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FOURTH EDITION, MUCH ENLARGED AND CORRECTED. ., ^ -»■■. it f- 'j * Jlhlia'&tphfa: GRIGG & ELLIOT, 9 NORTH FOURTH STREET. 1834- v/ ' Entered according to the act of congress, in the year 1834, by John Grigg, in the office of the clerk of the district court of the eastern district of Pennsylvania. Philadelphia: T. K. Collins & Co., Printers, No. 6, George Street. ADVERTISEMENT TO THE FOURTH EDITION. In preparing the present Edition of this work for publication, the Author has spared no efforts to make it as correct and complete as his means and abilities admitted, and to give it renewed claims to the confi- dence and patronage of the profession. In relation to the natural history and chemical character of many of the articles treated of, much correction was neces- sary. Such has been the progress of botanical and c chemical researches in relation to the Materia Medica, that a work which, but a few years ago, might have exhibited a satisfactory account of the existing know- ledge on these subjects, must now be regarded as deficient,' and abundarft in error. Upon these points, the author has availed himself freely of the various and accurate information embodied in the Dispensa- tory op the United States, by Drs. Wood and Bache, undoubtedly the most accurate, comprehensive, and, in all respects, excellent publication, of the kind, extant IV ADVERTISEMENT. in the English language. Besides a great many new facts and observations, introduced into the text of the present edition, the chapters on Iodine, Cahinca, Arte- masii vulgaris, Salicine, Polygonum hydropiper, and Disma crenata, are now, for the first time, added to the work. INTRODUCTION. When we fix our attention upon a diversity of mixed objects, we naturally, and almost unconsciously, begin our inquiries by separating them into groups or families, according to their various analogies or re- semblances. We thus obtain a general view of their common and partial relations; and are thereby better enabled to investigate their individual characters, as well as to retain what we have learned concerning them, by the influence of association. We become systematic from the very constitution of the human mind. To classify our ideas is the first step we make towards useful knowledge; and the highest attainments of intellect are but a more extensive and intimate view of the various relations which subsist between the ob- jects 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 exceed- ingly various and dissimilar. It is obvious, however, that the classification which includes the greatest num- ber of the conspicuous and constant relations of objects, IV INTRODUCTION. must best answer the purposes of such arrangement. The difficulty lies in fixing upon the strongest, most constant, and universal points of resemblance, and to bring them together under such a scheme of arrange- ment as will exhibit them in the order of their most essential 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 themselves. In med- ical science, however, we are obliged to enter upon a much more extensive and perplexing range of compa- rison. Here we must keep in view not only the rela- tions 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 ma- teria medica; and hence the great imperfection 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 re- ject all systematic arrangement, and to describe reme- diate substances in an alphabetical order. This simple mode of arrangement, it must be confessed, possesses advantages which cannot be obtained by more artificial classification. We are particularly enabled thereby to exhibit a connected view of all the remedial qualities and therapeutic applications of each individual article, INTRODUCTION. V without the frequent repetitions so unavoidable under every other known system of classification. But to counterbalance this advantage, which, in reality, is of no essential importance, we lose sight, by the adoption of such an arrangement, of those general physio- logical and therapeutic relations between the living body and remedies, which, in themselves highly inter- esting, 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 che- mical analogies alone. Burdach uses this mode of classification; but his system is exceedingly complica- ted and imperfect. Arrangements of the materia me- dica founded exclusively on the physical properties of medicine are even more objectionable, in every point of view, than the alphabetical order. Without throw- ing the least light on their therapeutic relations, they are necessarily very complex in their structure, and often bring articles together of the most opposite re- medial properties. Cullen's arrangement, which is principally founded upon the general effects of medici- nal agents, and partly, also, in its minor sub-divisions, upon their physical relations, is still viewed by many, and I believe, justly too, as the most perfect classifica- tion 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 ef- fects of medicinal substances, and which may be used with peculiar propriety as the basis of classic distinc- tions. Observation teaches us, for instance, that cer- VI INTRODUCTION. tain remedies direct their action specifically upon certain organs or structures in the animal economy. These specific affinities between external agents and the va- rious parts of the living body are fundamental, and their notice is essential to a comprehensive and philo- sophical scheme of arrangement. Cullen, however, overlooked these particular views of the action of re- medies, and founded his system on their ultimate me- dicinal effects alone. Thus the effect of opium in the living system is sleep. The medicine is, therefore, placed in the class of narcotics. This is well, so far as it goes. By this arrangement we at once know the general character of the effect; but we are not informed as to the particular organ or structure which is princi- pally influenced, and by the peculiar excitement of which the more manifest effects are produced. If, how- ever, we place the narcotics, as a genus, under the primary class of "medicines whose action 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 at- tending to this latter object, adopted a classification founded entirely upon the relations which remedial agents bear to particular organs or structures, or, in other words, on their specific tendencies to affect par- ticular parts of the organization. His arrangement is, however, still more objectionable than that of Cullen. It exhibits, it is true, an interesting physiological view of the connexions which subsist between medicinal INTRODUCTION. Vll agents and the various subordinate systems in the liv- ing economy; but it is deficient in the more useful practical distinctions derived from the ultimate effects of remedies, constituting the basis of Cullen's classifica- tion. More recently, Dr. Granville, of England, has pro- posed .a new classification of the materia medica, 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 particular organs, or systems of structure; and the old divisions of tonics, cathartics, &c, are introduced as secondary distinctions. This plan of arranging the materia medica appears to me to be superior to any that has hitherto been proposed. Dr. Granville has not, however, been altogether success- ful, 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 " medicines that act specifically upon the digestive organs;" whereas this genus undoubtedly belongs to his third class, which comprises those " medicines that act specifically on the circulating system." It may be said, however, that remediate agents of the stimulant class produce their effects upon the circulatory system, by a specific action primarily exerted upon the stomach; and that the loca- tion given to these medicines by Dr. Granville is, there- fore, proper. But although these remedies do certainly produce a primary excitement in the stomach, yet this * Vide London Med. and Phys. Journal, for April, 1822. Vlll INTRODUCTION. primary impression is constantly and specifically di- rected upon the circulatory system, where it alone 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 char- acter, which might be urged against the construction of this classification, although its general scheme is unquestionably very good. It forms the groundwork of the arrangement which I have adopted in this treatise, and of which, without any further comment, I subjoin the following synoptical view: 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 aliment- ary 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. INTRODUCTION. IX 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 efforts 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. Antispasmodics. E. Medicines whose action is principally manifested in the cir- culatory 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. Vol. I.—B x INTRODUCTION. I. Medicines calculated to increase the mucous secretion in the bronchia, and to promote its discharge. a. Expectorants. b. Inhalations. II. Medicines whose action is truly topical. a. Emollients. b. Escharotics. A TREATISE OF THE MATERIA MEDICA AND THERAPEUTICS. CHAPTER I. Observations on the General Modus Operandi of Medicines. The living economy is under the constant influence of extraneous agents, and subjected, by them, to an in- finite variety of impressions. Concerning the essential nature of their action, however, it would be in vain to inquire. All the information attainable, in relation to their modus operandi, is confined, perhaps, to a know- ledge of the organs upon which they primarily act; the medium through which their impressions are con- veyed throughout the system, and the successive order of the phenomena which result from their operation. The doctrines which prevail on this subject resolve themselves into the two following positions: I. All medicines act primarily on the solids; their impressions bein^ conveyed throughout the system by the agency of sympathy. 12 OBSERVATIONS, &C. II. 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 indisputable 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 perforin, it is evident that the brain and its appendages—the nerves, constitute this medium of connexion; for these alone receive and trans- mit impressions; and upon them, therefore, depend all those phenomena which are called sympathetic. The objection which has been made to this opinion, that sympathies 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 im- mediate influence of the sensorium commune, the brain; and that, therefore, all the parts of the body have a continuous nervous connexion with each other, through the medium of this common centre of feeling. That sympathetic actions are thus propagated through the system, may be inferred from the known laws of ner- vous excitement. An impression made on the nervous extremities of a part, is either altogether local or in- sulated in its effects, or it is communicated to the sen- sorium commune, whence it is reflected either upon the part in which the primary irritation exists, producing sensation in that part; or upon other parts, exciting in them new motions and feelings. OBSERVATIONS, &C. 13 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 absorbed 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 relic of the humoral 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 obser- vations concerning the so common want of success in detecting, in the blood, certain substances received into the stomach, or otherwise subjected to the action of the absorbents. Dr. Wollaston states, that he gave a per- son three and a-half grains of prussiate of potash re- peated 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 experi- ment is extremely 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 kidneys, no doubt, commenced throw- ing it off, as soon as any part of it was present in the circulation, it is obvious that but a very minute quan- 14 OBSERVATIONS, &C. tity indeed could, at any particular time, have existed in the blood. It is, therefore, 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 appeared in the urine, and con- sequently passed out of the circulation; for the portion of the prussiate present in the blood, was not only very small, but diffused, moreover, 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 experi- ments of professor Mackneven, it appears that it re- quires 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, sup- posing 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 re- garded as militating against the opinions I am advo- cating. 