NATIONAL LIBRARY OF MEDICINE Washington Founded 1836 U. S. Department of Health, Education, and Welfare Public Health Service DISCOURSES ON THE ELEMENTS OF Therapeutics and Materia Medica. BY N. £HAPMAN7 M. T). PIIOFESSOR OP THE INSTITUTES AND PBACTICE OF PHYSIC AND CLINICAL PBACTICE IN THE UNIVERSITY OF PENNSYLVANIA : 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." Newton. VOL. M. PHILADELPHIA: PUBLISHED BY JAMES WEBSTER, NO. 24, SOUTH KIGHTII ST. William Brown, Printer. 1819. %a^*& Eastern District of Pennsylvania, to ion : BE IT Ri.MtlAlBfcRhD, That, on the sixteenth day of January, in tie forty-third year of the Independence of the United States of America, A. D 1819, N Chapman, of the said District, hath deposited in this office the title of a book, the right whereof he claims as pro- prietor, n 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 ** v liat i have tviaA. and Jeave the rest to others for farther inquiry, " is all my design in publishing thesP papers. Newton.—Vol. II." 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 timts theuein 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 mention- ed,' and extending the benefits thereof to the arts of designing, engrav- ing, and etching historical and other prints." D. CALDWELL, Clerk of the eastern district of Pennsylvania. p. . CONTENTS OF VOL. II. DISCOURSE XXII. page Expectorants........1 DISCOURSE XXIII. Of Active Expectorants......11 DISCOURSE XXIV. Emmenagogues.......31 Of the Active EmmenagORUes.....37 DISCOURSE XXV. Of Mild Emmenagogues .....45 DISCOURSE XXVI. Anthelmintics . .....60 DISCOURSE XXVII. Of Particular Anthelmintics - • • .69 DISCOURSE XXVIII. Epispastics........87 DISCOURSE XXIX. Of the Practical Application of Blisters 96 DISCOURSE XXX. The Subject continued ....*. 108 DISCOURSE XXXI. Of Diffusible Stimulants......132 DISCOURSE XXXII Of the Practical Application of Stimulants . 142 DISCOURSE XXXIII. Camphora.........155 DISCOURSE XXXIV. Oleum Terebenthinae R'-ctificatum ..... 169 DISCOURSE XXXV. OfNarcotics........189 DISCOURSE XXXVI. The Subject continued . . . . . 206 t DISCOURSE XXXVII. The Subject continued—Lactucarium . . . 226 IV CONTENTS. DISCOURSE XXXVIII. Page The Subject continued . • • .212 DISCOURSE XXXIX. The Subject continued......259 DISCOURSE XL. Of Antispasmodics . • • • • .281 DISCOURSE XLI. Hydrargyrus........294 DISCOURSE XLII. The Subject continued......310 DISCOURSE XLIII. The Subject continued......330 DISCOURSE XLIV. The Subject continued......345 DISCOURSE XLV. The Subject continued......355 DISCOURSE XLVI. Of Tonics........366 DISCOURSE XLVIl. Of Medicinal Tonics ......376 DISCOURSE XLVIII. The Subject continued......389 DISCOURSE XL1X. The Subject continued......399 DISCOURSE L. The Subject continued......411 DISCOURSE LI. The Subject continued . . . ■ . * . 422 DISCOURSE LII. Mineral Tonics . .,.....433 DISCOURSE LIII. The Subject continued......446 DISCOURSE LIV. Of Astringents . . . .' . . . . 463 DISCOURSE LV. Of Mineral Astringents......477 ELEMENTS OF MATERIA MEDICA AND THERAPEUTICS. DISCOURSE XXII. Expectorants. EXPECTORANTS have been defined "those medicines which facilitate or promote the excretion of mucus or other fluids from the pulmonary sys- tem." Considering the great importance of the lungs, and their appendages, to the well being of the ani- mal economy, it is obvious, that a description of articles calculated to relieve any of the morbid de- rangements of these organs, must have no slender claims to our attention. Much difficulty has always been confessed, by those who have attempted an explanation of the modus operandi of this class of articles. It is con- jectured by Cullen, that they may increase the vol.- II. A effusion from the arteries of the lungs, which being a thin fluid, dilutes the mucus of the pulmonary fob licles, and by rendering it less viscid and tenacious makes its expulsion more easy. Whether any of the expectorants act in this way has been doubted. But since a pulmonary exhala- tion does constantly go on, it seems to me highly probable, that we have medicines which increase this discharge, precisely as diaphoretics promote perspiration. It is, however, not less true, that all the means employed as expectorants do not thus produce their effects. Endowed with dissimilar properties, it is reasonable, to presume, that the dif- ferent articles may variously operate. To this con- clusion, we can hardly help being conducted, when we reflect, how opposite are the states of the lungs in which we prescribe expectorant mixtures, and what essentially different substances we employ for this purpose. Expectoration may be repressed, or imperfectly performed, by a constriction of the lungs, and, by the removal of which, an infinite degree of relief is often afforded. It is also apparent, that the lungs occasionally, from extreme debility, pour out an excessive discharge, and that by direct stimulation of the exhalents, the effusion is abated, and oppres- sion removed, on the same principle as sweat- ing is checked, by active diaphoretics, in hectic fevers, and other cases of extreme weakness. Nor is it altogether unlikely, that some of the s__ expectorauts are useful, merely by diverting action to the surface of the body, and, perhaps, as well by moderating pulmonary exhalation, as by relaxing