A TREATISE MATERIA MEDICA THERAPEUTICS. BY JOHN EBERLE, M. D. MEMBER OF THE AMERICAN PHILOSOPHICAL SOCIETY; OF THE ACADEMY OF NATURAL SCIENCES OF PHILADELPHIA; CORRESPONDING MEMBER OF THE MEDICO- CHIIIURGICAL SOCIETY OF BERLIN, &C. &C. IN TWO VOLUMES. VOL. II. FOURTH EDITION, MUCH ENLARGED AND CORRECTED. ft ^ss.—M. ft. Dose, a table-spoonful three times daily. HEMLOCK. 67 Hunter recommends it combined with mercury in indo- lent buboes and swelled testicle. In syphiloid chancres, of an irritable and spreading character, cicuta, given in very large doses, will often do much good. In an extremely troublesome case of this kind I have lately obtained prompt and effectual relief from exhibiting this substance with the nitrate of silver. For many years past, I have very seldom treated a case of syphilis with- out employing this narcotic. My usual mode of pre- scribing it is in union with corrosive sublimate, in the proportion of two grains of the extract with one-eighth of a grain of the mercurial. This dose is to be taken three times daily. In old syphilitic ulcers and cuta- neous eruptions, I have employed this combination with more satisfaction than other remedy I have used. Narcotics were formerly much resorted to in the treatment of insanity. It seems, however, to be pretty generally admitted at the present day, that they can afford but little benefit in the diseases of the mind. Examples, however, do occasionally occur, of the bene- ficial operation of this class of remedies in mental dis- eases. The records of medicine, too, furnish us with proofs of their occasional efficacy in such affections; and we are, therefore, not permitted to regard them as entirely useless in this respect. Dr. Anthony Fother- gill, of Bath, has recorded several instances of the successful employment of cicuta in the treatment of insanity. I have employed it a good deal in the treatment of chronic rheumatism, and I am satisfied, that, if given in strong doses, it will often afford useful results. It is, however, much inferior, in this respect, to stramonium, of which I shall presently give an account. Cicuta has also been resorted to with success in tic 68 HEMLOCK. doloureux. Dr. Fothergill* speaks well of its efficacy in this disease. Dr. Jackson, of Boston, has also pub- lished cases in which the good effects of this article are strikingly illustrated.t Thilemus gave cicuta in full doses, together with the volatile tincture of guaiacum, in a case of neuralgia of the face, with prompt and entire success; and Jahn (Mat. Med. Vol. 1, p. 592) administered it in conjunction with gum guaiac, assa- fcetida, and calomel, with an equally favourable result. We have also the testimony of Pugol, Jackson, Gess- ner, Hufeland, Masius, and Siebold, in favour of the occasional efficacy of this narcotic in neuralgic affec- tions. Dr. ButlerJ has strongly recommended this medicine in the treatment of hooping-cough. His extravagant praises of this article have, however, never been con- firmed by other practitioners. I have used it very frequently, but never with any decided advantage. Belladonna is so greatly superior to the cicuta, in this disease, that it deserves a preference, perhaps, in all instances where a narcotic is wanted. The cicuta has also been employed in asthma; but it does not appear that it deserves any attention for its remediate powers in this disease. The same may be said of its use in epilepsy, chorea, and hysteria. In chronic cutaneous eruptions, particularly in herpetic and leprous affections, decided relief has been obtained from the employment of this narcotic. Gessner used an infusion of the leaves, as a topical application, with entire success in a case of inveterate itch. (Med. Beo- bachtungen, p. 204). Strune states, that in conjunc- * London Medical Observations and Inquiries, vol. v. f New England Medical Journal, vol. ii. No 2. X A Treatise on Kinkcough, with an Appendix on Hemlock, bv Wm. Butler, M. D. Lond. 1775. y HEMLOCK. 69 tion with great abstemiousness in diet, or what the Germans call hunger-cure, he has administered the cicuta in obstinate and long standing cases of herpetic eruptions with the happiest result. Stuive also re- sorted to this mode of treatment with complete success, in a case of inveterate leprous psora. In the cure of jaundice the powers of this article seem to be better established. Dr. J. Fisher, of Beverly, Massachusetts, has found it an exceedingly successful remedy in that variety of this disease which is occa- sioned by a spasmodic contraction of the biliary ducts. Drs. Bigelow and Jackson, of Boston, give their testi- mony in favour of this article in the cure of this disease. " When the dose is gradually increased until its effects are distinctly felt in the head and stomach, the yellow- ness of the skin and eyes, in most cases, begins to dis- appear by the second day, and the disease is soon removed."* Gudet (Jour, de Med. vol. xii.) asserts that cicuta possesses the power of greatly diminishing the secretion of milk; and Richter recommends its use where this secretion is too copious, or during weaning. In whatever disease this remedy be given, it ought to be used in large doses. Dr. Fothergill has published some excellent observations on this subject. He ob- serves, that its efficacy will always depend on its being given in as large a dose as the patient can bear. It should be given in sufficient doses to produce some obvious effect on the system. Vertigo seems to me the most certain mark by which to judge of the necessary influence of the medicine; and it is probable that we can never derive any decided advantage from its use, unless we give it to the extent of producing this effect. * Thacher's Dispensatory, p. 196. Vol. II.—K 70 HEMLOCK. Not a little of the contradictory experience which has been published with regard to the remediate powers of this article, may, perhaps, be ascribed to the great diversity which it exhibits in its strength as it is found in the shops. M. Orfila instituted a set of experiments with a view of ascertaining the comparative strength of the extract of hemlock properly prepared, and that which is usually sold in the shops. A drachm of this article prepared by himself was sufficient to poison a dog, whereas it required an ounce and ten drachms of that obtained from the shops to produce the same effect.* The extract is given in the dose of two or three grains, and gradually increased until some effect is produced. The powdered leaves, which, if good, have a fine lively green colour, are to be given in the dose of gr. iii., and increased until their influence becomes manifest. "Vinegar is considered its best antidote."t Hemlock has been mistaken for the following plants: chaerophyllum bulbosum and silvestre, aethusa cyna- pium, cicuta virosa, scandens odorata, caucalis anthris- * Orfila gives the following directions for preparing extracts: " 1. The plant must be taken when in full vegetation, and the flowers completely developed. Dried leaves treated with water, are perfectly useless. " 2. The juice is to be expressed, if the plant be succulent, if it be not succulent, water must be added, and then expression employed. In both cases expression is to be made without heat. " 3. The juice thus obtained is to be evaporated by a gentle heat in a very broad vesse.t, and in a water bath. When thus prepared the extract of hemlock is of a gold yellow and slightly reddish colour, whereas in the shops it is usually black." In the tenth volume of the London Medico-Chirurgical Transactions Mr. J. T. Barry gives a communication concerning a new mode of preparing pharmaceutical extracts. He evaporates the expressed juice in vacuo. Professor Jaenisch, of Moscow, about the same time, proposed a similar mode for preparing such extracts. The superior quality of extracts made in this way must be obvious. | Paris. Orfila. DEADLY NIGHTSHADE. 71 cus, and the common parsley. It is distinguished by the ferruginous spots on the stalks. Formulae. R.—Extract, cicuta? gi. Muriat. hydrar. gr. iv.—M. Divide into thirty pills. Dose, one three times daily, in scrofulous and syphilitic affections. R.—Tart, antimon. gT. x. Sapon. med. 3iii. G. assafcetid. gi. Extract, cicutse giss.—M. Divide into two grain pills. Dose, four or five three times daily. R.—G. assafcetid. gii. Extract, cicutae giss. ---- aconit. gss. Submuriat. hydr. Qi.—M. Divide into two grain pills. Dose, four three times daily, in visceral indurations. ATROPA BELLADONNA.--DEADLY NIGHTSHADE. This is an European plant, and an exceedingly ener- getic narcotic. Its leaves are inodorous and of a slightly nauseous, sweetish, subacid taste. It does not appear that they lose any of their peculiar properties by drying. According to the analysis of Vauquelin, this plant contains an albumenoid substance, salts with a base of potash, and a bitter extractive principle, in which the active properties of the vegetable reside. It appears, from recent experiments, to contain also an alkaline element, to which the name of atropia has been given. The whole plant is extremely active. The berries, however, seem to be more intensely poisonous than the other parts; " and from their beautiful and inviting appearance they have often tempted the un- wary" to fatal mistakes. In the Journal de Sedilot, Decembre, 1813, p. 364, there is an account given by M. E. Gaultier de Claubry, of the symptoms experienced by upwards of a hundred and fifty soldiers who were poisoned by eating the berries of this plant. They 72 DEADLY NIGHTSHADE. were affected by the following symptoms: " dilatation and immobility of the pupil; insensibility, almost com- plete, of the eye to the presence of external objects; or at least confused vision; injection of the conjunctiva by a bluish blood; protrusion of the eye, which, in some, appeared dull, and in others ardent and furious; dryness of the lips, tongue, palate, and throat; deglutition diffi- cult, or even impossible; nausea not followed by vomiting; sensation of weakness; lipothymia, syncope; difficulty, or impossibility of standing; frequent bend- ing forwards of the trunk; continued motion of the hands and fingers; gay delirium, with a vacant smile; aphonia, or confused sounds, uttered with pain; ineffec- tual desires of going to stool; insensible restoration of health and reason, without any recollection of the pre- ceding state."* Alibert states, that in three children who had eaten the berries of this plant, nausea immediately came on; the pulse became feeble and irregular, andi a delirium of the most singular character supervened. They cried, sang, and laughed alternately, and exhibited the most ridiculous and apparently involuntary gestures; the whole body was in agitation, and the countenance haggard and fixed.t The effects of a full dose of this narcotic, in healthy individuals are: a sense of weight and fulness in the head, ringing or a buzzing noise in the ears, dilatation of the pupils, a somewhat accelerated pulse, increased temperature, flushed face, and generally a diffused red- ness over the whole surface of the body, diminution of the appetite, a feeling of dryness of the mouth, fauces, and oesophagus, and much thirst. After these symp- * Orfila's Toxicology, p. 286, Dr. Nancrede's translation. f A. M. Giraudy has written a dissertation entitled " Le delire cause par la Belladonna a-t-il un caractere que lui soit propre?" DEADLY NIGHTSHADE. 73 toms have continued for three or four hours, they begin to abate, at the same time that the perspiratory and urinary secretions are increased. In a still greater dose, it gives rise to a sensation of constriction, attended with an extremely annoying dryness, of the oesophagus, and difficulty or even impossibility of deglutition, burn- ing and spasmodic pains in the stomach, and often vomiting; a feeling of great fulness and weight in the head, vertigo, drowsiness, dulness, and confusion of the mind, with more or less delirium, and visual illusion. A further increase of the dose will give rise to the extremely violent and dangerous effects mentioned in the preceding page. Belladonna possesses very important remedial pow- ers. By some it has* been a good deal praised for its virtues in the cure of cancer. Cullen's success with this article, as he informs us,was various. He cured entirely a cancer of the lip with it He also employed it with success in a scirrhosity of a woman's breast, and in an ulcer of a cancerous nature below the eye. In other cases, however, it proved entity ineffectual. Alberti and Juncker speak favourably «f it in scirrhus of the intestines and stomach. Haller, De Haen, Heister, and more recently Rahn, of Zurich, have, however, not only not confirmed these favourable accounts of the powers of belladonna in scirrhous and cancerous affections, but have, on the contrary, found it injurious m such cases. In glandular engorgements and indurations, of a scrofulous or ordinary character, great advantage may undoubted- ly sometimes be derived from this remedy. Evers employed it in engorgements, and indurated tumors of the breasts, and in chronic intumescence of the uterus with entire success. (Schmucker's Vermischt. Schriften. Bd. iii. s. 242.) Dalruc also dissipated indurations of this kind, by the external and internal use of this article 74 DEADLY NIGHTSHADE. (Jour, de Med. Vol. ii. p. 449); and Autenrieth declares that he has, in a considerable number of instances, derived very decided benefit from the external applica- tion of a strong infusion of belladonna to scrofulous tumours and swellings of the joints. (Richter's Spec. Arzneimittell. B. ii. p. 577.) A case occurred in the Polyclinic Institute of Berlin, which was regarded as an instance of indurated enlargement of the pyloric ex- tremity of the stomach, and which yielded ultimately un- der the internal use of the extract of belladonna dissolved in diluted prussic acid. In scrofulous ulcers, this nar- cotic will occasionally produce the happiest effects. In cases of this kind, I have in a few instances employed the extract, in conjunction with minute portions of the muriate of gold, with the most satisfactory result. For the cure of hooping-cough this remedy enjoys, at present, a very high character in Europe. Borda speaks in terms of unlimited praise of the advantages he has derived from it in tfis disease. Children, says he, to all appearance pasi recovery, have been saved by means of this remedy* Hufeland, Schseffer, Kopp, Jahn, Henke, Richter, and Marc, speak of it in similar terms of praise. Ttey consider it, indeed, as almost entitled to the character of a specific in this disease. Wetzlert is equaUy warm in its praise; and Alibert states, that in France, a similar success has attended the employment of this remedy. I have prescribed it in about a d^zen cases. In two of these its good effects were promptly and strikingly manifested. In five or six, its advantages were much less obvious, and in a few it produced no change in the disease what- * Primse Lineae. X Wetzler recommends this remedy to be given in this way: Take of the powdetfd root, mix it with a sufficient quantity of sugar, and divide it into parts containing one-fifth of a grain each. This is a dose for a child un- der one year old, which must be repeated night and morning. DEADLY NIGHTSHADE. 75 ever. I apprehend, however, that the extract which I employed was not very good; it was old, dry, and black. From the very numerous and respectable tes- timonies we have in favour of its powers in this disease, it certainly has claims to attention in the treatment of this harassing and intractable affection. It may be conveniently administered by dissolving four grains of the extract in an ounce of sweetened water, and giving from eight to twelve drops three times daily, to a child under two years old. As the extract, however, is of uncertain strength, the powdered root is preferable. It may be given in doses of from one-sixth to one-half of a grain, three times daily, according to the age of the child. Lenhosock says, that he has never found it necessary to give more than one-fourth of a grain in twenty-four hours. When the dose is too large, it is apt to produce vehement arterial excitement, and a general erythemous rash over the surface of the body, which, however, seldom continues more than two or three hours. This article ought to be administered with great caution to robust, plethoric, and irritable subjects, or to such as are predisposed to strong determinations of blood to the head. It is seldom found beneficial in hooping-cough, but often decidedly injurious, when in- flammatory or febrile symptoms are present. According to Mr. Q. Bailey's experience, belladonna is the most efficacious remedy we possess in tic dolou- reux.* He records many cases of extreme violence, which were effectually cured by this remedy, after every other mode of treatment had been tried without success. lie usually exhibited from two to three grains of the extract, or from twenty to thirty minims of the * Observations on the Use of Belladonna in Painful Disorders of the Head and Face. London, 1818. 76 DEADLY NIGHTSHADE. tincture every four or five hours, while the paroxysm v/as violent, and in smaller doses when the pains were mitigated. He informs us that the employment of this remedy sometimes produces vertigo, impaired vision, insensibility, tightness across the breast, and a sense of suffocation and dryness in the throat; but these effects do not continue long, and have never been observed to leave any unpleasant consequences. It has been much spoken of by some German writers, as a remedy for hydrophobia.* Mr. Munch, of Han- over, and Bucholz, of Weimar, speak of their success in this way. Burdach also speaks favourably of its powers in this frightful disease. It is, however, but too certain that all such hopes are fallacious, and that we are yet entirely without any effectual means for arresting its dreadful and fatal course. By some physicians this remedy has been a good deal extolled for its powers in epilepsy. Greeding, Hufeland, Stoll, and Mayerne, have published observa- tions favourable to the employment of belladonna in this disease. Subsequent experience has not confirmed these expectations. The belladonna has also been employed in mania and melancholia.! It is said to be particularly applicable to cases consequent to a suppression of some accus- tomed evacuation, or the repulsion of cutaneous erup- tions. I know nothing of its powers, from my own experience, in these affections. That they are but inconsiderable, may be inferred from the almost total neglect of this article in the treatment of these diseases. Belladonna has been recommended as a valuable * T. H. Munch kurze Anweisung wie die Belladonna in tollen hund biss Anzuwenden ist. Gottingen, 1783. f Observationes practice circa usum Belladonna in Melancholia, Mania et Epilepsia. J. H. Munch. Gotting. 1783. DEADLY NIGHTSHADE. 77 remedy in paralysis, more especially of the extensor muscles. Richter says, that in affections of this kind, this remedy has been too much neglected; and Jahn (Klinik. d. Chron. Krankh., vol. i. p. 365) declares, that cases which do not yield to this remedy, may be re- garded as incurable. Schmucker used the belladonna with success in hemiplegia, and Selle cured several cases of paralysis of the tongue by its use. It has also been successfully employed in some cases of local palsy by Verschuir (Gerson and Julius' Journal d. Auslaend Med. Literat. vol. vi. p. 57.) Mr. Bailey* states, that in a violent case of hysteria, which had withstood all other remedies, the efficacy of this article was conspicuously shown. I have employed the tincture of this plant in chronic hysteria with une- quivocal advantage. It is particularly beneficial in cases attended with pain in the stomach and bowels. In chlorosis, also, unattended with febrile irritation, the use of this tincture, in conjunction with the prussiate of iron, has in several instances appeared to me of material service. It has also been recommended in other spas- modic diseases, such as chorea, asthma, spasmodic ischuria, dysphagia, &c. Burdach speaks of its successful employment in amaurosis, sciatica, loss of speech, and hemiplegia. The belladonna, in common with some other plants of this class of remedies, possesses the property of dilating the pupils of the eyes in a remarkable manner, whether it be taken internally or only applied upon the external parts of the eyes. Advantage is taken of this property to dilate the pupils, in order to facilitate cer- tain operations on the eye, as couching, &c. It has also been employed as a local application, to relax the mouth of the womb when too rigid in parturition. Dr. * Observations on the Use of Belladonna. Vol. II.—L 78 DEADLY NIGHTSHADE. Conquest (Lond. Med. Reposit. vol. xiii. p. 75) states, that in a case of this kind, he injected a strong infusion of belladonna into the vagina, which was speedily fol- lowed by complete dilatation of the os-uteri. Chaussier employed for this purpose an ointment composed of two drachms of the extract, and an ounce of lard, which he applied to the mouth of the womb, and he asserts, that even when applied to the vulva and lower part of the vagina, it will often, in a short time, cause complete relaxation of the os-uteri. He declares, that for fifteen years he has, in nearly every case of rigidity of the os-uteri which occurred in his obstetrical prac- tice, resorted to this application, and that it almost uniformly had the desired effect in less than forty minutes. We have also the testimony of Henne (Rust's Reper- tor. vol. xiv. p. 137), of Mandt (Rust's Magazine, vol. xix. p. 350), and of Vogt (Pharmakodynamik, vol. i. p. 133), in favour of the usefulness of this narcotic in difficult labour, from rigidity of the os-uteri. Hufeland states that he has been in the habit of em- ploying the fumes of narcotic plants, in convulsions, epilepsy, and other nervous affections, with very con- siderable success. He takes equal portions of belladonna and hyoscyamus with a few grains of opium and exposes them to the heat of an alcoholic lamp on a thin iron plate in a vapour bath. The patient remains in this bath from fifteen to twenty minutes, care being taken that the fumes do not reach the face. The immediate effects are copious perspiration, succeeded, commonly, by a sense of fulness, and occasionally also with tre- mors, vertigo, difficulty of breathing, and very rarely spasms. Hufeland gives an account of twelve cases of epilepsy, all of which were cured in this way.* * Revue Medicale, 1822. DEADLY NIGHTSHADE. 79 A great deal has of late years been written concern- ing the alleged prophylactic powers of belladonna against scarlatina. It is said that the internal admin- istration of this narcotic will, in a vast majority of instances, protect the system completely against the influence of this contagion. Its prophylactic powers, in this respect, were first noticed by Hahnemann. He asserts, that he has, in a great many instances, found it to afford entire protection against this disease in chil- dren who were much exposed to its contagion. Hufe- land also employed it in a number of cases, and the result convinced him fully, that it possesses the power of preventing scarlatina. We have also the testimony of Brera, Kopp, Hedenus, Berndt, Behr, Wagner, Kcehler, Bloch, and many other writers, in favour of its decided efficacy in this respect. When employed for this purpose, it should be administered in very minute doses. Hufeland directed three grains of the extract to be dissolved in an ounce of water, of which as many drops are to be given, three times daily, as the individ- ual numbers years in age,—that is, one drop to a child one year old, two drops to one two years old, &c. The most convenient and effective mode of adminis- tering the belladonna is, by employing the powdered leaves or root. One grain of the powder of the leaves may be given to an adult morning and evening, and gradually increasing the dose to as much as can be borne. The root, if well dried, is somewhat stronger than the leaves, and must, therefore, be given in smaller. doses. The extract is extremely variable in its strength. If good, it^must be commenced with in the dose of gr. ss. An ov^r-dose produces so great an insensibility of the stomach as to render it almost impossible to excite vomiting by the strongest antimonial emetics. Vinegar is accounted the best antidote to this poison. It ren- ders the operation of emetics more certain and prompt. 80 THORN-APPLE. Formulae. R—Tinct. belladon. gss. Tinct. scillae §i.—M. Dose, from ten to twenty drops three times daily, to children between one and five years old, in hooping-cough. R.—Extract belladon. "$i. G. assafcetid. gi. G. aloes socc. gr. xv___M. Divide into thirty pills. In chronic hysteria, one to be taken two, three, or four times daily. STRAMONIUM.--THORN-APPLE. This is a very common plant in this country, known familiarly by the names of Jamestown weed, thorn- apple, or stink-weed. It is a powerful narcotic, and has of late become of considerable importance for its remediate powers. It contains gum, resin, carbonate of ammonia, and an alkaline principle which has received the name of doturia* On being received into the stomach in an over-dose its effects are exceedingly violent. The pupils dilate very much; vertigo, delirium, tremors, retching, exces- sive thirst, mania, and convulsions come on. The mania is of a very singular character, being attended with the most antique gestures, screaming, laughing, crying, and distorting the face continually. A deep coma comes on before death. We are indebted to Baron Storck for the introduc- tion of this powerful article into regular practice. He used it in mania, epilepsy, and other convulsive affec- tions ; and the result of his experience was much in favour of its remediate powers.t Sidren also adds his testimony in behalf of the efficacy of this remedy in con- vulsive diseases.J The experience of Wedenberg and * Paris's Pharmacologia. f Ant. de Storck Libellus, quo demonstratur, stramonium, hyoscyamum, aconitum,non solum tuto posse exhiberi, &c. Vindob. 1762, c. iii. tab. 8. X Sidren de Stramonii usu in morbis convulsivis. Upsal, 1772. In Baldinger's Sylloge, vol. ii. THORN-APPLE. 81 Odhelius* was less favourable; nor has later expe- rience, upon the whole, confirmed the hopes which the trials of Storck and others were calculated to inspire. The late professor Barton, however, considered it " a medicine of great and valuable powers," in the treat- ment of mental, as well as other diseases. He advises large doses in mania. In one patient he carried the dose from two grains of the powdered leaves to sixty. " When the patient (a maniac) had continued upon this dose for some time, she broke out into boils, upon various parts of the body, and was at length discharged from the hospital cured."t In an instance of hysteri- cal mania, which came under my notice a few years ago, the employment of this remedy afforded unequivo- cal benefit. On the third day after the use of the stra- monium was commenced, the maniacal symptoms began to subside, and in a few days more, they were entirely removed. The disease had continued for upwards of three weeks before this remedy was resorted to. This article has also been successfully employed in epilepsy. Dr. J. Fisher, a practitioner of high standing in Massachusetts, speaks very favourably of its employ- ment in this disease oecurring in young persons, and at regular periodical intervals. This article is more likely to prove beneficial when assisted by the simultaneous use of chalybeates. The patient should be kept under the constant influence of the medicine. He recommends the employment of a saturated tincture as most con- venient for children. The dose is to be regulated by the dilatation of the pupil. It has also been used in chorea, tetanus, and palsy. I have never employed it in any of these affections; * Wedenberg de Stramonii usu in morbis convulsivis. f Collection for an Essay towards a Materia Medica of the United States, p. 48. 82 THORN-APPLE. but I have no doubt, from its general properties, that, like many of the articles belonging to this class, it may be occasionally found successful in such cases.* Krey- sig treated a case of chorea successfully by exhibiting half a grain of the extract twice daily. This case was brought on by standing a long time in cold water. Odhelius, also, derived great benefit in cases of this kind from this remedy; and Hufeland employed the tincture, both in epilepsy and chorea, with evident advantage. (Hufeland's Jour. Vol. ix. p. 91.) Its chief importance, however, consists in the excel- lent effects which it produces in chronic diseases, attended with violent pain. Dr. Marcet is the first who noticed particularly its salutary operation in affections of this kind. " If I were called upon," says he, " to express in a few words the general opinion which I feel inclined to form from the opportunities I have had of studying the properties of stramonium, I should say that the most common effect of this remedy, when administered in appropriate doses,t in cases of chronic disease attended with acute pain, is to lessen powerfully, and almost immediately, sensibility and pain; to occasion a sort of nervous shock, which is frequently attended with a momentary affection of the head and eyes, with a degree of nausea, and with phe- nomena resembling those that are produced by intoxi- cation ; to excite, in many instances, nervous sensations which are referred to the oesophagus, or bronchise, or fauces, and which sometimes amount to a sense of * In the New-England Medical and Surgical Journal, vol. iv. p. 226, a singular case of spasmodic cough is reported, which yielded readily to the extract of stramonium, after a very great variety of other remedies had been tried in vain. The cough was attended with convulsions, subsultus tendinum, and other distressing nervous symptoms. f From one-eighth of a grain to a grain a dose, which should not be exceeded until its effects have been observed. THORN-APPLE. 83 suffocation; to have rather a relaxing than an astrin- gent effect upon the bowels; to have no marked influence upon the frequency of the pulse, though, in a few instances, it has appeared to render it somewhat slower; to produce but a transitory and inconsiderable dilatation of the pupils; and to have but little imme- diate tendency to induce sleep, except from the state of comparative serenity and ease which generally follows the symptoms I have just described."* The diseases of this kind in which this remedy appears to be most efficacious, are chronic rheuma- tism, sciatica, tic doloureux, and the violent pains which sometimes attend cancerous affections. Dr. Scudamore states, that he had succeeded with it in relieving gouty pains, dependent or immediately connected with spasm. He found the stramonium more decidedly useful when given in combination with lactucarium. " From reflection on my experience," says he, " I am tempted to affirm that the former acts most as an anodyne, the latter as a sedative; and whenever both effects are desired, they will be most favourably procured from the union of the two prepa- parations."t I have employed stramonium in rheumatism and sciatica, and the result of my trials has been ex- ceedingly flattering. It appears to me to be the most efficacious remedy we possess in those cases of chro- nic rheumatism which are attended by an irritable, quick, but weak pulse, swelled joints, and unattended by any great pain, unless on being moved. I have * On the Medicinal Properties of Stramonium, &c. by A. Marcet, M. D., in the Medico-Chirurgical Transactions, vol. vii. p. 2. f A Treatise on the Nature and Cure of Gout and Rheumatism, &c. p. 129. 84 THORN-APPLE. used it in three cases of sciatica within a year past, and in every instance with the most decided advantage.* Dr. Marcet tried it in three cases of tic doloureux. One case was essentially benefitted by it; in another its effects were equivocal, and in the third it failed entirely. Dr. Bigelow, of Boston, found it decidedly useful in a case of this kind.t I have employed the tincture of stramonium with excellent effects in dysmenorrhcea. By exhibiting from twenty to thirty drops of the officinal tincture three times daily, for two or three days immediately preced- ing the period of the menses, the distressing pains attending this affection will, in some instances, be entirely prevented. In one case it effected an entire cure. Dr. Elliotson strongly recommends the use of this narcotic in spasmodic pain of the bowels (enterodynia,) unaccompanied with febrile excitement, or the presence of irritating substances. In asthma it has been much employed by smoking the root and dried leaves in a common tobacco pipe. I have prescribed the use of it in this way in a number of instances, and my patients have occasionally ex- pressed themselves considerably relieved by it. In the East Indies, the root of the Datura ferox is regarded as almost a specific for the cure of spasmodic asthma. It is cut into thin chips, and smoked in a pipe. It appears, however, to possess extremely active narcotic * I have seen the stramonium employed in domestic practice for the cure of rheumatism, above twelve years ago, while practising in Lancaster county. I recollect that a rheumatic patient, upon whom I had in vain exhausted all the usual resources in this disease, was cured in less than two weeks by an old woman, who administered a saturated tincture of stramonium seeds, in the dose of a tea-spoonful three times a day. X Bigelow's American Medical Botany, vol. i. p. 23. WOLFSBANE. 85 powers. Richter states, that he tried it in one instance, but was immediately obliged to lay it aside. In a few moments it produced stupor, vertigo, and confusion of mind. Ward, (Lond. Med. and Phys. Jour.) however, employed a tincture of this species of datura, made by digesting four ounces of the leaves in fourteen ounces of alcohol, mixed with one ounce of caustic ammonia, with evident advantage in asthmatic affections. He gave from fourteen to twenty-four drops, once or twice daily. An ointment made of the leaves of this plant fre- quently affords great relief when applied to painful and irritable ulcers, and hemorrhoidal tumours. Dr. Bigelow states, that the stramonium ointment with the ointment of acetate of lead, forms one of the best applications in this affection. Like the belladonna, it produces great dilatation of the pupils, when applied to the external parts of the eyes. The following doses of the stramonium must be commenced with: Of the powdered leaves, one grain. powdered seeds, half a grain. Of the inspissated juice or extract, one grain. extract of the seeds, from one-fourth to half a grain. tincture, from fifteen to twenty drops.* ACONITUM NAPELLUS.--WOLFSBANE. This is a powerful narcotic poison, and was well known as such to the ancients. Ovid alludes to its * liigelow's American Medical Botany, vol. i. Vol. I.—3 M 86 WOLFSBANE. baneful properties, and the fatal purposes to which it was sometimes applied by the wicked. Lurida terribiles miscent aconita novercae.—Metam. i. 148. There are four species of aconitum possessing pretty nearly the same powers. The aconitum napellus, cam- marum, neomontanum, and tauricum, all of which are indigenous to the alpine regions of Europe. The aconitum napellus is, however, almost exclusively em- ployed in medicine. The juice of this species has a disagreeable smell, and a nauseous acrid taste. Ac- cording to the analysis of Bucholtz, the fresh root contains a green resin, albumen, a bitter and acrid extractive matter, with nitrates and acetates, gum, malate and citrate of lime. Brandes has discovered in the aconitum napellus, a peculiar alkaline principle, to which the aconitia has been given. The acrimony of the plant is almost entirely destroyed by exsiccation. When taken in excessive doses it produces sickness, giddiness, delirium, fainting, cold sweats, asphyxia, spasms, involuntary stools, apoplexy, and death. It has been known, on being introduced into a small wound of the thumb, to produce " pain in the fingers and arm, cardialgia, anxiety, with fear of suffocation, lipothymia, agitation, and finally grangrene, and co- pious suppuration."* When the leaves of this plant are chewed in small quantity, they cause a sensation of numbness in the gums and lips, which continues for two or three hours .t Aconitum has been a good deal employed in the practice of the German and Italian physicians; and it seems still to enjoy no inconsiderable reputation among * Orfila's Toxicology, by Dr. Nancrede, p. 220. Alberti Jurisprudentia Medica, torn. vi. p. 724. f Brodie; in the Philosoph. Transact. An. 1811, p. 185. WOLFSBANE. 87 them. Storck first introduced this article into regular practice. The character, however, which he gave it was, upon the whole, too flattering; and later expe- rience has not fully confirmed the favourable account which he gave of its powers. There is, notwithstand- ing, sufficient testimony extant in its favour to establish its claims to our attention; and I am led, independent of such testimony, from my own experience, to regard it as an article possessing valuable medicinal virtues. It is often of decided advantage in rheumatic and syphilitic pains, consequent to a mercurial course. I have been in the habit, for several years past, of giving a dose of the extract of this plant to such of my patients as are suffering from pains of this kind, as an anodyne, on going to bed, and I have often had reason to be satisfied with its effects. Borda,* an eminent Italian physician, commends its powers very highly in these affections. Richter says, that in acute rheumatism, after the fever had in a great degree subsided, but where much pain was still experienced in the affected parts, he has frequently known very decided relief ob- tained from the use of a solution of the extract of aco- nitum in antimonial wine. One drachm of the extract should be dissolved in an ounce of the wine, and taken in doses of from fifteen to thirty drops every four hours. It has also been extolled for its virtues in chronic rheumatism and gout.t In a case of the former of these diseases I employed it in large doses, and derived some advantage from it. Its virtues appear to be much enhanced by being united with antimonials in cases of rheumatism. It is, however, so decidedly inferior to stramonium in this respect, that it may very properly be neglected for this latter remedy in these affections. * Primae Lineae. f Bohmer de usu salutarii extracti aconiti in Arthritide. Halae, 1768. 88 WOLFSBANE. Swediaur used this narcotic, with a very good effect, in gleet, complicated with rheumatism. Borda praises it as one of the most valuable reme- dies we possess for relieving morbid secretions of the trachea and bronchia. " Crebro," says he, " etiam ob- stupui animadvertens extractum aconiti nedum sputo- rum redundantiam ocissime repellere, sed naturam eorum ita immutare ut mihi omnem prseperceptum ab- stergeret metum proximae desperate phthiseos cui mors quasi saxum tantali impendet." Busch recommends this article as an excellent remedy in phthisis pulmona- lis. It is said to be particularly useful in bronchial consumption, or chronic bronchitis. Baumes, also, speaks highly of its effects in this complaint. Both these writers say, that this narcotic is most apt to prove beneficial when given in the first stage of the disease. Burdach states that it has been applied successfully to the cure of obstinate quartans. It has also been used with advantage, according to the same writer, in amaurosis. I need scarcely say that its once reputed powers in the cure of cancer, are entirely fallacious. Yet in the treatment of scrofulous, venereal, and other obstinate ulcers, it has been known to be of unequivocal advan- tage.* We have also accounts of its efficacy in goitre, scirrhous breasts, mesenteric obstructions, and nodes. The aconitum is generally employed in the form of an extract. Half a grain is sufficient to commence with, if it be good, and gradually increasing the dose to * Vogler recommends the following compound in the treatment of arthritic and rheumatic cases: R.—Succ. inspiss. aconiti. napel. * Antim. sulphuret. precipit. aa gr. i. Magnesia, gr. x.—M. To be taken for a dose. SOLANUM NIGRUM. 89 as much as can be borne without inconvenience. The tincture is to be commenced with in the dose of gtt. xv. and gradually increased. Of the powdered leaves one grain is an ordinary dose. Formulas. R.—Tinct. guaiaci. vol at. ^ii. Extract, aconit. gi. Vin. antimonii f i._M. Take a tea-spoonful three times daily, in chronic rheumatism. R.—Extract, aconit. Sulph. aurat. antimon. a.a 9ii. G. guaiaci. giv—M. Divide into two grain pills. S. Take four pills three times daily; in chronic cutaneous diseases. R.—Fol. aconit. 3a. Liquor, anod. Hoff. gviii—M. Digest for three days. This is a very active preparation, and may be employed with much benefit in chro- nic hysteria, with nervous pains in the abdomen. The dose is from fifteen to twenty drops, four times daily. SOLANUM NIGRUM. This is a very common plant in the United States, and generally found growing in gardens. It possesses a slightly foetid odour; its taste is insipid and herba- ceous. Alibert,* states that a boy aged eight years, eat some of the black berries of this plant, which induced coma and torpor, attended with fever. He complained of great pain in the pit of the stomach, and was harassed with nausea and retchings. According to the experience of M. Dunal, it would appear that the extract of this plant is not very poisonous, but that it has the power of slowly destroying sensibility and irritability.t That the berries, however, are an active narcotic poison, I have had the most satisfactory evidence in a little girl, while I practised in Lancaster. Being called to visit this little patient, I found her lying * Nouveaux Elemens de Therapeutique, &c. torn. i. p. 417. f As quoted by Orfila. 90 SOLANUM NIGRUM. in a deep apoplectic stupor—entirely insensible, all the muscles relaxed, the face flushed, and the pulse full and irregular. She continued in this state about six hours, and then gradually recovered. When she had become sensible again, it was ascertained that she had eaten of the berries of this plant. M. Desforres, of Besancon, has obtained from this species of solanum, as well as from the solanum dulca- mara, a peculiar alkaline principle, upon which the active properties of the plants appear to depend, and which has received the name of solania. This sub- stance consists of a white, opaque, and sometimes pearly powder, without odour, and a slightly bitter, nauseous taste. It is insoluble in cold water, soluble in eight thousand parts of hot water, and sparingly in alcohol. Acids dissolve it speedily and afford a per- fectly neutral solution. In doses of from grs. ii. to grs. iv. given to dogs or cats, it excites violent retching and vomiting, followed speedily by drowsiness, which continues several hours. Eight grains did not destroy a kitten, although violent vomiting and stupor ensued. In the human subject, a very small quantity excited great irritation in the throat, accompanied with a very nauseous and bitter taste. Dissolved in active acid, which is said to be the best way for administering the solania, it may be given in quarter grain doses, two or three times daily. This solution almost always pro- duces some degree of nausea, but no subsequent drowsiness.* The solanum nigrum was very early introduced into the materia medica. It was used among the ancients as an external application, either in the form of poultice or its expressed juice, in a great variety of diseases.t * Magendie's Formulae, &c. translated by W. Darrach, M. D. of Philad. t Dioscorides, lib. iv. c. 71. SOLANUM NIGRUM. 91 Csesalpinus states that it was frequently employed as an internal remedy in inflammations of the stomach and bowels, and for ardor urinse.* It had, however, fallen almost into entire neglect, until the attention of the profession was again called to it by M. Gataker, surgeon of Westminster Hospital, in a paper read to the Royal Society, in 1757, and afterwards published in a separate work, under the title of " Observations on the Internal Use of the Solanum, or Nightshade." The account which this writer gives of the medicinal pro- perties of the solanum nigrum, is highly interesting, and, I conceive, in no degree exaggerated. He describes the following as its effects when exhibited in proper doses: " I found," says he, " from repeated trials, made with great caution, and safety to the patient, that so small a quantity as one grain weight of the leaf, in- fused in about an ounce of water, and the liquor after- wards strained from the leaf, and taken at bed-time, would sometimes have a considerable effect; but that two or three grains seldom failed either to vomit, sweat, or purge the patient moderately, or to increase the quantity of urine. It sometimes occasioned a gid- diness, especially when it made the patient sick; but neither the sickness nor giddiness were constant symp- toms ; and when they happened, they generally abated or entirely ceased after the first dose. The most common effects that I have observed to ensue upon taking the medicine were, a heat or warmth diffused in a few hours over the body, a plentiful sweat succeeding this heat, and a purging the next day. If a sweat did not break out, an extraordinary discharge of urine was the consequence, and frequently followed likewise by purging. One or more of the natural evacuations were almost always increased."t * De Plantis, 213. | Observations on the Use of Solanum, p. 6. 92 SOLANUM DULCAMARA. The disorders in the cure of which he found this plant to be more particularly advantageous, are, foul and painful chronic ulcers; pains in particular parts of the body; scorbutic eruptions, and ulcers of a cancer- ous nature. He relates a number of cases of each of these diseases, as having been successfully treated by this remedy, in his own practice, and he gives some on the authority of others, equally favourable to its powers. From my own experience I am entirely convinced that the remediate virtues of this plant are by far too much neglected, and that they are capable, in certain cases, of affording important advantages. While practising in the country, I very frequently exhibited this species of solanum in obstinate herpetic eruptions, and foul and painful ulcers, and often with the most decided benefit. I have also employed it with much advantage in sy- philitic eruptions attended with nocturnal pains. The dose, however, which I gave was much larger than that mentioned by M. Gataker. I commonly commenced with two grains of the dried leaves made into a pill, night and morning, and increased the dose until con- siderable nausea was excited, or until effects indicating its complete influence, such as vertigo, tremor, and debility, or pain in the stomach, arose. As an external application it has been highly com- mended for the cure of erysipelas. SOLANUM DULCAMARA. The dulcamara is a native of Europe and of this country; though with us it is most commonly found cultivated as a garden shrub. It is a climbing plant, with woody, brittle stalks,—it flowers in July, and bears red berries. The young twigs and leaves are the parts employed for remediate purposes, and should be col- lected early in spring. SOLANUM DULCAMARA. 93 It does not appear that this species of solanum was employed by the ancients as a medicine. Neither Theophrastus nor Dioscorides mention it in their works.*. The narcotic properties of this vegetable are much feebler than those of the plants I have already men- tioned. It is not, however, destitute of active qualities; for when taken into the stomach in very large doses, it is capable of producing vomiting, spasms, delirium, convulsions and insensibility. Dr. Bigelow states, that he has known the dulcamara, when collected in full vigour, to produce vomiting, in the dose of a few grains of the powdered leaves, or of a small cup of the decoc- tion. It generally, too, acts pretty strongly as a diu- retic, and its effects on the bowels are almost constantly aperient. It is said to contain a larger proportion of the pecu- liar alkaline principle solania than the S. nigrum. This circumstance does not countenance the opinion that the narcotic properties of these plants depend on the solania: for, were this the case, the S. dulcamara, which contains a greater proportion of this substance than the S. nigrum, ought also to possess more active nar- cotic powers, which, however, is contrary to the results of experience. This plant was formerly regarded as a very important remedy; and it is still thought by many to possess medicinal properties of very considerable value. From what I have myself seen of its effects, I am induced to regard it as a valuable article. It is of un- questionable service in herpetic and syphilitic eruptions. Dr. Crichton, physician to the Westminster hospital, states, in a letter to Dr. Willan, that he has found only two cases out of twenty-three of lepra graxorum to * Gataker on the Solana. Vol. II.—N 94 SOLANUM DULCAMARA. resist the curative powers of the dulcamara* Willan and Bateman add their testimony in favour of the utility of this remedy in the treatment of cutaneous diseases. The latter says, " One of the most effectual remedies in lepra, under all its varieties, is the decoction of the leaves and twigs of the solanum dulcamara."! In the London Medical and Physical Journal, for May, 1830, Mr. Gardner has published a paper in which he confidently asserts, that the solanum dulcamara, if properly administered, is a most valuable remedy in chronic diseases of the skin, more especially in those which are attended with much irritation, pustules, vesicles, scales, &c. In psoriasis, in several varieties of impetigo, in eczema and porrigo, as well as in lepra and ichthyosis, he delares that he has used this remedy with uniform success. " To insure success with the use of dulcamara, it is necessary that it should be col- lected at a proper'time, and carefully dried; it should, when dry, yield a powder of a bright green colour. The dose should be gradually increased until sickness, vertigo, and purging are produced. In no case have I known any benefit to be derived from its use, unless symptoms of its influence on the system were produced. The decoction, to be good, should be of a dark green colour, depositing a copious sediment as it cools, which should be shaken into the fluid before it is adminis- tered." (Lond. Med. and Phys. Jour., May, 1830.) * The following is his method of employing this remedy:—Take of stalks of dulcamara one ounce; water one pound and a half; boil to a pound, and strain when cold. Of this decoction two ounces are to be ad- ministered at first, morning, noon, and night, and then gradually increased until the patient takes of it to the amount of a puit a day. At the same time the skin is to be washed with a stronger decoction. If it produces giddi- ness, syncope, or palpitation, the dose is to be decreased. The good effects of this treatment are generally not observed until it has been contin- ued for eight or nine days. | Practical Synopsis of Cutaneous Diseases. By Thomas Bateman, M. D. F. L. S., p. 31. SOLANUM DULCAMARA. 95 Hufeland also declares that he has often used the dulcamara with decided benefit in chronic cutaneous diseases; and we may also cite the very respectable testimony of Carrere, Althof, and Sprengle, in favour of its usefulness in affections of this kind. Hufeland says, that he found the following combination particu- larly valuable.* The eruption is at first, generally, somewhat increased before it begins to disappear under the use of the narcotic. Alibert,t however, regards it as of doubtful efficacy in affections of this kind. From a very considerable experience with this remedy in the hospital St. Louis, he is led to consider it as at most but a useful auxiliary to more vigorous applica- tions. Much of the contradictory experience in medi- cine depends, perhaps, on the different modes and doses of exhibiting remedies. It appears from the writings of this physician, that the medicine was employed in much smaller doses in his practice than is generally used by the English and American physicians. It is, therefore, not improbable that Alibert's want of full success with this remedy, arose, in part, from his having used it in insufficient doses. It should, I think, always be given in doses sufficient to render its influence upon the system manifest, by the vertigo, palpitation, &c, which it produces. I have found the extract of dulcamara a very useful remedy, for chronic venereal pains and stiffness of the muscles. In the treatment of chronic rheumatism, too, this narcotic has been highly recommended. Kuhn, Althof, Hufeland, and Stark, have published statements illustrative of its good effects in this disease. It is * R.—Antim. crud. rji. Extract, dulcamara giv.—M. Divide into three grain pills. S. Take six pills, three "times daily, and gradually increase the dose to fifteen or twenty pills. f Elemens de Therapeutique. 96 SOLANUM DULCAMARA. said to be particularly beneficial in cases of rheumatism, arising from the abuse of mercury, or from the effects of cold while the system is under the mercurial influence. Walsh (on Venereal Affections, &c. 1811) says, that in rheumatism and other chronic affections from these causes, he has almost uniformly derived signal advantage from this remedy; and Girtanner declares, that in diseases of this kind, its powers cannot be too highly estimated. Let it be borne in mind, however, that to derive any decided benefit from this article, it must be given in full doses, and continued regularly until it produces some manifestations of its action, such as vertigo and nausea. Boerhaave and Werlhop speak highly of the powers of this remedy in phthisis. It need hardly be observed, that subsequent experience did not confirm their senti- ments on this point. Linnaeus recommends it as a most powerful remedy in jaundice and asthma.* From its diuretic properties it has sometimes pro- duced useful results in dropsy. It is stated in the Gazette de Sante, that a Flemish lady " who had the reputation of possessing a specific for dropsy," em- ployed the dried stalks of this plant. Dr. Thacher states, that "the bark of the root, sim- mered moderately for some hours, in fresh butter or cream, forms one of the most efficacious ointments to be applied to excoriated nipples of nursing women."t Bergius observes, that the narcotic properties of this plant are lost by drying; and that, of course, the fresh plant is much more powerful than when in a dry state. The best mode of exhibiting this remedy is in the form of decoction or infusion. The following formula, * Materia Medica, § 95. f The Am. New Dispensatory. FOXGLOVE. 97 altered from Quarin, is the one which I have commonly prescribed: take of the stalks (or twigs) of dulcamara, one ounce, cut them into small pieces, and bruise; steep them in a proper quantity of hot water for half an hour; boil afterwards for a minute or two over the fire. To a quart of the strained liquor, add of spirit, cinna- mon. L. Ph. two ounces. Dose, a cup full three times a day.* DIGITALIS PURPUREA.--FOXGLOVE. This is a biennial plant, growing abundantly in the mountainous forests of Switzerland, and cultivated with us, both for the beauty of its flowers and for remediate purposes. When properly dried it possesses a faint narcotic odour, and a bitter, nauseous taste. It yields its medicinal virtues both to water and alcohol. " It contains extractive matter and a green resin, in both of which its narcotic properties reside.t It is also said to contain ammonia and some other salts. When taken in an excessive dose, it produces heavi- ness of the joints, indistinctness of vision, nausea, syn- cope, trembling, vertigo, pain in the forehead and in the bottom of the orbits, drowsiness, slow and tremulous pulse, vomiting, and occasionally diarrhoea, with pain of the bowels, cold sweats, coma, convulsions, and apoplectic death. It has also been known to produce an inability to retain the urine. Small and frequently repeated doses occasion a peculiar distressing nausea, attended with anxiety and depression of spirits, debility, vertigo, false vision, great diminution of the frequency and force of the pulse, reducing it, sometimes slower than forty strokes in a minute; languor both of body * Thesaurus Medicaminum, p. 113. f Paris's Pharmacologia. 98 FOXGLOVE. and mind. It sometimes renders the pulse irregular and convulsive, without diminishing its fulness. Its narcotic effects are by no means transient, they are, on the contrary, apt to continue long, and even occa- sionally to reappear after having subsided.* In administering this powerful remedy, we ought always to bear in mind, that it will occasionally mani- fest no operation for many days, and then all at once display its powers, and bring on, very suddenly, the most alarming prostration. Dr. Baildon states a fact in the Edinburgh Medical Journal, July, 1807, which is extremely interesting as well as curious. After having got his own system under the sedative influence of digi- talis, he found his pulse not lessened in frequency when he stood erect, beating then at the rate of above a hundred in a minute; when he sat down it beat consi- derably slower, and when lying on his back it fell as low as forty. He tried this experiment on himself repeatedly, and always found the pulse to vary in the same manner. He states also that he observed the same results in other persons to whom he gave the digitalis. Other practitioners have observed similar variations in the pulse, in persons under the narcotic influence of this medicine. To Withering belongs the merit of having first regu- larly investigated the medicinal virtues of this plant. But, as is frequently the case with those who introduce a new remedy to the notice of the profession, he, with- out doubt, estimated its powers too highly. It is, not- withstanding, very deservedly considered as an import- ant article of the materia medica; and although physi- cians do not now place much reliance in its powers as a remedy in phthisis, it is still on various accounts entitled to very great attention. * Burdach, Arzneimittellehre, B. iii. FOXGLOVE. 99 The question whether digitalis be sedative or stimu- lant in its primary operation, is still a subject of con- troversy. Dr. Sanders, who has written an excellent work on the foxglove, strongly advocates the latter doctrine, whilst others, with more correctness, contend for the former opinion.* I am entirely persuaded that its operation is immediately sedative; for it is certain that its stimulant effects, if it has any at all, are ex- tremely feeble, and by no means proportionate to its ultimate sedative influence. " The fact of the sedative effects of digitalis," says Dr. Ferriar," is so decisive, that I do not hesitate to employ this term, notwith- standing the jargon with which the public has of late years been abused, on the subject of sedatives."! By means of this remedy we may direct the action of the heart without evacuations, and often reduce its fre- quency and force more effectually than by any other means in our power. From its extraordinary effects of diminishing the force and frequency of the heart and arteries, it is pre- scribed in a variety of diseases where this effect is desirable, and where venesection possesses no adequate power over the circulation. It is chiefly on these effects that its reputed advantages in phthisis are considered to depend. Drake, Fowler, Beddoes, Mossman, Stafford, and others speak in terms of great confidence of the curative powers of digitalis in phthisis. Drake J gives an account * " If any person were inclined to write a satire on medical evidence, the different testimonies respecting the properties of this single plant would furnish abundant materials. ' It is a diuretic,' says one physician. ' It has no diuretic power,'says another. «It is a stimulant,'says a third. ' It is a sedative,' cries another. ' It has no properties at all,' exclaims a fifth."—Ferriar's Medical Histories. X Essay on Digitalis, p. 2. X London Medical and Physical Journal, vol. ii. p. 268. 100 FOXGLOVE. of fifteen cases of confirmed consumption treated by this remedy, out of'which nine were cured, one relieved, and five died. Mr. Magennis,* physician general at the naval hospital at Plymouth, instituted an extensive course of experiments with this article, in consumption. Out of seventy-five, fifty-three were in the purulent stage, and twenty-five in the incipient. Of these forty- four were cured, twenty-two relieved, and but ten died. Dr. Beddoes also expresses, in very strong terms, his good opinion of the digitalis in this disease. " I daily," says he, " see many patients in pulmonary consumption advancing towards recovery with so firm a pace; that 1 hope consumption will henceforward as regularly be cured by foxglove as ague by the Peruvian bark."t In incipient phthisis, Dr. MossmanJ regarded this remedy as almost a specific. Unreasonable as these hopes may now appear to us, it is certain that considerable advantage may occasion- ally be derived from the employment of this medicine. When we consider the power which foxglove possesses of lessening irritability and the impetus of the circula- tion, we can hardly doubt that it is peculiarly adapted to the early stage of this disease. In the commence- ment of this complaint, when inflammation is going on in the lungs, and before it has terminated in suppuration, digitalis may be of service by subduing the circulation, and thereby resolving the local pulmonic inflammation. Dr. Ferriar§ was the first who entertained this view of * London Medical and Physical Journal, vol. v. p. 204. j; Observations on the Causes, Early Signs, and Prevention of Con- sumption, &c. by Thomas Beddoes, M. D., 1799. X Essay on Glandular Consumption in the Medical and Physical Jour- nal, vol. iv. p. 309. § " It is well known," says this judicious physician, " that bleeding with the lancet is very inadequate to the purpose of lessening (in some cases) the velocity of the circulation, unless it be carried to a dangerous FOXGLOVE. 101 the modus operandi of digitalis in diseases of increased vascular action. Darwin, Fowler, and Drake referred the beneficial operation of this remedy in pulmonary consumption to its power of diminishing secretion and augmenting pulmonary absorption. We know, how- ever, that the foxglove has a powerful tendency to diminish the activity of the heart and arteries; and as the most effectual mode of reducing inflammation is to lessen the general energy and velocity of the circula- tion, so we may fairly infer that in phthisis, which, in its earlier stages, is always attended with more or less pulmonic inflammation, digitalis, if it act beneficially at all, does so by virtue of its sedative properties. This accords with the experience of Dr. Magennis. "I have met," he observes, "with several instances in which the digitalis given freely and largely effected not the smallest reduction of the pulse; and in these the patients uniformly derived no advantage whatever from its use."* Measles are often attended with an inflammatory condition of the mucous membranes of the lungs and trachea about the time the eruption is subsiding; pro- ducing hoarseness, cough, and dyspnoea, and not unfre- quently leading on to pulmonary consumption. To obviate these occurrences, it is frequently necessary to adopt rigid antiphlogistic measures, of which bleeding and blisters are undoubtedly the most effectual. As an auxiliary to these means, digitalis has been employed v/ith undoubted advantage. Dr. William Hamilton, of Suffolk,! says, it is " in the advanced stages of excess. The foxglove furnishes us with the means of regulating the pulse to our wish, and of supporting a given state of velocity, as long as we judge it proper."—Ferriar on the Medical Properties of the Foxglove, p. 12. * Lond. Med. and Phys. Journal, vol. v. p. 204. | Observations on the Digitalis Purpurea, by \Ym. Hamilton, M. D. p. 154. Vol. II.—O 102 FOXGLOVE. measles, when the disposition of the membranes lining the chest to inflammation shall have ceased, or have been overcome by appropriate remedies, that its use will be found most effectual towards checking the con- sumptive tendency." Of its powers in pneumonia not much can be said. This is a disease too rapid in its course to allow of such tardy modes of reducing the activity of the circu- lation. We are enabled by the lancet to effect this purpose in a much more prompt and effectual manner. The employment of this article, though, perhaps, never to be depended on in this case, as a principal remedy, may notwithstanding become an useful auxiliary after more prompt antiphlogistic measures have been em- ployed, or where much general debility exists, attended with irritation of the lungs, difficult breathing, trouble- some cough, quick and corded pulse, and a dry skin. This article is well spoken of by Drs. Currie and Ferriar,* as a valuable remedy in active haemorrhages. Richter also recommends it as particularly useful in haemorrhages from the lungs and nose.t As a general practice, however, I agree with Dr. Chapman,:]: that wherever haemorrhage depends on an active state of the circulation, and where this requires reduction, bleeding is at once the most direct, safe, and efficacious remedy. In haemoptysis, however, where there is an irritable state of the heart and arteries, indicated by a small, quick, corded, and spasmodic pulse, digitalis may afford important advantages when venesection is of no avail. It is particularly recommended under such cir- cumstances by Frank, Richter, and Ferrinr.S In cases of threatened abortion, attended with hse- * Medical Histories and Reflections, p. 104 and 258. X Specielle Therapie, vol. iii. p. 296. X Elements of Therapeutics, p. 265, first edition. § Observations, &c. p. 99. FOXGLOVE. 103 morrhage, Mr. Burns recommends the exhibition of digitalis combined with opium. By this remedy, if given in strong doses, we diminish at once the con- tractile efforts of the womb, and the force of the circulation, and thereby lessen the chance of miscar- riage and the haemorrhage. Digitalis has also been successfully applied to the cure of epilepsy. Burdach says it is particularly ser- viceable in this affection when attended with a strumous diathesis in children. In the cure of spasmodic asthma, Dr. Ferriar states that he has found digitalis in conjunction with opium " remarkably useful. By keeping the patient constantly under the influence of the medicines, (a grain of each being given every four or five hours,) I have ever seen a permanent suspension of the symptoms of this dis- ease. When the stomach will bear the digitalis without difficulty, I believe that very great and almost immediate relief may thus be obtained."