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 se- cretion, whilst in the serum it escapes our tests. It may also be observed, that the articles usually employed 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 cir- culation they are again thrown off by the emunctories; * Experiments for ascertaining the permanency of chemical com- pounds in their passage through the fluids, in the New York Medical and Physical Journal, June, 1822. OBSERVATIONS, &C. 15 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 substances, after having been received into the stomach, or injected into the cavity of the abdomen, may be detected in the mesenteric veins, vena porta- rum, 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 di- rectly into the veins just mentioned, it is evident that the substances which these lymphatics absorb and con- vey into the veins in question, must be in a much less diluted state than they can be after becoming mixed with the general circulating mass. If we admit the existence of venous absorption, 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 detected substances which had been thrown into the in- testines of animals. But not to dwell on the testimony offered upon this subject by the older writers, we are furnished with abundant evidence of this physiological fact by the researches of many of the most enlightened physiologists of the present day. The experiments of Mayer,t of Home, J of Magendie,§ and the more recent * Magendie, Emmert. X In Meckle's Archiv fur die Physiologie. X Philosoph. Trans, for 1811. § Precis Elementaire de Physiologie. 16 OBSERVATIONS, &C. and satisfactory researches of professors Tiedeman and Gmelin* do not leave any doubt on this point. The experiments of the two latter physiologists prove, in a direct and conclusive manner, that almost all the sub- stances usually found in the urine, after having been taken into the stomach, may be detected also by proper management, in the blood of the vena 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 report which these gentlemen have just published, it appears 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 potassa) experimented on, entered the circulation. In nearly every instance in which it was found in the blood, the contents of the tho- racic duct, if examined, exhibited it in a much more obvious degree."t Still more recently, professor Mac- neven, in the paper already quoted, has published the results of some experiments, which are entirely confirm- atory of those just mentioned. " I triturated," says he, " one drachm of crystallized hydrocyanate of po- tassa 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. * Versuche ubur die wege, auf welchen substanzen aus dem magen und Darmcanal ins blut gelangen, u. s. w. Von. F. Tiedeman, M. D. und L. Gmelin, M. D. Heidelberg, 1820. f Philadelphia Journal of the Medical and Physical Sciences, for Feb. 1822. OBSERVATIONS, &C. 17 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 receptacu- lum, 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 immediate consequence." In another experiment of this kind Dr. Macneven found that, " whenever the mesenteric vessels of the exter- nal coats of the intestines were lightly scratched with the scalpel and touched with the solution of permuriate of iron, a strong blue was immediately 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 observa- tions in evidence of the admission of foreign substances into the circulation. Emmert, an eminent German physiologist, relates an experiment,* in which he passed a ligature round the abdominal aorta of an animal, and inserted the prussic acid into its legs. The extremi- ties became cold, but some portion of contractility and sensibility remained. In seventy hours after its appli- cation the ligature was removed, and the effects of the poison immediately showed themselves. Similar ex- periments were performed with the poison woorara, by Mr. Brodie.t " 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 mode- * Archiv fur die Physiologie, Von I. F. Meckle. X Philosophical Magazine, June, 1811. Vol. I.—C 18 OBSERVATIONS, &C. rately tight on the forepart of the thigh. He thus inter- rupted 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 af- fected, 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 otherwise have done, but twenty minutes after the ligature was removed, he found him lying on one side, motionless and insensible, evidently under the influence of the poison." It appears, therefore, that the poisons employed in these experi- ments were not able to affect the system until they had entered the general circulation. Brodie's researches render it, indeed, extremely probable that woorara, as well as several other poisons, produce 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- cians, which go to prove the absorption of foreign sub- stances into the circulation. The effects of the internal use of nitrate of silver on the skin, strikingly illustrates 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 instances, quite a black colour, from the long continued use of this medicine.* It is well known, too, that medicines taken by nurses very often produce the same effects upon their suckling infants, as if these had taken the * Lond. Med. Reposit. vol. v. May, 1817. OBSERVATIONS, &C. 19 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 digestion and assimilation com- pletely decomposes all substances subjected to its in- fluence; that, consequently, 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 properties capable of producing remediate or morbific impressions, in consequence of disease or the admis- sion of certain substances into the circulation. When the milk, urine, flesh, &c. become impregnated with the peculiar qualities of substances taken into the stomach, the blood, from which these secretions are formed, must have contained either the substances themselves or their elements. It is evident, however, that blood which con- tains such elements, contains parts which do not belong to it in its natural and healthy state. Thus, in the in- stance given above, in relation to the discoloration of the skin by the internal use of the nitrate of silver, if 20 OBSERVATIONS, &C. this substance were previously decomposed, and again regenerated in the skin, as has been alleged, we should then have silver, oxygen, and azote floating each m a separate state in the blood, and without which no ni- trate of silver could possibly be afterwards regenerated in the cutaneous vessels. In opposition to the opinion that remediate substances enter the circulation in an active state, it is more- over asserted in a late work on the Materia Medica, that " chyle, however 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 gratuitous, and contradicted by direct expe- riment. Dr. Marcet found that chyle formed from vegetable food contains 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 putrefaction in three or four days, whilst that from vegetables remain unchanged for weeks, or even months. It appears also from these experiments, that chyle from animal food is milky, and on standing, becomes covered with a cream-like substance; whilst that from vegetable food is generally transparent, resembling common serum with a coagu- lum almost colourless, and does not collect a creamy substance on its surface.* There is, therefore, a very striking difference between the chyle formed from ani- mal 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 Medico-Chirurg. Transact, vol. vi. p. 630. OBSERVATIONS, &C. 21 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 sys- tem, not only without, fatal consequences, but with the same effects as if they had been taken internally. The experiments 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 into the blood-vessels; whereas, in the other, it passes into the veins, drop by drop, without any unnatural impetus, enveloped in bland and con- genial 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 sometimes produce the same injurious effects that follow the introduction of other articles in the same way. It has been said, also: " By the medication of the blood, were it possible, as is contended for, we must, in all instances, do harm. The whole mass of the circu- lating fluids is equally charged in this case with the medicinal substance, and therefore, while an action is? 22 OBSERVATIONS, &C. 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 hypothetical objection, I will oppose the ob- servations of one of the editors of the New York Medi- cal and Physical Journal. " That every organ in the body," says the writer, " has its peculiar and appro^ priate stimulus, by which it is excited into action, is so universally admitted as to require no process of reason- ing 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 sys- tem, without producing any particular effects until it reaches the organ upon which, from its peculiar pro- perties, 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, ope- rates upon the intestines, and not upon the brain and lungs,—we can no more explain than we can the rea- son why the planets are kept revolving in their orbits. If we are told that the movement of the planets are the result of attraction, so we may say that the deter- mination of medicines to certain organs is occasioned by a similar attraction. This, however, explains no- thing, and we must, after all, be content with the broad fact, that such phenomena do occur, and that they are governed by certain laws; but the cause why they occur must forever remain concealed." From the foregoing observations, therefore, it is, I think, perfectly evident, that medicines may produce remedial 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 INTESTINAL CANAL, OR UPON MORBIFIC MATTERS LODGED IN IT. I. Medicines that Excite Discharges from the Alimentary 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 phy- sician 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 vomiting. The conclusions which he drew from his experiments are: that in the act of vomiting the sto- mach is quiescent, and that its contents are ejected solely by being forcibly compressed between the dia- phragm and abdominal muscles. Magendie, without alluding to the experiments of Chirac, has drawn the same conclusions, from a set of experiments he has lately performed on this subject. The experiments of * Historie de 1' Academie Royale des Sciences, p. 12, an. 1700. 24 EMETICS. Haighton, on the contrary, seem to prove, very con- clusively, 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 enter- tained. There can, however, be but little doubt, that all the powers which have been mentioned, conspire to produce the act of vomiting. 