spasm. To these may be added vomiting, which, partly by inducing relaxation, and still more by the mechanical force applied to the respiratory appa- ratus, very effectually expels the accumulated con- tents of the lungs. It follows, therefore, from the preceding observa- tions, that expectorants are to be considered in several points of view. But in all cases, and in whatever manner these medicines arc productive of advantage, it is, by an impression first made on the stomach, and subsequently extended to the lungs, through the medium of that sympathy which so inti- mately and conspicuously connects these parts. No- thing is more absurd, or less to be reconciled with the present state of our knowledge, than the hypothesis which is to be found, even in the most recent of the writers on the Materia Medica, that expectorants operate by reaching the lungs through the circu- lation ! Two rules only shall I suggest for the admini- tration of these remedies : 1. As in the use of diaphoretics, let the patient be kept warm. There is a very close consent be- tween the skin and pulmonary organs, and we shall always perceiVe that moderate warmth, and even moisture, on the surface, greatly facilitates expec toration. 4 2. Carefully avoid purging. As remarked on a former occasion, none of the complaints of the lungs will bear this evacuation to any extent. Besides which, the action of the secretory vessels of the lungs, and intestines, would seem to be alternate and opposed. Expectoration, at least, is uniformly suppressed or diminished by diarrhoea or by purging. Of Particular Expectorants. It is not easy, so various are the properties of these artiolp«, to arrange them, without a minuteness of classification, hardly admissible. But, perhaps all practical purposes may be attained by treating them, as I have done with respect to the other me- dicines, under the general division of the mild, and the active. By some writers, the mucilaginous beverages have been placed among the more lenient expector- ants, such as flax seed tea, or barley, or rice water. But, though these are useful in some of the pectoral affections, by doing away irritation about the fauces, and thereby palliating cough, they can scarcely be considered as expectorants, and may with more propriety be still designated, by the title of demul- cents. Of the milder expectorants, some of the emetic substances are deservedly most highly appre- ciated. But, of these, 1 have already said so much 5 under a preceding head*, that very little remains for me to add. It is sufficiently known, that the an- timonial preparations, and ipecacuanha, are pre- scribed with this view, sometimes alone, though oftener in various states of combination with other articles, and occasionally to excite vomiting where the lungs are much oppressed. LICHEN ISLANDICUS. This is a plant which grows very abundantly in Great Britain, and in all the northern parts of Europe. As yet, I have not learnt that it has been met with in any section of the United States. The leaves are exceedingly mucilaginous, and in a re- cent state so bitter, as to be given as an anthelmin- tic. But by the process of drying they lose this quality, and afford a species of farinaceous matter, which we are told is worked by the Icelanders into bread. As a medicine, it has long been used in dysentery, and other bowel complaints, by the Ger- man physicians, and probably with success. It has too, for some time, been much celebrated in ca- tarrhal and consumptive cases, and not a little evi- dence might be collected of its efficacy. But when we allow, that it is mildly nutritious, and that, like mucilages generally, it allays coughing, I suspect, as much is conceded as can be done consistently with a just estimate of its powers. Not more, at * Emetics, 6 least, does my own experience with it warrant. As an expectorant, I am not aware that it has any claims, though it is sometimes assorted with these medicines. The common mode of preparation is, bv boiling one ounce and an half of it in a quart of miik, over a slow fire, for fifteen minutes. If the milk is objectionable, on any account, water may be substituted. The quantity to be used is about a pint daily. GLYCYRRHIZA GLABRA. Liquorice is a perennial plant, native of the south of Europe, and may be naturalized in almost every climate. It is the root which is alone medi- cinal. This is possessed of many valuable pro- perties, and is directed for various purposes. To the taste it is sweet mixed with some degree of bit- terness, and is, perhaps, the only instance of a sac- charine substance not occasioning thirst. On this account, it received the title ofJldipson. At one period, the infusion of liquorice root was greatly employed in the several relations of deter- gent, attenuant, diuretic, demulcent, and expector- antj. But, at present, the use of liquorice is chiefly restricted to the alleviation of coughs, and a wa- tery solution of the extract, alone, or in union with other articles, is commonly preferred. A mixture of this sort is admirably adapted to the advanced •tages of the acute pneumonic affections, as well as 7 to consumption, and is greatly employed in the practice of this city.