* My own experience enables me to speak favourably of this practice. In two instances of this disease I derived very decided advantage from such a combination of opium and digitalis. The foxglove has acquired some character as a remedy in mania. From its sedative effects it would not be unreasonable to expect useful results from its employment in cases of mania, where, after frequent purging and bleeding, the arterial and nervous systems remain in a state of increased excitement. Mr. G. Hill has used this remedy with considerable success in mania; and Dr. J. M. Coxt observes, that no case ought to be given up as hopeless in which this remedy has not been tried, and its employment persisted in, till * Kerriar's Essay on Digitalis. f Practical Observations on Insanity, &c, p. 85. 104 , FOXGLOVE.. some obvious effects have been produced. He con- siders it most efficacious in those cases of mania where the circulation is increased without other febrile symp- toms. " I had a patient," says he," whose system was kept saturated, as it were, with digitalis for wTeeks in succession, whose mental wanderings seemed regulated by the state of the circulation: when the pulse was at ninety, he was constantly furious, at seventy, perfectly rational, at fifty, melancholic, and at forty, half dead. He was at length perfectly cured by such a dose of this remedy as kept the pulse pretty uniformly at about seventy, and yet he had sometimes taken three drachms of excellent tincture of digitalis three or four days fol- lowing." Dr. Currie, also, in his observations on the digitalis purpurea, published in the fourth volume of the Memoirs of the Medical Society of London, states, that he has sometimes derived very great advantages from its employment in this disease. According to the experience of Richter, digitalis is a remedy of much value in chronic pemphigus. He cured an inveterate case of this kind by the use of this article in combination with calomel and opium. He gave two grains of powdered digitalis with one grain of calomel and half a grain of opium, three times daily, with entire success. (Speciel. Therapie. vol. ii. p. 615.) Henning employed digitalis with marked benefit in herpetic eruptions. It has also been much extolled as an external application, in the form a strong infusion, in chronic cutaneous affections. Weavre (Lond. Med. Repos.) used it in this way in a case of inveterate itch, with complete success. Some of the old English writers on the materia medica speak highly of digitalis as an external applica- tion to scrofulous ulcers. In the Annals of Medicine, a periodical work, the beneficial effects of this article, FOXGLOVE. 105 as a local application in ulcers of this kind, are strongly set forth by Mr. Couch, of Polperro, in Cornwall. A strong decoction of the leaves was employed by this gentleman. N It has also been employed internally in scrofulous affections with manifest advantage. Hufe- land (Treatise on Scrofula, p. 249,) prescribed it with decided benefit in the early stage of active scrofula, and in the scrofulous diathesis. Administered in conjunc- tion with burned sponge, Rust found it very beneficial in struma. Kotrum administered the extract of digi- talis in union with the extract of cicuta, the golden sulphur of antimony and calomel, in scrofulous affec- tions ; and he asserts that he has often obtained im- portant advantage from this combination.* Uwins obtained very favourable effects from digitalis in tabes mesenterica. (Lond. Med. and Phys. Jour., 1818.) Like almost all other vegetables of great powers, this plant is found to be of very different strength, as it is met with in the shops. "It is therefore very important," says Dr. Paris,! " that the leaves of this plant be properly collected and accurately preserved; they should be gathered when the plant is beginning to flower; the largest and deepest coloured flowers should be also selected, for they are the most powerful; they should be also carefully dried until they become crisp, or they will lose much of their virtue. The powdered leaves ought to be preserved in opaque bottles, and kept from the action of light as well as of air and moisture; a damp atmosphere has a very injurious operation, by carrying off those faint poisonous effluvia * R.—Extract, digitalis jss. Extract, cicutae ji. Antim. praecipit. auri. §i. Submuriat. hydrarg. gr. x.—M. Of this mixture, ten grains is to be taken mornings and evenings. \ Paris's Pharmacologia. 106 FOXGLOVE. with which its efficacy seems to be intimately con- nected." It may be exhibited in substance, tincture, or infu- sion. The powdered leaves are to be given in the dose of gr. i. two or three times a day, and gradually increased, until its effects become apparent. If it be given with a view to obtain its diuretic effects, it will sometimes be necessary to combine it with opium, in order to prevent it from occasioning a vomiting or purging, which lessen or destroy its diuretic powers. The effects of an over-dose are most effectually coun- teracted by opium or brandy, and epispastics to the stomach. The tincture is very commonly employed. The dose of it is twenty drops, which is to be cautiously increased. The cataplasma digitalis is made thus: fol. digit, sice. giii. (or fol. digit, recent. §iv.) aquae ifcii. coque ad dimidium; strain, and with the decoction and lintseed meal make a poultice. When it is necessary to exhibit this remedy repeat- edly during the day, its effects ought to be watched with the strictest attention, to prevent the alarming and even fatal consequences which may arise from ad- ministering this powerful medicine incautiously. For the character and remedial employment of digi- talis as a diuretic, see the chapter on this article under the head of Diuretics. Formulas. R.—Tinct. digitalis §ss. ---- tutolem ^i. ---- opii gi—M. Take forty drops, three times daily; in chronic cough. R.—Pulv. digitalis gr. vi. ---- nitrat. potass, jiss. Submuriat. hydr. gr. iv—M. Divide into ten equal parts. Dose, one every two hours; as an antiphlogistic in inflammatory affections. R.—Pulv. scillae exsiccat. gr. iv. ---- digitalis gr. x. Submuriat. hydrarg. gr. vi. NICOTIAN A TABAGUM. 107 G. myrrh. 9i. Simul tere, et adde G. assafcetid. £ss. Extract, gentian. q. s.—M. In pil. dividend. No. xv. Take one three times daily. NICOTIANA TABACUM. Tobacco is endued with very active poisonous pro- perties, and may be applied to important remediate purposes. It possesses a narcotic foetid odour, and a somewhat bitter and extremely acrid taste. By chemi- cal analysis it is found to contain " mucilage, albumen or gluten, extractive matter, a bitter principle, an essen- tial oil, nitrate of potass, and a peculiar principle upon which the properties of the plant are supposed to de- pend, and which has been named nicotin." Vauquelin considers this substance as approaching the volatile oils in its properties; it is colourless, of an acrid taste, and has the peculiar smell of tobacco; it occasions violent sneezing; " with alcohol and water it produces colourless solutions, from which it is thrown down by tincture of galls."* The active matter of tobacco is readily extracted both by water and by spirit, but more perfectly by the latter. By distillation the leaves afford an oil which possesses the peculiar powers of the plant in a highly concentrated state. When tobacco is received into the stomach in a large dose, or is applied to any other part of the system susceptible of its influence, it produces nausea, great distress of feeling, cold sweats, vomiting, trembling, vertigo, spasm, insensibility, &c. When taken in an enormous dose it destroys life very speedily. Brodie,t from a number of experiments which he performed on animals with this plant, was led to conclude that it * Paris's Pharmacologia, p. 534. f Philosophical Magazine for August, 1811. 108 NICOTIANA TABACUM. destroys life by rendering the heart insensible to the stimulus of the blood, and thus stopping the circulation. Orfila asserts,* .that the action of tobacco is more energetic when injected into the anus than when re- ceived into the stomach. It seems to be almost equally active when applied to the external surface in parts where the skin is broken. Orfila mentions, upon the authority of Vandumond, instances where the decoction of the leaves applied to parts affected with itch, excited violent vomitings and convulsions.t I saw a child a few years ago thrown into alarming convulsions and syncope, by the impru- dent application of tobacco ointment to an obstinate pustular eruption on the top of its head. As a remediate article, tobacco may be very usefully employed in many instances. Stahl recommended an extract of it, made by long boiling, as a very effectual and safe expectorant and diuretic remedy. Paris states, that long coction weakens the powers of this plant; the extract recommended by Stahl, may there- fore be a safer and more effectual remedy in conse- quence of having its poisonous parts dissipated by the long-cOntinued boiling, whilst its aperient, expectorant, and diuretic properties may not suffer any material diminution by such a process. Tobacco has been successfully employed in the cure of dropsy and dysury. Dr. FowlerJ has written a work expressly on its virtues in these diseases; and he speaks of it as a remedy which, if properly adminis- tered, is capable of producing copious diuresis. He used it in the form of infusion, of which he gave about * System of Toxicology, article Tobacco. X Recueil Periodique, torn. vii. p. 67. X Medical Reports of the Effects of Tobacco in the Cure of Dropsies and Dysenteries, by Thomas Fowler, M. D. Lond. 1785. N1C0TIANA TABACUM. 109 eighty drops. He observes, that the best time for administering it is two hours before dinner, and on going to bed. He asserts, that he found it equally effectual in nephritis calculoso. Mr. Earl, surgeon of the Foundling Hospital, London, has published an interesting paper on the efficacy of tobacco injections in retention of urine.* The cases to which he considers it as particularly applicable are those which depend on a spasmodic state of the urethra, and which sometimes supervene in consequence of accidental causes, " in persons who have been long subject to strictures in the urethra, but who are still able to void their urine in a small stream." In instances of this kind it is often impracticable to introduce instruments into the bladder, and it becomes necessary to overcome the retention by other means. Under such circumstances, therefore, Mr. Earl has employed tobacco injections with great success in three cases, after all the usual means had been resorted to ineffectually. Dr. West- burg, also, states that he has frequently administered the tincture of tobacco in ischuria with signal success. He directs twenty drops to be taken every hour, in a glassful of flaxseed tea. (Revue Medic. Nov. 1823.) With a similar intention of removing constriction, tobacco is employed in cases of incarcerated hernia, and frequently with complete success. For this purpose either an infusion or the smoke of the plant is injected into the rectum. The very great relaxation which is thereby produced throughout the whole body, generally enables the surgeon to reduce the protruded parts very readily. The same practice will often produce almost imme- diate relief in cases of obstinate constipation, depending on a spasmodic constriction of the bowels. In employ- * Medico-Chirurgical Transactions, vol. vi. Vol. II.—P 110 NICOTIAN A TABACUM. ing tobacco injections it is, however, of the utmost importance to proceed with very great caution. If the quantity injected be too great, it will produce the most alarming symptoms; such as vomiting, cold sweats, universal prostration, syncope, and even death. I have known an empiric destroy, in less than twenty minutes, the life of a charming little boy—the son of a gentle- man at Lancaster, whose family I attended while resid- ing in that place—by an immoderate injection of the infusion of tobacco. In general, a half a drachm of the leaves infused in eight or ten ounces of water, will be as much as can with safety be thrown into the rectum at one time. Tobacco has also been recommended as an excellent remedy in dysentery. Dr. O'Brien employed it in the form of enemata, in the proportions of ten grains of the tobacco to six ounces of boiling water, at the same time that the abdomen was fomented with an infusion of the strength of two ounces to two pounds of boiling water. "When thus employed, tobacco is said to moderate the action of the heart and arteries, to allay the intestinal spasm, tormina and tenesmus, and to restore the free action of the cutaneous exhalents." Tetanus, too, is one of the diseases in which tobacco has been employed with decided advantage. Dr. James Norcom relates a case which was cured by tobacco injections (Philadelphia Jour. Med. and Phys. Science). Dr. Anderson has reported three cases of traumatic tetanus which yielded to this remedy. He employed it by fomentations, baths, and enemata. We have also the testimony of O'Beirne, Gardener, and Lefoulon, in favour of the usefulness of this remedy in tetanus. A cataplasm composed principally of this plant, ap- plied to the pit of the stomach, was employed with suc- cess, both in epilepsy and obstinate intermittents, by STRYCHNOS NUX VOMICA. Ill Dr. James Currie of Liverpool. The application was made about half an hour before the accession of the paroxysms of these diseases. As an external application either in the form of an ointment or infusion, it has been a good deal recom- mended in porrigo, and other cutaneous diseases. I have used it in two instances in this affection, to a very great extent, without, however, deriving any perma- nent advantage from it. The late Professor Barton was in the habit of applying a poultice of tobacco leaves pounded in vinegar to the region of the stomach, in cases of worms. " In consequence of this application," he observes, " worms are often discharged after power- ful anthelmintics have been exhibited internally in vain."* I have, in several instances resorted to this practice in cases of worms, without the slightest benefit, although the existence of worms in the bowels was rendered certain by the frequent spontaneous discharge of them. STRYCHNOS NUX VOMICA. The tree which affords this article is indigenous to the eastern continent. It is particularly abundant along the coast of Coromandel, Malabar, and at Cey- lon. Its fruit, which is a berry of the size of a small orange, contains in its pulp the seed which is the offi- cinal nux vomica. These seeds have been analyzed by Pelletier and Caventou, who obtained from them a yellow colouring matter, a concrete oil, gum, starch, bassorin, a small quantity of wax, and two peculiar alkaline principles, brucia and strychnia, united with a peculiar acid, which they named igasuric acid. Strych- * Collections for an Essay towards a Materia Medica of the United States, p. 63. 112 STRYCHNOS NUX VOMICA. nia, which contains the active properties of the nux vomica in a highly concentrated state, crystallises in small four-sided prisms, terminated by quadrilateral pyramids. It is inodorous, but has an intensely bitter taste, leaving a slight metallic flavour on the tongue. " So exceedingly bitter is this substance, that one part of it communicates a sensible taste of bitterness to 600,000 parts of water." It is very sparingly soluble in water, requiring 6667 times its own weight of water at fifty degrees of temperature for solution. Alcohol and the volatile oils dissolve it very readily. It forms neutral salts with the acids, which become " blood-red by the action of concentrated nitric acid." The dele- terious effects of the nux vomica on cats, dogs, foxes, and certain birds, were long since observed by Gessner, Wepfer, Bunner, and others. By the more recent experiments of Desportes, Magendie, and Delisle, the peculiar powers of this substance have been more particularly elucidated. When given to dogs as a poison, it produces great anxiety, laborious and confined breathing, retching, and nausea, tremors, violent convulsions, tetanic spasms of extraordinary force, asphyxia from immobility of the thorax, and death. In animals thus killed, Delisle, Ma- gendie, and Desportes never found the least trace of inflammation. It appears to extinguish life by destroy- ing the power of the respiratory muscles, and thus pro- ducing asphyxia. According to the experiments of Delisle, no effects whatever are produced when this substance is applied directly to an exposed nerve. When, however, thrown into the cavity of a serous membrane, it speedily proves fatal. Murray appears therefore to be wrong in attributing the deleterious effects of the nux vomica to its immediate operation on the nervous system.* * Alibert, Elemens de Therapeutique, &c. t. i. p. 435. STRYCHNOS NUX VOMICA. 113 Its effects upon the human system are similar to those which it produces in animals. Magendie and Delisle observed that it has the power, when taken in a proper dose, of exciting strong spasmodic contractions of the voluntary muscles without materially affecting the more important vital organs of the system. M. Fouquier, physician of the Hospital de la Charite, taking advan- tage of this singular property, conceived the idea of applying it to the cure of paralysis. He accordingly administered it to a number of patients affected with paraplesia and hemiplegia, and obtained from it very important results. The effects of a sufficient dose were, invariably, strong muscular contractions of more or less permanency; consisting sometimes of sudden and transient starts, and at other times of clonic contrac- tions of a tetanic character. These contractions are, in general, stronger in the paralytic parts than in those which are healthy. M. Fouquier observes, that a very strong dose has sometimes produced general tetanic convulsions, without however doing any mischief. Dr. Lescure* relates several cases of paralysis in which the nux vomica proved successful. He gave four grains of the extract, divided into two doses, daily, to a patient who had been for four years affected with paraplegia. The dose was gradually increased to six grains in the second week; the patient then began to feel heat in the stomach, a sense of constriction in the abdomen, diffi- culty of voiding urine, and now and then slight contractions of the muscles of the lower extremities. The remedy was now omitted for a short time. On being resumed and continued for some days, forcible and sudden contractions seized the paralyzed limbs, and the retention of urine was more complete than on the former occasion. On again omitting the * Journal Universel des Sciences Medicales, torn. xi. 114 STRYCHNOS NUX VOMICA. medicine these symptoms disappeared. It was then resumed in the dose of eight grains, and. at the termi- nation of three weeks, he again was taken with tetanic contractions, which continued four hours. The patient now gradually recovered the use of his limbs. The nux vomica has also been employed in intermit- tents, mania, epilepsy, gout, rheumatism, cutaneous eruptions, hydrophobia, scrofula, and hypochondriasis. Hagstrom, a Swedish physician, asserts that he found it of great service in an epidemic dysentery. It was given in the dose of twenty grains of the powdered nut once a day in some barley-water, after the bowels had been duly evacuated by laxatives. It is also particularly com- mended by Hufeland, for its good effects in an epidemic dysentery that occurred at Jena in 1795. A late Ger- man writer of great respectability, states that he used it in an epidemic dysentery that prevailed at Melle, a town in the principality of Osnaburg, in 1800. He gave it in doses of two and a half grains every two hours. " It sometimes allayed the pain, though in a few individuals it increased it."* It does not appear, upon the whole, that its efficacy in this disease is such as to entitle it to any particular attention. Strychnia has recently been employed with great advantage in certain diseases of the eye. Mr. Middle- more found it" of singular service" in a case of ptosis, dependent on partial paralysis of the levator muscle. He has also used this remedy with decided benefit in amaurosis. In cases arising from " overworking the eye," by confining it to the inspection of objects of tin same colour, " or by looking for many hours daily, at bright substances of the same, or nearly the same colour, or subjecting it to sudden transitions from at * Summa Observationum Medicarum, &c. L. I. Schmidtman M. D. Beraline, 1819. STRYCHNOS NUX VOMICA. 115 artificial glare to a comparative darkness;" in cases, in short, depending on mere functional torpor of the retina, unattended by structural change or congestion of the vessels of the eye, the use of this narcotic will often pro- cure decided benefit. The mode of using the strychnia, in cases of this kind, is to blister the skin above the eyebrow, and after the cuticle is carefully removed, to sprinkle the powder on the raw surface. One-twelfth of a grain of the strychnia on each side, will be suffi- cient to begin with. It always causes very severe, smarting pain of the part upon which it is applied. " Some patients cannot bear its application; others require great care, and a very gradual augmentation of the quantity to enable them to bear it; whilst others will admit of its application without experiencing any other inconvenience than what arises from its action upon the sore." Dr. Short (Edin. Med. and Sur. Jour. Oct. 1830) states, that in eight out of nine cases of amaurosis, decided benefit was derived from the appli- cation of strychnia. It may be applied once daily. Dr. S. observes that the good effects of this article are generally enhanced by the previous use of mercury. In paralysis, strychnia has been found highly bene- ficial. Dr. Geddings, of Baltimore, has given an ac- count of some cases of this affection, in which the good effects of this remedy " were strikingly manifested."* The nux vomica may be given either in substance or in the form of an extract. Four grains of the pow- dered nut, or two of the extract, may be given three, four, or five times a day, and continued until its opera- tion on the system is adequately manifested. It will in general be necessary to increase the dose gradually, in order to obtain its peculiar effects. The alcoholic extract alone is employed. * Amer. Jour. Med. Sciences, vol. vii. p. 334. 116 SWAMP SUMACH. In cases of poisoning from nux vomica, Orfila recom- mends two spoonfuls of the following mixture every ten minutes, after the contents of the stomach have been evacuated:—R. iEther vitriol, si.; ol. tereb. sii.; sacch. albi, gss.; aqua pura, 3ii. The best mode of adminis- tering strychnia internally, is to dissolve two grains of it in an ounce and a half of distilled vinegar. Of this solution, twenty drops may be given twice, or even three times daily, in a small portion of the infusion of orange peal. Formulas. R.—Extract, nucis. vomic. gr. x. Mucilag. g. arab. §i. Aq. fontancae §vi. Syrup zingiberis §i.—M. Dose, two table-spoonfuls every two hours, in dysentery. (Hufeland.) R.—Extract, nucis. vomicae gr. x. Pulv. ipecac. gr. xv.—M. Divide into fifteen pills. Take one pill every four hours, until its effects on the system are decidedly obtained, in dysentery or paralysis. RHUS TOXICODENDRON, VEL RADICANS.---POISON OAK— SWAMP SUMACH. This is a very common shrub in this country, and well known by its property of inflaming the skin to a very alarming extent, simply on coming in contact with its leaves, or even by a close approach to it, in persons who are particularly sensible to its influence. Mr. Van Mons of Bruxelles, has published a chemical ex- amination of this species of rhus. He asserts, that the poisonous exhalation of this shrub is a carbonated hydrogen gas. It contains also a considerable quan- tity of tannin, some gallic acid, a small portion of green fecula, and a still smaller quantity of gum and resin. It does not appear that it possesses any very delete- rious properties when taken internally. Orfila observes, SWAMP SUMACH. 117 that it blunts the activity of the nervous system after being absorbed. Alibert,* however, states that a M. Boullon inoculated himself, in his presence, with the juice of the rhus toxicodendron, with perfect impunity. On the skin, however, its poisonous properties act with great energy. When touched or handled it produces in the course of two or three days very serious symp- toms. The skin inflames and swells, being attended with a very distressing burning pain. If the face be affected the eye-lids are so tumefied as to close up the eyes; the whole head is swelled and covered with little blisters containing serum. Sometimes the whole body is enormously swelled and covered with serous vesicles. When the inflammation and swelling have in some degree subsided, the epidermis begins to separate in little squamae, and an intolerable itching is felt for some days longer. The arterial system, during an affection of this kind, is very considerably excited.f These symptoms bear a very strong resemblance to those of erysipelas; and it is observed by Mr. Van Mons, that they yield to the remedies commonly em- ployed for the cure of this latter affection. M. Gouan recommends aqua ammonia, diluted in water, as a useful application; but I believe nothing has as yet been discovered more effectual in such cases than the application recommended by the late Professor Bar- ton, namely, an aqueous solution of corrosive sub- limate. The rhus toxicodendron has been a good deal praised for its remediate powers in the treatment of paralysis, herpes, and consumption. M. Dufresnoy, professor of botany at Valencia, speaks in very high terms of its efficacy in these affections. The experience of Ver- * Elemcns de Thiirapeutiques, torn. i. p. 452. f Alibert, Elomens de Therapeutiqucs, torn. i. p. 454. Vol. II.—Q 118 TELA ARANEARUM. deyen, Koch, Van Baerlem, Rumpel, Burdach, and others is also in favour of its employment in these and other affections. M. Pou, professor at Montpelier, cured a paralytic patient in a very short time with the extract of this plant. M. Gouan was equally successful in curing a young lady affected with hemiplegia. Dr. Alderson relates seventeen cases of paralysis, in all of which this remedy was usefully employed.* In two cases of hemiplegia, the employment of this article was attended with very good effects, in my own practice; and Dr. Ossann has informed me, that in the Polyclinic Institute of Berlin, it has been used in conjunction with G. guaiacum, in paralysis, with unequivocal advantage. In very large doses, it is apt to produce active purging. The dose of the extract is at first about grs. xx. to be gradually increased until some effects on the system are produced. The powdered leaves are given in the dose of from one grain to ten, three or four times a day. Formulae. TINCTURE. R.—Fol. rhois. toxicodend. ^i. Spir. vini rectificat. §xii. Aq. fontanae §iv.—M. Digest for six days. Dose, from thirty to sixty drops, three times daily. R.—Tinct. rhois. toxicoden. §ss. Tinct. aconit Tinct. guaiaci. volat. aa gii.—M. Take forty drops every three hours. TELA ARANEARUM. The spider's web has been long known as a domes- tic remedy for the cure of agues; and we find it men- tioned in the dispensatory of Schroder, published in 1644, as possessing such remediate powers. It is to Dr. Robert Jackson, however, that we are indebted for * An Essay on the Rhus Toxicodendron, &c. by J. Alderson, M. D. TELA ARANEARUM. 119 a more particular and satisfactory account of its pow- ers, and consequently for the attention which it has lately received from the profession. This respectable physician, in a communication published in the Medical and Physical Journal,* states that Dr. Gillespie of Ed- inburgh had succeeded in curing a very obstinate case of ague by the spider's web, after various other means had been tried ineffectually. He then details his own experience with this substance in the treatment of intermittents, the result of which goes directly and strongly in favour of its remediate powers. " I think," says he, " I may venture to say that it prevents the re- currence of febrile paroxysms more abruptly and more effectually than bark or arsenic, or any other remedy employed for that purpose with which I am acquainted; that, like all other remedies of the kind, it is only effec- tual as applied under a certain condition of habit; but that the condition of susceptibility for cobweb is at the same time of greater latitude than for any other of the known remedies. The cobweb was rarely given before the subject was prepared by bleeding, emetics, or pur- gatives." The more obvious effects of this remedy when taken into the system is to allay irritation, to tranquillize the mind, and to induce easy slumbers. Dr. Jackson de- clares that the cobweb allays "morbid irritability, and calms irritations both of body and mind, in a degree far exceeding any drug or remedy within the circle of our knowledge." He further observes that the effects which it produces characterize it as powerfully stimulant. When the pulse is quick, frequent, irregular, and irri- tated, it becomes slow, calm, and regular by its opera- tion. In general the surface becomes relaxed and covered with perspiration. If the pulse is slow, regular, * Medical and Physical Journal, vol. xxi. 120 TELA ARANEARUM. and nearly natural, it generally becomes frequent, small, irregular, and sometimes intermitting. Where languor and depression exist, " sensations of warmth and com- fort are diffused about the stomach, and increased ani- mation is conspicuous in the appearance of the eye and countenance." I have taken it very often, and have uniformly found it to produce a calm and delightful state of feeling, succeeded by a disposition to sleep. This accords with the experience of Dr. Oliver of Sa- lem, who found it to produce in himself " the most de- licious tranquillity, resembling the operation of opium, and followed by no bad effects." In consequence of these soothing properties the cob- web has been found an excellent palliative in the ad- vanced stage of consumption. Dr. Jackson details a remarkable case of asthma, in which the tranquillizing effects of this substance were conspicuously evinced. The complaint was hereditary and connected with malformation of the chest. The patient was unable to lie down in bed from a sense of suffocation, and was obliged to take the little sleep he could get in a half-sitting posture, being supported by pillows. In this distressing condition he one night took twenty grains of the spider's web, and obtained from it a sound and uninterrupted sleep all night, "a blessing to which he had been an entire stranger above six years." The same writer states that he has found it very useful in the spasmodic complaints of females, which resist the powers of ordinary remedies. In chro- nic hysteria I have employed it with much advantage. I have found it particularly serviceable in women of a relaxed habit of body, accompanied with morbid irrita- bility of the nervous system. In a case which I have at present under my care, my patient derives evident advantage from this article, in combination with the PRUSSIC ACID. 121 cyanite of zinc, lately introduced into practice by Dr. Hufeland of Berlin. Dr. Webster* of Boston, adds his testimony in favour of the remediate virtues of this sub- stance. He has found it to produce very good effects in rheumatic headache, asthma, and chronic coughs. He has also derived much advantage from it in allay- ing the irritation which sometimes attends a mercurial course. He mentions the following remarkable effects of this remedy in an old and infirm asthmatic: " slight but pleasant delirium was produced, and from the report of the persons who slept in the room with him, the effect, though of longer duration, was very similar to that of a dose of nitrous oxide gas; the muscular energy having been exceedingly increased, the patient could not be confined to bed, but danced aud jumped about the room nearly all night: in the morning I found him quietly asleep. No unpleasant symptoms ensued." The same writer observes, that the cobweb is an excel- lent application to irritable sores. It is generally given in the dose of five or six grains, repeated every third, fourth, or fifth hour. According to the experience of Dr. Jackson, a dose of five grains produces nearly the same effects as one of twenty. HYDROCYANIC ACID.--PRUSSIC ACID. The prussic acid is the most prompt and fatal poison known. When perfectly pure, and brought into con- tact with a wound, or simply applied to the eye or tongue of an animal, it destroys life almost instanta- neously. When diluted, however, to a proper degree, it appears, from some late accounts of its employment in diseases, to be capable of very important remediate applications. * New England Medical and PhysicalJournal, new series, vol. iv. p. 218. 122 PRUSSIC ACID. The prussic acid, as it is usually prepared for medi- cinal purposes, is transparent, without colour, of a bland and sweetish taste at first, becoming acrid and hot afterwards. Its specific gravity, at seven degrees of Reaumur, is 0.70583. It reddens the tincture of turn- sole slightly. It boils at the temperature of 26° 5', under a pressure of 0.76m; and at 15° it congeals.* It is so extremely volatile, that when a portion is dropped upon a piece of paper, the part which almost instanta- neously evaporates, produces a sufficient degree of cold to crystallize the portion of the acid remaining on the paper. Its odour is strong and characteristic, resem- bling that of peach-blossoms and bitter almonds. When exposed to light it is soon decomposed, resolving itself into carbonic acid, ammonia, and carburetted hydrogen gas. It is, therefore, necessary to keep it excluded from light, otherwise it will very soon become inert and useless. It is found in a variety of vegetable sub- stances;—in bitter almonds; the kernels of black cherries; in the flowers and leaves of the peach-tree, and particularly in the kernels of the peach, and in the leaves of the prunus laurocerasus. For medicinal pur- poses it is usually obtained from this latter plant, or from the prussiate of iron. This acid was discovered by Scheele, in 1780. It was soon afterwards ascertained to be highly poison- ous, by Schrader, who found that a few drops, or even its vapour, very speedily killed some birds which he sub- jected to its influence. Its deleterious properties were afterwards more fully ascertained by the experiments of Ittner, Emmert, Coulon, Robert, Orfila, and more recently by those of Magendie. Ittner poured twelve drops of the acid into the mouth of a middling-sized dog. The animal immediately staggered and fell. His * Thenard Traite de Chemie, torn. iii. p. 462. PRUSSIC ACID, 123 respiration was quickened, and his faeces passed in- voluntarily. He was seized with violent opisthotonos, and died in about an hour after the acid had been given him. The effects, however, of the highly con- centrated acid are still more violent; and, indeed, truly frightful. Magendie states,* that on plunging into the throat of a dog the extremity of a glass tube, that had been previously dipped into a phial containing some pure prussic acid, the animal instantly made two or three long and rapid inspirations and fell dead. Not the smallest trace of sensibility in the muscular organs could be detected after death. In another experiment he applied an atom of the acid to the eye of a dog, " and the effects were as sudden and as fatal as the preceding experiment." "In short," says Magendie, "the prussic acid, prepared according to M. Gay- Lussac, is, without doubt, of all the known poisons, the most active and the most promptly mortal. Its deleterious and powerful influence permits us to believe what the historians have related of the criminal talent of Laucustus; and render the accounts of those extra- ordinary and sudden cases of poisoning, so frequent in the annals of Italy, less marvellous and incredible." The action of this acid appears to be immediately directed upon the nervous system. The excitation, however, which it produces in the system, is extremely transient, inducing almost immediate debility and tor- por. When the dose is very large its action is so rapid and intensely energetic, as to cause, like lightning, an almost instantaneous extinction of the vital properties. As a consequence of its power to lessen irritability and sensibility, it diminishes the action of the heart and arteries, though in general this effect is not conspicu- Journal of Science and the Arts, for 1818, No. viii. 124 PRUSSIC ACID. ously manifested, unless the dose be excessive. Dr. Thomson, in a letter to Dr. Granville, observes that he has never seen its sedative effects preceded by an increase of the action of the heart and arteries, " a circumstance which distinguishes it from all other sub- stances belonging to the class of narcotics." It does not appear to be capable of producing any inflamma- tion in parts to which it is applied. Bitter almonds, however, whose active principle consists of this acid, inflame the stomach when swallowed. It is only of late that this acid has been extensively employed for remediate purposes; and if the accounts we have had of its good effects be not greatly exagge- rated,—a suspicion which can hardly be admitted, as they proceed from sources so respectable and various, it is undoubtedly entitled to very great attention. Bitter almonds and lauro-cerasus, both of which owe their active properties to the prussic acid they contain, were formerly employed as remedies in the cure of intermittents. Hufeland states that he has known two or three bitter almonds, swallowed a short time before the paroxysm, sufficient to prevent its accession.* Ber- gius,f also, says that cases of ague have been cured by the bitter almond, after having used the cinchona and other remedies ineffectually. MM. Duvignon and Parent,J of Paris, state that during the first invasion of the allied army in 1814, a young English physician attached to the Russian imperial guards, effectually treated tertian intermittents with Scheele's prussic acid, combined with other substances, in strong doses. Substances containing the prussic acid, as well as the acid itself, have also been employed successfully in the * Bibliotheque Med. torn. viii. s. 38G. j- Bergius Mat. Med. p. 100. X Medical Recorder, vol. ii. p. 510. PRUSSIC ACID. 125 cure of some nervous disorders. The aqua lauro-cera- sus, which is but a very diluted form of the prussic acid, has been much recommended by Hufeland,* Thoma- sen, Thaussen, Baillie, Wurzer, and others, in mental disorders. Dr. Oliver, of Salem, states that in two instances of mania in females, the prussic acid has been of essential advantage/!" It has been particularly ex- tolled for its good effects in hypochondriasis depending on disorders of the abdominal viscera, or on onanism. It has also been thought particularly adapted to the cure of mania arising from suppressed excretions.^ Dr. Shallern asserts that he derived very consider- able advantage from the employment of laurel-water in combination with belladonna, in cases of hydrophobia. M. Dupuytren, however, employed the prussic acid in two instances of this hopeless malady, without the least benefit. A very large mass of testimony has of late been pub- lished, which goes directly and strongly in favour of its powers in the treatment of chronic nervous coughs, and phthisis pulmonalis. Magendie was, I believe, the first who employed the prussic acid in diseases of this kind.§ Observing its remarkable property of diminishing gene- ral sensibility, without materially affecting the respira- tion and circulation, he was led to the opinion that it might be advantageously employed in cases depending, as these affections appear to do, on a morbid increase of sensibility. He accordingly prescribed it to a young * Journal der Practish. Arzneyk, B. ix. s. iii. f Thacher's New Amer. Dispen. p. 433.—1821. X Duvignon and Parent, in the Med. Recorder, vol. ii. p. 545. § Since writing the above I have seen an article in the New England Medical Journal, communicated by B. Lynde Oliver, M. D., of Salem, in which he states that he administered both the distilled water and saturated tincture of lauro-cerasus, in phthisis pulmonalis, as early as 1810, and generally with much advantage. Vol. II.—R 126 PRUSSIC ACID. lady who had been affected with a distressing, dry, short cough for above eighteen months. He ordered her " six drops of Scheele's prussic acid, diluted with three ounces" of a vegetable infusion, to be taken by spoonfuls every two hours," and in four days her cough disappeared entirely. He states that he afterwards employed the prussic acid in numerous instances of ner- vous and chronic cough, and always with the greatest success. Having found it thus efficacious in the treat- ment of dry and convulsive cough, he resolved on try- ing it in consumptive cases. The result of his expe- rience, as given in his first report, is that out of fifteen persons affected with pulmonary consumption, he inva- riably found the prussic acid, administered in small and repeated doses, " to diminish the frequency of the cough, moderate and render more easy the expectoration, and lastly to procure the patients some sleep at night, with- out any colliquative sweats." In 1820, Dr. Magendie published a small work "On the Use of Prussic Acid in the Treatment of Diseases of the Breast, and particu- larly in Phthisis Pulmonalis," in which much interest- ing evidence is offered, in addition to what he had already given, concerning the efficacy of this substance in consumption and other pulmonary affections. Dr. Granville, too, in a late work on the medicinal uses of the prussic acid, adds his testimony in favour of its powers in pulmonary and other diseases.* He relates seventy-nine cases of different diseases, all of which were cured or relieved by this potent article. A considerable number of these were phthisis in the early stages of the complaint, and a few of them were already far advanced. We have also some observa- tions from Dr. Scudamore, which strongly indicate the * Further Observations on the Internal Use of Prussic Acid. London, 1820. PRUSSIC ACID. 127 good effects of this remedy. This respectable physi- cian prescribed the acid in the dose of ten drops a day to two young patients labouring under all the usual symptoms of confirmed phthisis. They both had a fatiguing cough, frequent pulse, were much emaciated, debilitated, and harassed with night-sweats and copious purulent expectoration; they also had that peculiar form of the nails which usually accompanies these symptoms. These two patients were perfectly cured by the employment of the acid. In the practice of Professor Macneven, of New York, this remedy has been known to produce excellent effects in incipient phthisis. " I have used the prussic acid," says he, "with great advantage. It almost always removes cough, which accelerates and favours tubercular inflammation in predisposed habits, and thus in many cases prevents the disease."* I have employed it in five cases of phthisis. In two of these the cough, night-sweats, and hectic symptoms were considerably relieved. In two I observed no obvious advantages from its use, and in one case it did manifest harm, by the excessive prostration which it produced. In the cure of hooping-cough this new remedy appears, from ample testimony, to be very efficacious. Haneman recommends the aqua lauro-cerasus as ex- ceedingly useful in this distressing affection. Dr. Oliver declares, that of all the various medicines which he has employed, he has never found one which operated so suddenly in hooping-cough; and Dr. Gran- ville asserts, that in no case need hooping-cough be suffered to proceed longer than eight or ten days, if timely and cautious recourse be had to the prussic acid. We have, moreover, the evidence of Dr. John * American Medical Recorder, vol. iii. p. 574. 128 PRUSSIC ACID. Elliotson, who has recently published an interesting work on the prussic acid, in favour of the good effects of this remedy in the present disease. He has also employed it successfully in a case of chorea; and in pyrosis and various other diseases of the stomach, he considers it a very valuable remedy. He does not, however, offer any thing which goes to confirm the ac- counts that have been given of its curative powers in phthisis; and he fears that it must be added to our list of remedies that have been fruitlessly applied to the cure of this disease. It has also been prescribed with advantage in asthma. Dr. Granville states, that he has known it afford signal relief in this affection. Dr. Oliver also speaks of it as a valuable remedy in this disease.* In chronic rheumatism the prussic acid has been employed with evident advantage. Dr. Coates,t of this city, in a statement of the result of the use of the prussic acid in the Pennsylvania Hospital, in the sum- mer of 1819, observes, that " in two cases of severe chronic rheumatism, and in one of mania, the prussic acid was eminently serviceable, and in combination with subsidiary means effected permanent cures." Dr. Magendie prefers the pure prussic acid, as pre- pared by the process of Gay-Lussac, and diluted with six times its volume of distilled water, or eight times its weight of the same, to that prepared by Scheele's pro- cess, which is not sufficiently uniform in its power, on account of the liberty which the process leaves to the preparer. The difficulty of procuring this acid of an uniform strength, and the still greater difficulty of pre- serving it from deterioration, has hitherto been a very great objection to its employment in practice. It is * New England Medical Journal. f American Medical Recorder, vol. iii. p. 145. PRUSSIC ACID. 129 therefore very desirable that so valuable and powerful a remedy as this is should be obtained in a more perma- nent form than the aqueous solution, which decomposes by light, by air, and by the water itself. Professor Thomas Cooper has introduced a preparation that promises to answer this purpose. The following is his process: into strong rectified alcohol, surrounded by ice, throw a quantity of the prussic acid gas, obtained from the prussiate of mercury. One ounce of such alcohol will, at 32° of Fahrenheit, absorb all the gas that can be procured from four hundred grains of prussiat of mercury slightly moistened with about fifty or sixty drops of muriatic acid, and exposed to a gentle lamp- heat in a small retort. Not more than two drops of this acid can be given in a day in doses of one-sixteenth part of a drop.* Formula. R.—Acidi. hydrocyanici gtt. viii. G. arab. Sacch. alb. aa gii. Aq. fluvialis gviii—M. Dose, a table-spoonful three or four times daily. * The following very interesting remarks and experiments on the effects of hydrocyanic acid and its counter-poisons have been lately published by John Murray, Esq., F. L. S. M. W. S., &c. " I had always found, that the violent headache which sometimes oc- curred in preparing hydrocyanic or prussic acid, was relieved and removed by ammonia, which induced me to think that the antidote to that acid, and virulent and formidable poison, might be found in ammonia. " A small portion of hydrocyanic acid was given to a healthy young rabbit, which proved fatal in ten minutes. Soon after its administration, the head declined on one side, violent spasms supervened, while the- eye lost its lu*stre, and the animal died in dreadful convulsions. " On dissection after death, the lobes of the lungs appeared paler than usual, coagulable lymph was found lining the trachea, as in cynanche tra- chealis, and the stomach was found inflamed near the pylorus. The brain was not examined. "The muscular fibre was still excitable by voltaic agency, but the .excitability soon declined. " A drop or two of hydrocyanic acid on the head of a frog soon proved fatal. The colour promptly changed to an unwonted paleness. 130 PRUSSIC ACID. " The sciatic nerves of the prepared limbs were moistened with hydro- cyanic acid, but no suspension of the voltaic excitement supervened. It was accompanied by a tremulous movement of the muscular fibre, con- nected with the lines of the nerves: and this spontaneous irritability seemed increased by the application of alcoholic solution of iodine. "It is a singular fact, that not unfrequently an alcoholic solution of iodine dropped on the muscular fibre of a frog, excited phenomena similar to the action of the voltaic apparatus. It seemed also to renew excitability when the susceptibility had declined or was lost. " When the symptoms were verging to a fatal issue in a frog, a drop or two of ammonia on the head effectually restored the animal. " A greater quantity of hydrocyanic acid was given to a young rabbit than proved fatal in the cases detailed. Ammonia was occasionally ap- plied to the mouth on a sponge. The animal exhibited no unhealthy symp- tom whatever. "A considerable quantity of hydrocyanate-of ammonia with excess of base was administered to another rabbit, but without any deleterious effect. " Haifa drachm of hydrocyanic acid was given to a healthy young rab- bit. The effects were prompt. Respiration became laborious and difficult, with a grating in the throat, the eye lost its brilliancy, the head dropped, it raised a sharp cry, and was convulsed. Strong ammonia was dropped into the animal's mouth, and it was repeatedly moistened with a sponge dipped into ammonia. It almost instantly revived, and even licked re- peatedly the finger which sometimes applied the ammonia, apparently quite sensible of the instant and continued relief afforded. The animal effectually recovered. Its lips were excoriated by the ammonia. " Conscious of the complete antidote of this formidable poison found in ammonia, I took a quantity of hydrocyanic acid sufficient to produce vio- lent headache, stupefaction, &c, but diluted ammonia afforded me instant relief. I occasionally applied it to the olfactory organs, and bathed the forehead. " Since hydrocyanic acid has been introduced into our pharmacopoeia, and employed in phthisis pulmonalis, and accidental poisoning may be anticipated, it is of much moment to know an effectual barrier to its viru- lence; and such is my complete conviction of the antidote, that I would feel no hesitation whatever in taking a quantity sufficient to prove fatal, provided there stood by a skilful hand to administer the remedy." CHAPTER X. II. Medicines that Increase and Equalize the Nervous Energy. ANTISPASMODICS. Dr. Cullen, on entering into the general considera- tion of this class of remedies, says: " This is the most difficult subject that has occurred to me:" and it must be confessed, indeed, that there is no object of the ma- teria medica surrounded with greater obscurity than the modus operandi of antispasmodics. Spasms occur under such a variety of circumstances, and in such opposite states of the system, that almost every article in the materia medica may, under peculiar circumstances, act as an antispasmodic. Thus spasm may depend on general debility, in which case tonics and general stimulants are serviceable. On the other hand, spasm may also proceed from, or at least be attended by, a plethoric condition of the system, as is sometimes observed in hysteria, and then we derive advantages from bleeding. Thus too, spasm very com- monly arises from gastric irritation, in which case we resort to emetics and cathartics as the best, antispas- modics. But although remedies of this kind may occasionally produce antispasmodic effects, yet they do this in an indirect manner; that is, by removing either the debility or the plethora, or the irritating cause upon which the spasm depends, and not by any indirect influence over irregular or morbid muscular contrac- 132 ASSAFCETIDA. tion. They are, therefore, not to be ranked with the antispasmodics strictly so called, any more than vene- section is to be placed with the stimulants, because, m certain states of congestion, its employment produces strength and fulness of the pulse. There are, however, substances which seem to exer- cise a more direct influence over spasmodic muscular motion. Of the modus operandi of these medicines we know but very little; nor can the utmost ingenuity hope to remove the veil which covers this subject, until the physiology of muscular motion and nervous influence shall be better understood. All that can be said, with any degree of plausibility, on this point is, that as the functions of the muscular system are not only under the influence, but probably directly depend- ent on those of the nervous system, we may infer that the remedies which calm the irregular actions of the former must do so by their action on the latter. ASSAFCETIDA. This is the inspissated milky juice of a perennial plant, indigenous to Persia, and known to botanists by the name of ferula assafcetida. It is brought to us in dry, hard pieces, somewhat unctuous to the feel, of a brownish, or reddish colour, interspersed occasionally with little shining tears of a whitish hue. Its odour is strong, foetid, and alliaceous, and its taste bitter and acrid. According to Pelletier, 100 parts of assafcetida contains 65 parts of resin, 19.44 parts of gum, 11.66 of bassorin, 3.60 of volatile oil, with traces of super- malate of lime. In addition to these ingredients, Mr. Brandes found in it a large proportion of saline matters. Assafcetida is one of our most penetrating nervine stimulants. Taken in a large dose it excites a more ASSAFCETIDA. 133 lively flow of spirits, increases the action of the heart and arteries, and induces vertigo. It also acts as a gentle laxative; but its long-continued use is said to weaken the muscular power of the intestines.* I have, however, never observed such an effect from the use of this remedy, although I have frequently employed it for a long time and in large doses. It possesses con- siderable powers as an expectorant, and may be very usefully employed in cases where we wish to pro- mote expectoration, and at the same time stimulate the general system, or allay spasms or nervous agita- tion. As a palliative in nervous diseases, assafcetida is one of our most efficacious remedies. To allay hysteric symptoms its employment is extremely common; nor do I know any other medicine more promptly beneficial in such cases than this one. It may also be advantageously employed to obtain temporary relief in hypochondryasis. Independent of its cheering influence in this affection, it is useful by awakening the dormant sensibility of the system to the action of other remedies. In the advanced stages of typhus, when"the system is much debilitated, and subsultus tendinum, tremor, and slight delirium exist, assafcetida, given in combination with other and more permanent stimulants, is often of very great service. It may also be employed with much benefit in all spasmodic affections of the alimentary canal, unat- tended by any active inflammation in this part. Much was formerly said of its employment in asthma and croup, and there can be no doubt that it may fre- quenl ly afford much relief in this disease. In the latter * Burdach'to Arzneimiitellehre, B. iii. s. 322. Vol. II.—S 134 ASSAFCETIDA. disease, Miller recommends in strong terms a mixture* of this substance in powerful and repeated doses. In the advanced stage of this affection, when by a success- ful antiphlogistic treatment, the inflammatory condition of the system and of the parts affected have been con- siderably subdued, I have known the assafcetida to do much good in relieving the dryness and hoarseness of the cough, and establishing a more healthy secretion from the lining membrane of the bronchia. In hoop- ing-cough, also, assafcetida will occasionally afford considerable advantage. I have, in a few cases, united this remedy with antimonials, so as to excite vomiting after a few doses had been taken; and it appeared to me that the relief obtained was both more complete and more permanent than is usually derived from emesis alone. In spasmodic pains of the stomach and bowels from indigestion, assafcetida is a remedy of very considerable importance/!" In my own person I have found it par- ticularly advantageous for the relief of such symptoms when combined with small doses of opium. Richter states, that a combination of assafcetida and ox-gall is one of the most effectual remedies we possess for cor- recting that morbid condition of the stomach which favours the formation of acid. " Some patients," says he," are constantly tormented with acid, eat what they may, and even though they take nothing but animal food. In such cases equal parts of assafcetida and ox's- gall are of so great use, that I can now, from experi- ence, recommend them almost as a specific.";): Assafcetida has also been recommended as an excel- * R.—G. assafcetida, 3H. aq. ammoniae acetat. ^i. aq. pulegii. ^iii. Solve. Dose, a table-spoonful every half hour to a child two years old. \ Cullen's Mat. Med. article Assafcet. X Medical and Surgical Observations, p. 191. ASSAFCETIDA. 135 lent remedy in chorea, occurring about the age of puberty in females. For this purpose it should be given in large doses. Gunther states, that he suc- ceeded in curing a case of this kind, by the use of this article, after many other approved modes of treatment had been ineffectually resorted to. In cases of habitual costiveness, assafcetida often acts as a useful and invigorating aperient. It is particularly serviceable when the torpor of the bowels is connected with nervous symptoms. In such cases this article may be very advantageously combined with the com- pound extract of colocynth. Assafcetida has been highly recommended in the treatment of caries.* Given in large and frequent doses it is said to promote the exfoliation of the dead parts, and to improve the discharges. It is, however, of more unequivocal advantage in the cure of old and ill-conditioned ulcers; and it appears to be more espe- cially efficacious in cases that are attended with a scrofulous or rheumatic habit of body.f Assafcetida is given either in substance, emulsion, or tincture. The dose in substance is from gr. iii. to 9i. or even more, according to the urgency of the symp- toms. An emulsion of two drachms of assafcetida, two yolks of eggs, eight ounces of water, and one ounce of syrup, is to be given in the dose of one or two table- spoonfuls, pro re nata. Formulae. R.—G. asafcetid. sji. — galban. — myrrh, aa. ^ss. Castor gr. xv—M. Divide into two grain pills. Dose, from three to six, three or four times daily, in hysteria. * Smucker's Chirurgische Scriften. See also C. L. Smalz Beobach- tungen uber die guten Wurkungen des stinkenden Asants, by drusen-und knochengeschwulsten, auch bey dem Beinpasz. In Loder's Jour. f. Ohir. ii. Bd. iv. st. No. 7. | Burdach's Arzneimitt. Lebi. B. iii. p. 327. 136 GALBANUM. R.—G. asafcet. — galban. — myrrh, aa. ^i. Castor Camphor, aa. 9ss. Bals. Peru, q. s.—M. Divide into two grain pills. Dose, from four to ten pills. R.—Asafcet. 3ii. P. ipecac. P. opii, aa. gr. viii.—M. Divide into three grain pills. Dose, from four to ten, in spasmodic pains of the stomach and bowels. GALBANUM. This substance is the inspissated milky juice of a perennial plant indigenous to Africa, and known to botanists by the name of bubon galbanum. Galbanum is a tenacious substance, of a whitish colour when recent, changing to a yellowish red when old. When broken it presents a variegated appearance from the number of white tears with which it is inter- spersed. Its taste is bitter and acrid, and its odour fcetid and strong. One-fourth of its weight will be dissolved if triturated with wine, water, or vinegar. To effect a permanent suspension in these fluids the addition of half its weight of some mucilage, or the yolk of eggs, is necessary. The best solvent, however, is a mixture of two parts of rectified spirits and one of water; this will dissolve all but the impurities of this substance. According to Pelletier, 100 parts of galbanum contains 66.86 parts of resin, 19.28 of gum, 6.34 of volatile oil, with traces of supermalate of lime. Galbanum has been a good deal recommended in hysteric affections; it is said to be peculiariy adapted to cases of this kind attended with a relaxed state of the system, and a deficiency or a suppression of the catamenia. I have never employed it in spasmodic GALBANUM. 137 diseases. But in one case of habitual asthma, attended with a troublesome cough, I have found it exceedingly useful. In spasmodic and flatulent colic, galbanum will often afford very considerable advantage. For this purpose I have known it to be combined with the ol. ricini, with very good effect. In addition to its antispasmodic virtues, it possesses no inconsiderable expectorant powers. In the latter periods of pneumonia, attended with considerable cough, and a difficulty of expectora- ting the tough mucus of the bronchia, a solution of galbanum in vinegar of squills is said to act very bene- ficially. It has been thought to possess very considerable de- obstruent and discutient properties. It enters into the composition of Smucker's visceral pills, so highly re- commended by Richter and others in the cure of gutta serena.* Externally galbanum is applied to discuss indolent tumours. Arnold (Hufeland's Jour. B. 26) and Kopp (Medical Observations, p. 104), speak very favourably of the employment of the tincture of galbanum in chro- nic inflammation of the eyes. A thin compress of linen to be saturated with the tincture, and applied over the eyes over night. I have resorted to this application in a few cases with very manifest advantage. The sum is given in the form of pills in the dose of from 9i. to 3i. Dose of the tincture is from 31 to 3iii. * The following is Smucker's formula: R.—G. galbani, G. sagapeni, Sapon. venet. aa >ji. Pulv. rhaei. gss. Tart. emet. in aq. font. q. s. sol. gr. xvi. Succ. liquiritffi ^j._M. Finat. pil. gr. i. Sumaf quotid. No. xv. 138 GUM AMMONICUM. According to Wildenow, this is the inspissated juice of the heracleum gummiferum, an umbelliferous plant, indigenous to the interior parts of Africa, the desert of Barka, and the western regions of Egypt. Externally this substance is of a brownish, and internally of a whi- tish, reddish, or deep yellow colour. It has a faint bal- samic odour; its taste is nauseous, at first sweet, soon becoming bitter and acrid. It is composed of gum, resin, gluten, and some volatile oil. Neither water nor alcohol dissolve it completely. In vinegar, sethereal oils, and nitric sether it is, however, perfectly soluble. The antispasmodic powers of this substance do not appear to be of much importance. In spasmodic colic it may, however, be given with much advantage. In this affection, when given in large doses, it not only tends to allay the spasm of the intestines, but also to promote their discharges. In chronic hysteria, connected with a cachectic state of the system, and a deficiency of the catamenial discharges, it is very advantageously com- bined with tonics, and particularly with chalybeates. This substance has been thought to possess very im- portant deobstruent properties. It has, accordingly, been much recommended by the German physicians in obstructions of the glandular viscera of the abdomen, and for the cure of such affections as are more or less intimately connected with derangement of those organs. Richter has employed this remedy in combination with other medicines with much success, in the cure of gutta serena; a disease which appears to be not unfrequently dependent on functional disorder of the abdominal vis- cera. " Experience," says this eminent writer, " con- firms me more and more in the opinion that the cause GUM AMMONICUM. 139 of gutta serena is most frequently seated in the abdo- minal viscera, and daily justifies me more in recom- mending the use of deobstruent visceral medicines. I can affirm, that I have frequently performed a complete cure in cases where I hardly expected it, and in some where the disease had actually continued for several years.* G. ammoniac has also been used in hypochondriasis, chronic rheumatism, caries, ulcers, and cutaneous erup- tions. Richter states that in incipient scrofulous con- sumption attended with a languid and irritable state of the system, he has used this gum, in conjunction with tart, antimony and belladonna, with marked advantage. He administered it according to formula No. 1, given below. G. ammoniacum has also been particularly recom- mended in hydropic affections, more especially ana- sarca, when attended with a feeble and relaxed habit of body. In cases of this kind, it may be very advantage- ously administered in union with squill and minute por- tions of calomel. As an external remedy, it enters into the composition of a variety of plasters; and forms an excellent application to discuss chronic and indolent swellings and glandular indurations. For this purpose it is softened by vinegar, or the vinegar of squills, and spread on leather. Of its expectorant powers, which are very consider- able, I shall speak particularly when I come to treat of that class of remedies. The most agreeable way of exhibiting ammoniac is in the form of an emulsion, sii. of this substance must be triturated with the yolk of an egg or sss. of gum. * He recommends the following pills: R.—G. ammon. assafcetid. sapon. venet. rad. valerian, summitat. arnic. aa oii- tart, antim. gr. xviii. pil. pond. gr. ii. quarum sumat ter quotid. No. xv. 140 MUSK. arab. gradually adding giv. of wrater. The dose of this is one or two table-spoonfuls every two or three hours. It is also conveniently given when dissolved in the liquor ammonii acetat. Two drachms of the former may be dissolved in three ounces of the latter. Formulae. No. 1. R.—G. ammoniac. — galban Extract, cicut. aa £i. Tart, antimonii gr. x. Pulv. herb, belladon. gss. Conserv. rosar. gi.—M. Divide the mass into three grain pills. Dose, six pills three times daily. No. 2. R.—G. ammoniac. giss. • ' Pulv. rad. senegae gii. Sulph. aurant. antim. gss. Rad. scillae gr. xv. Mucilag. q. s.