NATIONAL LIBRARY OF MEDICINE Washington Founded 1836 U. S. Department of Health, Education, and Welfare Public Health Serrice DISCOURSES ON THE ELEMENTS Therapeutics and Materia Medica. N. CHAPMAN, M. D. PROFESSOR OF THE INSTITUTES AND PRACTICE OF PHTSIC AND CLINICAl PRACTICB IN THE UNITERSITT OF PENNSTLVANIA: PRESIDENT OF THE PHILADELPHIA MEDICAL SOCIETY, &C. &C. " To communicate what I have tried, and leave the rest to others for farther inquiry, is all my design in publishing these papers." NlWTOW. VOL. I. PHILADELPHIA: PUBLISHED BY JAMES WEBSTER, NO. 10, NORTH EIGHTH ST W. Brown, Printer, Prune street. 1817. iJtUrict of feimsylvatua, to -wit. BE IT REMEMBERED, That, on the eighteenth day of October, in the forty-second year of the Independence of the United States of America, A. D. 1817, N. Chapman, of the said District, hath deposited in this office the title of a book, the right whereof he claims as pro- prietor, in the words following, to wit: " Discourses on the Elements of Therapeutics and Materia Medica. By " N. Chapman, M. D. Professor of the Institutes and Practice of Phy- " sic and Clinical Practice in the University of Pennsylvania: Presi- " dent of the Philadelphia Medical Society, &c. &c. To communicate '* what I have tried, and leave the rest to others for farther inquiry, " is all my design in publishing these papers. Newton.—Vol. I." In conformity to the act of Congress of the United States, entitled '• An act for the encouragement of learning, by securing the copies of maps, charts, and books, to the authors and proprietors of such copies, during the times therein mentioned."—And also to the act entitled " An act supplementary to an act, entitled ' An act for the encouragement of learning, by securing the copies of maps, charts, and books, to the au- * thors and proprietors of such copies, during the times therein men- tioned,' and extending the benefits thereof to the arts of designing, en- graving, and etching historical and other prints." D. CALDWELL, Clerk of the district of Pennsylvania TO JOHN SYNG DORSEY, M. D. PROFESSOR OF THE MATERIA MEDICA IN THE UNIVER SITY OF PENNSYLVANIA, &C. &C. MY DEAR SIR, Having adopted the ensuing work as the text book to your lectures, there would seem to be a propriety in my inscribing it to you. But, inde- pendently of such consideration, you have a claim to this mark of my respect and attachment, iu the very long and intimate friendship which has sub- sisted between us. Eagerly do 1 seize the present occasion, to bear testimony to your distinguished ability as a teacher, and to declare how greatly, in my opi- nion, you contribute to uphold the reputation of our School, by your diligent and successful exer- tions. With my best wishes, I am, dear sir, Very faithfully, Your friend, N. CHAPMAN PREFACE. Called, very unexpectedly, in the year eighteen hundred and thirteen, to teach the materia medi- ca in the University of Pennsylvania, I entered on the enterprize with none of the advantages which would have been derived from the previous study of the subject with this precise and definite view. After having delivered three courses of lectures on this science, I had the honour to be translated to the chair of the Institutes and Practice of Medicine in the same School. As soon as this event took place, I was pressed by the class that had formerly attended me, with an earnestness which I could not well resist, to prepare a work on the materia me- dica, or, in other words, to print my lectures. En- gaged since, in the execution of the weighty du- ties of my new appointment, and in the still more oppressive exercise of an arduous profession, I could command little or no leisure for such a pur- pose. Except, therefore, the retrenchments which were required, to reduce the work to the ordina- ry dimensions of a Text Book, and a slight revision of a few passages, I now commit my lectures to the press, in the state in which they were read, without yi PREFACE. any alteration or amendment, in the matter or style. To those, however, who heard them in the delivery, they may probably appear to have sustained an in- jury, in the loss of the facts and illustrations, thrown out in the extempore digressions, in which it is my habit very freely to indulge. No one can be more sensible than myself, how much the work suffers by this premature publica- tion. But, it could not be prevented, without vio- lating the promise to which I have alluded, and disappointing the purchaser of the manuscript, who had become exceedingly impatient of any further delay. Distinct from the motives I have assigned, I confess, that I was also infiuenced somewhat by the persuasion, perhaps a vain one, that the work, comparatively imperfect as it is, might prove not altogether unacceptable to the public, and particu- larly to the students and practitioners of physic, in the United States. It will, at least, be useful to my class, as exhibiting more than can elsewhere be met with, of my own speculative and practical views. Numerous, too, as are the treatises on the materia medica, there is no one which I have seen, precisely on the plan of mine, uniting to some of the more useful pharmaceutical details, copious practi- cal instructions, adapted to the management of dis- eases, modified, as they confessedly are, by the pe- culiarity of the state of society, and climate, of our own country. In every science, some system is required, and PREFACE. Vll in no one, perhaps, is it more necessary, than the materia medica. Consisting of an immense collec- tion of diversified materials, which are not always obviously related, it would, without a perspicuous arrangement, be greatly defective in practical utili- ty. After much deliberation, and a full comparison of the several plans of classification that have been proposed, I was induced to prefer the one which I have adopted. But I am now persuaded, that a much more natural, as well as useful arrangement of medicines, might be made, on the principle of their affinities to the several systems of the body, and should an opportunity be ever afforded me, it is the one which I shall attempt to establish. It will be perceived, that, instead of noticing in detail, as is usual with the writers on this depart- ment of physic, every individual article, I have dwelt more on the class to which it may be attach- ed, pointing out the mode of operation of the whole congeners, or kindred assortment, and their pecu- liar relations to disease. By thus treating the sub- ject, I cannot help thinking, that much greater order has been attained, and no little perplexity and tedi- ous recapitulation, avoided. But still, I have not omitted to give some account of each substance sepa- rately, to indicate its more important pharmaceutical preparations, and its medicinal virtues, when these may be different from others of the same class, to- gether with its dose, and manner of administration. Vlll PREFACE. I have also subjoined, from a small work, which has recently appeared, a list of incompatible sub- stances, or such as, when combined, produce a change of composition. In doing this, I was fully aware, that in many cases, these very changes give rise to new products, of increased efficacy : still, however, great mischief often ensues from a want of an acquaintance with the relative affinities of the articles of the materia medica, without which neatness and precision in our prescriptions,- are ut- terly unattainable. These general discussions on the modus operandi, and practical application of the several classes of medicines, are denominated Therapeutics, a province of our science exceeding- ly interesting, and which has been hitherto strange- ly neglected. There was, here, a very wide field open to me. I have sometimes been led into physiological en- quiries, and, still oftener, into discussions relative to the general nature of disease, or the peculiar character of the affection, directly before me. Dis- quisitions of this sort, though they may seem to trench upon another department, must be allowed as being indispensable to a clear and intelligible ap- plication of our remedies. Could it, indeed, be possible to convey a distinct conception of the va- rious uses of mercury, opium, bark, or of any active article of the materia medica, were we not permitted the privilege of entering so far into the history of PREFACE. IX the diseases, to which the medicine might be appro- priate, as to enable us to point out the exact circum- stances of the case in which it may be beneficially prescribed ? But, liberally as I have employed this license, I am afraid that I have not always succeed- ed in my object, and certainly, in many instances, by the apprehension of being accused of unwarrant- able digressions, I have so narrowed my limits, as to do great injustice to my own opinions, and modes of practice. As respects Nosology, I have not adhered, with strictness, to any one existing system : all attempts of this nature are marked, in my opinion, with so many absurdities, and false collocations, as to for- feit every claim to an entire and indiscriminate adoption. My own arrangement of diseases, which is according to their more prominent seats, I wish- ed more time to perfect and mature, before I offer it to the public. But though, in this instance, heed- less of the technical formalities of the Schools, I have not deviated from the established nomencla- ture of the science, nor ventured to disturb the lan- guage which seems now to be settled by common consent, and consecrated, as it were, by universal usage. By a recent writer, the materia medica has been compared to an inquisitive traveller, who, collecting every thing which interests him, on his journey, sees his baggage increase every moment, in bulk, and feels himself frequently obliged to stop and ex- b* x PREFACE. amine it, iu order to free himself from the useless articles, or to arrange, in a more convenient order, those which he cannot dispense with, that they may occupy less room, and the carriage, or the employ- ment of them, be more easy and commodious. This is a very happy and correct illustration, since sure- ly, never was a science, to continue the allusion, so overcharged with superfluous lumber, as the ma- teria medica is in its present state. xVs such is indisputably the case, I have, with intrepid decision, endeavoured to cleanse this au- gean accumulation, by expunging whatever sub- stances are known to be inert or redundant, and to retain only such as, from their powerful or effica- cious properties, are emphatically denominated the heroic remedies, or are confessed to be of unequivo- cal utility in the treatment of diseases. The practi- tioner who may wish information relative to the trite or subordinate medicines, I am content to refer to any one of the common Dispensatories. But, while thus boldly practising a system of expurgation with regard to the materia medica, 1 am by no means disposed to close the science against the introduc- tion of new articles, or such improvements as may be afforded by further enquiries, or more correct views. It will accordingly be found, that I have enlarged its boundaries by the addition of several medicines, chiefly the indigenous productions of the United States, and now and then, by expatiating PREFACE. XI more fully than heretofore has been done, on the properties and uses of some of the older articles. Having expressly treated, in one of the subse- quent discourses, of the improvement of the materia medica, I shall not here retouch the subject, inte- resting as it is in every view, and greatly as my re- flections upon it might be extended. Yet, I cannot forbear from again pressing upon our physicians, who are so advantageously distributed for the pur- pose throughout the country, the strong claims which the profession, as well as the cause of hu- manity, has upon them, to devote more attention to the study of our native plants. Enough, surely, has been done in this field of exertion, to afford the am- plest encouragement, and to facilitate further re- searches. To what I have elsewhere noticed, as already accomplished, may now be added a work on the American materia medica, recently issued from our University, which, in some respects, may challenge a comparison with any similar production of Europe. It affords me pleasure to announce, that an under- taking somewhat of the same nature in the School of Boston, is commenced, by one of the professors, who, I know, will bring to it qualifications that can scarcely fail to insure it success. These are enterprises of the highest utility, to the interests of mediciue, and which are well cal- culated, by reflecting the lights of science from the new upon the old world, to redeem, in part, the XII PREFACE. heavy literary debt we have incurred, and to vindi- cate the insulted genius of our country, from the contumelious reproaches, so long and disgracefully endured by us. PHILADELPHIA, September, 1817". CONTENTS OF VOL. I. Page. Dedication -..... ul Preface - ------ - \ DISCOURSE I. History of the Materia Medica ... - 1 DISCOURSE II. On the improvement of the Materia Medica - - 21 DISCOURSE III. On the Modus Operandi of Medicines - - - 40 DISCOURSE IV. On the Classification of the Miteria Medica - - 60 Oi Emetics—their Modus Operandi, &c. - - 68 DISCOURSE V. On the Practical Application of Emetics - - 76 DISCOURSE VI. On Particular Emetics, and first of the Mild Emetics 101 DISCOURSE VII. Of the Active Emetics.....129 DISCOURSE VIII. Of Cathartics—their Modus Operandi and Practical Ap- plication, &c. ......145 XIV CONTENTS. Page. DISCOURSE IX. The Subject continued - - - - - l55 DISCOURSE X. The Subject continued - - - - - 167 DISCOURSE XI. On Particular Cathartics, and first of Laxatives - 182 DISCOURSE XII. Of Purgatives.......200 OfEnemeta - ......220 DISCOURSE XIII. On Diuretics—of their Modus Operandi and Practical Application - - 226 Of Particular Diuretics, and first of the Mild Diuretics 234 DISCOURSE XIV. Of the Sedative Diuretics - ... 242 DISCOURSE XV. Of Stimulating Diuretics - 257 DISCOURSE XVI. Of Lithontriptics, or Antilithics - . . 276 DISCOURSE XVII. The Subject continued - 2o« DISCOURSE XVIII. Diaphoretics—their Practical Application, &c. - 307 DISCOURSE XIX. Of Particular Diaphoretics, and first of Mild Diaphoretics 331 Of Stimulating Diaphoretics ... . _ „„,_ CONTENTS. XV Page. DISCOURSE XX. The Subject continued - ... 349 DISCOURSE XXI. The Subject continued.....363 • ELEMENTS OF MATERIA MEDICA AND THERAPEUTICS. DISCOURSE I. History of the Materia Medica. JxlEDICAL Science, in its present state, is an ac- cumulation of such extensive and diversified know- ledge, that it has been found convenient to divide it into several distinct departments. My object is, to treat of that province of it, denominated the Materia Medica, or in other words, to deliver some account of those means which are employed, either in the prevention or cure of diseases. No branch of medicine is more copious than this, or which, perhaps, ought to be considered of greater importance. As well, indeed, might the mechanic attempt to carry on his operations without an acquaintance with his tools, as we to exercise our profession, ignorant of the properties of our remedies. \ o Notwithstanding the number of histories of the science already ex!ant, I shall present, as prelimi- nary to my main design, a concise view of the rise, progress, and existing condition of the materia me- dica. The rudiments of this department of medicine, were probably co-eval with the very existence of the species. It can hardly be supposed, that unin- terrupted health was ever among our happy privi- leges, and mankind, always liable to accidents and diseases, would naturally seek the measures of mi- tigation or relief. The rudest tribes of savages are found, accordingly, to have their remedies and modes of cure, often rash, violent, and injudicious, though sometimes discriminated with precision, and adapted with dexterity and skill. Commenced, however, as it may, the materia me- dica, humble in its origin, has gradually grown and become improved, by the contributions of vulgar ignorance, by fortuitous discoveries, by empirical experiments, and, in some instances, by well regu- lated inquiries. Anterior to the civilization of Greece, medicine is a dreary waste, containing little to excite curio- sity, or to reward the trouble of research. Though it had been previously cultivated in Egypt, it does not appear to have participated, to any extent, in the general improvement of the arts and sciences, or to have kept pace with the polish and refinement of that country. Not. indeed, till the appearance 3 of the illustrious character, on whom posterity, by common consent, has bestowed the enviable title of {i Father of Medicine," does the subject assume a shape to merit our attention. Endowed with a ge- nius vigorous and original, he cleared the profession of the incongruities of empiricism, and gave to it much of the order and perspicuity of scientifical arrange- ment. Every department of physic was more or less enriched by his discoveries, or reclaimed by his judgment. The materia medica is largely in- debted to him. Not a few of our remedies are the result of his observations and inquiries, and by his writings we are enabled, pretty accurately, to esti- mate the state of the science at the time. After the age of Hippocrates, little seems to have been done for any department of medicine in Greece. Of the materia medica, especially, the chief pro- moters were probably the philosophers, who cul- tivated natural history, and hence, the accessions to it were indirect, and exceedingly small and de- fective. Next, therefore, we are to trace the pro- gress of the science in Rome. It is well known, that this extraordinary people had long dazzled the world with the splendour of their military achievements, and excited astonish- ment by the extent of their conquests, before they were distinguished by the polish of civilization, or the culture of letters. Exclusively devoted to the profession of arms, to be adroit in the art of de- struction, was deemed by them the highest of hii- 4 man attainments. But, towards the commencement of the Christian era, when they had subdued the fairest portions of the globe, and in some degree allayed their avarice of dominion, the ferocity of their martial character began to subside, and a spi- rit propitious to the more liberal pursuits, was ma- nifested. Attracted by the wealth and renown of their mighty city, the learned and ingenious of every country, resorted to it. From Greece, " the native seat of the muses," she gradually imported much that was excellent, in the arts, ornamental or useful, and in literature, science, and philosophy. Nevertheless, medicine was little cultivated. Con- ceiving that their superiority over other nations was owing to a retention of an unmitigated ruggedness of character, it became a part of their policy to check, by legal prohibitions, whatever had a con- trary tendency, and on this account, the introduc- tion of those arts was still resisted which soften and embellish manuers, alleviate the sufferings of our nature, minister to the comforts, or smooth the asperities of life. But corrupted at last, by the ac- cumulated wealth which flowed in upon them, lux- ury and indoleuce ensued, and with these vices, a train of diseases, of which they are the fruitful source. The necessity of procuring men skilled in the art of healing; being now generally felt, the injurious restrictions relative to the profession of medicine, were in consequence removed. Of their writers, among the earliest of any const- 5 deration, was the chaste, the elegant, the classical, Celsus, who lived in the second reign of the impe- rial dynasty. Disputes have arisen, whether he pursued medicine as a profession, or only attended to it as a part of liberal science. Be this as it may, the work of his which has descended to us, is un- rivalled by antiquity, and will reward the most stu- dious perusal. An eminent modern teacher em- phatically enjoins on every student " to keep Cel- sus in his hands by day and by night." As respects the materia medica, more information may be derived from him than from any of his pre- decessors. He does not professedly treat the sub- ject, but the view which he exhibits of it is very satisfactory, up to the time in which he wrote. In the succeeding century, no province of medi- cine received any material improvement. Engaged in perpetual controversies on points of doctrine, its cultivators have bequeathed to us little else than a mass of vague and unintelligible hypotheses. Two writers, however, on the meteria medica, at length appeared. These are Dioscorides and the elder Pliny, who, though perhaps they ought to be ex- cepted from this harshness of criticism, are now consulted rather as objects of curiosity, than for the purpose of gaining, in the present comparatively en- lightened state of the science, any sound or useful information. At no distant interval, came Galen, one of the most remarkable characters whom our science has 6 produced, whether we regard the extent of his learn- ing/or the universality of the homage which he commanded. During thirteen hundred years, his opinions were received as oracular authority, wherever medicine was cultivated. But so long and uninterrupted a reign, must in part be ascribed to the operation of those geueral causes, which, we shall presently see, extinguished the lights of learn- ing, and enveloped Europe for a portion of the time in the darkness of barbarism. As Galen wrote copiously on the materia medi- ca, it was to be expected, from his vast erudition and practical experience, that this subject would have been considerably benefitted by his exertions. But in this respect we are disappointed. The knowledge which he affords us is exceedingly encumbered by spurious theory, and obscured by the complexity of his prescriptions. After his death, the progress of medicine may be considered as having terminated in Rome. Towards the close of the second century, this stu- pendous empire, which had proudly ruled the world, and where the human character had appeared to the greatest advantage, began to exhibit the melan- choly spectacle of decay, and was ultimately over- thrown entirely by the successive attacks of differ- ent tribes of uncivilized nations. Not content with the conquest and plunder of the country, these ruthless invaders destroyed, in their fell career, all the monuments of taste, literature and science, i which had been so' splendidly raised, and, after effecting this state of desolation, carefully repres- sed the spirit of intellectual cultivation, lest it might enfeeble that martial energy which they so greatly prized. During this turbulent age, so far from any pro- gress having been made in the cultivation of sci- ence, or the correction of taste and manners, even the vestiges of ancient learning and civility were nearly lost. Thus neglected, the human mind was depressed into the profoundest ignorance, or shot into the wild licentiousness of savage nature. Eu- rope, accordingly, did not produce, for a long se- ries of time, a single work deserving of criticism, nor one solitary discovery or invention. Even the scattered relics of literature, which floated from the wreck of the western into the eastern di- vision of the empire, maintained only a temporary and feeble existence, uucherished and unproduc- tive, and then sunk under the overwhelming inun- dations of the Saracens. As soon, however, as the violent dispositions of the barbarous enthusiasts, to whom 1 have just al- luded, were lulled by a relaxation of religious ar- dour, by a satiety of conquests, and a full indul- gence of the lust of plunder, the arts and sciences began to be cherished, and medicine was particu- larly patronized. By the middle of the ninth century, we find that establishments for the teaching of it were liberally 8 endowed, and many of the Greek writers transla- ted. Physicians were now rewarded with an unu- sual elevation of rank and emolument. But our sci- ence, even with such munificent encouragement, did not succeed. The only branch of it whieh is at all indebted to the labours of the Arabians, is the matera medica Dwelling in a region rich in ac- tive plants, in spices, in aromatic gums, the medi- cinal properties of some of these substances they detected, and applied to the treatment of diseases. The mind of Europe, which we have seen plung- ed into the deepest lethargy, did not suddenly emerge, or recover its tone. The presages of ifs renovation were long in accomplishment. This slowr advancement has very properly been attribu- ted to the pernicious operation of the feudal system. The incessant contentions of its petty tyrants, not only interrupted the quietude so essential to literary pursuits, but an ignominious vassalage was impos- ed, which palsied the moral energies below the ca- pacity of vigorous exertion. As has been truly said, the lily and the bramble may grow and flou- rish together, but genius and slavery admit not of this social proximity. Wherever the highest order of intellectual excellence has been attained, there we have found neither the turmoils of anarchv, nor the fetters of despotism. To shoot with luxuriance and bring to perfection its choice productions, ge- nius should be placed in a soil secured from dis- turbance by the provisions of a regular government 9 and sustained by the protecting care which such a government is alone competent to afford. But while the austerities of feudal tyranny prevailed, there was not the shortest repose from the distractions of war, nor the least defence against violeuce and op- pression. The nobles had become arrogant by the practice of command, and the people dastardly from the habit of submission. Of the causes which conspired to abolish this state of confusion and servitude, and to introduce order, regularity and freedom, the Crusades have generally been thought the most leading and effica- cious. They aroused Europe out of its torpor, and en- gaged it in those enterprises which inspire activity, and invigorate intellect. Men, in every gradation of society,were infected with thewild enthusiasm which originated these singular expeditions. Composed of all the nations of Europe, armies were seen marching in the delirium of their zeal, pledged ei- ther to redeem the Holy Land, or die at the tomb of Christ. In prosecuting this romantic project, the Crusaders were happily obliged to traverse coun- tries whose institutions and customs were superior to their own. These could not fail of exciting emu- lation. Captivated by the charms of literature, the more enlightened of them collected some of the classical writings and many of the Arabian pro- ductions, and returned with a taste improved, and views widened and liberalized. Dispositions in every respect so auspicious were strengthened and B 10 confirmed by the invention of the art of printing, which, increasing the number, and reducing the price o<" books, diffused more widely the light of knowledge, and quickened thev speed of moral im- provement. But the efforts of literature at the dawn of re- turning civility, were very unprofitably directed. They were turned either into the course which pro- duces the wild and irregular sallies of the imagina- tion, or were lost in the mists of metaphysical intri- cacies, and the mazes of scholastic theology. The science of medicine appears to have solicited little esteem. In the succeeding age, however, the study of al- chymy, or the art of transmuting base metals into gold, and the still more ridiculous attempt to invent an elixir by which disease should not only be cured, but life prolonged beyond tie ordinary term, en- grossed the attention of most of the learned and in- genious. Experience has shown the futility of these pursuits. But intense exertions, in whatever way employed, are seldom wholly unproductive; and accordingly, in the eager chase of these illusions, contributions of real value were occasionally made to the materia medica, and especially to chemistry. Medicine moved on iu this devious career, till about the middle of of the fifteenth century, when it underwent a revolution which had considerable in- fluence on our department. At the period alluded to, the medical science of Europe was wholly oor- 11 rowed from the Arabians ; but on the conquest of Constantinople, the last lingering monument of im- perial grandeur, many of the erudite Greeks fled in- to Italy, and carried with them the ancient writings. The doctrines of Galen now regained their for- mer ascendency. They were destined, however, speedily to fall under the formidable attacks of the chemists. The difference between these, rival sects related both to theory and practice; but chiefly turned on the'use of the powerful remedies which the latter derived from the processes of their art. In this contest, the leader on the part of the op- position was the celebrated Paracelsus, who, though destitute of regular learning, had that sort of auda- cious genius, which is peculiarly calculated to sap the foundation of existing systems, and to prepare the way for the receptiou of unexpected innovations. The cures effected by the energies of his remedies, and the confident manner in which these were an- nounced by himself and his disciples, procured with many the adoption of his opinions, and a wide dis- semination of his popularity and fame. Elated by success, the chemists urged with fresh ardour their analyses, and while they render- ed their theories contemptible by an extravagance approaching to fanaticism, continued to elicit, by the operations of the laboratory, medicines of the greatest importance. Nor was this the only source, from which our science was enriched, at this time. The art of na- IS vigation having recently received its memorable im- provement, maritime enterprise was emboldened Ao extend its researches, and the new world, now re- vealed to an adventurous spirit, poured into Europe its treasures and its drugs. Cotemporary, or nearly so, with these events was the discovery of the circulation of the blood, which imparted a vigorous impulse to medicine, and changed very materially its character and aspect. But the light shed by it on the animal economy, in- stead of leading, as was anticipated by the sanguine enthusiasts of the moment, to some correct and per- manent conclusions, which might place the science on a basis, never again to be shaken by the changes of opinion, served only to redouble the rage for speculation, and to exacerbate the temper of con- troversy. As having no direct leaning on our subject, it would be improper in me to dwell on the series of conflicting hypotheses, resulting from those angry contentions, many of which were the progeny of an unnatural alliance between medical science and the prevalent branches of knowledge. In every age, medicine has been corrupted by the ambition to apply to it the general theories, or particular views of the other sciences. Its early history shows that it was constantly subjected to the dominant philosophy of antiquity. When che- mistry triumphed, we have seen its reasonings in- terwoven with every set of opinions, and shaping 13 every form of practice. Next mathematics came into vogue, and the functions of the living system, as Well as the operations of medicines, were ex- plained on pure geometrical principles. After a while, however, the reign of metaphysics ensuing, we had all its subtleties, and abstractions in the place of the preceding parade of data, postulates and demonstrations. Thus stood our science at the dawn of the eighteenth century, when three distinguished cha- racters arose, to subvert the authority of their pre- decessors, and to share among them the empire of medicine. These were Stahl, Boerhaave, and Hoffman. Each of their systems made a consider- able impression on the materia medica, and must therefore not be entirely overlooked in the present review. That of Stahl, which is rather of the earliest date, evidently grew out of those mataphysical discussions to which I have alluded. It assumes as a fundamental principle, that the rational soul of man rules his body in health and disease. No period has perhaps existed, in which some indis- tinct notion has not been entertained of a power resident in the animal economy, by which it is en- abled to resist injuries, and to correct or remove the morbid derangements, to which it may be ex- posed. This mysterious faculty has received va- rious names, as the impulsive principle, the Soul, or Anima Medica, the Archseus, the vis conserva- 14 trix, et medicatrix naturae, the vital principle, the nervous power, and most commonly the vague appellation of Nature. Giving to this faculty more definite attributes, he strenuously maintain- ed that it is independent of any physical neces- sity, and operates by virtue of its intelligence. Theoretical views like these, must inevitably have dictated a practice cautious, feeble, and irresolute. Confiding in the wisdom of the soul, the disciples of this sect were accordingly vigilant in observa- tion, and acute in discernment, but averse to the use of active remedies, lest they might interfere with its sanative designs. To them, we are peculiarly in- debted for the art of curing diseases by expectation, and their practice has, with some propriety, been called " a meditation on death." No one could have been better prepared than Boerhaave to construct a medical system. To a mind calm, reflecting, and discriminative, he united the widest range of erudition, and the most patient industry. All the branches of knowledge auxiliary to his profession he had diligently cultivated. These advantages, however, did not exempt his speculations from the grossest errors. As a genuine eclectic, he seems, in framing his system, to have been anxious to select from every source the best materials, and to blend these with such as his own genius might supply, into one whole, exhibiting the aggregate truths of the sci- ence. But this, like most finely wrought schemes, 15 did not succeed. Excellent as was the mechanism of the work, the incongruity of the parts could not be concealed. To harmonize the contrarieties of medical doctrines was indeed a task as impractica- ble as to arrange the fleeting vapours around us, or to reconcile the fixed and repulsive antipathies of nature. Boerhaave adopted, in the utmost latitude, the prevailing mechanical and chemical philoso- phy ; and his system bears its full impression on the face of it. Neglecting the peculiarities of vi- tality, he represented the animal body pretty much as a machine controuled by the laws of hydraulics in the circulation of its fluids. Medicines he sup- posed to operate chiefly by chemical combinations. The system of Hoffman differs very widely from those of his two cotemporaries. Discerning the errors of the humeral pathology, he early rejected it. Whatever changes the fluids undergo, he al- leged were produced through the intervention of the solids, and denied, that they exercise any direct or essential influence, on the healthy or morbid states of the body. Believing that the living sys- tem is regulated by a vital priuciple, he retains lit- tle of mechanical or chemical reasoning, but, very properly seeks for explanations of the phenomena of the animal economy in the agency of that princi- ple exerted through the primary moving powers. With his subordinate notions relative to spasm, we have nothing to do. In tracing those systematic arrangements of me- 16 dical knowledge, which had any decisive influ- ence on the materia medica, we must not entirely overlook that of the original and eccentric Brown, ei the child of genius and misfortune." My inten- tion, however, is not at all to detail the well known doctrines of the " Elemental Medicines." It will be quite sufficient for my purpose, to remark, that this intrepid theorist divides all diseases into two classes, sthenic and asthenic, or of increased or diminished excitement, and that he maintained every agent which operates on the living body to be a stimulant, having an identity of action, essentially differing only in the degree of its force. Whatever may be the merit of these views in some other respects, a point however, exceedingly disputable, they could not fail to produce the worst effects on the materia medica. Noihingcan be less true than the notion which is here inculcated of the powers and modus operandi of medicines, or more mischievous than the abridgement of our re- medial resources, to which such an estimate direct- ly leads. Let it be conceded, that diseases really consist in graduated proportions of excitement, and that our medicines are weaker or stronger stimu- lants only, it follows, that a practitioner might sally forth to attack the foes of human health and hap- piness, armed alone with the lancet in one hand, and a bottle of alcohol in the other, to reduce vi- gor, or remove debility, as the case might de- mand. Extraordinary as this may seem, it is still 17 a legitimate deduction from the premises, which were carefully laid down and so often elaborately defended, by the disciples of this sect, and which they actually illustrated by their practice. But more of this hereafter. Leaving now, these bold attempts at medical ge- neralization, we revert to the more direct history of our department. It can hardly be supposed, that, during the last century, when physical science was so studiously cultivated, the materia medica should remain stationary. No section of medicine is in- sulated, and whatever light is thrown upon oue, soon becomes reflected over the whole. The im- provements which took place in the departments, even the most distantly related to it, were therefore not without effect. As physiology and pathology, the laws of the animal economy in a healthy, and the doctrines of its deranged condition, were fur- ther elucidated, we acquired more accurate views of the operation of medicines, and a happier man- ner of adapting them to the management of diseases. But, it was from those branches which are its im- mediate kindred, that the materia medica derived its principal acquisitions. Every province of na- tural history has been tributary to its extension. To the chemistry of modern times especially, we owe the highest obligations. Correcting its own errors by the surest methods, it has also extended the spirit of reformation to our science, and while it has armed practitioners with some of the best IS means of combatting disease, has uotonly expung- ed others which were inert, but inculcated the art of preparing and administering remedies with in- finitely more neatness, precision, and efficacy. During the period under review, much has also been written expressly on the materia medica. We have distinct dissertations on many of its active articles, in which the properties of the sub stance are carefully investigated, and not a few works encompassing the whole science. It is not my intention, at this time, to give any minute ac- count of these productions, having hereafter occa- sion very repeatedly, to recur to this subject. Now, I shall merely mention, that among the numerous works the science claims, there are three, which by reason of their superior merit, are entitled to be singled out, and noticed. These are the celebrated systems of Lewis, Culleu, and Murray.*, The Edinburgh professor was decidedly the most distinguished medical personage of the age in which he lived. He occupied a larger space. His fame was more diffused. Deficient, perhaps, in that transcendent genius which reforms every thing by bold and general views, he had, to compensate it, the faculty of careful observation, and an un common share of diligence, sagacity, and judgment. The character of his mind is conspicuously dis * I allude hereto the work of my friend Dr. Murray, of Edinburgh. The " Apparatus Medicaminum," by an author of the same name, J have never been able to procure. 19 played in all his writings, which, though nofcdea. titute of speculation, are eminently practical, and have tended, in the greatest degree, to the establish- ment of true and rational medicine. Yet, his work on the materia medica, is not without defects, and by the changes which medi- cine, since its date, has undergone, is become in a certain degree, antiquated, and even obselete in many of its parts, in theory as well as practice. As presenting in narrower limits, a much more correct-view of the existing state of the science, reformed as it has recently been by new discoveries and improvements, the treatise of Murray is fa be preferred. No notice has hitherto been taken of the efforts in the United States to advance the materia medica. These, owing to the long neglect of the subject, are comparatively slender and imperfect. It is true, the naturalists, distributed through the different sec- tions of the country, have, at no time, been alto- gether heedless of its physical productions. But, their inquiries being directed rather to the botani- cal history than medicinal properties of plants, very few important accessions were made to the stock of remedies. As soon, however, as our Medical School began to flourish, an attachment was awakened to the sci- ence, and it has since been considerably enriched from our native stores. Many of our graduates have signalized their talents by the investigation. 20 in their inaugural dissertations, of no inconsidera- ble number of the indigenous medicinal plants. But the credit of leading in this new career is in disputably due to my predecessor in the chair of the materia medica. Confessedly, it was by him, that a real taste for the natural sciences was created and diffused in the United Ssates, the charms and utility of which, were ardently and eloquently en- forced in his lectures, in his conversation, and by his writings. Too early has he been removed from the Kphere of his labours. Emulating, however, his example, those who have succeeded to him in the School, in the several departments of the materia medica, natural history, and botany, seem resolute to 1 pair his loss, by pursuing the same radiant patn of duty and usefulness. 21 DISCOURSE II. On the Improvement of the Materia Medica, Considerations arising from a due estimate of its importance, have led, in every age, to the assi- duous cultivation of the materia medica. Long before principles were introduced into medicine, or even the common rules of practice establised, no small attainments had been made in this particular department. But studiously as we have endeavoured to promote its cultivation, the materia medica, as a^ section of medical philosophy, is still exceedingly crude, wild, and unregulated. It is true, we have a prodigious collection of re- medies, chosen however with little discrimination, and as carelessly investigated, arranged obscurely, and ministered without much accuracy or precision. In treating a science so defective, it seems to me proper that I should point out the mode by which, in my opinion, it may be prosecuted with the greatest success. To this discussion, I am the more inclined, from the singular advantages which our country holds out to the extension and improvement of this branch of medicine. Nature has cast the new world in her largest mould, and given to all its productions correspond- ing proportions. No instance of stinted, or nig- gardly creation exists. Every where, we behold as the evidence of a physical luxuriance, equalled only by the moral and intellectual energies of the people. Even our diseases partake of the same character, and have a violence, which exacts for their cure either new means, or original combinations of vigor- ous practice. But most evils have their correctives, and it would seem especially to be a part of the benevo- lent scheme of Providence, that the malignant dis- tempers incident to a climate, should be invariably associated with their appropriate remedies. If this be the case, can there be a nobler field to excite or reward exertion, than that which lies before us ? The immense regions which we claim, though hi- therto little explored, are known to be exuberant in the most active vegetables. It is more than proba- ble, that on some of the Alpine heights, or along the margin of those bold streams which pervade our wide spread continent, there blooms many a plant, whose virtues, now flung on the " desert air," may be peculiarly adapted to the gigantic forms of dis- ease, and capable of reducing the lengthened cata- logue of the opprobria medicorum. To aid those who may be disposed to enter on so useful an enterprise, I shall now proceed to review somewhat in detail, the various means which have been suggested, in order to acquire a knowledge of the medicinal virtues of substances, and to show how far these are applicable to the purpose. 23 Of the means alluded to, it is reasonable to sup- pose, that the sensible qualities of the article, by which is meant its odour, taste and colour, were the first employed. To these criteria we are obvi- ously led by a very strong instinctive impulse. No one can pick up an unknown plant or substance with a view of ascertaining its properties, without at once subjecting it to the decision of one or the whole of his senses. To the rude and educated man, as well as to the brute creation, it is incident to practice this mode of investigation. But, what- ever advantages the savage or the lower animals may derive from the acute preceptions of the or- gans of sense, we are indebted very little to this source in our medical researches. The utility of smell is limited chiefly to vegeta- bles, as few animal or mineral bodies betray their qualities in this way. Most generally, pleasing smells, as we are told, are salutary, and nauseous ones injurious. But pleasing and nauseous are re- lative terms. The odour which is grateful to one person, may be to another loathsome and disgust- ing. It is alleged that the tastes of substances have a much more iutimate connection with their medicinal properties than odours. This it perhaps true. Tastes, however, like smells, are so infinitely va- ried, that an accurate discrimination is not easy to be made. Much of what I have said in relation to the one. is equally applicable to the other. I shall 24 therefore merely remark in addition, that certain medicinal virtues are found pretty constantly asso- ciated with peculiar tastes and odours, and will lead to a tolerably satisfactory conclusion where these are simple and unmixed. But, if compound- ed, which is usually the case, we ought always to hesitate in deciding, as amidst the confusion of blended sensations, there can be nothing certain or definite. By a writer of no ordinary authority, it has been maintained, that such substances as do not affect the taste or smell, or only in a slight degree, may be considered as inert and useless. To this rule, which is indisputably of very extensive application, there are not wanting some striking exceptions. Not to mention other conspicuous instances, the corrosive sublimate, the arsenic, and the poison of serpents, are equally insipid and inodorous. As a test of medicinal virtues, it seems to be ad- mitted, at present, that colour is entitled to less con- fidence than either of the two preceding criteria. But a different opiuion was once entertained, and especially by the celebrated naturalist of Sweden, as is expressed in his memorable aphorism: " Color pallidus, insipidum, viridis, crudum, lutens, ama- rum, ruber, acidum, albus, dulce, niger inqratum indicat." Each of these positions, though true in the main, is to be recieved with many limitations, and on this 25 account, the mere circumstance of colour, will al- ways prove a devious and precarious guide. In the enthusiasm of that period, when chemis- try, as a novelty, solicited attention, it was imagin- ed that the processes of the art would illustrate every physical obscurity, and among the rest, re- veal the medicinal properties of substances. Dur- ing the reign of the humeral pathology, these ex- travagant expectations were sanguinely indulged. They are no longer entertained. As applied here, ehemical resolution cannot be trusted. Experi- ments have fully demonstrated, that articles widely discrepant in their general nature, as aliments and medicines, the most salutary food, and the rankest poison, exhibit, on analysis, nearly the same results. This indeed holds so generally true, that the virus of the viper, and the mildest mucilage, constitute no exception ; as, when resolved into their elementary principles, they are precisely analogous. Chemistry, however, in other respects, is of the utmost importance to the materia medica. Copious in resources, this noble science explores all nature, and educes from each province the most valuable remedies. The animal, the vegetable, the mineral kingdoms, it lays under contribution to our pur- poses, and by it we are moreover taught neatness and precision in our pharmaceutical preparations. As soon as botany assumed a regular shape, and was reduced to system, it came to be observed that many of the plants which had been arranged toge n 26 ther from their agreement, or affinity in botanical characters, were also allied iu medicinal virtues. Nature having established, in not a few instances, a connection of this sort, it was presumed that she had done so universally. Classifications were ac- cordingly made on this hypothesis, and to a certain extent, they proved to be correct. There is espe- cially one of the great divisions of Linnseus, em- bracing a very large number of plants, which scarcely exhibits an exception. But so far from this coincidence prevailing throughout his classes, it frequently does not obtain even iu the species of the same genus. As proofs to this effect, I may mention the cucumis inelo, or common melon, and the cucumis colocynthis, or colocynthe of the shops. Nor is the difference less in a medicinal and diete- tic view between the solanum tuberosum, or pota- toe, and the solanum nigrum, or deadly nightshade. Examples of this kind, it would be easy to multi- ply, were not those which have already been ad- duced sufficient to show the fallacy of the criterion, and at the same time, the extreme danger which might result from carrying it into practice, without proper care and circumspection. Exactly on the same footing stand the conclusions derived from what is called the natural order or assortment of plauts. Many vegetables, resembling each other in their general aspects, do not disagree in their medicinal properties. But this does not always hold, and among the instances to the contrary, may 27 be enumerated the digitalis, and the verbascum, or common mullein of our fields, each of which is in- cluded in the same natural family, though the one is as active as the other is mild in its effects. Nor is this all. Different portions of some plants are pos- sessed of very opposite qualities, as we see strik- ingly illustrated in our own podophyllum peltatum, or may-apple, the'leaves of which are poisonous, the root powerfully cathartic, and the fruit agree- ably esculent. What, on the whole, physiognomy proves in relation to the human character and dis- positions, the exterior appearances of plants per- haps shew as to their virtues and powers. Each sometimes acquaints us correctly, though he who implicitly trusts to either, will often have reason to complain of his misapprehension and disappoint- ment. Let us not, however, disparage the utility of bo- tany. To ascertain the identity of any plant, which the arrangements of this science enable us to do, is an object of no minor consequence. De- prived of the aid which it lends us, the greater part of the experience of our predecessors would be lost to us. We should have to start anew in our inves- tigation of plants, and, like mariners cast on a de- solate shore, move through unexplored regions with a step slow, faultering, and retarded. Not the least of the extravagancies which mark- ed the wild career of Paracelsus, was the inculca- tion of the notion, that such plants as bear a re- 28 semblance to auy one part of the body, have a pe- culiar efficacy in relieving its disorders. Thus, the euphrasia, even at the present time, is used in the complaints of the eyes, because it has a black spot in its corolla resembling the pupil; and the pulmo naria retains not less reputation in the affections of the lungs, since in its form, its texture, and its areolae, it is not altogether dissimilar to these or- gans. Exploded as it is, wherever intelligence prevails, nothing except the desire to preserve something like a regular chain in my present narrative, would have induced me to notice, as one of the means of ascer- taining the virtues of plants, this old and absurd doctrine of Signatures. To determine the powers of medicines it was formerly the practice to make experiments on the fluids taken out of the body. This was more par- ticularly the case while the doctrines prevailed which supposed disease to depend on a depravation of the blood or other fluids. To the disciples of this sect, the operations of the laboratory were con- sidered as presenting a faithful image of the ac- tions of the living system, and hence they were very naturally seduced into this course of inquiry. Not the slightest advantage, however, has accrued from such visionary projects. Those who were deluded by them ought to have recollected the pe- culiarity of vital power, and how much the chances 29 which the fluids undergo are influenced by impres- sions made through the intervention of the solids. In pursuit of the same end, it has been not less the custom to experiment largely on the brute crea- tion, and on the first view it promised the most in- teresting results. Subsequent experience has, how- ever, taught us that it cannot be trusted. Different animals we have discovered are variously affected by the same article. What is food to one may be to another an active medicine, or virulent poison. Thus cows and hares will eat hemlock; hogs, hen- bane and hellebore; goats, nicotiana and euphor- bium ; and some birds, the laurel berry. The pow- erful antimonial preparations are comparatively fee- ble on a horse, and a dog which will take three times as much opium as a man, may be thrown into convulsions, or perhaps killed, by a moderate dose of jalap, or even by a few bitter almonds. Disappointed in their anticipations from the pre- ceding modes of inquiry, the cultivators of the ma- teria medica were ultimately driven to make their trials on the human species. But doomed, as it would seem, to perpetual fallacy on this subject, they re- stricted their experiments chiefly to the system in a state of health. Nothing could be more inconclu- sive. Disease so materially influences the condi- tion of the body, and its susceptibilities to impres- sion, that the agency of substances is in consequence very strangely modified, and in many instances en- tirely changed. Nevertheless, such investigations so are not to be contemptuously rejected. They will sometimes serve, at least, to acquaint us with the general powers of the article. That, however, they may be conducted to any practicable purpose, the phenomena produced by the substance must be carefully watched, and faithfully reported, not only as indicated by the pulse, but as is displayed in every part and function of the animal economy. By more than one enthusiast it has been assumed, that all medicines are similar in their operation, differing only in degree of force, permanency and diftusibility. JVly own conviction is, on the con- trary, that we should approach much nearer the truth, by considering every article, or at all events, congeners, or assortments of kindred articles, as endowed with peculiar powers, and having a rela- tion or affinity to some one organ or portion of the body. As yet, then, no means have been mentioned of ascertaining the medicinal virtues of substances in which we can implicitly confide. The sensible qualities of the article, chemical analysis, botani- cal affinity, experiments on dead matter, on the lower animals, or on the healthy human system, may conduct us, in some instances, to a tolerable knowledge of its general nature, but can never be adopted as safe criteria for practical purposes. Experience of their effects on the body, in a diseased condition, is the only mode of determin- ing the virtues of medicines. But even this is 31 liable to fallacy, and its dictates must be received with doubt and hesitation. Medical conclusions differ very widely from every other species of evidence. We cheat our- selves by a thousand illusions, and have imposed upon us still more deceptions. It is not necessary that I should enforce this remark by the enumera- tion of any examples. No one who i* conversant with the practice of physic need be told how often his own deductions have proved erroneous, or how little credit is to be reposed in those pompous re- commendations with which medicines are daily pro- mulgated. If, therefore, we cannot trust to experience, what must be our resource? There is a true and a false experience. The latter, which is the creature of ignorance, or results from ardent and precipitate observation, can be distinguished by a careful scru- tiny, and ought to be repudiated. Yet, it must be confessed, that it is exceedingly difficult to deter- mine the precise powers of a medicine. Experiments ou this subject present many ob- scurities, and are liable to various inaccuracies. Distinct from other perplexities incident to the case. we have to encounter the original idiosyncracies of the constitution, or those fluctuations of condition induced by disease or by age, temperament, habit. climate, the season of the year, and a variety of other causes. Applied in different states of the system or iu 32 different quantities, the same medicine will be pro- ductive of very coutrary effects. This is indeed so emphatically true, that we can hardly ever pro- nounce with certainty what will be the exact re- sults from the dose exhibited. By reason of this it is, that we have always had so much controversy respecting the powers of medicines, and that we find, even at the present time, the articles of the materia medica so oppositely arranged, and their properties so contradictorily described, in the trea- tise? on the subject. Taught, however, by repeated trials, the virtues of the substance in a simple state, we are next to inquire how far these may be altered or improved by a combination with other matters. It was a practice with the ancient physicians to incorporate a vast number of articles in the same prescription. This luxuriance was no doubt often mischievous, as ingredients wholly discrepant were associated, counteracting each other in their operations, and producing effects not at all anticipated. But in the rage for reformation it is not uncommon to step be- yond the proper limits, and in every science, as in human affairs, it becomes salutary to review, at stated period-, what has been done, to correct the r-oiisecpienc-e> of intemperate zeal, and to endea- vour to hit the medium between the conflicting ex- tremes. Of late, the formulae of practitioners have been marked by a simplicity which is commendable. 33 To me, however, it seems to be sometimes pushed too far, and that consequently, certain compound preparations are discarded, which were unques- tionably of great value in the hands of our prede- cessors. To check, in some degree, this tendency to ex- cessive refinement, I mean hereafter to show, by examples, that combination in our prescriptions is, in many instances, eminently advantageous, by ren- dering the exhibition more convenient, and that while it imparts new powers, it increases the effi- cacy of the articles. All these preliminary points being settled by a series of clinical observations carefully made uu- der every diversity of circumstance which can shed light on the properties of a medicine, we are lastly to seek for the several indications of its use. Li- mited indeed would be its value, were its applica- tion confined to the case only in which it was first discovered to be serviceable. But to trace the multiplied relations of a medicine to disease, the exercise of the higher faculties of the mind is demanded, and we at once introduce the spirit of speculation, or what is termed reasoning in medi- cine. Nothing has been more prejudicial than the abuse of this noble prerogative. Consulting the records of our science, we cannot help being dis- gusted with the multitude of hypotheses which have been obtruded upon us at different times. No F. 34 where is the imagination displayed to greater ex tent, and perhaps -ay- an eloqueut writer,* so am- ple an exhibition of the resources of humau inven- tion might -ratify our vanity, if it were not more than counterbalanced by the humiliating view of so much ab-urdity, contradiction, and falsehood. The number of preposterous theories should not, however, continues he, create an antipathy to the term, nor mu-t a panic terror of them drive us from the sacred abodes of philosophy. To be hurt w ith the imperfect and puerile commencements of rea- soning in phytic, and to relinquish the hopes of ra- tional theory, is to be offended with the prattle of infancy, and to expect nothing better from maturer age. To exclaim azain*t theory has been considered as a proof of an ardour for observation. But is it not really to declare, that we must rest stupid and indifferent spectators of the events constantly pass- ing before us? To think is to theorise. We can- not contemplate fact- for a moment without perceiv- ing some relation between them, and the very dis- covery leads to classifications. To deny its utility! therefore, is to clip the wings of genius, to banish • The venerable M'Ciurg of Virginia. Nearly half a century has elapsed ^nce be gave to the public an experimental inquiry rela- tive to the bile, with a preliminary disquisition, in defence of reisom- ing i.i me>'• ie->t impulses, let <> cordi- ally co-operate to :;ive to medicine a new direction, and attempt tlntsp great improvements, which it so imperiously demands. Even if we should not carry it to that point of absolute perfection, which sometimes has been, perhap* too sKu^uinely. pre- dicted, we may, at least. " by infusing into the sci- ence the genuine spirit of«-easnn. and phih.s.ihv render it richer in glory, and more frui'fnl in benefits to mankind." But a higher reward awaits oor exertions. w Let us only pursue with a steady and undeviat- mg perseverance that track of correct philosophis- ing which h;-s been indicated, and we cannot fail to place medicine on a basis so solid as never again to be convulsed by the revolutions of opinion, or the vicissitudes of fashion, but which shall endure as a monument of our triumphant industry, unimpaired amidst the waste of ages, and the ravages of time. 10 discourse m. On the Modus Operandi of Medicines. This is a very intricate question, and one, on which not a little difference of opinion prevails. After much controversy, the only point which seeMs. indeed, to be conceded, is. that the operation of medicines does not depend on any of the com- mon laws of matter, but on a principle incident to vitality alone. "Me^icamentnm, non ag^t in cadaTer." As this is so universally admitted, a« even to be- come oue of the established maxims of the schools, it mav be right before we advance further into the discussion, to endeavour to fix oor notions in rela- tion to the nature of life. But as speculations of this sort, indulged to any extent, would be here misplaced. I shall exhibit my views of the subject, in as narrow a compass as possible. Of the various doctrines of vitality, one only ap- pears to me to be at all well founded, and consequent- ly deserving our attention. It presumes that every auimated body, animal or vegetable, is endowed with a primordial principle of life, and which, re- sident iu the ova of animals, and the seed of plants, ron-'iNH.'s the power by which, in the first place. 41 the various organs are moulded, developed, and perfected, and by which, afterwards, the animal economy is defended against the action of mecha- nical and chemical laws. Located, perhaps, in the highest degree, among the digestive and assimilative organs, it enables them to change, or destroy the qualities of the sub- stances exposed to their operation, without sustain- ing in return the slightest injury or change. It would hence, really appear, that instead of matter, whether aliment, drink or medicine, acting on the living system, as is commonly imagined, it is, on the contrary, the living system which operates on these matters. But, such is the case only, when the vital energies are in a vigorous and healthy condition. Different, very different indeed, is the result, where from debility or other imperfection, the vital organs are rendered unfit to act upon sub- stances, or of resisting the action of substances ou the system. Whatever is taken into the stomach under such circumstances, preserves its properties unaltered, or undergoes the same sort of altera- tion, which it would do out of the body, or beyond the sphere of the vital powers. Each ar- ticle in this state obeys the order of its affinities, and the changes which occur, are purely chemical. Common matter, now acting by its own laws, the system being thus languid aud decayed, sinks un- der the attack it cannot repel, and the processes of fermentation and putrefaction ensue, which, if not 42 imely arrested, become the precursors, as well as the causes of death and destruction. Life, therefore, may be defined the principle. or power by which the system preserves its own in- tegrity unimpaired, and its several parts from de- composition, amidst the action of surrounding agents, while it acts upon things foreign to itself, assimilates them to its nature, and appropriates them to the supply of its exigencies, or to the re- dress of its injuries. My theory of the operation of medicines is of mo- dern date, and alleges, that they all act by exciting a local impression which is extended through the medium of sympathy. By many, however, it is still believed, that certain articles, at least, enter the circulation and produce their effects in this way. The latter hypothesis is evidently a relict of the humoral pathology. By the disciples of that sect, it was held, that disease consists in a depra- vation of the blood, •'•' from too great tenuity or viscidity, by an excess of acid or alkaline acrimo- ny, by morbific matter entering from without, or generated within." As a necessary consequence of this view of dis ease, medicines were supposed to penetrate into the circalation, and by a sort of chemical action to correct the vitiated condition of the fluids, and hence the origin of the terms, inspissants, attenu ants, antacids, antalkalies, antiseptics, diluents, de mulcents, &c. &c. 43 As they are now pretty generally exploded, to demonstrate the fallacy .of these speculations, by any very miuute detail of facts or reasonings, can not be required. My opinion is, that changes in the condition of the fluids are wrought by impressions made through the intervention of the solids. Not the slightest proof exists, so far as I know, of their undergoing any mutations, either by spontaneous action, or from the introduction of foreign matters, much less that such is the cause of disease, or the mode in which our remedies operate. To reach the circulation, medicines must pass either by the lacteals or lymphatics. Now it seems more than probable, in either case, their powers would be so neutralized by the preparatory pro- cesses of animalization, as to be deprived of all activity. Can it indeed be credited, that any substance, after a subjection to the digestive and assimilative powers, retains in the slightest degree its original properties. Experiments, on the contrary, show, that chyle, however diversified the materials»may be out of which it is formed, whether animal or ve- getable, has invariably an identity of nature, and instead of being a crude, as is commonly imagined, is in reality a highly elaborated fluid, having many, and perhaps all the properties of blood, exeept its red colour. Three of the constituents of blood it at least contains. t. There is one portion of chyle, which preserves u its fluidity during life, but coagulates after death, by e\po-ire to the air, and is probably fibriue. 