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 speculations 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 inten- sity, 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 confirmation of this view of the subject, he refers to the vomiting produced by causes manifestly debilitat- ing, 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, in- deed, which it is but seldom allowed us to attain. When an agent is applied to the system, a longer or shorter train of actions take place intermediately between its EMETIC'S. 23 application and its ultimate or characteristic effect. In proportion as we trace the successive links in the chain of actions which proceeds from the operation of a re- medy, 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 sto- mach. This impression is immediately referred to the sensorium commune; in consequence of which its na- tural energies are diminished, as is evinced by the lan- guor of both the intellectual and corporeal powers. But as the sensation of an irritated organ depends, in real- ity, directly on a peculiar excitement in the sensorium commune, so we may infer, that the sensation of nausea is the immediate«and necessary result of the diminished and peculiar excitement of the brain, referred to the stomach. That this is, in fact, the case, is demon- strated by the vomiting and nausea which are sometimes excited at the sight, smell, taste, or even .the thought of a disgusting object. Here, however, our progress is arrested. For we can trace no necessary connexion between nausea and the mechanical process of vomit- ing. 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 con- cerned 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 nau- sea ; this gradually grows stronger and stronger, while the pulse becomes feeble, frequent, and irregular; the V<>. 1.—D 26 EMETICS. face turns pale, and the skin becomes cold and shrunk; vomiting 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- twrentieth of a grain of tart, antim. was sufficient to cause 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 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 duo- denum 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 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 seve- ral full evacuations have occurred, we may conclude * Cullen's Materia Medica. EMETICS. 27 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 dis- charges, until vomiting has continued for some time. In this case, the bile is probably furnished from the gall- bladder, which being compressed by the action of the diaphragm and abdominal muscles, during vomiting, pours its contents into the intestines, and thence into the stomach. 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 primae viae. Evacuation of the contents of tfce stomach is by no means the only remedial effect which may result from this class of medicinal agents. By agitating and com- pressing the contents of the abdominal viscera, vomit- ing gives an impulse to the portal circulation—an effect which, in certain diseases, connected with a sluggish and congested state of this system of blood-vessels, is often highly salutary. Emetics may moreover prove beneficial, by the general shock or excitement which they produce in the nervous system. It is by an influ- ence of this kind, perhaps, that they are sometimes capable of arresting the progress of febrile affections, when administered in their forming stage, while the morbid excitement is as yet principally confined to the nervous system. The operation of emetics is generally attended with an increased activity of the absorbents. The experiments of Magendie have established the physiological fact, that the rapidity of absorption bears an inverse ratio to the fulness and activity of the sanguiferous system. When the blood-vessels are in a state of repletion or 28 EMETICS. of vigorous action, absorption goes on very imperfect- ly; and, on the other hand, when the circulation is feeble, or the vessels in a state of depletion, the action of the absorbents is generally much increased. It is, doubtless, by an effect of this kind, namely, a reduction of the momentum of the circulation, that emetics in- crease the absorption of effused fluids. If this be the mode in which emetics increase absorption, it seems evident, that those articles of this class of remedies which cause the greatest degree of nausea, must be most efficient in reducing hydropic accumulations; for it is chiefly by the nausea which emetics produce, that they occasion any obvious reduction of the momentum of the circulation. At the same time that absorption is thus increased by an enfeebled state of the circula- tion, the reduction of effused fluids may be further in- creased by diminished exhalations; for it seems reason- able to presume, that when the action of the heart and arteries is materially diminished, exhalation, also, will suffer a corresponding decrease. In prescribing emetics, attention should be paid to the following circumstances: 1. Unless an urgent necessity exists for the immedi- ate evacuation of the contents of the stomach, emetics should be administered in under doses, repeated at short intervals, until the desired effect is produced. The susceptibility of the stomach to the. impressions of emetics, varies very greatly in different individuals, or in the same individual at different times. A dose scarcely sufficient to excite nausea, in one person, or at one time, would produce hyper-emesis in another, or in the same person at another time. By giving the emetic in small portions, repeated at suitable intervals, we may, in a great measure, control its operation, and produce the desired degree of emesis. EMETICS. 29 2. In plethoric subjects—in such as are predisposed to apoplexy, particularly when signs of undue fulness of the vessels of the head exi'st—and, in general,-where the momentum of the circulation is great, blood ought to be abstracted, previous to the administration of emetics. Without this precautionary measure, serious and even fatal accidents might result from the forcible propulsion of the blood into the brain, by the exertions attending the operation of an emetic. Apoplexy, palsy, and convulsions have thus been suddenly produced. 3. During the operation of an emetic, the patient should drink warm diluents, such as lukewarm water, chamomile tea, and weak infusion of eupatorium per- foliatum—more especially when the^ principal purpose is to procure the removal of offensive substances from the stomach. 4. The patient should be cautioned against-taking cold water during or soon after the operation of the emetic. I have known two instances of speedy death produced by cramp of the stomach, in consequence of a draught of cold water immediately after the operation of a dose of tartar emetic. 5. For at least twenty-four hours after the operation of an emetic, the diet should be simple, unirritating, digestible, and moderate in quantity. 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 nre indispensable, at some period or other of their pro- gross. 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 30 EMETICS. exhibited in the forming stage of the disease, they some- times arrest its progress in a very prompt manner. " Antimonial emetics," says Dr. Armstrong, "have been very generally recommended in typhus fever, and, ac- cording to my observation, are serviceable wrhen the fever is of the least complicated form, commonly pro- ducing an improvement 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 surface, and of changing the morbid states of the circulation, that their efficacy depends." In typhus pneumonica, I have derived much advan- tage from emetics. They appeared to be particularly serviceable where much distress and pain in the thorax, with signs of internal congestion, 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 suscep- tible to the operation of stimulants. " In the typhoid and typhus pneumonica," says professor Potter, " that occasioned such lamentable mortality, of late years, throughout the United States, emetics, judiciously em- ployed, were more beneficial than any other remedy. It was, indeed, a novel spectacle to those who were accustomed to unsheath the lancet in almost every thoracic affection, to behold a pneumonic fever, per- haps an haemoptoe, removed by the incantation 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, EMETICS. 31 injurious. In fevers of this character there is always a very strong tendency to inflammatory irritation of the mucous membrane of the alimentary canal; and, in nearly all cases, such a state of irritation or phlogosis occurs in the advanced periods of the disease. It seems obvious, therefore, that emetics cannot be resorted to in fevers of this kind, without considerable risk of doing injury; for it cannot be doubted, that where there is a strong tendency to mucous inflammation of the sto- mach, the irritating impressions of an emetic must tend, very materially, to promote the supervention of this unfavourable condition. General experience, in fact, has decided against the employment of emetics in fe- vers of this character, except, perhaps, in the forming stage, at which period they may, doubtless, often be useful, by the shock and a new excitement which they give to the nervous system, and by obviating or remov- ing internal visceral congestions. In intermittents, vomits are a very common remedy. They, indeed, sometimes put a stop to the disease, without the employment of any other medicine. There exists some difference of opinion with regard to the im- portance 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, render the subsequent employment of bark more certainly suc- cessful ; 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 impression of other remedies, and consequently to give them a greater chance of displaying their reme- dial powers. 32 EMETICS. In some of the exanthemata, emetics are often of essential service. They are especially useful in the early stage of scarlatina, both in its simple and malig- nant forms. 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 commencement of this disease, and by thus equal- ising 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, hi the Dictionaire des Sciences Medicales, also adds his testimony in favour of the use of emetics in this affec- tion. In general, however, emetics are improper in cases attended with dryness of the skin, much thirst, great heat of the epigastrium, and a high grade of fever. (Cazenave.) In cases attended with bitterness of the mouth, a yellow fur on the tongue, nausea, and a mo- derate temperature of the skin, they may generally be employed with considerable advantage. In the first stages of measles and small-pox, attended with strong internal congestions, the operation of an emetic often proves decidedly beneficial. " In the be- ginning of measles," says Dr. Armstrong, " when the lungs have been exceedingly oppressed, and particular- ly when vomiting has been absent, I have often seen the most striking relief follow an antimonial emetic, which may fairly be ranked among the most efficacious remedies in pulmonic congestions."t They are par- * Armstrong on Scarlet Fever, p. 35. , X Practical Observations on Scarlet Fever. Measles, and Pulmonary Consumption, p. 130. EMETICS. 33 ticularly useful in cases where, from great internal venous congestions, the appearance of the rash is re- tarded. In cases of this kind—that is, where the tem- perature of the skin is moderate, the pulse weak, and the animal functions depressed, about the period when the irruption of the exanthema may be expected, the operation of an emetic will often speedily develope the arterial excitement, and bring the measly rash. Emetics constitute an important auxiliary in the treatment of many of the phlegmasia?. 