—M. Divide into three grain pills. Take from three to six pills three times daily, in chronic catarrh, &c. MUSK. This substance is produced by a quadruped of the ruminant kind, called moschus moschiferus, a native of Thibet, Tartary, China, Siberia, and the kingdom of Tangut. The fluid which forms this substance is secreted principally by the male; that which is obtained from the female possesses but little odour. It is secreted most copiously by the animal during its periods of venereal incalescence. The bag in which this secretion is formed is situated immediately behind the umbilicus. It is about three inches long and of an oval shape, having one side con- vex and the other flat. The musk comes to us in round thin bladders, covered with light brown hairs, of the size of a pigeon's ngg. It consists of small grains of a MUSK. 141 dark brownish colour, having a somewhat unctuous feel. Its odour is very peculiar, diffusive, and durable, "and it has the curious property, when added in minute quantity, to augment the odour of other perfumes, with- out imparting its own." Its taste is bitter. It contains resin combined with volatile oil, a mucilaginous extract- ive matter, minute portions of albumen, gelatine, mu- riate of ammonia, and phosphate of soda. iEtius is the first who mentioned this substance as an article of the materia medica. Since his time it has been generally regarded as a very important remediate article. It is undoubtedly one of the most diffusive, penetrating, though fugacious stimulants we possess. It acts particularly on the nervous system, giving a lively impulse to its powers, and a temporary exalta- tion both to the mental and corporeal energies. It elevates the pulse without increasing the heat of the body. Cullen thought it the most powerful antispasmodic we possess, and there appears to be no reason to think that, in this respect, he has estimated its powers too highly. In all spasmodic affections it has accordingly been much employed, and its effects in this way have often been exceedingly useful. Dr. Cullen relates the case of a gentleman affected with spasm of the pha- rynx, preventing deglutition, and almost respiration. This case was effectually relieved by this remedy, after a very great variety of other medicines had been used abortively. Dr. Owen relates a striking example of the efficacy of musk in an obstinate convulsive affec- tion of a young lady.* Dr. Hillary speaks favourably * This case occurred in a young lady, who, having received a slight electric shock from a charged vial, felt, in a few hours after, slight con- vulsive motions, which recurred once or twice a day. The convulsions gradually increased in violence, until they became very alarming. " Her Vol. II.—T 142 MUSK of its powers in the treatment of tetanus, as it occurs in hot climates.* Dr. Richard Huck, also, adduces strong testimony in favour of its remediate effects in this dis- ease. He gave it to the extent of half an ounce, with a drachm of opium, in the course of twenty-four hours, and by this treatment cured a considerable number of tetanic patients.! Dr. Wall states that he found this remedy highly efficacious in convulsive hiccups, given in the dose of ten grains.^ When given in doses under six grains, he never saw it produce any perceptible advantage. In spasmodic asthma, as well as in spasmodic croup, musk is a remedy of very considerable value. In the latter affection especially, its beneficial effects are often prompt and decisive. Hufeland, indeed, regards the musk as almost a specific in this malady; and the tes- timony of Harless, Schaffer, and Wichmann, is equally favourable to its usefulness in this complaint. In hysteric convulsions, prompt and decided relief may sometimes be derived from the use of musk, either by fits always began with a disagreeable, and rather a painful sensation at her stomach; almost at the same instant her mouth and all her features became distorted. Her head was suddenly and violently drawn down to her breast, and the next moment backwards. Her legs, arms, and, in short, every muscle of her body, at one time or other of the fit, seemed to be violently agitated, and betfame spasmodically contracted. Her parox- ysm used to continue ten or fifteen minutes, at the decline of which, as if nature was quite exhausted or overcome, her muscles became at once relaxed, and she fell into an hysteric fit of crying, which was succeeded by a comfortable sleep." After oleum succini, with small doses of musk, valerian, opium, bark, steel, cold-bath, aether, castor, and the foetid gums had all been tried ineffectually, he ordered her half a drachm of musk, to be taken every hour. "It was no sooner-in the stomach, than the fit, at the beginning of which the first dose was taken, began to abate, and in a minute or two entirely went off. In four days she was entirely free from the disease.—Med. Observat. and Inquir. vol. iii. p. 186. * Cullen's Materia Medica. ■j- Medical Observations and Inquiries, vol. iii. p. 330. X Philosoph. Trans. No. 474. MUSK. 143 itself, or in conjunction with opium or assafcetida. In eclampsia from nervous irritation, unattended with much sanguineous determination to the head, much benefit may sometimes be obtained from full doses of this antispasmodic. In the epileptic variety of this affection, however, that is, when the face is flushed, and the vessels of the head turgid, all stimulating remedies ought to be carefully avoided. Prompt and copious blood-letting is indispensable in such cases. Its powers in the cure of mania, though recommended by several writers of high respectability, are more doubtful. In hysteric mania I have seen it given in one case with evident advantage; though its beneficial effects were but temporary. From its antispasmodic powers it has, indeed, been employed in every variety of spasmodic disease:—in subsultus tendinum, epilepsy, spasmodic colic, spasms of the stomach, cholera, cynanche trachealis, asthma, and even in hydrophobia. Sachse declares, that in later stages of croup, he has employed this article with great advantage. Schuter administered it in conjunc- tion with calomel in this affection; and Albers (De Trachitide infant, &c. p. 97) states, that he derived signal advantage in the advanced period of the disease, attended with much prostration, from the use of a mix- ture of musk, calomel, and kermes mineral. In bron- chitis, also, after the inflammatory symptoms have been subdued, and there is much prostration, musk will often afford material benefit. In the erysipelas of new- born infants, this article has been used with decided advantage by Renard (Hufeland's Jour. vol. xxii. p. 87) and by Lutzelberger (Ibid. vol. xxxv. p. 119.) Berger, a Swedish physician, recommends musk as a highly efficacious remedy in hooping-cough. He gave it to children in doses of fifteen grains every six 144 MUSK. hours, and he asserts, that the fits of coughing were very generally prevented after six or eight doses had been taken. In gout the good effects of this remedy are much extolled by Pringle and Cullen. " In another disease," says the latter, " I can vouch for the powers of musk, and that is in several circumstances of gout." When the gout falls upon the stomach, musk, according to this writer, is an invaluable remedy. In retrocedent gout, affecting the stomach, lungs, or head, large doses are said to give very speedy relief. Having never used it in this disease, I can say nothing either for or against its employment. In the advanced stage of typhus, when great de- bility, subsultus tendinum, tremors, hiccup, delirium, pale urine, pale and cold skin, and a frequent, small, and corded pulse are present, musk is one of our most valuable remedies. It is also a very useful medicine in the typhus stage of the exanthemata, as well as in the latter stages of peritonitis, enteritis, and pneu- monia, when typhoid symptoms supervene. Schmidt, a very respectable German writer, says that musk is particularly useful in the typhus of habitual drunk- ards. Musk is said to afford much relief in the morbid vigilance which sometimes attends hypochondriasis. It has also been recommended in vertigo unconnected with any evident fulness of the cerebral vessels. This remedy has been employed with advantage in combi- nation with opium or ammonia, to check the progress of mortification.* Musk is generally given in substance, in doses of from six to thirty grains, repeated according to cir- * Observations on Gangrenes, Mortifications, &c, by C. White, F. R. S., 1790. CASTOR. 145 cumstances. It may also be exhibited in the form of a julep.* There is an article made with the oil of amber and nitric acid, which having nearly, if not altogether, the powers of musk, has received the name of artificial musk. It is made by pouring three and a half drachms of nitric acid on one drachm of ol. succini, and then carefully washing the product. This substance appears to be nearly equal in all respects to the natural musk, and is given in the same dose. In pertussis it has been highly recommended; and I have, in my own practice, found it decidedly useful in this disease. Formulae. R—Moschi 9i. Muc. g. arab. q. s.—M. Divide into twenty pills. Dose, from three to six every hour. R.—Moschi gr. x. G. assafcetid. gr. xv. Extract hyoscyam. gr. iii.—M. Divide into ten pills. Dose, from two to four every four or six hours, in chronic hysteria, or hypo- chondriasis. R.—Assafcetid. G. guaiac. Extr. valerian aa ji. Moschi Carbonat. ammon. aa gr. x. G. opii gr. v.—M. Divide into three grain pills. Dose, two to three pills every two or three hours, in hysteria. CASTOR. This substance is obtained from a small animal found in Canada, Poland, Russia, Siberia, and the north of Germany, &c, and known to naturalists by the name of castor fiber. Near the anus of this animal, there are * R.—Mosch. gii. Sacch. albi. gi. Pulv. g. arab. gii. Aq- font- 3vi.—M. Dose, a table-spoonful every two or three hours. 146 CASTOR. four small membranous bags, two of which are princi- pal, and the other two accessory. These bags contain a fluid which thickens on being exposed to heat, and forms an unctuous concrete substance. It is this sub- stance which forms the castor. The castor has a brownish black colour, possessing a peculiar penetrating, disagreeable odour, and a taste somewhat bitter and sharp. The best castor is brought from Russia and Poland; it comes to us in large black bags, and has a very strong odour. It contains volatile oil, resin, mucilage, extractive matter, iron, and small portions of the carbonate of potash, lime, andammonia. It contains, also, according to the analysis of Laugier, a small portion of benzoic acid. It is said that castor manifests less activity in males than in females. Alexander (Med. Eperim. and Obser- vat.) took two drachms of it, without experiencing any other effect from it than disagreeable eructations; and Joerg (Material, zu einer kuinft. Heilmittell. ect. p. 274) noticed 'the same result, in some experiments made with it on himself. Richter observes, that it ex- erts a much more decided influence on the uterine system than musk. In general, its tendency to excite the ganglionic system of nerves is very considerable, although on the spinal and cerebral system, its effects are extremely slight. In torpor and functional derangement of the abdominal and pelvic viscera, castor, when em-. ployed in full doses, sometimes produces excellent effects. Castor was formerly esteemed as one of the most active articles of this class of remedies. Its reputation, however, as an antispasmodic, does not seem to be con- siderable at the present day. It was at one time regarded as possessing narcotic properties, but this opinion appears to be entirely without foundation. CASTOR. 147 In combination with assafcetida and aether, I have very frequently employed it in hysteria. I have, also, occasionally given it by itself with considerable advan- tage in hysteric affections. To derive any advantage from it, however, it should be given in very large doses. Instead of giving from thirty to sixty drops of the tinc- ture, as is commonly directed, I generally administer from two to three tea-spoonfuls of it at a dose. It is particularly applicable in cases of hysteria, attended with severe spasmodic pains in the abdomen, or region of the uterus. In cases of this kind it may be very advantageously administered in union with laudanum. It is to be observed, however, that in some individuals, particularly in delicate and irritable habits with a ten- dency to febrile irritation, castor, even in moderate doses, is apt to give rise to very unpleasant symptoms, such as oppressed breathing, dryness and heat of the skin, flushed face, and anxiety in the region of the heart. In chronic hysteria, attended with a leucophleg- matic or chloratic state of the system, I have known great benefit to be obtained from the employment of this article in conjunction with the phosphate of iron. It often affords considerable relief in spasmodic and flatulent colic. It has also been recommended in asth- ma, epilepsy, vertigo, and in the delirium of typhus. Burdach speaks well of its employment in irregular labour pains. Dr. M. Morris, physician to the Westminster Hospi- tal, speaks very highly of the efficacy of this article, in combination with Peruvian bark, in the cure of hoop- ing-cough. He gave eight grains of castor and fifteen of the bark every four hours, with perfect suc- cess.* Alcohol and proof spirit extract its active properties: * Med. Obser. and Inquir. vol. iii. p. 283. 148 ALLIUM SATIVUM. water does so but feebly. It may be given in the form of tincture or in substance. Formulas. R.—Pulv. rhaei Magnes. carbon, aa ^i. Pulv. castor gr. viii.—M. To be taken at once. Richter states that in pains in the stomach and bowels, from acidity, this is a most excellent remedy. R.—Tinct. castori gss. Aq. ammon. sjii. Tinct. opii ^i—M. Dose, from thirty to forty drops. ALLIUM SATIVUM. This is one of the most diffusive vegetable stimulants we possess. Taken into the system, its peculiar odour very soon manifests itself in the perspiration, the urine, and the pulmonary exhalation. It contains an acrid sethereal oil, which readily inflames the skin, a viscid gummy substance, a sharp extractive matter, resin, and some salts.* Garlic docs not appear to possess any very important powrers as an antispasmodic. It is, nevertheless, some- times of considerable advantage in cases where expec- torant and antispasmodic remedies are indicated. It is accordingly recommended in spasmodic asthma; and in pertussis and croup it is much in use as a domestic remedy. It cannot, however, be employed with safety in these diseases until the inflammatory symptoms have been subdued by depletory measures. In the advanced stage of croup, when the disease has lost its acute cha- racter, I have employed it, while practising in the country, with considerable advantage. In chronic catarrhal affections, attended with a cold, phlegmatic habit of body, this article is often very serviceable. It is also recommended in the treatment of hysteria, * Pfaff. VALERIANA. 149 gastric pains from flatulency, and nervous tremors. Dr. Chapman asserts that it is an exceedingly useful remedy in those vertiginous affections which sometimes trouble gouty and intemperate persons. Its employment in the cure of intermittents, though sanctioned by the authority of Bergius, is of very little consequence. Garlic may be ranked, in this respect, with that host of unimportant articles which have at one time or other been employed to cure agues, and which, though no doubt sometimes serviceable, have not suf- ficient power to entitle them to any particular conside- ration. Lind and Cullen recommend garlic in the cure of scurvy; and Sydenham speaks well of its powers in dropsy. This substance is a very common domestic remedy for the expulsion of worms. I have known it to be given with decided advantage for this purpose. It is generally administered in the form of a decoction, with milk, on an empty stomach. VALERIANA. There is perhaps no medicine which has been more extravagantly praised on the one hand, and neglected on the other, than valerian. In some of the modern works on the materia medica it is not even mentioned, whilst in others its virtues are greatly extolled. That it possesses medicinal powers worthy of very consider- able attention is, however, too well established to admit of a reasonable doubt. The valerian is a perennial plant, indigenous to Eng- land and Germany. The root, which is the only part employed for medicinal purposes, is fibrous, with a cen- tral knob, and possesses a strong, peculiar, and unplea- Vol. II.—U 150 VALERIANA. sant odour, and a warm, bitter, and subacrid taste. It contains gum, resin, fecula, extractive matter, and an essential oil possessing the peculiar odour of the root, but is considerably milder in taste. The root of this plant, when growing on a dry and elevated soil, contains much more essential oil, and is therefore stronger than that which is found growing in low and moist grounds. It loses much of its strength by being kept long, and it ought to be preserved in closed vessels. In its general operation it acts as a stimulant, producing considerable antispasmodic effects. It excites the action of the heart and arteries, promotes perspiration and diuresis, and when taken in very large doses, produces anxiety, vomiting and purging. For some time after Fabius Columna had cured himself of epilepsy by means of this substance, it was regarded as almost a specific in this disease. A more extensive experience, however, showed that, though not destitute of valuable properties, its powers had never- theless been greatly overrated. At present, indeed, its reputation in this disease seems to be almost entirely gone. Alibert states, that he tried it with a number of epileptic patients in the hospital St. Louis, and he assures us, that during an experience of six years, he obtained nothing but negative results.* By Quarin, however, this medicine is highly recommended in cases of epilepsy in infants, depending on some irritation; as, for instance, irritation produced by worms in the stomach and bowels; and Burdacht says, that it is particularly applicable in cases of this disease depending on a suppression of the catamenia in young females. Richter cured a case of epilepsy of more than four years duration, in which a great many of the most * Elemens de Therapeutiques, &c. X Burdach's Arzneimittellehre, B. iii. p. 342. VALERIANA. 151 approved remedies had been ineffectually employed by the use of valerian in conjunction with the cajeput oil. He administered a drachm of the former, with three drops of the latter article, four times daily. The famous anti-epileptic powder of Ragoli contains a large proportion of valerian. According to Smelin, it is composed of half a drachm of valerian, three grains of the muriate of ammonia, the same quantity of carbo- nate of magnesia, and two drops of cajeput oil; but according to Knopf's analysis, it consists of one drachm of valerian, a scruple of powdered orange leaves, two grains of muriate of ammonia, and four drops of cajeput oil (Richter's Arzneimittellehre, vol. iii. p. 20). Richter states, that he has known this mixture to be employed with entire success even in obstinate and inveterate cases of this malady. To be effectual in this complaint, valerian must be given in very large doses. In hemicranea and vertigo assuming a regular peri- odical form, valerian has been recommended as an efficacious remedy by Cullen. Dr. Barton, also, adds his testimony in favour of its employment in this affec- tion. Cullen, who placed considerable reliance in its antispasmodic powers, speaks favourably of its use in hysteria and other spasmodic diseases. In chronic hysteria in females of a cold, phlegmatic temperament, valerian in combination with bark is a valuable remedy. I have employed it in such cases with evident advan- tage. Hill,* who wrote a small book on the employ- ment of this remedy in nervous disorders, speaks very highly of its powers in such complaints. In excessive nervous irritability of the stomach, unattended with inflammatory irritation, the oil of valerian dissolved in * Valerian, or the Virtues of that Root in Nervous Disorders. London, 1758, 8vo. 152 VALERIANA. sulphuric ether, is, according to Richter, a remedy of great utility. In hysteric or nervous pains of the sto- mach or bowels, prompt relief may often be obtained by the use of the ammoniated tincture of valerian. (Berends.) In every form of asthenic fever, valerian may be very generally employed with advantage. In typhus or nervous fever, either in its simple or complicated form, when there exists a spastic condition of the system, characterized by a small, quick, and frequent pulse, a rapid and short respiration, cold and pale skin, trembling and delirium, it has been recommended as very useful, when given in large doses and combined with ammonia or bark. Vaidy considers it preferable to the cinchona in this disease. It appears, however, well established by the extensive experience of M. Chau- meton, that it is, upon the whole, considerably inferior to this latter article.* A decoction of this root, administered in the form of a clyster, is strongly recommended by Horn, for the relief of tormina and tenesmus. It has also been much employed as a remedy in gutta serena. Both Richter and Smucker speak favourably of its virtues in this disease. The dose of the powder is from sss. to 3m. three or four times a day. It may also be given in the form of tincture, in the dose of sii.—gss. The etherial tincture is made by digesting one drachm of the root in an ounce of sulphuric ether. This is an excellent mode of prescribing valerian in hysteric affections. Dose, from twenty to forty drops. The infusion formed of gii. of the root to gvii. of water, is given in the dose of sii. two, three, or four times a day. Decoction impairs the powers of this article. The ammoniated tincture * Alibert, Elemens de Therapeutiques, torn. ii. p. 119. SKUNK-CABBAGE. 153 is a very useful preparation. Its dose is ^ss.—sii. twice a day. The oil possesses the active properties of the root. It is given in doses of from six to twenty drops. Formulas. R.—01. valerian gii. Sulph. aether %i.—M. Dose from twenty to forty drops. R.—Rad. valerian §ss. ----calam. aromat. giii. Aq. fervid §vi.—Stent per 1-4 horae vase clauso. Colat. deinadde: Mixturae camph. ^iss. Sulph. aether ^ii. Syrup limonis %\.—M. Dose, a table-spoonful in the ad- vanced stage of typhus. SYMPLOCARPUS FCETIDA.---SKUNK-CABBAGE. This is a very common plant in the United States. It grows in wet and marshy situations, and is easily recognized by its exceedingly offensive odour, being almost entirely similar to that of the skunk or polecat. The inflorescence which appears in April, consists of a boat-shaped, inflated spathe, variegated with red and yellow spots, acute and incurved at the top, containing an oval spadix, having perfect tetrandrous flowers. The fruit, which consists of the maturated spadix, is a globular fleshy mass, containing large oval seeds. The spathe, with its spadix, is the first part of the plant which appears above ground; the leaves afterwards shoot forth, and bear some resemblance to those of cabbage. This plant is perennial. Tlie skunk-cabbage possesses very considerable antispasmodic powers. Shcepf, speaking of the root of this plant, calls it "incidens, califaciens, expec- torans," and mentions it as useful in phthisical coughs. As a palliative in the attacks of spasmodic asthma, it is very highly recommended by the Rev. Dr. Cutler and others. I have, in several instances of this dis- 154 SKUNK-CABBAGE. ease, derived very considerable advantage from the employment of this remedy. The powdered root, in the dose of from thirty to fifty grains, is to be given during the paroxysm, and repeated according to the urgency and obstinacy of the symptoms. The medi- cine ought to be continued for some time after the paroxysm has entirely subsided. Dr. Thacher of Boston, states, on the authority of a correspondent, that two tea-spoonfuls of the pow- dered root of this vegetable gave very prompt and effectual relief in a case of hysteria, after the ordinary remedies for such cases had been used without benefit. The same writer states that it has afforded much advantage in chronic rheumatism, in wandering spas- modic pains, and in hooping-cough. In chronic cough attended with a cold, phlegmatic habit of body, I have employed the powdered root of this plant with the most decided benefit. In an old man, who had been for many years afflicted with a very troublesome cough and difficulty of breathing, I found nothing to give so much relief as this substance, administered in forty- grain doses once or twice a day. I was, indeed, much in the habit of prescribing this plant, while practising in the country, in cases of chronic catarrhal and asthmatic affections, and very generally with evident advantage. The seeds are said to be stronger than the root. " In spasmodic affec- tions of the abdominal muscles during parturition, or after delivery, this root has proved an effectual remedy."* The plant should be kept in close stopped vessels, as its active properties seem to be of a very volatile nature. Decoction greatly impairs its virtues. * Thacher's Dispensatory. 155 SULPHURIC jETHER. ./Ethers are the product of the distillation of acids with alcohol. They are limpid, extremely volatile, and light, very odorous and inflammable. The sul- phuric aether is most commonly employed in medicine. It is of 739 sp. gr. and boils at a temperature of 98°. When perfectly pure, this aether consists of oxygen, hydrogen, and carbon; " the rectified aether, however, still contains some water and alcohol, for Lovitz obtained an aether of 632." It is converted into a species of oil by soda and potash, and it robs metallic oxides of their oxygen. It is only partially soluble in water; but it unites in every proportion with am- monia and alcohol. It is a powerful solvent of oily and resinous substances, and " takes up about a twen- tieth part of its weight of sulphur." This aether is an exceedingly diffusive stimulant. Its immediate operation is to excite the brain and nervous system, inducing as its secondary effect a considerable degree of stupor, listlessness, and disposition to sleep. Alibert observes, that when taken a long time, and in strong doses, it is capable of destroying the mucous lining of the digestive organs.* * Dr. Robert Reid, of Dublin, a gentleman of eminence in the profes- sion, in a very interesting paper, " On the Pathology and Treatment of Fever," observes, " aether acts directly sedative upon the spinal system. Some time since, I had an opportunity of seeing the sedative effects of this fluid on the spinal system remarkably evident, in a case of tetanus. The patient had not been able to swallow the smallest quantity of any thing for two days. I proposed that he should get a common enema, with the addition of one drachm of aether. This was done. In a few minutes the patient said he felt a warm glow within; the spasms totally relaxed; he sat up; complained of languor, and ate a bowl of jelly. This fluid is essentially different from alcohol in its effects on the animal economy, though the effect may appear stimulant in the first moment^'(a) (a) Transactions of the Association of the Fellows and Licentiates of the King and Queen's College of Physicians m Ireland, vol. iii. p. 56. 156 SULPHURIC .ETHER. This is one of the most important antispasmodics we possess for the cure of the hysteric paroxysm. When given in combination with opium, its beneficial effects in cases of this kind are generally prompt and decisive. It may also be usefully employed in various other spasmodic affections. It is capable of affording great relief in asthmatic complaints, or where dyspnoea arises from a spastic condition of the respiratory organs. In such cases the simple inhalation of the aethereal vapour is frequently sufficient to put a stop to, or at least greatly to mitigate, the difficulty of breathing. In catarrhal complaints, attended with difficult respiration, I have sometimes directed the inhalation of this vapour with manifest benefit. Alibert states, that Pinel and he employed the inha- lation of the vapour of sulphuric aether with great advantage in croup. In the spasmodic form of the disease, it often procures prompt and decisive relief, when employed in this way. In general, in all cases of difficulty of breathing, depending on nervous irrita- tion, the inhalation of the vapour Of aether will afford speedy relief. It is also given to check vomiting and sea-sickness; and has been used with advantage in hooping-cough, chorea singultus, nervous headache, and vertigo. It the treatment of typhus, this remedy has been a good deal employed in combination with other stimu- lants ; and there can be no doubt that it may often act beneficially in this disease, especially when symptoms of spasm attend. It is obvious, however, from the transient nature of its effects, that it ought to be given in very frequently repeated doses; and even under its most advantageous mode of exhibition it can never be regarded otherwise than, at most, but a useful auxiliary in this disease. It has likewise been prescribed for SULPHURIC /ETHER. 157 the cure of intermittents.* Considerable importance has been ascribed to sulphuric aether as a remedy in traumatic tetanus. Gay states, that he employed it in conjunction with the essential oil of cinnamon, in several cases of this kind, with entire success. (Journ. de Med. Sept. 1812.) In some of the cases of tetanus, which occurred after the battle of Austerlitz, the remedy was employed with unequivocal advantage. Richter states, that he prescribed sulphuric aether in very large doses (amounting at last to a table-spoon- ful) with complete success in a case of melancholia, caused by onanism. (Med. Chirurg. Obser. vol. ii. p. 128.) Being the lightest and most evaporable fluid known, it produces, in consequence of its rapid evaporation, a sudden and very great reduction of the temperature of those parts to which it is applied; and hence its exter- nal employment is capable of answering very useful purposes. Charles L. Smalz, physician at Pirna, has published some very interesting observations concern- ing the utility of this article as an external application in strangulated hernia." In two cases of this kind, after all the usual means of reduction had failed, aether was poured on the hernial tumour. From the cold produced by its evaporation, the hernia immediately softened, diminished, and was readily returned/!" Many cases have since occurred to other practitioners, in which the application of the aether was found to pro- duce similar good effects. In rheumatism and gout also, the external applica- tion of this remedy has afforded very great relief. We are told by Sedillot, who has published a memoir on this subject (in the Recuiel Periodique de la Societe * Rochefort, Cours Elementaire de Matiere Medicale, vol. i. p. 118. t Alibert, Elemens de Therap. torn. ii. p. 144. Vol. II.—V 158 OIL OF AMBER. de Med. de Paris), that the acetic aether is still more decidedly beneficial as an external remedy in rheuma- tism and gout, than the sulphuric aether.* A mixture of sulphuric and muriatic aethers evaporates with so great a rapidity, as to produce a degree of cold seve- ral degrees below O. of Fahrenheit's thermometer. The liquor anodynus Hoffmani, is nothing else than sulphuric aether with the admixture of a small portion of alcohol and oil of wine. The sulphuric aether is liable, according to Gay Lussac, to undergo sponta- neous decomposition, when kept a long time without disturbing it; " acetic acid, perhaps some alcohol, and a particular oil, are produced from it." This article is given in the dose of zi—siii. and repeated according to the exigencies of the case. OLEUM SUCCINI.--OIL OF AMBER. Ameer, which affords this essential oil, is a solid bi- tuminous substance, of a yellowish brown colour, clear and transparent, possessing very little taste or smell. It is dug out of the earth, and found along the coast of the Baltic and Mediterranean. This substance was much esteemed by the ancients, not only for its sup- posed remediate powers, but also as an ornament worn by the Roman ladies at their public games. ------stillataque sole rigescunt De ramis electra novis; quae lucidus amnis Excepit et nuribus mittit gestanda latinis. Ovid. Met. L. ii. 1. 364. Amber was called electrum by the ancients, from its property of becoming electric on being rubbed. The essential oil obtained from it by distillation, possesses an acrid pungent taste and bituminous smell. * Alibert, Elemens de Therap. torn. ii. p. 144. OIL OF AMBER. 159 It is very sparingly soluble in alcohol. When taken internally this oil evinces considerable stimulating properties; it heats the system and excites the secre- tions. The oil of amber has been much recommended in tetanus, hysteria, and other spasmodic complaints. Dr. Rush employed it in a case of tetanus with very decided benefit. In France, a mixture consisting of equal parts of ol. succin. spirit terebinth, and bals. copai- va, has lately been strongly recommended as a remedy in gleet, leucorrhcea, and nocturnal pollutions. The dose of this mixture is thirty drops, gradually increased to sixty, three times daily. Dr. Chapman says it is very useful in pyrosis, especially if attended with spas- modic pains. I have never employed this article in spasmodic affections, and can therefore give no opinion concerning its powers. Hufeland speaks very highly of the good effects of amber in union with musk, in the cure of gangrene. Lentin also adds his testimony in favour of its employ- ment in this disorder. Liniments, of which this oil forms a principal part, have been used with advantage against fixed rheumatic pains, torpidity, and slight paralysis. The oil of amber is given in doses of from ten to thirty drops. By the continental physicians it is fre- quently administered in union with caustic ammonia. Ten or fifteen drops of the oil are put into a glass con- taining a small portion of caustic ammonia, which is to be shook until it becomes of a milky appearance.* * Alibert. CHAPTER XI. E. MEDICINES WHOSE ACTION IS PRINCIPALLY MANI- FESTED IN THE CIRCULATORY SYSTEM. Stimulants. The term stimulus, used in its most extensive signi- fication, is applied to whatever agent is capable of ex- citing the vital energies, or, as it has been expressed, of producing sensation, motion, or thought. It is not, however, in this wide and indefinite sense, that this term is employed in the classification of the materia medica. It is restricted to the designation of those remedies which, without producing any evacuations, increase the action of the heart and arteries, and of the nervous power. The articles, however, which, accord- ing to the meaning of the term, come under the gene- ral title of stimulants, differ very materially from each other in relation to the particular effects which they produce in the animal economy. Thus, a certain set of remediate substances, besides their general stimulant effects, produce, as a secondary result, insensibility, sleep, and if the dose be very large, apoplectic stupor and death. These are called narcotics, and appear to act more especially on the nervous system. Another set of stimulant remedies operate with great rapidity, producing an immediate, but transient increase of the action of the heart and arteries, and calm irregular STIMULANTS. 161 muscular motions, by their power of exciting and equalizing the nervous energy. These are the anti- spasmodics. A third class of stimulant substances, act more exclusively on the heart and arteries, producing a full, strong, and frequent pulse, a general warmth and fulness on the surface, and a temporary vigour of the general powers of the system, without manifesting any particular tendency to allay pain, or spasm, or to produce sleep and insensibility. These are the inci- tants, or stimulants properly so called; and constitute the class of remedies which is the object of the pre- sent chapter. Stimulants, however, differ from each other, not only in relation to those general effects, by which they are distinguished into narcotics, antispasmodics, and incitants, but also in the more intimate or spe- cific impressions which they produce in the animal economy. By Brown and his followers, it was ima- gined that the operation of all stimulating articles is essentially alike, and that they differ from each other, simply in the degree of activity which they possess. The hypothesis, however, could not stand long before the positive evidence of experience and observation; and it is now, I believe, almost universally abandoned. That stimulants, though agreeing in their general or obvious effects, are essentially diverse, as regards their specific impressions on the system, is sufficiently evident from the fact, that when the system becomes in a degree insensible to the impressions of one stimulus, from frequent repetition, it still retains nearly, if not entirely, its ordinary sensibility to the operation of another agent of the same kind. Thus, a person habituated to the use of ardent spirits, will be but triflingly affected by a dose of alcohol, which, in one of temperate habits, would produce very power- ful effects, and yet both will be nearly equally affected 162 STIMULANTS. by the same quantity of opium. If the excitement which these agents produce were not essentially diverse, it would be impossible to conceive how this circumstance could occur. But, independent of con- siderations of this kind, the phenomena which result from the action of differe-nt stimulants, at once estab- lish the fact of a radical discrepancy in the excitement which they produce upon the organization. By no management, for instance, can assafcetida, alcohol, or any other stimulus be made to produce precisely the effects which result from a proper dose of opium. What is here said in relation to stimulants applies, with equal propriety, to every article capable of affect- ing the animal economy. When two phenomena suc- ceed each other, as cause and effect, their relation towards each other is positive. The one necessarily follows the other, and whilst the former remains the same, the latter cannot possibly vary. It is evident, therefore, that no agents that are in the slightest degree dissimilar in character, can affect the living system in exactly the same manner, and that the nature of the excitement produced by remedies, must be as various as the remedies themselves. If these observations be correct, then the utility of a copious materia medica is at once obvious. For it cannot be doubted, that our means of controlling morbid excite- ment will be in proportion to the extent and variety of the impressions we are enabled to produce on the system. As a general rule, stimulants are forbidden in all cases where bleeding is indicated. When debility is connected with much torpor and insensibility, as in the latter stage of typhus fever, it is necessary to be- gin with large doses. Where, however, prostration depends on direct depletion, or is connected with an excitable state of the system, it is of the utmost im- VOLATILE ALKALI. 163 portance to begin with small doses, and gradually to increase them, as the susceptibility to their influence is lessened by repetition. *The power of stimulants appears to be much en- hanced by giving them in combination with each other. " There are, perhaps, no remedies," says Dr. Paris, " which receive greater mutual benefit by intermixture with each other, than the individuals which compose the class of stimulants; they not only thus acquire increased efficacy, but at the same time they lose much of their acrimony; if, for instance, any one spice, as the dried capsule of the capsicum, be taken into the stomach, it will excite a sense of heat and pain; in like manner will a quantity of pepper; but if an equivalent quantity of those two stimulants be given in combina- tion, no such sense of pain is produced; but, on the contrary, a pleasant warmth is experienced, and a genial glow felt over the whole body; and if a greater number of spices be joined together, the chance of pain and inflammation being produced, is still farther di- minished." CARBONAS AMMONITE.--VOLATILE ALKALI. The carbonate of ammonia is obtained in the form of white, semitransparent masses, of a fibrous texture, and efflorescing when exposed to the air. It has a pungent and peculiar odour, and an acrid taste. The degree of its solubility is not accurately ascertained. According to Mr. Phillips, it is soluble in four parts of cold water; Dr. Duncan says in two parts. It is inso- luble in alcohol. When dissolved in boiling water, it undergoes a partial decomposition with effervescence. The carbonate of ammonia is a very active stimu- lant, and may be employed as such in a variety of 164 VOLATILE ALKALI. cases, with peculiar advantage. In typhus fever it has been particularly recommended by Huxham, Pringle, and others, and some have considered it superior in this disease to any other stimulant we possess. " In the more advanced stages of the disease," says Dr. Chapman, " when the indications of increased debility come on, the volatile alkali, either alone or in combi- nation with opium and wine, is, of all the remedies which I have ever tried, one of the most decidedly useful." In my own practice I have been much in the habit of employing this remedy, and it has appeared to me, in general, more beneficial in the advanced stages of typhus, than any of the other stimulants usually resorted to in this disease. It may be given at a much earlier stage of the disease than other remedies of this kind; for, instead of producing a hot and dry skin, like wine, camphor, &c, when given before the stage of excitement has passed by, it commonly excites a gentle diaphoresis, rendering the skin moist and comfortable, while the action of the heart and arteries is raised. "In one respect," says Dr. Chapman, "the volatile alkali differs from every article of the class to which it is attached, and, it would seem, from all other medi- cines. The peculiarity to which I allude is this, that the excitement it raises approaches more nearly to that of healthy action, and hence it may be recurred to earlier than stimulants generally, in the inflammatory affections." In puerperal fever, when the inflammatory action has subsided, and the system is sinking, ammonia has been much used, and it is undoubtedly one of our most important remedies in cases of this kind. This remedy has also been recommended in the cure of pneumonia. In the latter stage of the disease, when, after much depletion, expectoration is imperfect, the VOLATILE ALKALI. 165 pulse is small, and the skin dry, the volatile alkali is a remedy of unquestionable efficacy. It is obvious, how- ever, that so long as bleeding is indicated, this, as well as all other stimulants, cannot be employed without much risk of injury. In the typhoid pneumonia which prevailed through the United States a few years ago, I often administered the ammonia in combination with a decoction of serpentaria, from the very commence- ment of the disease, with unequivocal advantage. In general the carbonate of ammonia may be regarded as a peculiarly useful stimulant, whenever a hot and dry state of the skin exists, with much prostration of the vital powers. Ammonia may also be given with advantage in the latter periods of phthisis. "Where the cough is troublesome, the pulse weak, and great debility pre- vails, the exhibition of ammonia is attended with excel- lent effects. It does not flush the cheeks like most other stimulants."* The volatile alkali has been much recommended in some affections of the alimentary canal. It is given in flatulent colic, unconnected with inflammation; and in cardialgia, depending on acidity in the primae viae, I have frequently known it to afford very speedy relief. Dr. Chapman states, that in the nervous or sick head- ache, "a dose of the volatile alkali will in some instances afford almost instantaneous relief." In the gastric affections which are common to persons of intemperate habits, this remedy is, in general, very beneficial. It is also said to produce excellent effects in diarrhoea and dysentery, depending on a debility of the intestinal canal.t In these affections it is usually given in combination with opium, and I have myself * Barton's MS. Lectures on .Mat. Mod. f Burdach's Arzneimittellehre, vol. iii. p. 417. Vol. II.—W 166 VOLATILE ALKALI. employed it in this way with benefit. It is only, how- ever, in the chronic form of dysentery that we can venture on the employment of this remedy. When the discharges are not attended with much tormina, and seem to depend more on a relaxed, than on an inflam- matory condition of the bowels, it will act very bene- ficially, not only by giving tone to the intestinal canal, but also by establishing a gentle diaphoresis, and, perhaps, by neutralizing acidity in the primae viae. In chronic rheumatism, ammonia may often be used with considerable advantage. Dr. Barton employed the carbonate of ammonia with excellent effect in this disease.* It is more particularly applicable to those slight cases of wandering rheumatic pains and swell- ing, which remain as the sequelae of an attack of the acute form of the disease. In several instances, after the inflammatory symptoms had been subdued by antiphlogistic measures, and pain and stiffness, with a small and irritable pulse remained, I have given the aqua ammonia in doses of twenty drops, three or four times a day, with manifest advantage. I am at present treating a case in this way, and the effects of the remedy are such as to encourage me to proceed with it. Dr. Kuhn of this city, was in the habit of employ- ing this remedy in regular gout.t According to Brande (Mat. Med. p. 280), a plaster composed of one part of carb. ammon. and three of extr. belladonna, form a very efficacious application for allaying rheu- matic or nervous pains. In the treatment of humoral asthma, pertussis, and catarrhal affections, the volatile alkali has been a good deal recommended by some of the older writers. It does not, however, merit any particular attention in these affections. * MS. Lectures on Mat. Med. t Jbid. VOLATILE ALKALI. 167 Dr. Paris states, that he has found it very useful in hoarseness depending on a relaxed state of the throat. In the hoarseness which succeeds measles it is an ex- cellent remedy. This salt has also been applied to the treatment of croup. Grittfeld caused his patients to respire the va- pours of it, with the view of exciting cough, and thus expelling the membrane, commonly formed in the tra- chea. M. Rechon, a French physician, employed it both externally and internally in this disease; and, as he informs us, with much advantage.* No one at pre- sent, however, would, I hope, be willing to place any reliance on this remedy. Nothing but the most prompt employment of depletory measures, can be relied on with any degree of confidence in this formidable mala- dy. Bleeding, emetics, calomel, and the warm bath, judiciously employed in the early stages of the disease, will in general rescue the patient from danger. After the inflammatory symptoms have been subdued, and a dry cough, with oppressed breathing and a harsh skin be present, the volatile alkali may, perhaps, be employ- ed with some advantage. But in the first or inflamma- tory stages of the complaint, it would be the height of imprudence, I conceive, to use this remedy. It has also been prescribed in tetanus, epilepsy, and other convulsive diseases. In the treatment of apoplexy, especially, it was at one time a good deal recommended, but excepting in what has been called nervous apoplexy, or in that variety of the disease which is not connected with cephalic congestions, it is evidently an improper remedy. In cases attended with a pale countenance and a small and feeble pulse, the volatile alkali may be * Observations et Reflexions sur le Croup; Recueil Periodique de la Societe de Medecine, vol. xxii.—-Traite de Matiere Med. par J. A. Schwil- que, torn. i. p. 410. 168 VOLATILE ALKALI. a very proper remedy; but where the vessels of the head are turgid with blood, and the face is livid and puffed up, we cannot employ stimulants w ithout greatly endangering the patient's life. This remedy has been highly recommended in the treatment of syphilitic affections. Peyrilhe, a French physician, speaks in extravagant terms of its efficacy in this disease ;* but the experience of others has not yet confirmed the statements made by this writer. Roche- fort says, that he gave the volatile alkali in venereal affections without ever deriving the least advantage from it.t This article has also been recently proposed, as a means for arresting haemorrhages. For this pur- pose the volatile alkali is to be dissolved in three times its weight of water, and applied to the bleeding vessels, by means of dossils of lint. Mr. Lapira, a Sicilian chemist, who first recommended its application in this way, made many experiments with it on sheep and dogs, and found it in some instances to arrest the bleed- ing from the divided crural arteries of these animals with much promptness. The volatile alkali, in conjunction with guaiacum, is an excellent remedy in certain states of dropsy and in visceral obstructions. " I have succeeded," says Dr. Barton, " with this medicine when foxglove and squills made no impression on the disease.} To counteract the effects of the bites of venomous reptiles and insects, the volatile alkali was formerly considered a very efficacious remedy. It was first re- commended for this purpose by M. Bernard de Jussieu, who states that he employed it with complete success * Essai sur la Vertu Anti-venerienne des Alkalis volatiles. X Cours Elementaire de Matiere Medicale, par Dem. Dubois de Roche- fort, torn. i. p. 136. X Barton's MS. Lectures. VOLATILE ALKALI. 169 in the case of a student who was bitten by a viper. Dr. Ramsay, of South Carolina, has also recorded seve- ral instances of its successful use in cases of this kind; but the late Dr. Barton, who paid a good deal of atten- tion to this subject, considered it as useless in this re- spect. The Abbe Fontane, too, made a number of experiments in relation to the antidotal powers of this remedy, and the result of his experience is, that it is not only ineffectual, but in many cases evidently injurious. Larenti, who has also attended to this subject, found the volatile alkali entirely ineffectual in every case in which he tried it.* The volatile alkali has moreover been applied to the treatment of cancerous affections. Martini, an Italian, and Hufeland, have published favourable ac- counts of its effects in this disease. Mr. Home also states, that he cured a scrofulous cancer of the lip, by administering fifteen drops of aq. ammon. three times a day, and gradually increasing it to forty drops. After using this remedy for three months, the ulcer was entirely healed. It is not, however, entitled to any particular attention in this respect. M. Patin asserts, that the acetate of ammonia is one of the most effec- tual remedies we possess for allaying the excruciating pains which attend carcinoma of the womb, and dys- menorrhcea. In the latter affection I have prescribed it in five or six cases, and always with signal benefit. It should be administered in full doses, and repeated every hour. (Rev. Med. November, 1828.) Aq. ammonia is said to possess the singular pro- perty of obviating the inebriating effects of alcoholic liquors. This fact was first publicly stated by Dr. Girard of Lyons. Dr. Chantourelle, who was ap- pointed to make a report on this subject to the * Barton's MS. Lectures. 170 OLEUM TEREBINTHINjE. Medical Society of Paris, thought it might be sup- posed that this effect arose from the decomposition of the wine by the ammonia; chemical experiments, however, showed that such was not the case.* As an external remedy, this article will again be noticed when I come to speak of the rubefacients. It may be given either in the form of powder or julep.t The dose is from five to twenty grains. The incompatible substances are, sulphuric and nitric acids, nitrate of silver, acetate of lead, muriate of mercury, sulphate of zinc, tartarized iron, the fixed alkalies, lime, alum, magnesia, and sulphate of magnesia. Officinal Preparations.—Spiritus ammonias succinatus; dose, from ten to thirty drops. Spiritus ammonias aromaticus ; dose, from twenty to sixty drops. Spiritus ammonias fostidus. Formulae. R.—Carbonat. ammonia? 3L Aq. fontanse §vi. Mucilag. g. arab §ss. Syrup, zingiberis %\.—M. f. Dose, a table-spoonful. R.—Carb. ammonia? sji. Pulv. camph. gss. Mucilag. g. arab %i. Sacch. albi §iss. Aq. cinnamon gvi—M. f. Dose, a table-spoonful. R.—Liq. ammon. succinat. jii. Tinct. castor sjiii. ./Ether, sulph. sji.—M. Dose, from twenty to forty drops. OLEUM TEREBINTHINjE. This is a limpid essential oil, possessing a strong penetrating odour, and a hot, bitter, and pungent taste. In hot alcohol it dissolves without difficulty; but on suffering it to cool, it again separates. It is com- * Lond. Med. and Phys. Journ. No. 270. X R.—Ammon. carbonat. ^ss. Aq. menth. pep. Jvii. Syrupi aurantii §s».—M. Sumatur octava pars. OLEUM TEREBINTHIN.E. 171 pletely soluble in six parts of sulphuric aether. It unites with sulphur, wax, resins, and balsams, when exposed to a gentle heat. The alkalies have no action on it. The oil of turpentine is an active and penetrating stimulus; and admits of a great variety of import- ant remediate applications. It possesses diuretic and anthelmintic properties, and in large doses produces active purging. When taken in moderate doses, it increases the fulness and frequency of the pulse, and the heat of the skin, without materially affecting the functions of the brain. In large doses, however, it produces a sense of fulness in the head, attended with vertigo, or a feeling of intoxication, and slight nausea. It appears to be speedily absorbed into the circulation, for whether injected into the rectum or received into the stomach, its peculiar odour is soon very percepti- ble in the breath, and to the urine it imparts the odour of violets. Employed in moderate and frequently re- peated doses, it is apt to give rise to irritation of the urinary passages, amounting, sometimes, to violent strangury. As a general stimulus in the low states of fever the turpentine is but seldom prescribed. It has, however, been recommended in the treatment of yellow fever, by some practitioners both of the West Indies and of the United States. Dr. Physick was, I believe, the first who employed it in this disease. He prescribed it, with much benefit, for allaying the irritability of the stomach, and consequent violent vomitings, which occur in this fever. It does not appear, however, from the experience of other practitioners, that it deserves any particular notice in this respect. Lately the oil of turpentine has been much recom- mended as a remedy in puerperal fever. Dr. Breiman, 172 OLEUM TEREBINTHINjE. of Dublin, was the first who administered it in this dis- ease, and his report of his experience with it is very favourable.* Other English practitioners have since employed it with benefit in this dangerous malady: but I am not aware of its having, as yet, been employed with any particular advantage by the physicians of this country. Since the last edition of this work was pub- lished, I have prescribed the turpentine in nine or ten cases of this disease, and in most instances with decided benefit. I have generally administered it in conjunction with castor oil, in the proportion of three drachms of the turpentine to an ounce of the oil at a dose. I am entirely convinced, that after prompt and efficient blood-letting, very great advantage may often be obtained from the use of the turpentine and castor oil in this formidable malady. This remedy is par- ticularly beneficial in that variety of puerperal fever which depends on intestinal irritation; and which, though not often attended with inflammation, strongly resembles genuine puerperal peritonitis. In the treatment of epilepsy the spirits of turpentine is a valuable medicine. Dr. Latham speaks in high terms of its effects in this disease; and Dr. William Money, surgeon to the Royal Metropolitan Infirmary for sick children, employed it with much advantage in cases of this kind.t Dr. Paris also thinks it may prove beneficial in cases of this kind by unloading the bowels, and by the peculiar cerebral excitement which it produces, when given in large doses, and which is evinced by a species of intoxication, " unaccompanied by that hilarity and elevation of thought that so usually follow the potation of spirituous liquors. I am inclined * Transactions of the Fellows and Licentiates of the King and Queen's College of Physicians of Dublin. X Medico-Chirurgical Review and Journal, Sept. 1822, p. 451. OLEUM TEREBINTHINjE. 173 to believe, however, that it often acts beneficially in cases of this kind by destroying worms in the alimen- tary canal, a very frequent cause of epilepsy." In uterine epilepsy—that is, in cases depending on catamenial disorders, this remedy is said to be particu- larly efficacious. Dr. Prichard declares, that according to his experience, the oil of turpentine is decidedly the best emmenagogue we possess in uterine epilepsy. He asserts, that he has employed the turpentine with entire success in cases of this kind, after various other reme- dies had been ineffectually used. In a case of epilepsy in a young lady, about twenty years old, who had never menstruated, I succeeded in establishing the catamenial function and arresting the disease, by the employment of the remedy, in conjunction with blood- letting, and the daily use of the hip-bath. In this case, one drachm of the turpentine was administered twice daily, until it produced severe strangury; after the strangury had subsided, the turpentine was again administered, until the same effect was produced, &c. In about two weeks after the commencement of this treatment the menses began to flow, and the epileptic attacks ceased to return. Turpentine is a medicine of very considerable utility in chronic rheumatism. In sciatica, especially, it was employed with much success by Dr. Cheyne, and Dr. Francis Home.* Of its efficacy in this form of rheu- matism I have, in several instances, had unequivocal evidence. Cheyne gave it with honey, in doses of from one to four drachms, three times a day. Home, however, used it in much smaller doses, and his suc- cess was not less than that of Dr. Cheyne. I have commonly given from twenty to thirty drops, three times a day, on sugar, and at the same time directed • Clinical Experiments. Vol. II.—X 174 OLEUM TEREBINTHINjE. frictions with the camphor liniment, recommended by Home and Ferriar, for lumbago.* This remedy has lately been much extolled for its efficacy in removing obstinate obstructions of the bowels. Dr. Kinglake gives an account of two cases in which the turpentine manifested decidedly beneficial powers. The first case was one of extreme obstinacy; " bleeding, the warm bath, blistering, lenient and brisk cathartics, with repeated clysters, were assiduously but unavailingly used. The case appeared almost hope- less, when the spirit of turpentine was administered in doses of two drachms, conjoined with half an ounce of castor oil, every two hours. The first and subsequent doses, to the number of four, remained on the stomach, when full and complete catharsis was produced.'f Dr. Paris also adds his testimony in favour of the utility of turpentine in cases of this kind. " In obstinate con- stipation, depending on affections of the brain, I have lately had several opportunities of witnessing its bene- ficial effects. In an unfortunate instance of hydroce- phalus acutus, in a boy of thirteen years of age, it brought away an accumulation of feculent matter, almost incredible as to quantity, after the total failure of the strongest doses of ordinary purgatives.''^ In chronic cases, attended with flatulence, acid eructations, a sallow countenance, a foul tongue, with griping and acrid stools, the oil of turpentine will fre- quently produce highly beneficial effects. Dr. Prichard declares, that he never employed any remedy with so much benefit as oil of turpentine, in cases attended with such a state of the bowels. " It occasions mode- * Pulv. camph. 9ii. ungt. basilic. |i. sapon. commun. giss. pulv. sem. sinap. Qi. Fiat, unguent. f Lond. Med. and Phys. Jour. No. 271. X Pharmacologia, p. 540. OLEUM TEREBINTHINiE. 175 rate and regular evacuations, corrects the tendency to a frequent repetition of griping and irritating stools, and relieves, or completely removes, flatulence. At the same time the oil of turpentine exerts a peculiar sedative or tranquilizing power on the nervous system; it lessens irritability, the disposition of starting and convulsive twitching of the muscular fibres, and pro- motes sleep."* The oil of turpentine, has also been successfully employed in tetanus. Dr. Hutchinson cured a case of idiopathic tetanus by administering half an ounce of the turpentine every two hours. Dr. Mott, of New York, also employed it with signal benefit in a traumatic case. He gave a tea-spoonful of the turpentine every fifteen minutes, for two hours, when the spasms intermitted. It was then repeated at much longer intervals until one hundred and twenty tea-spoonfuls were taken. In certain diseases of the eye, the ol. turpentine appears to be a remedy of very excellent powers. In iritis, it has been frequently employed with the'hap- piest effects. Drs. Carmichael and Guthrie adminis- tered it with decided benefit in cases of this disease; and Mr. Middlemore has more recently employed it " in ordinary iritis with results fully confirmatory of the observations of the two former physicians." Mr. Middlemore strongly advises the use of a drachm of turpentine, two or three times daily, in cases where, after the acute symptoms have been relieved by mer- cury, there remains a slow disorganizing inflammation in the iris. The turpentine has been found equally beneficial in choroidal and retinal inflammation. formerly, the spirit of turpentine was frequently em- ployed in hepatic obstructions, and especially in jaun- dice from the obstruction of the bile-ducts by biliary * Prichard on Diseases of the Nervous System, p. 263. 176 OLEUM TEREBINTHINjE. concretions. Its use in these affections is now, how- ever, entirely neglected. In the treatment of obstinate gleets, turpentine, ad- ministered internally, will often produce very good effects. I have also known it to be employed with success in gonorrhoea; but in recent cases it is too irritating to be early given in this affection. As an external remedy turpentine admits of a great variety of useful applications. In the treatment of burns and scalds it is undoubtedly a remedy of great utility. Kentish, who first employed the turpentine in cases of this kind, directs that it be mixed with a por- tion of basilicon ointment, with which pieces of linen are to be spread, and laid on the injured part, being careful not to let the ointment extend over the sound skin. When this is done very soon after the burn has been received, it hardly ever fails, in a short time, to remove the burning pain and violent inflammation of the part, and to establish a regular suppuration. Ac- cording to the experience of Dr. Geddings, the oil of turpentine is a valuable remedy for excessive saliva- tion. He states that he has used it extensively for this purpose, both in hospital and private practice," "with the most satisfactory results." "It has also been much employed" he observes, "by several of our medical friends, whose testimony fully substantiates our good opinion." Two drachms of the turpentine should be diluted with eight ounces of thin gum arabic muci- lage, and used frequently during the day as a gargle. In some instances Dr. Geddings used the undiluted turpentine " with the same happy effects." It at first generally causes severe smarting, which, however, soon subsides, and becomes less and less at each successive application. (Am. Jour, of Med. Sciences, vol. vii. p. 266.) OLEUM TEREBINTHIN^. 177 Mixed with oil, and introduced on cotton into the ears, turpentine has been found serviceable in deafness arising from a diseased action of the ceruminiferous glands.* I have already spoken of the vermifuge powers of this article, under the head of Anthelmintics; and I shall hereafter again have to notice it when I come to speak of rubefacients. As an anthelmintic, turpentine is given in doses of from one to three ounces. When used as a stimulant or diuretic, it is given in doses of from ten to forty drops. Two ounces of the oil, incorporated with a pint of mucilage, forms a very valuable clyster, in ob- structions of the bowels and flatulent colic. Dr. Nimmo recommends the following method for purifying the oil of turpentine for medicinal use, "with- out diminishing its efficacy, but greatly lessening its disagreeable taste and its injurious effects upon the kidneys:—To eight parts of the oil add one part of the strongest alcohol, and let them be well agitated; in a few minutes a separation takes place; the oil, unless very impure, falls to the bottom, and the alcohol, 'having dissolved the impurities, floats at the top. Pour off the alcoholic portion, add an equal quantity of alcohol as before, agitate, and separate the liquids. If this be repeated three or four times, the oil becomes nearly tasteless, almost without smell, and when a por- tion of it is evaporated, it leaves no residue. The oil, however, speedily undergoes alteration, and returns to its original state of greater or less impurity. M. Vangelin has ascertained that if 100 parts of pure oil of turpentine in volume, and 20 parts of alcohol be mixed together, they do not separate again by rest, but form a homogeneous fluid. * Paris's Pharmacologia. 178 PHOSPHORUS. Phosphorus is a compact substance, of a pale yellow colour, readily cut with a knife, and exhibiting when broke a vitreous fracture. It is exceedingly combusti- ble, inflaming at the medium temperature of the atmos- phere. It has an acrid taste and a strong alliaceous odour. It becomes fluid when put in hot water, and assumes the appearance of an oil. Alcohol and water do not dissolve it; but in the essential and fat oils, and in sulpuric aether, it is quite soluble. Phosphorus is one of the most active and penetrating excitants with which we are acquainted; producing, when incautiously taken, exceedingly violent and dan- gerous effects. When rubbed upon the skin it imme- diately creates a burning pain and inflammation of the part to which it is applied. Taken inwardly, in the dose of from one-eighth to one-fifth of a grain, it produces an agreeable warmth, and temporary vigour of the powers of the system, and increases very considerably the secretion of urine. In somewhat larger doses it produces restlessness, heat, an irritated and feverish pulse, furred tongue, engorgement of the vessels of the head, stricture and dryness in the breast, violent burn- ing and pain in the stomach, nausea, and bilious vomit- ing. Two or three grains produce excrutiating burning pains in the stomach and bowels, attended commonly with distressing vomiting and hiccup; a sinking of the powers, the pulse becoming gradually imperceptible, and the whole surface of the body cold, and death. The inflammation in the stomach and bowels is gene- rally of small extent. The stomach is commonly found much distended, and the intestinal canal closely con- tracted in different places. It is said, that when given PHOSPHORUS. 179 even in moderate doses, it is apt, on being long con- tinued, to produce indurations in the stomach, chronic vomiting, constipation, atrophy, and death. Weikard states, that he once gave to a paralytic patient two grains of phosphorus incorporated with some conserves. On the following day the dose was increased to three grains, and he proposed augmenting the dose progress- ively, when all at once, on the third night, the patient was seized with violent contractions. Blisters were applied, and copious draughts of mucilaginous drinks given. Nevertheless, the patient sunk and died on the fourth day.