sauventon, of Lyons, has lately published a case,
illustrating  the good effects  of the Peruvian  bark in
cases of poisoning by this article.  A lady swallowed,
bv mistake, about a drachm of  tartarized antimony in
whey. M. Sauventon saw her in ten minutes after, and
immediately administered about two ounces of  tincture
of yellow bark, diluted in several glasses of cold water.
The only injurious effects the patient experienced from

  * Orfila's Directions for the Treatment of Persons who have ta-
ken Poisons, page 60. 
ANTIMONY.
71
the poison was some nausea and epigastric pain, which
latter continued more or less for four or five weeks.*

                        Formula:.

  R.—Pulv. ipecac.     ^i.
      Tart, antimon.    gr. ii.—M.  To be taken at once, as an
active emetic.
  R.—-Tart, antimon.    gr. viii.
      Aq. fontanse     giv.—M.  Take a table-spoonful every
ten or fifteen minutes, until vomiting is excited.
  R.—Sulphat. magnesia 5iss.
      Tart, antimonii    gr. ii.
      Aq. Fontana3      §v.—M. Take a table-spoonful every
hour until it operates as an emeto-cathartic.
                     NITROUS POWDERS.
  R.—Pulv. nit. potassse  3iss.
      Tart, antimonii    gr. i.
      Calomel          gr. vi.—M.   Divide into six equal parts.
Take one every hour or two.
                         ENEMA.
  R.—Tart, antimon.     scruple ss.
      Decocti hordii     Oi.
             SULPHAS ZINCL—WHITE VITRIOL.

   White  vitriol has a  styptic, metallic, and some-
what acidulous taste.   " It is composed of one propor-
tional of oxide, and one proportional of acid;" its crys-
tals, which  are four-sided  prisms, terminated by  four-
sided pyramids, " contain seven proportionals of water.
* Med. Chir.Rev. July, 1826, p. 285. 
72
WHITE VITRIOL.
  It is dissolved by 2.5 times its weight of water  at the
  temperature of 60°.  Alcohol has no action on it.  The
  alkalies, earths, hydro-sulphurets,  astringent vegetable
  infusions, and milk, destroy or weaken its powers.77*
   Its remediate effects vary  according to the dose in
  which it is administered.   Given in a small dose, from
  one-half to two grains, it acts as an  astringent tonic. In
 larger doses, from ten grains to 3ss.  it is strongly emetic.
   Sulphate of zinc  is, perhaps, the most prompt emetic
 with which we are  acquainted;  and hence its peculiar
 applicability to cases where poison  has been swallowed,
 and where, of course, it is of the utmost consequence to
 procure speedy and  effectual vomiting. Previous to the
 discovery of tartarized antimony and ipecacuanha, this
 preparation of zinc  was very commonly employed as an
 emetic in all cases where emesis was desired.   At pre-
 sent, however, its  use as an emetic is almost  entirely
 restricted to the purposes just mentioned.  The objec-
 tion alleged against its employment by Cullen, namely,
 " that it is apt, if  not thrown  up again immediately, to
 continue a disagreeable nausea, or even vomiting, longer
 than is necessary,77 does not appear to be well founded.
 Moseley, indeed, gives quite a contrary character to this
 remedy.  His experience with it was very extensive, and
 his opinion upon this point is, therefore, entitled to re- .
 spect. He affirms, "  that the patient is not harassed with
 its operation;  that it is never violent as antimonials are,
and generally instantaneous, and suddenly over, always
leaving the stomach strongly invigorated.  Neither does
it cause  spasms  in the viscera, nor any nervous affec-
tions, mischiefs often  produced by the antimonials."
* Para's Pharmacologia. 
WHITE VITRIOL.
75
   I have  exhibited  this substance, with a view to  its
 emetic operation, in a very considerable number of in-
 stances, and sometimes to the extent of thirty  grains,
 without ever noticing any of the disagreeable conse-
 quences mentioned by Cullen.  It does not appear, in-
 deed, that its effects on the system, even when taken in
 excessive quantities, are eminently deleterious.   Orfila
 mentions the case of  a young lady, who by mistake took
 a solution of two ounces of white vitriol.   On his arrival
 " he found the lady in a dreadful situation; her counte-
 nance was pale and sunk; the extremities cold, the eyes
 dim, and  the pulse convulsive.77   Vomiting) however,
 soon came on, which was promoted by draughts of warm
 water. After the greater portion of vitriol had been eva-
 cuated " he set about decomposing the rest by means of
 the fixed alkali, diluted with sugar-water." The vomit-
 ing  now ceased  instantaneously, and in less  than two
 hours she was free from every painful or alarming sensa-
 tion.
   Richter states that he has frequently given this article
 as an emetic in the commencement of typhus with great
 advantage; and from  its  sudden and rapid  operation,
 there can be no doubt that it is well  calculated to do
 good in affections of this kind, since the general shock
 and  agitation of the  system produced by emetics 19,
 perhaps, the principal source of the benefits afforded
 by these remedies.*
  Moseley recommends  this remedy as very useful  in
 dysentery.   "I  give  it," says he, "at  first without
alum, in sufficient doses to cause evacuations, and after-
Wards with the alum, in nauseating  doses, and frequently
        * Specielle Arzneimittellehie, Bd. 2. p. 538.
  VOL. II.—12 
74
WHITE VITRIOL.
with opiates at night.77*  I have  used this preparation
in the dysentery  of children, after  it had assumed a
chronic character, and  generally  with considerable ad-
vantage.  I have  always, however, confined myself, in
these cases, to the  employment of nauseating doses;  and
it should never be used, until the inflammatory symp-
toms have been moderated  by depletory measures, and
the bowels freely evacuated by suitable  laxatives.   In
referring  to the  testimony of  Moseley, in favour of
this  practice, it must be recollected  that he employed
it in tropical  dysenteries; a circumstance  which may,
perhaps, account  for its less  favourable  results in the
treatment of more northern climates.  Mr. Bampfield,
who has published an excellent book on tropical dysen-
tery, makes  the following  observations, in relation to
Moseley7s zinc mixture in  dysentery.  "The mixture
of sulphas zinci and alum, recommended by Dr. Mose-
ley, has nearly the same effects on the intestines, as the
infusion of  simarouba,  if there be  an excess of alum.
It is extremely difficult to adapt the proper quantity of
alum to the  astringent effect required; when it  pro-
duces constipation,  the morbid secretions,  tormina, &c.
are increased, and sometimes induce an  actual relapse^
and when the  excess  of sulphas zinci maintains a free
 discharge of natural faeces, the morbid  secretions  are
 diminished, "f

   * The following is his formula, for exhibiting the white  vitriol
 with alum.  gulp, zinci 3m- sulp- alum. 3i. pulv.  coccinel. gr. iii.
 aquae bulentis ffci.  Mix  these in a mortar, until the  solution  is
 cold and the sediment deposited, then pour it off.   Dose, a table-
 spoonful for an adult.
   t Practical Treatise on Tropical and Scorbutic Dysentery, p*
  193. London, 1819. 
WHITE VITRIOL.
75
  In the treatment of diarrhoea, this remedy appears to
be more decidedly advantageous, and is certainly less
hazardous than in dysentery.
  Dr. Moseley speaks also in favour of the employment
of the  zinc  solution, in  colica pictonum.  After  the
bowels  are evacuated by suitable  purgatives, a table-
spoonful of the solution is to be taken every five or six
hours, until the pain ceases.   Of this practice I can say
nothing from my own experience, nor does it appear to
have gained much credit with the profession.
  To relieve hooping-cough, the  sulphate of zinc is,
undoubtedly, a  remedy of  very considerable powers.
For this purpose I have prescribed it in a few instances
with considerable  advantage.   I think it decidedly su-
perior to the antimonial emetics, in cases  where there
is much pulmonic oppression, or  difficult respiration.
The only objection  to its use is its very  disagreeable
taste, a circumstance, indeed, which renders its employ-
ment with children, extremely difficult, and often al-
together impracticable.
  As an expectorant, in  chronic  catarrhal  affections,
attended with oppressed breathing and a tough mucous
expectoration, the same writer whom I have already so
often mentioned, speaks in exalted  terms of his " vitri-
olic  solution.77  He directs it to  be taken in slightly
nauseating doses, three or  four times a day.  In phthisis,
attended with  bloody expectoration, he  declares this
remedy to be often of signal service.   In all these affec-
tions I have  occasionally  employed it, but never with
any  decided advantage.  Dr. Paris, however, adds his
testimony in  favour of the use of this remedy in pecto-
ral complaints.  " In affections of the chest,77 says he,
" attended with inordinate secretion, 1 have  witnessed 
76
WHITE VITRIOL.
much benefit from its exhibition, particularly when pre-
sented in the form of lozenge.77
  The sulphate of zinc has also been recommended, as
an emetic, in croup.   Dr. Francis, of New-York, has
employed it with the  happiest effects in  this dangerous
disease.*
  Under the head of astringents this remedy will  be
again noticed, to which the reader is referred for an
account of the  various other uses to which it has been
applied in medical practice.   "The white vitriol of
commerce,77 says  Dr. Paris, " ought never to be used
in medicine, since it generally contains the sulphates of
copper and iron."
                SECOND AR Y EMETICS.

             SPIR^A TRIFOLIATA.

  This is an icosandrous plant, and found in considera-
ble abundance through almost every  part of the United.
States.   Its root is perennial, sending up annually seve-
ral slender stems, to the height of several  feet, branch-
ing above,  and of a  reddish colour.   It  flowers in June
and July, and delights in hilly woods or on the borders
of rivulets.  The root, which consists of " long, brown,
slender branches, radicating from a thick tuber," is the
part employed for medicinal purposes.  It  is said that
the cortical part of  the root alone possesses active qua-
lities.  " The predominant soluble ingredients in this

  ♦Essays on Various  Subjects of Medical Science  By D,
Hosack, M. D. vol. i. 
SPIRES A TRIPOLI ATA.
77
 root appear to be a bitter extractive matter and resin.
 When boiled in water, it imparts to it a beautiful deep
 red-wine colour, and  an intensely bitter taste.  This
 decoction undergoes no change from alcohol or gelatin,
 though it gives a precipitate with muriate of tin.  Wa-
 ter  distilled  from  the  root has its peculiar flavour with
 little of the bitterness.   A large portion of resin is pre-
 cipitated on the addition of water to an alcoholic tinc-
 ture of the root.77*   From my own experience with this
 plant, which has not been inconsiderable, I  am  led to
 regard it as very little inferior to the officinal ipecacu-
 anha, as an emetic.  Like this latter article it is a safe
 and efficacious vomit.   While practising  in  Lancaster
 county, I employed this  plant  very  frequently as  an
 emetic,  in   the  treatment  of intermittent and bilious
 fevers, and it very seldom disappointed me of the desired
 effect.  Dr. Bigelow, however,  observes,  that from his
 own experience with this remedy, he was  led  to regard
 it as an emetic of very  uncertain operation.
  Given with opium I have found it particularly service-
 able as  a sudorific in dysenteric affections;  and from
 what I have observed of its effects in other cases it ap-
 pears to me that the opinions entertained by the late
 Dr.  Barton,  of its possessing tonic properties,  is not
 without foundation.   In small  doses, from two to four
grains, I have taken it myself, when  suffering from dys-
pepsia,  and  generally with evident advantage.
  As an emetic it should be given in the dose  of about
thirty grains of the powdered  root.   It should be col-
lected in September.  Accurate figures of this plant are
given in the first volume of Barton7s Vegetable  Materia

  *  Dr. Bigelow'* American Medical Botany, vol. iii. p. 14. 
78
SPIRJJA TRIPOLIATA.
Medica of the United States; and in the third volume
of Bigelow7s American Medical Botany.
            EUPHORBIA IPECACUANHA.

  This plant is found no where except in the United
States.  The root is perennial, long, tuberculated, from
half an inch to  an inch in diameter, and of a yellowish
colour.   It is light and brittle when dried,  and has a
sweetish and  not very disagreeable taste.   Dr. Bigelow
subjected this root to chemical examination, from which
it appears, that—" sulphuric ether digested on the pow-
dered root dissolved a part of it;  and this ethereal solu-
tion gives a precipitate if alcohol is added  to it.  Alco-
hol alone takes  up another portion of the  root, and as-
sumes a pearly  turbidness after water is added.  Both
the ethereal and alcoholic solutions, evaporated to dry-
ness, leave a  residuum which is fusible and inflammable.
The decoction  gives no precipitate with  gelatin or sul-
phate of iron.  With alcohol it gave out a white preci-
pitate, which rendered the solution turbid, and subsided
in flocks.   The cold infusion exhibited the  same phe-
nomena in a  smaller degree.   From  these experiments
we may infer that  the root contains caoutchouc, resin,
mucus, and probably fecula."  For a good description
and figure of this plant the reader  is referred to Dr.
Barton's Vegetable Materia Medica, vol. i. p. 213, and
 to Dr. Bigelow7s American Medical Botany, vol. iii. p.
 111.
   The emetic virtues of this plant  had been but little 
EUPHORBIA IPECACUANHA.
79
noticed until  they were more particularly investigated
by Dr. Barton, the present Professor of Botany in the
University of Pennsylvania.  In his excellent work, to
which we have just referred, he observes :  "That the
Euphorbia Ipecacuanha is possessed of virtues entitling
it to supersede the use of the imported ipecacuanha, my
own extensive experience with it, corroborated by the
numerous trials of the medicine by Professor Hewson :
my brother, Dr. J. R. Barton, of the Pennsylvania Hos
pital, and others, all embolden me to declare.77  Dr. Bige
low states, that in the trials which he has made with it,
he  has found it, in the majority of instances,  to operate
with as much ease as the other emetics.  In large doses,
however, " it excites active and long-continued vomit-
ing, attended with a sense of heat, vertigo,  indistinct
vision, and prostration of strength.77* From what I have
myself seen of this remedy, I am satisfied that it is well
worthy the  attention of the  profession.   Given in the
dose of from fifteen to twenty grains, the powdered root
of this plant  acts as a safe and efficacious emetic.   It
seems to have a greater tendency to act on the bowels
than ipecacuanha, as I have known it to  produce very
considerable purging. In the dose of twenty-five grains,
Dr.  Barton  has found it to produce hypercatharsis,
 which continued for fourteen hours.   It may be advan-
 tageously substituted for  ipecacuanha,  in the various
 " combinations into which this latter substance enters
 as a part."   As the officinal  ipecacuanha is but seldom
very good,  or perhaps unadulterated, it is a matter of
 very  considerable importance to attend to such native
 articles as  promise to become adequate  substitutes in
 its place. In this respect there is, perhaps, no indigenous
* American Medical Botany, vol. hi. p. 112. 
80
EUPHORBIA IPECACUANHA.
vegetable known, which deserves greater attention from
the profession than the euphorbia ipecacuanha.
                 SCILLA MARITIMA.

   The squill belongs to the liliaceous  plants.  It is a
 maritime plant, and found in very great abundance on
 the  sandy coasts of Portugal, Spain, Sicily, &c.  The
 root, which is the only part employed in medicine, con-
 sists of a large bulb, composed of fleshy scales, which
 overlap each other and give it a pyriform shape.  It
 has no odour, but is bitter,  nauseous, and acrid to the
 taste.  The recent  root will inflame the  skin if kept in
 contact with it for  any considerable time.   According
 to the analysis  of Vogel it  contains six parts  of gum,
 twenty-four of tannin, six of sugar, thirty-five of bitter
 principle, (Scillitin, which  is  white, transparent, and
 breaks with a resinous  fracture,)  and thirty of woody
 fibre.*
  The squill, when taken in very large doses, acts with
 great and dangerous violence on the animal  economy.
 It has been known to produce excessive tormina, colic,
 and even convulsions.   Alibert asserts that he has  per-
 formed many experiments  on  animals  with  this  sub-
 stance, and that the  result confirmed what had been said
 of its effects in this respect.
  It is chiefly employed as a diuretic and expectorant;
for both of which purposes it is, indeed,  one of our most
 valuable remedies.  As an emetic  it is but little used.

        * American Medical Botany, vol. iii. p. 112. 
SCILLA MARITIMA.
81
In the pectoral diseases of very young children, however,
it may often be resorted to with peculiar advantage.   I
have frequently prescribed the syrup of squills, so as to
produce vomiting, in the catarrhal affections of infants;
and it has appeared to me in some instances to produce
greater relief than usually arises from the operation of
other articles of this class.
  The active principle of this root is readily and per-
fectly extracted by  any of the usual menstrua.   The
officinal preparations are, Ace turn scillse, Pil.  scillse.
composit.  Pulv. scill. Syrup, scillse. matim. Tinct. scill.
  To procure an emetic  effect, the fluid preparations
must be given in the dose of an ounce or more to an
adult.  A tea spoonful of the syrup is generally sufficient
to puke a child under a year old.
   Alkalies diminish both the bitterness  and acrimony of
this  root.   Vegetable acids do  not materially affect
cither of these qualities, but are supposed to increase
its expectorant powers.
             SANGUINARIA CANADENSIS.

  This  plant is generally known by the name of Poc-
coon, or blood-root, and grows abundantly throughout
every section of the United States.   It is among the
earliest of our spring plants, shooting up its humble but
beautiful white flowers, as  soon as the  frost leaves the
earth.  The root, which is the only part employed as a
medicine, is red, horizontal, and tuberous; its taste is
acrid, leaving  an hnpression in the fauces some time
after  it is chewed. "According to the minute analysis
  VOL. i.—13 
82
SANGUINARIA CANADENSIS.
 of this  root by Dr. Fitzgerald Bird, it appears to con-
 tain cinchonin, extractive matter, a gummy matter, a
 resin, and gallic acid, in a state of combination.*  The
 colouring  principle  of this root  resides chiefly  in its
 resinous parts, the alcoholic solution being always more
 than twice as highly coloured as the aqueous.f
   The  medicinal properties of the sanguinaria,  have
 been very variously represented, and its powers do not
 appear  to  be, as yet, well understood.   Dr. Bigelow
 considers this root as an acrid narcotic.  Dr. Bird says
 that " its medicinal properties are in every respect simi-
 lar to those which characterize the cinchona officinalis.
 This, however, is certainly an erroneous estimate  of its
 powers, for although it will often speedily put a stop to •
 intermitting fever, its tonic  virtues in this, as in every
 other respect, are incomparably below those of the cin-
 chona.   The late Dr. Barton valued it chiefly for  its
 emetic  and  expectorant  powers.   Its  properties are
 certainly very  peculiar, being capable of producing
 tonic, narcotic,  stimulant, or emetic  effects, according
 to the dose and form in which it is administered.   Taken
 in a large dose,  it produces nausea, heat in the stomach,
 faintness, often vertigo and indistinct vision, and finally
 emesis.   These effects are  produced by doses of  from
 eight to twenty  grains.J  In smaller doses, its effects on
 the pulse are analogous to those of digitalis.  I have no-
 ticed this  effect in several instances;  but it  does not
 appear  to be very certain in its effects  in this way;  as
 in a number of instances in which I have given it, I did

  * An Inaugural Dissertation on the Sanguinaria Canadensis, by
Fitzgerald Bird, of Georgia.  New-York, 1822.
  | Bigelow's Medical Botany, vol. i. p. ^79.
  J Bigelow's  American Med. Botany. 
SANGUINARIA CANADENSIS.
83
 not find it to diminish the frequency of the pulse, in the
 smallest degree.  Given in such doses as are not suffi-
 cient  to produce nausea, it acts as  a stimulant tonic.
 Applied in the form of powder to fungous flesh, it evin-
 ces pretty active escharotic properties.
   From the concurrent testimony of a number of emi-
 nent practitioners, the sanguinaria appears to be entitled
 to  considerable attention as an  article of the materia
 medica.  Professor Francis, of New-York,  in an inte-
 resting paper on the medicinal properties of this plant,
 states  that he has used it " with  essential  benefit in a
 long protracted and distressing affection of the chest.
 The patient laboured under repeated attacks of pneu-
 monia, and notwithstanding very active treatment, had
 suffered by haemorrhage from the lungs ;  the  conse-
 quences were, much constitutional debility, and habitual
 returns of spasmodic dyspnoea, similar to those of pertus-
 sis.  The tincture of the sanguinaria, to the amount of
 twenty drops, three times a day, has  obviated the most
 formidable symptoms, and given strength and vigour to
 the  constitution.77*   Dr. Ives,  of  New-Haven,  also
 speaks very favourably of its remediate powers in dis-
 eases of the lungs and liver.  "  In plethoric constitu-
 tions," he observes, " when respiration is very difficult,
 the  cheeks and hands  become livid, the pulse full, soft,
 vibrating,  and  easily  compressed, the  blood-root has
 done more to obviate the symptoms and remove the dis-
 ease than any remedy he has used.*7   It should be given
 in large doses  in cases  of this  kind,  he observes, and
 repeated until it produces vomiting.   He also recom-
mends  it as highly useful in influenza, hooping-cough,

     * New-York Med. and Phys. Journal, vol. i. No. 2. 
84
SANGUINARIA CANADENSIS.
and croup.  In this latter disease, it must be given so as
to produce vomiting.*
   Dr. Francis, in the paper which I have already quot-
ed, states that he has used this  remedy with  advantage
in a " formidable case of acute  rheumatism occurring in
a gouty habit, the patient having been previously pre-
pared by copious blood-letting, cathartics, and sudori-
fics.   The  patient took thirty drops  of  the saturated
alcoholic solution, three times  a day.   Dr. Macbride,
of Charleston, South Carolina, in a letter to Dr. Bigelow?
states that he has found it useful in hydrothorax," given in
doses of sixty drops ter in die,  and increased until nau-
sea followed each dose."   My own experience with this
article has been limited.   I have, however, administer-
ed it in doses of about twenty drops a day, (the saturated
alcoholic tincture) with unequivocal benefit in an asth-
matic affection.  In  this instance,  the  pulse became
reduced about ten strokes in a minute.  In another case
of weakness of the breast, and copious mucous expecto-
ration, it produced a similar diminution of the action of
the pulse, but its good effects were not so conspicuous as
in the former instance.
   As an external remedy, the  powdered  root has been
found very beneficial " in ill-conditioned ulcers with
callous edges, and an ichorous  discharge.77   Professor
Smith,  of Hanover,  New-Hampshire, states that he
has cured several  polypi of the soft kind,  by using it as
a snuff.f  I once employed it  a long  time in a case of
this kind, and although it diminished the  polypus very
considerably for a time, I could  not succeed in obtaining
any permanent advantage by its use.

   * Bigelow's American Med. Botany, vol. i. p. 81.
   | Lond. Medico-Chirurg. Transact, vol i. 
SANGUINARIA CANADENSIS.
85
  Dr. Francis very judiciously observes, that in a state
of high general excitement, or in aetive local inflamma-
tion, its employment cannot  but  prove injurious;  for,
whatever may be its ulterior effects, it is always actively
stimulant in its primary operation.
  Two ounces of the powdered root to a pint of diluted
alcohol, are recommended as proper  proportions  for
making its tincture.
             APOCYNUM ANDOSjEMIFOLIUM.

  This vegetable is indigenous to the United States, and
has been a good deal employed in some parts of this coun-
try, as an emetic.   Some fifteen years ago, I prescribed
it \n several cases of intermitting fever, and found it a
prompt, and in these instances,  a mild and safe emetic.
Given in small doses, it forms an excellent tonic in indi-
gestion from debility and torpor of the stomach.   The
root of the  plant alone is used.  Its taste is  intensely
bitter.  As a tonic it may be given in doses of from two
to fiye grains three times daily.   About twenty-five  or
thirty-grains of the recently powdered root is the pro-
per dose when given with a view to its emetic operation
This root deserves more attention than it has yet receiv-
ed from the profession.  The  very  considerable tonic
powers which it unites to its emetic virtues, render  it,
we may presume, peculiarly suitable to dyspeptic cases. 
(  86  )
                RAD. VIOLjE ODORATjE.

   This species of viola has been introduced into the
United States, from Europe, and is abundantly cultivated
in our gardens.  The  root of the sweet-scented violet,
possesses considerable  emetio properties.   M. Caven-
tou asserts, that it  contains a very large portion of eme-
tin ;* and Boullay,f found a peculiar alkaline principle
in every part of the plant, strongly resembling emetin,
to which he has given the name, of violin.
                robinia pseudacacia.

   The inner bark of this our common locust tree, has
a sweetish and slightly acrid taste, and possesses pretty
active powers as an emetic.  Its operation is generally
prompt and mild.   An infusion made of an ounce of the
bark to a pint of water may be taken in doses of a small
wine-glassful every ten minutes, until  vomiting is pro-
duced.   I have known it to be employed  with as much
advantage as is usually obtained from the  ipecacuanha.
It is said to  be particularly useful in the  early stage of
dysentery when given in  under doses so as merely to
excite nausea, or but slight vomiting.

  * Diet, des Science Med. Tom. 5S. p. 158.
  | Journal de Pharme. T. 10, p. 23. 
(  87  )
  SULPHAS CUPRL—SULPHATE OF COPPER—BLUE VITRIOL.—
                    BLUE COPPERAS.

    This salt occurs in the form of rhomboidal prisms of
 a deep blue colour, having  an exceedingly harsh  and
 styptic taste.   It  consists of one portion of peroxide,
 with two portions  of  sulphuric acid, constituting there-
 fore, an  oxy-sulphate.   It  dissolves in four  parts of
 water, at the temperature of 60°, and in less than two,
 at the boiling point.  It is not soluble in alcohol.
    The operation of blue vitriol, as  an  emetic, is very
 prompt,  but its impressions upon the  general system
 appear to be much less powerful and  extensive than
 those of  the other  articles of this class.  When  taken
 into the stomach it very  speedily excites strong efforts
 at  vomiting: and  though the agitation of the  body
 which it creates is very considerable, yet its impressions
 seem to be a good deal confined to the  stomach, since,
 neither during  the operation, nor after it, does  the  pa-
 tient experience that  distressing relaxation, and general
 prostration which is occasioned by the other emetics.
   As an emetic, this remedy has been  very little em-
 ployed, except in the cure of phthisis pulmonalis.  Dr.
 Marryatt* appears to have been the  first who used the
 sulphate of copper in this way.   He recommends it to
 be  given  with tart, emetic, in doses of little more than
 two grains of each, two or three times a  week.   Noth-
 ing is to be  drank  during its operation, and hence  he
 calls it the dry vomit.   When diarrhoea  attends,  he
gives one grain of the  sulphate  of  copper with five
grains of  ipecacuanha.
* Therapeutics; or, the Art of Healing, 21st edition, 1806. 
88
SULPHAS CUPRI.
  In a paper on phthisis  pulmonalis, published  in the
first volume of the Transactions of the College of Phy-
sicians of Philadelphia, Dr.  Senter  declares, that  he
"has restored  more  persons labouring under  hectic
fever from  glandular suppuration, by vomiting every
second or third  day with the sulphate of copper, and
giving in the intervals as  much  as the  stomach  would
bear of Dr. Griffiths  myrrh  mixture, than by all other
methods he has ever tried.77   He considers this  prepa-
ration of copper, when united with ipecacuanha, as one
of the safest and  most efficacious emetics we possess.
Dr. Thomas,* also  adds his testimony in favour  of the
good effects of this practice.  He says, that he has  adopt-
ed it in the treatment of many cases of incipient phthisis
"with  infinite  advantage.77   Dr.  Samuel  Fort Sim-
mons,! likewise  speaks very  favourably of this remedy
in consumption.
  That considerable advantage may, at times, be obtained
from this practice, in incipient catarrhal consumption,
is very probable ; but of its power to  restore persons to
health who are " labouring under hectic from glandular
suppuration, is  a point, at which we may well demur.
Formerly, there was but little attention paid  to the di-
verse pathological conditions  upon which consumptive
symptoms  may  depend ;  and all cases attended with
cough, slow fever, and a puruloid expectoration, were
regarded as instances of  phthisis pulmonalis fron ulce-
rative suppuration of the glands or pulmonary structure.
When  this preparation  is taken into the stomach  in
excessive doses, it  acts as a  strong  poison, producing

  * Modern Practice.
  | Practical Observations on the Treatment of Consumption.
London, 1780. 
SULPHAS CUPRI.
89
pain in  the  throat, stomach,  and intestines, accompa-
nied with violent vomitings, " foetid eructations; hiccup,
difficulty of respiration, and almost suffocation; the
pulse becomes  small, hard,  and accelerated,  and in
certain  cases it  may be said to vibrate under the finger
like catgut.   An inextinguishable thirst, difficulty of
making water, cramps, the extremities of an  icy cold-
ness, horrible convulsions, general decay of strength,
the  features of  the face changed,  delirium—death."
To counteract these effects it has been found that  the
white of eggs, beat up with water, is the best remedy
we possess.   Sugar is also useful, and by many has been
highly praised as an antidote to this poison.  Orfila ad-
mits the propriety of its employment, but he says it is
not a counter-poison.   " Liver of sulphur, the alkalies,
gall-nuts, Peruvian bark, charcoal, &c.  considered as
counter-poisons, are useless, often dangerous, and ought,
therefore, to be banished.77*
   The alkalies and their carbonates, sub-borate of soda,
acetate  of ammonia,  tartrate  of potass, muriate of
lime, nitrate of silver, sub-acetate and acetate of lead,
oxymuriate of mercury, all  astringent vegetable infu-
sions and tinctures, decompose it and alter or  destroy
its effects.f
   In the dose of from  two grains to  fifteen, this article
acts as  a prompt emetic ; from one-eighth to one-fourth
of a grain, it operates as a tonic.

   * Orfila.
   f Paris's Pharmacologia.
VOL. I.—14 
(  90  )
              MERCURIAL PREPARATIONS.

   The subsulphas hydrargyri flavus, or turpith mineral,
is the most active and prompt emetic of the mercurial
preparations.  It was,at onetime, a good deal employed
for this purpose, but it is now almost entirely neglected,
on account of the violence of its operation, and its apt-
ness, sometimes to excite salivation.  It has been recom-
mended for the cure of virulent gonorrhoea, and hernia
humoralis, in which affections it has been said to act bene-
ficially, both as a mercurial and an emetic.  In leprous
diseases, it has also been employed with advantage, par-
ticularly when it  affects  robust  constitutions.  It  has
likewise  been administered  with  good effects in putrid
sore-throat, croup, and in peripneumony.
   It is given in the dose of from two grains to  six  or
eight.  Given in smaller doses, it acts as an alterative and
diaphoretic.  Dr.  Hope, senior, states that it forms an
excellent errhine by mixing  it with powdered liquorice-
root.
   The corrosive sublimate has also been employed with
a view to its emetic effects.  Its use, however,  for this
purpose,  has been  properly  abandoned, as violent and
dangerous. 
CHAPTER 111.
                    CATHARTICS.

   Cathartics are medicines which evacuate the con-
 tents of the intestines downwards, or which, when given
 in proper doses, produce purging.
   As, in many parts of the intestinal tube, its contents
 are carried forwards in a direction contrary to their
 gravity, a very considerable force, it  is evident, must
 be pretty constantly exerted from  above downwards, in
 order that the alvine evacuations  may be regularly ef-
 fected.   This force consists in that regular series of
 contractions of the  muscular fibres of the intestinal
 canal from above  downwards, called  peristaltic  motion.
 Constipation must, therefore, depend either upon a cessa-
 tion, or an inadequate force of this peristaltic action, or
 upon some mechanical resistance to  its natural propul-
 sive power, or upon both these causes combined.
   Whatever, therefore, increases the alvine discharges,
 acts either by  increasing the peristaltic action  of the
 bowels;  or, by removing the impediments to its regular
 powers; or,  by producing both these effects.
   It is in this latter way that cathartics produce their
 evacuant effects.  For, while they excite the peristaltic
or propulsive action  of the intestinal  canal, they also
augment its natural secretions.  They  thus at once in-
crease the force of the propelling power, and diminish
the resistance of the substances propelled, by lubrica- 
92
CATHARTICS.
ting the internal  surface of the bowels and attenuating
their contents by the increased secretions they produce.
  Independent  of  the different degrees  of evacuant
power which these remedies possess, they differ also es-
sentially from each other in relation to the particular
parts of the intestinal tube upon which they more imme-
diately exert their actions, as well  as in the  nature and
appearances  of the discharges which they produce.
Thus gamboge, calomel, and a few others, direct their
action more particularly upon the upper portion of the
intestines; whilst aloes acts almost entirely upon the
lower  portion of the bowels.  With regard  to the par-
ticular character of the  evacuations  produced  by the
articles of this class, the diversity is equally remarkable.
Jalap  and the saline  purgatives, for instance, produce
copious  watery discharges;  castor oil, rhubarb, &c.
merely  evacuate the  contents of the bowels;  whilst
others, as calomel, increase the secretion of bile, and
carry  off this fluid  in  augmented quantities.  It  is not
improbable, as Dr. Paris observes, that the diversity
which exists in relation to the part of the intestinal tube
upon which different purgatives act, is owing to the dif-
ferent degrees of " the solubility of the active elements77
of  these  remedies.  " It is, for instance, easy to con-
 ceive,77 says this writer, " that a medicine may act more
 immediately and especially upon the stomach, small or
 large  intestines, according to the relative facility with
 which its principles of activity enter into solution ; that
 those which are dissolved  before they pass  the  pylorus
 are quick and violent in their effects, and  liable  to affect
 the stomach, as is exemplified by the action of gamboge,
 &c. whilst some resinous purgatives, on the  other hand,
 as they contain principles less soluble, seldom act until 
CATHARTICS.
93   ;
they have reached the colon.   Colocynth has a  wider
range of operation, since its principles of activity re-
side both  in  soluble  and  insoluble elements.   Aloes
again,  being still  further  insoluble,  pass through the
whole alimentary canal before they are sufficiently dis-
solved,  and act, therefore,  more particularly upon the
rectum.77   A knowledge of these circumstances is  of
very great consequence,   both  in  a therapeutic and
pharmaceutical point of view.   For it  will «not only
enable the practitioner to  modify the peculiar action of
these remedies, by changing the degree of their solubi-
lity, but also to select those articles which are peculiar-
ly adapted to the particular circumstances of the dis-
eases for which they are prescribed.  Thus, in  ascites
we would be naturally led  to  employ those purgatives
that have a more especial tendency to serous evacuations,
as the saline cathartics; whilst in cases attended with
redundancy or vitiated bile, we would resort to such as
act particularly upon the upper portion of the bowels,
and at the same time influence the functions of the biliary
system.  Again, if, in addition to the mere effect of un-
 loading the contents  of the bowels, we wish also  to pro-
 duce a determination to the pelvic viscera, to the uterus,
for instance, in amenorrhcea, we  select aloes as the ap-
 propriate  purgative,  because  of its  more  particular
 action on the rectum.
    Besides the more immediate operation of evacuating
 the contents of the bowels, cathartics produce other  ef-
 fects on the animal economy, to which no small  part of
 their remediate powers may, with reason, be ascribed.
    1.  They diminish the action of the heart and arteries,
 and are therefore of more  or less advantage in  all dis-
 eases of a  sthenic character.   They produce this effect 
94
CATHARTICS.
 not only by evacuating the vitiated or accumulated con-
 tents of the bowels, and  thereby removing a  source  of
 general irritation, but also, by abstracting from the con-
 tents of the blood-vessels themselves;  by the increased
 secretion of serum they produce in the alimentary canal.
 In this respect, the operation of these remedies resem-
 bles, in some degree,  those of blisters; which,  though
 acting  primarily as stimulants upon the sanguiferous sys-
 tem, reduce its action as  a secondary effect, by the eva-
 cuation of serum which they occasion.
   2. They promote the  absorption of  fluids,  from the
 internal cavities.  This  effect they produce  by a  two-
 fold operation; namely, by depriving the blood-vessels of
 a  portion of their serous contents, and by augmenting,
 as a consequence of this, the reabsorption of serum,  from
 those cavities in which it may exist in a state of mor-
 bid accumulation.  To render this explanation intelligi-
 ble, it will be necessary to enter into a more particular
 exposition of the  grounds upon which it rests.  It ap-
 pears to be conclusively established, both by direct ex-
 periment* and pathological  observations, that absorp-
 tion is accelerated in proportion  as the quantity of fluid
circulating in the blood-vessels is diminished.  It would
appear too, that there is a constant effort in the system
to preserve  the  regular  proportion  of serum in  the
blood, and that its inordinate loss by one emunctory, is
counterbalanced  either by  a greater  absorption from
some of the internal cavities,  in which it may be accu-
mulated, or by the diminished action of one or more of
the other serous emunctories.  Thus, when the exha-
lents of  the peritoneum effuse a  preternatural portion

 *  Journal of Experimental Physiology, by M. Magendie,  192L 
CATHARTICS.
95
 of serum into the cavity of  the  abdomen,  producing
 ascites, the morbid diminution of this fluid in the blood-
 vessels is,  in  some degree, counteracted by the dimi-
 nished action of the cutaneous  exhalents,  and  of the
 kidneys.   The moment, however, that the  kidneys are
 excited into a more perfect performance of their func-
 tions, then (this check to the  morbid diminution of thfc
 serum of the blood being removed) some new supplying
 power is requisite to keep up the necessary proportion of
 serous fluid in the  blood-vessels;  hence the absorbents
 are called into action,  and  the  dropsical fluid is reab-
 sorbed into the circulation, and thence eliminated by the
 regular  emunctories.   From  these  facts, we  readily
 perceive the way by which active cathartics promote the
 absorption  of dropsical effusions.   By irritating the ex-
 halents of the internal surface of the intestines, a very
 greatly increased  secretion of serum is suddenly pro-
 duced  by the action of these remedies. As  a conse-
 quence of this, not only is the further effusion  of drop-
 sical fluid diminished by deriving the blood from the ex-
 halents of the cavities to those of the intestines, but its
 existing bulk is also directly lessened, by the absorbents
 assuming a  more vigorous action, in order to  supply the
 deficiency which  the purging  has suddenly  induced in
 the serous portion of the blood.  This view of the sub-
ject will aid us, I think,  in accounting for the fact men-
tioned by Dr. Paris, and others, that cathartics often in-
crease the effects of diuretics.  If, for instance, we give
a diuretic to  a dropsical patient,  a  slight, but insuffi-
cient increase  of  urinary secretion, for  the most  part,
follows; the absorption is,  of course,  proportionally
small.   Let a  cathartic be  now  administered.   This
will excite a sudden and considerable increase of serous 
96
CATHARTICS.
evacuation by the bowels;  hence, an unusual demand
for a restitution of this constituent portion of the blood
is created; and, by consequence, a new impulse given to
the supplying or  absorbing vessels ; which, continuing
after the operation of the cathartic has ceased, will have
the effect of supplying the kidneys with a larger portion
d? the elements of their secretion, and, therefore, ena-
ble those medicaments which are calculated to increase
their action, to operate more effectually.
   3. Cathartics tend to remove the torpor which some-
times prevails in  the portal circulation, and thereby to
promote the biliary  secretion.   This they do by excit-
ing " a brisk peristaltic motion of the intestines, where-
by the blood, which is accumulated, and as it were stag-
nated in the portal circle, is propelled forwards.77*
   4.  They produce a powerful  derivation of the circu-
lation  from the  superior  to the inferior parts of  the
body, on the principle of ubi irritatio ibi fiuxus;  and
hence their utility in cephalic diseases.
   It may be  observed, that, under particular  circum-
stances, bleeding has a decided effect in  increasing  the
susceptibility of  the intestinal canal to the operation of
cathartic medicines.  " I have often noticed this fact,7"
says Dr. Paris, " in contending with a plethoric  dia-
thesis; whenever the bleeding preceded the purgative^
the effects of the  latter  have been uniformly more
 speedy and considerable;  in obstinate constipation the
 same fact has been observed, and mild  remedies have
 been known to act more powerfully, when preceded by
 blood-letting, than  potent ones have when exhibited
 antecedent to it.77

       * Johnson on the Disease* of Tropical Climates. 
CATHARTICS,
97
   Having  premised these general observations, I shall
now pass on to a more particular account of the prac-
tical application  of this class of  remedies.   There is
no  class of articles  belonging to  the  materia medica,
whose  application  is more extensive, or whose  aid is
more essential to the medical practitioner, than this one.
In  almost  every  variety of febrile disease, purgatives
are among the most useful curative means we possess.
The alimentary canal has been, not unaptly, called the
" storehouse  of  diseases.77    Whatever may be the
original febrile cause; whether seated in the bowels or
elsewhere, it is certain that the secretions which are
poured into the alimentary canal are, perhaps in almos
every  instance of fever, changed from their natural or
healthy condition,  to a state which renders them addi-
tional causes of irritation, to the already preternaturally
excited system.   Hence, simply with a view to remove
these additional supporters of febrile action, purgatives
are important throughout the whole course of acute dis-
eases.   But it is not merely  by evacuating the vitiated
and irritating contents of the bowels, but also by their
direct depletory effects on the sanguiferous system, and
their consequent power of reducing arterial excitement,
that purgatives are beneficial in febrile diseases.
   Although purgatives are unquestionably highly useful
in every form of fever, yet it must not be  forgotten,
that in all febrile affections there  exists a considerable
tendency  to inflammation of the mucous membrane of
the alimentary canal;  and that, consequently, no small
degree of injury  may be done, by too frequent a  use of
active cathartics.   This observation applies more espe-
cially to the  advanced stages of catarrhal and  bilious
fevers;  for when these forms o fever become protract-
   vol.  i.—15 
98
CATHARTICS.
 ed, there is almost always more or less inflammation de-
 veloped in the internal coat of the stomach and bowels.
 In general, the more active articles of this class of re-
 medies should be rejected in all febrile diseases where
 there is a probability  that frequent purgation may be-
 come necessary with the view of removing the vitiated
 contents of the bowels.  Without adopting the patho-
 logy of Broussais, I am yet entirely convinced that pur-
 gatives are often  exceedingly  abused  in the treatment
 of fevers.  It is  in  vain  to deny that gastro-enteritis
 does, very frequently, exist  in fevers, and  it matters
 little whether it be secondary or primary, for in either
 ease the irritation of cathartics must almost  inevitably
 prove injurious.
  Not long ago, I met with an instance (in consultation)
of the most lamentable abuse of cathartics in a  case of
fever apparently excited by checked perspiration from
cold.   The patient,  when I first saw him,  had already
been sick about ten days.   I was told by the attending
physician, that  there had  not been  the slightest remis-
sion for six days, notwithstanding the daily employment
of very active cathartics.  For four days  in succession
 the patient had taken senna and manna, calomel and jalap,
and salts, and on the morning  when I  saw him he had
already swallowed a  full dose of rhubarb.   I  found the
patient lying  on his  back slightly delirious,  his knees
constantly drawn up, the tongue dry and brown in the
middle, and deep  red at the tip and edges, and the ab-
domen tumid,  tense, and exceedingly tender  to the
touch.   He died  in  two  days  after.  Whenever the
tongue is red and granulated along the  border,  or red,
 smooth, and glassy over the whole surface, with a tender,
tumid, and tympanitic state of the abdomen, and watery 
CATHARTICS.
99
 flocculent stools, nothing can be more injurious than the
 administration  of cathartics.   The longer I practice,
 the more I  become convinced, that the milder  laxa-
 tives are decidedly preferable to  the  more active arti-
 cles of this  kind in  general fevers; and except in the
 very commencement, where there is reason to believe
 that the bowels are in a loaded condition, it will always
 be advisable to abstain from energetic or irritating pur-
 gatives.
   Typhus fever having been long considered as essen-
 tially characterized, ab  initio, by debility,  purgatives
 were, of course, almost universally held as improper in
 its treatment, until Dr. Hamilton, of Edinburgh, pointed
 out their utility, in his inestimable work on purgatives.
 That  they are,  in  fact,  not only  safe,  but eminently
 useful, in the management of this form of fever, where
 there  are no signs  of gastro-intestinal inflammation, is
 now sufficiently established by the concurrent testimony
 of the ablest practical writers of the present  day.   Dr.
 Rush  has long  since  observed,  that- purgatives are
 often  found to remove,  in  a  sudden  and remarkabje
 manner, the apparent debility which frequently exists
 in the latter stages of acute  diseases.   In the yellow
 fever  he often saw .the prostrated strength of a parent
 suddenly renovated by the operation of a single purga-
 tive.  That  debility is conspicuously produced by the
 impression of irritating matters on the intestinal nerves,
 is  a  fact too frequently witnessed to admit of a moment's
 doubt.  Who has not seen the impression of indigesti-
 ble food,  in  persons of debilitated  digestive organs,
bring on the most alarming prostration ?   Why do we so
strenuously  restrict  our debilitated  convalescents from
taking food,  which,  in health,  would be deemed alto- 
100
CATHARTICS.
gether insufficient to sustain the natural powers ?  It is
because we fear, and justly too, lest it either prostrate
the already debilitated vital energies, or raise a tumult
in the system dangerous to life.   If  the natural ingesta
are thus able to affect the animal economy, when not
fortified by strong digestive powers,  is it not reasonable
to expect similar pernicious consequences from  the re-
tention and irritation of the vitiated matters, on the in-
testinal nerves of the debilitated typhus patient ? That
the contents of the intestines are more or less vitiated in
all febrile  diseases,  and especially  in the low  typhus
fever, is  certain, I think,  not only from the actual ap-
pearance of  the discharges themselves,  but also  from
the necessary results of the suspended digestion and
morbid intestinal secretions which occur in these fevers.
From this view of the subject, therefore, we can readi-
ly perceive  the utility of employing mild laxatives in
the latter stage of typhus fevers; since we thereby free
the system from a powerful cause of irritation,  and at
once renovate the vital powers,  and enable the intesti-
nal emunctories to recover their natural functions.   " I
have  directed  a strict attention,77 says  Dr. Hamilton,
" to  this practice for. a long time, and I  am now  tho-
roughly persuaded that the full and  regular evacuation
of tKe bowels relieves the  oppression of the stomach,
cleans the  loaded  and parched tongue,  and mitigates
thirst, restlessness, and heat of surface;  and that  thus
the latter and more  formidable  impression on  the  ner-
vous systen\ is prevented;  recovery more certainly and
speedily  promoted, and the danger of relapsing into the
fever much  diminished.77*  These observations apply
particularly to the latter stages  of typhus, for,  in the
* Hamilton on Purgatives. 
CATHARTICS.
101
commencement of this disease, when vascular excite-
ment is pretty active, brisk purgatives will be beneficial,
both by unloading the bowels of their  irritating  con-
tents, and by their direct depletory effects on the blood-
vessels.
  In  relation to  the  modus operandi  of purgatives
in typhus, Dr.  Armstrong* nfekes the following re-
marks,  which, though correct, do not, as this respect-
able writer would seem to think, invalidate the forego-
ing remarks concerning the mode in which these medi-
cines  produce their good effects in typhus. " Purgatives
seem  beneficial by unloading the intestines of faeces and
excrementitious matters, which, when retained, excite
and keep up much general irritation.  But is it not ex-
ceedingly probable, that they have another and far more
salutary effect, in restoring healthy secretion, and in re-
moving irregular distributions of blood from the head,
liver, and other parts ? The full operation of aperients
sometimes reduces the morbid heat of the skin and the
morbid force of the pulse, almost  as effectually as the
affusion  of  cold water  or  venesection; consequences
which surely indicate, that their action extends further
than  the mere removal of fecal matter from the  intesti-
nal canal.77  It  cannot, indeed, be denied,  that the
consequences here mentioned do sometimes follow the
operation of cathartics : but when we  reflect ^that the
very circumstances of  a hot and dry skin, an irritated
pulse, morbid function of the intestinal exhalents, and
irregular distributions to the head, liver, and other vital
parts, are in reality often produced by irritating matters
lodged in the intestines;  it will appear evident, that
these symptoms may be mitigated by mild laxatives, not
* Treatise on Typhus Fever, p. 102.  First Am. edit.

       ***■**» Co, 
102
CATHARTICS.
 by any operation independent of their mere evacuant
 effects, but solely by removing those irritating matters
 from the bowels, upon which the  morbid  phenomena
 just mentioned depend.
    Dr.  Armstrong makes another  observation on  this
 subject, to the reasonableness of which I readily sub-
 scribe.  " I believe,77 says he, " that purgatives are also
 beneficial by preventing, through their operation,  the
 absorption of the morbid secretions and excrementitious
 matter of the intestines; for when these have been allowed
 to be retained in typhus, I have generally observed a con-
 siderable increase of irritation, with an offensive odour
 from the lungs and from the skin ; and, on the contrary,
 when the morbid secretions and excrementitious matter
 have been regularly evacuated, there has mostly been a
 diminution of irritation, with an absence of this peculiar
 odour."
  I have already said  that some purgatives excite the in-
 testinal exhalents to a copious evacuation of serous fluid,
 and thereby occasion a very considerable reduction of
 vascular action, whilst others appear to do little more
 than merely to evacuate the contents of the bowels. This
 circumstance should be always kept in mind when pre-
 scribing purgatives in typhus.  For while cathartics of
 the former kind may answer well in the first stage of the
 disease, they are, undoubtedly, less proper in its advanc-
 ed stages than the milder laxatives, when our object  is,
 in general, merely to unload the irritating contents of
 the bowels, with as little reduction of the vital powers
as is possible.
  In all the exanthematous  fevers, purgatives are very
useful remedies.  Their beneficial operation  in these
diseases would seem, I think, to depend chiefly on their 
CATftARTICS.                  10S
  power of determining the circulation from the cutaneous
  to the intestinal capillaries.   That the exanthemata are
  peculiarly characterized by strong morbid excitement in
  the cutaneous  vessels, is perfectly  obvious from  the
  manifest character of these diseases.  It would, therefore,
  appear reasonable, a,priori, to suppose, that whatever is
  calculated to moderate the action, of the vessels of  the
  surface,  is by this effect equally calculated to moderate
  the characteristic symptoms of these diseases.  It is upon
  this principle, that cold air and tepid ^blutions act  so
  beneficially in  affections of this kind.  It  is chiefly
  during the eruptive fevers of diseases of this kind that
 purgatives are especially useful.   After the eruption is
  completed, it will be best to keep the bowels open with
 the gentlest aperient  remedies,  or  with the  regular
 employment of laxative enemata.  Experience has taught
 us, that an increased action of the vessels of the intes-
 tines,  or an afflux of blood to these organs, is almost in-
 variably attended by a  simultaneous  diminution in the
 action of the extreme vessels of the  cuticular surface,
 or, in other words, by^a partial desertion of the blood
 from these vessels, and  vice versa.  Hence, sudorifics
 are useful in checking intestinal fluxes; and hence too,
 cathartics, by exciting intestinal exhalation, act benefi-
 cially  in the exanthematous fevers.  Undoubtedly, how-
 ever, something is also to be ascribed to the mere remo-
 val of  the irritating contents of the intestines,  and to the
 general reduction  of arterial  excitement, which these
 remedies occasion.
   In the early stage of scarlatina simplex and anginosa,
purgatives are of essential service.   Their utility in this
disease has been particularly dwelt on by Dr. Hamilton,
in his work on purgatives; and Dr. Armstrong adds his 
104
CATHARTICS.
testimony in favour of this practice—a practice which
is, indeed, pretty universally recommended at the pre-
sent day.  In order to derive the full advantage of pur-
gatives, it is necessary to produce  brisk  and copious
evacuations.  For, if the views just  given  of the modus
operandi of purgatives, in affections of this kind, be cor-
rect,  it is evident that such cathartics as act briskly
upon the bowels, must be most efficacious in this disease.
Dr. Armstrong recommends the employment of sulphate
of magnesia, with tartrate of antimony, with the view
of exciting rapid purging and vomiting.  The same ob-
servations apply to the use of purgatives in erysipelas.
   In no disease are laxatives more decidedly beneficial
than in dysentery.  Such is the tenderness of the in-
flamed intestinal canal in this disease, that  even its ordi-
nary contents become a source of great and painful irri-
tation.  One of the first steps,  therefore,  in its  treat-
ment, is to remove these irritating matters by the em-
ployment of such purgatives as produce a speedy and full
action on the bowels;  and, as the secretions which are
poured into them  are, perhaps,#in  all instances in a
vitiated state, these remedies must be occasionally em-
ployed throughout the whole disease.  As  our principal
object however, is, to remove those  substances from the
bowels which have a tendency to irritate,  it is obvious
that our purpose will be best answered by suclx, means,
as will evacuate them with the least  possible irritation.
It is, therefore, of considerable consequence to select
such aperients as  are  least harsh  in  their operation,
though sufficiently active to induce copious evacuations.
   Cathartics are exceedingly useful  in puerperal fever
 and peritonitis.  Active  purging in the onset of these
 diseases, is, indeed, often sufficient  of  itself effectually 
CATHARTICS.
105
  to  arrest their future progress.   Used in conjunction
  with  decisive venesection,  purgatives constitute  the
  only remediate measures upon which any reliance  de-
  serves to be placed.  There is generally much difficulty
  in moving the bowels in these affections, and we must,
  therefore, employ strong doses of the  most active of
  these  remedies.
    I am decidedly of opinion, both from theoretical con-
  siderations and practical observation, that the benefit
  resulting from purgatives in these diseases will,  in  ge-
  neral, be proportionate to the activity of their operation.
  Drs. Abercrombie* and Broussais are  of  opinion that
  purgative medicines are injurious in peritoneal inflamma-
  tions.   The latter writer observes, that these remedies
  are hurtful, " because the vermicular contractions which
  they excite in the intestines, must increase the morbid
  sensibility of the peritoneum.77  The following observa-
  tions of Dr. James Johnson upon this subject, appear to
  me to be highly judicious.  " In abdominal inflammation,
  provided the mucous tissues are not inflamed, purgative
  medicines  excite the secreting vessels,  not only of the
  whole internal surface of the intestines themselves, but
  of the glandular organs whose excretory ducts open into
  the primae viae, and thus powerfully deplete locally the
 vascular system of  the  abdominal viscera.  When the
 portion of peritoneum reflected over the intestines  is
 inflamed, but where the villous coat is unaffected, I he-
 sitate not to assert, from personal experience,  that con-
 stipation of the bowels will, in nine cases out of ten, be
 a feature of the disease; and in such cases we  maintain

  * Researches on the Pathology of the Intestinal Canal, in the
63d number of the Edinburgh Medical and Surgical Journal.
   VOL.  I.-—16 
106
CATHARTICS.
that to excite the natural  action of the mucous mem-
brane, immediately after proper vascular depletions, is
a powerful mean of checking  the  peritoneal inflamma-
tion ; in the same way that a free expectoration from
the mucous membrane of the lungs, relieves the vascular
turgescence  and  inflammation of  the parenchymatous
structure or pleural covering of the same organ.*
   Dr. Marshall  Hall gives an account of a disease pe-
culiar to puerperal women,  resembling very  closely
genuine puerperal fever, in which purgative medicines
would appear to be the only remedies offering any pros-
pect of success;  and in  which  bleeding, according to
his experience, is  almost  certainly  fatal.  Dr. HalPs
description of this disease, as distinguishable from puer-
peral  fever, properly  so called, is, however,  by no
means satisfactory.  He has  pointed  out no  marks by
which it may be discriminated from this latter disease;
there can, however, be no doubt, that great prostration
of the vital  powers, pain, and arterial excitement, may
 sometimes  arise  from intestinal  irritation in  puerperal
 women, without  the existence  of any local abdominal
 inflammation;  and under  such circumstances  we can
 readily  perceive, that  bleeding, especially if copious,
 would be improper, since it would create additional de-
 bility without removing the  cause of irritation, which
 would, indeed, by this very practice, become more per-
 nicious  in its effects.
    From the general antiphlogistic operation of cathar-
  tics, it  is evident  that they are not  inapplicable in the
  treatment  of  acute rheumatism.   They  are, in fact,
  much recommended in this disease by writers  of great

      * Medico-Chirurgical Review, No. 2. Analytical series. 
CATHARTICS.
107
respectability.   "The advantage,7' says Dr.  Scuda-
more, " of making a detraction from the general circu-
lation by the channel of the alimentary canal, is no less
remarkable in rheumatism, than in every other inflamma-
tory disease.  In proportion as we pursue this practice
upon a continued principle  from day to day, do we ob-
tain its good effects in acute rheumatism;  the circula-
tion becomes moderated;  the  inflammatory diathesis
subdued, and the absorbent system is excited to increas-
ed action.   Hence, we powerfully promote the removal
of those excessive secretions of the synovial membranes,
which have been  already described as causing the dis-
tention and impeding the motion of the affected parts.
A saline purgatke, administered in small doses, and at
repeated intervals, is the most advantageous.77*  Drastic
purges  are, however, as a general rule, not to be em-
ployed in the treatment of this disease.  These are, in
some degree, incompatible with that  regular action of
the cutaneous exhalents  which  seems to be indispensa-
ble to the removal of this painful affection.  Laxatives,
on  the contrary,  are  of  unquestionable service; they
remove the sources of intestinal irritation;  tend gently
to equalize the circulation, and lessen the action of the
heart and arteries, by their evacuant effects upon the
extreme vessels of the intestines.   As an auxiliary to
other antiphlogistic measures, they can seldom be ne-
glected with propriety in the cure of acute rheumatism.
Nearly the  same thing may be said in relation to the
use of cathartics in the treatment of gout.   Whatever
be  the real nature of this disease, it seems certain that
there is, perhaps, always functional derangement of the

 * A Treatise on the  Nature and Cure of Gout and Rheumatism. 
108
CATHARTICS.
 secretory organs of the alimentary canal, and especially
 of the liver  and portal system of vessels.*  There is
 no difficulty, therefore, in accounting for the beneficial
 operation of purgatives in  gout.   They not only  re-
 move the vitiated and irritating contents of the bowels,
 but tend also to correct the action of those glands whose
 products are poured into the alimentary  canal, and by
 detracting  from the general  circulation, to moderate
 the febrile excitement, and  especially to promote  and
 invigorate the  portal circulation, which, according to
 Scudamore, is in a congested condition.f   Dr. Sutton,
 in his Tracts on Gout, &c. speaks strongly in favour of
 the employment  of cathartics  in this  disease.  Dr.
 Scudamore states, that " he has invariably employed,
 with the greatest advsantage, purgative  and  diuretic
 medicines conjointly, so that the exhalent vessels of  the
 alimentary canal, and the secreting function of the kid-
 neys are stimulated to increased action at the same time.77
 Such a union of purgatives and diuretics is particularly
 serviceable in those  cases that are attended with drop-
 sical effusions in the extremities.
  There is no acute disease  in which purgative medi-
 cines ate more indispensable  than in hydrocephalus in-
 ternus.   The pathology of this complaint  has, of late
 years, been  much elucidated.   It  appears now  to  be
pretty generally admitted, that it often depends on gas-
tric irritation.   The alvine discharges, in this  disease,
afford  unequivocal proof of  great  functional disorder
of the liver.  They very commonly consist of large
 quantities of black, or green and glary bile, and seldom,

  *  Dr. Scudamore on Gout, p. 74.
  t  Ibid. p. 100. 
CATHARTICS.
109
 if ever, exhibit the appearance of natural and healthy
 faeces.   In post mortem examinations of hydrocephalic
 children, Dr. Cheyne " found in the liver the remains
 of great inflammatory action, and also proofs that undue
 irritation had existed in the alimentary canal.77*  And
 Mr. Abernethyf states, that on  dissecting the body of
 a child  that  had died  of "unequivocal symptoms of
 hydrocephalus,"7 he found the brain perfectly healthy,
 the only diseased appearance being in the boivels.   Dr.
 Cheyne also mentions the case of a girl, who, complain-
 ing  in the evening of headach, was put to bed  by her
 mother,  and  soon asleep; next  day, at noon, she  was
 still sleeping profoundly, respiring fully and  slowly,
 with now and then a heavy sigh; the eyes were fixed,
 the pupils large and immovable.   She  had been  very
 costive for some days previous, and was languid; she
 was ordered an enema, and  this roused her so far  as to
 swallow a bolus  of jalap and calomel.   This operated
 powerfully; and brought away "two chamber-potfuls
 of the  most  extraordinary  collection  of faeces77  the
 doctor ever saw.   The patient recovered immediately.
 This case shows, in a striking manner, the powerful in-
 fluence which intestinal  irritation, from acrid or vitiat-
 ed matters, may have upon the brain.  We have a fur-
 ther confirmation of the correctness of this  pathology
 of hydrocephalus, in  the fact, that cholera infantum
 very often terminates in unequivocal symptoms  of hy-
 drocephalus.   Nor is it an uncommon thing to see chil-
 dren who have long been harassed with indigestion  and
diarrhoea, die with symptoms of hydrocephalus acutus.
* Cheyne on Hydrocephalus.
| Surgical Observations, part ii. p. 190. 
110                 CATHARTICS.
Indeed, proofs of the morbid influence of visceral irri-
tations on the brain are so various and palpable, that the
most careless observer must have often noticed them.*
  But, whether the disease be an idiopathic, or only a
secondary affection of the encephalon, purgative medi-
cines are amongst the most important of our remediate
resources.   It is evident, however, that where the dis-
ease is dependent on a primary irritation in the bowels,
cathartics  are  more especially indicated, since they
tend, at once, to remove the remote  cause of the dis-
ease, and, by determining an afflux to the  intestines, to
lessen  the flow of  blood to  the  brain.   The bowels
should, therefore, be actively moved, in every instance
where hydrocephalic symptoms supervene,  whatever
other measures be adopted.  They have a more power-
ful effect in lessening the action of the circulation in the
head, than any other internal remedies we can employ.
" Should we  ascertain,7' says Dr. Cheyne, " that the
alimentary canal is torpid, and imperfectly performing
its functions, admitting  an  accumulation  of feculent
matter, or that the secretions flowing into it are vitiated
or diminished in quantity, which we discover by the pe-
culiarity in the appearance, or the pungent foetor of the
stools, we must, by steadily pursuing the purgative plan,
endeavour to effect a change; for while this is produced
in the appearance of the stools, by the stimulating qua-
lity of our medicines, we are effecting a most important
 change in the  hepatic system, alimentary  canal, and all

   * This pathology of hydrocephalus is particularly advocated by
Drs. Cheyne and Yates.  Spurzheim thinks that it is sometimes
dependent  on primary gastric irritation, but generally, an idiopa-
thetic cerebral affection. 
CATHARTICS.
Ill
the parts, including every organ essential to life, which
is connected with them."*
  For the same reason that purgatives are prescribed in
hydrocephalus;  namely, to determine  the circulation
from the head, and to remove  the causes  of intestinal
irritation, are they useful in apoplexy.  Whatever spe-
culative notions  be entertained in relation to the patho-
logical character of this disease, all experience would
seem to testify in favour of the  employment of active
cathartics in its cure.   As the advantages derived from
these remedies, in the present disease, arise probably
chiefly from the strong tendency they have to diminish
the afflux of blood to the encephalon, and directing it
upon the intestines and other gastric viscera, it is evi-
dent that the more rapidly they  purge, the more bene-
ficial will be their operation in this malady.
   Hypochondriasis is, in general, obviously connected
with and often preceded by  a deranged  state  of the
chylopoietic viscera. We may frequently trace the suc-
cessive grades of dyspepsia up to  the full  formation of
this deeply distressing  complaint.   It is almost invaria-
bly preceded by disorder of the digestive organs.   The
appetite is either morbidly  increased, or  depressed;  a
distressing  sense of fulness  is experienced  in the sto-
mach, and  there  are foetid eructations, with a white
tongue,  obstinate constipation, and  headach.  Yet  in
this disease active purging does not appear to be proper;
for, as the gastric symptoms just mentioned, and upon
which those of  the mental  affection would seem to de-
pend, arise from an irritation of the digestive  organs,
it is easy to understand why  drastic purgatives rather
* Essays on the Diseases of Children, by John Cheyne, M. D. 
112
CATHARTICS.
 do harm than good.   For, although they might effectu-
 ally remove the vitiated  contents of the intestines, yet,
 as their operation would have a tendency to irritate still
 more the already too  greatly irritated condition of the
 mucous membrane of  the stomach and bowels, it is evi-
 dent that they cannot be employed  with  propriety  in
 this affection.   The same objection does not, however,
 stand against the use of laxatives in this disease.  These,
 on the  contrary, are indispensable auxiliaries in its
 treatment.  By gently exciting the action of the bowels,
 they tend to restore  the  natural intestinal and  hepatic
 secretions, and to remove the torpor which, in this dis-
 ease,  prevails in  the portal circulation.  Purgatives
 ought to be united with mild bitter tonics, and given in
 such a way as to procure  one, or at most  but two good
 evacuations every  twenty-four  hours.  There is often
 an amazing quantity of faecal matter impacted  in the
 lower bowels of  hypochondriacs, which has a strong in-
 fluence in keeping up the disease, and which it is almost
 impossible  to  remove  by purgatives.   When there is
 reason to suspect the presence of such accumulated con-
 tents, there is no way by which we can so conveniently,
 and at the  same  time so effectually and beneficially re-
 move  them, as by the daily employment  of mild and
 copious  laxative injections.  These, indeed,  should
 never be neglected in the  treatment of this and other
chronic diseases, dependent on gastric derangement and
accompanied with intestinal torpor.
  Hysteria is a disease closely allied to the preceding;
and its intimate  connexion with disorder of the diges-
tive viscera, is demonstrated  by  the symptoms of wan-
dering pains in the abdomen, flatulence, acid and foetid
eructations and  constipation, which characterize the 
CATHARTICS.
11^
hysteric constitution.*  " In my opinion," says Dr. Ha-
milton, " these symptoms  afford conclusive evidence,
that this gastric affection is primary, and that the other
multifarious symptoms  of hysteria depend on it.   I
have, therefore, thought it reasonable to attend particu-
larly to the state of the stomach and intestines, and to
employ, in the first  place, purgative medicines, to re-
move the  constipation of the body which most common-
ly prevails in hysteria,77   I  have been  much  in the
habit of employing purgative medicines in hysteria.  In
some cases I have succeeded in putting a stop to the
paroxysm  by  means  of a  brisk cathartic, after  all the
ordinary remedies for cases of this kind had been tried
with little or no advantage.  Purgatives will, however,
produce very little  benefit in this disease, unless they
be administered in doses  sufficient to occasion full and
active purging.   They may  be very advantageously
united with  the foetid gums, particularly assafoetida.
Dr^  Hamilton observes, what,  indeed, I  have myself
repeatedly noticed, that " the first purgatives seem, on
some occasions, to aggravate the  symptoms; but the
practice must not be deserted  on  this account.  The
additional irritation which purgatives may give in the
first instance, soon passes away;  and perseverance in
the use of them removes that irritation which gave rise
to the disease, which, of course, disappears in propor-
tion as the bowels are relieved  of the oppressive mass
of accumulated faeces.77   It is  evident, however, that
in a disease, which, like this  one, is so intimately con-
nected with disordered digestive powers, the employ-
ment of tonic and gently stimulating remedies will often
be found necessary along with purgatives.
                 * Dr. Hamilton.
VOL. l.—17 
114
CATHARTICS.
   Chorea is another of the neuroses  in which the em-
ployment of purgatives has been especially recommend-
ed.  That it  is often  dependent on  gastric irritation,
and  connected with great faecal  accumulations in the
lower  intestines, I have not  the least doubt; and that,
in such cases, purgatives will be useful is at once obvi-
ous.   Dr. Hamilton is the  first who directed the atten-
tion  of the profession to the purgative plan of treating
this disease.  It appears, however, that the exhibition of
purgatives in the present  disease, is countenanced by
the practice of Sydenham, De Haen, and Dr. Stoll.
   "Chorea,77 says Dr. Hamilton,  "consists of two sta-
ges.   In the  first, while the intestines yet retain their
sensibility, and before the accumulation of faeces is great,
gentle purgatives, repeated as occasion may require, will
readily effect a cure, or rather  prevent the full forma-
tion  of the disease.  In the  confirmed stage, more se-
dulous attention  is  necessary.   Powerful purgatives
must be given, in successive doses, in such a manner
that  the latter doses may support the effect of the  for-
mer, till the movement and expulsion of the accumulat-
ed matter are  effected."  It is absolutely indispensable
to pursue this treatment in a firm and decided way, in
order to derive permanent advantages from its employ-
ment.   "Half measures, in instances of this kind,  will
prove unsuccessful.77
  It must be confessed, however, that, although chorea
may frequently, perhaps generally, have its origin in the
alimentary canal, yet  we  sometimes meet with cases
which do not seem to depend upon causes seated in the
abdominal viscera, or which, at least, do not yield to a
course of purgative remedies.  I have seen two cases in 
CATHARTICS.                  115
 which purging was  practised copiously and regularly
 for a reasonable length of time, with no alleviation, but,
 on the contrary, with a manifest aggravation of the con-
 vulsive motions of the patients.   One of these patients
 was finally cured by  tonics and  antispasmodics ;  the
 other  did not recover.  I have, however, seen other
 cases, both in my own practice and  in the practice of
 other  physicians, which were effectually cured on  the
 plan recommended by  Dr. Hamilton.   I am, therefore,
 fully persuaded, that although this mode of treating the
 disease will not always succeed, it  holds out a more
 certain and rational prospect of success  than any other
 treatment with which we are at present acquainted.
   Respecting the employment of purgatives in the treat-
 ment of tetanus, no very satisfactory results have been
 obtained.  When this disease arises from general causes,
 or, more properly speaking, when it does not depend on
 any local  mechanical injury,  it would seem, from the
 reports of Drs. Hamilton and Burns, to  be occasionally
 remediable by the vigorous employment of purgatives.
 In the treatment of trismus nascentium, or the locked-
 jaw of infants, purging has  also been successfully em-
 ployed.   Dr. Chalmers says, " I have cured one case of
 the jaw-falling of infants, by purging with an infusion of
 rhubarb, to which a few grains of musk  and a little ol.
 tart. per. deliq.  were added."*   When once  formed,
 however,  this disease  of infants is but very rarely cured.
 I know of no authority for the assertion made by Dr.
Chapman, that " the  utility of purging is  indisputably
established in trismus nascentium.77  A very few solitary
cases appear  on record, in which these remedies were

  *  London Medical Observat. and Inquiries, vol. i. p. 109. 
116
CATHARTICS.
employed with seeming success ;  but their utility is far,
I  am  sorry to say, very far from being " indisputably
established77 in this fatal variety of spasmodic disease.*
   In the treatment of marasmus, a disease unequivocally
and essentially connected  with  morbid derangement of
the digestive organs, purgatives constitute  our most im-
portant remediate  resources.  In the first  stage of this
disease,  which, according to Hamilton, extends from its
commencement to  the accession of the febrile symptoms,
and in which  " the bowels  are not altogether  torpid,
neither  are  they overloaded with  accumulated  faeces,
mild purgatives will, in general, effect a cure.77   When,
however, the disease has advanced  into the second,  or

   *  The following observations on spasmodic diseases are quoted
by Dr.  Hamilton from Camper's  Anatomico-Pathological Demon-
strations.
   "Nervis descriptis  ad symptomata accedo, quae exeorum unioni-
bus  facile explanatur;  Ordiar autem a pedum tremor,  qui  hys-
tericis  familiaris est.  In antecessam vere monere  debeo, omnia
terribilia  hysterica symptomata, quae turn in singulis, turn  in uni-
versi corporis  locis quotidie videmus,  ab acrimonia putrida pri-
mas vias occupante omnino dependere ; excrementorum enim fetor
intolerabilis, fauces, et  alia qua  praeter naturam  sunt, rigorum et
 convulsionum  accessum annuntiant.   Res igitur  ita  se habere
 videtur;  plexu mesenterico inferiori affecto,  nervi omnes  cum
 eo conjunct!, lumbales  scilicet, et proinde crurales, atque obtura-
 tores nervi afficiuntur. Si acrimonia tanta est ut etiam rectum intes-
 tinum irritare queat, nervi Ischadici in concensum trahentur,  rige-
 bitque pes integer, concucietur, et per vices quiescet, donee animi
 deliquium tumultum sedet.
    " Infantum  infenorum exhemorum convulsiones, ex ascaridibus
 rectum intestinum occupantibus, hanc theoriam confirmant.
    " Purgantia, etiam drastica licet imprudentur abhibita, propterea
 forsan, epilepsia spurias, choream sanctiviti,.aliosque spasmodicng
  sanarunt morbos qui  desperati a rqfidiris habebantur" 
CATHARTICS.
117
febrile stage, more active  aperients must  be regularly
and perseveringly employed.  For  this purpose, Dr.
Hamilton recommends the exhibition of small, but fre-
quently repeated doses of the purgative medicines; "so
that the latter dose may support the  effects of the pre-
ceding ones. When the bowels are once opened, stronger
purgatives, given at longer intervals, will accomplish the
cure."   In  my own  practice I  have obtained the hap-
piest results from the continued  employment of purga-
tives,  together with a light but nourishing food, in the
treatment of this disease.
  Dr.  Hamilton speaks favourably of the use of purga-
tives in the  treatment of chlorosis.   " The slightest at-
tention to the history of the disease,77 says he, " evinces
that costiveness proceeds and  accompanies the  other
symptoms.  Costiveness induces the feculent  odour of
the breath, disordered  stomach,  depraved appetite, and
impaired digestion.  These preclude a sufficient supply
of nourishment,  at a period of growth, when it is most
wanted; hence  paleness, laxity, flaccidity, the nervous
symptoms, wasting of the muscular flesh, languor, debili-
ty,  the retention of the menses,  the suspension of other
excretions, serous effusions, dropsy,  and  death.77  He
accordingly recommends purgative medicines, until the
bowels are well  emptied, after which he has  recourse  to
tonics.   I have never used purgatives in this disease, nor
am I disposed to employ them to the extent recommend-
ed by  Dr. Hamilton.   The costiveness, as well as the
amenorrhoea, is, I think, in some instances at least, the
consequence and not the cause of the general debility
and torpor of the system.  There can be no doubt, how-
ever, that these  effects  may, of themselves, contribute to
keep up that  state of the general system  which in the 
118
CATHARTICS.
 first place produced them.   And hence, although pur-
 gatives will be proper, to remove at least one of these
 symptoms, namely, constipation, still, our main depend-
 ence ought^to be  placed on  the employment  of  tonics,
 nourishing diet, and exercise.   The same author speaks
 in very high terms of the employment of purgative me-
 dicines, in that variety of vomiting of blood which "at-
 tacks females  who are from  eighteen to thirty years of
 age." The attack of this variety of haemorrhagy " is pre-
 ceded by great languor and oppression,  both  about the
 chest and the praecordia; and by a sense of fulness of the
 praecordia; by cough, dyspnoea, and sometimes by pain
 of the breast; by  loss of appetite, headach, vertigo, and
 disturbed sleep ;   the eye is dull, the countenance is ex-
 pressive of much  distress, the pulse is feeble, and the
 bowels are  constipated." " In  this state of  impaired
 health, a particular fit of sickness and nausea is the im-
 mediate forerunner of the  attack  of the vomiting  of
 blood.77  I have in a few instances known very conside-
 rable advantage to result from free purgation in this af-
 fection, where it  was connected with a loaded state of
 the bowels.  Dr.  Hamilton speaks strongly in  favour
 of this practice.   " My success," says  he, " has been
 so uniform, that I now; lay it down as a certain position,
 that the proper exhibition of purgative remedies affords
 sure and  effectual  means  of removing the vomiting of
 blood which I speak of."
  Cathartics have long been  considered as important
 remedies in the cure of dropsies.   As I shall, however,
 have occasion to speak more particularly on this sub-
ject when I come,  to treat of cremor tartar and  elate-
 rium, it will be unnecessary to dwell particularly on this
 point in the present place. 
(   119  )
            OF THE PARTICULAR CATHARTICS

                RADIX  JALAPiE—JALAP.