2 There is a second portion, which resemhle> s? rum. in continuing fluid uhen exposed to the at- mosphere, and in coagulating at the same degree of temperature as serum. 3. Ti: re is a third, consisting of globules, simi- lar to those of blood, with this difference only, that they are much more minute. The fact of the perrect and uniform constitution of chyle seems to mc at once, to put down the hy- poth' s"ts which 1 am combatting. But, perhaps it may be said, it proves nothing iu the case of medi- cines administered otherwise than by the stomach, as when applied to the surface of the body, or in- troduced into the bowels. To this objection the answer i* obvious, and I thiuk very satisfactory. No one who has carefully attended to the pheno- mena of the absorbent system, can help admittiug, that every section of it is endowed with the power of digestion and assimilation, and the lymphatics quiff as conspicuously as the lacteals. This capa- city i- given, as a provision of nature, to exclude noxious matters from the circulation. The absorbents, in some instances, are fully ade- quate to this end, and when they are not, the sub- stance peuetrates to the first conglobate sland. which takes on inflammation, and arrests its fur- ther progress, these organs acting here as centinels. guarding the exterior approaches of the bodv. 45 That some of ilie properties of certain articles, as" the odour of garlic, and the colouring matter of mad- der, are displayed in the secretions and excretions, I am not disposed to deny. But it does not hence follow, that these substances entered the circula- tion in their primitive state. Directly the reverse indeed seems to be proven, as neither the one nor the other can be detected in the serum of the blood. To me it is clear, that the process of assimila- tion, as performed either by the chylopoietic viscera, or by any part of the absorbent apparatus, com- pletely decomposes all substances, and however discrepant in their properties, reduces them to a ho- mogeneous fluid fitted for the purpose of nutrition. But when thrown into the secretions or excretions, beiug removed beyond the sphere of the vital ener- gies, the chemical affinities are sometimes again brought into play, by which these substances are in part, or wholly regenerated. Whether this explanation be received or not, it must at least be acknowledged, that no substance, in its active state, does reach the circulation, since experiments have shewn, that a few drops even of the mildest fluid, as milk or mucilage, oil or pus, cannot be injected into the blood vessels, without occasioning the most fatal consequences.* " In the year 1799, in conjunction with my friend, the late Dr. George Lee, then resident in the Pennsylvania Hospital, I instituted a series of txperiments, with a view of ascertaining the effects of certain substan- ces, when injected into the blood vessels. All the articles enumerated *>buve, were tried in succession, together with some ethers of an acrid 46 Conceding, however, to the bumor.il pathologists ail which their doctrine demands, and s:iil irmaiiier- able difficulties remain in the vray of i'_s a do:j don, to account for the opora.fion of medicine Not to dwell tediously on this subject, I shall coitent my- self at present with merely mentioning that we are no: at all informed by it. why oor remedies, aner mixing with the blood, should be direc:ed to one or- gan iu preference to ano:her. as mercary to the sa- livary glands, or how indeed they operate at all. Nothing, surely, is less probable, than that dead matter, by mere mixture with an ius^ risible fluid, like the blood, should produce any effect on a liv- ing system. If it be alleged, as it has soai: dmes been, that the action of medicines, under such cir- cumstancjs. is on the surface of the blood vessels, then, the doctrine becomes u:;erly deserted, and we are forced to recur to sympathy, as affording the on- ly explanation. By a recent writer of hi^h authority, whose opi- nions however on this subjec:, are not wholly with- out the taint of the humoral pathology, it is con- ceded, as an incontrovertible fact, that a large pro- portion of our medicines do act by the ••' medium of nervous communica:iun.'5 ar.d s::.:rii::*v.r£ nature, on dogs and cats, the ir.'.-:.'.■= sele;:ei fir tbe purpose. But diTersifiei as these substances are in their properties, vre cud discern no materia', difference in ibe'ir effects, the whole seeming to act merely as extraneous matter in error he:, producing, at firs:, great distress to the animal, as was indicaed by its nu.verr.errj and cr.es, followed by difficult paring respiration, vomits rj and purg- ing, nervous tremors, conTuLi.or.s, iid ct^'z 47 "This," says he, "is manifest, from the ef- fects of these substances being produced in a short- er time after they have been received into the sto- mach, than they could be, were they to act by be- ing absorbed with the chyle into the circulating mass. The stimulus of wine or opium will instant- ly remove lassitude, and increase the vigour of the circulation, or of muscular exertion. Digitalis given in sufficient quantity, very speedily reduces to a great degree the frequency of the pulse, or a large dose of cinchona, exhibited half an hour be- fore the expected recurrence of the paroxism of an intermittent, will prevent its attack."* The principle being thus clearly established in so large a number of instances, which, if necessary might be still further increased, it appears to me, that it should be admitted as an universal law, un- less exceptions to it are very clearly made out and demonstrated. To multiply causes superfluously, is against one of the fundamental rules of philoso- phising, and is not less repugnant to the general course of nature, whose means are proverbially dis- tinguished by great simplicity and uniformity. As regards the mercurial preparations, an exam- ple particularly selected by the writer whom I have just cited, to illustrate the occasional admis- sion of medicines into the circulation, we have the most conclusive proof that this never happens. * Murray's Mat. Med. 1*3 whatever may be the manner in which they are em- ployed.* and no doubt such is the case with all the articles of the materia medica. It i* at least as clearly shown, by experiments made by myself ma- ny years ago, and which have been since more than once repeated with greater precision, and on a more extensive scale, by graduates of this school, that none of the preparations of iron, of copper, of lead, nor the colouring matter of indigo, of madder, or of rhubarb, can be traced even «<• far as the chyle.f Could more proof be required of the operation of medicines beins entirely independent of the circu- lation, it might be found in the well ascertained fact, that many of them produce their full efTee;?. though the heart and blood-vessels be previous- ly removed. L0112 ago it was shown by YVbytt. that if the heart of a frog is taken out, and a solu- tion of opium be injected into the abdomen, the ani- mal speedily becomes convulsed. The poison ol the vip^r. according to Girtanner, applied to a frog prepared in the same way. will destroy it as soon as if no mutilation of the animal had takeu place. Numerous experiments of a similar import, with other active suhsfauces. have been instituted, the results of which are so exactly correspondent, that to detail them would be superfluous. But. before • Experiments of Dr. Phjsick and Seybert, Medical Repository. vol v. f H *tj»e's Inaug. Dissertation, in whic_. many of these esne-'-men's are con'.air.ed 49 I finally dismiss this part of my inquiry, I will on- ly remark, that the converse has been equally proved, or that no extension of the impression of medicines happens in'cases where the brain and spinal marrow have been destroyed, though the heart and vascular system be preserved uninjured * It results, on the whole, from what I have said, that we are to reject the fluids altogether in our in- quiries relative to the operations of medicines, be- cause, in addition to the reasons already stated for doing so, we have in that law of the animal^cono- my termed sympathy, or consent of parts, a solu- tion of the problem which comports infinitely better with the existing state of our knowledge. Conformably to the theory which I have propos- ed, whenever a medicinal substance is applied to a susceptible portion of the body externally or inter- nally, an action is excited, which is extended more or less, according to the ditfusibility of the proper- ties of the substance, or the degree of sympathetic connection which the part may maintain with the body generally. Thus a set of actions is raised, every one of which is precisely similar, provided they are confined to the same system, by which is to be understood parts of an identity of structure. If, however, the chain runs into othe, systems, it loses its homogeneous character, the actions being modified by the peculiar organization of the parts in * Murray's Mat. Medica G 50 which they may take place. These are principle* of universal application. In every case, whether it respects the operation of remedies, or the pro- duction of disease, the spot-primarily acted upon is a point, from which is diffused the radiated impres- sions. As the doctrine here advanced is intimately con- nected with the principle of sympathy, it may be proper that I sho« Id say a few words on this sub- ject There are indeed not wanting some who have effected scepticism as to the very existence o£ such a law. It must be confessed, at present, wc have no verv distinct intelligence relative to its na- ture. But are we. on this account, to question its existence? Equally might we doubt of the sensi- bility or irritability of the body, since neither of these qualities of vital matter has been precisely de- monstrated. Notwithstanding this, we are per- suaded of their existence from the phenomena which they exhibit, and it is by the same descrip- tion of evidence that we are, or ought to be, assured of the existence of sympathy. "Causa latet risest notissima." In employing this term, therefore, we mean onlj to denote, like chemical affinity, caloric, and many other such expressions, a principle, or power, of which we know nothing except from the experi- ence of its effects, the precise essence or nature be- ing occult, and concealed. Thus, iu the same way, 51 says Newton, "What I call attraction maybe per- formed by impulse, or by some other means un- known to me. I use the word here to signify only in general, any force by which bodies tend towards one another, whatever be the cause." Of the manner in which impressions are extend- ed, as well as of the cause of the more intimate con- sent of parts, we are not perhaps accurately inform- ed. It would seem, however, that in neither case is it to be exclusively referred to the mediation of the nerves, as is commonly supposed. Those sym- pathies which prevail among the various viscera of the abdomen, and between them and the head, neck and contents of the thorax, may be explained with sufficient probability, by the extensive anastomoses of the intercostals with almost all the nerves which proceed from the spinal marrow. But, there are many other sympathies, not less conspicuous, be- tween parts, the nerves of which have not the slightest connection. It appears, that either by the co-operation of different organs in the perform- ance of a function, as in the complex apparatus subservient to respiration, or from similarity of structure, parts, though detached, being prone to be affected by the same cause, as the parotid gland and testes in the male, and the same gland with the mammae in the female, the habit of acting in unison is acquired, and sometimes confirmed. This habit of concerted action is termed association, and has been adopted as a principle by Locke, by Hartley. 52 and bv Darwin, to accoont for the connection in manv of the motions of the body, ,« well as :n the opera ions of the mind. Both the sound and mor- bid stales of the «\ The s^n 3. The organ of smell. ? E.ion of these parts has a considerable suscepti- bility, aud maintains a very extensive connection with the sv.tem generally, though the s omaeh is poss.s.ed of infinitely the quickest seusibility to ac- tion, and the most intimate and multiplied relating. No vU > or oigao. not even the brain itself, can be 53 compared to it, in this respect, or which occupies so important a station in the animal economy. Destitute of a stomach, no animal can exist. Life may be sustained, even in the perfect animals, independently of almost every other organ. Ex- amples are numerous of foetuses being born of a full size without a brain, spinal marrow, heart, lungs, liver, or uterus. No instance, however, has been met with, iu the course of my very extensive re- searches on this subject, where the stomach was wanting. As the most indispeusable of the vital organs, it seems, indeed, to be an inseparable inci- dent to every variety and gradation of animal ex- istence. No matter how inferior the being may be, it is always provided with some apparatus equiva- lent to a stomach. Conveniently situated for the purpose, the sto- mach is probably the throue of the vital principle, from which would seem to emanate, an influence that, diffused over the system, preserves, as I have already mentioned, the order of the parts, and sus- tains the vigour, tone, and well-being of the whole animal economy. «• I.anguido ventriculo, omnia languent." Assailed, however, by impressions which it cannot resist, this organ, as the centre of association, be- comes the seat of the first link in the chain of most diseases, and is always the chief medium of the 54 operation of our remedies, in the correction of morbid derangements. As a continuation, pretty moch of the same struc- ture as the stomach, the intestines, afford also a medium by which medicines may be introduced, and sometimes, with great advantage. There is, indeed, scarcely one article of the materia medica which cannot be so managed, as to produce its full effect when thus employed. To attain this, how- ever, the dose should be largely increased, and, as a general rule, about three times the quantity is de- manded. It is, perhaps, not sufficiently known. tli i*. after the sumach. !>v Ions: list-, has lost, or had greatly impaired. i> susepptibility to fhe action of a medicine, this will operate with fresh and una- ba'i-d force, if-lopliecl to the rectum. TLai the surface of the body is another part on which our remedies act. has been known from the earliest times, and the practice founded upon it. is probably to be ranked •■ among the first attempt that were made in the infancy of our science, to- ward the removal of disease." The whole of the cutaneous surface seems endowed with some sensi- bility to impression, though the soits of the feet are possessed of it in the largest degree, and hence. have been pronounced, by a distinguished teacher of physic, as constituting, anions; the widest ave- nues to the invasion of disease, or for the introduc- tion of remedial im[ u»sions. But. though the prac- tice bus been so long and generally pursued, it was 55 never doubted till lately, that when thus applied, medicines operate in any other way than by erner- ing the circulation. Even the rubefacient and ve- sicating applications were, at one time, not except- ed ; the effects of these, on the contrary, being as- cribed altogether to the absorption of the acrid par- ticles of the substance u-ed for these purposes, into the blood, and thereby raisiug the excitement of the system. Nearly about the same period, Mons. Seguin, in France, and Dr. Rousseau, of this city, called in question the existence of cuticular absorption. But the praise of laborious and successful investi- gation, is due exclusively to the latter experimen- talist. As early as the year 1800, it was proved, or at least rendered highly probable by him, that the pulmonary organs, and not the skin, constitute the inlet through which certain substances enter the system. By cutting off all communication with the lungs, which he easily effected by breathing through a tube protruded into the external atmosphere, he found, that though the surface of the body were bathed with the juice of garlic, or the spirit of turpentine, none of the qualities of these fluids could be detected, either in the urine or the serum of the blood. Conducted nearly on the same principle, but with a greater diversity of substances, experiments exceedingly well devised, and neatly executed, 56 have since been made by persons of opposite pre p(,s«e-*ions. to an almost incredible extent. Con- tradictory as many of these are, a candid examina- tion of the whole, will still lead to a pretty satisfac- tory conviction, that absorption from the surface of the human body, does not exist as a natural and ordinary function. Borne down with the weight of evidence against them, most of the advocates of the ancient hypothe- sis were indeed prepared »o abandon it. a« no long. er tenable, when about four or five vtars ngr>. an experiment made by Dr. Mussev. a^ain revived their faith in cuticular absorption. He very clearly proved, that if the body be immrt «pi! in a decoction of madder. *'e colouring matter of this substance will be taken in. and may be displaced in the arine by usins any one of the alkalies. a« a test. Determined, if possible, to put this agitated ques- tion to test. Dr. Rousseau, assisted by his friend Dr. Sainl. B. Smith, has subsequenily performed a series of experiment*, many of which I witnt-s^ed, and can therefore bear testimony to their accuracy, with every variety of substance, mild and acrid, vo- latile and fixed, nutritive, medicinal, and poistnuus The result of these extensive researches, is ; 1. That of all the substances employed, madder aud rhubarb are those only which affect the urine, the latter of the two. the more readih enrei> the svstem. Neither of these articles can be uaced 57 in any other of the secretious or excretions, or in the serum of the blood. 2. That the power of absorption is limited to a very small portion of the surface of the body. The only parts, indeed, which seem to possess it, are the spaces between the middle of the thigh and hip, and between the middle of the arm and shoulder. Topical bathing with a decoction of rhubarb or madder, poultices of these substances applied to the back, or abdomen, or sides, or shoulders, produced no change in the urine, and equally ineffectual was the immersion of the feet and hands in a bath of the same materials, which, after being kept in it for several hours, not the slightest proof of absorption was afforded. As I have described, such is the state in which this interesting subject is at present left. Though, perhaps, not absolutely decided, enough surely has been done, to demonstrate, that cuticular absorp- tion rarely happens, and that whenever it does, it cannot be deemed the effort of a natural function. Covered, as is the whole surface of the body, by the impervious cuticle, it is manifest to me, that ab- sorption can alone take place in one of two ways ; either by forcing the substance under the scales of the epidermis, as in the instance of the application of frictions, or by continued bathings, or fomenta- tions, the cuticle becomes so changed in its organi- H 58 zation. as to admit of transudation, or the insinua- tion of the fluid under its -famous . ructure. so as to come in contact with the months of the lympha- tics situated within. At all even s. whatever difference of opinion may be entertained as to the degr* e of conclusive- ness of the experiments to which 1 have alluded, it cannot be necessary to resort to cnticular absorp- tion to explain the effects of substances applied to the surface of the body. We shall do this much more satisfactorily, by referring it to sympathy, and to another source which I am presently to point out. That the skin has a very intimate connection with the body generally, and more especially with the stomach. is a fact so notorious, that it would be a waste of time in me, to attempt to prove it. It is through this medium that most substances applied to the surface, certainly operate. The discovery of the pulmonary absorption. would seem. 1 confess, on the first view, to militate in some degree against this opinion, and to render it more than probable, that volatile matters, at least, are inhaled and act through the lungs. Ex- periments, however, have recently been made,* which go far to invalidate this supposition, and shew, that under such circumstances, it is the ol- factory nerves, which are the seat of the impres • By Dr. Rousseau 59 sion, and the medium through which these volatile matters produce their effects. These experiments would occupy too much space to be separately de- tailed. Collectively, they warrant the conclusion, that, by simply closing the nostrils, either by com- pression by the fingers, or by filling them up with putty, the fumes of ardent spirits, of a strong de- coction of tobacco, or an infusion of opium, may be inhaled for one hour, without any unpleasant ef- fects ; w7hereas, if the precaution mentioned be omitted, the consequences are proven to be most distressing. New as these results are, and inconsistent with our pre-existent notions as they may be, they are rendered highly probable, independently of the re- spectability of the source whence they proceed, by some facts of a very striking and indisputable na- ture. Every practitioner has witnessed how power- fully all the volatile and odorous matters operate on the olfactory nerves in health and in sickness ; and it is hardly less known, that when the sense of smell is impaired by a coriza, or entirely suspended by obstructing the nostrils, that the sensible qualities of most substances are so lost, that they cannot be accurately discriminated, and this extends, even to those articles of our food or drink, with which we are most familiar. The preceding facts are suffi- cient, at least, to awaken curiosity on this subject, and to urge to more exact inquiries, by which the truth may be elicited and confirmed. 6o DISCOURSE IV. On the Classification of the Materia Jl^dica. I have completed what I mean, at present, to say on the modus operandi of medicines generally. It has not occupied as much of ray attention, as perhaps the importance of the subject demands. But I shall again revert to it, in treating of the particular classes of remedies, when an opportunity will be afforded me of giving to it a further and more precise consideration. The materia medica has sometimes been divided into nutriments and medicines. This arrangement, I shall not adopt. The plan which hitherto has been pursued in the investigation of the articles of food, seems to me to be exceedingly idle in itself, and to lead to no sort of practical utility. No one need now be told, at least in this abundant country, of the solid qualities of beef and mutton, of the de- licacy of poultry, or of the flavour of game : that we have some vegetables which are flatulent, and some otherwise : that ardent spirits, when drank to excess, will intoxicate, and ultimately produce dis- ease, and that, on the whole, the use of water is more natural, preserves sobriety, and conduces to health. Daily experience teaches us all on this 6i subject what to select, and which to avoid, with infinitely greater certainty, than any system of abstract instruction which can be devised* The disquisitions, indeed, which I have met w ith of this sort, are among the specimens of the most arrant pedantry and empty flummery that have ever been imposed on the credulity, or insulted the common sense, of mankind. Let it not, however, be supposed, that I wish to disparage the utility of diet, or to deprecate any further inquiries into the subject. Directly the reverse are my sentiments. To a proper regulated regimen, as a means of preventing and curing dis- eases, or for securing a speedy convalescence, it is impossible for any one to attach a greater import- ance than myself, or more ardently to desiderate a work, which, coming from the hands of a practi- tioner of enlarged experience, and sound judgment, shall exhibit the most minute and detailed instruc- tions, for the adaptation and even cookery of food, and preparation of drinks, iu such cases. As respects the classification of medicines, much difficulty has always been confessed. It is not my intention to notice, in detail, the multiplied systems which are extant. The history of these may be found in most of the treatises on the materia uiedi- * " The common experience of mankind will sufficiently acquaint any one with the sorts of food which are wholesome to the generality of men ; and his own experience will teach him which of these agree best with his particular constitution." Hebcrden. ca. I shall now merely remark, th,at every attempt which ha- been made to arrange medicinal sub- stances according to their sensible qualities, their chemical compositions, or their botanical affinities. has completely failed. The principle on which they are all founded, unavoidably associate- arti- cles, which, is remedies, have no resemblance, and separates others, that are intimately allied by their properties. As our object, in the cultivation of the materia medica. is to acquire a knowledge of the medicinal virtues of substances, it is obvious, that the best ar- rangement is the one, which places them as nearly as possible, as they correspond in their effects on the living system. But even this, is not without i'.s perplexities aud disadvantages, the chief of which, arises from our imperfect acquaintance with the laws of the animal economy, and the operation of remedies. It is uot easy, on this account, to appre- ciate their effects with accuracy, and especially in a state of disease. Many of our medicines are possessed of diversi- fied powers, and hence require, to be considered in different views. The same article may be emetic, cathartic, diaphoretic, and therefore, in order to its complete history, must be introduced into each of these classes. This is exceedingly inconvenient, as it exposes us to couslaut repetitions, and renders our descrip- tions necessarily broken and detached. But even 03 with all these defects, this mode of arrangement is incomparably superior to every other plan, and will be pursued by me. Cullen, who of late has been usually followed by the teachers of the materia medica, has a general division of medicines as they operate on the solids am\ fluids. The first class, according to him, acts either on the simple or vital solid. Those which operate on the simple solid, are astringents, tonics, emollients, and erodents. Those which act on the vital solids, are stimu- lants and sedatives, including narcotics, refrige- rants, and antispasmodics. The medicines which operate on the fluids are such as either produce, a change in^ them, or occa- sion some evacuation. The former comprise at- tenuants, and inspissagts. When they correct ge- neral acrimony, they are called demulcents. When partial acrimony, antacids, antalkalies, and anti- septics. The latter, as evacuants, are errhines, sialo- gogues, expectorants, emetics, cathartics, diuretics, diaphoretics, and emmenagogues. In this respect, however, he has manifestly de- parted from his own system of pathology, since he strenuously maintains, that the fluids are never pri- marily affected. I will not pause here to point out the many other objections which might be alleged against this celebrated classification. They are too (51 obvious fo escape observation, after what 1 have said on a preceding occasion, and therefore demand no particular criticism. My own opinion, as relates to the operation of remedies, I have already distinctly expressed. It is my most deliberate conviction, that they all act by virtue of that law of the animal economy termed sympathy, and that, whatever changes may be wrought in the fluids, are to be referred to impres- sions through the mediation of the. solids- But, while I maintain so far the uniformity of the opera- tion of medicines, I wish it to be understood, that 1 am not among those who, in the eagerness of ge- neralization, have insisted, that they ail are endow- ed with the same properties, differing only in de- gree of force, permanency, and diffusibility. I en- tertain, indeed, an entirely opposite view of the sub- ject. My impression is, that scarcely any two agents produce entirely the same effects, and hence the infinitely diversified shades of disease, and the necessity for a variety of remedies in the manage- ment of them. Every organ of the animal economy we know is excited to the performance of its office ouly by its natural and appropriate stimulus, as the eye by light, the ear by sound, the testicles by venereal desire ; and it is the same with regard to medicines and other external ageuts. The difference in the kind of action which they exert, is not less conspicuous. Mercury, and opium, and wine, and volatile alkali, 65 and camphor, are all stimulants, and so far they agree in their general properties, though, in the na- ture of their operation, are extremely discrepant, and cannot, by any variation of dose, or manner of administration, be assimilated. This holds equally true with respect to all the important articles of the materia medica. By an attentive observation of the phenomena, we shall be persuaded, that while each displays a stimulating power, its action is modified by its own peculiar qualities, and that the effects produced are, to a certain extent, sui generis. But another distinction is to be attended to, in the operation of medicines. There are some which have a wide pervading operation, extending over the whole system, while others are local in their primary effects, being limited to a single organ or part. Of the first class, or general stimulants, we have a considerable section, which is marked by great diffusibility, and as soon as they are exhibited, oc- casion an universal excitement. There is a second division, by which vigour and tone are imparted to the body, attained, however, very slowly, and only by a long continued administration. Those which are diffusible arc very transient in their ef- fects, while such as are more gradual in their ope- ration, produce permanent impressions. The local stimulants act either immediately on the stomach, or are directed by a species of affinity i 66 to some distant part. The relations between me- dicinal substances, and certain portions of our or- ganic structure, are exceedingly curious, and de- serving, in a practical view, the most serious reflec- tion. In advancing the preceding opinion, I am aware that the possibility of any medicine acting specifi- cally on one part, without exerting the same sort of action on other parts, has been denied, and on the ground of the intimate connection, which can be traced throughout the whole animal structure. It must be conceded, that a superficial view of our or- ganization, and the uniform order of its various ac- tions in a sound state, render such an objection very plausible. But a more minute examination, independently of a series of well conducted experi- ments, performed in this university,* establishes directly' the reverse. The fact is, that while the several systems, or subordinate divisions of the body are so linked to- gether as to constitute one whole, such is still the independency of each, and such the difference in the operation of the same article, that certain ap- plications made to an individual part, will be pro- ductive of the most fatal consequences, which to some other will be attended with mild and even sa- lutary effects. It follows, from the preceding remarks, that 1 hold all medicines to be stimulants. As, how- * Bibb's Inaugural Dissertation. 67 ever, it is very material iu every enquiry, that we should have a clear understanding of the terms to be employed, I shall, at this early stage, define what I mean by stimulants and sedatives. The discussion which has so long been maintained on this point, is really little else than a dispute about words. As whatever produces any positive impres- sion on the living system must do it by an incitant power, there can be no doubt, that, in a very strict sense, every medicinal substance is a stimulant. But the effect thus created may be inferior to the natural degree of excitement, and much less than that of desease. When this happens, as lessening action, the article may with propriety be deno- minated, and in a practical view considered, se- dative, in contradistinction to our more energetic remedies. The views which I have presented, of the qua- lities and modus operandi of substances, lead to a very simple classification of the articles of the ma- teria medica. I might, indeed, comprise the whole of them under the two heads of local and general stimulants. But, as such generalizations are una- voidably deficient in perspicuity, I shall subdivide each of these leading departments into subordinate classes. The first will include, emetics, cathartics, diure- tics, lithontriptics, diaphoretics, expectorants, em- menagogues, anthelmintics, epispastics. The second, diffusible stimulants, tonics, astrin- gents. 08 EMETICS. These may be defined medicines which excite vomiting, independently of any effect arising from the mere quantity of matter introduced into the sto- mach.* The use of these remedies is so extensive, and their effects often so salutary, that I shall be justified in treating of them at some length. Emetics were employed in the most ancient times, and, perhaps, were among the earliest remedies. To evacuate the stomach, for remedial purposes, seems indeed, to be the suggestion of an instinctive im- pulse. It is a practice pursued by the most savage tribes, and even by the brute creation, and nothing, therefore, can be more absurd, than the opinion of those physicians who have objected to their use, as an unnatural and dangerous remedy. We have no class of medicines so generally resorted to, or of which nature has provided such a profusion. Of the mechanism of vomiting, little need be said. The vermicular motion of the stomach, in this pro- cess, is inverted, the diaphragm and abdominal mus- cles are called into action by association, and the pylorus being contracted, the contents of the sto- mach are forcibly ejected. But how this retrograde motion takes place, it is not very intelligible. Emetics are undoubtedly stimulants, though the ef- fect is not always proportioned to the degree of power which the article may possess. It is, indeed, * Murray's Mat. Med. 69 maintained by Darwin, with sufficient plausibility, that vomiting is not the consequence of increased, but of diminished action, proceeding from the disa- greeable sensation of nausea and sickness. This state being induced, he presumes that the natural motion of the stomach is gradually lessened till ul- timately it ceases, and a new and inverted action takes place. The supposition of vomiting having its origin in debility of the stomach, certainly derives some confirmation from the circumstance of its be- ing frequently excited by extreme languor, or syn- cope, whether induced suddenly, or brought on by protracted disease. Whatever, in fact, relaxes the system, disposes to vomiting. But, on the other hand, many of our medicines, actively stimulant, are also emetics. Lt is not easy to reconcile such a contradiction, and the only way in which it seems to me that it can be done at all, is, by supposing, that while the article is acting locally as a stimu- lant, it is producing, indirectly, general debilitating effects. By some physiologists, it has been doubted whe- ther the stomach is not entirely passive in the ef- fort of puking. They allege, that in the opera- tion the diaphragm and certain auxiliary powers are alone concerned. But the experiments of the cele- brated Mr. Haighton are so conclusive, as to leave this uo longer a matter of speculative controversy, During the effort of vomiting, he opened the thorax of several animals, and distinctly saw the contrac- 70 tions of the stomach, and, of course, its direct agen- cy in the process.* ' Connected with the operation of this class of ar- ticles, there is a peculiarity not unworthy of remark. Most other medicines lose their power by repetition, which, indeed, would seem to be one of the laws of habit. Exactly, however, as emetics are repeated, so does the stomach increase in susceptibility to their impression, so much so, that after frequent use, the mere sight of the medicine, or even con- versation relative to it, will excite vomiting. Yet, like other articles, emetics operate with various degrees of facility on different persons, and at dif- ferent times on the same person, which is, in part, to be imputed to original peculiarities of constitu- tion, and still more to the influence of disease. In most of the febrile affections, vomiting is readily provoked, while in those belonging to the order ve- sanise and the class neuroses, as in mania, epilepsy, and tetanus, it is a matter of extreme difficulty. This is also most remarkably the case with respect to cynanche trachealis. Emetics do not immediately display their effects. The first indication of their action is an uneasy vermicular sensation of the alimentary canal, at- tended with some nausea and chilliness, a pale * These experiments are said to have been recently repeated in France, by Majendie, in the presence of a committee of the National Institute, and with opposite results. 71 countenance, and a pulse feeble, quick, and irregular. But as soon as vomiting is induced, the face becomes flushed, the circulation is more vigorous, though still comparatively weak, and there is a glow ou the surface. The operation having ceased, the system is left languid, and there is a disposition to sledp, which is interrupted for some time by slight occa- sional sickness. The skin is cool and moist, with more or less perspiration, and the pulse, which con- tinues weak, is slower and fuller. In a curative point of view, the leading effect of an emetic is the evacuation of the stomach. This alone is a very important consideration, when we reflect on the extensive influence of this organ, and recol- lect how dangerous are the consequences which of- ten ensue from the retention of its acrid, vitiated, or oppressive contents. Nor do the advantages stop here. The same inverted motion which empties the stomach, is extended to the duodenum, and in some measure to the inferior portions of the intes- tinal tube, and while the united functions of the dia- phragm and the abdominal muscles compress the gall-bladder and force out its fluid, the inverted motion alluded to, expels it. Emetics in this way promote the secretion and evacuation of bile, and perhaps of the pancreatic liquor. But it has been maintained by some, that the bile thus thrown out, exists in the stomach previously to the inverted peristaltic motion. This may some- times be true, though, were it uniformly the case, 73 we should have the bilious discharges in the first paroxisms of vomiting, which we know rarely hap- pens. On more than one occasion, I have expatiated on the extensive dominion of the stomach over the whole animal economy, and especially as relates to the surface of the body. By virtue of this intimate connection, one of the primary effects of emetics is, to induce an universal relaxation, approaching, in some instances, even to syncope, of which state of the system the extreme vessels partake, and as a consequence, perspiration breaks out, from which, if kept up by proper means, results the most salutary sometimes take place. There are, however, some writers, who deny that so close a sympathy prevails between the stomach and the exterior surface, be- cause diaphoresis is not uniformly the consequence of vomiting. But I really cannot perceive any force in this objection, since it proves, at most, only, that emetics, in common with all other remedies, are sometimes precarious in their operation. An effect of this class of medicines, not less ob- vious, is the promotion of absorption. No one has attempted to w ithhold from them this valuable pro- perty, though the precise manner in which this is accomplished, is not so manifest to all. It has been contended, that they act immediately on the lym- phatics, exciting these vessels to an increased effort. To me, however, It appears, that a solution of the 73 difficulty is to be sought in an entirely opposite state of things. Whoever carefully attends to the phenomena of absorption, will be persuaded, that this function is always most vigorously carried on when the body generally, and especially arterial action, is much reduced. Of this fact, indeed, we can have little doubt, as it is coufirmed by the clinical experience of every practitioner, and hence the conclusion is, that our medicines invigorate absorption by an indi- rect effect. But emetics would seem also powerfully to act on the kidneys, and in some instances, certainly pro- duce a copious flow of urine. Whether this is owing to an inherent diuretic property in the medicine, or to the quantity of drink taken at the time, or to the mechanical compression of the organs during vomit- ing, or to the mere promotion of absorption, has not been satisfactorily determined. My conviction is, that they promote the urinary discharge independ- ently of absorption, since 1 have witnessed this effect in cases where no dropsical effusions existed. Every one is aware of the very intimate connec- tion which subsists between the stomach and head. The effects of emetics on the brain are, on this ac- count, very conspicuous, and form, as we shall hereafter see, a very important class of remedies in the management of many of the affections of the head. Nor, perhaps, have they a less striking affinity K 71 to the pulmonary organs. As soou as nausea takes place, we may remark a copious flow of saliva, and a discharge more or less from the bronchiae, which, when vomiting is induced, becomes considerably augmented. Before I proceed to the application of emetics to the cure of diseases, I shall suggest a series of pre- cepts to be attended to in their exhibition. t. When the vessels of the head are full, or other symptoms of plethora exist, the emetic should always be preceded by the loss of blood. Two ad- vantages result from this practice. It renders the vomiting safe, and more easy and effectual. By neglecting this admonition, many a life has been either endangered, or sacrificed, by apoplexy or haemoptysis. 3. When the necessity is urgent, and a certain and powerful operation is demanded, give a large dose, and of the most active species. 3. In ordinary cases, minister the medicine in divided quantities, so as to guard against too vio- lent an effect. 4. Where the object is to make a strong impres- sion on the system, little drink should be allowed. But if the design be to evacuate the contents of the stomach, large draughts of tepid water, or some other light drink, as warm chamomile tea, will pro- mote this end, and, at the same time, facilitate the vomiting. 5. As a general rule, emetics should always be 75 given on an empty stomach, and in the morning. They act with greater certainty, and with less dis- tress to the patient. They will, however, answer very well in the evening. 6. To check inordinate vomiting from too large a dose of emetic medicine, direct laudanum, com- bined with some cordial, apply fomentations to the pit of the stomach, and sinapisms to the extremities. Chicken water copiously drank is sometimes use- ful, by turning the action downwards. When these fail, anodyne injections may be resorted to, and a large blister should be put on over the epi- gastric region. 76 DISCOURSE V. On the Practical Application of Emetics. Closing the preceding inquiries, I am next to point out the use of emetics in the treatment of dis- eases. But in making this practical application of our remedies, I shall enumerate only the more pro- minent cases in which they are employed. In fevers of every species, emetics have been pre- scribed, and commonly with success. These, for the most part, are accompanied in the commence- ment with nausea, vomiting, and other symtoms indicating a disordered state of the stomach. Eme- tics, under such circumstances, are productive of much advantage, and have been recommended from the earliest times. Even Hippocrates was apprised of their utility, and the practice seems to be the obvious suggestion of nature. Emetics, in these cases, clear the stomach of its noxious contents, and prepare the way for the re- ception of other remedies. But they are not always indispensably necessary, as the stomach may some- limes be appeased by an agreeable mixture, such as the neutral or effervescent draught, and then a mercurial purgative substituted. Yet, where the at- tack is exceedingly vehement, whatever may be the 77 type of the fever, whether it be intermittent, remit- tent, or continued, we should never fail to resort to the emetic, and even to repeat it, if a very success- ful impression be not made on the case by the first exhibition. This precept, however, is more applica- ble to the bilious fevers of our own climate, and es- pecially as they occur in the southern states, where they prove exceedingly intractable under any other mode of treatment. As. respects the use of emetics in the more malig- nant fevers, medical opinion is, perhaps, not so de- cided. They were, at one period, very much pre- scribed in the commencement of the typhus gravior as well as the mitiorof the nosologists, and even now are not altogether neglected. The innovation, in this case, partial as it is, has been no improvement, nor are the views which led to it at all correct. Emetics, how- ever beneficially they may operate as mere evacuants, produce effects not less salutary in another way. Whatever may be the cause, fever is always a dis- ease of sympathy, having tbe primary link of its ultimately lengthened and complex chain, in the stomach. It is upon this organ that contagion, marsh effluvia, and other noxious matters act, and hence, precisely as in the cases of poison, a local irritation at first occurs, which, if not at once arrest- ed, spreads itself by multiplying the trains of mor- bid association, till the disease becomes general, involving, more or less, every part of the animal economy. 78 Either, therefore, to expel the offending cause from the stomach, or to subvert the nascent impres- sion which it has created, before it becomes invi- gorated, diffused, and fixed, an emetic is obviously the remedy for the purpose. Nor does the uti- lity of this practice rest solely on speculative grounds. Experience, on the contrary, has long since proved it, in the malignant, fevers of Europe, not even excepting the plague, and confessedly, its efficacy was great in that shape of pestilence, w,hich for a series of years so severely desolated our ci- ties. Yet, it cannot be too often repeated, or strongly impressed on the mind of the practitioner, that it is iu the forming state of this description of fevers, that emetics are at alt admissible. Exhi- bited in the more advanced stage of the case, or af- ter the disease is absolutely confirmed, and per- vades the system, they not only prove wholly in- competent to its removal, but generally heighten the worst symptoms, sttid augment the difficulty of cure. This effect was inost_ remarkably exempli- fied, in the treatment of our yellow fever, and has been remarked in some other epidemics, as> the plague, &c* * The efficacy of emetics, given on the principle which I have sug- gested, did not escape the sagacity of Sydenham. " When I have hap- pened," says he, "sometimes carefully to examine the matter thrown up by vomit, and found it neither considerable in bulk, nor of any remarka- bly bad quality, I have been surprised how ii should happen, that Uie patient should be so much relieved thereby.; for, as soon as the opera* 70 Emetics have of late been much recommended, in puerperal fever. This is a disease which so of- ten proves obstinate in its career, and fatal in its issue, that every suggestion relative to its cure is worthy of our attention. What renders this fever so very unmanageable, it is not easy to determine, We hardly know even the seat of the complaint, or, much difference of opinion, at least, exists on this subject. My own impression is, that it has its ori- gin in a primary irritation of the uterus, and that the peritonaeum, in the more violent cases, takes on sympathetic inflammation. To this conclusion, I am inclined, not only from what I have observed in my dissections, but from the peculiar malignity which often distinguishes the disease. It is an interesting fact, and one, of which, per- haps, we are not all apprised, that peritoneal in- flammation, when permitted to attain any height, is hardly ever cured, or, certain it is, that it constitutes one of the most difficult cases to contend against, in the whole circle of morbid affections. tion was over, the several symptoms, viz. the nausea, anxiety, restless- ness, deep sighing, blackness of the tongue, &c. usually abated and went off, so as to leave the remainder of the disease tolerable." Com- menting on this passage, Wallis, the annotator on the work from which it is extracted, very correctly observes, that " Sydenham was not aware of the sympathetic affections which take place in the constitution, nor knew that an extremely small portion of morbid matter could produce effects so sudden and surprising, from local action, so as to derange the whole system." 80 The employment of emetics in puerperal fever, is not a new practice. But they got out of vogue, and we heard little of their use till recently, when the practice was revived by an English writer, who ad- vises it to be trusted to exclusively, which, surely is the language of enthusiasm. 1 have several times prescribed emetics in puerperal fever, not so much to meet the general indications of the disease, as to relieve one most distressing symptom. The sto- mach is here not unfrequently loaded with a dark offensive matter, resembling the black vomit of our pestilential fevers, which occasions great distress and sickness, and if allowed to remain, uniformly keeps up fever, and depresses the system into a typhoid state. To evacuate this noxious matter, an emetic is indispensable, and its operation, in some instances, will be followed by effects the most prompt and satisfactory. Many years ago, emetics were strenuously re- commended in haemoptysis, by Dr. Robinson of Dublin. But the practice was not much followed, having been tried by Cullen in particular, and abandoned on account of its temerity. No doubt, however, emetics will very frequently check haemor- rhages from the lungs. 1 have seen spontaneous vomiting do it in several instances, and, on one oc- casion, I witnessed the worst hsemorrhagy of this sort, which ever came under my notice, complete- ly suspended by a dose of digitalis which puked 81 violently. But still, I concur with those writers who hold the practice to be hazardous, and ne- ver would resort to it, except under extreme cir- cumstances, and where milder remedies had total- ly failed. I speak, at present, in relatiou to those cases in which there is a copious haemorrhagy, in consequence of the rupture of a vessel of some size. But where there is only a slight raising of blood, mixed with the matter expectorated, as commonly happens in tubercles of the lungs, eme- tics may be administered with perfect safety, and sometimes with no little advantage. They divert the blood from the lungs, they promote a more equable circulation, they remove cutaneous con- striction, they calm the general condition of the system, and thus lessen the anxiety, cough, san- guine evacuation, and difficulty of respiration. It is in this way, that we, in part, imitate the effects of a sea voyage, and command some of its advan- tages. Emetics have also been much recommended in menorrhagia. When I come to discuss the subject of emmenagogues, I shall endeavour to shew, that menstruation consists, not in a simple efflux of blood, but, that the fluid is the result of a secretory action of the uterus. As a part of this'doctrine, I shall maintain, that all copious discharges from the uterus of this sort, are to be considered as i. 82 haemorrhages, and not, as has hitherto been held, a profuse or immoderate discharge of the cata- menia. I cannot, from my own experience, speak of the use of emetics in this species of haemorrhagy. I have never employed them, or seen them employed. If the woman were of a robust frame, and with a to- lerable degree of strength remaining, perhaps an emetic might be exhibited beneficially. I should, however, even in this case, which I deem the most favourable to the use of the remedy, greatly prefer venesection, and, at all events, nauseating doses of the medicine. Thus administered, emetic substan- ces are eminently serviceable. They were origi- nally recommended in this manner by a Swedish writer, whose name has escaped my recollection, and by the celebrated Bergius, this practice was soon afterwards adopted, and if his reports can be ere- dited, with no ordinary success. By another pro- fessor in the university of Upsal, of the name of Althof, the same remedy has been employed, and we are told, with similar effects. He even declares, without the slightest reservation, that he never failed in a single case. I am not prepared to go half so far, though I must say, that I have the highest confidence in this plan of treating uterine haemorrhagy. I have been in the habit of pursu- ing it for many years, and in numerous cases. The result of this enlarged experience, is a complete 83 confirmation in my mind, of what had been previ- ously said respecting its superior efficacy. Every practitioner is acquainted with the utility of emetics in cynauche trachealis. This is not the place for me to expatiate on the nature and treat- ment of this very formidable disease. I cannot, however, pass it over without some few observa- tions. Croup has been divided into spasmodic and in- flammatory, - and not a little discussion has taken place on this subject. It would seem to me, that in all cases where it suddenly attacks, it must par- take of the nature of spasm. The early symptoms correspond exactly with this view of its pathology, and dissections fully confirm it, shewing, where death promptly happens, none of the phenomena of inflammation. But, under opposite circumstances, or where the disease slowly comes on, or is the ef- fect of inflammation of other parts, extending to the trachea, then, of course, it is of a contrary nature, and inspections after death have revealed exactly such appearances as might have been anticipated. Admitting, however, the distinction contended for, 1 am not aware that it leads to any practical difference, and especially as relates to the use of emetics. No one disputes the indispensable ne- cessity of puking actively in the commencement of an attack of this disease, whatever theory may be entertained. But unhappily, as t'.have before re 84 marked, croup is one of those cases in which we often have to encounter very great difficulties in getting the remedy to operate. What is now to be done? My experience teaches me, that nothing is so effectual as the warm bath, and where it fails, venesection, in extreme cases, even ad deliquium animi. Never have I witnessed one solitary in- stance in which these means combined, did not suc- ceed in awakening the susceptibility of the stomach to the action of the emetic, and effecting all which can be expected from the most free and copious vo- miting. But in a more advanced stage of croup, emetics are scarcely less demanded. The disease having been permitted to continue for eight or ten hours, and sometimes even for a shorter time, it extends itself to the bronchi*, and into the very substance of the lungs, producing vast accumulations of mu- cus and phlegm, or an engorged state of these or- gans, as in peripneumonia notha. The lungs, now loaded and oppressed, very imperfectly execute their functions, which is indicated by all those symptoms incident to such cases. Emetics, cups, or leeches, and blisters, applied to the back, afford the only means of relief. Besides cynanche trachealis, emetics are favour- ite remedies, with many practitioners, in some ofs the other anginose affections. They have especi ally been prescribed in the malignant sore throat, 85 and doubtless with considerable utility. I have sometimes given them, when the stomach was dis- tressed with nausea, probably from an accumula- tion of the feculent matter incident to the complaint, and not only afforded relief in that respect, but have improved very much the coudition of the ul- cers about the fauces, which being cleansed, take on a disposition to heal. It was formerly the uni- versal practice, and is still recommended by some writers, to excite active vomiting for the purpose of rupturing the abscess in the severer attacks of cy- nanche tonsillaris. The plan, though undoubtedly often effectual, was uniformly productive of great pain, if not danger to the patient, and is now aban- doned by the best practitioners, as wholly unne- cessary, the abscess being very readily opened by puncture. In most of the complaints of the chest, emetics are liberally employed. As expectorants, we all know their utility. Even in some of the acute af- fections, and especially in the peripneumonies of old persons, they are eminently serviceable by emulging the bronchial vessels, and re-establishing an equilibrium in the circulation. It was on the same principle, that they were so beneficially em- ployed in the pneumonic forms of our late winter epidemic,* and have been found, in short, so ser- viceable in all cases of engorged or suffocated lungs, attended with feeble action. ' The peripneumonia typhodes. 86 Emetics, of course, are also advantageous in asthma. . The distinction which has been instituted in this desease, of humoral and spasmodic, seems in some instances to be correct, and perhaps the two species may occasionally exact some modification of practice. But, as relates to the use of emetics, I suspect the distinction need not be very nicely ob- served. They generally afford relief in the parox- ism, and, if timely administered, will sometimes prevent the recurrence of it.* Of the various remedies which, at different pe- riods, have been suggested for the cure of pertussis, or whooping cough, 1 know of no single one from which I have derived such good effects, as emetics. They are, however, chiefly applicable to the ear- lier stages of the complaint, and where the attack is violent, must be repeated daily, or even twice a day, for a week or two in succession. By stea- dily persevering in this course, and with the use of the auxiliary means, which I am hereafter to indi- cate, we shall generally be able to conduct the case to a comparatively speedy and successful issue, provided it be that of a child, as the remedy is not so well adapted to persons in more advanced life. Emetics have been extolled in the treatment * Cullen, I am aware, holds a more qualified language on this point. But I cannot help thinking he docs so- incorrectly, and especially as re- gards the distinction which he takes between the spasmodic and the pituitous or catarrhal species of the complaint. 87 of acute rheumatism. As yet, I have never used them iu any of the forms of this disease, with one exception only, and must therefore advance my opinion with diffidence on the subject. The parti- cular exception to which 1 allude, is that species of rheumatism originating in districts exposed to marsh exhalation, and where the attack, as some- times happens, is blended with intermittent or re- mittent fever. They here prove serviceable, on a principle perfectly intelligible. Nor have they been less commended, in the analogous affection of gout. They were formerly administered for the purpose of evacuating morbific matter which was supposed to be accumulated in the alimentary canal, and it is said, they mitigate pain and abridge the parox- ism. That this is sometimes the case, I can readily believe, having observed the same effects in this disease, from purgatives, as I shall more particu- larly mention in a subsequent discourse. Like rheumatism, gout is, in some instances, associated with fever of the intermittent or remittent type, and these cases, which are to be met with in low coun- tries, or in persons who have been transiently ex- posed to marshy exhalations, often require for their cure, the exhibition of an emetic, and even the use of the bark. As might be expected, emetics have unquestion- ably done much good in dyspepsia, and other de- praved conditions of the stomach. My first step 88 generally in the treatment of these gastric affec- tions, is to resort to this remedy. By the use of it, we now and then succeed in so completely reform- ing the state of the stomach, as by it alone to put an end to the complaint, and where this does not hap- pen, we at least pave the way for the introduction of other means. Emetics, judiciously repeated for a time, a regular course of tonics, and a diet con- sisting chiefly of milk and the lighter meats, without vegetables, will rarely fail to cure indigestion, and all its concomitants. To some of the bowel affections, emetics are well suited. It was usual with Sydenham, and his ex- ample has since been imitated by many, to com- mence the cure of dysentery with exciting vomiting, which he advised to be followed up by copious draughts of some thin beverage, to cleanse more completely the stomach. Of the propriety of this practice, I am not prepared to speak from any per- sonal experience. It may occasionally be necessary in the early stage of the disease, where the stomach is loaded, as sometimes happens, with bilious or other foul matter, creating nausea and distress. Cases of this sort are common in countries subject to intermittent fever, and the bowel affection will put on more or less of this type, and here the reme- dy is highly useful. Emetics, iu diarrhoea, are still more employed, and their utility, perhaps, is less disputable. But the complaint is dependent on such a variety of 89 causes, and assumes such different shapes, that it is difficult to indicate, in a mere summary, the precise cases to which the remedy is applicable. Of course we should not hesitate to prescribe it, where there was reason to suspect the diarrhoea to be caused, or kept up, by a disordered stomach. Under these circumstances, it will always operate beneficially. Besides relieving that organ of its irritating con- tents, it checks purging by inverting the peristaltic motion, and relaxing the skin, it produces perspi- ration, which, on account of the intimate connec- tion between the surface of the body and the ali- mentary canal, is salutary in these cases. On a future occasion, I shall enter more fully into a discussion relative to the pathology of those diseases which are embraced in the class of neu- roses, or nervous affections. My object will be to shew, the it is highly probable, that every one of the series has its origin very often in the alimen- tary canal, and, sometimes, in the stomach itself, and can only be successfully treated, by our keep- ing this fact steadily before us. After this declaration, it is hardly necessary to mention, that I consider emetics as among the most important of our means, in the management of these cases. Of the class of neuroses, however, the one which appears to me sometimes, to be most unequi- vocally a gastric affection, is epilepsy. Entertaining this impression of the nature of the disease, I have freely prescribed emetics in it, and with manifest M 90 advantage. By exhibiting them just before the ac- cession of the paroxism, they will often prevent it, and even if they do not altogether resist it, they render it milder, and of shorter duration. >ior is this all which they accomplish. By the strong and direct impression made on the stomach, the com- mencement in that organ of the wrong association constituting the disease, is broken, and afterwards the case yields to those remedies which we deno- minate tonics. The very close connection which is known to exist between the stomach and bead, has induced practitioners to rely greatly on emetics in many of the cephalic affections. Much has been said of their utility in that dis- tressing complaint which is denominated the sick headache,* one of the most heavy of the curses which are entailed on the sedentary and the studi- ous, as well as on those of delicate and valetudi- nary habits. This is unquestionably a purely gas- tric affection. It recurs periodically, and is always preceded by nausea,-sour eructations, and the other indications of imperfect digestion. But evacuations of the stomach will not alone cure it. The bowels must also be kept open, and the strictest attention to diet is demanded. Emetics are very frequently directed in apo- plexy. This disease may be seated either in the brain or stomach, though it is most commonly * Fothergill's Works. 