* Brera relates a similar occurrence in his practice. He administered two grains to a paralytic woman. After the first dose she appeared to be better; on taking the fourth dose, however, she began to com- plain of violent burning pain in the stomach and bowels, and in forty-eight hours after she died.t Mentz, a German physician, is said to have been the first who published any thing relative to the remediate employment of this article.^ It is highly recommended by some authors in the treatment of typhus fever. Lobstein says, that when given in this disease, the effects frequently appear after four hours, but sometimes not till twenty-four. " The vital warmth returns, tran- spiration is restored, the pulse improves, the urine is voided freely, and commonly turbid, with a sediment; the abdomen loses its tension; the excrements have a sulphurous smell, and shine in the dark; the delirium ceases, and the patient recovers his recollection, the mental faculties return, and a beneficial sleep restores * Alibert, Matiere Medicales, &c. vol. i. p. 192. f Brera Rifflessione Medico-prattishe sull' uso interno de Fosforo. Pa- via, 1798. X Menzius, Dissertatio de Phosphori loco Medicinae Assumti Virtate Medica. Wittemb. 1761,—in Haller's Disp. Pathol, torn. vii. p. 288. 180 PHOSPHORUS. the strength in a few days."* I do not doubt that its cautious use in the latter stages of this disease may often be followed by salutary consequences. Still, how- ever, as it is an exceedingly active substance, and apt to produce dangerous effects when improperly taken, its use should not be ventured on without the utmost cau- tion. Burdach states that it is especially efficacious in the typhus of the exanthemata, where the eruption has receded or does not come out sufficiently, from defi- ciency of action in the system. Phosphorus has also been given with success in spas- modic and convulsive diseases. Handel mentions seve- ral cases of epilepsy which were cured by this remedy. He relates the case of a girl who had frequent attacks of epileptic convulsions, and who was entirely freed from the disease by taking, in a mistake, some water out of a vial containing phosphorus. Instructed by this case, he says that he afterwards gave it to other epileptic patients, and with much success/]" Alibert, on the contrary, states that he gave this substance in one- grain doses, every twenty-four hours, to six epileptic patients, and continued its use for nearly two months, not only without deriving any advantage, but, in the majority of cases, with evident injury. Lobstein, who appears to have paid great attention to the remediate employment of phosphorus, attributes the dangerous effects which have been observed to arise from its use to the improper mode in which it has been usually ad-> miEiistered; namely, in pills, electuaries, or emulsions. Its beneficial effects, he observes, are only produced when the remedy is completely dissolved in its vehicle. Ho found, from much experience, he says, that its solu- *1 J. F. D. Lobstein, Recherches et Observations sur le Phosphore a Strlsburg, 1815. Vid. Lond. Med. and Phys. Journal, for October, 1816. i] Alibert, Mac. Med. vol. i. p. 192. PHOSPHORUS. 181 tion in vitriolic aether, with the addition of some aro- matic essential oil, is a safe and convenient mode of exhibiting this medicine. From one-eighth to one- fourth of a grain of the phosphorus may be thus given at a dose; and experience has shown, that one grain in twenty-four hours is, for the most part, quite sufficient. It is said that phosphorus agrees much better, and can be borne in larger doses, when the atmosphere is dry and clear, than in cold and damp weather. " It ought never to be taken on an empty stomach, but always an hour after the patient has taken nourishment; salad and acid food, and drink in general, even beer, is improper. To quench the thirst, a mucous solution of salep, with sweet and generous wine, is the best beverage; the patient must also refrain from drinking immediately after having taken phosphorus. In acute diseases, where there is commonly but little appetite, broth, with a little nutmeg, or vermicelli, sago, &c. may be taken; but in chronic disorders, where digestion is not impair- ed, veal, beef, and mutton, either boiled or roasted; also light vegetables, such as carrots, French beans, &c. are a fit diet. Cabbage, turnips, onions, radishes, rape, cole, peas, &c. must be avoided, causing a sensa- sation of fulness in the region of the stomach, together with anxiety, insupportable heat, and often vomiting and diarrhoea. The foochmust neither be too hot nor too cold. In case the patient go out, it is of the greatest importance to be on his guard against catching cold, which is apt to occasion vertigo and diarrhoea, or a relapse."* From what we know of this substance, therefore, there is much reason to believe that, in the hands of * Lond. Med. and Phys. Jour, for Oct. 1816. See also Lobstein's Mo- nograph, already referred to, and Lobstein Loebel's Observations in Horn's Archiv. 1810, B. ii. No. 2. Vol. II.—Y 182 ALCOHOL. a prudent physician, and employed with the precau- tions mentioned above, it will be found a safe and valuable remedy. ALCOHOL. This is a colourless and transparent fluid, obtained from vinous liquors by distillation. Its specific gravity is .815. It boils at the temperature of 176°, and does not congeal at any known degree of cold. It burns with a pale blue flame, and leaves no residue. In a state of perfect purity, alcohol consists of a combina- tion of carbon, hydrogen, and oxygen. " It dissolves soap, vegetable extract, sugar, oxalic acid, camphoric, tartaric, gallic, and benzoic acid; volatile oils, resins, and balsams; it combines also with sulphur and the pure fixed alkalies, but not with their carbonates." Alcohol is an exceedingly active and diffusible stimulus. The effects which arise from its action on the living system, are so well known, that it would be superfluous to give a description of them. Brodie, who made experiments with alcohol on living animals, concludes that it is not absorbed, and that its general effects depend on a sympathetic impression on the brain by means of the nerves of the stomach. This he infers from the following facts: 1. Animals that die from the action of alcohol exhibit a decided inflam- mation of the stomach, but the brain is never found inflamed. 2. The effects produced by this fluid follow its application so rapidly, that it would seem impossi- ble that there could be time for its absorption. 3. Persons labouring under the influence of spirituous liquors are frequently restored by vomiting. 4. When alcohol is introduced into the stomach, combined with rhubarb, this latter substance can never be detected in ALCOHOL. 183 the urine when examined after death.* According to the experiments of Orfila, however, it appears that alcohol is sometimes absorbed into the circulation; and this opinion is corroborated by other authenticated facts.t Be this as it may, it is evident the phenomena which result from an over-dose of alcohol depend di- rectly on the action which it exerts upon the sensorium commune. The effects which alcohol produces are, indeed, very analogous to those which arise from con- cussion or compression of the brain; and it is not improbable that the symptoms which arise from large draughts of alcoholic liquors, depend mainly on the inordinate flow of blood which they determine to the vessels of the brain, and the consequent compression of the organ. Alcohol, in its pure state, is seldom employed as an internal remedy. In the various forms of ardent and vinous liquors, however, it is an exceedingly common remedy in all cases of general debility unaccompanied by local inflammations. In the treatment of typhus fever, brandy and wine have long been considered as a principal remedy. When the stage of excitement is over, and stimulants are indicated, there is, indeed, no remedy more grateful and beneficial than the prudent use of generous wine. Where there is great pros- * Philosoph. Trans, for the year 1811, p. 178, first part. X A singular fact of this kind is related by Dr. Cook, in his Treatise on Nervous Diseases,(a) on the authority of Mr. Carlisle: " A few years ago," says Dr. Cook, " a man was brought dead into the Westminster Hospital, who had just drunk a quart of gin for a wager. The evidence of death being quite conclusive, he was immediately examined, and within the lateral ventricles of the brain was found a considerable quantity of a limpid fluid, distinctly impregnated with gin, both to the sense of smell and taste, and even to the test of inflammability. The liquid appeared to the senses of the examining students as strong as one-third of gin to two- thirds of water. (a) Vol. i. p. ;>21 184 ALCOHOL. tration, it may be given in very large and repeated doses without inducing the slightest intoxicating effects. Whenever this is the case, and it produces a fuller, stronger, and slower pulse, and renders the skin moist and of a natural warmth, we may be assured that its influence is beneficial. If, however, it render the pulse more frequent and corded, flush the countenance, and induce restlessness, delirium, thirst, and a dry and burning skin, then its effects will be injurious, and we are admonished of the necessity of at once laying aside its use. Wine has been employed with much advantage in tetanus. Rush says, " it should be given in quarts, and even in gallons, daily." Currie saw a patient cured of this disease, in the Liverpool Infirmary, " by drinking nearly a quarter cask of Madeira wine." Dr. Hosack also speaks highly of wine in this disease, and advises its being given without any other stimulant.* In the chronic form of bowel complaints, the use of the red wines, particularly of port, is almost invariably attended with salutary effects. The slight astringency which these wines possess, renders them peculiarly serviceable in such cases; and wherever a stimulus is indicated and a looseness of the bowels exists, they ought never to be neglected. During the state of con- valescence from acute diseases, when the vital powers return slowly to their wonted vigour, wine may be employed with very great benefit. In the debility of old people, wine is especially useful; Pliny, speaking of its salutary effects, says— ------vino alunter vires, sanguis Calorque hominum. And it has, indeed, been emphatically called," the milk of old age." * Rush's Medical Inquiries, vol. i. p. 186. RED PEPPER. 185 In relaxed and cachectic subjects, the moderate en- joyment of wine is commonly attended with very agreeable and salutary effects. It imparts vigour to mind and body, and infuses a genial glow throughout the whole system. Ovid well understood its benign influence— Vina parant animos, faciuntque caloribus aptos, Cura fugit multo, diluiturque mero. Tunc veniunt risus, tunc pauper cornua sumit, Tunc dolor et curae, rugaque frontis abit, Tunc aperit mentes aevo rarissima nostro Simplicitas, artes excutiente Deo. Alcohol is also used as an external application to sprains and rheumatic swellings; diluted with water, it has been much recommended as an application to burns. CAPSICUM ANNUUM.--RED PEPPER. This is a native of South America; cultivated in large quantities in the West India islands, and fre- quently also in our gardens, for the beauty of its red pods. The taste of the pods, which are the only parts of the plant employed either for medicinal or economi- cal purposes, is exceedingly pungent and acrimonious. They contain an oily matter, extractive and fecula. Oersted has obtained the acrid principle of pepper separately, which appears to possess some of the characteristic properties of an alkali. The virtues of the capsicum are entirely extracted by alcohol and oether. This substance is an active and agreeable stimulus, and admits of very useful remediate applications. Ber- gius recommends it as an effectual remedy in obstinate intermittent fevers, connected with much debility and torpor of the digestive organs and intestinal canal. Capsicum has also been prescribed in the latter stage 186 RED PEPPER. of typhus; and in certain circumstances of this disease, it undoubtedly is a very useful remedy, as I have in several instances experienced in my practice. When the alimentary canal becomes torpid, and ceases to expel the flatus, giving rise to symptoms of tympanitis, the capsicum, with spirits of turpentine, has afforded me very great advantages. I do not think, however, that this article is well calculated to answer our pur- poses, where we wish merely to excite the general powers of the system. It is, as Dr. Chapman correctly observes, more a local than a general and diffusive stimu- lant, and answers, therefore, exceedingly well, where general debility is accompanied by much torpor or relaxation of the alimentary canal. In the treatment of cynanche maligna, capsicum has been much recommended, both as a gargle and an in- ternal remedy. Mr. Stuart,* in particular, speaks very highly of its powers in this disease. He directs " two table-spoonfuls of the small red pepper, or three of the common Cayenne pepper, and two tea-spoonfuls of fine salt to be beat into a paste, on which half a pint of boiling water is to be poured, and strained off when cold; an equal quantity of very sharp vinegar being added to this infusion, a table-spoonful every half hour is a proper dose for an adult." Mr. Stephens gave it to four hundred patients labouring under this disease, and " it seemed to save some whose state had been thought desperate." It was also employed with great benefit in this disease by Mr. Collins. He ob- served, that swallowing the infusion produced slight convulsive motions, and a sensation of heat in the oeso- phagus and stomach, and in a short time after a general glow over the body was felt, without materially * Medical Commentaries, vol. xii. CLOVES. 187 changing the state of the pulse. Mr. Collins also used this remedy successfully in intermittent fevers.* Dr. Makitrick states, that he has found this medicine very serviceable " in that morbid disposition which he calls the cachexia africana, and which he considers as a most frequent and fatal predisposition to disease among the slaves." Capsicum has also been used in partial paralysis; and Dr. Wright says, that it is an excellent remedy in lethargic affections. Lately' this medicine has been recommended as highly useful in the advanced stages of acute rheuma- tism. About five years ago I employed it in a case of this kind, in large and frequent doses, with evident advantage; and I have heard of other practitioners who have given it in this disease with favourable results. Capsicum may be given in the form of pills or tinc- ture. The dose of the powder is from ten to thirty grains. CARYOPHILH AROMATICA.--CLOVES. These are the unexpanded flower-buds of a beautiful tree of the family of myrtles, indigenous to the Molucca islands, and now carefully cultivated by the Dutch at Amboyna. The whole tree is strongly aromatic; but the flower-buds, which are collected in October and November, when they are still green, and dried in the sun, after having been exposed to smoke for a few days, are the only parts met with in commerce, or employed for domestic or medicinal purposes. The taste of cloves is highly aromatic, pungent, and permanent. Their odour is strong, fragrant, and aro- matic. By distillation, they yield about one-eighth * Wilson on Febrile Diseases, vol. ii. p. 141. 188 GINGER. their weight of an essential oil. Water extracts from them a nauseous and slightly astringent extract, con- taining very little of their peculiar aromatic taste. All its virtues are completely extracted by alcohol and aether. Cloves are the most stimulating of all the aromatic remedies, and may be used with advantage in all cases where we wish to produce a strong local impression on the stomach. They have accordingly been frequently prescribed with very good effect in flatulent colic, and in cholera morbus. In the latter affection I have known the tincture of them administered with prompt relief to the patient. The cloves are, however, much more commonly employed as adjuncts to other reme- dies than in an uncombined state. The essential oil is used as a local application in toothache. They may be taken in doses of from five to fifteen grains. ZINGIBER.--GINGER. This is the root of a plant* growing spontaneously in the East Indies, and now abundantly cultivated in some parts of the West. The root is tuberous, a little compressed, and marked with irregular prolongations, which often give it a palmated appearance; the surface is of a pale or ash colour, and sometimes purple. Its taste is exceedingly acrid, producing a glowing heat throughout the whole cavity of the mouth. Its odour is highly aromatic, frequently producing sneezing when held to the nose. It contains, according to Vauquelin, a peculiar acid, a resino-extractive matter, fecula, and an essential oil. The watery and alcoholic extracts are extremely acrid. * Amomum zingiber. Linn. BLACK PEPPER. 189 Ginger is a powerful, but not very diffusible stimu- lant, and appears to possess very useful remediate powers. In an atonic and torpid state of the alimentary canal, attended with colic pains and other dyspeptic symptoms, ginger often affords very great relief. The dyspeptic symptoms and pains in the stomach which are common in gouty persons are frequently much relieved by taking the infusion of this root. It has also been employed with success in the cure of inter- mittent fevers, accompanied with torpor of the abdo- minal viscera ;* and in hooping-cough, where the lungs are much oppressed with slime, it is said to be a remedy of very considerable utility. It is usually given in the form of an infusion. By decoction its aroma is dissipated. The dose of the powder is from ten to twenty grains.t PIPER NIGRUM.--BLACK PEPPER. Pepper contains, according to the analysis of Pfaff, a mild essential oil, having the peculiar odour of the pepper; a dark brown extractive, possessing no acri- mony ; and a green, acrid, inflammable resin. Alcohol and eether extract all its virtues, but water does so only partially. Pepper is a very permanent and general stimulant, and may be employed in a variety of cases with con- siderable advantage. Lately it has been recommended as an efficacious remedy in intermittent fever. Dr. Louis Frank, privy counsellor and principal physician to her majesty Maria, duchess of Parma, has published * Burdach. X Ginger Beer—"■ Tho following is the receipt by which this popular beverage is prepared: Take of lump-sugar half a pound, cream of tartar half an ounce, bruised ginger an ounce, boiling water one gallon. Ferment for twenty-four hours with yest." Vol. II.—Z 190 BLACK PEPPER. a summary of his experience of the utility of black pepper in this disease, from which it appears that its powers in this respect are not inconsiderable. Dr. Frank states, that by the use of this remedy fifty-four out of seventy patients were completely cured in a short time, without relapse. The mode in which he gave the pepper was, to dip the seeds into mucilage of gum arabic, and afterwards into some powdered colomba to disguise it, and then to administer them as pills. The dose is from five to eight pills twice a day.* None of his patients required more than from seventy to eighty pills for perfect recovery. In an atonic and torpid state of the intestinal canal, a few grains of pepper swallowed two or three times a day, are often very beneficial. Pepper has also been employed in chronic rheumatism with good effects. It is, however, more frequently given in combination with other substances, particularly with tonic bitters; and it may be thus employed with much advantage in weakness of the digestive organs, paralysis, and inter- mittent fever ,t * Journal Complementaire du Dictionnaire des Sciences Medicales, No. 22. X Ward's celebrated paste for fistula and piles, contains a large propor- tion of pepper. It is thus prepared : Take black pepper and elecampane, powdered, of each ^viii., powdered fennel seeds §xxii., honey and sugar, of each, ifei.; beat, and mix them well together in a mortar. Dose, the size of a nutmeg, three times a day. CHAPTER XII. F. MEDICINES ACTING SPECIFICALLY UPON THE ORGANS OF SECRETION. I. Medicines that Act on the Cutaneous Exhalents. DIAPHORETICS. These are medicines that increase the natural trans- piration by the cuticular exhalents. When they aug- ment this discharge to such a degree as to produce sweat, they are called sodorifics; the term diaphoretic being usually applied to such articles as increase the insensible perspiration. But as these two terms ex- press simply a stronger or weaker operation of the same kind, it is customary, in classifications of the materia medica, to employ only the latter, as a general appellative for the remedies of this class. Obstructed perspiration may depend on very oppo- site states of the general system. We find it connected with high febrile action, and also with a slow and lan- guid circulation. It is evident, therefore, that the re- medies which are calculated to restore this function when its defect or loss is associated with high vascular action, must be very different from those which are calculated to excite it in an opposite state of the sys- tem. In the former case, our diaphoretics must be 192 DIAPHORETICS. such as have a direct tendency to lessen the action of the heart and arteries, and at the same time to relax the mouths of the transpiratory vessels. Hence cold ablutions, refrigerants, antimonials, and bleeding are very often directly and decidedly diaphoretic. When the arterial reaction is strong, and the skin very dry and hot, a draught of very cold water often causes free diaphoresis. Where, on the contrary, torpor of this function is accompanied with a languid circulation, and with a pale, shrivelled, and cold skin, recourse must be had to diaphoretics of a stimulant character. Although, perhaps, every stimulant may, under certain circum- stances, produce sweating, simply by increasing the action of the heart and arteries, yet it must not be sup- posed that the stimulant diaphoretics act solely by giving a general increase of momentum to the blood, since many of these remedies undoubtedly possess a peculiar tendency, not only to determine the circula- tion to the capillaries of the cuticular surface, without materially augmenting the action of the heart and arte- ries, but also specifically to excite the activity of the perspiratory vessels. Diaphoretics act either by re- laxing the mouths of the transpiratory vessels, or by increasing their activity, or by establishing an increased flow of blood to them, or, finally, by at once producing both the former and the latter of these effects. Although many of our diuretics are manifestly stimu- lant in their primary operation, yet by the increased evacuation which they produce, they are ultimately antiphlogistic in their effects. Those of the refrigerent class are eminently so, and they therefore constitute very important remediate means, in all acute febrile disorders. It is not, however, simply by depleting, that they act beneficially in acute affections. Much advan- tage, it may be presumed, is derived from the evapora- DIAPHORETICS. 193 tion and consequent abstraction of morbid heat which constantly takes place during diaphoresis. In this way a very considerable source of irritation is obviated. There is another effect by which these remedies do good, especially in the inflammatory affections of inter- nal organs. They increase the flow of blood to the skin, and thereby relieve, in some degree, the internal inflamed vessels, by a kind of local abstraction from the affected organs. Health is very intimately connected with the regular performance of the respiratory function. Whenever the transpiration by the skin is suddenly checked, more or less derangement of the system is invariably the consequence. That portion of the circulating fluid which nature designs to be cast off by the cutaneous emunctories, as no longer fit for the purposes of the animal economy, is retained, and becomes a source of morbific irritation to the heart and other organs. That obstructed perspiration may prove detrimental to health in this way, can, I think, hardly be doubted; for it is obvious, that the accidental obstruction of any important emunctory must give rise to an accumula- tion of recrementitious elements of the blood, and impart to it morbific qualities. Frequently the inju- rious consequences that might result from the retention of the perspirable matter is in part, if not wholly, obvi- ated by the vicarious action of the internal emunctories, and particularly of the kidneys. There is, however, another mode in which the sudden suppression of the perspiratory discharge, may excite morbid phenomena in the animal economy. It disturbs the regular cur- rent of the circulation; the blood retreats to the vessels of the internal organs, giving rise to con- gestions, inflammation, and fever. One of the most frequent external causes of obstructed perspiration is 194 . DIAPHORETICS. exposure to a cold and humid atmosphere. When the body is exposed to the influence of this cause, the circulation in the sub-cutaneous vessels is immediately diminished, both in velocity and in volume, and the skin becomes pale, shrunk, and cold. As a natural and necessary result of this condition of the circula- tion on the surface, the blood is repelled to the internal vessels, and much of that recrementitious fluid which nature intends, and the welfare of the economy re- quires, to be cast off by the skin, is retained in the system. There is, therefore, under these circum- stances, a superabundant portion of deteriorated blood forced upon the heart, which acting upon it as a pre- ternatural stimulus, brings on sooner or later re-action, or the stage of febrile excitement. From the manifest influence, therefore, of the per- spiratory function over the health of the body, it is obvious that those remedies which are calculated to restore the regular action of the cutaneous exhalents, must be of much importance in the cure of diseases. Sudorifics have, indeed, been among the earliest and most common remedies in every nation. Valuable, however, as their judicious employment undoubtedly is, there is perhaps no other class of medicines which has been so frequently and perniciously abused in the treatment of diseases. Van Helmont and his follow- ers, believing that acute diseases were to be cured by expelling some morbific matter after its proper concoc- tion, employed the most stimulating sudorifics together with high temperature, in every grade of febrile exa- cerhation. This practice appears to have been exceed- ingly common during the seventeenth and early part of the eighteenth centuries. It is easy to perceive that its effects must have been highly pernicious. It is not, however, to be concluded from this that dia- DIAPHORETICS. 195 phoretic remedies are injurious, even in the most vehement febrile excitement. Quite the contrary, in- deed, is the fact; for diaphoresis is, perhaps, always salutary in fevers of high excitement, and the more so in proportion as the arterial action is vehement. The utility or perniciousness of this discharge, in acute disorders, depends on the means that are used to excite it. It is the employment of heating or stimulating remedies for this purpose that renders the practice so injurious. If we elicit perspiration by cool applica- tions, or by the use of diaphoretics of the refrigerent kind, we in general derive unequivocal advantage from it. Having premised these general observations con- cerning the nature and employment of diaphoretics, I come in the next place to say something relative to their particular application in certain diseases. Dia- phoretics are, in general, strongly indicated in all those febrile affections which arise from the influence of atmospheric vicissitudes. As the first link in the chain of morbid actions in diseases from this cause, is torpor of the perspiratory vessels, it is always of great con- sequence to attend to the full re-establishment of this important function in their treatment. In the phlegmasia?, diaphoretics are indeed among our most common, and certainly also among our most useful remediate means, when judiciously employed. But it must not be forgotten, that where the febrile excite- ment runs very high, the stimulating diaphoretics will often do injury, unless the inordinate action of the heart and arteries be previously moderated by bleed- ing, and evacuations from the intestinal canal. It is not so, however, with the refrigerent or relaxing dia- phoretics; these may be resorted to with advantage, in fevers of the most violent inflammatory excitement. In the treatment of remittent and continued fevers, 196 DIAPHORETICS. diaphoretics are among our most common and useful remedies. A hot and dry skin is invariably attended with augmented distress, in whatever disease it may occur. When this is the case, nothing affords so much relief to the patient as a free flow of the perspiration. In general, however, it is not necessary to excite copious sweating, as every advantage derivable from this source, may be obtained by a degree of diaphoresis just sufficient to keep the skin moist. Before resorting to remedies of this class, the contents of the alimentary canal should be well evacuated. An attention to this is especially necessary in cases where there is reason to suspect the existence of vitiated secretions in the bowels. When the action of the heart and arteries is of a high grade, recourse must be had to cooling appli- cations, and to the refrigerent or relaxing diaphoretics, such as nitre, antimony, acids, &c. But in fevers of low vascular excitement, attended with a dry and burning skin, the stimulating diaphoretics must be used, in conjunction with relaxing applications to the external surface, such as cool or tepid affusions, &c. In the congestive forms of typhus, nothing is of greater importance than the application of such external means as are calculated to excite the action of the skin and sub-cutaneous vessels. The application of heat, by means of bladders or bottles filled with hot water, and the use of rubefacient frictions of the most active kind, tend in a powerful manner to draw from the congested vessels of the oppressed internal organs, and to re- establish the equilibrium of the circulation. Although we should endeavour to keep the skin soft and gently moist in every stage of typhus, copious sweating is not to be encouraged, except in the early stages of the complaint, before the system has become greatly debilitated. The very intimate sympathetic connexion which sub- DIAPHORETICS. 197 sists between the cutaneous surface and the lungs, renders the employment of diaphoretics particularly proper in the treatment of the inflammatory affections of these organs. When the skin is moist with perspi- ration, the breathing is generally more free, the pain and distressful feeling in the throat less severe, and expectoration easier. In incipient phthisis pulmonalis, the most important remedial means are such as tend to keep up a regular action of the cutaneous emunctories. It is for this pur- pose that flannel is worn next the skin, and that patients are directed to visit mild and equable climates. In the treatment of acute rheumatism, diaphoretics are very commonly employed, and they are undoubtedly sometimes of much service. The advantages, however, arising from copious sweating in this disease, are gene- rally but temporary. It mitigates, for awhile, the vio- lence of the pain, but is apt to produce much debility, and to render the system exceedingly sensible to the influence of atmospherical vicissitudes. Gentle diapho- resis is not liable to this objection; "and the employ- ment of antimony, in conjunction with calomel and purgatives; or of antimony or ipecacuanha with opium in moderate doses, so as to produce a favourable deter- mination to the surface, is entitled to our fullest regard in this disease."* Some writers speak very favourably of the employ- ment of diaphoretics in gout. It will certainly always be useful to preserve a moisture and comfortable tem- perature of the skin; but profuse sweating can seldom be of advantage, and must often do harm by increas- ing the susceptibility to the influence of atmospherical changes. Medicines of this class, as is observed by Dr. Scudamore, are also apt to weaken the digestive * Scudamore on the Nature and Cure of Gout and Rheumatism. Vol. II.—2 A 198 DIAPHORETICS. organs, a circumstance which is to be particularly avoided in this disease. Whether gout be primarily seated in the stomach or not, it is certain that it is invariably attended by much derangement of the di- gestive functions, and it is therefore a matter of some importance, when we wish to excite a diaphoresis, to use such articles of this class as have the least tend- ency to weaken the powers of the stomach. When the skin is hot and dry much relief may be obtained by sponging the body with tepid vinegar and water, by cool drink, and a moderate temperature.* I have known a gentleman who always, in his attacks of gout, derived much advantage from a weak infusion of the eupatorium perfoliatum, a plant which, along with its diaphoretic, possesses considerable tonic powers. In no class of diseases are diaphoretics more certain- ly useful than in the bowel affections. Vogeler, Stoll, Akenside, and Richter, were among the first who par- ticularly recommended sweating in the cure of dysen- tery. More recently, Dr. Moseley has bestowed the highest encomiums on the sudorific plan of treating this affection. He affirms, " that the intermittent fever is not cured with more certainty by Peruvian bark, than dysentery by diaphoretics."! As this disease is essentially connected with a con- gested and inflamed condition of the vessels of the intes- tinal canal, and as there exists a very intimate relation between the cutaneous capillaries and those of the internal organs, it is obvious, from the general effects of diaphoresis, that it must prove salutary in this affec- tion. It will not only act as a general depletory measure, but also, in an especial manner, derive from the vessels of the affected parts, and thus aid very * Scudamore on the Nature and Cure of Gout and Rheumatism. X Treatise on Tropical Diseases. DIAPHORETICS. 199 materially in the reduction of the disease. The influence of the morbid condition of the cutaneous exhalents on those of the bowels, and vice versa, is often manifested in a very conspicuous way. We observe, for instance, dysentery, diarrhoea, and inflam- mation of the bowels to ensue from the sudden sup- pression of perspiration; and on the contrary, these diseases, from whatever cause they may arise, are almost invariably attended with a dry skin. By excit- ing the cutaneous emunctories in these affections, therefore, we break the chain of morbid actions, equalize the circulation, and give an exit to those recrementitious matters which nature designs to be cast off by the skin, and the retention of which cannot but prove injurious to the animal economy. Useful, therefore, as the operation of appropriate diapho- retics evidently must be in dysentery, general experi- ence does, nevertheless, not warrant us in attributing to them all the efficacy in this disease which some writers, and particularly Dr. Moseley, have ascribed to them. In cases which arise from the sudden appli- cation of cold to the body, sweating is undoubtedly our chief remedy. In the ordinary autumnal dysenteries, however, or in such as arise from the influence of marsh miasmata, our principal attention must be directed to the biliary organs, and to evacuations from the intesti- nal canal. After the contents of the bowels have been sufficiently evacuated by mild mercurial purgatives, and bleeding premised if the febrile excitement run high, diaphoretics are always highly useful. For this pur- pose small doses of opium, ipecacuanha and calomel answer exceedingly well. This combination tends at once to allay the local irritation and pain of the bowels, to correct the biliary secretion, and to determine the circulation to the surface and excite diaphoresis. 200 DIAPHORETICS. What has just been said of the utility of diaphoretics in dysentery, may be applied with equal force to the treatment of diarrhoea. But as in this disease the intes- tinal exhalents are rather in a relaxed than in an in- flamed state, diaphoresis is not often adequate of itself to give substantial relief. In addition to those re- medies which excite the cutaneous emunctories, and determine the circulation to the external surface, it is generally necessary, also, to resort to such means as are calculated to restore tone to the intestinal exhalents; such as astringent and absorbent remedies. Where the diarrhoea depends on vitiated secretion, either of the biliary organs or intestinal glands, neither sweat- ing nor astringents are of much service, unless they are aided by alterative doses of mild mercurial remedies, and gentle laxatives. In the treatment of cholera infantum, considerable advantage may be obtained by exciting the action of the skin. Here, however, we can seldom employ dia- phoretic remedies, on account of the extreme irritability of the stomach, characteristic of this disease; and we are therefore obliged, for this purpose, to resort to ex- ternal means, such as stimulating or mild rubefacient frictions, the warm bath, flannel rollers applied tightly round the body, &c. The application of a broad flan- nel roller round the abdomen, is especially useful in the chronic form of this disease, as well as in protracted cases of diarrhoea and dysentery. "By this very sim- ple expedient," says Dr. Chapman, " I have done great good in these complaints, having very much used it, as is well known, both in public and private practice, long before the appearance of Dr. Dewar's book, where it is particularly noticed."* Whatever plan of treatment * Dr. Dewar's book, entitled " Observations on Diarrhoea and Dysentery, &c." was first published in 1801. Dr. Chapman must therefore be mis- DIAPHORETICS. 201 we pursue in this disease, we shall derive essential advantage from the concomitant employment of such applications to the surface as are calculated to excite the action of the sub-cutaneous capillaries. When we consider the intimate relation which exists between the functions of the skin and the kidneys, we would at once be led to expect advantage from the em- ployment of diaphoretics in diabetes. Experience, how- ever, does not furnish us with much evidence of their utility in this respect. A few cases are on record which yielded to the employment of such remedies. Cornick* and Wernert relate instances which were successfully treated with the pulvis ipecacuanha com- positus, given in doses of from ten to thirty grains. But we know that opium has been used with success where no particular diaphoresis was produced, and we are therefore not fully warranted, in these cases, to ascribe the benefit derived from this powder to its dia- phoretic operation. Dobson cured a case by the warm bath. As the skin is always remarkably dry and harsh in this disease, there can be little doubt that the warm bath or frictions would, in general, answer very well as auxiliary means. Diaphoretics have also been employed in dropsy. It is, however, generally exceedingly difficult to excite sweating in affections of this kind, nor does the dis- charge, if it can be induced, often afford any particular relief. There is nevertheless very respectable testimo- ny extant in favour of this practice, and it is said to be more especially useful in such cases of the disease as arise from obstructed perspiration, or appear as a con- sequence of measles, scarlatina, or rheumatism. Rich- taken, as to his having used the flannel roller, " both in private and in pub- lic practice, before the appearance of Dr. Dewar's book." * Medical Commentaries, vol. x. f London Medical Journal, 1790, vol. xi. p. 221. 202 DIAPHORETICS. ter speaks well of the use of diaphoretics in cases of this kind.* Monro and Cotunnius employed Dover's powder and opium with antimonials, with success in dropsical affections ;t and Frankf states, that warm bathing is one of our most efficacious means in cases connected with arthritic pains, or arising from repelled cutaneous eruptions. The ancients excited sweating, in dropsy, by burying the patient up to the neck in heated sand or ashes ;§ and Lyson cured cases by placing his patients in rooms heated to a very high tem- perature. I have never resorted to diaphoretics in dropsy, but I have no doubt that they may often prove serviceable, especially in such cases as depend on a primary disorder of the perspiratory function. Richter says that they may be advantageously employed in conjunction with diuretics. Before dismissing this part of my subject, it will be proper to say something concerning the rules that are to be attended to in administering these remedies. When we wish to excite sweat, the patient must be confined to his bed. If the pulse is strong, full, and tense, venesection is to be premised. The state of the general system is to determine the choice of the dia- phoretics to be used. When the action of the pulse is vehement, antimonials, neutral salts, acidulated drinks, cool ablutions, &c. must be employed. Where no in- flammatory excitement is present, recourse must be had to stimulating diaphoretics. When the sweat once appears, it should be supported by copious draughts of gently stimulating drinks. The best time for using diaphoretics is after digestion is completed; during the * Specielle Therapie, torn. iii. p. 58. f Observations on the Nature and Treatment of Dropsy. X De Curand. Homin. Morbis, 1. vi. p. 136. § Celsus de re Medicina, lib. iii. cap. 30. ANTIMONIAL PREPARATIONS. 203 performance of this function the emunctories of the skin are less disposed to action. When the sweat flows, purging and bleeding must be avoided, as they have a tendency to check it. The temperature of the room should be kept at a medium point; and sudden transitions from a warm to a cold air carefully avoided after the sweating has subsided. THE ANTIMONIAL PREPARATIONS. The preparations of antimony deserve to be placed at the head of this class of remedies. When taken in large doses they all produce vomiting; but exhibited in minute portions, they excite the action of the cutaneous vessels, and give rise to a free transpiration by the skin. It is well known that all emetic substances are capable of exciting sweat when given in nauseating doses. Nausea is invariably accompanied by great relaxation of every irritable part of the system. The cutaneous exhalents especially, are always greatly relaxed when under the influence of this feeling, and are thereby rendered more permeable to the watery portion of the blood. The diaphoretic operation of antimony does not, however, appear to depend altogether on its nau- seating or relaxing effects; and in this respect it differs from the other diaphoretics taken from the class of emetics. It does not appear, for instance, that ipeca- cuanha has any tendency to excite the vessels of the skin when given in doses insufficient to produce nausea. Antimony, however, possesses a direct and specific influence upon the capillaries of the skin, as is demon- strated by its occasional effect of removing obstinate cutaneous diseases, when exhibited in minute doses. Its effects upon the cutaneous exhalents, when given so as not to excite nausea, appear to be simply an 204 ANTIMONIAL PREPARATIONS. increase of the insensible perspiration: when we desire to produce free sweating by the antimonial prepara- tions, they must be given so as to cause some degree of sickness of the stomach. In all asthenic diseases the preparations of this metal are decidedly the best diaphoretics we possess. For, independently of the diaphoretic operation of tartarized antimony, it appears to possess the power of moderating the action of the heart and arteries,*—a virtue which must render it par- ticularly adapted to cases of high febrile excitement. But whether it be endued with sedative powers or not, certain it is, that it has not the least tendency to aug- ment febrile irritation, and may therefore be employed during the most violent arterial excitement. It has been alleged that antimonials do most good in fevers, when they do not produce any sensible evacuation by the skin, or obvious diuresis. From my own observa- tions upon this subject, I am inclined to believe that there is some foundation for this opinion, and the cir- cumstance does not appear to me to be altogether inexplicable. The function of perspiration is more or less deranged in all febrile disorders, from the very commencement, throughout their whole course. Tor- por of the cutaneous exhalents would appear, in many instances, to be the very first link in the chain of febrile actions. This is especially the case in those fevers which depend on atmospheric vicissitudes. It is evi- dent, therefore, that the greater portion of those recre- mentitious elements which nature is constantly casting off in the form of perspiration, remains mingled with the mass of the blood, and becomes an additional source of febrile irritation. Now, whatever contributes most to restore the natural action of the cutaneous emunctories, must also most effectually obviate this * Balfour, Lenthois. ANTIMONIAL PREPARATIONS. 205 source of irritation to the heart and arteries. This appears to me to be the point upon which the explana- tion of the circumstance in question turns. When antimonials are given in very minute doses, they aug- ment that insensible discharge of matter, the uninter- rupted elimination of which, is essential to health. They promote the natural secretory action of the exhalents, and enable them to throw off, in a duly elaborated form, those substances which it is their function to separate from the general mass of the blood. When given, however, so as to produce co- pious sweating, they give rise, certainly, to a much greater discharge; but this discharge being more the result of relaxation of the exhalents, and a consequent readier transmission of the watery parts of the blood in a crude state, than of increased activity of the secre- tory excitement of these vessels, it does not so well answer those purposes in the animal economy which nature intends to fulfil by this emunctory. Sweat cannot be regarded as consisting entirely of recremen- titious matter. It unquestionably contains a consider- able portion of fluid, whose retention could not prove detrimental to the living economy. It is not so, how- ever, with the matter that passes off by insensible transpiration. This being a product of regular secre- tion, and essential to the welfare of the animal econ- omy, is necessarily wholly recrementitious. It is not to be supposed, however, that the regular discharge of the insensible transpiration will, in all instances, be as effectual as free sweating. The contrary is the fact. In all fevers connected with inflammation, especially of the internal organs, copious perspiration is beneficial, both as a oerieral depletory measure, and as a power- ful means of deriving the circulation from the affected organs to the surface. But in idiopathic fevers, at- Vol. II.—2 B 206 ANTIMONIAL PREPARATIONS. tended with a dry and constricted skin, and with- out any particular indication for direct depletion, more advantage is, in general, derived from antimonials when given in such doses as are just sufficient to re- store the ordinary action of the perspiratory vessels, and to give softness to the skin, than by pushing them to the extent of producing free sweating. In the account given of antimonial preparations in a former part of this work,* I have already mentioned their use in' chronic cutaneous eruptions, in which, in- deed, they often display very important powers. When employed in diseases of this kind, they are always prescribed in such doses as produce a slow and insen- sible operation on the system. They probably prove beneficial, chiefly by keeping up a regular discharge of the insensible transpiration by the skin. As a diaphoretic, antimony is employed in various states of preparation. Formerly a great deal was thought of James's powder, a nostrum which, accord- ing to the analysis of Mr. Pearson, consists of phos- phate of lime and antimony. M. Pulli, a French chemist, has made a very rigorous analysis of this substance; according to him, thirty-six grains of James's powder, contain fourteen grains of per-oxide of antimony, eight of phosphate of lime, nine of sul- phate of potass, and seven of potass.t This prepara- tion is recommended as peculiarly beneficial in febrile affections. Within a few years past, Dr. Cheyne of Dublin, has published some observations concerning its employment in hydrocephalic and apoplectic cases, from which it would appear that it possesses an obvi- ous tendency to diminish the flow of blood to the head, and to remove the disposition to apoplexy.^ In per- * Vol. i. p. 64. f Alibert, Elem. de Therap. torn. ii. p. 363. £ Dublin Hospital Reports, vol. i. 1818. ANTIMONIAL PREPARATIONS. 207 sons predisposed to apoplexy, or frequently alarmed by the usual precursory symptoms of this disease; such as a sense of fulness in the head, vertigo, indis- tint vision, tinnitus aurium, &c, the long continued use of this remedy is said to prove highly useful. Dr. Cheyne recommends the following method of exhibiting James's powder, in cases of moderate determination of blood to the head. The patient is to begin with about two grains at bed-time, and to increase the dose by half a grain every night, until 'some sensible effect is produced upon the stomach, bowels, or skin. If it excite nausea, the dose must be reduced. When the skin becomes soft, or the bowels affected, the dose must not be further increased. Its use must be per- sisted in for a length of time. Dr. Cheyne says, that the addition of a little rhubarb to this powder renders it less apt to excite nausea. Drs. Crampton and Stoker, of Dublin, also mention its good effects in cases of this kind. The pulvis antimonialis, which is an imitation of James's powder, is an excellent diaphoretic in febrile diseases. It is given in doses of from four to eight grains, repeated every third or fourth hour. When exhibited in larger doses it is apt, like all the antimo- nial preparations, to excite vomiting and purging. The kermes mineral, which is a hydro-sulphuret of ajBtimony, is held in high esteem by the German and French physicians; and it is certainly entitled to much more attention than it appears to receive from the profession in England and in this country. It is better adapted than any other preparations of this metal, to cases that require a long continued use of antimonials, or where there is much weakness of the digestive organs. Its operation on the stomach is mild, and it may be given a long time without weakening this 208 ANTIMONIAL PREPARATIONS. organ, or bringing on an increased disposition to nausea or vomiting. It is said to be particularly beneficial in obstinate scrofulous eruptions of the skin. It is chiefly in chronic disorders of the eruptive kind, that its good effects have been particularly noticed. As an emetic, or diaphoretic in febrile disorders, it is at present seldom employed in any country. As an alterative, it is given in doses of from a half to one and a half grains, either alone, or in combination with guaiac, calomel, extract of cicuta, solanum dulcamara, &c. The precipitated sulphuret of antimony resembles kermes mineral, both in composition and medicinal properties. Its dose is from four to ten grains. But of all the antimonial preparations, the tartar emetic is unquestionably the most valuable, in every point of view. It will seldom fail to produce diapho- resis when properly managed, and it is now almost the only preparation of this metal employed for this purpose. As a diaphoretic in febrile diseases, it is usually combined with some of the saline articles of this class. In union with nitre, it forms one of our most efficient refrigerent diaphoretics, and it is in this way that it is commonly prescribed for this purpose. When we take into consideration what has already been said concerning the sedative effects of this pre- paration, it must appear obvious that it is peculiarly calculated to do good in asthenic diseases. Given in doses of from one-twelfth to one-eighth of a grain, it has been known, in common with the other prepara- tions of this metal, to produce excellent effects in chronic cutaneous affections. When employed for this purpose it may be advantageously combined with gum guaiacum, extract of cicuta, &c, or given dis- solved in the infusions of sarsaparilla, solanum dulca- mara, burdock, or sassafras-root. It is a singular fact Dover's powder. 209 that tartarized antimony has its emetic powers greatly diminished by giving it in union with Peruvian bark. A know ledge of this circumstance may sometimes be turned to much advantage in prescribing this latter substance in intermittents. Cases of this disease are occasionally met with, in which the bark appears rather to do harm than good, in consequence of a general inflammatory condition of the system. In such instances we may unite the tartarized antimony with the bark, and administer it to the extent of from one to two grains every three or four hours without producing vomiting, but with a manifest antiphlogistic operation. When exhibited with the bark in cases of this kind, it keeps up an agreeable moisture of the skin, reduces inflammatory action, and thereby favours the febrifuge operation of the cinchona.* I have already noticed the employment of very minute doses of this preparation in phthisis pulmo- nalis.t One grain of it dissolved in six or eight pints of water, and used exclusively as a common drink, is stated by M. Lenthois to have proved successful in a number of cases in his practice. I have used it in this way, in cases of incipient phthisis with very obvi- ous advantage. Perhaps the very large quantity of water which is taken in this way may contribute some- thing to its good effects. A very free use of bland drinks, with abstemiousness, will often do more to- wards restoring health in chronic inflammatory affec- tions than any other remedies we possess. RADIX IPECACUANHA.--DOVER'S POWDER. This article is but seldom employed by itself as a diaphoretic, nor does it appear to display any particu- * PfafFs System der Materia Medica, B. ii. p. 402. t Vol. i. p. 75. 210 Dover's powder. lar powers in this way. Its operation in augmenting the discharge by the skin depends, probably entirely on its relaxing influence by the nausea it creates. It does not, certainly, evince any manifest diaphoretic powers, unless it be given in nauseating doses. Com- bined, however, with opium and vitriolated tartar, it helps to form one of our most valuable diaphoretics— the pulvis ipecacuanha compositus,* or Dover's pow- der, as it is usually called. " In this composition," says Dr. Paris, " the opium is so modified that it may be given with perfect safety and advantage in inflam- matory affections accompanied with increased vascular action. It would seem that whilst the opium increases the force of the circulation, the ipecacuanha relaxes the exhalent vessels, and causes a copious diaphoresis. The sulphate of potass is also an important ingre- dient, for experience has fully proved that ipecac, and opium in the same proportions, have not so powerful an effect without it." It seldom fails, by proper man- agement, to excite free diaphoresis, and in a variety of diseases, its effects are peculiarly serviceable. In the treatment of dysentery, after the bowels have been sufficiently evacuated by mild purgatives, it generally proves highly beneficial. It not only determines the circulation to the surface, but also allays the pain and irritation of the bowels by its anodyne properties. In obstinate cases it may be very advantageously com- bined with small doses of calomel, and given at regu- lar intervals until the gums become tender. In cholera infantum I have frequently employed small doses of calomel and Dover's powder, with the most favourable results. A quarter of a grain of the former with half a grain of the latter article may be given every half hour, to an infant under two years of * This composition consists of ipecacuanha one part, opium one part, and sulphate of potass eight parts. Dover's powder. 211 age. I can confidently assert that I have much more frequently succeeded in arresting the vomiting and purging with these minute doses, than with the free doses of calomel usually prescribed in this disease. In diarrhoea, too, a mixture of calomel and Dover's powder, after the operation of a gentle purgative, forms one of our most efficient remedies. In chronic inflammation of the mucous membrane of the bowels, small doses of Dover's powder often pro- duces very excellent effects. It may also be very beneficially administered in dyspepsia, attended with much gastro-intestinal irritation. In chronic catarrh, and bronchial consumption, this powder, when admin- istered in small and repeated doses, often affords very considerable relief. In arthritic affections, this composition is particu- larly useful. Given in small doses, two or three times in twenty-four hours, it proves a valuable remedy in the declining stage of acute rheumatism. It may, in- deed, be employed with advantage in every variety of symptomatic fever, attended with much pain and a dry skin. I know of no remedy more useful in peripneu- monic inflammations than this one, after proper vene- section has been made. It at once assuages the pain and promotes diaphoresis and expectoration. Drs. Brook, Percival, Cheyne, and Crampton, speak highly of its efficacy in hydrocephalus. Of its powers in this disease I can say nothing from my own experience; I must confess that I should not be inclined to employ it, since opium, in whatever shape it be given, has a mani- fest tendency to increase the flow of blood to the head. Where the cephalic affection is purely sympathetic, depending on gastric irritation, opium given in this way may, perhaps, be serviceable. But in idiopathic hydrocephalus there would be reason to apprehend danger from its employment. 212 NITRAS POTASS.E. This powder has also been successfully used in the cure of diabetes.* It does not appear, however, that its virtues in this respect are superior, or, indeed, even equal to simple opium. Favourable accounts have likewise been given of its effects in dropsy.t It is given in doses of from five .to fifteen grains. When taken with the view of exciting sweat, the pa- tient should be cautioned not to drink any thing for at least one hour after the powder is taken, as it is very apt to produce vomiting when this precaution is not attended to. NITRAS POTASSjE. The nitrate of potass, or saltpetre, crystallizes in white, semi-transparent, six-sided, and flattened prisms, terminated, for the most part, by dihedral summits. It has a sharp, slightly bitter, and cool taste. It is soluble in seven parts of cold water, and in its own weight at 212°. Alcohol has no action whatever on it. It is not changed by exposure to the air. It is decom- posed by alum, sulphate of magnesia, sulphuric acid, the sulphates of zinc, copper, and iron, and partially by the sulphate of soda at the temperature of 32°. When nitre is taken in doses of from ten grains to fifteen, its effects are gently diaphoretic, diuretic, refri- gerent, and sedative. In doses of from thirty to sixty grains it generally proves aperient; and when swallowed in much larger qnantities, its effects are those of an acrid poison, producing violent and obstinate vomiting, bloody stools, with all the symptoms of gastric inflam- mation, convulsions, and death. Taken in very large doses, it often acts particularly and violently on the * Cornick, Med. Comment, vol. x. Werner, Lond. Med. Jour. 1790, vol. xi.p.p. Ill, 221. f Dr. Chapman's Therapeutics, vol. i. NITRAS POTASSiE. 213 nervous system, giving rise to " a sort of intoxication, palsy, convulsions, and other nervous symptoms."* Dr. John Butler relates the case of a woman who became affected with a convulsive disease resembling chorea, after having swallowed by mistake two ounces of nitre.t The diaphoretic effects of nitre are not very manifest, its operation in this way being commonly confined to an increase merely of the insensible perspiration. It pos- sesses, however, an obvious tendency to moderate the action of the heart and arteries, and to diminish febrile heat; and it is consequently one of our most common and useful remedies in diseases attended with high vascular excitement. When employed for this purpose it is usually combined with emetic tartar, to which, occasionally, a small portion of calomel is added. The emetic tartar is a very important addition. It increases its diaphoretic operation, and adds very considerably to its general antiphlogistic powers. In fevers attended with derangement of the biliary organs, the nitre and emetic tartar are very advantageously combined with small doses of calomel.J By such a composition we excite at once the secretory functions of the skin and the liver, and moderate the action of the heart and arteries. In bilious remittents I commonly employ this medicine until the gums become slightly affected, interposing occasionally a saline purgative. As soon as this effect is induced, the disease often assumes a perfect intermission, or at least becomes much more mild and manageable in its progress. In simple * Orfila, Directions for the Treatment of Persons who have taken Poi- son, p. 65. f Edinburgh Med. and Phys. Jour. No. 53. X B-—Sal. nitri. jss. tart, antim. gr. i. calom. ppt. iv. Divide in pulv. x. one to be given every two or three hours. Vol. II.—2 C 214 NITRAS POTASSiE. inflammatory fevers, the calomel should be omitted. Dr. Wilson Philip speaks very highly of the effects of nitre in counteracting a tendency to inflammation in the advanced stages of indigestion. " Of all the medi- cines," he observes, " which I have employed to coun- teract the inflammatory tendency in the second stage of dyspepsia, 1 have found none equal to the nitrate of potass taken in a considerable quantity of water, in which a little gum had been dissolved."* Selle,t Richter,J and others recommend a saturated solution of nitre in brandy as one of the most effectual remedies in haemoptysis. A table-spoonful of it is to be given every half hour. Of late years, indeed, this article has been particularly extolled by some eminent Italian and French physicians, as a remedy for spontaneous haemor- rhage. In uterine haemorrhage, especially, it often affords prompt and very decided relief. I have em- ployed it in a few instances of haemoptysis, attended with a warm and dry skin, and a strong and full pulse, with unequivocal advantage. From fifteen to twenty grains should be given, and repeated at intervals of from thirty minutes to two hours, according to the exigencies of the case. In hydropic affections, attended with a full and vigorous pulse, and a warm and dry state of the skin, the nitrate of potass has been employed with decided advantage. It is most apt to prove beneficial in those cases which result from suppressed perspiration after an attack of scarlet fever or measles. A solution of nitre in vinegar, is strongly recom- mended by Mr. Patterson as a remedy for scurvy. Mr. Cameron also employed this solution in a number of * Treatise on Indigestion, p. 222. f Med. Clin. X Specielle Therapie, B. iii. s. 302. PREPARATIONS OP AMMONIA. 215 scorbutic cases which occurred among the convicts on board the Ferguson transport, with the most satisfac- tory results. Eight ounces of nitre were dissolved in about sixty ounces of vinegar, and of this solution, an ounce was given from three to eight times daily. When nitre has been taken in such quantities as to threaten dangerous consequences, the best treatment, according to Orfila, " consists in causing the patient to swallow a large quantity of sugar and water, of warm or cold water, or of a decoction of linseed or mallows; by this means the stomach is filled, vomiting caused, and the poison ejected." If symptoms of inflammation ensue, bleeding, together with leeching and blistering of the abdomen, and copious draughts of mucilaginous drinks, must be resorted to. PREPARATIONS OF AMMONIA. The carbonate of ammonia has a very considerable tendency to increase the activity of the cutaneous ex- halents. By itself, however, it is rarely employed as a diaphoretic; but saturated with the acetic or citric acids, it forms a pleasant and very useful medicine for this purpose. These preparations are usually given in doses of a table-spoonful every hour or two, and they seldom fail to excite a flow of perspiration, when assisted by warm and gently stimulating diluents. They seem to hold a middle rank between the relaxing or refrigerent and the stimulating diaphoretics. They do not stimulate or heat the system, nor yet depress or relax it in their primary operation. They tend cer- tainly, in a manifest manner, to moderate febrile excite- ment, but this appears to be the result simply of the increased discharge by the skin. In fevers attended 216 EUPATORIUM PERFOLIATUM. with a dry and hot skin and a very irritable state of the stomach, the acetate of ammonia, or spiritus min- dereri, is peculiarly beneficial. It allays the irritability of this organ, and by promoting perspiration, moder- ates at once the action of the heart and arteries, and the febrile heat. When the arterial excitement is not of a very high grade, and the skin is torpid, a small portion of laudanum may be advantageously united with this "preparation. In cases of this kind I have known the aqua ammonia, given in warm wine whey, in the proportion of about forty drops of the former to one pint of the latter, to produce excellent effects. The acetate of ammonia is an excellent palliative in dysmenorrhcea, and uterine pains from other causes. I have frequently prescribed it in the former complaint, and in general with speedy and very decided relief. Formulas. R.—Spirit, mindereri §v. Spirit, nitri. dulc. §ss. Vin. antimon. gi. Syrup. § ii.—M. Dose, a table-spoonful every hour or two. This is an excellent antiphlogistic diaphoretic in febrile affections. EUPATORIUM PERFOLIATUM. This plant is indigenous to the United States, and well known by the various familiar names of boneset, crowswort, vegetable antimony, thoroughwort, &c. Its stem is erect, round, hairy, branching at the top, and rises to the height of from two to five feet. The leaves are horizontal, serrated, rugose, and gradually tapering off from the middle, where they are perforated by the stem to the extremities. The flowers are white, col- lected into large corymbs at the termination of the branches, and appear in July and August. It grows in low meadows and marshy places. EUPATORIUM PERFOLIATUM. 