   Jalap is the root of the  Convolvulus Jalapa, a pe-
 rennial  plant, indigenous to the southern parts of the
 United  States, Mexico, and some of the West  India
 Islands.  It is  brought to us, either in transverse  slices
 or in pieces of a pyriform shape;  these  are compact,
 solid, and heavy; rugous and blackish externally, and of
 an obscure gray colour internally.*  When powdered,
 it has a peculiar and  somewhat  nauseous odour, and a
 slightly acrid  and sweetish taste.   It contains a large
 proportion of resin, upon  which its purgative powers
 seem entirely to depend.  It contains also a gum, which,
 though almost  wholly  destitute of  laxative  properties,
 is extremely active as a diuretic, and some extractive
 matter, with fecula and salts, enter into its composition.
 It appears  that a combination of the resinous, gummy,
 and extractive  principles of this root, " is requisite for
 the production of its full cathartic effect;77  and hence,
 proof spirit is its proper menstruum.f
   Jalap is  commonly  given in  the form of  powder.
 From twenty to forty grains may be given at a dose, ac-
 cording to  circumstances.   In combination  with calo-
 mel it forms one of the mildest and most effective purges

  * Jalap is sometimes mixed with briony root; but this may be
readily distinguished from jalap by its pale colour, its spongy tex-
ture, and its greater lightness  and  bitterness, and by its not burn-
ing so readily when held to the flame of a candle.—Burdach.
  | Paris. 
120
JALAI".
with which we are  acquainted.   This  Combination fe
particularly applicable, when we wish  to emulge the
biliary organs, to excite the healthy  functions of the
liver, and to produce prompt and copious alvine evacua-
tions.  Hence calomel and jalap are very generally pre-
ferred to the other purgatives in the treatment of bilious
fevers, jaundice, hepatitis, &c. The proportion in which
these two substances may be combined  varies considera-
bly.  About ten grains of the former with fifteen of
the latter, forms a very  suitable mixture.
   A combination of jalap and  cremor tartar, in the
proportion  of about twenty-five grains of the former,
with forty to sixty of the  latter, forms an  exceedingly
useful cathartic in dropsical cases.  It powerfully ex-
cites the intestinal exhalents, causing them to pour out
large quantities of serous fluid,  in consequence of which
it produces very copious  watery evacuations.  It is on
this account too, that this combination  forms a peculiar-
ly efficacious cathartic for reducing local inflammations;
such as that of the hip  disease, ophthalmia, &c.;  for it
not only abstracts copiously from the general  circula-
tion, but also excites a strong afflux to  the intestinal ex-
halents,  and thereby diminishes the  determination of
the circulation to the parts affected.
   Dr. Aiken  asserts that fifteen grains of jalap, given
in union with two or three grains of ipecacuanha, will
purge more promptly and actively than twice this quan-
tity of jalap given by itself.  The officinal preparations
of this  substance are:  the pulvis jalapx compositus;
 extract jatapse;  iincturajalapse; tinctura sennse com-
posita.  The  Prussian Pharmacopoeia  contains a for-
 mula for preparing the sqpojalapinus, which is said to 
JALAP.
121
 operate mildly and promptly.*   The dose of this pre-
 paration is from three  to five grains for children, and
 twelve to twenty grains for an adult.  The  resin  acts
 powerfully, but is apt to produce violent griping pains.
 Its dose is from gr. x. to 9i.   It should be well rubbed
 up with sugar or vitriolated  tartar, in  order to obviate
 its griping effects.
    The following is an excellent  formula for administer-
 ing this preparation.

   R.—Resin, jalapae     gr. x—xv.
        Vitel. ovi.       Nr. ii.
       Aq. fontanae      5i.
       Syrup. Zingiberis jss.—M. ft. emuls.  To be  taken at
 once.

 Richter was  in the habit of prescribing it as follows:  .

   R.—Resin, jalapse     gr. xh.
       Camphorse, submuriat. hydrarg. aa. gr. vi.
       Mucilag. g. atab. q. s. ut fiant pil. ponder, gr. ii.  Four of
 these pills are to be taken mornings and evenings, in cases requir-
 ing free and repeated purgation.

    The tincture is now but rarely employed, and might
 with propriety be altogether rejected from  our officinal
 preparations  of this article.   It is uncertain in its ope-
 ration, and always causes very severe griping.
   The sapo jalapinus, in combination with other aperi-
 ent remedies is said to form a very excellent deobstruent

  * This is  made by taking equal parts  of castile soap and of
resin of jalap, and digesting  them in a sufficient quantity of alco-
hol, with a moderate degree  of heat, and  evaporating to the con-
sistence of a conserve.
   VOL. I.—18 
122                     JALAP.
in chronic affections  attended with torpor and a loaded
state of the bowels.  Thus—

  R.—Sapon. jalap.             3*sa«
      Pulv. rhsei.              3i.
      Assafcetid.              3iss-
      Tart, antimon.           gr. iii.
      Mucilag. g. arab.        q. s.  M. ft.  Divide into two
grain pills.  From three to six to be taken twice daily.

   Vogler  recommends a mixture  of eighteen grains of
this preparation in an  ounce  and a half of sweet oil as
a valuable substitute for castor oil.   A table-spoonful of
this mixture is to be given every two  hours until purg-
ing is produced.   In the Polyclinic Institute at Berlin
the following combination has been used with much suc-
cess for the expulsion of tape-worm.

  R.—Terebinth, venetae        3L
       Sapon. jalap.            3ss.
       Extr. hyoscyam.         gr. vi.
       Calomel               gr. viii.
       M. ft. pil. pond.         gr. ii.  Take  four pills every
three hours.*
               RADIX RHEI—RHUBARB.

  There are  two sorts  of rhubarb  met  with in the
shops; the rheumpalmatum and the rheum undulatum.
The former is brought from Russia and Turkey, and is
considered the better sort.   It consists of round, rather
compact and heavy pieces, with perforations [through
* Hufeland's Journal, Bd. 62. St. vi. s. 117. 
RHUBARB.
123
 the middle.   Externally it is of a yellow colour, and, on
 being cut,  exhibits  a variegated appearance, from  a
 number of reddish or white streaks which pass through
 it.   Its taste is slightly styptic, subacrid, and bitterish.
 That which is imported from China consists of long and
 somewhat flat pieces.  It  is heavier and more compact
 than  the Turkey  rhubarb, and  is seldom perforated
 with  holes.   It is also more nauseous to the taste, and
 its  powder has a  deeper shade of red than the  other
 sort.
   Rhubarb contains "gum,  resin, extractive, tannin,
 gallic acid, and a peculiar colouring matter, with traces
 of  alumina and silex."  The white or reddish streaks
 which run through it, consist almost entirely of sulphate
 and oxalate of lime.   It was  supposed to contain a pe-
 culiar  acid,  to which the name of rheumic acid was
 given, but it has been satisfactorily ascertained, that this
 supposed new acid is nothing more than the oxalic acid.
 Rhubarb has been frequently subjected to minute chemi-
 cal analysis.  Pfaff obtained from it what he considered a
 peculiar principle, which he called rhubarbarin*   Ac-
 cording to Henry, it constitutes the yellow colouring
 matter of this root.  It consists of a dark-brown, hard,
 shining opake mass, very bitter and nauseous to the taste,
 and readily soluble in  water.   It does not appear to
 possess any alkaline  properties.   Nani obtained a  sul-
phate of rhubarbarin.\  The Chinese rhubarb contains
 less tannin, resin, and oxalate of lime, but a greater pro-
 portion of extractive and  gallic acid, than that which
 comes from Turkey.   Out of sixty parts of Turkey rhu-
 barb, twenty-four are taken up by water at the tempe-

  * Mat. Med. Bd. iii. s. 23. and Bd. vi. s. 308. Also, Bd. vii. s. 154.
  t Bibl. Universelle, June, 1823. 
124
RHUBARB.
 rature of 212°.   By long  boiling it loses its cathartic
 properties,  but becomes more astringent and bitter.
 Alcohol  extracts  2.7 parts out of  ten.   That which
 comes from  China is, however, more soluble.   One half
 of its weight is taken up by boiling water,; and alcohol
 extracts  four out of ten parts.   " Its  habitudes  with
 acids, alkalies, and neutral salts differ likewise from those
of the Russian variety."*   The active properties of
rhubarb do not, however, appear to reside wholly in the
extractive principles of this  root; or more correctly
speaking, perhaps, they seem, in  part, at least, to con-
 sist in a volatile principle.   This may be inferred  from
the fact,  that the purgative  powers of this root diminish
very materially by age; more especially when it is suf-
fered to  remain exposed for  a long time in the pulve-
rized state.
  With its cathartic properties rhubarb possesses a very
considerable  degree of astringency.  Given  in  small
doses, as from four to {en  grains, it acts as a stomachic
and gentle tonic.   In the dose of from twenty to forty
grains, it operates as a mild and pretty active cathartic;
but, from its astringency, it is apt to leave the bowels in
a costive condition after its operation.  From this union
 of properties, it  is evident that it is not well suited to
the treatment of  inflammatory diseases, nor, indeed, to
 that of any other complaint in which we wish at once to
 evacuate the  contents of the bowels, and to  abstract
 from the general circulation by  means of the intestinal
 exhalents.   It has been much recommended in dysen-
 tery,  and there can be no doubt of its peculiar utility in
 the advanced stages of this complaint;  but in the  com-
* Paris's Pharmacolocia. 
RHUBARB.
125
 mencement of the disease, before the inflammation has
 been considerably moderated by more decisive antiphlo-
 gistic measures, rhubarb is unquestionably an improper
 cathartic.
   On the  contrary, however,  the  very  astringency
 which rhubarb  possesses in common with its cathartic
 properties,  renders it particularly useful in the treat-
 ment  of diarrhoea, and other diseases connected with a
 laxity or debility of the intestinal canal.   It is evident,
 that much advantage is to be derived in affections of this
 kind,  from a remedy, which,  like the present  one, at
 once evacuates the bowels of their vitiated contents, and
 acts upon them as a  gentle tonic.
   In the treatment of indigestion, rhubarb is decidedly
 the most useful purgative we possess.  Where,  from
 debility of the digestive organs, much acid is generated
 in the primae viae, rhubarb may be very advantageously
 exhibited in  union  with magnesia.  In  the diseases of
 infants this medicine  has been long regarded as peculiar-
 ly beneficial.  It is  especially useful,  when combined
 with magnesia, in the griping bowel complaints of very
 young infants.  From one to two grains of rhubarb with
 three or four grains of magnesia, and two or three grains
 of powdered valerian root, rubbed up with a little cina-
 mon-water  and sugar, forms a most excellent medicine
 in cases  of this kind.
   United with aromatics, rhubarb forms a highly use-
 ful aperient  in atonic gout,  attended with  uneasy sen-
 sation  and debility of the stomach.  For this purpose it
 is generally admitted  that Warner7s cordial is an exceed-
 ingly useful preparation.*
  * Rhubarb bruised fi.  senna |ss. saffron 3i. powdered liquorjce
3iv. raisins pounded fti. brandy fciii.  Digest for a week  and
strain. 
126
RHUBARB.
  Externally the powdered rhubarb is sometimes  em-
ployed as an application to  ulcers, for the purpose of
promoting granulations.  It is particularly recommended
by Home* as an application to old and indolent ulcers;
and some have advised it as a useful stimulant to chronic
venereal sores.   If  it produced considerable pain, in
ulcers of this kind, a few  grains  of  powdered opium
should be mixed with it.   I have derived much benefit
from sprinkling indolent chancres with a powder com-
posed of about  a drachm of very finely powdered rhu-
barb with  twenty grains  of calomel and ten grains  of
powdered  opium.  When taken internally its colouring
matter passes  rapidly  through the circulation, and is
soon conspicuously manifested in the urine.   Its purga-
tive effects  are considerably enhanced by uniting it
with neutral salts; " the super- sulphate of potass forms
a very useful adjunct, and its acidulous taste completely
covers that of  the rhubarb.f
   The officinal preparations of rhubarb, are—1. Tinc-
 tura rhsei aquosa.   This  preparation is not introduced
 into the English and American Pharmacopoeia, although
 well  deserving a place among the preparations of this
 article.  According to the  Prussian  Pharmacopoeia, it
 is made by pouring twelve ounces  of boiling water on
 one ounce and a half of the rhubarb with three drachms
 of carbonate of potash, and digesting  twelve hours.   To
  ten ounces of the strained infusion, two ounces of cina-
  mon-water is to be added.  Simply as a purgative,  this
   * Observations on the Practical Treatment of Ulcers, &c.
   | Incompatible substances. " The  stronger acids; the sulphates
  of iron and zinc; nitrate of silver; tartarized antimony ; acetate
  of lead; oxymuriate of mercury; and  the infusions of cusparia,
  cinchona, catechu, galls, and  of some other astringent vegetables;
  the alkalies deepen the colour, but produce no decomposition." 
RHUBARB.
127
preparation does not  possess much  value,  but in the
colic and griping  of infants from-acidity in the primse
viae, it is a most excellent remedy.   From ten to twenty
drops may be given to an infant.   2.  Tinct. rhsei.  3.
Tinct. rhsei et aloes.   This is an excellent preparation
in chronic hysteria attended with weakness of the diges-
tive powers, flatulency,  and  torpor of the bowels.  It
may also be used with much advantage in amenorrhcea,
attended with a sluggish state of the system, and intestinal
torpor.  The formula is introduced into the American
Pharmacopoeia.   A table-spoonful should be taken two
or three times daily.  4.  Tinct.  rhaei et  gentianse,
(Am. Pharm.) is valuable in indigestion, from mere gas-
tric  debility.   5.  Syrupus  Rhsei.  6.  Pilulx rhsei
 composit. (Ph. Edinb).   It may be advantageously used
 in cases of amenorrhoea,  attended with general relaxation
 and torpor of the bowels.
                        Formulse.
   R.—Rad. Rhaei            3ii.
       Rasur. liq. quass.       3SS-—Digest for twelve hours with
 5v. of boiling water.   Strain and add, tinct.  aromat.  3i- syrup,
 cort. aurant. ^ss. M.  A table-spoonful  of  this infusion may be
 taken every three hours, in  cases attended with much debility and
 relaxation where it may be thought necessary to keep up a moderate
 action of the bowels, and to  increase the tone of the stomach.
   R.—Rad. rhsei       3'ss-
        Rad. ipecac.      5SS« Boil them in three ounces of water
 about fifteen minutes, then strain and add, pul. gum arab. 3iii. M.
 A table-spoonful of this  decoction taken  every two or three hours
 will often prove highly serviceable in mild cases of dysentery (Jahn,
 Richter.)
   R-—Tartrate of potash.
       P. cort. aurant.
       P. rad. rhaei.
       P. sen. foenical aa 3»-
       01 cajeput gtt. viii. M.—A tea-spoonful of this mixture is an
 excellent remedy in habitual torpor of the bowels.   This i3 the so-
 lamen hypochondriacum of Klein. 
(■  l*8  )
             FOLIA SENNjE—SENNA LEAVES.

    The senna of the shops, according to the observations
 of Nectoux, is furnished by three different plants:  the
 cassia senna, the cassia lanceolata, and  the cynanchum
 olesefolium.  The leaflets of the cassia senna (known
 in Egypt by the name of senna bellidy,) are  obtuse, oval,
 unequal at the base, somewhat thick, and supported on
 footstalks destitute of  glands.   The pods of this species
 are compressed oval, sickle-shaped, and marked on each
 side with small longitudinal elevations, corresponding in
 situation with the seeds they contain.   The  leaflets of
 the senna lanceolata of Lamarck, which is  known to
 the inhabitants of Egypt by the name of senna quebelly,
 may be distinguished from those of the former by being
 more acuminate, or lance-shaped, and having a  small
 elevation or gland at the base of the footstalk.   The
 pod of this species is very flat, oval, oblong, and not
 curved.  The leaves of cynanchum olesefolium, (arguel,)
 known in commerce by'the name of  senna Mekki, are
 very often found mixed with those of  the two species of
 senna ^ust described.   They may, however, be detected
 by their greater length, and especially by being covered
 with a long down.*  Of these the cassia lanceolata, or
 as it is commonly called, the Alexandrian senna, is re-
 garded as the most valuable.   It does not appear, how-
 ever, that the leaves of the cynanchum olexfolium, are
 in any degree  inferior as a cathartic to the  "best senna.
 Mr. Nectoux  observes  that the  arguel (cynanchum

  * The senna of  the shops is sometimes adulterated by the leaves
of coluta  arborescens.  These are, however, easily  distinguished
by being conspicuously cordate, and notched at the points. 
SENNA LEAVES.
129
   oleaefol.)  possesses properties equal to those of good
   senna;  he even holds it as being preferable to either of
   the species of  cassia;  an opinion which he predicates
   upon the  experiments  made  with it by Dr. Pugnet, as
  well as upon the  testimony of the inhabitants of those
  parts of Egypt from which it is brought.
    According to an interesting analysis of senna, made
  by M. Bouillon Lagrange, it appears: 1.  That the watery
  extract of senna is almost  entirely  soluble in alcohol,
  and that the part thus soluble is not a resin, as has been
  supposed, but a substance which requires  simply the
  addition of a certain  portion  of  oxygen to  convert  it
  into a matter which has all the characteristics of resin.
  2.  That the part soluble in water contains  sulphate  of
  potass, potass,  carbonate of lime, magnesia, silex, &c.
  together with that substance, which I  have just said is
  connected with a  matter possessing the character  of
  resin by uniting with a portion of oxygen, and to which
  senna seems to owe its purgative  qualities.   It appears
  also that this peculiar substance  has a very strong affi-
  nity for oxygen; and hence we see the propriety of the
 caution given by Dr. Paris,  that  the  infusion of  senna
 should never be suffered to stand long before it is taken,
 "since, by simple  exposure to the air  for  only  a few
 hours, in consequence of the powerful affinity of its ex-
 tractive matter  for oxygen,  a yellow  precipitate  takes
 place,  and the  infusion  loses  its purgative  quality."
 "In  preparing  it, therefore,77 he adds, "we see the
 necessity of conducting the  process in covered vessels,
 and of making only such a portion as may be required
 for immediate use.77*  The  senna has been  more re-

  * M. M. Lassaigne and Fenuelle, have lately succeeded  in se-
parating the active principle of senna in a pure state, and to which
   VOL.  I.—19 
130
SENNA LEAVES.
cently subjected to a minute chemical examination by
Lassaigne  and  Fenuelle.*  Besides a fatty matter, a
small portion of an ethereal oil, albumen, a yellow co-
louring matter, malic  acid,  and various saline  substan-
ces, they detected in the senna chlorophyll, or the prin-
ciple that gives to vegetables their green colour, and a
peculiar  substance, obtained in the  form of a yellowish
red mass, of a nauseous smell, and extremely bitter taste,
to which the  name  of cathartine  has been given, and
in which the purgative properties of this vegetable ap-
pear to reside.
   Senna is hardly ever employed as a cathartic, except
in the form of an infusion.  In order to divest it of its
griping quality, which it possesses  to a very considera-
ble degree, it is commonly mixed with other substances,
such as manna, coriander, fennel, or anise  seeds.   For
this purpose,  however,  the best adjuncts are soluble
tartar and alkaline salts,  which have the power " of  in-
 creasing the  solubility of its oxidized extractive.77  A
 decoction of guaiacum is said to increase its powers and
 to render its operation milder. f$

 they have given the name of cathartine.   This principle does not
 crystallize; it is of a reddish yellow colour, and has a peculiar
 smell and a bitter and somewhat nauseous taste.   It is soluble in
 alcohol and  water in all  proportions, but  insoluble in ether.   The
 extract attracts  the humidity  of the  atmosphere and becomes moist
 when exposed.   It is powerfully cathartic.
    * Richter's Specielle Arzneimittellehre, Bd. 3. 2. p. 326.
    t Paris's Pharmacologia.
    X The infusum sennas limoniatum, is a  very convenient mode of
  exhibiting this medicine to children.  It is made by pouring six
  ounces  of boiling water upon  ^ss. of fol. senna, 3iL lemon peal,
  and 3ii« lemon juice.
     The infusum laxativum viennense, is also an excellent preparation. 
SENNA LEAYES.
131
  It appears to be  particularly well adapted as a pur-
gative in cases attended with much torpor of the bowels,
unconnected with irritation or phlogosis of the mucous
membrane of the alimentary canal; and  where we de-
sire to make a strong impression on the intestinal nerves,
as in cases  of hemiplegia, apoplexia, &c.  In  indivi-
duals of  an  irritable habit, where there is a predisposi-
tion to bowel complaints; and in general in all affections
attended with an excited state of the intestinal canal,
this purgative must be avoided.   It may be beneficially
used  in  those cases of  general depression which  arise
from  irritating matters in the bowels, soon after parturi-
tion,  and which sometimes give rise to symptoms resem-
bling puerperal fever.
   It  is  observed  by Alibert, on the  authority of M.
Bouillon Lagrange, that the powdered senna is very apt
to undergo alteration or decomposition, from being suf-
fered to  remain exposed to a humid  atmosphere.  In
such  a situation it becomes covered with a kind of pel-
licle, or  mouldiness, which  contains a small portion of
potass.   The powder, however, is but very seldom em-
ployed,  except in the form of  an  electuary in combina-
tion with other purgatives.  " The infusion is disturbed ,
by strong acids, lime  water, nitrate of silver, oxymu-
riate of  mercury, acetate of lead, tartarized  antimony,
and by the infusion of  yellow cinchona.77
   The officinal preparations are: 1. Electuanum leni-

It is made thus: folior. sennas 3ii. cremor tart. 3iss. pulv. rhei. 3i-
sem. coriander 3'ss- mannae §i. aquae ferventis  |vi.  Digere per
4*. horas.
  Selway's prepared  essence of senna.—" This is a concentrated
infusion of senna in combination  with an alkali.  It is admirably
adapted for domestic use."—Paris. 
132
SENNA LEAYES,
 tivum, an  excellent composition  in cases  of  habitual
 costiveness.  2.  Tinctura  senna.  3.  Tinctura sennse.
 compositum, of the London Pharm.
                        Formulse.
  R.—Electuar. lenitiv.        %\i—x'
      Acid, tartar.            5ii—9iii.
      Sachar. albi            5ii.
      Aq. flor. aurant.         5ii.
      iEther acet.       scruple ss.  M.  ft.   Of this a table-
spoonful may be taken every hour or two.  It is a mild and most ex-
cellent laxative, and may be given with peculiar advantage in weak
and irritable habits.  I have employed it much in practice, and es-
teem it particularly valuable in weak and nervous persons affected
with torpor of the bowels and haemorrhois.  It is strongly recom-
mended in cases of this kind by Heim.*
                 GAMBOGIA—GAMBOGE.

   This gummy resinous substance  is furnished  by the
staligmitis cambogioides, a tree of middling size, indi-
genous to the kingdom of Siam and Ceylon.   It  con-
sists of small, irregular, solid lumps, of saffron yellow
colour, breaking with a shining  or vitreous  fracture.
When  moistened it assumes  a beautiful bright yellow
colour.  It is destitute of odour, but has a slightly acrid
taste.   It consists of one portion of gum, four of a very
brittle resinous  matter, and a portion of a peculiar sapo-
naceous principle.   Neither water nor alcohol dissolve
it entirely; unless potash be added to the water, or am-
monia to the alcohol.   In a solution of caustic potash it
is readily and wholly dissolved; the solution has a beau-
* Rust's Magazin, Bd. 3. p. 308. 
GAMBOGE.
133
 tiful red colour, and may be mixed with water and alco-
 hol without becoming turbid.
   Gamboge acts very powerfully both as a cathartic and
 an emetic, and is, in consequence, condemned by some,
 as apt to excite violent and  dangerous hypercatharsis
 and vomiting.  Others, on the contrary, speak strongly
 in its favour,  and  represent  it as a mild,  certain, and
 safe cathartic.  Dr.  Ferriar, especially, recommends it
 as one of the  gentlest and most certain of our purgative
 remedies.  " After a long  and extensive experience,77
 says he, "of  the  qualities of gamboge, I  can  recom-
 mend it as one of the gentlest, most certain, and least
 nauseous laxatives in  the materia medica.   Being nearly
 free from either smell or  taste, it is particularly well
 adapted to the  management of children, with whom its
 anthelmintic  power is likewise  valuable.77*  It seems,
 however, to be  generally allowed, that its  action is too
 powerful for the ordinary purposes of purgative reme-
 dies; and, unless as an adjunct to  other substances of
 this class, it  is, at present, but  seldom employed in
 practice.
   Gamboge has been a good deal employed in dropsy.
 By proper management, it is undoubtedly a medicine of
 considerable value in this  disease.  It is particularly a
 useful hydrogogue in ascites, attended with a sluggish
 state of the system.  In cases accompanied with a ge-
 neral irritable and phlogistic  habit, it will rarely ope-
 rate favourably; and it  is  particularly  to  be avoided
 where there are any evidences of the existence of high
irritation of the mucous membrane of the alimentary
canal.  For this purpose it is commonly given in union
* Medical Histories, p. 270.  Philad. edit 1816. 
134
GAMBOGE.
with  cremor  tartar,  in  the proportion  of  about two
grains of the  former  to half an ounce of the latter for
a dose.   Large  watery  stools  and an increase of urine
are generally produced by the operation of such a dose.
Dr. Ferriar relates several  remarkable instances of the
efficacy of gamboge in dropsy, given in union with the
nitrous or vitriolic ether.  He directed  five grains of
gamboge with two drachms of spiritus setheris vitriolici,
in a draught two or three times a week.   This compo-
sition acted as a gentle purgative, and considerably in-
creased  the urine.   " When there is imminent danger
of suffocation,77 says Dr. Ferriar, " from the quantity of
water effused in hydrothorax, I have frequently given
immediate relief by the  following purgative draught.*
A draught of this kind  may be given twice or thrice a
week, in such cases, while the cremor tartar and diuretic
dropsf are employed in the intermediate days.77  An
excellent mode of giving this  article in  dropsical and
other affections, is, a solution of it in the liquor potass.
carbonici, in the proportion of a scruple of the gamboge
to  half an  ounce of  the latter.  Of this solution from
thirty to forty drops may be given  three or four times
daily.

   * R.—Cambog.          gr. iv.
        Sp. aether nitros.   %i.
        Tinct. senn.       3U-
         Syrup rhamni.
        Ag. menth. aa      §ss.   Misce.
   | R.—Oxymel. colchi.
                scill.
         Tinct. nicotian.
         Sp. aether, nitros. 52, p. ae. M.
  Capiat cochleare parvulum, ex aquae pauxUlo, quater in die. 
GAMBOGE.
135
  Gamboge has also been frequently employed with ad-
vantage for the  expulsion of  intestinal worms.   It has
been especially recommended against the tape-worm ;
and as an active cathartic, either after the exhibition of
more direct anthelmintics, or independent of such reme-
dies, there can be no doubt of its occasional beneficial
operation in such cases.
  Given in minute doses, such as do not produce either
vomiting or purging, this remedy is said to be'servicea-
ble, as a stimulant, in chronic rheumatism, asthma, and
particularly in exciting the activity of the portal circu-
lation.*
  Its great solubility increases its tendency to act upon
the stomach and to excite vomiting.   This effect is ac-
cordingly much diminished by giving it in combination
with other substances, which lessen its solubility,  and
hence,  the addition of a portion of aloes to it (as in the
pil. cambogias compos.)  renders it  a very mild  and un-
irritating purgative.
  To obviate its tendency to produce vomiting Dr. Cul-
len prescribed it in small doses, and repeated it at short
intervals until purging was produced.   Dr. Ferriar, in
his Medical Histories, says: "a very commodious form
for exhibiting gamboge, is a solution in distilled water, in
the proportion of half a  grain to half an ounce of water.
A table-spoonful may be given to an adult, every hour,
till it operates.   A tea-spoonful of this solution, given in
the same way, is a dose  for a child under twelve years
of age.  When given in this manner,  doses of seven or
eight  grains  have been found  necessary to move  the
bowels, and it has proved strongly diuretic.77

          * Burdach's Arzneimittellehre, Bd. iii. s. 66. 
  136                   GAMBOGE.

                        Formulce.
   R.—G. gambogiae                 9i.
       G. arab.                     3'-
       Solve in aq. fontanae           ^iv.
       Adde potassae carbonat.         5SS-
       Syrup limonis 5ss. M. ft.—Take  a  table-spoonful every
 two or three hours.
   R.—G. gambogiae.
       Sulph. aurant. antimonii.
       Ext. scillse.
       Extr. hyoscyam. aa tyi.  M.  ft.—Divide into two  grain
 pills.   Take one pill every three hours, as a hydrogogue in dropsi-
 cal affections.
   The sapo G.  guttse of the Germans, is said to  be a
 very excellent hydrogogue preparation.   It is made by
boiling six ounces of gamboge with three drachms of
 caustic potash in nine ounces of water,  until they begin
 to unite; and then adding two and a half drachms more
 of caustic potash dissolved in four ounces  of water  and
 simmering the whole until  it  has acquired the consist-
 ence of a soap.  From twelve to twenty grains of  this
 mass is said to operate copiously, without  exciting  the
 severe tormina so apt to be produced  by this article.
              ALOES EXTRACTUM—ALOES.

   We meet with three  varieties of  aloes in the shops.
1. The aloes spicata or socotorina. 2. Aloes vulgaris, or
hepatica.  3. Aloes caballina, or horse aloes. The aloes
socotorina is imported in small pieces from the island of
Socotora, in the Indian ocean, and is much purer than
the other two varieties.  It is of a reddish brown colour, 
ALOES.
137
 with a faint purple cast, slightly diaphanous when broke
 into thin pieces ; and when pulverized becomes of alively
 yellow colour.   The hepatic, or Barbadoes aloes, is the
 product of the aloe  vulgaris,  a plant which Dr.  Sib-
 thorpe states, in his  Flora Graeca, to be the true  aloe
 described by  Dioscorides.  This variety  of  aloes is
 brought from the East Indies,  but chiefly from  Barba-
 does.   It comes in large lumps, of a brighter brown co-
 lour, and  a much stronger and more disagreeable odour
 than the former variety.   Its taste, too, is almost entirely
 destitute of the aromatic flavour which accompanies the
 bitterness of the  socotorine aloes.   The caballine or
 horse aloes, is the most impure of the three species, and
 may be easily distinguished by its peculiar rank smell.
 In other respects,  however, it differs  but little from the
 hepatic aloes.
   According to the analysis of Tromsdorff,  socotorine
 aloes consists  of twenty-five parts of resin and seventy-
 five of a saponaceous  extractive matter, soluble both in
 alcohol  and in water; a slight trace  of gallic acid may
 also be detected in it.  This saponaceous extract is in-
 tensely bitter, and possesses a faint odour resembling, in
 some degree,  that of saffron.  The resinous matter is
 not  very bitter, and  possesses but feeble powers as a
 purgative.  Mr. Braconnot, " conceives aloes  to be a
 substance sui generis," which he terms, " bitter resin."
   Aloes is but very slowly and  sparingly dissolved  by
 cold water. Boiling water dissolves it readily, " but, on
 cooling, a precipitation ensues.77   Long boiling deprives
 it entirely of its purgative properties.   Its appropriate
 solvent,is proof spirit.  The solubility of aloes.is increas-
ed " by alkaline salts and soaps,  but by such a  combina-
tion aloes undergoes a material  change in its medicinal
   vol. i.—20 
158
ALOES.
properties;  the bitterness is  diminished, its purgative
effects impaired, and it ceases  to  operate specifically
upon the large intestines, a fact so far valuable as it ena-
bles us in certain cases to obviate  its irritating action
Upon the rectum.77*
  Aloes is a slow, stimulating cathartic,  exciting a sen-
sation of warmth in the stomach  and bowels, and direct-
ing its operation more especially upon the lower portiort
of the intestinal canal. This latter circumstance depends
on  its  great insolubility,  in  consequence of which it
passes  through the stomach  and small intestines before
it has had time to dissolve, and,  therefore, to act upon
them.  Being, however, at last dissolved in its progress
through the large intestines, it acts upon them with con-
siderable force,  and  produces free evacuations.   Dr.
Cullen observes, that aloes  evacuates the bowels simply
by exciting the peristaltic action of the intestines, with-
out increasing materially the intestinal secretions, as is
evident from the  state of the evacuations, which are
hardly ever liquid.
  In consequence of its tendency to act more particular-
ly on the rectum, and thereby create an afflux of the
circulation to the pelvic viscera,  aloes  is a  good deal
employed to promote  the  secretion of the menses;  for
Which, indeed, it seems to be well adapted in cold, phleg-
matic, and costive habits.  This very tendency, how-
ever, renders aloes an improper aperient in persons sub-
ject to hemorrhoidal tumours, or affected with any other
disease of the rectum.
  From its acting in small doses  as a slow aperient, it is
well suited to obviate habitual costiveness.  When em-
* Paiis's Pharmacologia, 
ALOES.
139
ployed with this intention, it is  necessary to avoid a
strong operation, as it is apt, when it acts fully, to leave
the bowels in  a  dry and costive condition.   Given in
small doses, as from one to two grains, it acts  as a tonic
upon the  alimentary canal;  promotes  digestion ; and,
in relaxed and  torpid habits, keeps up the regular pe-
ristaltic action of the intestines;  and it is only when it
produces  this slow but natural action of the bowels,
that it can be employed with propriety in constitutional
costiveness.   It should be recollected, however, that
the habitual use of this aperient, has a very particular
tendency to bring  on congestions in the veins of the
pelvic viscera, and thereby to cause hemorrhoidal tu-
mours and discharges.  Its aperient operation  is not
proportionate to the  size of the  dose given;  four or
five grains will often produce nearly the same opening
effect that ten or fifteen grains will do.  It is, however,
almost always very slow in its aperient effects upon the
bowels.    It  seldom operates before the expiration  of
five or six hours after it is taken, and often not until after
the lapse  of ten or  twelve hours.  In an uncombined
state, indeed, it hardly ever produces large evacuations,
whether it be given in a small or large dose.  In union
with other articles, however, it furnishes us with several
very useful preparations :  viz. pulv.  aloes compos. L. ;
pil. aloes cum myrrha.  L. E.D.; pil. aloes compos.;  pil.
aloes cum asafoetid. E.;  pil. aloes cum colocynth. E.; pil.
scammon. cum aloe. D.; extract, colocynth. compos. L.
D.; tinct. aloes comp. L.E. D.; tinct. aloes setherea E.;
extract, aloes aquosam.
  Individuals of a sluggish and  irritable habit,  with a
slow and languid state  of the circulation, generally bear
this aperient much better than persons of sanguine and 
140
ALOES.
irritable temperaments.   In subjects of this latter habit,
its operation  is apt to leave a dry and irritated state of
the colon and rectum, and consequently protracted con-
stipation.
  Externally, aloes has been used in weakness  of the
eyes, as well as in opacities of the cornea.   Janin speaks
in the  highest terms of the following  collyrium :  R.
vin. alb. lb. i.;  aloes ; tutiae praep.;  croci.  metallor aa
3i.   Put them into a bottle, and digest it in  the sun for
two months.   Reil says that this tincture, diluted with
an equal part of rose-water, forms an excellent wash  for
weakness of the eyes attended  with a  profuse flow  of
tears.    Beer recommends a  salve composed  of ten
grains of sulphate of zinc,  the same  quantity  of the
acetate of copper and burned alum, with eight grains of
aloes and half an ounce of honey, as a very useful appli-
cation for the removal of opacities of the cornea.   It is
to be applied with  a small and  very soft pencil to the
opake part of the cornea.
                        Formula.
  Dinner pills.—Lady Webster's, or  Lady Crespigny's pills.—
These popular pills are the '' piluicc stomachichce, vulgo piluloz ante
ct'6wm," of the  Codex Medicamentarius Parisiensis, cdito quinto,
A. D. 1758: viz. R.  ales opi  mae  5iv. ; mastiches et  rosarum
rubrarum, aa 5H.; syrupi de absintbio q. s. ut fiat massa: the mass
it is to be divided into pills of three grains each. The operation of
this pill is to  produce a copious and bulky evacuation, and in this
respect experience has fully established its value.—Paris's Phar-
macologia.
  R.  Extract,  glycyrrh.  ^:-s. ;  carbonat.  potassae  5U.;  aloes;
myrrhae ;  crocci, aa 3i«  Boil them in a  pint of water down to
twelve ounces; then stein and add,  tinct.  cardamoni. compos.
3iv.   Brand says, that from four to six drachms of this decoction,
mixed with an equal part of some aromatic water and taken every
other  morning, is a most excellent tonic aperient in debility of  the
digestive organs attended with acidity. 
(  141  )
               SCAMMONIA.—SCAMMONY.

   This substance is the inspissated juice of the root of
 the convolvulus scammonia, a perennial plant, growing
 abundantly in the mountainous parts of western Asia.
 It comes to us from  Smyrna and  Aleppo, in  blackish
 gray cakes.   That which is imported from the latter
 place, is purer and better than the Smyrna scammony.
 It has a bitter, subacrid taste, and a peculiar disagree-
 able odour.   When rubbed with water, it forms a milky
 fluid.   Aleppo  scammony, according to the analysis of
 Buillon Lagrange, contains sixty parts of resin, two of
 extractive, three  of  gum, and thirty-five of insoluble
 matter.   That which comes from  Smyrna contains less
 resin but  more gum and  extractive.  Proof spirits is
 its best menstruum; it dissolves all except its impurities.
 Water takes up about one-fourth and alcohol two-thirds.
   Scammony was one of the purgatives employed  by
 the  ancients.  A decoction  of the root of the plant
 which yields it was used by Hippocrates; and it is said
 to be an exceedingly  good purgative when given in this
 way, procuring  free  evacuations, without occasioning
 griping  or any  manner  of sickness.*  During the
 middle ages it was much employed as a cathartic, under
 the name  of diagrydium.
   Scammony is a powerful  purgative.   The accounts
 given  of its  effects by different writers are, however,
very discrepant.   Some  represent  it as  mild and per-
 fectly  safe; whilst  others mention it  as a violent and
 dangerous cathartic.

  * Dr. Alexander Russel, in a letter to Dr. Fothergill.  See Medi-
cal Observations and Inquiries, vol.  i. p. 13. 
142
SCAMMONY.
   Orfila found  ulcers in the stomachs of animals that
had  been killed by scammony.   These  differences in
the action of this remedy, are, however, supposed " to
be entirely owing to the different circumstances of the
patient, and not to any hurtful quality, or irregularity
of operation of  the medicine; where the intestines are
lined with an excessive load of mucus, the scammony
passes through  without acting upon them; but where
the natural mucus is deficient, a small dose of this  or
any other resinous cathartic, irritates and inflames.77*
   Scammony  enters  into the composition of many of
the purgative remedies that have been  recommended
against worms.  It enters also into several useful offici-
nal preparations;  such as the confect. scammon. L. D;
pulv. scammon. comp. L. E; extract, colocynth. com. L;
pulv. sennse comp. L.
   A very good  mode of exhibiting scammony, is to tri-
turate it  with  sulphate of  potass, sugar, or  almonds.
Given in this  way, it operates mildly  and  with consi-
derable promptness.  It may also be very conveniently
exhibited by being  dissolved  in a  strong  infusion of
liquorice, and poured off from the faeces.   The dose is
from three to fifteen grains.\  Much was formerly said
of a preparation into which scammony enters as a chief
ingredient, and  known by  the name  of Count  War-

  * Dr. Andrew Duncan's Dispensatory.
  t Dr. Paris says, that " there is a compound bearing the name
of scammony to be met with in the market which is altogether fac-
titious, consisting of jalap, senna, manna, gamboge, and ivory-black.
Good scammony ought to be friable, and  when wetted with the
finger, it should  lactify or become milky; and the powder should
manifest its characteristic odour, which  has been compared to that
of old ewe-milk cheese.—Pharmacologia. 
SCAMMONY.
143
tvick's powder, or pulv. detritius.  It consists of  a mix-
ture  of sulphureted  scammony,  diaphoretic antimony,
and cremor  tartar.   Ramazzini, Baglivi, Van Swieten,
and  Werlhoff, recommend it as a peculiarly efficacious
purgative in intermittent fevers.
                        Formulx.
  R.—Aloes,  spicat.  9i.
      G. scammon.   gr. xii.
      Extract, rhaei   '^ii.
      Pulv. capsici.   gr. vi.—M.  To be made into sixteen pills.
Two may be taken on going to bed.
  R.—P.  g.  scammon.       gr. v.
      Pulv. rhaei            gr. xv.
      Sub. carbonat. amnion,  gr. v.—M.  To be taken  at once.
  R.—Lactis.  amydalar. dulc.   5iv.
      Rasin jalapae             gr. viii.
      Sacch.  albi.              3vi.
      G. scammon.             gr. vi.—M.  Solve resinam jala-
pae in ovi vitillo, misce scammon. et sacchar. dein adde lac.  amydal.
(Alibert.)
                 COLOCYNTHIDIS PULPA.

   This is the  medullary or pulpy part of the fruit of
the cucumis colocynthis, an annual cucurbitaceous plant,
growiug  in abundance  in  Syria, Arabia, and also in
some parts of Spain.   It is intensely bitter, and  con-
tains a  soponaceous extractive, a bitter resin, gum, and
vegetable fibrous matter.*

  * Dr.  Paris observes, that u when the fruit is larger than a St.
Michael's  orange, and has black, acute pointed seeds, it is not
good." 
144
COLOCYNTHIDIS TULPA.
   This is one of the most ancient purgatives employed
 in practice at the present  day.  The Greek and Ara-
 bian physicians mention it in their writings as a power-
 ful and valuable cathartic.
   It is now but seldom administered in an uncombined
 form, on account of  the great violence of its operation.
 It is  apt to  occasion  extremely  severe  griping; and
 when  given  in very large doses, seldom  fails to pro-
 duce  vomiting, tenesmus,  and other  manifestations of
 high gastro-intestinal irritation.   It appears  to possess
 a particular tendency to act upon and irritate the mu-
 cous membrane of the  lower portion of the  intestinal
 canal.   Orfila says, that he uniformly found the rectum
 in a state  of high  inflammation  and gangrene, in the
 animals which he destroyed with this article.   As a
 hydragogue,  however,  it is still  occasionally given in
 dropsical cases; in one instance of which, I have myself
 prescribed it with great advantage.  Along with  its
very active purgative  powers  colocynth possesses also
a considerable tendency  to excite the  action of the
 kidneys.  Bang recommends a decoction  of it  as  an
 exceedingly good remedy in dropsy; and Hufeland con-
 siders  it as the most effectual  diuretic we possess, in
 persons of a cold and  sluggish  habit of  body.  His
 mode of prescribing it  for this  purpose is, to  boil two
 drachms of the colocynth in a  quart  of beer, down  to
 a pint, of which one or two  table-spoonfuls are to be
taken  every day.*
  This substance has also been recommended in small
doses, in paralysis of the lower  extremities and in her-
petic  eruptions.  It has been particularly  praised as a
remedy in  paralysis of  the  bladder.   Heim, a German
Journal. B. v. p. 65. 
COLOCYNTHiniS PTJLPA.
145
writer, speaks a great  deal in favour of the tincture of
colocynth, in union with tinctura antimonii saponata, in
the proportion of twenty drops of the former to sixty
of the latter every three hours, in cutaneous affections.*
Christien asserts, {Jatroleptik.) that he has found fric-
tions with the tincture and infusion of this article of
especial  service in melancholia, and other  forms of
torpid mania.  The tincture has also  been used with
much benefit in chronic nervous affections, particularly
in such as are connected with a torpid state of the cata-
menial function.   (Dalberg.)
   Colocynth has been a good  deal  employed in  coma
and apoplexy; and, as the beneficial effects of  cathar-
tics in these diseases  depend, perhaps, entirely on the
afflux which they occasion from the head to the intesti-
nal canal, there can be no doubt  that a remedy which
produces such prompt and strong impressions on the
bowels, and  which, therefore, procures  such  copious
watery evacuations as the  present one, is well calculated
to prove beneficial  in affections of this kind.
   The officinal preparations are: extractum  colocyn-
thidis. L. extract, colocynth. compos. L. and D.pillulm
aloes cum colocynth. D. tinct. colocynth. Pharm. Bonis.
Bavar.
   The compound extract of colocynth is a very useful
preparation.  In combination with calomel this extract
forms  one of the most effectual, and at the same time,
mild purgatives with which I am acquainted.   In cases
where we wish at once to evacuate  the bowels  gently,
but copiously, and to correct the functions of the biliary

  * Kolpin iiber die Wiirkung der Tinctura Colocynthidis.—See
Hufeland's Jour, of Pract. Medicine, vol. ii. No. iii. p. 4.
   VOL. I.—21 
146
COLOCYNTHIDIS PTJLPA.
organs, I have found the  pill recommended by Dr.
James Johnson,* a most valuable medicine.
   The dose of the compound  extract  of colocynth is
from ten to fifteen grains.   The colocynth, in substance,
is given in doses of from  five to ten grains.
   The subacetate and  acetate of lead, the nitrate  of
silver, sulphate of iron, and the fixed  alkalies, disturb
its infusion.
                      ELATERIUM.

   This substance is obtained from the fruit of the mo-
 mwdica  elaterium, a  cucurbitaceous plant, growing
 wild in the southern parts of Europe.   The  fruit of
 this plant bears a very  strong resemblance to the com-
 mon garden cucumber; differing from it merely in point
 of size.   " When full  grown it is from  an  inch to  an
 inch and a half in  length, and of proportionate thick-
 ness.  The seeds, which when fully ripe are of a black

                        Formulas.
  * R.—Extract, colocynth. comp.  3'-
        Submuriat. hydrarg.       gr. xv.
        Antim. tart.              gr. i.
        Olei carui               gr. v.—M.   In pilulas,  24
divid.   Take 1,2, or 3.
    B.—Tinct. colocynth.  ^ss.
        Ol.  ricini         ^iss.—M.   Heim  asserts  that  he
has derived great benefit from this mixture, applied by frictions to
the abdomen, in children affected with scrofulous swellings.
  The tincture, according to the Prussian Pharmacopia is made by
digesting one ounce of the colocynth with a drachm of aniseed,
in a pound of rectified alcohol. 
ELATEMCM.
nr
 colour, are lodged in a light green pulp, the interstices
 of which  contain from half a drachm to a drachm  of
 nearly limpid fluid."   This juice, when first collected,
 is perfectly limpid.   On  standing a few hours it first
 becomes turbid, and then gradually lets fall a sediment,
 which, when  slowly dried, without being exposed to a
 strong  light, has a yellowish white colour, with a faint
 shade of green.   This is the pure  elaterium; a sub-
 stance which is decidedly the most powerful cathartic
 we possess.  Its  taste is acrid and slightly  bitter.   It
 appears to be entirely insoluble in water, whether hot
 or cold.  That which is obtained from the spontaneous
 deposition of  the juice, is almost wholly soluble in alco-
 hol ;  whilst, of that which is commonly met with in the
 shops,  not more than  one half,  and  sometimes not
 above a fourth part is dissolved by alcohol.  That part
 of it  which is left undissolved, appears to possess no
 medicinal powers whatever.  According  to the expe-
 riments of Dr. Paris, elaterium consists of water .4,
 extractive 2.6, fecula 2.8, gluten .5,  woody matter 2.5,
 elatin and bitter principle 1.2.
   According  to  the  experiments  of Dr.  Clutterbuck,
 elaterium is almost entirely, if not wholly  confined to
 the limpid fluid contained in the centre of the cucum-
 ber;  for no other part of  the  plant has been found to
 possess active  properties.   It is evident, therefore, that
 the common mode of  preparing this substance, namely,
 by pressing the fruit  and collecting its  ordinary juice
 together with that which  is lodged in the centre, and
afterwards evaporating it, must yield an article of infe-
rior and uncertain powers.  Dr. Clutterbuck  recom-
mends the following method for preparing this medicine, 
148
ELATERIUM.
and its superiority  over the modes usually adopted is
manifest.
  " The cucumbers should be gathered when as nearly
ripe as possible, and without violence, that might  en-
danger their bursting.  They should then be wetted by
the affusion of cold water, that less of the juice, when
they are cut, may  adhere to the external surface.  In
this state they should be cut through longitudinally, and
the juice  allowed to strain through a fine sieve  placed
in a large earthen vessel.  The seeds  and  surrounding
pulp should be scooped out upon the sieve, and washed
with  repeated affusions of cold water, by which they
will be freed from all adhering juice.   Something will
be  saved also by afterwards rinsing the split cucumbers
themselves in cold water, from which a portion of  ela-
terium may be collected.  After standing a few hours a
sediment is formed, from which the  clear liquor is to
be poured off; it is then to be thinly spread on  fine
linen, and exposed to the air to dry; a gentle warmth
may be employed without injury; but the access of sun-
 shine destroys the fine green colour which the substance
 otherwise  acquires.77*
   Elaterium is a very  ancient  remedy, and  was, for a
 long time, much esteemed as a hydragogue in hydropic
 diseases.  In modern times it had, however, almost sunk
 into  entire  neglect, in consequence  of  its occasional
 harsh and violent operation, until it was again brought
 into notice as a remedy for dropsy, by Dr. Ferriar.   It
 certainly  is a medicine of exceedingly active powers,
 and may readily do mischief if improperly administer-
  ed.   Elaterium, says Dr. Clutterbuck, is, with  the ex-

       * London Medical and Physical Journal, July, 1819. 
ELATEBITJM.
149
ception of arsenic,  perhaps, and the hydrocyanic acid,
the most active article of the materia medica;  and Dr.
Ferriar observes, that " on its first exhibition to a pa-
tient, it is nearly as active and as  dangerous, if incau-
tiously given, as arsenic.77   It is, nevertheless, suscep-
tible  of  such management in  its administration, as to
render it, not only a safe, but a most important remedy.
   " Its powers,77 says this latter writer, " in removing
serous accumulations in the cavities of the human body,
surpass those of any other medicine;  and the astonish-
ing relief which it affords in the  dyspnoea  occasioned
by hydrothorax or ascites, even in persons of the most
advanced  age, must place it in the first class of hydra-
gogues.77  Dr. Clutterbuck  also speaks in the highest
terms of this remedy.   " I know of no medicine,77 says
he, " from which  I have derived greater  benefit, on
various occasions, nor one in which greater  confidence
may be  placed.  Whatever  can be accomplished in the
cure of diseases, by  active purging, may be effected
certainly by this medicine.77
    The sensible effects of this substance  are, excessive
 nausea, copious and frequent watery  stools;  and if the
 dose be very large, vomiting, violent pains in the stom-
 ach and bowels, inflammation of these organs, spasms,
 and death.  Along with its cathartic effects, it excites
 the action of the  heart and arteries, even when  given
 in moderate doses.
    When prepared according to the method of Clutter-
 buck, one-eighth  of a grain will  be  sufficient to pro-
 duce violent purging.  As it is met with in the shops,
 its dose is from one to two grains.   It should, however,
 always be commenced  with in a small dose, as, for in-
 stance, half a grain, and repeated every hour until the 
150
ELATERIUM.
 desired effects be produced.   Dr. Ferriar  states, that
 he generally gave it in union with some diuretic, when
 employed in dropsy, and commencing with a very  small
 dose, sometimes carried to the extent of six grains a day.
                        Formula:.
  R.—E. elaterii             gr. iii.
      Spir. nit. dulc.          3U*
      Tinct. scillae
      Tinct. colchici      aa  3SS.
      Syrup, rhamn. cathart.   §ss.—M.  Chisholm  has  found
this mixture highly serviceable in ascites.  He gave a tea-spoonful
every six hours.   (Lond. Med. Repos. March, 1824.)
 Or, according to Dr. Ferriar,
  R.—Extract,  elater.    gr.  i.
      Spir. nit. dulc.      ^ii.
      Tinct. scillae
      Oxymel  colchic.  aa 5ss.
      Syrup, rhamni      fi.—M.  Take one drachm  three or
four times daily.
  R.—Ext. elateri.      gr. ii.
      Pulv. sacch. alb.  3'i.—M.  Divide into  eight equal parts.
Take one every fifteen minutes until purging is produced.   (Brand.
Mat. Med. p. 483.)
                   CROTON TIGLIUM.

  The oil  which is  obtained  from the seeds of this
plant, has been recently introduced to the notice of the
profession, as one of the most active purgatives known.
It is generally  supposed to be a new remedy, but this is
a mistake;  both  the seeds  and oil were very early no-
ticed and employed in medicine.   Serapion the young-
er, mentions this plant and its seeds.   (De Simplicibus, 
CR0T0N TIGLIUM.
151
  c. 261.) M. Pomet, chief druggist to Louis XIV. in his
  General History  of  Drugs,  speaking of the seeds  of
  Tiglium, says, " the  use of these kernels is  to  purge,
  and it is indeed one of the greatest purgatives we have.77*
  M. Lemary speaks of the oil of these seeds  " as being
  capable of exciting  purging, simply  by rubbing the
  stomach and belly with  it.77| Rumphius, also, speaking
  of this  plant says,  "Olim  grana (tiglii)  per  totam
  Indiam Orientalem crebro in usu fuerat ad lympham
  hydropicum  per  alvum prseprimis eliminandam, in iis
  vero, quorum ventriculus debilissimul emesis subsequuta.
  Fortioribus bina  grana  suflicerunt, aliis granum  unum
  cum semisse.   Variis aliis in morbis in quibus purgantia
  fortiora opportuna videntur, ista in India adhibent.  Et
  hanc quidem  acrimoniam oles ipsi seminis inesse, tam ex
  dictis quam inde apparet, quod olei ex siccis granis ex-
  pressi  gutta  una cum  canariensi  vino capta vulgare
 apud chirurgos in India degentes purgans constituent.7 ":j:
 The seeds are also mentioned  by Dr. Fleming in the
 11th vol. of the Asiatic Researches, as having been for-
 merly  well known and  employed in Europe  as hydra-
 gogue  purgatives.  Bergius, Lour, Linnaeus, and  Bur-
 dach speak of the grana tiglii as powerfully purgative.
   According to the experiments of Dr. Nimmo, alcohol
 of sp. gr. 825, dissolves only a portion of the oil.   The
 part which remains undissolved, is destitute of the cha-
 racteristic  acrimony of the oil, " this  property being
 entirely transferred to the alcoholic  solution, which an-

  * Medical Histories, vol. i. p. 46.
  | Vide Mr. Iliff's Paper, in  the  97th No. of the  London Med.
Repos.
  X Vide Medico-Chirurgical Review for Sept.  1821.   Rumphius
Herb Amboininu, torn.  iv. p. 98. 
152
CR0T0N TIQLIUM.
swers the medicinal properties of the entire oil in a
more certain manner, and unattended by several incon-
veniences formerly experienced from its use.77   The
oil contains forty-five parts of acrid principle, and fifty-
five  of fixed oil.   The acrid principle is united with a
resinous substance, which is dissolved by alcohol, sul-
phuric aether, volatile and fixed oils.*  The oil itself is
converted into a saponaceous mass by means of an alkali.
  This oil is powerfully purgative.   Given in the dose
of from one-half to one drop, it produces  copious eva-
cuations.   Mr.  Iliff, apothecary to the  South London
Dispensary, whose  experience with this remedy has
been very extensive, thinks, however, that it produces
nausea and griping more frequently than has been sup-
posed ; nor does it appear to be uniformly certain in its
operation.  Mr. Iliff  states that he gave nine drops in
a case of apoplexy, in three drop doses, without any
operation  whatever;  whereas  ten grains of calomel,
which was afterwards resorted to, acted briskly .f  This
 accords with my own  experience; and it is now pretty
 generally  admitted to be uncertain in its  operation,
 causing copious discharges in some  instances, whilst in
  others it operates very imperfectly, giving rise to small
 mucous stools  and  extremely  severe tormina.  I have
  myself taken it twice;  in both  instances it operated
  but sparingly, and left a considerable feeling of soreness
  throughout the abdomen.  There are nevertheless some
  writers who speak very favourably of  its powers as a
  purgative.  We have the testimony of Dr. Carter, one
  of  the physicians of the Kent and Canterbury Hospital,
  in  favour of the employment of this article as an active

   * London Medical Repository, vol. xvii.
   t Ibid. 
CROTON TIGLIUM.
153
 purgative.   He  says that he employed it in  seventeen
 cases,  in one  of which  only did  it  fail  to operate.
 Croton oil has been successfully used in maniacal cases.
 Sir George Tuthill, one of the physicians to Bethlehem
 Hospital, has found it beneficial in affections of this
 kind.  It has  also been  used with advantage by Dr.
 Pearson;* and it is said to be an excellent hydragogue,
 and to have proved very  serviceable in hydropic cases.
 Professor Francis of New-York states in a letter to me,
 that " he is induced to pronounce  the oil of croton a
 powerful and certain and  speedy purgative, and free in
 its action from  griping.   In a case of most obstinate and
 very long continued costiveness, he says it effected what
 neither the elaterium,  nor the other  vegetable drastics,
 nor mercury could accomplish.77  He thinks  it will be
 found peculiarly serviceable in habitual torpor of the
 intestinal canal.
   This oil appears to make a very powerful and prompt
 impression  on the nerves.   The editor of the London
 Medico-Chirurgical Reviewf says,  that " cases of tic
 doloureux have been lately relieved,  and even removed,
 by a drop or two  of oil of croton applied to the tongue.
 The effect on the  nerve was almost instantaneous.77  Mr.
 Frost says that  he has  seen instances in which the ap-
 plication  of this oil to the tips of the  fingers " produced
 a sense of numbness in the fingers, hand, and arm, (but
 no local inflammation)  dryness in the throat and head-
 ach, which continued for several hours.7'  It generally,

  * A Sketch of the Botanical Literature, &c. of Croton Tiglium.
By John Frost, Esq.  See London Med. Repos. July, 1822.
  f No. vi. p. 428. New Series.
i  vol. I.—22
6. 
104
CROTON TIGLLUM.
however, produces a very  considerable degree of local
inflammation when applied externally.
  It may be  conveniently given in the form of pills,
made with the oil and crumbs of bread.
  The violence of the action of this oil may be lessened
by giving it in union with  some aromatic, and particu-
larly with any of the volatile oils: viz. oleum, caryophil-
lorum, cinnamoni, &c.   Roasting, or baking the seeds,
previous to extracting the  oil, is said  also to lessen the
violence of its action.   The vegetable acids are likewise
said to moderate its action.*   Dr. Frost  recommends
the following formulae for exhibiting this oil.
                        Formidos.
    R.—01. expres. sem. croton  gtt. i.
        01. caryophiller         gtt. i.
        Confec. rasar.          gr. iv.—M.  Form into a pill.
    R.—-Extract jalapae aquas,   gr. 3ss
        01. croton            gtt. 3.—M.  Divide into ten pills.
Take two every hour until they operate.
    R.—Olei. croton tiglii   gtt. ii.
        Saponis albi.       gr ii.
        G. arab.           q. s.—M.   Divide into four pills.
Take two pills.  (Tavernier.)
              OLEUM RICINL—CASTOR OIL.