91 brought on by congestions in the latter viscus, the result of debauchery and excess. When thus oc- casioned, vomiting is obviously the proper remedy. Encouraged by the success of emetics in apo- plexy, some practitioners, and especially of the continent of Europe, have recently urged the use of them in palsy. I have no experience on this sub- ject, though, were I to determine from the great ef- ficacy of the drastic purgatives in some instances of this affection, I should not hastily condemn the practice. Of the utility of emetics in mania, much has been said. But the circumstances in which they are ap- plicable, have not, so far as I know, been very ac- curately discriminated. No one, I presume, would think of exciting vomiting in the more violent forms or states of the disease, where there is great arte- rial action, with high excitement of the brain. Nauseating doses, in conjunction with copious bleedings, would be here certainly preferable. They, in a very peculiar manner, subdue fever, re- duce excitement, depress muscular power, and re- store the mental and corporeal quietude of the pa- tient. Nausea, thus kept up, will, in some cases, do more in these respects than any other course of treatment. It may, perhaps, be proper for me to repeat here, a remark which I formerly made, that mania is one of those diseases in which the stomach loses, in a most extraordinary degree, its susceptibility to the 93 operation of medicines, and particularly to emetics. This I am inclined to believe is even more conspi- cuously evinced in melancholia than violent insa- nity. Whether this torpor of the stomach is the cause, or effect, of the morbid state of the brain, cannot be stated positively. But of this there is no doubt, that its removal, as in croup, is a pretty cer- tain sign of a speedy convalescence. As this seems to be the case, would it not be right, to address our remedies more directly to this organ, with a view of arousing it out of its indolent and torpid condi- tion ? To meet this indication, nothing promises so completely as a succession of our most active and stimulating emetics. The effects of emetics in two or three cases of this description, under my care, have, indeed, very much strengthened these speculative notions, and authorize me to recommend the practice, with no small confidence of its future success. By a very ingenious physician of this city, Dr. Klapp, this mode of treating one species of insa- nity, the mania a potu, or, as he terms it, from Sau- \ ages, mania a temulentia, has been adopted, and, according to him, its superior efficacy is fully and indisputably confirmed. To this course, he says, be was led, by often remarking, that the subjects of derangement from intemperance, are very apt to labour under vomiting for several days before they become affected, aud that, when the mental disease begins, the vomiting ceases : and also, by having 93 seen, that spontaneous vomiting, when it recurs, in these cases, is generally attended with beneficial consequences.* Of the practice, as here applied, I cannot speak from my own personal observation, having always been so well satisfied with a different plan of ma- naging the disease, which I shall hereafter mention when I come to- discuss the properties of opium, that I have not been induced to deviate from it in a single instance. By some practitioners, emetics have been pro- posed iu hydrocephalus internus. By a very at- tentive observation of its phenomena, as well as from the lights of dissection, I have come to the conclu- sion, that the name hitherto conferred upon this dis- ease, is a misnomer, proceeding from an erroneous pathology. Most commonly, at least, the disease does not depend on an accumulation of water in the ventri- cles of the brain, but consists in an altered state of that organ, arising from a primary derangement in the chylopoietic viscera, and particularly of the sto- mach. Emetics are, therefore, occasionally useful, though I should administer them on a very different principle from that on which they have heretofore been supposed to operate. It would be to make an impression on the parts in which I presume the dis- ease to be seated, and not to promote the absorption of effused fluids. They are especially called for * Eclectic Repertory, vol. vii. 94 where the stomach is oppressed with bile, or other matters, as sometimes happens. But I shall say more on this subject, under the head of the mercu- rial preparations. Externally, the head is liable to very acute, and sometimes even to excruciating spasmodic pains, attended by an exquisite tenderness of the scalp, and though this complaint may not hitherto have arrested so much attention as to be accurately described, it has not altogether escaped notice. The plan of treatment pursued in this city, in some instances, after various other remedies had failed, was, to cut through the integuments, under the conviction that the case partakes of the nature of tic doloureux, and that, by dividing the affected nerve, a cure might be accomplished. What was the precise degree of success of the practice, I can- not say, though I suspect it afforded little encou- ragement, as I do not learn that it has often been repeated.* Early adopting the notion, that this complaint proceeds from a morbid condition of the stomach, the only two cases of it which have come under my care, 1 managed by emetics, and had reason to be entirely pleased with the result. Even genuine tic doloureux. the neuralgia of some writers, has been cured, in several instances, by this same practice, and with such facility, as to * The practice has been tried in England and failed. Bendingfield's Medical Prattice. 95 place it decidedly above all other modes of treat- ing this most painful, and hitherto intractable af- fection. The credit of employing emetics in this case, seems due to Dr. Physick, and is one of the many valuable contributions which the profession has re- ceived from his ample resources. Yet, it is not to be concealed, that there is a passage in the writings of Mr. Abernethy, which shews, that he also has adopted the same view of the pathology of the case, though he appears to have attained the end by means somewhat different, and perhaps not quite so prompt aud efficient.* In opthalmia of a very obstinate kind, emetics have of late been prescribed, and with great advantage. This practice has been strenuously recommended by * Mr. Dausou, a surgeon of eminence in London, aud was found peculiarly serviceable iu that species of the disease which prevailed so extensively among the British troops, during the campaigns in Egypt. It is, perhaps, not generally known, that Richter, a writer whom I shalr'often have occasion to cite in the progress of these discourses, maintains, that many of the diseases of the eyes proceed, more or less, from a disordered state of the chylopoietic * " In the cases of tic doloureux, which have fallen under my obser- vation, there has been great disorder of the digestive organs, and I have known cases resembling those of tic doloureux cured by correcting the unhealthy state of these organs." Abemethy on the Disorders of the Di- gestive Orcranx. 96 viscera, though chiefly the stomach, and this he thought to be especially the case as regards amau- rosis. No one of the time had half his reputation, in the management of this complaint, and, of course, an equal experience. His fame, indeed, was so dif- fused, owing to his unrivalled success, that persons afflicted with it resorted to him from all the countries of Europe. He deduced his practice directly from the theory of the disease, which he had adopted. Considering it primarily a gastric affection, he directed the free exhibition of emetics, and after- wards a combination of tartarized antimony, with some other articles, to keep up a constant impres- sion on the stomach. Extraordinary as this hypothesis may seem ou the first view, I am convinced of its correctness. The more we study the economy of the stomach, .the more we shall be enlighted on the pathology of diseases, and esnecialbg'tfifogii of the head. My practice has afforded ine several cases of very vio- lent and intractable optnTfiniia, that I could trace directly to a vitiated state of the stomach. Accumu- lations of bile in that viscus, have long been known most distressingly to disorder the head, and par- tially to affect the eyes, though the more painful aud obstinate inflammations of these organs have not hitherto, I believe, been ascribed to this cause. That, however, it does occasionally produce them, I am most entirely persuaded, and of this, at least. 97 there is no doubt, that they are at once relieved by emetics. Depraved vision, I have several times seen from spasms of the stomach, and one case, perfectly well authenticated, is in my possession, where total blindness took place, and continued for many hours, in consequence of a severe attack of bilious colic, and which was ultimately removed, by copious evacuations from the alimentary canal. On a previous, occasion, I adverted to the ac- tive promotion which absorption receives from the operation of emetics. It may, therefore, be presumed, that these medicines have not been ne- glected in the various forms of dropsy. They are undoubtedly useful in this disease, though it is not very easy to designate the precise cases to which they are applicable. As a general rule, I may observe, that emetic medicines, exhibited with a view to their nauseating effects, are to be prefer- red. But where dropsy is conceived to arise from congestion, or obstruction of the biliary organs, from gall stones or spasm, active vomiting has often been productive of decisive advantage. It acts un- der such circumstances, either by mechanical force, or, by inducing universal relaxation, removes the spasmodic constriction of the ducts, and it is in the same way, that it proves so serviceable in many in- stances of jaundice. There is, however, another case in which erne tics are beneficially prescribed. It seems to be ad- mitted, that where dropsy is connected with the in- N 98 termittent fever, as often occurs in situations ex- posed to miasmatic exhalations, evacuations from the stomach are in some instances imperiously de- manded. Nevertheless, it is to ascites and anasarca, that this practice is chiefly restricted; no one, I believe, having ventured to try it in hydrothorax, and though recently some cases of hydrocele are reported to have been cured by emetics, it was not so much by vomiting, as by nausea very long and perseveringly continued. In diabetes, emetics have sometimes been deemed necessary. They are mentioned by Richter, as having very speedily cured a case of the disease, which succeeded to fever, by the discharge of a large quantity of bile, and as the stomach appears always to be more or less concerned in this disease, the re- medy might probably be more frequently resorted to, with advantage, than has heretofore been done. Emetics were at one time much employed in se- veral of the affections of the male organs of genera- tion. I have already mentioned, that of late, they are reputed to have cured hydrocele. Long since they were resorted to in the indurations, and other morbid states of the testicles. But they seem now to have lost their reputation, or rather have sunk into disuse, in all these cases, except hernia hu- moralis. Of their efficacy here, no one doubts, yet, being a disagreeable remedy, and as we have other 99 modes of treatment equally successful, are rarely used. On precisely the same principle, they have been frequently administered in the discussion of buboes, and other glandular tumefactions. The strong and decisive tone in which Mr. Hunter has asserted their superior powers in the venereal swellings al- luded to, had, indeed, once the effect of inspiring the greatest confidence in their utility. I am in- clined to believe this confidence was not misplaced. But, for the reasons already assigned, the practice has not often been imitated by me. The case to which the remedy is more peculiarly appropriate, is that of indolent or inactive bubo. Emetics have been prescribed in the bites of ve- nomous reptiles, inducing constitutional affections. This was originally an oriental practice. But I have understood that it is at present a good deal followed throughout our western country, where people are often bitten by the rattlesnake and other poisonous serpents. Of the utility of the remedy, I cannot speak from my own knowledge, though, as in all cases of morbid poisons, the stomach is al- ways very seriously, if not principally affected, I am disposed to entertain very favourable impres- sions of the remedy. To induce extreme relaxation of the system, by the exhibition of emetics in nauseating doses, is one of the resources of surgery. Of the cases in which it has been resorted to, incarcerated hernia is one. 100 Nauseants have, under these circumstances, been advantageously used in this city, and, by a surgeon of England it appears, that they are still more suc- cessfully employed in the reduction of luxated limbs, by overcoming muscular resistance. Nor has the same remedy been neglected by the practitioners of midwifery. It was at one period much prescribed by them, in order to induce relax- ation in obstinate parturition, dependant on rigidity of the passages. Exceedingly plausible in theory, it however totally failed when reduced to practice. I have tried this means, and have seen the experi- ment made by others. The effect was, a very great degree of general relaxation, and distress, without at all facilitating the dilatation of the parts, or in any manner promoting the labour, and hence the practice has been abandoned. With the same view, emetics were once directed in tetanus, and other violent spasmodic affections; but whether with any advantage, as ordinarily ad- ministered, does not very clearly appear. lOt DISCOURSE VI. On Particular Emetics. In looking back on what has been said on the use of emetics, we cannot help being struck with their great value, as means of combating disease, and at their wide and diversified application in the practice of our profession. Exceedingly disagree- able in their operation, they have, by a false refine- ment, been permitted to be laid aside, or super- seded by other remedies, or modes of treatment, which, in my opinion, are less efficacious. To the complaints of children, emetics are especially adapted, and, since the effort of vomiting in early life is productive comparatively of little distress, fewer objections can here be alleged to this class of medicines. Extensively beneficial as they are, we have, how- ever, cases in which emetics must be resorted to with great circumspection, and some, where they are even wholly inadmissible. The danger of pre- scribing them, under circumstances of plethoric tendencies, I have already noticed. Equally are they prohibited, in all high degrees of visceral in- flammation, and more particularly in that of the alimentary canal. To these cases may be added, an extremely debilitated system from any cause, 103 and finally, the advanced state of pregnancy, or where a prolapsus uteri, or hernia exists. Next I am to treat of particular emetics, which I shall ar- range according to their effects on the system, either as they are lenient or active, and first: OF THE MILD EMETICS. Contemplating this class, there is no one article which strikes me as having such strong claims to our attention as ipecacuanha. Though this medicine was long employed in practice, it has only been re- cently known to what genus of plants it belongs. It is now clearly ascertained, that the genuine ipe- cacuanha of the shops, is the root of a pentandrous plant, the cepbselis emetica of some botanists, and the callicocca ipecacuanha, of other writers. It is a native of South America, and I believe has been discovered no where else; we have, it is true, a plant in this country, which approaches near to it in its medicinal properties, and its general resem- blances, though it does not altogether agree with it in its botanical affinities. Of the root of ipecacuanha, the only part of the plant used, there are several varieties imported, of which the ash-coloured is the best, and is the sort most commonly to be met with in the shops. It is derived from Peru. That cultivated in other dis- tricts of the southern continent, is not possessed of such active properties. 103 The Peruvian ipecacuanha comes in small wrin- kled pieces, externally brown, and internally some. what whiter. It has a faint smell, and a bitter, slightly acrid taste, containing both a resinous and gummy matter. It was once supposed that its eme- tic power, and, indeed, all its virtues, a^e resident in the former, but it is affirmed by Dr. Irvine, that they are contained in the gum. Ipecacuanha is the mildest of the emetics which are, at the same time, certain in their operation. It evacuates the contents of the stomach, without ex- citing violent vomiting, and is, therefore, peculiarly adapted to a large circle of cases. Much has been said respecting the proper doses of this medicine. In many cases, a single grain will create sickness, and excite pretty active puking, yet it is asserted, that the Brazilians commonly administer a drachm at a time, and only experience from such a gigan- tic dose the desired effect. But, perhaps, they do not employ the most active species of the medicine. It is also to be recollected, that ipecacuanha is one of those emetics which generally come up with the first effort of vomiting, and, if tepid beverages be not drunk, leaves the stomach in a state of compo- sure. As such is the case, a very large quantity might be given without producing any injurious, or even increased effects. It is stated by Cullen, as a general rule, that " to excite vomiting, and especi- ally repeated vomitings, we cannot depend on a dose under ten grains, and frequently a larger dose 101 W is required." But it seems to me, that this quantity is too small for the purposes assigned. As an ave- raged dose for an adult, I conceive a scruple little enough, and even this will produce very inadequate effects, unless it be assisted by warm water or some other drink. My practice is, where I deem it ex- pedient to give activity to the ipecacuanha, to com- bine with it a grain or more of the tartarized anti- mony, and this indisputably constitutes, for many purposes, the most valuable of our emetic prepara- tions. I have already hinted at the inestimable proper- ties of this medicine in particular diseases. Dis- tinct from its emetic property, ipecacuanha has been recommended as having peculiar powers in most fe- vers. But on trial, it was found, in the estima- tion of practitioners generally, inferior to the an- timonial preparations, and is now, I suspect, not much employed. If it retains any share of confi- dence, I am inclined to believe, that it is in inter- mittent fever, a case in which, at least, at one time, it was supposed to evince something approaching to a specific power. By Cullen, especially, it is stated, that he knew a respectable practitioner who broke the paroxisms of this disease by administer- ing the ipecacuanha at the accession, or end of the cold stage. But here I would ascribe nothing to the peculiar properties of this medicine, having done as much with other emetics, and especially the tar- 108 tarized antimony, which I, indeed, prefer in these cases. Exhibited with a view to its nauseating effects, our medicine is an exceedingly important one in haemorrhage of every descripti n Many practi- tioners of respectability bear testimony to its good effects in haemoptysis, though it is in ute- rine haemorrhagy that it displays its best powers. In these cases, I really think it is quite equal to the saccharum saturni, and sometimes, is even to be preferred to that useful medicine. To do good here, it must only be prescribed in nauseating doses, as, when urged so as to create vomiting, I am afraid it proves mischievous. Let me, however, be not understood as saying, that this is always the con- sequence of vomiting in haemorrhagy. The con- trary sometimes, indeed, happens. I have known, myself, uterine haemorrhage to cease by the coming on of spontaneous puking or retchings. But perhaps there is a distinction to be made between a natural and artificial effort of this kind, the one being often salutary, while the other is pernicious. The effects of small doses of ipecacuanha, are sometimes really altogether astonishing in checking uterine haemorrhagy. I have remarked in several cases, that the moment the nausea was induced, the flooding ceased. By what precise mode of action it causes such an effect, is a point on which there is no unanimity of sentiment. It cannot be by the astringency of the medicine, as some have alleged, o 106 since the most powerful astringeuts will not do it, and besides, ipecacuanha does not appear to possess this property in any degree. It was con- tended by Murray,* that it is to be referred to the antispasmodic qualities of the article, and the same hypothesis has been adopted by several subsequent writers. But admitting that ipecacuanha is emi- nently antispasmodic, of which we have very slen- der proof, there are other medicines confessedly more powerful iu this respect, which produce no such effect. Neither of these explanations is there- fore at all satisfactory. May it not operate simply by inducing relaxation and debility, thereby dimi- nishing arterial action, which so uniformly has a tendency to suppress effusions of blood? My mode of administering ipecacuanha in uterine haemor- rhage is, to combine two grains of it with half a grain of opium, and give this dose every two or three hours, as may seem necessary. Next to its use in haemorrhages, our medicine is, perhaps, most celebrated in the several affections of the alimentary canal. In dysentery, particularly, it is eminently usefnl. After evacuating the sto- mach and bowels sufficiently, I begin with giving the medicine very much in the same way as I have mentioned in uterine haemorrhage. It very soon affords relief to the more distressing symptoms, and ultimately effects a cure. By some practitioners, it has been thought, that the ipecacuanha is more es- * Apparatus Medicaminum. 107 pecially adapted to those cases of the disease where there are great discharges of blood, amounting al- most to haemorrhagy, from the bowels. This opi- nion, from the general powers of the medicine, is, perhaps, correct. But, in every form of dysentery, it is useful, though 1 think I have employed it to most advantage, where the pain has been great, and the desire to stool frequent and ineffectual. The efficacy of our medicine in this disease does not rest on my own authority. It has been em- ployed for the last half century, by the most cele- brated practitioners in every quarter of the world, and has extorted from them the most unqualified commendations. Of its modus operandi here, we know as little as in other cases. We can hardly suppose, with Cullen and Sir George Baker, that it acts as a purgative, because other purgatives have not the same effect, and, as it does quite as much good when there is no evacuant operation from it. By Mosely it is considered advantageous in dy- sentery, by relaxing the surface, and exciting dia- phoresis. Whether this explanation be just, or not, it is more plausible than the other, and com- ports better with the obvious qualities of the medi- cine, and its known effects on the system. Twq other modes of administering the ipecacu- anha' in dysentery, have been employed. By a late writer,* it is recommended, in the shape of a clys- * Clarke on the Nature and Cure of the Dysentery of the East and West Indies. 108 ter, three drachms of the bruised root, boiled in a quart of water down to a pint, which is to be re- peated twice or thrice in the twenty-four hours. Of this I know nothing myself, though, other objec- tions aside, we have always been taught to believe, that a decoction of ipecacuanha, is wholly an inert preparation. Much more confidence, I think, ought to be reposed in the second new prescription of the medicine to which I have alluded. Defeated in his attempts to cure dysentery by the ordinary manner of giving the ipecacuanha, Mr. Playfair,* a sur- geon at Bengal, has used it with great advantage, in the dose of from a half to a full drachm, combin- ed with from thirty to sixty drops of laudanum, confining the patient for some hours afterwards to a horizontal posture. If the first dose be rejected, the mixture is to be repeated, and is commonly retained. The practice, which is represented as exceedingly efficacious, is confessed to be only adapted to the very commencement of the attack, since, if it be at all advanced, the stomach becomes so irritable as to reject the medicine at once. By Mr. English, another surgeon on the British esta- blishment, the success of this remedy is corrobo- rated.! Diarrhoea has also been treated by ipecacuanha. The case in which it is supposed to be suited, is * Edinburgh Med. and Surg. Journal, vol. x. f Ibid. vol. x. 109 well described by a writer on whose authority, 1 apprehend, it was originally introduced into the management of this disease. " We meet," says he, " with persons of both sexes, and different ages, who, from a variety of causes, have long been sub- ject to habitual diarrhoeas, sometimes accompanied with sickness, bitter taste, furred tongue, and some degree of fever ; and sometimes, without these symptoms, yet, both liable to frequent discharges, often in the morning, sometimes in the night, and generally after taking any quantity of aliment, whether liquid or solid." Two or three grains of ipecacuanha in the morning, and an anodyne in the evening, to be repeated for some days, are repre- sented as having succeeded in a number of cases, which had " obstinately withstood the efficacy of very opposite remedies. " Of the use of our medicine in dyspepsia, I am not prepared to say much. It has been highly extolled by Daubenton, in his tract on the subject, and I have met with some respectable practitioners, who seem to place no slender confidence in its powers. As an emetic, no one questions its efficacy in this disease, though this is not the prescription to which I allude, the medicine being usually given iu small and repeated doses, too small almost to excite nau- sea. Thus exhibited, it is alleged to act as an al- terative, changing imperceptibly the state of the * Fothergill's Works, vol. iii 110 stomach, till finally it restores the organ to its natu- ral tone, and healthy actions. Much stronger claims, most undoubtedly, has the ipecacuanha to our notice, in some of the pulmona- ry affections, and especially in asthma.* Confes- sedly it is here, to be preferred to all emetics. As far as I know, the practice of using it in this case, originated with Akenside, the poet and the physi- cian. There is, at least, an excellent paper by him in the transactions of the London College of Phy- sicians, on this subject. During the paroxism of the disease, he administered a scruple of the medi- cine, in order to afford immediate relief, and in the intervals, from three to five grains every morning, to excite nausea and effect a permanent cure. Whe- ther it produces vomiting or not, under such cir- cumstances, he says, it is equally useful. Given in very minute doses, sometimes alone, though oftener united with calomel and opium, our medicine has been liberally prescribed in the cough of the advanced stages of pleurisy and peripneu- mony, in that of ordinary catarrh, and even of con- sumption. But I will not anticipate what I have * It is somewhat curious, that, though ipecacuanha is so efficacious in asthma, the odour which is emitted from the powder will produce, in some persons, a short and difficult respiration, approaching almost to this very disease. I have witnessed this in one case myself, have heard of another, and a still more extraordinary one is recorded in the Phile- snphical Transactions, part 1. vol. lxvi. Ill to say on this subject under the head of expecto- rants. The medicinal virtues of ipecacuanha may be ex- tracted by several menstrua, though wine is the one chiefly employed, and by which a preparation is formed called vinum ipecacuanhae. This is a very neat medicine, and is sometimes substituted for the powder. It is well suited to children, and is ac- cordingly often resorted to in their cases. As an emetic, the dose of the wine for an adult, is an ounce.*f SPIRiEA TRlFOLIATA. This is an indigenous emetic, which has acquired great reputation among us. It is afforded by a plant, which grows very plentifully in various parts of the United States, and is to be found even in the neighbourhood of this city. This is known by the above botanical title, and still more by the po- pular name of Indian physic. Like the ipecacu- anha, to which it has been compared in more re- spects than one, the root is the only portion of the plant employed, though the stem and leaves are not * Vid. Diaphoretics and Expectorants. ■j- Incompatible substances—AH the vegetable acids, and especially vi- negar. By decoction, its active properties are destroyed. They are, moreover, lost by keeping the ipecacuanha in powder, and more spee- dily, if it be exposed to the air and light. US destitute of active properties. The bark, much more than the wood of the root, has the emetic virtue. Of this medicine, I have no very great experi- ence. Many country practitioners, however, place such confidence in it, that it has nearly superseded the ipecacuanha in their hands. Enough I have seen of its use, to couvince me of its powers to ex- cite vomiting effectually, though leniently, and such, I suspect, is the amount of our information concerning its medicinal properties. It may, in common with the ipecacuanha, be applied to other purposes, though 1 have not heard of its having hitherto been done, except in the case of inter- mittent fever. On the whole, 1 am inclined to be- lieve, that the spiraea will be an important acces- sion to the materia medica, and should be glad to see the plant further investigated, and more vari- ously and extensively employed. It is commonly given in the dose of thirty grains. The western states, afford a species of this plant which is said to be, in every respect, superior to the one 1 have described. But of this 1 know nothing myself.* • By the present professor of botany in our university, we are told, that neither of these plants is a spiraea, but that they both belong to the genus GiUenia. To the first, he gives the name of GiUenia trifoliata, and calls the second GiUenia stipulacea.—Vegetable Mat. Med. of the U. States, by TV. P. C. Barton, M. D. 113 ANTIMONIAL PREPARATIONS. These can hardly be considered as lenient eme- tics. But the preparations of which I shall chiefly treat, are by no means harsh in their operation, and may, perhaps, on the whole, without much incon- gruity, be assorted with the preceding articles. Antimony is a name bestowed on a peculiar me- tal, which is naturally combined with sulphur, and in this impure state, is collected out of the mines of several of the countries of Europe. ^Affluent, how- ever, as we are, in such products, it has never, so far as I know, been discovered in any part of the United States. The origin of the term antimony, is somewhat curious. It is related, that Basil Valentine, a Ger- man monk, much addicted to experimental inqui- ries, gave the crude antimony to some hogs, which it speedily fattened, Encouraged by analogy, he also, with the same view, administered it clandes- tinely to his brethren of the cloister, all of whom, however, died, and, from the circumstance of its proving so deleterious in this case, it acquired the appellation of anti-monk, and ultimately, by cor- ruption, antimony. Like most active medicines, this urged its way into the practice of physic with great difficulty. Af- ter very violent contentions with many of the medi- cal men of the age in which he lived, Basil Valen- tine, whom I have just mentioned, succeeded in es- p Ill tablishing its credit as an internal remedy. Elated by his success, he published a work exhibiting its properties, and his pride, which, in the plenitude of exultation, he entitled " Currus triumphalis An- timonii." Nevertheless, the medicine soon relaps- ed into disrepute, and was once more brought into notice by the strenuous efforts of the wild and eccentric Paracelsus. During the angry controversies, so long carried on between the disciples of the Galenical and che- mical schools, relative to the employment of those active preparations, which the latter derived from the processes of their art, antimony was rejected or received, just as the one or the other party acquired the ascendency. At this period it was, that a so- lemn act passed the parliament of Paris prohibit- ing, under the severest penalties, the use of this medicine in any part of the French dominions. Notwithstanding this, it continued to be occasion- ally prescribed in other sections of Europe, with a variable, and disputed reputation, till at last its ef- ficacy was sanctioned by the approbation of Hoff- man, and fully confirmed by the still higher autho- rity of Cullen and Fordyce. Nearly inert in its native condition, antimony, however, by its multiplied combinations, supplies us with a profusion of active remedies, amounting, indeed, most probably, to several hundred. To no- tice these in detail, or even to enumerate them, would be a most irksome and unprofitable employ- 115 ment. It fortunately happens, that the antimonial preparations, though of different degrees of strengh, are characterised by considerable uniformity in their mode of action, and general medicinal pro- perties. On many accounts, the antimoniated tar- trate of potash, or, as it is familiarly called, emetic tartar, is the one which is almost universally pre- ferred in the practice of Great Britain and this country. Being nearly insipid, without colour, inodorous, and very minute in the dose, it may sometimes be given with perfect facility, in cases, where it would be exceedingly difficult, if not impossible, to get down any other medicine. By reason of this, it is admirably suited to children, and, while it has this superiority over its kindred preparations, it pos- sesses, in an eminent degree, all the properties com- mon to the class. As an emetic, the tartarized antimony is distin- guished by the certainty, extent, and permanency of its operation. The impression which it makes on the stomach, is more forcible, and continues longer than that from most other substances, and hence it produces a more thorough evacuation, and occasions, in a greater extent, all the effects of ac- tive vomitin'g. When, therefore, we wish the stomach to be completely evacuated, and a lasting effect to be left, the emetie tartar should be selected for the purpose. Either exhibited in a large dose, or in 116 small ones repeated, it will both puke and purge copiously, in some instances. Besides these two leading and primary effects of the medicine, it, moreover, not unfrequently proves diuretic and ex- pectorant, and almost invariably excites perspira- tion. Wishing to puke effectually, the dose of our me- dicine is from two to five grains, and to promote its operation, some tepid drink should be freely drank. But, in ordinary cases, it is customary to dissolve five or six grains of it in the same number of table spoonfuls of warm water, and direct one every ten or fifteen minutes, till the end is attained. Not the least commonly used of these prepara- tions, is the vinum antimonii tartarizati, of the dis- pensatories, or the emetic tartar, dissolved in wine. As formerly prepared, the antimonial wine was very objectionable, from the uncertainty of its strength. Employing the glass of antimony, which is soluble in the tartaric acid, the power of the medi- cine very much depended on the degree of acidity of the menstruum. After all, I do not know whe- ther the simple solution in water is not a more cer- tain, and a better preparation. But the antimonial wine is, perhaps, too strongly fixed, at least in po- pular confidence, readily to be excluded. It ought to be recollected, that, when prepared according to the Edinburgh Pharmacopoeia, one ounce of it con- tains two grains of emetic tartar, and is a dose for 117 an adult, while that of the London College is of double the strength. To the cases of children, the autimonial wine is habitually appropriated, and is sometimes prescrib- ed at a very early period of life. I have given it to an infant at birth, to relieve difficult respiration, in consequence of an accumulation of phlegm. The dose, under such circumstances, should not exceed one or two drops. It is, however, more common to resort to this medicine, in cases of children a lit- tle more advanced. At any period within the year, provided they have attained the age of three or four months, the dose, for the purpose of vomiting, is ten or fifteen drops, according to the urgency of the case, to be repeated at short intervals, till the effect is produced. But if the disease be croup, the quantity should be. larger, as there is here a very great insensibility, as has before been men- tioned, to the operation of medicine. Iu such an attack, we may not hesitate to give a child six months old, a tea-spoonful every fifteen minutes. I should now proceed to point out, in detail, the application of the antimoniol preparations to the cure of diseases, had I not already anticipated much of what I might otherwise have said, under the general head of emetics, and more particularly, when treating of ipecacuanha. I must, therefore, dismiss the subject, with some desultory and mis- cellaneous reflections. Considering the emetic tartar as justly represent- 118 ing all the antimonial preparations, I shall confine my remarks exclusively to it.* This medicine has been chiefly celebrated in the cure of febrile affections. It is given in the com- mencement of almost every description of them, to evacuate the alimentry canal, by its united emetic and purgative properties, and, in the subsequent stages, in minute doses, to moderate arterial action, and to excite and keep up perspiration. To Cullen, the praise has generally been con- ceded, of having indicated, more particularly than had previously been done, the great value of anti- monials in the management of fevers. Being usher- ed into notice, under the auspices of his distinguish- ed name, the practice soon attracted attention, and became universally adopted, wherever his influence extended. Of the precise manner in which our medicine operates, in these cases, or with the principle that should guide its use, we are not sufficiently ac- quainted. Cullen maintains, that it produces no advantage unless it vomits, or creates considerable nausea. But it is, on the contrary, asserted by Fordyce, than whom there cannot be higher autho- rity, that, by exciting vomiting, much of its power is impaired, and that it is most efficacious, when there is the slightest gastric disorder created. * It is decidedly the opinion of Cullen and Fordyce, that the emetic tartar, on the whole, is to be -preferred to all the antimonial prepare. 'ions. 119 To this point, I have directed a very careful at- tention, and am led, independently of all authority, to concur in the latter opinion. Nausea, by what- ever means induced, is not, in itself, a salutary ef- fort, nor does it ever dispose fever to a crisis, or fa- vourable solution. During its continuance, arterial action, muscular power, and animal temperature are undoubtedly lowered, though the moment it ceases, there is uniformly, at least in the febrile affections, are-action of the system, and a correspondent exa- cerbation of the disease. Did the sickened state of the stomach operate in the beneficial way contended for, then the utility of the medicine should be pro- portioned to the effect thus created, and a variety of other nauseants, infinitely more powerful and last- ing in their impressions, as the digitalis, the tobacco, and squill, ought to be preferred in these cases. But this is contradicted by the lessons of experience, and the united voice of practitioners is against their use} under such circumstances. Medicines seem to do good in the cure of fever, by exciting their own specific or peculiar action, and when they disorder the stomach by sickness, they depart from this, and, if they do not act as poisons, always become nugatory, or more or less mischievous. To illustrate this position, by parti- cular examples, would be easy in an inquiry more detailed than I can now indulge, and I am sensi- ble, too, that they cannot be required by any one who has, or will devote his mind to this subject. 120 Many, indeed, of the febrifuge preparations, are among the most pleasant of our medicines, such particularly as the effervescent draught, and the neutral mixture, the primary effect of which is to remove nausea, or to sustain the tone and tranquil- lity of the stomach. But, while I contend, that the antimonials, like mercury, lead, arsenic, bark, &c. operate by virtue of a peculiar power, I wish it to be understood, that I conceive, as in the instance of the articles just enu- merated, that their efficacy in the reduction of fever, will always be proportioned to the quantity taken, provided they exercise their genuine mode of ac- tion, which, as before stated, is incompatible with any nauseating effect. Curious as these views of the modus operandi of our medicine, may be in speculation, they become incomparably more inte- resting when applied to practice. Be it admitted, that they are correct, and we have, indeed, at once, rescinded all the prejudices and objections against the use of a class of remedies, which confessedly are of the highest utility. Nevertheless, it is not to be inferred, that any part of the preceding re- marks are applicable to emetics, in the forming stage of fever, these operating entirely on a differ- ent principle, and their efficacy, when thus em- ployed, is too well attested to be shaken or dis- turbed.* • Fordyce's Third Dissertation on Fever. 121 Besides the more purely febrile affections, our medicine has been liberally prescribed in various diseases, and is thought especially to be adapted to inflammatory cases. Bleeding, and other direct evacuations, having been premised to a certain ex- tent, the antimonials are recurred to, with great ad- vantage. Exhibited to keep down arterial action, this they do, by promoting the discharges from the alimentary canal, or the surface of the body, and by a direct impression on the circulatory system. Com- bined with opium, or nitre, or calomel, in various proportions, their powers are vastly increased, and are rendered susceptible of a much more extensive and diversified application.* Nor was less confidence reposed in our medi- cine, at one period, in active haBmorrbages. No doubt, from the highly respectable testimony which we have in its favour, the emetic tartar was here useful. I have sometimes directed it, in conjunc- tion with nitre, in febrile haemorrhages, and have thought it eminently serviceable. It is well suit- ed to all cases of this description, though more particularly to haemoptysis, or bleedings of the lungs. Yet, it must not be supposed, that I mean, by the preceding remarks, to derogate from the value of ipecacuanha, or the lead, in haemorrhages. My * Vid. Diaphoretics. Q \2Z object is not to institute even a comparison between the three remedies. Each one has its own appro- priate cases, which a skilful practitioner will al- ways discriminate and select. Notwithstanding all that has been said of the utility of antimonials, in dysentery, I must think, they are decidedly inferior to the" ipecacuanha. It is stated, however, by Sir George Baker, that the result of a very extensive experience with both medicines, in that disease, was entirely on the side of the antimony. To the same point, we have also the authority of Sir John Pringle, though not so strongly expressed.* The deliberate opinion of such men, on a prac- tical matter, is always entitled to great weight and consideration. But still, I do believe they were deceived, or, at least my own observations and re- flections have conducted me to an opposite conclu- sion. The antimonials, in dysentery, are now ad- ministered on the same priuciple, and under simi- lar circumstances of the disease, as the ipecacu- anha. Competent evacuations having preceded, they are then introduced in minute doses, so as to affect the stomach, and, through this medium, to relax the extreme vessels. Emetic tartar has been a favourite remedy in some of the exanthematous affections, and especi- ally in small-pox. No practice, indeed, was more * It was the cerated glass of antimony, which Pringle employed 123 generally adopted, than that of using our medicine in the eruptive fever, where it threatened to become high and inflammatory. In a different mode, it was also prescribed to meet some other indications. When, for instance, the eruption was retarded, and, as a constant effect, the system greatly depressed by extreme gastric uneasiness, the emetic tartar, here given, so as to vomit actively, relieved the stomach, restored its energies, and the eruption appeared. Declining, at present, to discuss the pathology of this order of diseases, it still may not be uninte- resting, to call attention to the fact, of the very close relation which they all have with the stomach. In this view, I have in some degree, been antici- pated by Darwin, who has speculated, with his usual ingenuity, on the subject. By opposite states of the stomach, he explains the difference between the distinct and confluent small-pox, supposing that, in the first instance, it is secondarily affected, by sympathy, with the irritation of the original pus- tule, and, in the second, that it is primarily the seat of the disease. The same sort of connection would seem to exist with regard to all the cutaneous affections, though not so conspicuously, excepting in the urticaria, or nettle rash, aud two or three other cases, where we see it very strikingly illustrated. This eruption is uniformly preceded by a very disordered condition 124 of the stomach, and can often be traced directly to some wrong impression on that viscus, from crude aliment, or other matters. Even after being com- pletely out, if it recedes, or, to use more familiar language, the eruption is struck in, the same train of symptoms return, which are most speedily re- moved by affording relief to the stomach through the operation of an emetic, and here, the antimonial medicine effectually answers the purpose. Without, perhaps, having any distinct concep- tion of their modus operandi, the antimonial prepa- rations have long been much resorted to, in the cure of chronic diseases of the skin, and other superfi- cial affections, as some of those proceeding from ve- nereal contamination. They are, indeed, one of our principal remedies in all the herpetic cases, and even confirmed lepra, has probably been as success- fully managed by them, as by any other plan of treat- ment. They are given, here, in minute doses, either alone, or in combination with the mercurials, and other articles, having an affinity to the surface of the body. To produce, however, any decisive ad- vantage in these cases, they must be very long and perseveringly continued.* To create extreme relaxation of the system, by emetic substances, I have already remarked, is one of the expedients of surgery. The most distin- • Wlllan on Diseases of the Skin. 125 guished application of this practice has recently been made in the reduction of dislocated limbs, where the operation proves difficult, from muscular resistance. By Mr. Wilmer, an English surgeon, several instances, derived from his own experience, or that of other practitioners, are adduced in con- firmation of its efficacy. He recommends, that a very large dose of tartar emetic be exhibited, so as to produce an entire prostration of muscular power, and, during this state of relaxation, to make the at- tempt at reduction. He closes his paper on the sub- ject, with some remarks on its superior efficacy over bleeding, purging, baths, fomentation, and the other means hitherto employed with similar views. He maintains, that his plan is not only more certain, but, that no mischievous effects ever result from it.* Nevertheless, I am inclined to believe, that the best remedy, in these cases, is v enesection ad deli- quium animi, as practised, with such prompt and decisive results, by the professor of surgery iu this school. In concluding my enquiries in relation to the antimonial preparations, it remains for me on- ly to state, that, as an enema, the emetic tar- tar has proved, in my hands, a most powerful and efficacious remedy, and one which promises hereafter to be of very diversified and exten- sive application. The first case in which I em- * Eclectic Repertory, vol. iii 126 ployed it, was to evacuate the stomach, to remove poison which had been swallowed. After having unavailingly tried a series of the most active emetics, I directed, that half a drachm of the tartarized antimony, dissolved in a little wa- ter, should be thrown up the rectum, and, as I an- ticipated, a violent cholera morbus ensued, evacu- ating the entire alimentary canal, so much so, in- deed, that the food undigested, came by stool. I have, since this time, had frequent occasion to resort to the same means, though not under similar circumstances. It has been chiefly in cases of very obstinately obstructed bowels, that I have repeated my experiments, and generally with results highly satisfactory. My ordinary prescription for this purpose, are eight or ten grains of the medicine, which I have commonly found sufficient. But, if this does not prove so, the injection, with the same, or an increas- ed quantity, may be repeated in fifteen or twenty minutes. Even in the dose of half a drachm, 1 have sometimes used it. Where the effect is full and complete, an extraordinary degree of muscular debility takes place, which sometimes lasts for an hour, or more, without, however, pro- ducing, so far as I have observed, any permanent mischief. Bearing in mind the fact, of the uncommon re- laxation thus occasioned, I had early resolved to m;ike a new practical application of it to the cure of 127 tetanic, and other spasmodic affections, which I have since done, and with such complete success, in a case of locked jaw, that I cannot forbear to in- dulge the hope, that, under this treatment, the dis- ease may hereafter be divested of some portion of its terrors and mortality. Lwill not, on so narrow an experience as a solitary instance affords, venture to predict, that such will be the result. Enough, however, has been done, to inspire confidence in the remedy, and to induce us, on future occasions, to zive it a fair and decisive trial. To the adop- tion of this course, we are, moreover, encouraged, by the success of a similar mode of treatment, more than one case having been recorded, of tetanus be- ing cured by the tobacco injection. Nevertheless, we are to recollect how diversified is the nature of this disease, and, that no rational expectation can be entertained, of all its forms submitting to any one remedy, or system of practice. Of the case before us, all I could learn of the cause from the patient was, that the nerve of one of his teeth was very much ex- posed, and that, by touching it, he had often the most acute pain, with convulsive twitches of the muscles of the face. But, whether the attack was brought on by this sort of irritation, or by lying out iu the cold, cannot be determined. By the man himself, it was ascribed to the former cause, though I confess, my own opinion has always been other- wise, as it appeared exceedingly analogous to those 128 cases which are notoriously excited by sleeping iu a chilly and moist atmosphere.* * Incompatible substances—Mineral acids, alkalies, and their carbo- nates—earths, soaps, hydrosulphurets, and the astringent vegetable in- fusions. The latter, indeed, so completely decomposes the emetic tar- tar, that they are found to be antidotes to that article, and of them, an infusion of the peruvian bark answers best. Orfiila's Toxicology. 129 DISCOURSE VII. Of the Active Emetics. The nicotiana, or tobacco, is not commonly plac- ed in the class of emetics. I do not know that I am right in doing so. It is, undoubtedly, a very active emetic, but it has other properties, which give it as strong a claim to a different position in the materia medica. Not to mention its minor qualities, it is a narcotic, a diuretic, and a purgative. The history of this plant is interesting. The pro- duction of a little spot, the island of Tobago, it has engaged the attention of the sordid, and enchanted the witty and the wise. Every where its powers are felt, and its fascinations acknowledged. The Arab cultivates it in his burning deserts. The Lap- lander risks his life to procure it, amidst his snows. No privatiou is too severe to the seaman or the sol- dier, while he commands this luxury. Even polish- ed man, with all the comforts of elegant society, cannot dispense with his cigar. The nicotiana is so called, from M. Nicot, by whom it was originally carried into France, and tabacum, from the island iu which the plant was first discovered. But, previously to its introduction by Nicot, it had been brought to England by Sir Francis Drake, and rendered an article of fashion Tt 130 able use, by the influence of Sir Walter Raleigh, notwithstanding the solemn denunciations against it by James I. and the ready submission of many of his court to this proscription. Evidently a narco- tic, from this proceeds all its charms. Like opium, it calms the agitations of our corporeal frame, and sooths the anxieties and distresses of the mind. Considered in a medical view, its property, as an emetic, now first attracts our attention. By Cul- len, and some other writers, its use is opposed, on account of the peculiar harshness of its operation. Certainly it exceeds all others in the promptness, violence, and permanency of its impressions. But these very qualities, unpleasant as they are, enhance its value in many cases. The tobacco seems, espe- cially, to be welladapted to the evacuation of some poisons, and may be exhibited, either internally, or applied to the region of the stomach. It is recorded by the late professor Barton, that he resorted to such an application of the moistened leaves to the epigastric region with complete effect, to expel an inordinate quantity of laudanum, in a case, where even the active emetics, in the largest dose, would not operate, from extreme torpor of the stomach. Many instances of poison, and particularly the cor- rosive poisons, are attended, however, with such an extreme exhaustion of strength, that it would seem perilous to recur to tobacco, lest from its own effects the powers of vitality might be still fur- 131 ther prostrated, or, perhaps, irrecoverably extin- guished. Exhibited in small doses, it does still appear, that it may be prescribed safely, and even with ad- vantage. By a writer of respectability, we are told, that while at the Cape of Good Hope, he had a number of Hottentots under his care, with intermit- tent fever. Being deficient in medicines, he resort- ed to tobacco, and found, as he says, six grains of snuff as effectual in exciting vomiting, as two grains of tartarized antimony. Nevertheless, the tobacco is preferred in minute doses, with a view to its nau- seating effects. Thus administered, I have seen it exceedingly serviceable, in subduing the turbulence of some of the more furious shapes of mania, and, where it cannot be given, as often happens, under such circumstances, a poultice of it, externally ap- plied, will answer nearly as well. But the cases in which our medicine is \nore commonly used, re- main to be indicated. These are, incarcerated her- nia, and obstinate constipation of the bowels, from whatever cause produced. To meet these purposes, the tobacco is, I suspect, always prescribed as an enema, and certain it is, that, iu this way, it proves very effectual, and has the unimpaired confidence of practitioners.* Deducing his practice from the same principle, * For the manner of preparation, see Enemeta. 132 Mr. Earle, the distinguished surgeon, has recently treated several of the worst cases of retention of urine, with signal success, by this same remedy, and has added some confirmation to the fact, of which we were already apprised, that it might be beneficially applied in tetanus, and the kindred spasmodic affections.* As an unguent or lotion, the tobacco is very freely employed, especially in the popular practice of this country, to cleanse foul ulcers, to remove eruptions, as tinea capitis, and some of the herpetic affections, and also, in the shape of poultice, as a discutient application to indolent tumors.f SCILLA MARITIMA. Of the squill, 1 have little to say, under the head of emetics. It is a plant, with a large bulbous root, resembling the tulip or onion, having an acrid, bit- ter taste, and scarcely any odour. Two species of it are used in medicine, the red and white squill, which grow on the shores of the Peninsula of Eu- rope, and along the margin of the Levant, and the Barbary states. As an emetic, the squill is now nearly supplanted by articles of more value. Yet, in the dried state, eight or ten grains of it will pro- duce vomiting, with tolerable certainty. , The re- * Earle's Paper, Med. Chimrgical Transactions, vol. vi. t Diuretics. 133 cent squill is uot so active, even as twenty to four, owing to its containing a considerable portion of inert juice, which escapes in the process of exsicca- tion. Different menstrua are employed to extract the virtues of this article, and we have three offici- nal preparations of it, the vinegar, the oxymel, and syrup of squills, each of which is nearly of the same strength, and will puke with sufficient activity, in the dose of an ounce. Neither, however, is, at pre- sent, resorted to for this purpose, except to relieve the pulmonary system when oppressed by phlegm or mucus, and here it answers, sometimes, exceed- ingly well.* PREPARATIONS OF COPPER. Several of these are powerfully emetic, and, per- haps, the whole might be so managed, as to become so. The only one, however, which is retained in practice, is the blue vitriol, or the sulphate of cop- per. By Cullen it never was employed as an emetic, but, he seems to think, that it is well calculated to excite nausea, where such an effect is desirable, and that, in this way, it sometimes promotes the urinary discharge. Much was, at one time, said, of the utility of our medicine in the pulmonary consumption. It has been particularly extolled by an English writer, * Vid. Diuretics and Expectorants. 134 who, I believe, originally applied it to the treat ment of this disease. The plan which he proposes, is, to excite vomiting in the morning, every day, for weeks together. But there is nothing new in the suggestion. The same course has often been pursu- ed, on the supposition that, by it, the effects of a sea voyage might be attained. As yet, I am not aware, that the blue vitriol has any property which entitles it to a preference in these cases. The only ground of superiority claim- ed for it, even by its warmest advocates, is, that it is more local in' its operation, and hence does not produce the general relaxation of the other emetics, and especially the antimonial preparations. They allege, that it is really little more than a mere eva- cuant of the stomach. If this be true, I should pre- sume it not to be well suited to consumption, it hav- ing been pretty clearly shewn, that emetics are ser- viceable in these cases, in proportion to their wide and pervading influence. By virtue of this it is, that they subdue arterial action, promote absorption from the lungs, equalize excitement, and re-establish that just balance in the various parts of the system, on which health depends. Of late, the blue vitriol has been strenuously re- commended, in this country, as an emetic in cy- nanche trachealis. It is affirmed, that it is far more certain in its operation, which, if it be so, renders the medicine a valuable acquisition. But I am dis- posed to doubt the accuracy of the report on the 135 subject, aud, at all events, I can discern no good reason, on such slender evidence, for adopting the medicine, to the exclusion of others of tried effica- cy in this disease. But it is right for me, at the same time, to state, that I have no knowledge of the sulphate of copper as an emetic, never having used it in a solitary case. The dose is from three to five grains. Combined with an equal portion of the tartarized antimony, our medicine constitutes the once cele- brated dry vomit of Mariatt, so called from its be- ing exhibited without drink.* MERCURIAL PREPARATIONS. Not a few of the preparations of mercury occa- sionally produce vomiting, and, perhaps, as effec- tually as any medicine. This often happens with regard to calomel, which, when it does operate in this way, most thoroughly evacuates the stomach, though, it is not resorted to with this view. As an emetic, the turpith mineral, or sub-sul- phate of mercury, is the only preparation of mer- cury which has been used to any extent. It was originally employed chiefly to excite salivation, * Incompatible substances. Alkalies and their carbonates—sub-borate of soda—acetate of ammonia—tartrate of potasse—muriate of lime—ni- trate of silver—acetate and superacetate of lead—oxymuriate of mer- cury—the preparations of iron—and all astringent vegetable infusions or tinctures 136 though subsequently it has been prescribed in seve- ral cases with the intention only of vomiting. Either alone, or in union with squills, it is al- leged by some writers, to do good in the putrid sore throat, and in some of the forms of dropsy. Of its utility here, I am not prepared to speak from any personal experience. Emetics are, unquestionably, sometimes, beneficially prescribed in each of these diseases, and the turpith mineral, as one of them, may be productive of the same effect. The highest reputation, however, which it has attained, is, in the dispersion of the venereal swelled testicle. As an emetic, it is distinguished principally by the promptness of its operation. Exhibited in the dose of six or eight grains, it hardly enters the sto- mach before vomiting commences. It would, on this account, seem to be well adapted to the expul- sion of poisons, and, indeed, to all cases where a speedy operation is demanded. But there is a two- fold objection to its being generally introduced into practice. It operates with violence, and is very apt to induce a salivation. The corrosive sublimate, or muriate of mercury, Was early employed as an emetic. Being, however, harsh in its operation, it soon came to be consider- ed even as a dangerous remedy. By some practi- tioners it has lately been revived, and applied, it is said, with great success, in the treatment of croup. Nevertheless, 1 would enjoin a caution against its use, and especially in children. Before we resort 137 to so violent a remedy, we ought to have, for our justification, much stronger proof, both of its safety and efficacy, than we have heretofore received. As relates to cynanche trachealis, I am per- suaded we do not want this medicine. Though, it is true, we often have to encounter great resistance to the ordinary emetics in this disease, the suscep- tibility to their impression may be awakened by venesection, and the warm bath, as formerly men- tioned. PREPARATIONS OF ZINC. Of these, the white vitriol, or sulphate of zinc, is the only emetic in much esteem. Its operation is exceedingly expeditious and complete, and hence it has been much appropriated to the evacuation of the noxious contents of the stomach. The common dose of it are ten grains. But, where poisons have been swallowed, three or four or five times the quantity may be administered. I have known a drachm to be given at once, and repeated several times. Cullen, who is not friendly to any of the mineral emetics, except the preparations of anti- mony, does not very much approve of the white vi- triol, even in the particular case before us. To render its effects certain, says he, the dose must be large, and, if this is not soon thrown out, it is apt 138 to continue a disagreeable nausea, or even vomiting longer than is necessary. But there are other practitioners, of nearly equal reputation, who give us a very opposite account of the medicine. It is especially stated by Mosely, whose experience was ample with it, perhaps more so, than that of any person, that •* the white vitriol, besides being in all respects safe and innocent, has advan- tages over every other nauseating or emetic medi- cine. These are, that the patient is not harassed with its operation, for that is never violent, as anti- monials sometimes are, and is, generally, instanta- neous, and as suddenly over, always leaving the stomach strongly invigorated. Neither does it cause spasms in the viscera, nor any nervous affec- tions, mischiefs often produced by the antimo- nials."* Consulting the results of my own experience, I should say, that the language of this writer is some- what extravagant, and seems to be dictated by ex- treme partiality to the medicine, which the whole tenor of his work very conspicuously evinces. But I would still concede to him, that Cullen, in his de- scription of its effects, has run into the opposite ex- treme, and that, so far as I am competent to judge, the white vitriol, as an emetic, is safe, and highly efficacious. To hooping-cough, it is peculiarly well adapted. * Mosely on Tropical Diseases. 139 By some enlightened practitioners, it is thought to evince, in this disease, in addition to its property of puking, a very decided antispasmodic tendency. Whether this be so or not, 1 have, perhaps, not ob- served with sufficient care to determine. But of its great efficacy, no one can doubt. Many of the quack remedies advertised for the cure of this dis- ease, are combinations of opium and zinc. Nor is it scarcely less useful in cynanche trachealis. Ex- cepting, indeed, the tartarized antimony, I would prefer it to all the rest of the emetics, in vehement attacks of the disease. Of the zinc, we have a preparation, which has acquired considerable repute, called the vitriolic solution, and is made agreeably to the annexed pre- scription, which I copy out of Mosely?s work on Tropical Diseases.