* I know not, indeed, any article, which seenis to have in a higher de- gree, the quality of -calming pulmonary irrita- tion, than the liquorice. Either the solution, or infusion, of which I have spoken, answers well as a vehicle for the administration of many other medicines, the unpleasant tastes of which it dis- guises very effectually, and this applies especially to the Peruvian bark. ARABICUM GUMMI. It is said, that several different plants in Egypt furnish this valuable gum, though the purest sort is the product of the Mimosa Nilotica. It is im- ported from the Levant, and comes to us in small irregular masses, somewhat of a yellow hue, and the best is more or less transparent. Of the gums, this is most generally employed, aud for medicinal purposes might, with advantage, he made to supersede all its kindred articles. As an expectorant, it is prescribed in tickling coughs, and still more as a demulcent in dysentery, diarrhoea, cholera infantum, &c. Nearly with the same view, if is freely given to prevent, or remove strangury * "§-.. Extract, glycirrh. 3ij. aq. font. ferv. |ijj. m. ft. soliit. adde vin. ant. Jj. tinct. theb. gtt. xxx. m. Of this, a table spoonful is the dose. 8 from blisters, and to soothe the ardor urinse attend- ant on the inflammatory affections of the urethra. In pharmacy, the gum arabic is also found useful, " serving to suspend heavy powders in water, to diffuse oils, balsams, and resins in the same ve- hicle, and to give tenacity to substances made into pills." As an article of diet, it is not a little prescribed, and particularly in the complaints of the alimentary canal. To this, we have probably been led by the notion of its light and digestible nature. That it is bland, and without stimulation, cannot' be denied. But, I strongly suspect, that there are few matters received into the stomach which prove less tract- able to the operations of ihat viscus. It passes through the bowels very little changed, as I have an hundred times observed, and, we are told, that it even reaches the urinary bladder pretty much in the same state. Nevertheless, there are not wanting facts to attest its nutritive qualities, and among others, the very strong one mentioned by Hassel- quist, of its sustaining a caravan, for a length of time, whose provisions were exhausted. ULMUS RUBRA. Of the elms, this country furnishes several spe- cies, all of which are, perhaps, in some degree me- dicinal. But it is the red or slippery elm,* which * Ultnus rubra of Muhlenburgh. 9 is mostly employed. The inner bark of this tree, by infusion, affords very abundantly, a viseid or mucilaginous matter, which is now, especially by country practitioners, extensively applied. As an expectorant or demulcent, it is a favourite remedy in catarrhs, in the declining stage of pleurisy, in consumption, &c. and, is also found, not less bene- ficial in the complaints of the urinary organs. But its reputation is still better established in diarrhoea, and above all, in dysentery. It is in these cases, directed to be very copiously dnink, and is alleged to answer sufficiently the double purpose of medi- cine and nutriment. That it does good in dysentery, and even more than the other mucilaginous beverages, I am in- clined to believe. To this point I have much evi- dence in my possession, though my own experience with it, is very limited. It is known to many, that the late Dr. Grant, of Virginia, had for nearly half a century an unrivalled reputation in the part of the country where he resided, in the management of dysentery. As he once informed me, his practice consisted in little more than purging moderately in the commencement of the case, and subsequently pouring in very freely the elm mucilage. By Jhis alone, he declared, that the bloody stools, tormjha, ij tenesmus, &c. were more speedily removed than by the ordinary remedies. Even admitting that one half of this statement is correct, the article will still appear strongly deserving of attention. vol. n. R 10 As an external application, it has not been less extensively employed. It forms an excellent emol- lient poultice, even milder, it is said, than the bread and milk, or flax seed. This is a good deal resort- ed to in country practice, in ulcers, recent burns, chilblains, cutaneous eruptions, and, in the discus- sion of tumors and other swellings. By many of our army surgeons, it is well thought of in gun-shot wounds, and is said, sometimes to be beneficial in arresting a tendency to mortification. Like other mucilaginous matters, it is nutritive, so much so, in- deed, that it constitutes one of the resources of out Indians in extreme emergencies. u DISCOURSE XXIII. The Subject Continued. Of the Active Expectorants. Excepting emetics, all the articles of which I have treated, may, perhaps, be considered as de- mulcents. If they have any expectorant power, it is in so feeble a degree, as hardly to entitle them to a place in this latter class. But, the medicines now to be enumerated, do most unquestionably operate on the lungs, and, in some way relieve those organs of their oppressive contents. AMMONIACUM. Ammoniac is a gummi resinous concrete, import- ed from Egypt and the East Indies. Of the tree which produces it, nothing is ascertained with cer- tainty, though it is presumed to be the lieracleum gummiferum.