  This oil is obtained by expression, or decoction, from
the seeds of the ricinus communis,.a plant which grows
wild in the East and West Indies, and in some parts of
South America, and which  is now cultivated  in this
country.
* Lond. Med. Repos. June, 1822. 
CASTOR OIL.
151
   It is a yellowish .or colourless oil, possessing a faint,
peculiar, sweetish taste, and scarcely any  odour.   On
being swallowed it excites an unpleasant acrid burning
in the throat  and  fauces, which, however, is but very
slight when the oil is fresh and entirely free from ran-
cidity.   It is  wholly  soluble in alcohol  and sulphuric
aither;  and mixes more readily with caustic ley than
any other oil.   These circumstances distinguish it from
the other fat oils, and  enable  us without  difficulty to
detect its adulterations.
   Castor oil is a very  mild, unirritating, but certain  and
prompt cathartic, procuring copious faecal  evacuations,
without appearing to excite the intestinal emunctories,
since it hardly ever occasions any very liquid or watery
discharges.    Where we wish  simply to evacuate  the
contents of the bowels, or avoid costiveness, there is no
article belonging to this class of remedies, so well adapt-
ed as castor oil to answer our intentions.  Independent
of the mildness  and completeness of its  operation,  i%is
less apt than any other  cathartic to leave the bowels in
a dry or costive condition.                          ,
   In  cases of obstinate  constipation, castor oil, though
often insufficient, by itself, to procure adequate evacua-
tions, acts, in  general, with much advantage when given*
some hours after the exhibition of a full dose of calomel,
or calomel and jalap.
   No laxative is more* commonly employed in the treat-
ment of dysentery tMn  this one; and when the stomach
can bear it, it is, without doubt, a very important reme-
dy.   " Oleum ricini,7' says Dr. Bampfield, " is, perhaps,
better calculated to afford relief in  dysentery than any
other aperient  or cathartic; for its action  is not only
mild  and generally effectual, but I have observed, that 
156
CASTOR OIL.
 some of it passes undecomposed, in its oily form, through
 the intestines, and appears on the surface of the excre-
 ment, and hence may serve as a sort of sheather or de-
 fence  to  the diseased  intestines, from the stimulus of
 faeces  and morbid secretions.77
   A common mode of prescribing it in this disease,
 when  there  is much tenesmus and griping, is in union
 with a full dose of laudanum.   Given  in this way it is
 much  less apt to be rejected  by  the stomach, and it
 moreover mitigates directly the sufferings of the patient^
 and loses but very little of its aperient effects.
   Castor  oil  has  also been  much recommended in the
 treatment of  colica pictonum.   It is particularly useful
 in this disease to put the bowels in motion, after large
 doses of calomel and opium have been administered.
   In the form of an emulsion it is a very excellent ape-
 rient for children.
   Castor oil  has  also been  highly recommended as a
 remedy for the expulsion of the tape-worm.  Dr. Odier,
 of Geneva, and Dunant, employed it with much success
 in expelling the unarmed txnia,* and Brera states that
 " it sometimes serves wonderfully well to expel also the
 armed taenia.77!  • After having previously administered
 three drachms of powdered male fern, Odier gave the
 ol.  ricini,  by  table-spoonfuls every  half hour  until  full
 purging is induced.  Brera, however, recommends it to
 be given to the extent of three ounces for a dose.   " In
 my journal,7'  says he, " I have twdfccases of armed taeniae
 expelled by three ounces of this oivtaken by a patient
 during three  successive  days, and by another taken twice
 a day for a week.7'

  * Manuel de Medicine-Pratique, par. L. Odier, p. 225.
  X A Treatise on Verminous Diseased, by V. L. Brera, professor
of clinical medicine at Pavia, p. 234. 
CASTOR OIL.
157
    The celebrated S. G. Vogel has introduced a compo-
  sition which  strongly resembles  castor oil,  and which
  forms an excellent substitute for it when it is rancid. It
  consists of nine grains of resin of jalap, three grains of
  Venitian soap, to be triturated in a mortar with an ounce
  and a half of oil of olives.  The dose is a table-spoonful.
  Dr. Schmitman speaks very highly of this  mixture in
  dysentery.  He says it always allays the pain and severe
  excitement of the intestines, but at the same time gently
  and completely evacuates their contents.*   An ounce
  is a full dose for an adult.    It may in  general be more
  conveniently taken in hot milk than  in any other way.
                          Formula.
   The following is an excellent mode of exhibiting castor oil where
 there is much griping and tenesmus in dysentery.
   R. 01. ricini          3i.
      Yitel. ovi         q. s. tere simul et adde.
      Syrupi papaveris  3''-
      Tinct. opii       git. xviii.
      Aq. fontanas       ^'ss*—^*  ^-  haustus.  To be taken
 at once.
   For children this emulsion will  be found convenient:
   R. 01. ricini             31.
      Sacch. alb.           $i.
      Alburn ovi            q. s. tere simul et adde,
      Gradatim aq. menthie  ^ss.
      Aq. fontanas          5ii.  Dose for a child one year old,
a tea-spoonful every hour.
  R.  Magnesiae alb.  3ss.
      01. ricini       j^i.
      Syrup, limonis rf^ss.—M. ft.   First  triturate  the oil  and
magnesia together, then add the syrup. This forms an elegant  and
highly useful purgative for young children.
  R.  01. ricini   3ii.
     Syrup, rhaei $iv.—M. ft. Dose, a tea-spoonful for an infant.
* Summa Observationum Medicarum, &c. 
C  158  )
                SULPHUR .SUBL1MATUM.

  The sulphur of commerce is extracted  from pyrites
by sublimatk n.   In volcanic districts, it is occasionally
found in a perfectly pure and crystallized state ; and it
exists in a combined state in some animal and vegetable
substances. It is insoluble in water and alcohol, but per-
fectly soluble in both the essential and fixed oils.  Lin-
seed oil is one of its most powerful  solvents.
   Sulphur was much esteemed for its medicinal powers
by the ancients, and continues to  this day to hold a very
important rank among the articles of the materia medica.
When taken in the dose of from  one to two drachms, it
acts as  a  mild and pretty  certain  laxative, producing
one or two copious evacuations, without either heating
the system or griping the bowels.   " These circumstan-
ces,77 says Dr.  Cullen, " render  it a most proper and
convenient laxative;  and were it not for the feetor that
sometimes attends its operation, and is ready to be dif-
fused in  the air around, sulphur would  be one of  the
most agreeable laxatives that could be employed.77
   Sulphur, when taken into the alimentary canal,  ap-
 pears to  pass with  facility into the circulation, as is
 evinced by the sulphurous odour which the breath and
 cutaneous exhalation of those who take sulphur soon ac-
 quire: and also by  the black colour which  polished
 metals carried in the pockets of  such*persons are apt to
 contract.
    As a purgative, sulphur seems  to direct its action
 more especially upon the lower  portion of the bowels, 
SULPHUR STTBLTMATUM.
159
and to excite the activity of the circulation in the por-
tal system of vessels.  It has been accordingly much
recommended in haemorrhoidal affections, more, how-
ever, with a  view of obviating, than of removing the
disease.
  With the view of keeping up a regular action of the
bowels, so as to  procure one  or  two soft  stools daily,
without actual purging, this article, in combination with
cream of tartar will in general answer an excellent pur-
pose, in slight cases of this affection.   In bleeding piles,
however,  and where much inflammation,  or ulcerated
fissures exist, sulphur is by  no means a proper remedy,
and ought to be wholly abstained  from.   Its usefulness
is, in a great degree, confined to the haemorrhoidal habit,
with a tendency to constipation, with the  view  of pre-
venting congestions in the portal vessels, and the conse-
quent formation of varicose  haemorrhoidal tumours.
  The most  important medicinal powers  of this sub-
stance are, however,  those  which it possesses  against
various obstinate diseases of the skin.   Alibert consi-
ders it as the most efficacious article we possess in af-
fections of this kind.   " I  have  used sulphur a great
deal in my practice,77 says he, "and have  removed cu-
taneous eruptions with it, that had resisted all the'other
means known.77   It is observed by the same author, that
persons whose  employment exposes them  much to the
fumes of sulphur, are never affected with chronic cuta-
neous eruptions.  He considers it as particularly effica-
cious in the cure of herpetic diseases.   For the cure of
tinea capitis, too, he thinks that there is no remedy su-
perior to the unguentum sulphuris.   I have, however,
employed the kali  sulphuratum, according to the pre- 
160
SULPHUR SUBLIMATUM.
  scription of Barlow,* with much better effect than the
  simple sulphur ointment.
    For the cure of psora, it is a very common  remedy.
  I have found  Jasser7s ointment, as it is altered in  the
  Prussian Pharmacopoeia, an exceedingly useful remedy
  in this disaarreeable affection.t
    For the cure of  psora in children, Dr. Clark, of Dub-
  lin, recommends a  lotion, made by pouring a  quart of
  boiling water  on an ounce of broken sulphur, and  suf-
  fering it to infuse for twelve hours.  In this  process,
  says Dr. Paris, the water probably takes up a small por-
  tion of sulphurous  acid.
    Munro speaks very favourably of a union of  sulphur
  and  crude antimony  in  chronic  rheumatism ;   and
  Schaeffer,  (Hufeland7s Journal,) strongly recommends a
  a combination of magnesia,  sulphur and nitre, in rheu-
  matic affection of the internal organs, particularly of the
  stomach.   Hufeland asserts, that he  has succeeded in
  keeping off the attacks of gout for years, by the use of
  sulphur and gum guaiacum given in combination, and
  in doses sufficient to procure two or three  alvine eva-
  cuations daily, repeated three or four days in succession,
  once every month.   (Journal B. 14.  St. 1. p. 181.)
    Sulphur has also  been much praised as a  remedy in
  gout and rheumatism.   Barthez, in  particular, com-

   * R.   Kali sulph. (recens. preperat.) %\\\.
         Sapo hispan.               3*-
         Aq. calc.                 fviii.
         Spir. vin. rect.              3ii.—M. fiat lotio. Wash
the head morning and evening.
   t R.   Flor. sulp. gii.
         Sulp. zinci. |ii.
         01. lauri. auxung. porcin. q. s. ut fiant unguent. 
srLPIirR SUBLIMATUM.
16*
mends its powers in the former of these diseases ; in the
chronic form of the latter I have, in several  instances,
derived great advantage from  the  employment of sul-
phur, in combination with guaincum. Its beneficial ope-
ration in these diseases is, no doubt, mainly dependant
on its tendency to  excite the cutaneous exhalents, and
to equalize the general circulation.
   Wedekind, a German  physician  of celebrity, speaks
very  favourably of the employment of sulphur, in the
Jose of twenty grains, with  double the portion of gum
arabic, in the  cure of dysentery.   "The bloody dis-
charges," he says, " together  with tormina and tenes-
mus, often  cease as soon as a few doses of this medicine
have been  administered.77*.  Sulphur has also been re-
commended in  amenorrhea.   Richter observes that it
is especially  useful in cases  where  the menses are sud-
denly  arrested during their  flow, by cold  or violent
mental  emotions;  and in deficient menstruation  with
torpor of the bowels, much benefit may sometimes be
derived from its use, provided the general habit be not
phlogistic.f
   Werlhof recommends the  internal employment of sul-
phur  as a valuable remedy  for  the anasarca, which is
sometimes the consequence of scarlet fever.
   In certain chronic pectoral  affections, also, much ad-
vantage  may sometimes be obtained from the employ-
ment of  sulphur.  In chronic catarrh, attended with a
copious expectoration of  a muco-purulent matter I have
derived  great  benefit  from the mixture recommended
by Engelhard,! according to the first formula mentioned

  * Burdach's Arzneymittellehre, Bd. 111. p.  14.
  \ Richter's Ausfiihrliche Arzneimittcllehre, Bd. 3. p. 423.
  I Dielungens.in ihrreschid formen undZeitraumen, p.97.—1823.
  vol. i. —23 
162
SULPHUR 8UBLIMATUM.
below.  The preparation so highly  recommended  by
Fr. Hoffmann, may also be used with peculiar advan-
tage in chronic  bronchitis.   Formerly I was much in
the habit of employing this  combination, and occasion-
ally with the most decided benefit.   See formula No. 2.
Kopp speaks greatly in favour of a union  of sulphur
and  the extract of belladonna  in hooping-cough;  and
Randhahn(Rust7sMagazin. Bd. 24. p. 493) prescribed,
in this affection, a combination sulphur and ipecacuanha,
in the proportion of  four grains of the former to two
grains of the latter, two or three times daily, with much
benefit.   Herholdt,  Garnett,  and  Hoffmann,  recom-
mend the  use of  sulphur and  pulverized  charcoal in
chronic pulmonary catarrh.
   Sulphur has  also  been especially  recommended in
various blenorrhagic, or chronic  mucous  discharges.
Hermann asserts  that he has known the internal use of
sulphur to produce the  happiest effects in morbid mu-
cous discharges  from the bladder and  vagina.*  Pits-
chaft, an  eminent German writer  of the present day,
states that in catarrh of the bladder, he  has  derived
 important advantages from the employment of a drachm
 of the flowers of sulphur with two  grains of calomel
 twice daily.   (Hufeland7s Journal, Bd.  49.)
   Sulphur is, by many, supposed to have the  property
 of diminishing the salivant effects of mercury, and it is
 accordingly a good deal prescribed for the purpose of
 moderating ptyalism.  I do not believe, from what I have
 observed in my own  practice, that it possesses any vir-
 tues in this respect beyond what may be ascribed to its
 diaphoretic operation.

        * System d. praktischen Heilmittill, Bd. 2. p. 89. 
SULPHUR 8UBL1MATUM.
163
                           Formula.
  No. 1.   R.—Extract, hyoscyam.
               Flor. sulph.
               Extract, glycyrrh.   aa 3i.—M.   Eight grains of
this mixture is to be taken three times daily.
  No. 2.   R.-—-01. amydalar dul.   ^ii.
               Flor. sulph.        3ii.  Boil them gently until
the sulphur and oil are completely united; then add, still keeping
it at a boiling heat,
       Bal. copaiv.         3'-
       01. anise            gtt. xx.
       Spermscceti         9iv.
       Syrup, papaveris    ^ss.—M.  Dose, a drachm three or
four times daily.   (F. Hoffmann.)

             Pulvis liquiritiai compos. Phann. Boruss.
   R.—Pulv. rad. glycyrrhez   ii.
       ---- fol.  sennae
       ----- sem. anise
       Flor. sulph.        aa M.
       P. sacch. albi.         |iv.—M.  This  mixture is  said to
be an excellent medicine in catarrhal aflections.   If febrile irrita-
tion  attends, half an ounce of powdered nitre  should be added.
The dose is a tea-spoonful three or four times daily.
  R.—Phos. sodae
       Magnes. cabon.
       Flor. sulph.
       P. sem. fcenicul.  aa 3ii-
       P. camphora      gr. xvi.—M.   Divide into sixteen equal
parts.   One to be taken every three or four  hours until the bowela
are moderately moved, in hemorrhoidal affections.   (Richter.)
  The formula; for the internal use of this article are given in the
second volume, in  treating of sulphur as a diaphoretic. 
(  1M  ;
                      MAGS ESI A.

   Nature no where presents us with this substance in
a pure state.  It is commonly found in combination with
sulphuric acid, from which it is separated by precipitat-
ing it from its solution by potash.
   Magnesia is a white and very light earthy substance,
having a specific gravity of 2.3.  It converts very deli-
cate blue vegetable colours to a green ; ib very sparingly
soluble, requiring two thousand times its weight of water
to hold  it in solution.  The solutions of alkaline carbo-
nates dissolve  it;  but those of the caustic alkalies have
no action on it.  It increases the solubility of camphor,
opium, and resins, in water.* It combines with  sulphur.
   This substance was, for a long time, sold in Italy as
a secret remedy, under the name of magnesia  alba, or
Coant Palina7s powder ; und it was not until about the
middle of the last century that it was  introduced into
practice as  a regular remedy.  At present it is much
employed as a mild aperient, both in its pure state and
in that of a carbonate.
   As  a laxative,  magnesia is by no means uniform or
certain in its operation.   Its purgative  effect  depends
in a very considerable degree,  on the  presence  or
absence of acid in the prima viae-.   When the stomach
is free from acidity, it seldom produces free evacuations,
unless given in very large doses,—whilst  even mode-
rate doses often operate promptly  and pretty actively
when it meets with acid in the stomach.  This circum-
btance  renders it peculiarly serviceable  where an acid
'* Paris's Pharmacologia. 
M.Ui.Yi.slA.
165
 exists in the prim::*, viie.   It unites with the acid, and,
 acquiring thus the character of a neutral bait, acts with
 greater energy us a purgative.  If the carbonate of mag-
 nesia be employed under such circumstances,  the acid
 in the stomach, uniting with the magnesia, evolves a con-
 siderable portion  of carbonic gas,  and may thus  create
 painful flatulent distentions.   This effect is obviated by
 using the pure magnesia, instead of the carbonate.  Mag-
 nesia  is particularly valuable as a laxative for infants,
 affected with acidity of the prima: via;, flatulency, and
 colic.  The usual mode of prescribing it in the gastric
 complaints of infants,  is to unite  it with a few grains of
 rhubarb.  I  have generally  given it in combination
 with rhubarb and powdered valerian, in the proportion
 of  three grains of the two first with two grains ol  the
 valerian.   In weak und nervous subjects, the magnesia
 may be very beneficially given  in  union with rhubarb
 and powdered orange  peel.   This  combination is par-
 ticularly useful in relaxed and hysterical females.   A
 mixture of an ounce of magnesia, with a drachm of rhu-
 barb and the same quantity of orange peel,  is recom-
 mended by Richter in such cases—in tea-spoonful doses
 until the bowels are freely moved.
  When in the advanced stage of low fevers, or during
 convalescence, symptoms of acidity in the stomach ma-
 nifest themselves,  the union of gentian, ammonia, and
 magnesia,  is, according to Mr. Brand,  an  excellent
 remedy.   Half a  drachm of  the magnesia,  with the
same quantity of aqua ammonia and ten drachms of the
infusion of gentian may be given at  one  dose, (Mat.
Med. p. 157.)
  Magnesia  has been  much commended for its good 
166
MAGNESIA.
effects in gout.  Dr. Scudamore,* however, states his
conviction, that its use in this disease  is derived solely
from its qualities as an antacid and purgative ; and that
in no other way than by such influence on the stomach
and alimentary canal, can he consider it as having any
claim to our regard.
   In  cases of dyspepsia, attended with an acid in the
stomach, magnesia may be advantageously united with
aromatics and some of the milder tonics.   In this way
we not only remove the morbid contents of the stomach,
but at the same time  also invigorate  this  organ, and
thereby counteract the new formation  of the acid.
   Used simplyas an absorbent or neutralizer, magnesia
is highly useful in all affections  attended  with morbid
acidity of the stomach.  In the griping bowel complaints
of children,  attended with green or sour stools,  magne-
sia is much employed, in which it is indeed a very useful
remedy. For this purpose, the prescription given below
is a very convenient form of exhibiting it.j
   In dyspepsia, attended with acidity in the primae viae,
pain  and flatulency, Dr.  Johnson highly recommends
a mixture  composed of  half a drachm of the carbonate
of magnesia, a drachm of the aromatic spirit of ammo-
nia, half an ounce of the tincture of rhubarb, and half
a drachm  of  the tincture  of hyoscyamus,  with four
ounces of water, in table-spoonful doses,  two or three

   * Treatise on the Nature and Cure of Gout, &c. p. 278.
   X R. Magnes. calc. 3ss.
       Pulv. rhei.    gr. viii.
       Sacch. alb.    2i.
       Pulv. g. arab.  3SS-
       Aq. menlh.   5ss.
       Aq. foutanse   ^i.  Misce. Dose, a tea-spoonful. 
MAGNESIA.
167
times daily.*   I have myself employed this mixture
with very excellent effects in cases of this kind.   Rich-
ter speaks very favourably of the employment of mag-
nesia, in union with  lac sulphuris, in doses of twenty
grains of each,  twice  daily, in acidity of  the stomach
attended with flatulent pains in the  abdomen.   (Spec.
Therap. B. 4, p. 92.)
   Magnesia has of  late been recommended as a very
useful remedy to prevent the  too copious secretion  of
uric acid by the kidneys, and consequently to  obviate
the  formation of those urinary calculi  that are chiefly
or wholly composed of this acid.f
   Mr. Brande has published some  very interesting ex-
periments and observations on the comparative value of
magnesia and  alkalies in calculous  affections.   Sir E.
Home had suggested the superiority of the former over
the latter remedy,  on the ground of its  possessing less
solubility, and being, therefore, more apt to remain long-
est on the stomach,  and to counteract  the  formation of
uric acid.   The correctness  of this suggestion, so far as
regards the fac*> was confirmed by the experiments  of
Mr. Brande.  Dr. Scudamore admits the fact of its su-
periority over the alkalies ; but he ascribes it chiefly to
its purgative qualities, by which the acid of the stomach
is not only neutralized, but also carried out  of the body.
Dr.  Marcet,J however,  contends  that the alkalies are
superior to this article as means for correcting the lithic
acid diathesis; but  the inference  to be  drawn from

  * Essay on the Morbid Sensibility of the Stomach.
  f Brande on Calculuos Disorders, in the Philos. Trans. 1810
P- 1-
  X An Essay on the  Chem. Hist, and Med. Treat, of Calculous
Affections. 
168
MAGNESIA.
 these contradictory statements is, that there is no cer-
 tain appreciable  difference between magnesia and the
 alkalies in this respect, except what may arise from the
 purgative powers of the former.
   Magnesia has of late years been strongly recommend-
 ed as  a remedy in  diabetes.  Trotter asserts, that  he
 succeeded  in curing two cases  of  diabetes millitus  by
 the  use  of half a drachm  of carbonate of  magnesia
 four or five times daily.   Haase also speaks very favour-
 ably of this article in diabetes. (Chron. Krank. v. 3.)
   Magnesia may be  conveniently given in union with
other purgatives.  It is frequently  united with lac sul-
 phuris; in which combination it is said to be particular-
ly useful in bilious complaints.   The dose of the carbo-
nate, for an  adult, is from twenty to sixty grains.   In-
 fants may take from two to five grains.
   It ought  to be observed,  that from a considerable
number of authentic cases reported in the journals within
the last  ten or twelve years,  it would appear that the
long use of magnesia  produces sometimes enormous and
dangerous accumulations of this  substance in the large
intestines.
   In the Journal of Science and  the Arts, No. xi. Mr.
Brande  has given an  account  pf two  cases, " in which
the long continued use of  magnesia  was  productive  of
a concretion of this earth  in the bowels, in an immense
quantity," and which "gave rise to many of the Worst
symptoms attendant on an obstruction of the intestinal
canal."   In the second case, it is stated that "not only
large quantities of a concretion of a similar description
were voided, but upon examination after death, which
took place perhaps six months after any magnesia had
been taken, a collection, supposed to be from four to six 
MAGNESIA.
169
 pounds, was found  embedded in the head of the colon,
 which was, of course, much distended."   Cases similar
 to these have since  been published by other physicians.
   Carbonate of magnesia has  been much recommended
 by some late writers as an antidote. Mr. Marshal* men-
 tions  this article as one of the most  valuable remedies,
 in  cases  of  poisoning from arsenic.   Mr. Hume alsof
 speaks highly of its effects  in this way.   He  relates a
 case of poisoning by arsenic,  of a very  hopeless cha-
 racter,  which  was cured  by the composition given
 below. X   Orfila,  from  some  experiments  made with
 this article as an antidote, concludes, that magnesia is
 decidely the best medicine  in poisoning from sulphuric
 or  nitric acid.

                         Formidoz*
  R.—P. rad. valerian     3'>
       P. rad. ireos florent. 5'ss-
       P. rad. liquir.      3H.
       P. sem. anise      3SS*
       Magnes. carbon.   3i. M.  ft. pulv.  From  six to eight
grains of this may be given to an infant twice or thrice daily. (Hufe-
 land.)
  R*'—Magnes. alb.   gr. xii.
       Sacch. alb.    5'u
       Aquse fontanae  5i.
       Tinct. opii     gtt. iii.  Dose, a tea-spoonful for an infant
every two hours, until relief is obtained. (Dewees.)
  * Remarks on Arsenic.
  X London Medical and Physical Journal, Nov. 1821, p. 466.
  !J R.—Magnes. carbonatis   ?i.
        Aquse distillae        5xv.
        Vini opii            3issk
        Spiritus lavand. comp. 3iii.
        Sacchari albi         ^ss. M.  Capiat seger  cochlear!*
duo magna frequenter, phiali assidue agitata*
   vol. 1.—24 
(  1^0  )
                   NEUTRAL SALTS

         SULPHAS SOD^.--GLAUBERS SALTS.

   This salt is one of the most common and useful pur-
gatives we possess.   In general the saline cathartics are
preferable to any of the other purgatives in diseases of
a decidedly phlogistic  character,  on account  of their
tendency to moderate febrile irritation by their general
antiphlogistic  influence, as well as their  aptitude to in-
crease the renal  secretion.  The  operation of this, as
well as of the succeeding  article, appears to be princi-
pally directed upon the small intestines, giving rise to
free liquid  evacuations;  and hence it seldom answers
Well for the removal of  the loaded or infarcted state of
the lower portion of the  bowels so common in chronic
affections. In plethoric, robust, and irritable habits, and
in acute inflammatory or congestive aflections, particu-
larly of the head, such as a tendency to apoplexy, oph-
thalmia,  encephalitis,  and in  the  exanthematous and
other general febrile diseases, the sulphates of sodae and
magnesia  are  peculiarly  valuable  purgatives.   They
cannot, however, in  general,  be  so  properly used  in
chronic affections attended with general languor and
weakness, unless some local inflammation  or high irrita-
tion exists, as is often the case in leucorrhcea.  This salt
consists of 24.64 parts of sulphuric acid,  19.36 of soda,
and 56 of water.  It crystallizes  in transparent six-
sided prisms, terminated by dihedral  summits.   When
exposed  to  the  air it effloresces.   It possesses a saline
and disagreeable bitter taste.   One ounce of water at
60° dissolves 3iiiss.  of the  salt;  boiling water dissolves 
GLATJBETt's  SALTS.
in
it in much greater proportion; in alcohol it is quite inso-
luble.   It is decomposed by the muriates of ammonia,
baryta, and lime; nitrate of silver;  sub-acetate and
acetate of lead.
  The dose is from 3ss. to §ii;  when  administered in
lemonade, or with the addition  of a small portion of
cremor tartar, it is much less  disagreeable to the taste.
  It does not  appear to be generally known that Glau-
ber's salt is  much more active in the dry and effloresced,
than in the crystallized state.   Half an ounce of the
former will  in general operate as promptly and actively
as an ounce  of  the latter.   Richter, however, says that
the effloresced is not so certain in its purgative effects
as the crystallized salt;  but I have not  noticed any dif-
ference between them in this respect. Glauber's salt may
be very advantageously given, in small doses united with
tartar  emetic, as an  antiphlogistic  aperient  in febrile
complaints.   An ounce of the salt with half a grain of
tartar emetic dissolved in a pint of water, may be used
in table-spoonful doses every hour until the bowels are
pretty freely moved.   The French call this  combina-
tion set de Guindre.   When the febrile  excitement runs
high, a portion of nitre  may  be very appropriately
added.
           SULPHAS MAGNESLE.—EPSOM SALTS.

   This is also a very common and useful purgative.  It
consists of small, needle-like, tetrahedral prisms;  pos-
sesses a bitter taste, and is soluble in its own weight of
water  at 60°.  When pure,  it effloresces on being ex- 
172
EPSOM IA1TS.
posed to the  open air.   It is decomposed by " baryta,
strontia, the  alkalies, and all the salts formed by these
salifiable bases, excepting the alkaline muriates; and by
the nitrate, muriate, and carbonate of lime."  The ad-
dition of a little common salt is said to increase its pur-
gative powers,  and a small portion of tart, antimony
quickens its operation.  The dose is from |ss. to gii.
The sulphates of  magnesia and soda  differ but little in
their effects.  Being less apt to heat the system than the
other active articles of this class, they are more particu-
larly applicable  to the treatment  of febrile diseases.
Given with a minute portion of antimony,  according to
the  directions of  Sir Gilbert Blane  and Dr. Chisholm,
they are exceedingly useful in the beginning of bilious
fever.  A solution of §ii. of either of these salts, with
gr. ii. of tart, antimony, in a pint of water, may be very
usefully given in the beginning of such fevers, in  doses
of a wine-glassful every hour, until  vomiting and full
purging is produced.
   The sulphate of magnesia is in general  less apt to be
rejected by the stomach than the sulphate  of soda, and
it is on this account best suited, to cases attended with
 morbid irritability of the  stomach.  It has been  said
 that Epsom salt has a peculiar power of moderating gas-
 tric pain, independent of  its cathartic  effects.  Exhi-
 bited in small and frequently repeated  doses, its effects
 have been particularly extolled in ileus and colica pic-
 tonum.   According to Orfila, the sulphates of magnesia
 and soda are peculiarly useful as purgatives in poisoning
 by  sugar of lead, and Buchner in his valuable work on
 Toxicology, makes the same statement, from facts which
 had come under his own observation.   A solution of
 this salt in lemonade is a very convenient and efficacious
 laxative in the diseases of very young children. 
VITRIOLATED TARTAR.
173
  The  sulphate  of  magnesia is particularly  recom-
mended by Mr.  Brand, for the  purpose of obviating
habitual costiveness.   It must  be given in small doses
and in union with  some bitter tonic infusion.   Thus,
half a drachm of the salt, dissolved in six drachms of the
infusion of gentian, with  one drachm of  ginger  syrup,
and ten drops of elixir of vitriol, taken an hour before
eating at noon, will  seldom fail to procure an alvine eva-
cuation towards evening.
       SULPHAS POT ASS./E.—VITRIOLATED TARTAR.

  This salt crystallizes in small, transparent, hard, six-
sided prisms,  terminated by six-sided pyramids.   It is
bitter, and  dissolves slowly in water,  requiring  |i. of
water at 60° to  dissolve twenty-four grains of the salt •
in alcohol it is quite insoluble.  It consists of 32.8 acid,
67.2 of potass and water.   The barytic salts, the nitrates
and  muriates of strontia, and lime, decompose this salt;
it is partially decomposed by the tartrates and the salts
of mercury, silver, and lead.
  Sulphate  of  potass acts as a gentle aperient,  when
given in doses of about twenty or thirty grains.  In the
dose of from 3v. to  3vi. it acts as a mild cathartic,
though,  on account of its difficulty of solution, it acts
much slower than the preceding two salts.   It appears
to be more  apt, when given in aperient doses, to debili-
tate the digestive  organs than any other of the  saline
purgatives.   It does not excite the intestinal exhalents
so much as the sulphates of  soda and magnesia, and in
general procures more consistent  stools than the other 
174
VITRIOLATED TARTAR.
salts.  It is,  however, very rarely employed  with a
view to its  purgative effects,  except  in  combination
with other articles, in which it constitutes a minor in-
gredient.  In  union  with  opium  and  ipecacuanha it
forms the well known and  excellent diaphoretic  prepa-
ration Dover7s powder.   The formula for this prepara-
tion, is given under the head of ipecacuanha.
      SUPER-TARTRASS POTASS^.—CREMOR TARTAR.

   This is a bi-tartrate, having two proportionals of acid
and one  proportional of potass.  It is but sparingly so-
luble, requiring for its solution one hundred and twenty
parts of water at 60° and thirty parts at 212°.   By long
keeping the watery solution of cremor tartar undergoes
decomposition, depositing a mucous matter, and leaving
" a solution of carbonate of potass, coloured with a little
oil.'**   The  solubility of cremor tartar is greatly in-
creased, by combining it with boracic  acid.  The alka-
lies, alkaline earths, and mineral  acids decompose it.
   Cremor tartar is, for many purposes,  an exceedingly
useful purgative.   It is a mild, cooling, and certain laxa-
tive, exciting  the intestinal exhalents  to a copious effu-
sion of serous  fluid, and producing at the same time
pretty  strong diuretic effects.  It  possesses, however,
a very considerable tendency to weaken the  digestive
functions; and  this  circumstance  together  with  its
strong  pewTers of exciting copious  serous  evacuations,
renders it an improper aperient for dyspeptic patients,
or such as are of a relaxed and dibilitated habit, with a
* Paris's Pharmacologia. 
CREMOR TARTAR.
175
  sluggish state of the circulation, and an aptitude to gas-
  tric pains, flatulency, and acidity. In certain dropsical
  affections, however,  it  may be  accounted among the
  most valuable remedies we possess ;  and  there are, in
  fact, but few hydragogues which have been so generally
  employed and recommended for the cure of ascites and
  anasarca as  this article.  It is  more especially,  how-
  ever, in cases of dropsy  connected with manifest  gene-
  ral irritation of the sanguiferous system,  that cream of
  tartar is apt to prove serviceable.  In the more relaxed,
  languid, and debilitated  cases, it answers best  when
 given in combination with powdered squill and gamboge.
 Dr. Ferriar  gives  an account of forty-three cases of
 dropsy  treated by cream of tartar,  of which thirty-three
 were effectually cured.   He says : " I  think we may
 fairly rank this medicine in the  first class of hydra-
 gogues.'7*   Dr. Home also speak much in favour of its
 effects in dropsical diseases.f   In  my own practice, I
 have often derived  the most decided  advantage  from
 this remedy in the treatment of ascites.
   Among the German writers of eminence we may cite,
 in favour of the especial usefulness of this saline hydra-
 gogue in hydropic  affections, the names of P.  Frank,
 (Epitom. vol. v. p. 189,) Jalm, (Chronish. Krank. t. i.
 p. 114,) Kahn, Lentin, (Beiti-iig.  B.  i.)  and Richter.
   Cremor tartar may be  very beneficially united with
gamboge and  tartar emetic as a hydragogue in dropsi-
cal affections.  But the most efficient of all the hydra-
gogues,  I  have  ever used  in dropsy, is a mixture of
cremor tartar, tartar emetic, pulv. scillse, and  sulphate
of potash, according to the formula,  No. 1, given below.

  *  Medical Histories and Reflections, p. 46.
  f  Clinical Observ. Exper. &c. p. 349. 
176
CREMOR TARTAR.
   Cream of tartar has been  a good deal extolled for its
power in removing obstinate constipation. In union with
jalap, it will often  excite the  action of the intestines,
after the most powerful cathartics  have been given in
vain.
   In the dose of 3iv. or 3vi. it  acts as a hydragogue ca-
thartic ; in smaller doses  it  produces diuretic effects.
A very pleasant aperient beverage may be made by dis-
solving about 3i. of this salt in  a pint of hot water, and
flavouring it with lemon-peal and sugar.
   This article may also be employed with peculiar ad*
vantage in the early periods of disease of the hip joint.
Dr. Physick has been long in the habit of prescribing
cream of tartar, in union with powdered  jalap, in this
affection, and the  experience  of other practitioners in
this country has fully confirmed its usefulness.
   Hufeland asserts, that he has found no remedy  so be-
neficial  in the vertigo of old  people  as  a mixture of
cream of tartar and gum guaiacum,  in doses of  half a
drachm of each twice daily.  In the vertigo of  young
persons from vascular  congestion of the brain, he  em-
ployed magnesia and cream of tartar with great advan-
tage,   (lour. B. 3.)

                        Formidai.
   No.  1.  R.—Crem. tartar    5iss.
              Sulphat. potass, ^ss.
              Pulv. scillse     $u.
              Tart, emetic   gr. iii.  M.  A tea-spoonful to
be taken three or  four times during the day.
   No. 2.  R.—Crem. tartar       j^ss.
              Sach. alb.        2,iv.
              Cort. limon. recen.  ^ss.
              Aq. fervid        lb. iv.  M.   This is an ex-
 cellent cooling-aperient beverage.  (Brand.) 
(  177  )
              CREMOR TARTAR1 SOLUBILIS.

  The union of boracic acid and cream of tartar forms
a soluble salt, possessing the sensible and medicinal pro-
perties of the latter article. The precise chemical con-
stitution of this combination does not appear to be as yet
well determined.  According to Berzelius, it consists of
one part of borate of soda (one part of soda to six parts
of boracic acid) and two parts of supertartrate of potass
(one part of potass and six parts of tartaric  acid). This
salt may  be made  in various ways.  The  following mode
for preparing it is given in the Codex Medicamentarius
of Paris.  " Let thirty parts of boracic acid and twenty
parts of  distilled water be heated together in a silver
dish ; as soon as this  has  been effected,  add in divided
portions one hundred and twenty parts of super-tartrate
of potass, taking care to shake the mixture continually 5
the whole will soon liquefy, and by continuing the heat
a pulverulent mass will result."
  This combination appears to possess more active diu-
retic properties than  the simple cream of tartar; and it
is said  to be an  excellent  aperient  in chronic com-
plaints—particularly  in jaundice—chlorosis—hemorr-
hoidal affections, and in chronic gastric  affections with
deranged action of the liver, &c.   Richter states that
this salt  is peculiarly beneficial as an aperient in  hyste-
rical and  hypochondriacal affections;  and Bang asserts
that it is a better remedy in  dropsy than the supertar-
trate of potass.  (Acta Reg. Societ. Med. Hafn.  t. iii.)
Selig also mentions  it as pre-eminently beneficial in
hydropic affections.    He  gave  it according  to  the
formula,  No. 1.   As  a  laxative, the dose of this  salt  is
  vol.  1.—25 
178           CREMOR TARTARI SOXUBILIS.
 one ounce.   As a resolvent, it is given in doses of from
 twenty to thirty grains every two or three hours,

                        Formula;.
  No. 1.  R. Crem. tart, solub. ^i.
            iEther muriatic.   3''-
            Oxymel scillse    ^i.
           Aq. menth.      ^v'u* ^* Dose, two table-spoonfuls
every two  or three hours. (Selig.)
  No. 2.  R.  Extract, taraxac.  3'v'
            Ext. cheledonii.   ji.
           Crem. tart, solub. 3V'«
           Aq. fcenicul.     5vi.   M.  Dose, a table-spoonful
every two  or three hours. (Richter, Arzneimittel.)
          TARTRAS POTASS^—SOLUBLE TARTAR.

   This salt  consists of one atom of acid  and one  of
 potass.  It is soluble in its  own weight of water when
 in a crystallized state; but when it is in the form of small
 grains, as  it  is commonly met with in the shops, it re-
 quires  four times its weight of water  for  its solution.
 Alcohol dissolves it very readily.   It  is decomposed by
 magnesia,  baryta, lime, and  strontia;  tlfe sulphates  of
 potass, soda, and  magnesia, and the muriate of ammonia
 decompose it  partially.  It  is also  entirely or partially
 decomposed by all acids; uand hence it is improper to
join it with tamarinds or other acid fruits, as is too often
 done  in the extemporaneous practice of those physicians
 who are fond of mixing different cathartics together, and
 know little of chemistry."*
   Soluble tartar, given  in the dose of  from  thirty  to
k Dr. A. Duncan. 
SULUULK TARTAR.
179
sixty grains, acts as a mild and unirritating aperient. In
the dose of 3vi. or gvii. it acts  pretty strongly as a ca-
thartic.   It is commonly employed in conjunction with
senna or  the other resinous cathartics, with  a view of
correcting their griping  qualities.   Soluble tartar has
been  much recommended  as an aperient in maniacal
affections.  It  has also been  recommended  in dropsy
and jaundice.
         , CALOMEL, OR SUBMURIATE OF MERCURY.

    Calomel is unquestionably one of the most important
 articles of the materia medica, whether we consider it
 in relation to its purgative virtues, or to its more exten-
 sive and specific  influence upon  the animal economy.
 Under the head of mercury, I shall  consider the reme-
 diate powers of this article, so far as they depend on its
 constitutional  or specific effects, and confine myself, in
 this  place, merely to a consideration of its virtues  as a
 purgative.
   Given in proper doses, either by itself or in combina-
 tion with other articles of this class, it produces copious
 evacuations, without  any harsh or drastic effects.  Along
 with its cathartic virtue, calomel has the peculiar power
 of exciting the biliary organs, and it is, therefore, parti-
 cularly adapted as a  purgative to all diseases attended
 with functional derangement of the hepatic system.   A
 combination of calomel and  jalap forms one of our most
 useful and common  purgatives in bilious diseases, as well
as for the  ordinary purposes to which remedies of this
kind  are usually applied.   Where we wish to procure
easy, but copious alvine evacuations, we in general find 
180
CALOMEL.
our intentions  fully answered  by giving  three or four
grains of calomel in the evening, and exhibiting on the
following morning an ordinary dose of any of the milder
cathartics.
  Calomel, from  its possessing very little  taste, is well
suited as a cathartic for children.   In my own practice
I seldom employ  any other  purgative in the diseases of
children.   It evacuates more freely, and at the same
time  more  mildly than perhaps  any other  article  of
this class, the intestinal mucus which  is often morbidly
accumulated in the bowels of children.  Of late it has
been  much  recommended  as a cathartic  in dysentery.
Dr. James  Johnson  speaks  strongly in favour of large
and frequently repeated doses of calomel in this disease,
as it occurs in tropical climaUs.—He gave scruple doses
three or four times a day, and he affirms that it was ge-
nerally followed by great alleviation of all tlje distressing
symptoms which attend this complaint.
   When calomel is given in very minute doses  it has a
direct anti-cathartic effect, by lessening the morbid irri-
tability of the intestinal canal.   It is, indeed,  one of our
 most valuable remedies for excessive purging.  Dr. Ayre,
 of Hull, in his very valuable work on bilious affections,
 adduces satisfactory testimony of the utility of small
 doses of this remedy in cholera, diarrhoea, &c. From an
 eighth to one-fourth of a grain, given every half hour or
 hour, very often puts a speedy stop to the most violent
 vomiting and purging.  I have employed it in this way
 with much advantage in cholera infantum, and especially
 in chronic diarrhoea, in which latter affection, I regard
 it as decidedly the most important remedy we possess.
 In affections of this kind it is, perhaps, most  effectually
 administered  in union with prepared  chalk; or, as I
 have sometimes  given it, with small doses of some  as* 
CALOMEL.
181
tringent vegetable powder, as,  for instance, the pow-
dered root of geranium maculatum.
  Calomel is also frequently employed as a vermifuge ;
but as I have occasion to mention it again in relation to
its powers in this way, in the chapter on Anthelmintics,
I shall dispense  with any further remarks on it in this
place.
  The usual dose of calomel, as a cathartic, isfrom eight
to twenty grains ;  ten grains may be  considered  as  a
medium dose.   If given in too large a dose, it is apt to
excite vomiting.
               SECONDARY PURGATIVES.

      HELLEBOliUS NIGER.--BLACK HELLEBORE.

  Tins article will be particularly described under the
head of Emmenagogues, and I shall, therefore, in this
place, speak of it only as a cathartic.
  Of all the articles of the materia medica, this has held
the greatest reputation among the ancients for its reme-
diate  powers,  and especially for its virtues as a cathar-
tic.   It was particularly esteemed in the treatment of
mania, melancholia, and gout.  For the  cure of this
latter disease, it is mentioned by Aretseus, as being su-
perior to every other remedy then known.
  Black hellebore  is an exceedingly active cathartic,
and, when given in an over-dose, is apt to produce the
most alarming effects.  It occasions very copious watery
evacuations, and hence it has been a good deal employed
in dropsical affections.  Dr. Ferriar reports several cases
of this kind, in which the good effects of  this remedy 
182
BLACK HELLEBORE.
 were conspicuously evinced.   He prescribed  it in the
 form of Bacher's tonic pills ; a  preparation which, on
 various accounts, deserves much more attention than it
 appears to receive at the present day.  Dr. Ferriar ob-
 serves, that when these pills have succeeded in his prac-
 tice,  their  operation  was  in  general  soon manifested,
 producing,  very early,  copious  evacuations.   Their
 action,  he says, is easy, but in  protracted cases, con-
 trary to Mr. Bacher's assertion, they evidently weaken
 the patient, however cautiously given.*  From two to
 six of these pills may be given three  times every day,
 according to the effects they produce.
   The black hellebore  is now but seldom  if ever em-
 ployed by itself, or in  substance, with a view to its ca-
 thartic effects.  From twenty to thirty  grains of the
 powdered root are said to be a proper dose for this  pur-
 pose.
                        Formulae.
  Bacher's pills. R.—Extract, hellebor. nigr.
                    Extract, myrrh, aquos. ** 31.
                    Pulv. card, bened.      3"* M. In  pi-
lulas divid. aa gr. i. pendere.  Dose, five pills, three  times daily.
  R.—Extract, hellebor. 3i-
      Flor. sulph.      3ii.  M. Divide into two grain  pills.
J. Frank speaks highly of this combination in chronic scabby af-
fections about the head.
                 CASSIA MARILANDICA.

  This  species  of cassia is exceedingly abundant  in
many parts of the United States.  Its leaves  differ but
* Medical Histories, vol. i. p. 46. 
                CASSIA MARILANDICA.              183

little in appearance and properties  from the senna of
the shops.   The predominant constituents of the leaves
of this plant are resin and a volatile  substance.  " The
tincture is of a dark brown colour, and is rendered  ex-
tremely turbid by water."* I have very frequently em-
ployed  it instead of the officinal senna ; and have always
found it a certain and safe purgative.   It seems to be
more apt to gripe than the common  senna, "a  quality
which may, however, in a great measure be corrected,
by infusing with  the leaves a small  quantity of the  root
of glycyrrhiza, or anise, and employing a large quantity
of water."  The cassia marilandica  is not so  powerful
as the senna of the shops.  It requires  about  one-third
more than the latter to produce an ordinary cathartic
effect.   For a particular description, and very accurate
figures  of this plant, the reader is referred to Dr. Bar-
ton's Vegetable Materia Medica of  the United  States,
vol. i. and to Dr. Bigelow's American Medical Botany,
vol.  ii.
        PODOPHYLLUM PELTATUM.—MAY APrLE.

   Thts is an exceedingly common plant in the United
States ; and every where well known, on account of its
esculent, and, to some, delicious yellow fruit.  Its root
possesses valuable cathartic properties ; but t\\eturio7ies,
or young shoots of this plant are said to be highly poi-
sonous.   Dr. Barton,  the present professor of  botany
in the University  of Pennsylvania,  has shown  me a
letter from the  Rev. F. Heckewelder, of Bethlehem, in

    * Bigelow's American Medical Botany, vol ii. p. 168. 
184
MAY APPLE.
which it is stated, that the Indians of this country have
been known to  use these shoots as a poison, to destroy
themselves.  According to Dr. Bigelow, the root con-
tains a resin, a  bitter extract,  faecula, and a small pro-
portion of  gum.   As a cathartic,  the  powdered root is
pretty extensively employed in some parts of this coun-
try.  I have myself given it very frequently instead of
jalap, and  have always found it active and  safe in  its
operation.   It  is, however, more drastic  and apt  to
gripe than jalap, nor does it appear to be so prompt in
its  effects as this cathartic.  " Its operation," says Dr.
Burzon, " in all cases in which I  have administered it,
is slower than  that of jalap,  but it leaves the bowels
longer  in  a lax  and soluble  condition.   I once took
twenty grains at four o'clock, P. M. which gave me no
disturbance till the next morning, when its operation
commenced, and  produced continual  motions all  that
day and part of the  next night,  together  with severe
tormina; this was the first dose of podophyllum I had
ever administered ; and its effects being so decided, I
have since prescribed  it in a multitude of cases,  and
for the most part, with  similar results.   It is more dis-
 agreeable  to the stomach than common purgatives,  and
 will often  occasion emesis."*
    Calomel renders its  operation  milder.   In combina-
 tion with  crem. tart, it forms an  exceedingly good ca-
 thartic for the cure of anasarca and ascites.   It has also
 been  particularly recommended  in  bilious fevers.   It
 certainly  is entitled  to considerable attention  from the
 American practitioner, as a useful indigenous cathartic.
 "  The medical properties of the podophyllum peltatum,"
 says Dr. Bigelow, " are those of  a sure  and active  ca-

         * American Medical Recorder, vol. iii. p. 332. 
MAY APfLE.
IBS
thartie, in which character it deserves  a high rank
among our indigenous productions.  We  have  hardly
any native plant which answers better the  common pur-
pose of jalap, aloes, and rhubarb."
  The best time for taking up  the root  is in autumn,
when the leaves are turning yellow.  The extract of it
is said to  operate  mildly and freely.  For excellent
figures of this plant, see  Bigelow's American Medical
Botany, vol. ii. and Barton's Vegetable Materia Medica
of the United States, vol.  L
  JUGLANS CATHARTICA—WHITE WALNUT.—BUTTERNUT.

   The white walnut grows in considerable abundance
throughout the United States, and furnishes us with the
most important of our indigenous cathartics.   During
the American revolution, it was much employed in our
military hospitals, and was esteemed as a most excellent
substitute for the ordinary officinal cathartics.
   The extract made from the inner bark of this tree is
alone employed for medicinal purposes. Given in doses
of from fifteen to thirty  grains,  it operates as an active
cathartic, without " occasioning heat or irritation."  It
is thought to be particularly applicable as an aperient in
habitual costiveness, as it is less apt,  than most other ca*
thartics, to leave the bowels in a state of languor or cos-
tiveness.  Calomel increases its activity,  and combined
with this article,  it is said to  be especially useful in bi-
lious fevers.   The bark of the root will blister the skin.
The extract should be made from the bark in the month
of May or June.
   vol. i.—26 
c  l86  )
              CORTEX SAMBUCI INTERIOR.
                              y
  The inner bark of ttt% common elder possesses very
active purgative powers.  Formerly, it was much used
as a hydragogue in dropsy; and Sydenham,Boerhaave,
and particularly Fr.  Hoffmann, speak very highly of its
usefulness in this  disease.   Some sixteen  years ago I
employed it in several instances of dropsy with evident
advantage.  In conjunction with its cathartic properties
it possesses considerable diuretic  powers, and in full
doses it is apt to excite  pretty active vomiting.  From
four to six drachms of the dried bark may be infused in
eight ounces of water, and taken in table-spoonful doses
every half hour until it  operates.  Its operation is ren-
dered much milder  by  uniting it with anise or fennel
seed.  Richter thinks that this article is undeservedly
neglected as a remedy in dropsy; and my own observa-
tions incline me to the same opinion. 
CHAPTER IV.
H. MEDICINES CALCULATED TO DESTROY OR COUNTER-
  ACT  THE  INFLUENCE  OF  MORBIFIC  SUBSTANCES
  LODGED  IN THE  ALIMENTARY CANAL.

                   Anthelmintics.

  Anthelmintics are  such medicines as have  the
power of dislodging and  expelling worms from the in-
testinal canal.  The operation of these remedies is not
difficult to understand.   Some of them act in the man-
ner of a poison on these  animals; others destroy them
by a mechanical action on them ; others again simply ex-
pel them from the bowels, by producing strong purging;
and  some finally increase the  tone of the  digestive or-
gans, and thereby obviate that condition of the stomach
and  bowels which appears to favour the  generation and
nourishment  of these animals.
   There are five species of worms generated in the in-
testinal canal.  The taenia solium;  the taenia lata; the
tricocephalus or trichuris;  the ascaris vermicularis, and
the lumbricoides.
   The tsenia, or tape-worm, is a long tape-like worm,
" formed of a chain of flat articulations, united together
by means of  a border or edge varying in  breadth  and
thickness."  These links or articulations are possessed
of independent vitality,  and  capable of becoming  dis-
tinct worms, when  left in the intestinal canal.
   The tainia occasionally grows to an amazing length. 
188
anthelmintics.
Brera speaks of one, preserved in the cabinet of the Uni-
versity of Pavia, which exceeds two hundred and thirty
feet.   There are two species of taenia: the taenia cur-
cubitina, or armed tape-worm,  and the taenia lata, or un-
armed tape-worm.  The former of these species is found
exclusively in the human subject.  It is very difficult to
dislodge it from the bowels, in consequence of the power
it has of insinuating itself into the mucous membrane of
the intestines, by means of two small fangs  or crotchets
with which its head is armed, and from which it derives
its specific name.   This "species of taenia is rarely dis-
charged entire; it usually comes away in small pieces,
or in  single joints resembling the seeds  of the gourd.
The taenia  lata is not  furnished with  the  fangs which
characterize the other species,  and is, therefore, much
more  easily expelled than the armed one.
  The trichocephalus or trichuris.—This worm is  but
very seldom found in the human intestines.  It was first
described by Dr. Wagler, a German writer,  about  the
middle of the last  century, who found it in the ccecum
of some French soldiers who had died of  a contagious
epidemic at Gcettingen.*  It is a very thin spiral worm,
from an inch and  a quarter to two  inches in  length.
The external surface is marked by  a great number of
transverse lines, like rings. "One  part of the body ter-
minates in a filamentous elongation,  as fine as  a hair,
and coiled round in a very surprising manner; the other
part, turning in a spiral form, most commonly terminates
in a hook, broad and obtuse, and similar to the pistil of
the liliaceous flowers.   From  this extremity the worm
can put forth a sort of tube enveloped in a sheath."   It
is commonly found in the ccecum or ileum.

      * Brera's Treatise on Verminous Diseases, p. 44. 
anthelmintics.
189
    The ascaris vermicularis or ascarides, are an exceed-
  ingly common worm, and are often discharged  in asto-
  nishing numbers.   They are round, thread-like, very
  slender, and not more than from a quarter of an inch to
  an inch in length. They skip and move with very great
  vivacity, and when touched contract to nearly half their
  length.  The ascarides reside in the large intestines,
  and are commonly most abundant in the  rectum, just
  within the anus.  They are also occasionally discharg-
  ed from the stomach.  Brera states that he found several
  masses of  ascarides in the oesophagus of a woman who
 had died of a nervous fever.   He states too, that this
 worm is  frequently found in  the  vagina of women.
 "The ascarides live longer than any  other, in thehuman
 body. It can  exist an almost incredible space of time.
 The nature of the aliment  which supports  this worm
 has been the subject of various opinion.   But it has at
 length been observed that the mucous matter which lu-
 bricates the intestines and the vagina of women,  is the
 substance for which  it has  the  strongest  predilection.
 Agreeably to  this, it is not wonderful that we find the
 ascaris vermicularis in other parts of the body, in which
 the mucous fluid abounds, as those of the bladder, sto-
 mach, oesophagus, &c."*
   The lumbricoides bear a strong resemblance in shape
 to the common earth-worm, and they were by Linnaeus
 regarded as belonging to the same species.   This worm
 is white,  sometimes of a flesh-colour, and commonly
 about  the  thickness  of a goose-quill,  and  perfectly
 round.  <{ The canal which passes  through the abdo-
 men of the worm is  yellow and transparent," which
some regard as a characteristic  sign of this species.

       * Brera'a Treatise on Verminous Diseases, p.  50. 
190               ANTHELMINTICS.
Its length is from four to twelve inches.   Worms of this
species are generally situated in the small intestines, but
not unfrequently in the stomach, and occasionally in the
colon and rectum.   (i When they have once passed the
valve of Bauhin,"  says Brera, " we may consider them
as destroyed."  They are  generally soon  evacuated
after having passed into the lower intestines.   Children
are particularly subject to the lumbricoides ; and  they
are often discharged, even by very young subjects,  in
great numbers.  They  are sometimes  discharged col-
lected together into round balls.
  Worms are capable of producing great  disturbances
in the system.  Not only do they aggravate ordinary
diseases when they are  present, but they also give rise
to a great variety of very alarming and anomalous affec-
tions.  The whole train of  spasmodic  and convulsive
diseases may proceed from the irritation of worms in the
alimentary canal.  Chorea, epilepsy, catalepsy, tetanus,
paralysis, mania,  convulsions, as well as a variety of
other nervous and convulsive affections, are not  unfre-
quently the immediate effects of this cause.  Besides
these diseases, worms have also been knowTn to produce
pleuritic  and rheumatic pains, dysentery,  remitting
fever, hydrocephalus,  consumption, chronic and  spas-
modic cough, &c. &c.  But I must refer the  reader to
the works on  practice,  and particularly to Brera's ex-
cellent treatise on verminous diseases, for a full account
of the morbid effects of intestinal worms.
   Although we have no unequivocal  signs of the pre-
sence of intestinal worms, except their actual discharge
either from the  bowels or stomach; yet there  are cer-
tain symptoms which enable us to pronounce, with toler-
able  assurance,  on their presence in  the  alimentary 
anthelmintics.
191
 canal.  Among these symptoms the following  are  the
 most common and striking: a pale, leaden-coloured, and
 occasionally flushed countenance; a bluish streak under
 the eyes; these are  dull and heavy; the pupils are di-
 lated, or very much contracted ; the lower eyelids  and
 upper lip tumefy,  especially during  the night while
 sleeping; great itching in the nostrils, which causes the
 patient to pick his nose ; foetid breath ; disturbed sleep,
 during which the patient grinds his teeth, is apt to lie
 on his belly, to scream out and start up suddenly, as if
 frightened ; tingling in the ears; giddiness; interrupted
 speech ; palpitation of the heart; muscular debility and
 flaccidity; pulse frequent, corded,  and often intermit-
 tent ; a dry and  spasmodic cough; irregular  and  de-
 praved appetite, being sometimes  entirely suppressed,
 and at others exceedingly voracious ; abdomen swelled
 and hard ; diarrhoea or costiveness ; unnatural, slimy,
 and  foetid stools ; pricking  and tearing pains in  the
 bowels;  emaciation;  convulsions;  paralysis, &c.
   The above symptoms may be considered as common to
 all the species  of worms  that  have been  mentioned.
 There are others, however, which are  peculiar to some
 of these species separately, and which  it will be proper
 to advert to in this place.
  A pricking and rending pain in the umbilical region;
 colic, with a rumbling noise in the belly, may be consi-
 dered as symptoms peculiar to the lumbricoides.  This
 worm is capable of perforating the  intestines with  the
 sharp cutting point of its head ; and its  efforts to insi-
 nuate itself into the mucous coat of the  intestines  are
 supposed to  cause the pains just mentioned.
   The symptoms which are puculiar  to the ascarides are;
an irritation and intolerable itching and pricking pain in
 the extremity of the rectum.  These worms  are usually 
192
anthelmintics.
 found in conglobated masses, and although near the ex*
 tremity of the large intestines, they are exceedingly diffi-
 cult to remove  entirely from their place of lodgment.
 They sometimes produce inflammation  of the  rectum,
 with bloody stools and tenesmus.   Swelling and pain of
 the anus is also occasionally observed as  the effects of
 ascarides.
   The symptoms of  taenia, besides those which have
 already been mentioned as common to  the intestinal
 worms, are: a sense of weight and pain in the abdomen,
 accompanied with a burning motion of something alive
 in the bowels. " Occasional prickings, or rather bitings,
 are felt in the region of the stomach, the abdomen swells
 at intervals, and then subsides almost by undulation; a
 sense of cold from  time to time pervades the abdominal
 viscera.  The  appetite  is usually uncommonly great;
 his complexion is livid, and he is frequently faint; the
 pupils are unusually dilated; vertigo confuses the head
 of the patient and excites vomiting ;  the legs vacillate,
 and sometimes the  whole  body seems to be affected with
 convulsive trembling.  Often small substances  resem-
bling the seeds of lemon or gourd are evacuated with the
 faeces of the patient, which are portions  of the marginal
papillae of these worms."  It is stated also, by authors,
that persons affected with taenia  become uneasy and ill
whenever they hear music, particularly the music of an
organ at church.*
Brera's Treatise on Verminous Diseases, p. 147. 
C  193  )
              Particular Anthelmintics.

          SPIGELIA MARYLANDICA—riNK-ROOT.

  This plant is indigenous to the southern parts of the
United States, where it is found in great abundance. It
has a  perennial root,  consisting of numerous fibrous
branches, of a yellowish colour when first dug out of the
earth, but becoming black on being dried and long kept*
The stalk is herbaceous, and grows to the height of from
six inches to two feet.  Spigelia possesses a bland but
somewhat nauseous taste.   It contains  a considerable
portion of mucilage, which is precipitated  from its de^
coction by the addition of alcohol.  It does not appear
to contain any resin.   Water  extracts its active princi-
ples.*  «
   The pink-root  is esteemed as a very valuable vermU
fuge.   Its anthelmintic properties, however, are almost
entirely confined  to the long round worm,  possessing
little or no powers in destroying or removing the other
species of intestinal worms. It was first introduced into
regular practice  by Drs.  Lining,!  Garden, and Chal-
mers of South Carolina, and  it is now more frequently
prescribed in this country for  the expulsion of the round
worm, than  any  other anthelmintic we possess.  The
whole plant possesses anthelmintic properties; the root,
however, is by far the most powerful portion of it. Spi-
gelia is much more active  in  its recent state than when

  * Bigelow's Medical Botany, vol, i. p. 144.
  X  Essays and Observations  on Physic and Literature, vol. iiu-
p. 151.
  VOL.  I.—27 
194
PINK ROOT.
old ;  by very long keeping it loses nearly all its active
qualities.
   Dr. Thompson* took large doses  of this  root, and
found it to produce  acceleration of the pulse,  flushed
face,  drowsiness, and a sensation of stiffness of the eye-
lids.  It is now ascertained beyond a doubt, that this
plant possesses narcotic powers, capable of producing
unpleasant and even alarming symptoms,  when taken
in very large doses.   I once had a little patient, in the
commencement of my practice, to whom I administered
this medicine in very large and frequent doses, and the
effects were such as clearly demonstrated its narcotic
powers.   The  child, a boy about six years  old, after
having taken three or four gills of a strong decoction of
the root, was  suddenly affected with  complete mental
derangement.   The derangement was precisely of the
kind  sometimes produced by the seeds of stramonium.
He was affected by alternate fits  of laughing and cry-
ing, ran and skipt about the room incessantly, and dis-
torted his countenance in a frightful  manner.  The
pupils of his eyes were greatly dilated, and his talk was
wild and incoherent.   These symptoms went off in the
course of about twenty-four hours, and left him quite  »
as well as he had been before he took the pink-root. I
have, however, since,  prescribed  this medicine in a
great number of instances, and have not, except in one
ease,  seen any ill effects from it, and in this instance it
only produced slight giddiness, with  dimness of sight,
and dilatation of the  pupils.
   The pink-root may be given either in powder, or in
decoction.  The latter mode of using it is, however, the
preferable one, as the medicine  is much more rapidly

  * An Inaugural  DissertJition  on  the Spigelia Marilandica, by
Hodge Thompson*  Philadelphia, 1802. 
                       PINK ROOT.                   195

 and equably diffused  through the intestinal canal when
 in a liquid form than when given in a powder.   The
 powder is given to children in doses of from ten to twen-
 ty grains.  A pint of the decoction made from an  ounce
 of the root should be given in the course of  four, five,
 or six  hours.   It  is  usual  to combine  senna with the
 pink-root in order to procure the expulsion of the worms
 as soon as they have  been  destroyed or weakened by
 this anthelmintic.  It  is better, however, to  give the
 spigelia by itself, and to exhibit a strong mercurial purge
 immediately after the medicine  is taken.  Given in this
 way it will seldom fail to bring away worms, if there are
 any present.  The pink-root possesses purgative  pro-
 perties ;  but these are both uncertain and feeble.   The
 root is much  more active  than  the other parts of the
 plant.

                        Formulas.
  R.—Rad. spigelia.        3'u*
      Pulv. sem. santortjea.  3"«
      Flor. sulph.          3'v*
      01. chenopodii anthclm. gtt. x.
      Syrupi communis.      q. s. ut  fiat electuar.  Take  a tea-
spoonful three times daily.
  R.—Rad. spigelian ^i.
      Fol. sennae   3'-
      Sem. santonic. 3>i<
      Rad. valerian. 3"*
      Aq. bullient.   ^x.   Simmer down to  ^vi.  Give a  table-
spoonful every two hours to a child from two to five years old. 
(   106  )
       MELIA AZEDARACK.—THE PRIDE OF CHINA.

  This beautiful and stately tree was originally brought
from Japan, and is now naturalized to most of the coun-
tries of Europe, and  to the southern parts of the United
States.
  It appears from the testimony of some of our south-
ern physicians, that  the fresh  bark of the root  of this
tree possesses very active anthelmintic properties. Dr.
L. Kollock, vice-president of the Georgia  Medical So-
ciety, speaking of the vermifuge powers of this tree, says:
(i It is a vermifuge of efficacy.  Its use is in some mea-
sure general among  the planters, and with many super-
sedes the use of all others,  I have given it with success
where all others in common use  have failed of relieving,
But when given  in  the months of March and April,
while the sap is mounting into the tree, it has sometimes
been followed  by stupor, dilatation of pupil, stertorous
breathing,  subsultus, &c.  But these  symptoms,  like
those sometimes produced by spigelia, pass off  without
any perceptible injury to the system.   This article like
the spigelia, is also a useful febrifuge medicine, in those
affections  usually denominated  verminous fevers, but
where no worms are voided.  The common form is that
of decoction.   A large handful, say about four  ounces,
of  the  bark of the fresh root,  is  boiled in a quart of
water, till it acquires the colour of strong coffee, i. e. to
 about a pint, of  which  from  half an  ounce to an "ounce
 may be given every two or three hours till it operates.
 Given in this manner its operation is powerful, sometimes
 producing both vomiting and purging."   .The late pro-
 fessor Barton had a very high opinion of the vermifuge 
MELIA AZEDARACK.
197
powers of this tree. He considered it as the most valua-
ble anthelmintic with which we are acquainted.*   The
berries have also been employed with success  as an an-
thelmintic.   Children are suffered to eat them, " with-
out any particular regard to the dose," and it is stated by
some, that they are quite as efficacious  as  the bark of
the root.  The pulp of the fruit made into an ointment
with lard, has been employed with success in tinea capi-
tis.!
   CHENOPODIUM ANTHELMINTIC^.—JERUSALEM OAK.

  This  is a native of Buenos Ayres, and of different
parts of  the United States.   It  has been much praised
for its anthelmintic power, and  from no inconsiderable
experience with it, I  am fully satisfied that it is worthy
of very  considerable  attention  as  a  vermifuge.   The
leaves and stalks are bitter, and possess an aromatic acri-
mony.   Every part of the plant is endued with active
properties, but the seeds are decidedly the most power-
ful.  The  juice of the fresh  leaves is occasionally em-
ployed in the dose of a table-spoonful two or three times
a day, for children under five years old.  Given in this
way, however, it  is  exceedingly unpleasant,  and very
few children can be induced to take it.  I have employed
the juice in a few  instances with much advantage.  The
best, and, indeed, usual form for giving  this remedy, is
the powdered seeds, made into an electuary, with syrup.
From twenty to forty grains of  the seeds may be thus

  * Collections for an Essay towards a  Materia Medica of the
United States, P. ii. p. 53.
  X Thacher's  Dispensatory, p. 2S3. 
198
JERUSALEM OAK.
 taken two or three times a day, by a child  four or five
 years old. It is usually directed to be given early in the
 morning, before eating, and again in the evening, some
 hours after supper.
   The seeds of the  chenopodium  contain  an essential
 oil, which has been lately much recommended, in cases
 of worms.  It is, indeed,  an exceedingly active vermi-
 fuge ; I have, in many instances, succeeded in expelling
 numbers of lumbrici with  it, after various other anthel-
 mintics had repeatedly been tried in vain.  A child two
 or three years old may take from three to  eight drops
 twice a day, mixed with a good deal of sugar or mucilage.
 After it has been given for three or four  days, some
 brisk purgative medicine should be administered.  The
 oil, like the expressed  juice,  is  very offensive both to
 the taste and  smell, and this forms a very great obstacle
 to its employment with children.  Where it can be re-
 gularly given, however, it is unquestionably one of the
 best anthelmintics of which we have any knowledge.

                       Formula.
  R.—01. chenopod. 3'*
      Sacch. alb.
      G. arab.    ** 3'* Misce. dein adde.  aq. menth. sativ.
 iii.  Dose, a tea-spoonful four or five times daily, for three days
in succession; after which a full dose of castor oil is to be adrni-
 aistered.
          GEOFFR.EA INERMIS.—CABBAGE-TREE.

  The bark of this tree, a native of Jamaica and other
West India islands, has been lately introduced into no-
tice, as a vermifuge of great powers. It is of a grey co- 
cabbage-tree.
199
 lour externally, and of a  dark-brown or black and fur-
 rowed appearance on the inside.   It has a sweetish and
 mucilaginous taste, and a pretty strong unpleasant smell.
   This article is prescribed either in the form of pow-
 der, or decoction, or of extract. The decoction is, how-
 ever, most commonly employed.   It is made by boiling
 one ounce of the bark in a quart of water, till it acquires
 the colour of  Madeira wine.  Brera states, that  it is
 more efficacious when it is combined with valerian. He
 says that he has employed it with great efficacy against
 lumbricoides and the ascarides.
   When given in  full doses, it often  produces nausea
 and  occasional vomiting.   If the dose is too large  its
 effects  are sometimes very  violent,  producing strong
 vomiting  and purging, delirium and  fever.   It should,
 therefore, always be commenced  with in small doses;
 and when carefully administered, it is said by those who
 have tried it, to be a very powerful vermifuge. It is more
 particularly useful for the expulsion of the lumbrici.  Of
 the decoction two  table-spoonfuls may be given to an
 adult two or three times a day;  the powdered  bark is
 given in doses of about half a drachm ; of the extract,
 from  three to four grains  are considered a full dose.  It
 is said by some that cold water, drank during the em-
 ployment of this remedy, is apt to occasion very alarming
 effects.  When fever, delirium, or other disagreeable
 effects arise from its use, relief may be obtained by drink-
 ing warm water, vinegar, or castor oil.
i
-> . 
( 200 )
           DOLICIIOS PRURIENS.—COWHAGE.

  This plant grows in considerable abundance  in  the
East and West  Indies.   It bears pods, thickly beset on
the outside with stiff hairs, which, when applied to the
skin, occasion a most intolerable itching.  These hairs,
by their mechanical action on worms, are a safe and ef-
fectual anthelmintic.  It  appears  that  this article is
equally useful against every species of intestinal worm.
When used for the expulsion of the tape-worm, it ought,
however, to be given in at least double the quantity which
is usually directed in cases of  lumbricoides.  In cases
of ascarides, I have, in some instances, employed this ar-
ticle with much benefit.  Against whatever species of
worm it be employed, however, it should always be pre-
ceded by one or two cathartics, as its efficacy is common-
ly much increased by this practice, probably by exposing
the worms more to the action  of this substance.  The
proper mode of giving  the cowhage is to mix it with mo-
lasses or syrup, into a thick electuary.   Of this a tea-
spoonful may be given to a child two or three years old,
and repeated in the morning and evening for three or
four successive days.  The dose for an adult is a table-
spoonful of the  electuary.   It appears to be quite a safe
remedy, and I  am persuaded from my own experience,
that it is often  very effectual.  Mr. Chamberlain says,
that one of his children, about five years  old, " took, by
stealth, three or four ounces of the syrup of cowhage,
without any other inconvenience than a diarrhoea, which
did her more good than harm."*
   The root of this plant is said to possess very valuable
* Thacher's Dispensatory. 
COWHAGE.
201
diuretic properties; and a vinous  infusion of  the pods
(12 to a quart)  is stated  to be a certain remedy for the
dropsy.*   Dr. Collier, of London, in a late number of
the London Medical  and Physical Journal,  proposes
scattering some of the pubes dolichi prurientis over the
body, for the purpose of rousing  the system in cases of
poisoning by narcotics.   The effects are said to be sud-
den and powerful.