* It is stated, that whatever he added to impart to the mixture a more agreeable taste, always detracted from its efficacy. Nor are the same ingredients so powerful, when adminis- tered, even the same quantity, in a pill. As an eme- tic, this solution is exceedingly active, though it is used chiefly as a nauseant. To procure this effect, the dose for an adult, is a small table spoonful. Not a little has been said, of the importance of this medicine in some of the bowel affections. * Take of white vitriol 3*111., rock alum Zi., cochineal gr. iii., boiling water lb. i. Mix these together in a marble mortar, until the solution is cold, and the sediment is deposited, then pour it off clear for use. 140 Ci I have," says Mosely, " used the solution io dysentery, with the greatest success. I give it at first without alum, in sufficient doses to cause eva- cuations, and afterwards with the alum, in nauseat- ing doses, and frequently with opiates at night. This I have found far more efficacious than emetic tartar, ipecacuanha, rhubarb, or salts, as evacuants, in whatever manner combined or administered." " In diarrhoea," continues he, " of long stand- ing, the cure must necessarily be performed by slow degrees. The treatment here is a dose every morn- ing, to be persevered in, where the case is intracta- ble, for weeks or months, omitting it now and then for a few days." My knowledge of this remedy, in the preceding cases, is not intimate or extensive. As a mere mat- ter of experiment, I have occasionally tried it, and, sometimes, not entirely without effect. To the me- dicine, however there is one objection, which is insuperable, W'here any delicacy of stomach ex- ists, and which is a very usual attendant on the bowel affections. It is so nauseous, that, even if we force it down our patients, it will not be retain- ed. The colica pictonum is another case in which the vitriolic solution is stated to be in the highest de- gree serviceable. After the constipation incident to the complaint is removed, by purgatives, a dose of the medicine is directed to be taken every five or 141 six hours, while the pain continues, and, to prevent relapses, the same dose is to be repeated for seve- ral successive mornings. To cleanse the foul ul- cers, in the angina maligna, moderate vomiting by this medicine, we are told, is peculiarly well suited. But I know nothing of its powers myself. It is also alleged to be pre-eminently useful, in the disorders of the chest. Taken in small doses, says Mosely, several times in the day, it proves an excellent ex- pectorant, and is conspicuously beneficial in all pul- monic oppressions in which respiration is performed with difficulty, and where the bronchial vessels re- quire to be relieved, by discharges of accumulated phlegm or mucus. Nor is this all. The worst haemorrhages of the lungs, continues he, are some- times suspended, by the steady exhibition of nau- seating doses of the medicine. Even iu pulmonary consumption, that most hideous of the opprobria medicorum, it has, according to him, very advan- tageously displayed its powers. To its utility, in any one of these cases, I can myself bear no evi- dence. But there are practitioners, and some of high re- spectability, within the immediate sphere of my ac- quaintance, who repose more confidence in the powers of the medicine than I have ventured to ex- press. They, herhaps, have had a wider experi- ence with it. Devoted, as I am, to the combina- tions of ipecacuanha and antimony, in most of the 142 cases where the vitrolic solution might be applica- ble, I have hesitated to prescribe it, in preference to medicines, the efficacy of which, I had habitually witnessed.* * Incompatible sufefcrnces-Alkalies, earths, hydro-sulphurets, and as- tringent vegetable infusions. 143 DISCOURSE VIII. Of Cathartics. These are medicines, which, by quickening the peristaltic motion, increase the evacuations of the intestines, or, as may happen, induce purging. The intimate connection which exists between the whole of the alimentary canal, and the other portions of the complicated structure of the animal machine, gives to them an extensive influence, and renders them among the most important means in the prac- tice of our profession. It is well known, that cathartics differ very ma- terially, in their degree of activity, some operating mildly, while others are more violent in their ef- fects. The former have been usually distinguish- ed by the title of laxatives, and the latter by that of purgatives, the harshest of which, are called drastic purgatives. Nor is this the only difference observable in this class of medicines. Most cathartics act through the entire extent of the alimentary canal, while some few seem to be restricted to the rectum, or ex- tremity of the tube only. There is a section which operates speedily, and another, which is exceed- ingly tardy and sluggish. We have some, which always produce nausea, griping, and tenesmus, and 144 others, that, however actively they purge, never cause any such uneasiness. In every age, cathartics have been freely em- ployed. Like emetics, they are found, as reme- dies, among the rudest and most uncultivated sa- vages. But, though thus early and generally re- sorted to, it appears to me, that their utility has not always been clearly perceived, or their administra- tion properly directed. At the period, when confidence was reposed in the tenets ofjudicial astrology, it was customary to prescribe cathartics, at stated times and seasons, under the impression, that they were more benefi- cial at particular stages of the moon, or in certain conjunctures of the planets. Even at the present moment, the relict of this preposterous notion ex- ists to a considerable extent, among certain de- scriptions of people, and proves, in some instances, a very serious impediment to rational practice.* Nor were the views of the humeral patholo- gists, in relation to this subject, more correct, or the principles on which these medicines were di- rected, less absurd. Conceiving, that by a process analogous to fermentation or putrefaction, a peccant matter was separated from the mass of the blood, purges were given, with the intention of expelling it out of the system, and, as each fluid was conjec- * I allude, here, more particularly, to the lower class of Germans in this city, who adhere, with great pertinacity, to their prejudices. 145 tured to require its own appropriate evacuant, we had introduced into the nomenclature of our science the uncouth terms, cholagogues, phlemagogues, and menalagogues. The views to which 1 have allud- ed, engendering these ridiculous notions, though long declining, may still be traced, in the reason- ings and practice of many, who have received their impressions from the earlier writers. Nevertheless, as respects the use of this class of medicines, we have, indisputably, attained to greater accuracy, whatever may be the obscurity in which their pre- cise modus operandi may continue to be involved. The primary and most obvious effect of cathar- tics, is the evacuation of the bowels. These are liable to various accumulations of a morbid nature, which, remaining, disturb health, and frequently excite or confirm disease. Cathartics, in relieving the bowels, under such circumstances, extend also their operation upwards, and bring down, in many instances, the contents of the stomach. To this may be added, that the strong impression which they impart to the liver and pancreas, excites these glands to invigorated efforts, and the result is a vast increase of their respective secretions. It is in this way, that congestions are removed, biliary calculi dislodged, and jaundice, and other affections from organic obstruction, cured. Cathartics have, moreover, a wider operation, in which the circulatory system is embraced, and, as a leading effect, arterial action greatly diminished. T 146 This they do, by stimulating the exhalent vessels on the surface of the intestines, and the copious ef- fusions of serum which take place, are so much de- tracted from the circulating mass. Thus it is, that they subdue the pulse, equalize excitement, and render such important service in the management of the febrile and inflammatory cases. Yet, it is not to be dissembled, that several writers, and some of these of high authority, have denied, that purging exercises any material influence over the blood-ves- sels. The arguments, however, by which this ex- traordinary opinion has been attempted to be main- tained, are so slender and frivolous, as really to de- serve uo serious examination. All which is neces- sary, in order to its confutation, is, to recollect the extent of the intestinal canal, the number of exba- lents opening into it, the prodigious quantity of fluid matter discharged by stool, and the depression of the pulse, which uniformly takes place, as a direct consequence of these evacuations. To this diminution of arterial action we, indeed, owe the activity with which absorption is* pro- moted by these remedies. Confessedly we have none, not even diuretics, which, in many cases, more conspicuously display this property. But, cathartics, on another principle, conduce to the re- duction of the pulse. It is a law of the circulation, sufficiently admitted, that, if depletion be made from any one set of vessels, the current of the cir- culation will be directed to these, and, of course. 147 the blood diminished in other parts. Cathartics oc- casion this revulsion, and hence, in part, their uti- lity in some of the diseases of the skin, of the head, of the great viscera dependent on undue determina- tion of blood; and it is, on the same account, that they produce so much mischief, when the intestines are inflamed. From what has been said, it follows, that, while the action of this class of medicines is undoubtedly stimulant on the stomach and bowels, all their re- moter and more permanent consequences are emi- nently, and most unequivocally sedative, agreeably to my definition of the term, by which I mean, whatever abates the vigour of the circulation, aud lessens general excitement. Medicines so pervad- ing in their effects, must be calculated to meet a va- riety of indications. But, before I proceed to enu- merate the cases to which they are applicable, I shall lay down, more precisely, the rules for their administration. 1. As in the case of emetics, give the medicine on an empty stomach, and either in the morning, or at bed time. By doing this, we prevent its being rejected, and secure a much more easy and effec- tual operation. 2. Let it be recollected, that there are cathartics of very different properties and modes of operation, and carefully adapt the medicine to the circum- stances of the case. 146 3. Xor should it be forgotten, that the drastic cathartics operate, not only more leniently, but also more completely, when combined with some one of the milder purgatives. 4. To promote the action of this class of reme- dies, as well as to obviate griping, warm beverages are to be freely taken after the first discharge, such as chicken water, or gruel, or molasses and water. 5. It is sometimes necessary to give purges daily. Many diseases, as we shall hereafter see, require this practice. By doing so, we imitate the effects of a spontaneous diarrhoea, which we know occa- sionally removes the most obstinate and intractable acute, as well as chronic affections. 6. To check hypercatharsis, most of the means prescribed to arrest the inordinate action of emetics may be employed. The best, however, is lauda- num, largely given per anum. OF THE PRACTICAL APPLICATION OF CATHARTICS. Cathartics, in every form of fever, are prescribed, and the mode in which they do good, in these cases. may be collected from my preceding observations. Exhibited in the commencement of almost anv febrile affection, they will often arrest its pro gress, and, during the subsequent or more advanc- ed periods, they are sometimes daily repeated, and, so far from weakening, add to the strength of the patient. 149 Iu detailing the several species of fever, where purgatives are deemed more especially useful, 1 may remark, that, in the treatment of intermittents, it has, of late, become very much the custom to pre fer them to emetics, as evacuants of the aliment:»v canal, preparatory to the reception of the bark, and other tonics. But this preference is owing, more to motives of convenience, than to any conviction of their superiority. Emetics are still considered, in many of the worse cases of the disease, as indis- pensable; such, at least, is the result of my own experience, which, I find, is corroborated by the most respectable practitioners living in those dis- tricts of country, where these troublesome com- plaints prevail to the greatest extent, and with most violence. To be effectual, in some of the obstinate cases, it is necessary to repeat them several times, and I think this may be done most advantageously, a little before the anticipated accession of the pa- roxism. To remittent fevers, cathartics seem to be still better adapted. They are employed here, not only to evacuate bile, which, from the highly excited state of the liver, is perpetually accumulating, but, also, to keep down the force of the blood vessels, and to obviate the exacerbations of the disease. Continu- ed fevers, of a bilious inflammatory type, are so closely allied to the remittent, in their causes, nature, and treatment, that what I have said of the one, will equally apply to the other form of the disease. 150 Meaning, on a future occasion, to notice, more in detail, the course pursued in our yellow fever, I shall now be content to state, that, acting at first. under the impression of its being a highly aggra- vated bilious fever, it was universally the practice to purge, even with the drastic articles, most stea- dily and copiously. Taught, however, at length. a more correct pathology of this epidemic, by dis- sections, and by a closer examination of its pheno- mena, this treatment was. in a great measure, su- perseded, and the remedies now substituted were such, as are suited to a very malignant species of gastritis, of the character of which, was this dis- ease. As regards our more recent winter epidemic,* it is not possible, within a limited space, to indicate the precise practice, so diversified were its aspects in the several sections of the country, and conse quently. so differeut the means employed. As it occurred in this city, and still further north, purging was rarely found expedient, though, in the southern states, it partook strongly of the bilious diathesis, and demanded the freest evacuations from the bow- els. Notwithstanding, a contrary opinion has been very strongly expressed by some physicians, whose authority I am bound to respect, I am persuaded of the rectitude of this practice, having witnessed the necessity of it among those members of the medical * Peripneumonia typhodes. 151 class, natives of the south, that had the disease, un- der my care, and who retained, in a very great de- gree, the bilious tendencies of their climate. Of late, it is much the vogue to treat typhus fever by our class of remedies. To the work of Hamil- ton on Purgatives, to whom the credit of having in- troduced the practice is due, I must refer for all the illustrations, by cases of it, and for many other inte- resting details. This fever, by which I understand what is more familiarly called jail, ship, camp, or hospital fever, had long been managed by emetics, in the first onset, and afterwards by the mild anti- monials, and other nauseating medicines, with a de- sign of maintaining diaphoresis. Not being, how- ever, much encouraged by the success of this prac- tice, he resolved on the innovation just stated, and the experience of his new plan, has entirely per- suaded him of its superior efficacy. He ascribes the usefulness of purgatives " to their acting through the whole extent of the intestines, and to their mov- ing and carrying oft' feculent matter, rendered of- fensive and irritating by constipation, and by the changed nature of the fluids, secreted into the intes- tinal canal." To accomplish this purpose, he ap- pears to give a purgative nearly every day, and that of a very active sort, such as calomel, or jalap, or both united. Yet, while he is thus attached to copious purging, he by no means excludes such other remedies, as the fluctuating state of the dis- ease may seem to exact. Lo2 Betweeu the intestinal canal, and the surface of the body, as has more than once been noticed, there is so close a sympathy, that an impression made upon the one, is speedily felt on the other part of the system. Much, therefore, is to be expected from cathartics in the exanthematous fevers. Next, in- deed, to cool air, purging was found, in small-pox, most to allay the heat, reduce fever, and lessen the crop of the eruption. Except venesection, I know of nothing so beneficial in measles, as the milder laxatives. They occasion a depletion by the bow- els, which commonly mitigates or prevents the pneumonic symptoms, and, the distressing diarrhoea incident to the sequel of the complaint, is certainly not so apt to take place. Nor is this remedy of less service, in some other of these affections. In ery- sipelas, especially where the inflammation runs high, every one is acquainted with the utility of purgatives. The evacuations, however, ought to be copious, and, in the progress of the attack, to be frequently induced. But, notwithstanding which, the loss of blood will sometimes be necessary, and, on account of the very heated sensation on the sur- face, a topical application must be used, and of the various means which I have tried, for this purpose, none has afforded such prompt and perfect relief, as a watery solution of opium. Cathartics have recently been much employed in scarlatina. " Many years ago," says a distinguish- ed practitioner, " when the prejudices against the 153 use of purgatives were more decided, and more prevalent than they are at this time, I ventured to prescribe them. My doing so was, indeed, the ne- cessary consequence of the advantage I had expe- rienced from the same remedies in typhus. 1 had learnt, that the symptoms of debility which take place in this species of fever, so far from being in- creased, were obviously relieved by the evacuation of the bowels. I was, therefore, under little appre- hension from them in scarlatina. I have never wit- nessed sinking and fainting, as mentioned by some writers, and so much dreaded by them, neither have I observed a revulsion from the surface of the body, and consequent premature fading, or, in common language, striking in of the efflorescence, from the exhibition of purgatives."* The practice, as here described, with the occasional introduction of the lancet, is undoubtedly that kind, which has proved to be the best adapted to the disease, as it occurs in this section of the United States. I have pursued it invariably, and have always had abundant reason to be satisfied with its efficacy. To me, it has ap- peared to be calculated, not only to cure the dis- ease in a more summary manner than any other mode of treatment, but, likewise to afford the best means of preventing the dropsical swellings, and other derangements of health, or of removing them, when, by negligence, or unskilfulness, they have been permitted to take place. * Hamilton on Purgatives. U 154 But, it is not to the acute affections of the sur- face, that these medicines are restricted exclusive- ly. They have, on the contrary, even from the re- motest times, been much employed in all the chro- nic eruptions of every description. In some of these cases, and especially such as are of a pustular na- ture, they undoubtedly sometimes prove efficacious, and much more frequently in children, than persons further advanced iu life. Many of the eruptions, however, including, per- haps, all the herpetic varieties, are purely local, and being situated on the very verge of vitality, are lit- tle, if at all, influenced by general or constitutional impressions, and therefore, are more advantageous- ly managed by direct applications to the part on which they are seated. Diversified, as are these affections, it would be impossible for me, within the narrow limits to which I am unavoidably confined, to deliver, with any sort of precision, a system of practice, applicable to all the cases, and must, therefore, be content to refer to the works of established reputation on these subjects, and particularly to Willan's and Bate man's treatises on cutaneous diseases. 155 DISCOURSE IX. The subject continued. It is hardly necessary for me to mention, that cathartics constitute a very important part in the treatment of the morbid states of the alimentary canal itself. I shall first speak of constipation of the bowels. This is a relative term. While a large majority of our species, require for the preservation of health, a daily evacuation, there are some who are said to have passed days, weeks, months, and even years, without an opening; and experience, from the interruption of this natural function, no very serious inconvenience. Many cases to this purport are recorded, and a large collection of them may be met with in Hal- ler's great work on physiology. But still this ha- bit of body is generally found to be wholly incom- patible with the enjoyment of health, and is mark- ed by head-ache, vertigo, nausea, foetid breath, offensive excretions; and numberless other symp- toms of a highly unpleasant, and even disgusting nature. Numerous causes produce this condition of the bowels, which, however, may be, perhaps, ar- ranged under the two heads of inirritability of the intestines, and deficiency of bile, or vitiation of its properties. Each of these states may be removed 156 by purging and, in the first, after having quicken- ed the peristaltic motion by stimulant cathartics, we should next resort to the milder laxatives. Mer- curial purges answer best, in the second, by the pe- culiar impulse which they impart to the liver, cor- recting its secretions, and when they fail, a slight salivation may be induced which is almost always successful. Besides the condition of the bowels which I have noticed, they often have their discharges inter- rupted, by spasmodic constrictions, denominated colic. Without at present engaging in the inquiry relative to the varieties of this disease, I shall state, that in all such cases, cathartics are of indispensable utility. It is customary here, to direct the more active articles, and in liberal doses, but it is important to know that, in some in- stances, the most lenient of the purgatives are to be preferred. There is a certain relation between the power of a medicine and the tone of the system, which would seem sometimes to be graduated with extreme nicety and precision. What operates at one time, we find to prove utterly inert at another, under apparently similar circumstances, and in the same person. This is owing to the want of harmony in the case. In a directly opposite state of the bowels, purga- tives are not less demanded. Every one is acquainted with their utility in dysentery, in the several forms of cholera, and in some instances, even of diarrhoea. 157 As relates to dysentery, it seems to be a maxim set- tled, and very much by common consent, that they are to be continued till the evacuations assume a natural appearance. As a general rule, this is un- questionably correct, though in this form of intes- tinal disease, proceeding, as it sometimes does, from mere irritation, the purging may be intermit- ted sooner, and anodynes recurred to with very great advantage. The case of diarrhoea, which calls for purgatives is, where it arises from acrid bile, or some other cause irritating the bow- els, and provoking them to discharges of preterna- tural frequency. Of the utility of cathartics, no one doubts, in all the cases of inflammatory fever with local determi- nations. 1 have already explained the modus ope- randi of purging under such circumstances. It is on the two fold principle of direct revulsion, and by the depletion which takes place in consequence of effusion from the exhalents. No disease is more purely of this nature than acute rheumatism,* aud of course cathartics, among other evacuants, are useful. Notwithstanding, however, the most judicious treatment, the com- plaint will sometimes continue without any consi- * Such undoubtedly is the established doctrine on the subject. But it is nevertheless not true, that rheumatism is a purely inflammatory disease. There is in the case great increase of action, requiring, the freest use of all the depleting means for its cure, but it is an action of a peculiar nature, having none, at least, of the characteristics of genuine or phlegmonic inflammation, either in its progress or terminations 15b derable abatement for weeks, and even for months. In these cases, the phlogistic diathesis of the arte- ries is kept up, while the strength in general is so much reduced, as utterly to forbid the further loss of blood. Even if venesection be admissible from the degree of vigour remaining, it only has the ef- fect, as I have often remarked, of augmenting the excitability of the vessels, and thereby aggravating the mischief. Under circumstances like these, ac- tive purging will occasionally prove of great advan- tage. It seems, more than any other remedy, to quiet the mobility of the arteries, and to diffuse the excitement over the system, which in this case, is chiefly concentrated in the blood vessels. Consulting the history of diseases, we shall often discover certain relations between them, which will lead us to the most curious aud inter- esting practical conclusions. Every one who has much clinical experience must have observed, how intimate is the connection which subsists between rheumatism aud the acute affections of the intestinal caual, as cholera, diarrhoea, and dysentery. The affinity indeed is so striking, especially with dy- sentery, that this disease has been maintained, on no slender evidence, to be a rheumatic state of the bowels. Be this however as it may, we learn that they frequently alternate, or that the affection of the limbs is thrown on the intestines, or reversely, and by this translation, the pre-existing complaint is for the time, completely relieved. 159 Nothing, indeed, is more common in the practice of physic, than to see rheumatism suspended, or even cured, by diarrhoea, spontaneously induced. Taught by this fact, the course which nature points out, I have often imitated it, in the treatment of the more obstinate and protracted cases of the disease before us, and have had much reason to be satisfied with the results. By a very natural transition, I pass on to the consideration of gout. The alliance is very close between this aud the preceding disease, so close, indeed, from the many common points of resem- blance, that they cannot always be discriminated. Consulting the early writers, it will be found, that active purging in podagra, or regular gout, is a very ancient practice, and must, indeed, have been even violent, as the articles then in use, were of a severely drastic nature. It, in fact, prevailed, with no interruption, till it was prohibited by Sydenham on purely theoretical prejudices, it being he ob- serves, " an inviolable law of nature, that the mat- ter of the disease should be thrown out by the ex- tremities, emetics and cathartics will have no other effect, than that of bringing back the offending matter to the bowels." Enslaved by his high authority, we have, ever since, with some very limited exceptions, nearly abandoned the use of purgatives, and been content, most commonly, to let the attack spontaneously ex- 160 baust itself. To envelope the limb with flannel, and to urge a patient endurance of the pain, constitute, indeed, proverbially, the amount of what is at present done in a regular paroxism of gout. It appears to me, that the example of Sydeuham ha= been, in this case, exceedingly mischievous, having led to ihe desertion of a practice which, if judiciously ap- plied, is, iu my opinion, not ouly safe, but peculiar- ly calculated to overcome this most distressing dis- ease. Interesting as would be the enquiry, it is not allowed me to indulge iu any minute, or length- ened disquisition concerning the nature aud causes of gout. My impression, very concisely stated, is, that this disease, if not originating in, has a most intimate connection with, certain states of the ali- mentary canal. I am inclined to this view of the subject, among other reasous, from having so fre- quently observed gout to commence with those symptoms, which denote a depraved condition of the stomach and bowels. The precursory indica- tions of an approaching attack of the disease, are, almost invariably, flatulence, sour eructations, indi- gestion, depraved appetite, nausea, strong sensa- tions of internal heat, and obstinate constipation, or a laxity of the bowels. It may seem, at first, some- what extraordinary, that I should place in the ali- mentary canal a disease, the apparently regular, and certainly ostensible seat of which, is in the ex- tremities. Were it permitted me to extend such speculations, I could easily shew, that there is no 161 thing irrational in the hypothesis, or, which is not illustrated and confirmed, by many analogous cases. But, whether the opinion I have ventured to ad- vance on this subject be correct or not, it may be confidently stated, that the practice it dictates, is perfectly sound, and fully warranted by experience. I have now, for several years, habitually em- ployed purgatives in the paroxisms of goot, and with unequivocal advantage. Not content with simply opening the bowels, I completely evacuate, by active purging, the entire alimentary canal. This being accomplished, all the distressing sen- sations of the stomach which I have mentioned, are removed, the pain and inflammation of the limb gradually subside, and the paroxism, thus broken, speedily passes away. To effect these purposes, however, it is often necessary to recur to the remedy repeatedly. Next I am to consider the utility of cathartics, in some of the affections of the head. Whatever may be the difference of opinion among practition- ers on other subjects, there seems to be the most perfect unanimity, as to the indispensable necessity of purging in these complaints. By the generality of writers, it is maintained, that the proximate cause of apoplexy consists in, a compression of the brain, produced either by congestion, or an extravasation of blood. That such appearances often exist, dissections have x 162 abundantly shewn. But, whether they be the ef- fects of disease, primarily seated' in the brain, or produced secoudarily, by sympathy with the sto- mach, is not so manifest. Of late, it has been held, by the pathologists of the continent of Europe, more especially, that apoplexy is really a gastric affec- tion, and, in support of this hypothesis, they have argued with great plausibility. Whether we con- cur, or not, in this view of the subject, to the full extent, it must be conceded, that certaiu impres- sions on the stomach are capable, and do very of- teu excite the apoplectic state. Evidence to this point may be collected in the history of those cases of (he disease, which are brought on by the narco- tic poisons, by worms, by a load of indigested mat- ter, and by various depraved states of this viscus, the consequeuce of debauchery, in eatiug or drink- iug. Curious as this case may be, as a matter of speculation, I do not know that it leads to any prac- tical difference, so far, at least, as respects the em- ployment of cathartics. Next to venesection, this class of remedies constitutes, in the hands of most practitioners, the leading ingredient, not only in the management of Ibis, but of all the acute disorders of the head. Yet, to be effectual, the purlins should be exceedingly copious, and induced by the drastic medicines. Evacuations of this sort, wilP be Wll mure required where we have reason to sus- pect the cause of the attack to be accumulations in 163 the stomach, though, in these cases, emetics are to be preferred. As resembling, in several points, the preceding disease, I. shall next make a few remarks on palsy. The pathology of the two complaints is precisely the same, in my estimation. They are, indeed, re- ciprocally, cause and effect, or convertible diseases, and palsy, perhaps, as frequently ruhs into apo- plexy, as apoplexy into palsy. Nor does the treat- ment essentially differ. But I wish, particularly, to call attention to the use of cathartics in the latter. It has so happened, that I have seen much of paraly- sis, the disease abounding iu our public institutions. My mode of treating it, originally was, by bleed- ing, blistering, and stimulating embrocations, ac- companied by the pretty free exhibition of tonics. Being, however, not satisfied with the result of my practice, I have long since abandoned it, and rely, now, almost exclusively, on actively evacuating the bowels, by the drastic purgatives. Of the pro- priety of the change, I can entertain no doubt, my success having exceeded my most sanguine expec- tations. To do justice, however, to the practice, it should be steadily persisted in, and aided by such auxiliary remedies* as the cases may, from time to time demand. Of the auxiliary means to which I allude, there is none so important as a repetition of blisters, not to the affected limb, for this is compa- ratively useless, but to the back of the neck, or, 164 what answers still better, caustic issues on the same part, or behind the ears, or on the top of the head. These drains must be kept freely discharging, by irritating dressings. In a preceding discourse, I intimated my senti- ments of the nature of the disease called hydroce- phalus internus. Whatever may be our speculative differences on this point, no one disputes the great efficacy of purging, in the commencement of the complaint. In many instances, at least, when this state of the brain was suspected. 1 have seen the disordered stomach, the dilated pupil, the comatose tendency, and other alarming svmptoms, removed by very copious evacuations from the bowels. Af- ter these remarks, 1 need hardly add, that purga- tives are entitled to our highest confidence in phre- nitis, a case which partakes much of the nature of hydrocephalus, in its early stage. To mania, in all its varieties and stages, this class of remedies has long been thought well adapt- ed. The ancients managed the disease, and espe- cially melancholia, chiefly by purging. It is by no means rare, in the history of the maladies of the mind, to meet with cases, distinguished by a pecu- liar insensibility to impression* of every descrip- tion, so much so, that even the most copious vene- section produces no effect. The vessels under these circumstances acquire a certain habit of per- verted action, which is not at all influenced by the 165 loss of blood. Nor is this state peculiar to the men tal affections. We see it, on the contrary, in vari- ous other cases of chronic disease. Continued nausea, or occasionally active vomit ing for several days successively, will sometimes arouse the system out of its indolence or torpor, and when this fails, I have often derived the most signal advantage from large doses of drastic ca- thartics, so as violently to gripe and otherwise har- rass and torment the bowels. This practic is also very well calculated to subdue the ferocity of the more furious shapes of the disease. Cathartics are among the more prominent means employed in most of the visceral inflammations. To comment on each of this series of cases indi- vidually, would be a tedious repetition of the same observations. Yet there is one of these affections, in which it may be proper to insist more particular- ly on the utility of purging. From the enormous size of the liver, the vast flow of blood to it, and its peculiar structure, inflammation here is exceed- ingly rapid in its career, and often requires to ar- rest its progress, a concurrence of all the depleting powers. In aid of venesection, which in its fullest extent is indispensable, the administration of brisk cathartics, constitute a very prominent part of the plan of treatment. They reduce the force of the circulation in the way which I have so often men- tioned, and obviate those congestions, which so much aggravate inflammation. 166 To the general rule which 1 have stated of the applicability of copious purging to the order of phlegmasia, there are some exceptions, which will be hereafter pointed out. 167 DISCOURSE X. The subject continued. The diseases arranged under the class of neu- roses, or in other words, the nervous and spasmodic affections, will next engage our attention, and I commence with chorea sancti viti. Determining from my own experience, which of course cannot be very extensive, in a disease of comparatively rare occurrence, I should say, that there is scarcely any chronic affection of long standing, that yields more rapidly to any plan of treatment than chorea does to purgatives. It would seem, indeed, that the practice has acquired much confidence and very widely prevails. The medical journals of Europe contain many cases of cures of this disease effect- ed by purgatives. Chorea, like most other dis- eases, consists of two stages, and in the first, while the intestines still retain their sensibility, gentle purgatives, repeated as occasion may re- quire, will readily effect a cure, or rather prevent the full formation of the disease. But in the second a more careful attention is necessary. Cathartics, the most active, must be here given in successive doses, in such manner, that the latter doses may support the effect of the former. The impression once made on the bowels is never to be permitted 168 wholly to subside. Without this is done, relapses are apt to take place, and we loose all which we had previously gained. Nor are we to trust exclusively to this one remedy. The disease, if not inflamma- tory, is often connected with a very plethoric state of the vessels, and imperiously calls for the u-e of the lancet. To bleed freely iu it, was the practice of Sydenham, the propriety of which, has been amply corrobarated as well by my own, as the experience of other practitioners. Topical evacuations, by leeches or cups from the head, are also in some cases demauded, and to confirm the cure, a course of touic remedies becomes expedient. In epilepsy, a disease very nearly allied to the preceding, I have used purgatives with the happi- est effect*. This practice, if not original with me, has never, perhaps, been pushed to the same ex- tent by any one else. To its adoption I was led, not less by ray theoretical views of the disease, than by the total failure of the ordinary plan of treating it by tonics. Nor could I help being en- couraged to pursue it by the great advantage which I had derived, or seen derived, from the same prac- tice in several of the kindred affections. Epilepsy, in common with all the cases to which I have al- luded, is connected with a certain mobility of the system, which would seem to proceed, if not always, at least very generally, from irritation in the ali- mentary canal. Thus, among a variety of other causes, it has been brought on by worms, by the 169 sordes of dysentery, by the pain of dentition, by the narcotic poisons taken into the stomach, by in- toxication, by repletion from excess in eating, by acidity or flatulence, by eruptions repelled from the surface, and finally by obstinate constipation. When, therefore, we have reason to suspect the dis- ease to be seated in the alimentary canal, we must look to emetics or purgatives as the chief means of cure. The circumstances under which emetics are proper, I have already indicated. Determining on the use of purging, it will not do merely to evacu- ate the bowels. Cathartics, on the contrary, must be repeated day after day, without interruption, un- less imperiously forbid by peculiar circumstances. By continuing this course for several months suc- cessively, I have cured several cases of the disease completely, and afforded considerable relief in some others. My success, indeed has been suchj that I am almost encouraged to hope, could we get our patients to persevere in the use of this remedy, the disease would become incomparably more ma- nageable than it has ever yet been. Let it not however be understood, that I would limit the treatment of epilepsy simply to purgatives. Even those cases which are most strictly primary affections of the alimentary canal, uniformly re- quire the aid of various remedies. To remove the symptoms of plethora, which are very usual inci- dents of the disease, venesection, as well as topi- cal bleeding by leeches, or cups to the head, are Y 170 often necessary. Nor is it less important, under such circumstances, to impose the trictest regula- tions with regard to diet. The lowest and least stimulating regimen, as vegetables only, or bread and water, 1 have sometimes found absolutely in- dispensable in conducting the cure of the disease. But though, perhaps, a large majority of the cases of epilepsy, arise from derangement of the alimen- tary canal, there are some which may be traced to organic affections of the brain. These pre- sent much greater difficulties in the management, and most generally will prove to be altogether in- curable. Of the use of purgatives in hysteria, I have not much to say. As its name imports, this disease has long been supposed to originate in the uterus. But I cannot help believing, notwithstanding what may be urged so plausibly to the contrary, that this generally received opinion with respect to its pa- thology, is as unfounded as the practice deduced from it, has proved to be unsuccessful. My conviction is, that this, like all the rest of what are denominated nervous affections, is intimate- ly associated with certain morbid conditions of }? stomach and bowels. The symptoms which denote this connection in the present case, are vio- lent pains in different parts of the alimentary canal, hiccup, sour eructations, flatulence, indigestion, constipation, vomiting or purging, which invaria. bly precede a paroxysm. In the view which I 171 have taken of this disease, I am fully supported by the results of my own practice, and the concur- rent experience of some very distinguished autho- rities, and by Hamilton, especially. To illustrate, as well as to vindicate this mode of treating the complaint, he has collected a number of cases, which will be found in the appendix to his work. That purging alone will invariably cure hysteria, I am by no means prepared to assert. Though I have often rendered essential service by the reme- dy, it has not been my custom to trust to it exclu- sively. Many of the cases of the disease are at- tended with a very full state of the vessels, and re- quire bleeding, while others, seem, from the com- mencement, to call for the pretty free exhibition of stimulants and tonics. My general practice is, to evacuate the stomach and bowels by the steady ex- hibition of cathartics so long as there appears to be a necessity for it. But before this is effected, I have sometimes had occasion to repeat them every third day for a very considerable period. Most com- monly, however, they may be omitted in two or three weeks. The alimentary canal being thus re- lieved, tone and vigour may be restored to the sys- tem by combinations of the foetid gums with the chalybeate preparations, or by the bark and other tonics, as I shall hereafter detail more particularly. Tetanus is the last disease of this class, on which I shall at present make any remarks. It is very properly divided into two kinds, the 175 idiophatic, and symptomatic. The first is pro- duced by general causes, and the second is the ef- fect of wounds, or other injuries. Tetanus of the former species, at least, I cannot help considering as merely an acute and highly aggravated form of the several preceding affections. They have each, that is, hysteria, chorea, and especially epilepsy repeatedly taken on tetanic symptoms. Like these complaints, tetanus originates in a va- riety of causes, but by whatsoever it may be pro- duced, the attack is uuiformly ushered in, and ac- companied by the strongest indications of the ali- mentary canal being chiefly affected. Even where it is occasioned by a wound, much anxiety and dis- tress are immediately felt at the pracordia, and sickness of stomach, and spasms of the bowels soon follow. But the irritation of a local injury, is only one of the causes of the disease. Tetanus is also excited by the vicissitudes of heat and cold, by exposure to marsh miasmata, by the exhaustion from over exertion, by worms in the intestines, by the acrid matter of dysentery, by the bites of venomous reptiles, by powerful stimuli acting on the stomach, as the stramonium, camphor, hemlock, ardent spirits in excess, and lastly by constipation of the bowels. If this history of the disease be correct, the propriety of actively evacuating the ali- mentary canal is exceedingly obvious. We have already seen the efficacy of purgatives in the milder 173 forms, of hysteria, chorea, and epilepsy, and there cau be no objection to the extension of the practice to the aggravated cases of the same disease. In one variety of tetanus, the utility of purg- ing is indisputably established. My allusion is to trismus nascentium, or that spasmodic affection which occurs in the first days of infancy, in conse- quence of a disordered state of the stomach and bowels, from the retention of the meconium, a con- genital accumulation of acrid and offensive matter. Nor are we entirely destitute of direct evidence of the efficacy of the purgative plan, in the disease when existing under other circumstances. Cases are recorded by Hamilton in his work, and by ma- ny other writers in the late periodical journals, of a character the most conclusive and irresistible. The earlier authorities, and particularly the writers on the diseases of tropical climates, might also be cited in favour of copious purging in tetanus, when originating, as they state it frequently does, in loaded and oppressed bowels, or, from acrid or in- digestible matter received into the stomach. I once met with a case of confirmed tetanus in a boy, produced by a collection of cherry stones in the rectum, and another from asearides. They both gave way almost immediately on the cause being removed, and surely nothing can prove more strik- ingly, the intimate connection between such spas- modic affections, and primary irritation iu the ali- mentary canal, than these facts. 174 With this I conclude what I have here to say on the application of purgatives to the cure of the ner- vous affections. My observations, though copious, have been general, and, perhaps, on this account wanting in perspicuity, and that uice discrimina- tion, which is required in practice. This, however, was unavoidable. It would have been inconsistent with my province, to have expatiated more on prac- tical points, or to have descended further into the details of clinical instructions. My chief object has been, to point out some new views relative to these troublesome affections, which I honestly believe to be true in speculation, and which I know, as well from my own experience, as that of others entitled to my confidence, will be found just and useful in practice. Considering the close analogy between the opi- nions I have delivered, and those contained iu the work on purgatives, to which I have so frequently referred, it may seem, that candour required, that I should make a distinct acknowlegement, of my having borrowed them from that source. But such is not the fact. Nearly twenty years ago, and very early in the progress of my professional studies, I read a paper before the Medical Society of this city, on the connection of the alimentary canal with the rest of the body, which embraces this very pa- thology, and, as an obvious deduction, precisely the same modes of practice. But, though I must assert my own claims to originality in this respect, I am 175' not the less sensible of the obligations due to tile distinguished character, who has propagated, and established, by the weight of his high authority, one of the greatest improvements which practical medicine, in my estimation, has of late received. To those who are not conversant with the reputa- tion of the author of the work on purgatives, it may not be uninteresting to be told, from my of own per- sonal knowledge, that, as a practitioner, he unites to the quickest perceptions, and the soundest judg- ment, the accumulated experience of nearly half a century, acquired from private practice, and by an attendance in one of the most extensive, and, per- haps, the best clinical school, in Europe. Evacuations by the bowels have long been deem- ed of the greatest service in dropsy. Not a few practitioners, indeed, rely almost exclusively on purgatives in these cases. By Sydenham they are recommended to be employed every day, unless prohibited by the debilitated state of the patient, and this is, undoubtedly, sound practice, though it ought not to be resorted to indiscriminately. Drop- sy is connected with very opposite states of the sys- tem, and requires to be treated by different reme- dies. Every practitioner has seen it associated with fever, and no inconsiderable degree of even inflammatory action. Exactly as the case assumes this aspect, does it indicate the use of the lancet, the saline purgatives, and especially the soluble, or cremor tartar. But in the selection of cathartics, it 176 is much more common to prefer the drastic species, or what were formerly called hydragogues. Me- dicines of this character, are indisputably [mischie- vous, under the circumstances mentioned, and are only advisable, where the alimentary canal is tor- pid, the habit generally phlegmatic, without fever, or local visceral disease. That dropsy is some- times a febrile affection, attended by great fulness and activity of the arteries, is no new opinion, though it has recently been claimed as such. The doctrine is distinctly laid down by Stahl, in his chapter on haemorhagy, and subsequently, by Dr. Grapengiesser, in his dissertation '•' De Hydrope Plethorico.''* Yet dropsy is, perhaps, not less frequently a disease of very feeble action, the con- sequence of a debilitated and exhausted system, or of a highly disordered state of some one of the principal organs, as the spleen, liver, &c. Cases of this description, do not admit, at all, of the use of purgatives, but exact for their cure, a com- bination of the tonics, with the more stimulating diuretics, and, in some instances, especially when associated with visceral disease, a temperate exhi- bition of mercury. Of the several forms of dropsy, however, anasarca and ascites are the only ones, in which purgatives, under any circumstances, are employed. To hydrothorax, they seem wholly in- applicable, as they do not. in these cases, promote * Vide Duncan's Commentaries. 157 absorption, and are apt to increace debility, while the dyspnoea, and other distressing symptoms, are aggravated. Marasmus is a complaint more particularly con- fined to children, and generally makes its appear- ance soon after weaning. It had long been cus- tomary, owing to the symptoms of debility, to treat it by steel, and other tonics. The result of the prac- tice shewed its impropriety. 1 have seen several cases of this disease, and, under the impression of its superior efficacy, have invariably pursued the purgative plan. My success has been such, as to inspire me with much confidence in it. Different opinions have been entertained relative to the cause of this disease. It has been imputed to worms, and to obstruction in the mesenteric glands. It may occasionally arise from both of these causes, though I am disposed to think, that it has most commonly its origin iu a torpid, or weakened state of the alimentary canal, with which the whole of the chylopoietic viscera sympathize. To this con- clusion I am led, not less by the external pheno- mena, or signs of the disease, than by the appear- ance after death. Dissection shews the intestines filled with black foetid sordes, or impacted mucus, the liver much enlarged, and the mesenteric glands considerably tumefied. The intestines being thus loaded by these foul collections, the passage of the nutriment is not only impeded, but the absorption of the chyle prevented, and the langour, from in- z 178 auilion, ensues, attended by all those derange- ments which I have described. But, whatever the- ory may be adopted in this case, the practice is ne- cessarily the same. If the disease has its origin in worms, purgatives, which are among our best an- thelmintics, w ill be useful. If it is produced by a morbid state of the mesenteric glands, this class of remedies which are the most powerful deobstru- ents, must be equally required. If it is owing to a torpid state of the intestines, they will be most .effectually excited, by active purgatives. Two stages are very distinctly marked, in the ma- rasmus of children—the incipient, and confirmed. The bowels, in the first, are not altogether inactive, and mild purgatives, repeated at proper intervals, are to be employed. But it is very different in the se- cond stage, there being here little sensibility, and the accumulation of feculent matter is prodigious. We are, therefore, required to purge actively. Calo- mel, given in as large a dose, and as frequently re- peated, as circumstances will admit, has always answered best in my hands. Extraordinary as it may appear, this copious purging, instead of add- ing to the debility of the child, will be found to re- lieve its distresses, by daily increasing its strength.* In chlorosis, or that general derangement of health, to which girls are exposed about the season of puberty, this class of remedies has sometimes • Hamilton on Purgatives. 179 signalized its powers. As it is not permitted me to enter minutely into the history of diseases, I shall overlook the multiplied theories that have been ad- vanced, to explain the singular group of affections incident to this period of life, or of the divers modes of treatment, which, at different times, have been adopted. It is remarked by the writer, by whom this practice is particularly recommended, that the " slightest attention to the general history of the disease, evinces, that costiveness precedes, and ac- companies the other symptoms. It is this, which induces the feculent odour of the breatji, disordered stomach, depraved appetite, and impaired diges- tion, which preclude a sufficient supply of nourish- ment, at a period of life when it is most wanted." Considerations of this sort, it appears, led him to the use of purgatives, and he declares, that they proved at once safe, and quickly salutary.* Of the advantages of this practice, I cannot speak with much confidence from personal knowledge. Though of late years, a good deal consulted in the diseases of women, I have not had many very well marked cases of chlorosis. The vigour of the female constitution, in this city, seems to prevent its occur- rence, in any very great degree. Certain it is, how- ever, that, in states of disordered health closely al- lied to it, and particularly in some of the forms of * Hamilton on Purgatives. 180 amenorrhcea. I have seen the most decisively good effects, to follow active purging. As not very remote from this subject, it may be right for me to notice here, that a species of haeina- temesis, occurring in females in early life, is stated to be very successfully managed, by the liberal use of purgatives. It had generally been held, that this particular haemorrhagy, which is proved to have no connection with any organic affection of the stomach, is a discharge vicarious to the menses. I confess, that I still incline to this opinion, be- cause, among other reasons which might be alleged in its support, I have always remarked, in the cases which have come under my notice, that amenor- rhoea existed. But, it is now conteuded,* that it proceeds from, or at least, is mainly dependent on, a constipated state of the bowels, the faeces which are brought off, being always copious, and of an un- natural colour, consistence, and smell. What is the success of this, compared with the former mode of treating these cases, I will not take on myself to pronounce. Of this, however, I am well assured, that purgatives have hitherto been too sparingly re- sorted to in the cachectic complaints generally. De- termining from my own experience, I should say, that they are, sometimes of the greatest advantage in scrofula, and its associate affections. I have seen the white swelling most essentially relieved, * Hamilton on Purgative^. 181 by a long continued course of purging, aud its be- neficial effects are now fully attested, in the morbus coxarius, more especially, I think, when it proceeds from a strumous contamination. Nor is it hardly less useful, in the dissipation of glandular enlarge- ments, or of those tumors approaching to scirrhus, which frequently occur in the mammae of wo- men. But, to be productive of any decisive utility, in any of the preceding instances, it is required, that this plan of treatment be persisted in with stea- diness, and for a great length of time, and, that there be brought to its aid various other mea- sures, such as topical bleeding, blisters, low diet, and a state of rest. I speak now, more particularly, in reference to the disease of the hip joint, which I have cured, by purging on every other day, for se- veral months successively. It was Dr. Physic, I have reason to believe, who originated this prac- tice, or rather, urged it further than before had been done. Much has it already accomplished, though infinitely more may be anticipated from it, when it comes to be applied, as I am sure it might, to all the diversified shapes of chronic inflammation. 182 DISCOURSE XI. On particular Cathartics. Extensively as I have entered into the consi- deration of the use of cathartics, many cases still remain to be indicated in which tbey are habitu- ally prescribed, and with the greatest advantage. But these are comparatively of minor consequence, and the principles which I have already delivered on the subject, will serve sufficiently as a guide, to the further application of these remedies. Even at the present time, cathartics are too much neglected in the management of disease, and most commonly from an impression of their extremely exhausting effects. As regards acute diseases, there is no doubt that active purging reduces very rapidly ar- terial action, and with it, the general strength of the system. But such is precisely w bat is here de- sirable, and in the chronic affections, where any increase of debility is to be avoided, these medi- cines would really seem, as a general rule, to ope- rate very differently. Nevertheless, as in all other cases, a recurrence to this class of remedies is to be controuled by a sound discretion, and, onder certain circumstances, they are either utterly precluded, or to be very sparingly and cautiously used. Exceptions to their general use 183 at least to their active use, may be found in all low and sinking conditions of the system—in most of the complaints of the chest, and especially where expectoration is solicited—in the first stage of in- flammation of the stomach and bowels—in haemor- rhoidal predisposition—and, during mentruation, pregnancy, and immediately after delivery. It is a very curious fact, but one fully confirmed by experience, that urged to any extent, evacua- tions from the bowels, are found in the complaints of the lungs always mischievous, and in some cases so injurious as to be wholly inadmissible. Even in pleurisy, we cannot purge with the same freedom as in other cases of acute inflammation. But in the chronic pneumonic affections, and espe- cially in pulmonary consumption, the system imme- diately sinks under the operation of purgatives, and hepce we are so careful to restrain diarrhoea in this disease. I proceed now to the history of particular ca- thartics, and these I shall arrange according to their activity, or under the two heads of laxatives and purgatives. Of Laxatives. Of this description, the first substance which presents itself is the oleum ricini, or castor oil. This is derived from the seeds of a plant called palma christi, or the recinis communis, a native of 184 the West Indies, but which thrives and grows lux- nriantly in many parts of the United States. These seeds are variegated with black and white streaks, resembling both in shape and colour the insect ricinis, or tick, whence the name is given to the plant. They were early used, so early, indeed, as the time of Hippocrates, but the skin of them beins: extremelv acrid, one or two of them will often operate violently, as a drastic purgative or emetic. It is perhaps about half a century since it was discovered in the West Indies that the oil expressed from the seeds, constitutes an excellent laxative, mild in its effect, and wholly destitute of the disagreeable or baneful properties of the seeds themselves. Castor oil operates with great cer- tainty, and produces its effects without griping or stimulating the iutestines, and is therefore admira- bly adapted to all cases where merely opening the bowels is required. In the habitual costiveness of sedentary and studious persons, it answers exceed- ingly well. Most other purgatives, and especially the resiuous purgatives, rather aggravate the state for which they are given to relieve. They confirm the habit of costiveness, and lose their efficacy by repetition. But the oil, it is said, after a little use, will act even in a less dose, and always leaves a laxative tendency. Castor oil was originally employed in colica pictonum by the physicians of the West Indies, where the disease abounds. Its efficacy in these 185 eases is tod well attested to be doubted. I have indeed often witnessed its passing through the bow- els in other forms of colic when powerful cathar- tics have been resisted. Yet we cannot generally trust it in obstinate constipation, or when copious evacuations are demanded. It will insinuate itself through the intestinal canal, bringing with it a small portion of the more fluid contents, but leaving be- hind the collection of indurated faices. Were I to resort to it, under such circumstances, it should be some hours after a dose of calomel and jalap, or any other active cathartic. When thus adminis- tered, it very generally promotes purging, and miti- gates the harshness of the drastic medicine. Castor oil is much employed in dysentery and other inflammatory states of the bowels. It has been supposed to be peculiarly adapted to these cases, as it passes very generally through the whole extent of the alimentary canal without being sen- sibly changed, and hence while it purges away of- fensive matters, it sheaths the delicate surface of the intestines. This however, I suspect to be a mere notion; the quantity of oil commonly employed being too small to answer any such purpose. In a more advanced period of the disease, when there is tormena, or tenesmus, I have sometimes used with great advantage the annexed prepara- tion.* Of this, which is known by the name of * R Ol. ricin. ^i. Pulv. Gum. Arab. Jii. Sacch. alb. 3i. Tinct.theb. gtt. xl. Aqua, menth. 5 ii, m. A a 186 oleaginous mixture, a table spoonful is to be taken everv hour, or two, as circumstances may demand. This mixture remains on the stomach much better than the pure oil, and sometimes very speedily relieves the symptoms which 1 have mentioned. To cholera infantum, the oil is supposed by most practitioners to be not less suited. It is given in the beginning of an attack to evacuate the bowels, and subsequently, in smaller doses. pretty much with the same view that it is direct- ed in dysentery. As. however, this complaint is usually attended by nausea and acidity, I have found the oil still more advantageously adminis- tered in the following shape :* the dose of w hich, and the manner of repeating it, must be determined by the age of the child, and the circumstances of the case. As exciting little or no irritation, the oil has also been much commended in haemorrhoids, in puer- peral women, and after surgical operations. As a laxative, it is useful in all the diseases of children, no medicine indeed, being so appropriate. The dose of the oil for an adult, when we wish it. full effect, is an ounce, and for the infant, not less than a tea spoon full even at birth. As the oil is an exceedingly unpleasant medicine to most persons, several means have been sug- f R Ol. ricin. 5 i. Sacch. alb. 3 i. Album : ovi q. v. ft. mis.; adde gradaum. An. calcis. "~ v. Tine:, theb. gtt. xx. m. 187 gested to obviate this inconvenience. It is some- times taken in ardent spirit. This vehicle, however, is obviously improper in very many cases. The French always take it in coffee. It is said, when mixed with a stroug infusion of sen- na, in the proportion of three parts to one, to be far less nauseous, and sits more comfortably on the stomach. Made into an emulsion uith the yolk of an egg, and cinnamon or mint water, it is certain- ly not very disagreeable. 