217 The whole plant is intensely bitter, " without astrin- gency or acrimony." Its bitter extractive, in which the medicinal qualities of the plant appear to reside, is equally soluble in water and alcohol. The decoction forms copious precipitates with muriate of tin, nitrate of mercury, nitrate of silver, and acetate of lead. It contains a very small portion of tannin, as is evinced by the solution of isinglass forming a slight precipitate with its tincture.* From Dr. Anderson's experiments it would appear that the leaves are the most active parts of the plant.t The eupatorium perfoliatum possesses important medicinal properties. When taken in large doses it excites vomiting and purging; in smaller doses it pro- duces copious perspiration, and acts as a gentle tonic. It has been much recommended by some practitioners of the United States as a remedy in intermittents. Dr. Anderson states, that this remedy was used in nearly every case of intermittent that occurred in the New York Alms-house in 1812, instead of the Peruvian bark, and that it uniformly proved success- ful. I do not doubt that it has sometimes proved successful in this disease: but the result of my own experience with it, does not lead me to form a very high opinion of it in this respect. I have known it to remove the disease in a few instances, by producing vomiting and copious perspiration. But in the great majority of cases in which I have tried it, no manifest advantage was obtained. It has also been adminis- tered with very good effects in remitting fevers; and we have the testimony of Dr. Bard and Dr. Hosack in favour of its usefulness as a diaphoretic, in yel- low fever. As a diaphoretic it may generally be * Bigelow's American Medical Botany, vol. i. p. 34. \ Inaugural Dissertation. New York, 1813. 218 EUPATORIUM PERFOLIATUM. employed with much benefit in catarrhal fevers. In slight cases of this kind, a weak infusion of it, drank warm on going to bed, will often remove the disease very speedily. It but very slightly increases the action of the heart and arteries, and may therefore be employed with advantage in every variety of inflammatory affec- tion. In acute rheumatism the infusion of it, used as a common drink, produces very excellent effects. It sel- dom fails to excite a moderate diaphoresis, and by this effect to procure considerable relief to the patient. It can, however, be considered only as an auxiliary to more efficient remedies, and as such it is unquestionably an article of considerable consequence. In the epidemic typhoid pneumonia of the winters of 1812, 13, and 14, the eupatorium was a good deal employed by some practitioners, and its effects are stated to have been very salutary. It has also been recommended as a good medicine in obstinate cutaneous diseases. Dr. Barton speaks well of its powers in affections of this kind. Dr. Thacher says, that in anasarcous swellings of the extremeties, depending on general debility, the alcoholic tincture of this plant " may be safely recom- mended as an excellent tonic."* Dr. Burgon, of Bucks county, in this state, has found it very useful in cases of anorexia consequent to drunkenness. "In such cases," he says, " I have used a cold infusion with evident benefit, and I prefer it to any article I have hitherto employed; it very speedily restores the tone of the stomach, and no unpleasant effects follow its administration."f Dr. Bigelow, also, adds his testi- mony in favour of its good effects as a tonic in loss of appetite and other dyspeptic symptoms, " as well as in general debility of the system." I have found * The American Dispensatory. X American Medical Recorder, vol. iii. p. 331. ASCLEPIAS TUBEROSA. 219 it particularly useful in very old people labouring under indigestion; it gives tone to the stomach, and renders the skin soft and comfortable. The warm infusion, as is observed by Dr. Bigelow, is an excellent substitute for chamomile tea, to promote the operation of an emetic. The powdered leaves are given in doses of from ten to twenty grains, as a tonic or diaphoretic; or an infusion made by pouring a quart of boiling water on two drachms of the leaves, may be used in draughts of about a gill every three or four hours. For excellent figures and descriptions of this plant, see Dr. Bigelow's American Medical Botany, and Dr. Barton's Vegetable Materia Medica of the United States. ASCLEPIAS TUBEROSA. This plant is a native of the United States, growing in dry and sandy soils, and well known as a domestic remedy by the familiar names of butterfly weed and pleurisy root. The root, which is the part employed for medicinal purposes, is large, fleshy, spindle-shaped, or branched, of a brownish colour externally, and white and striated internally. It sends up numerous round, and generally decumbent stems, very hairy, and of a reddish colour. The leaves are scattered, narrow, oblong, hairy, waved at the edge, having footstalks at the bottom, but none at the top. The flowers, col- lected into umbels at the top, are of a bright orange colour, and appear in July and August. The root of this plant has a slightly bitter taste without any traces of astringency, and yields its active principles entirely to boiling water. Its effects upon the system are those of a diaphoretic and expectorant, 220 ASCLEPIAS TUBEROSA. without in the least heating the system, or materially exciting the action of the heart or arteries. It pro- duces a gentle tonic operation, and when given in large doses proves mildly laxative. It is, indeed, one of our most useful indigenous medicinal vegetables, being applicable in every case where diaphoresis and expectoration are to be promoted. In pleurisy, catarrh, and other pulmonary complaints, this root often evinces highly beneficial powers. The late Dr. Barton spoke in favourable terms of its employment in affections of this kind; and Dr. Benjamin Parker, of Bradford, Massachusetts, as is stated by Dr. Thacher, has been led, from a very extensive experience with this root, to regard it " as possessing the peculiar and almost specific quality of acting on the organs of respiration, powerfully promoting suppressed expecto- ration, and thereby relieving the breathing of pleuritic patients in the most advanced stage of the disease.* He gave it in the form of a strong infusion, in doses of a tea-cupful every two or three hours. We have also the evidence of Dr. Bigelow in favour of the remediate powers of this article. " I am satisfied," says he, " of its utility as an expectorant medicine, and have seen no inconsiderable benefit arise from its use as a pallia- tive in phthisis pulmonalis.t While practising in Lancaster, I frequently employed this remedy in catarrhal affection?, and generally with manifest advantage. I have also witnessed its good effects in pneumonia and phthisis pulmonalis; and in one case of acute rheumatism I prescribed it, with much apparent benefit. The asclepias has also been recommended as a useful medicine in the fever, diar- rhoea, and other distressing symptoms which frequently * Thacher's Dispensatory. f American Medical Botany, vol. ii. p. 65. GUAIACUM OFFICINALE. 221 accompany dentition. Dr. Burgon, of Bucks county, speaks very highly of its powers in this respect. " It is peculiarly adapted to the diseases of children," he says, " as they freely take it, from its not possessing any disagreeable taste or smell." He recommends the following mode of administering it. Boil two drachms of this root, in a pint of fresh milk, down to three gills. An ounce of this is to be given two or three times in twenty-four hours. It very seldom fails to excite a copious perspiration, and at the same time proves gently laxative.* Dr. Burgon recommends it also in cholera infantum, and marasmus. This root may be given either in substance or in decoction. The latter is, however, considered the best mode of administering it. About a gill of the strong decoction may be taken two or three times a day. The powder is given in doses of from twenty to forty grains. GUAIACUM OFFICINALE. The guaiacum officinale is a considerable tree, in- digenous to the West Indies and the Brazils. Both the wood and the resinous substance which exudes from incisions made into its trunk, possess important medicinal virtues. The wood is compact, heavy, of a yellowish colour, and has but little smell, and a bit- terish and slightly acrid taste when chewed. The gummy resinous substance, or gum guaiacum, comes to us in large irregular masses of a greenish-brown colour; it is brittle, and exhibits a shining uneven frac- ture. When reduced to powder it is of a grayish-white colour, becoming greenish on being left exposed to the air. It melts in a moderate degree of heat, and be- * American Medical Recorder, vol. iii. p. 334. Vol. II.—2 D 222 GUAIACUM OFFICINALE. comes soft and tough when chewed. It has a sweetish bitter taste, and produces a peculiar sensation of acri- mony in the fauces when swallowed. It has a very faint and peculiar balsamic odour, and when thrown upon hot coals evaporates in fumes, which are exceed- ingly irritating to the lungs. About nine parts out of a hundred of its substance are dissolved by water; aether dissolves about forty parts in the hundred, and alcohol ninety-five. It is readily soluble in the solu- tions of the alkalies and in their carbonates. The mineral acids dissolve, and at the same time decom- pose it, being therefore incompatible with it.* Nitric acid changes the tincture of guaiacum to a beautiful blue colour; which, by adding water, lets fall a copious precipitate of a light blue, but which soon turns to a green, and finally to a greenish-white colour. With concentrated sulphuric acid it forms a dark carmine red solution, which throws down a lilac coloured sedi- ment on adding water. According to Mr. Hatchett, gum guaiacum is a peculiar substance, possessing neither the characteristics of a resin nor of a gum. Gum guaiacum acts as a pretty strong and general stimulant upon the system. It excites the action of the heart and arteries; increases the heat of the body; and promotes the serous excretions, especially those from the skin and lungs. When taken in very large doses it produces nausea, anxiety, purging, with violent pains in the abdomen, and deep sleep. Its continued use has been known to excite a gentle salivation.t Guaiacum was first introduced into medical practice as a remedy in syphilitic affections. Many of the most celebrated medical writers of the preceding century recommend it as one of our most useful articles in * Paris's Pharmacologia. -j- Burdach's Arzneimittel. B. iii. p. 163. GUAIACUM OFFICINALE. 223 cases of this kind. At present, however, it holds but a very subordinate rank among our anti-syphilitic re- medies. Mr. Pearson, who had ample opportunities of estimating the value of medicines of this kind, says, that "guaiacum will often suspend the progress of certain secondary symptoms of lues venerea, for a short time; such as ulcers of the tonsils, venereal erup- tions, and even nodes; but that he never saw one single instance in which the powers of this medicine eradicated the venereal virus."* In the treatment of rheumatism also, this article has been long considered as peculiarly serviceable; and it is unqustionably a remedy of very considerable value in this disease. In the acute form of this painful affection, after the in- flammatory symptoms have been considerably subdued, and wandering pains and swellings of the joints con- tinue to harass the patient, the volatile tincture of guaiacum will often afford great relief. It is occa- sionally also prescribed in gout; but its employment in this disease can only be resorted to with propriety during the intervals of the fits, as it is much too heat- ing to be given in the paroxysm.t In gouty affections of the stomach, so frequently experienced in the irregu- lar form of the disease, the volatile tincture of guaiacum is said to prove very serviceable. Many authors speak very favourably of the use of this remedy in old scrofu- lous affections and in various diseases of the skin. Mr. Pearson says," I have given the decoction of guaiacum with the best effects, to a great number of patients, in cutaneous diseases, in ozoena, and scrofulous affections of the membranes and ligaments." In combination with sulphur, antimony, mercury, dulcamara, &c. it has been recommended as an excellent remedy in tinea * On the Effects of various Articles in the Cure of Lues Venerea, &c. f Scudamore on Gout, p. 189. 224 GUAIACUM OFFICINALE. capitis, herpes, and psora. It is also much prescribed in affections arising from the influence of mercury; and in such cases I have had several striking examples of its usefulness. In chronic catarrh, attended witlv a very copious mucous expectoration, important benefit may sometimes be derived from small doses of g. guaiacum in combination with minute portions of tart, antimony. (Double. Jour. Gener. de Med. torn. xix. p. 278.) It has also been employed with entire success in anasarca depending on rheumatism. In haemorrhoidal affections, attended with a sluggish state of the system, and torpor of the bowels, guaiacum in conjunction with sulphur, is said to be a remedy of very considerable value. The tincture of guaiacum has also been recom- mended in gutta serena, and in painful menstruation. Dr. Dewees, of this city, has been long in the habit of employing it in this latter affection; and he speaks with much confidence of its efficacy in this respect. Sapo guacicinus.—According to the Prussian Phar- macopoeia, this preparation is made by dissolving one part of caustic potass in two parts of water. This solution is to be heated, and as much powdered gum guaiacum added as it will dissolve. It is then strained and slowly evaporated until it acquires a consistence proper for forming it into pills. The German physi- cians speak very favourably of this preparation as a remedy in rheumatism, lithiasis, and torpor of the por- tal circulation. The dose of gum guaiacum in substance is from gr. x. to sss. The tincture is taken in doses of from one to two tea-spoonfuls. It may also be very conveniently given in the form of an emulsion, made by rubbing the powdered gum with the yelks of eggs, and gradually adding water to it.* * " Jesuit drops. This is nothing more than the elix. anti. venereum of DAPHNE MEZEREUM. 225 Formulae. R.—Rasurae ligni guaiaci. R. sarsaparillae aa §i. — liquiritiae ;§ss. P. sem. fcenicul. gi. Aq. bullientis ifeii—Boil for half an hour, then strain. Dose, a wine-glass full four or five times daily. R—Liq. guaiaci. giii. Stip. dulcamar. Rad. graminis aa ^ss. Sem. fcenicul. gi. Aq. bullientis rbii—Boil down to one pint, and strain. Dose, a wine-glass full three or four times daily. R.—Pulv. gum. guaiaci. Flor. sulph. aa ^ss. Carbonat. potassae £i.—M. Take a tea-spoonful three times daily. R.—Gum. guaiaci. giii. Mucilag. g. arab. giv. Terent. affund. Sensim. aq. menth. pip. §ivss. Syrup, zingiberis gss—M. Take a table-spoonful three or four times daily. DAPHNE MEZEREUM. This is a low shrub, growing spontaneously in the high and woody parts of Spain, France, and the south- ern districts of Germany. The bark is the only part of this shrub employed for medicinal purposes. It is thin, light, externally of a reddish grey, and internally of a yellowish white colour; the parenchyma or inter- nal substance of the bark is of a dark green colour. It has an acrid and burning taste, but no smell. It con- tains, besides extractive matter, an acrid resinous sub- stance, which, according to Pfaff, bears a strong resem- blance to the active principle of cantharides, to which the name of daphnin has since been given.* The bark of the root is much more active than that which is ob- tained from the stem or branches. Quincey, consisting of guaiacum, balsam of copaiva, and oil of sassafras, made into a tincture by spirit." * System der Materia Medica, B. iii. p. 195. 226 DAPHNE MEZEREUM. Applied to the skin in a fresh state or in powder, moistened with spirits or water, it produced inflamma- tion and vesication, attended with a good deal of burning and smarting in the part. Taken internally in large doses it occasions vomiting, violent pain in the stomach, inflammation, gangrene, and death. In smaller but full doses, it sometimes produces heat in the stomach, nausea, vomiting, griping pains, diarrhoea, vertigo, headach, weakness, anxiety, convulsions, &c. It affects the respiratory organs, giving rise to pain in the breast, difficulty of breathing, cough, and hoarse- ness. It promotes the secretory action of the kidneys; and has been known to bring on bloody urine. It also increases the activity of the cutaneous exhalents.* The mezereon bark has been much recommended in a variety of affections. In obstinate diseases of the skin it was formerly a good deal prescribed; and it has been particularly commended for its powers in affections depending on a syphilitic taint, or in such as arise from the injurious influence of mercurial remedies. Its reputation in this respect does not, however, appear to be very great at present. Mr. Pearson states, that " from all that he has been able to collect in the course of many years' ■ observation, he feels himself authorized to assert unequivocally, that the mezereon has not the power of curing the venereal disease in any one stage or under any one form." Some later writers have spoken more favour- ably of its powers in affections of this kind, and especially in the mercurial diseases. It has also been recommended in chronic cutaneous eruptions. Dr. Cullen states, that he found it successful in diseases of this kind; and Dr. Pearson knew it to confer tempo- rary benefit in an instance or two of lepra. I have not had a great deal of experience with this remedy * Burdach, Arzneimittellehre, B. iii. p. 169. SMILAX SARSAPARILLA. 227 myself, but from its effects in some old syphilitic com- plaints, in which I prescribed it, I am inclined to attribute to it considerable remediate virtues. Dr. Withering states, that he has known this bark to produce very good effects in difficulty of swallowing. He mentions one case of this kind, of very long stand- ing, which was entirely cured in two months by chew- ing the mezereon root. Parry states, that he has derived decided advantage from the external application of a decoction of this root in nodes, rheumatic indurations, and cancerous ulcers. Hill, also, speaks very favourably of this ap- plication in affections of this kind. I have employed cataplasms made with the decoction in chronic swel- lings of the knee-joint with evident benefit. The best mode of exhibiting this remedy is in de- coction. Half an ounce of the bark, with the same quantity of liquorice root, may be boiled in three pints of water down to a quart, and given in doses of half a gill four times a day. Formulas. R.—Cort. mezerei Stip. dulcamar aa jiss. Rad. arcti lappo ----sarsparil aa ^iss. Aq. ferv. ibii.—Boil down to one pint. Dose, a wine- glass full three times daily. SMILAX SARSAPARILLA. This is a climbing plant growing in low and humid situations in various parts of South America, and in the western parts of the United States. The root, which is the only part, employed in medicine, is composed of a great number of long and slender creeping radicles, of a yellowish-brown colour externally, and white within. It 228 SMILAX SARSAPARILLA. has a slightly bitter and mucilaginous taste, but no odour. It contains fecula, in which its active properties ap- pear to reside, and vegetable albumen. Boiling water readily and completely extracts its active principles. The medicinal character of this root has been very variously represented. According to some writers, it possesses no powers whatever; whilst others represent it as being endued with highly valuable properties. When first introduced into practice it was strongly recommended as a remedy in venereal affections. It did not, however, long sustain its character in this respect. Cullen thought it unworthy of a place among the materia medica; and Pearson declares, that "he feels himself authorized to assert, that the sarsaparilla has no power of curing any one form of the lues venerea. Lately, however, it has again come into notice, and many of the most respectable practitioners of the present day employ it, and speak of it as a medicine of very useful powers in complaints of this kind. It is thought to be particularly useful in those chronic venereal disorders which resist the influence of mercurial remedies, as well as in those affections which occasionally arise from the action of mercury. My own experience with this root has not been exten- sive; but from what I have seen, I am inclined to regard it as capable of affording considerable advan- tages, when employed as an auxiliary to other more efficient remedies. It has also been recommended in scrofulous and rheumatic affections, and in some of the chronie dis- eases of the skin. Quarin regarded the decoction of sarsaparilla as the most useful remedy we possess in gout, when administered conjointly with antimonial remedies. Sydenham also considered it useful in the declining stage of this affection; and Scudamore says, SMILAX SARSAPARILLA. 229 it will sometimes prove beneficial during the state of convalescence. It is usually given in union with other articles of the same kind, particularly with guaiacum, mezereon, sassafras root, &c* According to the experiments of Mr. Battley, of London, it appears that the active properties of sarsa- parilla reside exclusively in the cortical part of the root, and that its virtues may be effectually extracted by infusion in cold water. The woody or central part possesses no medicinal powers whatever; and it fol- lows, as Mr. Battley observes, " that when the cortical part has been materially injured, or when in the pre- paration of the medicine the ligneous part of the root has been chiefly regarded, the remedy so prepared must be, in a great measure, if not wholly, ineffica- cious."! The decoctum sarsaparillae compositum of the Lon- don and Dublin Pharmacopoeias, is taken in doses of from four to six ounces three or four times a day. The compound fluid extract of sarsaparilla is a neat and very excellent preparation. It possesses all the active properties of the root, in a highly concentrated state; a table-spoonful being equivalent to half a pint of the ordinary decoction. I have used it in several instances, with decided benefit. From the smallness of the dose it is peculiarly adapted for administering this remedy to children. This preparation was, I believe, introduced by Mr. G. W. Carpenter, druggist, of this city, to whom we are indebted for several new and valuable medicinal preparations; and whose enter- * The once celebrated Lisbon diet drink is made according to the following formula: R R. sarsaparillae, R. chinae, aa %i. nucum juglandis cortice siccatarum, No. xx. anlimonii sulphureti "gW. lapidis pumicis pulverizati gi. aquse dis- tillate tbx. To be made into a decoction. f London Medical Repository, for Feb. 1819. Vol. II.—2 E 230 LAURUS SASSAFRAS. prise and intelligent zeal in the prosecution of phar- maceutic inquiries, entitles him to the confidence and patronage of the profession. LAURUS SASSAFRAS. The laurus sassafras is a very common tree through- out every part of the United States. Its bark has a fragrant smell, and an agreeable aromatic taste. It contains a large proportion of an essential oil, upon which its taste and odour as well as its medicinal pro- perties appear to depend. It is said also to contain a small proportion of camphor and some resinous matter* Its active principles are extracted both by alcohol and water. The watery infusion is red, possessing the pe- culiar odour and taste of the sassafras, and changes to an olive green colour by the addition of sulphate of iron. The bark and pith of the young branches con- tain a great deal of mucilage. "A very small quantity of pith, infused in a glass of water, gives to the whole a ropy consistence, like the white of eggs. This mu- cilage has the uncommon quality that it is not precipitat- ed, coagulated, or rendered turbid by alcohol."! This mucilage is an exceedingly good application in acute ophthalmia, and it is no less useful as a demulcent in catarrhal and dysenteric affections. The sassafras was at one time held in very high esteem as a remedy in syphilis, cutaneous eruptions, scrofula, and rheumatism. At present it is not much employed in practce, but I am convinced from my own experience with it, that it is entitled to much more attention than it now receives. Alibert speaks very favourably of its virtues in rheumatic affections. He * Pfaff's Mat. Med. vol. iv. p. 242. X Bigelow's American Medical Botany, vol. ii. p. 145. PRICKLY ASH. 231 administered it frequently at the Hospital St. Louis, and it always appeared to him, he observes, to exert a ma- nifest action on the cutaneous emunctories. He men- tions a case of chronic rheumatism which yielded to the infusion of sassafras, after a great variety of other remedies had been tried ineffectually. He speaks also of two cases of gout in which the sassafras was em- ployed with complete success* I have known the long continued use of an infusion of this article effectually to cure a case of inveterate rheumatism. Sassafras enters as an ingredient into the decoctum sarsaparilla comp. It is generally employed in the form of an infusion; but the oil is the most efficient, and therefore the best preparation. When this is used it should be rubbed up with mucilage, sugar, and water. The infusion of the flowers is also frequently employed. XANTHOXLYUM FRAXINEUM.--PRICKLY ASH. The prickly ash is a tall shrub, indigenous to the United States, in many parts of which it grows in con- siderable abundance. The bark is aromatic and very pungent to the taste, the pungency being perceived only after it has been held in the mouth for some time. The leaves also are considerably aromatic, but have not the pungency of the bark, and resemble those of the lemon- tree in odour. " The rind of the capsule is highly fra- grant, imparting to the fingers, when rubbed between them, an odour much like the oil of lemons. The odorous portion is an essential oil residing in transpa- rent vesicular points on the surface of the capsules, and about the margins of the leaves. The acrimony which resides in the bark, has its foundation in a different * Alibert, Nouveaux Elemens de Therapeutique, torn. ii. p. 302. 232 PRICKLY ASH. principle, being separated by decoction, but not by dis- tillation."* The bark of this shrub is a warm stimulant and dia- phoretic, being analagous to mezereon and guaiacum both in its sensible and medicinal properties. In this country it has been a good deal employed as a remedy in chronic rheumatism, and I have no hesitation in say- ing, from my own experience, that it is a medicine of very considerable value in this complaint. Its con- tinued use has been known to produce salivation. " A lady in Buckingham," says Dr. Burgon, " who had taken a considerable quantity of the tincture for rheu- matism, was completely salivated by it, and challenged her physician with giving her mercury. I have heard much of its salivating, but have never witnessed this effect from its administration; chewing the capsules powerfully promotes the flow of saliva."f Dr. Bige- low states that he gave the bark of this shrub in doses of ten and twenty grains in rheumatism, with consider- able advantage. "In one case," he observes, "it ef- fectually removed the complaint in a few days;" but in some instances he found it entirely ineffectual.^ I once employed this remedy in a case of rheumatism attended with an obstinate eruption on the skin, and succeeded perfectly in relieving both these affections. I had reason to believe that the disease depended on a syphilitic taint. This article has also been recommended as an excel- lent remedy in malignant ulcers. For this purpose it is used both internally and externally. Several instances of its efficacy in this respect are related in the Medical and Physical Journal, and in the Transactions of the * Bigelow's Amer. Med. Bot. vol. iii. p. 158. X American Medical Recorder, vol. iii. p. 333. X Amer. Med. Botany, vol. iii. SAPONARIA OFFICINALIS. 233 Medical Society of London. It has also been found very useful as a topical stimulant. It is generally given in decoction. One ounce of the bark to a quart of water, boiled down one-third, may be taken in doses of a gill, repeated five or six times in twenty-four hours. The powdered bark may be given in doses of from twenty to thirty grains. For an excellent figure and description of this shrub, the reader is referred to Bigelow's Medical Botany, Vol. iii. SAPONARIA OFFICINALIS. This plant is common to France, Germany and Eng- land, and is now naturalized and abundant in the United States. It has a long, creeping, articulated and knotty root, of a reddish-brown colour externally, and white within. The stem is erect, branched, jointed, and from five to eighteen inches high. The calices are cylindric, and the flowers white. It grows among rubbish along road-sides, and near neglected out-houses. It flowers in July. The whole plant has a bitterish and slightly acrid taste. The infusion of the leaves assumes a pale black colour on adding to it some sulphate of iron; the decoction of the root, however, undergoes no change by the addition of this salt. A saponaceous substance may be obtained from the decoction of the recent leaves, which appears to contain all the active properties of the plant. Alcohol extracts an acrid and penetrating sub- stance.* The soapwort has been highly recommended for its medicinal powers. Alibert, whose opinion merits great deference, observes that it is surprising that this plant is not more frequently employed; its energetic proper- ties entitling it to a distinguished rank in the materia * Alibert, Elemens de Therap. vol. ii. p. 333. 234 SULPHUR. medica. In rheumatic affections depending on a syphi- litic taint, and in arthritic pains, it is stated to be an exceedingly useful remedy. " It often happens," says Alibert, " that venereal affections resist the powers of mercury; the symptoms increasing instead of diminish- ing under its influence. In such cases the saponaria produces excellent effects. I have very frequently administered this remedy in scaly tetters, (dartres.fur- furaceus,) and I have had occasion in a great variety of instances, to be satisfied that this valuable plant is too much neglected by practitioners."* I once saw a case of herpetic eruption entirely cured by the use of this article, after it had resisted almost every other treatment recommended in such cases. It is also said to be very serviceable in scrofulous and other ill-con- ditioned ulcers; particularly in venereal ulcerations of the throat and mouth.t The saponaria is usually given in decoction; and the root is said to be much better for this purpose than the plant. The decoction may be made by boiling two ounces of the root in two quarts of water, down to one quart; the whole of which is to be taken in twenty- four hours. SULPHUR. I have already given an account of the medicinal powers of this substance in the chapter on cathartics, and need, therefore, in this place do little more than to notice more particularly its tendency to act upon the cutaneous system. Sulphur has been long celebrated, l>oth as an internal and an external remedy in the cure of chronic cutaneous diseases. It has also been highly recommended in rheumatic and gouty affections, and * Alibert, Elemens de Therap. vol. ii. p. 332. X Burdach, Arznei. B. iii. p. 150. SULPHUR. 235 in diseases of the lymphatic system.* Not to repeat, however, what I have said upon this subject in the first volume,t it will here be necessary only to add some- thing concerning the effects of this remedy when ap- plied externally in the form of funles. Sulphurous fumigations have been highly extolled, within a few years past, in the treatment of a great variety of obstinate complaints. Dr. Gales, of Paris* was the first who introduced this method of applying sulphur. The apparatus which he used for this purpose con- sisted of a wooden case, having an aperture in the upper part. The fumes arising from ignited sulphur are applied to the naked body of the patient seated in this box, with his head out of the aperture at the top. Around the edge of this opening a leather bag is fixed, which being fastened round the neck, prevents the fumes of the sulphur from reaching the eyes, nose, or mouth. The immediate effects experienced from fumigation, is a sense of prickling heat in the skin, which is soon followed by profuse perspiration. The diseases in which sulphurous.fumigation has been found most beneficial, are chronic rheumatism, psora, lepra, and herpes. Dr. Gales relates many cases of this kind, in which the good effects of this treatment were surprisingly prompt. Dr. De Carro, of Vienna, who introduced the sulphurous fumigating baths into Germany, has also published the result of his experience with this remedy; and we are informed that, in the majority of the cases," the benefit derived was very striking, and the shortness of the period necessary for the cure really astonishing." Ali- bert observes, that the pustular and papular itch are not equally benefitted by sulphurous fumigation. The former variety is almost always exasperated by the * Alibert, Soemmering, De Morbis vasorum absorbentium, &c. f Page 182. 236 SULPHUR. contact of sulphurous vapours, whilst a liquid applica- tion, composed of a certain proportion of sulphur of potass and sulphuric acid, readily cures it. This is also the case in long standing and cachectic cases, attended with brown crusts of different sizes scattered over the arms and thighs. Frictions with sulphur ointment alternated with simple baths, are generally sufficient to remove this variety of the disease; whilst fumigations often are followed by no evident advan- tage. The papular itch, however, may be treated with peculiar advantage by fumigation.* It appears from the observations of MM. Alibert and Biett, that many persons are wholly incapable of supporting the influence of sulphurous fumigations. It sometimes produces alarming syncope, and a sense of suffocation. Alibert points out the following coun- ter-indications to the employment of the sulphurous vapour bath. 1. A predisposition to apoplexy. 2. Asthma and chronic catarrhal affections in old people, and a predisposition to phthisis. 3. Organic affections of the heart. 4. Pregnancy. That sulphur applied in the form of fumes will often act very beneficially in cutaneous affections, cannot be doubted. It would appear, however, from later expe- rience, that its powers were at first considerably exag- gerated, and that its good effects are pretty much confined to those cases in which sulphur applied in the form of ointment, or the application of diluted sul- phuric acid, has been found serviceable. It possesses, however, the advantage of acting much more promptly, and of exciting profuse perspiration, which latter cir- cumstances will sometimes enable it to afford relief in rheumatic and other affections connected with torpor of the perspiratory function. * Alibert, Elemens de Therap. vol. ii. p. 487. CHAPTER XIII. EPISPASTICS. The term epispastic was anciently applied to all such articles as produce redness, inflammation, or vesication when placed in contact with the cuticular surface. At present, however, it is used in a more limited sense; being restricted to those substances alone which excite the exhalents to an abundant effusion of serum under the cuticle, producing vesication, or in common language, blisters. The modus operandi of vesicatories in the cure of diseases has been a subject of much controversy. Much of their beneficial operation was formerly as- cribed to the evacuation they produce. That they do some good in this way, though not so much as has been supposed, I cannot doubt. I suspect, however, that more advantage is derived from the secondary or purulent discharge than from the serous, or that which is the immediate consequence of vesication. To be convinced of the effects of discharges of this kind, we need only advert to the manifest influence which the occurrence of abscesses, or the production of artificial eruptions occasionally produces on diseases. The sup- pression of a small discharge from behind the ears of children, is often followed by the most dangerous con- sequences, and its re-establishment is, as generally, manifestly beneficial. It is frequently observed, too, that the good effects of blisters do not occur until the seen tion of pus commences. It is, after all, highly Vol. 11.—2 F 238 EPISPASTICS. probable that the discharge from a vesicated surface is in the majority of cases salutary, more by its secondary effects in keeping up a new determination to the part, than by its direct influence as an evacuation. When we advert to the nature of those diseases in which blisters are most beneficial, it appears evident, I think, that their salutary operation must depend mainly on diverting the circulation and excitement from the af- fected organs, and directing them upon the vesicated part. Thus blisters applied to the side in peripneu- mony, establish an increased determination to the surface, and by this effect produce a derivation from the inflamed vessels of the pleura and lungs, and enable them to recover their healthy state. A blistered sur- face may be considered in the light of a new excretory organ, the formation of which requires the establish- ment of a new current or determination of blood. So long as the discharge continues, so long will there be an especial demand of blood in the blistered part, and a consequent derivation of the circulation from the inflamed and engorged vessels of the neighbouring organs. It is by thus rendering a constant supply of blood necessary in blistered parts, and thereby sustain- ing the local determination to the surface, and not by evacuating any morbific matter, that the discharge from blisters, for the most part, appears to do good. It is nevertheless quite probable that blisters do some- times act beneficially by their direct depletory effects. In erysipelas, for instance, we often derive immediate and decided benefit from blistering the affected part. To explain this, as is commonly done, by ascribing it to the establishment of a new action in the part, appears to me exceedingly vague and unsatisfactory. Is not the direct evacuation of serum from the inflamed ves- sels sufficient to explain the- advantages obtained in EPISPASTICS. 239 cnses of this kind from blistering? In erysipelas the cutaneous capillaries are especially involved in inflam- mation. Why therefore should wre not expect benefit from an application which is calculated in a direct way to lessen the contents of these engorged capillaries? Blisters have also been supposed to do good by their stimulating and cordial effects. " That these remedies," says Dr. Chapman, " are cordial and exhilarating, is proved by their efficacy in all nervous affections, whether distinguished by a preponderance of mental or corporeal infirmity and weakness." It appears to be well ascertained, however, that in all cases of real de- bility vesicating applications can prove serviceable only when employed in such a way as simply to produce a rubefacient effect; blistering under such circumstances being almost invariably detrimental. In nervous affec- tions, attended with weakness, blistering is without doubt often beneficial. But it must not be inferred, that the good effects of blisters in such cases are in any particular degree dependent on their " cordial or exhila- rating" operation. For it is to be observed, that the weakness which attends nervous affections, is frequently immediately dependent on irregular determinations to some of the internal organs, and that in proportion as we obviate such determinations or congestions, and thereby relieve some oppressed vital organ, so do we remove the weakness to which they give rise. It is by an operation of this kind chiefly, I conceive, that vesi- cation is found occasionally to produce invigorating consequences in nervous affections. Cullen ascribes the beneficial operation of blisters to their supposed power of relieving spasm. That the skin frequently becomes moist and relaxed from vesica- tion, is certain; but it is very questionable whether this can be properly ascribed to the direct antispasmodic 240 EPISPASTICS. or relaxing powers of such applications. By relieving pain, irritation, and congestions of the internal organs, blisters may give a general healthy impulse to the va- rious emunctories of the system, and enable the cuta- neous capillaries to resume their regular action. The utility of blisters in some of the spasmodic affections, would seem to countenance the idea of their possessing direct antispasmodic powers. Their effects in this way, however, must be referred to the same operation that has been mentioned in relation to their employment in nervous affections. In whatever manner we may account for the opera- tion of blisters, experience has fully demonstrated their utility in a great variety of affections. In the treatment of febrile diseases they are capable of affording very important advantages. Physicians have, however, by no means been unanimous in recommending them in fevers. Dr. Fordyce rejected them as not only useless, but even pernicious. The authority of this eminent physician has, however, not been sufficient to counter- vail the testimony, which the experience of the majority of the profession has brought forward in favour of the beneficial effects of blistering in fevers. In the treat- ment of intermittents, blisters cannot be considered as an ordinary remedy. Under certain circumstances of the disease, however, they may occasionally be employ- ed with great advantage. Cases occur which are attended with an irritated pulse and a dry skin during the intermission, and which are found to resist the most liberal use of bark, &c. In such cases the application of blisters to the wrists or ankles, or a large one laid between the shoulders, will generally produce such a change in the character of the disease, as to enable the bark fully to display its febrifuge powers. In continued fevers, blisters judiciously managed EPISPASTICS. 241 arc undoubtedly often of great advantage. But it must be admitted, that unless they are well timed, as to the period of the disease, they are not only useless, but frequently manifestly injurious. As a general rule, blisters are inadmissible in the commencement of febrile affections. Where inflammation or dangerous congestion of some important internal organ is pre- sent, they are nevertheless sometimes of essential service, and may be resorted to in the very beginning of the disease concomitantly with venesection and other antiphlogistic measures. But in idiopathic fever, without any evident congestions or inflammation, they seldom fail to do harm when employed before the alimentary canal has been duly evacuated, and the action of the heart and arteries moderated by proper depletory measures. There is a period in the course of continued fevers intermediate between the stage of high excitement and the appearance of symptoms of collapse, in which blisters will generally produce un- equivocal good effects. This is what has been called the blistering point, an expression familiar to those who are acquainted with the writings of Rush. Those who have contemplated fevers most attentively have noticed, that they often begin to decline immediately after the occurrence of some particular spontaneous evacuation, or on the appearance of abscesses, &c. It is also ascertained that such " critical movements" seldom, if ever, occur during the primary stage of febrile excitement. It appears, therefore, that there is a tendency in fevers, at a certain period of their course, to throw a more than usual burthen upon some of the emunctories, or to establish particular determi- nations, giving rise to haemorrhage, abscesses, &c. as the first movement towards amendment. It is at this period in the course of febrile diseases, during which efforts of this kind are sometimes observed to occur, 242 EPISPASTICS. that blisters appear to be particularly serviceable. It is only, however, when the indications of a change of action in the system are obscure or imperceptible that vesicatories are admissible; for during what is com- monly denominated a critical discharge, they would be obviously improper. The utility of blisters in continued fever unattended by any particular local affection, appears to me therefore to depend on giving an impulse to the sanative powers of the living economy, and at the same time establishing a new secreting surface, towards which the humours are especially directed. In cases attended with symptoms of particular affection of any of the important internal viscera, we employ blisters upon a different principle. In instances of this kind our object is to relieve the oppressed organ, and we accordingly apply the blister as near the affected viscus as is practicable, in order more effectually to derive the blood from the engorged or inflamed vessels. Thus, in fevers attended with delirium, and other symptoms of inflammation and engorgement of the vessels of the brain, blisters are applied to the head, not so much with a view of arresting the progress of the general disease as of relieving and protecting this important organ. Perci- val observes, that in fevers attended with a general disposition to inflammation, without any one part suffering more than another, blisters always act inju- riously. When, however, local inflammation of any of the internal organs is connected with the fever, vesication *is almost universally useful. Experience, he says, demonstrates, that in such cases blistering the skin near the affected part lessens the flow of blood to it, and thus contributes to resolve the inflammation, and consequently the general febrile excitement.* Blisters are very important remedies in the treat- * Essays, Medical, Physiological, and Experimental. EPISPASTICS. 243 ment of the different varieties of phlegmasial diseases. In acute pulmonic affections especially, they are often indispensable. Some difference of opinion exists among physicians as to the proper time for applying blisters in pneumonia. It is contended by some that they do more mischief than good when resorted to before the action of the heart and arteries has been considerably reduced; while others allege that they may be advan- tageously applied in the very commencement of the disease. That blisters may be very early resorted to in pneumonia with advantage, I am entirely persuaded from repeated experience. Without doubt, however, they will perhaps always act with more decided benefit when applied after the vehement arterial excitement has been somewhat moderated by depletory measures. But they may nevertheless, generally, be resorted to very early with advantage; and more especially, as several bleedings may be practised, between the time of their application and the commencement of vesica- tion, and the general momentum of the circulation be thus diminished, before the stimulus of the epispastic has had time to disturb the system. In relation to this point, Dr. Armstrong makes the following obser- vations : " It has sometimes struck me very forcibly," says he, " that the precipitate application of blisters to the chest, before general or local blood-letting, is a prejudicial practice; at least I have occasionally seen hydrothorax rapidly follow it, from the increase of the general and topical excitement which blisters thus ap- plied had apparently produced. This point therefore is, perhaps, deserving of further investigation in the acute pulmonary inflammation."* In pleurisy and other acute pulmonic affections, the blister should be laid * Practical Illustrations on the Scarlet Fever, p. 151. 244 EPISPASTICS. immediately over the part which appears to be princi- pally affected. Some very celebrated writers, however, recommend them to be applied on the thighs or legs. Baglivi observes, that cases of pleurisy sometimes occur in which great difficulty of respiration and sup- pression of expectoration come on about the fifth or sixth day, whether bleeding has or has not been prac- tised. " Two blisters applied to the legs and thighs in such cases, will not only promote the expectoration, but remove the difficulty of breathing, and produce a favourable change."* This practice, as Alibert ob- serves, is sanctioned by the following aphorism of Hippocrates: In pulmonis affectibus, quicunque tu- mores fiunt ad crura, boni; nee potest quidquam melius accidere si mutato sputo, sic appareant." In the treatment of hepatitis, both chronic and acute, blisters are often highly serviceable; and in inflamma- tion of the bowels and peritoneum they are indispen- sable. In all these affections the blisters should be large, and applied immediately over the affected parts. In acute hydrocephalus, also, blisters over the scalp, or what is better, on the back of the neck, can never be neglected with propriety. In all these affections, how- ever, it is necessary to observe that bleeding forms the primary and most essential curative measure. In acute rheumatism, after the violence of the general excite- ment has been considerably reduced, blisters will com- monly procure great relief when laid over the parts particularly affected. They are also useful in some varieties of the chronic form of this complaint, and par- ticularly in sciatica. " In the worst chronic states of local rheumatism of the nerves," says Dr. Scudamore, " 1 have seen the cure obtained, or very material relief Alibert, Elem. de Therap. EPISPASTICS. 245 afforded, by the successive application of blisters."* In the cure of gout, blisters have been recommended by some writers and condemned by others. Rush and Musgrave speak favourably of their employment both in acute and chronic gout; whilst Cullen and Scuda- more consider them as at least hazardous. It is unnecessary, however, to mention particularly every variety of phlegmasial disease in which blisters may be employed with advantage. With the excep- tion, perhaps, of nephritis, they may be considered as primary remedies in all internal inflammatory affec- tions. In nephritis, however, they are inapplicable on account of the tendency which cantharides possess of irritating the urinary organs, and consequently of in- creasing the inflammation of the affected parts. We need only advert to the modus operandi of blisters in the cure of internal inflammatory affections, as ex- plained in the beginning of this chapter, to see their general applicability in the various forms of these complaints. For it is obvious that every remediate measure which has a tendency to divert, in any degree, the circulation from the affected parts, and direct it upon external and less important ones, must be capable of procuring beneficial effects in this class of diseases. In the treatment of dysentery, and especially of cholera, blisters may often be applied, both to the extremities and the abdomen, with great advantage. In the latter of these affections, blistering with can- tharides is much too slow for the very rapid course of the disease. The nitric acid has, however, been recently employed for this purpose with the happiest effect, being exceedingly prompt and active as a vesicatory. In cholera infantum, blisters, or at least rubefacients, * Treatise on Gout and Rheumatism, p. 316. Vol. II.—2 G 246 EPISPASTICS. are of essential utility. Applied over the region of the stomach, they often allay the inordinate irritability of this organ in a very effectual manner. In severe cases of dyspepsia, attended with inflam- matory irritation of the mucous membrane of the sto- mach, blisters laid over the epigastric region, generally procure important relief. Blisters have also been frequently resorted to in the exanthemata, and particularly in confluent small-pox, and in measles, when the eruption recedes suddenly, or symptoms of pulmonic inflammation and oppression supervene. But in subjects who have been much worn down by these diseases, and in whom the existence of obscure visceral inflammation may render epispastics necessary, blisters must be applied with great caution. For the blistered portions of the skin, in cases of this kind, is apt to become gangrenous, producing dan- gerous and obstinate ulcerations. " The skin is one of the principal seats of the measles. It is exceedingly stimulated during the eruptive fever, and suffers a cor- respondent loss of tone as that fever declines; and as this cutaneous debility is greatest in emaciated, or in broken up habits, so the surface in them is less able to resist inflammation, without ending in gangrene or in an ill-conditioned sore."* In the treatment of erysipelas blisters have been recommended as very efficacious. They are to be applied immediately on the inflamed part, and suffered to lie until vesication is produced. To arrest the progress of grangrene, blisters are among our most valuable remedies. Cotunnius states, that he once saw the lower extremities of a patient labouring under putrid fever become gangrenous, and that the gangrene extended to every part of the legs except to those * Practical Illustrations on the Scarlet Fever, Measles, &c, p. 172. EPISPASTICS. 247 upon which the blisters had been laid. The mortifi- cation terminated about a finger's breadth from the margin of the blisters.* Blisters, observes Roemer, appear, therefore, to possess the power to arrest the progress of mortification.t It is to Dr. Physick, how- ever, that we owe our knowledge of the real value of this remedy in gangrene. The blister should be large enough to cover all the sound parts in contact with those which are in a state of gangrene. " I have wit- nessed the effects of blistering," says Dr. Dorsey, " in a variety of instances, and have no hesitation in recom- mending them in preference to all other local remedies. After the first dressing of the blister, it will generally be found that the mortification has ceased to progress, and in a short time the separation of the sloughs com- mence.";): Blisters have also been employed with much benefit in some varieties of haemorrhage. They are especially useful in epistaxis; an alarming case of which I once saw effectually arrested by a blister laid on the back of the neck. Dr. Robert Archer, of Norfolk, has related a remarkable instance of the utility of blisters in a case of this kind. The patient was nearly exhausted; every means that could be suggested had been tried in vain. On the fifth day a blister was applied to the back of the neck. This application " produced an astonishing effect, for it no sooner began to vesicate than the haemorrhagy ceased, as if by a charm." The patient recovered rapidly; but as soon as the blister healed the bleeding returned. The blister was re- newed and kept open for some time; the haemorrhage immediately ceased, and the patient recovered his * De Sedibus Variolarum. X Roemer's Chirurgische Arzneimittellehre, torn. i. p. 218. X Elements of Surgery. 248 EPISPASTICS. health.* In hydropic affections, blisters are sometimes highly beneficial. They are particularly useful in ascites and hydrothorax, unattended with much ana- sarcous effusion. They tend, very considerably, to derive the blood from the irritated or congested serous membranes, from which the effusion occurs, and consequently to lessen the effusion and promote its absorption. In anasarca, blisters cannot be applied without more or less risk of gangrene or mortification. In the treatment of spasmodic affections, blisters have been observed to display very considerable powers. Several cases are related of their successful application in tetanus. Dr. William Carter, of Canter- bury, gives an account of a case of this disease from a wound, in which he applied a blister between the shoulders the whole length of the spine, and directed an active purge every two or three days, giving, on the intermediate days, oil of amber and assafcetida. By these means the patient recovered his health in less than three weeks.t In the cure of epilepsy, blisters have been more frequently employed than perhaps, in any other of the spasmodic diseases. Mead,J Baumes, and Percival mention cases of the successful applica- tion of blisters in this disease. Richter observes, that vesicatories are most applicable in such cases as are attended with an irritated condition of the brain during the intervals, and connected with a dull and soporose disposition and a small and trembling pulse.§ Blisters are said to act most beneficially in this disease when laid on the calves of the legs. Rivereius|| and Piso * American Medical Recorder, vol. i. p. 16. X Medical Transactions of the Lond. College of Physicians, vol. ii. p. 34.—1772. X De imperio Solis et Lunae, etc. cap. ii. p. 8. § Richter's Specielle Therapie, vol. vii. p. 710. |j Opera, lib. i. sect. 2, cap. 6. EPISPASTICS. 249 cured inveterate cases of epilepsy by applying them to the scalp and keeping them open for a considerable time. That cases of epilepsy have been cured by this remedy, we are not permitted to doubt. It does not appear, however, from the aggregate experience of the profession on this head, that they are entitled to any particular confidence in this intractable complaint. In a great variety of local complaints vesicatories are of essential service. In inflammations of the joints, both acute and chronic, they are highly useful. They should be laid immediately over the affected joints, and kept discharging for a long time. This remedy, together with rest and a general antiphlogistic regimen, will frequently produce the happiest effect. The application of a blister to the tract of an inflamed vein is a practice of much value. This treatment was first introduced by Dr. Physick. " A small plaster of simple cerate, spread on linen, is to be applied to the orifice, and over this a blister laid, large enough to cover the whole inflamed part, extending three or four inches from the orifice in every direction."* In incontinence of urine, depending on paralysis of the sphincter of the bladder, blisters laid on the sacrum have been employed with much advantage/!" Oliphant relates two instances of this kind, one of which was in a man of seventy-two years of age, in which the appli- cation of a blister over the os sacrum gave perfect relief.}: Blisters have also been found very serviceable in some of the chronic cutaneous diseases. Bloch§ and Richter|| employed them with great success in herpetic * Dorsey's Surgery. | Lond. Med. Observat. vol. i. p. 318. X Gesner's Endeckungen, B. iii. p. 725. § Schmucker's Chirurg. Schriften, vol. ii. p. 96. || Richter's Medical Library, vol. iii. p. 289. 250 CANTHARIDES. eruptions, and Ambrose Pare relates a remarkable case of an eruption in the face cured by this remedy. The patient was a lady of distinction; her face was covered with innumerable little ulcers, and considerably swollen. The physicians considered it as a case of elephantiasis. After employing a vast variety of remedies without the least advantage, they applied blisters over the affected parts. These had hardly lain an hour before she ex- perienced violent pain in the bladder, which was soon followed by tormina, vomiting, and fever. The blister drew well, and the disease disappeared, and never after- wards returned.* For obviating, or removing the injurious consequences which sometimes result from the sudden retrocession of cutaneous eruptions, blisters are among our most efficient means. LYTTA VESICATORIA.--CANTHARIDES. The cantharides are a beautiful and well known in- sect of the beetle tribe, being exceedingly abundant in the southern parts of Europe, and particularly in Spain. They delight to dwell on the leaves and flowers of the ash, the black poplar, the elder, and lilac, from which they are collected in June and July, and afterwards destroyed with the fumes of strong vinegar, and dried in the sun.t These insects have a peculiar sweetish and nauseous odour. When first taken in the mouth they have very little taste, but on being chewed they become consider- ably burning and acrid. Hippocrates directs the heads, wings, and feet to be thrown away, as being, according to his notion, particularly poisonous. Galen, Pliny, and * Opera, lib. xx. cap. 27. f This mode of destroying cantharides is of very ancient date. Dios- corides recommends it particularly. CANTHARIDES. 251 Ettmuller, on the contrary, thought that the bodies were the most poisonous; and that the heads, wings, and feet possess the power of counteracting the poisonous effects of the bodies. Cantharides have frequently been the subject of chemical analysis. According to Mr. Robiquet, they contain, 1. A blistering principle, to which Dr. Thomson has given the name of cantharadin. 2. A green concrete oil. 3. A yellow fluid oil. 4. A peculiar black substance, soluble in water and proof spirits, but not in pure alcohol. 5. A saponaceous or yellow substance, soluble both in water and alcohol. 6. Uric acid. 7. Acetic acid. 8. Phosphate of mag- nesia. 9. A parenchymatous substance.* The blister- ing principle, or cantharadin, when obtained in a sepa- rate state, consists of small plates of a micaceous lustre. It is insoluble in cold alcohol and in water. Boil- ing alcohol, however, dissolves it, but precipitates it again on becoming cool. ^Ether and the oils dissolve it readily. Although not soluble in water, it is render- ed so by the presence of the yellow or saponaceous substance with which it naturally exists in a state of combination. The blistering property is very highly concentrated in the cantharadin. An atom of it dis- solved in sweet oil, and applied to the skin with a bit of paper, produces vesication in five or six hours.t Nei- ther the black substance nor the green oil possesses vesicating powers. Cantharides have a peculiar tendency, whether taken * Annal de Chemie, torn, lxxvi. f The cantharadin may be obtained by the following process: Boil the cantharides in water repeatedly, until all the soluble parts are extracted; filter the decoction, and evaporate it to the consistence of an extract. Di- gest this extract in concentrated alcohol, then pour off the alcohol, and evaporate it; sulphuric aether, added to this alcoholic extract, will take up the cantharadin, which may be obtained in a pretty pure state, by evapora- tion.— Pfaffs Mat. Med. vol. iii. p. 243. 252 CANTHARIDES. internally, or applied as a vesicatory to the skin, to act upon the urinary organs, and especially to produce irri- tation and inflammation of the neck of the bladder, and consequently strangury. It has been much disputed, whether strangury be produced by the absorption of the acrid portion of the cantharides, or whether it be merely the result of a sympathetic impression conveyed to the bladder. That strangury proceeds from the ab- sorption of the acrid principle of the cantharides, is ex- ceedingly probable from the fact that no other vesicating substance produces this effect. It is moreover very unlikely that the bladder should possess so extensive a sympathy with the surface of the body, as it must do if strangury from blistering be the result of a sympathetic impression; for, on whatever part of the body blisters be laid, strangury may be the result. Dr. Chapman observes, that " if strangury do thus arise, it ought in- variably to take place on the application of a blister," which, however, is an incident of rare occurrence. But wherefore should strangury more frequently follow blistering, if it be occasioned by absorption of the cantharides, than if it depend on a sympathy between the skin and bladder ? We might with just as much, and perhaps more plausibility, say, that if strangury arise from a sympathetic connexion between the external sur- face and the bladder, it ought more constantly to follow blistering. We know that turpentine occasionally pro- duces strangury when taken internally, and that it is absorbed, and conveyed out of the system by the urinary organs. But are we to deny the absorption of this substance because it does not always produce strangury ? The fact of its absorption is unquestion- able. Dr. Chapman also states, " it is known that the internal use of cantharides is seldom attended by any effect, and when it does occur, it is more frequently CANTHARIDES. 253 from small than large doses of this article." Against the correctness of this statement I may with confidence appeal to the general experience of the profession. By large doses of this article strangury may be generally induced, whereas small doses seldom produce any sensible effect whatever. Nor is it a fact that the internal use of cantharides is seldom attended by this affection of the bladder. In a highly interesting paper, published by Dr. J. Klapp, on the emmenagogue pow- ers of cantharides, nineteen cases are detailed in which this remedy was administered internally, and in eight of which symptoms of strangury supervened.* Blisters are particularly apt to excite strangury when applied to the head immediately after the scalp has been shaved; and more especially if the skin be wounded. This may be attributed to the greater facility which the absorbents possess of taking up the active principle of the fly, when the cuticle has been abraded and wounded by shaving; and hence, when cantharides are applied from twelve to twenty-four hours after the head is shaved, this effect hardly ever ensues.t To obviate, or relieve strangury, much benefit may be derived from the free use of mucila- ginous and mild diuretic drinks, as barley-water, infu- sions of flaxseed, parsley, melon-seed, and particularly of marshmallows, or of our common round leaved mallows, (malva rotundifolia.) In addition to these, opium, taken into the stomach or administered in the form of a clyster, is always of essential service. Much benefit is also to be derived from warm bathing, or from fomentations to the perineum and pubis. For- merly camphor was a good deal recommended as a remedy for strangury; and it does not appear to me * American Medical Recorder, vol. ii. p. 37. X Percival'9 Medical Essays, vol. i. Vol. II.