                        Formula.

  R.—S|>icular. dolichi. 5'ss-
      Mellis.         q. s. ut fiat ele.-tuar.  Dose, a tea-spoon-
ful for a child from two to five years old,  taken twice daily  on an
empty stomach, for three days  in  succession, and followed  by a
full  dose of castor oil.
                 ARTEMISIA SANTONICA.

   The seeds of this plant are an excellent anthelmin-
 tic.  They  have a bitter and subacrid taste, and a mo-"
 dcrately strong and disagreeable odour.   They contain
 a large portion uf an essential oil, upon which  their ac-
 tivity appears entirely to depend.
   They are prescribed in substance, in infusion, in the
 form of an electuary, and in that of  an  extract.  The ^
 dose for children under five years, is from  six to ten
grains, and for adults from two scruples to a drachm, two
or three times a day.   The following is an  excellent
formula for giving  these seeds.   " Take an  ounce of
pulverized semen santonicum, and of black sulphur of

 *  Coffin's translation of Brera*s work on Verminous Diseases.
  vol.  i.— 28 
202
ARTEMISIA SANTONICA.
mercury, resin of jalap, and of powdered cinnamon bark,
three scruples, white sugar seven ounces;  dissolve these
in water and boil to a consistence, mix the whole,  and
form the  mass into  boluses.   The  dose for a child  is
from one to two drachms."

                         Formula.

  R.—Pulv. sem. santonic.  3h«
      Pulv. jalapae        3SS*
      Calomel           gr. v. M.  Divide into ten equal parts.
Take one every three hours—(For children between two and five
years old.)
  R.—Sem. santon. gr. xx.
      Rad. rhsei   gr. xii.
      Aloes      gr. vi.
      Calomel    gr. iii.
      Rad. ipecac, gr. i.  M.  Divide  into  three equal  parts.
One to be  taken on an empty stomach in the morning.
  R.—Pulv. sem.  santonic.  5ss.
      Pulv. rad. valer.     3U*
      Pulv. rad. jalap.     3SS#
       Sulph. potassae      3"*
       Oxymel. scyllae     q. s. ut ft.  electuar.  A tea-spoonful is
 to be taken three times daily. This is Bremser's celebrated anthel-
 mintic electuary.
          POLYPODIUM FELIX MAS.—MALE FERN.

  The root of  this fern has been  long celebrated as an
efficacious  anthelmintic.  Pliny,* Theophrastus, and
Galen,f prescribed it  against taeniae and lumbricoides;
and it is still considered by many practitioners as a re-
* De Simplici Medicina, lib. viii.
j Opera, lib. xxviii. 
MALE TERN.
203
medy of very important vermifuge powers.  Its employ-
ment is, however, at present almost exclusively confined
to cases of taenia;  and there is much testimony extant
of its efficacy against this species of worm.   The pow-
der of this root forms the basis of the celebrated specific
of Madame Nouffer.*
  When administered in substance it is given in doses of
from one  to three drachms, followed  by a full  dose of
some active cathartic.   In  this way I have employed it
in four or five instances, but never with any advantage.
I have, however, known it to be used with perfect suc-
cess  in the practice of other physicians.   The French
commissioners who were appointed to examine  the  re-
medy of Madame Nouffer,  assert that it will not destroy
the armed taenia.  Brera and others, however, contradict
this statement.   " I have had several patients attacked
by armed taenia," says Brera, " who were happily cured
by  this remedy."  He states, in  a note, that  he cured
seven patients affected with armed  taenia  by Nouffer's
method.  Herenschwand, a German physician, had em-
ployed the male fern before  Madame Nouffer's secret was
known, in a way very similar to her method.   His mode

  * The secret  of this  remedy was purchased by Louis XV. of
France. The following are the directions given for using it: Take
three drachms of the root of the felix mas, reduced to a powder,
mixed with four or six ounces of water.  The whole is to be swal-
lowed by the patient, in the morning, on an  empty stomach.   For
children the dose is lessened to one drachm of the powder.  If this
produces nausea, the patient must inhale the odour of strong vine-
gar. Two hours after the powder is taken the patient is to swallow
the following bolus : take submuriate of mercury,  and dry resin of
scammony, of each twelve grains, and five grains of gamboge ; let
them be finely powdered and formed into a bolus, and taken at one
dose. 
204
MALE FERN.
 of  using  this remedy, is  to administer  two drachms of
 the male fern-root two successive  mornings and even-
 ings,  and  on the third  day a cathartic  composed  of
 "twelve grains of gamboge, thirty of  carbonate of pot-
 ass, and two grains of turpentine soap, dissolved together
 in a cup of water."  Three hours after an ounce of ol.
 ricini is to be given, and repeated in an hour ; if the
 worm does not come away, another dose of the castor
 oil must be given in two hours after. " But, if the worm
 be still not discharged, a clyster of equal parts of milk
 and water, and three ounces of oleum ricini must be in-
jected towards evening, by which means the worm will
 come away entire and with ease."  This plan of treat-
 ment has  been  found very efficacious by some  physi-
 cians.
                PUNICA GRANATORUM.

  The bark of the pomegranate tree was a favourite an-
thelmintic with the ancient Roman physicians.   Celsus
prescribed it for the expulsion of taenia,  and evidently
placed much confidence in its powers.  " Si lati sunt,"
he says,  i( aqua potui dari  debet, in qua  lupinum, aut
cortex mori decoctus sit; aut cui adjectum sit contritum
vel hyssopum vel  piperis acetabulum, scammonise pau-
lum. Vel etiam pridie, cum multum alium  ederit, vomat.
Postero que  die mali punici tenues radiculas colligat,
quantum manu comprehendet, easque conlusas in aquas
tribus sextariis decoquet, donee  tertia pars  supersit;
huic adjiciat nitri paulum et jejunus  bibat.  Interpo-
sitis deinde tribus horis, duas potiones sumat talis aquae
vel murise duas huic adject*; turn desideat, subjecta 
PUMCA GRANATOUUM.
205
 calida aqua in pel ve."  Aetius also recommends the use
 of this bark as a very efficacious remedy for the removal
 of taenia.
    It is remarkable that so valuable a remedy as this ap-
 pears to be, should so long have been wholly neglected,
 or rather  unknown by the profession.  About  twenty
 years ago Dr. Fleming mentioned this article as a power-
 ful vermifuge,  in  his Catalogue  of Indian Medicinal
 Plants.  Dr. Pollock afterwards published a case of tae-
 nia in an infant, in which this article was employed with
 complete success.*   Quite recently, the favourable ac-
 counts which had  been  published of this remedy in
 taenia, have been amply confirmed by P. Breton, Esq.
 surgeon to the Rhamgur  battalion in the East  Indies.
 He relates eight cases which were  promptly and com-
 pletely relieved by  this  medicine.   In  almost  every
 instance the taenia was expelled, entire and alive, in the
 course of from three to six hours after first taking  the
 remedy.   He employed it both in the form of  decoc-
 tion and of powder.  The former he made by boiling two
 ounces of the bark in a pint and a half of water down to
 three-fourths of a pint.  Of this  he gave a wine-glass
 full every half hour, unt^l four or five doses were taken.
 Of the powdered bark he gave twenty grains every hour,
 four or five times repeated. The remedy is apt to occa-
 sion nausea, and occasionally also, when taken in strong
 doses, giddiness and  faintness.  When these effects en-
 sue, the use of the medicine should be suspended for a
 time.   " The temporary suspension and renewal of the
 medicine," says  Mr.  Breton, "may be successfully
adopted  under such  circumstances."!  Dr. Ruggia, a

 * Medico-Chirurgical Transactions, vol. xi.
 f Edinburgh Med. and Surg. Journ. vol. x. p. 419. 
206
PUNICA GRANATORUM.
Neapolitan physician, has  employed  this remedy with
great success; and Dr. Mile informs us that in a number
of instances he has succeeded completely in removing
taeniae with this article.   Dr. Mease, of  this city, pre-
scribed it in a case with the happiest effect; and I have
heard of other instances of its successful employment in
this country.
                camphora.—camphor.

  Camphor has been a good deal prescribed as an an-
thelmintic. Brera and others extol it very highly. "Of
all the remedies for the expulsion of the lumbricoides,"
says Brera, " there is no one, according to my observa-
tions,  which is more active or more certain than camphor.
This substance,  administered according to rule, expels
lumbricoides with facility and promptitude,  and at the
same time strengthens the intestinal tube and the whole
body."*  Pringle states that  he found  this  remedy
very  efficacious in  verminous diseases; and Moscate,
as we are informed by Brera, generally preferred cam-
phor  to  other  anthelmintics  in cases of lumbricoides.
" The employment of camphor," says Brera,  " is also
attended with this precious advantage, that  it counter-
acts the predisposition to the  further development  of
verminous seeds.   I have  always used  it  with  great
success,  and I cannot too strongly recommend its use to
physicians,  in  worm complaints."!   Camphor has also
been  used with success against  taenia.  Vogel expelled
one of these worms, of great length, by  administering
camphor in the form of pills and enemata.

   * Treatise on Verminous Diseases, p. 299.
   j Ibid. 199. 
CAMPHOR.
207
  Camphor is most conveniently given in the form of an
emulsion with  gum  arabic  and sugar.   By  triturating
camphor with carbonate of magnesia, we greatly increase
its solubility in water.  Two or three  grains may be
thus dissolved in an ounce  of  water, and if sugar be
added to this solution it forms an elegant and efficacious
medicine in the worm affections  of children.   It is
sometimes given  in combination with asafoetida, semen
santonica, valerian, &c.
   The dose of camphor varies from one grain to  thirty,
according to the age and strength of the patient.
               oleum terebinthin^e.

  A great deal has lately been  said concerning the
vermifuge powers of the spirits of turpentine.   Its effi-
cacy in the expulsion of taenia has been so frequently at-
tested, that we can  no longer doubt of its excellence in
this respect.
  On the continent of Europe, the spirit of turpentine
has been for many years prescribed in verminous affec-
tions.  In England and in this country, however, its in-
troduction into practice as a vermifuge, is of recent date.
It was first noticed in England as a remedy against taenia,
in a letter from Dr. John R. Fenwick,  of  Durham, to
Dr.  M. Bailie, and published in the Medico-Chirurgical
Transactions for 1811.   Three cases are mentioned by
Dr.  Fenwick, in which the turpentine was successfully
administered.  Many other cases have since been relat-
ed in the periodical journals, which demonstrate  the
powers of this remedy against taenia.  When employed 
 208            OT/EUM TEREBINTHIN.'B.

 for the expulsion of this worm it should be given in large
 doses.   From one to three ounces are commonly admin-
 istered at once.  Before the turpentine is taken  the
 bowels should be freely  evacuated by some active pur-
 gative  medicine.    " Whatever quantity  it may  be
 thought proper to give at one trial of the remedy should
 usually be given in one dose. Three ounces of the spirit
 of turpentine taken at once will be more likely to destroy
 the worm or worms, than the same  quantity  taken one
 third at once, repeated after an  interval of one, two,  or
 three hours, and will be much less tedious to the patient.'"*
 When given in large doses it generally passes through
 the bowels in a short time,  and  is consequently less apt
 to be absorbed, and  to affect the urinary  organs than
 when employed in  small doses.   If it does not move the
 bowels in three hours after it is taken, a large dose  of
 castor oil  should be given.  Dr. Coffin says, that as soon
 as it begins to be discharged per anum, " whether the
 worm appear or not, the patient should be permitted to
 drink freely of any bland suitable liquid."  The turpen-
 tine is also an active  remedy against the lumbriocoides.
 When employed for the destruction of these worms,
 however, it may be given in much smaller doses than is
 necessary for the expulsion of taenia.
   Dr.  Klapp, of this city, in a  paper on worms in the
 stomach, adduces a  number  of examples of the value of
 this remedy as a vermifuge.   He gave it in doses  of
 from twelve to fifteen drops  every  four,  five,  or six
 hours, occasionally interposing a mercurial cathartic.f
 It acts with peculiar advantage when the worms are sit-
 uated in the stomach.  In several instances of verminous

  * Coffin's Translation of Brera's Treatise on Verminous Dis-
eases, p. 250.
  t American Medical Recorder, vol. iii. p. 155. 
OLEUM TKREBINTHIN.B.
209
 affections, attended with a dull pain in the  epigastric
 region, sickness of  the stomach after eating, vertigo, a
 dry short cough, foul breath, and an occasional choking
 sensation in the throat,  I have administered turpentine
 in doses of from fifteen to twenty drops, and  continued
 for three or four days with the  most complete success.
 The worms are usually discharged in a dissolved state.
 Under  the head  of Stimulants I shall again have occa-
 sion to speak of this article.
   Many other vegetable substances have  been recom-
 mended for their vermifuge powers.  Of these the fol-
 lowing are the principal: allium cepa, angelica, asafcetida,
juglans regia,  tanacetum vulgare, Valeriana officinalis,
 veratrum sabadilla, caria papaya.
   According to Schmucker, the veratrum sabadilla is a
 very powerful vermifuge ; it is, however, apt to produce
 violent  symptoms, and ought, therefore, to be employed
 with great caution.   Garlic also possesses strong anthel-
 mintic properties.   Taken  on an empty stomach in the
 morning, in the form of decoction, it seldom  fails to ex-
pel lumbrici, if any be present.
  For the  expulsion of ascarides, anthelmintics ought to
be administered both by the mouth and in the form of
injections.   Clysters are, indeed, indispensable in cases
of this kind.   Aloes dissolved in water and thrown into
the rectum, is an excellent remedy against these worms.
The infusion of semen santonici, is also  highly recom-
mended for this purpose.  Mr.  C. M. Clark says,  " a
strong decoction of the sem. santon.  is the most effica-
cious of all  the injections in use."*
  A very effectual mode of destroying these worms is to

             * Diseases of Females, p.  109.
  vol. i.—£9 
210
TIX.
introduce a large bougie or tent into the rectum, smear-
ed with  mercurial ointment.  Dr. Coffin  says, that a
friend of his who suffered violent irritation in the rectum
from these worms, obtained complete  relief by intro-
ducing  a  bougie,  covered  with whale oil, into the
rectum.
                   STANNUM.—TIN.

  Tin is a remedy of very considerable powers as  an
anthelmintic.   Of its efficacy against taenia as well as
against the lumbricoides, there is abundant evidence ex-
tant.   Alston,  a  Scotch  physician, was  the first who
prescribed it for the expulsion of  taenia.*   Dr.  J. Fo-
thergill also  speaks in high terms of its powers against
this worm.  He recommends an ounce of the filings to
be given for six days in succession, and  a purgative to
be taken on  the seventh.f   Dr.  Brera observes, that in
cases of old, large armed  taenia, he has known the me-
thod of Nouffer to be ineffectual,  and that  in these in-
stances the  filings of tin, regularly administered, pro-
duced the desired effect with promptness.  Tin appears
to be most efficacious when given  in the form of filings.
These are given in doses of from  half a  scruple to an
ounce, formed into an electuary with honey or syrup.
It should be continued for several days, and  occasionally
suspended for the purpose of interposing a purgative.

  * Medical Essays and Observations, by a society at Edinburgh,
vol. v. p. 87.
  X Medical Observations and Inquiries, vol. vi. p.  71. 
TIN.
211
 Brera says,  that he has used this metal in the form of
 Guy's powder of Ethiopia, with great success.* He ob-

  * The following are the directions given for  making this pow-
der : " Take seven ounces of pure rasped tin, an ounce of mercury,
a drachm of sublimed sulphur, triturate  the whole thoroughly in  a
mortar to a very fine powder.  The dose is from twenty to thirty
grains twice a day."   Tin forms a principal part of the vermifuge
of Mathieu. This man received the title of counsellor of the court,
as well as a large pension for life, from the  king of Prussia, for
making known  his method of expelling taenia;  from the bowels.
This remedy consists of two electuaries; the first marked A, the
second B.
  " The First Electuary, A.—Take an ounce  of very fine English
tin filings, six drachms of the root of the polvpodium filix mas, half
an ounce of semen  santonicum, a drachm of the resinous root of
jalap, and  of sulphate of potass, and of honey sufficient to make an
electuary.
  " Second Electuary, B.—Take two scruples of the pulverized re-
sinous root of jalap, and of sulphate of potass,  one scruple of scam-
mony from Aleppo, ten grains of gamboge, and of honey sufficient
to form an electuary.
  " Those who may be inclined to adopt this method to expel tae-
niae, must observe the four following rules :
  " 1. For some days previous, the patient is to be confined to  a
suitable diet, that is, he is to eat salted  substances,—for example,
 herrings, light porridges and broths, and leguminous articles.
  " 2. The treatment is begun by administering  to the patient,
every two hours, a tea-spoonful of  the electuary A.   This  course
to be continued two or three  days,  till the worm is perceived to be
 in the intestines, and then,
  " 3. The patient is to take electuary B, and of this he also takes,
 every two hours, a tea-spoonful, till the worm is  expelled.
   " The discharge of the worm is facilitated by taking some spoon-
 fuls of fresh oleum ricini, or by some clysters of the same oil.
  " 4. The age, sex, and temperament of the patient may require a
considerable modification of the dose  of these remedies ; for this
reason the treatment ought to be directed and modified by a well
 informed physician.
  " Finally, it is to be borne in mind that the virtue of the electuary 
212
HYDRARGTRU8.
serves also:  (i The aurum musivum is one of the  most
efficacious remedies employed against taenia, particular-
ly the armed taenia. This preparation, more active than
the powder  of Guy, ought to be thus compounded:—
Melt twelve  ounces of very pure tin, and add to it three
ounces of mercury; let the mixture cool, triturate it in
a mortar to a very fine  powder; while  triturating the
mixture,  add seven  ounces of sublimed sulphur and
three ounces of muriate of ammonia.  The dose is ten
grains twice a day."*
                    hydrargyria.

  Mercury possesses the power of destroying intestinal
worms, and has been much employed  by physicians for
this purpose.  Formerly water boiled on mercury was
recommended as a remedy against lumbricoides.   Many
reports have been made in favour of its vermifuge pow-
ers when administered in this way;  but as mercury
seems to  be entirely insoluble in water, the decoction is
now entirely neglected as  an inert remedy.  Calomel,
however, is certainly a very useful anthelmintic.f  Given

A, depends in great  part on the root of the polypodium filix mas;
hence this root should be fresh,  and its internal hard part only
should be reduced to powder.
  " This powder will have a reddish colour; see Hartenkiel, Medi-
ciniscli-chirurgische, Zeitung, 1800, 2 Band, p. 293."
  * Treatise on Verminous Diseases, p. 344.
  f " Many of the nostrums advertised for the cure of worms, con-
tain calomel as their principal ingredient, combined with scammo-
ny, jalap, gamboge,  or some other purgative : they are uncertain 
HTORARGTRUS.
213
 in minute and repeated doses, it seldom fails to destroy
 the lumbrici.   Were it not for its tendency to affect the
 mouth, it would be a very important vermifuge in chil-
 dren, as it may be more conveniently administered than
 any other medicine.
   To children,  from one fourth to half a grain may be
 given night and morning, for three or four days, and a
 purgative given when the medicine is discontinued. The
 corrosive sublimate has also been prescribed as a vermi-
 fuge ;  but its extremely unpleasant taste renders it diffi-
 cult to give to young patients.   The ammoniacal  muri-
 ate is said to be a very efficacious form for  giving this
 remedy.   The sulphate and sulphur of mercury have
 also been recommended as useful against worms.  The
 mercurial preparations are frequently given in combi-
 nation with other vermifuges.

 and dangerous medicines ; the  method of exhibiting them  in  tin;
 form of lozenges, (worm cakes,) is also attended with inconvenience,
 for the  sugar and the gum generating an acid, by being kept in
 damp places, may considerably  increase the acrimony of the mer-
 cury ; besides  which, the calomel is frequently diffused very un-
 equally through the mass, one lozenge may therefore contain a poi-
 sonous dose, whilst others may  scarcely possess any active matter.
   " Ching's Worm Lozenges.—These consist of yellow and brown
 lozenges,  the former are taken  in the evening,  the latter the suc-
 ceeding morning.
   " The  Yellow Lozenges.—Saffron  ?ss., of water oj. boil and
 strain; add of white panacea of mercury (calomel washed in spirit
 of wine) lb. i., white sugar 28 lbs., mucilage of tragacanth as much
 as may be sufficient to make a  mass, which roll out of an exact
 thickness, so that each lozenge may contain one grain of panacea.
  • •" The Brown Lozenges.—Panacea ^vii., resin of jalap lb. hiss.,
 white sugar lb. ix., mucilage of tragacanth  q.  s., each lozenge
 should contain gr. § of panacea.
  " Story's Worm Cakes.—Calomel and jalap made into cakes and
coloured by cinnabar."—Paris's Pharmacologia. 
214
HTDRARGYRVS.
  There  are many other mineral  substances recom-
mended  in books,  as  possessing  useful anthelmintic
powers.   The principal of these are, arsenic, sulphur,
iron, muriate of barytes, muriate of  ammonia, and mu-
riate of soda. 
CHAPTER  V.
                     Antacids.

  Antacids  are substances which obviate  acidity in
the alimentary canal.   The action of these remedies is
purely chemical, " as they merely combine  with  the
acid present, and neutralize it."*
  In a perfectly healthy state of  the  digestive organs,
no acid is, perhaps, ever generated in the alimentary
canal.   As it, however, frequently happens even in the
most temperate, that digestion is retarded or enfeebled,
the aliment taken in is often subjected to chemical changes,
producing acidity and flatulencies. While these changes
go on only in a moderate degree, the system  does not,
in general,  experience any particular inconveniences
from them.   When, however, the evolution  of acid is
great, or has become habitual, a train of various and dis-
tressing symptoms generally ensue.
  Acid does not, however, always  depend on a chemi-
cal  change in the substances received into the stomach.
It has, in fact, been well  ascertained  that this acid is
usually different from that which is formed by vegetable
fermentation.   It appears to possess a peculiar charac-
ter, depending often on a morbid  secretion in the sto-
mach.  Still, however, as the generation of acid in the
primae viae is very often accompanied  by the evolution
of large quantities  of air,  it would appear to be pretty
* Murray's Mat. Med. 
216
ANTACID*.
 certain that fermentation does take place in the stomach
 and bowels, and that  the acid  depends on  this cause.
 "Acid," says Richter, "in the primae viae, is certainly
 of two kinds, arising from two different causes.  It is
 sometimes plainly the consequence of a corruptio spon-
 tanea, of acids taken by the mouth, or of meat and drink
 which have  become sour; and in this case it only in-
 commodes the patient when he has taken such meat or
 drink; it is easily and constantly blunted by alkaline or
 absorbent medicines, and keeps away as long as the pa-
 tient carefully uses diseta antacida.   Medicines which
 strengthen the system, with an antacid diet, generally
 cure the  patient of  this  acid.  But sometimes the pa-
 tient  is incessantly tormented  with  acid, eat what he
 will, even though he only takes animal food.  None  of
 the medicines which blunt acidity are  of any service,
 or they only procure him a short mitigation.   And in
 this case the acid is not the produce of a corruptio spon-
 tanea,  but a seeretio perversa liquorum menstruorum.
 The patient,  as Kaempf says, has a brewery of vinegar
 in his stomach."*
   The secretion of uric acid by the  kidneys,  is much
 influenced by the presence or absence of acidity in the
 stomach.   An accumulation of  acid  in  the  primae viae
 is almost invariably attended with an abundant secre-
 tion of the uric acid ;  and hence, we find  alkaline re-
 medies among the most  useful  for  counteracting  the
 lithic acid diathesis.
   The existence of  acid  in the stomach, produces, in
 some, a very disagreeable itching in the skin.   I have
 seen several  persons who experienced a very trouble-

  * Medical and Surgical Observations, p. 190.  See also the arti-
cle Asafoetida, in this work. 
ANTAClDSi
M
some itching in the skin, whenever acid was formed in
the stomach ; and who invariably obtained relief from
a dose or two of magnesia.
  The connexion between acidity in  the  stomach and
gout,  has  often  been observed.   "Acid,"  says Dr.
Scudamore, " when much accumulated in the primae
viae, will  always  powerfully concur  with the  othei4
causes  to excite  a  fit, and will sometimes prove  alone
sufficient.  I have met with several instances, in which
the discharge of acrid fluid from  the stomach has pro-
duced  immediate and very sensible relief."*
  In children, acidity in the bowels is very often the
cause  of much  uneasiness  and  distress.   Whenever
the stools are of a grass green  colour, we may be as-
sured of the existence of acid in the primae viae.  The
bile in its natural state is not green, but of  a pale yel-
low colour.  The  green colour which we may often ob-
serve it to possess  in the discharges of infants, depends
on the action of  the gastric acid upon it.  The efficacy
of the  common practice  of giving cretaceous powders,
when the stools have this  grass-green  appearance, de-
pends  on their property of obviating acidity*
           LAPIDES CALCARLE, ET TF.STACEA.

  Calcareous  substances are among the  most useful
articles of this class of remedies.   Of these there are a
great number, the most important of which are the fol-
lowing :

        * Scudamore on Gout, p. 57.  Philad. edit
   \oi,, i.---MO 
a 18        XAPIDES CALCARI^, ET TESTACEA.

   Creta Prseparata.—This is a very useful antacid, and
much employed in diseases  of children  depending on
acidity and relaxation of the alimentary canal.  It is in-
deed,  particularly serviceable in  the  chronic  bowel
complaints of infants, whether acid or not be present.
The usual mode of prescribing it is in union with gum
arabic, opium, cinnamon, catechu, &c.
   Testx  Ostrearum.—Pulverized  oyster-shells are an
excellent antacid and absorbent.  They are given with
bitter or  aromatic articles, in debility of the digestive
organs, attended with sour eructations and other gastric
affections arising from acidity.  De Haen states that he
cured  rachitis, by giving twice a day twenty grains of
powdered oyster-shells.  This article has also been re-
commended as very beneficial  in the debility and dys-
pepsia, which arise from excessive onanism.*   It may
be given in doses of from ten grains to two drachms.
   Oculi  Cancrorum.—These are small hemispherical
calcareous bodies, found on  each  side of the  stomach of
the cancer astacus, during the month of August.   They
consist of carbonate of lime and animal gelatine.   They
are slowly soluble in vinegar.  This article has  been
much used in affections arising from acidity of the first
passages.   It has been recommended as particularly ser-
viceable in disorders  of the  urinary organs, depending
on this cause.  I presume, however, that it is not supe-
rior, in this respect, to any of the other calcareous arti-
cles of this class.   Gaubius and others, recommended it
as useful in leucorrhcea, especially when this  complaint
is accompanied with acid in the  primae viae.f  It has
  * Burdach, Arzney. m. 1. vol. ii. p. 504.
  t Shippers, iiber eine besondere wiirkung der krepsaugen beym
weisen flusse—in Sammlg. auseil.  Abh. xviii. B. I. 471. 
             LAPIDES CAXCARTB, ET TESTACEA.         213

  been stated by some German writers, to be apt to excite
  haemorrhages, and we are,  therefore, cautioned against
  employing it where there  is  much  disposition to hae-
  morrhage.   I have no idea, however, that there is any
  foundation for this opinion.  This substance is given in
  doses of from twenty grains to  a drachm.
    The officinal  calcareous preparations  are: mixtura
  cretse, Lond. Vh.;potio cretacea, Edin. Ph.;pulv.  cretse-
  compositus, Lond. Ph.; Pulv.  carbonatis calcis compo-
  situs.  Edin.  Ph.; Pulv. cretse  cum opio, Lond. Ph.
                         Formulas.
   R.—Extract, hyoscyam. gr. ss.
       Lapis, cancror.     gr. xx. M. Divide into six equal parts.
 S. Give one every hour to a child of from two to five years old.
   II.—Pulv. cretce compos, cum  opio 9i.
       Pulv. catechu, extract.         gr. xv.  This is a  dose for
 an adult; and is an excellent remedy in recent diarrhoea.
   R.—Cretan pp.    .   .   gr. xx.
       Pulv. ferri. phosphat. gr. vi.
      Pulv. rhaei          gr. x.   M.  Divide into  ten  equal
 parts.  I have found this  a peculiarly useful combination in the
 bowel complaints of infants.  After the operation of a dose of rhu-
 barb, one of these powders may be given every six hours, provided.
 no fever be present.
   11.—Cretce. pp.    5ui-
      Sacch. alb.
      Pulv. g. arab.  aa 3iss.
      Tinct. opii   gtt. xl.
      Tinct. kino    3''*
      Aq. menth.    ^vi.   S.  Dose, a table-spoonful every two
hours, in diarrhoea. 
(  £20  )
                    AQUA CALC1S.

  Lime water is an efficacious corrective of acidity in
the first passages.   In dyspepsia, attended  with acid
eructations, and in chronic  diarrhoea,  this article is
often of great service.   It is usually given  with milk,
in doses of from two to four ounces, three or four times
a day.  Of the various remediate powers of this prepa-
ration, and especially  of its utility in counteracting the
lithic acid diathesis, I shall have occasion to speak when
I come to treat of Anthilitics.
                   magnesia alba.

  Magnesia unites readily with the acid generated in
the stomach, and is especially serviceable in all cases of
acidity  attended with   a torpid  state of  the  bowels.
Where, however, diarrhoea and a very irritable state of
the intestinal canal exist, it is much less useful than the
calcareous antacids already mentioned, since it acquires
pretty active purgative  qualities when united with an
acid.  In  the bowel complaints  of  infants,  attended
with green and griping stools, magnesia combined with
rhubarb, has long been a favourite remedy with prac-
titioners. 
(  221   )
            CARBONAS POTASSiE ET SOD/E .

  The fixed alkaline salts are the most perfect neutral-
izes  of  acids.  They  have accordingly  been much
prescribed in affections attended with  accumulations
of acid in the stomach  and bowels ;  as they are, how-
ever, much less pleasant and not more efficacious than
magnesia, in the diseases which depend on this cause, a
preference is generally given to  this latter substance. In
dysentery,  attended with acid  eructations, or  other
symptoms denoting acidity in the alimentary canal, the
carbonate of potass has  been particularly recommended
by Causland and Rademayer.  Dr.  Mitchill, of New-
York, also speaks highly of the alkaline medicines in
this disease.  The dose of these  carbonates is from five
to twenty grains. 
CHAPTER VI.
B. MEDICINES WHOSE ACTION IS PRINCIPALLY DIRECT-
           ED TO THE MUSCULAR SYSTEM.
I. Medicines calculated to correct  certain morbid con-
   ditions of the system, by acting on the tonicity of the
   muscular fibre.

                      TONICS.

   These are medicines which impart vigour and  tone
to the system, without  materially increasing either the
heat of the body or the  frequency of the pulse.
   Cullen thought that  the tonic principle does not dif-
fer essentially from that which gives them their bitter
taste.  That this  opinion is without foundation, is at
once evident from the  fact, that some  intensely bitter
substances do not possess the least tonic virtues, whilst,
on the other hand, some very valuable tonics are desti-
tute  of bitterness.  Thus, opium and digitalis, though
very bitter, have no tonic properties; and some of the
metallic preparations are tonic, though void of bitterness.
  The action of tonics, unless taken in very large doses,
is not manifested by any immediate and obvious excite-
ment.  The vigour which they impart to the system, is
the result of a slow operation  on the animal economy,
and altogether different  in its character from that  tern- 
TONICS.
223
 porary augmentation of force which is  the immediate
 consequence of the operation of stimulants, properly so
 called.
   When tonic remedies are employed in a debilitated
 state of the system, their operation is evinced by a gra-
 dual and permanent increase of the force of the circula-
 tion ; an invigoration of the digestive powers, and of the
 general energies of the animal  economy.
   There are three  ways  in which these remedies may
 produce their tonic effects on the system. 1. They may
 increase  the strength of  the system,  by improving di-
 gestion, and thereby giving rise to a more abundant and
 healthy formation of chyle. That debility and disease
 may arise from an imperfection of the chyle, there can
 be no doubt.   Out of this fluid every other fluid and
 solid part of the system are ultimately formed ;  and we
 may presume,  that every material  deviation from  its
 healthy  state  must intefere with  the  regular opera-
 tions of the animal economy.  It is evident, therefore,
 that whatever has the power  of restoring the diges-
 tive energies of the stomach, and  thereby the healthy
 condition of the chyle, will by this effect alone  give
 health and vigour to the body.   2.  Tonics may also im-
 part tone to the system, by exciting a peculiar action in
 the part  to which they are immediately applied,  and
 thence propagating  a similar action to the other parts
 of the body, through the medium of the nervous system.
 The effects of impressions on the stomach are often mani-
 fested in other parts of the body in an exceedingly  vio-
 lent and sudden manner.  Debility, syncope, and even
 death are sometimes suddenly produced, simply by the
action of indigestible food  on a weak stomach.  Seeing,
therefore, such violent affections excited by articles that 
224
TONICS.
suddenly resist or prostrate the energies of the stomachy
there is reason to believe, on the other hand, that what-
ever has a tendency to give vigour to this organ, will
communicate a corresponding vigour to the general sys-
tem.*  3. Finally, tonics  may strengthen by being ab-
sorbed into the circulation, and by thus acting directly
on the whole organization, through the medium of the
blood.  That remediate substances are carried, into the
circulation, is a fact which is, I trust, evident by what
has already been said on this head in the  first chapter;
and there can be no reason why a tonic substance ab-
sorbed into the circulation, should not produee the same
invigorating  impressions  on  the  parts  with which  it
comes in contact whilst circulating  in  the blood,  as
when applied to the surface of the stomach, the rectum,
or skin.   That they do in fact operate in this way,  is
further rendered probable  by the new qiialites which
some of  these  substances impart to  the  urine and the
other excretions.
   The remediate effects of these medicines are,  how-
ever, not to be exclusively  referred to any one of  these
modes of influencing the animal economy.   Tonics,  no
doubt, generally act, at once, in all these ways.
   Although tonics do not produce any very evident ex-
citement in the system, yet they have an obvious tenden-
cy to increase the inflammatory diathesis, and they are
therefore, as a general rule, inadmissible wherever there
is any tendency to inflammatory action in  the system.  It

  * Qui stomachum regem totius corporis esse
    Contendunt, vera niti ratione yidentur.
    Hujus enim validus firmat tenor omnia membra;—
    At contra ejusdem franguntur cuncta dolore.
                       Serenus Samonicus) De Med. Precept, 
TONICS.
225
is, indeed, at once obvious, from the general effects of
these  remedies,  that the diseases of debility alone are
those  in which they may  be employed  with advantage
or propriety.  As a general axiom  this undoubtedly
holds  good; yet experience has demonstrated that tonics
may  sometimes  be used beneficially in cases  attended
with an  evident phlogistic  condition of the system, as
in the declining stage of gout and rheumatism.
   As I shall have occasion to speak fully of the thera-
peutic application of tonics, when treating of the parti-
cular  articles of this class, I will not pursue this subject
any further, but proceed at once to the consideration of
the individual tonics.
                      CINCHONA.

  The cinchona is unquestionably the most  important
tonic we possess, and justly ranks among  the most
useful and indispensable articles of the materia medica.
  Its introduction into regular practice is said to have
occurred in the following manner.  In 1640, the lady of
the  Count of Cinchon, viceroy of Peru, was affected
with a tertian intermittent, which resisted  every mode of
treatment that  her physicians could devise.   Being, at
length, nearly exhausted by the disease, she was advised
by the governor of Loxa, who had been made acquaint-
ed with the febrifuge virtues of this bark  by an Indian,
to use it  as a remedy for her disease.  She took it, and
the  complaint very soon  disappeared.  The  event  of
this case spread its reputation rapidly throughout Spain,
whence it was carried into Italy by the Jesuits, where it
was  gratuitously distributed among the  poor sick  at
  VOL. i.—31 
226
CINCHONA.
Rome, by Cardinal de Lugo, and his physician Sebastian
Baldo.  This latter person  has  the credit of having
written the  first work on  this valuable remedy.*  Its
fame now  rapidly extended itself through France, Ger-
many, England, <kc. and although much opposed on all
sides, the  value of its powers was finally established on
the testimony  of  almost  universal  experience.  The
name  cinchona  was given  to  this substance by Lin-
naeus,  in  commemoration  of  the  incident mentioned
above.  It was also long known by the name of Jesuits'
powder, in consequence of its having been first brought
into Europe and extensively employed  by the Jesuits.
  The genus cinchona is a very extensive and remark-
able family of trees of the natural order rubacese:  and
of the class pentandria, order monogynia, of Linnaeus.
It grows on mountains, and is never found in the plains.
Until  of late a great deal of confusion  and  uncertainty
existed with  regard to the natural  history of this family
of trees; and, indeed, there still exists no inconsiderable
perplexity on this subject.
  The different varieties of bark,  as they occur in com-
merce, appear to be made up of a considerable number
of distinct species, and are assorted into the pale, the red,
and the yellow.
  The pale or grey bark of the shops, is principally de-
rived from the cinchona condaminea of  Humboldt and
Bonpland. This is the cinchona officinalis of Linnaeus,
and the cinchona Iancifolia of Mutis, which latter is the
name  adopted in the London Pharmacopoeia.  This spe-
cies of cinchona is found in abundance in the province
of Loxa,  and in the neighbourhood of Guancabamba
and Ayavaca, in  Peru.   Bonpland asserts that this  is
* Alibert. 
CINCHONA.
227
  by far the most valuable species of bark, and from its
  acknowledged superiority, the Spaniards have given it
  the name of cascarilla fina.
    The cinchona  condaminea consists of very slender,
  doubly rolled pieces, not more than a line in thickness,
  of a brown colour externally, and of a cinnamon colour
  internally. The epidermis is marked by fine transverse
  cracks, and readily scales off in small laminae, and is of
  a much deeper brown than the parts beneath, which are
  of an orange yellow.  Its  fracture, when good, is not
  fibrous or powdery, but even and somewhat  shining.  It
  has a  faint aromatic odour, and when chewed  becomes
  very bitter and astringent.  Besides this species, there
  are others which frequently goto make up the pale bark
  of commerce.  Bonpland and Humboldt inform us that
  the cinchona scrobiculata, a species found  very abun-
  dantly in the province of Jean de Bracemoras, forms a
  very great portion of the pale bark.  There is another
 species, the cinchona nitida, which is occasionally mixed
 with c. condaminea.  The c. nitida is considered as the
 most  valuable of the pale barks, and is now  but seldom
 met with.   Indeed, we are informed that the condaminea
 is  daily becoming scarcer, and it would appear from the
 account give#n by Humboldt and  Bonpland, that the
 greater part of the  pale bark, consists  now principally
 of the c. scrobiculata.
    Yellow  bark.—This is the cinchona  cordifolia of
 Mutis; the pubescens of  Vahl,  and the ovalifolia of
 Humboldt, and is known in commerce under the name of
 calisaya bark.  This species grows in cold mountainous
 regions, and is  particularly abundant in the provinces of
 Loxa and Cuenca.
  This bark comes to us in pieces of about six  inches in
length,  not so much rolled  up nor so thin as  the pre- 
:228
CINCHONA.
ceding kind.  Its internal surface is straw-coloured, be-
coming of  deeper yellow when dipt in water ; it is not
so heavy, and less compact than the pale bark.  When
chewed it is very bitter, possessing considerable astrin-
gency, with little or no  odour.   " Its decoction, when
hot, is redder, but when cold, paler. Its solution strikes
a deeper colour with sulphate of iron.   It contains more
of the active constituents than either of the others, but
less gum than the preceding species; according to Mutis,
it is the only one which is directly febrifuge, and we are
informed by Humboldt, it is that which is most esteemed
at Loxa."
   Bed bark.—This is the cinchona magnifolia of Ruiz
and Pavon, and the c.  oblongifolia of Mutis. It is found
in considerable abundance  in Peru, and at Santa-Fe de
Bogota. It is commonly imported in larger, thicker, and
flatter pieces than the  other  two kinds.  It is compact,
friable, and heavy: breaks  with a  smooth fracture; ex-
ternally it  is rough, and of a reddish brown colour; the
internal surface is redder,  of a fibrous woody texture;
the central part is resinous, brittle, of  a darker red, and
compact.  This species is more bitter and astringent
than the pale bark,  and by some is considered the best
of the barks in use.   Mutis, however, observes that its
febrifuge powers are not equal to those of the yellow
bark.  It is very frequently found in an  adulterated state,
being either nothing but pale bark coloured with some
other substance, or the red bark mixed with other pow-
ders resembling  it in colour, &c.
   Cinchona  caribsea.—This is a native of the Cari-
 baean islands, and was first brought to the notice of the
profession  by Dr. Wright, in an excellent account of it
published  in the Philosophical Transactions of London. 
CINCHONA.
229
 This bark is imported in pieces from four to six inches
 in length, rolled into a cylinder, and from a line to two
 in thickness.  Its external surface is brown, and covered
 with small white lichens. Under the epidermis, or thin
 external covering,  there is a  dark-brown  and fibrous
 substance.  Its taste is at first sweetish, but on being
 chewed it becomes bitter and  somewhat acrid, not un-
 like the taste of horseradish.   Dr. Wright  found it to
 answer every purpose for which the Peruvian bark is
 considered  useful. This species is not unfrequently con-
 founded with the cinchona floribunda, which is brought
 from St. Domingo, and which was first described by
 Badier, in 1777.  This may be distinguished by its grey
 epidermis, which covers! fibrous parenchyma of a pale
 brown colour.  It is very bitter, and it is said to possess
 considerable emetic properties.
   Chemical character.—There is, perhaps, no article
 in the materia medica which has been so frequently the
 subject of analysis as the  cinchona bark.  The results,
 however, have been very various, and in some respects
 so contradictory, that, on this  subject, there still exists
 much confusion and  perplexity.   The cause of this di-
 versity exists, no doubt, in the confusion and uncertainty
 which has hitherto existed with regard to the  different
 species of the cinchona,  and their  consequent liability
 of being mistaken one for the other.*
  It  would be useless and quite uninteresting to give a
 detailed account of the analyses that have been made of
 the bark; it will be sufficient to state the most impor-
 tant results upon this subject.
  Mr. Deschamps, of  Lyons, ascertained the existence
of lime in cinchona, which he considers as arising from
* Dr. Duncan's Dispensatory. 
230
CINCHONA.
 the decomposition of a particular salt residing essentially
 in the bark.   Mr. Vauquelin, who has  examined  this
 salt very attentively, thinks that the acid which is unit-
 ed with the lime is  a peculiar one, and  has, therefore,
 proposed  to  call it kinic acid.   This acid  crystallizes
 in thin lamina, unites with earths and alkalies, forming
 soluble and crystallizable salts, and forms  no precipi-
 tates with the nitrates of silver, mercury, or lead.
   According to the very minute analysis of yellow bark,
 by Marabelli, chemist of Pavia, it appears to contain
 citric acid, gallic acid, muriate of lime, muriate of mag-
 nesia, nitrate of potass, sulphate of potass, a resinous  ex-
 tract, a mucous extract, mucus, gum,  gluten, a pure  re-
 sin, and woody fibre.  Distilled with water  on  a  sand-
 bath, a lymph passes over, containing a small portion of
 acid, some ammoniacal salt, and a volatile oil.  Mara-
 belli observes, that the bark should not be   given with
 any of the martial salts, on account of the decomposition
 that would take place in  consequence of the gallic acid
 of the cinchona.   Alibert and Cabal detected a small
 portion of  iron in cinchona.  They digested the ashes
 of the bark in nitric acid, and obtained a  fine Prussian
 blue by the addition of some prussiate of potass.*
   Various opinions have been published in  relation  to
 the particular principle of bark in  which its tonic vir-
 tues are supposed to reside.   Sequin thought he had
 demonstrated the existence of gelatine in cinchona, and
ascribed its febrifuge powers to this principle.  In con-
sequence of this supposed discovery some of the French
and Italian physicians employed glue  in intermittents,
and, according to the reports that have been published,
with very considerable success.  Mr. Westring, a Swe-
* Alibert's Materia Medica, vol. i. p. 48. 
CINCHONA.
231
 dish physician of great eminence, was led to conclude
 from his  observations and experiments, that the febri-
 fuge power of bark resided wholly in the tannin  which
 it contains.
   More recent chemical researches, however, have de-
 monstrated the existence of peculiar alkaline principles
 in cinchona, in which its febrifuge or  tonic properties
 appear exclusively  to  reside.  We  are indebted to
 Pelletier and Caventour for the  discovery of this  sub-
 stance in cinchona, (Annales de Chimie,  &c .T. 15, p.
 289, 337,) and its properties were subsequently more
 fully investigated by Bardollier, Henry, Pfaff, and Meis-
 sener, (Schweiggers neues Jour. d. Chemie. und Phy-
 sick. B. 2. p. 413, B. 3. p. 62.)
   There are  two kinds or varieties of this alkaline prin-
 ciple in cinchona.   To the one the name of cinchonium
 is given ; and the oth er is termed chinium or quina or
 quinine.   Both these substances are  but  sparingly so-
 luble in water ;  but alcohol  and  ether  dissolve them
 readily.  They unite readily with acids,  and form neu-
 tral  salts, soluble in alcohol and ether, but not in water,
 unless supersaturated with the acid. In the natural state,
 as they exist in the bark,  these alkaline principles are
 united with the kinic acid.  They are very bitter, and
 their bitterness is considerably increased by their union
 with acids.
  The cinchonine (cinchonium) was  at first  supposed
 to reside only in the cinchona  condaminea; chinin
 (quinine) was thought to be solely confined to  the yel-
 low bark;  whilst the red bark was said to contain both
these principles.   Later experiments, however, have
shown, that both cinchonine  and chinin exist  in all
the different varieties of cinchona employed  in  prac-
tice,  although in very different relative  proportions, 
232
CINCHONA.
the one or the other generally predominating very con-
siderably.   Cinchonine may be obtained in fine, white,
transparent, needle-shaped crystals.   It dissolves  with
difficulty in water, more readily in ether, and still more
speedily in alcohol.   It has no smell, and is but slightly
bitter.   When  saturated  with  acid,  however, it be-
comes very bitter.   In a state of combination with acids
it forms crystallized salts, very soluble in water.
  Chinin also may, with nice management, be obtained
in a crystallized form. It is more soluble in water, ether,
and alcohol, than cinchonine,  and possesses also a much
more intensely bitter taste than the latter substance. It
unites very readily with acids, particularly the sulphuric
acid, forming the well-known and valuable preparation,
sulphate of quinine.   This salt dissolves very slowly and
sparingly in water, but by  the addition of a small portion
of the acid, so as to form a supersulphate, it becomes very
soluble in water, without losing any of its medicinal  pro-
perties.   It consists of white,  and when recent, shining
needle-shaped minute crystals ;  has  an intensely bitter
taste, and no perceptible odour; it is soluble in pure al-
cohol, but insoluble in water.   This preparation possess-
es all the medicinal  virtues of the cinchona, and is  now
almost universally employed  in preference to the  bark
itself, or any of its preparations.
   Mr. Sequin gives the following directions for ascer-
taining the relative powers of the different species of bark.
   " 1.  Good cinchona precipitates the solution of  tan-
nin, but those of  sulphate of  iron and gelatine are not
precipitated by it.
   " 2.  The precipitate which the febrifuge  principle
forms with the solution of tan, is reddish, slightly  floc-
culent, and heavy.   If the precipitate be considerable,
and sink quickly, it is a proof that the febrifuge princi- 
CINCHONA.
233
 pie is abundant and of good quality.   If it be not very
 decided, and remain suspended in the liquor, only dis-
 turbing its transparency, it is a proof that it is scanty
 and of bad quality.
   " 3. If it does not precipitate the solution of tannin, it
 is a proof that it does not contain any febrifuge principle.
   " 4. If it only precipitate the solutions of tannin and
 of sulphate of  iron, it is a  proof  that it contains an as-
 tringent substance not capable of tanning, which is fo-
 reign to it.
   "5. If it precipitates solutions of tannin, sulphate of
 iron, and  gelatine, it  is a proof that it contains an as-
 tringent substance analogous to that of the oak."
   Following  these principles,  M. Sequin makes six
 classes of cinchona.
   "Class  1.  Precipitate  neither  tannin  nor  gelatine,
 but form, with sulphate of iron, a precipitate soluble in
 acids, and insoluble in alkalies ; properties common to
 astringents.   This class has no febrifuge property.
   " Class 2.  Precipitate neither  tan, gelatine, nor sul-
 phate of iron.
   " Class 3.  Precipitate neither gelatine nor sulphate of
 iron, but act  slightly on solution of tan.  These act only
 in large and inconvenient doses.
   " Class 4.  Precipitate neither gelatine nor sulphate of
 iron, but solution of tan abundantly. The best cinphona
 of commerce  are of this class.
   "Class 5.  Precipitate solutions of  tan  and sulphate
 of  iron, but not gelatine.   The chalybeate precipitate
 was ferruginous, yellow, and abundant, and  soluble in
alkalies."   He  found  these properties to belong to a
specimen of a bark sold as Angustura.
  il Class 6.  Precipitate tannin and gelatine,  but not
sulphate of iron."  M.  Sequin  rarely  met with this
  vol. i.—32 
234
CINCHONA.
kind of bark, but he thinks favourably of it.   Water ex-
tracts the virtues of bark; but  the infusion very soon
undergoes decomposition and loses its medical proper-
ties.
  From an accurate and extensive series of experiments
by MM. Pelletier and Caventou, it appears  that when
cinchona is subjected for a considerable length of time
to the action of boiling water, the cinchonine in com-
bination with the kinic acid is dissolved, together with
some gum,  starch, yellow  colouring matter,  tannin, a
portion of red  matter,  kinate of lime, and  generally a
portion of fatty matter.  By reason of the simultaneous
existence of these various substances in the decoction,
it soon loses, on becoming cool, its clear colour, in con-
sequence of a new  compound, insoluble in cold water,
formed by the  combination  which takes place between
the tannin and the starch.  A part of the red and fatty
matter at  the  same time falls to  the bottom, carrying
with it a portion of the cinchonine, by which the active
principle of the preparation is diminished.   To obviate
these  circumstances  in some  degree, MM.  Pelletier
and Caventou recommend that a much larger quantity
of water than usual be  employed in making the decoc-
tion, in order  to keep the whole of the cinchonine in
solution; to  filter it when cold, and  afterwards to con-
 centrate it by  slow evaporation.
   The extract prepared from the decoction is liable to
 the same objections that exist against this latter prepa-
 ration; for that portion of the cinchonine which is com-
 bined with the kinic acid is insoluble, and is  therefore
 medicinally inert.
   Wine and alcohol extract very completely the active
 principles of cinchona.   According to MM. Pelletier 
CINCHONA.
235*   >
and Caventou,  the alcoholic preparations contain the
largest proportion of  cinchonine, and  constitute there-
fore the most powerful preparations of this remedy.
  It is sometimes infused in lime  water, and by many
this preparation is particularly recommended for chil-
dren.  In the  American Pharmacopoeia there is a for-
mula for an infusion of cinchona, in which it is directed
to triturate the bark with magnesia, previous to infusing
it.  When prepared  in  this way  it  is  much stronger
than when infused without the magnesia.  This substance
possesses  the  remarkable property of increasing, to a
very considerable degree, the  solubility of resins, bal-
sams, camphor, and oils;  and? as it  appears that the ac-
tive principle of cinchona resides chiefly in its resinoid
part, it is upon this prineiple,  no doubt, that the mag-
nesia acts in increasing the strength of the aqueous in-
fusion.
  MM. Pelletier  and Caventou have shown, that when
an alkali is added  to an aqueous decoction or infusion of
cinchona,  the cinchonine is precipitated by the  alkali,
and the liquid, when filtered,  is almost  entirely inert.
As  cinchonine is, however, fully soluble  in  alcohol,
there can be no objection, as these  gentlemen observe,
to the  practice which has been recommended by some,
of exhibiting the  tincture of bark  in combination with
an alkali.
  It is a singular and important fact that tartar emetic,
given in union  with bark, loses almost entirely its eme-
tic power.  It appears that when these two articles are
united, a partial decomposition takes  place, the oxyde
of the antimony uniting  with  the  tannin of the bark,
while the cinchonine is set free.
  It has also been ascertained that the active properties 
236
CINCHONA.
 of the bark are weakened by the tartaric acid ; the cin-
 chonine forming an insoluble compound with this acid.
   The salts of iron, sulphate of zinc, nitrate of  silver,
 oxymuriate of mercury, tartarized  antimony,  solutions
 of arsenic, form precipitates with the solutions of bark.
   Therapeutic  employment.—Mr.  Alibert justly ob-
 serves, that  the history of cinchona is very intimately
 associated with that of intermittent fever, both from the
 circumstances which attended its introduction into re-
 gular practice, and the high character which it has long
 held and still sustains, as a remedy in this  disease.   Of
 its very superior efficacy in intermittents, it would now,
 indeed, be altogether useless to adduce any evidence.
 Upon this subject  the profession may be considered as
 unanimous.   The  only difference of opinion which yet
prevails, in relation to the employment of cinchona in
these fevers, relates to the mode of administering it; the
periods of the intermission, in which it should be given:
the proper doses; and the utility or inutility of a pre-
 vious resort to evacuant remedies.
  With regard to  the propriety of evacuating  the sto-
mach and bowels  previous to administering the bark,
 considerable  difference of opinion has been expressed
 by writers.   But although some«have expressed doubts
 of the usefulness ■ or necessity of employing purgatives
 and emetics preparatory to the use of the bark,  yet ge-
 neral experience is decidedly in favour of the practice.
 There can be no doubt that many cases of  intermittent
 fever may be effectually removed by bark given without
 any  previous  evacuations whatever.  This is more es-
 pecially the  case  in  those instances which occur  in
 spring or winter, in subjects who have had the disease
 during the preceding  autumn; and which may,  there-
 fore,  be considered as relapses of the former attacks. 
CINCHONA.
237
  In intermittens  occurring in summer and autumn,  in
  miasmatic districts, and where the biliary secretions are
  much affected, an emetic, followed by a dose of calomel
  and jalap,  is in general a very useful measure previous
  to giving the bark.  There is too, sometimes, a phlogis-
  tic tendency in the system which is unfavourable to the
  febrifuge operation of the bark, and in such cases cathar-
  tics will act beneficially, by reducing the general ex-
  citement of the system.
    Bleeding also  is an important  preliminary in some
  cases of intermittents, before using the  bark.   I have
  had many examples of this  kind in  my  own practice.
 The tendency to  inflammatory action in  the system is
 sometimes so great that the fever has no power to deve-
 lop itself in its genuine character ; the intermission is
 incomplete, attended with restlessness, and an irritated
 state of the pulse; the cold stage is not marked by strong
 rigors, but only by creeping and  protracted chills ;  and
 the hot  stage does not go off by a profuse and universal
 perspiration.  In such cases the bark can seldom be em-
 ployed with advantage, unless it be preceded by vene-
 section,  and other evacuants.  By one good bleeding
 aiuLvCathartic, in  instances of this kind,  the fever will
 eommonly assume  its genuine character; the rigors will
 be strong; the  perspiration which concludes  the  hot
 stage copious and  general, and the intermission perfect.
 The bark will now act beneficially, however ineffectually
 it may have been previously employed.
   Considerable diversity of opinion has been expressed
 in relation to the proper time of exhibiting  bark in inter-
mittents.  Dr. Home gave  it at  the commencement of
the  hot stage.   Heberden gave as much as four ounces
immediately before the accession of the paroxysm; and 
238
CINCHONA.
Drs. Clark, Balfour, and others, recommended  it to be
given in the hot stage.  The proper stage of  this dis-
ease for  administering bark is, however,  undoubtedly
during the intermission.  Upon this point the profession
are now, I believe, unanimous.
  Cinchona should always be given in as large doses as
the stomach will  bear.   In general, from  one to two
drachms of the powder may be taken every hour.  Some
delicate stomachs will reject the bark when administer-
ed  even in the smallest  quantities.   When this  is the
case, it may be given in the form of decoction or infu-
sion, or  administered as a clyster.  " With children
who cannot  be prevailed  on to take the bark, we may
administer it with much efficacy in this way, repeating
the clyster every four hours."   It has also  been used
effectually in children, by applying it externally, quilted
in a shirt or waistcoat.
  When the bark occasions "purging, it must be  given
with the addition of small doses of opium.  This  is, in-
deed, frequently  a very important  addition to the cin-
chona.   It not oflily prevents  the bark from acting on
the bowels, but enables the stomach to bear much larger
doses of ity'and adds, moreover, in many instances, con-
siderably to its good  effects.  The snake-root may also
sometimes be very usefully combined with the bark. Dr.
Thomas says, that this combination is  particularly use-
ful in  intermittents of long continuance,  affecting old
debilitated persons, living  in a damp situation,  or when
the season is rainy.  I have myself occasionally given a
combination of bark,  opium, and snake-root, in cases of
this kind, and the effects  have, in  general, been very
favourable.
   Bergius speaks very highly  of a combination of bark
and mustard in this disease.  The late professor Barton 
CINCHONA.
239
recommended a mixture of  cinchona and black pepper
as an exceedingly efficacious remedy in intermittents.
The black pepper, indeed,  appears to be a remedy of
great powers in this disease, if we are to credit the ac-
count given of its effects by Dr. L. Frank.  This phy-
sician cured intermittents readily, by giving his patients
from five to eight grains of  pepper twice a day.   Dr.
Ghigini confirms this statement.*
   At present, however, the sulphate of quinine is al-
most universally employed in preference to the bark, or
any of its other preparations, for the cure of intermittents.
The highly contracted  state of the  tonic powers of the
cinchona, furnished in this preparation,  and the compa-
ratively small portions which suffice to arrest the disease,
renders  it altogether the most eligible preparation of
the bark, not only  in this but in every other disease,
where the cinchona is indicated.   Given  in doses of
from one to two grains every hour  during the intermis-
sion, it will do all that can be effected by the  most libe-
ral employment of the bark in substance.
   Dr. Alibert,  who has  published a highly interesting
work on malignant intermittents,X observes that the bark
is our only  remedy when the  disease assumes4 this cha-
racter, and that he has known this inestimable remedy
arrest, as if by magic, the delirium, convulsions, colliqua-
tive sweats, suffocating dyspnoea, lethargy, and excruci-
ating pains in the head, which attend this variety of the
disease.  This writer also observes, that the epidemic
constitution of the atmosphere  occasionally  impresses
such a  peculiar  character on  intermittent fevers, as to

   * Journal Complementaire de Dictionaire des Sciences Medi-
cales.
   f Traite sur le Fievres Pernicieuses Intermittentes. 
240
CINCHONA.
 render them incapable  of being cured by  the bark.*
 Hillary speaks of an epidemic intermittent at Barbadoes,
 in which the bark was of no avail, unless combined with
 saline remedies or some of the tonic bitters.  M. Bou-
 lou, also, mentions an epidemic intermittent, in which
 the cinchona was found ineffectual.
   When visceral obstructions accompany intermittents,
 the bark is a remedy of doubtful efficacy.   This is more
 especially the case where the diathesis is considerably
 inflammatory.  When the obstructions occur in weak
 and phlegmatic habits,  I have,  however,  seldom found
 any very particular obstacles to the successful operation
 of the bark.   In cases of this  kind, a gentle mercurial
 impression will, in general, either remove  the disease,
 or render it more manageable by the bark.   Dr. Barton
 observes that bark, combined  with mercury in a small
 proportion,  is one of the  best medicines  for removing
 the swelling of the spleen, which so often occurs after
 intermittent fevers.f
   Remittents.—After the inflammatory excitement has
 been somewhat moderated, by antiphlogistic measures,
 bark given during the remission has been recommended
 by some writers,  as not only a safe but a highly useful
 remedy.   Judging from my own experience, however,
 I am decidedly of opinion,  that the practice is, in ge-
 neral, not a safe one, except it be resorted to in the de-
cline of the disease, when  the exacerbations  are not
marked by strong vascular action, and the  remissions at-
tended with a cool and moist skin, and a small compres-
sible pulse.   It has already been stated, that where the
pulse remains  irritated and tense, and other symptoms

  * Elemens de Therapeutique, vol. i. p. 51.
  ■f MS. notes of Dr. B. S. Barton's Lectures on the Mat. Med. 
CINCHONA.
241
 cf an  inflammatory tendency in the system be present,
 in intermittents,  the cinchona will not only frequently
 fail to remove the disease, but aggravate its symptoms.
 This being the  case we can hardly  presume that the
 bark would  be  useful in remittents,  in which there is
 always some febrile action present,  however  complete
 the remission may be.   When the patient has been worn
 down by the long continuance of the disease,  and pro-
 per evacuations have been premised, bark may no doubt
 be employed with considerable  advantage in  this  form
 of fever.
    In certain stages of typhous fever, bark is a remedy of
 considerable utility.  During the stage of excitement,
 it is, however, wholly inadmissible.   When the disease
 is somewhat advanced,  and the  powers of  the  system
 begin to sink, bark, in conjunction with stimulants, given
 in  moderate  quantities,  will sometimes produce salutary
 effects.  Where,  in the latter  stages of the complaint,
 the tongue and skin are dry, and delirium or coma,  with
 convulsive twitches attend,  the  bark is however by no
 means a proper  remedy.   Here  camphor is,  perhaps,
 our most valuable  remedy.   It is in the state of conva-
 lescence, that the cinchona displays its salutary powers;
 but, in every other period of  the  disease,  where the
 powers of the system require support, it is decidedly
 inferior to some  of the more  diffusible stimulants, such
 as wine, volatile alkali, opium, musk, &c.
  It  must be observed,  that in all  febrile affections,
 where symptoms indicative of phlogosis of the mucous
 membrane of the alimentary canal are  present, bark is
 always highly pernicious, however  great  the  prostra-
tion may be.   When  in the latter stage of low fevers,
the abdomen  is tender to pressure, and the tongue red,
  vol. i.—33 
242
CINCHONA.
or dry and brown, nothing can be more injurious than
the employment of this tonic.   No degree of prostra-
tion can justify the administration of bark, under cir-
cumstances of this kind.  In general, the Peruvian bark
may be deemed  an  improper  remedy,  in  all diseases
where there is considerable irritation of the mucous
membrane of the alimentary canal.  The bark has also
been  highly recommended by some  writers, in acute
rheumatism and gout.   In the former of these diseases,
its powers have been particularly extolled by Morton,
Fothergill, Saunders, and Haygarth.  This latter writer
states, that for  many years he gave it in this disease in
doses of from grs.  v.  to xv. every two,  three, or four
hours,  having  previously  evacuated the stomach and
bowels by  means of antimony ; and  if  this quantity
proved  beneficial he gradually augmented  the  dose
to grs. xx. xxx.  xl.  taking particular care never to in-
crease the dose beyond what agreed  with the patient.
 He observes, that under this treatment, in the great ma-
jority of cases, "the pains, swellings, sweats, and other
 symptoms of inflammatory fever manifestly and speedily
 cease, till health is perfectly restored."
    Of the propriety  of this practice,  however, there is
 reason to entertain  much  doubt.  From my own ex-
 perience I can say  nothing  either  for or against  it,
 having never employed it in this disease ; but from the
 known properties of the bark,  we may infer, a priori,
 that it is a medicine which can be seldom employed in
 the acute form of rheumatism,  whilst the inflammatory
 fever continues, without doing injury.  After the sym-
 pathetic fever has been reduced by proper evacuants, and
 other antiphlogistic measures, the bark may, no doubt,
 be resorted to with advantage. Dr. Scudamore observes 
CINCHONA.
243
 that when the convalescence begins—when the tongue
 is becoming clean, the urine assuming a light specific
 gravity, the bowels acting regularly, and the skin relax-
 ed and soft to the feel,  he has found the bark, adminis-
 tered either as Dr. Haygarth directs, or in decoction with
 its tincture and sulphuric acid, a valuable medicine. Un-
 der opposite circumstances, however, he considers its
 employment of very doubtful efficacy.*
   Acute rheumatism, occurring in autumn, Or in mias-
 matic  districts, sometimes assumes a remittent, and even
 an intermittent type ; and when this is the case, the bark
 may be employed with much advantage, after  the  ali-
 mentary canal has been well evacuated, by emetics and
 mercurial purges.
   Dr. Tavares,f a Portuguese physician,  speaks  very
 highly of the remediate  powers of bark in gout.   He
 says in the words of Dr.  Held, whom he quotes in fa-
 vour of this remedy : " Uno verbo, cortex peruvianus in
 podagra divinum est remedium."  It is also recommend-
 ed by Drs. Small  and Saunders, as decidedly useful when
 administered in large doses  during the intermissions of
 pain and fever,  after the local  inflammation has been
 abated.J  It does  not appear, however, that this practice
 has ever been much pursued, and very few, I presume
 would now be willing to adopt it.  In the irregular form
 of this disease, where great  debility attends, bark  may
 be employed with advantage ; but in the  majority of
 cases of regular gout, it cannot be resorted to with safe-
 ty.  The late Dr. Barton used to state, in his lectures,
  * Scudamore on Gout and Rheumatism, p. 302.
  f Observationes et Epicrisis de Corticis Peruviani salutari et
proficus usu in Podagra. Sec Scudamore on Gout, p. 121. Philad.
edition.
  X Scudamore. 
244
CINCHONA.
 that he had observed the bark to be particularly perni-
 cious  in gout, when  it evinced a tendency to shift its
 situation to the stomach, lungs, or brain.
   According to some British  writers the bark is a re-
 medy  of very considerable efficacy in erysipelas.  For-
 dyce gave it in drachm doses every hour, and, as he in-
 forms  us,  with the  most decided  advantage.   Sir G.
 Blane, also,  in his Medical Logic,  observes;  "bark is
 the best remedy in erysipelas," and he adds,  that his
 success with it has equalled Dr. Fordyce's.  Instances
 of the  successful employment of the bark in this disease
 are also related by Dr. Parkman.*   When the attend-
 ing fever is of a typhoid character, and the local affec-
 tion manifests a tendency to gangrene;  or in the erysi-
 pelas of old and debilitated habits, the bark is a highly-
 useful  remedy.  In several  instances, that  occurred to
 me during the last few years, I derived great advantage
 from the free employment of quinine after  proper eva-
 cuations.   This tonic will also frequently  prove very
 beneficial,  where, after the local inflammation has nearly
 subsided,  the patient is left in a state  of considerable
 debility.   In the ordinary cases of erysipelas, however,
 where  the  system is plethoric, or the febrile excitement
 active, the employment of bark is decidedly contra-in-
 dicated, and can seldom fail to do mischief  when given
in the active period of the disease.   In a late work there
 is a form of  erysipelas described under the name of
 n~ysipelas phlegmonodes, which is said to be very pre-
 valent  in the British navy, and  in which bark  with
mineral acids may be  given with much benefit, when it
occurs in persons advanced in life, or of a weak habit.
and assumes a typhoid character.!