1 think ou the whole, there is no better way of giving it, than by pouring it on a little sugar and water, which prevents it adhering to the sides of the glass, and both before and after swallowing it, to rinse the mouth with rum or brandy. When the oil cannot be retained, a very excel- lent substitute may be had iu an emulsion made of the seeds of the palma christi, previously stripped of the skin. We should, indeed, often employ this preparation, could we always procure the recent seeds. These soon become rancid, and in this state are not only unpleasant to the taste, but very harsh in their effects. OLEUM OLIVARUM. In many of its leading properties the olive oil is similar to the medicine of which I have been treat- 188 ing. It is very mild, very quick, and a very certain laxative. I know not indeed of any property which it does not possess in common with the cas- tor oil. except perhaps its activity. It may be ad- ministered in all cases where the former is useful, and I am persuaded with nearly an equal advan- tage. Being less offensive to most people, it would seem, in this respect, to have a superiori- ty over the castor oil. There are two cases where it is decidedly preferable, as w hen certain poisons have been swallowed, and in the colicky affections of children, accompanied with obstructed and in- flamed bowels. The objection which I have heard made against the olive oil in inflammatory cases, that it is digest- ed, and therefore increases the quantity of circulat- ing fluids, is wholly unfounded. Given in such a dose as to purge, it always passes through the bow- els like castor oil. and not more changed. The fact is, that in all acute affections of the alimentary ca- nal, the process of digestion becomes nearly sus- pended, and whatever is received into the stomach, even the nutritious mucilages, are so little acted upon, that they are expressly directed to " blunt acrimony, and sheathe the delicate surface of the intestines." As a substitute for each of the preceding articles melted butter may, on some occasions, be employ- ed. It has often been prescribed, when acrid mat- ters have been taken into the stomach, and not with- 189 out utility. But the case, to which I think it more especially adapted, I shall hereafter notice, under the head of enemeta. As a fact of some practical importance, it is worthy of recollection, that the animal oils are much less irritating than the vege- table. SULPHUR. This is one of the laxatives, with which the mi- neral kingdom supplies, us, and was deemed, till recently, an elementary substance. The sulphur of commerce, is the product of volcanoes, in Italy, or is dug out of the mines of Germany, Sweden, and Hungary. Now and then, it has been found perfectly pure, though the more ordinary state in which it is met with, is that of adulteration with various extraneous matters. By the process of sublimation, it is purified, form- ing the flores sulphuris, and when melted, and run into cylindrical moulds, is called roll brim- stone, which is usually not so pure. The former of these preparations, is the one most commonly prescribed ; and, in the dose of one or two drachms, is anlong the most lenient and useful of our laxa- tives. But, though such is the general character of the medicine, we sometimes see its operation ex- ceedingly harsh, violent, and irritating, so much sc, indeed, as to produce bloody and painful evacua- 190 tions. Effects of this sort, however, most probably, are owing to the impurity of the medicine ; the sulphur in the process of sublimation, sometimes acquiring a degree of acidity, from a partial com- bination with oxygen, and hence the washed sul- phur,- is to be preferred for internal use. The action of sulphur, is principally on the great in- testines, and, on account of its mildness, is thought to allay the irritation of these parts, and is much employed especially in haemorrhoids. It is also adapted to the cases of habitual costiveness. Af- ter opening the bowels, it leaves a laxative ten- dency, without inducing that sort of weakness, which disposes to flatuleuce and eructations. We s sometimes, in these cases, combine the sulphur with an equal part of cremor tartar, in the form of an electuary. In gout, as well as rheumatism, the sulphur has acquired considerable repute. When the former of these diseases attacks the alimentary canal, with flatulence, and spasmodic uneasiness, it is undoubt- edly very often highly serviceable. I have not tried it, in any other forms of arthrites, though it has been much used to evacuate the bowels, in regular podagra. But in rheumatism. I have prescribed it much, and certainly with advantage. To the chro- nic states of the disease, attended with pain, it is the best suited. I have generally directed it in such • Sulph. sublim. lotum 191 doses as to keep the bowels, at least, in a laxative condition, though the sulphur also operates by ex- citing perspiration. It is by this twofold property, that it probably does good in these cases, and iu a variety of other diseases. By the German writers, a good deal has been said of the utility of our medicine, as a purge, in dysentery. As, however, their practice was never imitated to any extent, and is now nearly repudiat- ed, I presume it had no very solid claims to atten- tion. Yet, in dysentery of that species, which par- takes of the character of rheumatism, or catarrh, sulphur might, perhaps be applied with advantage, though this is mere conjecture, having no experi- ence whatever with the medicine, under such cir- cumstances.* MAGNESIA. This is a simple earth, found, for the most part, in a state of great impurity, from which it is cleared by certain chemical processes. Magnesia was in- troduced into the materia medica, at the beginning of the last century, by Count De Palma, at Rome, and continued, for a long time, a very lucrative se- cret. It scarcely, indeed, lost the character of a qur.ck medicine, till it was prepared, about forty or fifty years ago, by a Mr. Glass, an apothecary, at Oxford. * Diaphoretics. 195 Magnesia usually exists as a carbonate. When administered in this state, if it meets with an acid in the stomach, a decomposition sometimes takes place, and a considerable quantity of carbonic acid is disensrasred, which causes an uneasv disteusion, and the other symptoms of flatulence. It should, therefore, be always calcined, or, in other Words, deprived of its fixed air, before it is used. This is more especially necessary, as regards children, with whom it is much employed, even within the month, aud who sometimes suffer much, from the neglect of this precaution. Magnesia is a mild laxative. Combined with other substances, it becomes more active, and espe- cially uith rhubarb. Equal portions of it and the lac sulphuris, form one of the most certain,* and, at the same time, lenient of our purgatives, and is admirably suited to remove a torpid state of the bowels. Magnesia, however, is mostly prescribed alone, to correct acidity, add afterwards, to act as a purgative. It is, with this view, much given in gout, in all the depraved states of the stomach, in the griping colics of infants, and other analogous affec- tions. The annexed formula will be found useful in these latter cases, f * Sulphur precipitatum. t B M. os. caic. gr. xxx., pulv. rhei gr. vi., sacch. alb 5i, ui. anis et . iii., tine*, t'lfh. gtt. iv. aq. font. ?iss. M. Tic co se for the infant, is a tea-spoonful. 193 CARBO VEGETABILIS.* VEL CARBO LIGNI. This article, on account of its antiseptic proper- ties, has long been used for a variety of purposes in domestic economy. Excepting, however, its ex- ternal application as a poultice to ulcers, to cor- rect their odour, or to arrest the progress of morti- fication, no great use had been made of it in the practice of medicine. It is true, that, during the reign of the pneumatic pathology, it was proposed, and perhaps employed, as a means to rob the system of the excess of oxygen, which was presumed to cause certain diseases. Reasoning on its general properties, I was in- duced, several years ago, to administer it internally, in a case of ulcerated fauces, and tongue, accompa- nied with a very foetid breath, which I suspected to arise from a morbid state of the stomach. After a few trials, I had the satisfaction to find, that the fcetor was corrected, the ulcers improved, and, by perseverance in its use, a cure was ultimately ef- fected. I have since been much in the habit of em- ploying it in all chronic ulcers of the throat, where I supposed them to be owing to the same cause, and not without advantage. Encouraged, also, by what I had observed of its effects, in removing the offen- * Parr's Medical Dictionary. Bb 194 siveness of the breath, in some of the preceding cases. I have since, and with nut le*s success, prescribed it with the same view, where this existed, independently of ulceration. M\ observa- tions have taugiit me, that the odour, under such circumstances, does not proceed from di-eased lungs, as is commonly supposed, but is a fool exha- lation, from a depraved condition of the stomach. The powers of charcoal, in destroying the odours of substances, is very peculiar, and, I do not think has hitherto been well explained. Even medicines placed near it, are deprived, it is said, of this pro- perty, and more particularly valerian, galbauum, balsam of Peru, and musk. Charcoal, in the dose of a table spoonful twice a day, which is my mode of exhibiting it. opens the bowels gently, and seems to be well calcuia ed to obviate costiveness. It may. therefore, be placed among the milder purgatives, though it has claims to be considered iu another light. Certain 1 am, that it is a substance of much more extensive uti- lity, and will hereafter become an important acces- sion to the materia medica. It has, undoubtedly, veiy considerable tonic powers, and especially on the alimeutary canal. 1 have em; lnyed it in dys- pepsia, though not enough to conduce myself, that it was of any great utility. Nevertheless, it ap- pears to me, that it promises to be serviceable in acidities of the stomach, in pyrosis, in some of the stages of dysentery, where the stools are acrid and 195 highly offensive. To the latter case, it would seem to be well adapted, since it entirely divests, as I have remarked myself, the excrementitious dis- charges of their bad smell, and probably of their acridtr'ss. Exhibited in small doses, charcoal is, most unquestionably, astringent, or, in other words, operates on the bowels, in restraining inordinate evacuations, precisely in the same manner as the cretaceous preparations do, and might, on this ac- count, be useful in diarrhoea, and other atonic fluxes. May not, too, something be expected from it, in those low states of disease, such as were for- merly called putrid ? Experience has already de- monstrated its efficacy in intermittent fever, given in the dose of a drachm, during the apyrexia. ob- serving, in every respect, exactly the same rules, as in the employment of the Peruvian bark. Diswuet from what has been said of its powers in this dis- ease abroad,* I have, in my possession^ some very * In one of the late numbers of the Edinburgh Medical and Surgical Journal, 'here is an account of the successful use of charcoal i n the ague and fever, by Dr. Calcagno, of Sicily On the authority of this physi- cian, the remedy lias been pretty extensively tried in the sume disease, by Dr Calvert, physician of the British forces at Palermo, and with a full confirmation of its powers; and who lias also collected, from his medical correspondents, some additional proofs, to the same effect. He further states, thai it has been beneficial!) employed in intermittent fe- ver, blended with dysentery, and, it moreover appears, according to him, that it removes'he bitter and disagreeable tastes in the mouth, al- lays sickness whenever there is a tendency to vomit, and sometimes stops the vomiting when it has occurred, promotes appetite, and assists digestion ; thus verifying, in a great degree, my predictions of the pow- ers of the article. 196 s strong; evideuce of the same purport. I have said, that charcoal might be beneficial in a certain state of dysentery. In the form of the disease, complicated with intermittent fever, as described by Moreton and Cleghorn, it appears to me, that it may likewise prove a valuable addition to our means of manag- ing it. and such a one as is much required, having found the bark, notwithstanding what has been sta- ted iu its favour, by these writers, is here totally inadmissible, always, if it be retained at all, aggra- vating the bowel affections, without making any impression on the fever. Not lung ago it was confidently stated by M. Bert rand, physician in France, that by experiments he had ascertained, that charcoal is a complete an- tidote both to arsenic and corrosive sublimate. As we were not in possession of the means of counter- acting, especially the former of these poisons, this communication attracted great attention, so much so, indeed, as to be circulated through the most po- pular vehicles of intelligence even of this country. But, on the repetition of these experiments by other persons,* it was found, that charcoal has no such property, affording another instance of the fallacy of medical testimony, and of the impositions of this sort, which are constantly practised upon the pub- lic! " Vide Orfilla on Poisons. j After the above article was written, I had put into my hands, Uie J.ition of the Edinburgh Dispensatory for Is 16, where I find it stated. 197 NEUTRAL SALTS. These are a very valuable class of evacuants, and though there is a considerable number of them, they are so uniform in their properties, and so fa- miliar in their use, that little occasion exists, to en- ter into any details on the subject. They are all given nearly in the same quantity, which is about an ounce dissolved in water, and are considered as occupying, in point of force, an intermediate space between the laxatives and purgatives. Each is also distinguished by the peculiarity of operating in a smaller dose on repetition. As they relieve the bow- els pretty freely without exciting much action either locally or generally, they are usually resorted to when a phlogistic diathesis prevails. If, however, a thorough evacuation of the contents of the alimentary canal, or a sudden reduction of the excitement of the system, be demanded, as mostly happens at the commencement of inflammatory bilious fevers, these saline laxatives must give way to the mercurial combinations. But after such an effect has been produced, they are admirably calculated to keep down action, to preserve the bowels in a soluble state, aud may be so combined with antimonials as that two German writers, Hahneman and Juch, had mentioned that char- coal removes the fcetor of dysenteric stools, and that it is useful " in itch, worms, florid phthisis, and other atrophies." Externally applied in form of a paste, I have also lately heard that it will cure tetter and other herpetic eruptions. 198 to act on the surface, and to fulfil a variety of other indications.* Of this assortment of medicines, the ^latiber salts, or sulphate of soda, in some re«pect«. are to be preferred. They have all the leading proper- tie* of the rest, and are distinguished by rather more activity and certainty of operation Th^ next of the -aline laxatives is the sulphate of magne-ia It was once known by the name of biit r purging salt, and still more by that of Ep- som salt, from the name of the place at which it was originally manufactured. Excepting that it is moie apt to be retained. I do not know that it has any superiority. But on this account it has been s rongly recommended in colica pictonum, in dysentery, in cholera morbu*. in ententes, and other complaints attended with great gastric irritability. That it will lie on the stomach, when most other articles are re- jected, I have sometimes seen, and think particu- larly in cholera infantum, a disease, iu which it may be often recurred to with ad\antage The tartrate of potash and sUda, or Rochelle salts, are only recommended by the circumstance of their hems; less nauseous. They are now most generally given, dissolved in Seltzer water, and are by no means, unpleasant to the taste, or offen- sive to the stomach, in this shape. Of the vitrioiated tarter, or sulphate of potash, I have as little to say. It is very seldom used, * Diaphoretics. 199 and jseems to be less estimated as a laxative, than any of the neutral salts. When resorted to at all, it is iu the dose of a drachm or two, united to jalap or rhubarb, or some other vegetable purgative. But even in this way we see little of it in practice. The phosphate of soda is comparatively a new medicine, not having been introduced into the ma- teria mediea above twenty or thirty years. Like the preceding salts it is a mild laxative, and cer- tainly is not so disagreeable. Yet I doubt whether it is so active, or so well calculated to meet several important indications. It seems to be less cooling in its effects, and commonly produces an intolerable desree of thirst, and uncomfortable sensations about the stomach. It may be exhibited in solution in water, or in soup, or gruel made without salt. Be- ing very similar to the muriate of soda in taste, it will answer very well as a substitute in this way. Of the soluble tartar and cremor tartar, the tar- trite and supertartrite of potash, I shall defer say- ing any thing till I come to the history of diuretics. 300 discourse xn. Of Purgatives. The article which first arrests our attention is calomel, or sub muriate of mercury, and of all the purgatives this is the most important, and the one which is susceptible of the widest application in the practice of physic. There is scarcely indeed any case iu which purging is required, that it may not be so regulated either alone, or in combination, as to meet the several indications. It has the sin- gular property of imparting force to many of the mild, and moderating the severitv of the drastic medicines. Whenever we wish a strong and per- manent impression to be made on the alimenary ca- nal itself, and through it on the neighbouring visce- ra, or the system generally, calomel, by uuiversal consent is consecrated to these purposes. But, be- sides the superior efficacy of calomel as a purga- tive, it is recommended by the facility with which it is administered. Destitute of taste or odour and minute in Its dose, it will be often taken when other medicines are refused, and may be so disguised, as to be imposed on the most suspicious or unmanage- able of our patients. Calomel, on every account, seems to be peculiarly adapted to the cases of children. Whether we 301 wish to relieve actual disease, or merely to evacu- ate the contents of the bowels, it always operates leniently and efficaciously. But by many it is sup- posed to be a very violent purgative, and hence there is a sort of popular prejudice against its use in the complaints of children, an error, which leads to so much mischief, that we ought to unite to remove it. From a very extensive experience with the medi- cine, I am entirely convinced that in those cases, its action is incomparably milder, than in more ad- vanced life. To infants of ouly a few weeks old, I have known it to be given, and have witnessed no very harsh effects from it. But this is not my own practice. Never from choice do I resort to the calo- mel, till the child is old enough to distinguish tastes, and to resist the administration of what is nauseous. Believing the castor oil, or rhubarb, preferable, I seldom prescribe it within the first year. The dose of calomel for an adult, when taken alone, is from ten to twenty grains. We commit a mistake in giving too small a quantity of this medi- cine. Employed largely, its action is infinitely less harsh and irritating to the stomach and bowels, and is not so apt to be rejected by vomiting, its purga- tive operation being more prompt and complete. I have known a drachm to be taken at a time with- out inconvenience, or even with much increase of effect. c c 202 Rheum Palmatlm. This is the botanical title of the plant which af- fords rhubarb. The root, the only part used, is brought from China and also from Siberia, by the way of Russia. Beiuj; imported from the Levant, the latter has obtained the name of Tuikey rhu- barb, and is of a much superior quality. It is in small pieces, of a bright yellow colour, has a smell somewhat aromatic, and a bitter, approaching to a stvptic taste. The Chinese comes in larger and more cylindrical shapes, is paler in its appearance, harder and more ligneous in its texture, and has less of the sensible qualities. The rhubarb has within a short period been grown in different dis- tricts of Europe, and in our own country, and where care is taken in the raising and preparation of it, answers very well. Combining the purgative property with that of astriugency. rhubarb differs from almost every other article of the same class in this respect, that while it purges it imparts, instead of lessening the tone of the alimentary canal. Equal portions of ca- lomel aud of rhubarb, ten or fifteen grains of each, form a purgative admirably suited to all bilious affections. Exeept, indeed, that it lingers longer in i:s operation, I am not sensible that it is inferior to jalap, or any other medicine. It is hence not a little prescribed in our autumnal feveis, and is 203 as useful in the early stages of dysentery with ac- cumulations of bile. Evacuations having been premised, it may, in conjunction with ipecacuanha and opium be advantageously directed in the same disease, to relieve tormena, tenesmus, and other distressing symptoms * Many of the cases of diarrhoea are treated nearly in the same way. The rhubarb is at first given as an evacuant, and subsequently in minute doses, with a view to its astringent and tonic effect, sometimes alone, though oftener, perhaps with the same arti- cles, and pretty much in the shape, just mentioned. Nor is the rhubarb scarcely less resorted to, in the chronic complaints of the stomach, no medicine having been found perhaps to answer better, in the several forms of dyspepsia, and in those affections symptomatic of it, as hypochondriasis, &c. Connected with some of the cases of atonic gout, there is a very depraved state of the alimentary ca- nal, producing flatulence, sour eructations, and spasmodic uneasiness more or less severe, to re- lieve which, I know nothing more effectual than Warner's cordial, a preparation, into which the rhubarb enters largely.f * R Pulv. Rhei. gr. xx. Ipecac, gr. x. Gum. opii. gr. iii. ()'. cimiam. gtt. v. Gum Aiab. q. s. ft. mass. Div. in pill. x. O.ie of which, every two or three hours. t Take of Rhubarb bruised 1 oz. Senna $ oz. Saffron 1 5- Fennel seed and coriander seed, each 2$. Powdered liquo- rice 43- Raisins pounded lffc. Brandy 3 pints. To be di- gested for a week. The dose is half a wine glass full. 204 Considerable confidence was at one period, re- posed in the powers of rhubarb in all hepatic con- gestions and obstructions, and particularly in jaun- dice. As a purgative it unquestionably does good in many of these cases, though its efficacy may be increased by adding calomel to it. The liver hav- ing been strongly impressed by this active purga- tive, or by the action of an emetic, a very favour- ite prescription of mine, consists of rhubarb, aloes, and castile soap, in equal parts, made into pills, of which enough may be given to keep the bowels in a soluble state. To the cases of children, few me- dicines are so well suited as rhubarb. It is taken with tolerable facility, and operates so gently, that it may be prescribed at a very early period of life, and under almost every circumstance of their dis- eases. As the rhubarb very readily yields its virtues to water, to proof spirit, and to wine, these menstrua are employed to form a variety of preparations of this substance, all of which that are officinal, will be found in the different dispensatories. As some of these are neat and efficacious, they are worthy of attention. But while on this subject, I will men- tion a domestic preparation of rhubarb, in very Ge- neral use, of which the formula cannot be procured in books. It is called the spiced rhubarb, and there are two modes of making it, one with water, and ZQ5 another with spirit.* The dose of rhubarb when given alone, is from twenty to forty grains. \ ALOE PEKFOLIATA. This is the inspissated juice of a plant which grows in the south of Europe, in Asia, Africa, and America. Three varieties of the medicine are kept in the shops, the socotorine, the hepatic, or Barbadoes, and the caballine or horse aloe. The first is preferred, aud the last is only admitted into veterinary practice. As yet, the species of plants producing these different sorts of the article, have not been clearly determined. It seems, however probable, that the socotorine is afforded by the aloe perfoliata, and the Barbadoes and caballine, either by the aloe spicala, or aloe vulgaris. Aloes is a warm stimulating purgative which passes through * 5> Rad. rhei ? i. Cort. cinnam. J 'i. NuxMosch. 5 i< Caryophill. Jfs. Sacch. alb. 5 vj, Sp. cinnam. ftj ij. To put into a deep dish and burnt out. 1 R Rad. rhci. Cort. cinnam. Macis a"i 5 'i- Aq. font. nYj To be simmered away till half evaporated, and then add su- gar and brandy enough to preserve it from becoming sou;. Exhibited in divided doses, this medicine is sometimes useful in the second stage of most of the bowel affections, especial- ly of children. f Incompatible substances. The salt of iron, strikes a black with its infusion. By the alkalies, alkaline earth, or neutral salts, its colour is changed to red, and it is rendered more quick, and mild as a purga- tive, though its astringency is destroyed. It may not be altogether out of place, here also to mention, that by toasting or torrefying rhubarb, we add to its astringency though in the same proportion, we diminish ts force on the bowels. 206 the stomach and small intestines without making much impression, though operating with some force on the lower part of the alimentary canal, and espe- cially the rectum. It is on this account, when em- ployed for any leiig'h of time, very apt to produee hemorrhoids, or if they exist, to increase the pain aud irritation of these tumours. This medicine ought therefore to be studiously avoided by persons subject to these, or auy other affections of the low- er intestines. It is supposed aKo strongly to ex- cite the uterus, and hence is forbidden in pregnan- cy. But in many cases the aloes is both a safe and efficacious purgative. It was the opinion of the older physicians that it has some of the qua- lities of bile, perhaps from its intense bitterness, and that when there is a deficiency of that fluid, it might be prescribed as a substitute. I know not how far this hypothesis is well founded. But cer- tain it is, that aloes has in a very great degree, the power of stimulating the intestines, and hence its utility in habitual costiveness. a very small dose answeriug the purpose. Cullen says, that he has known innumerable instances of persons who very constantly obtained this effect from one or two grains, and it is equally remarkable, that though the dose be encreased to ten times the quantity, the effect is nearly the same. If this observation be correct, we are taught, that though perhaps no me- dicine is more fit to open the bowels, the aloes is wholly uusuited to the purposes of copious purging. 807 But it is not altogether true that the effect is not in- creased by a large dose. Ten grains of the medicine will operate with some activity. Cullen also, seems to think, that nothing is gained by mixing aloes with other articles, and is particularly opposed to its union with the drastic purgatives. But his ob- jections are evidently more the result of spe- culation than actual experience, and are there- fore entitled to little weight, being wholly unsup- ported too by the observations of any one else. This indeed, is so little the case, that aloes w ith perhaps the single exception of costiveness, is era- ployed alone for no purpose; it having been the practice ever since its introduction into use, to tor- ture it by every species of combination, and it now enters into an uncommonly large number of pre- parations. Whether in every instance, its efficacy has been improved, I am not prepared to say, though of this there can be no question, that when calomel, or rhubarb, or scammony, gamboge, &c. is added to it, its activity as a purgative, is consi- derably promoted. CASSIA SENNA. This is a'plant which grows in Turkey, Syria, and Persia. It is commonly called Senna Aiexan- driana, because it was once exclusively imported from the city of Alexandria, in Egypt. WTe have some inferior kinds of this medicine, which come ^us from Italy, the Barbary states, and the West Iri- dic s. They are, probably, the same plant, dege- nerated by cultivation in a less genial -oil and cli- mate. The seuna is one of those medicines, which we orisinallv derived from the Arabian*, and is an active and useful purgative, though very apt to gripe when given bv itself. As this effect, however, de- pends on the resin which the leaves contain, it may. in part, be obviated, by moderately infusing them in a large quantity of water, and be farther coun- teracted by adding some of the carminative seeds, ;is coriander or fennel: and still more effectually, hv an aromatic, as cardamom, or ginsrer. Bv in- fusing it with the common black tea, its taste, I am told, is much improved. At present, the senna is never prescribed in sub- stance, the dose being both bulky and disagree- able. It. however, viclds its virtues verv readilv to water, though we should, in preparing the infu- sion, carefully avoid the water boiling, as the vo- latile parts of the leaves, in which reside the more active properties, are evaporated. The senna is hardly ever used aloue. The ordi- nary mode of directing it, is with manna, salts, or cremor tartar, and s<.metimes, with all three in- gredients. As; a purgative, it is distinguished by the certainty and activity of its operation, and is al- so recommended by its lying well on the stomach. It is hence a good deal resorted to in obstructed 209 bowels, and whenever we require a searching and active cvacnant. CASSIA MARILANDICA. As its name imports, this is a plant of our own country. It is very abundant in different parts of the United States, and possesses nearly the same virtues as the foreign senna, being of the same ge- nus. As a substitute for it, I am informed, that it is much used by country practitioners. The dose and mode of preparation, are the same. From what I can learn of this plant, it is well worthy of further examination. PODOPHYLLUM PELTATUM. Every section of the United States furnishes this plant, and it is designated by several provincial names, as the mandrake, the ipecacuanha, the May apple, &c. To the New World, this species of po- dophyllum, I believe, is restricted, and is one of those plants, the several parts of which, are pos- sessed of different properties, the fruit being escu- lent, the leaves poisonous, and the root highly me- dicinal. My experience with this article, is not very ex- tensive, though I have seen enough of its effects to persuade me, that it is not without claims to our no- tice. As a purgative, it resembles the jalap, and I »d 210 think, in a similar dose, is not less active or effectual. Like that medicine, also, its pow ers are heightened by an union with calomel, and, in bilious cases espe- cially, ought not to be prescribed without it. As a remedy in intermittent fever, it is said to be useful, independently of its purgative property, of which, however, I know nothing myself. The proper season for collecting the root, is late in the fall, when the foliage begins to drop. If ga- thered in the spring, it is comparatively inert. This is a fact deserving of recollection. JDGLAN'S CINEREA,~ TBI JUGLANS CATHARTICA.f Of all our indigenous cathartics, at least such as are known to me, I suspect the butter nut, or white walnut, affords the most valuable. An extract made from the inner bark of it, had long been known as a popular purgative. During, however, our revolu- tionary war, when drugs became very scarce, the medical men of the army employed it as a substitute for the more elegant medicines of the shops. It has since been introduced very generally into practice. and is certainly entitled to much confidence. I have used it a great deal, and have seen it used even more. In the dose of from ten to twenty grains, it operates actively, evacuating, thoroughly, the con * Linnaeus. j Michaux 311 tents of the bowels. In the southern country, and especially in Virginia, it is much resorted to as a purge in all bilious cases, and is supposed to be well calculated to clear the alimentary canal, pre- paratory to the administration of the bark, or other tonics, in the intermittent fever. Its efficacy may be increased by the addition of calomel. The ex- tract should be made about the month of June, as the bark of the tree is, at this period, considerably more powerful. CONVOLVULUS JALAPA. The plant which furnishes this powerful cathar- tic, is a native of Mexico, and found near the city of Xalapa, from whence its name is derived. But it has since been discovered near Vera Cruz, and in the south of Florida, and we have some reason to suspect, that it exists within the limits of our own territories. It is the root that is used in me- dicine, and which is brought in transverse slices, solid, hard, and heavy, of a dark grey colour, and striated texture. The jalap has little smell, and scarcely any taste. When swallowed, how- ever, it affects the throat aud fauces with a slight pungency. Jalap is a very powerful purgative, its activity residing principally, if not wholly, in the resin, which, though given in small doses, oc- casions violeut griping. The gummy part bears an inconsiderable proportion to the resinous, and is &i'2 fouud to have little or no effect on the bowels, though, as a diuretic, it is extremely active. This is the opinion which has long been received on the subject. But recent experiments would go to shew, that the distinction in the properties of the two con- stituent parts of the medicine, is not well founded. The dose of jalap, is from twenty to forty grains. It is, however, commonly given in combination, and especially with calomel, in the proportion of ten or fifteen grains of each, which constitutes, undoubted- ly one of the most certain and efficacious of the pur- gatives, singularly well suited to the evacuation of bile. Triturated with the crystals of tartar, jalap will operate in smaller doses, than when taken by itself, and w ithout harshness : and such is also the case, when it is united with ipecacuanha.* From its active properties, jalap has been much used in the commencement of bilious fevers. Com- bined with calomel, in the dose often grains each is was the purge which came to be generally em- ployed in the yellow fever of this city, while the disease was considered highly bilious. As a hydragogoe, it had formerly an unrivalled repu- tation, so much so, indeed, that it was distin- guished by the appellation of panacea hydropico- rum. My experience persuades me, that it is en- titled to much of the praise which has been la- vished npon it in dropsy. But I cannot help think. • Vide AikuVs Mati Med 213 ing, that its efficacy is increased, by uniting cremor tartar with it. Ten grains of the one, with a drachm of the other, constitute the best medicine which I have ever tried, not only in the dropsical, but in all other cases, where long continued purging is dc- manded, CONVOLVULUS SCAMMONIA. The scammony is supplied by a plant, so called by Linnaeus, growing in Asiatic Turkey. From an incision made into the root, there issues out a milky fluid, which, by inspissation, becomes concrete, and constitutes the scammony of the shops. The best of this article is imported from Aleppo, in light, spongy masses, of a shining blackish colour, hav- ing a faint, unpleasant smell, and a bitterish, pun- gent taste, and consists of a resin and a gum, in nearly equal proportions. The Greek and Arabian physicians employed scammony as a purgative, and externally in the dis- cussion of tumors, and as a wash for tenia capitis, and in the herpetic eruptions. By Boerhaave, it was much used as a purgative, and since his time, has been considered as a safe internal medicine. The scammony, however, is very harsh and violent in its operation, and is now little prescribed, ex- cept in combination with other substances, which temper its effects. The common dose is from five 214 to ten grains. The genuine scammony plant, I have understood, has recently been discovered in Xew Jersey. STALAGM1TIS GAMBOGIOIDES. Gamboge is a gummy, resinous concrete, brought from the East Indies. It was formerly supposed to be the product of a tree, called, in the oriental language, Coddam Pulli. It is now better ascer- tained to be the stalagmitis gambogioides. But the accuracy even of this statement is questioned. It is not, indeed, precisely known, from what tree we derive it, though several are named by different writers. It is denominated gamboge, from the coun- try whence it comes. As received here, it is in large flakes or rolls, of a deep yellow colour, with no smell, and very little taste. Exhibited in a full dose, the gamboge operates most violently, both as an emetic and cathartic. It was, on this account, much used in the yellow fe- fer in this city, in cases, in which it was deemed, at one time, expedient to excite an artificial cholera morbus. But, in smaller doses, the gamboge acts, very generally, with sufficient mildness. Combined with calomel, in the proportion of two, three, or four grains to ten, it proves a most powerful evacu- ant of bile. No medicine, indeed, in some of the bilious cases, is to be preferred to it. Like the other drastic cathartics, the gamboge has 215 also been celebrated for its power in dropsies. It has been employed alone, and in connection with cremor tartar, though I have not understood that it displayed any peculiar efficacy. On the old prac- tice of treating gout by the drastic purgatives, I have already expatiated. During the period when this system prevailed, such was the repu- tation of the gamboge, that it came to be distin- guished by the appellation of " gutta ad poda- gram."* HELLEBORUS NIGER. Of the same description of purgatives, is the hel- leborus niger, or black hellebore. It is also known by the title of melampodium. Doubts have been entertained, as to the origin of this last appellation. The most obvious etymology, however, is, from Melampus, one of the earliest of the Greek physi- cians, who is said to have observed its purging ef- fects upon some goats, which fed on it, and hence to have introduced it into the materia medica. By the ancients, hellebore was held in the highest estimation as a cathartic, and was very extensively employed by them, in a great variety of cases. It is especially extolled by Hippocrates, and bis suc- cessors down to Galen, who seem to have consider- ed it as the most valuable of the purgatives. But , * Hill's Mat. Med. 216 when milder medicines, of the same class, were brought into practice by the Arabians, and still more by the discovery of the New Wrorld, helle- bore came, in a great measure, to be superseded. It was originally supposed to be singularly use- ful in the diseases of the mind, and particularly in melancholia. The practice of antiquity, in this case, consisted, indeed, chiefly of purging with the hellebore. There is somewhere recorded, the story of Melampus, the physician to w horn I have alrea- dy alluded, having acquired immense wealth and renown, by restoring to reason the daughters of an eastern monarch, of great dignity and power, who had all, from some cause, been deranged. The only article which he employed, was the hellebore. But distinct from this, perhaps a fabulous tale, we have, in the authentic writings of the earlier ages, suffi- cient evidence of its utility, in the several forms of insanity. Notwithstanding, however, the facts which might be collected in its favour, it is exceedingly proble- matical, whether hellebore is possessed of any pe- culiar powers in the mental affections. But, as was formerly observed in the treatment of many of these cases, there is no remedy entitled to greater confidence, than active, and even violent evacua- tions from the bowels. They sometimes will sub- due the fiercest forms of mania, and as often awaken the sensibility of the system, in the low est depres- sion of melancholy. The more griping the punsa- 217 tive, under such circumstances, the greater its effi- cacy, and, on this account, the hellebore, which is uncommonly severe in its operation, must, like the rest of the drastic cathartics, have done good.* CUCUMIS COLOCYNTHIS. The colocynthe, or coloquintida, is the produce of Svria, and some of the islands of the Grecian Archipelago. It is the soft pulp of the fruit, a spe- cies of gourd, dried, which constitutes the medicine of the shops. This has little smell, but is so in- tensely bitter, that it was once called Fell Terrae, the gall of the earth. Colocynthe is one of the oldest articles of the materia medica. To Hippocrates it was well known, and by him, not to mention many other writers, it is described as a most active cathartic, pre-eminently endued with all the powers of a hy- dragogue. Besides having this property, it is al- leged by the ancient authorities, to be highly be. neficial in the affections of the head, whether ajfrute or chronic, in obstructions of the viscera, and es- pecially of the uterus, in epilepsy and similar com- plaints, and in the diseases of the skin. Whether it is really calculated to be of much service in the preceding cases, I cannot speak from my personal knowledge, having rarely given it alone. When prescribed by me, it has been with the view to pro- * Emenagogue*. E e 218 mote the operation of the slower cathartics, as aloes, rhubarb, calomel, &c. Combined with ca- lomel especially, I Jiave sometimes directed it in mania, and in apoplexy, coma, and palsy. To all these diseases, which are invariably attended with more or less torpor of the alimentary canal, it i«= admirably suited. The dose of the colocynthe is from four to six grains. Externally applied, about the region of the navel, it is said to display all its purgative effects. CUMUMS AGRESTIS. The last of the cathartics which I am to notice, is the elaterium. This is the cucumis agrestis of some, and the momordica elaterium of other bo- tanists. The popular title is the wild cucumber, so called from its analogy to the vegetable which bears the same name. This plant grows in several countries of Europe. As yet, however, it has not been found within the United States. The elate- rium of the shops is the inspissated juice of the fruit, or the cucumber itself, previously pressed. It comes to us in small thin cakes of a loose and fri- able texture. The ancients were well acquainted with the powers of this medicine, and prescribed it freely, especially as a hydragogue. By the Greeks it was termed elaterium, which signifies to dart or squirt, most probably from the forcible manner in w hich it 219 ejects the contents of the bowels. As a cathartic, the elaterium is, in the most remarkable degree, harsh, griping, and irritating, to such an extent, as occa- sionally to produce inflammation of the intestines, and even bloody discharges. Nevertheless, its operation is sluggish, unless promoted by some more active article, and besides, it sometimes proves emetic, and disappoints our expectations, though commonly in a full dose, it operates both upwards and downwards. In one respect it differs very widely from the class of remedies to which it be- longs. During its action, the whole system is high- ly stimulated, so much so indeed, that the pulse and other circumstances indicate pretty considerable febrile action. It is, in short, indisputably the most violent cathartic with which we are acquaint- ed, and ought therefore to be resorted to with great caution, and only when the more lenieut medicines have failed. The dose is from half a grain to two or three grains. I have remarked, that the elaterium was known to the ancients. It appears that even up to the period of the last half century it was stijl in the hands of some practitioners. By Sydenham, by Lister, by Hoffman, and all their cotemporaries and immediate successors, it is very strenuously re- commended in dropsy. But, for various reasons, and particularly on account of its unpleasant ef- fects in many instances, it gradually lost ground, till finally it slipt altogether out of practice. We 220 may form some idea of what were the effects of elaterium when largely given, from the following declaration of a writer who appears to be conver- sant with the medicine : " Elaterium esse in ca- taloga, diaboli, quo necat homines/' kc. In the course of the last few years, however, its use has been once more revived by Dr. Ferriar of Man- chester, who has published a series of cases illus- trating its great powers in the several varieties of dropsy, and especially in hydro-thorax.* ENEMETA. As supplementary to the consideration of cathar- tics, I proceed to make some remarks on the use of enemeta or clysters. These, though they may ap- pear very humble means, are often employed as substitutes for the purgatives, and have been found to answer in practice many important purposes. Every part of the alimentary canal maintains the most intimate relations with the system, and on this ac- count remedies applied to either extremity of it are productive of pretty nearly the same results, though when introduced into the rectum, as a general rule, they ought to be used in about three times the dose. I shall treat of enemeta in the order of the indi- cations which they are calculated to fulfil. Most * This is the prescription of Ferriar:—R Extract. Ela- teriigr. i. Sp aether. nitros,unc. ij. Tinct. scill. Oxymel. colchic. sing. unc. fs. Syrup rhainni, unc. i. ft. solut. Capt. drach. i. ex. aquae panxilio, ter quater-ve in die. • 0.1 commonly, we recur to clysters to promote the tar- dy operation of a cathartic, or to evacuate the bow- els, where from delicacy of stomach, mediciues cannot be retained. All which is required here, is a simple laxative mixture, composed of an ounce of castor, or olive oil, and the same quantity of mo- lasses, with a pint or more of tepid water, and to ren- der it somewhat stimulating, a table spoonfull of common salt may be added. But it frequently hap- pens in obstinate constipations proceeding from va- rious causes, that the most active injections become indispensably necessary. Of this description we have a vast number, and one which is very gene- rally directed, is a large solution of glauber salts, alone, or with oil. What however answers, I think better, is the terebinthinate clyster, which I make by blending very intimately one or two table spoonsful of the oil of turpentine with the yolk or white of eggs, and afterwards add a full pint of water, or which is preferable, the thin mucilage of gum arabic, or flax seed. This is a very valuable prescription, under all circumstances of obstructed bowels, and particularly of flatulent colic. But if these ingredients can not be had, a watery solution of assafcetida, may sometimes be used in place of it, though it has less efficacy. By some practitioners, an infusion or decoction of the drastic purgatives, has been strenuously re- commended, and of the colocynthe particularly. The mode in which it is prepared, is to boil three 222 drachms of it in a pint and half of water for twenty minutes, and then strain the fluid, to which add on© ounce of oil, and as much of the sulphate of mag- nesia. My ordinary injection of this sort, is a full pint of a strong infusion of senna, mixing some- times with it a drachm or two of jalap, with the ef- fects of which I have had much reason to be sa- tisfied. Au opinion has been advanced, that enemeta act pretty much by the stimulus of distension, and hence the mildest fluids answer as well for the purpose as the more active articles. To a certain extent this is true, and in cases of stubborn consti- pation, the fact should be recollected as a guide to our prescription. Yet we have the clearest evi- dence of the susceptibility of the intestines to the impression of medicine, and of the increased pow- er of the remedy before us, by the addition of a cathartic substance. Distension of the bowels by warm water, having, in some instances, overcome obstruction when the active enemeta had failed, proves nothing, since the same effect is produced in the stomach, by similar means, in the torpid state of that viscus. and yet no one would deny the ge- neral power of emetics. Enemeta, of a very opposite character to those I have enumerated, are also prescribed in analo- gous cases, and which act chiefly, by inducing ex- treme relaxation. Every one has heard of the effi- cacy of tobacco with this view, either in the shape 223 ©f decoction or of fumigation. The first prepara- tion consists of a drachm of the leaves to a pint of water. But so distressing at all times are the effects of this remedy, and often so alarming, that it ought not to be resorted to, except on an emer- gency, and even then, it will be advisable te pro- ceed cautiously, and to exhibit only half the quan- tity at once. Death has sometimes happened from this injection, and I have repeatedly wit- nessed the life of individuals placed in great jeo- pardy from it, and still it is a remedy of such indisputable efficacy, that we cannot entirely dis- pense with it. By Mr. Earle it has therefore been lately proposed, that as a substitute for the enema, we should in all cases use a suppository of tobacco which at a moment may be withdrawn, and all bad consequences thereby averted. For the administration of the tobacco fumes, a particular apparatus has been invented. But should this not be at hand, it may be done very conveni- ently with a common clay pipe, introducing the tube into the rectum, and covering the mouth of the bowl with a fold of linen, through which the smoke may be blown into the bowels. It has been mentioned, that tepid water alone, often succeeds in opening the bowels. The very reverse of this is sometimes practiced, with still greater advantage, under desperate circumstances. I have, more than once, known the most unrelenting constipation removed, by throwing up the rectum the coldest water, even iced water has been used. §24 Effectual, however, as the preceding formulae will generallv prove, cases do occur in which they fail. As a dernier alternative, I would suggest the bold exhibition of the emetic tartar, as formerly pointed out, from twenty to sixty grains of it being dissolv- ed in water, and injected, and which may be re- peated, if necessary. It is to be recollected, that clysters rarely reach, even when most forcibly urged, beyond the sigmoid flexure of the colon. They act principally, by ex- citing the lower portion of the intestinal tube, and produce only partial discharges. It is on this ac- count, that they are comparatively of little service, unless a purgative has been previously taken, in whieh event, by promoting its operation, the ali- mentary canal becomes completely evacuated. But this is not invariably the case, as it sometimes hap- pens, that the local impression is extended through the medium of sympathy, and that very thorough and copious discharges are the consequence. Ne- vertheless, to accomplish this end, the injection should be frequently repeated, and the largest pos- sible quantity of fluid, which the bowels will admit, must be employed. To be more precise, however, I will state the measure adapted to the several stages of life. An infant, at its birth, or soon after, re- quires one ounce. A child, between the age of one and five years, from four to six ounces. A yonth of ten or fifteen years, a pint, and an adult, not less than a pint and a half, or a quart. T':is is the maximum, and apportioned to extreme cases. 225 The means in use, for the administration of in- jections, are, a pipe and bag, or a pewter syringe^ both of which are exceedingly defective, where we wish to throw up a large quantity. The best instrument for this purpose, is De Haen's, a common syringe, with a lateral tube fixed to it, through which it may be replenished without draw- ing it from the rectum. No doubt, by this con- trivance, so much fluid might be injected, as to overcome, by mere distension, almost any obstruc- tion of the bowels. This, indeed, is no longer a matter of conjecture, as the experiments of De Haen himself shew the practicability of it, he having, with this very instrument, completely filled the colon of a dog, forcing the valve, which offers the resistance to the passage of fluids, upwards. There are many other indications which injec- tions are capable of answering. But, as these do not properly appertain to cathartics, I can- not notice them in this place. All that I shall now remark further is, that, when clysters are used as fomentations, the blandest fluid, in large quantity, is selected, that, to restrain diarrhoea, or to relieve spasm of the bowels, or for any anodyne purpose, an ounce of thick mucilage, with a por- tion of laudanum, is the form adopted, and that, to remove the tormena, or- tenesmus, of dysentery, the best injection consists of a pint of melted butter, perfectly fresh, or, in other words, without salt. rf 226 DISCOURSE XIII Of Diuretics. Thesl are remedies which promote the urinary discharge. As respects their precise mode of opera- tion, some difference of opinion has always existed. It was formerly believed, and is even now, by those who retain any of the prejudices of the humoral pa- thology, that the articles of this class enter the cir- culation, with an entire retention of their powers, and act directly on the kidneys. Entertaining this impression, diuretics were much prescribed at the time, with a view of expelling certain peccant mat- ters, which were imagined to be the cause of par- ticular diseases, But. whatever mav be the utilitv of the practice, under certain circumstances, there ean be no doubt of the inaccuracy of the view s by which it was dictated. An increase of the urinary discharge may take place, either by stimulating the kidneys, or by an invigoration of tie powers of absorption, and espe- cially in cases of dropsical effusion. It hence ap- pt lis, that diuretics are of two species, though, in wiiich ever mode they operate, it is by an action primarily on the stomach, extended to the absorb- ent m kidneys, according to the affinity of the ar- ticle to the one or the other of these parts. As the 227 operation of these remedies is not a little influenced by certain circumstances, it is right that these should be indicated. By a law of the animal economy, it would seem, that the discharge from the skin and the kidneys, is in an inverse proportion. Whatever increases per- spiration, will, most commonly, diminish the urinary secretion. It is on this account, that, in the admi- nistration of diuretics, we studiously avoid the ap- plication of external heat, and, as much as possi- ble, with this view, keep the patient out of bed. Cold to the surface, on the contrary, heightens their effects, and, when admissible, may be resorted to with very great advantage. This, indeed, is so strikingly the case, that exposure to cold air, or walking on a cold floor, or immersing the feet in cold water, or cold applications to the pubes, will often excite the action of the urinary orgaus, when every thing else has failed. The operation of diuretics is also promoted by the use of diluent drinks. It is obvious, that, if much liquid be taken into the stomach, it must be eliminated by perspiration or urine. Yet there are states of the system, in which it has been thought doubtful, whether it would be prudent to endea- vour to excite the increased flow of urine by these means. It sometimes happens, that the serum of the blood, instead of passing oft' by the natural emunctories, is effused into some one of the cavities of the body, or cellular membrane, giving rise to 22S dropsy, or, if it previously exists, aggravating the disease. An apprehension of this sort, has so strongly prevailed with some practitioners, as to lead them, under such circumstances, to enjoin, as much as possible, an abstinence from drinking, and, it is alleged, that such abstinence has, in some instances, effected cures. But this statement, I suspect, will not bear a very rigorous scrutiny. Facts to this purport, are of rare occurrence, and the numerous examples of the total failure of the practice, have led finally to its abandonment. It is, indeed, a very painful and difficult task, to re- sist the vehement thirst, which usually attends this disease, Drinks, in these cases, most fortu- nately, seem to promote the urinary discharge, and, of course, to reduce the degree of effusion. while, on the contrary, the abstinence, which has been thought so important, conduces manifestly to the inactivity of the kidneys, and to a correspond- ent accumulation of water.* By observing their beneficial tendency, the prac- tice has, for some time, become very general, to en- deavour to invigorate the action of diuretics, bv the copious use of diluent beverages. Common wa- ter often answers the purpose exceedingly well, * ««I have frequently found, that a very entire abstinence from drink- ing, by diminishing the quantity of urine, allowed the secretories of the kidneys to fall into a contracted state, so that the quantity of urine void- ed was still further diminished, and, as I judged, tended to increase the effusion, and thereby, to aggraTate the disease." Cullen?t Mat. Med 229 though water, impregnated with the vegetable acids, will be found more agreeable to the patient, and of decidedly superior efficacy. Even by the use of such drinks alone, cures of dropsy have been ef- fected : to which point we have the evidence of Sir George Baker, of Sir Francis Milman, and of Cullen himself, not to mention a variety of other uames, of nearly equal respectability. The pro- priety, indeed, of indulging the patient in a liberal use of drink, is now so incontestibly settled, by the concurrent approbation of the ablest practitioners, that it would be superfluous in me to attempt to en, force it by any theoretical deductions, or by a re- currence to additional authorities. The action of diuretics, is, moreover, promoted, by the reduction of arterial action. The blood ves- sels, and lymphatics are, to a certain extent, anta- gonizing powers, and, while the former retain their force, the functions of the latter are feebly exer- cised. No one, indeed, can have failed to have ob- served the activity of absorption in most cases of debilitated circulation, and how imperfectly it pro- ceeds where the pulse is febrile or excited. In- structed by this very obvious fact, we should al- ways, in the use of diuretics, watch attentively the state of the system, and duly regulate it, by occa- sionally recurring to venesection, or purging. Diuretics have bepn recommended in many dis- eases. But it is in the several forms of dropsy, that they have displayed their best powers, and are ge- 230 nerally employed. The manner in wLich they ope- rate, in these cases, has been a matter of doubt and speculation. It has appeared inexplicable to some, how any evacuation by the kidueys, can remove the accumulation of fluids in the cavities of the body. To me. however, I conf s«, there is no such diffi- culty in the case. As I have already hinted, there are two solus of diuretics, the one having au imme- diate relation to the urinary organs, and the other to the lymphatic system, and, in the cases alluded to, it is to the latter we are chieuy to ascribe the effects. As might be suppose;!, the use of diuretics has been extended, so as virv ireuerallv to embrace the diseases of the urinary organs. Tk< re is, iudeed, scarcely one of these affection-, in which some one of this assortment of aiiicles is not occasionally prescribed, and often, as affording; the best means of relief. As respects their utility in nephritis of every spe- cif-, how ever induced, it is a matter so well known, and universally admitted, that little need be said on the subject. But, these cases are exceedingly dif- ferent, and connected with such opposite conditions of the system, that, for their successful manage- ment, some nicety of discrimination is required, in the selection of the proper article from the large and diversified class of diuretics. Equally do these re- marks apply to the affections of the urinary blad- der, these being also exceedingly various, aud ex- acting very dissimilar remedies. To point out now. £31 with any sort of minuteness, the relation of the se- veral articles of this class of medicines, to the cases of disease to which I have alluded, would be only an anticipation of what can be much better done, when 1 arrive at the consideration of particular diu- retics. It appears, that at one time, no slender confi- dence was reposed in the powers of diuretics in the disorders of the lungs, whether of an acute or chro- nic nature. " In omnibis morbis pectoris ad urinam spectandum." This is the language of a distinguished writer, by which he meant to express the importance of at- tending to the appearance, as well as to the pro- motion of the urinary discharge, in these cases. Certain it is, that, considering bow much, and vari- ously this secretion is affected by morbid impres- sions, we do, in the present state of medical refine- ment, improperly overlook it, not only in forming our estimates of disease, but also, as furnishing a means of cure. By a writer of no ordinary intelligence,* it has lately been shewn, and, I think, with sufficient pro- bability, that the urine, at least in dropsy, affords, among the most unerring criteria of the several states of the disease, and, of course, the leading in- dication of treatment. Nor should it 'be forgotten, * Blackall on DivpsJes. 232 that, by the aucieut cultivators of medicine, win". confessedly, are unrivalled in the precision and fidelity of their observations, the urine was greatly attended to, in framing their prognostics. Why we should so carefully inspect the alvine evacuations in disease, and be totally heedless of the urinary dis- charge, is neither to be explained nor vindicated. The kidneys are one of the emunctories. through which nature, when oppressed by disordered ac- tion, endeavours to relieve herself, and this she does chiefly, by throwing off the more watery parts of the blood, which, in some instances, amounts to a very large quantity. Evacuations of this kind, by emptying the blood vessels, though, perhaps, not so effectual, have, unquestionably, a tendency to reduce morbid excitement, and, therefore, are enti- tled to be classed with the other depleting reme- dies, as venesection, sweating, purging, &c. If these views be correct, it follows, that diure- tics are susceptible of a much wider practical appli- cation than has hitherto been made. No reason, in fact, exists, against their use in all diseases of much action, provided the milder ones be selected, either as auxiliary in the plan of depletion, or, where other means failing, separately and inde- pendently. Whether they are particularly service- able in the pectoral affections, as has been alleged- I cannot say from any experience of my own. More than one of the active diuretics are much prescribed in these cases, but not exactly with the ~v,*w;nSj tBe uri,jary secretion. S33 The febrile inflammatory affections are sometimes most indubitably benefited by medicines of thus class, and it may be remarked, how often these cases are brought to a favourable issue by a spontaneous diu- resis, and this, 1 think, I have especially seen in gout and rheumatism. That some of the affections of the head, and mania included, may be successfully treated by these remedies, my own experience has satisfied me. Copious discharges from the kidneys, kept up, without remission, for a succession of days, will as completely reduce the force of the circula- tion, and calm the violence of excitement, in some of these distemperalures, as the detraction of blood, or any other means, with which 1 am conversant. Neither should we forget in speculating on the probable utility of this set of medicines, that many of them operate most powerfully on the absorbents, a system of vessels, much more concerned in the production, as well as the removal of disease, thau has generally been suspected. This order of diu- retics, however, will be found chiefly suited to the feebler forms of morbid action, embracing a consi- derable proportion of the cachectic affections. As diuretics, the number of substances which has been celebrated, is prodigiously numerous. But many of these are very inefficient, and, a character common to the whole, is that of extreme uncertain- ty. This is, in part, owing to the want of discrimi- nation in the application of the medicines, and stilt more to the circumstance, that there is hardly one eg 134 of the class which is exclusively diuretic. They are almost all possessed of other powers, and espe- cially, are diaphoretics or purgatives, and when- ever either of these properties preponderates, diu- resis, so far from being increased, is commonly al- together lestrained. Of the rules to be attended to in the use of diu- retics, the following are the most important: 1. Be careful iu the selection of the article, that it Is properly fitted to the case. 2. Never prescribe diuretics, if it can be avoid- ed, to a patient in bed. 3. Let the temperature of the room be low, and all determinations to the surface, prevented. 4. As absorption is always promoted by the re- duction of arterial action, attend to the pulse, and keep it down below the natural standard. This is applicable, especially to the treatment of the drop- sical effusions. But avoid depletion by venesection or purging, during the action of a diuretic. 5. Where the full and complete effect of the me- dicine is wished, give diluent drinks freely. Of Particular Diuretics. As in preceding cases, I shall treat of these me- dii iues under the two heads of the lenient, and the active or stimulating, and first, of the MILD DIURETICS. The potassa or potash, either pure, or in a state of ZB5 imperfect carbonate, evinces, iu some instances, very considerable diuretic powers. By the older physi- cians, and, indeed, the custom is continued to the present time, among common people, the ashes of a variety of vegetables were used in dropsy. Being, however, only efficacious from the alkaline matter which they contain, the sub-carbonate of potash, as prepared in the shops, has completely supplanted them in regular practice. Of this medicine, I do not know a great deal from my own experience, though, from the few trials which I have made with it, I am disposed to think not altogether unfavourably of its properties. Ex- hibited in the dose of half a drachm dissolved in water, and repeated several times in the day, it has commonly proved, with me, considerably diuretic, and sometimes equally purgative. Cullen, who is abundantly sceptical on the subject of medicines, speaks not altogether contemptuously of this one. The cases of dropsy, in which the potash is, per- haps, more particularly useful, are such as are con- nected with great depravation of the powers of di- gestion. It is common, under such circumstances, for an acid to be evolved in the stomach, which produces, or is associated with, some very distress- ing affections. Cullen was of opinion, that the al- kali owes all its diuretic properties to a conversion into a neutral salt, by an union with this acid. But I doubt the accuracy of this hypothesis. By combining the potash with any of the bitter 236 tonics, we very much improve its efficacy in the-* cas s. Thus exhibited, it is sai-! to inei^ase the diuretic effect, while, at the same time, it removes the gastric disorder, and invigorates the system ge- nerally. To Sir John Pringle we are indebted for tlii- practice, which has since been imitated with sufficient success to warrant my noticing it. Yet, it must be confessed, that the alkali is very inferior to mnsr of its combinations with an acid, forming what are called the neutral salts. All of these have very considerable powers, though there is one, w hich has been supposed to possess it in so great a degree, as to be emphatically called saldiureticus. Notwithstand- ing its former reputation, I am not disposed to say much in its favour. The few trials which 1 have made with it. have disappointed my expectations. Like all the neutral salts, it has the mixed quality of a mild aperient with that of a diuretic, thou;!] I suspect it is more apt to act on the bowels than kid- neys. Comparatively, at least, it is much inferior to several of the same class of articles. The dose is about thirty grains, dissolved in water, to be re- peated four or five times a day.