—2 H 254 CANTHARIDES. to be wholly inefficacious in this respect. When speaking of this article under the head of narcotics, I adverted to its evident tendency to diminish venereal sensibility, or perhaps more properly speaking, to lessen the activity of the genital organs. This effect of camphor would seem to depend on an operation di- rectly the reverse of that of cantharides,—namely, a diminution of the flow of blood to those parts. But as the operation of camphor in this respect is slow, it can seldom be employed with any particular advantage in eases of this kind, which require much more prompt means of relief. After the violence of the symptoms is over, and some pain or irritation remains at the neck of the bladder, it will nevertheless often prove useful, as I have in several instances witnessed. Cantharides seldom produce complete vesication under ten or twelve hours. Before applying a blister, the skin upon which it is to be laid, or the surface of the plaster should be moistened with vinegar or brandy. When the blister is drawn it must be opened and dressed with simple cerate spread on linen. To keep up the discharge from a blistered surface, an ointment made of a small portion of cantharides and lard, is one of the best applications. Savin ointment is also very good for this purpose. When a blister is in a state of painful irritation, sweet oil, lard, or a soft bread and milk poultice should be applied. Complete vesication may be produced by removing the cantharides as soon as the skin is slightly reddened or inflamed, and applying an emollient poultice over the part. This is a good mode of blistering in infants, or where we wish to avoid much pain and irritation. We may, also, vesicate in this way, in anasarca, or oedema with little or no risk of producing gangrene or sloughing. 255 LYTTA VITTATA.--POTATO FLT. This insect is said to belong exclusively to the United States. It feeds chiefly on the potato plant, upon which it is often found in immense numbers about the end of July or beginning of August. It resembles in outward form the cantharides; being, however, some- what smaller, and of a different colour. Its head is red, with black antennae; the wing-cases are black, with a pale yellow margin, and a stripe of the same colour along the middle of them; the tarsi have five joints. " The abdomen of this insect is a hard, white substance, about the size of a grain of wheat, which, when powdered, appears like meal, and when rubbed with water forms a milky emulsion." Dr. Isaac Chap- man, of Bucks county, in this state, was the first who publicly noticed the vesicating properties of this spe- cies of Lytta.* According to his experience it is equal if not superior in this respect, to the cantharides; and this has been confirmed by the experience of other practitioners. The late professor Barton gave a de- cided preference to the American fly. " Long-keeping," he observes, " provided it be carefully kept, does not materially impair the blistering property of the lytta vittata. At the end of three or four years after freing collected, I have found it equal in power to the best shop cantharides." Dr. Gorham, of Boston, states, that in an extensive series of experiments with this fly, he found it equal if not superior in every respect to the cantharides. Administered internally, it pro- duces the Fame effects upon the urinary organs, and is applicable to the same medicinal purposes as the Spanish fly. * Medical Repository, vol. ii. 256 NITRIC ACID. There are other native species of this genus of flies which possess valuable vesicating properties. The lytta atrata is a very common insect in this country. In the autumn it is found in great abundance on some of the syngenesious plants, such as aster, soledogo, &c. " Though inferior," says Dr. Barton, " to the lytta vit- tata, it is well worthy of the attention of physicians." The lytta marginata is not so common, but is an ex- ceedingly powerful vesicatory. The lytta cinerea is said to be no less powerful than the latter species; it is, however, very scarce. I may also, in this place, mention the meleo niger, which was first noticed, as a vesicatory by the late professor Woodhouse. According to his experiments with this fly, it seems to possess very active vesicating properties. It is about half the size of the potato fly, and dwells particularly on the ambrosia trifida. NITRIC ACID. The nitric acid has been recently introduced into practice as a very valuable vesicating application in certain rapid and dangerous affections. Dr. Kennedy has published an interesting paper on this subject in the Edinburgh Medical and Surgical Journal. It has been 'found particularly efficacious in the cholera of India, a disease so rapid in its progress and fatal in its consequences, that nothing but extensive blistering of the epigastric region appears to be capable of arresting its course. Blistering with nitrous acid, being exceed- ingly prompt, and attended with much local irritation, is, according to the experience of Mr. Powell, surgeon at Bombay, a remedy of great powers in this affection. " The good effects," says Dr. Kennedy," of this sudden and powerful counter-irritation, were strikingly illus- TARTARIZED ANTIMONY. 257 trated in the case of an European, who received imme- diate relief in the burning sensation at the stomach on the acid blister being applied; and who, the next morn- ing, being annoyed with spasms of the extremities, requested the same remedies might be applied; it was accordingly done, and so great was the relief obtained to one leg, that he cried out for God's sake to apply it to the other, which was similarly affected." Another patient, he observes, was brought in, and supposed to be past recovery. His stools passed off involuntarily; the extremities were cold, and the pulse could not be felt. " The acid blister was applied to the stomach, and the patient got well." Two parts of the acid is to be diluted with one part of water; with this mixture the surface over the affected part is to be rubbed. As soon as the patient experiences pain from it, the acid is to be neutralized by washing the surface with a solution of carbonate of potash. " The cuticle can now be easily detached, and leaves the cutis very raw, upon which a common blister may be laid to keep up the irritation."* TARTARIZED ANTIMONY. Although not a vesicating substance, tartar emetic deserves to be particularly mentioned in this place, as possessing the power of exciting a peculiar pustular eruption, frequently followed by highly salutary conse- quences. The best mode of using it for this purpose is to incorporate it with simple cerate or lard, in the proportion of a drachm of the former to about an ounce of the latter, and to apply it either by frictions or spread * Observations on the Use of Nitrous Acid as a Substitute for Blisters, by Dr. Kennedy, F. R. S. E., in the Edinburgh Medical and Surgical Journal, for Oct. 1820. 258 TARTARIZED ANTIMONY. on leather and worn in the way of a plaster, on the skin. Dr. Jenner, who has recently published a most valuable essay on the influence of artificial eruptions on certain diseases,* recommends the tartar emetic ointment to be made according to the following for- mula/!" The effects which arise from inunction with this ointment are, a sense of itching or prickling in the part rubbed, commonly appearing on the second or third day after the frictions have been commenced. " If the part so affected be rubbed, or in any degree irritated, (from which few can refrain at first) an erup- tion of small watery pustules takes place immediately." If the patient abstain from irritating the part, the erup- tion will appear somewhat later. " The pustules," says Dr. Bradley, " are uniformly compared by patients to variolous pustules; but they are much smaller, not so red at the base, nor so tense and white when fully sup- purated." I have, however, seen them much larger than the variolous pustules, and they are generally very painful. In the essay already quoted, Dr. Jenner adduces a number of cases in which this ointment was applied with the happiest effects. He employed it with success in mania, phthisis, asthma, chronic hepatitis, chorea, epilepsy, and various other anomalous cases. This application has also been highly recommended as a remedy in hooping-cough. " Of all the remedies," says Dr. Robinson, "I have found beneficial in hooping- cough, frictions upon the region of the stomach with the tartarized antimonial ointment have been the most re- markably and most undeviatingly useful. The erup- * American Medical Recorder, vol. v. p. 684. X Antim. tart, (subtil, pulv.) 3ii.; ung. cetacei, £ix.; sacch. albi. £i.;* hydr. sulph. rub. gr. v.—M. fiat ungueut. * The sugar prevents the ointment from becoming rancid. TARTARIZED ANTIMONY. 259 tion on the stomach is frequently accompanied with a slight degree of inflammation about the remote parts in females, with a spare eruption of minute pimples; and, on this occurring, the disease uniformly begins to abate. In cases where the patient is of a full habit and the inflammatory diathesis runs high, it may be proper to apply a few leeches to the feet previously to the use of the antimonial ointment. But I have used it with advantage, even in cases where the fever was attended with delirium at night. I have never seen the eruption produced in this way threaten the bad consequences from gangrene which not unfrequently supervene when the blisters are applied too early in hooping-cough, when the inflammatory diathesis runs high, and before blood has been abstracted. The effects of the oint- ment in other respects are also widely different. When it does produce an eruption, it almost always affords relief; whereas I have never seen an instance where the application of a blister has been of the smallest ser- vice in hooping-cough, except after blood-letting, when there have been manifest symptoms of inflammation."* This accords with the experience of Dr. Jenner: " With tartarized antimony," observes this distinguish- ed physician, " we can not only create vesicles, but we can do more,—we have at our command an application which will at the same time both vesicate and produce diseased action on the skin itself, by deeply deranging its structure beneath the surface. This is probably one cause why the sympathetic affection excited by the use of cantharides and those changes produced by tartar emetic are very different." The eruption should be kept up for some time, either by the re-application of small portions of the diluted tartar emetic ointment to the affected part, or by other * London Medical Repository, January, 1821. 260 SETONS AND ISSUES. gently stimulating ointments. If they become much irritated and very painful, a soft bread and milk poul- tice, or an ointment made with equal parts of sweet oil and wax, will in general afford relief, without inter- fering with the eruption. "The activity of tartar emetic ointment is to a considerable extent proportional to the fineness of the powder of the tartar emetic; and as it is frequently carelessly prepared with the tartar emetic as found in the shops, we need not be surprised, that in many instances it disappoints the expectations of the practi- tioner. The reduction of the salt to a proper degree of minuteness requiring some time and labour, M. Mialhe recommends, that a saturated solution of it in cold water be made, and that it then be precipitated with alcohol. The precipitate is to be collected on a filter and dried. Two drachms of this powder mixed with an ounce of simple cerate, will make a very active ointment. A very small quantity of alcohol will suffice to precipitate the tartar emetic in the form of an impalpable powder." SETONS AND ISSUES. The effects of setons and issues are very analogous to those of the articles already mentioned in this chapter. Being, however, very permanent in their operation, they are often peculiarly applicable in cer- tain chronic affections where it is necessary to keep up a long continued counter irritating influence. Among the Greek and Roman physicians, caustic issues were frequently resorted to. Hippocrates em- ployed them in gout, sciatica, chronic diseases of the liver, spleen, and lungs; and ^Etius mentions their use in palsy and asthma. Celsus, also, employed them in SETONS AND ISSUES. 261 affections of the joints, in epilepsy and in phthisis. Boerhaave and De Haen, in modern times, recom- mended them in the treatment of the scrofulous disease of the hip joint; and Mr. Pott speaks highly of their efficacy in diseased or incurvated spine. A caustic issue on each side of the diseased vertebrae has been frequently known to give perfect relief in such affec- tions. Dr. Rogers, Professor of Natural Philosophy and Chemistry at Williamsburg, Virginia, has recently published some highly interesting observations on the employment of caustic issues. He relates several cases of phthisis pulmonalis, which yielded entirely to their influence. In a case of this kind, which, from the strong hectic symptoms, the constrained state of the respiration, and the appearance of the matter expectorated, was considered altogether hopeless, a caustic issue formed on the sternum inter mammas, performed a perfect cure in the space of about three months. " In chronic affections of the breast," says Dr. Rogers, " this remedy is less troublesome, less painful, gives more permanent caustic irritation, and appears to me much more efficacious than blistering, however managed. So strongly am I impressed with this sentiment, that for several years I have trusted no case of the kind to any course of remedies without the aid of that under consideration. In chronic catarrh I have found it of singular utility."* Dr. Rogers has employed them with perfect success to prevent abor- tion in habits prone to this accident, as well as in the treatment of leucorrhcea and menorrhagia. Issues have likewise been applied with much advantage in v ertigo, gutta serena, chorea, and tetanus. Dr. Harts- home, of this city, has employed them with success * American Medical Recorder, vol. iv. p. 222. Vol. 11.—2 I 262 RUBEFACIENTS. along the spine, in this latter affection;* and Dr. Lewis, of Pittsburg, has related a case of this disease which yielded to the application of caustic potass along the tract of the spine.t When setons or issues are employed for the re- moval of local affections, they should be applied as near the affected part as practicable. In general diseases, however, they may be inserted on some convenient part of the extremities, as on the inside of the leg, just below the knee; or on the arm, near the insertion of the deltoid muscle. The usual mode of forming a caustic issue is as follows:—Take a piece of adhesive plaster, of from three to four inches in diameter; out of the centre cut an oblong or circular piece of the size of the intended issue: the plaster is then to be laid over the part on which the issue is to be formed. Caustic potass, moistened with water, is now gently rubbed over the skin, presented through the opening in the plaster, until the skin acquires a dark brown colour. The caustic must remain on the part about four or five minutes. It is then to be wiped off, and a soft emollient poultice applied, and renewed two or three times daily, until the eschar is thrown off. RUBEFACIENTS. The articles which belong to this class do not vesi- cate, but simply produce a redness and inflammation of the part to which they are applied. Their modus * Eclectic Repertory, vol. vii. p. 245. X American Medical Recorder, vol. iii. p. 176. SEMINA S1NAPIS. 263 operandi in the cure of diseases, depends probably on the same principles that have been mentioned above in relation to the operation of epispastics. They con- centrate the excitement, and produce a determination of the circulation to the part upon which they imme- diately act. Without, however, entering into any discussion upon this point, I pass on directly to the consideration of the individual articles of this class. SEMINA SINAPIS. Mustard is one of the most useful rubefacients we possess. Its action on the skin is prompt and power- ful, producing, when good, pain and inflammation in fifteen or twenty minutes. It contains fecula, muci- lage, a bland fixed oil, " and an acrid volatile oil upon which its virtues depend, and which on standing de- posits a quantity of sulphur and ammoniacal salt." Water extracts nothing but tasteless mucilage from the unbruised seeds; when bruised they impart all their active principles to water; but very sparingly to alcohol. The mode of using this article, as a rube- facient, is to make a paste with the farina of the seeds and water or vinegar, and to apply it in the shape of a poultice to the skin. The pain which such an appli- cation produces is generally exceedingly severe, and if suffered to remain on too long it is apt to occasion troublesome sores. From a series of experiments made on sinapisms by MM. Trousseau and Blanc, it appears—1. That black mustard, fresh ground, is not more active than that which has been ground for five or six months, and kept wrapped up in paper in a damp place. 2. Sinapisms prepared with icarm water, act rather more promptly than those prepared with cold water; "but after a few minutes the difference 264 SEMINA SINAPIS. ceases to be discoverable." 3. " Mustard mixed with warm water acts with much greater energy than when mixed with ordinary vinegar, or with acetic acid much diluted; and even with concentrated acetic acid it acts less energetically than with water alone, although acetic acid in this state, if applied to the skin by means of a sponge, or mixed with some inert powder, as saw- dust, is a much more powerful irritant thari mustard itself, producing much inflammation of the skin in the course of three or four minutes; so that vinegar miti- gates the action of sinapisms, and mustard in its turn, diminishes the irritating property of acetic acid. Good mustard mixed with water, produces at the end of six minutes, as much pain as the same mustard made into a cataplasm with vinegar, does at the end of fifty minutes. Instead, therefore, of expecting greater energy from a mustard plaster made with vinegar, we may now direct this addition as a diluent, with the same view that we order rye meal to be added to the sinapism." White mustard was found to act in the same way precisely, whether mixed with water or vinegar. 4. Sinapisms prepared with alcohol are less active than those prepared with vinegar. 5. When sinapisms are made with good mustard, they can seldom be supported longer than about forty minutes, unless sensibility is blunted by opium or cerebral oppression; " and even then, the cataplasm should not be allowed to remain more than an hour in contact with the skin; for though it may be borne many hours, yet if the system re-act, very severe local inflamma- tion follows, which frequently ends in gangrene, and may even destroy the patient." (Archives Generales, Sept. 1830.) Sinapisms are often of great service in the treatment of diseases. In apoplexy and comatose affections they are applied to the feet, in order to pro- CAYENNE PEPPER. 265 duce a revulsion from the engorged vessels of the brain. They are, also, very beneficial when applied to the abdomen in spasmodic affections of the stomach and bowels: as well as in all painful affections unat- tended by high arterial excitement. In the low states of fever, they will sometimes manifest very useful effects, by their general stimulant operation, and their tendency, when applied to the lower extremities, of lessening the cerebral congestion, which always exists more or less in the latter periods of typhous fevers. Mustard seed is also used internally as a medicine. The unbruised seeds are particularly recommended in paralysis, dyspepsia, chlorosis, and chronic rheuma- tism. Powdered mustard mixed with warm water, in the proportion of a table-spoonful of the former to a pint of the latter, acts promptly as an emetic. Admi- nistered in this way, it has been much employed as an emetic in epidemic cholera, and according to some statements, occasionally with signal benefit. The white mustard seed is an excellent remedy for indiges- tion depending on mere torpor or weakness of the digestive organs. A table-spoonful of the seed swal- lowed once or twice daily, seldom fails to afford very considerable relief in cases free from inflammatory irritation of the stomach. This remedy is particularly adapted to cases of this kind, attended with habitual costiveness. CAPSICUM ANNUUM.--CAYENNE PEPPER. This is an excellent rubefacient. It may be em- ployed for this purpose, either by mixing the powdered capsules in proof spirits, or in the shape of a satur- ated tincture. In paralysis or torpor of the extremi- ties, and in the low states of fever, friction with either 266 OLEUM TEREBINTHINjE. of these preparations is sometimes very serviceable. Wearing socks dusted with red pepper, is said to be very useful in diseases of the bowels attended with cold feet. The cataplasms of capsicum have also been recommended as good applications to the feet, in the delirium and coma of typhous fevers. The diluted juice of the pods has been employed with excellent effects in chronic ophthalmia. ALIUM SATIVUM. Garlic is frequently employed to produce rube- facient effects. It is, however, apt to vesicate, and where mere inflammation or redness of the skin is desired, it is not so well suited as the two preceding articles. Sydenham speaks highly of the application of garlic to the soles of the feet, as a powerful means of producing revulsion from the head. The late pro- fessor Barton thought it an excellent application in deafness from atony or rheumatism. For this purpose he recommended a clove of the garlic to be surrounded with cotton and introduced into the ear; or wool or cotton moistened with the juice and applied in this way. It has also been employed with success, in the form of an ointment to discuss indolent tumours.* OLEUM TEREBINTHINjE. Turpentine is strongly rubefacient, and is one of our most common applications for purposes of this kind. There are some peculiar habits, however, in which it cannot be used on account of its occasioning violent smarting and erysipelatous inflammation. It is Thacher's Dispensatory. OLEUM MONARDjE PUNCTATA. 267 usually employed in the shape of a liniment, in union with alcohol and other rubefacient articles. When applied to the skin in an undiluted state, it excites considerable pain, with redness, and generally a vesi- cular eruption. It is an excellent application to the throat in cynanche trachealis; and may, indeed, be applied with advantage in all instances where remedies of this kind are indicated. Of the use of this article in burns and scalds, I have already spoken under the head of stimulants. Formulae. R—01. olivar. ^x. 01. terebinth, %iv. Sulph. acid. gii.—Misce. An excellent rubefacient. R.—Acid, nitro-muriati. ifiss. 01. terebinth. gi. Axungiae gvi.—M. Highly recommended as a counter- irritating application in phthisis and other internal affections__Sapo iere- binthinatus, Pharm. Bav. R.—Sapo. hispan. 01. terebinth, aa ibss. Carb. potass gi.—Misce. An excellent rubefacient in cold and indurated swellings. OLEUM MONARD.E PUNCTATA. The oil of the monarda punctata, a beautiful native plant of this country, is a most powerful rubefacient. Its powers in this respect were first noticed by Dr. E. A. Atlee, of this city, in an interesting paper pub- lished in the second volume of the American Medical Recorder. It is exceedingly active, producing heat, redness, pain, and vesication in a very short time, when applied to the skin. Dr. Atlee states, that he has used it with much advantage as a rubefacient liniment, in chronic rheumatism, difficulty of hearing, periodical headache, paralytic affections, cholera infantum, and typhus. " During the prevalence of the epidemic ty- 268 CAMPHORA. phus in our city a few years ago," says he, " I was much pleased with its effects in the remarkable sinking state, and coldness of the extremities, to which the patients were subject. The arms, breast, and legs were bathed with this liniment,* omitting the lauda- num, and in a few minutes a comfortable glow suc- ceeded." In the treatment of cholera infantum, I have myself employed it with great and prompt advantage. By bathing the abdomen and extremities with the oil properly diluted, it speedily produces redness of the skin, and very generally relieves the gastric irritability. From my own experience with this oil I am satisfied that it is one of the most active rubefacients we possess, and that it will be found to answer exceedingly well in all cases where such remedies are indicated. AQUA AMMONIA. This article is very frequently employed as a rube- facient. In union with sweet oil it forms an excellent application in a variety of affections. Pringle thought it particularly useful in cynanche tonsillaris, and it is still much used as a liniment to the throat in this and other similar affections. Its rubefacient powers are, however, not very great, its application being seldom followed by much redness, unless in young subjects. CAMPHORA. Camphor dissolved in alcohol is one of our most com- mon rubefacients. The celebrated Steer's opodeldoc consists of soap gvii. alcohol Jii. camphor |ii. liquor * R.—01. monard. punct. £ss. Tinct. camph. gii. Tinct. opii. £ii.—M. TINCTURA CANTHAR1DUM. 269 ammon. siv. and oil of rosemary jss. This mixture is a very useful stimulating liniment in rheumatic affec- tions. Dr. Ferriar recommends the following ointment as an efficacious application in lumbago. He speaks very highly also of frictions with camphor dissolved in vitriolic aether. According to Scudamore, one of the best embrocations in subacute rheumatism, and gout, is a mixture composed of three parts of the mistura camphoata, and one part of alcohol. After the violence of the inflammation has been considerably reduced, by proper antiphlogistic measures, important relief may often be derived from the application of this mixture. Strips of flannel should be moistened with it, and laid over the inflamed joint. R.—P. Camph. Qii.; ung. basilic. §i.; sapo. §ss.; pulv. sem. sinap.^i.; M. ft. unguent. TINCTURA CANTHARIDUM. The tincture of cantharides possesses but feeble rubefacient powers; it does not, like most of the other articles that have been mentioned under this head, produce much burning heat in the part to which it is applied, and it is seldom even that it can be made to produce much redness of the skin. It has nevertheless been recommended as peculiarly serviceable in chronic rheumatism and paralytic affections. A decoction of cantharides in the oil of turpentine, however, forms one of the most active rubefacient agents we possess. This decoction is frequently employed for the purpose of hastening the vesicating effects of epispastics. If previous to the application of the epispastic the part be rubbed with this liquid, vesication will take place in a few hours. Vol. II.—2 K 270 FIX BURGUNDICA. This resinous substance is obtained from the Norway spruce fir, (pinus abies,) by making incisions through its bark. Spread on leather, it is much employed as a rubefacient application, and its effects are, indeed, often highly useful. When applied to the skin, it generally begins to produce a prickling heat in the course of about twenty-four hours, followed commonly by nume- rous small red pimples exuding a serous fluid, and occasionally also by vesication. In lumbago a plaster of this substance worn over the loins often proves very serviceable. Applied between the shoulders or to the breast, it is also frequently attended with very good effects in diseases of the lungs, particularly in chronic catarrh, hooping-cough, and spitting of blood. In chro- nic diarrhoea and dysentery I have known very excellent effects to arise from a large Burgundy pitch plaster worn on the abdomen. Enveloped in cotton and introduced into the ear, it has been found serviceable in difficulty of hearing depending on a rheumatic affec- tion or atony of the ear. ERRHINES. These are medicines, which, when applied to the Schneiderian membrane, increase its natural secretions. In persons not habituated to their use, they generally produce sneezing, and hence they are also called ster- nutatories. The practical .application of these reme- dies is but very confined.' Their use is restricted exclusively to the cure of some affections of the head. Their modus operandi is not difficult to understand. By irritating the Schneiderian membrane, they occasion ASARUM EUROPIUM. 271 an afflux to this organ, and an increase of its secre- tions, and consequently a derivation of the circulation from the surrounding or neighbouring parts. Hence, they have been found serviceable in rheumatic affec- tions of the head, in pains of the ear, in ophthalmia, toothache, and various other affections of these parts. I proceed to mention a few of the principal articles employed as errhines. NICOTIANA TABACUM. Tobacco, in the form of snuff, is extensively used as a luxury. In persons not habituated to its use, in this way, it acts as a pretty powerful errhine. By repeti- tion, however, it soon loses its power of increasing the discharge from the nose; and, on this account, it can seldom be employed with particular advantage in cases that require a pretty long use of such a remedy. It has been said, that when snuffing produces a con- siderable discharge from the nose, which is sometimes the case even in such as take it habitually, it cannot be laid aside without the risk of injurious consequences. " From my own experience," says Dr. Cullen, " I am led to repeat here, that whenever the discharge has been considerable, the laying aside snuffing, and there- fore suspending that discharge, may have very bad effects." All artificial discharges become constitu- tional by long continuance, and can seldom be checked suddenly without producing injurious effects. ASARUM EUROPIUM. The asarabacca, besides its emetic and purgative properties, is powerfully errhine. When snuffed into the nose it produces violent sneezing and a copious 272 TURBETHUM minerale. discharge of mucus from the nostrils, and frequently also a plentiful secretion of saliva, continuing some- times for several days. It must be employed in mode- rate doses, as its effects are often exceedingly violent when snuffed in large portions. A few grains of it snuffed once or twice a day have been known to pro- duce excellent effects in toothach, ophthalmia, headache, and other affections of the head. HELENIUM AUTUMN ALE. This is a syngenesious plant, indigenous to the United States, in many parts of which it grows in great abundance. The whole plant is intensely bitter, and may be usefully employed as a tonic. As an errhine, the powdered leaves are recommended by the late professor Barton as safe and valuable. I have prescribed it in a few cases, and found it to produce profuse discharges of mucus from the nose. It is less violent in its effects as a sternutatory than the asarum, and produces quite as much discharge. TURBETHUM MINERALE. This is a very valuable errhine. It seldon fails, when snuffed up the nose, to produce very copious fluid discharges. When employed for this purpose, it is generally mixed with the powder of asarum, or with common snuff. In affections of the eyes and ears, this errhine has been found to produce valuable effects. Dr. Barton states, that he has employed it in cases of epilepsy, gutta serena, &c., and that he can confidently recommend it as a remedy entitled to attention. In two instances in which he used it, considerable saliva- tion was produced. TURBETHUM MINERALE. 273 Various other errhines are mentioned by writers on the materia medica, but of which I consider it super- fluous to give any particular account. It will be suffi- cient merely to mention their names, the principal of which are: beta,, betonica, majorana, hedera terestris, euphorbium, origanum, achillea, ptarmica, &c. CHAPTER XIV. II. Medicines that Increase the Action of the Urinary Organs. DIURETICS. Diuretics are such remedies as promote the dis- charge of urine. Some articles of this class appear to be absorbed into the circulation, and act directly upon the secretory vessels of the kidneys; others produce their effects in a more indirect manner, acting primarily, on the stomach, and propagating a sympathetic action to the kidneys. There are others, that act by promoting absorption, augmenting thereby the quantity of serous fluid in the blood-vessels, in consequence of which, the renal emunctories are excited into increased action* That many articles of this class are absorbed into the circulation, and act directly upon the secretory ves- sels of the kidneys, is demonstrated by the re-appear- ance of these substances in the urine. 1 have, however, already dwelt particularly on this subject when speak- ing of the general modus operandi of medicines, and shall therefore not say any thing further on this point, in the present place. With regard to the latter mode of producing diuresis, that is, by exciting the action of the absorbents and inducing serous repletion of the blood-vessels, it will be proper to be more explicit. * Murray's Materia Medica. DIURETICS. 275 The emunctories of the animal system are outlets to the effete matters, or the superabundant and imperfect- ly animalized fluids, circulating in the blood-vessels. They are " the scavengers of the animal economy," whose activity is proportionate to the mass of mate- rials which is to be thrown off. If the blood be deprived of its serous parts by dropsical effusion, the skin and kidneys, being less excited to active excre- tion, on account of the deficiency of the materials which they are destined to remove, become inactive, whilst the exhalents from which the dropsical effusion takes place, continue by a sort of vicarious office to separate from the blood its watery portion. If in this state we prescribe a remedy whose effect is simply to excite the secretory vessels of the kidneys, as, for instance, squills, we will seldom produce any augmented secretion of urine, because the necessary materials for the secretion of the urine do not exist in sufficient abundance in the blood. If, however, we unite with this simple diuretic another article, possess- ing the power of exciting the re-absorption of the effused fluid, we at once stimulate the vessels of the kidneys, and furnish them with an augmented portion of the materials of secretion. It is on this account that we often derive so much advantage from the union of squills Etnd calomel in dropsy; and it is upon the same principle that the action of diuretics is increased by copious draughts of mild diluents. The system appears to be equally incapable of bearing with impu- nity, too small or too large a portion of serous fluid in the blood. As soon as this part of the circulating mass becomes more than ordinarily augmented, the kidneys or the skin are excited into action to reduce its quantity; and hence, we often excite the action of the kidneys, by indulging our patients in the free use 276 DIURETICS. of milk drinks. But although diluents are certainly useful, in cases of dropsy, to excite the action of the kidneys, yet when once this effect is produced, and the absorption of the effused fluid takes place, they ought to be less liberally used, since, by supplying the blood- vessels with a sufficient quantity of watery fluid, there will be less demand made upon the absorbents, and consequently a slower reduction of the dropsical effusion. The action of diuretics is also promoted, in full and phlogistic habits, by whatever lessens arterial excite- ment, or diminishes the quantity of fluid circulating in the system. Thus, bleeding and cathartics sometimes do essential service, in this way. There is no contra- diction, in this statement, to the one made above,— that copious draughts of diluents often increase the efficacy of diuretics, by furnishing the vessels with a more abundant share of watery fluids. In opposite states of the system these contrary means produce, indeed, precisely similar results. They both increase diuresis by favouring the absorption of watery fluid. The only difference that subsists between bleeding and plentiful dilution in this respect is, that the former in- creases the activity of the absorbents, and lessens the rapidity of serous effusion, whilst the latter acts simply by furnishing the absorbents of the alimentary canal with a greater quantity of fluid for absorption. It must also be observed that bleeding and catharsis can only be useful in this respect in cases where the blood- vessels are full and active; whilst, on the contrary, copious draughts of bland liquids are particularly suitable, where the system is less plethoric, and the blood has already been much exhausted of its serum. It is not difficult to understand in what manner the discharge of urine is augmented, by the plentiful use DIURETICS. 277 of water; but how depletion, or the reduction of arte- rial excitement, acts in increasing the vigour of the absorbents we are not able to explain. The fact, how- ever, is fully ascertained, not only by the effects of bleeding and purging in the treatment of dropsy, but also by the direct experiments of Magendie, who has recently demonstrated, what, indeed, has been noticed before, that absorption is accelerated or retarded in proportion as the quantity of fluid circulating in the blood-vessels is increased or diminished.* Much dispute existed formerly with regard to the propriety or impropriety of allowing dropsical patients to indulge freely in the use of mild and diluent drinks. Although copious draughts of water will in general increase the quantity of urine, I can, nevertheless, not believe that any essential advantage will often result from a very great indulgence in this way. For if the urine be increased by the copious use of drink, it is to be observed, that the source of this increase is not so much in the absorption of the dropsical fluid deposited in the cavities of the body, as in the absorption of the water taken into the stomach and bowels from without. Hence it is, that, however copious the discharge of urine, dropsical swellings will often diminish but tri- flingly, or remain stationary, or even increase. To torture the patient, however, with excessive thirst, is not only useless, but absolutely pernicious. A pretty free use of mild drinks should always be allowed; thirst ought never to be suffered to become so intense as to produce general irritation. It may be observed as a general rule, that in all cases in which the blood contains an excess of serum, copious draughts of diluent drinks should be avoided. Where, on the contrary, the blood is found to contain * Journal of Experimental Phisiology, by M. Magendie. 1821. Vol. II.—2 L 278 DIURETICS. but a small proportion of serous fluid, the crassamen- tum being in excess, the free use of bland drinks may be advantageously allowed. How an increased secretion of the kidneys can re- duce dropsical accumulations, is difficult to perceive. It cannot be wholly from any direct action which di- uretic remedies may exert on the absorbent system; since we have it from very high authority* that drop- sies have been cured by the free use of diluent drinks alone; and it will hardly be contended that such a remedy could exercise any direct influence over the absorbents. I am inclined to believe that the explana- tion must be sought for in the following circumstances. When the discharge from the kidneys is much in- creased, in a case of dropsy, we not only determine the serous discharge to these emunctories, but lessen the general mass of this portion of the blood, and conse- quently lessen the effusion from the exhalents furnish- ing the dropsical fluid. Now, if the exhalation from these vessels be diminished, and the regular discharge from the kidneys be re-established, the dropsical accu- mulations must gradually disappear, although the ab- sorbents remain in the same condition, with regard to the degree of their activity. But independent of this effect of diuresis in diminishing accumulations of effused fluids, there are other results which we have reason to believe take place, concomitantly with those just men- tioned, and which still further increase the efficacy of diuretics in dropsy. I have stated above, that deple- tion favours, in a very decided way, the absorption of fluids; hence when the blood-vessels are suddenly de- prived of a portion of their serous fluid, by the action of a diuretic, nature, making an effort to sustain the * Dr. Cullen. DIURETICS. 279 necessary proportion of this component part of the circulatory mass, excites the absorbents into more vigorous action, in order to supply the deficiency which the animal economy experiences. From the great and rapid reduction of strength, pro- duced by excessive discharges of urine, as in diabetes, it is evident that the general powers of the system are much under the control of diuretic remedies. They are accordingly often employed as depletory remedies in sthenic diseases. In gout, and rheumatism especially, they have been recommended as highly useful, when employed in conjunction with cathartics. Dr. Scuda- more, speaking of the treatment of this disease, says, " In imitation of nature's efforts to remove redundant matter by the medium of the kidneys—an action, the existence of which I think myself entitled to infer from my experiments—we are to keep the corresponding treatment attentively in view; and I have invariably employed, with the greatest advantage, purgative and diuretic medicines conjointly, so that the exhalent ves- sels of the alimentary canal and the secreting function of the kidneys, are stimulated to increased action at the same time."* In the treatment of chronic dysentery too, diuretics have been prescribed with a view of determining the discharge of fluids from the intestinal vessels to those of the kidneys.t Celsus, in his account of the treatment of dysentery, says, " Et ea, quae urinam movent, si ea consecuta sunt, in aliam partem humorem avertendo prosunt."J On the principle here mentioned by Celsus, diuretics are sometimes found to produce useful results in affections of the breast and head. 1 have known a * Scudamore on Gout, p. 100. X Bampfield on Tropical Dysentery, p. 165. X Celsus, de Medicina, Lib. iv. Cap. xv. de Dysenteria. 280 DIURETICS. case of gutta serena cured by the employment of cream of tartar and calomel, in large doses, the immediate and only sensible effect of which was constant and copious diuresis. Diuretics have also been known to produce beneficial effects in certain affections of the pulmonary organs. Upon this subject Dr. Armstrong makes the following interesting observations. " The apparent benefit which I have seen to result from sudorifics and diuretics in some cases of threatened consumption, would alone seem to indicate the applicability of medicines which act upon the kidneys and skin in certain examples; but as my own experience is defective on this point, I recommend it to the notice of others, as well from practical as pathological considerations." Again, he observes: " As the skin and kidneys both closely sym- pathize with the lungs, is it probable that diseases of the latter might be benefitted by certain articles of food which operate on the former?" Diuretics are said to be a powerful auxiliary in the cure of ulcers situated on the lower extremities, and attended with cedema of the leg.* In various affections of the urinary organs, diuretic remedies are especially indicated, and often afford very decided advantages. In ulcers of the kidneys, or in- flammation of the mucous lining of the bladder and urethra, balsamic diuretics may in general be usefully employed. These appear to act, in the cure of affec- tions of this kind, by medicating the urine, which com- ing into immediate contact with the diseased part, act upon it as a local remedy. It is in this way, no doubt, that balsam copaiva and turpentine cure gonorrhoea. They impregnate the urine with their peculiar medici- *-Lond. Med. and Phys. Jour. No. 162. DIURETICS. 281 nal qualities, which, being passed through the urethra, acts upon it in the same way that injections do. If we admit, as I am fully disposed to do, that diseases do occasionally depend on a deteriorated state of the blood, we must regard diuretic remedies as a most im- portant class of medicinal agents in the cure of such diseases. The kidneys, perhaps, more than any other emunctory of the animal economy, are an outlet to such portions of the circulatory mass as are effete, or fo- reign and inimical to the regular actions of the system. We find, too, that the solution of diseases is more fre- quently attended by a critical discharge of urine than by any other of the excretions. Diuretic remedies have accordingly been recommended in a variety of chronic diseases, which appear to be accompanied by a morbid condition of the fluids; such as scurvy, elephan- tiasis, &c. In the beginning of this chapter it is stated that ca- thartics promote the operation of diuretics. It must be observed, however, that quite the contrary effect ensues from purging, when induced either by the diu- retic medicine itself, as sometimes occurs when the dose is very large, or from the simultaneous exhibition of some cathartic medicine. When purging is thus produced, a check is put to the absorption of the diu- retic remedy, in consequence of the rapidity with which it is hurried through the alimentaiy canal; and there is, moreover, a direction given to the discharge of the humours, by the intestinal exhalents. These observa- tions are particularly applicable to the saline diuretics, having a vegetable acid as a constituent. " The super- tartrate of potass, or cream of tartar, acts in well regu- lated doses, as we all know, upon the kidneys; the tar- taric acid being in this case abstracted, and assimilated by the digestive process, and the alkaline base at the same time eliminated and subsequently absorbed; but 282 FOXGLOVE. if we increase the solubility of the compound, by re- ducing it to the state of a neutral tartrate, (soluble tartar,) or by combining it with boracic acid, or some body that has a similar effect; or, what is equivalent to it, if we so increase the dose of the cream of tartar that catharsis follows its administration, then diuresis will not ensue, since no decomposition can take place under such circumstances; for it is a law of the animal economy, that the process of assimilation and absorption is arrested, or very imperfectly performed during any alvine excitement."* DIGITALIS PURPUREA.--FOXGLOVE. Under the head of narcotics, an account is given of the remediate effect of digitalis, so far as they seem to depend on its sedative virtues. In the present place, therefore, I have only to speak of it in relation to its property as a diuretic,—a property to which, indeed, it owes some of its most important medicinal effects.t * Paris's Pharmacologia. X The appearances of the urine were at one time regarded as of the ut- most consequence, in forming a proper opinion of the character of diseases. —At present this excretion is unquestionably too much neglected; by an attention to it we will often be greatly aided in our judgment of the nature of diseases. Dr. Prout, observes, "A diminished flow of urine accompa- nies active inflammation, and an inflammatory state of the system in gene- ral. The urine is invariably of a deep colour. "An increased flow of urine, or diuresis, very constantly accompanies those diseases connected with a peculiar state of nervous irritability, as hysteria. It may be also produced by certain passions of the mind, as fear. Lastly, it may be induced by local irritants acting on the urinary organs themselves. In those cases the urine is always of a pale colour. " Thus, generally speaking, nothing can be more opposite than the con- ditions of the system, and consequently the principles of practice, indicated by a diminished or increased flow of urine. Hence, they are symptoms of primary importance in all diseases in which the urine is concerned; and, whatever may be the disease, seldom fail of furnishing us with a clue to the principles upon which it is to be treated."—An Inquiry into the Nature and Treatment of Gravel, Calculus, and other Diseases connected with a De- ranged Operation of the Urinary Organs. Lond. 1821,^. 35. FOXGLOVE. 283 The diuretic powers of this medicine, seem to be entirely independent of its narcotic effects. It is even stated by some very eminent writers, that its diuretic and narcotic operations are incompatible. Dr. Ferriar observes, " that when given in such quantities as to excite nausea, or to produce evident narcotic effects, it does not operate as a diuretic." Withering expresses the same opinion. Although it must be admitted that the sedative and diuretic powers of digitalis are very generally exerted independently of each other, yet there can be no doubt, that though not necessarily connected, they are occa- sionally found to act concomitantly, and are at least not incompatible * Conceiving that the curative powers of digitalis in dropsy are dependent upon its sedative effects, Blackall and Paris disapprove of the common practice of prescribing this remedy in combi- nation with calomel, since this latter article always excites the action of the heart and arteries, and is therefore inconsistent with the sedative operation of digitalis. I feel persuaded, however, that this objection is entirely hypothetical, and wholly unsupported by experience and correct observations. Were it a fact, that the diuretic effects of this medicine are dependent on its sedative powers, the impropriety of such a com- bination would be evident; but as no such dependence exists, inasmuch as the diuretic effects of the medicine are generally most conspicuously evinced, when the action of the heart and arteries is least reduced, and on the contrary, often entirely wanting, when the sedative effects are most powerful, it does not seem * Dr. Ferriar observes, " that the diuretic action of digitalis, though independent of its sedative powers, may sometimes take place in conjunc- tion with the latter, and may even co-operate with it, by its effect on the system as an evacuant."—Essay on Digitalis. 284 FOXGLOVE. reasonable to ascribe any unfavourable consequences, to the mere stimulant effects of calomel upon the diuretic operation of digitalis, with which it is, some- times, combined. Although digitalis occasionally acts very powerfully as a diuretic, it is not to be regarded as very certain in its operation. In general, where it produces any good effects in dropsy, it does not require a long time before it manifests its diuretic powers. Dr. Ferriar observes, in relation to this point: " if no beneficial effects be perceivable in the course of a few days, I exchange the digitalis for some other diuretic." I have myself repeatedly noticed this circumstance, in my experience with this remedy; and I believe, that it will seldom be proper to continue it more than seven or eight days, if no manifest diuretic effects ensue. Great diversity of opinion exists, among writers, concerning the remediate powers of this medicine in hydropic diseases. Some physicians, of eminence, have extolled its virtues in the most extravagant terms; whilst others have not been willing to concede to it any properties, in this respect, whatever. The weight of good testimony is, however, in favour of the anti- hydropic virtues of this article, and almost all agree in opinion, at present, that, though not very commonly adequate to the cure of dropsy, it is nevertheless a remedy of valuable powers, and deserving of particular attention in the treatment of such affections. Dropsy is a disease by no means so uniform in its character and causes as is generally supposed. It arises in the most opposite states of the system, with regard to vascular action and repletion; it may depend on various organic affections; or appear as a conse- quence of different acute and chronic diseases; and the urinary secretion varies essentially, in character, in FOXGLOVE. 285 different cases. These circumstances point out some diversity in the character of the disease itself, and it is not reasonable to suppose, that any particular remedy is equally applicable to the disease under all these diversities of disposition. It appears, indeed, from the experience of physicians, that digitalis is peculiarly under the influence of circumstances of this kind, and hence, no doubt, have arisen the contradictory state- ments that have been made by writers concerning the anti-hydropic effects of this medicine. By Dr. Withering we are informed, that, in his practice, the digitalis seldom succeeded in curing ascites or ana- sarca, in persons of tense fibre and great general strength of system; on the contrary, however, it hardly ever failed to produce conspicuous diuresis, in persons having a feeble or intermitting pulse, much laxity of fibre, with a pale countenance and cold skin. Dr. Maclean, in his excellent work on hydrothorax, con- firms these observations, and observes, in addition to what Withering has said, that he seldom derived any benefit from the medicine in persons of a fat corpulent habit, connected with a dull, sluggish, inirritable fibre, but. that he generally succeeded well in relieving those of a "weak, delicate, irritable constitution, with a thin, soft, smooth skin, which in the anasarcous limb is transparent." Dr. Thomas states, that in cases where the urine does not coagulate by heat, he usually found digitalis unsuccessful; where the viscerae were sound, however, or the habit not entirly depraved, he found it to suc- ceed. He also observes, that when the digestive organs fail, and there is. frequent sickness or diarrhoea, with a bad habit of body, the use of this remedy has ap- peared to be injurious. With regard to its relative value in hydrothorax, ascites, and anasarca, the evi- Vol. II.—2 M 286 FOXGLOVE. dence of practitioners is contradictory, and does not afford any conclusions worthy of confidence. Dr. Blackall, who has paid very great attention to the different varieties of dropsy, and especially to circum- stances connected with the urinary secretion, observes, that in dropsies consequent to scarlatina, in which he invariably found the urine to coagulate by heat, he derived important advantages from the use of digitalis, in conjunction with blootl-letting. As digitalis, generally, operates most beneficially in dropsy, when united with other diuretic or hydragogue remedies, it is not commonly employed alone, but com- bined, usually, with calomel, squills, Dover's powder, cream of tartar, &c. Dr. Ferriar was in the habit of giving cream of tartar early in the morning, in doses sufficient to purge, and digitalis with opium, in increase ing doses, every evening. If there was naturally a tendency to purging, he gave the digitalis "in half- grain doses, at intervals of five, six, or eight hours, with the usual precautions." I have seldom employed this medicine by itself in dropsy. My practice has almost invariably been to combine it with acetate of potass or squills, and frequently also with calomel and Dover's powder, as directed by Dr. Ferriar.* Squills and the saline diuretics appear to be particularly qualified to increase the diuretic properties of digitalis. The reason of this does not appear to be very difficult to explain, if we adopt the opinion expressed by Dr. Maclean concerning the modus operandi of this medi- cine as a diuretic. He regards the beneficial effects of digitalis, in dropsy, as dependent mainly upon its powers of increasing the activity of the absorbents. * The formula which Dr. Ferriar generally used, contains pulv. digitalis gr. 1-2, calomel gr. i. pulv. Doveri gr. viii. made into pills. To be taken at bed-time, and repeated during the day according to circumstances. FOXGLOVE. 287 This opinion derives very considerable support from the fact, that this remedy very rarely produces any diuretic effects in persons unaffected by dropsical effu- sions, and in whom, consequently, no sudden repletion of the vessels, by absorption, can take place. The same circumstance takes place with regard to the ope- ration of calomel. In subjects where no effusion exists this remedy hardly ever manifests any diuretic opera- tion. In persons, however, labouring under dropsical collections, the diuretic effects of this medicine are often very powerful and sudden. These effects can hardly be explained upon any other principle than the absorp- tion of the dropsical collections, in consequence of which the vessels become suddenly overcharged with serous fluid, which is eliminated either by the bowels in the form of a diarrhoea, or by the salivary glands, or by the kidneys. If these views be correct, and I am much inclined to put confidence in them, the fact that squills and some of the saline diuretics have a tendency to increase the diuretic operation of digitalis, would appear to be explicable upon the principles mentioned in the preliminary observations to this chapter; namely, that whilst the absorption of the effused fluid is in- creased by the action of the digitalis, and consequently a greater portion of serum poured into the blood-ves- sels, the other remedies act more immediately upon the kidneys, and increase their functions, by which the ab- sorbed fluid is again discharged. From this view of the subject we see, too, why calomel has a greater tendency to increase the diuretic effect of squills than of digitalis; for with the former it produces the double and direct effects of absorption and renal action, whilst with the latter it can only produce increased ab- sorption, which may or may not excite the action of the kidneys. The best form for administering this medicine with a 288 FOXGLOVE. view to its diuretic operation is, an infusion of the leaves. The infusion of digitalis, directed by the Lon- don and Edinburgh Dispensatory, may be taken in the dose of from §ss. to3i. twice a day, and gradually increas- ed, until symptoms arise which require its suspension, such as slow pulse, accompanied with nausea, palpita- tions, faintness, purging, and great prostration. Dr. Blackall, in his excellent treatise on dropsies, mentions another symptom of the undue effects of this medicine, which it may be of importance to bear in mind; he states that the continued use of digitalis, or an over- dose of it, occasionally produces a tensive pain of the head, extending sometimes over one eye, and attended with a disturbance of the brain, which precedes other bad symptoms, and which, if not attended to and speedily obviated, often terminates in convulsions or death. Its narcotic effects, when too violent, are best coun- teracted by stimulants, such as brandy and water, opium, and volatile alkali, &c. The sulphate of iron, and the infusion of cinchona, produce precipitates, when added to the infusion of digitalis. Formulas. R.—Pulv. digitalis Calomel aa Qi. Pulv. scillae 9ii. Conserv. rosar. Dose, one pill three times daily. R.—Acid tartar q. s__M. Divide into twenty pills. Sodae carbon gr. xxiv. Infus. digitalis fl. Spir. nitr. dulc. Tinct. scillae |ss. . gtt.x. Aq. menthae ' gii.-M. Dr. James Johnson re- commends this mixture as a valuable diuretic in ascites. The whole of the mixture is to be taken at once, and repeated twice or three times daily. R.—Pulv. digitalis gr. xii. Calomel gr. viii. Pulv. doveri. gr. xxxii___M. Divide into eight equal powders. Take one every six hours, in hydropic cases attended with gastric or intestinal irritation. 289 SCILLiE RADIX.--SCILLA MARITIMA.--SQ.UILL ROOT.* This is one of the most certain, efficacious and valu- able diuretics we possess. Like digitalis it is rendered much more active in its operation as a diuretic, by combining it with some other articles of this class, and particularly by giving'it in union with calomel. I have already spoken of the propriety of uniting it with calo- mel, in cases where we wish to evacuate dropsical effusions. The squill seems to increase diuresis by stimulating the kidneys to invigorated action, and calomel, it is well known, has a powerful tendency to promote absorption. By uniting these articles together, therefore, we obtain a remedy which enables us at once to excite the action of the absorbents and the kidneys, and thus, in the most effectual manner, promote the removal of dropsical collections. The late Dr. Home of Edinburgh supposed that the diuretic effects of this medicine were greatly enhanced by uniting it with such articles as are capable of promoting its emetic opera- tion ; or by giving it in sufficient doses to produce decided impressions on the stomach and bowels. Di- rectly the reverse of this opinion was strenuously advo- cated by Dr. Cullen, who maintained that the diuretic effects of the squill are generally much less conspicuous when it operates strongly on the stomach and intes- tines, than when it produces no sensible operation on these organs. The reason of this he conceived to be, that by such effects on the howels the medicine is "prevented entering the blood vessels, and thereby reaching the kidneys." Whether we admit this expla- nation or not, the fact is, I believe, fully established that not only this, but every other article belonging to * A particular account of the natural history of this root has already been given under the head of Emetics. 290 SQJJILL ROOT. this class of remedies, is less apt to produce diuresis when it either purges or vomits, than when no such effects are produced. Upon this subject Dr. Blackall observes, " it never operates sO favourably as when it is given in the fullest quantity which the patient can bear without sickness." This corresponds with the experience of other writers who* speak of this remedy. It appears to be admitted on all hands, that the remedy is, in general, more apt to afford relief in hydrothorax, than in any of the other varieties of dropsy.* " In the early stage of this disorder," says Dr. Blackall, "medi- cal treatment does a great deal, principally by means of diuretics: and squills is by far the most powerful of them." "It is particularly useful," he says, "where, with an oppression of the chest, the urine is scanty, high-coloured, full of sediment, and without serum. Its use, however, is not limited to this state; I have some- times seen it render service where the urine is partially coagulable. But in proportion as that symptom becomes more marked by its extreme constitutional characters, inflammation, and a weakness of the diges- tive organs, it fails in its effect, or is even injurious." He recommends it to be given, at first, in doses of thirty drops of the vinegar or tincture, three times a day, and gradually increased to forty or fifty drops. When it does not act entirely as it could be wished, " the addition of a grain of calomel," says the same writer, " every night, is frequently followed by a great flow of urine at the same time that the salivary glands are effected." Dr. Maclean, also, speaks in very high terms of the efficacy of squills and calomel in hydro- thorax. I have, myself, uniformly obtained more ad- vantage, in this disease, from these two articles in union with nitre, than from any other diuretic I have ever * Blackall, Maclean, Van Swieten, &c. SQUILL ROOT. 291 employed. Such a combination is particularly effica- cious, when it produces inflammation of the gums and the glands about the throat. The reason why calomel and squills are more apt to afford relief in hydrothorax than in the other varieties of dropsy, may be owing to a threefold operation: it promotes absorption, excites the urinary discharge, and, by determining the circula- tion particularly to the glands of the mouth and throat, ft causes a derivation from the exhalents of the pleura, and thereby lessens the dropsical exhalation. The exhalents of the cavity of the thorax, would be more likely to be influenced by such an afflux to the glands of the mouth and throat, than those situated more remotely, and hence, perhaps, arises the more speedy relief which is commonly procured in hydrothorax by such a combination of remedies, than in ascites and anasarca. The expectorant operation of squills, is also a circumstance which would seem to render it more suitable in dropsies of the chest than the other diuretics. The diuretic operation of squills is said to be assisted by the mistura ammoniaci and spiritus aetheris vitrio- lici ;* and Dr. Ferriar observes, that " in some habits the combination of tincture of squills, with syrup of buckthorn, proves very powerfully diuretic." Dose: from one to four grains, in substance. Tinc- ture and vinegar of squills, from thirty to sixty drops. Formulae. R.—Pulv. scillae Qi. ---- nitrat. potass, gii. Calomel gr. v.—M. Divide into ten equal parts. Dose, one powder every four hours. R.—Pulv. scillae gr. viii. ----pip. nigr. gr. x. ----nitr. potass, gr. xviii. Calomel gr. iv. P. opii gr. ii.—M. Divide into three equal parts. Takf * Blackall. 292 MEADOW SAFFRON. one every morning, noon, and evening. According to Richter, this is a peculiarly useful diuretic in hydropic cases, attended "with much languor and relaxation of the system. R.—Pulv. scillae gr. xv. Calomel gr. v. Pulv. doveri Qii.—M. Divide into ten equal parts. Take one three times daily. This mixture is well adapted to hydropic cases, at- tended with gastric or intestinal irritations. COLCHICUM AUTUMNALE.--MEADOW SAFFRON. The colchicum autumnale is a perennial plant, grow- ing in abundance in the temperate climate of Europe, and may be conveniently cultivated in our gardens. " The root is a double succulent bulb. The flower is large, of a purple colour, and comes directly from the root. The leaves appear in spring, and are radical and spear-shaped. Corolla consisting of a simple petal, divided into six lance-shaped erect segments. Capsule three-lobed, divided into three cells, containing globu- lar seeds, which are not ripened until the ensuing spring, when the capsule rises above the ground upon a strong peduncle. It flowers in autumn, when the old bulb begins to decay, and a new* one is formed. In the following May the new bulb is perfect, and the old one wasted and corrugated. The roots are dug for use in the beginning of summer.* When fresh, the root possesses extremely active powers, producing, according to the observations of Stoerk, when taken in a dose less than a grain, "a burning heat and pain in the stomach and bowels, strangury, tenesmus, thirst, total loss of appetite," and in larger doses, violent and even fatal effects. Its active principle resides in a milky fluid, and consists of a peculiar alkaline principle, similar to the veratria obtained from the white hellebore. It contains ex- * Thornton's Family Herbal. MEADOW SAFFRON. 293 tractive matter, " which, when in solution, undergoes a chemical change." It has been ascertained by Sir E. Home, that the deposit which takes place in the vinous infusion, produces nausea and griping, and that the efficacy of the medicine is not destroyed by re- moving the deposit. The alkaline principle exists in combination with gallic acid;* which, when snuffed into the nose produces violent sneezing, and vomiting and purging when swallowed. Colchicum, taken in duly regulated doses, acts as a sedative upon the nervous and sanguiferous systems, allaying inflammatory pain, and moderating the action of the heart and arteries. It possesses also considerable diuretic properties, and when taken in full or frequently repeated doses, it pro- duces nausea and copious purging. Neither of these evacuant effects are, however, very constant results of its exhibition, nor does it appear that they are essential to its remediate influence, in many of the diseases for which it is prescribed. It is thought by many, that the colchicum autumnale, which has of late become so important a remedy, is the hermodactylus of the ancients. This appears, indeed, very probable, when we compare the description which Dioscorides gives of colchicum, with Withering's ac- count of the English meadowr saffron. They agree perfectly in giving the very same distinguishing marks to the plant which they respectively describe. Now Serapion, in his description of hermodactylus, employs " the very words in which Dioscorides describes col- chicum."