  * New-England Journal of Med. vol. xii. p. 132.
  X Surgical  Observations, by Mr. Copeland Hutchinson. 
CINCHONA.
245
    The bark was formerly a good deal employed in mea-
  sles.   Dr.  Percival describes an  epidemic  measles of
  the regular kind,  in which, however, it was not usual
  for violent pulmonic symptoms to occur  until five,  six,
  or eight days after the eruption had disappeared. Speak-
  ing of this epidemic, he says,  u I prescribed the bark
  with  great success to  many of my patients  under  the
  measles, combining it  with demulcents and  the  saline
  mixture;  and premising venesection when the signs of
  inflammation were urgent."  He ascribes the first em-
  ployment of this remedy in measles to Dr. Cameron, "a
  very eminent  physician at Worcester," and  extols  the
 practice very much.*
   In the putrid measles described by Dr. William Wat-
 son,! the  bark is said to  have  afforded great relief in
 the second stage, when great debility was present.   He
 observes,  however, that where there was much cough
 and difficulty of breathing, the bark generally  acted
 perniciously, however great the debility of the patient.
 Notwithstanding these  favourable reports of the effects
 of bark in  measles,  the  present  sentiment of the profes-
 sion appears to be  entirely against  the practice.  In
 this country, at least, the measles are always too strongly-
 marked by inflammatory symptoms to admit of this re-
 medy. Venesection, cold and tepid affusions, purgatives
 and diaphoretics, are the remedies now generally trust-
 ed to,  both in Europe and in this country.
  In the scarlatina anginosa, the bark  has been much
recommended by some writers.   In the last stage of this
complaint,  where there  is great prostration of strength,
with symptoms of malignancy and putrescency, and a

  * Medical Observations and Inquiries, vol.  v. p. 284.
  X Ibid. vol. iv. p. 136. 
246
CINCHONA.
tendency to gangrene in the throat, the bark is undoubt-
edly a medicine calculated to do good.  In its simple
form  of scarlatina, however,  the bark is inadmissible,
except, perhaps, as a tonic during the state of convales-
cence ; and even here it will seldom  be necessary or
very useful.  Nor  can  this tonic be  employed in  the
malignant variety of the disease during the inflammatory
stage, without  the risk of doing a great deal of injury.
Formerly it was customary to  prescribe the bark in the
early stage of this variety of the disease, but the experi-
ence  of the profession is now universally opposed to  this
practice.   Bleeding, purging, emetics, cold and warm
affusions,  are the remedies to be relied on during the
stage of excitement, in both  the simple and malignant
forms of the disease.
   Not much can be said in favour of bark  in the cure
of  epilepsy and tetanus.  In the former of these com-
plaints it  was once a good deal prescribed, but it does
not appear to be entitled to any particular attention for
its powers in this way.   In tetanus, it was employed by
Dr. Rush, and he speaks favourably of its effects.   Dr.
Morrison, in his excellent work  on tetanus, observes,
what indeed will be readily assented to, that the disease
being conquered, the patient should take wine and bark
for many weeks.  I have, however, never heard of any
case in which the bark effected a cure ; in the cases in
which it  appeared to do good, it was given in con-
junction  with the free use of  wine, to which latter we
may, I think, fairly attribute the benefit which  may
have been derived from such  a combination.
    Of the use of  bark in chorea, Dr.  Cullen entertain-
 ed a very favourable opinion.  I have seen one  case
 effectually cured by the bark, together with a few purges.
 The patient was a very delicate girl, about twelve years 
CINCHONA.
247
old, very debilitated before the disease came on, and of
a strumous habit.   She took  the  bark in forty grain
doses, four times a day, having previously evacuated the
contents of the bowels by purgatives, and was cured in
about three weeks.  In general, however, I should not
be inclined to use the bark in this disease, except in the
state of convalescence, at which time it may be servicea-
ble.   I am fully satisfied from what I have seen, that
the purgative plan of treatment recommended by Ha-
milton, with the occasional employment of gentle tonics
or antispasmodics, will, in the majority of cases,  be
more effectual than any other  plan of  treatment with
which we  are at present acquainted.
  Pertussis is another of  the  spasmodic  diseases in
which the Peruvian bark has been particularly recom-
mended. Dr. Morris appears to have been the first who
employed the bark in this  disease, and  his report of its
effects are very favourable.  He gave  it with castor.*
Cullen observes, that in the advancement of the disease,
when the cough is kept up by habit, and no pulmonary
congestions are present, the  bark may put an end to
the disease.  Many of  the German writers speak par-,
ticularly in favour of  the  bark in this  disease. !  In
this country it is, I believe, very seldom, if ever given ;
and except under the circumstances mentioned by Cul-
len, it does not, I am inclined to believe, deserve much
attention.
  Bark has been also much prescribed in asthma.   In
the paroxysm it can be of  no service;  but, where the
disease is  connected with  a cachectic state of  the sys-
tem, attended with indigestion,  this, in common with
other tonics, may be employed with advantage.
Medical Observations and Inquiries', vol. iii. p. 281. 
248
fclNCHOAA.
   In pulmonary consumption, the bark has been recom-
 mended by some writers, as a useful remedy.  Observing
 that this  disease is  marked by  periodical  paroxysms,
 with pretty regular cold fits, followed with heat, and at
 last copious sweats,  succeeded by a temporary abate-
 ment of all the symptoms, physicians were led to sup-
 pose, that as the bark is so valuable a remedy in intermit-
 tents, which are characterized  by a similar  train of
 symptoms, it might be employed with advantage in phthi-
 sis.  Experience, however, has proved that it is  not
 only of no value in this disease, but  uniformly perni-
 cious in its operation.  " I have seen the bark given,"
 says Dr. Fothergill, " in almost every state of the phthi-
 sis pulmonalis,  even in the  first commencement, whilst
 the breast was in pain,  the  cough dry and  harsh,  the
 pulse quick and hard, and the heat considerable. What
 was the consequence ?  Frequently an haemoptysis, and
 all its worst attendants—ulcerated lungs, purulent spit-
 ting, colliquation, and death."*
  This writer states, that symptoms resembling  those of
 genuine phthisis, are sometimes produced by  delicate
 mothers suckling their  children  longer than is consist-
 ent with their ability. In cases of this kind, he observes,
 the bark given  early and in  moderate doses,  often pro-
 duces very excellent effects; and  adds, that he is satisfi-
 ed that, by this remedy, he  has « retrieved many from
 deplorable situations," and that under such circumstan-
ces a prudent employment of the remedy may be made
with safety and advantage.
  Where symptoms of consumption supervene,  in con-
sequence  of copious discharges from  abscesses, fluor
albus, or other similar debilitating evacuations, the bark

  * London Medical Observations and Inquiries, vol. v. p. 347. 
CINCHONA.
249
is a useful remedy, provided the lungs be not yet in-
flamed.  If, however, the breathing is  oppressed,  the
cough dry, the  pulse  quick and  hard, with shooting
pains through the  chest, the bark  will inevitably in-
crease the disease.*
   There  is another variety of consumption, in which
the bark may sometimes be beneficially employed.   It
is that species of the disease which has  been lately  de-
scribed under the name of dyspeptic phthisis.   In  the
early stages of this complaint, whilst the affection of the
lungs is as yet sympathetic,  the moderate employment
of bark, with laxatives, may be attended with very  be-
neficial results.  It is,  however,  decidedly pernicious,
whenever the pulmonary organs become the seat of in-
flammation, or organic alterations.
   In catarrhal phthisis, or as it is more properly called,,
chronic bronchitis,  where the expectoration is copious
and the  system  much  debilitated, much benefit may
sometimes be derived from the free use of this tonic.   I
have prescribed  the sulphate of quinine in conjunction
with balsam copaiva, with advantage, in a few instances
of this affection.  Dr. Hastings states, that when given
in union with the diluted sulphuric acid, the Peruvian
bark tends to  restrain the profuse night-sweats,  and to
improve the  secretions from the mucous membrane of
the lungs.  I have used quinine in union with the ex-
tract of conium  with decided benefit in chronic bron-
chitis succeeding hooping-cough.
   Of the use of bark in dyspepsia,  I have no very  fa-
fourable opinion, when the disease is once completely
formed, and the  lungs  or liver brought into a morbid
condition. In mere weakness of the stomach, giving rise
                * Dr. Fothergill.
vol. i.—34 
250
CINCHONA.
 to flatulence and acidity, the bark, either by itself or in
 combination with iron, may be used with advantage; but
 in that fixed form of the disease in which the mind and
 body are equally unfitted, both for the  enjoyments and
 duties of life,  the bark, and indeed all  tonics, must be
 administered with the  greatest circumspection.
   In scrofulous complaints the bark is a remedy of very
 considerable powers ; and it deserves to be placed among
 our most useful medicines in this disease.  (i In tumefied
 glands, where  the habit happens to  be feeble, and the
 circulation weak, from constitution or accident,  bark is
 a most efficacious remedy; and, what is remarkable, acts
 as a resolvent and discutient."*   Dr.  Fordyce observes
 also, that much may be done with this remedy in scro-
 fulous ulcerations, or in " gleety, phagedenic, and semi-
 gangrenous sores." In  debilitated persons of a strumous
 habit, the bark, with cold  bathing  and iron, is a very
 valuable remedy. Bark,  in combination with the mine-
 ral alkali, has been known to remove scrofulous swell-
 ings, when no  other form of this medicine would have
 the least effect, f  In a few cases of  scrofulous ulcera-
 tions, I obtained much  advantage from the bark given
 conjointly with cicuta and minute portions of corrosive
 sublimate.  In this stage of the complaint, however, we
 can very seldom procure complete relief  by any mode
 of treatment which has  hitherto been devised.
  The bark has also been recommended as very service-
 able in certain  varieties of dropsy. Where, for instance,
 anasarcous swellings depend on mere debility, and no

  * An Account of some Virtues of the Peruvian Bark, not gene-
rally known nor described,  particularly in  Scrofulous  Cases,  by
John Fordyce, in  Med. Observ. and Inquir. vol. i.
  t MS. Lectures of the late professor Barton. 
CINCHONA.
251
visceral obstructions exist, the bark, as  a general robo-
rant, is a remedy of excellent powers.   In combination
with cream of tartar, it is said to be peculiarly efficacious
in the dropsies which succeed intermittents.   I should
doubt, however, its general applicability in cases of this
kind, since dropsies from  this cause are very commonly
connected with visceral  indurations—a  circumstance
which experience shows to be especially unfavourable
to the salutary  operation of this remedy.
   In hemicrania, when, like an intermittent, it returns
at regular periods, the bark is  the  last remedy  with
which we are acquainted.  I have usually combined
it with valerian, and administered it  in large doses.  It
is always  useful to evacuate the  stomach and bowels
previously to  employing  this remedy.   In periodical
neuralgia, we possess no remedy equal in efficacy to the
bark, or quinine.   Given in large doses it often arrests
the disease in a short time.   In all painful affections of
a periodical character,  the quinine  is  a highly effica-
cious remedy.
   The Peruvian bark is also very commonly prescribed
in gangrene.  When the gangrene depends on deficien-
cy of action, this  remedy is of  unquestionable  utility.
Where it depends on increased  action or inflammation,
the bark is always injurious if it be given before the ge-
neral inflammatory excitement has subsided. To promote
the separation and  sloughing of dead parts, however, and
support the sinking powers of  the system  during this
process, after the general inflammatory action has disap-
peared, the bark may be very advantageously resorted
to.  It is usually given in combination with opium, vola-
tile alkali, or wine, and  its powers are much assisted by
these articles.  In canerumoris, or the  sloughing ulce-
ration of the gums and cheeks of children* the quinine 
252
CINCHONA.
is perhaps the most effectual internal remedy we possess,
I have derived the greatest benefit from the free use of
this tonic in several instances of this kind.
  Having now given an account of the therapeutic ap-
plication of the bark, it remains for me to say something
concerning its preparation and modes of exhibition.
  With the exception of  the  sulphate of quinine,  the
best  form  for exhibiting the bark, undoubtedly  is
in substance.   The stomach,  however, will sometimes
reject it when taken in this  way, and  in this case it
should be given in the form of an infusion, conjointly
with the tincture.   When thus administered, it will, in
general, remain very easy on the stomach.  By giving
the infusion and tincture  together, we obtain all  the
power of the bark residing both in  its gummy and  re-
sinous  principles—an advantage which  cannot be  so
completely had by using these preparations separately.
  If the bark disagrees with the stomach in whatever
shape it be taken, it may be beneficially employed in the
form of a clyster. Administered in this way it is particu-
larly applicable to the diseases of children, where it may
be necessary to employ this remedy. The bark may also
be advantageously used as an external application, either
in the  form of powder quilted into a waistcoat, or of
decoction, as  a bath,   Dr.  Alexander  states, that he
cured intermittents by immersing the lower extremities
in a decoction  of bark, when the stomach rejected the
medicine.
   The sulphate of quinine is, without doubt, the most
valuable preparation of the cinchona we possess; and it
has now in  a great degree superseded the employment
of the bark  in periodical affections.   Experience has
indeed fully established its excellent  powers,  as a re-
medy in intermitting fevers and other analogous periodi- 
CINCHONA.
253
€al affections usually treated by tonics.   As a general
tonic, it does not, however,  appear to  be equal to the
bark in substance.   In general  debility and  relaxa-
tion of  the system, in extensive suppurations, in  gan-
grene,  &c. the sulphate of quinine seldom procures the
advantage that  may  be obtained from  the cinchona
'itself.  Occasionally this preparation acts strongly upon
the alimentary canal, producing violent purging or vo-
miting.   When it causes purging, the best corrective
is the  addition of a  small 'portion of the sulphate  of
zinc—a combination  which is peculiarly beneficial in
intermitting fevers.   In general,  its stimulant powers
are  much more  active  than those  of the cinchona  in
substance.   A full dose is usually followed  by a mani-
fest increase of the temperature of the  surface, and a
feeling  of  tension and fulness in the head.   Its tenden-
cy to determine the blood to the brain is very conside-
rable.   When full and  frequent doses are taken, the
countenance generally becomes flushed, and the vessels
of the  head turgid, attended with a sense of confusion,
heaviness of the head, and often ringing in the ears.  In
three instances under  my observation, the cerebral con-
gestion produced by  this article was so  violent  as  to
give rise to a singular form of  delirium, resembling the
mental  derangement  which is excited by an over dose
of stramonium.
   It is  prepared in the following manner: boil, for half
an hour, two pounds of the appropriate bark in powder,
in sixteen of distilled water, acidulated with two  fluid
ounces of sulphuric acid—strain the decoction through
a linen cloth, and submit the residue to a second ebulli-
tion, in a similar quantity of acidulated water: mix the
decoctions, and add,  by small portions at a time,  pow-
dered lime, constantly stirring it to facilitate its action 
254                   CINCHONA.

on the acid decoction.   (*Half a pound is near the quan-
tity requisite.) When the decoction has become slightly
alkaline, it assumes a dark-brown  colour,  depositing a
reddish-brown flocculent precipitate, which is to be se-
parated by passing it through a linen cloth.  The pre-
cipitate is to be washed with a little cold distilled water,
and dried: when dry, it is to be digested in rectified spirit,
with a moderate heat, for some hours: the liquid is then
to be decanted, and fresh portions of spirit  added, until
it no longer acquires a bitter taste.    Unite  the spiritous
tinctures* and distil in a water bath till three-quarters
of the spirit employed  be distilled over.   After this
operation,  there remains in the vessel a brown viscid
substance,  covered with a  bitter,  very alkaline, and
milky fluid.   The two  products are to  be separated,
and treated as follows: to the alkaline liquid, add a suf-
ficient quantity of sulphuric acid to saturate it;  reduce
it, by evaporation, to half the quantity; add a small por-
tion  of charcoal,  and after some  minutes' ebullition,
filter it while  hot,  and  crystals of sulphate of quina
will form.   These are to be dried in bibulous  paper.
Two pounds of the bark will yield  about five to six
drachms, of which eight grains are considered equal to
an ounce of bark.   This is the  younger  Henry's pro-
cess, modified by Paris.
  The dose of this preparation varies from one  to five
grains; but the usual  dose when a frequent repetition
is required, as in intermittents, is from one to three
grains.   For the mode of prescribing it see formulae.
  The extract of cinchona was formerly a good deal
employed,  particularly in the diseases of children re-
quiring tonic remedies.  From the experiments of Pel-
letier and Caventou, however, it appears that this pre-
paration  possesses but feeble tonic powers.  The ex- 
                       CINCHONA.                  25 J

 tract made by  maceration in cold water is more active
 than  that  prepared  by  decoction  or infusion.  The
 alcoholic extract possesses considerable powers; but it
 is nevertheless much inferior to the sulphate of quinine,
 or the bark in substance.
   The  alkaline principles  of the  cinchona, in their
 simple state, that is,  without being combined with an
 acid, have also been employed in practice; and it would
 appear that their powers are but little inferior to those
 of the  sulphate  of quinine.   Nieuwenhius employed
 both the cinchonine and the quinine.   The former ap-
 pears to be much less  efficacious than  the latter, and is
 moreover apt to disagree with the stomach and to excite
 vomiting.  Elliotson  also employed the quinine in its
 simple state, and his  experience led him  to consider it
 fully  equal to the sulphate.   He prescribed it in doses
 of five grains every six hours in intermittent fevers with
 entire  success.   As the simple quinine is much more
 easily prepared and at much less expense, than the sul-
 phate, it would appear to be well entitled to the atten-
 tion of the practitioner.
   The tincture of cinchona made with diluted alcohol,
 contains much of the active properties of this article.
 In affections or  states of the system where tonic and sti-
 mulating remedies are indicated, as  in  the low states of
 typhous fever, this tincture constitutes  an excellent re-
 medy.   It is, however,  much too  stimulating to render
 it a proper medicine in intermittents, and other affec-
 tions where the liberal use of the bark may  be required.
 In mere gastric debility, with a relaxed and torpid
state of the general system, the compound tincture of
bark  (Huxham's tincture) is often a very useful  medi-
cine.   In the convalescence of fevers, where the gene-
ral languor and debility is considerable, an excellent 
256
CINCHONA.
mode of administering  the bark is to  give the watery
infusion and  tincture in combination.   A wine-glassful
of the  infusion with a tea-spoonful of  the tincture may
be given at a dose, and repeated according to the degree
of debility and relaxation.   In this way all  the powers
of the  bark are obtained,   and in a  form which ge-
nerally agrees much better with the stomach than either
the cinchona in substance or the sulphate of quinine.

                         Formula}.
  R.—Pulv. cinchonae flav. 5i.
      Elix. vitriol.        3"-
      Aq. bullientis       %xvl-  Simmer it slowly down to 5xii.
Strain, and give a wine-glassful every hour or two.
  R.—Sulphat. quinae gr. xii.
      Sulphat. zinci   gr. iv.
      G. aloes       gr. iii.
      Conserv. rosar.        M.  Divide into ten pills.
  R.—Sulphat. quinae gr. xii.
      Sulph. acid     gtt. iii.
      Syrup, limonis  ^i      M.  Dose, a tea-spoonful.
  R.—Sulphat. quinae  gr. xii.
      Sulph. acid       gtt.  iii.
      Extract, glycyrrh. 3iii.
      Aq.  menthae      ^iv.
      Aq.  fontanae      §iv.  M.   Dose, a table-spoonful.
  R.—Pulv. cinchon.  flav.  ?i.
      Pulv. serpentariae   3ii.
      Sodae subcarbonat.   3iss.  M.  Divide into eight equal parts.
 Dose, one every two hours. 
(  257  )
             ARISTOLOCHIA SERPENTARIA.

                 Virginia Snakeroot.

  This plant is found exclusively in the United States ^
And  constitutes an  excellent article of our indigenous
materia medica.  The root which is  the only part em-
ployed  in medicine, is perennial,  consisting of very
numerous fibres, matted together,  proceeding from a
common head  or caudex.  The fibres are of a yellow
ochre colour externally,  and of a pale yellow within.
The central or  knotty part of the root is of a dark brown
colour.   It has an agreeable aromatic smell, resembling
that of valerian; its taste is warm, pungent, and bitterish,
not unlike that of camphor or of the pinus canadensis.
Subjected to the action of alcohol, " it affords a bright
green tincture, which is rendered turbid by water; by
filtration a small portion of a green matter is separated,
but its transparency is not restored.   It neither  precis
pitates tannin nor gelatine, nor affects the salts of iron or
tincture of turnsole.  When the diluted tincture is dis^
tilled, the spirits and tincture passes over milky, strongly
impregnated with  its peculiar odour."   Lewis states
watery,((not so much from its having lost less in evapora-
that the spirituous extract is more  powerful than the
tion, as from its containing the active parts of the root
concentrated into a smaller volume ; its quantity amount-
ing only to about one-half of that of the other."
   The snakeroot was first brought  into notice as a re-
medy for  the bite of venomous  serpents; and although
soon found to be  destitute of antidotal powers, experi-
ence showed it to  be a remedy of very  considerable
value in a variety of circumstances.
  vol.  l.—35 
25S
ARISTOXOCHIA SERFENTAIUA.
    When taken into the stomach,  it increases the force
 and  frequency  of the  pulse,  excites  a  glow  of  heat
 throughout the system,  and produces pretty copious di-
 aphoresis.  It is not, however, simply  stimulant and
 diaphoretic in its effects,  for  along with  these qualities
 it possesses very important  tonic powers.
   Possessing, along with its tonic, pretty powerful stim-
 ulant properties, the snakeroot is peculiarly suited to
 fevers of a low grade of excitement; on the other hand,
 however,  it can never  be  employed  without danger,
 wherever blood-letting is indicated.
   In every variety of fever, however, when the system is
 sinking into a typhoid state, the snakeroot is a remedy
 of unquestionable utility.  11 is especially  serviceable in
 the latter stages of febrile diseases, when  the skin and
 tongue remain dry and hot, and the pulse  is feeble and
 frequent.  When given  in this state, it commonly ex-
 cites  a general diaphoresis;  the tongue becomes moist,
 and the pulse and general  powers of the system are
 invigorated.
  A good deal has been  said in favour of the  powers of
 the serpentaria in putrid fevers, and, from the general
 properties of this remedy, there can be little doubt of
 its applicability  to the treatment of fevers of this kind.
  The  snakeroot was  formerly  much  employed  in
 intermittents.   Of its efficacy, however, in the cure of
 this disease, when administered by itself, not a great deal
 can be said.  I have employed it in some instances, but
always without success, and I am inclined to believe that
it is not often capable of arresting the disease.  When
united, however,  with  bark, or some of the bitter tonics,
it seems to increase their efficacy, and it is in this way,
that it is now commonly  employed in intermittent and
remittent fevers.   It is particularly useful with Peru- 
ARISTOLOCHIA SERPENTARIA.
259s
  vian bark, in those  intermittents, where the system is
  depressed, and sluggish during the intermission, with a
  small and feeble pulse, and a cold and  dry state of the
  surface of the body.
    During the prevalence of the late  epidemic pneumo-
  nia typhoides, in this country, the serpentaria was much
  prescribed  by some physicians.  Being at once stimu-
  lant, diaphoretic, and roborant, it was peculiarly calcu-
  lated to produce beneficial effects in  this disease, by
  equalizing the circulation, and imparting vigour to the
  vital powers. Dr. Dyckman states, that he has prescrib-
  ed the snakeroot in combination with seneka, with mark-
  ed advantage in this disease.   It may also be employed
  with advantage in the latter stages of pneumonia, and
  bronchial affections, being useful not only by its  tonic
  operation, but chiefly, perhaps, by exciting the cutane-
  ous emunctories, and thereby  relieving the pulmonic
 system.
   The infusion of snakeroot may be used with advan-
 tage, as a gargle, in  ill-conditioned ulcers of the throat.
   The dose,  in powder,  is from twenty  to thirty grains.
 It is  usually given in infusion, of which a wine-glassful
 may  be  taken every half hour or hour.  By boiling, its
 powers are entirely destroyed.

                        Formula;.
  R.—Rad. serpentariae  ^i.
       Rad. colomb.     3'i-
       Cort. cinnamon.   $i.
       Aq. bullientis.     vi.  M. Macerate  for one hour. Dose,
a wine-glassful.
  R.—Pulv. serpentariae.
      Magnes. albi aa gr. xvi.
      Pulv. rhaei     gr. xii.  M.  Divide into six equal parts.
This ia a very useful mixture in dyspeptic affections of infants. 
( 260 )
BONPLANDIA TRIFOLIATA, (CUSPARIA FEBRIl UGA.)—ANGOS-
                     TURA BARK.

   It is not a great while since this bark has been known
 to the profession ; but it would appear from the experi-
 ence of those who have given an account of its remediate
 powers, to be  entitled  to very considerable attention.
 The Angustura bark is obtained from a large and beau-
 tiful forest tree, growing in abundance in the woods near
 Carouy and Alta Gracia.   It is also found in  the valley
 of Santa Fe, between Cumana  and New Barcelona.,*
 and particularly  in the  woods near Carouy and Alta
 Gracia.  The botanical  character of this tree was not
 known until it was described by Humboldt and Bonpland.
 Wildenow,  to whom specimens  were sent  by these en-
 terprising and intelligent travellers, constituted it  into
 a new genus, to which he gave  the  name Bonplandia.
 It is said to approach very nearly in its botanical charac-
 ter to quassia, but to be, nevertheless, sufficiently discre-
 pant from this  to require for its classification a separate
 genus.
    The bark of this tree comes to us in small, slightly
 convex, wrinkled,  and  externally whitish  pieces,  of
  about four or five inches in length.  It has a very bitter
  and slightly aromatic taste.  Its odour  is  peculiar and
  nauseous.   When pulverised it becomes of a bright yel-
  low colour.
     According to M. Vauquelin, this bark does not pre-
  cipitate  animal  gelatine, but it forms a copious pre-
  cipitate with tartar emetic, iron, copper, lead, and tin.
   One of its principal chemical peculiarities, therefore, is
   that it does not precipitate animal gelantine.  M. Vau-
* Alibert. 
ANGUSTURA BARK.
261
quclin thinks, too, that the principle which gives to this
barkthepower of precipitating metallic solutions, is not
the same as that which gives a similar property to the
Peruvian bark.*  From the analysis of other chemists,
however, it appears that the Angustura  bark contains
cinchonin, besides  resin, extractive, carbonate of am-
monia, and an essential oil.   Its active principle is rea-
dily extracted  by cold and hot water,  and it does not
appear that long boiling injures its powers.f
   The Angustura  bark  is a  stimulant  tonic of very
considerable  powers;  and  is much less apt to  nau-
seate or oppress  the stomach than  the cinchona  bark.
It  is  especially a useful  tonic in cases  of  general
muscular debility  and relaxation,  attended  with an
inirritable  state of  the system.   When  first  intro-
duced into notice  it was  highly extolled  as a reme-
dy in intermittent fevers; and although  it has now
lost much  of its  former  reputation,  there  are still
some highly respectable  physicians who regard it as a
remedy of very great power in the cure of intermittents.
In intermittens attended with much weakness of the di-
gestive functions, and  general debility and relaxation,
the Angustura bark  is a  peculiarly valuable  remedy
(Richter).  It may be very advantageously given in union
with the cinchona ; and Vogel asserts that  he has often
succeeded in arresting the disease with this combination,
after the bark given by itself had failed  to do good.
    It has also been recommended as particularly useful
in chlorosis. I have lately prescribed it  in a case of this
complaint, in combination with iron, and the effect was
very beneficial.  In this case, however, the  iron may

   * Alibert, Mat. Med. torn. i. p. 76.
   x Paris's Pharmacologia. 
262
ANGUSTURA. BARK.
  have Been the most efficacious of the  two articles  in
  combination.
    In dyspepsia, while the disease is yet entirely confined
  to  the  digestive  organs, the Angustura bark  may be
  beneficially given.   I have used it in my own case, and
  obtained considerable relief from  it.   It is also said to
  be a very effectual remedy in diarrhoea, depending on a
  weakness of the bowels.   In chronic and malignant dy-
 sentery, the Angustura bark is said  to be a very useful
 remedy. Dreyssig asserts that he has used it with great
 advantage in what he calls the putrid  form  of this dis-
 ease ; and Richter also speaks very favourably of its
 powers in diarrhoea and dysentery.  In these affections
 I have never administered it, but I can readily believe,
 that  in the  former disease,  and  in the chronic form of
 the latter, it may be employed with advantage.
   In powder it is given in the dose of from six to thirty
 grains.   The dose  of  the decoction or infusion is from
 3i- to §ii. When given in very large doses it has a ten-
 dency to produce nausea.  The incompatible substances
 are:  sulphate of iron, sulphate of copper, oxymuriate
 of mercury, nitrate of silver, tartarized antimony, sub-
 acetate and acetate of lead, potass.*
   "There is found in the market," says Dr. Paris, "a
 particular bark, which has been called fine Angustura,
 but which is of  a different species,  and is a very ener-
 getic poison.  This bark is characterized by having its
 epidermis covered with a matter which  has the appear-
 ance of rust of iron,  and which, moreover,  possesses
certain chemical properties of  this metal, for if water
 acidulated with muriatic acid be agitated in contact with
 its powder, it assumes a beautiful green colour, and

                * Paris's Pharmacologja. 
ANGUSTURA BARK.
S6S
 affords, with an alkaline prussiate, a prussian blue pre-
 cipitate.   Late researches have detected  the presence
 of an alkaline element  in this bark, to which the name
[ of brucine has been bestowed.  When this alkali is dis-
 solved in boiling alcohol, and crystallized by spontaneous
 evaporation, it yields colourless and transparent crystals,
 in the form of oblique quadrangular prisms."

                        Formulae.
   R.—Cort. angusturae.
       Flor. arnic.  aa 3ii-
       Aq. fervid.     ^iv. ; boil down  to three ounces; strain,
 and add, Acet. vini,
        Syrup, aurant. aa 5i.
        G. arab.        3i.
        Tinct. opii      gtt. 60. M. S.  Dose,  a table-spoonful
every hour.   This is highly praised as a remedy in typhoid dysen-
tery.  (Richter.)
  R.—Pulv. cort. angust.
      Pulv. cinchon. flav. aa ^ss. M. Divide into six equal parts.
Dose, one every three or four hours.
                        COLUMBO.

   This is  the root  of the menispermum  columbo, a
 native of Ceylon, and is brought to us from Columbo, the
 capital of this island.   The  botanical character of this
 plant was entirely unknown  until Mr. Fortin, in 1805,
 discovered it near Mosambique, whence it was carried
 into Portugal, and ascertained to belong to the  genus
 menispermum.  The root, which alune is employed in
medicine, is imported in transverse slices, from an eighth
to a quarter of  an inch in thickness.  The bark of the
root is rugous, thick, and of  a  greenish, verging to an 
264
COLOMBO.
obscure brown colour.   The internal, or parenchyma*
tous part of the root is yellowish.  In general there are
three distinct parts composing this root,  the bark, the
woody part, and medullary portion.* It has a faint aro-
matic odour, and is intensely bitter and  slightly acrid
in taste.  According to an  elaborate  analysis made of
this root by M.  Planche, it contains a kind of animal
matter, which exists in it in very great proportion, and a
yellow substance of an intensely bitter taste, which rea-
dily dissolves in water and alcohol.   It also  contains
a very large portion of starch.   By repeated distillation
a volatile oil may be obtained from it;  and it appears to
contain malate of lime, and sulphate of lime.f  It also
contains cinchonin.  About  one-third  of its weight is
dissolved by  boiling water ; its best menstruum, how-
ever, is proof spirit,  with  which it forms a  very beau-
tiful and active tincture.
   This is one of the  purest and least stimulating bitters
we possess.   It has been prescribed in intermittents, but
it does not appear to be particularly efficacious in this
 disease.  It  has also been recommended  in phthisis;
 but, from what I have seen of its effects in this disease,
 I am not induced  to believe  that  it is often useful, or
 even proper, in this  hopeless malady.
    The columbo has also been recommended in diarrhoea
 and chronic dysentery.  In the chronic bowel complaints
 of children from debility of the alimentary canal, much
 benefit may, indeed, often be derived from this remedy.
 In the habitual diarrhoea of infants, I  have seen much
 good done by giving once or twice daily a  tea-spoonful
 of a mixture composed of half a drachm of extract of co-

    * Alibert,  Mat. Med.  torn. i. p. 96.
    t Ibid. torn. i. p. 97. 
COLUMBO.
265
  lumbo dissolved in an ounce of water, to which forty
  drops of the camphorated tincture of opium is to be added.
  Columbo may also be advantageously employed in cho-
  lera infantum,  when it assumes the chronic form.
    The disease, however, in which it seems most deci-
  dedly beneficial,  is indigestion.  In this complaint it is
  one of the best  tonics we can employ.  I have frequent-
  ly prescribed the columbo  in union  with  ipecacuanha,
  with marked advantage in dyspeptic complaints.   Ten
  or twelve grains of the columbo may be given with two
  grains of the ipecacuanha.   It  is  to  be observed, how-
  ever, that neither this, nor any other tonic can be ad-
  vantageously, or even properly given when  the dyspep-
  sia is attended with high irritation of the mucous  mem-
  brane of the alimentary canal.  It  is  only where the
  indigestion  depends on debility and inactivity of the
  digestive  organs, that articles of this kind can  be used
 with a prospect of advantage.
   The dose of the powder is from gr. xv. to 3SS. ;  that of
 the infusion from §iss. to §ii.   It may be given in  com-
 bination with iron, rhubarb, or saline  purgatives.  The
 incompatible substances are, infusion of galls and yellow
 cinchona bark, subacetate and acetate of lead, corrosive
 sublimate  and lime-water.  The nitrate  of silver,  mu-
 riate of mercury or tart, antim.  do not affect it.

                       Fortnula:.
  R.—Pulv. columb.
      ---- subcarbonat. ferri.
      ---- rhaei.
      ----- zingiberis        aa  3i.  M.  Divide into twelve
equal parts.  S. Take one three or four times daily.
  R.—Rad.  columb.    ?i.
      ----  zingiberis     5iii.
      ----  calom.  aromat. 5ss.
  VOL. I.—36 
26G
COLUMBO.
      Sem. fcenicul.       3*-
      Aq. bullientis.       vi.  Macerate for two hours. Dose,
a table-spoonful four or five times daily.
  R.—Rad. columb.  3**
      ----rhaei     3'*
      Sem. anise     %i.
      Aq. bullientis.   ^viii.   Macerate for two hours, strain, and
add to the infusion,
      Syrup, zingiberis    §iss*
      -----papaver. alb. ^ss.  M.   Dose, a tea-spoonful to a
child from one to three years old. This is an excellent combination
in the habitual bowel complaints of children.
              GENTIANA LUTEA.—GENTIAN.

  This is a perennial plant, indigenous to the mountain-
ous parts of Germany, France, &c.  The root, which is
the  only  part employed in medicine, is long, slender,
branched, externally of a brown colour, and of a yellow-
ish colour within.   Its taste is intensely bitter, but it has
no particular smell.   Chemical analysis shows it to con-
tain resin, some oil, bitter extractive, a portion of tannin,
and mucilage.   Both water and alkohol extract its ac-
tive principles, but proof spirit appears to be  its best
menstruum.
   Henry and Caventou  have detected a peculiar prin-
ciple in gentian to which they have given  the name of
gentianin.   When  carefully  prepared, it consists of
minute crystals  of a  beautiful yellow colour,  intensely
bitter, and somewhat aromatic, but without any  smell.
It  is readily dissolved by ether and alcohol;  boiling
water takes up the greater part, but cold water makes
little or no impression on it. 
GENTIAN.                    267
  Gentian is among the most active and useful of the
pure tonic bitters; and is perhaps more frequently em-
ployed than any other article of this class of remedies. It
possesses no astringency whatever; but it appears to be
considerably more stimulant in its general operation than
the columbo.   It is more apt, than any of the other tonic
bitters, to excite purging—though its effects in this way
are seldom manifested, unless it is given  in very  large
doses.  Persons of an irritable or excitable habit of body,
or of a sanguineous temperament, do not in general bear
the gentian so well as the columbo, from its  greater ten-
dency to  heat and irritate the general system.  From
this exciting power, however, it  is, on the contrary, pe-
culiarly suitable as a tonic in individuals of  a torpid,
phlegmatic, and inirritable habit. It is especially adapt-
ed to cases attended with a torpid and debilitated state
of the digestive organs.
  The  gentian has been successfully employed in com-
bination with  astringents  in  the cure of  intermittents.
Cullen says  he never knew it to fail  in curing intermit-
tent fever, when given with galls or tormental.  When
given alone, however, its  powers are much  less certain
and useful.  Lind,  also, commends it as  an efficacious
remedy in this disease.  At present, however, it is very
seldom used for this purpose, nor does it  appear to be
entitled to much credit for its virtues in this complaint.
  As a tonic, in general debility, or in a weak state of the
stomach and bowels, the gentian is an excellent reme-
dy.  It is particularly beneficial as a stomachic; and, in
indigestion, it is, perhaps, the most  useful of the bitter
tonics.  It has also been recommended in gout, particu-
larly in the convalescent  state,  when much debility of
the stomach is  present.   Gentian  is  an article in the 
268                     GENTIAN.
composition of the  famous Portland powder, which ap-
pears  to have been employed  with great advantage in
preventing the paroxysms of gout.
   The dose of the powdered root is from gr. x. to 3i.
It is also given  in  the forms of an extract, infusion, or
tincture, all of which are excellent preparations.* In a
large dose it is apt to  purge.
   The officinal preparations of this root are numerous;
the following  are the  principal.  Extract, gentianse;
tinct.  gentianse ;  tinct. gentian, compos.; tinct. gen-
tianse  cum  ammonise, Pharm.  Gallic;  tinct. amara;
infusum  gentianse composit. Lond. Dub. and Edinb.
Pharm.; vinum gentian,  compos. Ed. Pharm.

                        Formula:.
  R.—Rad. gentian, contus. ^i.
      Carbonatis ammon.   i,u.
      Alcoholis           ^xxxii.   M.  Digest for  four days.
This combination is much used in France as a tonic in scrofulous
affections; and constitutes a highly useful preparation in dyspeptic
complaints, attended with acidity in the primae viae.  Instead of the
ammonia, a few drachms of the carbonate of sodce, may be taken.
  R.—Extract, gentianse   £'\.
      Sulphatis ferri       gr.  viii.
      Pulv. ipecac.       59s-
      Mucilage g. arab.   q. s.  M.  Divide into thirty pills. Dose,
one pill, three times, daily.

  * " Brodum's Nervous Cordial consists of the tincture of gentian,
eolumbo, cardamon, and bark,  with the compound spirit of laven-
der, and wine of iron.
  " Staughton's Elixir is a tincture of gentian, with the addition of
serpentaria, orange peel, cardamus, and some other aromatics."—
Paris'* Pharmacologia. 
(  269  )
              QUASSIA EXCELSA.—QUASSIA.

  • The quassia excelsa is a large tree growing sponta-
 neously  in Surinam, from  which its wood was first
 brought into Europe in the year 1761.
   The wood of this tree, and more  especially that of the
 root, is of a pure and intensely bitter taste, which, ac-
 cording to Thomson, depends on a  peculiar bitter prin-
 ciple  to which the name of quassin has been given.
 According to Crell and Tromsdorff, the quassia contains
 a greater proportion of gummy matter than of resinous,
 and hence they infer that the infusion of it in cold water
 is its best preparation.
   The quassia is a very excellent tonic, and may be very
 usefully employed in all  cases where remedies of this
 kind are indicated.   It possesses scarcely  any stimulat-
 ing or heating properties, and is, therefore, peculiarly
 calculated to improve  the digestive powers of the sto-
 mach in weak  and very irritable  subjects.  It was  at
 one time a good deal employed in the cure of intermit-
 tents.   It has,  however,  not sustained its  reputation in
 this  disease,  and is now but very  seldom  employed in
 its cure.   It is said to be very efficacious in suppressing
 bilious vomitings,  attending  bilious and putrid  fevers.
 Alibert states that he succeeded  in curing a female, by
 this remedy, of habitual vomiting, which had prevented
 her for a long time  retaining any nourishment on her
stomach.   He  also  says,  that he has used the quassia
with much saccess in cases  of dyspepsia.  In the de-
praved appetite in chlorosis,  particularly when there is
a disposition to eating dirt, chalk,  &c. the quassia is said
to be a very efficacious remedy.*
* Barton's MS. Lectures on Mat. Med. 
270
QUASSIA.
   As a stomachic,  it is, indeed, one of our best reme-
dies ;  it is said to  be  especially  useful  in indigestion
arising from intoxication.   When administered in com-
bination with some absorbent, it acts with much advan-
tage in the weakness and languor attending chronic hys-
teria.*
   In diarrhoea from a want of tone in the  bowels  and
stomach, the  quassia is an  excellent  remedy.  It has
also been recommended in leucorrhcea, gout, cachexy;
and Alibert says that it ought to be employed as a pro-
phylactic,  by persons who are   subject  to  intestinal
worms.   It is usually given in infusion.  The infusion
made in the proportion of three or four drachms of the
wood to twelve ounces of water, may be taken in doses
of one, two, or three table-spoonfuls.

                        Formula.
   R.—Rasurae liq. quass. ^ss.
       Cort. aurant.        %\.
       Rad. rhaei contus.  9i.
       Potassae carbon.     3SS-
       Aq. fontanae fervid, ^viii.  M.   Macerate  for ten hours,
then strain, and add,
       Tinct. cardamom,  ^i.  M.  Dose, a table-spoonful twice
or thrice daily, in weakness of the digestive functions,  with acidity.
   R.—Extract, quassias  9ii.
       -------aroea     gr.  xii.
       Pulv. ipecac.     3SS-
       Mucilag. g. arab. q. s.  M. Divide into thirty pills.
 S. Take one three times daily.  I have used this combination with
 much advantage in debility of the digestive organs, with torpor of
 the bowels.
* Thacher's Dispensatory. 
(  271   )
           QUASSIA SIMAROUBA.—SIMAROUBA.

  This species of quassia is brought from  St. Domin-
go,  Jamaica, &c.  and is also  found growing spontane-
ously in the southern parts^)f the United States.  The bark
and not the wood  of this species of quassia  is used in
medicine. It is inodorous, and exceedingly bitter, with-
out any perceptible astringency.   It is of a tough and
fibrous texture, of a pale yellowish colour, and rough on
the  external surface.   It  furnishes a  very abundant
watery extract, and contains a large  portion of mucilage,
but very little resin. It does not, like the quassia, strike
a black colour with the sulphate of iron.
  The simarouba has been highly  spoken of as a  re-
medy in dysentery and diarrhoea.   It has been particu-
larly recommended for*its efficacy in the former of these
complaints, by Pringle, Lind, Stoll,  Zimmerman, Blane,
Tissot, Bampfield, &c.   The  latter writer^ in his work
on  scorbutic dysentery, observes: " The  infusion of
simarouba, or a decoction of it, has been recommended
generally in the obstinate chronic stages of  dysentery,
(See Blane on Diseases of Seamen, fyc.)  In my prac-
tice it has shown  great powers,  but these were of  un-
certain benefit.  It was too apt to produce constipation,
and its painful  and disordered  consequences."   I have
myself employed it in this disease, after it had assumed
a chronic form, and repeated evacuations had been pre-
mised, and the effects have frequently been  very bene-
ficial.   Alibert says that this remedy has been used with
much advantage at the hospital St.  Louis, in diarrhoeas,
following scurvy  and  intermittent fevers.   Although
many, and highly respectable testimonies may be adduc- 
272
SIMAROUBA.
 ed in evidence of the usefulness of this remedy in dysen-
 tery,  it can most assuredly not be a  proper remedy in
 the early stage of the ordinary inflammatory dysenteries
 of this climate.   In  the typhoid or  malignant form of
 the disease, as it occasionally prevails in hot climates—
 and in the chronic stage of the more sthenic varieties of
 the disease, advantage may, no doubt, be derived from
 it, under judicious management.   It  is indeed probable
 that the simarouba will,  in general,  do more good than
 any other astringent tonic,  in instances where reme-
 dies of this kind  are proper, and it undoubtedly de-
 serves particular attention in this respect.   It is said  to
 be particularly useful in the intestinal debility left by an
 attack of dysentery.
   It has also been much recommended in dyspepsia and
 intermittent fevers;  experience, however, has not esta-
 blished its efficacy in these diseases, and it  is  certainly
 inferior in  this  respect  to several other  articles  of this
 class of remedies. In powder it is given in doses of half
 a drachm.  The decoction,  however, is the most con-
 venient form, and it  possesses all the powers of the sub-
 stance.

                        Formulas.
  R.—Cort. simaroub.       ^ss.
      Lychen. island.        Ii.
      Aq. bullientis         vi. ss.; boil down to one pint; strain
 and add,
      Tinct. nueis. moschat.  ^ss.
      Syrup, zingiberis       jii. M.  Take two table-spoonfuls
four times daily.  (Richter.)
  R.—Cort. simaroub.   gss.
      Lign. campech.   f i.
      Aq. bullient.     §x.;  boil down to 5viii.; strain, and add,
      Syrup, papaver. alb. |i. M.   Take  a table-spoonful four
or five times daily. 
(  273  )
           CROTON ELEUTHERIA.—CASCARILLA.

   This is a small shrubby tree, indigenous to Jamaica,
Eleuthera, Carolina, Florida, and various parts of South
America.  The bark of this shrub,  which  is the only
part used as a medicine, comes  to  us in  the  shape of
round tubes, the external surface of which is ash-colour-
ed ; internally it is of a brownish colour.  Its taste is
very bitter, and it has a  strong aromatic  odour, which
becomes particularly manifest when burned. It contains
a very large proportion of resin,  and hence alcohol isits
most appropriate menstruum.   According  to the ana-
lysis of  Tromsdorff, it contains also, besides  resin, a
a small  portion  of mucilage, a  bitter principle, and a
very volatile essential oil.
   As a  remediate article,  this bark was first  brought
into notice in the year 1692, in a dissertation attribut-
ed to a Spaniard of the name of  Vincent  Garcias Salat.
It soon afterwards attracted the attention of many of the
most celebrated physicians of Germany,* and was highly
praised for its febrifuge powers ; which, by some, were
affirmed to be superior even to  those of the Peruvian
bark.   Stahl and his followers contributed greatly to its
reputation as a remedy in intermittent fevers ; and Jun-
ker and Alberti spoke  in the highest terms of its powers
in this  disease.   It possesses  considerable stimulant
properties, and is, therefore, peculiarly adapted to cases
attended with a sluggish, phlegmatic, and inirritable habit
of body.   It  has been particularly  recommended for
its usefulness in  what have  been called putrid  or nia-

                  * Alibert'a Mat. Med.
   vol.  i.—37 
274
CASCARILLA.
lignant intermittents.  The very strong and respectable
testimony which we have in the writings of physicians
in favour of the febrifuge virtues of the cascarilla bark,
do not permit  us to doubt of its usefulness in this way.
  This bark is especially a valuable medicine in weak-
ness of the stomach, attended with flatulent pains, aci-
dity, frequent  vomiting,  and  habitual  costiveness from
torpor of the  bowels.  Kiiglestein asserts that we pos-
sess no remedy superior to  this bark,  in the  gastric
weakness accompanied with frequent nausea and vomit-
ing, sometimes met with in  hysteric  and phlegmatic
females.   Given  in combination with  valerian, it will
often afford speedy  and complete relief in such cases.*
   It has also been employed in dysentery and diarrhoea,
but in  neither of these complaints  can it be beneficial
or  even proper, except in the chronic stage of  the
former, connected with great prostration; and in diarr-
hoea, depending solely on chronic irritation and relaxa-
tion of the intestinal canal.  Cullen  speaks very slight-
ly of this medicine,  but  I am inclined  to think that
his estimate of its powers falls considerably short of its
real merits.   I have  given it in  chronic debility of
the digestive organs with decided advantage; and  in
intermittents attended  with  much general debility and
relaxation,  I  have  known it  to prove  highly beneficial
given in combination with cinchona.
   It may be given  in powder—in doses of  from twelve
to thirty grains.  The tincture is an active preparation,
but the decoction or infusion possesses no  very active
powers.
* Richter's Arneimittell. B. i. p. 369. 
CASCARtLLA*
27S
                       Formula.
  R»—Rad. cascaril.    ?ss.
      ----valerian.    ^i.
      Aq. bullient.     gxii.; macerate for ten hours, then add,
      Syrup, zingiberis jii.
      Tinct.  cascarillas 3ii.   M.  Dose, a table-spoonful 3 times
daily.  This is an excellent combination, in gastric debility, with
flatulency and general languor.
                  Secondary Tonics.

          PRUNUS VIRGINIAN A,—WILD CHERRY.

  This is a large and handsome tree, indigenous to the
United States, in many parts of which it is found in con-
siderable abundance. The bark of the tree, which is the
part employed in medicine, has a bitter, astringent, and
slightly aromatic taste. Its smell resembles that of those
substances which contain prussic acid,  particularly the
peach kernel.   This bark, indeed, contains a Very con-
siderable  portion of the  prussic acid,  a circumstance
upon which I am inclined to believe its remediate pow-
ers mainly depend.
  When taken into the system, it  produces a slight in-
crease of the action of the heart and arteries, and in-
duces,  in some  individuals,  considerable  drowsiness*
When continued for  some time, and not in very large
doses, it gives tone to the stomach, and, by this effect,
vigour to the general system. When, however, it is taken
in large quantities, and frequently repeated, it weakens
the digestive organs, and  produces an effect upon the ac-
tion of the heart and arteries, the very reverse of a sti-
mulant. In my own person I have several times reduced 
276
WILD  CHERRY.
my pulse from seventy-five to fifty strokes in a minute,
by copious draughts of the cold infusion,  taken several
times during the day, and continued for twelve or four-
teen days.   This effect has not, I believe, been noticed
before, but from much experience with it I am strongly
inclined to believe that we may control the action of the
heart and arteries to a considerable extent, by the use
of this substance.
  The wild cherry bark has been highly recommended
in the cure of intermittents.  I have myself employed
it a good deal, while residing in the country, and in the
majority of cases, with success.   It has appeared to me
most useful in those  cases in which the bark  did not
produce its usual beneficial effects; and in one instance,
where the bark, arsenic, and mercury, had all been tried
ineffectually,  the patient was  finally cured by the use
of the wild cherry bark infusion.
   In phthisis,  also, this baric has been employed with
decided benefit.   I have  prescribed it often in hectic
fever, and in some instances with unequivocal advantage.
There is,  indeed,  no difficulty in perceiving how this
bark may produce beneficial effects in cases of this kind.
It is well known now, that the prussic acid, when judi-
ciously administered, is capable of moderating, nay, even
 of removing, all the symptoms attending the early stage of
 pulmonary consumption.   The testimony we have is too
 respectable and numerous to admit of  any reasonable
 doubt as to its powers in this way. Now, the wild cherry
 tree bark contains no  inconsiderable  portion of this
 acid, and it is obvious, therefore,  by using the infusion
 of it, we employ a medicine  which contains prussic
 acid,  together with a bitter and an astringent principle,
 dissolved in  a considerable portion  of  water.   These
 ingredients would appear, I think, particularly calcu- 
WILD  CHERRY.
277
lated  to produce good  effects in pulmonary consump-
tion, by at once lessening the irritability of  the system,
which the prussic acid does  in an eminent degree,
and supporting the strength of the patient by the tonic
principles which  it  contains.   I have  already  stated
the power which  this remedy possesses,  when taken
in very large doses,  of diminishing the action  of the
heart and arteries, and it is, doubtless,  by its control-
ling influence in this way, in consequence,  perhaps,  of
the prussic acid which it  contains, that its action has
been found so  useful in diseases attended with an  irri-
tated or hectic state of the circulation.  Whether it be
ever capable of giving perfect relief in phthisis, is ex-
tremely  doubtful, but of this I am satisfied from re-
peated experience, that it is one of our most valuable
palliatives, and well deserving  of attention in the present
disease.   Its effects, indeed, upon phthisical patients, are
very similar to those  of the prussic acid.   It lessens the
frequency, tension, and irritated state of the pulse ; mo-
derates the cough, and profuse nocturnal perspirations ;
checks the diarrhoea, and sustains the general stringth
of the system.
   In chronic hysteria, I have, in several instances, pre-
scribed this remedy, with great relief to the patients.  I
have  found it equally useful  in wandering rheumatic
pains and swellings, attended with a small, corded, and
frequent pulse, and general debility of the  system.
   The wild cherry bark has also been  recommended as
a very useful remedy in asthma.   Of its powers in this
complaint I can say nothing from my own  experience.
 It is to be given  during the intervals of the fits, and in
 large doses.
   When given in moderate doses,  it often produces ex-
 cellent effects in dyspepsia. I have, however, found that 
27S                WILD CHERRY.

large and frequent doses of this remedy, have a tendency
rather to weaken than  to invigorate the digestive pow-
ers of the stomach.  This I have particularly observed
in my own case.
  Very excellent effects are said to have been produced
by washing irritable and fungous  ulcers with a decoc-
tion of this bark.*
  The bark of the root is  stronger  than that of the
trunk.   To certain animals  the leaves  of the tree are
said to be poisonous.   The cherries have been advan-
tageously used, as  a  domestic  remedy, in scurvy and
dysentery.
  The dose of the powdered bark is from 3ss. to 3'ii.
The decoction does not appear to possess much strength.
The prussic acid,  which appears to be its most import-
ant partt is driven off by boiling.  The cold infusion,
however, is an excellent preparation.  An ounce of the
bark is to be infused in a pint of cold water,  for twenty-
four hours.  Dose,  a wine-glassful every four hours.
             CORNUS FLORIDA.—DOGWOOD.

  This is a common and well known tree throughout the
United States.   It appears from the experiments of Dr.
John M. Walker,f  that the bark of this tree differs but
very little in chemical composition  from the Peruvian
bark, and experience  has fully demonstrated that,  in
their operation on the system, these two articles possess
a very close resemblance.  In its sensible qualities too,

  * Thacher's Dispensatory.
  | Inaugural  Dissertation. Philadelphia, 1797. 
DOGWOOD.
279
the dogwood bark is very much like the cinchona; it
has a bitter, astringent, and slightly aromatic taste.  Its
astringency is, however, stronger than that of the Pe-
ruvian bark.
   In the cure of intermittents,  the  dogwood  bark has
been a good deal used in some parts of this country, and
from  the concurrent testimony of those who have em-
ployed it, as well as from my own experience, I am per-
suaded, that of all our indigenous tonics, this bark is the
most useful in the present disease.
   When employed in a recent state it is said to be apt
to disagree with the  stomach, and to produce pains in
the bowels.  To obviate this, it is only necessary to give
it in conjunction with a few drops of laudanum;  or to
employ the  bark after it has  been  collected  for  some
time.  Thirty-five grains of the dogwood bark, is about
equal to thirty of cinchona.   An infusion of the flowers
has been used with  advantage in flatulent cholic.  " A
decoction of the small branches and buds  agrees well
with weak stomachs, and is, perhaps, the most eligible
form of exhibiting this medicine."*
  The  co?-nus sericea, or  swamp  dogwood,  another
American species of this genus, possesses powers in
every respect equal to those of the c. florida.  It forms
a beautiful tincture  with proof spirit.   It is  given in
the same dose as the c. florida.
  Both these species of cornus may be advantageously
given with aromatics and other  tonics.  An excellent
mode of prescribing  them  in intermittents, is in union
with Virginia snakeroot.
* Collections,  &c. 
(  280  )
          CHIRONIA ANGULARIS.—CENTAURY.

  This is a beautiful plant, and exceedingly abundant
in some parts of the United States.   The root, which is
annual, consists of yellowish fibres;  the stem is erect,
from one to two feet high, herbaceous, smooth, and four-
sided ;  the  branches  are  opposite  and axillary; the
leaves opposite, ovate,  amplexicaule, and three-nerved.
The flowers, which are numerous, grow at the extremi-
ties of the branches, and are of a beautiful rose-colour
above, but pale, and in many specimens nearly white in
the centre underneath. The calix is much shorter than
the corolla; its segments are very acute. The centre of
the corolla is marked by a  pentangular star, of a yellow
colour, bordered with  green.  The petals are obovate,
and sometimes nearly lanceolate.
  This plant is one of  the most useful and  agreeable of
our indigenous vegetable bitters ; and is decidedly more
valuable than  the  centaury (chironia  centaurium)  of
Europe.  It is a pure  bitter, possessing a slight  aroma-
tic flavour,  and by no  means  offensive to the stomach.
Both alcohol and water extract its active principles.  It
does not appear to possess  any astringency.  In domes-
tic practice it  is much  used  as a stomachic, for weak-
ness of the digestive organs ; and I know of no bitter
which is more grateful and effectual in cases  of this
kind,  than this one.   It has also been a good deal used
 in some parts of the country in intermittents.   I  have
 myself employed it in  some instances, but I do not re-
 member any case in my practice which was cured  by
 it.  I knew a country practitioner,  however, who was
 in the habit of giving  this remedy conjointly with  cola- 
CENTAURY.
281
mus aromaticus, in intermittents, and with very consi-
derable success.
   It is commonly given in  the form of strong infusion.
Of this, from a half to a whole gill may be  taken  fre-
quently during the day.   The dose  of the powder, is
from twenty to  thirty grains.
  There is an excellent figure of this plant in Dr. Bar-
ton's Vegetable Materia Medica of the United  States,
vol. ii.
               LIRIODENDRON TULIPIFERA.

   This is one of the largest and most beautiful of Ame-
 rican forest trees.  It rises to the height of eighty, nine-
 ty, and even one hundred and forty feet, putting forth,
 about the middle of May, an abundance  of superb flow-
 ers, marked with green, yellow, and red streaks, which,
 together with its beautiful foliage, give to  the tree a very
 magnificent appearance.   The bark,  which is the part
 employed in medicine, is of a strongly bitter, and slightly
 aromatic taste.   According to  the analysis of Dr. Ro-
 gers,* it contains gum, resin, muriatic acid, iron, calca-
 reous salt, mucus, and fecula.   This bark has been long
 employed, both in  domestic and regular practice in the
 United States, and it appears from the testimony which
 has been published in favour of it, to be well entitled to
the attention of the profession.
  This bark possesses considerable stimulant properties,
but it is chiefly on account of its tonic effects that it de-

          * Inaugural Dissertation.  Philad. 1802.
  VOL. I.—38 
282
LIRIODENDRON TULiriFERA.
serves notice.   It acts also occasionally as a diuretic, and
in general it produces very conspicuous diaphoretic ef-
fects when largely administered.  The bark of the root
appears, however, to be less stimulant and more purely
tonic, than that of the trunk or smaller branches.
   Given in union with dogwood, and the prinos verticil-
latus, it has been  employed with much success in the
cure of intermittents.  The late Dr.  Rush  employed
it, as he states, " with as much satisfaction as any of the
common bitters of the shops."*
   Dr. J. T. Young,  in a letter to governor Clayton,  of
Delaware, says, " I have prescribed the poplar bark  in
a variety of cases of intermittent  fever ; and can de-
clare from experience that it is equally efficacious with
the Peruvian bark, if properly administered."! As this
bark is, however, considerably stimulant, it should never
be given where the intermission is marked by symptoms
denoting a phlogistic tendency in the system.   Bleeding
and  purging  are necessary preliminaries  to the em-
ployment of this remedy where the habit is inflamma-
tory.
   It has also been much recommended in chronic rheu-
matism and in gout,:}: and from its manifest tendency to
 produce diaphoresis, together with its tonic operation,
 there can be little  doubt of its occasional usefulness  in
 affections of this kind.  From these combined proper-
 ties  it  also often acts with great advantage  in the ad-
 vanced stage of dysentery.§>   In this disease I  have
 repeatedly employed it in conjunction with the ulmus

   * Transactions of the College of Physicians of Philad. 1798.
   X Carey's American Museum, vol. xii.
   X Barton's Collections.
   § Thacher's Dispensatory. 
LIRIODENDRON TULIP1FERA.
283
aspera, in the form of decoction, and  in  general  the
effects were very satisfactory.
  Dr. J. T. Young, whom I have already quoted, speaks
in very high terms of this remedy in the cure of hysteria.
"I can assert from experience," says he, "there is not
in all the materia medica a more certain, speedy, and
effectual  remedy  in hysteria,  than  the poplar bark,
combined with a small quantity of laudanum."
  Dr. Young also states, that he has used this bark with
much advantage as an anthelmintic.  " I  have  never
known it to fail," he observes, "in a single case of worms
which has come under my observation."  I have given
it for this purpose in several instances, without deriving
any good effects from it.
  In a debilitated  state of  the stomach, the powdered
bark of this tree, in union with steel dust, has been pre-
scribed with very great advantage.*  The bark may be
given in substance, tincture, infusion, or decoction. In
substance, however, it acts with most power. The dose
of the powdered bark, for an adult, is from thirty to one
hundred and  twenty grains.    If it  produces purging
and  griping, a few drops of laudanum should  be added
to it.
                 ANTHEMIS NOBILIS.

  Chamomile is one of the most ancient articles of the
materia medica.  It was employed by the Egyptians as
an external application, in the cure of fevers; and it ap-
* Thacher's Dispensatory. 
284
AKTHEM1S KOBILIS.
pears from the Greek writers, that it was held in very
great estimation by them.*
  It does not appear that chamomile flowers have as
yet been  subjected to any particular analysis.   They
have been ascertained, however, to contain a consider-
able portion of  bitter extractive, and an essential oil of
a beautiful sapphire blue, or of a greenish brown colour.
By being exposed to the light and air, this oil is liable.
to undergo changes.
  Chamomile flowers  were at one time  much prescrib-
ed for the cure of intermittents,  and much  respectable
testimony is extant in favour of  their powers  in this
complaint.  We are informed by Dr. Cullen that Dr.
Pitcairn thought them quite equal in this respect to the
Peruvian bark, and Hoffman considered them very effi-
cacious.   Cullen,  also, employed them  with success in
this  disease.   He states, however, that their employ-
ment is  frequently attended with the inconvenience of
readily  running off by stool, to obviate which he usually
gave them with an opiate or some astringent.
  As a stomachic bitter,  chamomile  flowers are much
employed, and their effects in  this way are commonly
decidedly beneficial.  They  are also an excellent re-
medy in spasmodic and flatulent colics;  in hysteria, at-
tended with habitual weakness of the digestive organs,
and in restraining violent bilious vomitings.  When em-
ployed for restraining vomiting,  a weak infusion  must
be employed; a strong one having  the property rather
of exciting  than  allaying vomiting.  The  infusion is
much employed to promote  the operation of emetics,
but for this purpose it ought to be used strong.
  Chamomile flowers are often employed in colds  and
* Paris's Pharmacologic 
ANTUEMIS N01ULIS.
285
catarrhs, as a gentle diaphoretic, and they, indeed, sel-
dom fail in producing this effect.  The  essential oil is
used'as a carminative, and cordial diaphoretic.   The
leaves and  flowers of chamomile have  sometimes  been
used as  an external discutient  application; and the in-
fusion of them is said to  be very beneficial when  used
in the form of a clyster,  in dysentery and colic.   The
incompatible substances are, the soluble preparations of
iron, nitrate of silver, oxymuriate of mercury, acetate
and siibacetate of lead, solutions of isinglass, infusion of
yellow Peruvian bark.
   In substance these  flowers may be given in the  dose
of a drachm or  more; but they are usually prescribed
in the form of an infusion.  They give out their virtues
both to  water and rectified spirit.
                    FERRUM—IRON.