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 some- times 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 in the very commencement of the disease, and where the in- dications for their employment just mentioned are present. In the treatment of croup, emetics are of unques- tionable advantage. They are, indeed, altogether in- dispensable in managing this formidable malady, and will often procure effectual relief without any other re- medy. In slight attacks, vomits, assisted by the warm pediluvium, and the application of rubefacients to the throat, often suffice 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 an- chor. Whenever, therefore, vomiting and the warm bath do not afford effectual and speedy relief, immedi- ate recourse ought to be had to the lancet. The bleed- ing should be carried to the extent of producing a de- cided impression on the system. " In all the cases of Vol. I.—E 34 EMETICS. croup," says Dr. Ferriar, " which I have seen, I have found it necessary to bleed immediately, and when I have seen the patients 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 re- lief can be effected. Even if the patient should not be seen till the day succeeding the attack, it is proper to bleed ad deliquium, if the subject be plethoric, and the difficulty of breathing and restlessness be great."* In- dependent 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 in- sensibility 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 dis- charge of the viscid mucus secreted in the bronchia. In cynanche laryngea, undoubtedly the most fatal variety of anginose disease, vomits have been known to afford decided benefit. Dr. Armstrong recommends the employment of emetics in this fatal affection, as one of the most effectual means we possess of arrest- ing 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 frequent vomiting took place. No circum- stance of my professional life," he continues, " ever gratified me more than the great and sudden relief which the vomiting afforded; in reality it removed all * Ferriar's Medical Histories and Reflections, p. 137. Philadelphia edition, 1816. EMETICS. 35 the urgent symptoms at the time, and being excited as soon as ever the slightest signs of stricture in the la- rynx 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 internal venous congestions, emetics, in repeated but-gen tie doses, are among our most ef- ficient remedies. Large quantities of viscid phlegm are usually thrown up, and in many instances immedi- ate relief is obtained. After the operation of the emetic, suitable stimulants, such as small doses of opium and camphor, with some gentle diaphoretic drinks, should be given.f Of course, blisters to the chest are never to be neglected. They are indispensa- ble to relieve the local pulmonary affection. Emetics are no less useful in the treatment of pneu- monia biliosa, than in the preceding variety of pulmo- nic, inflammation. Richter\ says, that they will often remove the excruciating pain in the thorax, -as by en- chantment. Stoll§ also speaks in the highest terms of the utility of emetics in this form of pleurisy. Profes- sor Potter, of Baltimore, in an interesting paper pub- lished 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 frequently commences."|| Since the * Armstrong's Practical Illustrations on Typhus Fever. First Ameri- can edition, p. 336. X Richter's Specielle Therapie, vol. i. p. 427. X Ibid. vol. i. p. 404. § Ratio Medend. vol. i. || American Medical Recorder, vol. iv. p. 118. 36 EMETICS. 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 serviceable. Many respectable writers have spoken very favour- ably of the powers of emetics in the cure of acute rheu- matism. Horn* 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 rheu- matism, which occurs in low and marshy situations, and which Richter calls rheumatismus acutus gastricus, depending, according to Stoll, on an irritation from vitiated or redundant bile in the primae viae.t In this form of the disease emetics are generally decidedly 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."§ I have occasionally met with cases of acute rheuma- tism, attended with manifest bilious symptoms, and in these I have employed emetics with advantage. In the purely inflammatory form of this disease, modified by * Uber die heils. wirk. der Brechmittel in hitzigen rheumat D. Archiv. b. viii. st. 2. X Ratio Med. torn. ii. p. 25. X De aere et morb. clausthal. p. 30. § A Treatise on the Nature and Cure of Gout and Rheumatism, p. 298. EMETICS. 37 marsh miasmata, I have, however, never resorted to emetics, and can, therefore, say nothing from my own experience 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 obviously indicated." He mentions a case, however, in which the good effects of an emetic were strongly exemplified. Mr. Alexander Small, surgeon at Mi- norca, 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.* Mr. Saunderst was in the habit of employing tartar- ized' antimony so as to excite nausea, or full vomiting, in acute opthalmia, with great success. In that variety of inflammation of the eyes, called Egyptian opthalmia, Sir W. Adams speaks of the use of emetics in the strongest 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 ab- dominal viscera, employed them much in conjunction with the deobstruent pills which will be hereafter men- tioned, under the head of antispasmodics.^ Of the propriety of employing emetics in haemopty- sis, 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 opera- tion of an emetic, it is difficult, I apprehend, to enter * Observations on the Gout, by A. Small, late surgeon to the ordnance in the island of Minorca, in the Med. Observ. and Inquiries, vol. vi. p. 198. f A Treatise on some Practical Points relating to Diseases of the Eye, by I. C. Saunders. X Richter'* Medical and Surgical Observations, p. 254. 38 EMETICS. upon the employment of vomits for the cure of this variety of haemorrhage, as recommended by Dr. Bryan Robinson, without considerable fears as to the result. During the process of vomiting there is a strong im- pulse 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* Besides these effects, there is undoubtedly some impediment created to the passage of the blood through the abdominal aorta, in consequence of the action of the abdominal 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 con- siderable languor in the circulation occurs, which might favour the suppression of the haemorrhage; and if these remedies be exhibited 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 mischief than could be compen- sated by any advantage to be derived from the subse- quent languor. Cullen, indeed, who tried this practice, states, that in one instance 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 inju- rious effect in haemoptysis. During the act of vomit- * An Essay on the Materia Med. by J. Moore, p. 320. EMETICS. 39 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 diaphragm, 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 experience has taught us, are not only free from danger- ous consequences, but are very often of unquestionable service. .* 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 bil- ious discharges from the stomach; and had the effect, besides, of giving a very decided check to the haemor- rhage. Emetics have, also, been particularly recommended for the cure of haematemesis. Dr. Sheridan states, that, in a considerable number of instances of this variety of haemorrhage, he has obtained decided benefit from emetics; and Dr. Chapman has resorted to this prac- tice with unequivocal advantage. 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 40 EMETICS. 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.! 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 diar- rhoea, 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 the surface. In that species of mania which arises from the intem- perate, use of ardent spirits, emetics are sometimes decidedly efficacious. This practice was introduced a few years ago, by Dr. Joseph Clapp, of this city, who has published the resultf of his very extensive expe- rience 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, * Observations on the Nature and Cure of the Diseases of the East and West Indies. f Cleghorn's Observat. on the Epidem. of Minorca, p. 146. X Vide Eclect. Repertory, vol. vii. p. 251. Also American Medical Recorder, vol. ii. and iii. EMETICS. 41 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 produced, 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 treat- ment, unless extreme exhaustion or hypercatharsis be induced by the emetic. Emetics have also been much recommended in other varieties of mania, and in hypochondriasis. In the latter complaint I have employed them with evident ad- 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 alternated with alterative doses of blue pill, and an occasional saline purgative. Whatever be our notions concerning the pathology of hypochondriasis, observation has fully demonstrated the intimate con- nexion of its symptoms with the particular condition of the abdominal viscera. In this disease there generally exists much congestion in the portal vessels, with tor- por and functional derangement of the liver. By the Vol. I.—F 42 EMETICS. employment of these remedies, therefore, we not only evacuate the alimentary canal of its vitiated contents, but also invigorate the circulation in the portal system, both by the mechanical agitation of the vomiting, and the specific influence of-the mercury upo-n the vascular extremities of the hepatic system. In a case of puer- peral mania, I derived the most decided benefit from the employment of emetics. . The patient had been de- livered of her first child four days, when she began to manifest symptoms 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 replied that she was talking to good spi- rits 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 of any medicines. In this state she continued for three days, and then, all at once, became extremely lo- quacious. Her pulse was small and frequent, and the pupils of her eyes much contracted. Under these cir- cumstances, I ordered her an antimonial emetic, which brought on pretty copious vomiting. She became evi- dently much tranquillized by its operation, and seemed, at short intervals, to be sensible of her real situation. On the evening after the vomiting, I gave her an ano- dyne draught, which, however, 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 recovered the full possession of her mental faculties. In hysteria, also, emetics are often of unequivocal advantage. 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 EMETICS. 43 functions, or 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 remedy 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 direction 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- plaint, or so far interrupted the habits of diseased action in the stomach, that antispasmodic and tonic medicines would, in general, complete the cure."t 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 effi- cacious than any remedy ordinarily employed.":): In asthma emetics are sometimes highly useful. They not only assist materially in expelling the viscid mucus from the bronchia, but operate in a direct manner in * American Medical Recorder, vol. iv. p. 124. f Ibid. p. 259. X Transactions of the New York Physico-Medical Society, vol. i. 44 EMETICS. 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 produces this effect, is evident from the circumstances which take place during the act of vom- iting. 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 expanded to the utmost degree. The neces- sary 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 vomiting, 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. In 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 venesection. 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 tendency 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 apoplexy. This disease may, however, occur under EMETICS. 