! It is therefore quite evident, that these writers must have had the same plant in view in their * Annals de Chimie, torn, xiv., Mai, 1821. f Medical Sketches, B. G. Kerr. From this little work I have drawn the principal part of my historical account of this plant. Vol. II.—2 N 294 MEADOW SAFFRON. descriptions. It appears, also, that in England, at no very remote period, colchicum was known by the name of hermodactylus. "In an English translation of Wirtzung's Praxis Medicinae Universalis, printed in the time of Queen Elizabeth, we have the following pas- sage : ' Hermodactylus, in Greek colchycum, in Latin ephemerum deleterium. Our common hermodactylus is the hermodactyle root and true colchycum, which Galen calleth ephemerum deleterium.' "* And Sir John Hill says, in his British Herbal, that " no one who has seen the hermodactylus of the east, and compared it with the meadow saffron of England, can for a mo- ment doubt that they are the same plant." The colchicum was in high repute among the an- cients, and prescribed for the very diseases in which it is at present so much commended. It had, however, nearly sunk into total neglect, when Mr. Want of Lon- don, within a few years past, again brought it into notice, as forming the active principle of the eau medi- cinale, D'Husson so much extolled for its remediate powers in gout. This opinion concerning the identity of the colchicum and the eau medicinale, is advocated by Sir Everard Home, in a paper published in the Phi- losophical Transactions ;t but is strongly contested by Scudamore and others. Be this as it may, it seems to be conceded very generally, that the colchicum is a remedy of great pow- ers in gout and rheumatism. It is not, however, allowed on all hands to be always a very safe remedy. It is stated, by very high authority, that although generally speedily effectual in removing the local symptoms of pain and inflammation in gout, it has a tendency " to leave the disposition to the disease much stronger in * Medical Sketches, by B. G. Kerr. f Part ii. 1816. MEADOW SAFFRON. 295 the system, and lead to still more calamitous, because still more constant pains of the chronic form of the disease."* This writer, however, does not disapprove of col- chicum when properly administered, but speaks of it, on the contrary, in terms of confidence and praise. When given in the subjoined formula,t " it produces all the good effects," he says, " of which the medicine in its other forms is capable, and is not chargeable with any one ill consequence." I have, myself, employed the colchicum, both in acute and chronic gout, and in most cases with prompt and complete success. Its remedial powers, in gouty inflammation, are indeed very extraordinary. I have known violent attacks of acute gout, completely sub- dued, in the course of twenty-four hours, by its use; and in no instance have I witnessed any injurious con- sequences to result from its employment. Colchicum is also a valuable remedy in rheumatism. Its use was, at first, entirely restricted to the chronic and sub-acute forms of the disease. Experience, how- ever, has shown, that it may be safely and often very beneficially administered, even in the most inflamma- tory cases of the complaint. When administered in acute cases, until it excites purging, it seldom fails to moderate the local inflammation, and general arte- rial excitement, rendering the pulse smaller, softer and less frequent, and mitigating, very considerably, the severity of the pain. Mr. Haden asserts, that in his practice, " it has proved itself a remedy of eminent power, in controlling the action of the heart and arte- * Scudamore on Gout, p. 108. Amer. edit. | R. Magnes grs. xv. ad xx. magnes sulphat. ^i. ad gii. aceti colchici 31. ad £ii. with distilled water most agreeable, and sweetened with syrup. To be taken at once, and repeated every four or six hours. 296 MEADOW SAFFRON. ries, and in curing those states of the constitution which we are taught to name diseases of excitement."* In pure inflammations, he says, if given every four hours until it purges freely, the pulse will become nearly natural, from being either quick and hard, or slow and full. The form in which he employed this remedy is a powder, composed of one part of pow- dered colchicum, three of carbonate of potash, and five of sulphate of potash. Of this he gave one drachm three or four times a day, in half a pint of warm water, in the state of effervescence, with tar- taric or citric acid. If this fail to move the bowels freely by the second or third day, he gave salts or the infusion of senna to quicken its operation. As the strength of this preparation must depend much on the manner in which the colchicum is dried, and as, more- over, its active powers are much weakened by this process, it is evident, that the remedy must be hable to great variations of strength. Professor Chelius states, that while patients affected with gout or rheu- matism make use of colchicum, a very remarkable increase of lithic acid takes place in the urine; and he attributes to this circumstance the great benefits which it produces in these affections. With regard to the employment of colchicum, with a view to its diuretic operation, late experience does not appear to speak much in its favour. By baron Stcerck, however, it was regarded as a very powerful diuretic, and exceedingly useful in dropsy. Having ascertained by experiments on himself that the oxymel of colchicum taken in doses of a tea-spoonful, pro- duced copious discharges of urine, he made trial of * Practical Observations on the Colchicum Autumnale, as a general remedy of great power in the treatment of Inflammatory Diseases, both acute and chronic, &c, by Charles T. Haden, surgeon, 1820. MEADOW SAFFRON. 297 this remedy " in the hospital at Vienna, in desperate hydropic and other serous disorders, in which it was always found to act without disturbance as a most potent diuretic, after the common medicines employed with that intention had failed." He commenced with a drachm twice a day, and gradually increased the dose to an ounce, and occasionally an ounce and a half a day. I have seen it employed in one case of dropsy only, and in this instance it excited copious diuresis, without, however, effectually removing the disease. This remedy has also been recommended in humoral asthma; of its powers in this disease, however, there is nothing extant, so far as I can ascertain, which is calculated to attract the attention of the profession. Chelius states, that he has employed this article with signal advantage in rheumatic ophthalmia, and in articular dropsies. He has, also, derived great benefit from its use, in prosophagia, and in paralysis of the inferior extremities, produced by an arthritic cause. Within the last year, the seeds of the colchicum autumnale have been introduced to the attention of the profession, as a remedy of extraordinary powers in the cure of chronic rheumatism, and greatly superior in every respect to the root of this plant. Dr. W. H. Williams, of Ipswich, in England, to whom the credit is due of having first brought before the profession the remediate properties of the seed, says: " Much as the powers of the root of this plant have been extolled by different writers, I cannot omit this opportunity of declaring my decided conviction, that, however suc- cessfully different preparations of it may have been occasionally administered, its uncertain effects, the violence sometimes accompanying its operation, the little reliance to be placed upon the experiments hitherto made to ascertain the exact period of the perfection of 298 MEADOW SAFFRON. the bulb, and the deterioration it frequently undergoes in keeping, are objections so weighty, that its value in the materia medica is insignificant, compared with the immense advantages attending the exhibition of the seeds." He states that he exhibited the vinum semi- num colchici* to a great many patients, some of whom were severely afflicted with chronic rheumatism, and he declares that he was astonished by the rapidity with which the pains were removed and the use of the limbs restored. He directs it to be given two or three hours after breakfast, and repeated at bed-time. "With respect, more especially, to the vinum seminum col- chici," he says, " of the safety of which I have experienced much abundant proof, I cannot contem- plate an extensive use of it in many painful diseases, besides chronic rheumatism, without entertaining the hope and belief that we have at length found the happy desideratum; a powerful, yet mild medicine, capable of substituting calmness, tranquillity, and balmy sleep, in the place of pain, weariness, and restless nights—a renovation of long lost limbs, and comparatively robust health, in lieu of feebleness and emaciation."! I fear, however, that this flattering account of the sanative virtues of our remedy will not be verified to the full * R.—Sem. colch. autumn, siccat. gii. Vini Hispanici (Sherry Angl.) Octan. i. Digere per dies octo vel decern, subinde agitando, dein per chartam cola, et in vasi probe clauso usui serva. Dose, gi. twice a day, gradually in- creased to giii. Dr. Williams states, that " the acidum aceticum and the spiritus ammoniae aromaticus, imbibe the powers of the seeds in the same proportion as sherry; that an abundant aqueous extract may be obtained from the seeds, but no oil, and the water distilled from them appears totally inactive." X Observations, with Cases illustrative of the salutary powers of the Seed of Colchicum Autumnale, &c. &c. by William Henry Williams, M. D. F. L. S. Sec London Medical Repository for August, 1820, and June, 1821. MEADOW SAFFRON. 299 extent. There can, nevertheless, be no doubt, from the statements we have had, that it possesses very active powers; and although it is not probably entitled to the high encomiums bestowed upon it, there are just grounds to expect from it very important remediate results. The flowers, also, possess the peculiar medicinal virtues of the seed and bulb. It has, indeed, been asserted, that the flowers furnish the mildest and most efficacious preparations of this plant. The editor of the London Medical Repository states, that " from the experiments which he has made, he was entirely satisfied, that the eau medicinale is nothing else than a tincture prepared of the flowers of colchicum. Dr. Paris thinks, " that acids and oxygenating sub- stances render the vinous infusion drastic; on the contrary, alkalies render its principles more soluble, and its operation more mild, but not less efficacious." The saturated vinous tincture is given in the dose of from a half to one drachm. Mr. Richard Battley, chemist, of London, who ap- pears to have paid very particular attention to the nature and properties of this root, and the best time for taking it, says, " that this root is deprived of its power, progressively, from the time of throwing out the new bulb until its final disappearance; and that, although very little change of appearance occurs during the winter months, it really undergoes a decided change during that period; that August before the new bulb is thrown out, is the proper season to procure the root; and that the various opinions, as to the medicinal properties of colchicum, have proceeded from the various states in which it has been brought into use. " The root, when dug up in August, should be imme- diately cut into transverse slues, equal in thickness to 300 NICOTIANA TABACUM. a half crown; to be then exposed, in wicker baskets without placing the pieces in contact, to a temperature of 170° to 180°, and so to remain until dried, which will require from two to three hours."* NICOTIANA TABACUM. Tobacco possesses very considerable diuretic pro- perties, but on account of its extremely unpleasant and sickening effects, it is seldom employed as an internal remedy. Dr. Fowler, who has written a work on the employment of this remedy in dropsy and dysury, speaks very highly of its efficacy in these diseases. He recommends it to be used in the form of an infusion; and observes that the best time for administering it is about two hours before dinner, and on going to bed. Dr. Ferriar also employed it in some cases with suc- cess ; though he does not speak of it as deserving much confidence. He gave it occasionally, in combination with other diuretics,f giving at the same time purging doses of cream of tartar in the morning. He states that he succeeded in several very unfavourable cases by this plan of treatment, and he thinks " that the ac- tion of the kidneys may in general be excited in this manner." I have employed the tincture of tobacco in two cases of dropsy, and although considerable diuresis was produced, no permanent advantage was gained. Tobacco has also been recommended in nephritis cal- culosa, and of late by Mr. Earle, in retention of urine from stricture. Under the head of narcotics, I have * London Medical Repository, for July, 1820. X R.—Oxymel colchic. Oxymel scilla?. Tinct. nicotian. Spi. aether, nitros aa p. ae. misce. capeat cochleare parvulum ex aquae pauxillo quater in die. LYTTA VESICATORIA. 301 already spoken of Its employment in this way; to which the reader is referred for a particular account of its various remediate powers. LYTTA VESICATORIA. Under the head of epispastics, I have given a par- ticular account of the chemical character, and of the external employment of cantharides, and shall therefore confine myself in the present place, to a consideration of its powers as an internal remedy. Cantharides are a very ancient article of the materia medica. Hippo- crates speaks of their internal employment in dropsy and amenorrhcea, and they are particularly mentioned in the writings of Dioscorides, Galen, and Pliny. When taken internally, in an excessive dose, can- tharides occasion a burning sensation in the fauces, throat, and stomach, producing. inflammation of the intestines, and frequently blisters of the mouth and oesophagus. The heart and arteries are greatly ex- cited, the pulse becoming full and hard, and the skin hot, like in inflammatory fever; the thirst is excessive and unquenchable; great anxiety is experienced, at- tended with retching, vomiting, diarrhoea, pains in the bowels, back, and joints, itching of the skin, vertigo, and syncope. But the most distressing and prominent operation of this article is its action upon the urinary organs. It produces, when taken in an over-dose, inflammation of the neck of the bladder and urethra, occasioning thereby the most painful dysury; the urine comes off drop by drop, being generally mixed with blood, and attended with excruciating pain; sometimes an entire suppression of it takes place, accompanied with the most distressing efforts to micturate. These symptoms are generally accompanied by the most Vol. II.—2 O 302 LYTTA VESICATORIA. tormenting erections. These are the effects of the medicine when exhibited in exorbitant doses; when employed in small ones, instead of producing difficult and painful discharges of urine, or its total suppression, it excites a copious diuresis, and may often be very usefully employed where the evacuation is to be pro- moted. Cantharides have been recommended as a very useful remedy in typhus aud malignant fevers. Home administered the tincture with wine whey; and Ettmuller states, that he has often derived important advantage from the use of this tincture in malignant nervous fevers. Reil, also, speaks very favourably of the employment of this remedy in fevers, attended with torpor and prostration; and Jahn (Mat. Med. vol. i. p. 500) asserts, that he has administered it in conjunc- tion with camphor and calomel, with signal advantage in malignant fevers. In cases of dropsy attended with a weak and languid circulation, cantharides will frequently produce very good effects. It appears to be more especially useful in those cases of anasarcous effusions, which sometimes supervene in persons recovering from scarlatina and other acute fevers. Dr. Ferriar reports some cases of this kind which speedily yielded to the conjoint employment of bark and tincture of cantharides. In anasarca, attended with a slugglish state of the circu- lation, Bucholz employed a mixture composed of two drachms of antimonial wine and half a drachm of tinct. cantharides, with the happiest effect. Hufeland, also, administered this mixture in similar cases with decided benefit. Cantharides have been recommended as particularly serviceable in hydrothorax, accompanied with a re- laxed habit of body. They are also mentioned by some writers as serviceable in humoral asthma, and in LYTTA VESICATORIA. 303 other chronic affections of the breast. Burdach says, that cantharides in union with bark, or opium, or aether, are very serviceable in chin-cough, after it has already continued for a considerable time, and is attended with considerable atony of the general system. It should be given so as to excite slight pain in passing urine. From what I have seen in my own practice, I am strongly inclined to believe that cantharides may be usefully employed in incipient phthisis, when it occurs in young females of relaxed habits of body, and suffer- ing from amenorrhoea. In the cedema which often accompanies suppression of menses* in young chlorotic females, I have found the tincture of cantharides, with bark, a most useful remedy. By this remedy we at once invigorate the general system, promote the action of the kidneys, and determine the circulation to the uterine vessels, and thereby frequently reinstate the catamenia, and with them health. From their powerful tendency to act upon the uri- nary organs, cantharides have been much employed both for the cure of incontinence of urine and suppress- ion of this discharge from torpor or paralysis of the bladder. Nothing, indeed, has as yet been discovered which is so effectual in the former of these affections as this remedy. Where the incontinence arises from a paralysis of the sphincter of the bladder, we in general derive essential advantage from cantharides, given to the extent of producing slight strangury. It is equally serviceable for that species of incontinence of urine which many young people experience during sleep. We thus not only strengthen the sphincter muscles of the bladder, but greatly increase the sensibility of the neck of this organ, as well as of the upper part of the urethra, in consequence of which these parts contract * See what is said of this remedy in the chapter of Emmenagogues. 304 LYTTA VESICATORIA. the moment the urine comes in contact and irritates them, and thereby prevent its escape. An excellent mode of employing cantharides for affections of this kind is, to apply them externally, in the form of plaster, to the sacrum.* Cantharides were formerly a good deal employed in gonorrhoea and gleet. Of late they have again been particularly recommended in the latter affection and in leucorrhcea. In the second volume of the Edinburgh Medical and Surgical Journal, Dr. Robertson has pub- lished an interesting paper on the employment of can- tharides in these diseases. In gleet I have derived the most satisfactory results from this remedy. It is ne- cessary, however, to give it in doses sufficiently power- ful to produce a considerable ardor urinae, and this effect should be sustained for some time. I have been less successful with the remedy in fluor albus: though in some cases I have known it to produce unequivocal good effects. " There is no article of the materia medica," says Dr. Hosack, " used in any individual disease, the value of which ought to be estimated more highly than lytta in cases of seminal weakness and impotency." The introduction of this remedy in cases of this kind, in the United States, is due to Dr. Francis, of New York. In a letter which I have lately received from him, he observes: " My experience of the remediate powers of the cantharides, and its perfect safety and innocence, when given to a great extent, is such, that I administer it in doses of two or three drachms a day, and on some occasions have given it to the amount of one, two, or three ounces in twenty-four hours. I have not yet * Of the use of Blisters applied to the region of the Os Sacrum, in the cure of Incontinence of Urine, &c, by Thos. Dickson, M. D. Medical Observat. and Inquir. art. xxvii. vol.. 2. LYTTA VESICATORIA. 305 failed in a single case of impotence, though I have had instances of this dreadful disease of four, five, or six years standing." Dr. Hosack mentions a remarkable case of this kind which came under the care of Dr. Francis and himself. It was induced by the misman- agement of a neglected syphilis, and the injudicious use of strong lead injections. The patient was reduced to such a state of mental anguish as to induce him to seek a termination from his wretchedness by self-destruction. " With this view he took nearly six ounces of the tinc- ture of cantharides during the night. Yet no danger- ous symptoms occurred: he admitted he felt a degree of wannth throughout his body to which he had been a stranger, and that his mind was less depressed than before the commission of this act of folly." He was now induced to take two drachms and a half of the tincture of cantharides three times a day in union with a dessert-spoonful of the tincture of amara, and to use a generous diet. In the course of three weeks he was completely relieved; " his virile powers resumed their wonted vigour, nor has he to the slightest degree re- lapsed into his former state of weakness."* It appears from experience, says Dr. Robertson, that the quantity of lytta requisite to keep up the irritation in the urinary organs is always proportionate to the " existing debility either of the general habit or of the generative organs." The use of cantharides in cases of this kind must not be soon relinquished if they should not immediately produce any obvious amendment. " Perseverance in the use of the remedy," says Dr. Hosack, " is a prac- tical precept that must here be enforced. The extent to which it may be carried would, unaided by expe- rience, seem incredible. Cures have been effected within a few days; at other times, from peculiarity of * Appendix to Thomas's Practice, sixth edit. p. 1034. 306 BALSAM COPAIBA. condition, as many months or years have been required to accomplish the object in view." Cantharides have also been recommended in cuta- neous eruptions. Mr. Mead* and Dr. Carmichael men- tion their success in this respect. It does not appear, however, that the remedy possesses any particular powers in cases of this kind. The strangury produced by cantharides is best ob- viated by copious draughts of bland liquids, such as flaxseed tea, gum arabic water, decoctions of barley, melon seeds, &c. The dose of cantharides in substance is from one to two grains. It is best given with opium or extract of hyoscyamus. The tincture may be given from thirty to sixty drops. In cases of poisoning from cantharides, it has been recommended to exhibit large doses of sweet oil; but the experiments of Dr. Pallas and Orfila prove that this is an exceedingly improper remedy in accidents of this kind. According to the experiments of the latter, cantharides macerated in cold oil, will, when exhibited to dogs, kill them in a few minutes. This depends on the property which oil possesses of dissolving the active principle of cantharides.t BALSAM COPAIBA. The treej which affords this resinous liquid, grows spontaneously at Guiana, Brazil, in the country around Tolu, and in the Spanish West Indies. Deep incisions are made in the trunk of the tree, from which the bal- sam flows in considerable abundance. When it first * Medica Sacra, p. 24. | Journal de Pharmacie, Nov. 1822. X Copaifera Officinalis, Linn. BALSAM COPAIBAE. 307 issues from the tree it is very liquid, and nearly colour- less. On being kept, however, it acquires the consist- ence of oil, and assumes a pale golden colour. Although susceptible of considerable inspissation, it never be- comes solid. Its taste is aromatic, acrid, and bitter; and its odour fragrant and peculiar. It is always transparent, whatever be the degree of its consistency. By distillation with water it affords a very odorous pale coloured essential oil, leaving an insipid resinous substance. The action of sulphuric acid on this bal- sam destroys its transparency, and gives it a very dis- agreeable odour.* In water it is quite insoluble; but alcohol, and the expressed and essential oils, dissolve it with facility. It forms white saponaceous compounds with the pure alkalies, soluble in water. The resin, when entirely deprived of the oil, is hard, brittle, trans- parent, of a greenish brown colour, and without taste or smell. When the resin and oil are mixed in proper proportions, they form a liquid identical with the origi- nal fluid balsam. If the balsam copaibae be triturated with a sixteenth of its weight of magnesia, and suffered to stand, it gradually acquires a solid consistence. The oil, by re-distillation becomes colourless, lighter than water, possessing the odour and taste of the copaibae, and entirely freed from oxygen, since potassium placed in it, is completely preserved from combustion or oxy- genation. Balsam copaiva is a stimulant diuretic, imparting to the urine a bitter taste and peculiar smell; in large doses it acts pretty powerfully as a cathartic, and in exorbitant doses, it sometimes produces " a sort of vi- bratory feeling in the brain, or causes a febrile anxiety, with a mental disturbance bordering on insanity."! * Alibert, Elemens de Therapeutique, torn. ii. p. 341. X Dr. J. Armstrong. 308 BALSAM COPAIBvE. The free use of this remedy is sometimes followed by an eruption like the nettle-rash, especially when it dis- orders the stomach. It has seldom been employed simply with a view to its diuretic operation, although in some diseases of the mucous linings of the urinary and genital organs, it is a remedy of unquestionable utility. In the cure of gonorrhoea, the reputation of this substance has long been very considerable, and it seems, indeed, to be very well founded. Many practi- tioners depend almost exclusively on its employment in this disease, and my own experience, independent of the authority of others, leads me to place very great confidence in its powers. Dr. Armstrong, in his work on scarlet fever, makes some excellent observations on the mode of administering this remedy in virulent gonorrhoea. This article, he says, " has been so gene- rally restricted to the advanced stages, that so far as I know, there is only one writer who advises it, and that by a short paragraph, in the inflammatory state." He recommends it as generally a speedy and effectual remedy " in the primary as well as in the last stage of gonorrhoea," and states that he derived his knowledge of the efficacy of its early use in this disease from Dr. Pearson Dawson, " who had prescribed it with great success for more than twelve years, in the very com- mencement of virulent gonorrhoea."* Dr. Armstrong gives it, at first, in doses of sixty drops, formed into an emulsion with sugar, mucilage, and water, repeated every morning and evening. The dose must some- times be increased to the amount of three, four, or five * Dr. Chapman in his Therapeutics recommends precisely the same practice. He seems, however, not to have read what Dr. Armstrong had said on this subject; for he speaks of the practice here recommended as peculiar to himself, and does not refer to the work of Dr. Armstrong. BALSAM COPAIBA. 309 drachms in twenty-four hours. To be entirely effectual the use of the copaiva should always be continued for a week or ten days after the discharge ceases. When there exists much ardor urinae, the copaiva may be allowed to act pretty freely on the bowels. To restrain its purgative operation, where this becomes trouble- some, some laudanum should be given with it. The good effects of this remedy will be much pro- moted by an antiphlogistic regimen, rest, and clean- liness. These remarks on the use of copaiva in gonorrhoea, are drawn from Dr. Armstrong's excellent account of his experience with this remedy. For several years past I have pursued this plan of treat- ment, and I am fully satisfied that it will in general be found much more effectual, and certainly less apt to produce injurious consequences, than the common practice of employing strong astringent injections. I have, however, frequently employed, conjointly with the copaiva, injections of very weak solutions of sugar of lead, especially towards the end of the disease; and it has appeared to me that the cure has been expedited and confirmed thereby. In the gonorrhoea of females, the balsam copaiva is less useful than in males. This is easily accounted for, when we advert to the circumstance, that in the latter, the urine, which becomes strongly impregnated with the balsam, passes immediately over the diseased surface of the urethra, and thus acts in a manner like an injection on the affected parts. In the female, however, no such immediate local impression can take place, inasmuch as the vagina, and not the urethra, is the part principally affected. That the urine becomes medicated by the copaiva is beyond a doubt, both from the taste and odour which it acquires in persons who take it; nor do we see any reason to suppose that a Vol. II.—2 P 310 BALSAM COPAIBAE. medicated fluid passing along the urethra from the bladder outwards, should not be as effectual, as if it passed from a syringe inwards. Balsam copaiva has also been recommended as a very useful remedy in chronic inflammation of the bronchia, and similar affections. Dr. Armstrong con- siders it among the best remedies we possess in affec- tions of this kind. " It seems," he observes," in many cases, to exert a specific influence over the mucous membrane of the trachea and its branches; it increases the flow of urine; it not unfrequently keeps the bowels regularly open, and sometimes it acts upon the skin, causing an itching or an irruption." I have employ- ed this article in a few cases of what I considered chronic inflammation of the bronchia; but its effects were not such as to induce me to think a great deal of its powers in this way. Dr. Armstrong observes, that the copaiva sometimes produces an itching or erup- tion of the skin, both of which frequently alleviate the cough very much. This remedy, combined with sul- phur, was much employed by Morgagni in chronic pulmonary diseases, and Dr. Armstrong states, that he has often exhibited such a combination with manifest advantage* This balsam has also been recommended as a useful remedy in chronic inflammation of the mucous membrane of the alimentary canal. In chronic diarrhoea I have known it to produce very excellent effects. When this disease depends on mere chronic inflammation, without ulceration of the mucous mem- brane of the colon, copaiba administered in conjunction with small doses of opium, may be regarded as among our most useful remedies. When employed in this complaint, the copaiba ought to be given in small doses. Richter recommends a mixture of equal parts * Armstrong on Pulmonary Consumption, p. 274, 2d edit. PIPER CUBEBA. 311 of bals. copaiba, ol. terebinth, and ol. succin. rectificat, as an efficacious remedy for involuntary emission of semen during sleep. Thirty drops of this mixture is to be taken three times daily, and the dose gradually increased until it amounts to sixty drops. To render it more pleasant, and less apt to offend the stomach, it may be very conveniently formed into a mixture with the yelk of egg, or mucilage and water.* It is very frequently found in an adulterated state in the shops. M. Bucholz says, that it is impure if it do not dissolve in a mixture of four parts of pure alcohol and one of rectified aether. Rape oil, says Dr. Paris, is often mixed with it, " in which case, if dropped into the water, the drops will not retain their spherical form, as they invariably will, if pure." Formulae. R.—Bals. copaib. £vi. Vitel. ovor. No. iii. Syrup Limonis §ii. Aq. fontanae §iv. Ax. menthae §i.—M. Dose, a table-spoonful, three or four times daily. R.—Bals. copaib. fss. Extract, oicutae gii. Pulv. rad. rhaei gi. Pulv. g. arab. q. s.—M. Divide into three grain pills. Take from three to six, four times daily. PIPER CUBEBA. This plant is a native of Java, the Philippine Islands, of Guinea, and the Isle of France, and furnishes the cubebs of commerce, an article which has lately at- tracted considerable attention as a remedy in certain * Bals. copaiv. ^ss. spt. lavend. compt. spt. nit. dulc. aa £ii. laud. £i. g. arab. gii. aq. font. §iv.—M. Dose, a table-spoonful morning, noon, and night. 312 PIPER CUBEBA. diseases. The cubebs, which are the berries of the plant, are of a light brown colour, wrinkled on the surface, about the size of black pepper, and furnished each with a slender pedicle. According to the ana- lysis of Vauquelin, they contain: 1. A volatile oil, which is nearly solid. 2. Resin resembling that of balsam copaiva. 3. A portion of another and coloured resin. 4. A coloured gummy matter. 5. An extractive principle, similar to that contained in leguminous plants. 6. Saline substances.* The cubebs are a warm and aromatic stimulant. In some persons they are mildly aperient, but in others they produce a contrary effect. Taken in the dose of from one to two drachms, they are considerably diu- retic, giving a deeper tinge and peculiar odour to the urine. Within a few years past this article has been highly recommended by some practitioners, in the cure of gonorrhoea. Mr. Jeffreys, senior surgeon of St. George's and St. James' General Dispensary, London, has lately published the result of his experience with the cubebs in this disease, from which it appears that out of twenty-seven cases which were treated with this remedy, eighteen were cured, six relieved, and three failed/!* In only three of the cases cured did the disease continue beyond the twelfth day. The majority of cases were well before the eighth day. Dr. Jeffreys thinks that this remedy is more decidedly beneficial in the more inflammatory form of the disease. He observes, also, that the good effects of the medicine commonly begin to show themselves within forty-eight hours after the exhibition of the first dose; and that in those cases which yield only partially to its influence, the disease is put in such a state as to dispose it to * Annals of Philosophy, for March, 1822. X Practical Observations on the use of Cubebs, p. 64. CAHINCA ROOT. 313 yield more readily to the balsam copaiva. Several other writers of respectability have published favoura- ble reports of the effects of cubebs in gonorrhoea. I have myself employed it in perhaps a dozen cases; and have found it decidedly beneficial in some instancse. The general result of my experience with it, however, does not lead me to regard it as superior, or even equal, to the pure balsam copaiva administered in large doses. The cubebs have also been prescribed with advan- tage in leucorrhoea. Dr. Trail of Liverpool, states that he has employed it in this disease, and that, in every instance, he has found it to mitigate the violence of the complaint, and in several cases to remove it entirely. The cubebs may be given either in the form of pow- der or of tincture. The former is given in doses of from si. to siii. two or three times daily. From one to two or three drachms of the tincture* is given three or four times during twenty-four hours. CHIOCOCCA VEL CAHINCA.--CAHINCA ROOT. The plant which affords the cahinca root is a native of Brazil, and is said by A. Richard, to be the chio- cocca racemosa of Linnaeus. This root, as it occurs in commerce, consists of cylindrical pieces, from one to three feet in length, of the thickness of a quill, and of a reddish-brown colour. They are composed of a thin whitish bark, covered externally with a brown cuticle, and of an internal ligneous portion, forming * The tincture may be made according to this formula: R.—Bacc. piper, cubeb. 3;iii. Syiritus vini tenu. O. i. Digere per dies septem, et cola. 314 CAHINCA ROOT. nearly the whole substance of the root. The external or cortical part, is of a resinous character, having a disagreeable, bitter, and somewhat acrid and astringent taste. The internal ligneous portion is entirely taste- less. Mixed with the genuine root other pieces " are sometimes found, derived either from the branches of the stem above ground, or from those which run along the ground and have taken root. They are distin- guishable from the true root, by being straighter and more regular, and presenting a medullary canal in their centre. The taste, too, is much weaker, and they appear to be less active." The medicinal virtues of the root appear to be en- tirely confined to its cortical portion. Both water and alcohol extract them completely. According to the analysis made by MM. Pelletier and Coventou, the ca- hinca contains: 1. A crystallizable substance, in which the bitter principle of the root resides. 2. A green fatty matter, of a nauseous odour. 3. A yellow colour- ing matter; and 4. A coloured viscid substance. The crystallizable substance is said to possess the proper- ties of an acid, and has hence been denominated cahincic acid by Pelletier and Caventou. This peculiar substance, which appears to contain all the active pro- perties of the root, " is white, without smell, of a taste at first scarcely perceptible, but afterwards extremely bitter and slightly astringent; of difficult solubility in water, but readily soluble in alcohol; permanent in the air, and unaltered at the temperature of boiling water. It reddens vegetable blues, and unites with alkalies, but does not form crystallizable compounds. The form in which it exists in the root, is thought to be that of a sub-cahincate of lime." (U. States Dispensatory.) The cahinca root is as yet but little known or em- ployed as a medicine in this country. It possesses APIUM PETROSELINUM. 315 stimulant, diuretic, purgative and emetic powers. It was introduced to the notice of the European pro- fession, in 1826, by M. Langsdorff, Russian Consul at Rio Janeiro, as a most efficacious remedy in dropsy. Since that time several accounts have been published, both in Europe and in this country, of its successful employment in this disease. Its remedial powers, in this respect, have been particularly illustrated by M. Francois of Paris. He has employed it with speedy and complete success in several very severe cases; and he declares his conviction, that it is superior to all other remedies we possess in hydropic affections. When given in full doses, it excites an increased flow of urine, and causes copious discharges from the bowels. I have employed it in two cases of ascites, with highly favourable results. The aqueous extract may be given in the quantity of from six to twenty grains. It may also be conveniently administered in the form of decoction.* The cahincic acid has lately been employed, and it is said to be much more certain and uniform in its operation than either the extract decoction, or powdered root. APIUM PETROSELINUM. This, the common parsley of the gardens, possesses very considerable diuretic properties, and is much used, as such, in domestic practice. The root has an agree- able sweetish taste, and the whole plant is slightly pungent and aromatic The root is considerably more diuretic than the other parts of the plant, as I have frequently had occasion to observe in my practice. * R.—Rad. cahincae §ii. Aq. bullient. rbissi—M. Boil down to gviii. Of this a table- spoonful is to be taken three or four times daily. 316 BUCHU LEAVES. Given in the form of decoction, it seldom fails to pro- duce a very considerable increase of urine. I have employed it very advantageously in suppressions of urine, and particularly in the strangury which some- times supervenes on the use of cantharides and tur- pentine. I have • also known it to give considerable relief in nephritic affections, attended with painful micturition. I have commonly prescribed it together with the malva rotundifolia, or with water-melon seeds. These additions are especially suitable in cases of strangury. It in general lies easy on the stomach, and is by no means unpleasant to the taste. DIOSMA CRENATA.--FOLIA.--BUCHU LEAVES. This plant is a native of the southern extremity of Africa, and is particularly abundant at the Cape of Good Hope. It is a small evergreen shrub, seldom rising above three feet in height, furnished with a num- ber of verticilated branches bearing lanceolate, crenate, and coriaceous leaves, dotted on their under surface. The flowers are large, white, consisting of a five-parted calix and ten unequal petals. The fruit is a stellate capsule, containing a great number of black shining seeds. The leaves are the only part of the plant used for medicinal purposes. They are from three quarters to an inch in length, about, three or four lines broad, elip- tical or lanceolate, and very finely notched at the edges. The upper surface is smooth and of a green colour; beneath they are much paler and punctuated. In con- sistence, they resemble the leaves of the uva ursi. They have a strong, diffusive, and somewhat aromatic odour, and a bitterish and warm taste, analogous to that of mint. According to Cadet de Gassicourt, the buchu BUCHU LEAVES. 317 leaves contain 6.65 parts of a light, brownish-yellow oil, 211.7 of gum, 51.7 of extractive, 11. of chlorophylle, and 22.51 of resin. Their virtues are readily and com- pletely extracted both by water and alcohol. The buchu leaves possess stimulant, diaphoretic, and diuretic properties. Among the natives of the Cape of Good Hope, they have long been esteemed as a reme- dy of various and valuable powers. Within the last seven or eight years, they have been considerably em- ployed in England and on the continent of Europe, and they have also, recently, attracted some attention in this country. These leaves have a peculiar and very decided tendency to operate on the urinary organs, producing effects analogous to those caused by the uva ursi. In chronic inflammation of the mucous membrane of the bladder, they have been employed with the happiest effects. In a case of this kind, attended with a very copious discharge of mucus from the bladder, I derived decided advantage from the use of this remedy. It has also been administered with great benefit in chro- nic nephritic affections, in morbid sensibility and irri- tation of the neck of the bladder, in disease of the pros- trate gland, and in retention or incontinence of urine, " from loss of tone in the parts concerned in the evacu- ation." From the accounts which have been published, of the effects of this remedy in diseases of this kind, as well as from my own experience, I have been led to regard it as worthy of particular attention in the treat- ment of urinary affections. The buchu leaves have also been recommended as an efficacious remedy in chronic rheumatism, in diseases of the skin, and in leucorrhcea. In the latter affection I have employed the saturated tincture, with very evi- dent advantage. Vol. 11.—2 Q 318 WILD carrot. From twenty to forty grains of the powder may be taken three times daily. The infusion prepared of half an ounce of the leaves, with a pint of boiling water, may be administered in doses of from one to two fluid ounces. Of the saturated tincture, I have given a tea- spoonful three times daily. DAUCUS CAROTA.--WILD CARROT. The wild carrot grows in very great abundance in many parts of the United States. In the vicinity of this city, particularly, it is one of the most common plants. The seeds of this species of carrot have a warm and moderately pungent taste, and a very agree- able aromatic odour. They are considerably diuretic, and are much used by the country people in suppres- sions of urine and painful micturition. In my own practice I have derived the most unequivocal advantage from an infusion of these seeds in anasarcous swellings of the lower extremities. They have also been employ- ed with success in the other varieties of dropsy. In a consultation letter which I received from the late Dr. Wistar, in the case of the late Judge Yeates of Lan- caster, who laboured under hydrothorax, the doctor observes: "The wild carrot seeds, in infusion, have also been sometimes successful in hydrothorax." They hardly ever fail to produce pretty copious diuresis; and an infusion of them may be drunk to almost any extent, without nauseating the stomach. The common, garden carrot is also applicable to useful medicinal purposes. When boiled and beaten into a pulp, it forms an excellent cataplasm to ill-condi- tioned ulcers. "A marmalade of carrots, on account of their strong antiseptic qualities, has been success- fully used for preventing and curing the sea-scurvy. ERIGERON HETEROPHYLLUM. 319 An infusion of these roots has also been found to afford considerable relief to persons afflicted with the stone and worms, but especially the tape worm. It may be given to the extent of a pint a day."* This plant is figured in Barton's Med. Bot. vol. i. ERIGERON HETEROPHYLLUM. This plant is common to the United States and Eu- rope ; and is found in very great abundance in almost every part of this country. It rises to the height of two or three feet; the stems are roundish, striated, pubescent, and about the thickness, below, of a pipe stem, gradually tapering towards the top, where it is divided into numerous spreading branches. The radi- cal leaves are ovate, acute, deeply toothed, and sup- ported by broad winged petioles, half the length of the leaves. The stem leaves are sessile, lanceolate, acute, deeply sinuated or remotely serrate-toothed in the mid- dle. The leaves of the branches are lanceolate, entire, and closely sessile. All the leaves, except those from the root, are ciliated at and near the base. The flow- ers, borne in terminal, rarely lateral, corymbs, are numerous, "and of the sun-flower shape. The disk or centre is bright yellow," and the rayflorets capillary, numerous, white, blue, and sometimes pale purple. It flowers from August to late in the fall.f This plant is well entitled to attention for its powers as a diuretic and antilithic. In this city it has been a good deal employed, within a few years past, in ne- phritic and gravelly affections. Dr. Physic employed it in a case of dysury, attended with great pain and irritability of the bladder, with much relief to the * Thacher's Dispensatory. X Barton's Vegetable Mat. Med. vol. i. p. 232. 320 ERIGERON HETEROPHYLLUM. patient. Dr. Wistar, in a letter to me, some years ago, says, " I once attended a gentleman who suffered with gout and hydrothorax; the squill produced great dis- turbance and pain of the stomach, and thus did more harm than good. This gentleman was greatly relieved by the infusion of scabius, which he took very freely." In another letter already referred to in the preceding article, he says, " The infusion of scabius, taken plen- tifully, once gave complete relief in a similar case, (hydrothorax, with gout,) but it has sometimes failed." I have been much in the habit of prescribing this plant in gravelly and hydropic diseases. It has sel- dom failed to produce pretty copious diuresis in my practice, and the advantages derived from it have been such as to give me a very high opinion of its reme- diate powers. It will, in general, lie easy on the stomach, and has no tendency to weaken the digestive powers. Some of my patients have even found an increase of appetite from its use, and I do not recollect an instance where it became injurious to the stomach. " My own experience," says Dr. W. P. C. Barton, " with this plant, enables me to bear testimony to its diuretic virtues. If it be not among the most powerful medicines of this class, it has the estimable property of being innocent to the stomach. I have used a strong decoction of this plant in a case of nephritis, at the Naval Hospital, and my success in this instance far exceeded my sanguine expectations, and emboldens me, with some degree of confidence, to recommend the scabius in similar cases."* The plant should be collected when in flower. The best way of using it is in decoction, of which a pint or two may be taken in twenty-four hours. For excellent * Vegetable Mat. Med. vol. i. p. 236. PIPSISSEWA. 321 figures and descriptions of the Erigeron Heterophyllum and E. Philadelphicum, see Dr. W. P. C. Barton's Vegetable Mat. Med. Vol. i. CHIMAPHILA UMBELLATA.--WINTER GREEN.--PIPSISSEWA. This plant is common throughout every part of the United States, growing in dry shady woods, and pre- serving its verdure during the winter season. The root is perennial, creeping, and of a yellowish colour. The stems are semi-procumbent, hard and woody at the base, from six to eight inches high, " and marked with the scars of the former leaves." The leaves generally grow in whorls, opposite or scattered, sub- sessile, lanceolate, somewhat wedge-shaped, acutely serrate, decurrent on the petiole, coriaceous, and of a deep shining green colour. The flowers appear in June and July, in a sort of umbel, variegated with purple and white. When chewed it imparts an aro- matic pungency to the taste, and when bruised it has a strong and unpleasant smell. This vegetable has been but recently introduced into regular practice, and from the accounts which have already been published of its efficacy in various diseases, it would appear to be entitled to much credit. Schcef speaks of it as " astringent and co-roborant," but says nothing of its diuretic qualities. During the American revolutionary war, it was employed as a tonic remedy in typhous fever. It was formerly a good deal used in some parts of the United States as a domestic remedy for rheumatism. Of late it has been introduced to the particular notice of the profession as a valuable diuretic medicine. Dr. Sommerville, of the British army, deputy inspector of the military hos- pitals in Canada, in a paper published a few years 322 PIPSISSEWA. ago, adduces some interesting facts demonstrative of its good effects in dropsical diseases. He states that the diuretic effects of a strong infusion of this herb were always very considerable, and that one patient to whom he gave it experienced an agreeable sensa- tion in the stomach soon after taking the medicine, and a very considerable increase of appetite. He states, also, that Sir Walter Farquhar employed this remedy in the case of a lady labouring under abdomi- nal dropsy, in which the diuretic effects of the medicine were very strikingly manifested. Dr. Marcet, in con- sequence of Dr. Sommerville's paper, tried the extract of this plant at Guy's Hospital, in doses of fifteen grains, with manifest advantage. Other writers speak favour- ably of this remedy as a diuretic. In my own practice I have employed it in one case only; and, although it evidently produced a considerable increase of urine, it did not afford any decided advantage. The bruised leaves will sometimes produce redness, vesication, and desquamation, when applied to the skin.* The pipsissewa has also been successfully employed in the cure of intermittents. Dr. Mitchellt relates several cases of this complaint which were effectually removed by the use of this remedy. It has also been recommended as an excellent antilithic. The late Dr. Barton says, that " all his trials and inquiries respecting this plant have convinced him that it is an important antilithic, not less so than the uva ursi." I have used it in some cases of this kind, but did not derive any particular advantage from it. I suspect that its anti- lithic powers are entitled to very little attention. * Barton's Collection towards an Essay on the Materia Medica, third edit., part ii. p. 21. X Inaugural Dissertation on the Medical Properties of the Pyrola Urn- bellata., Phila. 1803. 4, KALI PRjEPERATUM. 323 This vegetable has of late been a good deal employed in cancerous affections, and some very remarkable cases are published in testimony of its good effects in this way. Although I am perfectly satisfied of its total inutility in cases of this kind, I have, nevertheless, in several instances known its internal employment to produce excellent effects, in the cure of ill-conditioned ulcers, and venereal eruptions. It may be given in the form of a strong decoction, to the extent of a pint in twenty-four hours. The watery extract of this plant has also been employed to the extent of five scruples in twenty-four hours. SUB-CARBONAS POTASSJI.*--KALI PRjEPERATUM. Both the carbonate and sub-carbonate of potash, occasionally manifest considerable diuretic powers. Upon the subject of the modus operandi of the saline diuretics, Dr. Cullen observes, " With respect to the whole of them, it is to be observed in the first place, that as it seems to be determined, by the nature of the animal economy, that all saline substances received into the mass of blood should soon pass out again by the excretions, and particularly by that of urine, it will be obvious that, as all saline matters are more or less stimulant, they must all of them, in passing by the kidneys, be more or less diuretic." From the reap- pearance of these salts in the urine, after having been taken into the stomach, there can hardly be a doubt of the correctness of this explanation of their modus ope- randi in producing diuresis. This is rendered still more probable by the fact, that when they prove laxative, and are thereby prevented from being absorbed, by the * The chemical history of this article has already been given in the chapter of Antacids. 324 KALI PRjEPERATUM. rapidity with which they are carried out of the body through the alimentary canal, they produce little or no diuretic effect. To obtain the full diuretic operation of the neutral salts, it is therefore necessary to exhibit them in such small doses as to prevent them from act- ing on the bowels as a purgative, and they must be repeated at short and regular intervals. The diuretic effect of the fixed alkali is said to be enhanced by combining it with bitters, as was the custom of Sir John Pringle. Dr. Cullen observes, that by giving the alkali in this way, he " commonly found it to prove diuretic." He also adds, that" alkalies may be often prevented, by purging, from reaching the kid- neys; and that their diuretic effect may be often more certainly secured by giving an opiate at the same time." Dr. Mead was in the habit of using such a combination, and he represents the practice as a very useful one. Formerly, the carbonate of potash was much employed in the cure of dropsy. We find it recommended in the works of Dr. Ettmuller, Willis, Sydenham, Monro, Mead, Mascagni, and other writers of the early and middle periods of the last century, as an efficacious remedy in this disease. Monro speaks particularly in praise of it, when given in combination with rhubarb. " In the cure of those dropsical patients whose constitutions are so weak that they cannot bear purging, it is to be attempted," says Sydenham, " by diuretics: those are the best which are made of the lixivial salts." I have employed the carbonate of potash in combi- nation with squills, in persons labouring under hydro- thorax, attended with indigestion and acid in the stomach; it is obvious that in cases of this kind such a combination is especially indicated, and in a few instances in which I have tried it, I have had much ACETAS potass^e. 325 reason to be pleased with its effects. Dose from gr. x. to sss. ACETAS POTASS^.--SAL DIURETICUS.--TERRA FOLIATA TARTARI. This salt is obtained in foliated laminar masses; it is extremely deliquescent, and possesses a sharp and pungent taste. One ounce of water at 60° dissolves four hundred and four grains. Four parts of alcohol by weight, will dissolve one part of the salt. It con- sists of forty-five parts of potass and forty-eight of acetic acid. "It is decomposed by tamarinds and / most sub-acid fruits; by almost every acid, as well as every variety of neutral salt, whether alkaline, acid, or or metallic." This article was formerly much employed as a diu- retic; though at present its reputation as such does not appear to be very great. In combination with other diuretics it is, however, still frequently prescribed; and I have myself, in some instances, used it with evident advantage in the way recommended by Dr. Maclean in his work on hydrothorax.* Alibert, how- ever, speaks of it as a very efficacious diuretic in dropsy. " This remedy," says he, " is so well suited to the sensibility of the absorbents that its administra- tion is frequently followed by very salutary effects." He mentions a case of anasarca that was effectually cured by this remedy alone, after many other diuretics had been long tried in vain.t He observes that he * R.—Bacc. juniper, contus. %'u. infunde in aq. ferv. tbii. per horas aliquot, dein cola, colatur. adde kali acetat. gss. spir. junip. e. §ii.—M. This is to be used in draughts of about a gill, three times a day, as an adjuvant to a more active diuretic mixture composed of nitre, squills, and calomel. X Elemens de Therapeutique, vol. i. p. 327. Vol. II.—2 R 326 CREAM OF TARTAR. might cite many other cases treated in the hospital Saint Louis, which show "the remediate powers of this valuable medicine." It cannot be given in powder or pills on account of its extreme deliquescence. The dose is from £i. to 3i.; in the dose of from siii. to 3iv. it proves mildly cathartic. NITRAS POTASSjE.--NITRE.--SALTPETRE. In another place the chemical history of this salt is fully detailed, together with the various medicinal powers which it possesses independently of its diuretic operation. As a diuretic, nitre is not very powerful. It may, nevertheless, be advantageously employed, either alone, or conjointly with other diuretics, in drop- sical affections; particularly in cases attended by much arterial excitement, where it produces the twofold ad- vantage of diuresis and a reduction of the action of the heart and arteries. Alibert observes, that when given with a view to its diuretic effects, it should be administered in copious draughts of some mild liquid. When exhibited in this way, it is much more active as a diuretic, than when given in substance. The dose, as a diuretic, is from gr. x. to gr. xv. In exorbitant doses, it excites vomiting, spasms, convulsions, bloody stools, and even death. SUPER-TARTRAS POTASSjE.--CREAM OF TARTAR. I shall not repeat here what I have already said respecting the chemical character of this remedy. Possessing both hydragogue and diuretic properties, the cream of tartar would seem to be peculiarly suited to the treatment of hydropic diseases. By many, SPIRITUS jETHERIS NITROSI. 327 indeed, it is considered as one of our most efficacious remedies in such affections. When given in a large dose, it acts upon the bowels, producing copious wa- tery stools; and, at the same time, excites the kidneys to an abundant secretion of urine. By this combined operation upon the kidneys and bowels, the remedy often evinces a powerful control over dropsical accu- mulations. To increase its diuretic effects, it may be advantageously given in union with digitalis, as was practised by Dr. Ferriar. This accomplished writer observes, in those cases in which he employed the cream of tartar successfully, it operated very early, " producing an increased flow of urine within twenty- four hours. It commonly diminishes the swellings very speedily, and for the greater part, lessens the pa- tient's size more quickly than the increase of urine would lead us to expect." It is quite evident, indeed, that the power of this remedy, in evacuating dropsical accumulations, does not depend exclusively on its pro- perty of exciting the renal emunctories, but in a consi- derable degree also, on its powers to increase the action of the intestinal exhalents. Cream of tartar is apt, by frequent repetition, to weaken the digestive organs; to obviate this effect, cordials and tonics ought to be employed along with it. In doses of four to six drachms, it acts as a hydragogue: in smaller ones, it acts simply as a diuretic. To increase its diuretic operation, it should be given in solution. One drachm of the cream of tartar to a pint of boiling water, and flavoured with lemon peel and sugar, forms an excellent and cooling diuretic drink. SPIRITUS jETHERIS NITROSI. The dulcified spirits of nitre is a colourless fluid, extremely fragrant, and of a pungent acidulous taste. 328 TINCTURA MURIATIS FERRI. It consists of a portion of nitric aether and nitric acid in union with alcohol. " With the green sulphate of iron it strikes a deep olive colour, and with the tinc- tures of guaiacum it produces a green or blue co- agulum." Though by no means a very certain or active diu- retic, the sweet spirits of nitre may sometimes be administered with much advantage, as an auxiliary remedy in dropsy.* It is not, however, often employed in dropsy, and is certainly, perhaps, never to be depended on as a prin- cipal remedy in this disease. In the diseases of chil- dren, it is a very common remedy, and as it possesses considerable diaphoretic powers, it may be very use- fully employed, not only in diseases of the urinary organs, but also as a general remedy in febrile cases. As an antiphlogistic in febrile diseases attended with a dry and hot skin, the sweet spirits of nitre often pro- duces very excellent effects. It appears, indeed, to produce sedative effects, independent of the evacua- tions which it excites. When given in large and repeated doses, it seldom fails to reduce the action of the heart and arteries, and to moderate the febrile heat of the skin. From its pleasant taste it can in general be easily given to children. When administered as a diuretic it should be given in large doses, not less than three drachms at once to an adult. In doses of ten to thirty drops it acts as a gentle diaphoretic. TINCTURA MURIATIS FERRI. The muriated tincture of iron possesses consider- able diuretic powers. It has been especially recom- * Dr. Paris gives this formula, as a highly stimulating diuretic: R.—Tinct. lyttae M. x. spirit, aetheris nitrici 31. misturae camphorae gxii. syrup, zingiberis gi. t'iat haustus, ter in die sumendus. TINCTURA MURIATIS FERRI. 329 mended in suppressions of urine depending on spasm. Given in doses of ten or twelve drops every ten or fifteen minutes, it sometimes procures prompt relief in the most obstinate cases of this kind. " To the good effects of this medicine," says Dr. Thomas, "I can myself bear testimony, having tried it in some cases of spasmodic suppression with success. After six doses the urine usually flows easily." In a case of chronic dysury, attended frequently with discharges of bloody urine, and a constant feeling of uneasiness or soreness about the neck of the bladder, I prescribed this remedy with decided and permanent advantage, after a very great variety of medicines and modes of treatment had been employed with but temporary benefit. In chronic inflammation of the mucous membrane of the bladder, this tincture has been used with decided benefit. I have employed it with une- quivocal advantage in several cases of chronic catarrh of the bladder. In cases of this kind, it should be given with a considerable quantity of some mucilagi- nous fluid, such as flaxseed tea, infusion of slippery elm bark, &c. In a letter which I lately received from my friend Dr. Francis of New York, he observes, " the muriated tincture of iron is acknowledged by all as a valuable diuretic. But in cases where there is much local irritation, as in some affections of the prostrate gland, and in disorders about the neck of the bladder, its action is, at times, excessively painful. Under such circumstances," he continues, " I have found the muri- ated tincture of gold preferable. Indeed the gold deserves far more notice as a diuretic than as an anti- venereal remedy." CHAPTER XV. IODIUM.--IODINE. This substance was discovered in 1812, by M. Cour- tois, while engaged in the manufacture of soda from sea weeds. It exists naturally in various marine produc- tions, particularly in the fuci, the sponge, certain poly- pi, and the oyster. It may, also, be obtained in mi- nute quantities from sea water and from certain salt springs. Dr. William Usher discovered it in the wa- ter of the Congress Spring at Saratoga; and small quantities have been obtained from the Kenhawa saline waters. " When in solution, iodine always occurs in union with hydrogen and a base, forming a hydriodate. In sea weeds it appears to exist in the state of a hydrio- date of potassa, and it is from the ashes of these that the iodine is most readily obtained." Iodine consists of soft, friable, opake crystalline scales, of a dark colour, and somewhat metallic lustre. It has a strong odour analogous to that of chlorine, and a very acrid taste. It melts at a temperature of 225°, and boils at 347°. When exposed to a moderate de- gree of heat, it is speedily converted into a vapour, of a rich purple colour. Iodine dissolves in 7000 times its weight of water, and in a much smaller quantity of alcohol or aether. The alcoholic solution is acrid, and of a fine dark red colour; with aether it forms a deep brown solution. Iodine combines with nearly all the metallic, and with many of the non-metallic substances, IODINE. 