   Among  the mineral tonics,  iron  undoubtedly holds
the first rank, whether we consider it in relation to its
general tonic effects, or the extent and variety of its re-
mediate applications.
   Cullen thought that iron is totally inactive in its me-
tallic state, except it meet with an acid in the stomach,
to corrode and render  it soluble.
   This idea is, however, without foundation, as it is now
sufficiently ascertained that the gastric juice readily dis-
solves iron in its metallic state,  "without the interven-
tion or aid of the acetous, or any other acid present in
the stomach."*

        ■* Dr. Barton, in  a note to Cullen's Mat. Med. 
286
IRON.
  The effects of iron on the system, are those of a slow
but permanent tonic, increasing the fulness and frequen-
cy of the pulse, rendering  the blood  more florid, and
imparting permanent vigour  and tone  to the general
system.  It is therefore obvious, that this metallic tonic
is peculiarly adapted to cases  of debility attended with
a weak and sluggish pulse, and a pale, cold, and relaxed
state of the body.
  One of its earliest remediate applications was for the
purpose  of restraining haemorrhages; and in these cases
it may be injurious or beneficial, according to the par-
ticular state of the system attending the complaint.   In
what are called  active  haemorrhages,  this remedy can
hardly fail to prove pernicious, unless some of its astrin-
gent  preparations  be   employed.  In  those chronic
haemorrhages, however, which depend on a laxity of the
animal fibre, and are accompanied with a pale and ca-
chectic state of the body,  iron,  either  in its metallic
form, or in that of its milder  preparations, is a remedy
of unquestionable benefit.  It  is peculiarly advantageous
in  those  cases of  chronic  uterine haemorrhages which
occur in females somewhat  advanced in life, and of a re-
laxed and debilitated habit of the  system.   In cases of
this kind  I have  done much good  by exhibiting small
doses of iron and Peruvian  bark, and interposing occa-
sionally  some active astringent, when the discharge be-
 came alarmiug.  M. Alibert  says that he has employed
 this  remedy with  much success  in the haemorrhages
 which accompany scurvy.*
   In general, iron is a very important remedy in all dis-
 eases attended with a feeble and  cachectic state of the
 system.    In chlorosis, it is justly considered as one of
* Alibert, Elemens de Therapeutique, torn. i. p. 180. 
IRON.
287
our most  useful remediate means.   In this affection
there is always a great want of tone and activity in every
part of the system;  every thing indicates languor and
relaxation of the vital energies.  The pale and  leaden
hue of the countenance, the flaccidity of the skin and
muscles, the swellings of the feet, the anorexia or de-
praved  appetite, the  indisposition to active exercises;
all these symptoms point out the necessity of invigorating
measures, and none appears to be so generally useful as
iron, aided by the gentle exercise of gestation.   This,
however,  applies only to the strictly chronic cases of
the disease.  In  some instances of chlorosis, there exists
a considerable degree  of  febrile  irritation, or so strong
a tendency to pyrexial excitement, that tonics of every
kind are wholly out of the question.   Instances of this
acute character must  be managed  by mild  aperients,
pure air,  gentle exercise by gestation,  and a mild  but
nourishing diet.
   Iron is also much prescribed as an emmenagogue; and
it is, in fact, often the most effectual remedy we can em-
ploy. It must be observed, however, that  it is only in
those cases of amenorrhoea which depend on debility
and relaxation, that it can be employed with advantage.
Where the complaint  is  attended with an opposite state
of the system, this remedy is not only useless, but abso-
lutely pernicious.  The  emmenagogue  effects  of  iron
depend on  its general tonic powers; and it is  only in
proportion as its general roborant effects are produced,
that it acts beneficially in restoring the suppressed men-
ses in cases of this kind.
   Iron has been highly recommended in scrofulous af-
fections.   Alibert says,   " there are few remedies more
useful in scrofulous complaints than iron ;"* other prac-

       * Elemens de Therapeutique, &c. torn. i. p. 181. 
288
IRON.
 titioners have added their testimony in favour of its re-
 mediate powers in affections of this kind.
   Of late it has also been particularly recommended in
 the cure of cancerous ulcerations.  Dr. Carmichael, of
 Dublin, has written a work* expressly on the use of iron
 in the cure of cancerous  affections.   Respectable as is
 the testimony of Dr. Carmichael,  more extensive and
 diversified experience  is still wanting, before  we can
 pronounce on the real value of this practice.  It is not,
 however,  just to oppose speculative doubts to the facts
 of direct experiment; and we  have, therefore, no right
 to invalidate the large body of evidence offered by Dr.
 Carmichael in favour  of this  remedy in cancer, until
 ample and diversified experience shall have shown it to
 be inefficacious.   Dr.  C. recommends the iron to be
 given in very large doses,  and to be  continued for a
 long time; the ulcers are to be sprinkled with the pow-
 dered carbonate of this metal,  or touched with the
 muriated tincture.
   In atony of the stomach and bowels, chalybeates are
 often exceedingly  useful, when given in  combination
 with bitters.   This remedy  has also  been  commended
 for its effects in dropsy.  Sydenham proposed its em-
 ployment in the commencement of this disease, on the
 supposition that it  depends essentially on a weak and
 watery state of the blood.  "  Steel," he says,  "is the
 chief corroborative in the beginning of dropsy, for it
 heats and invigorates the blood."   It is, however, well
 known now, that this disease is  very generally connect-
 ed with a phlogistic condition of the system, and where
 this is  the case the use  of iron is obviously improper.
 In anasarcous swellings,  from general debility,  we may

  * An Essay on the Effects of the Carbonate and other Prepara-
tions of Iron in Cancer. 1809. 
IROX.
289
readily conceive that this remedy  may produce excel-
lent effects.  Alibert* mentions the case of a weak and
delicate female, labouring under anasarca, who was con-
stantly much relieved by the black oxyde of iron ; and
Dr. Robert Archer has reported a case of general drop-
sy, in a soldier, which was  effectually  cured  by  sul-
phuret of iron.f
   Mr.  Halle describes a singular  affection  under the
name of ansemia,  (privation of blood,) which, in the
year 1804, attacked all the workmen in a mine of anthra-
cite, near  Valenciennes,  and which is  represented  as
offering symptoms  very analogous  to those of chlorosis.
In this  malady he  administered iron filings, in combina-
tion  with  Peruvian  bark, with the happiest  effects.
Other physicians employed iron with equal success  in
this disease.   M.  Leblen, physician  of the hospital at
Dunkirk, to which some of the sick were taken, admin-
istered the red oxide  of iron with perfect success.£
   In another place I shall  speak  of the  anthelmintic
powers of this remedy.
   The  filings of iron may be  taken from twenty grains
to a drachm.   It is generally joined with some aromatic
substance,  and may be very  conveniently given in the
form of an electuary.  Care  should  be taken that the
filings be well  purified by a magnet,  as they are apt,
when  procured  from work-shops,  to be  mixed with
the  filings of other metals, particularly  copper. " For
pharmaceutical purposes, iron wire should be preferred,
as being the most pure, since  the softest iron only can

  * Elemens do Therapeutique, torn. i. p.  ISO.
  t American Medical Recorder, vol. ii.
  X Bibliotheqne Medicale, torn. vi. p. 195 et 342, et torn. viii. p.
297.   Vide Traite de Mat. Med. par '€. J. A. Schwilgue, torn. i.
p. 310.
   VOL. I.— 'V 
290
IROIT.
be drawn ; and Mr. Philips has shown us,  in experi-
ments upon the "ferrum tartarizatum," that soft iron
is more easily acted on by tartar.***
  The  preparations of this metal are very various ;  of
these I  shall,  however,  mention only such as are con-
sidered the most important, and fully capable of afford-
ing all the advantages which can be derived from chaly-
beate remedies.
  Ferri subcarbonas.—Carbonate of iron.—Rubigo
ferri.—This is a dark brown powder, destitute of odour,
and has a slightly styptic taste.  It consists of a mixture
of peroxide, protoxide, and subcarbonate of protoxide of
iron, in proportions subject to variation, according to the
temperature at which the preparation is made.   Acids
act upon it and dissolve it with effervescence ; in water,
however, it is wholly insoluble.
  This is, perhaps, the best preparation of iron,  in the
majority of cases  for which  martial  remedies may be
thought necessary. It is by no means unpleasant to take,
 and sits easily on the stomach.  In  certain  cases, how-
ever, where a costive habit of body exists, this prepara-
tion is apt to increase the confined state of the bowels,
 and when this is the case, we ought to employ the filings
 instead of the rust.
   The carbonate of iron has lately been recommended
 as  a very  efficacious medicine in tic  doloureux.  Mr.
 B. Hutchinson has published a pamphlet in which he
 adduces many examples of the efficacy of this remedy in
 this disease.  Mr. Richmond, also,  has lately reported a
 case which was promptly relieved  by the  carbonate of
 iron, after a great variety of remedies had been in-
* Paris's |Jharmacologia. 
IRON.
291
effectually tried. He prescribed it in drachm doses three
times a day.*
  It may be given in the form of pills, or powder, com-
bined with aromatics, in doses of from gr. vi. to  Ix.
  Ferri sulphas.—Green vitriol.—Copperas.—The sul-
phate of iron consists of green-coloured, transparent,
rhomboidal  crystals.   When exposed to the air they ef-
floresce, and when subjected to a high temperature, they
are deprived of their acid, leaving a peroxide of iron,
which constitutes the colcothar of vitriol.  The sulphate
of iron  dissolves in two parts of water at 60°, and  in
three-fourths at 212°.  In alcohol it is insoluble, unless
the iron be further oxidized, when it undergoes solution
in this menstruum, f
  This preparation possesses all the  powers of iron, and
may be employed with advantage where chalybeates are
indicated.   Its employment,  however, requires much
more caution than  the preceding preparation ;  for  in
large doses,  it is apt to produce pains in the stomach and
bowels, and may excite very alarming symptoms.
  Besides its tonic properties, it is also powerfully as-
tringent, and answers very well in solution as a wash for
indolent and fungous  ulcers.   It  is also a good applica-
tion to herpetic eruptions.
  It is given in the dose of gr. i. to v. in combination
with rhubarb, myrrh, &c.
  The incompatible substances are, "salts whose base
forms an  insoluble compound with sulphuric acid y the
earths, the alkalies, and their carbonates; borate of so-
da, nitrate of potass, muriate of ammonia, tartrate of po-
tass and soda, acetate  of ammonia, nitrate of silver, sub-
acetate and  acetate of lead, and soaps." '

  * Med. and Phys. Journal, No. cclxxi. p. 271, for Sept.  1S21.
  t Paris's  Pharmacologia. 
292
IROtf.
   Ferrum ammonialum.—Flores martialis.—This salt
is obtained in the form of small granular crystals, which
deliquesce on being exposed to  the air.  It is of an
orange yellow colour, of a styptic taste, and of an odour
similar to that of saffron.  The chemical  composition of
this salt appears to vary considerably with regard to the
proportion of the substances that enter into it, according
"to the degree of heat and time employed for  its prepa-
ration."   It would appear to consist of submuriate of am-
monia and submuriate of iron, with the  iron in a state
of red oxide.  Four drachms of this substance are dis-
solved in one ounce of water.   Alkohol dissolves it rea-
dily.*
   This preparation  possesses the tonic virtues common
to the other martial remedies.  In some instances, how-
ever,  where we wish to avoid constipation, it is prefera-
ble to the rust; for although it does not act sensibly as
an aperient, it has, nevertheless, no constringent  pow-
ers, and, therefore, does not interfere with the regular
action of  the bowels, as is sometimes the case with the
rust.
   The dose is from two to ten or twelve  grains, in the
form of a  bolus.
   Ferrum tartarizatum.—This preparation consists of
brownish  green-coloured powder,  having no odour, and
a taste slightly styptic.  It  dissolves with great ease in
water, the solution remaining a long time without under-
going any changes.f
   This is an excellent preparation of iron.   A watery
solution of it is recommended by Dr.  Bateman as a cha-
lybeate peculiarly suited, from its tasteless quality, to

   * Paris's Pharmacologia.
   t Ibid. 
IRON.                    293
the palates of children, and as being more efficacious
than the vinum ferri.  Its qualities have also been par-
ticularly commended in a communication from Dr. Bir-
beck, published in the London Medical Review.*
  The  incompatible substances  are,  "a strong  acid,
lime-water, hydro-sulphuret of potass, astringent vegeta-
bles.   The  fixed  alkalies and  their carbonates decora-
pose the solution very slowly, unless heated; but ammo-
nia and its subcarbonate produce upon it no effect, whe-
ther it be hot or cold."  Dose, from gr.  x. to 3ss.
  Phosphas ferri.—Phosphate of Iron,—The  phos-
phate of iron is a preparation, which, like the preceding
one, has been but  lately introduced as a remediate arti-
cle.  It consists of a powder, either of a blue or yellow
colour, according  to the mode  in which  it is prepared.
It has no odour, and little or no taste.  The blue  phos-
phate  is considerably stronger  than the yellow.  The
latter may be given in doses of from  twenty to sixty
grains, three or four times a day;  but the former can-
not be administered beyond eight or ten grains, without
being apt to excite nausea and vomiting.
  The  phosphate of iron is considered by those who
have employed it an excellent chalybeate.  It is said to
be particularly serviceable inamenorrhcea, attended with
weak digestive power.  It  has also  been administered
with very favourable results in obstinate cutaneous erup-
tions, chronic rheumatism,  and scrofula.   This is the
preparation chiefly recommended by Dr. Carmichael  for
the cure of cancer.
  Prussiate of Iron.—The prussiate of iron has been
lately employed with much  success in the treatment of
intermittent fevers.  Dr. Zollickoffer of Baltimore was
* No. xix. July, 1819. 
294
IRON.
the first who noticed its powers in this way.  He re-
lates a number of cases in which it was  successfully
used.*   He  gave it in doses of from four to six grains
every four hours.   During the present season, I have
known this remedy to be  employed with  considerable
success by several practitioners of this city.  I have
prescribed it in five  or six cases, in three  of which it
removed the disease very promptly.  In cases  of chil-
dren, it is a  very convenient medicine,  being destitute
of taste or smell, and the dose  forming but  a very small
bulk.
   The prussiate of iron has also been strongly  recom-
mended in passive  menorrhagiae.   In the menorrhagiae
which occur in weak,  relaxed, and irritable females,
about the final cessation of the  menses, this  article is in-
deed to be accounted among our  most useful remedies.
In general, this is decidedly the best ferruginous tonic,
where, along with debility and relaxation, there is great
irritability of the  nervous and sanguiferous systems.
The  prussic acid  which enters into  its  composition
would seem to be separated by the action of  the stomach,
and to  exert  its  peculiar  sedative powers  on  the
nervous system.
                  CUPRUM.—COPPER.

  Copper  has a slightly styptic  taste,  and a peculiar,
faint, nauseous smell.  It is said by some  writers that
this metal is perfectly inert when received into the sto-
mach in its metallic state.  Mr. Drouard  convinced

        * American Medical Recorder, vol. v. p. 540. 
COPPER.
295
himself of  its innocence by administering the  filings to
dogs; in no instance did it produce any injurious con-
sequences.   Indeed,  we often see children who  have
swallowed  copper coins without any perceptible effects
on the system.  In cases  where it has proved deleteri-
ous, an acid probably existed in the stomach, by which
the metal  was converted  into a soluble  salt,  and thus
rendered  active.   Others, however, assert  that  it  is
poisonous in its metallic state.  It is said to be acted on
by the  gastric liquor, and rendered active.   This may
be  the  case; but it  is extremely  probable that the cop-
per is not  dissolved in its  metallic state, but  in that of
an  oxide,  to which it is  previously converted by the
fluids in the stomach.*
   In its metallic state copper was formerly employed as
a remedy in  rheumatism; and Cothenius  recommends
its filings in the cure of hydrophobia.  At  present it is,
I believe,  never prescribed in the metallic state.   It is
susceptible of a variety of chemical preparations, some
of which are remedies of undoubted utility.
   Copper does not, however, manifest any particular ten-
dency  to invigorate the muscular system ;  and still less
perhaps to increase the activity of the digestive organs.

  * Dr. Paris mentions a striking instance in proof of the inertness
of copper when taken into the system in its metallic  state.  " A
young woman," says he, " swallowed six copper penny pieces with
a view of destroying herself; she was  attended  by Dr. Maton and
myself, in the Westminster hospital, for two years, for a disease
which we considered visceral, but which was evidently the effects of
mechanical  obstruction occasioned  by  the coin. After a lapse of
five years she voided them, and then confessed the cause of her pro-
tracted disease, during the whole course of which no symptom arose
which could in any way be attributed to the poisonous  influence of
copper. 
296
corrER.
 It is upon the nervous system especially that its tonic in-
 fluence is exerted; and it is chiefly in diseases depend-
 ing on a weakness or morbid  irritability of this system
 that its remediate powers are  manifested.
   Cupri sulphas.—Blue vitriol.—Having already notic-
 ed  this article as an emetic, I shall  here speak only of
 its remediate powers as a tonic and alterative.  As such
 it has been particularly recommended in the cure of in-
 termittents, by Dr.  Donald Monro and others.  Rich-
 ter avers that he has succeeded in curing intermittents
 with this article given in combination, after all  the other
 remedies usually relied on in  this disease  had  been in-
 effectually employed.   We have  also  the authority of
 Fr. Hoffmann, (Med. Ration,  et System, torn. ii.  cap.
 viii. p. 290;)  Adair,  (Duncan's Med. Commentar. vol.
 9 ;) and Hahneman,  in favour  of the excellence of this
 article as a remedy in intermittents.   Hoffmann (Hufe-
 land's Journal) speaks in the highest terms of the use-
 fulness of the  sulphate of  copper  in  bronchitis and
 tracheitis, or croup.  He asserts that when given in doses
 varying from a quarter  to half a grain every two hours,
 according to the age of the patient, in the commence-
 ment of the complaint,  it often produces the  happiest
effect.   He declares  that he  has often succeeded in
 curing well-marked cases of tracheitis by this remedy
alone, without any depletion whatever (Harless, Rhein.
Jahrb.  b. ii.).  Nyborg confirms the experience of
Hoffmann in relation to the-efficacy of  this remedy in
bronchial  inflammation  (Hufeland's Jour.  b. 57);  and
other German writers have  published  statements of a
similar tenor.
  Dropsy also, is said to have yielded to the powers of
 this remedy.   Gardane, (Med. and Philos. Comment. 
COPPER.
297
vol. iii.) Chalmers and Wright, (Lond. Med. Jour. 118)
speak well of its powers in hydropic affections connect-
ed with great relaxation  and debility.  Wright gave
half a grain of this preparation, with the same quantity
of opium,  gradually increasing the dose of the former to
one grain, twice daily.   In scrofulous phthisis pulmo-
nalis, the  sulphate of copper has been highly praised by
many  writers.  Curri,  Senter,  Simmons, Adair,  and
Jahn, have published accounts tending to show its use-
fulness in this affection.   Jahn says, he has known great
benefit derived in this disease from a combination, con-
sisting of one  drachm of  sulphat of copper, the same
quantity of powdered cinnamon, two drachms of the ex-
tract of cicuta, and two grains of opium, divided into two
grain  pills; of which four are to be taken three times
daily.   In the cure of epilepsy this remedy was, at one
time, a good deal prescribed.  Dr. Cullen,  before he be-
came acquainted with the cuprum ammoniacum, gave it
in this disease and in hysteria, and he states that its effects
were often highly beneficial. This salt has also been com-
mended for its effects in resolving scrofulous swellings.
Dr. Parsons speaks highly of it in this respect. Chalmers
prescribed it with success in  colica pictonum.  He
gave a wine-glassful every hour of  a solution of twenty
grains of blue vitriol in a pint of water, until vomiting
was produced.   This is to be repeated  until the dis-
 ease disappears.  Violent vomiting and  purging gene-
 rally  ensue   during the first forty-eight hours ; but
 these  effects gradually subside along with the symptoms
 of the disease.   Blood-letting is to be employed along
 with the vitriol, if fever  attends the disease.   Adair
 gave it with  advantage in other varieties of colic and in
 dysentery.   In chronic diarrhoea, depending on ulcera-
    vol.  i.—40 
298
COPPER.
tion of the mucous membrane of the bowels, this article
has of late been strongly recommended by several En-
glish  writers;  and my own  experience  enables me to
speak very  favourably  of its powers in this affection.
Half  a grain in the form of a  pill is to  be given three
times daily, and the dose afterwards gradually increased
to two, or even three  grains.   It  should be given  in
combination  with opium.  Dr. Elliotson has published
some  observations illustrative of the good effects of this
article in this disease.  (Med.  Chir.  Trans,  vol.  xiii.
p. 2,  1827.)  As an external application to chancre, and
other venereal  ulcerations,  it often produces excellent
effects.   For this purpose it is best employed in solution
in the proportion of about  five grains to one ounce  of
water.   When we wish  to use  it for the purpose of de-
stroying the surface of the chancre, it may be applied in
substance, like caustic.   It also forms an excellent injec-
tion for  gleety and leucorrhceal  discharges.  Dr.  J.
Foot, of London, in his late works on the venereal dis-
ease,  recommends, in the strongest terms, the following
injections in gonorrhoea, after the inflammation has been
reduced.   Dissolve blue vitriol in a sufficient quantity of
water, precipitate the solution with lixivium  of  tartar.
Suffer it to separate, then pour off the clear liquor; wash
the precipitate until it becomes insipid ; make a saturat-
ed  aqueous solution of  sal. volat.  amon.; mix as much
of this precipitate with the filtered solution of the vola-
tile salt as it  will dissolve, which reserve  for use.  Mix
of this six drops to every ounce of water for an  injection.
   In  the apthous ulcerations which occur on the inside
of the lips and cheeks, a solution of the sulphate of cop-
per is one of the most efficacious applications.  A solu-
tion of from  ten to fifteen grains of the vitriol in eight
ounces of water, with a few ounces of honey, maybe em- 
COPPER.
299
 ployed for this  purpose.  In  that terrible affection of
 the gums and cheeks which occurs in children—name-
 ly,  cancrum oris  infantum,  Dr.  Coates, of this city,
 found a mixture composed of two drachms  of sulphate
 of copper, one  ounce of powdered cinchona, and four
 ounces of water, applied to the ulcer twice  daily, more
 beneficial  than any other application.   In a case which
 recently came under my care, I employed this mixture
 with  the  happiest effect.   Raemacher,  (Hufeland's
 Journal, B. 62, p.  104) asserts, that a saturated solution
 of the sulphate of copper in whiskey, is one of the best
 means we possess for promoting the growth of hair. The
 scalp is to  be washed with it twice daily.

     Cuprum Ammoniacum.—Ammoniated Copper.
     »
   This preparation consists of a triple salt—a  subsul-
 phate of the oxide of copper and ammonia.  It has a
 metalline and exceedingly styptic taste, and  an ammoni-
 acal odour.  It  is soluble in the proportion of one scru-
 ple  to an ounce  of water.
   This is one of the most powerful and valuable prepa-
 rations of copper.  Its powers are more strongly exert-
 ed on the nervous  system than any of the other prepa-
 rations of this metal, and it has accordingly been much
 employed in nervous and convulsive affections.  When
 given in very large doses it is apt to cause vertigo, nau-
 sea, indistinctness of vision, vomiting, pains in the bow-
 els,  obstinate constipation or diarrhoea, and when its use
is long continued, it may give  rise to paralysis, hectic
fever, violent spasmodic pains  in the abdomen,  spasms
of the muscles, and even death.  These violent  effects
are,  however, never observed to follow its use, unless it
is employed in very full doses; for, under judicious and 
300
AMMON1ATED COPPER.
cautious management, it may be given with as little risk
of  doing injury as any  of the other more powerful
metallic tonics.
  In no disease, perhaps, has this preparation been more
celebrated as a remedy than in epilepsy.  It was a fa-
vourite remedy in this  disease with  Dr. Cullen, and
many of  the most eminent physicians  have published
statements illustrative of its good effects in this malady.
Among the  writers who speak particularly in praise of
its powers in  epilepsy, we  may mention Loebenstern-
Loebel,  Burserius (Institut. Pract. vol. iii.) Greding,
Michaelis (Med. Pr. Bibl.  1785,  B. L);  Stark, Van
Hoven; J. Frank (Prax. Med. Univ. Prac. p. ii. vol. i.);
and Richter  (Spec. Therap.  B. vii.)   Dr. Batt has
more recently published an account of its valuable pow-
ers in this disease.   He administered it in combination
with valerian, to  three  individuals affected with epi-
lepsy, and all were effectually cured by it.   Hufeland
asserts that  he cured a case of inveterate epilepsy, after
a great variety of remedies  had been ineffectually em-
ployed,  by  the use of a mixture composed of one-fourth
 of a grain of cuprum ammoniacum, three grains of the
 oxide of zinc, and one scruple of powdered valerian,
 taken mornings and evenings, at the same time that the
 patient  took a strong infusion of the flowers of arnica,
 valerian, and orange-leaves, during the day.
   This article has also been recommended as often very
 beneficial in other forms of spasmodic and nervous dis-
 eases; particularly  in chorea, catalepsy, and  in spas-
 modic asthma.   Odier asserts that its powers in diseases
 of this kind are much increased by uniting it with the
 oxide of zinc.  B. Bell gave it with  complete success
 in a case of spasmodic cough, attended with great irri- 
AMMONIATED COPPER.
301
tability of the nervous system; and Walker* states, that
he cured many cases of chorea with this remedy.   He
observes that he found it particularly successful where
the disease was accompanied with much relaxation and
debility.   Willan, also, cured a case of chorea with this
medicine.
  In hysteric affections, attended with great irritability,
anxiety,  cramps, and feebleness, the cuprum ammonia-
cum is a remedy of very useful powers.
  Thuessink, a German physician,  has published some
very interesting observations on the powers of this re-
medy in hysteria.  He  considers it particularly  useful
in those chronic cases which depend, or at least are ac-
companied with debility and relaxation, and a very irri-
table state of the system.|
   I have  myself employed this remedy in a considerable
number of instances of chronic hysteria,  and occasion-
ally with  the happiest effect.   I have usually given it
in  combination with  valerian, in  the proportion of a
quarter of a grain of the ammoniated copper with thirty
grains of  the valerian twice daily.  Particular attention,
however, should at the same time be paid to the  state
of the bowels.  If costiveness follows the use of this re-
medy,  a mild laxative must be given from time to time
so as to keep up regular alvine evacuations.  With re-
gard to  the powers of this preparation in epilepsy  and
similar affections, however, my own experience does not
 furnish me with any evidence of its particular usefulness,
 although I have used it in no  small number of cases of
 this kind.   Quite recently I prescribed it in an anoma-

  * A Treatise on Nervous Diseases.
   | Samlung. Auserles. Abhandlung fur Pract. Aerzte, vol. xvii. p.
266. 
302
AMMONIATED COPPER.
 lous spasmodic  affection, resembling in some respects
 catalepsy, with manifest advantage; but in this instance
 it was employed in conjunction  with  the oxide of zinc.
   In the cure of obstinate intermittents this remedy is
 highly spoken of by Brera;  he thinks it quite equal to
 arsenic in this disease,  especially where there is much
 irritability of the general system, and the intestinal canal
 is in a state of debility.*
   A solution of  this preparation is an excellent  appli-
 cation to  old and  ill-conditioned  ulcers; and has also
 been applied  with  much advantage  to  the  removal  of
 opacity of the cornea.
   We may commence with it in the dose of half a grain
 twice a day, gradually increasing the quantity as far as
 the stomach will  bear it.  It  is  best given in the form
 of pills.   It is sometimes given with sugar; but if it be
 true that  this vegetable  substance counteracts  the ope-
 ration of copper, such a combination would appear to be
 improper.
   In general, the addition of a small dose of  opium will
 be found useful  to obviate its unpleasant effects on the
 stomach and bowels; and this combination is especially
 proper where there is much gastric and general irritabi-
 lity present.   Boerhaave, Cullen, and Richter, indeed,
 assert that opium enhancesits powers as a remedy in spas-
 modic affections,  independent of its mere tendency to
 enable the stomach to retain it with less  inconvenience.
  Boerhaave mentions a  preparation made by digesting
 one drachm of copper filings in an ounce of aqua ammo-
 nia, which he represents  as a very valuable diuretic, and
as especially useful in some varieties of  dropsy.  The
* Burdach's Arzneymittellehre, B. ii. p. 184. 
AMMONIATED COPPER.
303
   dose is three drops, gradually increased to twenty-four
   drops every morning.
     Liquor cupri ammoniato-muriatici.—This prepara-
   tion was first mentioned by Kochlin  (Med. Chir.  Zei-
   tung, 1818 ;)  and appears to have, of late years,  been
   a  good  deal  employed by the  German  physicians.
  It is thus prepared.   Digest  one drachm  of copper
  filings in an ounce and a half of aq. ammonia nine or ten
  days;  then saturate this tincture with  muriatic  acid.
  Two drachms of this saturated tincture are to be mixed
  with twenty ounces of distilled water.   Of this, adults
  are to take a table-spoonful  three  times daily.*   This
  preparation is said to be peculiarly valuable as a remedy
  in syphilitic ulcerations ; as well as  in scrofulous,  and
  other obstinate or  corroding ulcers.   It is asserted by
  some writers that,  in males, this tincture has the  effect
  of exciting the  venereal propensity to a very considera-
  ble  degree.  The writers  who speak  particularly in
  praise of this preparation in  syphilitic  and scrofulous
  affections, besides  Kochlin, are, Kopp, (Beobacht. in
  Gebiete derPrack. Heilk. p. 330;) Henn,  (Hufeland's
  Journal, Bd. 58 ;)  Schneider, (Med. Prakt. Adversar.

   * Golis recommends the  following mode for preparing this tinc-
 ture :
   R.—Cupr. ammoniac.    5SS<
       Solve in aqua fontanae iiv.
       Adde, acid, muriat.   q. s.  ut post coagulum viride liquor.
 fiat pellucidus.
   Mr. Buchner's method of preparing it is as follows :
   R.—Cupri oxydati carbon.            gr. xlii.
 Solve in acidi muriat. s. q. donee  omnis effervescentia desiderit;
 adde, ammonii muriat. dep.  3ixss.   Cum gr. vi.  Aq. distill, q. s.
ut fiat liquor, ^vi.   Goelis*  preparation is three times as strong as
that of Kochlin. 
304              AMMONIATED COPPER.

&c. 1822;)Wolfe, (Grafe andWalther's Journal, 1825;)
Jager, (Harless,  Rheim, Jarhrb. B. 5.
   Acetas cupri.—Mrugo seris verdigris.—This prepa-
ration was formerly a good deal employed as An internal
remedy in certain chronic diseases, particularly in syphi-
lis, scrofulous ulcerations, and other varieties of external
ulcerative affections. At present, however, it appears to
be entirely laid aside as an internal remedy.   The cele-
brated nostrum of Gerbier consisted of a combination of
verdigris, roasted barley,  and calomel formed into pills.
These pills are said to be  highly beneficial in scrofulous
and  cancerous  affections.  The  French Academy of
Medicine commissioned  Solier de la I^omilias to  test
the usefulness of this remedy in one of the Parisian hos-
pitals ; and his report states that, in general,  its benefi-
cial  influence upon scrofulous or carcinomatous ulcera-
tions of the mammae were very considerable.  He found
it especially useful in noli me tangere of the nose.   The
 verdigris is given  in doses of an eighth of a grain three
 times daily, and gradually increased  until it begins to
 give rise to nausea and other unpleasant sensations in the
 stomach.  (Diet, des Scien. Med. t. vii. p. 576.)
    Schlegel (Material  f.  d.  Staats Arneiw.  1809, &*•
 Samml. No. II.) has published a series of cases tending
 to illustrate the good  effects of verdigris  in  syphilitic
 affections.  He gave it in the following way.*

   *  R.—iErugo aeris crystall.        gr. ii.
         Solve exacte in aceti concentr. ^ii.
         Admisce camph.           gr. iv.
          Opii                     gr. ii.
          Sacch. alb.                 3SS<
          Micae panis                q. s. ut fiant pil. No. 40.
  Take from five to ten, every morning, noon, and evening. 
AMMONIATED COfPER.
305
  Externally, the acetate of copper is still frequently
employed in certain cutaneous affections and ulcerations.
Dr. Good recommends  the following ointment as pecu-
liarly efficacious in porrigo circinata.*  Swediaur as-
serts that a saturated solution of verdigris in aqua am-
monia in the proportion of one drop to an ounce of wa-
ter, forms one of the most effectual injections for the cure
of gleet,  we possess.  I  have myself frequently employ-
ed this injection,  and usually with complete  success.
It is  much  too active,  however, for the acute stage of
gonorrhoea.  The unguentum seruginis,  or mel  segyp-
tiacum, as it was formerly called, forms an excellent ap-
plication in foul, indolent, and chronic ulcerations, par-
ticularly where the granulations are luxurious and spon-
gy.   In ulcerations of the gums, internal surface of the
cheeks,  tonsils, and fauces,  this  preparation is said to be
especially beneficial.  It may be applied  to the ulcers
by means of a fine pencil.  There are various formulai
for preparing the mel segyptiacum ; but  that  given in
the  London Pharmacopoeia appears  to  me  the best.
Swediaur  recommends a  liniment made of verdigris,
composed of four grains of this preparation rubbed up
with an  ounce of sweet oil, as a very  valuable applica-
tion to atonic and callous chancres and venereal ulcera-
tions with indurated edges, and weak and spongy gran-
ulations.
   A preparation of verdigris is mentioned by Hufeland,
under the name of set her cuprius, which he represents
as a peculiarly  useful remedy in spasmodic and  convul-
sive  nervous affections.   It is  made  according  to  the

  * R.—Cerat. resinse 5i. in balneo aquosa liquifactre, adde, tere-
binth, vulgar, ^ss. tunc, cupri. acetas, calomel *k ji. insperge, et
omnia misce.
   VOL.  I.—41 
306
AMMONIATED COPPER.
following formula.*   The dose of this preparation  is
from three to ten drops  three times daily.   (Richter's
Arzneimittell.  Bd. iv. p. 486.)
   The aqua viridis Hartmanni, is another preparation
of this article which was formerly much used as an ex-
ternal application to  foul, indolent,  or fungous  ulcera-
tions.  Baldinger asserts that it generally does a great
deal of good when applied to the painful ulcerative in-
flammation  which occurs at the roots of the nails and
causes their separation. (N. Magazin. f. Aerzte. Bd. iii.)
This preparation  consists of a mixture of two drachms
of verdigris, the same quantity of alum, half an ounce
of honey, and one pint of white French wine.
                         ZINC

          Oxide of Zinc.  Flowers of Zinc.

   This preparation was first introduced to the notice
of the profession by Gaubius {Adversaria, Varii Argu-
ment. ) He obtained his knowledge of its remediate pow-
ers from  a celebrated quack,  who employed it  with
much success, as a nostrum,  under the name  of  luna
fixata.  Since that time it has been much used in cer-
tain nervous and spasmodic affections, and its usefulness,
in diseases of this kind, is attested by  the general expe-
rience of the profession.  As a general  tonic, in relation
to the muscular system and the digestive organs, it pos-
sesses but feeble powers.   Its operation  appears  to  be

  * iEruginis. %i. solve in acidi. muriat. q. s.  adde:  Acidi. nitrici.
sext. partem acidi. muriatici.  Solutio ad siccitatem evaporetur, tum
seponatur, donee attracto humido et sere liquescat.  Liquamen
solve in triplo aetheris sulphurici. 
ZINC.
307
 chiefly directed and confined to the nervous system; ma-
 nifesting decided  antispasmodic  and roborant powers,
 with regard to this system.
   In small or ordinary doses, the oxide of zinc produces
 no immediate perceptible  effect on the system.   When
 given in very large portions, however, its action is  of-
 ten violent, giving rise to vomiting, spasms of the sto-
 mach, constipation or diarrhoea, inflammation of the
 bowels, convulsions,  and  paralysis.   Nevertheless, it
 rarely produces such violent effects, unless it be taken
 in enormous  portions, and there is, therefore, nothing
 to be apprehended from its regular and proper adminis-
 tration. Gaubius, who first employed it in regular prac-
 tice, gave it  in epilepsy; and the records of medicine,
 since his  time, contain numerous statements illustrative
 of its valuable powers in this affection.  Goodsir, Per-
 cival, Beircis, Crell,  Hufeland, and  other physicians,
 have reported cases  demonstrating  the  powers of this
 medicine in epilepsy. Hufeland gave it in combination
 with cuprum ammoniacum, extract of hyoscyamus, and
 valerian.   It appears to be more particularly useful in
 this disease when it affects children. Burdach observes,
 that it probably does more good in children by neutral-
 izing acid in the stomach and destroying worms.
   In a case of  this disease  in a child, I gave this re-
 medy in large and frequent doses, and in the course of
 two months succeeded  in  putting a permanent stop to
 the disease.   Dr.  Rush  states  that  he cured  a case of
 ten years standing with the flowers of zinc.  When pre-
 scribed for affections  of  this kind it should be given in
 as large doses as the stomach will bear.   Commencing
 with a grain  three times  daily, the dose may be gra-
 dually increased to twenty or even thirty grains thrice a
day, in adults.  In general, the quantity prescribed  at 
308
ZINC
a dose is much too small  to procure any permanent ad-
vantage in such affections.
  It has  also been employed against hooping-cough.
Hager and Lceffler recommend it highly in this singular
disease.
  The flowers of zinc is a remedy of considerable value
in hysteric  affections, connected with much relaxation
and weakness.   In cases of  this kind I have sometimes
employed it with Peruvian bark, and in several instances
with very considerable advantage.  Within the last two
years, I have in several instances of chronic hysteria,
 employed the oxide of zinc in  union with castor, with
the happiest effect.  Two grains of the zinc, with five
grains  of castor made  into pills  may be taken  thrice
 daily.
   This remedy has likewise been  employed with very
 good effects in spasmodic diseases arising from suppres-
 sion of chronic cutaneous eruptions.   Robcel used it in
 children  affected  with  symptoms  of chorea  in  conse-
 quence of the suppression of eruptions on the head, and
 he states that the result was entirely favourable; the
 eruption returned after using the remedy for some days,
 and the disease disappeared.*
    Its powers as a remedy in chorea, have indeed been
 much  extolled by many writers of great authority. Bur-
 serius  (Institut vol.  iii.,) Van Hoven,  (Handbuch, Bd.
 ii. cap. 14.,) Hufeland, (Journal, B. xxvi. St. iii. p. 74.,)
  Richter, (Med.  Chir. Observat. p. 105.,) Alexander,
  (Duncan's  Annals,  1801, p.  303.,) Thilenius, (Med.
  Chir.  Bemerk. Bd. i.,) Wright, (Memoirs of the Med.
  Society  of Lond.,) Brent, and many other  celebrated
  physicians have reported cases of this disease which
  yielded  to the oxide of zinc after various other remedies

          * Burdach's Arzneymittellehre, B. ii. p. 197. 
ZINC.
309
had been ineffectually used.   Dr. Alexander gradually
increased the dose until it amounted to forty grains.
  This preparation has also been successfully employed
in spasmodic asthma.   Wolff has related a remarkable
case which yielded completely to this remedy, (Hufe-
land's Jour. Bd.  xviii. st. i. p. 53.;) and Jahn, (Mat.
Med. Bd. ii ,) asserts that he has often derived  great
benefit from its employment in affections of this kind.
   According to the experience of Hufeland, the oxide
of zinc is a remedy of great value in the eruptive stage
of  small-pox, when the eruption  is slow and  imperfect
in its progress, or is interrupted  before it is fully com-
pleted, and  attended with nervous or convulsive symp-
 toms.   He says that  in such cases  this medicine allays
 the muscular twitching,  delirium, and febrile irritation,
and often speedily improves every symptom of the dis-
 ease.  To children of from one  to  three years old, he
 gave two grains of the oxide every two hours;  Sprengle
also speaks very favourably of this practice, and observes
that he found it especially useful to promote the regular
 suppuration of the pustules where this process went on
 imperfectly.  Thuessink (Hufeland's Jour. Bd. vi. p.
 672) employed  this article with marked benefit in an
 epidemic small-pox, attended with prominent catarrhal
 symptoms.  Hufeland states that in some instances where
 violent  symptoms ensued  the retrocession of measles,
 he derived  great advantage from the free employment
 of this remedy; and Richter expresses a favourable opi-
 nion of its powers in cases of this kind.*
   Externally, the oxide of zinc admits of various use-
 ful  applications.   Hufeland recommends  an ointment
 made by mixing half a drachm of the oxide of zinc with
 an ounce of spermaceti ointment, as peculiarly beneficial

          * Specielle Arzneimittellehre, B. iv. p. 508. 
310
ZINC.
 in painful excoriations and ulcers of the nipples.   It is
 also one of the most effectual applications we possess in
 obstinate herpetic ulcerations, and in other eruptions of
 a scabby and ulcerative character.   Greiner (Richter,
 Spec. Arzneimitt.) asserts that we  possess  no remedy
 superior to this ointment in ulcerations of this kind. He
 succeeded in curing an ulcer on the nose simply by the
 application of this ointment, after it had for eight years
 resisted various modes of treatment.  Bateman mentions
 it as an excellent application in porrigo furfurans.   In
 herpes  of every variety it will  often  do  much  good.
 Wetzler states that he cured  cases of  this  kind  after
 various other approved remedies had been ineffectually
 employed.  Crusta lactea also has been successfully treat-
 ed  by this ointment;  and Thuessink states that he has
 derived great benefit from the application of  the oxide
 of zinc,* mixed with powdered starch, in erysipelatous
 inflammation.  Somme (Archives Generates de Med.
 t. i. 1823) strongly recommends injections composed of
 half an ounce of this preparation and two pints of water
 in fluor albus.   He declares that he has succeeded in
 putting a permanent stop to the disease by this remedy
 in the course of three or four days.  In ophthalmia, the
 oxide of zinc in the form of an ointment has been much
 used.  Plenk recommends a lotion consisting of a drachm
 of this preparation and six ounces of water; or an oint-
 ment made by mixing  one scruple of it with an ounce
 of fresh unsalted butter, applied to the edges of the eye-

  * " Dr. Roloff, of Magdeburg, has lately discovered the casual
presence of arsenic in the oxide of zinc; by boiling the substance
in distilled water and assaying the solution with ammoniaco-nitrate
of silver, its presence may be instantly recognised; chalk may be
detected by sulphuric acid,  exciting  an effervescence; and white
lead, by forming an insoluble sulphate of lead.  It ought to be vo-
latile."—Paris's Pharmacologia. 
ZINC.
311
  lids. In pruriginous ophthalmia, an ointment composed
  of half a drachm of the zinc, one ounce of lard, and four
  grains of opium, will often procure speedy relief.
    Sulphas zinci.— White vitriol.—The sulphate of zinc
  is a  remedy of very considerable powers, and has been
  much employed in spasmodic and other diseases.  Under
  the head of Emetics, I have  already spoken of the re-
  mediate application  of this substance,  so far as its eme-
  tic properties are concerned, and it remains for me,
  therefore, in this place, only to notice its virtues as  a
  tonic.
    In the cure  of epilepsy,  many practitioners  have
  thought it preferable to the preceding preparation, and
  I am inclined to believe that this opinion is well found-
  ed.  Cullen gave it  in this disease  with advantage, and
 JohnstonJ states  that he cured several  cases  with it.
   Chorea also has  been successfully treated with this
 article.   Two instances of this disease,  which appear
 to have been of a very  obstinate character, were cured
 by the sulphate of zinc in the Berlin Polyclinic Insti-
 tute, (Hufeland's Journal,  B. 57.)  The dose was gra-
 dually increased from half a grain twice daily, to seven
 grains.  Muller  used it with success in this disease.
   Lettsom and Crell  employed this  article with success
 in habitual  palpitations  of  the heart.   Asthma has also
 been  successfully treated with this preparation (Siinde-
 lin,)  and Meglin, (Journal de  Med.  par Corvisart)
 cured neuralgia of the  face and  hemicrania, with it.
 Paris says, that sulphate of zinc, in  union with camphor
 and myrrh is an excellent remedy in spasmodic cough,
 (Pharmacologia;) and  Brand mentions it as often particu-
larly serviceable in hooping-cough; Schwartze also states,
that he has given it with marked benefit in this affection.
* Medical Essays and Observations. 
312
ZINC.
   In hysteria, Dr. Lettsom employed this article in con-
junction with quassia, and the result, according to his
account, was favourable.
   Dr. Hewson, of this city, has  lately informed me that
he has been particularly successful  in curing intermit-
tents with this remedy. Dr. S. Ffirth, in a letter to Dr.
S. Mitchell, dated Calcutta, 1805, speaks in very high
terms of this practice.  "The sulphate of zinc," says
he, u is a  remedy which I have been in the habit of
prescribing  in several diseases as a tonic, and am of
opinion, that when combined with a narcotic anodyne,
it may  be substituted  very advantageously for the cin-
chona officinalis.   I have often  done this in practice,
and was seldom disappointed in  its good  effects."
   " In remittent fevers it is a useful and valuable reme-
dy, and can be given  when the  bark is  inadmissible,
especially if combined with  the extract of hyoscyamus
niger.  In the remittent form of the malignant fever of
Asia, I have given it to the extent of three grains of the
hyoscyamus niger, and four of vitriolum album, every
hour and a half.  I formerly used this remedy with much
success," he continues, u in  a number of cases of inter-
 mittent fever, in Pennsylvania ; when I resided at the
 Philadelphia Dispensary, I had frequently an opportu-
 nity of comparing its virtues in the cure of intermittent
 fever,  with bark and arsenic ;  the result of my experi-
 ence was,  that in many cases it cured  where the bark
 failed ; but I found, also, that the bark  succeeded in as
 many cases where the  vit. alb.  had disappointed me."
    I have used the sulphate of zinc with great benefit in
 chronic rheumatism arising from the long-continued and
 incautious use of mercury.  In one instance, the relief
 obtained was complete and so far permanent, after a
 great variety of other approved remedies had been used
 for many months, with little or  no advantage.   From 
zinc.
313
what I have observed of its effects in this respect, I am
inclined to regard it as a valuable remedy in affections
of this kind.  I have used it in one instance of syphilitic
rheumatism with marked advantage.   I gave it in com-
bination with the extract of cicuta, in the proportion of
one grain of the former,  to  two grains of the latter.
Weil and Crell recommend this article in chronic arti-
cles.   The dose of this medicine, when employed as  a
tonic, is from one grain to two or three.  It is most con-
veniently given in the form of pills.
   For an account of the  external use of this remedy,
the reader is referred to the  article sulphate of zinc, in
the chapter on Astringents.
   Acetate of Zinc.—From  the experience of Orfila,
Deveaux  and  Dejaer, it  appears that this  preparation.
may be taken into the stomach in considerable quantities
without causing any poisonous or injurious consequences.
Henry was the first who employed the acetate as a re-
medial agent.  He recommends  it strongly, as an in-
jection in gonorrhoea, and  other  writers  have  since
expressed opinions equally favourable to its employment
in this disease. (Med. Phys. Jour.,  1803.)  Internally
it may be given in doses of from six to fifteen grains ;
and its powers appear to  correspond with those of the
 oxide and  sulphate.  Rademacher,  (Hufeland's Jour.,
Bd. 62,) recommends it in maniacal affections.  He af-
 firms that he has known it to produce the happiest effect
 in cases of this kind.  He gave it  to the  extent of a
 drachm and a half in twenty-four hours.   Dr. Dewees
 recommends this preparation in  the proportion of two.
 grains to four ounces of water, as an excellent lotion  in
 the purulent ophthalmia of infants.  I have used it with
 much benefit in this affection.
   Muriate  of Zinc.—The  muriate of zinc,  speedily
    vol. l.—42 
314
ZINC.
 deliquesces when exposed to the air—forming what has
 been called the butter of zinc,  (butryum zinci.) Hufe-
 land  recommends a solution of this preparation in sul-
 phuric aether,  in the proportion of one part of the dry
 muriate to eight parts of the aether, as a very excellent
 remedy, in the nervous  affections which have already
 been mentioned as often susceptible of being cured by
 the oxide of this metal.   In the Charite at Berlin,  this
 solution was used  with much success in chronic pains
 in the bones and joints.   (Hufeland's  Journal, Bd. 30,
 St. 30, p. 15.)  The muriate of zinc, has however been
 most commonly employed  as an  external remedy.  It
 is said to be a peculiarly valuable escarotic, producing
 little or no pain, or general irritation,  although suffi-
 ciently active, in this respect, for all the purposes of an
 escarotic.   Several German writers, prefer it to all the
 other  articles of this kind  we  possess,  in.old, atonic,
 fungous, or indurated ulcerations.-  Two grains of the
 muriate dissolved  in an  ounce of water may be applied
 by means of a dossil of lint, to indolent and fungous ulcers.
 In old and indolent syphilitic ulcerations it is  said to be
 especially beneficial.  When its  escarotic effects  are
 desired,  the muriate may be sprinkled or applied in a
 layer over the part.  Hancke asserts that in cancerous
 ulcers, he has known this  application to prove more
 effectual than the usual arsenical pastes.   Applied over
 the whole ulcer, about a line in  thickness, it will in ge-
 neral destroy  the diseased parts in the course of eight
 or ten hours, with but very little pain, and without ex-
 citing much inflammation in the surrounding parts.  In
 every  affection, in short, where an escarotic, may be
 deemed proper, this article, it is said, may be used with
as much, if not  more advantage,  and with less suffering,
than any other application of this kind.   Internally the 
ZINC.
315
dose of the muriate is from one-eighth to one-fourth of
a grain.   Of Hufeland's setherial solution may be given
in doses of from five to ten drops, three times daily.*
       OXIDUM BISMUTHL—MAGISTERY OF BISMUTH.

   It is not more than twenty-eight years since this re*
medy was  introduced into practice by Dr. Odier, f of
Geneva, and De la Roche, of Paris.   Its remediate vir-
tues had, however, been particularly noticed by Jacobi, J
nearly a century before Dr.  Odier published his obser*
vations on its employment;  but it does  not appear that
it had attracted the attention of the profession anterior
to the publication of Dr.  Odier's paper.
   The medicinal powers of this article do not  differ
very materially from those of the oxide of zinc.   Given
in inordinate doses, it is apt to  give rise to  nausea, a
sense of constriction in the epigastrium, anxiety, vomit-
ing, giddiness,  prostration, and a small and weak pulse.
The diseases in which it has been particularly recom-
mended, are, gastrodynia, spasms of the stomach, hys-
teric colics,  pyrosis, and other dyspeptic complaints.
The testimony of Dr. Marcet, Dr. Bardsley, and Clark,
in England; of Hufeland, Reil, Krysig, Belsen, &c. in
Germany, and of Dr. Hosack, and Moore, in^this  coun-
try, are strongly  in favour of the remediate powers of
this article, in this disease.
  At present its employment is chiefly confined to the

  * Richter'* Spec. Arzneimittell,  Bd. iv. p. 535.
  | Journal de Medecine, 1786, torn. Ixviii. p. 49.
  I L. F. Jacobi de Bismutho.  Erford, 1697, 4 Burdacb, 
316
MAGISTERY OV BISMUTH.
cure of gastrodynia, pyrosis, and cardialgia.   In these
affections it seems to be pretty generally admitted to be
a medicine of considerable value.  Dr. Marcet, whose
testimony deserves  great  respect,  in a paper read in
1801,  before the London Medical Society, says,  " I
have since had frequent opportunities, at Guy's hospital,
of trying the oxide of bismuth in spasmodic affections of
the stomach, and those trials have fully confirmed the
opinion which I formerly gave  of the utility of  this
medicine."   Dr. Samuel W. Moore,  of New-York,
in his excellent  dissertation on the medical virtues of
the white oxide  of  bismuth, relates three  cases of
painful affections of  the stomach, in which this remedy
was employed with much success.  I have employed it
in several cases of  spasmodic pain of the  stomach, and
in two its effects were decidedly beneficial; though in
the others, which appeared  to me perfect cases of gas-
trodynia, it had not the slightest effect whatever. Upon
 the whole, however, the evidence we have in favour of
 the powers of this remedy, in the diseases mentioned,
 entitles it to much attention from the  profession.
  This medicine may be given in the dose  of from three
 grains to ten, three or four times a day.  Hufeland says,
 that its virtues are increased  by  being given in combi-
 nation with the extract of hyoscyamus and ol. cajeput.
 Odier gave  it a quarter of an hour before eating, and to
 the extent of twelve grains for a dose.
    Carminati (Opusc. Therap. vol. i.,)  asserts that he
 has not only found this article highly beneficial in gas-
 trodynia, but also in  debility with morbid sensibility of
  the stomach;  and  Bardsley and  Yeats strongly recom-
  mend it as a tonic in dyspepsia, attended with spasmo- 
MAGISTERT OF BISMUTH.
31?
die pains,* and  increased sensibility of the stomach.
It has also been  employed with success  in violent and
spasmodic vomiting. (Kopp.)  According to the expe-
rience of Durr, a German writer of considerable reputa-
tion,  the oxide  of bismuth is  an excellent remedy in
dysmenorrhoea.   He gave two grains in combination
with a grain of  the extract of belladonna, and half a
grain of calomel  every three hours.f  Epilepsy, also,
has been successfully treated with this remedy.   Lo-
benstein-Loebel says, that it is most apt to prove advan-
tageous in those cases of epilepsy which arise from gas-
tric irritation.  He gave it in union with the  essential
oil of valerian.
  Externally the oxide of bismuth has been much used
by  females as a cosmetic,  that  is, for  the purpose  of
beautifying,  and  improving the  complexion.   In the
form of ointment  it is said to be a very  efficient remedy
in herpetic  and  other chronic  cutaneous affections.
Mixed with lard, in the proportion of one part of the
oxide, to three of the lard, it has been used with prompt
success in the itch.  (Schroder, Richter.)  Odier, and
Hahnemann  assert that tooth-ach will often  speedily
subside by taking a portion of the oxide of bismuth into
the mouth.f   I  do not know  a better application to
excoriated and tender nipples than an ointment com-
posed by mixing a drachm of this article with an ounce
of fresh lard.

  * London Quarterly Journal, vol. viii. p. 295.
  t Hufeland's Journal, Bd. Ivi. st. v. p. 48.
  X Voigtel's Arzneimittell. 2 Abth. Bd. iii, p. 436 Richter's Arz-
neimittell. 
(  S18  )
                      ARGENTUM.

   Metallic Silver.—It has been asserted that silver, fr-
its metallic state,  taken into the stomach,  exerts usefin
tonic and alterative powers on the system.   Meyer af-
firms that he has used the filings of silver with the hap-
piest effects in obstinate intermitting fevers.   He states
that a single dose  of fifteen grains  taken just before the
accession of the paroxysm, was in general sufficient to
arrest the disease. (Hufeland's Journal, Bd. 64.)  Rich-
ter, however, thinks that the effects ascribed to the sil-
ver by Meyer, depended on the small portion of copper
with which this metal is usually alloyed, and this opinion
is not at all improbable.
   Nitrate of Silver.-—The nitrate of silver, when fused
and  cast into small cylindrical pieces, forms  the lunar
caustic of the shops.  These peices are of a dark gray co-
lour, and break with a shining crystalline fracture. Thelu-
nar caustic possesses no odour, but it has an  exceedingly
austere,  bitter, and metalline taste.   It is soluble in an
equal  weight of water, at 60°; it  also dissolves in al-
kohol.
   In another place I shall have occasion to speak of the
employment of this substance as an escarotic.; in the pre-
sent place, therefore, I have only to. notice its remediate
powers as a tonic.
   Internally the nitrate of silver has been particularly
recommended in  the  cure of  epilepsy.   We find it
mentioned by Paracelsus and Stahl, as possessing highly
useful  powers.   Dr.  Simms, of London, relates several
cases in which this remedy was successfully employed. 
ABGBNTUM.                   319
  Dr. Cappe,* also, speaks well of the powers of this me-
  dicine in epilepsy.   Nord,  a  German writer, gives an
  account of a case of epilepsy complicated with mania,
  in which the nitrate of silver  was employed with com-
  plete success.!  It has  also been successfully used in
  the disease by Dr. Gough,J  Sir Henry Halford,§> and
 Dr. Roget. ||   Sementini, an Italian physician, says it is
 more efficacious in this disease than  any other remedy
 we possess.  It ought to be given in combination with
 a vegetable extract.  This writer  states, also,  that he
 found it successful in paralysis. H"  He says that a cuta-
 neous eruption, of a pustular kind, frequently appears
 in those who are taking this remedy ; when this takes
 place we  may be assured of the beneficial influence of
 the medicine.  Lbebenstein-Lobel, (Wesen. und Heil.
 et Epilepsie,  p. 243,) recommends the following com-
 bination as peculiarly valuable  in this affection, where
 the digestive  powers are  not particularly impaired.**
 Other names  might be added in testimony of the effica-
 cy of this medicine in epileptic  complaints. Many prac-
 titioners, however, who have prescribed this remedy,
in the present disease, have been  entirely disappointed.
In my own practice,  it has but very  seldom produced
any decided advantages, although I have given it largely

  * Arzneimittelehre, bd. iv. p. 419.
  X Medcinishe National Zeitung,  1798.  Sup. No. xiii. s. 206.
  X Medical Museum, by Dr. J. R. Coxe, vol. iii. p. 70.
  § Medico-Chirurgical Transactions, vol. ix. p. 230.
  j| Ibid. vol. vii.
  IT Giornale di Fiscia, torn. xi. p. 355.
 ** R.—Nitrat. argenti,     gr. x.
       Extract cicutae,      9i.                        ,
       Extract valerian,    3i—M.  Divide into one grain
pills.  Take three every morning and evening. 
320
AR.GENTUM.
and perseveringly in several  instances.  Nevertheless,
the successful instances treated with this remedy are so
numerous, and so well  attested, that no doubt can be en-
tertained  of its especial  efficacy in  the symptomatic
forms of the disease.   Since the second edition of this
work has been published, I have witnessed its success-
ful employment, in a well-marked and obstinate case of
this disease.
   The nitrate of  silver has also been used with advan-
tage in other convulsive affections.   Wolf speaks of  it
in the most exalted terms as  a remedy for tremours  of
the heart.   And Dr. Powel,  of London, has published
cases of its successful use in chorea.
   This remedy has likewise been employed with suc-
cess in agina pectoris, dropsy,  and leucorrhoea.  " In
several instances  of leucorrhoea," says Dr.  Thacher,
 " the nitrate of silver has been employed  in  doses  of
one-twelfth of a grain  three times a day, with complete
 success."   Bayle and Geoffroy speak favourably of its
 effects in dropsy.
   In combination with cicuta, I have, in a few instances,
 prescribed this remedy with excellent effect in scrofu-
 lous ulcerations. In old constitutional ulcers, the nitrate
 of silver, administered in doses of from gr. i. to vi. three
 times a day, has been  known to prove highly beneficial.
 I once prescribed it with complete success in an alarm-
 ing case  of ulceration of the gums  and jaws, from the
 imprudent use of mercury. A part of the palate and up-
 per jaw, with  the two middle incisors, had already come
 away, and the ulceration was spreading rappidly. I ad-
 ministered four grains of the nitrate of silver, three times
 a day, and by this remedy alone, succeeded without dif-
 ficulty in arresting the disease. This preparation is, in-
 deed, highly recommended by Hahnemann, in the treat- 
ABGENTUM.
321
ment of mercurial diseases.   Dr. Roberts,  an English
writer, employed it with much benefit in counteracting
the deleterious effects of lead.
   The nitrate of silver may be given from one-fourth of
a grain to six  grains; gradually increasing  the  dose.
Nord began with half a grain, and gradually augmented
the dose to fifteen grains three  times a day."  I have fre-
quently given it to the extent of six grains.
   It is now ascertained beyond a doubt, that  the  long
continued use of nitrate of silver  is capable of giving a
permanent black colour to the skin.  The late Dr. Al-
bers, of Bremen, relates several cases of this  kind.*  A
case, also, is reported by Dr.  F.  Harrold, of England,
in which the skin became nearly  black in consequence
of the internal use of this remedy ;f and Sir H. Halford
gives an account of a person who  took it for a year and
a half, and whose skin,  at last,  assumed  a  permanent
dark hue. J
  The incompatible substances are, ei fixed alkalies and
alkaline earths; the muriatic, sulphuric, and tartaric
acids, and all  the salts which contain  them;  soaps,
arsenic, hydro-sulphurets, astringent vegetable ^infusions,
undistilled waters."  It does not  deliquesce when free
from copper.
  For an account of its employment as an external re-
medy, see the  article lunar caustic, in the chapter on
Escarotics.

  * Vide Eclectic Repertory, April, 1816.
  X London Med. Repository, vol. v. May, 1817.
  X Medico-Chirurg. Transact, vol. ix. p. 237.
   vol. i.—43 
322
ARGENTUM.
                        Formula.
  R.—Argenti. nitrat.      gr. xii.
      G. opii            gr. x.
      Extract, gentian.    31.—M. Divide into 60 pills.  Take
three pills, twice daily—gradually increasing the dose according to
circumstances.

       Liquor argenti muriutico—ammoniati.
   Kopp has given the following directions  for making
this preparation,  which he asserts to be in many respects
decidedly superior to  the nitrate—more especially in
epilepsy.   Dissolve ten grains of lunar caustic in  two
ounces of  distilled  water; filter, and  add  a  sufficient
quantity of muriate of  soda  dissolved in water, to pre-
cipitate the solution.   The precipitate is to be carefully
washed, and dissolved  in ?iss. of caustic  aq.  ammon.
Then add to this solution 3iii. of muriatic acid.   The
dose for a child from five to ten years old is three drops,
in a table-spoonful of water three times daily.
                    AURUM.—GOLD.

  During the ages of alchemy, gold  enjoyed consider-
able reputation as a medicine.  It had, however, sunk
into entire neglect, when Dr. Chrestien,* in 1811, pub-
lished his observations concerning its remediate powers,
and again brought it to the attention of the profession.
This  writer adduces a number of facts illustrative of its
efficacy  in syphilitic and scrofulous cases; and asserts

  * Observations sur un Nouveau Remede dans  le Traitment des
Maladies Yeneriennes et Lymphatices, par A. Chrestien, a Paris,
1811. 
GOLD.
323
 that the employment of gold is not liable to the same in-
 convenience which occasionally attends the use of mer-
 cury.   It cures the disease without exciting ptyalism;
 and unless given in too large doses,  produces no sensi-
 ble disturbance in the system.   No particular care as to
 regimen is required during its  employment, and  the
 patient, we are told, may go about his ordinary business;
 nay, it is even stated, that the remediate employment of
 gold admits of a generous diet and the moderate enjoy-
 ment of wine.   The preparations which  he used are:
 metallic gold, in the state of minute division ; oxide of
 gold, precipitated by potash ; the oxide precipitated by
 tin ; and the triple muriate of gold and soda.  Of these
 preparations the muriates are vastly more powerful than
 the oxides and divided gold.  The latter is the weakest
 of them all.  Orfila ranks  the muriate of gold  among
 the poisonous substances; and Chrestien asserts that it
 is incomparably stronger than corrosive sublimate.  He
 administered it in doses, at first  no larger than one-fif-
 teenth of  a grain, and if pushed beyond one-tenth of
 a grain, it never failed to excite fever and inflammatory
 symptoms.  The oxide he  gave in doses of from half a
 grain to two grains, arid the metallic gold, to the extent
 of three grains daily.
  Duportal, who, in conjunction with Pelletier, publish-
 ed a very  interesting  memoir  on the preparations  of
 gold, adds his testimony in favour of the efficacy  of this
 remedy in syphilitic complaints.   He relates a remark-
able instance of  the good effects of these preparations
in a cancerous ulcer, " that had  destroyed the upper lip,
attacked the soft parts of the nose and left cheek, de-
stroyed the square  bones, and rendered  the maxillary
bone carious."   Notwithstanding the very high terms in
which the auriferous preparations have been spoken of 
324
GOLD.
by  Drs.  Chrestien,  Duportal,  Plenciz,  and others, it
does not appear that they are much attended to at pre-
sent in the treatment of any diseases.  Pontin, however,
and several other Swedish physicians, who have tried
this remedy, state that they never obtained any real ad-
vantages from its use.
  In this country the reports of several eminent prac-
titioners have not been very favourable in relation to the
power  of  this  remedy  in  scrofulous  and syphilitic
diseases.   Dr.  Hosack  and Dr. Francis saw several
cases in  which the  syphilitic symptoms returned  after
they had disappeared under  the use of the gold.  It
ought to be  observed, however,  that this  is not unfre-
 quently the  case even with the acknowledged specific,
 mercury, when too s,oon discontinued, or improperly
 used.   It would appear, also,  from  the experience of
 these and other physicians, that the  muriate of gold  is
 of doubtful  efficacy in the  secondary symptoms  of this
 disease.* To this, however, we may oppose the evidence
 of Dr. Samuel L. Mitchill, who, in a communication to
 Dr. Dyckman, says,  " The efficacy of this  medicine
 has been tried year after year in  the New-York hospital.
 My practice with it there has been witnessed by all the
 attendants of the wards.  It possesses admirable virtues
 against syphilis.  Without presuming to affirm that it is
 capable of eradicating the distemper in every instance,
 my opinion, upon the whole, is, that the muriate of gold
  will effect all that is achieved by muriate of quicksilver,
  with incomparably less inconvenience to the patient.
  He gets well under the operation of the former without
  the hazard of a sore  mouth  or a  salivation, and with
  very little  wear and tear of constitution.  I consider the
* Dyckman'* Dispensatory, p. 201. 
GOLD.
525
introduction of  this preparation  into  common use as
one of the greatest improvements  in modern medicine;
and I wish it were already as universal as the malady it
is intended to remove.  The muriate of gold is found to
increase the quantity  of  urine, in many instances, to
such a degree, that it  ought to be ranked  among the
diuretics'of the materia medica."*
   I have employed the gold  in two cases of secondary
syphilitic ulcers of long standing ;  in one of these there
was an evident  amendment in the appearance of the
ulcers, but I could not succeed in curing them  by this
remedy;  the other case yielded to its powers, and the
patient has since remained perfectly well. In both  these
cases I had previously employed mercury for along time,
but without any good effects whatever.  I have also ad-
ministered  it in  a  case  of  scrofulous ulcerations, and
succeeded very soon in healing up the sores.   The cure
was not, however, permanent.  In a  recent memoir on
the remediate properties of gold, by Dr. J. C. Niel, a
French physician, it is asserted, " that the aurific pre-
 parations are exceedingly efficacious  in  tinea, elephan-
 tiasis, and scrofula."   This writer states, that the pre-
 parations of gold sometimes excite salivation; which,
 however, is not attended by the unpleasant effects that
 arise from a mercurial salivation.   It seldom produces
 much inflammation of  the mouth, and does not  affect
 the teeth, nor is it attended with a foetid breath.f
    From  what has already been published  in relation to
 this remedy, it is sufficiently  evident that it  possesses
 very important powers. We, however, want much more
 ample experience upon this subject, before we can de-
    * Dyckman's Dispensatory, p. 201.
    X London Med. and Phys. Jour. vol. xlvii. p. 248. 
326
GOLD.
 cide upon its real merits, and the particular cases to
 which it may be especially adapted.
   Dr. Chrestien administered the different preparations
 of this metal by friction  on the  gums.  It may, how-
 ever, be more efficaciously used internally, either en-
 veloped in some mucilaginous liquid, or in the form of
 pills.  The pure muriate cannot be  well given in this
 latter way, as it is much too caustic  and deliquescent.
 For this purpose the  triple  muriate  of gold  and  soda
 must  be  employed.  This  may be  given from  one-
 fifteenth to one-eighth of a grain, gradually increasing
 the dose.   According to M. Figuer, the  pure muriate
 may be conveniently given in the following mode :  dis-
 solve sixteen grains of the salt in one ounce of water;
 preserve this solution in a vial well closed, and seclude
 it from the light.  A half a drachm of this may be made
 into pills, with starch or  the crumbs of bread, or by
 being mixed with a sufficient quantity of some mucila-
ginous fluid to obtund its acrimony—it may be taken in
 a liquid form. The oxide is given in much larger doses.
 Dr. Chrestien gave it from a half a grain to two grains.
 Other practitioners have, however, given it to a much
greater extent.  Van Mons administered from twenty to
twenty-five grains. The report of this physician is much
 in  favour of the efficacy of this preparation.  He found
it particularly efficacious in curing chancre.*
* Burdach, Arzneymittellehre, vol. ii. p. 208. 
C  327  )
                ARSENICUM.—ARSENIC.

   Arsenic is a hard gray-coloured metal, of a granu-
lar texture, and great brittleness.  In its  metallic state
it does not affect the animal economy. Combined, how-
ever, with a certain portion of oxygen, it forms the  white
oxide of arsenic of the shops—the  most active  mineral
poison with which we are  acquainted.  The  oxide of
arsenic is generally found in the form of white semivi-
treous lumps,  exhibiting, when pulverized, the appear-
ance of white sugar.  When exposed to a heat of about
383° of Fahrenheit,  it  rapidly volatilizes in white ino-
dorous fumes.  The alliaceous or garlic-like smell does
not belong to the oxide  of arsenic in a state of  vapour,
but is wholly confined to the fumes of metallic  arsenic.
When the oxide of this  metal, or  the  common arsenic
of the shops, is thrown upon hot charcoal,  the  garlic
smell of the fumes is quite perceptible.  But in this in-
stance the oxide  is decomposed, the oxygen uniting to
the charcoal,  and the metal escaping in the form of
fumes, having  a garlic odour.
   " It is stated by Orfila and other chemists," says Dr.
Paris, " that if it be projected upon heated copper the
alliaceous odour is evolved.  This, however, takes place
only when the copper is in a state of ignition, at which
temperature its affinity for oxygen enables it to reduce
the arsenious acid ;  for  I find, by experiment, that if a
few grains of this substance be heated on a plate of cop-
per, by means of a spirit-lamp or blow-pipe, no odour is
perceptible, for the whole of the acid  is dissipated before
the copper can acquire a sufficiently exalted temperature
to deoxidize it.  If the arsenious acid be heated  on a
plate of zinc, the smell is not evolved until the metal is 
323
ARSENIC.
in a state of fusion; if, instead of these metals, we em-
ploy, in our experiments those of gold, silver, and pla-
tina, no alliaceous smell  whatever  is  produced  at. any
temperature."  The knowledge of this  fact is of con-
siderable importance in  employing this experiment as a
test for arsenic ;  for it is evident, that if the substance
suspected to contain the white arsenic be subjected  to
heat, without being in contact with any substance capa-
ble of depriving it of its oxygen, no alliaceous odour will
be evolved.
   The  oxide of arsenic combines with potash, soda, and
liquid ammonia to saturation, forming soluble arsenites,
.and possessing, therefore, some of  the essential proper-
ties of acids.
   According to the accurate experiments of Klaproth,
it takes four hundred parts of water at 60°, to  dissolve
one part of the oxide of arsenic,  and only thirty parts
at 212°.   If  it be boiled  in water, and  the solution be
suffered to cool, it will retain thirty parts of it to one thou-
sand of water, and deposit  the superfluous part in the
 form of tetrahedral crystals.  " This fact," observes Dr.
Paris,  " shows the importance of  employing  boiling
water in every chemical examination of substances sup-
posed to contain arsenious acid."  The oxide of arsenic
is also  soluble in alcohol and oils.
   The oxide of  arsenic acts with great violence when
 taken internally,  and commonly destroys life in a very
 short time.   When taken in too large a dose, as for in-
 stance, one-fourth of a grain, it excites nausea and slight
 chills.   By continuing  it in such doses,  it destroys the
 appetite,  excites  vomiting,  pains in the stomach and
 bowels, painful diarrhoea, great anxiety and oppression
 in the breast, debility and emaciation, numbness of  the
 hands  and feet,  dropsical swellings,  tremors, and para- 
ARSIiMC.
S29
iysis.  In doses above a grain it destroys life, with symp-
toms denoting inflammation of the alimentary canal.  It
is generally believed to  produce its deleterious effects,
by acting directly on the villous  coats of the stomach
and  bowels, producing inflammation and ulceration of
these parts.  This idea is certainly countenanced  both
by the appearances on dissection, and by the corrosive
quality of this substance.  Mr. Brodie, however, rejects
this  explanation of its  modus operandi,  and thinks  him-
self  warranted to  conclude, from  several experiments
which he performed on this subject, that arsenic enters
into the circulation, and that it produces its effects by
acting at  once upon  the nervous system, the organs of
the circulation, and the alimentary canal; and that death
depends immediately  on a suspension of the  functions of
the  brain and heart.*  This opinion is also  entertained
by Orfila.  Dr. George F. Jaeger, of Stutgard, in a very
elaborate and interesting  dissertation  on the effects of
arsenic on various organized bodies, adduces a number
of strong arguments to prove that arsenic does not pro-
duce its  deleterious effects by a local action on the sto-
mach  and bowels, u nor  in the  manner of the  acrid
poisons,  nor upon the nervous  system ; but is analogous
to the poison of the viper and ticunas, which act prima-
rily  upon the blood."f It appears from the experiments
of Jaeger, that arsenic is entirely inert when applied di-
rectly to  a nerve.   That death from arsenic does not
depend on the inflammation or  local lesion which it pro-
duces in the part to which it is applied, is rendered cer-

  * Philosophical Transactions for the year 1812.
  X Edinburgh Med. and Surgical Journal, January, 1811.   Dis-
sertatio Inauguralis de Effectibus Arsenici in Varisc Organismos,
&c. Auctor. G. F. Jaeger. 1808, Tubingce.
   VOL. I. —14 
330
ARSENIC.
tain  by the fact, that it  has been  known to destroy
animals in a short time on  being  applied to wounds.
Sprsegel states that he sprinkled a drachm of arsenious
acid into a recent wound on a dog's back, and that the
death of the animal took place at the end of five hours.*
It is a remarkable fact, also, that when arsenic destroys
life on being applied  to a wound, it often produces nearly
the same organic effects on  the membranes  of  the ali-
mentary canal, as when taken internally. In the  experi-
ment just mentioned from Sprsegel, " the stomach and
intestines were greatly inflamed, both on their exterior
and interior surface ; coagulated blood was effused into
their cavities, and had  insinuated  itself  between their
coats.   The  pleura, pericardium, and lungs appeared
very inflamed."  Hunter, Home, and Brodie  have made
the same observations.   Arsenic has even been known
to destroy life, when taken internally, without  leaving
any very manifest traces of inflammation on the stomach
and bowels.   There can  be no doubt,  however, that
the extensive disorganization which this mineral  com-
monly produces in the coats of  the alimentary canal  is
sufficient, independent of any other effects, to  destroy
life;  and it is, probably,  in this way that it is most fre-
quently fatal when received into the stomach. Arsenic
is not  only destructive of animal, but also of vegetable
life.   From  M.  Jaeger's observations, it  appears that
the death  of vegetables  is  induced by arsenic  by the
gradual absorption and distribution of the poison by the
vessels and  cellular  membrane,  so that the  parts die in
succession as the particles of the arsenic reach  them."
Paris states that the  influence of arsenical vapours near

  * Orfila's Toxicology, vol. i. p. 114. Spra?gel Experimenta cir-
ca varia Yenena.  Disp. Med. Goet. 1753. 
AKIBX1C
351
  the copper smelting works of Cornwall and Wales, " is
  very apparent in the condition both of the animals and
  vegetables in the vicinity."
    Arsenic, like most other powerful substances, may be
  applied to very important remediate purposes.  It was
  employed as an external remedy, both by the Greek and
  Arabian physicians.  Dioscorides recommends its use in
  this way; and Athenaeus speaks of some arsenical pre-
  paration as very beneficial in the  form of  a clyster in
  dysentery.  It is only in  modern times, however, that
  the medicinal powers of arsenic have been particularly
  noticed as an internal remedy.  Nearly a century ago it
  was recommended in the cure of intermittent fevers by
  Jacobi ;* and the observations of Brera and Fowler have
  since brought it into general  notice as a remedy in this
  disease.  By many physicians it has, indeed, been very
  highly extolled, and  its reputation as an efficacious me-
  dicine,  is now well established.  It is not, however, to
  be employed with equal advantage, or even with safety,
 in all cases of this disease.  In patients of debilitated and
 cachectic  habits of body, especially where a scorbutic
 tendency,  or a disposition to passive haemorrhage exists,
 this remedy is apt to  produce dropsical swellings, great
 debility, and symptoms of general depravation.  It is,
 also, said  to act perniciously in phthisical  persons, or
 where there exists a strong inflammatory diathesis.
   Examples of  this kind,  I  have occasionally observed
 in my own practice, and  I  feel  entirely satisfied, that,
 although a very powerful  remedy in the  majority  of
 cases, it cannot be indiscriminately employed without

  * Burdach, Arzneymittellehre, vol. ii. p. 475.  Jacobi de Arse-
nici Sale alcalico domiti usu interne salutari, (Acta Academ. Elect.
Mogunt. torn. i. p. 116.) 
332
ARSENIC.
running the risk of doing injury. ,  The state of the sys-
tem in which arsenic appears to be peculiarly calculat-
ed to do good in this disease, is the very opposite of that
which I  have just mentioned  as inimical to its remedi-
ate powers.   In cases attended with considerable fulness
of habit, not very irritable or  debilitated, with a mode-
rately full, soft, and regular pulse during the intermis-
sion,  and unaccompanied by any  local congestions, Or
organic affections of internal parts, the arsenic will, in
general, act as a very efficacious and safe remedy.*
   Dr. Thomas D. Mitchell, a very intelligent physician
of this city, states, that while practising at Norristown,
in 1820, where he had  an opportunity of seeing many
cases of intermittent fever, he found the bark ineffectu-
al in  the majority of instances, whilst arsenic, in the
form of  Fowler's solution, given  from  fifteen to twenty
drops, almost uniformly proved successful.   He never
observed any injurious effects to follow its exhibition.
Before giving such large doses, he  had tried the ordi-
nary ones, as from eight to ten drops, but his patients de-
rived no advantage  from  the  medicine when  given in
this way.   It appears, therefore, from the statement of
 this physician, that where arsenic is indicated, it ought
 to be given in as  large doses as the stomach will bear, it
 being much more promptly efficacious; and not more
 detrimental to the general habit, when thus administer-
 ed,  than when given  in smaller  doses.  To  children
 from vwo to five years old, he gave from one to six drops
 of the solution three times a day.