- TARTRA5 POTASS.!. This, which is as well known by the title of so- luble tartar, is still retained among the diuretics. There are some of my medical friends, indeed, who repose much confidence in its pow ers. But my own ■387 experience with it has not led me to appreciate it so highly. Given in the dose of a drachm, several times a day, it will, now and then, very actively, promote the urinary discharge, and, at the same time, bring away watery stools. SUPER TARTRAS POTASS.*;. This is not a neutral salt exactly, though it is nearly so, and, in all its medicinal properties, so closely resembles these preparations, that we should do a sort of violence in removing it to any other place. The cremor tartar has been much employed in drop- sy, and is a very valuable medicine. To ascites and anasarca it seems, however, to be the best adapted. Of all our diuretic medicines, it is perhaps, most fitted to those cases of dropsy, which are accompa- nied with increased or febrile action of the pulse, though it here, sometimes, operates more effectually when combined with jalap, or some other drastic purgative. Cremor tartar has been strenuously recommend- ed in this disease, by several highly respectable practitioners, among whom are Home and Fer- riar. By experiments they were led to consi- der its anti-hydropic power, to use the phrase of one of these writers, as quite equal to the digitalis and, in many respects, is to be preferred to that active, and, in some degree, hazardous medicine. 238 My intention is not to make any comparison be- tween the two articles, nor do I see how it could well be done. They are possessed of very differ- ent properties, and seem to me not at all applicable to the same description of cases. Certain it is. how- ever, that the cremor tartar, if judiciously adminis- tered, will often disperse dropsical swellings more speedily than any other medicine. When it does this so expeditiously, I have observed, that it is by a com- bined operation on the kidneys and bowels, produc- ing free discbarges of urine, and copious watery stools. This fact I mention the more particularly, because there are two modes of exhibiting the arti- cle, in which its effects are not a little different. Dis- solved in a large quantity of water, it acts merely as a diuretic, whereas, the same dose given as an electuary, or in a small portion of water, either alone, or in combination with some other purgative, will operate as an bydragogue- The latter mode, from what I have said, is, therefore, to be prefer- red, where we wish to evacuate large accumulations of fluid, and it will be here proper also to enjoin on the patient an abstineuce from drink. This should not be forgotten in practice. The dose of the cre- mor tartar alone, is about a drachm, to be repeated every three or four hours. XITRAS POTASS^. As a diuretic, the salt of nitre has been much pre- 839 scribed, and is, unquestionably, one of our best re- medies iu dropsy. It seems, however, to do'good in this complaint, more by subduing febrile action, than by the promotion of the urinary discharge. Dropsy, in its first stages especially, is very often connected with a strong pulse, and a high degree of excitement. Cases of this description are only to be cured by first reducing the force of the circu- lation, and, as one of the means of attaining this end, the nitre is eminently useful. The average quantity of the medicine directed, is a drachm a day, and a very common mode of giving it, is, dis- solved in some diluent drink. But it is better to di- vide this quantity into six or eight powders, and I am sure that its efficacy is improved, by a small ad- dition to it of emetic tartar, aud in some cases, also, by that of calomel.* • SPIRITUS JETHERIS NITROSI. As one of the mildest of the diuretics, I shall say a few words on the dulcified spirit of nitre. This medicine has long been held in great esteem, and it certainly answers a great variety of indications. As a diuretic, it sometimes proves very active, when largely given. But it is chiefly valuable in the cases of children. We have, indeed, scarcely any medicine which, in their complaints, we can substi- • For the exact prescription, vid. Diaphoretics. 840 tute in its place, and it may be given to them, even in the earliest periods of life. Besides drops v. to which children, in certain parts of our country, are very subject, the spirit of nitre is a very valuable remedy in the disorders of the urinary pas-ages. and particularly in partial or complete suppressions of urine. We commit a mistake, in givirs too little of this medicine. As a diuretic, the dose for adults should always be half an ounce, and for children, in the same proportion. The spirit of nitre is one of those articles which has also, in some measure, a tenden- cy to excite perspiration, and, exhibited in a re- duced quantify, it is much more apt to be directed to the surface. APIUM PETROSELIXUM. The last article of this section of diuretics which I shall notice, is the common parsley of our gar- dens Every part of the plant is actively diuretic, though a strong infusion of the roots I have usually prescribed. The seeds will probably answer as well. Having become a domestic remedy, the parslev has been too mnch over looked in regular practice. I know of no diuretic more valuable, in certain cases. In dropsy, it has, undoubtedly, done suod, hav- ing, within my own knowledge, cured ascites. where tappins: had been twice used. But. benefi- cial as it may be here, 1 suspect it is still better £41 adapted to the ordinary suppressions of urine. In strangury from blisters, it is one of our best reme- dies, and I think it scarcely less serviceable in si- milar affections from other causes. The painful micturation, so habitually an attendant on nephritis, I have sometimes relieved by its use. This medicine is recommended, particularly by the circumstance of its being retained, nearly un- der all circumstances, and, which is the more impor- tant, as the stomach is generally very irritable in the complaints of the urinary organs. To heighten the effect, it is customary to unite with the parsley, the seeds of the watermellon, but, whether any particular advantage is gained by the addition, I am prepared neither to aver nor deny. j» Ah 242 DISCOURSE XIV. Digitalis Purpurea. Besides the mild and stimulating diuretics, we have a set of articles, strongly possessed of the pow- er of increasing the urinary discbarge, hitherto de- nominated sedative, which may. perhaps, with pro- priety, be interposed between these two sections of this class of remedies. Of these sedative diuretics, by far the most prominent and interesting article, is the digitalis, or fox glove. This plant is not a native of the United States, though it is cultivated among ns, and succeeds per- fectly well, and may, therefore, be considered as naturalized in this country. Of the several species of fox glove, the one which is selected for medicinal use, is the digitalis purpurea. This is a luxuriant plant, growing to the height of two or more feet, if the soil be fertile. The leaves are large, oblong, covered with hairs, and serrated. They have a bitter, nauseous taste, with some acri- mony. The blossoms, which appear on the second year, are of a purple colour, elegantly mottled on the inside. Every portion of the plant possesses its peculiar pow ers, but the leaves are preferred for medicinal purposes. Considerable attention is required, in the selec- 243 tion and preparation of the medicine. The leaves should be gathered when the flowers are just begin- ning to develope themselves, and the largest and deeper coloured are the best. They are to be care- fully dried in a wrarm room, through which a cur- rent of air passes, and when crisp, to be reduced to powder, and kept in bottles closely corked, and not exposed to the light. These are the direc- tions of a writer, who has devoted much attention to the subject. It is a more common practice, how- ever, to preserve the leaves entire, and, from what I have heard, the virtues are, in this mode, best re- tained. The effects of digitalis on the system, are some- what peculiar, and there is no little difficulty in de- termining its precise mode of operation. In a full dose, it produces exhaustion of power, marked by a great and sudden reduction in the vigour of the cir- culation, the pulse being diminished, both in fre- quency and force, falling, sometimes, from seventy- five or eighty to thirty or forty beats in a minute, and is rendered exceedingly small and tremulous. This is accompanied with sickness, anxiety, verti- go, dimness of vision, and, in a very large dose, with vomiting, syncope, coldness of the extremities, coma, convulsions, and, pushed a little further, by death. But these consequences of the medicine are not uniform, as, even from the same dose, we ob- serve considerable diversity of operation in differ- out individuals. Thus the pulse is sometimes ren- 244 dered lower, without being diminished in fulness, while, at other times, it becomes broken and irre- gular, imparting a sort of jerking, or convulsive stroke. Nor does sickness, or other gastric affec- tions, always attend even its extreme, much less its usual, operation. Iu some cases, when adminis- tered in the ordinary quantity, no effect whatever is evinced for a considerable length of time, and then suddenly, and very unexpectedly, the whole of its powers are disclosed, to such an extent, indeed, as occasionally to excite alarm for the safety of the patient. Examples of these violent effects, are not of very frequent occurrence, though they are suffi- ciently so, to create some degree of circumspection in the use of the article, where we find its operation slow and protracted. I have had several opportunities of witnessing. especially in dropsical effusions, that, though the medicine, for a succession of days, were siven in an ample quantity, that it was entirely passive, neither influencing, perceptibly, the arterial or absorbent vessels, nor disturbing any of the functions of the animal economy, when, almost instantly, there would come on. depression of the pulse, a loss of general power, and a profuse discharge by the uri- nary passages. Thus induced, its effects will con- tinue for several days without the slightest abate- ment, though the medicine be omitted, being analo- gous, in this respect, to mercury. Another singularity attending the digitalis, orid- 2l.i nally mentioned in the Edinburgh Medical and Surgical Journal, is worthy of attention. 1 al- lude to its action being, in some instances, regu- lated by the different positions of the patient's body. In the case in which this extraordinary pe- culiarity first attracted observation, the pulse was not at all lessened iu frequency when the patient stood up, being, in this posture, upwards of an huu- dred: but in sitting down, it fell to seventy-five, and when lying on his back, to forty strokes in the minute. _The experiment was repeated again and again, and with precisely the same result. Cases of a similar nature, though not in the same degree, have since been recorded by Hamilton, Beddoes, and other writers of respectability, so as to leave no doubt of the occasional existence of the fact. These anomalies, or exceptions to the ordinary operation of digitalis, are curious in themselves, and eminently interesting in a practical point of view. It has been a matter of considerable discussion among practitioners, ever since the digitalis claimed much attention, whether it produces its more regu- lar effects by a sedative or a stimulant operatiou. I do not mean to entangle myself in this idle dispute. Conformably to the definition which I have already delivered of those terms, it appears, that I, at least, must place it among those articles which are calcu- lated to reduce action. It is, nevertheless, insisted, md, from actual experiments too, that its primary 246 •peration is, to increase the number, and in some •nstances, perhaps, the force of the pulsations. This^ mwever, even admitting it to be true, is a mere ransient effect, which passes away in a very short time, leaving the system in a state which can only be referred to the operation of a sedative. In the experiments to w hich I have alluded, the effects of the article on the pulse were alone attend- ed to, not the slightest notice being taken of its ac- tion on other parts of the system. This is a defect which is incident to almost all the investigations I have met w itb, of the articles of the materia medi- ca. The arterial, is only one of many systems of the body, and is so insulated, in its relations to cer- tain medicines, that very strong impressions may be made upon it. without at all extending to the other portions of the animal machine. The converse is equally true. There are many substances which act intensely on particular parts of the system, with- out affecting, in the slightest degree, the blood ves- sels. The state of the pulse, therefore, can never be trusted alone, as affording a safe criterion, by which we are to determine the properties, and mo- dus operandi, of medicines. Looking, however, at the general effects of the medicine, as I have alrea- dy detailed, we can have little hesitation as to the nature and properties of the digitalis. Connected by botanical affinity with the nicotiana, the byos- eiamus, the cicuta, the solanum, and other narco- tic sedatives, it has, with some modification, all the 847 distinctive features, of its congenera, or kindred plants. Like these, it lessens the mobility, or ex- citability, and, in this way, it reduces, after a short interval, the actions of the system. As I have now disposed of all those preliminary points which were necessary to the correct under- standing of the properties and modus operandi of digitalis, I next proceed to the application of it to the cure of diseases. This is no easy under- taking. The fortune of our medicine has been va- rious in the medical world. At one time, it was ex- tolled as the most valuable of remedies, in a wide circle of cases, and at another, proscribed and re- jected as inert and useless. This fluctuation and contrariety of opinion has extended to the present moment, and while one set of practitioners consider the digitalis as indispensable in the management of certain diseases, there are others of equal respecta- bility, who, in contempt of its properties, would al- most be for expunging it from the materia medica. These opposite views of the same article are, in- deed, very extraordinary, and can only be account- ed for by supposing, that the plant, owing to negli- gence in the curing, has not always possessed equal powers, to the want of accurate observation of its effects, or to its having been given in diseases, or forms of the same disease, which were not all suit- ed to its use. Of the diseases in which the digitalis has been employed, its efficacy in dropsy is least disputed. 245 To Dr. Withering, we owe the introduction of the medicine into the treatment of this disease. It ap- pear-, that he had the most ample opportunity- of experimenting with it in every species of dropsical effusion, and, so highly did he estimate its diuretic powers, that he declares, so far as the removal of the water will contribute to cure the patients, so much may be expected from this medicine." No sooner was the fact known, of the utility of digitalis in dropsy, than the periodical journals were filled with communications from the most emi- nent men, of its further success in their hands, and, in the list of those who bore testimony in its fa- vour, are the distinguished names of Darwin, Ba- ker, and Percival. The former of these spoke of it with his usual enthusiasm, and thought it service- able in everv varietv of effusion, whether occurring iu the cellular membrane, or in the cavities of the body. But, in the latter part of his life, he appears to have lost, in some degree, his confidence in the remedy, and it became, finally, bis opinion, that it was best suited to those cases of dropsy produced by intemperance and debauchery. Combining the digitalis w ith the bark, he also gave a grain of opi- um at bed time, and continued this practice, without intermission, for a length of time. No medicine, I suspect, will be found more useful in all the com- plaints of drunkards, than opium, and hence I have every reason to suspect, that the above prescription is an excellent one. 248 By Dr. Ferriar, one of the most able and accom- plished medical men of the age, the digitalis has also been used very extensively in dropsy. But the result of his multiplied trials with the medicine, is not so favourable as that of some other practition- ers. From a review of the cases which he has pub- lished, the following estimate may be made. " Digi- talis," says he, " has been given in twenty-nine cases, of which eleven were cured, seven died, two were relieved, and nine remained stationary. But the cremor tartar succeeded in thirty-three cases out of forty-three." It appears, therefore^ from this statement, that the digitalis is decidedly inferior, in point of efficacy, in dropsy, to the cre- mor tartar, an article which has hitherto been con- sidered as having infinitely less power over the disease. By the no less celebrated Dr. Currie, even a still more unfavourable report has been made of the fox glove, in hydropic affections. Considering the di- gitalis as a sedative, or highly debilitating medicine, he thought it indeed, wholly inapplicable to a dis- ease which, he maintained, originates in exhaustion. It would be easy for me to cite many other wri- ters, and such, too, as are by no means contempti- ble, who go still farther to disparage the powers of our medicine. But it is superfluous, since, by a fair comparison, it will be found, that the weight of authority decidedly preponderates in support of its efficacy. If, indeed, there be a fact in the practice i i zoO of physic, which is so deeply rooted in certainty, as not to be disturbed by cavils or disputation, it is. of the superior utility of digitalis in dropsy. There is no species of the disease in which I have not employed it, occasionally, with great advantage, and it seems to me, to be nearly as well adapted to the one as the other. It is useful in hydrotborax, in anasarca, and ascires: all which we have to attend to in its administration, is to see that the system is in a proper state for its reception. As long as there is much activity in the pulse, and a considerable portion of general strength remaining, it will prove disserviceable, and often eminently mischievous. Cases of this description are to be previously ma- naged by venesection, purging, and other directly depleting or antiphlogistic remedies. In these views of the subject, I am fully warranted by Withering himself, whose ample experience entitles his opinion to particular respect It appears, according to his account, ** that in persons of tense fibres, and great natural strength, the medicine seldom succeeded, while, on the contrary, if the pulse were feeble or intermitting, the countenance pale, and the skin cold, it hardly ever failed to do good." By ob- serving this, he was induced to attempt the reduc- tion of his patients to that state which he conceiv- ed w as favourable to the operation of the medicine, and for this purpose he chiefly recommends squills and cremor tartar, which, he thinks, are the best preparatives to the use of digitalis. 251 It has been remarked, that the digitalis is equally serviceable in all the species of dropsy. This is not a common opinion. By many, it is considered to be productive of little advantage in ascites, and to be singularly useful in the accu- mulations of the chest: to which, I can only state in reply, that my own experience teaches me the contrary. Certain I am, that I have done less good with it in hydrothorax, than in the other cases. My disappointments, indeed, have been so frequent in this particular application of the digitalis, that I have nearly ceased to resort to it, decidedly prefer- ring several other remedies. Of those who differ from me on this point of prac- tice, Dr. Hamilton, the author of an excellent trea- tise on digitalis, expresses his opinions with the greatest confidence. " That a collection of water," he says, " in any of the cavities within the chest must constitute a disease of great danger, by im- peding the action of orsjans essentially necessary to life, cannot be denied, aud, it is equally obvious, that such a disorder, if not removed, must soon prove fatal. But, that this desirable object may be obtained by the proper use of the digitalis, experi- ence, by which alone I presume to be guided, will not allow me to doubt. For, since I have adopted the effective use of this medicine in such cases, I have never seen one, however advanced, or despe-' rate, that was not speedily relieved by it: indeed, it has, in such distressing instances, appeared pos- 232 sesscu of powers infinitely beyond what could have been hoped from any medicine whatever, and al- most approaching to certainty of effect.'* Mcst happy would it be for humanity, were one half of this account correct, and, it is truly surprising, how a writer, otherwise so respectable in every view. should permit his judgment so far to be deceived by his prejudices or enthusiasm, as to make so cxtra- va_;arr and nnfonnded a statement. There is a case, however, of dropsical effusion. in which I fully coincide with him as to the efficacy of digitalis. The more violent attacks of scarlet fever are often succeeded by anasarcous swellings of the lower extremities, and occasioi ally of the whole bo- dy, which are exceedingly troublesome, and some- times even dangerous. Being considered as the effect of debility, it has been customary to treat this com- plaint by tonics or stimulants, and rarely with suc- cess. Of the utility of active purging, under such circumstances. I have already said much. But, like all other modes of treatment, this will not, uni formly succeed, and there are cases of it connected with a low and enfebled condition of the system, to which it is utterly inapplicable. Exactly where purgatives are precluded, in these affections, w ill the digitalis be found serviceable. As might be presumed, our medicine has not been overlooked in the disorders of the urinary or- gans. By several writers, it is well spoken of in nephritis vera, and I have heard of its being pre- 253 scribed in painful micturition from other causes, though I am distrustful of its efficacy in these cases. My conviction is, that the digitalis is one of the di- uretics which act directly on the absorbent system, and has little or no relation to the kidnevs, and to this inference I am led, by having observed, that it never produces an increased discharge of urine, un- less there be dropsical effusions in the case. The digitalis is now prescribed in three different forms, in substance, in tincture, and in infusion. The infusion is made by putting one drachm of the dried leaves into eight ounces of boiling water, to be reduced to seven ounces, to which, when strained, one ounce of any aromatic spirit is to be added. The dose of this infusion for an adult, is about a table spoonful three times a day. The powder is usually given either alone, or mixed with some aro- matic, in the dose of a grain, morning and night, and may also be made into a pill, which is, per- haps, a more convenient and agreeable mode of ex- hibition. Of the tinctures, there are more than one, and, the most approved, is prepared agreeably to the formula of Dr. Darwin. It is made by di- gesting two ounces of the dried leaves, coarsely powdered, in eight ounces of proof spirit, for some days, and is called the saturated tincture, while that prepared after the directions of the London and Edinburgh Pharmacopoeia, contains only an ounce of the leaves, The medium dose of the first, is 334 about five or six drops, and of the second, double the quantity. An opinion is entertained by some practitioners. and among others, bv Dr. Withering himself, that lite infusion is peculiarly adapted to drop*y, or other cases in which the diuretic effect is desirable, and that, in substance, the medicine answers best where its narcotic property is indicated, as in the pneumonic affections. Thus given, it is aHo al- leged, that it is much more apt to produce its noxious or exorbitant effects, as not passing off so readily by the kidneys, the repeated doses, nnder such circumstances, being accumulated together in the system. As I have never witnessed any such result, or heard of any well authenticated rases of its happening. I presume that this is a mere conjec- ture, wholly unwarranted by the fact. In the exhibition of the digi'ali-. the dose requires to be regularly increased, where we wish to derive full advantage from the medicine. But, in making this increase, we must proceed with caution, from the circumstances already mentioned, that the ac- tion of the remedy is, in some instances, suspended for a time, or at least, does not develop itself, and as we are often surprised with inordinate effects, even from a moderate dose, owing to some peculia- rity of constitution. Certain si^ns usually occur, by which we are admonished of its undue effects, and on their appearance, it should instantly be dis- continued. These are, retardation of the pulse, 255 palpitations, faintness, sickness, and purging. There is, likewise, a membranous tensive pain of the head, sometimes over one eye, with a sort of disturbance of the brain, that occasionally attends an over dose, preceding every other bad symptom, and which has not hitherto been sufficiently noticed, though, if ne- glected, generally proves the precursor of convul- sions and death.* The more violent and ordinary effects of the me- dicine, are denoted by extreme nausea, or vomiting, dim and perverted vision, nervous tremors, cold sweats, with an utter prostration of arterial and ge- neral strength, the pulse sometimes slow, though as often quick, diminutive, and tremulous, and the whole accompanied by the utmost degree of indis- cribable wretchedness. To afford relief in a case like this, we are called upon without delay, and the treatment consists of a blister over the stomach, or finapisms to the extremities, and the freest use of the active stimulants, and cordials, as opium, vola- tile alkali, the tincture of cloves, and above all, strong brandy and water. Great reliance is also to be placed on opium, and where, on account of the state of the stomach, it cannot be retained, anodyne* enemeta may be substituted.! NICOTIANA TABACUM. To what I have said of this article, under the * Bkckall on Dropsies. t Narcotics. ij6 head of emetics, little remains for me to add. A« a diuretic, it is, in some respects, similar to digita- lis, though, undoubtedly, a very inferior medicine. Not many years ago, it was introduced by D.. Fowler, with much commendation, as a remedy m dropsy, and, at the time, as is usual with new me- dicines, was strongly supported by the attestations of some other respectable practitioners. But its re- putation has gradually been declining, and, at pre- sent, I suspect, it is very rarely prescribed in any of the cases of dropsical effusion. Of my own knowledge, I cannot speak relative to its properties in dropsy, having never prescribed it with such a view. Being so exceedingly unpleasant in its ef- fects, we ought to have very unequivocal evidence in its favour, before we resort to it, in preference to other remedies of indisputable efficacy. To the utility of this article in the nephritic affections, the evidence is more pointed. I have elsewhere mentioned Mr. Earle's mode of treating retention of urine by it.* But, it would seem to be, in some of these cases, scarcely less serviceable when given internally. It is prepared for use, by infusing on© ounce of the dried leaves in a pint of water, of which, the dose is fifteen or twenty drops, gradu- ally augmenting it, till it amounts to three or four times this quantity. • Emetic? 237 DISCOURSE XV. Of Stimulating Diuretics. MELOE vesicatorius, lytta vesicatoria. The Spanish fly is one of the very few medi- cines which we derive from the animal kingdom; Of the external use of the remedy I shall treat here- after, under the head of blisters. Cantharides, iu whatever manner applied to the body, evince a very decided affinity to the urinary and genital organs, and hence have been used in many of the diseases of these parts. But they are also a diffusible sti- mulant, increasing the celerity, and force of the circulation, and produce an universal glow over the body. Exhibited too largely, the effects are most distressing, such as great pain, heat, and thirst, de- noting inflammation of the stomach and bowels, and a complete suppression of urine, or, if it passes away at all, it is stillatitiously, and bloody. The surface soon becomes cold, and the pulse loses all its force, sinking so much, indeed, as hardly to be perceptible. Cantharides have sometimes been prescribed in tetanus and hydrophobia, with a view of exciting Kk 238 strangury, under the expectation, that the counter- action, in this case, might be beneficial. But, though we have one or two cases recorded, of its having proved so in the former disease, not much confidence seems any longer to be reposed in the remedy. The same principle I have extended to the treatment of mania, in its weaker and more de- pressed forms, and have certainly, in some in- stances, experienced at least temporary advantage from it. To promote, as well as to restrain, the urinary discharge, this medicine is employed. It would seem, at first, not a little extraordinary, that the same article should be capable of meeting such contra indications. As an attempt towards an ex- planation of it, I shall only observe, that the medi- cine seems to evince dissimilar effects, when used in opposite conditions of the system, and in differ- ent quantities. Exhibited in a state of excilement, or at any time, in small doses, it most commonly occasions strangury. But, taken in a reverse state of the system, or in large doses, it as constantly proves diuretic. Thus, in the weaker forms of dropsy, two. three, or four drachms of the tincture, dven in divided doses during the twentv-four hours. will produce the mo-t copious evacuations of urine. Never, indeed, have I witnessed more powerful ef- fect in this way, from any remedy, than sometime- from cantharides, and to such cases of the disease. therefore, it appears to be adapted. 259 The fact which I have stated, does not rest en- tirely on my own observation. It is, on the con- trary, corrobarated by several very respectable au- thorities. But 1 must not conceal, that, by some of equal weight, very different representations have been made, of the properties of the article. Cul- len, among others, seems to distrust altogether its diuretic powers, and to consider its operation as confined to the neck of the bladder. But he is sure- ly incorrect in this view of the subject. As I have before mentioned, cantharides are used in some of the cases of incontinence of urine, and here, they occasionally display their very best powers. They have, also, and especially within a few years, been very strongly recommended in gleet and leucorrhcea.* But, after a pretty fair trial in each of these complaints, I am not warranted to say much in favour of the remedy. Cantharides may be given either in substance or tincture. The dose of the former to begin with, is about a grain, made into pill, and of the latter, ten or fifteen drops, except in reduced or phlegmatic states of the system, where it may be much more liberally prescribed. terebinthina veneta. Of the terebintbinate medicines, still retained in practice, the Venice turpentine is the purest, and * Robertson on Cantharides. 260 the one now chiefly employed. This is an exuda- tion from a tree, the pinus larix of Linnseus. It comes to us a thick tenacious mass, of a pale yel- low colour, having a pungent taste, and a very pe- culiar odour. By distillation it affords a large por- tion of essential oil, the oleum terebinthioae, w hich is highly volatile aud inflammable. The residuum constitutes the resina alba, vel flava, of the shops. Of these three preparations, tbe first two only are prescribed internally, and the oil is preferred. It is a very pervading stimulant, directed specifically to the urinary organs. As a diuretic, however, it does not display much activity in dropsy, or, at least, my trials with it, in the atonic shapes of this complaint, have not been successful. Much more may be done with it in some of the nephritic affec- tions, and I have, undoubtedly, seen it useful in the strangury from blisters, in gleet, and leucorrhcea, The dose of tbe concrete turpentine, is four or five grains, and of the oil, ten or fifteen drops, to be re- peated once or twice a day. Exhibited much more largely, its diuretic effect is defeated, by the purg- ing which it occasions. The resin is onlv used in the composition of unguents and plasters.* balsamcm copaiv^. This is the exudation of a tree, called by Lin- naeus copaifera officinalis. Though, undoubtedly, * Incitants 261 operating very actively on the urinary passages, i^ has never claimed much attention in dropsy. But in some cases of nephritis, it is admitted to be highly serviceable, and has not been less benefi- cially employed in leucorrhoea and gleet. My conviction, however, is, that it is more particularly adapted- to the early stages of gonorrhoea. Ever since I entered upon the exercise of my profession I have trusted to the copaiva exclusively, in the ma- nagement of this disease, and my confidence in its powers has increased, and is fully confirmed. This is no new practice. The medicine was long ago em- ployed in gonorrhoea, though, in the final stages, wrhen the inflammatory symptoms had subsided, and the doses were small and inefficient. My experience has taught me to pursue entirely a different course. Commencing with the medicine on the very acces- sion of the disease, I am utterly regardless of all the appearances of inflammation, such as ardor, urinae, chordee, &c. No remedy, indeed, is better calculated to relieve these very symptoms, than the copaiva itself. The proper dose is about forty drops, more or less, according to circumstances, to be repeated morning, noon, and night. It is con- veniently taken dropped on a little wine, or mixed with milk. Thus administered, a cure is commonly effected in three or four days, and sometimes, even in a shorter period. In the treatment of gonorrhoea, one caution, at least, should always be enjoined on patients who 26* are desirous of a speedy cure. It i-. an entire ab- stinence from every beating article of food or drink, and a state of complete repose. Without low liv- ing and us:, this, and all other plans of managing the disease, are counteracting, and rendered com- paratively of little use. There are two circumstances which interfere with the exhibition of tbe copaiva, and detract from its utility. It sometimes purges, and when it does. its efficacy is lost or greatly diminished. We should here combine laudanum with it. which com- monly checks this prejudicial tendency. But if it should not, the medicine must be discontinued for a few days, till tbe bowels recover their tone. To the stomach of'some persons, the copaiva is also ex- ceedingly ofTen-ive, so much so, indeed, that it can- not be retained. It is often very difficult to over- come this prejudice, as it is hardly possible to dis- guise the taste of the article. In my various eu- deavours to effect this purpose. I do not know that 1 have succeeded better than by one of the annexed prescriptions.* Ou the use of the copaiva, I am thus precise in my instructions, because I do really conceive, that I am suggesting a very important practical improve- * ^ Ba's copaiv. sp. nitr. dulc. il5>5 , sp. kverH. coTp. 5'iL linct. theS. 5 . pu.v. g<-:m. ra > 5: , a-]. fon*. ~i i m. R Rals. copav. sp. ni'r. dulc aa^ss,albu: ovi, saac . alb. 3". ft. mist— de t ct. th.b. 51 a ,. ton . ^iiu m. Oftiese mixtures, the dose is ataKls spoonful, t'-.ree times a day, 263 ment, and one, perhaps, on which information can- not elsewhere be prescribed. No complaint, of so slight a nature, is so troublesome to tbe patient, or more vexatious to the practitioner, than gonorrhoea. Contrasted with the ordinary mode of treating it by injection, the plan which 1 propose has several ad- vantages. It is more convenient to the patient. It produces no swelled testicle. It occasions no stric- tures. It leaves no gleet. It is more prompt and certain in the cure. In what manner the copaiva operates in this case, I am not prepared to say. It does, indeed, seem, in some degree, an anomaly, that so heating and active a stimulant, should be salutary under such circumstances. Nothing, however, is more absurd or leads to grosser fallacies, than speculations on the precise properties, or modus operandi, of medi- cines. Could any one suppose that turpentine, tbe most acrid, perhaps, of all the irritants, would allay the heat, sooth the pain, and arrest or subdue the inflammation of a burn? It would appear, that the copaiva is distinguish- ed in a very eminent degree, by the property of a specific relation to the genital and urinary organs, and to the whole of the neighbouring parts. This is evinced, independently of the facts which have al- ready been mentioned, by the great relief which i^ affords in strangury from blisters, as well as in he- morrhoidal tumors. Notwithstanding, however, what 1 have said iu 264 relation to the poweis of the copaiva in gonorrhoea, we are not always to expect it to succeed in that disease. There is, perhaps, no medicine, which is so apt to be adulterated, or to be met with of an in- ferior quality. Where this happeus. we shall uni formly be disappointed. SCILLA MARITIMA. I shall not repeat, here, w hat I have said in ano- ther place, of its natural history, and emetic pro- perties. As a diuretic, the squill is. indisputably, the most certain, active, and useful article which we possess. In every species of dropsy, it has been employed. and with the most signal success. Both in ascites and anasarca, it is eminently useful- But if I were to determine from my own experience, I should say, without hesitation, that it is still better adapted to hydrothorax. In the practice of the Alms House, where the pa- tients have, for the most part, those habits which produce effusions in the chest, I have had the most ample opportunities of making comparative experi- ments with this, and other medicines, in these cases. and. the result is altogether in favour of the squill. My mode of using it in hydrothorax, as well as in the other forms of dropsy, is, to combine it whh ca- lomel, in the proportion of three grains of tbe for- mer, and one of tbe latter, to be made into a pill, 865 which may be given morniug and night, or even oftener, if circumstances should urge its use. Cullen disapproved of this combination, suppos- ing that it would produce purging, which he thought interfered with the diuretic powers of the medicine, and, under the expectation of its being determined more directly to the kidneys, he prescribed it with the neutral salts. Being entirely hypothetical, his opinion here is entitled to no sort of confidence or respect. When tbe calomel purges unduly, which it will sometimes do, we may restrain it, by adding to tbe preparation a little opium. In the use of the mercury, the mouth becoming affected, is always an auspicious circumstance. I have ob-erv d, more especially in hydrothorax, that the distressing symptoms commonly subside on the appearance of ptyalism, and which is not altogether owing to the mercurial action, since mercury alone will not pro- duce the same effect. It was once a question a good deal debated, whe- ther, in the exhibition of our medicine, its powers are increased or diminished by permitting it to pro- duce vomiting, or other effects on the alimentary canal. By Home, then Professor of the Mate- ria Medica at Edinburgh, the. affirmative side was assumed in this discussion. In dropsy, he gave of the squill and nitre, each ten grains daily, so as to excite vomiting, and at night supported the patient by means of cordials. Cullen, who was cotempo- rary in the same school, and between whom a great l1 266 rivalship existed, loudly condemned this practice. He, on the contrary, maintained, that the diuretic effect of the medicine is greatly abated, whenever it operates either as an emetic or purgative, and which be ascribed " to its being prevented entering tbe blood vessels, and thereby reaching the kid- neys." By " a certain writer," savs be. in another place, alluding to Home, #i it is allegtd, that the diuretic « ff«ct of the squill is not to be expected, un- less it shews some operation on the stomach. This, perhaps, may be founded. But I understand it no other way. than that some operation on tbe stomach is a test, and a necessary test, of the squill's being in an active state, in tbe same manner as we are only certain, of the activity of the mercurial prepa- rations, when they have shewn some effects on the mouth. 1 have often observed, that when the squill operates strongly on the stomach or intes- tines, that the diuretic effects were less ready to happen." Like most other cases, truth lies, in this contro- versy, nearly between the extremes, and. in order to reach it, we must pursue a middle course, avoiding Scylla, as well as Charibdis. The point in dig- pute, is not whether emetics or purgatives are use- ful in dropsy, but. whether the peculiar powers of the squill, in these cases, are best attained by push- ing the medicine to this extent. Determining from my own experience, which has been ample, I should say, without hesitation, that the just me? £6? dium, in the employment of the medicine, is a very slight and moderate degree of the nauseating effect. Nevertheless, this is not absolutely neees ary to the successful operation of the medicine, as, in some cases, I have commanded its full effects, wiftout having observed the slightest affection of the sto- mach. COLCIIICUM AUTUMNALE. The meadow saffron, though not a native, is cul- tivated in our gardens, arid succeeds well. It Kas a bulbous root, the only part of the plant that is medicinal. In its recent state, this is exceedingly acrid, and, on being cut into pieces, emits particles which irritate the eyes, and fauces, and even para- lise the fingers, for a time, with which it was held. Taken into the stomach, in so small a quantity as a grain, enveloped in some vehicle, it at once excites a sense of heat and thirst, with strangury, tormena^ and tenesmus. Notwithstanding, however, these violent effects^ the baron Stoerk, with his characteristic intrepidity, resolved to make an application of the article to the cure of disease. Having first tried it on himself, he prescribed it freely, "in desperate hydropic, and other serous disorders," in which, as exhibited by him, it was always found to act " without disturb- ance, as a most potent diuretic, after the common medicines employed with that intention; had fail-' 268 ed.v As an oxyrael. or syrup, he ascertained, that its harshness is mitigated, and bis formula has since been generally adopted, and is contained in the dispensatories. Of this preparation, a drachm may be given two or three times a day. and gradu- ally augmented to a much larger quantity. Of the powers of the colchicum, I cannot say much mvself. having rarely seen it used, and, in- deed, I suspect that it never had, in any great de- gree, the confidence of the practitioners of Great Britain or this country. But on the continent of Europe, particularly in Germany and France, it has always been, and continues to be, in high re- pute, in dropsical effusious. in some of tbe com- plaints of the chest, as an expectorant, and in the treatment of intermittent fevers. Within the last two or three years, a very gene ral attention ha- been directed to this article, iu eonsequeoce of its being supposed to constitute tbe basis of the Eau Medicinale, a nostrum, that has acqniied immense celebrity, in the cure of gout and rheumatism.* The preparation of colchicum now * The Eau Med:::-i< was invented nearly talf a century srco.by M Husson, a mil;*-*-;.- officer in Me service of Frar.ee. It soon acquire* great reputation on die continent of Europe, as a remedy in Oie arthri- tic affections, which it has ever since maintained, whh little or no dini- it'ition. But, it is only within the last six or eight years, thit it has v.- tr^cted much attention in England or ttus country. As H comes to us, it is in small bottles, vhich hold about two drachms, and is a fluid of the colour of ale, with a nauseous bitter taste, ar.i itrcngly scented of the Spanish wine, used as the menstruum. The whole contents of a bottle is recommended as a dose, the ugh I have found it safer to give hi'f -jv.» 269 A in use, is a saturated vinous tincture, of which, from forty to sixty drops, are the proper dose, to be ta- ken morning and night, and to have its operation encouraged by warm diluent drinks. Whether this tincture is substantially the Eau Medicinaleor not, I will not take upon myself to determine. But, by quantity. It is usually taken on going to bed, and its operation may be promoted by drinking warm beverages. After a few hours, the patient complains of nausea, which is sometimes followed by active vomiting, and copious evacuations of dark bilious matter by stool. To these, suc- ceed a moderate diaphoresis, and ultimately, very powerful diuretic effects, which will continue for a succession of days. During the operation of the medicine, the pain and swelling of the joints so rapidly subside, that it is not uncommon for the person to be at perfect ease in the morning, and to have, in a great degree, restored to him the use of his limbs. If the paroxysm should return, or not en- tirely go off, the dose is to be repeated. As might be imagined, this medicine is very differently estimated by practitioners. While, by some, it is most highly extolled in gout, there are not wanting others, who condemn it as both useless and pernicious. Even by some of those who ad.Tiit its immediate utility, it is dreaded lest it might eventually produce injury to the constitution, like the Portland powder, &c. From my own experience, which, however, is not very extensive with it, Ishouldbe warranted in saying much in favour of the Eau Medicinale. I have seen it tried in five or six cases of gout of different forms, and al ways with signal advantage. In a paroxysm of podagra, the effects which I have witnessed, were nearly such as I have just described, with this difference, however, that long before nausea or purging commenced, there was, in every instance, a marked mitigation of pain, and a corre- spondent degree of composure, resembling, very nearly, the state in- duced by an anodyne. Twice I have given it in misplaced gout, attack. ing the stomach with great violence, and each time promptly afforded relief by it. Whether the repeated use of this medicine has any ten- dency to impair the tone of the system, and thereby aggravate tke mis- chief which it is designed to remove, I have not sufficient experience to decide. The only fact which has come within my own knowledge, is 270 those whose experience with the two articles i* more e\fen-ive than minp. tl eir identity ha* beeu very confidently a = «erted. To tbi» point, at l«ras\ v. h have «ome very vron; evidence, that the colchi- rnm ha- done a ?reat deal of z= <: s. relame to the colcbicoTi. of iis diuretic p:»«ers, or of i:s ap- plication, iii this view, to the treatment of di?ea«e. IOLYGALA SENEGA. Of :e natural history of this plant, a< well a* of is ^.n-»a! effecrs on the »y, during the greater r.ir.T j. i:ng life, vai the victim c :"?:•_-, in', is seve- ral forrr.s. who, b} recurring to small doses of Eau Mei.cir.a2e. witer.ever admonished by any of die indications of an attack, has verv successfully warded err a paroxysiri for several years, ^nd :s now in a sound and vi- gorous sta*e of health. N evertheless, I do not recommend an mikado-. of this practice. My experience with the medicine is much too nar- row, to speak in a tone of confidence, with regard to its applications. The Eau Me::::^i: his also been ; jpp.sed to consist of tie nicot* ana, the g.-atiota, the veratrum, the elaterium, &«. &©. * Expectorants. %7i The seneka has long been celebrated as a diure- tic. This, indeed, is the only properly of the medi- cine, which was particularly noticed when it was originally introduced into the practice of physic. But though I have used it much, I have never been able to see any exiraordinary operation from it on the kidneys. Nevertheless, it is undoubtedly ser- viceable in dropsy. It has been employed iu all the forms of this disease, and, if the most respecta- ble writers are deserving of credit, it would seem^ with distinguished success. We are informed, by Sir Francis Millman, that he cured six out of thir- teen cases of ascites, by this medicine only. By Dr. rPercival. it is highly commended, under the same circumstances, and likewise in hydrothorax, and Cullen, who seems not to have employed it himself, cites some authorities in its favour. The medicine. however, has lost much of its reputation in dropsy, and, I suspect, from its having been too indiscrimi- nately used. Certainly no one, as yet, has pointed out, with any sort of precision, the species of the disease in which it is applicable, or prescribed any principle for its just administration. From what I have observed of its use, as well as from my theoretical notions respecting its proper- ties, I am inclined to believe, that it will be found most efficacious in those cases of universal dropsy, which depend on a very enfeebled absorption, and are connected with a general cachectic, or vitiated state of the system. It is only under such circum, stances, that my own experience teachos me, that it is beneficial. The seneka, is a pervading stimu- lant, and, in its diffusive operation, often extends to the lymphatics, exciting these vessels to very in- vijrorated efforts. Its efficacv here, mav sometimes be promoted, by combining small quantities of ca- lomel with it. Tliis is easily done, by previoosly reducing it to powder, and forming it into pills: the proper dose of which is about a srruple. to be re- peated several times in a day. I have, however, exhibited much more of it at a time. LOBELIA SYPHILITICA. This is an indigpnous plant The root, which is the only part used in medicine. cousisrs of short white fibres, resembling tobacco in the taste, and if chewed, is apt, at first, to create nausea, and even vomiting. The lobelia had long been celebrated as an Indian remedy, for the cure of syphilis, till it was fairly tried, and found to be useless.* But its diuretic properties are fully confirmed, and it seems not at all unreasonable, to conjecture from this, that its reputation may have arisen in consequence of its doing good in gonorrbcea, which, from all that we can learn, is by far the most prevalent form of tht venereal disease, among our aboriginal people. The lobelia is employed, I understand, by some * Pearson on the effects of various articles, kc. in the cnre of Lues Venerea. 873 practitioners of the western country in dropsy, and not without success. I know nothing of it myself. But it is undoubtedly one of those native vegetables, which, on every account, ought to be carefully ex- amined, and its properties accurately determined. CHIMAPHILA UMBELLATA. This is one of the plants common to the Old and New World. It is said to be found in several of the districts of Europe, in the south of Asia, and throughout the United States. Nothing appears, however, to have been accurately ascertained with respect to its medicinal properties, till very recent- ly, though we have some reason to believe, that it has immemorially been employed as a diaphoretic, by our Indians, in their inflammatory diseases. It is called by them Pippsissewa, and is recognised in popular practice, where it has been long used also, for the same purposes, by the title of rheumatism weed. But it is, moreover, perfectly well known to the country people as an active diuretic, and is much resorted to by them in dropsies, and the af- fections of the urinary organs generally, being a remedy, too, on which they greatly rely to relieve their cattle of strangury. Nor, from recent intelli- gence, does it seem, that our northern Indians, at least, are unacquainted with its powers over the urinary discharge. In the year 1803, the proper- ties of this plant were, probably for the first time, m m S7* investigated with any sort of care or precision and the credit of doing this, is due to Dr. Mitrlit-'.l. a sradu-ite of our university, who made it the subject of his inaugural dissertation. But. tr.75 maphila, is distinguished by activity and certainty of operation, and has this peculiarity, that while it stimulates the kidneys to a very increased effort, it acts on the stomach unequivocally as a tonic, and with so much effect, that it has been prescribed in intermittent fevers, and, as reported, not without success. Whether the medicine is serviceable in correct- ing the lithic diathesis, an opinion of the late pro- fessor Barton, I am not prepared to assert from any new facts. Being, however, exceedingly analo- gous to tbe uva ursi, one of our best remedies under such circumstances, it is more than likely that it might be of advantage. The chimaphila is directed in strong infusion of the entire plant, or in the shape of an extract, a pint or more of the formerjo be taken in the twenty- four hours, and of the latter, during the same pe. riod, one or two drachms, made into pills, or dis- solved in water. 276 DISCOURSE XVI. Of Lithontriptics, or Antilithics. By a very natural transition, I pass from the dia- retie remedies, to tbe consideration of the lithon- triptics, or, as they have been more recently called, antilithics. They constitute a class of medicines, which was once supposed to break down or dis- solve the stone, and now are more generally held to be correctives only of the lithic diathesis. Each of these terms appears to me to be appropriate, and ought to be retained. We require a name for the set of medicines which exists, or is supposed may ex- ist, as solvents of the stone, and not less, some ap- pellative designation of such as prevent, or correct the tendency of the system to the calculus formation. What occasions the lithic diathesis, is not dis- tinctly understood. Its connection with gout is ob- vious, and the latter is seemingly dependent, in a great degree, on a weakened or disordered stomach. Certain habits and peculiar modes of living, the se- dentary occupations of the studious, the indulgen- ces of the voluptuous, or the excesses of the still more intemperate, are found alike to be the sources of the two diseases. Yet. by this analogy, we do not add much to our knowledge, the origin of the one, as well as of the 277 other complaint, being shrouded in obscurity. To me, however, it is manifest, that the first link of the series of actions, which cause these two formidable maladies, the scourge of our nature, and, in some degree, the reproach of our art, has its commence- ment in the stomach. It is, indeed, now, very generally presumed, that gout is owing to a peculiar matter, originating in a vitiated state of the digestive process, and the hy- pothesis is not, by any means, gratuitous or unsup- ported. Nor, perhaps, is it less true, that this same matter, taken up, and ultimately thrown into the bladder, constitutes the foundation of gravel and stone. There are a variety of reasons for this con- jecture, and among others which might be men- tioned, Is, the perfect identity of the arthritic con- cretions and urinary calculi, as relates to composi- tion. After reaching the urinary organs, all which seems necessary to the formation of stone, is some nucleus, and which is usually supplied by a depo- sition of animal mucus, or particles of sand, or drops of extravasated blood, or, in short, by any extraneous matter, and around which an accretion takes place with greater or less rapidity, according to the tendencies of the constitution. Chemistry had no sooner made its way into me- dicine, than it began to exercise its ingenuity in de- vising theories to explain more precisely the origin of the urinary concretions. But, even its extraor- dinary resources have been baffled by the difficulty 27* ai the subject. Nevertheless, chemical analysis has ascertained, pretty accurately, the substances which enter into the composition of calculi, and pointed out to us the agents, which operate upon them most powerfully, at least out of the body. The sub- stances hitherto discovered, are the following: 1. Uric acid, 6. Magnesia. 2. Phosphate of lime, 7. Phosphate of iron, PB. Phosphate of mag- 8. Silica, nesia and ammonia, 9- Urea, 4. Oxalate of lime, 10. Cystic oxid. 5. Muriate of ammo- 11. Mucus. nia, Tl rse elementary parts of urinary calculi, exist in different combinations, which have been various- ly arranged. The classification of Dr. Wollaston is. perhaps, the best, and certainly, in a practical point of view, deserves a preference. Calculi he divides into four kinds : 1. Uric calculi—composed of uric acid, or chief- ly of that substance. 2. Fusible calculi—composed chiefly of phos- phate of lime, and phosphate of magnesia and am- monia. 3. Mulberry calculi—com posed of oxalate of lime. 4. Bone-earth calculi—composed chiefly of phos- phate of lime. Endeavours have been repeatedly made with tht 279 view of discovering solvents for these several pro- ductions. The enquiry, which, for some time, was neglected, has recently been renewed by tbe French chemists, and, as I have already remaiked, not wholly without success. These experiments were instituted, expressly for the purpose of shewing the practicability of dissolving stones in the bladder, by injections through the urethra. The result most incoutestibly proves, 1. That a solution of pure potash and soda, so weak that it may be kept in the mouth, and even swallowed, without pain, soon dissolves calculi composed of nric acid, and of urate of ammonia, provided they be kept plunged in it. 2. The phosphates are quickly dissolved by ni- tric or muriatic acid, so weak that it may be swal- lowed without inconvenience, and possessed of no greater acidness than urine itself. 3. Calculi composed of the oxalate of lime, are slowly dissolved by nitric acid, or by carbonate of potash or soda, weak enough not to irritate the bladder. It has been contended, that these sol-vents, in- jected into the bladder, ought to act upon the stone, and gradually dissolve it, nor do I perceive any reason why they should not, though the few at- tempts which have been made, do not afford us much encouragement. But, may not this be owing to their not having been conducted with all the care which the case requires? To succeed in experi- *so men* of this sort, much skill and perseverance will be necessary. As yet, T do not know whether any practical advantages have been derived from these theoretical suggestions. They are, however, wor- thy of a fair and ample trial. The fact of the differeut species of calculi being so readily soluble out of the body, should also in- cite us to further and most assiduous exertions, to detect some agent which might produce the same effect in the bladder. Whether we, at present possess such a solvent, is extremely problemati- cal, though casr s have sometimes been recorded where a stone has disappeared under the use of li- thontriptics. The older writers abound in state- ments of this description, aud we are not deficient in more recent and authentic evidence to the -ame point. Even within my own knowledge, facts to this purport have occurred. But still, it is not clearly ascertained, whether this effect is to be im- puted to the medicine, or to the spontaneous opera- tions of nature. My impression is. from a review of the whole ground, that certain articles have oc- casionally displayed this valuable property, still the practice, under these circumstances, must be very ambiguous and precarious. Of the many difficulties incident to the case, not the least is to determine the composition of the ex- isting stone, iu order to select tbe appropriate sol- vent. As we have no precise mode of doing this, we shall be compelled to practise empirically, ex. *31 perimenting with one and another substance, with- out rule, or principle, till we hit upon some one, which may answer the purpose. The opinion which I have expressed, of the pos- sibility of dissolving a stone in the bladder by a course of medicine, rests upon two grounds : 1. That, by experiments already referred to, it appears, that we possess solvents for almost every species of calculi, out of the body, which might be given in a sufficient quantity to effect the end, with- out any prejudice to the system. * g. That some of these solvents do reach the uri- nary bladder without any, or, at least, a material change being wrought in their properties, so that, when coming in contact with the stone, there might be a play of chemical affinities, and thereby a de- composition of the calculous body. My present view of the subject is perfectly consistent with the doctrine which I delivered in the early part of these discourses, that no substance enters the circulation, with a retention of its original powers. To me it is still most manifest, that the process of the assi- milation, whether performed by the chylopoietic viscera, or by any part of the absorbent apparatus, completely animalizes all articles subjected to its influence, and, however various in their composi- tion, reduces them to one homogeneous fluid, bland in its nature, and fit for the purpose of nutrition. But, in the secretions or excretions being removed beyond the sphere of the vital powers, chemical ac- n n 882 tion takes place, by which those substances are, 114 part, or entirely regenerated. Besides, it would seem, that there is really a di- rect communication between the s;omach and blad- der, through which substances are conveyed with- out undergoing the slightest change. The fact, of a rapid transmission of certain fluids to the urinary or- gans had, long ago, led to the suspicion of such a pas- sage. Every physician was aware, that nitre, rhu- barb, turpentine, and garlic, may be detected in the urine twenty or thirty minutes after they have been taken into the stomach, a time much too short, to be- lieve that they reached that destination through the ordinary route of the blood vessels. It was suppos- ed by Darwin, that the transmission takes place, in these cases, in consequence of the retrograde' ac- tion of the absorbents. But this is surely a very lame and imperfect solution of the problem. Even admitting, that the lymphatics do occasionally per- form this inverted office, which, from their valvular structure, is rendered next to impossible, it is obvi- ously the effect of disease, and it is contrary to all the rules of medical philosophizing, to resort to an irregular and morbid process, to account for the phe- nomena of an uniform and healthy function. But, whatever may be the precise mode of this more di- rect communication between the stomach and blad- der, of the fact, there cannot now be much doubt. It has been long known, that in some cases, Where the kidneys were nearly destroyed by the £83 ravages of disease, the bladder rwas filled, as usual, I will not say with ur^ne, because this is a peculiar fluid, the result of a secretory action of the kidneys. By tying the ureters in the dog, it has also been found, that the discharge from the blad- der, though diminished, is not entirely suspended. These facts I state on the authority of Darwin. The experiments, however, which have been more re- cently made by Mr. Home of London, are of a cha- racter still more conclusive and satisfactory. With a view of determining this point, he placed a liga- ture round the pylorus of the stomach of a dog, which had been previously evacuated thoroughly, and, afterwards introducing fluids into it, coloured by rhubarb, he detected this substance in thirty minutes in the urine, a time infinitely too short, to allow of its being transmitted through the regular rout of the circulation. These experiments he re- peated so frequently, and under circumstances ap- parently of such precision, as to leave little hesita- tion as to their truth and accuracy. By what pre- cise means this intercourse between the stomach and bladder is maintained, it is impossible, at pre- sent, to decide. It is highly probable, that it is done by an inosculation of the lymphatics of these two organs, though, it must be confessed, that no such connection has hitherto been demonstrated. Yet, so imperfect is our knowledge of the absorbent system, that the hypothesis, on this account alone, ought not to be discredited. 