331 forming iodides. With oxygen it forms iodous and iodic acid; and with hydrogen, a gaseous compound called hydriodic acid. Iodine may be readily detected, by starch, with which it forms an insoluble compound of a deep blue colour. This test is so delicate, that" it will indicate the presence of iodine contained in 450,000 times its weight of water. In order that this test may succeed, the iodine must be in a free state, and the solutions cold. To render it free, when it happens to be in saline com- bination, a little nitric acid must be added to the solu- tion suspected to contain it. Iodine is a powerful and valuable medicinal agent. Although very extensive in its influence on the animal system, its action appears to be especially directed on the absorbent or lymphatic system. Coindet says, that his experience with this article, upon more than two hundred patients, has convinced him, that " it is one of the most energetic excitants of the lymphatic system with which we are acquainted." It operates also as a general stimulant on the sanguiferous system, and manifestly influences, in no inconsiderable degree, the action of the secernants, " or those vessels whose func- tion it is to deposit and reproduce." Its action on the heart and arteries, however, appears to be very much under the influence of constitutional habit or physical temperament. In nervous and irritable subjects, even moderate doses generally produce considerable arterial excitement; whilst in lymphatic and torpid habits, or- dinary doses rarely produce this effect. Administered in minute doses, iodine frequently manifests decided tonic powers, giving tone to the stomach and exciting the appetite. It is also said to possess considerable emmenagogue powers. Coindet declares, that " if given in a certain dose and continued for some time, it is one 332 IODINE. of the most active emmenagogues we possess." Its powers in this respect, however, are by no means such as is asserted by Coindet. It may indeed, sometimes, restore the suppressed menstrual secretion, but its effects, in this way, are uncertain, and doubtless de- pend more on its general influence on the system, than on any direct or specific tendency to operate on the uterus. Brera observes, "that like mercury, iodine maintains a permanent action on the system, for a con- siderable time after its administration has been sus- pended. It powerfully excites the nervous system, accelerates the action of the heart and arteries, and restores the healthy functions of the sanguiferous and glandular systems. It improves the appetite, fattens the lean, and emaciates the corpulent, and directing its action, particularly on the thyroid gland and uterus, it removes the enlargements of the former, and promotes scanty, and lessens excessive menstruation." Although an article of valuable remedial powers, and under judicious management, generally free from all unpleasant effects, yet like all other energetic medici- nal agents, iodine, when administered in excessive doses, and in certain physiological states of the system, is apt to produce very distressing and alarming conse- quences. The effects which often result from its inju- dicious use are: " highly accelerated pulse, palpitation, frequent dry cough, insomnia, great loss of strength and emaciation, swelling and tremors of the lower extremi- ties, wasting of the mammae, and a continued and an- noying increase of appetite." (Coindet.) Certain indi- viduals can never take it in doses sufficient to affect the constitution, without very unpleasant consequences; such as "dimness of vision, indistinct hearing, fallacious touch, palpitation and various other nervous symptoms." (Gairdner.) Dr. Gairdner states that in a case in IODINE. 333 which the use of this remedy was pushed too far it gave rise to "gnawing pains at the stomach, great anxiety and oppression, emaciation, frequent vomiting, severe pains in the abdomen, with the most distressing thirst, and finally violent cramps and convulsive action of the muscles of the arms, back, and legs, without scarcely any intermission." In some individuals iodine produces a peculiar itch- ing or tingling sensation over the whole surface of the body; and its external application, in the form of an ointment, is said sometimes to cause a " total loss of sensation in that part of the integuments on which it is rubbed, extending itself occasionally to those parts which are supplied by the same nerves of sensation." The tendency of iodine, when its use is long continued, to cause wasting of the mammae has already been men- tioned. I have witnessed one remarkable instance of this kind. Cases have also been related in which the protracted employment of this remedy was attended with the almost entire, and even total absorption of the testicles. Although violent and dangerous effects may result from the careless or improper use of this article, it is, nevertheless, a.remedy of important medicinal powers, and, under due circumspection and judicious manage- ment, may be employed without the least risk of dan- gerous consequences. Dr. Manson asserts that he administered it "in several hundred cases, without ever having cause for disapproving of it;" and Dr. Roots, an English physician, says, that he used it in more than three hundred cases, without any injurious effects. We may also refer to the experience of Drs. Coindet, Gairdner, Baron, Decarro, and Brera, all of whom employed this remedy extensively, without hav- ing, in any instance, witnessed injurious consequences Vol. II.—2 S 334 IODINE. to result from its operation. M. Zink states, " that as soon as the tincture of iodine became known as a cure for goitre, it was used to an enormous extent at Lau- sanne ; it was pushed so far, that I may say, without exaggeration, the tincture of iodine bottle occupied the place of the bonbonniere, for I have seen persons* carry- ing it about with them. With few exceptions it was in general use; some took it to prevent this dreadful affection. This medicine was procured at the shops without physician's prescription. This mania for iodine had some victims; but in general, much less mischief was done than might be expected from the incautious manner in which the tincture was used." (Magendie's Formulary, p. 62, sixth ed.) Iodine was first employed as a remedial agent, in the year 1819, by Dr. Coindet, of Geneva. Reflecting on the fact, that goitre had frequently disappeared under the internal employment of burnt sponge, and that the fucus vesiculosus had recently been used with equal benefit in this disease; and knowing that the latter vegetable contains a considerable portion of iodine, he concluded, that as sponge was also a marine plant, iodine was, probably, the active remedial prin- ciple in both these marine productions, and that it might be very efficiently employed in its pure and separate state. This conjecture was soon fully con- firmed by experience; and this substance is now universally acknowledged as a remedy of extraordi- nary efficacy in goitre. It has seldom been employed, even in the most inveterate and violent cases of this malady, without manifest benefit; and in a vast majority of the instances in which it has been used, the disease has gradually and completely disappeared under its influence. In scrofula, also, iodine is a remedy of valuable powers. It is particularly beneficial in dis- IODINE. 335 cussing or removing scrofulous indurations. For this purpose, it is generally employed externally, by rubbing the ointment several times daily into the enlarged lymphatic gland. In enlargement of the mammary glands of a scrofulous character, iodine has been used with the happiest effect. Dr. Gairdner states, that a case of strumous enlargement of the right breast, which had existed for two years, was entirely cured in six weeks, by rubbing the ungt. potass, hydriod. into the axilla of the affected side every night on going to bed. Dr. Coindet also asserts, that he has repeatedly resorted to this remedy with entire success in " indolent enlargement of the glands of the breast, consequent upon delivery." Bayle (Rev. Medicale, Aug. 1828) relates several cases of enlarged mammae which yielded to the internal and external employment of iodine; one of these cases was of eighteen years standing. In enlargements of the liver and spleen, iodine has shown itself a valuable remedy. Dr. Thompson, of Louisiana, employed it with complete success in six cases of indurated enlargement of the spleen; and Dr. Cartwright, of Natchez, asserts, that he used it in cases of this kind with the happiest effect. I have myself resorted to the use of this remedy in two inveterate cases of indurated and enlarged spleen with entire success. This remedy has, moreover, been successfully used in chronic enlargement of the testi- cles. Dr. Brown, of Ohio, has related a severe and obstinate case of this kind, which yielded entirely to the influence of the iodine. (Western Jour. Med. and Phys.' Sciences, No. 3.) Dr. Gairdner states, that he has employed this remedy with very decided benefit in marasmus or strumous disease of the mesenteric glands. M. Callo- way, also, resorted to it in this affection, with the most 336 IODINE. satisfactory results. It is asserted by some writers, that iodine has been employed with entire success in scirrhous cancers. That it has been used with unequi- vocal advantage in this formidable affection, is too well attested to admit of doubt. Graefe, of Berlin, has related a case of cutaneous cancer on the left breast in a female fifty years of age, which yielded entirely to frictions with the ungt. potass, hydriod. (Graefe and Walther's Jour.) In carcinoma uteri, also, very decided benefit has been obtained from the use of this remedy. Hufeland employed it in cases of this kind with great advantage; and he states, that Dr. Hannemann prescribed it in a case, which had ad- vanced to the last stage, and in which there was a communication between the vagina and cavity of the abdomen, with surprising advantage. In certain affections of the nervous system, very decided benefit has been derived from the use of this article. Dr. Manson informs us, that he has employed it in all the different varieties of palsy with the most satisfactory results. Dr. Brown, of Ohio, used it with complete success in a case of paraplegia. It has also been successfully admininistered in chorea; but its efficacy in this affection does not appear to be re- markable. Out of seventy-two cases, in which Dr. Manson employed the remedy, eleven only were cured. Iodine appears to be entitled to considerable atten- tion as a remedy in gonorrhoea. M. Richond, in a memoir he has published on this subject, mentions a number of cases, which yielded to the influence of this remedy, after various other approved means had been ineffectually resorted to. Dr. Bell, of Philadelphia, has also used it in this complaint with satisfactory results. The iodine should not be resorted to, until the inflammatory symptoms of the disease are sub- IODINE. 337 dued. This remedy has likewise been successfully used in venereal bubo. M. Richond has related a number of cases, in which the iodine was employed with great advantage; and Drs. Cartwright and Bell prescribed it in cases of this kind, with very favourable results. Iodine would seem, moreover, to be beneficial in syphilis. Dr. Bell states, that" in ulcers of the mouth and throat, whether consecutive of syphilis, or pro- ceeding from other causes, I have derived the very best effects from iodine."* Both in amenorrhoea, and dysmenorrhcea, iodine has been administered with unequivocal benefit. It has also been employed, with complete success, in chlorosis. Coindet informs us, that in the latter affec- tion, he has prescribed this article with the happiest effect; and Dr. Bell administered it in amenorrhoea, with entire success. Magendie states (Formulary) that he prescribed the iodine in a case of supposed amenorrhoea; in about three weeks abortion took place. In leucorrhcea, very decided benefit has been obtained from this remedy. Dr. Goeden used it with success in two cases of six years duration ;t and Dr. Bell asserts, that he administered it in several cases of this complaint, with " speedy and permanently bene- ficial effects." Dr. Girnelle, also, declares that he has employed this article with peculiar satisfaction in inve- terate cases of the malady. I have myself prescribed the iodine in a number of cases of leucorrhcea; and although in the majority of instances it failed to do much good, several cases of long standing were entirely cured by its use. In a case which occurred to me about six months ago, and which had continued in * Dr. Bell's paper on Iodine. North Amer. Med. and Surg. Jour. No. 12. X North. Am. Med. & Surg. Jour. vol. ii. p. 412. 338 IODINE. an aggravated form, for about ten years, the iodine has effected a cure, which I have reason to think will be permanent. The use of the iodine was continued for nearly three months. Decided benefit has been derived from this remedy in hydropic affections. Dr. Baron, in his work on " Tuberculous Diseases," mentions a case of ovarian dropsy, in which great advantage was obtained from the use of iodine; and Dr. Gairdner declares that he witnessed an instance of this disease, which was com- pletely cured by this remedy, after the tumour had been twice tapped. In a case of this affection which came under my care, about two years ago, frictions over the ovarian tumour with ungt. potass, hydriod., caused a very considerable reduction of its size. Iodine has also been used with much advantage in certain forms of cutaneous disease. Dr. Goeden used it with success in tinea capitis; and Dr. Mandon knew it to cure a case of leprosy. The iodide of sulphur is said to be particularly efficacious in affections of this kind. Dr. Biett employed it in psoriasis, tinea favosa, and acne rosacea, with remarkable success. He em- ployed it externally in the form of an ointment, com- posed of one part of the iodide of sulphur, with sixteen, twenty, or twenty-five parts of lard. Iodine is said to have manifested very decided remedial powers in phthisis pulmonalis. Dr. Baron mentions a case, in which the existence of tubercles in the lungs could not be doubted. Under the use of iodine, the consumptive symptoms gradually subsided, until the patient's health was completely restored. Dr. Gairdner also employed this remedy in phthisis pulmo- nalis, and in several cases, its effects were decidedly beneficial. It must be observed, however, that it is only in the early or incipient stage of the disease, that IODINE. 339 any advantage can be expected from the use of this remedy; and even when thus early resorted to, the chances of success must be regarded as very limited. M. Fermon employed the following mixture in a case of phthisis, with great benefit.* The vapour of iodine has also been employed in the treatment of this dis- ease. Dr. Benton says that he has derived unequivo- cal advantage from the inhalation of iodine vapours in phthisis. The mode'of using it is as follows: "In a bottle with two tubular openings, put some diluted sulphuric acid, and project on it, daily, about half a grain of hydriodate of potassa. The iodine is imme- diately disengaged in the form of vapour, and this may be inhaled by the patient through one of the tubes of the bottle. The inhalation must be repeated from four to ten times daily, the duration of each being from four to five minutes." The usefulness of iodine in scrofulous ophthalmia, has already been noticed. It would seem, also, worthy of attention, as a remedy in iritis, and in opacities of the cornea. Drs. Manson and Cartwright employed it in both these affections with great success. In scrofulous ophthalmia attended with opacity of the cornea, Dr. Cartwright applied the ungt. potass, hydriod. twice or thrice daily to the eyelids and adjacent parts, exhibiting at the same time, the tincture of iodine internally. Great care should be taken that the ointment do not come in contact with the conjunc- tiva, as it would inevitably produce violent and painful irritation. Dr. Gendrin, of Paris, declares that he has used the iodine with extraordinary benefit in gout or arthritis. He found it especially efficacious in reducing the chronic enlargements of the joints, as well as arti- cular concretions. He applied the iodine ointment to * R.—Lettuce water, %iv. solution of hydriodate of potassa, gtt. xv. medicinal Prussic acid, gtt. x. to xv. syrup of marshmallows, 51.—Mix. Take a tea-spoonful every hour. 340 IODINE. the affected joints by frictions, and, at the same time, exhibited the tincture internally. He asserts, that in every case of gout in which this treatment was adopted, the patients were cured in a few days, or their con- dition rapidly meliorated.* Dr. Choate, of Salem, resorted to this mode of treatment in a very severe case of this affection, and the result was highly satis- factory.! Dr. Manson relates several cases of white- swelling, or fungus articuli, in which the use of iodine was attended with the happiest effect. He used it both externally in the form of a liniment, and internally. He employed it with success also, in a case of dropsy of the knee-joint. M. Zink has given an account of two cases of white-swelling, both of which were cured with the iodine. (Magendie's Formulary). We may also cite the testimony of M. Lugal and of M. Bayle in fa- vour of the excellent effects of this remedy in articular affections of this kind. It has been found equally beneficial in hip-joint disease. Dr. Manson used it in four cases, two of which were entirely cured, and the other greatly relieved. There are a great many dis- eases, besides those already mentioned, in which iodine has been found useful. Dr. Manson prescribed it in deafness, depending on chronic inflammation, and thickening of the lining-membrane of the eustachian tube, with great success. He cured also, several cases of. dysphagia with this remedy, and for the cure of fistula lacrymalis he considers it superior to any other remedy we possess. In spinal distortions he says it manifests excellent remedial powers. By keeping his patients at rest in a recumbent posture, and employing the iodine both internally and externally, by frictions over the affected part, and keeping the bowels con- stantly open by gentle laxatives, the cure was generally * See Amer. Med. Recorder, No. xlvi. 1829. X Boston Med. and Surg. Jour. No. 33. IODINE. 341 s effected in the course of two or three months. This remedy has, likewise, been successfully used in circocele. Dr. Cartwright mentions four cases of this affection which yielded to the influence of iodine. Magendie states, that he has known inveterate cases of ulceration of the tongue and pharynx, cured by the use of this remedy. Dr. Oliver, of Salem, employed it with suc- cess in several cases of angina pectoris. In polysarchia or excessive corpulency, great benefit was obtained from the use of iodine, by Dr. Graefe, of Berlin. Io- dine has been recommended in enlargement of the pros- K trate gland, and it is highly probable that much benefit might be derived from it in this distressing affection. I have, in two instances, used it with almost complete success, in chronic enlargement of the tonsils. Advan- tage might, perhaps, be derived from the use of iodine, in ozena, fungus haematodes, indolent piles, cataract, fungus of the testicle, elephantiasis, osteo sarcoma, Ace.* PHARMACEUTICAL PREPARATIONS. Tincture. R.—Iodine gss. Spirit, vini. rectificat. %i. Solution of Hydriodate of Potass. R.—Potass, hydriod. 9ii. Aq. fontanae. %i.—M. ft. solut. To form the Ioduret- ted solution, ten grains of iodine must be added to the solution of hydriod* of potass. Ointment of Hydriodate of Potass. R- —Potass, hydriod. 3ss. Adeps suillae §i___M. ft. ungt. Iodic Ointment. R. —Iodine JSS. Adeps suillae gi.—M. ft. ungt. Iodic Liniment. R.- —Liniment sapon. comp. gi. Tinct. iodin. 31.—M. ft. liniment * An Essay on the History, Preparation, and Therapeutic uses of Iodine. By Samuel J. Hobson, M. D. I have resorted freely to this ex- cellent Essay, in drawing up the present chapter. Vol. II.—2 T 342 IODINE. Iodic Pills. R.—Iodine gr. x. Micae panis. gr. v.—M. Divide into twenty pills, one to be taken twice or thrice daily. The dose of the tincture of iodine and of the solu- tion of hydriodate of potass is from six to ten drops, three times daily, and gradually increased, until it amounts to twenty-five or thirty drops. In some in- stances, indeed, it may be carried to a much greater extent, without producing any unpleasant effects on the stomach or general system. It may generally be safely increased by one drop per diem. Its effects should, however, always be carefully watched; for in some habits, even moderate doses, soon give rise to very violent symptoms. The solut. potass, hydriod. is usually much less apt to disagree with the stomach than the tincture of iodine. The iodides of mercury have recently been strongly recommended, and they are doubtless very excellent iodec preparations. They may be administered ac- cording to the following formula: Tincture of Deuto-Iodide of Mercury. R.—Deuto-iodide of mercury gr. xvi. Spirit, vini rectificat. gxiiiss.—M. Dose, from ten to twenty drops, in a glass full of distilled water, as common water readily decom- poses it. Ointment of Deuto-Iodide of Mercury. R.—Deuto-iodide mere. gr. xvi. Adeps suillae. JJxiiiss.—M. Highly recommended in the treatment of old and obstinate venereal ulcers. The proto-iodide may be used instead of the deuto-iodide of mercury. Pills of Deuto-iodide of Mercury. R.—Deuto-iodide mere. gr. i. Extract of juniper gr. x. Liquorice powder q. s.—M. Divide into eight pills. Two to be taken at first, morning and evening; increasing the dose subsequently to four. The ioduret of sulphur made into an ointment with lard, forms an excellent remedy for chronic cutaneous affections. CHAPTER XVI. III. Medicines that Alter the State of the Urinary Secretion. LITHONTRIPTICS, OR ANT1LITHICS. These are medicines capable of correcting the lithic diathesis, or of dissolving urinary calculi. The urine, even in a state of health, is by no means a simple homogeneous fluid. It contains various substances, in such proportion as to be held in permanent solution. Some of these are liable, from particular causes, to be augmented beyond the proportion which the urine is capable of holding in solution, anojgthey are therefore deposited, creating urinary sediments, gravel, and by further accretion, calculi. A disposition in the system to form such an excess of urinary sediments, is deno- minated the lithic diathesis, and constitutes a very important object of medical attention. It appears from the researches of chemists, that these urinary depositions are of very various, and even opposite characters, as they occur in different individuals,' or in the same individual, at different times and under different circumstances of health, diet, exercise, drinks, Ace. All the varieties of urinary deposits described by authors may, however, be regarded as composed of the four following elementary substances. 1. The lithic acid and its compounds. 2. The oxalate of lime. 3. The cystic oxide. 4. The earthy phos- 344 LITHONTRIPTICS. phates.# Almost all the pulverulent and amosphous sediments consist either of the lithic acids and its compounds, or of the earthy phosphates. The yel- lowish, or nut-brown, reddish brown or lateritious, or pink sediments are of the former kind. The white precipitate consists of the latter substance. The particular state of the system which favours the formation of the lithic acid or lithates, is called the lithic acid diathesis, and that which gives rise to the phosphates, the phOsphatic diathesis. What the es- sential characters of these diatheses are, it would be in vain to inquire. Observation and experience, how- ever, have given us some information with regard to the causes which favour their rise. Thus, it appears, that an excess of lithic acid is especially favoured by whatever tends to weaken the digestive organs; and especially by those causes, either dietetic or otherwise, which produce acidity in the primae viae. It is on this account that persons who live chiefly on vegetable food, are most subject to lithic acid sediments in the urine. The circumstances which appear to favour the formation of phosphatic diathesis, are, injuries done to the back, and whatever produces a nervous state of the system, as fear and mental anxiety, and also, the long use of alkaline remedies.t With regard to the * Prout on Calculous Affections, p. 110. X " A deposition of the earthy phosphates from the urine has been long observed to be attended by very distressing symptoms, though no one seems hitherto to have generalized them. They consist in great irrita- bility of the system, and derangement of the chylopoietic viscera in general; such as flatulence and nausea, obstinate costiveness, or pecu- liarly debilitating diarrhoea, or both, frequently alternating; and the stools are extremely unnatural, being either nearly black, or clay-coloured, or sometimes like yest. These are always accompanied by more or less of a sensation of pain, uneasiness, or weakness in the back and loins. There is a sallow, haggard expression of countenance; and as the disease pro- LITHONTRIPTICS. 345 influence of the ingesta on urinary deposits, Dr. Wilson Philip draws the following conclusions from an interesting and long series of experiments which he performed on this subject.* " 1. That acid and aces- cent ingesta tend to increase the deposition of lithic acid from the urine, and to prevent that of the phos- phates. 2. That a diet composed of a large propor- tion of animal food tends to lessen the deposition of lithic acid, and to increase that of the phosphates. 3. That every thing which promotes the action of the skin tends to prevent the deposition of lithic acid, and to occasion that of the phosphate. 4. That dyspepsia tends to increase the deposition of lithic acid, and to lessen that of the phosphates, both by producing acidity of the primae viae, and by rendering the skin inactive. 5. That indolence has the same tendency, both by inducing dyspepsia and by lessening the acti- vity of the skin in proportion as it impairs the vigour of the circulation. 6. That an acid passes by insensible as well as sensible perspiration." Dr. Prout observes, that " an unusually heavy meal, especially of animal food or of bread, is invariably followed by a deposition of the lithate of ammonia from the urine." From these observations it is evident that our most efficacious antilithic means, consist of such remedies as are calculated to invigorate the digestive organs, and to correct the morbid contents of the primae viae; and especially a proper attention to the nature and quantity of the food. With regard to lithontriptics, or those articles which are supposed to have the power of dissolving urinary ceeds, symptoms somewhat analogous to those of diabetes begin to appear."—Proufs Inquiry into the Nature and Treatment of Calculous Affections, p. 152. * Medical Transactions of the College of Physicians in London, vol. vi. 1820. 346 LITHONTRIPTICS. calculi, it is obvious that they can produce no solvent effect until they are brought into immediate contact with the calculi. Their modus operandi must therefore be very different from that of the antilithic remedies. These appear to produce their remediate effects chiefly by favouring healthy digestion and chyhfication, and by thus preventing the formation' in the digestive and chylopoietic organs of an undue proportion of those materials from which the urinary deposits are formed by the kidneys. The former remedies, on the other hand, pass through the circulation, and being thrown into the urinary organs, exert a solvent power upon the lithic concretes, existing in the kidneys and bladder. When we reflect how great an influence diet and the state of the digestive organs have upon the nature and quantity of urinary deposits, it would appear highly probable that the ingredients out of which these de- posits are formed by the kidneys, are prepared for them in the digestive and assimilative organs, and that they are not formed by the renal emunctories " from whatever may be presented to them indiscriminately."* If this be the fact, it is clear that the remedies which check the formation of urinary sediments act before they reach the kidneys; and that in proportion as they are adapted to restore the healthy condition of the digestive and chylopoietic organs, so are they calcu- lated to act beneficially in the lithic acid diathesis. It is very questionable, whether we possess any remedies capable of dissolving calculi existing in the urinary organs. The attempts at removing calculous concretions by remedies of this kind having hitherto, with very few exceptions, proved abortive, is a fact which sufficiently warrants the scepticism which pre- * Prout. LITHONTRIPTICS. 347 vails on this subject. Still, as it is ascertained that some substances exert an evident solvent power upon calculi out of the bladder, and as it is moreover equally well established, that these very substances, when taken internally, are absorbed and carried to the bladder, there would appear some reason to expect advantages from the employment of remedies of this kind in calculous cases. Mascagni states, that after using the carbonate of potash, he found his urine so impregnated with it as to convert the yellow colour of turmeric to a brown, and to evince no slight solvent power upon a calculus put into it. It must, however, be observed, that the alkalescence of the urine produced by the internal use of an alkali, is but very transient. Mr. Brande states, that in the experiments he made on this subject, he found "that the effects of the alkali, in becoming prominent in the urine, was at its maximum probably in less than a quarter of an hour after it had been taken into the stomach; and in less than two hours the whole of the alkali had passed off." In speculating upon the lithontriptic power of certain substances, it must not be forgotten that well attested cases are on record, in which the internal employment of such remedies was followed by a complete cessation of all the symptoms indicating the presence of urinary calculus, and where, notwithstanding, the calculus still remained in the bladder, as was ascertained by the introduction of a catheter. Early in the last century a Mrs. Stephens received a large pecuniary reward from the British parliament for discovering a remedy which she used with signal success in calculous affec- tions. It was found, however, that although her pa- tients got rid of all their painful symptoms, the calculi were not dissolved. De Haen relates a remarkable case of this kind, in which he gave, from November, 1756, to June, 1757, 348 LITHONTRIPTICS. seventeen pounds of Venitian soap, fifteen hundred pounds of lime-water, and the same quantity of milk. Under this treatment the patient gradually got better until all his calculous symptoms entirely vanished. Notwithstanding this apparent cure, the presence of a calculus was still demonstrable by the sound.* Sir E. Home mentions two cases where the symptoms had subsided under the employment of alkaline medicines, but on dissection the calculi were found of great size, imbedded in cysts. He moreover states, that in some instances the calculous concretions increased rapidly while the patients were taking these remedies regu- larly. One patient took alkaline medicines four or five years, and " at his death the bladder was found nearly filled with light spongy calculi of different sizes, not less than three hundred and fifty in number. Ano- ther who had taken soda, both mild and caustic, for some months, and then submitted to the operation on the symptoms increasing, was found to have a calcu- lus, which was surrounded with a coat of triple phos- phate one-tenth of an inch thick, the rest being a mixture of uric acid and phosphates." Whytt sup- poses that, in cases where the symptoms disappear under the use of lithontriptics, the calculi, though not dissolved, have their asperities removed, and that they are coated by a mucilaginous crust by which they are prevented from doing injury to the tender parts with which they are in contact. "Exemplo nobilissimi equitis H. Walpole aliorumque, debuit concludere si calculi non solverentur, eis tamen asperitates demi, circumvolvique crustam mucilaginosam, quae ne noceat * Calculi verus martyr sumptis libris 17 saponis Veneti, 1500 libris lactis, et 1500 libris aquae calcis, liberatus sic fuit, ab ejus symptomati- bus, ac si ultra no adesset calculus; qui tamen et post curam, et elapso post eandem anno, praesons demonstratus cathetere fuit.—Ratio Medendi, vol. i. p. 138. LlTHONTRIPTICS. 349 calculus, cfficiat."* Dr. Marcett also contends, that although little or nothing can be expected from this class of remedies, in destroying calculi already formed, '• yet in some instances the sharp edges of small calculi may be so blunted by the internal use of chemical sol- vents, as to allow them to be passed with less difficulty and inconvenience." Where, therefore, the symptoms of calculus disappear under the internal use of solvent remedies, we cannot conclude positively that the cal- culi have been dissolved and removed out of the sys- tem, especially if they be located in the kidneys, in which case we can derive no information from examina- tions with the sound. Experience is therefore decidedly opposed to the opinion which ascribes any very particular solvent power to this class of remedies. From the same source, however, we learn with equal assurance, that these remedies are often of unequivocal advantage in certain gravelly affections, and especially in counter- acting the tendency which often prevails in the system to form an excess of lithic matter with urine. I would, however, ascribe very little to the solvent power of these remedies; nor can I believe that they produce any very considerable effect by the power they may have of neutralizing the uric acid before it has time to form concretions, and thus prevent, as Mr. Brande supposes, the further increase of calculi.J The medi- cines which are most useful in this respect, tend to correct acidity in the primae viae, and to favour the digestive process; circumstances which I have already said have a very intimate relation with the generation of lithic matter by the renal emunctories. * I have not access to the works of Dr. Whytt, and therefore quote from De Haen's Ratio Medendi, vol. i. p. 136. f Marcet on Calculous Disorders. London, 1817. ± Philosophical Transactions, for 1810, Part I, Vol. II.—2 U 350 CARBONAS SODjE ET POTASSJE. In treating of the particular articles of this class of remedies, I shall have occasion to speak more especially on this point; to which, therefore, I now proceed. CARBONAS SOD.E ET POTASSjE. When we advert to what has already been stated, concerning the tendency of acid and acescent ingesta to increase the secretion of lithic acid and its com- pounds, by the kidneys; and of the influence of an acid condition of the contents of the primae viae, from indi- gestion, there can be no difficulty in perceiving that the fixed alkalies may operate beneficially in urinary depo- sitions composed of lithates or lithic acid. For, whether we admit their solvent power or not, it would appear quite reasonable to suppose, that as these urinary sedi- ments are more copiously secreted by the kidneys when morbid accumulations of acid exist in the stomach and bowels, the remedies in question would, by removing this exciting cause, tend to correct the renal secretions. I would not, however, ascribe every thing, in this re- spect, to the mere antacid properties of the alkalies. They are, undoubtedly, absorbed to a degree into the circulation, and again thrown into the urinary secre- tion, and may thus exert some remediate effect, not only by their immediate action upon the secretory vessels of the kidneys, but also, in a small degree, per- haps, by their solvent properties. Be this as it may, there can at present be but little doubt of the utility of alkaline remedies in correcting the lithic acid diathesis, or of occasionally affording relief in nephritic and cal- culous affections. It is thought by some late writers* that the alkalies are inferior to magnesia, as antilithics; and Sir E. Home * Sir E. Home, Brande, Scudamore, Prout, &c. CARBONAS SODiE ET POTASSjE. 351 accounts for their inferiority, by supposing it to depend on the greater insolubility of the magnesia, and in con- sequent longer retention in the stomach, affording it thereby a greater opportunity of counteracting " the formation of uric acid." I am much more inclined, however, to adopt the opinion of Scudamore on this subject. He contends," that although some advantage is afforded to the alimentary canal by its power of neutralizing acid matter, yet that its (magnesia) chief superiority over the alkalies depends on its purgative qualities; so much more easy is it to arrest the morbid process of digestion by a medicine which removes the cause, than by one which merely has the effect of tem- porary correction." When the lithic acid sediments prevail, we almost invariably find the digestive process out of order, and much acidity in the alimentary canal; and from what I have already said concerning the connexion between such a state of the digestive organs, and the secretion of uric acid by the kidneys, it is quite plain that the alkalies are the proper remedies. For, although it does not appear that they reach the urinary passages in sufficient quantity to exert any particular solvent power upon the pre-existing calculous matters in these organs, still, however, the prevailing tendency of the system to form lithic matter may be checked, *' by the beneficial changes which they produce during the first stages of assimilation, by neutralizing excess of acid, or other- wise disturbing those affinities, which, in the subsequent process of assimilation and secretion, give rise to cal- culous affections."* Independent of the effects which are here ascribed to the action of the alkalies, they appear to possess very considerable power in allaying the morbid irritability of the urinary passages. It is * Marcet. 352 CARBONAS S0D7E ET POTASSA. very different, however, with the white urinary sedi- ments. These, as has been observed above, consist of earthy phosphates, forming a triple compound with ammonia, and are in general unconnected with indi- gestion, and acidity in the primae viae. In urinary sediments of this description the alkalies are not only useless, but absolutely pernicious. " The white sedi- ments," says Mr. Brando, " may always be abundantly formed by alkaline medicines, and persons who habit- ually drink soda wTater, or take magnesia, are frequently voiding it. Its appearance, in the latter cases, has oftenled to serious errors. I have known soda water, exhibited in a case of a stone in the bladder, to refer abundance of white sand, which the ignorance of the patient and his medical attendant led them produce to the solvent power of the medicine upon the stone, which they thought was giving way, and being voided; whereas great mischief was doing by giving the urine more than its usual tendency to deposit the phos- phates, and consequently to augment the size of the calculus."* The alkaline carbonates are generally given in pre- ference to the pure alkalies. They appear to answer equally well, and are much less offensive to the sto- mach. " The stomach," says Dr. Paris, " appears to bear the protracted exhibition of the carbonate of pot- ass and soda with more temper than it does any other alkaline combination. From twenty to fifty grains of carb. of soda or potass may be taken two or three times a day. The liquor potassae, or sodae, may be taken in solution in doses of from gtt. xv. to gtt. 1. two or three times a day, in veal broth or table beer," which latter is said to disguise its nauseous flavour completely. * Brande's Observations on the Medico-Chemical Treatment of Calcu- lous Disorders. Quarterly Journal of Science and the Arts, No. 12. CARBONAS SOD^E ET POTASS^!. 353 Whilst pursuing a course of alkaline remedies, it will be useful occasionally to interpose a purgative medi- cine. Upon this point Dr. Paris observes, " but we must not combine it (the purgative) with the lithon- triptic, for it is a law, that catharsis suspends the pro- cess of absorption." If it were true that the antilithic power of the alkalies depended on their being absorbed and conveyed to the urinary organs, this caution would no doubt be very proper. But this is extremely doubt- ful; and it appears, moreover, that magnesia, whose powers in this way are superior to those of the alkalies, operates most beneficially when it produces a purgative operation. Besides, the existence of such a law is by no means established. Every one must, indeed, admit that while purging is going on absorption must be diminished; but it is much to be doubted whether it is suspended. Rhubarb impregnates the urine with its colour, not- withstanding its purgative operation;—here absorption is not suspended. From Mr. Brande's experiments, it appears very clearly that neither the carbonates nor sub-carbonates of the fixed alkalies exert any sensible action on uric acid; and it seems equally clear, from what this able writer says, " that an alkali administered to a calculous patient stands no chance of reaching the uric concretion in a caustic state." If these facts be correct, and there can scarcely be a doubt on this point, we have a very plausible explanation of the in- efficacy of the alkaline carbonates as solvents of urina- ry calculi. Alkaline solutions have been injected into the bladder through the urethra; I have not, however, learned that any decided advantage has been gained from such a practice. Fourcroy and Vauquelin paid particular attention to this mode of dissolving urinary calculus. 354 MAGNESIA, Incompatible substances: " acids and acidulous salts, borax, muriate of ammonia, acetate of ammonia, alum, sulphate of magnesia, lime-water, nitrate of silver, ammoniated copper, muriate of iron, submurkte and oxymuriate of mercury, acetate of lead, tartarized an- timony, tartarized iron, the sulphates of zinc, copper, iron, &c. MAGNESIA. The antilithic powers of magnesia are very consi- derable, and appear to be pretty generally acknow- ledged by the practitioners of the present day. Mr. Brande, in an interesting paper published in the Philo- sophical Transactions, first directed the attention of physicians to the efficacy of this remedy in preventing the formation of certain varieties of urinary deposi- tions. Instead of pursuing the hopeless inquiry after an efficient solvent for urinary calculi, physicians and chemists have of late endeavoured to ascertain the nature of urinary sediments, and the causes which influence their increase and decrease, " with the view of administering such preventive medicines as may indispose the system to produce those concretions, or check their growth, without altering the tone of the constitution." From some trials made by Mr. Brande, he found that magnesia diminished the quantity of uric acid in the urine more promptly and conspicuously than any of the alkalies, however largely administered. He relates four cases in which the antilithic powers of this remedy were unequivocally displayed.* The first was a gentleman whose urine was constantly highly * On the efficacy of Magnesia in preventing an increased formation of Uric Acid, &c. by W. T. Brande, M. D., in the Philosophical Transac- tions, 1810, Parti. MAGNESIA. 355 charged with uric acid, which was deposited in the form of red sand or crystals.. He successively took the subcarbonates of soda and potass without any benefit from the former, and but little from the latter. He was finally directed to take fifteen grains of mag- nesia three times a day; in a week after commencing with this remedy the uric deposits were sensibly dimin- ished. The medicine was continued for eight months, and the urinary deposit disappeared entirely. Another patient, suffering from a similar complaint, after having tried the alkalies ineffectually, was wholly cured by taking twenty grains of magnesia, night and morning, for six weeks only. The third case is that of a person who succeeded in removing repeated attacks of uric acid, by the use of magnesia. The fourth case was a confirmed calculous tendency, which yielded almost completely to the free use of magnesia. Dr. Scuda- more, whose opinion deserves great weight, does not admit the claims which are allowed to magnesia, as a remedy in gravelly affections. " I condemn," says he, " any unlimited confidence in this medicine, as being, in most cases of complaint, a very inadequate remedy for the disease which is existing. The gravel and the gout are, as it were, but symptoms of the morbid action of other parts; and the primary disease and its true cause, is to be found in the digestive organs. But the gravel has a deeper foundation than the mere produc- tion of acid matter in the alimentary canal. In these cases we must look with vigilance to the state of the stomach, of the liver, and of the bowels, and to all the digestive assimilation, in connexion with the wrong functions of the kidneys, in a manner less superficial than the rule of placing all our dependence on mag- nesia, or upon any alkaline medicine whatever, seems to imply. We shall learn that these remedies are use- 356 MAGNESIA. ful, and even important, as auxiliary parts of treatment, but that they do not deserve any higher character, or stronger dependence."* It is scarcely necessary to observe, from what has already been said, that magnesia, like the alkalies, can only be properly administered in gravelly affec- tions when the urinous precipitate is of the uric acid description; without an attention to this circumstance, the use of magnesia may become very pernicious in calculous complaints. I have lately employed this remedy in the case of a person much harassed by indigestion, and whose urine was loaded with an un- common quantity of uric acid. The vessel into which he discharged his urine was coated with a crust of this substance. I ordered him twenty-five grains of mag- nesia three times a day, with infusion of gentian and orange peel. In less than three weeks the uric de- posit had nearly disappeared; but I could not succeed in removing it wholly, although he took it for upwards of four months. Magnesia has lately been strongly recommended as a remedy for diabetes. Dr. Trotter has published an account of five cases which were effectually cured by this remedy. He directed his patients to take from one drachm and a half to two drachms of the pure magnesia in twenty-four hours. The relief obtained from it was generally very prompt, and the cure in the course of a few weeks perfect.t Since publishing the first edition of this work, I have had occasion to prescribe in two cases of diabetes. In one case, which was of long standing, but not very vio- lent, the magnesia proved effectual. In the other case, however, which was violent and rapid in its progress, * Scudamore on Gout, p. 256. f London Med. and Phys. Jour. vol. xxxix. p. 366, and vol. xlvii. p. 460. aq.ua calcis. 357 this remedy did not produce the slightest beneficial effect. AQ.UA calcis. Lime-water* was formerly much employed in cal- culous affections; and there can be no doubt of its having sometimes manifested very useful powers in these complaints. Like the two former articles, it exerts but little or no solvent power upon urinary concretions, when taken internally. It appears to act chiefly by correcting that state of the digestive organs upon which the lithic acid diathesis would seem to depend. Whytt, De Haen, Alston, and others mention cases of its successful em- ployment for the removal of the symptoms of calculous complaints. It appears that, like the alkalies, it has been known to give effectual relief in calculous com- plaints, without, however, dissolving or removing the calculus. I have already quoted a case of this kind from De Haen, and similar ones are related by Whytt, Alston, and others. In nephritic affections, depending on calculous concretions, or on too abundant a secre- tion of uric acid, the free use of lime-water will often afford great relief. Lime-water is generally directed to be given in milk to the extent of from a pint to a quart daily. Whytt gave it in combination with soap; but it does not ap- pear to be more powerful in this way, and is much more unpleasant to take, than when mixed with milk. Atten- tion must be paid to the nature of the urinary de- posit: its exhibition, where the phosphates predominate, would prove not only of no avail, but very pernicious. Lime-water has been employed for various other * Contains about 1-680 of lime. Vol. II.—2 V 358 AQUA CALCIS. remediate purposes. It has been much recommended for its good effects in diabetes. Dr. Ferriar constantly gave it as an auxiliary remedy with cinchona, opium, and uva ursi. Shutz and Wilhelm, two German wri- ters, detail cases of diabetes mellitus and insipidus, in which the use of lime-water alone proved successful.* It has also been employed with advantage in dysury depending on excess of lithic acid in the urine. In a case of this kind I prescribed it with the happiest effect. Pringle, Mar, and others recommend lime-water with milk in phthisis, and not a few cases have been reported in testimony of its efficacy. As gout is always connected with a lithic acid dia- thesis, lime-water having a tendency to counteract such a disposition, may often be usefully employed in the chronic form of the complaint. It is very advan- tageously united with bitters in gouty complaints. In the cure of obstinate scorbutic ulcers, lime-water has been known to produce very excellent effects. There is a case of this kind related in the first volume of the London Medical Observations and Inquiries, which was effectually relieved by taking three pints of lime-water every day for five months, after a multiplicity of other means had been tried without any benefit. The ulcer was of several years standing, and situated on the left leg. Hoffman asserts that there is no remedy equal to lime-water in that variety of scurvy which proceeds from the continued use of salted diet. Baumbeck speaks well of lime-water as a remedy in cancer; but it is scarcely necessary to observe, that in this respect it is not entitled to the least attention/!" It has also been found useful in chronic dysentery, leucorrhcea, and * Hufeland's Journal of Practical Medicine, vol. ii. p. 128. X Vogel. Repos. Dissertatio de curatione cancri oculti et aperti per aquam calcis vivae potam praestita. Getting. 1769. MINERAL ACIDS. 359 chlorosis. It may in general be usefully given in all cases, attended with a sluggish, phlegmatic habit of body, and an acid state of the contents of the aliment- ary canal. As an external remedy lime-water may be applied to very useful purposes. With olive oil it forms a most excellent liniment for burns and scalds; and with corro- sive sublimate, it constitutes the aqua phagedenica, a highly useful wash for foul and sluggish ulcers, particu- larly of the syphilitic kind. According to Hufeland and others, lime-water mixed with some mucilaginous decoction, forms an exceed- ingly useful injection for the removal of ascarides. If the internal use of lime-water occasions heat and thirst, the sweet spirits of nitre ought to be given two or three times a day, according to the advice of Whytt. It is, in general, useful to employ some bitter tonic infusion whilst taking the lime-water. Acid drinks must be avoided during a course of lime-water. MINERAL ACIDS. The alkalies and alkaline earths, as is stated above, are the appropriate remedies in the lithic acid diathesis. They can only be employed with propriety as antili- thics, when the urinary deposits are of the red or late- ritious kind, or in other words, consist of calculous matter, in which the uric acid predominates. As might be supposed, quite the reverse obtains in relation to the employment of the mineral acids in calculous affections. These are by no means fit remedies when the sediments are of the uric acid kind; but their antilithic power is generally unequivocally evinced in complaints in which the phosphatic diathesis prevails, and where the calcu- lous sediments are white, or of that species in which 360 MINERAL ACIDS. the earthy phosphates predominate. "When from any cause," says Mr. Brande, " this white sediment appears, the internal use of acids will, in most cases, diminish or remove it." It is asserted by those who employ the alkalies and acids in calculous complaints, on chemical principles, that the urine " has a tendency to deposit white sand whenever its natural acidity is diminished, as is shown by the addition of a little alkali to recently voided urine, which immediately throws dow7n a white powder." The modus operandi of acids in preventing such deposits would therefore appear to be easily explained; for as it is demonstrable that acids taken into the alimentary canal show themselves again in the urine, it is evident that, to obviate the deposi- tions of this white sediment, we need only to exhibit an acid internally, with a view of augmenting the acidity of the urine, and thereby enabling it better to hold its earthy phosphates in solution. Dr. Scudamore opposes the chemical theory on this subject, and maintains that the phosphates are deposited, notwithstanding the ex- istence of a free acid in the urine. "I have now arrived at the end of an extensive examination of spe- cimens of urine depositing the phosphates, and also holding them in solution, yet still having the power of reddening litmus in the usual manner."* He thinks that the mineral acids are useful in cases where the gravelly deposit consists of the earthy phosphates, simply by their tonic action on the stomach. That acids may prove advantageous in such complaints, by their tonic operation, can hardly be doubted. But if any considerable share of their good effects depended on a tonic influence, we ought, I think, to see them as efficacious in the lithic acid depositions as in those consisting of the earthy phosphates, since the former * Scudamore on the Gout, p. 256. American edit. MINERAL ACIDS. 361 are generally even more conspicuously connected with a weakened state of the digestive organs than the lat- ter. Still, however, it is undeniable, that bark, exer- cise, bitters, and mineral tonics, are often successfully employed in complaints attended with urinary deposits of this kind. " The febrile affections of children are very frequently attended by an apparently alarming deposit of white sand in the urine, and a dose of calo- mel will often carry off both the fever and sand." Whatever may be the modus operandi of mineral acids in diminishing the earthy phosphates of the urine, their utility in this way seems to be fully established. The nitric, the muriatic, and the sulphuric acids, have each been employed to check the formation of white urinary sediment. The nitric acid is thought, by Mr. Brande, to be more liable to occasion those symptoms of indigestion which are attended by flatu- lency and eructations, than the other two acids, " and in a few particular cases its long continued use has rendered the patient reluctant to food; though many instances might be cited of its tonic effects, as a pro- moter of digestion and increaser of appetite." The sulphuric acid has a much more uniformly tonic effect, and may usually be persevered in much longer than the nitric and muriatic acids, without producing griping and other disagreeable gastric affections. The muriatic acid, though mostly agreeing very well with the stomach, is apt, by long use, to act upon the bowels, and to bring on a troublesome diarrhoea. " This cir- cumstance," observes Mr. Brande, "however, often recommends it; for constipation very frequently attends the state of the body which favours the formation of white sand." " When the mineral acids agree," says this writer, " they are usually very effective, and in a few days they diminish or entirely prevent the forma- 362 MINERAL ACIDS. tion of the sabulous deposit; but where they disagree they rather increase the quantity, or they tend to the production of a mucous secretion, probably from the coats of the bladder, which envelops and is voided with the sand, and which, in particular cases, may certainly tend to increase the risk of its agglutinations, and of the formation of a concretion in the bladder. The mineral acids, too, almost always disagree with children, who are equally liable with adults to an in- creased secretion of the phosphates, and in whom prompt and effectual treatment is equally requisite to prevent the formation of a stone in the bladder."* In cases of this kind recourse must be had to the vegeta- ble acids. The tartaric acid may be given freely, either in a pure state or in combination, as in cream of tartar. From five to twenty grains of the former, and from twenty to sixty of the latter, may be administered two or three times a day. The citric acid is, however, preferable to the tartaric, and may be administered in doses of from five to sixty grains; it rarely proves inconveniently purgative, and is very effectual in mo- difying the secretion of urine. Although the vegetable acids, when properly adminis- tered, will seldom increase the phosphatic diathesis, yet it appears from the observations of the writer I have just quoted, that cases do occur where a copious white deposit is attended with a peculiar irritability of the bladder, and which are aggravated by any of the acids just mentioned. When a copious white sabulous deposit in the urine is connected with a biliary derangement, as is some- times the case, it will be best to depend rather on an acescent regimen than on medicine; "and to obviate * Brande on the Medico-Chemical Treatment of Calculous Disorders. Quarterly Journal of Science and the Arts, No. 12. CARBONIC ACID. 363 costiveness, if necessary, by an occasional dose of magnesia in a glass of sour lemonade."* CARBONIC ACID. This gaseous acid was at one time much in vogue as a solvent for urinary caiculi. It appeared from the experiments of Hales, that water impregnated with carbonic acid, has the power of gradually dissolving urinary calculi; and it was demonstrated also that, when taken into the stomach, it soon makes its appear- ance in the urine. Hence it was concluded, that by means of this aerial fluid, we might readily dissolve " human calculi while yet in the bladder;" an opinion which was zealously advocated by Percival, Saunders, and others. Whether the opinion of these men be cor- rect or not, with regard to the modus operandi of car- bonic acid, in gravelly disorders, there appears to be no reason to doubt its occasional utility in preventing the white urinary deposit. Where, from peculiar cir- cumstances, in cases of this kind, the other acids dis- agree with the patient, the carbonic acid, Mr. Brande observes, will often afford very decided advantages. This acid may be very conveniently taken, as it is dissolved in the artificial mineral waters, " or it may be administered in the form of a saline draught, in the state of effervescence; which is best done by dissolving thirty grains of carbonate of potash, and twenty grains of citric acid, in separate tea-cups of water, and then mixing the solutions in a large tumbler, and drinking the whole during effervescence. This dose may be repeated two or three times a day, or oftener if expe- dient.'^ * Brande. | Brande, Philososph. Trans., 1813, p. 213. 364 \JYJE URSI FOLIA.--BEAR BERRY. The uva ursi is an evergreen, creeping plant; with small, oblong, oval leaves, resembling very closely those of the common garden box. It is indigenous both to Europe and the United States. The leaves have an odour bearing some resemblance to that of hyson tea, and are of a bitterish and sub-astringent taste. They contain "tannin, mucilage, gallic acid, extractive, resin, and traces of lime;" and yield their active principles both to alcohol and water. The virtues of this plant are variously represented by writers on the materia medica. Alibert says, " all that can be said of this remedy is, that its action is, under certain circumstances, manifestly diuretic;" and he declares that its supposed specific power in nephritic and other diseases of the urinary passages has not the least foundation. The weight of testimony is, however, greatly in fa- vour of its remediate powers in disorders of this kind. The account given by De Haen of its efficacy in dis- eases of the urinary organs, is indeed exceedingly flattering, and although few other practitioners may have been equally successful with it, there is, notwith- standing, sufficient evidence extant to warrant us in re- garding it as a useful remedy in such diseases. De Haen relates some very remarkable instances of the successful use of uva ursi in calculous and nephritic affections. He employed it with much success, also, in a case of ulcer- ation of the penis and perineum from calculus in the bladder, and in purulent discharges from the urinary passages. He insists, however, that this remedy is wholly ineffectual in cases where there is much derange- ment of the internal urinary organs, whether from cal- BEAR BERRY. 365 culi, pus, or the too frequent and long retention of urine. " Magis confirmor," he says, " magisque in eo quod in hoc opere toties monui, nullarum earn virium esse, tibi in systemate urinoso interno multa facta fuerit, sive a calculo, sive a pure, sive ab urina, saepius diutiusque retenta, degeneratio."* He states, that in several instances of urinary calcu- lus, this remedy afforded complete relief, "although the catheter showed that the calculus still remained." It does not appear from late experience, however, that any dependence is to be placed on this remedy in cal- culi of the bladder. In nephritic affections from gravel and other cases, we have abundant proof of its utility. Dr. Ferriar, whose testimony deserves the highest re- spect, says, " I have given this remedy (uva ursi) in a considerable number of nephritic cases, in very mode- rate doses, and always with manifest advantage." It must be confessed, however, that we are by no means warranted in ascribing all the good effects of the prac- tice detailed by Dr. Ferriar to the uva ursi. He states, that " when the pain was very acute and the pulse quick, he began the cure with bleeding and a gentle purgative, composed of manna and a neutral salt. This purgative he repeated twice a week, and on the inter- mediate days directed the patient to take five grains of uva ursi, and half a grain of opium, three or four times a day.t Out of sixteen patients treated in this way he cured twelve. It is impossible to say how much of the good effects of this treatment is to be attributed to the uva ursi. That however some, perhaps a consi- derable share of the success, is to be ascribed to this remedy, may be inferred from its beneficial operation in diseases of this kind, when administered by itself, as * Ratio Medendi, vol. iii. p. 117. f Medical Histories, vol. i. p. 56. Vol. II.—2 W 366 BEAR BERRY. I have myself witnessed in a few instances. Dr. Fer- riar observes, that he never found it necessary to give it in larger doses than five grains, and that in doses of a scruple or half a drachm he found it to produce nau- sea, even when given with opium. The same circum- stance is mentioned by Lewis. "In all the cases," says he, "that have come to my knowledge, it produced great sickness and uneasiness."* In that variety of urinary disease which is attended with copious wrhite sediment in the urine, especially in the last portions discharged, occasioning pain and irri- tation in the urethra, Dr. Prout states, that " he has often seen the greatest advantage from the combined use of muriatic acid, hyosciamus, and uva ursi, together with the use of alterative purgatives." I have a patient under my care now, who has been for upwards of two years exceedingly afflicted with a pain in the region of the right kidney, attended with all the usual symptoms of renal calculus. He has been gradually getting better under the use of uva ursi and opium, in doses of twelve grains of the former with half of the latter, three times a day; and is at present almost entirely free from any symptom of his disease. The late pro- fessor Barton thought it particularly serviceable in nephritis depending on gout. " In my own nephritic paroxysm," he observes, " alternating with attacks of gout in the feet, I have certainly found the medicine of much service; and I confidently and with much pleasure recommend it to the notice and trial of other sufferers from the same affection."t Of the modus operandi of uva ursi in nephritic and calculous disorders, we are entirely uninformed; nor will I consume the reader's time by speculations upon * Materia Medica. f Barton's edition of Cullen's Materia Medica, vol. ii. p. 422. HUMULUS LUPULUS. 367 a topic which has been so fruitlessly attempted by many of the ablest physicians. The remediate employment of uva ursi has, how- ever, not been confined to affections of the urinary organs; it has been equally extolled in the cure of other maladies, particularly in diabetes, consumption, leucorrhcea, haematuria, and gonorrhoea. In the treatment of diabetes, Dr. Ferriar was in the habit of giving it in conjunction with cinchona, opium, and lime-water.* Dr. Bourne, professor of the prac- tice of physic in the University of Oxford, speaks very highly of the efficacy of uva ursi in the cure of pulmo- nary consumption. He states, that out of sixteen cases treated with this remedy, nine were cured, four relieved, and three died. This is certainly very extra- ordinary success; and is calculated to create the suspi- cion that some error in diagnosis may have occurred. He gave the medicine in ten grain doses, with half a grain of opium, three times a day.f It is best administered in the form of powder. The dose is from ten grains to one drachm. HUMULUS LUPULUS. The hop was at one time much recommended for its supposed lithontriptic properties. It has also been accused of being favourable to the production of cal- culous affections. From my own experience I can say nothing in favour of its antilithic powers. Nor do I believe that it is entitled to any attention for its pro- perties in this respect. Several of the bitter astringent * R.—Pulveris uvae ursi, corticis Peruvian, aa 9i. opii gr. ss. quater in die sumend. bibat aquae calcis §ii. postsing. dos. pulveris. X Cases of Pulmonary Consumption, &c. healed by Uva Ursi, to which are added some Practical Observations. London, 1806, p. 393. 368 HUMULUS LUPULUS. vegetable medicines have been commended for their good effects in cases of gravel and calculus. The gentiana lutea and quassia have been particularly mentioned as useful in affections of this kind. From the frequent connexion of gravel and disordered func- tion of the digestive organs, and the apparent depend- ence of the former on the latter, it is not at all unlikely that these articles may often produce bene- ficial effects in nephritic and gravelly disorders. They may in general be very usefully given conjointly with the alkaline antilithics, as has already been stated when speaking of these remedies. CHAPTER XVII. IV. Medicines that Promote the Secretory Action of the Salivary Glands. SIALAGOGUES. HYDRARGYRUS. It does not appear that the Greek and Roman physicians had any knowledge of the medicinal proper- ties of mercury. They regarded it as a dangerous poison, and excluded it from the materia medica.* It was first employed by the Arabians, as an external remedy in the itch and other cutaneous eruptions. The corrosive sublimate and red precipitate, two of the most active preparations of this metal, are men- tioned by Geber; and both Rhazes and Avincenna speak of the outward employment of mercurial reme- dies. In Europe mercury was used externally in cuta- neous disorders, as early as the twelfth century, by Gilbert, Theodoric, and others; but it was not em- ployed as an internal remedy until early in the six- teenth century, when John de Vigo first gave it in the plague. About the same time Mathiolus used it in- ternally in the cure of lues venerea; and Paracelsus adopted and advocated its employment with his char- acteristic zeal and enthusiasm. From this period the reputation of this medicine gradually extended itself, though not without great opposition; its powers be- * Auvaaj/xiv ie *x?1 0ap1nt«ii «to6sit* t« jSapsi Sict Gi£(<&a-KU