   * " It is a very extraordinary fact," says Dr. Paris, " that pre-
 vious  to the  establishment  of the copper-works in Cornwall, the
 marshes in their vicinity were continually exciting  intermittent fe-
 ver, whereas, since that period, a case of ague has not occurred in
 the neighbourhood.—Pharmacologia, p. 2S2. 
ARSENIC.
333
  M. Gasc, a French physician of eminence, has lately
published the result of his experience with this remedy,
in the cure  of intermittents.   His observations  were
made at  the hospitals of Dantzic.   " The number  of
patients, with this fever, was so great  in the hospital,"
says the  physician,  " and the disease had been so re-
bellious to the ordinary modes of treatment, that  I de-
termined to have recourse to the use of  arsenic.   My
first trials with it were so satisfactory, and the success-
ful  results so numerous,  that I did  not hesitate to ex-
tend the use of it to almost all the cases of fever of that
species in the hospital,  without regard to particular
complications of disease,  provided they  were not of a
nature to contraindicate it in a positive manner."   The
result, he states, was highly satisfactory.*
   I have myself been a good deal in the habit of em-
ploying arsenic in the cure of this disease; and have oc-
casionally found it  successful where I could do nothing
with the  cinchona.   These two remedies are,  indeed,
adapted to very different states of the system. The cin-
chona is most  efficacious  in a relaxed  and  exhausted
state of the system, and will often disappoint our expec-
tations in persons of a full and robust habit of body.   In
intermittents, attended with a phlogistic habit, the bark
is always more  effectual after the general powers  of the
system have been somewhat reduced by evacuants.
   On the contrary, however, the arsenic, as has  already
been stated, would seem to be best suited to the cure of
this disease in persons of a firm and healthy constitution,
and often to act injuriously when given in a debilitated,
cachectic, and irritable state of the system.
   I have hardly ever employed  arsenic in this disease
* London Med. and Phys. Jour. Feb. 1817. 
S34
AKIBNIt.
 without giving it in conjunction with opium.   I have
 usually given the laudanum and arsenic separately;  the
 former in the dose of from ten to fifteen drops, about
 half an hour after the dose of the latter.  By this plan
 we avoid the disagreeable sickness which effectual doses
 of the arsenic are apt to create,  and it does not appear
 that its powers are lessened by this mode of exhibition.
 This remedy has, also, been prescribed in combination
 with bark.   These two substances are, however, chemi-
 cally incompatible, the arsenical solutions forming pre-
 cipitates with the bark,—a circumstance which renders
 this combination  of doubtful propriety.
   Dr. Ferriar speaks very favourably of the use of arsen-
 ic in the last stage of typhus, when the tongue is covered
 with a thick black crust, and the  ordinary tonics and
 stimulants do not produce any beneficial effects.  By the
 use of arsenic, he says,  the tongue very generally be-
 comes clean.*
  Arsenic has, also,  been recommended as a useful re-
 medy in rheumatism.   In the  chronic variety of this
 complaint, I have, in a few instances, employed it with
 remarkable advantage.  But the powers of this remedy
 are more decidedly evinced in syphilitic rheumatism,
 and in that variety which  is sometimes  the consequence
 of the imprudent  use of mercury.   In  rheumatic pains
 from this latter cause, I know, indeed, no remedy which
 is so effectual as the  present one.   Among the writers
who speak more particularly in favour of the remediate
powers of arsenic  in chronic rheumatism, may be men-
tioned Kellie, Hardman, and Jenkinson.
  Favourable reports  have, also, been published of the
effects of arsenic in epilepsy.  Drs. Duncan and  Alex-
* Medical Histories, vol. i. p. SI. 
ARJENie.
335
 ander give  examples of its successful  employment  in
 this disease.
   Dr. Ferriar speaks well of the powers of arsenic  in
 hooping-cough, after the inflammatory symptoms have
 been subdued by antiphlogistic remedies.   " In the be-
 ginning of this disease,"  says  he,  " when it is accom-
 panied by symptoms of fever and inflammation, bleeding
 is sometimes necessary.   Blisters are  more frequently
 necessary, and Dr. Armstrong's plan of exhibiting tar-
 tarized antimony, in doses which prove gently emetic,
 is undoubtedly very useful; chiefly, perhaps, by sup-
 plying the means of expectoration to very  young chil-
 dren.   But, after these preliminary steps are taken, I
 believe that the only remedy which promises to shorten
 the disorder effectually, is the solution of white arsenic."
 He gave it, at first, in the dose of one drop, for an infant;
 and to children under seven years,  he gave two drops,
 daily.   Dr.  Klapp, of this city,  informed me, that
 he has found the arsenic decidedly beneficial in the pre-
 sent disease.  I have given it in some cases, in a few of
 which its good effects were conspicuous.
   Arsenic has also been prescribed with success in spas-
 modic asthma.  Dr. Alexander mentions its successful
 employment in this way.  Of its powers in this disease
 I know nothing from my own experience.
   Some accounts have,  also, been published of the suc-
 cessful  employment of  this remedy in  tic  doloureux.
 Dr. M'Kechnie, surgeon at Paisly, relates a case which
 was  cured  by arsenic, after various modes of practice
 had  been tried ineffectually.*   Hardman and  Jenkin-
son,  also, commend  its powers  in this painful affection.
   Arsenic has recently been employed with much suc-

    * Edinburgh Medical and Surgical Journal, July, 1811. 
nnp.
ARSENIC.
cess in chorea.  In the fourth volume of the Medico-
Chirurgical Transactions, a case of this disease is related,
which yielded without  difficulty to this remedy.   Mr.
Salter, also, has.  given  an account of four cases of cho-
rea successfully treated with this medicine*
  Mr.  Hill, in  an excellent  paper published in the
Edinburgh Medical Journal, recommends arsenic as a
highly useful remedy in hemicrania.  I found it promptly
successful in a  case of this kind which lately came under
my care,  and I know of  other  practitioners who place
great reliance on its powers in this complaint.
  In that species  of cephalalgia which is commonly call-
ed  sick  headach,  arsenic has  been  known to afford
permanent relief.   To Dr. Mease, of this city, we are
indebted for the first account of its efficacy in this pain-
ful and troublesome affection.  Several cases are related
by this respectable physician, in which this remedy was
used with perfect success.   In one case I have known
it to be employed with great advantage,; the  disease was
greatly mitigated, but  not completely overcome.  Dr.
Otto, also, employed it  with success  in a case of this
kind.
  In  old and obstinate syphilitic ulcers, much benefit
has been derived from the employment of this remedy.
It is particularly  recommended in such cases by Remer,
Hagstrom, and Horn.f  I have known it to be used with
complete  success in a  case  of venereal ulcerations  of
the septum of the nose, under the care of Dr. M'Clellan,
of this city.

  *  Medico-Chirurgical Transactions, vol. x. part i. p. 21S.
  X  Burdach's Arzneymittellehre, vol. ii. p. 469.  Horn's versuche
mit gebrauche des Arsenicks in veralterter Syphilis, in his Archives
of Medical Experience, vol.  iv. No. 257.  See also Remer's Ob-
servations in the same work, vol. i. No. 9. 1812. 
ARSENIC.
337
   In the treatment of venereal nodes, arsenic is an ex-
 ceedingly useful remedy.  Dr.  Colhoun, of this city,
 was, I believe, the first  who published any  account  of
 its efficacy in  these affections.  His experience with
 this remedy, as published in the third volume of the
 American Medical Recorder, is directly in favour of its
 powers in this way ; and Dr. M'Clellan, one of the sur-
 geons of the Philadelphia Alms-house Infirmary, in-
 forms me  that he  has used it with success in several
 cases of this kind, and particularly in swellings  of the
 periosteum.  A remarkable case of the efficacy of arse-
 nic in venereal nodes,  is reported by Dr. M. S. Baer, of
 Baltimore,* and  my  experience enables  me to speak
 with much confidence of the utility of this practice.
   Charles Lane, esquire, gives a very interesting ac-
 count of the successful employment of arsenic in an ill-
 conditioned ulcer of the tongue.   The ulcer extended
 through the substance  of the tongue, and passed through
 its root into the throat.   u The general appearance,"
 says he, " was  most alarming, bearing a  very strong
 character  of carcinoma."  By one month's use of this
 remedy the ulcer appeared perfectly  healed  ;  it, how-
 ever, broke out again, and was again cured by the same
 means, and finally got  perfectly well under its use.f
  Arsenic is a very useful remedy in certain'obstinate
 cutaneous  affections.   It has been particularly recom-
 mended in leprosy and ichthyosis.  " In the  lepra vul-
 garis,"  observes Dr. Bateman, e< the  arsenical solution
 recommended by Dr. Fowler, is often extremely bene-
ficial, in doses of four or five drops, which may be slowly
increased to eight, and persevered in for a month and

  * American Medical Recorder, vol. iv. p. 461.
  f Medico-Chirurgical Transactions, vol. viii. p. 201.
  vol. I.—45 
338
ARSENIC.
more.*  In a mild  case of  ichthyosis, the same writer
states that, " this medicine produced a complete change
of the condition of the cuticle, which acquired its natu-
ral texture."f  It has also been used with advantage in
elephantiasis, and other chronic affections of the cuticle.
   Arsenic has been employed  both internally  and ex-
ternally in the cure  of cancer.   It is said  to allay the
pain,  in the  ulcerated stage of this affection,  without
producing either stupor or disposition to sleep.   It has,
however, been chiefly extolled in  cancer as an exter-
nal remedy.  Applied in this way, it acts as an esca-
rotic, destroying the diseased parts without affecting the
sound ones, and thus enables the surgeon,  in some in-
stances, to remove the whole of  the diseased parts.
Richter speaks very favourably of its use in cancerous
ulcers.  i( I have employed arsenic," says he, " in can-
cerous ulcers of  the face,  with much advantage,  and
without any  bad or remarkable effect.   I have gene-
rally used  Bernard's mixture.^   I lay it on about the
thickness of the back of a knife.   The  pain which it
 occasions is,  for the most  part, inconsiderable."^   He
 mentions several cases in which this mixture was applied
with the most remarkable  success.   I have known the

   * Practical Synopsis of Cutaneous Diseases, p. 33.  Philadel-
 phia edition.
   t Ibid. p. 53.
   X This mixture consists of factitious cinnabar 3;»i« ashes of burnt
 shoe soles gr. viii., dragons blood gr. xii., white arsenic gr. xl.
 Reduce them all to a fine powder and mix them intimately. " When
 it is used some of it is mixed with so much water as to form a thin
 paste, which, by means of a small hair-pencrl, is applied to the
 whole surface of the ulcer." Richter calls this Bernard's prepara-
 tion, but it was first employed  and published by the celebrated li-
 thotomist, Frere Cosme.
   § Medical and Surgical Observations, p. 47. 
ARSENIC.
339
arsenical solution, weakened by water, to be injected
into the vagina in cancer of the uterus, with evident ad-
vantage.   It has, also,  been  applied to cancers in the
form of an ointment.  Plunkett's ointment* had, at one
time, very considerable celebrity in this affection.
  Arsenic is now usually prescribed  in  the  form  of
Fowler's solution.   The  dose, for an adult, of this, is
from eight to fourteen drops.  It may, also, be given in
the form of pills, with opium or some of the other nar-
cotic extracts,  in  the  dose  of one-fourteenth  to one-
eighth of a grain.
   The arseniate of ammonia is an excellent arsenical
preparation  for medicinal purposes.   It may be  made
in the following way: Dissolve  one part of the oxide of
arsenic in four parts of nitric acid  with half a part  of
muriatic acid; saturate the  solution with  carbonate of
ammonias,  and crystallize the arsenic  by  evaporation.
For use, one grain  of  this salt is to be dissolved in an
ounce of distilled water ; and of this solution from twenty
to twenty-five  drops is  to   be  taken  at a dose  to the
amount of a drachm in  the course of twenty-four hours.
Biett asserts that this  is decidedly  the best arsenical
preparation  we possess;  and my  own experience  fully
confirms this opinion.
   Antidotes.—Sugar and water,  or a decoction of lin-
seed and mallows, drank  in large quantities,  are said  to
be our best means  for counteracting this  poison.   By
taking copious draughts of any of these, vomiting is ex-
cited and  the arsenic ejected.  Lime-water with sugar
has, also, been highly recommended.   Orfila states, that

  * This ointment is composed of arsenic,  sulphur, the powdered
flowers of the ranunculus flammula, and the cotula fcetida,  made
into a paste  with the white of eggs. 
340
ARSENIC.
" theriac, oil,  gall-nuts, the bark of the pine, liver of
sulphur,  vinegar, suggested by some,  ought  not to  be
used,  because they are not  only useless but often inju-
rious."   In addition to  these remedies, warm fomenta-
tions and leeches must be applied to the abdomen; ge-
neral bleeding, promptly and largely employed.   When
the fever abates the patient should be  directed to take
veal or chicken broth ; and when convalescent, rice-milk,
gruel, &c.   Wine, spirits, and solid  food must be avoid-
ed.   " Wine, regarded  by  many persons  as proper to
restore action, is, in this case, a new poison, which acts
precisely as that, the effects of which we have combated.
It is only after  three or four days that solid  food is to
be taken,  in small quantities, and such as is of easy  di-
gestion."*

                        Formulas.
  R.—Solutionis arsen. Fowleri  gtt. lx.
      Tinct. opii              gtt. xl.
      Spir. lavend. compos.     3'*
      Aq. cinnamoni           ^iii.  M.  Dose, a table-spoon-
ful for an adult; a tea-spoonful for a child.
                      Asiatic Fills.
  R.—Oxidi arsenici   gr. iii.
      Pulv. piper, nigr. ^i.
      Conserv. rosar. q. s.  M.  Divide into twenty-one pills.
  R.—Oxidi arsenici    gr.  iv.
      G. opii         gr.  vi.
      Muriat. ammon.  gr.  xxiv.
      Extract, gentianse 9ii. M.  Divide into forty-eight pills.
Two pills are to be taken at a dose.
* Orfila. 
                  CHAPTER  VII.

 II.  Medicines calculated to correct certain morbid states
       of the System,  by acting  on  the  contractility
       of the Muscular Fibre.

                   ASTRINGENTS.

   Astringents are substances that produce constriction
 or condensation in the  living animal fibre.   Of the mo-
 dus operandi of these  remedies we know nothing of a
 satisfactory character.    It is certain,  at least, that it
 cannot be explained, as Cullen supposed, on the princi-
 ple  of  their action  in the process of tanning.   It is  by
 producing a peculiar excitement on the living system,
 directed  upon the contractile and  irritable fibre, that
 these substances  produce their effects.  Further than
 this general  and vague fact, we shall never, probably,
 be able to go in our inquiries upon this point.
   Various opinions have been entertained relative to the
 particular principle which gives to substances their as-
 tringency.  By some it  has  been supposed to be the
 gallic acid ; others have considered it as constituted by •
 an union of this acid with an earthy base;  and  others
 again have regarded tannin as the astringent principle.
 That none of  these  hypotheses are  entitled  to any cre-
 dit,  is  evident  from the fact, that some of the most as-
 tringent substances  knowu, contain neither tannin nor
gallic acid.  The truth  is, that the proximate principle
of remedies is just  as inscrutable as the essential cha-
racter  of  the  impressions which  they produce on  the 
342
ASTRINGENTS.
living system.   tThesc  are objects which the  human
mind cannot reach, and about which all our most inge-
nious speculations are worth nothing.
  Astringent substances are applicable to a great variety
of remediate purposes.  In the treatment of excessive
evacuations, especially of haemorrhages, they have been
recommended  in all ages.  In haemorrhagy from the
nose, lungs, stomach, bowels, and uterus, these remedies
are, indeed,  often of decided utility.   They  are not,
however, to be employed without reference to the state
of  the general circulation.   In what is called active
haemorrhage,  where  there is tension and force in the
pulse, astringents,  except perhaps the sugar  of  lead,
should never be employed without previous depletion.
   In the treatment of  dysentery, astringents were for-
merly much employed. At present, however, their use in
the early stages of this disease is very justly considered
as  highly pernicious.   Cullen was  one of the first who
spoke decidedly against their employment in this  com-
plaint.  Although his objections to their use are unques-
tionably correct, they were not predicated upon just
views concerning the nature of dysentery.  He suppos-
 ed that this disease depends on an  u increased constric-
 tion of a considerable  portion of  the intestinal canal,"
 and concluded, therefore, that astringents must do harm
 by increasing  still more  this constricted state of the
 bowels.   The pathology of  this complaint is, however,
 better understood  at present, it being well established
 that it is essentially connected with a phlogistic state of
 the intestinal canal, as well as of the general system.  It
 is on this account that astringents act perniciously in the
 early stages of this disease.   They not only tend to in-
 crease the general inflammatory excitement of the sys- 
ASTRINGENTS.
343
tem, but their direct action upon the tender and irritat-
ed surface of the bowels, is calculated to do  much mis-
chief, by increasing  the local intestinal inflammation.
They are further injurious by confining the vitiated and
irritating contents of the bowels.  After the inflamma-
tory symptoms have been subdued, and proper evacua-
tions made from the bowels, the  employment of mild
astringents may sometimes  be resorted  to with benefit.
As a general rule, however, they are to be regarded as
improper,  especially in the dysenteries of this climate.
In tropical dysentery, as it has been called, astringents
are more frequently useful. But even here they require
a cautious employment.
   In the treatment of  diarrhoea,  astringents  are more
generally useful.  They are not,  however, to be em-
ployed, even in  this complaint without some  risk of
doing harm, when febrile symptoms accompany the dis-
charge, or when administered without having previously
unloaded the bowels of their vitiated contents, by pro-
per purgatives. When given without these precautions,
 they are apt to give rise to colic, headach, and other un-
 favourable symptoms.   When the disease is protracted,
 and  no signs of a phlogistic tendency be present, we
 may,  in general,  use  astringents  with advantage.   In
 cases of this kind I have  found very  minute doses of
 calomel, given in union with some vegetable astringent,
 exceedingly useful.
    Astringents are, also, much employed in leucorrhoea.
 In that form of the disease which Dr.  Darwin calls the
 fluor albus frigidus, these remedies are commonly very
 beneficial.  When there is much febrile action connect-
 ed with the  complaint, they are, however, universally
 injurious.   The  usual and best way of employing as-
 tringents  in this disease, is in the  form of  injection.
t 
344
ASTRINGENTS.
•
 They are not unfrequently, also, given internally;  but it
 does not appear that  they are capable of  doing  much
 good when thus  employed.  In using astringent injec-
 tions in  this complaint, we should  take care that  we
 adapt the strength of the injection to the degree of sen-
 sibility and irritation in the affected parts. Where  there
 is considerable ardor urinse, with other marks of a  phlo-
 gistic state of the internal  surface of the vagina, the as-
 tringency of the injections should be very weak, and
 employed for the purpose rather of washing away the
 irritating secretions, than with a view to arrest the dis-
 charge by an impression made on the parts affected.
   The employment of astringent  injections in  gonor-
 rhoea, is  exceedingly common.  Many writers, however,
 reprobate their indiscriminate use in this complaint, and
 there can be little doubt that much mischief is often
 done by their employment.  During the early or  more
inflammatory stage of the complaint, they can never be
useful, and will seldom fail to do harm.  The conse-
quences  which  result from their imprudent use are,
chordee, hernia humoralis, stricture, violent inflamma-
tion  in the urethra and neck of the  bladder, phymosis,
&c.   After the discharge has continued  for some time,
and the general as well as local inflammatory action'has
 been reduced by antiphlogistic measures, mild astringent
or stimulating injections are of unquestionable utility.
Too  little attention is, however, commonly paid to gene-
 ral remedies in this affection.   Bleeding, saline purga-
tives, and a low diet, are of essential service in the, early
stage of the majority of cases  of this kind.   By these
measures, and the liberal employment of balsam copaiva,
we may,  for the most part, cure the disease speedily and
safely.
   Astringents are, also, much used as external applica-
• 
4
                   ASTRINGENTS.                  34$

lions to inflamed parts.  In ophthalmia they may often
be  employed with great advantage.  In this, however,
as in the former complaint, they may, also, produce much
mischief by being applied during the early or active stage
of the inflammation.  When the local and general in-
flammatory action has been reduced by proper antiphlo-
gistic means, moderately astringent collyria are gene-
rally very serviceable.   In aphthous ulcerations of the
mouth and throatj or»in inflammation or relaxation of
the palate and  tonsils, astringent gargles are much -em-
ployed.   In prolapsed parts, as of the uterus and anus,
astringent injections are, also, often of great service.
   Some writers have supposed  that astringents possess
the property of relieving the symptoms of urinary cal-
culi.   This opinion- is certainly countenanced by the be-
neficial effects which uva ursi produces  in affections of
this kind.   But it would appear that the antilithic pow-
ers of  this substance do not  reside in its astringency,
since we know  of no other astringent that possesses any
obvious powers in this way.
  The class of  astringent substances is very numerous*
The property of astringency is especially common in the
barks and roots of vegetables.   The mineral astringents
are, genertffly, much move powerful than those which
are obtained from the vegetable kingdom.   The majo-
rity of  the latter are connected with other active pro-
perties ; the former are, for the  most part, purely astrin-
gent, or astringent and tonic.
  vol. j.—46 
(  346  )
                  •CORTEX QTJERC1.

  The genus quercus is a very extensive one, and the
barks of all its different  species possess more or less as-
tringency.  That which is  employed in  medicine is
chiefly obtained from the black oak, {quercus tinctoria,
Mich.) although some of the other species of this family
furnish us with barks, equally, if not  more astringent.
The late 'professor Barton was of opinion that the ches-
nut and Spanish oak barks {q. monticola, q. falcata,) are
preferable, in most cases, to the black oak bark; he as-
serted that they possess all the useful properties of the
tinctorise in a superior degree, without partaking of the
purgative quality of the latter.*
   Oak bark contains  a very large proportion oftannin,
which is readily extracted by infusion.   It appears from
the experiments of Mr.  Davy, that the proportion of
tannin varies according to the age of the tree from which
the bark is taken ;, the younger containing more of this
principle than the older bark.
   The oak bark was  very early employed  in medicine.
Galen recommended a decoction of the leaves and outer
 bark of the oak in  dysentery, uterine and  pulmonary  •
 haemorrhages, and in fluxus cceliacus.f   It is undoubt-
 edly one of the most  powerful vegetable astringents we
 possess; and capable, as such, of being applied to  very
 useful purposes in medicine.  In the treatment of inter-
 mittent fevers it has  been recommended as a remedy of
 very considerable  efficacy.%   I have  known it to be

   * MS. Lectures on Mat. Med.
   X Alibert, Nouv. Elem. de Therap. vol. i. p. 93.
   X Dr. Rousseau; Philad. Med. Museum, vol. ii. 
CORTEX OJJERCI.                347
given  in this disease with  prompt success; it  is, how-
ever,, exceedingly disgusting to the  taste, and  few pa-
tients can be induced  to take it.  In the intermittents
of very young children, I have,  in a  fewinstances, used
the oak bark decoction as a  bath with benefit.  But there
are other indigenous barks of superior efficacy in this
respect, and they do not, like this one, give so disagree-
able a dye to the skin.   Iq chronic diarrhoea, this bark
has  been found very serviceable.  Its  employment in
dysentery is, however, very objectionable, except, per-
haps, in  the last stage of very protracted  cases.   As an
injection in leucorrhoea, the infusion of oak bark  has been
much recommended by some writers, and I have myself
employed it in this way with very good  effects.  It is,
also, a useful application in inflammation and swelling of
the  fauces, prolapsus uvulai, and cynanche tonsillaris.
" In many cases," says Dr.  Cullen, i( this decoction,  ear-
ly applied, has appeared useful  in preventing those.dis-
orders.  I have, indeed, almost constantly joined a por-
tion of alum to these decoctions  ; but I have frequently
found  that  a solution of alum alone, of the  strength it
could be conveniently employed in,  did not prove so ef-
fectual."
   Bathing in a decoction  of black oak bark has, also,
been1 recommended as an efficacious remedy  in tabes
mesenterica.  Dr. J. Fletcher, of Virginia, has.reported
four cases of this disease which  yielded readily to pur-
gatives, together with bathing twice a day  in a strong de-
coction  of this bark.*  The inhalation  of  the  finely
powdered oak bark Jias been  known to produce  very ex-
cellent effects in pulmonary consumption.   An  instance
of this kind was communicated to me some years ago by
* Am. Med. Recorder, vol. iii. p. 363. 
348                VORTEX %UERCI.
 Mr. William Webb, of Lancaster county.   He informed
 me that a man who had laboured under the usual symp-
 toms of confirmed phthisis, was advised to employ him-
 self in grinding bark for a tanner in his neighbourhood.
 He was extremely weak and  emaciated when  he went
 into the bark-mill; in a short time, however, the cough,
£ night sweats, and other hectic symptoms began to abate
 sensibly, and in less than three months he  was perfectly
 restored to health.
   The powdered oak bark, in the  form of a poultice, is
 an excellent application to mortified or gangrenous parts.
 Dr. Barton employed it both internally and externally
 with great success, in a case of gangrene, of the  foot.*
   Mr. Lizars has recently published some observations
 on the efficacy of oak bark in  the cure of reducible her-
 nia, in which he declares that he has used it with " won-
 derful success."!  He directs it to  be used in the follow-
 ing manner : a strong decoction is to be made.by boil-
 ing a  few  pounds of the bark over a gentle fire for two
 or three days, adding a  little boiling water from time to
 time, so that the bark may be always covered.   This de-
 coction is to be strained  and  evaporated to the consist-
 ence nearly of an inspissated juice.  Previously  to using
 this inspissated decoction, it should be warmed in order
 to suspend the  astringent matter.  The hernia having
 been reduced, the groin is .to  be bathed with the decoc-
 tion three  or four times a day, and the truss applied.
 Mr.  Lizars states,  that he has  cured  hernia of  many
 years standing in the course of a few weeks.
    It may be observed that the use of oak  bark  for  the
 cure of hernia is by no means a new practice. Desessarts

   * Collections towards a Mat. Med. of the United States, p. 11.
   | Edinburgh Medical Journal, No. 72. 
CORTEX O.UEECI.
349
 employed the powdered bark for this purpose more than
 fifty years ago.*  He put it into small muslin bags which
 he moistened with wine, and laid on the groin under the
 pad of the truss, having previously returned the hernia.
 He affirms  that it seldom required  more  than a  few
 weeks to  perform a perfect cure in  children.   In the
 35th number of the  Gazette Salutaire, the efficacy of a
 strong decoction of this bark in hernia is strongly insist-
 ed on ;f and Kaempf, a writer of  great respectability,
 says, that the good effects of the oak bark in the cure of
 hernia cannot be too highly praised.J
    For internal  use an ounce  of  the powdered bark is
 to be boiled in   two  pints  of  water down  to one pint.
 The dose of this is from one to two ounces.
    The leaves and cups of  the acorns differ very little
 in astringency from the bark.   The acorns possess more
 of the bitter principle, and on being roasted, evolve a
 considerable portion  of an empyreumatic  oil.   These
 have been highly recommended in tabes mesenterica.§>
 They are, also,  said to be very serviceable in spasmodic
 cough, asthma, chronic hysteria, amenorrhcea,|| diarrhoea,
 and rheumatism. They are given to the extent of from
 one to two ounces daily.  They are used,  by some, as
 a  beverage instead of coffee.

   * Gardane, Gazette de Sante, 1775.
   t Richter's Chirurgische Biblioth. B.  iv. p. 25.
   X Von einer neuen methode die hartnoeckigsten krankheiten zu
heilen, &c. p. 382.
  § Kaiser von dem Nutzen der Eicheln in der dorrsucht der kin-
der.  Frankfort, 1784, 8.
   || Marx, Greschichte der Eichlen,  &c.  Burdach's Anneymit-
tellehre, torn. iii. p.  564. 
350
CORTEX Q.UERCI.
                        Formula.

  R.—Cort. querci     §iv.
      Aq. fontanae     lb. iv. coque ad reman, lb. ii. colat. adde
      Sulphat. aluminis 3iss.  M.  This forms  an excellent in-
jection in leucorrhoea ;  and may be very beneficially used as a gar-
gle in relaxed uvula.             '  .
  R.—Pulv. cort. querci    ^i.
      -----rad. serpentaria 3ii.
      ---------rhsei       Jss.
      Super carbonat. sodne 3i. M.  Divide into eight equal parts.
One every two hours—in intermittents.
                        GALL2E.

  The gall-nuts  of commerce  are obtained  from the
quercus  cerris,  a  species of oak  indigenous to  Asia
Minor, " froni the Bosphorusto Syria, and from the shore
of the Archipelago to the frontiers of Persia."  It is
also found growing in the southern countries of Europe.
The galls are excrescences from the young  shoots of
this tree, and are produced by the puncture of ah insect
(diplolepis  gallae tinctoriae) to deposit  an egg.  They
are nearly round, and studded with a number  of rough
wart-like tuberosities. They are hard, and when broke
exhibit a smooth or flinty fracture.  They have no odour,
but are extremely astringent, and  bitter  to the taste.
Both water and alcohol extract their active  principles.
According to Neumann's experiments,  water extracts
seven-eighths of their substance, alcohol a little more than
seven-eighths.* The chemical composition of galls does
not appear  to be as yet  perfectly ascertained.   Sir H.
* Chemia Medica, vol. ii. p. 2. 
CALLJE.
551
Davy obtained from five hundred grains of Aleppo galls,
one hundred and thirty grains of tannin, twelve of mu-
cilage and matter rendered  insoluble by evaporation,
thirty-one of gallic acid, and a little  extractive matter,
and twelve of calcareous earth and saline matter.
  Besides these component parts, it  appears, from  the
experiments  of M. Braconnot, that the gall-nut contains
a peculiar acid, distinct  from the gallic  acid,  and to
which he has given the, name of ellagic acid*  The in-
fusion and tincture of galls  strike a  black precipitate
with  iron.   The precipitate formed by the acetate and
subacetate of lead is grayish ; that by tartarized anti-
mony, yellowish; by sulphate of copper, brown ; sulphate
of zinc, reddish-black; nitrate of silver, deep olive ; and
nitrate of mercury, bright yellow.f   Concentrated sul-
phuric acid produces a copious milk-white curdy preci-
pitate, which soon  becomes  brown,  and assumes the
appearance of a resinous substance.  This precipitate is
soluble in alcohol and boiling water.   It consists of tan-
nin and extractive matter, and is powerfully astringent.
Nitric acid destroys the astringency of the infusion, but
does  not produce any precipitate ; muriatic acid forms
a white flaky precipitate. The carbonate of potass pro-
duces a similar white precipitate, which consists of tan-
nin, lime, and potass, and destitute of astringency.  It
is but very sparingly soluble in water and alcohol. Lime-
 water occasions a precipitate of a dark green  colour.
 Animal jellies and starch precipitate the tannin from the
 infusion.
   Galls are a very powerful astringent, and may be  use-
 fully employed in cases wh'ere  such remedies are indi-

   * Annales de Chimie, vol. ix. p. 1S7. new series.
   | Paris's Pharmacologia. 
352
UAtLA.
 cated.   They were at one time a good deal prescribed
 in the cure of intermittents, but it does not appear that
 they possess sufficient febrifuge power to entitle them to
 much attention in this respect.   M. Poupart  has made
 a favourable report on this subject in the memoirs of the
 French academy for the year 1702 j but according  to
 Bergius, galls are very pernicious when  employed in
 this disease.   Cullen, however, states that they produce
 no bad  consequences when given with gentian or other
 bitters.*
  The infusion of galls has been recommended as a very
 useful injection in leucorrhoea and in gleet.  In chronic
 diarrhoea, also, we  may often derive much advantage
 from this remedy when prudently administered.  In ul^
 cers, or inflammation of the palate, tonsils, or gums, arid
 in relaxation of the uvula, the infusion forms an  excel-
 lent astringent gargle.
  An ointment made of one part of finely powdered
 galls to eight of lard, forms a very useful application  in
 haemorrhoidal  affections. In internal piles the decoction
 has been injected into the rectum.  Such a practice is,
 however, not to  be rashly imitated.   The  sudden sup-
 pression of haemorrhoidal discharges, by applications of
 this kind, has been often productive of very serious con-
 sequences ; epilepsy, apoplexy, phthisis, and other dan-
 gerous affections have been iuduced in this waj. Where
 the  discharge  has not as yet become  habitual, and  is
 very profuse, the employment  of astringent injections
 may often be resorted to with advantage.  As a general
 rule, however, the practice is not to be recommended.
 In prolapsus ani and uteri/injections of the infusion  of
galls are generally very useful.
* }lat. Med. vol. ii. p. 24. 
GALL*
353
                        Formula.
  R.—Gallarum. contusar.   3i.
      Aq. bullientis         jvi.—Infuse for  four hours, strain
and add,
      Cretae preparat.      ?ss.
      Tinct. opii           ji.
      G. arab.             jss.—M.   Dose,  a table-spoonful
every two or three hours, in diarrhoea.
 R.—Pulv. galarum.      3i.
     ---- camphors    '$i.
     ---- opii          gr. x.
      Adipis suillce       ^i.
      Misce. ft. unguentum.—Used in haemorrhoidal affections.
                GERANIUM MACULATUM.

   The  geranium maculatum,  or  spotted  cranesbill,
grows abundantly in almost every section of the United
States.  The root, which is the only part used for me-
dicinal purposes, is thick, rough, and knobby.   Exter-
nally the dried root is of a dark brown, and internally of
a pale flesh colour.  It is one of the most powerful and
pure vegetable astringents with which we are acquaint-
ed.   According  to professor Bigelow's  experiments, it
contains a considerable proportion of tannin, and some
gallic acid.   "The gallic acid is indicated by the dark
precipitate remaining in solution.  It differs, however,
from the acid of oak galls in not reddening vegetable
blues, and not passing over in distillation."*  Its active
principles are readily extracted both by  alcohol and
proof spirits.  The tincture is strongly astringent.

      * Bigelow's American Medical Botany, vol. i. p. 89.
   vol. I.—47 
354
GERANIUM MACULATUM.
  This root is the most agreeable astringent we possess.
Its  astringency is not associated with bitterness or any
other unpleasant  taste.   In the diseases of children,
where astringents are indicated, a decoction of it in milk,
is a  very convenient and  efficacious  remedy.  In this
form it has been a good deal  used in cholera infantum,
and  I have  myself repeatedly prescribed  it, in pro-
tracted cases, with great benefit.  I have, also, admi-
nistered the  powdered root  in  union with  calomel,
in the proportion of gr. vi. of the former to one-sixth of
a grain  of the latter, with much advantage in this affec-
tion.  In the advanced stages  of diarrhoea and dysen-
tery, after proper evacuations  have been made,  it has
proved very beneficial.  In my own practice I have oc-
casionally given it in cases of  this kind with very good
effects.   I have, also, used the watery infusion as an in-
jection in gonorrhoea, but not with any decided benefit
In apthous affections of the mouth  this remedy is fre-
quently very useful.   In a  chronic and  very  obstinate
case of ulceration of the mouth the patient was perfect-
ly relieved by the use of gargles made of this root, after
a great variety of other substances had been tried un-
successfully by myself and others.   Dr. Mease recom-
mends it as very efficacious in  restraining internal hae-
morrhages ; and Dr.  Thacher  says, that  he has known
the infusion to restrain haemorrhage from  the lungs in a
very prompt manner.  It is said that the western Indians
consider the geranium as the most effectual remedy they
have for the venereal disease.
   From considerable experience with this medicine, as
well as from the  testimony of many other physicians, I
am entirely satisfied that it is one of the most useful ve-
getable astringents we possess.   The saturated tincture 
GERANIUM MACULATUM.
355
may be given in doses of from one to two drachms.   In
substance it may be given to the extent of thirty or forty
grains.
               OROBANCHE VIRGINIANA.

  The orobanche virginiana, or beech drop, is a para-
sitic plant, growing almost exclusively on  the  roots of
the beech tree.   It is herbaceous, from six inches to a
foot in height, and  commonly of a pale yellow colour.
The root is tuberous, clay-coloured, and covered on its
lower part with a number of small fibres.   The stem is
erect and furnished " with short ovate scales instead of
leaves, of which it is  entirely destitute."
  The  root of this plant is powerfully astringent,  and
has been frequently employed as such in the practice of
some of our physicians.  It entered as an ingredient
into the famous cancer powder of Dr. Martin ;  and Dr.
Barton observes, that u it has been of great service, ex-
ternally applied, to obstinate ulcers, some of which had
resisted the  applications that are commonly made use of
in such cases."   In apthous ulcerations of the mouth
I have known it to be highly beneficial.  I  have,  also,
used a strong decoction of this root as a wash in an ob-
stinate cutaneous affection of  the  herpetic kind,  with
complete success. Internally I have never employed it;
I do not doubt, however, of its  applicability to all the
purposes for which  vegetable astringents may be useful.
In some parts of this country it is a common remedy for
diarrhoea and dysentery. 
(  356  )
           H.EMATOXYL0N CAMPECHIANUM.

  This tree, which furnishes the logwood of commerce,
is a native of South America, and is particularly abun-
dant in the province of Honduras, whence it was brought
into Jamaica, where it now grows very plentifully. The
wood  is compact and heavy, and of a deep red colour
internally.   When split open it has a peculiar sweetish
odour.  Its taste is sweet, followed by a slightly bitter
astringency.   The colouring matter of logwood may be
obtained in a separate state, in the form of small brilliant
crystals of a reddish white colour, and of a sub-astrin-
gent, bitter, and acrid flavour. This crystalline substance
has recently received the name of hematin.  The infu-
sion of logwood is of a  deep  blood red colour.  By
adding to it the sulphate of iron it becomes black; the
solution of the sulphate of alumine changes it to a purple
colour, which by the admixture of some potass assumes
a fine violet hue.* The oxydulated sulphate and nitrate
of iron change the blood red decoction to a very beauti-
ful dark blue.  Carbonate of iron strikes a dull  black
precipitate, leaving  a brown supernatent  fluid.  Mu-
riate of tin forms a light and loose red precipitate with
both  the  decoction and infusion, leaving the  fluid as
clear and colourless as water.   Phosphate of lime ren-
 ders  the colour somewhat more light, and forms, after
 some  time, a  dark  brown precipitate.  The alcoholic
 tincture is of a dark yellowish red colour, possessing the
 same chemical habitudes as the watery infusion.  Wa-
 ter distilled from  logwood remains perfectly clear, but
 acquires the peculiar odour of the wood.

   * Pissertatio de Haematoxylo  Campechino.  Vide PfafPs Sys-
 tem der Mat. Med. t. ii. p. 213. 
            HA5MAT0XYLOX CAMrEClUANUM.        357

  When the decoction is taken internally it very soon
gives a deep red colour to the urine.  By some practi-
tioners it  has  been recommended as a very efficacious
remedy in dysentery and diarrhoea.   Dr. John Hunter
asserts that  he found  the extract  of logwood very ser-
viceable in cases of dysentery where  the discharges were
frequent and copious, and  not attended with much tor-
mina.*  It  has, also, been used  with advantage in the
chronic form of cholera infantum,!  and  I have known
it to be given with excellent effects in a case of diabetes.
   The best form for exhibiting  this remedy is an infu-
sion.  A cup-full  of this may be taken  every three or
four hours.   The extract is, also, frequently employed.
 It may be given in doses of from twenty to thirty grains.
                   RUBUS VILLOSUS.

  The bark of the blackberry root is a pure and pow-
erful astringent, and is now a good deal employed as such
both in popular and in domestic practice.  Theplphate
of iron changes the colour of both the infusion and de-
coction into a  beautiful dark purple, and occasions a
copious precipitate.  Gelatin, also, produces a copious
white and  opake precipitate.   The alcoholic solution
undergoes a partial decomposition on adding water to it.
The precipitate thus formed is of a  flocculent appear-
ance, and when dry " exhibits the common resinous pro-
perties on exposure to heat."|

  * Treatise  on the Diseases of Jamaica, p. 186.
 • | Dr. Chapman's Therapeutics and Mat. Med. vol ii. p. 270.
  X Bigelow's American Medical  Botany, vol. ii. p. 163. 
358        HJEMATOXTLON GAMPECHIANCM.

   This root has been much extolled by some late Ame-
rican writers for its efficacy in the cure of chronic dys-
entery diarrhoea, and cholera infantum.  1 have myself
employed it with advantage in the latter complaint.   I
prefer,  however, using the geranium maculatum, as be-
ing much more pleasant to the taste.   I have seen an in-
fusion of the blackberry root used in a case of haemate-
mesis with apparent advantage.   I have, also, known it
to be used with very good  effects as an application in
the form of a cold poultice, in haemorrhoidal  tumours.
As an astringent, this article may, no doubt, be usefully
employed, wherever such remedies are indicated.
   The berries of this bramble have also been used  in
medicine.  Dr. Mease says, " a jelly made of blackber-
ries when on the turn from red  to black, is much used
in the United States for gravel.    It has been said that a
decoction of the root of this plant is very  useful in gra-
velly complaints.  I  am not aware, however, that there
is any foundation for this opinion.
                       KINO.

  This is an inspissated vegetable juice, possessing very
great astringency.  The natural history of the trees from
which it is obtained  is, as yet but imperfectly known.
The kino of commerce consists of three distinct kinds:
" The first is in very small jet black fragments, perfectly
opaque, without smell, crackling under  the teeth when
chewed, not colouring the saliva, after some time impart-
ing only a slight astringent taste, not fusible, and diffi-
cultly reduced to powder." There is another kind which 
KINO.
350
 consists of large pieces, of a very dark brown colour,
 resinous appearance, and  interspersed with  little air
 cells; very thin pieces of it are translucent, and of a ruby
 red colour; when chewed it crackles under the teeth; its
 taste is at first slightly acid, which soon changes to a very
 bitter and astringent one,  "succeeded by a  peculiar
 sweetness.   It  is infusible, and forms a reddish brown
 powder."  This variety of kino is obtained from the
 juice of the coccoloba uvifera. There is a third variety
 of this substance, which consists of dark brown pieces of
 different sizes.   It  is generally covered with a reddish
 brown powder, has a resinous and unequal fracture, and
 is often  mixed with  bits of leaves, twigs, &c.  Very
 thin pieces are transparent; it crackles but slightly un-
 der the  teeth,  and its taste is astringent, followed by
 sweetness. This variety is obtained from the eucalyptus
 resinifera, a  tree  indigenous to New  South Wales.*
 " The London college," says Dr. Duncan, " have indi-
 cated the butea frondosa as the source of kino, but cer-
 tainly erroneously.   It,  however, produces,  in  large
 quantities, a red juice very analogous to kino, and which
 may unquestionably be used as a substitute for it.   The
 production of these substances  from so many different
 trees in Africa, America, Asia, and New Holland, show
 that kino is to be considered as a genus of which these
 are species.
   Kino contains a very large  proportion of tannin, and
 does not  possess  any of  the characteristic  habitudes of
 the resins or gum-resins.   According  to VauquelhVs
analysis, one  hundred  parts of kino consist of seventy-
five of tannin, twenty-four of red mucilage, and one of
* Dr. Duncan's Dispensatory. 
S60
KINO.
fibrous matter.*   Cold water dissolves about four-fifths
of its substance;  but in hot water it is much more solu-
ble ; and hence the decoction, on cooling, lets fall a co-
pious reddish  brown sediment,  and becomes turbid.
Alcohol dissolves the whole of this substance except its
impurities.  "It is remarkable," says Dr. Duncan, " that
alcohol dissolves  kino entirely, but does not dissolve the
residuum  of the  decoction."   The solutions of kino
form a grayish yellow precipitate with acetate of lead,—
a reddish yellow one with nitrate of silver, a yellowish
white one with tart, antimon.—and  a  green one with
sulphate of iron.   Gelatine, also, precipitates the solu-
tions of kino.f   By exposure to  heat kino becomes soft,
and if the heat is very considerable, it slowly enters  into
fusion.
  This substance was first  introduced  to the notice of
the profession as a useful remediate article, by Dr. John
Fothergill, about eighty years ago 4  It has been recom-
mended as an efficacious remedy in intermittent fevers,
given either by itself or in conjunction with some of the
bitter tonics.  In the advanced stages of diarrhoea, and
in chronic dysentery, it is very frequently employed;
and I do not doubt that it will generally answer all the use-
ful purposes in these complaints, that can be obtained
from astringents. In the bowel complaints of children, es-
pecially,  it may often be very advantageously given in
union with chalk and small portions of laudanum.  The
aqueous solution of kino has been highly recommended as
 an injection in the cure of fluor albus and gonorrhoea. In

  * Ann. de Chimie. torn. xlvi. p. 321-332.
  t PfafPs Mat. Med. torn.  ii. p. 200.
  X A letter from Dr. John Fothergill to the Medical Society, con-
cerning an astringent gum brought from Africa. See Med. Observ.
and Inquir. vol. i. p. 358. 
KINO.
361
the former of these complaints a solution of this substance
in lime-water, is said to be particularly useful. Its use in
this way is objectionable,  however,  on account of its
staining every thing with which it comes in contact of
a  blood-red colour.  It has, also, been employed with
good  effects in diabetes;  and  Pemberton speaks very
favourably of its virtues in pyrosis.  Some practitioners
have  found it to produce excellent effects in certain va-
rieties  of haemorrhage,  more  especially in protracted
menorrhagia from laxity of the solids.   Gillespi recom-
mends a solution of kino in red French wine, as an excel-
lent application to foul scorbutic ulcers.*
   Kino  is  given in substance, in doses of from ten to
thirty grains.   It is also very frequently given in the
form  of tincture; from  twenty to forty drops of which
may be administered for a dose.
                       Formula.
   R.—Tinct. kino
       .---- ipecac, aa ^ss.
       ____ opii      3ii.—M. Take from thirty to forty drops
every  two or three hours.  This is an excellent mixture in chronic
dysentery and diarrhoea.
   R.—Pulv. kino       gr. xxvi.
      ---- opii       gr. ii.
      Mucilag.  g. arab. q. s.—M.  Divide into tea pills.  Take
two every three or four hours—in diarrhoea, &c
                 CATECHU EXTRACTUM.

  The tree, mimosa catechu, which  furnishes this ex-
tract, is a native of Hindostan, and is said to be particu-

             * Lond. Med, Jour. vol. iv. p. 373.
  VOL. J.—48 
352
CATECHU EXTRACTUM.
larly abundant on  the uncultivated mountains of Rotas
and  Pallamou, in the  province of Bahar, westward of
Bengal.*  Catechu is, however, also obtained from other
species of mimosa; and at Bombay it is principally pre-
pared  from the nuts of  the areca catechu.   The cate-
chu obtained from the mimosa?,  is prepared from the
internal part of the wood by decoction, and evaporation
in the sun.
   This substance comes to us in compact, hard, brittle,
flat pieces, of a dark brown colour; and, when broken,
exhibiting light and dark brown streaks.  It possesses a
powerfully astringent taste, succeeded by a slight sensa-
tion of sweetness in  the mouth.   It  has no  odour.  Its
specific gravity varies from 1.28  to 1.39.  Formerly it
was thought to be a mineral product, and was, therefore,
described under the  improper name of terra japonica.
Hagcdorn and Boulducf  were amqng the first who op-
posed this error, and  who established the fact of its ve-
getable origin.  According to Mr. Davy's analysis, two
hundred grains  of Bombay catechu contains one  hun-
dred and nine grains  of tannin, sixty-eight of a peculiar
extractive matter, thirteen of mucilage, and ten of resi-
dual matter.  Bostock found traces of gallic acid in
catechu.  That which is brought from  Bengal contains
less tannin.   It is almost wholly dissolved both by water
and proof spirits.  The oxysulphate of  iron produces a
beautiful green precipitate with the aqueous solution of
this substance, which changes to an olive green, with a
faint  shade  of brown, by the further addition of some

  * For a good account of the tree producing the catechu, and of
the mode of preparing this substance, see Med. Obd. and luquir. vo .
v.. p. 148.
   j" Mem. dc l'Acad. des Sciences de Paris. A. 1709, p. 22K 
OATECHU EXTRACTUM.
363
 muriate or  nitrate of  iron.  Lime, barytcs, and stron-
 tian produce copious light brown, and the preparations
 of copper dark brown precipitates.  It also  forms a co-
 pious  precipitate  with gelatine.   The  concentrated
 muriatic and sulphuric acids produce pale precipitates,
 and the fuming nitrous acid destroys its property of pre-
 cipitating the solutions of lime and iron.
   The catechu was formerly much employed by phy-
 sicians, and it is unquestionably an article of strong and
 useful astringent powers.  In diarrhoea and the advanced
 periods of dysentery, it is equal if not superior to any
 of the vegetable astringents we possess.  It  is also said
 to be  a very valuable remedy in fluor albus, when em-
 ployed in the form of an  injection.   Combined with
 gentian it, has been used with success in obstinate inter-
 mittents.*  In relaxation of the uvula, and ulcers of the
 mouth and fauces,  it has been  known to produce very
 excellent effects.   It  has, also,  been prescribed with
 much advantage in general relaxation of the system with
 debility of the  digestive organs.
  Clysters of a solution of catechu have  been recom-
 mended as highly useful in restoring tone and energy to
 the bowels in cases of cplica  pictonum.f  Mr. James
 Kerr states, that this substance forms a  principal ingre-
 dient in an ointment of great repute among the Hindoos,
 composed of sulphate of copper 5iv. catechu giv. alum
 ix.  white resin |iv. reduced to powder and mixed with
 olive  oil and water sufficient to bring the mass to the ^,
 consistence of an ointment.   This ointment they use in
all kinds of  ulcers.   " A  gentleman,"  says Mr. Kerr,

 ' * Dr. Barton, in a note to Cullen's Mat. Med. vol. ii. p. 31.
  X Chirurg. Arzncymittollehre, Von C. L. Romer,  B. i. s. 119. 
364              CATECHU EXTRACTUM.

" of great practice, told me he used this ointment with
success beyond expectation."*
  The catechu is administered both in  the form of a
powder and of  tincture.  The former is given in doses
of from grs. x. to 9i.  The latter  from thirty to sixty
drops.  It is,  also, occasionally prescribed in the form
of an electuary and in lozenges.   The latter by gradu-
ally dissolving in the  mouth, may be very conveniently
and beneficially  used in relaxation of the  palate and
fauces.

                        Formula.
  R.—-Catechu        5SS«
       G.  arab.        3'*
       Pulv.  aluminis   '^ii.
       Aq. menth. pip.   5iv.
       Vin. alb. generos. 5ii.—M.  Dose, a table-spoonful every
two hours.
  R.—Pulv.  ipecac. 3ss.
       ----  catechu 3i.
       ----  opii    gr. iii.
       Sacch. albi.  3i.—M.   Divide  into twelve equal parts.
Take one every two or three hours.
                SUPERACETAS PLUMBI.

  The  acetate  or sugar of lead consists  of irregular
masses resembling lumps of white  sugar, " being an
aggregation of acicular four-sided prisms, terminated by
dihedral summits."  Its taste is sweet and styptic.  When
exposed to the air it slightly effloresces; and it is decom-
posed by heat  and  light.  It is  soluble in twenty-five
* Medical Obs. and Inq. vol. v. p. 158. 
SUPERACETAS PLUMBI.
S65
parts of water, and also in alcohol.  The aqueous solu-
tion is turbid and of a milky colour, but becomes trans-
parent on adding a small portion of acetic acid to it. It
is decomposed by the " alkalies, alkaline earths and their
carbonates, most of the acids, alum, borax, the sulphates
and muriates, soaps,  all sulphurets, ammoniated and tar-
tarized iron, tartarized antimony,  undistilled water."
  When taken internally the sugar of lead produces  a
sensation  of constriction on the  fauces  and along the
whole course of the  oesophagus.   It accelerates the fre-
quency of the pulse, but does not augment its strength
or volume.*
  The effects of the  continued  influence of lead on the
animal body,  are of  a nature so distressing and danger-
ous, that it was long  before physicians would venture on
the internal employment of the saturine  preparations.
We find, however,  that the sugar of lead was occasion-
ally used as an internal  remedy  as early as the days of
Paracelsus. This eccentric genius.extolled it as a reme-
dy of great powers  in diseases of the  thoracic viscera,
all of  which  he included  under the general name of
asthma.f  Its internal  use was,  also, strongly recom-
mended  in all species  of dropsies, by  Goulard; and
Wuerz and Gramannus, of the sixteenth, and Libavius,
Raumer, and others, of the seventeenth  centuries em-
ployed it freely  as  an internal medicine.  The use of
lead in this way, was,  however, strongly opposed by
Stahl,  Hoffmann, Boerhaave,  and subsequently by Sir
G. Baker, J and the authority of these names proscribed

  * Semmes' Inaugural Thesis, on the Effects of Lead, &c Philad.
 1801.
   X Paracelsi Opera Omia, vol. ii.
   X Medical Transactions of the London College of physicians,
vols. i. and ii. 1772. 
366
SUPERACETAS PLUMBI.
almost  wholly,  for a time,  its internal  employment.
But the apprehensions of the profession, in this respect,
gradually gave place to the  accumulating testimony of
experience in favour of its general inoffensiveness;  and
it is now pretty commonly admitted, that, although not
destitute of deleterious  properties,  the sugar of lead
may be exhibited internally in a  variety of  affections
with great  benefit and without the least injury, if ma-
naged with prudence and judgment.  It must be con-
fessed, however, that this remedy has been  known to
produce injurious effects even under the most judicious
administration ;  and we are,  therefore, not to resort to it
with an entire assurance of  its being uniformly innox-
ious.   Like all  our heroic  remedies,  it is  capable of
doing a great deal of good, and, also, under unfavoura-
ble circumstances  of administration and constitutional
predisposition, much harm.
  The  sugar of lead was very early  recommended as
a useful medicine in phthisis pulmonalis.  The Phar-
macopoeia  Bateana  contains  the formula of a tinctura
anti-phthisica,* into which  sugar of lead enters as  a
principal ingredient^ and whiclvis stated to be "truly a
good medicament in those consumptions which proceed
from ulcers of the lungs."f   Ettmuller, also, employed
the sugar of lead  internally  in this disease.   More re-
cently this remedy has been  particularly recommended
in this affection  by Horn,J-Amelang,§.  Remer, Kopp,||

  *  R.—Sacch. saturn. 5ii.
       Sal. martis    %\.
       Inf. spir. vin.  lbi.  Dose from twenty to forty drops.
  "j"  Pharmacopoeia  Bateana, or Bates' Dispensatory, fourth  edi-
tion, by William Salmon, M. D. 1G93.
  X  Horn's Arcbiv. fur Mcdicinische Erfahrung. 1S12,  torn. i.
  §  HufelamJ's Journal of Pracktischcn Ilcilkundc, torn. xxii. p. 3.
  ||  Ibid.  torn. xi. p. C2. 
SUPERACETAS PLUMRI.
367
Hildebrand.* Jahn,f and others.   Ossiander, (En-
twicklungs Krankeiten .B. ii. p. 147) is a zealous advo-
cate for the employment of this article in phthisis.   He
asserts,  that in a great many cases he derived unequivo-
cal benefit from its employment, and in some instances,
the disease, he affirms, yielded  completely to its sana-
tive powers.   It is said to be  particularly  beneficial in
cases attended with a copious purulent expectoration;
and in that  variety  of consumption which depends on
chronic inflammation of the mucous membrane  of  the
bronchia.  Ossiander gave the acetate of lead in union
with opium, or with the extract of cicuta.   Horn relates
the history of a  case of phthisis pulmonalis, in which
the sugar of lead was given in gradually increased doses
until the quantity taken  during the day  amounted to
eighteen grains.  The patient's health was, finally, en-
tirely restored by the  continued use of this remedy.
(Archives f.  Med.  Erfahr. 1808,  B. vii.)   Hufeland
also employed this article with success in a case of  ca-
tarrhal  consumption; and  in addition  to the  names
already mentioned in testimony  of its  valuable powers
in this disease, we may cite, also, those of Greiner, (All-
gem. Med.  AnnaL 1811,) Kopp; Herschberg,  (Hufe-
land7s Jour. Bd. xxxi. St. 5 ;) Wolfe,* (Ibid. Bd. xxxiv.;)
Amelang, (Ibid.  Bd. xxii.;) Latham, (Med. Transact.
vol. v.  1815;)  Wesener, (Hufeland's Jour.  B.  liii. ;)
Fauquier; Lentz ;  and Weber, (Grund ziige d. Con-
sumptions Krank. d. Lunenorg, &c, 1823.)   I have my-
self, in a few instances, given  it in this disease, and its
effects were always manifestly beneficial.  It  generally
lessens  both  the night  sweats and expectoration, and

  * Hufelandrs Journal of Pracktischen Heilkundc, torn. viii. No.
1. p. 3.
  X Materia Medica, p. 2. 
368
SUPERACETAS PLUMBI.
often very considerably relieves the cough.  It is espe-
cially useful as a palliative in the advanced stage of the
complaint, when the patient is harassed by frequent col-
liquative discharges from the bowels.
  To check internal haemorrhages the sugar of lead is,
undoubtedly, the most efficacious remedy we possess. It
was occasionally resorted to in cases of this kind by the
older physicians, but its virtues in this respect have only
become duly appreciated during the last twenty or thirty
years.   The efficacy and safety of the sugar of lead in
haemorrhages, rests now  upon the evidence of a very
extensive experience.  Monro, Hill, Reynolds, Barton,
Amelang, Williamson, Jahn, Richter, Heberden, and
many others have written in favour of its employment
in such affections.   It appears to be equally applicable
to the treatment both of active and passive hsemorrhages.
When, however, the pulse is full and hard,  bleeding is
obviously an essential preliminary to the use of the lead.
The late Dr. Barton was  in the habit of prescribing
this remedy in combination with small portions of opium
or ipecacuanha.  " Seldom," says  he, " have I been
disappointed in my expectations of benefit from this
medicine, which, of all the articles of the materia me-
dica, seems to me to possess the greatest command over
the movements  of the arterial system."  From my own
experience with this remedy, in  haemorrhagy, I am in-
duced to entertain a very high opinion of its powers. In
a single instance only have  I known its use to be fol-
lowed by symptoms of  colic, and these readily yielded
to a few doses of castor oil and opium.
  The sugar of lead has also been recommended in the
cure of  dysentery  and  diarrhoea.  To this purpose it

         * Cullen's Mat. Med. vol. ii. p. 21, in a note. 
SUPERACETAS PLUMBI.
369
 appears to have been very early applied,  as we find it
 mentioned by several of the older writers,—particularly
 by Ettmuller and Adair, who speak highly of its reme-
 diate pewers in dysentery.   Drs. Moseley and  Jackson
 have also added their testimony in  favour  of  its useful-
 ness, under certain circumstances,  in this disease.  " In
 chronic dysentery," says Dr. Jackson,  " a solution of
 sugar of lead, viz. ten grains of the acetate to one drachm
 of the crystals of tartar and two parts of boiling water,
 given every three or four hours, to the quantity of two
 ounces for  a dose, gives, evident relief on many occa-
 sions, and in no instance within my knowledge  has any
 inconvenience  arisen  from the supposed deleterious
 effects of the lead."* Moseley employed this substance
 in the form of enemata, where  the tenesmus was inve-
 terate and harassing, attended with frequent discharges
 of bloody mucus, or purulent  matter, and great sore-
 ness  about the  anus.f   Dr.  Bampfield,  another  late
 writer on tropical diseases, states that Dr. Ainslie, at the
 artillery hospital at the mount of Madras,  showed  him
 cases u where this medicine was said to be strikingly  use-
 ful." He does  not, however, add much in favour of this
 remedy from his own experience.  He says, that during
 its exhibition animal  food should be abstained from. J
 Quite recently, Dr.  Harlan, of this city, has published
 cases illustrative of  the  efficacy of this medicine in  dy-
 sentery,§> and he seems to entertain  a very high opinion
 of its powers as well as an entire conviction of its safety.
 My own limited experience  with this article, in  dysen-

  * Jackson on Febrile Diseases, vol. ii. p. 61.
  X Moseley on Tropical Diseases, p. 404, fourth edition.
  t Practical Treatise on Tropical Dysentery, p. 198.  London,
1818.
  § American Medical Recorder, vol. v.
  VOL. I.—4CJ 
370
SUPERACETA8 TLUMBI.
tery, has by no means been satisfactory.   I have found
it in a few instances to produce constipation with a dis-
tressing pressing down of the bowels, without affording
any relief to the tormina.  I have no doubt, however,
that cases may occasionally occur in which the sugar of
lead will be found advantageous. But, as a general prac-
tice, I am not disposed to think favourably of the re-
medy.
   Of the employment of sugar of  lead in intermittents
I know nothing from my own experience. Some writers
of the last century have spoken well of  it in  this dis-
ease, but I suspect that its powers in  this respect arc
not entitled to much attention. In some of the neuroses
this article has been found decidedly beneficial.  Sax-
torph,* Richter,f Ossan,J and others employed it with
success in epilepsy and hysteria.  Dr. Rush,§ also, cured
a case of epilepsy with this  remedy ;  and in the New-
York Medical Repository, ||  I have reported a  remarka-
ble case of this disease, in which the sugar of lead prov-
 ed completely successful.   In this case the fits returned
 regularly about the periods  of full moon.  I prescribed
 three grains of the sugar of lead t6 be taken mornings
 and evenings, commencing  three or four days before
 the expected return of the paroxysms, and-continued it
 for five days at each period.  The medicine  was thus
 taken at five successive periods  of full  moon, and the
 patient who had been affected with the disease upwards
 of eight years, was permanently cured thereby.

   * Act. Reg. Soc.  Med. Hafniensis, vol. iii. 1792.
   ■j* Specielle Therapie, vol. vii.  p. 266.
   X Osann. Dissertatio de  saturni usu  Medico, maxime interno,
 1809.
   § Philadelphia Medical Museum, vol.  i. No. 1.
    || Vol. ii. No. 1. New Series,  1813. 
SUPERACETAS PLUMB I.
371
  The sugar of  lead has also been  prescribed in other
spasmodic diseases.  Kramp, a German writer,  cured a
case of spasmodic  dysphagia by it, and Ettmuller em-
ployed it in melancholia, in which he says "it is esteem-
ed a specific."* It is said, also, to have been given with
advantage  in tetanus, f   Lately this remedy has  been
highly spoken of in the cure of hooping-cough.  I have
used it in five or six cases of this disease,  and  in a few
instances it appeared to do some good.  Its efficacy in
this respect is, however, not sufficiently great to entitle
it to much attention^ and more especially as its employ-
ment can certainly not be said to be without some risk
of unpleasant consequences.
  The sugar of lead is one of the most useful remedies
we possess for  the reduction of external  phlegmonous
inflammation.   In  ophthalmia it has  long  been  an ex-
ceedingly common remedy ; and,  although applications
of this kind are by far too indiscriminately made, it may
often be resorted to with great benefit.  When the in-
flammation does not  depend  on a constitutional cause,
and is unaccompanied by much excitement of the gene-
ral circulation,  saturine collyria will, in general, prove
very serviceable.  Under opposite circumstances, how-
ever, such  applications  will not only do no good, but
almost  invariably  produce mischief.  The  use of this
remedy  has  been no less  common,  as an injection, in
gonorrhoea, than in ophthalmia; and it certainly is very
often adequate  to the removal of the disease.
   The solution of sugar of lead, made into a cold poul-
tice with the crumbs of bread, is also an excellent ap-
plication in phymosis, hernia humoralis, and swelled in-

   A  Allen's Synopsis Medicinal, vol. i. s. 437.
  X Burdach, Arzneymittcllehre, vol. ii. 241. 
372
SUPERACETAS PLUMBI.
guinal glands.   Applied in the same way, it frequently
affords great relief in inflamed haemorrhoidal tumours.
This  remedy  has also  been  much praised by  some
writers for its effects in erysipelatous inflammation aris-
ing from external  causes.   By others, however, its use
in this affection has been condemned; and my  own ex-
perience has furnished me with no evidence of its use-
fulness in this respect.
   The sugar of lead may be given in doses of from half
a grain to six  grains, according to the nature  and ur-
gency of the symptoms for which it is administered.  It
is  frequently given in the  form of pills, in combination
with opium.   In administering this preparation of lead,
care must be taken that the  patient do not at the same
time  receive other" substances  into the stomach which
have  the power of decomposing it.  The sulphates of
magnesia and alum, for instance, would decompose the
acetate and produce a sulphate of lead, which is entirely
insoluble and consequently inert.*   Dr. Paris  advises,
that in taking the  sugar of lead  the patient should ab-
stain " from all  potation except cold water or draughts
composed of diluted acetic acid,  for at least an  hour af-
ter the ingestion of the medicine."
   The immediate  effects of an enormous dose of sugar
of lead are, a sweet astringent taste, with a sense of con-
striction in the throat, pains in the stomach, with retch-
ing,  or vomiting of bloody mucus, bowels constipated
or relaxed, with bloody evacuations,  foetid eructations,
hiccup, a sense of constriction in  the thorax, with diffi-
culty of respiration, great thirst,  painful micturition,
cramps of the extremities, cold sweats, convulsions, ge-
neral  sinking of the vital powers, and  death   To coun-

                *■ Paris's Pharmacologia. 
SUPERACETAS PLUMBI.
373
 teract these  effects, experience proves that much ad-
 vantage may be derived from the early use of solutions
 of Glauber's  salts, Epsom salts, and hard water.   Orfila
 says that the  liver of sulphur,  which  has been recom-
 mended by some, is pernicious.   If the symptoms be not
 early  subdued by these measures,  and signs of gastric
 inflammation come on, the warm bath, fomentations, and
 leeches to the abdomen,  with copious draughts of infu-
 sions of linseed or mallows, or of water sweetened with
 sugar, should be resorted to.*

                         Formula.
   R.—Plumbi acetatis  gr. viii.
       Aq. distillat.   ^vi.
       Syrup, scillae   ^ss.
       Tinct. opii     3SS-
       ----- digitalis  3'ss'   M. One ounce of this mixture may
be taken three times daily in phthisis pulmonalis.
   R.-—Vitel. ovi
       01. amydalar.     3"*
       Mucilag. g.  arab. 5ss.
       Plumbi acetat.     gr. iii.
       aq. fcenicul       5v.   M.  Take a  table-spoonful every
three hours.
   R.—Plumbi acet. gr. vi.
       Opii puriss.  gr. iii.
       Sacch. albi  5L   M.  Divide into  twelve  equal  parts.
Take one three times daily.
  R.—Plumbi acetat.    gr. xv.
       P. Digitalis purp. 3ss.
       G.  myrrh
       Bals. peruvian
       Extract, helenii aa 3ii.  M.  Divide into two hundred pills.
Take six or eight pills, three or four times daily.
* Orfila's System of Toxicology, vol. i. p. 484. 
(  374  )
                   SULPHAS ZINCI.