284 Notwithstanding all I have said, I shall not, however, insist upon the absolute solvent powers of any substance, with which we are at present ac- quainted. It has always appeared to me, that onr knowledge respecting the lithontriptic medicines, is exceedingly imperfect, very vaguely stated for tbe most part, and mixed with, and disfigured by, a vast deal of credulity and empiricism. Enough, however, is asrertained, in relation to this class of remedies, to warrant us to persevere in our trials, not only with those which we already possess, but also with new and untried substances. Even ad- mitting, that we niether have, nor never shall have, a real lithontriptic, it must still be conceded, that there are now in our possession, and no doubt, others remain to be discovered, many articles which are eminently useful in mitigating the pain, or ar- resting the growth of calculus, not to mention the vast number of gravelly and nephritic affections, in which such medicines are so peculiarly serviceable. Of Particular Lithontriptics. Of the substances which are supposed to possess such properties, the carbonic acid, or fixed air, is one of the most conspicuous, and longest known. Its utility, however, in calculous complaints, was not very satisfactorily illustrated, or the mode of its administration pointed out, till the appearance of the work of Dr. Dnbson on the subject, about thir- ty-five or forty years ago. The remedy soon after 285 attracted general attention, and we find both Dr. Saunders and Percival, very strenuously insisting, to use the language of one of those writers, " for the solubility of the human calculi, while yet in the bladder, by the regular and continued use of fixed air." It was now proved, as had been previously sug- gested by Dr. Hales, that calculi immersed in malt liquor, or in water impregnated with carbonic acid, are, by virtue of this principle, gradually diminish- ed in bulk, till, finally, they undergo a complete solution. These experiments were made by Drs. Saunders, Percival, and Falconer. The next point to be determined, was, whether this fluid taken into the stomach, could be so con- veyed, as to enter the bladder unchanged, the prac- ticability of which, was also speedily demonstrated. We are informed by Dr. Percival, that a patient of his, while under a course of the fixed air, which he took daily, in very large quantities, had his urine strongly impregnated with it, as appeared by the precipitation it produced in lime water, by the bub- bles it copiously emitted when placed under the re- ceiver of the air pump, and by the solution of seve- ral urinary stones immersed in it. This fact, which is so strong in itself, has since been fully corrobo- rated, by a series of experiments conducted by the celebrated Dr. Priestley. It, moreover, appears, on the authority of seve- ral respectable writers, that when human calculi are 28G placed in the waters of Pyrmout and Spa, which contain the carbonic acid, they are dissolved, and. that the urine of the persons drinking tlu -e waters. has the same effect. As respects the utility of carbonic acid, in cases of stone, I can say little from my own personal obser- vations. It would, however, be an unjustifiable degree of scepticism, to donbt its occasional effica- cy. I do not mean as a solvent, for, in this view, it is altogether questionable, but as a palliative remedy. In gravel, and a variety of nephritic affections, I have certainlv used it with some advantage. It has been given by me in the form of seltzer water, an exceedingly pleasant beverage, which is readily taken, in any quantity, by the patient, aud 1 sus- pect is quite as good as any other mode. FIXED ALKALIS. The idea of calculus having its origin in an acid, has led to the very common employment of the al- kalis, as solvents or correctives, in stone, and also, in almost every modification of urinary disease. This, which, by some, is supposed to be a modern prac- tice, is not so. Consulting the writers at the com- mencement of the last century. I find the alkalis recommended in these very cases. In Robinsons Treatise on the Gout, which appeared in the year 1721, the saltof tartar is expressly suggested among other things, as a solvent for the stone. At a pe- riod somewhat later, these medicines are particn- larly noticed in the works of Hartly, Whytt, Kirk. patrick, De Haen, and other medical writers of dis- tinction. But, notwithstanding all this weight of recommendation, the alkalis were certainly laid aside, and, for a long time, had lost nearly all their reputation in such cases. It was not, indeed, till about thirty years ago, that they were revived, and once more introduced into the treatment of calcu- lous complaints. Experience has subsequently con- firmed, in a great measure, the virtues of the medi- cine. The fixed alkalis are prescribed both in tbe mild and caustic state, according to the object in view. If the solution of the stone be intended, the pure alkali is used, in the dose of fifteen or twenty drops of the aqua potassae, morning and evening, increas- ing it gradually, as far as the stomach will allow. It is, however, very apt, after a short time, to pro- duce gastric distress, which may, in some degree, be obviated, by combining it with mucilage, and still more, by taking it in soup, or other gelatinous mat- ter. But, under the best management, it cannot bo very long continued, owing to the nausea, and even vomiting which it excites. On this account, the ve- getable alkali is more commonly directed, in the state of a carbonate, or super carbonate, as a pallia- tive only, and here it operates by merely neutralis- ing the lithic acid, thereby preventing the further increase of the stone. Thirty or forty grains of the salt of tartar, in some diluent drink, to be repeated 2S% several times in the twenty four hours, is one mode of exhibiting the medicine. But, a super saturation of it with carbonic acid, constituting the aqua mt- phitica, or the aerated alkaline water, as it is called, prepared by a well known apparatus, is more frequently prescribed, and, perhaps, has greater efficacy. As this, there are, indeed, very few remedies which afford so mueh relief, at least, in the nephritic affections, especially when drank to the amount of two or three pints in the course of the day. But w here this cannot be had. a tolerable substitute is afforded in the common effervescent draught, very frequently repeated. As a lithontriptic. or, at least, as a corrective in calculous affections, the carbonate of soda, is found to be not less advantageous, the pure alkali very rarely, if at all, being used- It is given in solution, in the proportion of a drachm, or more, to a quart of water, of which the w hole may be drank in di- vided quantities, in a day, or it may be prepared exactly as is the super carbonate of potash. It is sometimes directed in pills. The salt is, for this purpose, previously exposed to a very gentle heat, till it loses the water of crystallization, and the dry powder thus obtained, is worked up with mucilage. Each of the alkalis has, moreover, been much nsed in the form of soap. It is, of course, the purer soaps that are prescribed, such as are made with the mild expressed oils, of which an ounce may be taken daily, in pills or otherwise. But an object- 289 lion of some force has lately been raised against the employment of the alkalis, in any shape, in stone. It is alleged, that the phosphates of lime and mag- nesia, which exist in the urine, are retained in solu- tion, principally by its excess of acid, and if, there- fore, for the purpose of dissolving a uric acid cal- culus, or preventing its growth, alkalis be given so as to neutralize this acid, the deposition of these phosphates may be favoured, and a layer of them form on the existing stone.* Chemically, all this may be true, aud no doubt does occasionally hap- pen, but, the calculous productions in the bladdery arc not limited exclusively to this particular com- position, and the experience of every practical man has shewn, that this set of articles is highly benefi- cial in many cases of this complaint, and must not too hastily be laid aside, f- AQUA CALCIS. As closely allied to the alkalis, the lime water has been used for similar purposes. If it be not a solvent, as has beeu suspected, it is, most unques- * Murray's Mat. Med. f Incompatible substances, as regards both the vegetable and mineral alkatis.__Acids and acidulous salts, borax, muriate and acetate of ammo- nia, alum, muriate of lime, sulphate of magnesia, lime water, nitrate of silver, ammoiiiated copper, muriate of iron, acetate, submuriate and oxymuriate of mercury, super acetate of lead, tartarized iron, tartarized antimony, sulphates of zinc, copper and iron. O 0 tionahlv. one of the best palliatives of the pain and distress of the calculous affections. It will not only relieve the sufferings from the stouc, at the mo- ment, I it. in some instauces, suspetds them for a considerable length of time. There is a case pre cisely of this kind, related by Dj Haen, of a man who drank eight hundred qua is of the lime water iu six month-, who, in consequence, continued ex- empt ft. m pain fur three years, though the 1:01:1 still remained in his bladder. To he decidedly us"ful where there is a stone. the aqua calcis should he given in very considera- ble quantilies, cliciwi-e little or no effect is pro- duced by it. I presume that not less than a quart daily would answer the pui; ese. Iu gravel, and other milder affecii us. mucii less, however, will do. I 'ieoeraiiy direct, i:i tliese cases, about a wire g'.:i'S fui:. five m- six times a day. mixed wi:!i au equal um->oriion ei* new mil!;, lixhibited in this way, it is far moie pleasant, r.nd agrees better v. Ill: the stomach. In a,I the :_-.iS':s n'i r.. ;ii.*iL;s. "aether ;:: >ceediii_; fro^ iravel, or other cat s. which are accom. panic d with much di-u 1 r of the >iomac!i. r> ga-!rod n' :. so:;r irritations, flatulence. ::i.d nau- sea, the lime water. I h=».ve : mud. extremely use- ful. It is, perliap-. on the sune ii:isiei*»Ie. li.at i: proves ?.-■ SieiKllcii-l in diabet -. a disease, whi • . nudoubted'v commences iti so:cv ••. ro-r -v-'j-n j.; th-' st JlDJl:;. 291 If lime water ever proves a solvent, it can only be by acting on the albuminous matter, which serves as a cement to the different strata, or parti- cles of all urinary calculi. That out of the body, it has the power of destroying the cohesion in this case, has been shewn by more than one experimen- talist. But it is said, that it ought to be given in combination with an alkali, to neutralize the excess of acid in the urine, otherwise it would unite w ith the lime, and render it wholly inert, a process, I fear, not to be very easily adjusted, in actual prac- tice, though this is substantially the composition of Stephens medicine, which acquired so much cele- brity as a solvent of the stone, that the English par- liament was induced to purchase the secret of pre- paring it, at an enormous price.* MINERAL ACIDS, Nothing can illustrate, more strikingly, the dif- ference in tbe composition of urinary calculi, than that remedies so directly the reverse of each other as the alkalis and acids, should be serviceable in the same set of affections. The muriatic, as well as the nitrous acid, has of late acquired not a little reputation in Europe, as lithontriptics. It is now • Incompatible substances.—All alkaline and metallic salts, phosphates, borates, tartrates and citrates, acids, sulphur, spirituous preparations the infusions of orange peel, colmubo, cinchona, rhubarb, senna, and all vegetable astringents. 292 about six or seven years, siuce s me ca^« were r- - corded in the periodical journals, of the efficacy of the muriatic acid especially. But. still more re- cently, Mr. Copeland. a surgeon of London, has called the attention of practitioners to both of these acids, and, from comparative trials, is led to be- lieve, that the nitrous, as a solvent, has the supe- rior pow/ers. Two cases are stated by him, in which a solu- tion of the stone, according to his account, certainly took place. In the first, thirty drops of the muriatic acid were taken in water, three times a day, the dose being gradually increased to fifty drops, and continued till two ounces were consumed, when the complaint was removed. The patient was directed to collect daily in one vessel, all the urine of the twenty-four hours. The clear urine was then pour- ed off, and tbe sediment collected upon a paper filtre. The sediment thus collected, amounted to one hundred and four grains, of a buff-coloured im- palpable powder.* In the second case, forty drops of the diluted ni- trous acid were taken in water, every two hours. • One hundred grains of this powder, subjected to chemical analy- »s, was found to conta:n, Uric acid 72 grs, Ammonia 18 Carb. of lime 3 Phosp. of lime 5 ICO 293 till a sediment appeared in the urine, and after- wards continued four times a day. By persevering with the mediciue, for nearly live months, during which time twenty-seven ounces of the diluted acid were consumed, six hundred grains of a thick light coloured powder were collected, in which, towards the conclusion, a few fragments of calculus were found, partially decomposed.* In the treatment of these cases, opium was occasionally ordered, to mi- tigate the pain. Costiveness was prevented by mild laxatives, and the stomach,, when oppressed by the frequent doses of the acid, was relieved by taking spirit and water. It appears, from Mr. Copeland's observations, that the nitrous acid, in many other instances of lithiasis, procured a discharge of sedi- ment with the urine, and an alleviation, more or less of the symptoms. As in the case of alkalis, an objection has been started to the use of the acids, in calculus. It is said, that if the stone consists chiefly of phosphate of ammonia and magnesia, instead of producing a solution of it by the introduction of acids, we should occasion a deposition of uric acid. But, in all * One hundred grains of this sediment, subjected to analysis, gave Uric scid 80 grs. Ammonia 11 Carb. of lime 2 Phosp. of lime 1 Loss 6 100 294 these cases, we must attend to the state of the urine, endeavour to ascertain its constitution, and the in- fluence of the remedies npon it, as well as their ef- fects on the comfort of tbe patient, and to suspend. or vary them accordingly. 295 DISCOURSE XYII. The Subject Continued. As yet, I have treated only of lithontriptics, or those medicines which possess, or rather, are sup- posed to be possessed of solvent powers. Butj as I have already remarked, there is another section of this class, which may, with more propriety, be call- ed anlilithics, as correctives of the lithic diathesis, or the mere palliatives of calculous affections. All the bitters and astringents, are, I suspect, without an exception, more or less of this description, though it is more conspicuously the case with gentian, quassia, centaury, chamomile, the hop, and espe- cially the uva ursi. It is also affirmed, that the common tea is endued, in a very great degree, with this property, so much so, indeed, that in China, where the article is so copiously consumed, it ap- pears that calculous affections are wholly unknown. The employment of astringents, under such cir- cumstances, is a very ancient practice, and which seems to have prevailed at all subsequent times. By some, it has been presumed, that several, or the whole, of the class of remedies of which I am speaking, have the property of dissolving the stone But it is now pretty clearly ascertained, that they have no such power, and that the symptoms in- 19) duccd by a «:on-.' may be relieved, whi'.e it continues in the bladder. Their m "do* i>p • iao di, iu the-casi-. is not disiinity understood. It ^ as conjectured, by.Cullen, and, I think, very absurdly, that they operate by absorbing the acid which i* evolved in the s^ra-ch. To me it appears infinitely moi* probable, that they act only by restorii-g the h althv lone and condition * f the digestive process, ami thereby bind; r the generation of uric acid, the fur- ther deposition of which being thus arre-vd. the asperities of the c\ -ting stone are gradually worn off, or. perhaps. a» sometimes happens, it becomes imbedded in a cist of tbe bladder, and in this way, the p-iu from irritation is diminished, or entirely removed. Of all the astringents, the nva ursi, or the arbutus uva ursi, as it is called by the botanists, is the most valuable in thes? cases. Ti/js is a plant fonnd both in Europe and this country, and is a low shrub, somewhat resembling the myrtle, growing in all the northern states, and plentifully not far from this city. It is also known by the provincial uarae* of bear berry, bears whortle berry, wild cranber rv. Aze. The uva un\ is an ancient medicine. It was employed even so early as the time of Galen, uu--;- ly. however. a> a simple diuretic, nothing of its other properties being ascertained, especially it- antilithic properties, till «ome few years ago. It is now very much prescribed in all calculous affec 297 tions, and, if it be not a solvent of the stone, it at least mitigates the symptoms of this painful disease; and promotes a freer discharge of urine. My im- pression, however, is, that it is more particularly adapted to nephritis, in all the forms of which, I have prescribed it, and with very great advantage. It is an exceedingly popular remedy in this city, and has the confidence of many of our most respec- table practitioners. From my own, as well as from the practice of my medical friends, I could adduce a variety of examples, of the successful treatment of nephritis, by this medicine. These cases, how- ever, I shall not detail, as the uva ursi does not re- quire much precision in its use. Being without any very positive action, and especially on the blood vessels, it may be exhibited in almost every state of the system, and in every variety of the diseases of the urinary organs. To the great efficacy of the uva ursi iu these cases, we have the testimony of Fer- riar, very strongly stated. " I have," says he, "given this medicine in a considerable number of nephritic cases, in very moderate doses, and al- ways with manifest advantage. When (he pain is very acute, and the pulse quick, I begin the cure with bleeding, aud a gentle purgative, composed of manna and a neutral salt. This -purgative 1 repeat twice a week, and on the intermediate days, direct the patient to take five grains of the uva ursi, and half a grain of opium, three or four times a day, ac- cording to the urgency of the symptoms. 1 have rp ■2{j8 never found larger doses necessary. This method. always relieves, and generally effects a cure. Of sixteen patients, treated in this manue . I have dis. charged twelve, cured. In reckoning the cures. _ d not rest on the cessation of a single fit. but re- quire a permanent relief from pain. Many of my po lents have used the remedy for several months together, before this end was attained. The fit- became slighter, and at length ceased.'" Besides the preceding affections, tbe uva ursi has been highly extolled in several other com- plaints of the urinary organs. By De Haen, to whom we are indebted for much of our knowledge of this remedy, it is mo«t favourably spoken of in ulceration of the kidneys, the bladder, and their ap- pendages. Catarrbus vesicae. I have seen very suc- cessfully managed by it. and the strangury from blisters not less so. But in the former complaint, its use ouzht generally to be preceded by those re- medies, which are more direetly calculated to sub- due inflammatory action, a state, of which, it al- ways partakes in the commencement. In leucorrhoea, as well as gonorrhoea, of Ions standing, our medicine has been very strenu- ously recommended. But I have tried it in all these affections, and I cannot say. that I was much encouraged by the results Leucorrhcea is a most unmanageable complaint, in very many in- stances. It consists, for the most part, of a vitia- tion of the catamenial secretion, which, in this case, 299 s very difficult to rectify, or restore to its healthy condition. Not less, perhaps, has the uva ursi been prescribed in menorrhagia, under the impression of Its great astringency. My own experience will not permit me to speak very favourably of any one of these applications of the article, still I cannot doubt of its occasional utility, after what has been affirm- ed by several respectable writers. The medicine is, on every account, well worthy of a trial in these lisorders. It appears, from its general properties,' o be admirably suited to them, and we have abun- lant authority for its having actually done good. 3ut I repeat, that I myself have been, in a great neasure, disappointed in the experiments which, as et. I have made with it. Every one who has tried the uva ursi in diabetes, eems to have been pleased with its effects. It*is iow very much used, both in Europe and tuts** ountry, and the few cases of the disease which ave come under my care, were treated partly by ■:, and successfully. Yet, diabetes can very rarelj- e cured by any one remedy. It mostly preserKs*-*a ase exceedingly complicated in its nature, often ighly febrile, and exacting copious venesection, nd purging, as preliminary measures. After the ystem is brought down to the point where tonics ve proper, then the uva ursi may be recurred to ith advantage, and not before. The annexed i.escription is that of Ferriar, which has generally 300 been adop '!, and is certainly a good one.* The uva ur-i. in this case, I have reason to believe, ope- rates very much as a tonic to the stomach, though, by virtue of its affiniiy to tbe kidneys, it may, at the same time, do away, or mitigate the irritation of these organs. That it is beneficial in the first view which 1 have exhibited of its properties. I am sa- tisfied, from having very frequently witnessed its great efficacy in tbe ordinary forms of dyspepsia, and especially, when the disease can be traced to a relaxed state of tbe stomach. The uva ursi, on the w hoi'. is undoubtedly an article possessed of very valuable properties, and which has. "m everv view, verv strong claims to om attention. Of this medicine, the average dose, in every casp. to which it may be applicable, is about • twenty grains of the powder of the leaves only, three times a day. to be gradually increased. Dou- ble this quantity, however, is sometimes prescribed. It is also given in the shape of infusion and decoc- tion. Thus prepared, ir answers very well, though I prefer tiie form of powder, as beins:. on the w hole. more certain, and, perhaps, less disagreeable to tbe taste.t HL'ML'H s LUPULU5. Tbe hop is too well known, to require any de- scription. Xor do I mean, at present, to detail its * §, Pulv. uva urs., cort Peruv aa ^i., opii. pr. ss. qua- ter in die . bibataq. cal . rii.post sin,,, dos. pulver. f Astringents. 301 general medicinal properties, or enter into tbe en- quiry, bow far calculous affections have been influ- enced by the increased consumption of malt liquors. As a lithontriptic, the infusion of hop has long been celebrated. We are told by Lobb, in his Practice of Physic, that, out of the body, it is one of the most promp and certain of the solvents of urinary calculi, and that, when given internally, it affords much relief. My experience with the hop, is confined to ne- phritis only, where it has sometimes proved very efficacious. Exhibited in a strong infusion, to the extent of a pint or more a day, it lulls pain, ex- cites the urinary evacuatiou, and after a while, in some instances, effects a cure. The tincture of the hop, which is preferred by some practitioners, is far less efficacious, and appears, indeed, to be whol- ly unadapted to these cases.* DAUCUS CAROTA. This species of carrot grows wild in many parts of the United States, and most abundantly in the vicinity of this city. It was stated, by the late pro- fessor Barton, to be the same as the common gar- den vegetable, changed somewhat by the want of cultivation. But, it would seem, that he was de- ceived. The wild, is certainly the more powerful of the two plants, though the domesticated is by up means inactive. Throughout the country, this is a * Narcotics. 302 jemedy much employed in all the urinary complaints, and, I suspect, that co:iiidencj is not misplaced in it. Hiave used it in sev r;! of these affections wi.h great advantage, and particularly in gravel. As a diuretic, it is very certain aud active. Ex- hibited merely to promote the urinary secretion, >*e shall rarely be disappointed, and, perhaps, it ought to be placed with that assortment of medi- ant, s. It is one of our best means of relieving the $rangury from blisters. An infusion either of the ic.-r or se?d, is v>>^(\. though the latter is preferred, * and may be drank as freely almost as any other he.h tea. ALLIUM SATIVUM. The alliacese. or, at least, some of these articles, lave undoubtedly been productive of utility in cal- culous affections. The allium sativum, or the com- mon garlic, i- the most powerful of the class. /rom the circumstance of its reaching the urine in dxunchanged a state, we should suspect a priori, fitat it operates pretty actively on the urinary or- rans. This suspicion has been fully verified by ex- perience. It is a highly stimulating diuretic, and, ik atony of the kidneys and bladder, has proved very serviceable. By Sydenham, a? well as by more modern wri- tes, it is much commended iu dropsy. It was. likewise, formerly, resorted to as a lithontriptic, 303 and, indeed, in anct'tnt time;, ww a very iavu;v.'itfl remedy in calculous nelections, I^ .;u s.;EC cause liuv ever, it lost all its reputali■.:■:) iu these cases and for a century we scarcely (i.id it-mentioned, ii reference to its lithontriptic virtues. But of late, ii is again creeping into practice, and, if we can ere. c 1 it the accounts which we have published, it is un« doubtedly entitled to our notice. When I was hi Europe, it was employed in tbe London hos- pitals. I do not, however, remember any very de- cided effects from it. It may be given either in substance, by cutting the cloves into pieces of a convenient size to be swal- lowed, .or the juice may be extracted by pressure, and exhibited. The leek is said to be equally use- ful, and may be administered precisely in the same manner. MAGNESIA. In the course of the last few years, not a little has been said of the value of magnesia, in calcu- lous affections. To Mr. Brande, one of the most enterprising of the European experimentalists, we owe the credit of this discovery. Denying the li- thontriptic power of any substance with which we are at present acquainted, he was induced to insti- tute an enquiry, with a view of ascertaining some means of preventing the formation of uric acid in the bladder. Comparative trials with the alkalis 304 aud rua^uesia, satisfied him of (he decidedly supe- rior efficacy of the latter article in this case, and the practice which he deduces from it, is illus- trated by four cases. These I will present, in a verv abridged form, as the remedv is a new one. to serve, in some degree, as a guide to Us use. The first is that of a srentlenian sixtv vears of a.^e. who had been in the habit of indulging in tbe free use cf acid liquors, aud who repeatedly passed small calculi, entirely composed of uric acid. Of the subcarbonates of soda and potash, he freely took without effect. Next the magnesia was di- rected, iu the dose of fifteen grains, three times a da v. in an ounce and a naif of the infusion of gen- tian. After a week, the uric acid was found, by examining the urine, to have greatly diminished, and in a short time nearly disappeared. The mag- nesia, however, was persevered iu for eight months longer, and ultimately a cure may be considered as having been effected. The second case, is that of a gentleman about forty years ago, who occasionally voided consider- able quantities of uric acid, in the form of red sand, and once passed a small calculus. His urine was generally more or less turbid, and, after taking any thing which disagreed with his stomach, even in a slight degree, the red sand often made its appear- ance. Twenty grains of magnesia, in a little lime water, every night and morning, were pre- 305 scribed for him, which, by continuing for six weeks uninterruptedly, he perfectly recovered. The third case, is that of a gentleman forty-three years of age, who, after violent exercise on horse- back, was attacked with pain in tbe right kidney and ureter, and in the course of the night, discharg- ed a small uric calculus. His uriue was turbid, and deposited red sand. To relieve these symp- toms, twenty grains of Magnesia were ordered every night. The result was, a speedy cure. The fourth case, is that of a gouty person, aged fifty-six, whose urine constantly contained a large portion of mucus and red sand His stomach was weak, and he often complained of heartburn, and pain in the neighbourhood of the rigfit kidney. The alkalis and some other remedies having failed, he was put upon twenty grains of magnesia, three times a day, mixed with water, which, however, af- fecting bis bowels, one powder was omitted, and five drops of laudanum were added to each of the other doses. Continuing this plan of treatment for six weeks, the urine became less loaded, and there was a longer escape from a paroxysm of gout, than for the six preceding years. It appears, from the cases which I have detail- ed, that while magnesia is a remedy singularly well adapted to nephritis calculosa, or gravel, it will, most probably, render little service in stone. Ex- perience has taught us, that there is, in some in- stances, a very material difference in the two com- Q q 306 plaiuts. The red sediment of urine, is simply the uric acid, and is must usually met with iu gouty and dyspeptic persons, somewhat advanced in life. Children, on the contrary, are most subject to stone, the composition of which, is. for the most part, tbe triple phosphate of ammonia and magne- sia, sometimes combined w itli the phosphate of lime, on which magnesia will not at all act. Neverthe- less, even limiting its utility to gravel, it is still a very important accession to our stock of remedies, for surely there is no case more painful, or which oftener proves difficult of management, than these affections. In dismissing this subject. I shall only further remark, that the arraugement of the preceding arti- cles, under the separate heads of diuretics and an- tilithics, is arbitrary, and. perhaps, unnecessary. Excepting the maguesia. the lime water, and. pro- bably, some of the bitters, all these medicines are possessed of nearly the same properties, and are equally appropriate to the affections of the urinary organs. 307 DISCOURSE XVIII. Diaphoretics. Next I am to treat of those means which pro- duce a discharge from the surface of the body. These constitute a very important class of remedies, and one which is applicable to the management of an extensive circle of diseases. In the common language of the schools, the term diaphoretic, is re- stricted to those articles only, which promote the insensible perspiration, and such as occasion sweat- ing, are distinguished by the appellation of sudori- fics. But, as in the medicines arranged under these titles, we can discern no difference, except in the degree of force, or what arises from the manner of administration, I shall comprehend the whole un- der the bead of diaphoretics. As the discharge from the skin is merely an in- crease of a natural secretion, it is plain, that this may take place by an invigorated aclion of the cutaneous vessels, produced, either by the direct application of stimulants to them, or by augmenting the gene- ral force of the circulation. Diaphoresis, however, is not the constant and necessary consequence of increasing the energies of the heart and arteries, as there often exists a constriction of the extreme ves- sels, which counteracts the natural tendency to per- 3 Oft spiration. To produce sweating, under such cir- cumstances, something is required to overcome this resistance, and which is most effectually accom- plished by inducing a state, which is usually deno- minated a relaxation of the surface. But, however diversified in their modus operan- di, they all concur, when properly administered, in reducing morbid action, and hence are to be consi- dered as one species of depleting remedies. They lessen the force of the heart and arteries, by a di- rect evacuation from tbe skin, bv taking out of the ordinary route, a certain portion of blood, which is determined to the extreme vessels, and by over- coming the constriction of tbe surface, which acts as an indirect stimulus to the moving powers of the circulation. As it is important, in tbe management of many diseases, that sweating should be excited, I shall now suggest some few rules to be observed in the administration of the remedies which are calculated to produce this effect. 1. To promote perspiration, it is essentially ne- cessary that tbe patient should be confined to bis bed. Let the pulse, aud the temperature of the body be carefully watched. If the one be vigorous, or the other high, venesection, where it is not par- ticularly forbidden, should be employed. It is said, that sweating never takes place, when the heat of the skin is above a hundred and eight de- grees, and by a later writer, six degrees less, and, 300 it is equally true, that, with a vigorous pulse, it rarely happens, and when it does, it is partial, and injurious. 3 In the exhibition of diaphoretu-s, give, diluent drinks, unless the stomach is irritable. This re- mark particularly applies to the antimonial prepa- rations, and some of the combinations of ipecacuan- ha. The temperature of the drinks must he regu- lated by that of the skin. The latter not being big!), they should be warm, or even hot, but, if the. contrary prevails, they must be given cold. 3. Be careful to have the linen of the pa lien f, and bed clothes often changed, when under the ef- fect of diaphoretics. The filth thus generated, does sometimes suppress perspiration, and adds much to his wretchedness. 4. In the low stages of disease, while pursuing the diaphoretic plan, studiously avoid purging, un- less circumstances imperiously require this remedy. It is very apt, iu this state of the system, to cheek sweating, and to bring on an aggravation of the complaint. It does this, by diverting action Horn the surface to the intestines, and by exposing the patient to cold. 5. As the action of the cutaneous vessels, and of the urinary organs, is in an inverse ratio, it is no less obviously proper, that when we wish the one, the other is to be restrained. During the ope- ration of a diaphoretic, therefore, we are carefully 310 to abs'aiu from the u;e of whatever has a tendency to promote the secretion of the kidneys. 6. In cases where a regular ami long continued discharge from the skin is desirable, we should ne- ver hesitate to substitute the flannel for the linen shirt. This is a very important precept, aud one which we ought always to carry with us into prac- tice. It is, indeed, impossible to keep up perspi- ration for an v length of time, wiih uniiormitv. with- out using flannel next to the skin. The older practitioners resorted to it, in all cases in which diaphoresis was to be promoted, a custom, how- ever. 1 think, not only unnecessary, but really in- jurious in acute diseases, and more especially in fe- brile affections. The frequent changes of linen, in all such cases, is exceedingly refreshing to the pa- tient, and, by its neat and eomfnnahle feel, has a tendency to allay irritation, and to subdue the rest- lessness and inquietude of fever. O.i the practical application of Diaphoretics. Diaphoretics, on the whole, when judiciously managed, constitute, undoubtedly, a very important class of remedies. As already remarked, thev de- termine blood to the surface of the body, lessen or remove internal congestion, obviate constriction of the extreme vessels, promote tbe cutaneous dis- charge, and diminish action, by reducing the quan- tity of the circulating fluids. But, perhaps, there 311 is no description of our remedies, w hieh has been more abused. The practice that universal- ly prevailed, at one time, of endeavouring to cure diseases of an inflammatory nature, by extorting sweat, by the liberal exhibition of the beating and stimulating articles, was productive of the most mischievous effects, and brought this class of me- dicines completely into discredit. It has been alleged, however, that, since di- aphoretics are not resorted to by the brute cre- ation, like emetics and cathartics, they can- not be medicines of primary importance. But, an obvious reasou for this exists, as there are very few of the lower animals, in which the function of perspiration takes place. Clothed in a thick coat of fur, or wool, or hair, no such action can be ex- cited, ou the surface of their bodies. But, as re- gards the human subject, and certain animals, there is no mode of curing diseases, more distinctly and intelligibly pointed out by nature, or the beneficial tendency of which, is more fully recognized by practitioners. Of all the modes, indeed, of managing disease, the practice of sweating is, perhaps, the most popu- lar, and generally prevalent. By the vulgar, it is resorted to on all occasions, aud, in their estima- tion, is the safest and most effectual remedy. Nor is this opinion confined altogether to the low and illiterate orders of mankind. Every class of society seems, more or less, to have acquiesced in the pre- 31.2 judice, and to entertain the same views. It is still however, <-b\ious. that, remedies which so power- fully operate on tbe swtni as diaphoretics do. aie not waiitOiily to be trifled with, or iucusiderately u-cd. To the intermittent fever, diaphoretic? arc well adapted. When correctly prescribed in these casts. i!:ey have, indeed, the twofold effect of conducting tbe paroxysm to a speedy solution, by exciting per- spiration, and of obviating its recurrence, by sup. porting the tone of the extreme vessels. I! in these opposite states of the disease, a very diuercnt species of the medicine is exacted. To prevent tbe paroxysm, the stimulating diaphoretics are usually directed, while, to subdue it, the cooling and relax- ing are found to be preferable. Nor are these remedies scarcely less suited to remittent and continued fevers. They are uot. bow- ever, to be rashly or indiscriminately employed. Discarding utterly the notion, of fever being an ef- fort of nature to throw off peccant matter, as w r.s once supposed, we are not to force or encourage pi.spiration in tbe early stages, by the use of any of the alexipharmic means. But, on the contra- ry, it is to be recollected, that, in the present re- formed state of our science, it is a principle settled and fully recognised, never to resort to diaphore- tics, iu fevers of an inflammatory species, till arte- rial action and general excitement are considerably reduced by previous, venesection and evacuations h\ 313 puking or purging. After this direct depletion, diaphoretics then come in with great advantage, aud will commonly either mitigate, or completely ar- rest the progress of the disease. Even here, how- ever, we trust only to the milder medicines, com- bining with them all the auxiliaries which have the same cooling and relaxing tendencies, it mav, in- deed, be laid down as a rule, never to be deviated from, that, in the whole of the inflammatory cases, we are rather to solicit perspiration by lenient means, than to extort it by any violent measures. These reflections are alike applicable to our com- mon bilious, and the yellow fever. In that order of febrile affections, comprehended- under the denomination of typhus, it is sufficiently known how beneficially the diaphoretic remedies are prescribed. As these fevers are accompanied with feeble action, attempts to excite perspiration may be much earlier made, than in the preceding cases. Even here, however, some degree of cir- cumspection is necessary. It is now, I believe, an established practice, sanctioned by the highest au- thority, that, in the two forms of typhus, the gravior and mitior, of the systematic writers, sweating ought to be preceded by evacuations of the alimentary canal, and cold affusions to the surface. This, at least, was the course of proceeding in those diseases during my residence in Europe, and 1 have no rea- son to suppose, that any change, in this respect, has since taken place. it r 314 The typhus fever, such as I have alluded to, is not one of the complaints of this city, or, perhaps, in any great degree, of any section of the United States. Exclusively, or nearly so, the product of camps, of ships, of jails, and other crouded re- ceptacles of vice, poverty, and filth, it finds no where within the limits of our happy country, any copious source of generation, or the medium of ge- neral prevalence. As yet, I have had uuder my care only a few cases of this species of fever, affording me too uarrow an opportunity of testing, by my own personal experience, any mode of treatment, and therefore I advance my opinion diffidently on the subject. Determining, however, from what I ob- served in the hospitals abroad, I should, without hesitation, say, that the practice which 1 have al- ready detailed, is the one by which the disease is mast successfully managed. But. in the place of this severe scourge of Eu- rope, there has, of late years, appeared among us a w ide wasting pestilence of the same typhus charac- ter, which, in its career, has ravaged and desolated some of the fairest portions of our country. All ac- counts agree in representing this disease, the spot- ted fever, as a perfect Proteus, assuming every va- riety of shape, and requiring no little diversity of treatment. But iu whatever form it commences, there generally ensues a great, and in many in- stances, an unprecedented prostration of strength. Two leading modes of treating the disease, have 315 been adopted. By one set of practitioners, the most profuse use of the diffusible stimulants, has been recommended, while, by another, the sweating plan is preferred. My opportunities have been sufficient to compare these different plans of managing the dis- ease, and 1 do not entertain the slightest doubt of the superiority of the latter course. The mind of the physicians of this city, at least, is pretty well made up on this point, and they all acknowledge the infi- nitely greater success which attended the early and steady employment of the more active diaphoretic remedies. But, such is the practice when the dis- ease assumes its most simple guise. Distinguished, as it very often is, by great local determinations, as in the bilious, pneumonic, and anginose cases, it is universally conceded that in these, some difference of treatment is required. Emetics, here, have been found pre-eminently useful, and are sometimes fol- lowed by tbe mercurial purgatives. After the end is attained for which these evacuants arc adminis- tered, we may recur to the diaphoretics, and, to re- move any remnant of topical congestion or pain, blisters, or the most acrid rubefacient applications, become the appropriate means. But, besides this new species, we have another form of the same description of disease, which hi- therto has not been noticed, or I have not, at least, met with any account of it in the course of my reading. It is produced by the long exposure to cold, and affords one of the clearest illustrations 316 of the sedative influence of a low deqiee of tempe- rature on the animal economy, when Ion;; conti- nued. The cases of the disease, which have come under my observation, have been chieiH the pau- pers of the Alms House, who, sometimes, are brought into that establishment dnrinzthe intensely cold weather of winter, in a state approaching tor- pidity. They are in a heavy stupor, the power of speech is lost, or greatly impaired, the pulse is ei- ther very feeble, or wholly imperceptible, the sur- 4 face is cold, with nearly an extinguishment of sensi- bility, and suppression of the movements of vitality. In this situation, which resembles not a little the in- cipient state of hybernation of some of the inferior animals, the indication is obviously to solicit the re- turn of the actions of life, by tbe use of stimuli, gra- duated to the feeble remains of excitability. The warm bath,in the commencement, perhaps, answers better than any other remedy, but, where this can- not be procured, dry heat applied to the surface, may be substituted, and cordial stimulants should be given internally. It is often exceedingly difficult, from the loss of susceptibility, to arouse the system by any plan of treatment. But, most commonly, after a very short time, a partial re-action takes place, and the result is, a slow and feeble state of fever, very analogous in all its essential attributes and leading features, to the typhus gravior, of the schools. Like that dis- ease, in its advanced stages, there is the dark and 317 i:;"ruslated tongue, the skin is hot and parched, the pulse is quick and small, there is low delirium, the eyes are glassy, with dilated or exceedingly contracted pupils, and that lank, haggard, and dis- tressing expression of countenance exists, which is peculiar to the worst forms of the malignant fe- brile affections. In many instances, I have known the patient to continue in this state, with little or no deviation, for six or eight weeks, and ultimately to recover. The treatment, during this protracted in- terval, has consisted, in the persevering exhibition of stimuli, chiefly the volatile alkali, the capsicum, camphor, wine, or warm spirituous drinks. As soon as the system begins to re-act, which is perceived by a more complete exercise of the natu- ral functions, stimulating sudorifics may be em- ployed with advantage. They relax the surface, develop a new animal temperature, and release, as it were, from the bondage in which they had so long been held, all the vital energies. As, in some degree, connected with the preced- ing diseases, I am next to make a few remarks on the application of diaphoretics to those febrile affec- tions, which are supposed to be produced from con- tagion. During tbe dominion of the humoral pa- thology, a system of notions, that originated in an eclipse of medical reason, and which has been perpetuated to the present moment, by an ignoble servitude to authority, it was believed, 318 that the particles of the virus floating in tbe circula- tion, and still keeping up the fever, could be eliminat- ed through the pores of the skin. Conducting the treatment on this hypothesis, the sweating plan was early resorted to, and pushed to the utmost extent, in everv sta^e of the disease. As described, such was the course pursued, more especially in plague, smallpox, and, at one time, even in syphilis, afford- ing an example, among many others, which might be adduced, of false theory being the parent of mis- chievous practice. In disease of this nature, whether of a low or inflammatory character, there is unquestionably a point which will occur to every judicious practi- tioner, at which we may very usefully r^on to dia- phoretics. But there is nothing peculiar in their operation, iu these cases. They act here, as in other instances, on the general principles 1 have already stated, and the only guide which is ne- cessary to their correct administration, is. a due attention to the state of the system, either usins: the stimulant or relaxing medicines, as the existing cir- cumstances may seem to demand. Eruptive complaints, whether of an acute or chronic nature, have always been much treated by diaphoretics. The skin being tbe immediate seat of those diversified affections, it was reasonable to suppose, that sweating would produce the best ef- fects. There are many of these, however, in which there is so much heat of the surface, and, at the 319 same time, such arterial action, that it is not admis- sible to resort even to tbe mildest diaphoretics, without previous evacuations of a more direct and powerful description. But the force of the circula- tion being reduced by venesection or purging, or by cold affusions, a relaxation of the surface, by means of these medicines, is often productive of the hap- piest effects. In most of the affections of the bowels, diapho- retics are, undoubtedly, among our best remedies. It is now more than half a century, since the cele- brated Dr. Akenside, the poet and the physician, proclaimed the superiority of the sweating plan over all others, in the management of dysentery. To the preparations of ipecacuanha, as we have be- fore seen, he chiefly confided in these cases. These views have subsequently been adopted, with some modifications, by several very distinguished practi- tioners. It has been particularly insisted by Rich- ter, an authority, among the highest of the present age, that dysentery is a rheumatic, or catarrhous affection of the larger intestines, and accordingly, in its treatment, the leading indication, is to excite perspiration. Without adopting precisely his theo- ry, as applicable to all cases of tbe disease, I con- cur, most entirely, in the rectitude and propriety of his practice. It has long been my conviction, that, in all the bowel affections, we have, as a general rule, purged infinitely too much. Cherishing, still, the an- 320 liquated doctrine of morbid humours, it is usual, in these complaints, with many practitioners, to evacu- ate the intestines, so long as almost any discharge can be procured, under the impression, that the matter retained, is irritating and offensive, and, therefore, the immediate source of all the mischief. The very reverse of this, 1 hold to be true. Contrary to the generally received opinion, it appears to me, that the accumulation of acrid matter, in these cases, is the effect of previous irritation in the stomach and bowels, which causes an increased effusion from the mucous follicles, or the exhalent vessels, and sometimes, a very vitiated secretion of bile. De- ducing my practice from this view of the nature of the disease, I have been accustomed, after compa- ratively moderate evacuations of the bowels, to exhibit medicines so compounded, as to meet the double indication of allaying, immediately, tbe in- testinal irritation, and more remotely, of relaxing the surface. Combinations of opium and ipecacuanha, are an invaluable preparation for this purpose. But "•where the irritation is excessive, and, as usual, is productive of frequent and painful discharges, I either augment the quality of opium, or, what is more effectual, administer anodyne injections, three or four times in the course of the twenty-four hours. These remedies will, in most cases, very speedily calm the irritation of the bowels, and, as soon as this happens, the acrid discbarges, together with the other symptoms, cease to be troublesome. 321 In cholera morbus, as well as in the bowel affect tion of children, which is emphatically called the summer complaint, I pursue pretty nearly the same1 practice, and with equal success. The latter dis- ease, which might really be considered as among the opprobria medicorum, from the dreadful expenditure of life which it occasions, in the early season of ex- istence, owes, undoubtedly, much of its mortality to the preposterous mode in which it has hitherto been treated. Continually purged for days in sue* cession, what else can be anticipated from such a course of exhaustion, except the rapid decay, and ultimate dissolution, of the delicate frame of a child? My practice in cholera infantum, is ex- tremely simple. Entertaining the same views with respect to it, as I do of dysentery, I endeavour, after limited evacuations, to quiet the irritation of the bowels, which being accomplished, I next re- sort to astringents, to restore tbe tone of the ali- mentary canal, and for this purpose, the decoction of the root of the black or dew berry,* is preferable to every other article. As yet, my remarks have had reference chiefly to the acute forms of intestinal disease. Before I finally dismiss the subject, I must say a word or two relative to chronic dysentery. This is a com- plaint, which, perhaps, has not attracted as much attention as it deserves. In these cases, though the acute symptoms be removed, there still re- * Vid. Astringent*, S S 323 mains considerable tenderness of the bowels, which are excited to action frequently, and by the slight- est causes, producing small stools, mostly consisting of mucus, and very offensive. Every evacuation is attended with more or less griping, and which often becomes exceedingly painful. Little appetite exists, and what food is taken, is not digested. The skin is dry, and parched, the complexion sallow, and the eyes are sunk, with a shrivelled and meagre ex- pression of face. Evidently, there is here a confine- ment of tbe blood to the great vessels, and, on this account, the determination to tbe surface is consi- derably diminished. I have met, in the course of my practice, with se- veral such instances, which, after resisting the or- dinary treatment by tonics, have very rapidly reco- vered under the use of those means which are neces- sary to promote, and keep up a gentle relaxation of the surface, and a moderate degree of perspiration. The same practice may be pursued in chronic diar- rhoea, and in protracted cholera infantum with no less advantage. The disease, in all these cases, is occasionally continued, by a morbid condition, ei- ther of the liver, or some other of the viscera, and where this happens, or we have reason to suspect it, calomel, in minute quantities, may very usefully be united to the other medicines. After having said so much, it is hardly neces- sary to add, that in enteritis, the same course is to be pursued, with this difference, only, that venesec- 323 tion is much more, in the latter instance, urgently demanded. As respects peritoneal inflammation, I have had already several occasions of expressing my opinion of tbe peculiarity of its nature, and the extreme dif- ficulty of its cure. I shall, therefore, after repeat- ing here, that the most prompt and copious detrac- tions of blood, are indispensable in the first stages of an attack, only mention, that having reached the point when the lancet must be stopped, sweating is the remedy in which we ought to confide, and that it will often be productive of the most satisfactory re- sults. It may be further remarked, that it is highly im- portant in the management of every bowel affection, and in every stage of it, to attend vigilantly to the state of the surface, with a view of preserving the tone and excitement of the extreme vessels. To at- tain this end, the co-operation of blisters, and of warmth, by means of flannel, is frequently required, and, to render tbe latter more effectual, in these chronic cases, it should be applied as a roller tightly around the body, from the hips to the arm-pits. By this very simple expedient, I have done great good in these complaints, having very much used it, as is well known, both in my public and private prac- tice, long before the appearance of Mr. Dewar's book, where it is particularly noticed.* The roller, * It is also a matter of proof, that many years ago, I used the roller to rheumatic limbs, and in gangrene from (edematous swellings. 324 under such circumstances, seems to act, by afford- ing mechanical support to the bowels, by producing a determination to tbe surface, by exciting mode- rate diaphoresis, and by sustaining the natural de- gree of temperature. By the writer to whom I have just alluded, it is stated, that this application is equally beneficial, even in the early stages of dy- sentery, an opinion, however, in which I cannot acquiesce. But as a preventive of a relapse, where such is apprehended, it may be very advantageous- ly recurred to, in the convalescence of that disease. There is scarcely a case of phlegmasia, in which the skin is not hot and dry, and hence diaphoretics are plainly indicated. But, as the temperature is often above the sweating point, we must previously resort to measures which have a more powerful ten- dency to reduce the force of tbe circulation, and to restrain the evolution of heat. Cold to tbe surface, is an admirable remedy under such circumstances, though there are some exceptions to its use, and rheumatism is one of those cases. Why cold should prove injurious, when applied to the heated and in- flamed joints in this disease, does not very clearly appear. But of the fact, there can be little doubt, and we must be governed accordingly in practice.* Every one who is at all conversant with disease, has heard of the peculiar efficacy of sweating in * I am perfectly aware, that cold applications to rheumatic swellin gs, have been used in this country, on the authority of the Russian physi- cians, but, I have reason to helieve, with results, such as I have stated. 325 rheumatism. It is, however, worthy of remark that, in the early stages of this complaint, it is rare- ly beneficial, and ought, invariably to be preceded by more active depletion. As regards the associate affection, gout, much difference of opinion has prevailed, as to the pro- priety of our class of remedies. Believing it to be one of those diseases, dependent on morbific mat- ter, and that the skin is the natural emanctory for its discharge, the disciples of the humoral patho- logy, iudulged in the very free use of diaphoretics. I have already developed my views, as to the treat- ment of the arthritic affections. As auxiliary means, diaphoretics are unquestionably servicea- ble, and may be liberally employed. Next to purg- ing, there is scarcely any thing which affords so much relief as sweating, in this disease. Nature, whose indications ought alvvays to be consulted, and which, most generally, may be trusted, distinctly points out these two operations. It ought not to be forgotten, that the paroxysms of regular gout, when spontaneously cured, go off", most commonly, with di- arrhoea, or diaphoresis, and sometimes by diuresis. Nevertheless, we are not too early to resort to this re- medy. As much as any other case, is the arthritic pa- roxysm distinguished by a high degree of inflammato- ry action, peculiar in its nature, though best managed by the ordinary means of depletion. The pulse and temperature of the surface being lowered, sweating comes in, sometimes, very advantageously. As in 326 rheumatism, cold applications, though apparently proper, are prohibited. Much, I am sensible, has been said in their favour, and especially of the uti- lity of immersing the feet in a cold bath, when they are painfully swollen by podagra. But the expe- rience of the wise and the circumspect, the only guide in such matters, is against the practice most decidedly. Tbe only case in which it is at all ad- missible, is where the subject of the attack is of a vigorous constitution, and even here, it will be pru- dent, to fortify tbe stomach previously, by taking something cordial and stimulating, so as to guard more completely against a retrocession. Of the utility of diaphoretics, in some of the pul- monary affections, we are all apprised, and they e appropriate to very different stages of these cases. Exhibited in the forming state of catarrh or of pneumonia, and sometimes of asthma, they will completely suppress the attack, and reinstate health. But if postponed till the disease is firmly fixed, they never fail violently to exacerbate the symptoms, and to render the cure more tedious and difficult. Yet, as in the preceding cases, when ar- terial action is sufficiently reduced, sweating may be recurred to, with a view of equalizing excite- ment, and extinguishing tbe last remnants of dis- ease, and this is especially true, in relation to pleu- risy, and the other acute shapes of pneumonic in- flammation. The only case of Neuroses, in which sweating 327 has been used by me, is idiopbatic tetanus. This affection, when brought on by exposure to cold, by far the most common cause of it, partakes much of the character of rheumatism, and exacts nearly the same treatment. But there is this difference in the two cases, that the former has little activity of pulse, and the surface is cold and damp in the first stage. Diaphoresis, therefore, is at once indicated, and when the system fully re-acts, which it will speedily do, under the cordial and stimulating re- medies, as the hot bath, volatile alkali, and wine whey, then, if necessary, we may purge and bleed. Diaphoretics are advantageously prescribed in a variety of other morbid affections. They have been especially recommeuded in diabetes, and some few cases are recorded, of their successful exhibition. Two opinions at present exist, relative to the origin and seat of this disease. The first refers it altoge- ther to derangements in the secretory organs of the urine, and the second, to a vitiated or depraved state of the digestive apparatus. The latter hypothesis, which is by no means a modern one, was adopted by Cullen, and has sub- sequently been supported by a number of able and ingenious writers. My own conviction is, that dia- betes depends maiuly on a morbid condition of the stomach, and, perhaps, more or less, of the whole cbylopoietic viscera, by which the assimilative pro- cess is imperfectly executed. To this conclusion, 328 I am led, by various considerations, which I cannot here be permitted to detail. Of this disease, there are two distinct species: 1. Diabetes mellitus, when the urine has the co- lour, odour, and taste of honey. 2. Diabetes insipidus, when limpid only. But, though the complaint may assume different forms, it is managed by the same remedies, accom- modated to the state of the system, and the particu- lar circumstances of the case. It is not my inten- tion to enter into the treatment of diabetes. Yet, I cannot forbear again to mention, that in the few cases of the disease which have come under my notice, there was great activity of pulse, and many of the other indications of the febrile condition. After bleeding very repeatedly, and never without mani- fest advantage, I have trusted to occasional purg- ing, and finally, to the plan of treatment which is adopted in dyspepsia, consisting of tonics, the uva ursi and lime water more particularly, and to a diet restricted to milk, and the lighter and most di- gestible meats. I have remarked, that sweating has sometimes been used with success in these cases. Diaphore- tics are, indeed, a class of medicines, from which salutary effects might have been anticipated. I mean so far, at least, as respects the diminution of the urinary discharge. The principle on which they act here, has been explained on a preceding occasion. But, besides diverting evacuations from 329 the kidneys to tbe exbalents of the surface, they seem to be especially required by the state of the skin itself, it having been noticed by the writers on this subject, that the surface of the body, in dia- betes, is singularly dry, and often either parched and heated, or cold and scaly. Dropsy is the last disease of which I shall speak. As an increase of the discharge by the skin, has the effect of diminishing that from the kidneys, diaphoretics could hardly be presumed to be admissible in dropsical effusions. They have, however, unquestionably done good in some of these cases. It was, indeed, at one time, quite a favourite practice, to treat dropsy by sweating, and has recently been again revived on the continent of Europe. 1 have used it myself with sufficient suc- cess to recommend it to attention. The cases to which the remedy seems more particularly adapted, are such as have had their origin in inter- mittent fever, and are kept up by visceral conges- tions. Commonly, there is here a small, tense, corded pulse, with cold extremities, and pallid countenance, a dry skin, together with all the other circumstances which denote a feeble and imperfect circulation on the surface. Diaphoretics, from their centrifugal operation, relieve the viscera by deter- mining the blood to the extreme vessels, and re- store that equipoise in the circulation, which con- stitutes the first step in the cure of the disease, and the re-establishment of health. T t 930 No practitioner can be ignorant of the utility of diaphoretics in the more obstinate chronic affections of the skin, and especially in the leprous and her- petic cases. They act here, most probably, by changing the morbid condition of the extreme ves- sels, and the antimonials, united with mercury, are thought the most effectual. But, as we shall here- after learn, there is a class of articles, as sulphur, guaiacum, &c. not less suited to certain cases. To the preceding diseases, many others might be added, in which diaphoretics have proved service- able. But I have already lingered so long on this subject, that I cannot go into further details. Enough has been said, to serve as a guide to their general administration, and, as respects their spe- cial application, I must leave much to the sagacity and experience of the practitioner himself. 331 DISCOURSE XIX. Of Particular Diaphoretics. These may be divided, according to my general plan of classification, into the mild or relaxing, and the active or stimulating. Of the first order, or mild diaphoretics, we have not many articles which possess this, as a distinct or independent property. They either have it, in common with an emetic or purgative power, or ac- quire it by combination with one or more substances, and most of the neutral salts are of this description. Exhibited in minute doses alone, or in union with antimony, they will generally produce diaphoresis, or, at least, a softness of the skin, accompanied by a reduction of arterial action, and of animal tempe- rature. In this respect, they resemble the mineral acids, and some other articles, which are denomi- nated refrigerants. How this class of medicines produces its effects, is not easily explained. By the later writers, it is referred altogether to a che- mical action. But the hypothesis, though suffi- ciently ingenious, affords no satisfactory solution of the problem. As the reduction of the power of the circulation, usually diminishes, in a correspondent proportion, animal heat, may it not be owing only to this cause? 