45 circumstances of gastric irritation, which will not only render the employment of an emetic useful, but abso- lutely indispensable. When, for instance, apoplexy comes on immediately after eating a full meal, it would be exceedingly unwise to suffer the stomach to remain oppressed and over-distended by what had been eaten. But even under such circumstances, a copious abstrac- tion of blood should always be premised, for the apo- plectic symptoms may as yet depend simply on tumes- cence of the vessels of the brain, which from the further impetus given to the blood by the efforts of vomiting, may become ruptured, and bring on fatal extravasation. The occurrence of this event will be rendered much less probable, if we lessen, to a considerable degree, the general mass of the blood previous to administering the emetic. Where there is no strong reason to suspect irritation in the stomach, either from over-distention or from the presence of some irritating substance, I can- not conceive what advantage could result from the administration of an emetic. If apoplexy be essen- tially connected with engorgement of the cerebral ves- sels, 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 46 EMETICS. varieties dependent on a difference in the remote causes. 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 irritation are present, such as nausea, flatulency, disturbed sleep, and other marks of indigestion, emetics are sometimes of essential import- ance. Dr. J. Clark advises, for this purpose, a solution of the sulphate of zinc in an aqueous infusion of ipe- cacuanha, to be repeated in six, eight, or ten days, ac- cording to circumstances. Dr. Thomas says, that when an attack of idiopathic epilepsy can be foreseen, there is, perhaps, no remedy which will be more likely to prevent the paroxysm, than an emetic administered about an hour before its accession. In a child, which had been about eighteen months affected with occa- sional epileptic convulsions, I succeeded in removing the disease entirely, by a long course of emetic reme- dies, 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 em- ployed ipecacuanha. Of the utility of emetics in the early stages of indi- gestion there can be no doubt. In the advanced pe- riods of the complaint, however, when the disease no longer consists, simply, in functional derangement of the stomach, but has degenerated into chronic inflam- matory irritation of its mucous membrane, they are decidedly improper. In recent attacks of indigestion, attended with distressing. pains of the stomach, or EMETICS. 47 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 inno- cent and nutritious, will sometimes 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 Bal- timore, relates several cases in which their efficacy was promptly and conspicuously manifested.* 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 evi- dent symptoms of gastric impurities are present. In dropsical diseases emetics have been much em- ployed. They have been prescribed in every variety of dropsy, but they appear to be more particularly applicable to the treatment of anasarca and ascites. Emetics have also been recommended in diabetes. Richter relates several cases that were effectually cured by them. Where this disease is evidently connected with gastric irritation, as in the cases mentioned by Richter, vomits will, no doubt, do much good. This writer mentions an instance of this disease, where an emetic brought up a very great quantity of bilious mat- ter; " and I can assert with truth," says he, "that next morning there was not a vestige of diabetes or of any other complaint present."f We have also the testi- mony of Frank, in favour of the employment of this class of remedies in the present disease. Emetics are, * American Medical Recorder, vol. iv. p. 50. X Medical and Surgical Observations, p. 84. 48 EMETICS. indeed, a very common remedy in the treatment of diabetes with the German physicians; and many cases may be found in their writings illustrative of their beneficial effects. In the treatment of jaundice, emetics are often of essential service. They are particularly calculated to promote the passage of gall-stones through the com- mon 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 relaxed 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,* Praxagoras,t Ccelius Aurelianus,J Alexander Trallianus ;§ and among the moderns, by Stoll,|| Sims,1F Sumeire,** and De- place.tt Quite recently Professor Hosack has pub- lished his experience upon this subject. He details seven cases of this kind, from which it appears, " that in the commencement of constipation, or in its more * met N3,j>. 209. CALX. 411 infecting dissecting rooms, privies, common sewers, docks, and other places which exhale offensive effluvia. In destroying contagion and infection, it is also highly useful. Hence hospitals, alms-houses, jails, ships, &c, may be purified by its means. In short, all places, which may be deemed infectious, from having been the receptacle of cases of virulent disease, may be more or less completely disinfected by its use, after they have undergone the ordinary processes of cleansing." The chloride of lime has also been strongly recom- mended as an application to ill-conditioned ulcers, burns, cutaneous eruptions, and certain forms of oph- thalmia. When applied to foul and offensive ulcers, it not only completely destroys their fetor, but in gene- ral, greatly improves their appearance and condition. From one to four ounces of the chloride, dissolved in a pint of water, " forms a solution within the limits of strength ordinarily required for this purpose." The best mode of using it is, to saturate lint with the solu- tion, and applying it to the ulcer. In purulent ophthal- mia, much benefit may sometimes be obtained from a solution of this salt, employed as a colly rium. Mr. Var- lez, surgeon of the Military Hospital at Brussels, and Mr. Gutherie, regard this solution as the best astringent application we possess in the variety of ophthalmia. Mr. Varlez declares that he has employed this colly- rium in more than four hundred cases of this complaint, and invariably with marked benefit. After the local and general inflammatory excitement has been mode- rated by depletory measures, a solution of this salt, in the proportion of a scruple to an ounce of water, should be applied to the inflamed conjunctiva. If the inflammation does not subside, and the patient bears the application of the solution without complain- ing, its strength may be increased, to one, two, or 412 CALX. even three drachms of the salt in the same quantity (an ounce) of water. In the purulent ophthalmia of infants, I have, in several cases, used this remedy, in the proportion of ten grains of the chloride to an ounce of water, with great advantage. A small portion of it should be carefully injected under the eye-lids, two or three times daily. In that singular gangrenous pus- tule of the lips, peculiar to children, called noma, or aquatic cancer, the local application of the chloride of lime has been found signally beneficial. A case of this affection is related in a late number of Hufeland's Jour- nal, by Mr. Berndt, which, "in the course of eight days, was entirely cured by this application." A paste was made with the chloride and a small portion of water, and applied to the lip of the child every two hours du- ring the day. In proportion as the disease yielded, the remedy was less frequently used. Dr. Gubian, of Lyons, asserts, that if the pustules of small-pox, about the ninth or tenth day, when in full suppuration, be punctured, and afterwards washed several times daily, with a weak solution of the chlo- ride of lime, the drying will be very rapid, and the pocks leave no marks or cicatrices. (Jour, de Chimie Medicale, Mai, 1830.) Dr. Graefe, of Berlin, has recently employed this remedy, internally, with entire success in gonorrhoea. He administered it in the form of an emulsion composed of a drachm of chloride of lime, seven ounces of almond emulsion, and an ounce of syrup. " The dose of this mixture is a table-spoonful, containing about four grains of the chloride, to be repeated every three hours. Three or four portions are usually sufficient to effect a cure. The medicine, at first, usually excites an increased flow of urine, with irritation of the urethra; but these BARYTES. 413 symptoms soon disappear, and the discharge dimin- ishes with them." (Rev. Medicale, July, 1830.) Liquor calcis muriatis, or muriate of lime. (Pharm. U. States.) This preparation of lime was formerly much extolled for its efficacy in scrofulous affections. Fourcroy, Beddoes, and Hufeland have published very favourable accounts of its effects in this disease. It was particularly recommended as an internal remedy in ulcerations, and ophthalmia of a scrofulous charac- ter. I have employed it in affections of this kind, but never obtained any obvious advantage from its use. 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 manifest any sensible operation. An inordinate dose, however, excites nausea, vomiting, and sometimes anxiety, palpitation, and vertigo. Hufeland states, that he has known this medicine to produce a con- tinued 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 gene- rally keeps the bowels somewhat relaxed. It has no perceptible effect upon the pulse. Hufeland says, that it appeared to him rather to retard than accelerate it. The excretory organs are more obviously influenced by this remedy. It generally augments the urine and cutaneous exhalation. Applied to the skin, it produces a smarting, burning pain, and when concentrated it proves escharotic* * Hufeland, Darstellung der Medicinishen Krafte der Salzsauren Schwererde, p. 15. 414 BARYTES. The muriate of barytes, or, as it was formerly called, terra ponderosa, was first introduced to the notice of the profession by Dr. Crawford,* of England, as a remedy 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.t Some writers, among whom are Girtanner and Arne- mann, 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 patient get well under its use. In employing this medicine, 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 purgative interposed. This remedy is said to be most useful when there is an inflammatory and very irritated condition of the lymphatic system pre- sent, or where the bowels are loaded with irritating * Duncan's Medical Commentaries, vol. iv. Dec. 2, p. 433. f Richter's Specielle Therapie, vol. v. p. 623. ACIDUM NITRICUM. 415 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 complicated with scorbutic affec- tions.* 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 com- menced with in a small dose, and gradually augmented. The sulphuric and nitric acids, the alkalies, magnesia, 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 compositions affected. ACIDUM NITRICUM. The 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- 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, * Hufeland, op. citat. 416 ACIDUM NITRICUM. and Hammick, published observations tending to confirm its character as an efficacious antisyphilitic remedy. But no one was more extravagant in its praise than Beddoes.* 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 subject is,—that in old cases of syphilis, connected with a cachectic condition of the system, the nitric acid is capable 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 benefit may commonly be derived from the alternate employment 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 symptoms; 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 perform a perfect cure. This acid has also been re- commended 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 application to syphilitic ulcers,t and in certain chronic cutaneous eruptions.:}: Plenk recommends an ointment made of nitric acid and ung. althaea, of each half an * On the Effects of Nitrous Acid, &c. 1797. X This is said to be an excellent ointment for purposes of this kind: R. Acid nitric, concentr. 