  The emetic and tonic properties of  this article have
already been noticed ; and to complete its remediate his-
tory, it remains, therefore, only to speak of its virtues as
an astringent.
  In chronic ophthalmia, a weak solution of the sulphate
of zinc often produces excellent effects.  It is certainly
preferable, in such cases,  to the acetate of lead, as hav-
ing besides its constringing, a greater roborant  effect
upon the dilated and debilitated capillaries of the inflam-
ed part.   As  an astringent  injection in gonorrhoea, its
employment is  very common.   Its indiscriminate  and
unguarded  use in this disease is, however, by no means
to be approbated.   It is much too harsh and irritating,
and frequently  gives rise  to  injurious  consequences,
when  employed in the  acute  stage  of the  affection.
When the discharge has assumed the character of gleet,
it may generally be used with advantage.   In injections
for this complaint it is usually united with sugar of lead,
to which some mucilage and a small portion of laudanum
is commonly added.
   The sulphate of zinc has been employed with much
benefit against opacities of the cornea, and in pterygium
or  thickening of the conjunctiva.  Himly used it with
success in tumours of the  sclerotica and cornea, applied
 in  the form of  powder mixed  with sugar.  It has also
been successfully used as  an escharotic in polypus of the
 nose; and in fungous tumours in the external  meatus of
 the ear.  A solution of it forms an excellent  gargle in
 apthous affections of  the  mouth, for which purpose it is
 highly recommended by  Selle,  Armstrong, Hertz, and 
SULPHAS ZINCI.
375
others.   A lotion composed of a pint of sage-tea two
ounces of honey, two drachms of the tincture of myrrh,
and two scruples of sulphate of zinc, is often peculiarly
beneficial in affections of this kind.  The sulphate of
zinc is a remedy of very considerable powers in chronic
cutaneous eruptions.   The  famous ointment of Jasser
consists principally of  this article.  I have frequently
employed it in the form of a, lotion in scabies with perfect
success.
  In obstinate venereal  ulcerations, great  benefit may
often be derived from a lotion composed of two drachms
of calcined sulphate of zinc, the same quantity of burn-
ed alum dissolved int wo ounces of water, with the addi-
tion of a drachm of the tincture of galbanum.
  This article affords one of the most effectual astringent
injections in fluor albus.  It may be very advantageous-
ly united with alum for this purpose.  A drachm of each
dissolved in a pint of water forms  an injection of suffi-
cient strength ; but it is proper to  observe, that neither
this, nor any other application of this kind,  can be em-
ployed with propriety  before the vaginal inflammation
has been moderated, by low diet, saline purgatives, and
injections of warm water, or weak solutions of sugar of
 lead.
   The sulphate of zinc,  has also been much praised as
a remedy for the removal of polypus in the nose.  Mur-
sinna asserts, that we possess no application equal to the
sulphate of zinc, to prevent the renewed  growth of a
 polypus after it  has been  extirpated  with the knife or
 forceps.  He  says, that  it seems  to possess a specific
power in opposing the growth of such tumours, when any
 of its roots remain after an operation.  He recommends
 the injection of a strong solution of this salt, for several
 weeks after an operation of. this kind. 
 376                SULPHAS ZINCI.

                        Formula.
  R.—Sulphat. zinci   3'ss«
      Mellis         §i.
      Tinct. myrrh.   ^ii.
      Spir. vini gallici  5iss.
      Infus. salvise    £viii.  M.  An excellent gargle in ulcer-
ated gums, tonsils, &c.
  R.—Pulv.  sulph. zinci 3'i-
      Flor. sulphur.   3m>
      Axung.         ^ii.  M.   In itch and other chronic cu-
taneous affections.
                   SULPHAS ALUMIINLE.

   Alum is an earthy salt,  consisting of sulphuric acid
 and alumina, with a portion of potass,  or  ammonia, or
 sometimes of both.   " It crystallizes  in regular octo-
 hedrons, whose  sides  are equilateral triangles."  Its
 taste is sweetish,  rough, and exceedingly astringent.  It
 dissolves in fifteen times its weight of water at 60°, and
 in three-fourths of its weight at 212°.   It is  also solu-
 ble  in  alcohol.   When exposed  to the air it slightly
 effloresces.    u By the action of  heat it first undergoes
 the watery fusion, then loses its water of crystallization,
 and  lastly a  great part of its acid," assuming a white,
 spongy appearance, friable and very light.  It is decom-
 posed  by the alkalies and  alkaline  salt, carbonate and
 muriate of ammonia, carbonate of magnesia, tartrate  of
potass,  lime-water, superacetate of  lead, the mercurial
salts, "as  well as by many vegetable and  animal sub-
stances, especially galls and kino."*   Hence, as Dr.
Paris observes, the addition of alum to vegetable astrin-
gents is very injudicious.
* Paris's Pharmacologia. 
SULPHAS ALUMINA.
377
   Alum was well known to the ancients, but it does not
 appear to have been used by them as an internal remedy.
 Dioscorides and Hippocrates  praised its effects as a lo-
 tion, in  various kinds of ulcers, and particularly in sores
 of the  mouth, and  in spongy,  swelled  gums.   Van-
 Helmont, Helvetius, Mead, and Thompson, were among
 the first who brought its  internal use  into  particular
 notice.
   Lind  speaks very highly of the powers  of alum given
 with nutmeg in intermittent fever.   He  declares  that,
 except the Peruvian bark, it proved more successful in
 his practice than any other remedy he ever used.   Cul-
 len  speaks  less favourably of  it.   During the present
 season, I have prescribed it in four cases combined with
 nutmeg  and serpentaria.   One of the patients was cured
 after using  the remedy four or  five days.   According to
 Dr. Darwin, alum is particularly  suited  to the cure of
 fevers attended with disease of the bowels.
   Alum  is said  to  be one of the most effectual  reme-
 dies we  possess in colica  pictonum.  Grashuis  was the
 first who used it in this disease.   Richter speaks  in the
 most exalted terms of its effects in this painful and often
 intractable  complaint.  The testimony of a great  many
 others eminent writers might be adduced in favour of
 its virtues in this respect.*  I have myself prescribed
 this article  in several cases, with prompt and  conspicu-
 ous advantage.   In an instance which occurred to me,
 quite recently, relief was  obtained from the alum, after
 opium, and the most active cathartics had failed to re-

  * Sommer, in Hufeland's Journal d. Pract.  Heilk. B.  vii. st.
 1, p. 73.  Gebel, ibid. B. viii. st. 2, p.  195.  Percival, Observ.
and Experiments on the Poison of Lead, p. 71. Lentil Memoral.
circa aerem, vitse genus, sapitat, et morbis clausthalicns, p. 115.
   VOL. I.—50 
SULPHAS ALUMINiE.
move the  affection.  Ffteen  grains of the  powdered
alum is to be given every two or three hours, either by
itself or in combination with opium.*
  In chronic discharges from  the bowels, alum, either
alone or in combination with other articles, has been fre-
quently employed with  considerable  advantage.   The
alum whey forms an  excellent remedy in such  cases.
I have known  the use  of  powders composed of ten
grains of alum,  fifteen of calamus aromaticus,  and one-
fourth of a grain of opium, to arrest a chronic diarrhoea,
of long standing, very promptly, without any disagreeable
consequences.  Alum has also been successfully employ-
ed in internal haemorrhage.   Van-Helmont gave it with
much  success  in  uterine  haemorrhages; and Cullen
states that he found it serviceable in bleedings from the
uterus, but not in those from the lungs. This, he thinks,
was owing to the latter variety of  haemorrhage being
almost invariably of the  active kind. In protracted san-
guineous discharges from the uterus, connected  with
great relaxation  of the solids, alum  is undoubtedly a
very valuable remedy.   In cases of this, kind it is very
advantageously administered in combination  with Peru-
vian bark.   Where the pulse is active it ought not to be
 given without  previous  depletion.   J^eake  used a solu-
 tion of this substance in the form of an injection in this
 variety of haemorrhage.  Alum  has also been much ex-
 tolled for its remediate powers in leucorrhoea ; and, em-
 ployed as an injection  in this  disease,  it  is  certainly
 capable of doing considerable good.   I have prescribed
 it occasionally in this way,  though seldom with decided
 advantage^  Where this disease is attended with  great
 relaxation of the general system, or with that habit of

          * Richter's Specielle  Thcrapie, B. iv. p. 201. 
SULPHAS ALUMINiE.
379
body  which has been  denominated leucophlegmatic,
alum combined with the rust of iron, is said to be pecu-
liarly beneficial, as an internal remedy. I have also used
the alum in union with  ipecacuanha, with much advan-
tage in this complaint.   From six to ten grains of the
former, to four or five grains of the latter, may be given
twice or three times daily.  Dr. Dewees states that he has
used the alum in combination with nitre,  in leucorrhoea,
with complete success in several very obstinate cases.
   Diabetes is another disease in which  alum  has  been
successfully used.  Its employment in  this complaint
was particularly recommended  by the celebrated Dr.
Mead, and by Dover.  Selle, also, states that he cured
an obstinate case by giving the  patient  thirty grains of
alum three times  daily.*   The majority, however, of
those who have tried the alum  in this  disease,  do  not
speak favourably of its powers ; and it does not, at pre-
sent, enjoy any  particular reputation in  this respect.
Used as an auxiliary to other measures, the alum whey
may, no  doubt, often be serviceable.   As a principal
remedy,  however, it is certainly not to be relied  on.
The alum has also been recommended in flatulent colic,
 gastric debility, and in colliquative sweats, &c.
    Alum  has likewise been recommended as a useful re-
 medy in morbid dilatation of the cavities  of  the  head.
 Professor Dzonde speaks particularly in  favour  of its
 powers in cardiac affections of this kind.  (Aeskulap. Bd.
 i. 1821.)  He states that he has derived unquestionable
 benefit in habitual palpitations  of the heart, from mor-
 bid dilatation, from a solution of two drachms of alum in
 six ounces of water, given in doses of  a table-spoonful,
 five or six times daily. Sundelin, (Arzneimittell. B. ii.

          * Beitraege zur Natur. and Arznei. &c. B. i. 
380
SULPHAS ALUMlNiB.
 p. 244,) also asserts, that he has used this article with
 great advantage  in  a case  of this kind.   As  an ex-
 ternal application, alum may be  advantageously  em-
 ployed in  a  variety of complaints.   In relaxations
 of the  uvula and cynanche tonsillaris much  benefit
 may often  be derived from the use of gargles contain-
 ing alum.   " In many persons," says Dr. Cullen, " who
 are  liable to be affected  with swellings of the tonsils,
 we have known the disease prevented, or soon removed
 by a decoction of oak bark, to a pound of  which a half
 a drachm  of alum  and two ounces of brandy were
 added."*
  Bretonneau has recently published a statement which
 goes to show that alum may be very beneficially used
 as a  local remedy in croup, more especially in that va-
 riety of the disease,  which commences by inflammation
 in the fauces, and the formation of pseudo membraneous
structure on the  tonsils,  &c.  His mode of using it is
to blow some finely  powdered  alum, through a small
tube, into the fauces.   When thus applied it is said that
this  substance often  speedily arrests the further  pro-
 gress of the malady.
  To arrest the bleeding of leech-bites, on parts where
compression cannot well be made, a solution of alum or
powdered alum applied  to  the part, will in general
 answer better than any other application.
  In ophthalmia,  after the inflammation has been some-
 what subdued by  local and general  depletory measures,
 or in the chronic form of the complaint, the alum  curd,|

  * Mat. Med. vol. ii. p. 12.
  X This is made by rubbing a piece of alum  with the white of
eggs  in a plate until a coagulum is formed.   It is applied to the eye
between two pieces of fine linen. 
SULPHAS ALUMINjE.
381
as it is called, will, in general, prove very serviceable.
Cullen states, that he has found the solution of alum, in
the proportion of five grains to the ounce of water, still
more effectual than the coagulum aluminosam.   In the
beginning of acute ophthalmia,  these applications will
very generally prove hurtful.  Alum has also been used
as an  injection  in gonorrhoea.  In gleet it may  be use-
ful, but in recent gonorrhoea it is much too harsh and
irritating, and ought never to be  employed.
                         CALX.

   As a mild astringent, lime-water is a remedy of very
 considerable utility.   In the advanced periods of dysen-
 tery,  diarrhoea, and in cholera infantum,  it often pro-
 duces excellent effects.  In the chronic  form of the
 latter disease I have been in the habit of prescribing it
 in union  with a weak  infusion of cinchona, and it has
 very generally appeared to me to be of service. Where
 there  is acidity in the primae viae, attended with vomit-
 ing or diarrhoea, the lime-water is doubly  indicated.
 In such cases it at once  corrects the vitiated contents,
 and  allays the  morbid  irritability of the  stomach and
 bowels.   It is, indeed, one of  our most useful remedies
 to check  inordinate  vomiting.   For this  purpose it is
 usually administered with milk, given in doses of a table-
 spoonful of each every twenty or thirty minutes. Under
 the head of Antacids I have already noticed its utility
in dyspeptic cases  attended with acidity of the primae
vise.
  Hoffman asserts that lime-water is the most effectual 
382
CALX.
remedy we possess in scurvy arising from the continued
use of salted provisions.  This, however, is not confirm-
ed by the experience of others.*
  As an external remedy, lime-water may often be ad-
vantageously used in old fungous ulcers,  attended  with
inordinate discharges of a serous matter.  It has also
been recommended as affording great relief from the
pain and foetor of malignant ulcers.   It is even asserted
to  have been  used  with  success  in genuine  cancer.
Baumbach, a German writer,  relates two cases of  can-
cerous ulcerations of the lips and breast, which, he  says,
were effectually  cured by the  internal and external use
of  lime-water, f   In the  cure of porrigo larvalis,  or
crusta lactea, lime-water, used both externally  and in-
ternally,  is  recommended by Barlow,  Dreiszig, and
Wichmann,J as  an  efficacious  remedy.  Hufeland re-
commends a liniment made of  equal parts of lime-water
and sweet oil,  as one of the most effectual  applications
in herpes.^   This liniment, with the addition of a por-
tion of laudanum, is also a very excellent application in
burns and scalds.   I have repeatedly seen its virtues in
this respect exemplified.
   Much was said a few years ago of the efficacy of the
 muriate  of lime  in scrofulous complaints.   Fourcroy,
 Beddoes, and Hufeland have published very favourable
 accounts of its effects in this disease.  I have known it
 to be employed in  several instances of  external scrofu-
 lous ulcerations, but, although it  was  given in  large

   * Burdach, Arzneymittellehre, B. iii. p. 500.
   X Vogel, resp. Baumbach.  Diss, de curatione cancri occulti et
 aperti per aquam calcis vivos potam praesti^a.
   % Ideen Von Diagnostick, B. i. p. 50.
    § Journal der Practischen Heilkunde, B. xxiii. st. 3, p. 209. 
CALX.
383
doses, and continued  for a considerable time, it did not
evince any beneficial  operation. It is certain that it has
not answered the expectations that were at first excited
by the accounts given of its effects by Beddoes and Hufe-
land.  The mode of giving it is, to dissolve one drachm
of it in two ounces of  water, of which thirty or forty
drops are to be given every three or four hours.
                      BARYTES.

  The only preparation of  barytes employed in medi-
cine is the muriate.   This salt has a bitter and pungent
saline taste.  Given in a moderate dose, it does not ma-
nifest any sensible operation.  An inordinate dose, how-
ever, excites nausea, vomiting, and  sometimes anxiety,
palpitation, and vertigo.   Hufeland states, that he has
known this medicine to  produce a continued feeling of
distressful anxiety for several days without  any other
obvious effect.   It often occasions, when first used, and
especially in patients who  have worms, slight  griping
pains, with diarrhoea.   It  generally keeps the bowels
somewhat relaxed.  It has no perceptible effect upon
the pulse.  Hufeland says, that it appeared to  him ra-
ther to retard than accelerate it. The excretory organs
are more obviously influenced by this remedy. It gene-
rally augments the urine and cutaneous exhalation.  Ap-
plied to  the skin, it produces a smarting, burning pain,
and when concentrated it proves escharotic*
   The muriate of barytes, or, as it was formerly called,

  * Hufeland, Darstellung der Medicinishen Krafte der Salzsauren
Schwererde, p. 15. 
384
BARYTES.
 terra  ponderosa, was  first  introduced  to  the notice of
 the profession by Dr. Crawford,* of England,  as a re-
 medy of great powers  in  scrofulous  affections.  This
 writer assures us that he has found it successful in many
 of  the most confirmed cases of  scrofula.   Mr. Pearson
 and Drs. Clark and Hamilton, have  published observa-
 tions confirming Dr.  Crawford's statements  upon  this
 subject.    In Germany and France this remedy has
 found a number of able advocates.  Goering, Fourcroy,
 J.  A. Schmidt,  Petermann, and especially Hufeland,
 have published statements  illustrative of its  beneficial
 effects in affections of this kind.  It cannot, indeed, be
 doubted that it has been found useful in this disease; but
 later experiments with  it in this country as well as in
 Europe, do not justify the  high praises that have been
 bestowed on it.   Ferriar, Kretschmar, Fleisch, Henke,
 Richter, &c. employed it in large and continued doses,
 without deriving the  least advantage from it.f  Some
 writers, amongst whom are Girtanner and Arnemann,
 have represented it as frequently productive  of highly
 injurious and  even poisonous effects.
  In a single instance of violent and'obstinate scrofu-
lous ophthalmia in a child, I  prescribed the solution of
this  substance, and had the satisfaction to see my pa-
tient get well  under its use.  In employing this medi-
cine, it is necessary to continue its use for a long time.
In very tedious cases, Hufeland observes, its use should
be interrupted every eight or fourteen days, and a pur-
gative interposed.   This remedy is said to  be  most use-
ful  when  there is an inflammatory and very irritated
 condition of  the lymphatic system  present,  or where

  * Duncan's Medical Commentaries, vol. iv. Dec. 2, p. 433.
  t Riehter's Specielle Theraj?ie, vol. v. p. 623. 
BARYTES.
385
 the bowels are loaded with irritating and bilious matters.
 It is especially efficacious when  the disease appears in
 the  form of cutaneous  eruptions.  In  cases attended
 with great relaxation and weakness, or where symptoms
 of hectic are present, it seldom does any good, and often
 harm. Nor can it be used with benefit in cases compli-
 cated with scorbutic affections.*
   The muriate of barytes has also been used with ad-
 vantage in herpetic eruptions, scabies, porrigo, scirrhus,
 amenorrhoea, and  mania;  successful examples of all of
 which are mentioned by Hufeland and others.
   The dose of this remedy is  from ten  to fifty drops
 every three  hours, of a solution  of one drachm in an
 ounce of distilled water.  It should always be commenced
 with in a  small dose, and gradually augmented.
   The sulphuric and  nitric acids, the alkalies, magne-
 sia, tartarized antimony, burned  sponge, and flowers of
 sulphur decompose  it.   Antimonial  wine renders it
slightly|turbid, but does not entirely decompose it.  It
 may be given with vegetable extracts  and syrups, and
 decoctions, alcohol, corrosive sublimate, arsenic, with-
out having its composition affected.
                  ACIDUM NITrvICUM.

  Thk nitric acid has, within the last twenty or thirty
years, become  an article of very considerable import-
ance in therapeutics.   M. Alyon, a French physician,
introduced it to the notice of the profession as an ex-
                                                 i
                  * Hufeland, op. cilat.
  VOL. I.--SI 
386
ACIDUM NITRICUM.
ceedingly valuable remedy in syphilis. He published a
number of cases  illustrative  of its efficacy  in this dis-
ease ; and it was  soon  afterwards tried by several emi-
nent English physicians, whose reports on its effects were
very  favourable.   Cruickshank,  Scott, Sandford, and
Hammick, published observations tending to confirm its
character as an efficacious antisyphilitic remedy.  But
no one was  more extravagant in its praise  than Bed-
does.*   As is usual, however, with new remedies, it did
not long  sustain the reputation it at first acquired. The
result of the experience of the  profession on  this sub-
ject is,—that  in old cases of  syphilis, connected with a
cachectic condition of the system, the nitric acid is ca-
pable of  mitigating the disease, but is  inadequate to a
perfect cure.  In cases of this kind, and especially when
symptoms of scurvy are complicated with it, much bene-
fit may commonly be derived  from the alternate employ-
ment of the  acid, and  mercurial  remedies.  Where
mercury  fails to remove the symptoms  entirely, and
rheumatic pains, nodes, ulcers,  &c. remain, the acid
will sometimes prove highly  serviceable.   It is seldom
sufficient to prevent the occurrence of secondary symp-
toms ; though  it will often remove them after they have
made their appearance.
   The nitric acid has  been recommended as a very use-
ful medicine in chronic hepatitis, as well as in scrofulous
ulcerations.   I have used it in some cases of the former
disease with advantage ; but I have not known it to per-
form a perfect cure.   This acid  has also  been  recom-
mended in  dysentery and diarrhoea,  but its use in this
way does not appear to merit much consideration.
   This acid may also be beneficially used as an external

         * On the  Effects of Nitrous Acid, &c. 1797. 
ACIDUM NITRICUM.
387
 application to syphilitic ulcers,* and in certain chronic
 cutaneous eruptions, f  Plenk recommends an ointment
 made of nitric acid and ung. althaea, of each  half an
ounce, and two drachms of ung. juniperi, applied twice
 a day, as highly  efficacious in tinea capitis.  The nitric
 acid may be taken from one to two drachms daily, dilut-
 ed in a quart of water, to which six or seven ounces of
 syrup is added.   Its use increases the appetite, accele-
 rates the pulse, augments the secretion of urine and sali-
 va, and when long continued, produces a tenderness of
 the gums.$
   The nitro-muriatic acid has lately attracted very con-
 siderable attention, both as an external  and an  internal
 remedy.   Dr. N. Scott was the first who noticed  the
 superior remediate powers of this mixed acid.§>  It ap-
 pears  to have a very particular tendency to act  upon
 the glandular system, and especially to excite the secre-
 tory action of the liver and cutaneous exhalents.  " As
 a very general rule for its employment," says Dr. Scott,
 "it may be observed, that whenever the mercurial pre-
 parations are indicated,^the nitro-muriatic acid will be
 found useful, with this difference, that in cases where
 mercury is highly injurions from delicacy or peculiarity
 of constitution, or from other causes, the nitro-muriatic
 acid may be employed with safety and advantage."  It
 is inadmissible in acute diseases. It is especially recom-
 mended in chronic hepatitis and in functional disorders
 of the liver.  In these diseases Dr. Scott considers it as the
  * This is said to be an excellent ointment for purposes of this
kind.  R. Acid nitric, concentr. ^\. pingued. vacc.  ^i. misce  int.
sub leni igne et adde, opii puriss. 5'- fiat unguentum.
  X Alyon, Essai sur les Proprietes Medicinales d'Oxygene, 1791.
  t Richter's Specielle Therapie, vol. v. p. 321.
  § Beddoes' Contributions. 
388
ACIBUM NITRICUM.
most effectual and the safest remedy.  It is said, likewise,
to be very efficacious in syphilitic and pseudo-syphilitic
affections. Dr. James Johnson, who appears to place con-
siderable reliance on the nitro-muriatic bath, in the treat-
ment of chronic hepatitis, gives the following directions
for preparing and using it:  "Into a glass vessel capable
of holding a  pint or more of fluid,  put eight ounces of
water, and then pour in four ounces of the nitric acid of
the London Pharmacopoeia, and four ounces of muriatic
acid.  One ounce of this mixture to a  gallon of warm
water, will form a bath of medium strength, and  such as
Mr. Astley Cooper commonly  prescribes.   The pro-
portion may be increased to one ounce and a  half, or
diminished to half an ounce of the solution to the gallon
of water, according to the  age, strength, delicacy, or
other peculiarity of the patient.  The feet and  legs of
the patient ought to be immersed  in this bath at a com-
fortable warm temperature, say  96°, and  kept there
twenty minutes or  half  an  hour, just before going to
bed.  This  may be done every night, or every second
night, and  the same bath will  remain good for five or
six nights."*
   It is proper to observe, however, that several very
respectable physicians, who have published the result
of  their experience with the nitro-muriatic acid bath,
have not found it to answer  the expectations which were
 excited by the publications of Dr.  Scott and others.  Mr.
 Guthrie,  deputy inspector  of  military hospitals, states,
 as  the result  of  his experience with this remedy, that
 it  is of very  uncertain operation, and that no depend-
 ence can be placed on it.   He does not, however, con-
  tend  that  the  remedy is  entirely destitute of useful

           * On the Influence of Tropical Climates. 
ACIBUM NITRICUM.
389
powers.  " It seems often," he says, " not to produce any
effects whatever, however extensive its application; and
yet the complaint for which it has been used shall slowly
subside or disappear, whilst in other instances it remains
stationary or gets worse."*  From my own experience I
know very little of this remedy.   I have employed it in
a few instances of functional derangement of the liver;
but as it was alternated with mercurial remedies, I am
not able to say how much of the  beneficial  result is  to
be ascribed  to its operation.   It appears to be beyond a
doubt, however, that it is possessed of very useful re-
mediate powers.   But no one will now pretend to say
that it approaches mercury in any of the  diseases in
which it has been recommended.  It may, nevertheless,
be sometimes usefully substituted for  mercury, where
this article cannot be given on account of idiosyncrasy,
debility, or  other causes. It may even occasionally hap-
pen to prove effectual where mercury has done no good,
or has been  hurtful. This has been observed of a variety
of articles whose remediate powers are in  no  respect
equal to this metal.
                AC1DUM SULI'IIURICUM.

  The sulphuric acid is a medicinal agent of very con-
siderable  importance.  By the German physicians this
acid is very frequently prescribed in haemorrhagies; and
some  of the older English writers recommend it very
highly for its powers in such cases.  Sydenham espe-
cially considered it as a remedy of great use in haemorr-

    * Mcdico-Chirurgical Transactions, vol. viii. for 1817. 
S90
ACIDUM SULPHURICUM.
hagy, at present it is only prescribed  as  an auxiliary,
after the immediate violence of discharge has been re-
strained by more active measures.   In spitting of blood,
and in slight but protracted bleedings from the uterus, it
often  answers very good purposes.  As a tonic this acid
is very frequently administered.  It  seems to be parti-
cularly adapted to invigorate the digestive organs during
convalescence from febrile diseases.   Sometimes, how-
ever, it will produce unpleasant affections of the sto-
mach, such  as pains  and  nausea.  When this occurs, it
must, of course, be at once discontinued.
  The sulphuric acid is a  very efficacious remedy in
certain chronic eruptive diseases.   The  use of it  in
this way originated,  I believe, in Germany. Dr. Cothe-
nius, principal physician of the Prussian army, employed
it for the cure of the itch, in 1756.   It has,  since that
time, been  employed and commended by many of the
most  eminent physicians of  Europe.   Crollius, Tissot,
Baldinger,  Hafenreffer, Gahn,  Richter,  and a number
of  other writers have mentioned its virtues in  this re-
spect.   Richter observes, that the external application
of  this acid, diluted with water,  is  perhaps the most
useful of all our  remedies in itch  complicated with a
scorbutic habit of body.* Dr. Kinglake,  also, has found
this acid very effectual in cases of this kind.f  Dr. Fos-
broke, of Berkeley, in England, has recently published
 a paper on the use of diluted sulphuric acid in cutaneous
 affections, in which he relates several very striking ex-
 amples of its efficacy.  He prescribed it in an obstinate
 case of lichen agrius, with prompt success. It was taken
 in a decoction of elm bark and of the wood of solanum

   * Specielle Therapie, torn. vi". p. 179.
   | London Med. and Phys. Jour. 1801, p. 614. 
                ACIBUM SULPIIURICUM.             391

dulcamara,  " using, at the same time, as a wash, a de-
coction of the deadly nightshade.*   It should be taken
in as large doses as the stomach will bear ; from one to
four drachms, properly diluted, may be taken in twenty-
four hours.   It is  usually employed in the form of the
acidum sulphuricum aromaticum,  or elixir of vitriol.
Made into an ointment with lard, it forms a very effica-
cious application in diseases of this  kind.  In this way  I
have repeatedly employed it with prompt success in the
itch. I have also cured  a distressing case of prurigo for-
micans, by the external and internal use of this remedy
alone.   The ointment is made by simply incorporating
the acid with lard, in the proportion of about thirty
drops to an  ounce of the  latter.
   Quite recently  I have been informed by Dr. J. R.
Lucas, of Brunswick, Virginia, that the  sulphuric acid,
properly diluted, forms an exceedingly efficacious injec-
tion in gonorrhoea.f   I  have tried it in one instance
with success.  About eight drops of the acid should be
mixed with eight  ounces of water,  when used for this
purpose.

   * London Medical and Physical Journal, for July, 1822, vol.
xlvii. p. 483.
   X American Medical Recorder, for October, 1822. 
                CHAPTER VIII.

MEDICINES WHOSE ACTION IS PRINCIPALLY DIRECTED
             TO THE UTERINE SYSTEM.
 I. Medicines that promote the Menstrual Discharge.

                EMMENAGOGUES.

   Under this class are arranged such remedies as are
supposed to be capable of promoting the menstrual dis-
charge.  It is very doubtful, however,  whether any of
the articles which have hitherto been employed for this
purpose, possess any direct  influence over the uterine
secretions.   We know, at least, that their emmenagogue
effects are very uncertain; and that remedies  of the
most opposite character do occasionally, under peculiar
circumstances, produce such effects.
   That the menstrual  discharge is a secretion, and not
a mere  effusion  of blood from the  extremities of the
uterine vessels, is an opinion now pretty generally enter-
tained.   This opinion is distinctly expressed by Allen,
in a quotation from an  author whom he does  not men-
tion.  " I dare assert," says he, " that the menses  pro-
ceed entirely from the  superfluous chyle concocted  into
a viscid humour, which by degrees mixes with the mass
of blood, and, as is well known of all  the several other
secretions, is separated  by the glands situated therefor
that very purpose, as manifestly appears on the dissection
of those parts.  The  menses  are  considerably  more 
EMMENAGOGUES.               393
viscid and thick than the rest of the blood, and have ge-
nerally an ungrateful and  unusual smell, very different
from what is drawn off  by bleeding,  or  flows from an
haemorrhage."* Bordeu, too, in his invaluable Treatise
on the Glandsf advances the same opinion.
  Whatever opinion  we  may adopt  in relation  to the
nature of this evacuation, certain  it is, that whenever it
becomes irregular or  suppressed,  the  health always suf-
fers more or less disturbance. Even the peculiar destiny
of the sex,—the noble prerogative of becoming mothers,
is destroyed, and with it, often, the tenderest hope of
the female.
   I have already said that it does not appear probable
that any of our emmenagogues exert  any direct action
upon the uterus.   If this  were  the  case, we might, I
think, calculate with much more  certainty, on the ope-
ration of these remedies, than experience teaches us to
do.   If  we  attend particularly to the effects of these
articles, we discover that many of them have a decided
tendency to increase the flow of blood to the pelvic vis-
cera generally.  This is also the case with some  other
means occasionally resorted to  for the restoration of ob-
structed catamenia, and which cannot be properly placed
under the head of emmenagogues.   Thus ligatures on
the thighs, the semicupium, and fomentations to the ex-
ternal parts of generation, can only act  by creating a
local plethora in the vessels of the pelvic viscera, and
consequently of the uterus.  I have known the extirpa-
tion of  large haemorrhoidal tumours to restore suppress-
 ed catamenia, by which  the local drain of blood from
 these parts was removed, and the ordinary fulness of the

   * Synopsis Medicinae, vol. ii. p. 232.
   j- Traite des Glandes.
    VOL.  I.—52 
394
EMMENAGOGUES.
uterine vessels re-established.  It is not necessary that
we should regard the menstrual discharge as a mere ef-
fusion of blood, arising from local  uterine plethora, in
order to admit this explanation of the modus operandi of
emmenagogues.   The phenomena are perfectly compa-
tible with our notions of the secreted nature of the men-
strual discharge.  There is an intimate relation  between
the degree of exaltation in the vital properties of a part,
and the quantity of blood circulating through it.   We
find, accordingly, that whatever increases the  flow of
blood to a gland,  increases also its  secretion.  It is in
this way, perhaps, that all irritations increase the pecu-
liar secretions of  the  organs to which they are applied.
They produce an immediate flow of blood to the organs
irritated, the vital properties of which are thereby ele-
vated, and a larger secretion of their peculiar fluid takes
place.
   We can, therefore,  readily understand how an  in-
creased determination of blood to the pelvic viscera may
very often remove torpor in the uterine vessels,  and thus
restore the suppressed catamenia.  Although emmena-
gogues are a class of remedies  expressly  set  apart as
means for removing catamenial obstruction, they yet, in
reality, constitute but a small portion of our remediate
resources in such cases.  In a very great number of in-
stances we find it necessary to have recourse to general
remedies, to the exclusion of such articles as are techni-
cally denominated emmenagogues.  If, for example, the
catamenia cease to flow in consequence of a general re-
laxation or debility  of the system, our best  curative
means, of course, are such as invigorate the vital powers.
Hence, tonics, exercise, the cold bath,  an invigorating
diet,  &c.  do occasionally produce the best effects in
cases of obstructed menstruation.   A suppression of the 
EMMENAGOGUES.
395
menses is also frequently attended by a state of the sys-
tem directly the reverse of that of debility and relaxa-
tion.  There is a rigidity of  fibre unfavourable to the
regular performance of some of the organic functions;
the habit is full and inflammatory, and though apparent-
ly vigorous, easily subdued by any unusual exertion.  In
cases of  this kind, all the stimulating emmenagogues
would, without the use of previous depletory measures,
not only  be ineffectual, but injurious.  Bleeding, a tem-
perate diet, tepid bath, &c. are  here the proper reme-
dies ; and they often restore  the regular evacuation of
the catamenia, in a prompt and effectual manner.
   In prescribing,  therefore, for  suppression  of the
menses, it is of the utmost consequence that we attend
to the general state of the system.   Without such atten-
tion, indeed, our success must not only be  extremely
precarious, but our  remedies very often  increase the
mischief we are called upon to remedy,
   Alibert  justly observes, that there are few disorders
which depend on such a variety of causes, or are con-
nected with such different conditions of the general sys-
tem, as obstructed catamenia.  Hence, its remedies are
so various, and  often  of such contrary character;  and
hence, too, the great uncertainty of all our  remediate
measures in such cases.
               RADIX HELLEBORI NIGRI.

  The plant which furnishes this article is indigenous
to the Austrian Alps, the Appenines, and the Pyrenees.
The root, which is the only part employed in medicine,
consists of numerous black fibres, springing from knotty 
396
RADIX HELLEBORI NIGRI.
branches, which issue out of a central radical tuber.  Its
taste is acrid, bitter, and nauseous, and, when  chewed,
it imparts a benumbed feeling to the tongue.*
   Water and alcohol draw from it a bitter and acrid ex-
tract.  According to the analysis of Vauquelin, its con-
stituent principles are,  a very acrid essential oil, a small
portion of  extractive matter, fsecula,  a vegeto-animal
substance, and salts.
   Geise considered the acrid oleo-sethereal fluid  as a
peculiar principle, to which  he gave the name of helle-
borinum.   According to Pfaff, however, this substance
approaches more  to  the character  of a resin than to an
essential oil.    It is best extracted by alcohol, and is dis-
tinguished by its  leaving an exceedingly acrid taste in
the back part of the  mouth and fauces when chewed.f
   The root loses it active properties by age. Its fibrous

  * The root of black hellebore is not unfrequently adulterated by
other roots, some of which  are powerfully poisonous.  The roots
of the  adonis vernalis,  trollius europseus, actas spicata, astrantia
major, helleborus fastidus, veratrum alcum, and aconitum neomon-
tanum, are occasionally  mixed with or entirely substituted for it.
The root of the  adonis vernalis may be distinguished from that of
the black hellebore by the fibres not issuing from branches, but im-
mediately springing from a central tuber ; they are also more nu-
merous and more fleshy, externally darker and internally whiter,
than those of the hellebore.   The principal root of helleborus fce-
tidus is thin, not knotty, nearly  straight, with fewer fibres, which
are short, very black, and much more acrid than those of helleborus
niger.  The root of actcea spicata is spindle-shaped,.jointed, yellow
within, with woody fibres.  Trollius europaeus has a very  short
radical tuber with branched fibres, which have neither taste  nor
smell when dry.   The root of astrantia major is articulated, spindle-
formed, and slightly acrid.   That of aconitum napellus is roundish,
spindle-shaped.
   t PfafPs Mat. Med. torn.  iii. p. 253. 
RADIX HELLEBORI N1GRI.
397
are much  more powerful  than  its knotty or tuberous
parts.
   This is one of the most ancient articles of the materia
medica.   Ctesias,  who lived in the time  of Plato, and
anterior to Hippocrates, speaks of it as a medicine  of
important  virtues.   It was particularly celebrated with
the Greek and  Roman physicians as a remedy in mania.
The extraordinary cures peformed at the island of An-
ticyrus, famous for its hellebore, are celebrated by the
poets and historians of antiquity.   The doses which the
ancients employed were, however, much largerthan we
would venture upon at the present day, and its effects
accordingly were often excessively violent.  It appears
indeed, by the accounts which have reached us of the
employment of this article among the ancients, that they
never expected to cure, without producing with it symp-
toms of a very violent character.   Hence Oribasius, in
his treatise on the use of hellebore, has  two chapters,
entitled " Quae faciendum sit quum strangulatio occupat
eos  qui Elleborum sumpserunt," and " Quae fasiendum
sit ubi vox et sensus ammittitur."*
   When given to animals in large doses, hellebore pro-
 duces the following effects: slow and difficult respiration;
 slowness and sometimes irregularity of pulse; vomiting
 of mucous and bilious matter; an increased flow of sali-
 va ;  trembling and unsteadiness; vertigo;  convulsions
 followed by tetanus, and diminution of heat.   The ani-
 mal  finally becomes cold,  respires after long intervals,
 and dies.f  From a variety of experiments  performed

   * Medical Sketches, by G. Kerr, p. 22.
   X A Memoir upon the Effects of Helleborus Niger and Albus, by
 M. Schabel, of Weissenburg, read in Sept. 1818, to  the Society of
 Emulation, of Paris. 
398
RADIX HELLEBORI NIGR1.
 by M. Orfila on dogs, he concludes, 1. That powdered
 hellebore, applied to the cellular texture, is rapidly ab-
 sorbed into the circulation;  2. That its local effects are
 confined to the production of slight inflammation;  3.
 That " the part which is soluble in water is that  in
 which the poisonous property of the hellebore resides;"
 4. That the alkaline extract of black hellebore, which
 forms part of Bacher's tonic pills, is also extremely ac-
 tive.*
   When taken into  the human stomach it manifestly
 increases the force and rapidity  of the circulation, and
 excites a sensation of warmth throughout the whole body.
 When taken in large and repeated doses, its effects are
 often, as I have already stated, very violent.  Indepen-
 dent of the powerful vomiting and  purging which this
 article is known sometimes to produce, its long use occa-
 sions a singular feeling of coldness in  the abdomen, mus-
 cular debility, anxiety about the heart, slow and small
 pulse,  headach, stiffness of the muscles of the neck, pain
 in the  glands about the  throat, slimy whitish mucous
 discharges from the bowels, spasms, delirium,  haemorr-
 hages, &c.f
  The  emmenagogue  virtues  of this article remained
 unnoticed until the celebrated Mead announced them to
 the public.   As is usual with those who introduce new
 remedies, he lavished  the most extravagant encomiums
 on the emmenagogue powers of this substance.   On the
 continent of Europe,  especially with the Germans,  this

  * System of Toxicology,  by M. P. Orfila, M. D. translated  by
J. G. Nancrede, p. 208.
  f Buchner de salutarii et noxio Ellebori Nigri  usu. Halae, 1748.
Burdach's System der Arzneymittellehre, vol. iii. p. 124. Hartman
de virtute Hellebori Nigri. 
RADIX HELLEBORI NIGRI.
399
 remedy stands in no small repute.   But in England,  as
 well as in this country, the authority of Cullen, who re-
 garded it as nearly inert in this way, has thrown it into
 unmerited neglect.
   It seems to me quite certain, however, that both Mead
 and Cullen were wrong in their estimates of the powers
 of this medicine, and that it is entitled neither to the ex-
 travagant praises of the one, nor the unqualified condem-
 nation of the other.  Indeed, within a few years past, its
 reputation as an article of the materia  medica seems to
 he again advancing.
   Hellebore appears to possess a very considerable ten-
 dency to determine the circulation  to the  hypogastric
 and pelvic viscera.   This  is evinced  by the sense  of
 weight and  pain which  patients generally experience
 after having taken it for some days; I have known this
 determination to be  so great as to  produce  a profuse
 haimorrhagy from the uterus.
   From its stimulant properties, one would be led to re-
 gard it as inapplicable to  cases where there  is a fulness
 of habit, or  in a sanguine  constitution.  Yet  Mead,
 Lewis, and other eminent writers say, that it  is precisely
in such  cases  that its emmenagogue virtues  are most
conspicuous.  Burdach, however, in his excellent work
on  the  materia medica, asserts that  it is particularly
valuable  in cases of torpor, where the face is pale and
leucophlegmatic, and the pulse  soft.  To  this  latter
opinion I am inclined myself; at least, my own  expe-
rience goes directly in favour of it, independently of the
theoretical considerations which point that way.
  In a recent work on the materia medica,* it is stated

     * Elements of Therapeutics, &c. by Dr. N. Chapman. 
400
RADIX HBLLEBORI NIGRI.
that  it  is especially useful  as an emmenagogue when it
purges, in cases attended with torpor and constipation
of the bowels, and " perhaps with a degree of insensibi-
lity of the uterus."  My own experience, however, leads
me to a contrary conclusion.   It does not appear to me
that  its cathartic effects  are, under any circumstances,
necessary, or even accessory to the attainment of its em-
menagogue results.  I have been much in the habit of
employing this article in amenorrhoea, and it has always
appeared to me,  that, whenever it purged freely, as it
generally does when  it purges at all, it was  less apt to
evince the desired effects.  If, indeed, its emmenagogue
powers depend  upon its tendency to produce a  local
plethora in  the  uterine system, we can  easily imagine
how an active catharsis should lessen  these effects.
   It may be exhibited in  substance,  or  in  the form of
extract, infusion, or tincture.   The extract is given in
the dose of from six to ten  grains. The tincture is most
commonly employed ; its dose is from twenty to forty
drops, two or three times  a day, in a cup of some aro-
matic tea, such as rosemary, pennyroyal, &c. Bacher's
pills answer extremely well. They are composed of equal
parts of the extract  of  hellebore, myrrh,  with a small
portion of carduus benedictus.
   Given as an hydragogue, these pills have been taken
 to the extent of thirty a  day, in three doses of ten each,
 at the distance of an hour between every dose. Taken in
 this way they produce very copious evacuations by stool
 and urine.   "During their use the patients must be en-
 joined to drink plentifully of mild liquids.   Upon a due
 attention to this  circumstance, viz. dilution,  the success
 of the remedy as an  hydragogue in a great measure de-
 pends." 
                  RADIX HELLEBORI NIGRI. *           401

                         Formula.
                       bacher's pills.
   Si.—Extract, hellebori nigr.
       Ext. myrrh, aq.      aa ?i.
       Pulv. card, bened.       3iii.—M.  ft.   Divide into  one
grain pills.
   R.—Tinct. hellebor. nigr. 5i.
       ----  aloes soccot.  5ss.
       ----  opii          3i.—M.  Dose, a tea-spoonful three
times daily.
   R.-—Tinct. hellebor. nigr.
       ----  secale cornut. aa ^ss.—M.  Dose, a tea-spoonful
three times daily.
   R.—Extract, hellebor. nigr.
       ----   sabinae       aa 3i.
       ----   aloes soccot.    3ss.—M. Divide into three grain
pills.   Take one twice daily.
                    JUNIPERUS SABINA.
   Savin is a small evergreen tree, of the cedar species,
indigenous to Italy, Portugal, and Switzerland, where it
grows  in elevated situations in considerable abundance.
It is cultivated, with us, in gardens, and  is perhaps, of
all other articles of this class, the most commonly known
for its emmenagogue virtues.
   Its leaves contain a  large portion of  a very pungent
essential oil, to which the medicinal virtues of the plant
may be  fairly ascribed.
   When taken internally it powerfully excites the vas-
cular system.   It  produces a manifest flow of blood to
the uterine system; and, when taken in large doses, oc-
casions great heat, agitation, haemorrhage, and inflam-
mation of the bowels.
  vol. i.—53 
402
JUNIPERUS  SAB1NA.
  The testimony of Dr. Home, of Edinburgh, is strong
in favour of the emmenagogue powers of this plant; and
until the time of Cullen, it was very generally regarded
as one of the most potent articles of this clas of reme-
dies.  By this writer, however, whose authority, though
great on all subjects,  has, perhaps, often  been too im-
plicitly received, the reputed emmenagogue virtues of
this substance were  considered  as unimportant.   It
therefore soon  fell into general disrepute  both in Eng-
land and in this country.
  When amenorrhoea depends on a relaxed state  of the
general system, or on an inactive and torpid condition of
the uterine system, the savin may be often very advan-
tageously employed.*  It need hardly be observed, that
its  great stimulant properties render it inapplicable in
cases attended with a high degree  of phlogistic diathesis.
   Wedekind,t a German writer of great respectability,
says, that this article may be applied with very  great
advantage in the treatment of that atonic, or relaxed state
of  the uterus, attended with an unnatural secretion and
soft swelling of this organ, which is sometimes met with
in  women of advanced age, who have suffered much from
repeated child-bearing or abortions, and which is gene-
rally attended with a train of hysteric  disturbances.
    I have occasionally employed  this article in cases of
 amenorrhoea, in females of a relaxed habit of body ; and,
 though sometimes without success, I have had sufficient
 evidence of its powers in this way to establish,  in  my
 opinion, its just claims to our attention.
    Savin has been employed in various other affections,

    * Bayler iiber die heilkraft. der sabina.  Burdach's Arzneymit-
 trllehre, vol. iii. p. 300.
    X Wedekind iiber die anwendung der sabinae by frauenzimer-
  krankheiten.  In Hufeland's Journal, vi. Bd.  1st. nr. 3. 
                 JUNirERUS SABINA.               403

in some of which its remediate powers seem to be very
considerable.   Rave, a German writer of respectability,
speaks in the  highest  terms of its use in chronic rheu-
matism.*  I have employed this remedy for more than
ten years past, in this disease, and I can truly say that
its good effects have, in my practice, often been surpris-
ingly prompt  and decisive.
   Savin, according to some writers, possesses active an-
thelmintic powers.f   From my  own experience I can
say nothing of its virtues in this respect.
   Werlhof speaks well of  this  article in caries of the
bones.   It has also been much extolled by some German
writers for  its remediate  powers when applied to old
and obstinate ulcers,  either in the form of decoction or
of poultice.  As an  escharotic  application to venereal
warts  and other fungous  excrescences, the powdered
savin is not unfrequently  employed.  And an ointment
made of it is one of the most excellent applications we
possess for keeping up a discharge from a blistered sur-
face.
   It is given in substance in the dose of from one to two
scruples three or four times a day.  It is almost impos-
sible  to  pulverize it  without  previously  drying it in a
high  degree of heat; and, as the active part is an essen-
tial oil,  very readily volatilized by heat, the powder is
always an improper  form for exhibiting it.   The best
way is to beat it  up  with  honey or with any kind of
syrup, into the consistence of a conserve.   A decoction
of one ounce of the leaves to one pint of water, boiled
down to half a pint, with the addition of two  ounces of
syrup, may be conveniently given in the dose of a large
wine-glass full every two or  three  hours.   The oil is

   ■*• Uber die anwendung der Sabina by der gicht, &c. 1794.
   | Alibert.  Burdach. 
404                JUNIPERTJS SABINA.

given in doses of from one to six drops.  Hartman gives
the following prescription,  into which savin enters as a
most powerful emmenagogue:

         R.—Pulv. hellebor. nig. 9iv.
             Pulv. g. myrrh.
             Ferr. ammoniat.
             Extract, sabinae. aa 3ss.
  Syrup, croc. q. s. ut, fiant pilulee ponder, aa gran. una?.  Three to
be taken three or four times a day.*
  The compound tinct. of savin, L.  Ph. is given in the
dose of a drachm twice a day.

                        Formula.

  R.—Extract, sabinae  5i-
      Pulv. cantharid. 3SS«
      G. aloes socc.   '$\.   M.  Divide into  sixty pills.   Take
one three times daily.
  R.—Tinct. sabinae comp. ^i.
      -----aloes compos. 5ss.  M.  Take a tea-spoonful twice
daily.
  R.—Fol.  sabinae
      Rad. polygala aa  £ss.
      Aq. bullientis     ixrv»   Simmer down to ^xii.  Dose, a
table-spoonful four times daily.
           MENTHA PULEGIUM—PENNYROYAL.

  The plant which goes by the name of pennyroyal in
this country, is the cunilapulegoides, and not the men-
tha pulegium, as is commonly thought by those who are
not acquainted with botanical distinctions.  These two
plants, however, are so nearly allied to each other, both
* Thesaurus McdicaminumT p. 145. 
PENNYROYAL.
405
in botanical character and in their sensible  properties,
that we would be led, a priori, to expect, which in fact
appears to be the case, an entire similarity in their me-
dicinal powers.
  As a popular remedy for  suppressed menstruation
there is, perhaps, no other article so generally employ-
ed. Its emmenagogue virtues are, however, extremely
problematical.   Cullen considered it as perfectly useless
in this respect, although he thinks it of service in " the
dyspeptic  and spasmodic symptoms of the stomach,"
which some females experience about the period of men-
struation.   From my own experience I can say nothing
in favour of this article,  although I have  prescribed it
very frequently. As a vehicle for the exhibition of other
emmenagogue remedies, an infusion of the pennyroyal is
much in use in some parts of Europe, and in the interior
of our own countrv.
               ROSMARINUS OFFICINALIS.

  The rosemary is a plant well  known in this country
as a common garden shrub.   It is indigenous to Spain,
Italy, and the south of France.  Water draws from it a
bitter extractive matter.  A very odorous, resinous prin-
ciple  is  extracted  from  it by alcohol.  It also yields a
very pungent essential oil by distillation. Proust has dis-
covered a sixteenth part of  camphor  in  this oil.   M.
Margueron has found that oil  of rosemary decomposes
the  nitrate of mercury, the oxymuriate of mercury, the
yellow sulphate of mercury, and the caustic  muriate of 
406
ROSMARINUS OFFICINALIS.
antimony.* It is much in use as a domestic remedy for
obstructed catamenia, and it would appear from the tes-
timony of several respectable writers, that its powers as
an emmenagogue are not inconsiderable.  Cullen, how-
ever, attributes to it no virtues in this way.  Dr. Chap-
man, on the contrary, gives it a  better character, and
alleges that he has used it in several cases  " with une-
quivocal success."  Murray does not^ mention it as an
emmenagogue.   I have employed it in but a very  few
cases, and can therefore say but very little of it from my
own experience.
   As a warm, aromatic stimulant, it may  often be given
with much advantage in nervous disorders, sutoh as ver-
tigo, palsy, and  spasmodic pains of the stomach.   It has
also been extolled in the treatment of glandular  swell-
ings in infants.f  But its usefulness, says M. Alibert,$ is
particularly conspicuous in chlorosis, a disease which is
very generally complicated with a weakness of the abdo-
minal viscera, or an aberration of their sensibility. The
same author states, that a vinous infusion of this plant is
an excellent remedy in chronic diarrhoea.
   It is generally used in the form of  an  aqueous or vi-
nous infusion.  The essential oil is given from two to
ten drops, on sugar. Rosemary is a principal ingredient
of the preparation  known under the name of  Hungary
water.

   * Alibert, Matiere Med. vol. ii. p. 127.
   X J. C. Speis Rosmarini Historia Medica.  Helm, 1818.
   X Nouveaux Elemens de Therapeutique et de Matiere Medicalc,
vol. ii. p.  128. 
C  4or  )
             RUBIA TINCTORUM—MADDER.

  This is a perennial plant, and cultivated as an article
of commerce in different parts of Europe.   The root,
which is the only part of the plant  employed, is long,
slender, of a red colour, and succulent, with a white lig-
neous pith in the centre.   Its taste is slightly bitter and
somewhat austere, and imparts both its taste and colour-
ing principle to water.
  When given to animals with their food it soon gives
a red tinge to the bones and the urine.  Mr. Gibson* of
Manchester, has experimented largely with this article,
in relation to  its effects upon the bones and secretions
of animals, and he has established the fact that its  co-
louring principle is manifested only where it meets with
phosphate of lime,  which acts as a mordant in fixing and
evolving it.
   It is chiefly upon the evidence of Dr. Home in favour
of its emmenagogue virtues, that its claims to notice are
founded.   By this eminent physician it was regarded as
the safest and most powerful emmenagogue known.  He
asserts, that out of nineteen cases treated with this re-
medy fourteen were cured. By the late Dr. Barton, also,
it was thought to possess  no inconsiderable powers in
this way.  Respectable as these testimonies are, it is still
very doubtful  whether  this article possesses any such
powers.  Very few physicians employ it at the present
day ; and whatever may be its virtues, it does not possess
the confidence of the profession as a remediate article.

   * Transactions of the Manchester Literary and Philosophical
Society. 
408
MADDER.
I have employed it  frequently, but never derived the
slightest advantage from it.  It appears, indeed, to have
very little influence of any kind  upon the functions of
the animal economy;  nor has Cullen's  suspicion with
regard to its its supposed deleterious qualities ever been
confirmed.  It is given in substance, in the dose of from
9i. to 3ii.*
                  POLYGALA SENEGA.

   This plant, indigenous to the United Stated, is enti-
tled to very great attention for its various and important
medicinal virtues, whatever we may think of its powers
as an emmenagogue.
   Dr. Hartshorne, of this city, appears to have been the
first who noticed the emmenagogue virtues of this arti-
cle.  Dr. Chapman speaks  of it in the highest terms of
praise.  " Of all the emmenagogues which I have tried,"
says he, " this is the most efficacious,  and will be found
useful in all  forms of amenorrhoea."  And  again:  " I
have used  it  with sufficient success to  warrant  me  in
recommending it as one of the most active, certain, and
valuable of the emmenagogues."   From my own expe-
rience,  however,' as  well as from that of some of the
most respectable physicians of this city, I am led to a
very different estimate of the powers of this remedy as a

  * Dr. Colhoun informs me that he saw a case of amenorrhoea, in
the Pennsylvania Hospital, in which ^ss.  was given by mistake,
instead of 3ss.  It produced a slight discharge of blood from the
uterus. The  medicine may, therefore, be usually given in too
small a dose. 
POPYGALA SENEGA.
409
promoter of the menstrual discharge.   I have  tried it
repeatedly, but hitherto uniformly without success.   I
am not, however,  disposed to regard it as  wholly inert
in this respect.  The  testimony  in  favour of it is too
respectable to allow  me to doubt its occasionally mani-
festing such powers.  I am nevertheless  entirely con-
vinced that Dr. Chapman has expressed an opinion much
too favourable of its efficacy as an emmenagogue.
  It is best given in the form of decoction.   An ounce
of the bruised root to a pint of boiling water, and boiled
down one-third,  will make it sufficiently strong.  Three
or four ounces of this decoction  must be given during
the day.   It should  be commenced six or eight  days
previous to the regular period of menstruation,  and gra-
dually increased to as much as the stomach  will bear.*
                    CANTHARIDES.

  Agreeably-to the ideas given in the commencement
of this chapter, concerning the modus operandi of em-
menagogues, we should be led, a, priori, to expect such
virtues  in  cantharides: for  they have  undoubtedly a
very considerable tendency to determine the circulation
to the pelvic viscera.
  The  emmenagogue properties of cantharides have
been  noticed by  Allen, f Adair,%  Burdach.§   The
latter writer says:  " In  obstructions of the catamenia,

  * Chapman's Therapeutics and Materia Medica.
  X Synopsis Medicinae, vol. ii. p.  235.
  X Essays on Fashionable Diseases, &c.
  § System der Arzneymittellehre, B. iii. s. 107.
  vol.  I.—54 
410
CANTHARIDES.
arising from debility and torpor of the uterine system,
fly plasters laid on the lower part of the abdomen, or on
the sacrum, have been known to do good ;  or the tinc-
ture of  cantharides may be given  internally, in combi-
nation with tincture of aloes."   Adair recommends this
latter combination as very useful in amenorrhoea. Allen,
in enumerating a  variety  of emmenagogues, mentions
cantharides in union with camphor,  but makes no fur-
ther  observations as to the  powers  of this mixture.
Within  a few years past Dr. Joseph Klapp, of this city,
has directed  his attention particularly to  the emmena-
gogue virtues of this article, and has published the result
of his experience upon this  subject, furnishing thereby
much interesting evidence in favour of the existence  of
such properties in cantharides.*
  In my own practice I have found this article to display
very  decided emmenagogue virtues in several instances.
In the majority of cases, however, I have found it to fail
in common with other articles of this  class.f In exhibit-
ing this remedy, it is necessary to attend to the state of
the general system.  When the habit of body is full and
inflammatory, venesection ought always to be premised
to the exhibition of this medicine.  In cold and phleg-
matic temperaments, its action in  this way would seem
to be  most conspicuous.  It seems to be peculiarly adapt-
ed  to those cases  of amenorrhoea  which are  attended
with fluor albus.   In this affection it appears to do good
by  exciting the, mucous  membrane of the uterus and
vagina  to a new train of actions,   independently  of its

  * American Medical Recorder.
  | I was directed to the employment of cantharides, as an emme-
nagogue,  by Dr. Klapp's publication, prior  to  which I was not
aware that this article had ever been used for such purposes. 
CANTHARIDES.
411
powers to increase the determination of blood  to  these
parts.
  Twenty drops  of  the tincture is to be  given  three
times a day, and gradually increased until symptoms  of
strangury supervene.
                  ALOES EXTRACTUM.

   The natural history of this article has already been
 given under the head of Cathartics.  Agreeably to the
 opinion expressed in the beginning of this chapter, rela-
 tive to the modus  operandi of emmenagogues, there is
 no difficulty in perceiving how aloes should prove em-
 menagogue, independent  of any specific virtue in this
 way.  When speaking of this article before, its peculiar
 tendency to act upon and stimulate the rectum was par-
 ticularly pointed out.  The effect of such an irritation,
 by a well-known law of the animal economy—ubi irita-
 tio ibi fluxus—is, an afflux of blood to the rectum and
 neighbouring  organs.   Hence  the pernicious conse-
 quences  of aloetic purges in persons labouring under
 haemorrhoidal affections.   In cases of this kind it is ex-
 ceedingly apt  to bring on bleeding from  the tumours in
 the rectum, or, at least, to render  them turgid and in-
 flamed.   In males a long course of aloetic medicines
 seldom fails to bring on piles.  In females,  on the con-
 trary,  where  there is no  strong  tendency  to  hsemorr-
hoides,  it more commonly brings  on copious discharges
of blood from  the uterus, or in  amenorrhoea,  re-esta-
blishes the regular flow of the catamenia.  In patients
of a delicate and relaxed habit of body,  with  a consti-
pated condition of the bowels, we may often derive very 
412               ALOES  EXTRACTTJM.
great advantage from a combination of aloes,  steel, and
myrrh.  Where amenorrhoea  is connected with hae-
morrhois, which is not unfrequently the case, aloes is an
improper remedy.   Instead of re-establishing the men-
strual  discharge, it is apt to increase still further  the
haemorrhoidal affection ; and by thus establishing a more
copious discharge from the vessels of the rectum, a de-
rivation  from the uterine vessels, and with it a diminu-
tion of the menstrual effort takes  place.   In chlorotic
females small doses of aloes and iron will sometimes pro-
duce very happy effects.  I have known it to be pre-
scribed with prompt success in a case of amenorrhoea,
in combination with pulv. ipecacuanhse,  in  the propor-
tion of ten grains of aloes to  one grain of ipecacuanha,
every morning, noon, and evening.  The  semicupium
is an excellent auxiliary  to this, as,  indeed, it is to all
the other articles of this class.  It does not appear that
the emmenagogue effects of aloes is proportionate to its
cathartic  operation.   Small doses, just sufficient to un-
load the bowels, will, in general, do  better than such as
are large  and more active in their  purgative effects.

                        Formula.
   R.—Pil. aloes cum. myrrh.
       ---ferri comp.  aa 3i.
       Sodae sub-carbonat. 9i.—M. Divide into thirty pills. Dose,
 two twice daily.
   R.—G. aloes soccot. 3SS<
       Prussiat. ferri   5i.—M.   Divide   into  sixty  pills.—S.
 Take one three times daily.
   R.—Tinct. aloes compos. 5i.
        ----secale  cornut. 5ii.—M.  Dose, a tea-spoonful twice
 daily.  I have used this combination with prompt success in several
 instances. 
(  4ifr  )
II. Medicines that increase the Parturient Action of
                     the  Uterus.

                      ABORTIVA.

   As yet we know of but  one article which has any de-
cided tendency to excite  the  propulsive  efforts of the
gravid uterus, and this is the secale cornutum, or ergot.
   This article is a parasitic fungus, occupying the glumes
of the rye, [triticum secale,) of the  genus sclerotium, and
natural order fungi.   For an interesting  account of its
natural history, the reader is referred to a paper by Dr.
William Tully, published in Silliman's Journal of Science
and the Arts,  vol.  ii. p. 48.
   There is no article of the materia medica more emi-
nently calculated to excite our admiration of that won-
derful and mysterious connexion of the various organs of
the animal economy, by which a slight impression upon
one part is instantly propagated  to another, and there
manifested often by the most vehement actions.
   Taken internally in a large dose, it excites nausea and
vomiting, attended sometimes with vertigo, pain in the
head, and increased excitement  of the vascular system.
Its power, however, of increasing the parturient efforts
of the womb, is by far its most  prominent and important
character.  As a partus accelerator, it stands alone in
the materia medica, and is  capable, by its prompt and
certain operation, of affording the most happy results, in
the hands of a cautious and judicious practitioner.
   When  labour is protracted  in consequence of feeble
or irregular contractions of  the  uterus, this medicine, 
414
ABORTIVA.
*  administered under due precautions, hardly ever fails to
   excite vigorous and effectual contractions.  In a large
   majority of cases the ergot may, indeed, be regarded as
   a very fit substitute for the forceps and vectis.   When
   once the uterus is under its influence, the parturient ef-
   forts generally continue  uninterruptedly ;  the contrac-
   tions of the womb  never totally cease,  but keep up a
   constant propulsive effort.   It commonly manifests its
   operation in twenty or thirty minutes after its exhibition.
   Sometimes, however, the effects do not show themselves
   until a much longer time has elapsed.  The force of the
   contractions are often surprisingly vehement; and it is,
   therefore, obvious that this medicine cannot  be given
   indiscriminately, or without a proper regard to circum-
   stances.   Should it be improperly given, before the os
   uteri is soft and in a state to dilate, or has already consi-
   derably dilated, rupture of the wound might ensue.
    If the mouth of the uterus is considerably dilated, and
   no particular rigidity of the external  parts present, it
   may be  given with perfect safety and with almost a cer-
   tainty of success.
    By some physicians it is supposed that this article ex-
   erts  a deleterious influence  on the foetus: the  life of
   which, they assert, it not unfrequently destroys.  If this
   be true, it  forms, indeed, a very serious objection to its
   employment.  My own experience with this article has
   not been sufficient to enable me to speak with confidence
   upon this point.  I suspect, however, from what  I have
   myself seen, and from the detailed experience of others,
   that there is no good  foundation for this opinion,  and
   that the cases which have been recorded by some prac-
   titioners, as demonstrative of its injurious effects,*  are
* Vide Dr. Chatart's paper in the Med. Repos. for 1820. 
A110RT1VA.                   415
 to be considered in the light of accidental coincidences,
 rather than the positive results of the medicine.*
    The cases to which it seems  particularly applicable,
 are:
    1. Where abortion  becomes  inevitable  in  the early
 part of pregnancy, and the  contractions are feeble with
 considerable haemorrhage.   In such cases the exhibition
 of this article will not only shorten the sufferings of  the
 patient, but in a great degree remove the danger.
   2.  In cases of alarming haemorrhage near the close of
 utero-gestation, not occasioned by attachment of the pla-
 centa over the os uteri, and not accompanied by efficient
 contractions.
   3. In puerperal  convulsions in which a  speedy deli-
 very becomes necessary.
   4. In lingering labour,  the os uteri being sufficiently
 dilated, and the parts properly relaxed.
   5. In retention of the placenta from a want of contrac-
 tion of the  uterus.
   6. " In subjects liable to haemorrhage after delivery
 from laxity and deficiency of contraction."!   In such
 cases the hsemorrhagy may be entirely prevented by the
 exhibition  of a  proper dose of  ergot  fifteen  or thirty

  * Dr. Hosack,  speaking of this article, says:  " The ergot  has
been called,  in some of the books, from its effects in hastening la-
bour, the pulvis ad partum; as it  regards  the child, it'may, with
almost equal  truth, be denominated the pulvis ad mortem—for I be-
lieve its operation, when sufficient to expel the child, in cases where
nature is alone unequal to the task, is to produce so violent a con-
traction of the womb, and consequent convolution and compression
of the uterine vessels, as  very  much to impede, if not totally to in-
terrupt the circulation between the mother and child."—New-York
Med. and Phys. Jour. vol. i. p. 206.
  X  Dr. E.  A. Atlee.   Vide American Med. Recorder, vol.  iv.
p. 141.
                   L 
*
416                  ABORTIVA.

minutes previous to the time when labour would other-
wise be expected to terminate.
  7. To restrain haemorrhagy after delivery.
  Ergot has been recommended as an emmenagogue,
but I believe  upon a very slender foundation.  I have
prescribed it in four cases, with a view to its emmena-
gogue effects, but without the least advantage. It seems,
indeed, to exert very little influence on the vascular sys-
tem ; and when we consider, that as an uteri contractor,
it  must  tend  rather  to diminish  than  to  increase the
quantity of  blood in the vessels of the womb, its emme-
nagogue powers will at once appear very doubtful.
  This article was used,  out of the profession, as a pro-
moter of parturition, more than a century ago.   In re-
gular practice, however, it  was not known until Dr.
Stearns, of Albany, brought its virtues before the pub-
lic ; and to him, therefore, belongs the merit of having
first directed the attention of medical men to the extra-
ordinary powers of this article.
   In Europe it was at one time regarded as a powerful
and extensive cause of  disease.  Epidemics of a very
fatal character were ascribed to the effects  of the ergot,
mixed  with the rye which was  ground up for  bread
stuff.   What foundation  there  is for this opinion I can-
not undertake to  say.  It  appears to me unphilosophi-
cal, however, to account for epidemics by ascribing them
 to a cause which must be always, in a degree, present.
END OF VOL. I. 
 
 
 
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