332 ANTIMONIAL PREPARATIONS. It is well known, that all of these, without a so- litary exception, may be so managed as to prove diaphoretic, though there are two or three of them which, at present, are greatly preferred for this pur- pose. As an imitation of the once celebrated James's Powder, a combination of the calx of anti- mony with the phosphate of lime, called the pulvis antimonialis, has been introduced into the materia medica, as one of the most active of the sweating medicines. It is not at all improbable, that it may answer exceedingly well, but it has now, for some time, entirely given way in practice to a neater and less precarious preparation. Those, however, who are disposed to try it, may direct it in the dose of eight or ten grains, to be repeated, if necessary, at stated intervals. On the continent of Europe, and especially in France, the golden sulphur of antimony, or Kermes mineral,* for they are essentially the same, has long maintained an indisputable ascendency, in the estimation of practitioners, over all its correlative preparations. My own experience will not allow me to speak in any decisive tone, as to the value of this medicine. I have very rarely prescribed it, be- cause my prejudices were against its use, chiefly on account of its being less convenient in the adminis- * Sulphur Auratum Antimonii, vel Sulphuretum Antimonii Prjeci. pitatum, 383 tration. Compared with the emetic tartar, it is, I think, in every view, decidedly inferior. As I have, more than once before said, this latter medicine may be so combined, as to supersede all the rest of the antimonial preparations. Nearly tasteless and inodorous, it can, at all times, be exhibited without difficulty, and certainly possesses, so far as I am able to determine, equal, if not transcendent pow- ers. As a diaphoretic, the golden sulphur of anti- mony is usually directed in the dose of five or six grains, made into pills. The emetic tartar is, when given alone, simply dissolved in water, sometimes coloured with cochineal merely to disguise it, and in the fourth, sixth, or eighth of a grain every hour or two, till the effect is fully attained. But it is much more customary to prescribe it in various states of combination, and particularly where it is desirable to move the bowels, as well as to relax the surface. To meet this double indication, I have often resorted, with conspicuous advantage, to the annexed formula.* Of this mixture, a table spoon- ful may be given every hour. Exhibited more fre- quently, or in ia larger dose, it will evacuate most copiously the alimentary canal. After the previous use of the active purgatives, as calomel, and its or- dinary adjuncts, I know of no medicine, which is better suited to the bilious fevers of our climate. It * R Sal glaub. 5i., Emet. tart. gr. i., Succ. limon. ^i., aq. font. ferv. 2iii. m. 334 keeps the bowels and the skin precisely in that condition which is so favourable to the solution of fever. Not dissimilar in its effects, or, at least, in some of its leading effects, to this mixture, is a saturated solution of tbe carbonate of potash, with a vegeta- ble acid.* To increase its diaphoretic power, the dulcified spirit of nitre and the antimonial wine may be added, in such proportions as may seem ne- cessary, and the dose is a table spoonful. This preparation is peculiarly adapted to tbe febrile af- fections of children, and even to grown people of delicacy of habit. Exceeding grateful to the sto- mach, when given without the antimonial wine, it is eminently calculated to allay nausea, to soften the skin, to preserve the laxative state of the bow- els, and to obviate or subdue the exacerbations of fever. This is called the saline or neutral mixture: the draught of Riverius differs chiefly from it in being given during its effervescence, and is form- ed by dissolving forty or sixty grains of the salt of tartar in half a wine glass full of water, adding gra- dually the citric acid, or very sharp vinegar, till the fixed air is disengaged, when, in this foaming state, it is swallowed. By some practitioners, the solu- tion of the alkali is first exhibited, and immediately afterwards the acid, so that the disengagement of * R Succin. lim. vel Acet. com. §ii., Sal. tart. q. s ad sa- turated: adde Aq. font, ^ii., Saccu. atb. Ji. m. 335 the fixed air may take place in the stomach. Tbe former mode, however, appears to me to be prefer- able. As a corrective of nausea, and even to re- strain vomiting, this draught has been much cele- brated. Excepting this quality, which it certainly has in a very high degree, it is inferior, I believe, in all other respects, to the saturated mixture. NITRAS POTASS^. No medicine is, perhaps, more used in fever, and other inflammatory cases, than the nitrate of potash, or common nitre, with a view to its diaphoretic pro- perty. But I am doubtful whether it has any di- rect operation of this sort: unquestionably it does not often produce sweating. It is, nevertheless, a very important medicine in reducing the force of the circulation, from whatever cause proceeding, and hence is applicable to the treatment of a very ex- tensive set of diseases. To increase its powers, however, it is usual to unite with it calomel and emetic tartar, and this combination constitutes the well known nitrous pow- der, which, of late years, has been so universally em- ployed. These three ingredients enter into its com- position in the proportions which are stated below.* Of these powders, one may be taken once in two * R Sal. nitr. 31., Calom. prep. gr. xvi, Emet. tart. gr. i. m. Div. in pulv. viii. 336 •r three hours. This prescription is suited rather to the more robust patients, and, from the quantity of calomel which it contains, will be apt to purge. But this is a matter which, in practice, may be easily regulated. In some cases, it will be prudent to ex- clude the calomel, lest it might harass the bowels, or even excite salivation, which it is likely to do, when continued for several days. I have known, indeed, in more than one instance, a single dose of the powder to have this effect. The emetic tartar will also have to be graduated to tbe circumstances of the case. Even in the moderate quantity in which it enters into the preceding prescription, it iometimes exceedingly distresses the stomach, or excites vomiting. The principle, which is to serve as a guide to tbe exhibition of this valuable medicine, may be col- lected from the tenor of my preceding observations, and hence I shall not notice particularly the cases to which it is suited. IPECACUANHA* The last of the relaxing diaphoretics I shall men- tion, is the ipecacuanha, than which, no article ap- pertaining to this set of medicines is more certain, active, and efficient, in the generality of cases. It may be given in the dose of one or two grains, to be repeated, as is customary with such remedies. This L>U/ is an article which seems to have a peculiar affinity to tbe surface, and operates very remarkably, by the degree of relaxation which it induces. It is, on this account, exceedingly appropriate to all cases where spasmodic constriction, of any kind, is to be over- come by sweating. The wine of ipecacuanha may be substituted, and the dose is about a drachm. In concluding the consideration of the lenient diaphoretics, I have to remark, that they ought to be given at much shorter intervals, and, if necessa- ry, from gastric distress, in smaller doses, than is commonly directed. As a general rule, the pe- riod between the doses of a medicine should not be so remote as to allow of the slightest abatement in the impression, and this applies with peculiar force to the articles of which I am treating. The operation of most of them is extremely transitory, and if the impression be not kept up, by a regular and frequent renewal, it quickly passes away, leav- ing the system to contend against all the conse- quences of the process of sweating, imperfectly per- formed, or too suddenly suppressed; Of Stimulating Diaphoretics. The force of the circulation, with a view of ex- citing perspiration, may be increased by a variety of means. Of the medicines capable of doing this, I shall first mention opium, which, though undoubt- edly a diaphoretic, is rarely exhibited alone. It is u u 338 highly stimulating, and with a view of tempering this effect, as well as to determine it more directly to the surface, we usually combine it with some other substance. Either antimony or ipecacuanha, is employed for this purpose, and may be prescrib- ed in substance or in the fluid state. A grain of opium, and one fourth or sixth of a grain of emetic tartar, will sometimes actively excite sweating. But combinations of laudanum, with antimonial wine and the dulcified spirit of nitre, are a neater, and perhaps a still more efficient prescription.* This draught is usually given at bed time, and is very applicable to the ordinary catarrhal affections, or other complaints where a moderate diaphoresis is desirable. But it is not so well suited to excite, or to keep up profuse sweating in the more intracta- ble cases. To meet this indication, the union of opi- um with ipecacuanha is infinitely to be preferred. There is, indeed, not in the whole circle of dia- phoretics one article, which in my opinion, can at all be compared, either as regards certainty, or ge- neral utility, to the preparation called Dover's pow- der, f Comprising within itself opposite properties, it may, on this account, be applied to a great diversity of cases, as has and will be still further indicated in * ]$> Tinct. Theb. £tt. xxv. Sp. nitr. dulc. 3 l Vin. anti- mon. gtt. xxxx. Aq. font. 5 ss. This combination very fre- quently operates as a diu etic ii dropsy, and has more than once within my knowledge removed the effusion in this dis- ease, under circumstances, the least to be expected. f Fulvis Ipecac, et Opii. 339 the progress of these discourses. This famous com- position consists of one part of opium and ipecacu- anha each, and eight of the sulphate of potash. By some practitioners, attempts have been made to improve its qualities, by substituting in the place of the vitriolated tartar, loaf sugar, nitre, &c. But so far from any advantage having accrued from these in- novations, I am persuaded that they have proved injurious. The exact prescription of Dover, has always appeared to me to be one of those lucky hits in the compounding of medicines, which al- lows of no alteration, either in the ingredients themselves, or the proportions. As a diaphoretic, this powder, made in the old way, has for a very long time maintained an almost unrivalled reputa- tion for certainty of effect, and before we run the risque of change, the evidence to the improvement of it by doing so, should be very clear and satis- factory. In the exhibition of the Dover's powder, very precise rules have been laid down by several wri- ters, and particularly by Cullen, which they insist upon having observed. But I am not sensible that any particular formalities are demanded in this case, and all that seems to me to be necessary is an attention to those general precepts which 1 sug- gested in my preliminary discussion on this class of medicines. The dose of the powder is about ten grains, to be repeated every third, fourth, or fifth hour, and to have its operation promoted by warm 840 drinks, and particularly wine whey. But these, as I formerly mentioned, are not to be allowed imme- diately, lest vomiting should be provoked. To point out in detail, the various diseases in which this medicine is directed, seems to me to be superfluous. It is, perhaps, suited to the whole of the phlegmasia, in the secondary stages, when arte- rial action, and general excitement, have been sub- dued by venesection, and tbe rest of the directly depleting processes. But it is in rheumatism, un- der the precise circumstances which I have just stated, that it has been mostly employed. As a maxim pertinent to this case, let it be recollected, that the Dover's powder is never admissible in this disease, while any considerable febrile excitement prevails, and, when once begun, the sweating is steadily to be maintained for not less, on an ave. rage, than twenty four hours. Of the utility of this powder in the bowel affec- tions, I have nothing to add to what I have so re- cently and repeatedly said, under different heads, Though this precise preparation is not here always prescribed, we resort to combinations of nearly the game articles, and pretty much in a similar way. Not long ago, we had some communications, in the London medical journals, of the efficacy of Do- ver's powder in diabetes. Whether it is really useful in any of these cases, I cannot determine, from any experience of my own. Diaphoretics are, undoubtedly, sometimes called for in this disease, 341 and the Dover's powder, under such circumstances, would seem to have, on several accounts, strong claims to our attention. By this medicine, I have treated dropsy exclu- sively, and not without success. Tbe experiment was made in one of the public institutions of this city, on cases apparently excited by cold, and blended with intermittent fever, and in ascites, as well as anasarca. Three out of the five, were promptly and radically cured. CAMPHOR. To the class of medicines of which I am treat- ing, camphor has always been considered as be- longing. It undoubtedly evinces some affinity to the skin, though, given by itself, rarely produces any perspiration. In this respect, its power may be augmented by connecting it with opium, calo- mel, nitre, ipecacuanha, or antimony.* PREPARATIONS OF AMMONIA. Closely allied to camphor, in its leading proper- ties, is the carbonate of ammonia. Like that medi- cine, it acts on the surface, and pretty much in the same degree. They are each employed with singu- lar advantage in the low states of disease, but more * Stimulants. 342 to sustain the tone and excitement of the system, than to promote sweating.* The Spiritus Mindereri, or acetate of ammonia, is a much superior diaphoretic. This preparation was once in high repute, but, as too often happens, in the fluctuations of practice, has been supplanted by other medicines of far less efficacy. Exhibited iu the dose of a table spoonful every hour or two, mixed with a little water, it with great certainty excites per- spiration, and may be very advantageously reported to on many occasions. Of all the diaphoretics, it is the best adapted to break down and bring to a speedy issue, the paroxysm of intermittent fever. In its ef- fects, it is neither very heating nor stimulating, and may, therefore, be applied with less caution, than most of the other articles of the same class- There is another circumstance which recommends this me- dicine : being cordial to the stomach, it will often be retained, when, from irritability of that organ, every thing else is rejected. The citrate of ammonia has many of the qualities of the preceding preparation, and may be used as a substitute, though I cannot doubt of its inferiority. It is generally an extemporaneous prescription, the lemon juice being saturated by the ammonia, in the same mode precisely as I have directed with regard to the potash, in the neutral mixture. * Stimulants. 343 EUPATORIUM PERFOLIATUM. This, which is a native vegetable, I am persuad- ed, is among the most valuable of the diaphoretics. Combining within itself a vast diversity of proper- ties, it is susceptible of being applied to numerous practical purposes. By a different mode of exhibi- tion, it proves emetic, purgative, diuretic, tonic, and actively diaphoretic. But it is in the last view, that it now interests us. Every part of the plant is medicinal, though the flowers are most so. Exhibited in strong infusion, they hardly, indeed, ever fail of their effect, and hence are greatly prescribed, especially in domes- tic practice. To catarrhal affections, in the early stage, our medicine is said to be well adapted. The people of the country prescribe it freely in such complaints, and repose no slender confidence in its powers. Not the least memorable application of the article, was of this nature. Thirty years ago, we had through- out the United States, a singular catarrh, or species of influenza, which, in consequence of the sort of pain attending it, came to be denominated the break bone fever. The eupatorium, acting as a diaphore- tic, so promptly relieved this peculiar symptom, that it acquired the popular title of bone-set, which it retains to the present moment. The more common name, however, is thorough wort. Nor is it less used in acute rheumatism. My own 344 experience will not permit me to say much of it, under these circumstances. Determining, however, from analogy, which is corroborated by reports I have received from several respectable practitioners who have tried it, I can entertain no doubt of its be- ing beneficial in some of the rheumatic cases. It has been stated, that in one of our epidemics, the eupatorium was successfully prescribed. En- couraged by former experience, during tbe yellow fever of 1798, in this city, when the sweating plan of treating the disease was so eagerly pursued, the thorough wort was again recurred to, and most strenuously recommended. Nor was it overlooked in the management of the still more recent epide- mic of our country, the spotted fever. But, on tbe contrary, it came into very general use, and receiv- ed tbe strongest attestations of many practitioners, to its superior powers. The disease, however, in which the eupatorium has probably been productive of the greatest advan- tage, is intermittent fever. It has, in many parts of the country, so fully established its reputation in this case, as to exclude the Peruvian bark, and si- milar articles, and, on account of its peculiar effi- cacy, it is known by the significant appellation of ague weed. An intelligent medical friend informs me, that his experience with it is ample, and that he is able to confirm all that has been alleged, of its powers in these cases. The result of my own ob- servations, which have also been considerable, will 345 not authorize me to pronounce so favourable a deci- sion as to its virtues. But I still estimate it highly, as one of the remedies in this disease, having, by it alone, cured some very obstinate intermittents. The cases, to which it seems to be more particularly suited, are those which occur, or run into the win- ter. These, almost universally* require, in their management, a combination of the diaphoretic and tonic power, and hence, perhaps, the efficacy of our medicine, which is exactly of this description. Besides the diseases already mentioned, the eu- patorium has been successfully administered in some other cases. To several of the forms of drop- sy, it is alleged to be applicable. Whether it be so or not, I cannot say from my personal know- ledge. I have, however, collected sufficient evidence of its doing good in the hands of other practitioners. The physicians of this and the neighbouring states^ are much in the habit of prescribing it, in the dropsical effusions. But their practice seems to have been regulated by very little discrimination, It is presumable, from the general qualities of the medicine, that it would render most service in those cases of the disease, generated in marshy dis- tricts of country. Dropsies of this sort, commonly wear the intermittent type, and are successfully treated, in many instances, by an union of the tonic and diaphoretic remedies. It is, moreover, said, that the eupatorium is very beneficial in some of the x x 346 chronic cutaneous affections, and particularly in a species of herpes, incident to the people of the sou- thern states. That it should prove advantageous, under such circumstances, was, indeed, to have been anticipated, from its active operation on the surface. These are all the diseases, in which, so far as I have heard, the eupatorium has hitherto been em- ployed. Considering, however, its various powers, there is every reasonable probability, that it will hereafter prove to be susceptible of a much more extensive and diversified application in the practice of physic* ASCLEPIAS DECUMBENS. This is the botanical title of a very beautiful and valuable plant, which is peculiar to the United States. To the southward, it is found more abun- dantly, though it is scattered throughout the country. It is known by the vulgar titles of swallow-wort, butterfly weed, and pleurisy root. As far back as the earliest recollection extends, the root of the asclepias has been employed in po- pular practice, as a sweat in catarrh, in rheuma- tism, in the inflammatory fevers, and, above all, in pleurisy. No medicine has, perhaps, an equal re- putation among the people of the country, in these cases, and in the pneumonic inflammations, es * Tonics. 347 pecially. Nor are there wanting some respectable practitioners, who repose much confidence in its powers. The usual mode of giving it, is, to make a strong infusion of the root, which may be drank as freely as the stomach will allow. My experience with this medicine, is sufficient to enable me to speak with some degree of confi- dence of its powers. As a diaphoretic, I think, it is distinguished by great certainty, and permanency of operation, and has this estimalde property, that it produces its effects without increasing much the force of the circulation, raising the temperature of the surface, or creating inquietude and restlessness. On these accounts, it is well suited to excite per- spiration, in the forming states of most of the in- flammatory diseases of winter, and is not less use- ful, in tbe same cases, at a more advanced period, after the reduction of action by bleeding, &c. Tbe common notion of its having a peculiar efficacy in pleurisy, I am half inclined to suspect, is not alto- gether without foundation. Certain it is, that it very much relieves the oppression of the chest, in recent catarrh, and is, most unquestionably, an ex- pectorant in the protracted pneumonies. As a tonic, our medicine has sometimes been pre- scribed in the autumnal fevers, and still more so, in debilitated states of the stomach, attended with fla- tulence, and is supposed to be so serviceable in the latter case, that it is designated by the term wind weed, or wind root, in domestic practice. The 348 powder of the root, in the dose of half a drachm, is preferred, when the medicine is directed with this view. Of late, I have understood, that another species of this plant, the asclepias syriaca, or silk weed, or milk weeds has been found to have nearly the same properties, with this addition, that it is narcotic, and affords much relief in asthma, in old coughs, and even in pulmonary consumption. As one of the lactescent plants, it is not improbable, that this may be, in part, true, 349 DISCOURSE XX. The Subject Continued. I have now enumerated the chief articles, which are usually to be met with in the class of diapho- retics. But, in addition to these, there is a set of medicines, which indisputably has a close relation to the surface, as is evinced, very strikingly, by the influence of the articles over the cutaneous af- fections. The medicines to which I allude, though they produce little or no perspiration, cannot, per- haps, be more appropriately introduced, than in this place, and I shall, therefore, proceed with their history. SULPHUR. In treating of cathartics, this substance was no- ticed, somewhat in detail. But, it has properties which, in another view, give it even stronger claims to our attention. No one is entirely ignorant of the efficacy of sulphur in the diseases of the skin. The only comment I shall make on this trite application of the remedy, is, that it is necessary, in some of these cases, to use it in the shape of an unguent, as well as to give it internally. We direct, particu- larly in psora, or itch, the surface of the body to be anointed with the ung. sulphuris of the dispensato. 350 ries, while tbe powder is exhibited, so as to induce some degree of purging. Without the external ap- plication, it proves, indeed, wholly inert. As, however, its use, in this way, is exceedingly dis- agreeable and inconvenient, several other remedies are, at present, substituted in private practice, which I shall hereafter mention. While on this subject, I will also observe, that I have found nothing so speedily and completely to cure tinea capitis, as an ointment made of an ounce of sulphur and lard each, with an addition of two drachms of sal. ammoniac. No cutaneous disease is sometimes more difficult to manage, than this spe- cies of eruption. I have known cases of it to baffle the united skill of some of the ablest practitioners. But, since using the above ointment, I have been uniformly successful. It is perhaps, worthy of recollection, that Rosen- stein, a writer held in some esteem, has said, that when eruptions are repelled, they may again be re- stored to the surface, by the use of sulphur, and, in epilepsy, and other convulsive disorders, brought on in this way, the practice has been found, according to him, exceedingly beneficial. At one period, and that not very remote, the se- veral preparations of sulphur were among the reme- dies most in vogue, in the management of catarrhs, asthma, whooping cough, and the rest of the com- plaints of the chest. The confidence of practi- tioners was, indeed, so great, in the virtue* of the 351 medicine in these pectoral affections, that it was distinguished by the appellation of anima pulmo- num, the soul of the lungs. To what extent this high character is deserved, I am not prepared to pronounce, from my present knowledge. Certainly the practice does not want the support of authority, and if we advert to the properties of sulphur, we can hardly be altogether incredulous on the subject. Distinct from its other qualities, it is confessedly diaphoretic, and, perhaps, as much as any article, has the effect of relaxing the surface, which always relieves the lungs. To alleviate or remove those painful spasmodic contractions of the muscles, denominated cramps, sulphur is much resorted to, and, most general- ly, it is advised to grasp a roll of brimstone, dur- ing tbe paroxysm. How far this popular expe- dient is salutary, I will not pretend to say. But I have unquestionably done good in numerous in- stances, by recommending pads of sulphur to be worn on the part prone to such attacks, while, at the same time, the medicine is taken internally. Not long ago, I had under my care a man, who, for years, had been subject to cramps of the ab- dominal muscles, recurring several times in the day, and so violently, as to draw him double, at- tended with a degree of pain, scarcely to be en- dured. As he had tried almost every other remedy, I suggested the use of the pad, which, while on, al- ways prevented an attack, and on taking it off", the cramps speedily returned. By wearing it, 352 however, for some weeks steadily, he was com- pletely cured. The sulphur is a well known remedy in paraly- sis, and I am inclined to believe, from what I have seen, that it ought not to be disregarded by us. On a former occasion, I dwelt at some length, on the effi- cacy of purging in this disease. But it does not ap- pear to me, that we are to ascribe all its effects to this property. Many other articles, which much more effectually evacuate the bowels, are not half so useful, and, indeed, I am not sure, whether we do not attain as much, when the sulphur operates not at all as an aperient. I shall not repeat, here, what I have said under tbe head of cathartics, of the utility of our medicine in gout aud rheumatism. It will be sufficient merely to mention, that, in proportion as I employ the sul- phur, especially in the latter disease, my confidence in its powers is strengthened. Of late, this medicine has been introduced, and with high commendations, into the cure of intermit- tents. The first notice of this practice which I have met with, is contained in a work on the anomalous fevers of Batavia, by a writer of the name of Grain- ger. It is there stated, that, by exhibiting two drachms of sulphur in brandy, an hour prior to the anticipated return of the paroxysm, it will be alto- gether prevented. At one time, I was disposed to impute tbe success of this mixture entirely to the brandy. But a wider experience has taught me 353 differently. During the two or three last seasons, I saw so many instances of confirmed ague and fe- ver cured by it, that my opinion is wholly changed, and I do now believe, that the sulphur is alone the efficient ingredient. That it is, indeed, is suffi- ciently proved, by the circumstance of its operating quite as beneficially, when given in milk, syrup, or any other inert vehicle. Nor is its utility confined to this form of feven The hectic of phthisis, in which I have used it much, is as promptly suspended by it, as by any course of treatment, with which I am acquainted. Few articles, in short, evince more power over the febrile condition, especially when marked by the paroxismal type, than sulphur. It affords me plea- sure, to be enabled to cite the authority of Dr. Phy- sick, in support of this view of the properties of the medicine. Nay, he goes so far as to declare, that, in all fevers of an anomalous or equivocal charac- ter, having a tendency to intermit, and where, from the state of the system, the ordinary tonics are in- admissible, he has experienced from sulphur the best effects. The use of the medicine he would even extend to other periodical diseases, and above all, to the affections of the head, of this description, the propriety of doing which I have witnessed, in several cases in my own practice. vy 354 GUAIACUM OFFICINALE. The guaiacum, or lignum vita, is a genus of plants, of which there are three species, all natives of the West Indies. The one in medical use, is the guaiacum officinale. The wood of this tree, and the gum resin procured by exudation, are the parts employed in medicine. The general properties of guaiacum, are those of a warm stimulant, proving, for the most part, diaphoretic, sometimes, however, diuretic, and even purgative, in large doses. The mode in which the wood is prepared for exhibition, is in strong decoction, of which a quart, or more, may be drank in the course of the day. Guaiacum was originally introduced, as a reme- dy in the treatment of lues venerea, aud for a long time enjoyed uninterrupted confidence. Before the discovery of the utility of mercury, it was, indeed, among the chief means employed in this disease. But, whatever may be its powers, in relieving some of the symptoms of the secondary stage of the com- plaint, it is utterly inefficient in syphilis itself. This has long been tbe settled and concurrent opi- nion of the ablest practitioners.* But, though we are compelled to withdraw our * " When I have exhibited the decoction of guaiacum in pains of the bones, as they are called, confining the patient, at the same time, to the bed, and enjoining a diet consisting of fluids only, I have rarely seen any beneficial consequences result from the use of it, except where it acted as a sudorific ; and, in this respect, I think its qualities manifestly inferior to anjimony, or volatile alkali. In several instances, after per sisting in a course of it during four or five weeks, I have not gained any 355 confidence in the anti-venereal powers of the guaia- cum, there are, unquestionably, some other pur- poses to which it may be applied. Besides the minor affections, in which its usefulness is admitted material advantage; and I have remarked, that when the dolores osto. copi were not connected with some morbid alteration of the structure of a part, this medicine was of little avail. When the strength and vigour has been reduced by a successful mercurial course, with confinement to the house, and where a thickened state of the ligaments, or of the peri- osteum, remains, or where there are foul indolent ulcers, these sorei will often heal, and the enlarged membranes will subside, during the administration of this decoction. " The decoction of guaiacum will often suspend the progress of certain lecondary symptoms of lues venerea, for a short time ; such as, ulcers of the tonsils, venereal eruptions, and even nodes; but I never saw one single instance, in which the powers of this medicine eradicated the ve- nereal virus. It has been recommended by many people, to combine guaiacum with mercury, with the intention of improving the specific powers, and of counteracting the injurious effects, of that mineral; the advantages to be derived from this compound mode of treatment, are by no means well established; for guaiacum is certainly no antidote against syphilis j nor have any proofs been given to the public, of its me. liorating the action of mercury. When the decoction is given during the mercurial course, it sometimes seems to improve the health; but, as it is very liable to produce complaints in the stomach and bowels, the palpable inconveniences surpass the uncertain advantages connected with it; and, as no previous course of the decoction renders the disease milder, nor authorizes us to rest satisfied with a smaller quantity of mer- cury than usual, it will seldom happen, that a satisfactory reason can be assigned, for giving the two medicines to a patient at the same time. In concluding this chapter, I would farther remark, that I have given the decoction of guaiacum, with the best effects, to a great number of pa- tients, in cutaneous diseases, in the ozaena, and in scrofulous affections of the membranes and ligaments; and it appears to me, that it is equally efficacious in such morbid alterations, vhich arc not at all connected with the lues venerea, nor with the mode of treating it, as in those cases for which it has been the most highly celcbi-aU-i." Pearson on the Ef fectsofvariout Articles in the CiireofLucs Vennezx '""«-. 356 - by Mr. Pearsou, it is a very valuable medicine in several other diseases. But the tincture, of which there are two kinds, the one simple, being merely a solution of the gum-resin* in alcohol, and the other prepared with the carbonate of ammonia, is here universally preferred. The simple tincture I have rarely employed, since, for all purposes where the medicine is admissible, the volatile '"preparation seems incomparably superior. After arterial action is properly reduced, this is one of our most valuable remedies in rheumatism. The dose, however, in which it is commonly recommended, is wholly in- sufficient. Not less than half an ounce, and often an ounce, should be prescribed, and the proper time for its exhibition, in these cases, is on going to bed at night. Its effects are very much promoted by copious draughts of any warm beverage. Given in so large a quantity, and with the auxiliary means suggested, it seldom fails of producing diaphoresis, and of affording very essential relief to all the symptoms. But it is sometimes directed in powder, mixed with sugar, in the dose of ten or fifteen grains, to be repeated several times in the day. In the arthritic affections, the guaiacum has also been used. It was first resorted to in these cases, by a writer, who proclaimed its efficacy in so confi- dent a tone, that it excited for a time, a good deal of attention throughout Europe. But, when it came * The chemists have, of late, ascertained, that this is not a gum re? sin, but q,peculiar substance. 357 to be more generally tried, these high expectations were not realized, though it is still considered a useful remedy, in some of the irregular shapes of the disease. Wandering gout, not unfrequently displays itself in the stomach, in the form of colic, or some other painful spasmodic affection, and here I have often prescribed, it with advantage, to alle- viate not only the pending paroxysm, but also as a preventive to its recurrence. More than once, I have insisted on the close connection which can be traced between a dis- ordered condition of the stomach, and many of the complaints of the eye. Exactly as I enquire, observe, and reflect on this subject, so have I increased reason to confide in the correct- ness of this view. Every practitioner has probably seen very inveterate cases of opthalmia, proceeding altogether from a gouty or rheumatic state of the stomach, and which will yield only to remedies ad- dressed directly to this viscus, among which sul- phur or guaiacum I have found most effectual. But there is another morbid affection of the eye, of a gastric origin, hitherto not sufficiently noticed, where, though no external inflammation exists, or so slightly as hardly to be perceived, there is great sensibility, with intolerance of light, sometimes very acute lancinating pain through the ball, though, more generally, the sensation is that of a dull, obtuse ache, attended with much heat and aridity of sur- face, which, whatever may be its nature, is wholly C58 independent of the cause above mentioned, though it is still very successfully treated by the guaiacum. Cases, such as I have described, are not of very common occurrence. But I have had several un- der my own care, or in consultation, and never knew one to be cured, or even much benefited, by any means, except the remedy I have just men- tioned. The dose of the tincture of guaiacum, un- der other circumstances than rheumatism, is about a tea-spoonful, three or four times a day. DAPHNE MEZEREUM. The mezereon, used in medicine, is tbe bark of the root of a shrub, called as above by the botanists, which grows wild on the Alps and Pyrenees. It is acrid to the taste, and aromatic in odour, having all the essential properties of guaiacum, and has been converted pretty much to the same purposes iu practice. It is a stimulating diaphoretic, and oc- casionally, also proves diuretic and purgative: is a common remedy in rheumatism, in chronic cutane- ous affections, and was formerly employed in sy- philis. Its reputation at present, in this latter dis- ease, rests precisely on the same foundation, as the preceding article.* * " From all that I have been able to collect, in the course of many years observation, I feel myself authorized to assert unequivocally, thai the mezereon has not the power of curing the venereal disease, in any one stage, or under any one form. " If a decoction of this root should ever reduce a venereal node, where no mercury has been previously given, yet the patient will by no means 359 SMILAX SARSAPARILLA. Of the sarsaparilla, I have not much to say. When first introduced into the materia medica, it was thought a sovereign remedy iu the venereal disease, though, in this respect, it has long since lost its re- be exempted from the necessity of employing mercury, for as long a space.of time, and in as large a quantity, as if no mezereon had been taken. " With respect to the power it is said to possess, of alleviating the pain, and diminishing the bulk, of membranous nodes, nothing peculiar and appropriate can be ascribed to the mezereon on these accounts; since we obtain the same good effects, from sarsaparilla, guaiacum, vo- latile alkali, bhstering plasters, &c. Nevertheless, venereal nodes which have subsided under the use of any of these articles of the materia me- dica, will appear again, and often with additional symptoms, if a full and efficacious course of mercury be not submitted to. It has, indeed, been alleged, that mezereon always alleviates the pain occasioned by a vene- real node, and generally reduces it, where the periosteum only is affect- ed ; and that it seldom fails of removing those enlargements of the peri- osteum which have not yielded during the administration of mercury. " That some instances of success, in cases like these, may have fallen to the share of those who make the assertion, it would not become me to deny; but I have met with few such agreeable evidences of the effi- cacy of this medicine. I have given the mezereon in the form of a sim- ple decoction, and also as an ingredient in compound decoctions of the woods, in many cases, where no mercury had been previously employ- ed, but never with advantage to a single patient. I have also tried it in numerous instances, after the completion of a course of mercury; yet, with the exception of two case*, where the thickened state of the pe- riosteum was removed during the exhibition of it, I never saw the least benefit derived from taking this medicine. "In a few cases of anomalous pains, which, I suppose, were derived from irttegularities during a mercurial course, the mezereon was of ser- vice, after I had tried the common decoction of the woods without suc- cess ; but, even in this description of cases, I have alwsy* found it a very uncertain remedy. 360 putation. ^Nevertheless, it is still valued as a dia phoretic, and especially by the humoral patholo- gists, who consider it as a great purifier of the blood. It has hence been, and continues to be, milch employed in venereal and scrofulous ulcera- tions, in the herpetic eruptions, in visceral obstruc- tions, in the common and venereal rheumatism, and to restrain the inordinate action of mercury. No doubt, its powers have been exceedingly overrated in all these cases. It possesses some properties analogous to its associate articles, though probably in an inferior degree.* It may be used in the same " I have made trial of this vegetable in a great number of scrofulous cases, where the membranes covering the bones were in a diseased state, and I am not sure that one single patient obtained any evident and material benefit from it. " The late Dr. Cullen, whose reports may justly claim attention from all medical men, when treating of the mezereon, in his Materia Medica, says, * I have frequently employed it in several cutaneous affections, and sometimes with success.' It were to have been wished, that the pro- fessor of medicine had specified what those diseases of the skin were, in which the mezereon was sometimes employed with success: for, if I except an instance or two of lepra* in which the decoction of this plant conferred temporary benefit, I have very seldom found it possessed of medicinal virtue, either in syphilis, or in the sequels of that disease ; in scrofula; or in cutaneous affections." Pearson. * " 1st. Is the sarsaparilla root, when given alone, to be safely relied on, in the treatment of lues venerea ? "The late Mr. Bromfeild, my predecessor, and, during some years, my colleague at the Lock Hospital, has given a very decided answerto this question: ' I solemnly declare, (says he,) I never saw a single in- stance in my life, where it cured that disorder without the assistance of mercury; either given at the same time with it, or when it had been previously taken before the decoction was directed.' 361 way, and in a similar dose. But it is now more com- monly prescribed in combination with various other substances. The sarsaparilla has recently been discovered very abundantly in the western states. That to be had in the shops, is imported from the Spanish West Indies. " My own experience, during many years, coincides entirely with the observations of Mr. Bromfeild. I have employed the sarsaparilla, in powder, and in decoctions, in an almost infinite variety of cases; and I feel .nyself fully authorized to assert, that this plant has not the pow- er of curing any one form of the lues venerea. " The sarsaparilla, indeed, like the guaiacum, is capable of alleviating symptoms derived from the venereal virus; and it sometimes manifests the power of suspending, for a time, the destructive ravages of that con- tagion : but, where the poison has hot been previously subdued by mer- cury, the symptoms will quickly return; and, in addition to them, we often see the most indubitable proofs, that the disease is making an ac- tual progress during the regular administration of the vegetable remedy. " The nature of that benefit which many persons actually obtain from sarsaparilla, when they are afflicted with the lues venerea, will form a subject of discussion hereafter j in the mean time, I shall pro- ceed to treat the second question, connected with the enquiry before me. " 2. Wrhen the sarsaparilla root is given, in conjunction with mercury, does it render the mercurial course more certain and efficacious ? " In replying to this query, it is necessary to observe, that the phrase 'to increase the efficacy of mercury,' may imply, that a smaller quanti- ty of this mineral antidote, will confer security on an infected person, when sarsaparilla is added to it; or, it may mean, that mercury would be sometimes unequal to the cure, without the aid of sarsaparilla. If a decoction of this root did indeed possess so admirable a quality, that the quantity of mercury necessary to effect a cure, might be safely reduced, whenever it was given during a mercurial course, it would form a most valuable addition to our materia medica. This opinion has been, however, unfortunately falsified by the most ample experi- ence ; and, whoever shall be so unwary as to act upon such a presumr - tion, will be sure to find his own and his patient's expectations egrc- giouslv disappointed." Pearson. z z 362 LAURUS SASSAFRAS. Not the least valuable of this class of medicines, is the sassafras. Excepting, indeed, the guaiacum, it is, perhaps, the most so. The sassafras is indi- genous, and may be found every where within our territories. The tree, in all its parts, is medicinal. Most generally, however, the bark of the root or the flowers, are selected for the purpose, both of which are highly aromatic, and agreeable to the taste. As a decoction, the sassafras may be taken freely, though the best mode, of prescribing it, is in a strong infusion, with the addition of sugar and milk. Thus prepared, much of it is consumed as a sub- stitute for the cheaper teas, by the poorer people of the country. Endued with the same properties, the sassafras is applicable to all the cases in which the medicines already enumerated are used. To gether with these, it enters as an ingredient into the decoctum lusitanicum, or famous Lisbon diet drink.* * B Rad.sarsaparillse, ligni sassafras, santal. rubri, guaiac, aa 3iii., cort. iau. mezereon Ji., semin. coriand. Jvi. Coq. in Aq.font fox.x.ad.tb •• Sumatjfcss. u i qu: er ue in dies. To this formula, some one of the antimonials is sometimes added. 363 DISCOURSE XXI. The Subject Continued. JUNIPERUS SABINA. As agreeing with the preceding articles, in many of its properties, I shall here introduce some ac- count of the savin. Though not a native, it is cul- tivated in many parts of the United States, and flourishes well. Baffled in'my attemps to cure some of the forms of chronic rheumatism with the ordinary remedies, I was early led, in consequence of my speculative notions, as to the powers of this medicine, to expe- riment with it in this disease. During the period which has subsequently elapsed, I have prescribed it very extensively, both in public and private prac- tice. The result of my numerous trials with it is such, that I hope it will not be deemed the lan- guage of enthusiasm, when I declare, that I hold it to be entitled to he placed at the very head of the remedies in chronic rheumatism. But, for its suc- cessful application, it requires a very nice discrimi- nation in the selection of the proper cases. My en- larged experience with the medicine, has taught me some degree of certainty in its use. It is still, however, not easy, by any general description to im- 364 part the same sort of tact or knowledge. Those who are conversant with clinical practice, must have remarked, that in some of the cases of rbeu matism, there is a coldness of the surface, and especially of the lower extremities, which are dry, or covered with a clammy sweat. Connected with this state of the system, we have also an extreme tumefaction and rigidity of the joints, amounting, sometimes, even to the loss of motion, accompanied by pains excessively acute, which are always ag- gravated by the vicissitudes of weather, and even by the slight exposure, arising from any accidental withdrawing of the covering during sleep. Cases of this description are readily to be met with in all the large receptacles of the sick, and especially in the severer climates, which continue for a great length of time, with no material variation, complete- ly resisting the ablest concerted plan of treatment. No doubt can exist, of the condition of the parts, under such circumstances. It is manifest, that the circulation is carried on languidly, from the debi- lity and exhaustion of the extreme vessels, by which they are thrown occasionally into spasms, whenever, indeed, external heat, or internal stimuli, do not contribute to invigorate their action, and support the natural tone. That the pain, in this case, is produced by a species of irregular convulsive mo- tion, and not by inflammation, is very conclusively proven, by the well known and universally acknow- ledged fact, of the complaint never going off by any 363 one of the usual terminations of this latter process. The joints in rheumatic limbs will often appear puffed, or swollen, for several months in succession, without effusion, suppuration, or scirrhus taking place in the slightest degree. Conformably to the pathological view which 1 have presented, is my practice. No one, in this case, thinks of cold or other applications of similar tendencies, but, on the contrary, every practitioner, whatever may be his theoretical notions, concurs in recommending the very opposite course. By the common consent of all, the treatment is made to consist of the various vesicating or rubefacient re- medies, while we endeavour to rekindle the gene- ral excitement, by pouring in camphor, ammonia, turpentine, cantharides, the seneka, the arum, the mezereon, the sarsaparilla, the guaiacum, with an infinity of combinations, of which opium constitutes the basis. Endued with properties, such as it was alleged to possess, it was reasonable to presume, that the savin would prove eminently serviceable in the pre- cise form of rheumatism which has been described The primary effects of the medicine, or, at least, its sensible effects, are, to heat and stimulate the whole system, producing particularly, a glow on the surface, with much itching, and now and then miliary eruptions, with sometimes a slight perspi- ration, which, however, seems to be extorted by the mere force of excitement. The pulse, which, 366 previously to the exhibition, of the medicine, is commonly small, weak, and accelerated, now be- comes full, active, and comparatively slow. No portion of the body seems, indeed, to escape its wide pervading operation, every function being more or less invigorated, and especially some of the secretory offices, as the urinary, the catamenial, and, perhaps, the seminal. Contrary to a very uniform law of the animal economy, by which it seems to be ordained, that the vigour of the arterial and lymphatic apparatus should be in an inverse ratio, we have here indis- putable evidence, in the speedy removal of the chalky dispositions, and of the various morbid growths incident to the disease, of absorption being actively promoted. After some days continuance of the savin, either from the mitigation of the dis- ease, or the positively tonic power which the medi- cine exerts, the situation of the patient is very con- siderably improved, as relates to his strength, ap- petite, rest, and general sensations. Encouraged by the success which attended the remedy in the preceding description of cases, I have been induced also to apply it to the cure of what is denominated syphilitic rheumatism. The diffi- culty often experienced in the management of this form of the disease, is universally confessed. My conviction is, that hitherto we have entertained very wrong views, as to the nature of this obsti- nate and distressing affection. To me, there is 367 the strongest reason to suspect, that, instead of proceeding from a remnant of venereal contamina- tion, it has its cause in the abuse of mercury. Nor am I singular in this opinion, though I take to my- self the credit of having first promulgated it in this city, and of most steadily acting upon it in practice. But either view of the case warrants the remedy. Even those practitioners who retain the ancient pre- judices on the subject, conduct the cure of the dis- ease chiefly by medicines of nearly similar proper- ties. It was, indeed, by this very analogy, that I was originally led, in some measure, to extend my prescription of the saviu, and the advantages which I derived from it were so conspicuous, as fully to confirm all my anticipations. Few persons, perhaps, are more sensible than myself, of the delusions which naturally arise with respect to new remedies. The sources of error here, are numerous, and so seductive, that an entire escape from them rarely happens. It is possible that I also, may be deceived in the present instance, and have stated too strongly the powers of this me- dicine. But so far am I from believing it, that I shall venture the prediction, that, at no distant pe- riod, all my observations will be established, and the medicine enhanced, by a more extensive prac- tical application of it. Already, indeed, do I learn, that the savin is pre- scribed in gout. By professor Huffeland, one of the most distinguished men now on the continent of 368 Europe, who seems to have introduced it on this occasion, we are told, that it imparts tone to the ali- mentary canal, and removes the nausea, acidity. and flatulence, incident to the atonic state of the disease. Nor is it, according to him, less useful in the arthritic head-ache. By some other practitioners, it is recommended as having done good in podagra, or regular gout, averring, that it alleviates the pain, and breaks the force of the paroxysm. Of my own knowledge, I can say nothing of its efficacy under such circum- stances, though I should presume it to be a very in- appropriate and hazardous remedy. To rheumatic gout, a mixed state of disease, it will probably be found to be better suited. In no application of the savin which I have hi- therto made, was I able to perceive any immediate advantage from it. The system must be fully un- der its impression, before the disease begins to yield, even in a slight degree. Commencing with twelve or fifteen grains of the powdered leaves, three times a day, my rule is, gradually to increase the dose, till some positive effect is manifested, to produce which, three or four times the quantity I have mentioned, are sometimes demanded. Nor ought we too suddenly to withdraw the medicine in despair of its being useful. To accomplish a cure of protracted rheumatism, especially, it must be continued for several weeks. No matter how tri- vial the improvement from it may be, at first, we 369 should not be discouraged. The extraordinary success which I have seen result from the long and steady exhibition of the medicine, entitles me to re- commend, very confidently, an imitation of the same course. Of the external means of producing Perspiration. By simple friction, long continued, the exbalents may be made to pour out a pretty copious discbarge. But the usual means to effect this purpose is heat, applied either through a dry or moist medium. By the ancients, a vast deal of refinement was intro- duced into this process, and among the Oriental, as well as some of tbe European nations, even now, it constitutes one of the most expensive luxuries. These splendid establishments contain, or did con- tain, a series of coutrivances, by which tempera- ture might be conveniently graduated to every exi- gency. But, we claim no such arrangements, and are content, for this purpose, with a few simple means, exceedingly rude and defective. It is the common practice, where we wish to induce sweat- ing by stimulating the surface, to resort to heated bricks, or bottles filled with boiling water, which are put to the soles of the feet, or some other por- tion of the lower extremities. Co-operating with these, the patient is covered with more than an or- dinary quantity of clothing, and warm beverages are liberally exhibited. 3 A 370 In cases demanding a prompt and profuse dia- phoresis, the local applications I have mentioned, should also be placed between the thighs, on each side of the trunk, and under the arm-pits, the effect, in this way, being greatly increased. It will, how- ever, sometimes, be found more convenient to sub- stitute in place of the bricks or bottles, bags, filled with hot salt, or oats, or sand, or ashes. These are readily accommodated, on account of their soft- ness and flexibility, to the shape and contour of the part, and of course, prove infinitely more com- fortable, and are especially adapted to relieve to- pical pains. By some practitioners, vapour or steam is direct- ed in the place of dry heat, and, in the inflamma- tory cases, it is thought both safer and more effica- cious. Of this, indeed, there can be little doubt, and under such circumstances, ought always to be preferred. The cases in which this application is more particularly useful, are the incipient stages of inflammatory fever, and in all other states of the system, where sweating is indicated, though the propriety of inducing it by stimulating medicines, may be questionable. Nor is it less easy of attain- ment. There has lately been invented a very sim- ple machine for the purpose. But if this cannot be had, we shall do very well by pouring vinegar on hot bricks, and while the vapour is escaping, to in- troduce them, wrapt up in flannel, under the bed clothes. Three or four applications of this sort, 371 will very speedily cause a relaxation of the sur- face, and bring out an abundant diaphoresis. Near- ly the same effect is occasioned by immersing the whole body in a bath, the temperature of which should be so high as to produce a decided sensation of warmth. The natural temperature of the human species is about ninety eight degrees, but, owing to the cooling process constantly taking place on the surface, it is here considerably lower, and hence we feel the sensation of warmth, at several points be- low animal heat. It is this circumstance, which renders it difficult to adjust a precise standard, though, perhaps, we may not err much by fixing it from ninety-two to ninety-six degrees. A bath of this description, is unequivocally stimu- lant, increasing the force and activity of the circula- tion, and particularly in the extreme vessels, render- ing them full and turgid, and inducing a state of red- ness approaching to inflammation. These primary effects, however, are counteracted, in some degree, by the relaxation and perspiration which speedily follow, and to promote which, the patient, after be- ing carefully wiped dry, is to be replaced in bed, and to take some warm drink, such as any one of the va- rious herb teas, or lemonade, or wine whey. From the extensive sentient surface exposed to the impression of this remedy, it must be productive of very positive effects, aud hence is prescribed in a variety of cases. But, owing to the intimate connec- tion subsisting between the alimentary canal and the 372 surface of the body, it has been found more especial- ly useful in the affections of the stomach and bowels, whether of an acute or chronic nature. Few reme- dies are, perhaps, more recurred to in the spasmodic affections of the intestines, and by no means unfre- quently in enteritis, cholera, and dysentery. The inordinate irritability of the stomach in gastritis, is sometimes allayed by the warm bath, and its effi- cacy is fully attested in several of the forms of dys- pepsia, and not less so in the atonic fluxes. Nephri- tis affords another instance in which the remedy is greatly employed, and I may add, dysmenorrhea, or partial and difficult menstruation, as being very often relieved by it. Of the chronic complaints to which it is most ap- plicable, the weaker states of rheumatism, and pa- ralysis, may be named. Each of these cases is marked by a great deficiency of temperature, a pal- lid skin, and other evidences of a debilitated circu- lation, and here the power of the bath may be im- proved, by adding to it salt, mustard, or Cayenne pepper, as well as by raising its temperature seve- ral degrees higher than the point I have mentioned. Nor should frictions afterwards be neglected. Efficacious, however, as the warm bath proves to be, under the preceding circumstances, in adults, it is infinitely more so, when applied to children, and may also, in them, be more safely extended to the treatment of the febrile, and indisputably so to the convulsive affections, being here very generally followed by tranquility and sleep, 373 But it often happens, that a bath cannot be pro- cured, and when this is the case,a pediluvium or se- micupium is the ordinary resource. Even this par- tial bathing is salutary, both as a diaphoretic, and as a means of exciting a counteraction, and espe- cially in some of tbe chronic complaints of the head. The utility of it, when directed with this view, may be greatly heightened by dissolving in the water any of the stimulant articles recently mentioned. To some cases, a bath of less warmth than the one I have mentioned, is better suited. This is called a tepid bath, and is generally directed of the temperature of about ninety degrees, though from the different susceptibilities of persons, this cannot be definitely fixed. It will hence be right, always to consult the feelings of the individual, and so to regulate it, that it may impart a slight, but an agreeable sensation of warmth. In the chronic affections of the skin, as the herpetic and leprous cases, this sort of bathing is mostly pre- scribed. It is, however, admirably calculated to recruit the energies of the system, when exhausted by fatigue or watchfulnesss, and has sometimes been found not less advantageous, iu some forms of protracted rheumatism, gout, paralysis, chorea, and other convulsive or spasmodic complaints. But, though the application of heat to the sur- face, in the mode which I have described, will very generally excite sweating, it does not do so uni- 37* formly. There are, indeed, circumstances, in which it is ascertained rather to impede, than facilitate this process. This is most conspicuously the case in the early stage of typhus fever, in scarlatina, not to mention other diseases. These cases are attend- ed by great heat of the surface, which is aggravated by all the means I have enumerated, as designed to create perspiration, and to reduce the animal tem- perature. In this state of the system, cold will more effectually remove the constriction of the cu- taneous vessels, and is, therefore, the appropriate remedy. The ancients were well acquainted with this fact. Celsus speaks of directing large draughts of the coldest water in ardent fevers, aud dwells with great emphasis on the highly beneficial con- sequences. " The patient," says he, *' falls into a sound sleep, the heat remits, and a free perspira- tion ensues, though he had previously suffered much from thirst, heat, and restlessness." In the fluctuations of medical opinion, this practice seems to have been rejected, or at least lost sight of for many centuries. Nearly a hundred years ago, how- ever, an attempt was made to revive it by a writer, who entertained such extravagant notions of its effi- cacy in the inflammatory fevers, that he denomina- ted water the febrifugum magnum. But the reme- dy did not gain much ground, antecedently to the appearance of the celebrated work of Currie, since when its utility has been fully confirmed by the concurrent experience of many of the most distin- 375 guished practitioners in various sections of the world. As yet, I suspect this mode of treating dis- ease has not been very generally adopted in the United States, certainly not to the same extent as in Britain, and her colonial dependencies in the East and West Indies. This may, in part, be owing to our attachment to the lancet, and other directly depleting remedies, which, to a certain de- gree, operate in a similar way. Nevertheless, I am persuaded that we have not done justice to the prac- tice. By some of us in this city, cold ablutions are sparingly used in our autumnal fevers, to allay the heat of the skin, and ice is habitually applied in all the inflammatory attacks of the head. Not more is done with it by us. But in the European hospitals which I attended, nothiug was more common than to see patients, in the early stage of typhus fever, placed under a shower bath, or to have water dash- ed upon them, and nearly the same course was pur- sued in scarlatina, and in the whole of the com- plaints, in short, where a heated surface exists. The effect most commonly, was a free perspiration, fol- lowed as is usual, by highly beneficial tendencies. But a remedial process so active as this, must not be rashly or indiscriminately employed. The precautions required to be observed in its use, have been very clearly indicated in the work to which I have alluded. It is said by Currie, that affusion with cold water may be resorted to, 376 :{ whenever the heat of the body is steadily above the natural standard, when there is no sense of chil- liness, and especially when there is no general or profuse perspiration," to which, however, must be excepted, the cases attended with much local con- gestion, and particularly of the lungs. The prin- ciple on which he supposes the remedy to act, is merely by the abstraction of the excess of heat from the surface. But, a very different view has been taken of this point, by Dr. Jackson, a writer who, if he is sometimes seduced into apparent extrava- gance by an ardent enthusiasm, is eminently dis- tinguished by the force and originality of his opi- nions in theory and practice. Cold applications to the surface, he maintains, on the contrary, are a power making a strong and gene- ral impression on the system, by which the existing morbid actions are subverted, or essentially chang- ed, and which, according to him, is effected inde- pendently of tbe reduction of temperature. In pre- scribing the remedy, all which he insists upon, as important to be attended to, is, what he calls the evidence of a susceptible condition, and where this is wanting, he attempts previously to restore it by frictions, the warm bath, &c. Considering also, a very highly excited or inflammatory state of the system as not well suited to the remedy, he advises venesection, and other evacuations, as preliminary measures. Directed in the use of these applications by tbe 377 precepts of Currie, I have not ventured, on any oc- casion, to imitate a different course, though never for a moment have I believed, that the remedy ope- rates simply by lessening the heat of the skin. Cold water applied to the surface, is prescribed in the shape of ablution, aspersion, or affusion, and the cases to which these several modes are best adapted, will occur to the practitioner, without any precise designation. But in closing these desul- tory observations, I cannot forbear to recommend, in the strongest terms, an attentive perusal of the writings of Currie and Jackson, on this subject. END OF VOL. I 3x 1*17 v. ' '•I