3L pingued. vacc. %i. misce int. sub leni igne et adde, opii puriss. ^i. fiat unguentum. X Alyon, Essai sur les Proprietes Medicinales d'Oxygene, 1791. ACIDUM NITRICUM. 417 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, di- luted in a quart of water, to which six or seven ounces of syrup is added. Its use increases the appetite, ac- celerates the pulse, augments the secretion of urine and saliva, and when long continued, produces a tender- ness 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.t It appears to have a very particular tendency to act upon the glandular system, and especially to excite the secretory 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 preparations are indicated, the nitro-muriatic acid will be found useful, with this difference, that in cases where mercury is highly injurious 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 recommended in chronic hepatitis and in functional disorders of the liver. In these diseases Dr. Scott con- siders it as the 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 considerable reliance on the nitro-muriatic bath, in the treatment of chronic hepa- titis, 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 * Richter's Specielle Therapie, vol. v. p. 321. X Beddoes' Contributions. Vol. I.—3 C 418 ACIDUM NITRICUM. 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 proportion 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 pecu- liarity of the patient. The feet and legs of the patient ought to be immersed in this bath at a comfortable 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 hos- pitals, states, as the result of his experience with this remedy, that it is of very uncertain operation, and that no dependence can be placed on it. He does not, how- ever, contend that the remedy is entirely destitute of useful powers. " It seems often," he says," not to pro- duce any effects whatever, however extensive its appli- cation ; 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."t 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 * On the Influence of Tropical Climates. X Medico-Chirurgical Transactions, vol. viii. for 1817. ACIDUM SULPHURICUM. 419 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 remediate 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 happen to prove effectual where mercury has done no good, or has been hurtful. This has been observed of a variety of articles whose reme- diate powers are in no respect equal to this metal. ACIDUM SULPHURICUM. 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 especially considered it as a remedy of great use in haemorrhagy; at present it is only prescribed as an auxiliary, after the immediate violence of discharge has been restrained 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 particularly adapted to invigorate the digestive organs during convalescence from febrile diseases. Sometimes, however, it will produce un- pleasant affections of the stomach, such as pains and nausea. When this occurs, it must, of course, be at once discontinued. 420 ACIDUM SULPHURICUM. 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. Cothenius, 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 respect. Richter observes, that the external applica- tion 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.t Dr. Fosbroke, 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 examples 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 dulcamara, " using, at the same time, as a wash, a decoction of the deadly night- shade.J 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 sulphuri- cum aromaticum, or elixir of vitriol. Made into an ointment with lard, it forms a very efficacious applica- tion 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 * Specielle Therapie, torn. vi. p. 179. X London Med. and Phys. Jour. 1801, p. 614. X London Medical and Physical Journal, for July, 1822, vol. xlvii. p. 483. ACIDUM SULPHURICUM. 421 formicans, by the external and internal use of this remedy alone. The ointment is made by simply incor- porating 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 in- jection in gonorrhoea.* 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. ♦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 emmena- ' gogiie 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 en- tertained. This opinion is distinctly expressed by Al- len, in a quotation from an author whom he does not mention. " I dare assert," says he, " that the menses proceed 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 there for that very purpose, as manifestly appears on the dis- emmenagogues. 423 section of those parts. The menses are considerably more viscid and thick than the rest of the blood, and have generally 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 suffers 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 viscera generally. This is also the case with some other means occasionally resorted to for the restora- tion of obstructed catamenia, and which cannot be properly placed under the head of emmenagogues. Thus ligatures on the thighs, the semicupium, and fomentations to the external 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 extirpation of large haemorrhoidal tu- mours to restore suppressed catamenia, by which the local drain of blood from these parts was removed, and the ordinary fullness of the uterine vessels re-establish- * Synopsis Medicinse, vol. ii. p. 232. X Traite des Glandes. 424 EMMENAGOGUES. ed. It is not necessary that we should regard the menstrual discharge as a mere effusion of blood, aris- ing from local uterine plethora, in order to admit this explanation of the modus operandi of emmenagogues. The phenomena are perfectly compatible with our no- tions of the secreted nature of the menstrual 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 peculiar secretions of the organs to which they are applied. They produce an immediate flow of blood to the or- gans irritated, the vital properties of which are thereby elevated, 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 emmenagogues 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 instances we find it necessary to have re- course to general remedies, to the exclusion of such articles as are technically denominated emmenagogues. If, for example, the catamenia cease to flow in conse- quence of a general relaxation or debility of the sys- tem, 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 men- struation. A suppression of the menses is also fre- RADIX HELLEBORI NIGRI. 425 quently attended by a state of the system directly the reverse of that of debility and relaxation. There is a rigidity of fibre unfavourable to the regular perform- ance of some of the organic functions; the habit is full and inflammatory, and though apparently 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, &e. 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 attention, indeed, our success must not only be ex- tremely precarious, but our remedies very often in- crease 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 connected with such different conditions of the general system, as obstructed catamenia. Hence, its remedies are so various, and often of such contrary character; and hence, too, the great uncertainty of all our reme- diate 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 medi- cine, consists of numerous black fibres, springing from knotty branches, which issue out of a central radical tuber. Its taste is acrid, bitter, and nauseous, and, Vol. I.—3 D 426 RADIX HELLEBORI NIGRI. when chewed, it imparts a benumbed feeling to the tongue.* Water and alcohol draw from it a bitter and acrid extract. According to the analysis of Vauquelin, its constituent principles are, a very acrid essential oil, a small portion of extractive matter, faecula, a vegeto- animal substance, and salts. Geise considered the acrid oleo-aethereal 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 distinguished by its leaving an exceedingly acrid taste in the back part of the mouth and fauces when chewed.t The root loses its active properties by age. Its fibrous 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 root of black hellebore is not unfrequently adulterated by other roots, some of which are powerfully poisonous. The roots of the adonis vernalis, trollius europaeus, actae spicata, astrantia major, helleborus foeti- dus, veratrum alcum, and aconitum neomontanum, 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 immediately springing from a central tuber; they are also more numerous and more fleshy, externally darker and internally whiter, than those of the hellebore. The principal root of helleborus foetidus 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 actaea 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. f Pfaff's Mat. Med. torn. iii. p. 253. RADIX HELLEBORI NIGRI. 427 the Greek and Roman physicians as a remedy in mania. The extraordinary cures performed 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 larger than 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 cos 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 respira- tion ; slowness and sometimes irregularity of pulse; vomiting of mucous and bilious matter; an increased flow of saliva; trembling and unsteadiness; vertigo; convulsions followed by tetanus, and diminution of heat. The animal finally becomes cold, respires after long intervals, and dies.t From a variety of experiments performed by M. Orfila on dogs, he concludes—1. That powdered hellebore applied to the cellular texture, is rapidly absorbed into the circulation; 2. That its local effects are confined to the production of slight inflam- mation ; 3. That " the part which is soluble in water is that in which the poisonous property of the helle- bore resides;" 4. That the alkaline extract of black * 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. 428 RADIX HELLEBORI NIGRI. hellebo/e, which forms part of Bacher's tonic pills, is also extremely active.* 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. Independent of the powerful vomiting and purging which this article is known sometimes to produce, its long use occasions a singular feeling of coldness in the abdomen, muscular debility, anxiety about the heart, slow and small pulse, headache, stiffness of the mus- cles of the neck, pain in the glands about the throat, slimy whitish mucous discharges from the bowels, spasms, delirium, haemorrhages, &c.t 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 remedy stands in no small repute. But in Eng- land, as well as in this country, the authority of Cullen, who regarded 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 extravagant praises of the one, nor the unquali- fied condemnation of the other. Indeed, within a few * System of Toxicology, by M. P. Orfila, M. D., translated by J. G. Nancrede, p. 208. X Buchner de salutarii et noxio Ellebori Nigri usu. Halae, 1748. Burdach's System der Arzneimittellehre, vol. iii. p. 124. Hartman de virtute Hellebori Nigri. RADIX HELLEBORI NIGRI. 429 years past, its reputation as an article of the materia medica seems to be again advancing. Hellebore appears to possess a very considerable tendency to determine the circulation to the hypogas- tric 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 haemorrhagy from the uterus. From its stimulant properties, one would be led to regard it as inapplicable to cases where there is a ful- ness of habit, or in a sanguine constitution. Yet Mead, Lewis, and other eminent writers say, that it is pre- cisely in such cases that its emmenagogue virtues are most conspicuous. Burdach, however, in his excellent work on the materia medica, asserts that it is particu- larly valuable in cases of torpor, where the face is pale and leuco-phlegmatic, 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 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 insensi- bility 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 circum- stances, necessary, or even accessory to the attainment of its emmenagogue 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 y Elements of Therapeutics, &c. by Dr. N. Chapman. 430 RADIX HELLEBORI NIGRI. 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 aromatic tea, such as rosemary, pennyroyal, &c. Bacher's pills answer extremely well. They are com- posed 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 enjoined to drink plentifully of mild liquids. Upon a due attention to this circumstance, viz. dilution, the success of the remedy as an hydrogogue in a great measure depends." Formulae. bacher's pills. R.—Extract, hellebori nigr. Ext. myrrh, aq. aa %i. Pulv. card, bened. 3iii.—M. ft. Divide into one grain pills. R.—Tinct. hellebor. nigr. §i. ----■ aloes soccot. §ss. ---- opii , 31.—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. 31. ------ aloes soccot. jss.—M. Divide into three grain pills. Take one twice daily. 431 JUN1PERUS 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 abun- dance. It is cultivated, with us, in gardens, and is per- haps, of all other articles of this class, the most com- monly 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 vascular system. It produces a manifest flow of blood to the uterine system; and, when taken in large doses, occasions great heat, agitation, haemorrhage, and inflammation of the bowels. 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 class of remedies. By this writer, however, whose authority, though great on all subjects, has, perhaps, often been too implicitly received, the reputed emmena- gogue virtues of this substance were considered as unimportant. It therefore soon fell into general disre- pute both in England and in this country. When amenorrhoea depends on a relaxed state of the general system, or on an inactive and torpid condi- tion of the uterine system, the savin may be often very advantageously employed.* It need hardly be observed, that its great stimulant properties render it inapplica- ' Bayler liber die heilkraft. der sabina. BurdacVs Arzneimittellehre, vol. iii. p. 300. 432 JUNIPERUS SABINA. ble in cases attended with a high degree of phlogistic diathesis. Wedekind,* 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 secre- tion 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 generally attended with a train of hysteric dis- turbances. 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, 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 sur- prisingly prompt and decisive. Savin, according to some writers, possesses active anthelmintic powers .J 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 * Wedekind uber die anwendung der sabinas by frauenzimerkrankheiten. In Hufeland's Journal, vi. Bd. 1st. nr. 3. f Uber die anwendung der Sabina by der gicht, &c. 1794. X Alibert. Burdach. JUNIPERUS SABINA. 433 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 surface. It is given in substance in the dose of from one to two scruples three or four times a day. It is almost impossible to pulverize it without previously drying it in a high degree of heat; and, as the active part is an essential 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 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. Qiv. Pulv. g. myrrh. Ferr. ammoniat. Extract, sabinae. aa 3ss. SyTup. croc. q. s. ut, riant pilulae ponder, aa gran. unae. 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. Formulae. R.—Extract, sabinae £i. Pulv. cantharid. ^ss. G. aloes socc. 9i.—M. Divide into sixty pills. Take one three times daily. £.__Tinct. sabinae comp. £j. _____aloes compos, ^ss.—M. Take a tea-spoonful twice daily. * Thesaurus Medicaminnm. p. 145.. Vol. I.—3 E 434 ROSMARINUS OFFICINALIS. R.—Fol. sabinae Rad. polygala aa ^ss. Aq. bullientis ^xiv.—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 cunila pulegoides, 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 in botanical character and in their sensible pro- perties, that we would be led, a priori, to expect, which in fact appears to be the case, an entire similarity in their medicinal 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 use- less in this respect, although he thinks it of service in " the dyspeptic and spasmodic symptoms of the sto- mach," which some females experience about the period of menstruation. From my own experience I can say nothing in favour of this article, although I have pre- scribed it very frequently. As a vehicle for the exhi- bition 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 country. 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 ROSMARINUS OFFICINALIS. 435 a bitter extractive matter. A very odorous, resinous principle is extracted from it by alcohol. It also yields a very pungent essential oil by distillation. Proust has discovered 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 antimony.* It is much in use as a domestic remedy for obstructed catamenia, and it would appear from the testimony of several respectable writers, that its pow- ers as an emmenagogue are not inconsiderable. Cul- len, however, attributes to it no virtues in this way. Dr. Chapman, on the contrary, gives it a better charac- ter, and alleges that he has used it in several cases " with unequivocal success." Murray does not men- tion 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, such as ver- tigo, palsy, and spasmodic pains of the stomach. It has also been extolled in the treatment of glandular swellings in infants.t But its usefulness, says M. Ali- bert,:!: is particularly conspicuous in chlorosis, a disease which is very generally complicated with a weakness of the abdominal viscera, or an aberration of their sen- sibility. The same author states, that a vinous infu- sion of this plant is an excellent remedy in chronic diarrhoea. It is generully used in the form of an aqueous or vinous infusion. The essential oil is given from two * Alibert, Matiere Med. vol. ii. p. 127. t J. C. Speis Rosmarini Historia Medica. Helm, 1818. ± Nouveaux Elemens de Therapeutique et de Matiere Medicale, vol. ii. p. 128. 436 MADDER. to ten drops, on sugar. Rosemary is a principal ingre- dient of the preparation known under the name of Hungary water. 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 colouring 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 isxhiefly 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 reme- * Transactions of the Manchester Literary and Philosophical Society. POLYGALA SENEGA. 437 diate article. 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 supposed deleterious quali- ties ever been confirmed. It is given in substance, in the dose of from one scruple to two drachms.* POLYGALA SENEGA. This plant, indigenous to the United States, 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 article. 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 recom- mending 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 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- * Dr. Colhoun informs me that he saw a case of amenorrhoea, in the Pennsylvania Hospital, in which gss. was given by mistake, instead of zss. It produced a slight discharge of blood from the uterus. The me- dicine may, therefore, be usually given in too small a dose. 438 CANTHARIDES. fes'ting 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 gradually 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,J and Burdach.§ The latter writer says: " In obstructions of the catamenia, 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, men- tions cantharides in union with camphor, but makes no * Chapman's Therapeutics and Materia Medica. f Synopsis Medicinae, vol. ii. p. 235. X Essays on Fashionable Diseases, &c. § System der Arzneimittellehre, B. iii. s. 107. ALOES EXTRACTUM. 439 further 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 dis- play 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.t In exhibiting 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 phlegmatic temperaments, its action in this way would seem to be most conspicuous. It seems to be peculiarly adapted 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 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 * American Medical Recorder. + I was directed to the employment of cantharides, as an emmenagogue, by Dr. Klapp's publication, prior to which I was not aware that this article had ever been used for such purposes. 440 ALOES EXTRACTUM. opinion expressed in the beginning of this chapter, relative to the modus operandi of emmenagogues, there is no difficulty in perceiving how aloes should prove emmenagogue, 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 particularly pointed out. The effect of such an irritation, by a well-known law of the animal economy —ubi iritatio ibi fiuxus—is, an afflux of blood to the rectum and neighbouring organs. Hence the pernicious consequences of aloetic purges in persons labouring under haemorrhoidal affections. In cases of this kind it is exceedingly apt to bring on bleeding from the tumours in the rectum, or, at least, to render them turgid and inflamed. In males a long course of aloetic medicines seldom fails to bring on piles. In females, on the contrary, where there is no strong tendency to haemorrhoides, it more commonly brings on copious discharges of blood from the uterus, or in amenorrhoea, re-establishes the regular flow of the catamenia. In patients of a delicate and relaxed habit of body, with a constipated condition of the bowels, we may often derive very great advantage from a combination of aloes, steel, and myrrh. Where amenorrhoea is con- nected with haemorrhois, which is not unfrequently the case, aloes is an improper remedy. Instead of re- establishing the menstrual 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 derivation from the uterine vessels, and with it a diminution of the menstrual effort takes place. In chlorotic females small doses of aloes and iron will sometimes produce very happy effects. I have known it to be prescribed with prompt success in a case of amenorrhoea, in combination with pulv. ipecacuanhas, in the proportion of ten grains of aloes* POLYGONUM HYDROPIPEROIDES. 441 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 unload the bowels, will, in general, do better than such as are large and more active in their purgative effects. Formulae. R.—Pil. aloes cum. myrrh. ----ferri comp. aa. gi. Sodae sub-carb'onat. £)i.—M. Divide into thirty pills. Dose, two twice daily. R.—G. aloes soccot. ^ss. Prussiat. ferri |ji.—M. Divide into sixty pills.—S. Take one three times daily. R.—Tinct. aloes compos, %i. ----secale cornut. Sj"*—M. Dose, a tea-spoonful twice daily. I have used this combination with prompt success in several instances. POLYGONUM HYDROPIPEROIDES. Water-Pepper, Biting Knot-weed.—Although this plant has, hitherto, not been included in the list of our vegetable materiae medicae, my experience with it, as an emmenagogue, has induced me to regard it as justly entitled to a place among the remedial agents of this class. This species of polygonum is extremely common throughout every section of the United States. The stem rises to the height of from about twelve to twenty- four inches, is slender, smooth, branching, and erect. The leaves are lanceolate, very acute, and end at the base in a short compressed sheathing petiole. The stipules are truncate and pubescent. The flowers are in one or two simple slender spikes, and of a pale pink, or white colour. It flowers from July to September. Vol. I.—3 F 442 ERGOT. I have employed this plant in perhaps twenty cases of amenorrhoea, and I can affirm, that with no other remedy or mode of treatment have I been so succesful as with this. I have seldom found it necessary to continue its use for more than six or seven days, before its emmenagogue. powers were manifested. When taken into the stomach, it generally produces a warmth and peculiar tingling sensation throughout the whole system. I have never known it to cause either purging or vomiting; but in nearly all instances, its use was attended with slight aching pains in the hips and loins, and a sense of weight and tension within the pelvis. Several of my medical friends, who, at my request, have employed this remedy in amenorrhoea, found it, in the majority of cases, promptly effectual. I use it in the form of a saturated tincture. A tea-spoonful of the tincture should be taken three times daily. It may also be advantageously used in the form of an extract. From four to six grains of the extract may be taken every six hours. II. Medicines that Increase the Parturient Action of the Uterus. ABORTIVA. SECALE CORNUTUM.--ERGOT. This article is a parasitic fungus, occupying the glumes of the rye, {triticum secale,) of the genus scle- rotium, and natural order fungi. For an interesting account of its natural history, the reader is referred to ERGOT. 443 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 eminently calculated to excite our admiration of that wonderful and mysterious connexion of the various organs of the animal economy, by which a slight im- pression upon one part is instantly propagated to another, and there manifested often by the most vehe- ment 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 partu- rient 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, 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 efforts generally continue uninterrupt- edly ; the contractions 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 sur- prisingly vehement; and it is, therefore, obvious that this medicine cannot be given indiscriminately, or 444 ERGOT. without a proper regard to circumstances. Should it be improperly given, before the os uteri is soft and in a state to dilate, or has already considerably 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 certainty of success. Bv some physicians it is supposed that this article exerts 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 ar- ticle 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 expe- rience of others, that there is no good foundation for this opinion, and that the cases which have been re- corded by some practitioners, as demonstrative of its injurious effects,* are to be considered in the light of accidental coincidences, rather than the positive results of the medicine.t 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 * Vide Dr. Chatart's paper in the Med. Repos. for 1820. X Dr. Hosack, speaking of this article, says: " The ergot has been called, in some of the books, from its effects in hastening labour, the pubis adpartum; as it regards the child, it may, with almost equal truth, be denominated the pulms ad mortem—for I believe its operation, when sufficient to expel the child, in cases where nature is alone unequal to the task, is to produce so violent a contraction of the womb, and consequent convolution and compression of the uterine vessels, as very much to im- pede, if not totally to interrupt the circulation between the mother and child."—New York Med. and Phys. Jour. vol. i. p. 206. ERGOT. 445 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 placenta over the os uteri, and not accompanied by efficient contractions. 3. In puerperal convulsions in which a speedy delivery 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 con- traction of the uterus. 6. " In subjects liable to haemorrhage after delivery from laxity and deficiency of contraction."* In such cases the haemorrhagy may be entirely prevented by the exhibition of a proper dose of ergot fifteen or thirty 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 vas- cular system; 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 emmenagogue powers will at once appear very doubtful. This article was used, out of the profession, as a promoter of parturition, more than a century ago. In regular practice, however, it was not known until Dr. Stearns, of Albany, brought its virtues before the public; and to him, therefore, belongs the merit of having first * Dr. E. A. Atlee. Vide American Med. Recorder, vol. iv. p. 141. 446 SOD^E BORAS. directed the attention of medical men to the extraordi- nary 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 unphilosophical, however, to account for epidemics by ascribing them to a cause which must be always, in a degree, present. SOD.E BORAS. Borate of Soda.—Borax.—Borax is found in a native state, both in Europe and in South America; but that which is met with in commerce is almost exclusively obtained from certain lakes in Thibet and Persia by spontaneous evaporation. The borax, in an impure state, is found concreted on the margin of these lakes, from which it is dug up in masses, constituting the tincal or crude borax of commerce. In this state it is imported into this country packed up in boxes or chests, and requires to be refined before it can be applied to medicinal purposes, or in the arts. Borax as it is met with in the shops, consists of irre- gular masses, or in flattened hexahedral prisms ter- minated by triangular pyramids. It possesses a slightly alkaline and sweetish taste, and manifests alkaline properties when tested with litmus. It is dissolved by twelve times its weight of cold water, and by twice its weight of boiling water. It effloresces on the surface when exposed to the air. "Subjected to a moderate heat, it undergoes the aqueous fusion, swelling con- siderably, and finally becoming a dry porous mass, SODjE BORAS. 447 with loss of half its weight." When subjected to a high degree of heat it fuses into a limpid fluid, called glass of borax. Dr. Duncan states that borax possesses the property of converting the mucilage of gum arabic, lichen islandicus, or of salep into a gelati- nous mass, wholly destitute of adhesive qualities. " It is decomposed by the majority of the acids, by potassa, and by the earthy and ammoniacal sulphates, muriates, phosphates, and fluates." Borax has the property of greatly increasing the solubility of cream of tartar, combining with it, and forming the soluble cream of tar- tar. " This preparation is made by boiling six parts of cream of tartar with two parts of borax in sixteen parts of water, for five minutes, allowing the solution to cool, and then filtering to separate some tartrate of lime." It is then to be evaporated to dryness by the heat of a sand-bath. Among the Germans, borax is now fre- quently employed as an internal remedy. It is said to possess anti-spasmodic properties, and to exert a peculiar tranquilizing influence on the nervous system, without increasing the action of the heart and arteries. Richter asserts, that it tends very considerably to in- crease the determination of blood to the abdominal and pelvic viscera, and to excite the portal circulation. In the aphthous sore mouth of infants, borax is much employed in this country, either in the form of a mouth- wash or of powder. Pitshaft says, that when this af- fection is attended with acidity in the primae viae, which is almost always the case, the most effectual mode of using the borax is to give it internally, in union with magnesia. From two to four grains of the powdered borax, v/ith five or six grains of carbonate of magnesia should be given two or three times daily, at the same time that a solution of the borax is repeatedly applied to the aphthae of the mouth, by means of a 448 SODiE BORAS. soft pencil, or lint fastened to the end of a thin piece of whale-bone. Borax is undoubtedly the most effectual remedy we possess, as a local application for the cure of aphthae. In that distressing aphthous affection which sometimes occurs on the internal surface of the pu- denda of pregnant females, the application of a strong solution of borax generally procures speedy relief. Richter says that borax possesses excellent emmena- gogue virtues. We have also the testimony of Lentin, Stark (Einricht. des Klinisch. Instituts. &c. Jena, 1782), Bayler, Hufeland (Hufe. Journal, B. 9, p. 127), and Kopp (Beobacht. im. Gebiete der ausub. Keil- kunde 1821, p. 134), in favour of the usefulness of this article in amenorrhoea, or uterine torpor. Kopp de- clares that he has employed this remedy with peculiar success in deficient or obstructed menstruation, attend- ed with general plethora, or a febrile habit of the sys- tem. He gave from four to six grains of the powdered borax four or five times daily. Richter states that he gave this article in a case of chorea attended with amenorrhoea. After its use had been continued for seven or eight days, the menses began to flow, and the choreal symptoms to subside. Twelve grains of the borax were administered three times daily. Hirschel says (Hufeland's Jour. vol. 52, p. 27) that he gave fif- teen grains, mornings and evenings, and thereby restored the catamenial function, after it had been for more than two years wholly suppressed. Borax has also been used with advantage in deficient or suppressed lochial discharge. (Oswald.) Of late years, this article has been much used by Wiegand, Rudolph, and others, for increasing the par- turiant contractions when too feeble from atony or tor- por of the womb. Jahn asserts, that he has often SOD/E BORAS. 449 known a few full doses of borax in union with safron, to excite, in a short time, very powerful and effectual labour-pains, and that it very rarely failed to produce an obvious increase of the parturient efforts of the womb. He gave from twenty to thirty grains of the borax with five grains of safron every hour. Loeffler, also, declares, that during a long course of experience, he has almost uniformly found the borax useful in ex- pediting labour, when arrested or lingering from atony or torpor of the uterus; and Krandendonk (Frorieps Notizen, vol. xix. p. 96) has published statements equally favourable to its virtues in this respect. Besides its usefulness, as an external remedy, in aph- thae, borax has also been found highly beneficial in in- flamed haemorrhoidal tumours, superficial excoriations, sore nipples, and certain cutaneous eruptions. Harless recommends the use of a mixture, composed of one drachm of powdered borax, the yolk and albumen of an egg, one ounce fresh almond oil, and half a drachm of bals. peruv. as an application to excoriated or ulce- rated nipples. Hufeland declares, that a solution of half a drachm of borax in an ounce of rose water, is one of the most prompt and certain means we possess for removing those yellowish blotches (Lichen ) which often appear on the face, neck, and chest of young people. It is also an excellent remedy for chil- blains. For this purpose, two drachms of the borax must be dissolved in an ounce of water, and applied to the affected parts several times daily, by means of a small piece of soft sponge. Reinhart (Hufeland's Jour. vol. Ixv. p. 121) employed a strong solution of borax in four cases of pityriasis (dartre furfuracee volante) with entire success. It is said to be an excellent re- medy lor removing opacities of the cornea. Richter employed it for this purpose with great advantage. VOIj. 1.—3 G 450 SODJE BORAS. Half a drachm of the borax, with double the quantity of white sugar, is to be dissolved in an ounce of rose- water. Five or six drops of this solution must be in- troduced into the eye two or three times daily. (An- fangsgr. d. Wundarzneik. B. iii. p. 127.) END OP VOL. I. 1 v^wT'