* As we receive it, it is in small • Wildenow, who raised the tree from seeds commonly found among the gum of the shops. It was before thought to be afforded by a species of ferula, of the same family as the plant that produces assa. fuetida. \% round fragments, externally yellowish, and white within, of a faint foetid smell, and nauseous taste. Ammoniac wrs once employed in a large circle of diseases, and especially as a deobstruent in visceral obstructions. But it so completely lost its rcputatiou, as no longer to be prescribed in these cases. Of late, I find, that on the continent of Europe they are recurring to its use, and I know it to have been a very favourite remedy of the late Dr. Wistar in hepatic obstructions. Whether it is really entitled to credit under such circumstances, my own experience docs not enable me to say. As an expectorant, its reputation is much better established. Confessedly it proves highly service- able in all cases where the lungs are heavily op- pressed. To the coughs of aged people, to some cases of pituitous asthma, to the advanced stages of pneumonia notha, and, sometimes to consumption, it is singularly well suited. The most common mode of administering ammoniac is in emulsion, denominated lac ammoniaci,* though it is occasion- ally prescribed in the shape of pills. Its dose is ten or fifteen grains. Excellent as are the powers of ammoniac, they seem to be improved, in most in- stances, by uniting with it squills, antimony, lauda- num, &c. Nitric acid may also be added to it, as directed below ;f and, from this mixture, I have * Vid. Dispensatory. f Pour very gradually two drachms of nitric acid, diluted in eight ounces of water, on two drachms of ammoniac, and triturate them in a 13 witnessed very good effects, where large accumula- tion of purulent or viscid matter existed, with fee- ble and difficult expectoration. Externally, am- moniac is applied as a discutient, in the form of a. plaster, prepared by beating it into a soft mass with vinegar, and spread on leather. It is said to have done good in white swellings, indolent tu- mors, &c. SCILLA MARITIMA. This article has already been twice brought be- fore us,* so diversified are its powers. No expec- torant is more generally prescribed than the squill, or which, perhaps, is better deserving of confi- dence. But, it is actively stimulant, and requires to be directed with some circumspection. To the cases enumerated under the preceding article, it is best suited, and is very often united with it in the proportion of one or two ounces of the oxy- mel, or vinegar of squill, to eight ounces of the am- moniac emulsion. Exhibited alone, the dose of either of the above preparations is about a drachm. As an expectorant the squill in substance is rarely ordered. glass mortar till the gum is dissolved, forming a milky fluid. Of this a table spoonful may be taken every two or three hours in sweetened •^■ater. Laudanum in some cases may be usefully added. " F.nietics and diuretics. 14 ALLIUM SATIVUM.* The whole of the alliaciae are expectorant. But the garlic is decidedly the most active, and in many of its qualities closely resembles the squill. It may hence be given in similar cases, and pro- bably with equal advantage. As an expectorant, it answers best in the shape of an oxyinel, which may be prepared by digesting the garlic in vinegar, and afterwards boiling the liquid with a portion of honey. The expressed juice, mixed with syrup, is often given, and after the reduction of febrile ac- tion, is one of the best remedies in croupy, catarrhal affections, and especially in children, and very old people. FERULA ASSAFG3TIDA. Commonly, this article is placed among the anti- spasmodics, and I shall, under that head, treat of its general properties. But, it is also decidedly expectorant, and in this view I must not altogether neglect it. Coughs connected with pulmonary. weakness and tendency to spasm, are the cases in which it ought to be employed. Every practitioner of experience has probably seen it do good in tussis senilis, and of its great utility in the secondary * Antilithics. 15 stage of whooping cough, there is even less doubt. The watery solution, is the only preparation now prescribed in these cases.* ARUM TRIPHILLUM. The Indian turnip is a native of the United States. The root, which is bulbous, is only used in medicine. In the recent state it is exceedingly acrid, emitting, on being sliced, a sharp pungent ex- halation. But, by the process of exsiccation, much of this is lost, though, in swallowing, the acrimony is still sensibly felt about the fauces. Of all our indigenous plants, this has the highest reputation, at least in provincial practice, as a remedy in the pulmonary affections. It is habitually prescribed, in phthisis pulmonalis, in asthma, and protracted coughs. My experience with it is not extensive, though I have seen enough of its use to be convinc- ed, that it is among the most active of our expec- torants, and so far may be serviceable, especially in old catarrhs, and other pituitous cases. Expe- riments show, that like many other acrid articles, its effects are local, the general system not being at all influenced by any dose of it. The dried root, boil- ed in milk, is the mode in which it is given. As an external application in tinea capitis, tetter, &c. an ointment made with the recent root is much re- lied on in popular practice. * Antispasmodics 16 POLYGALA SENEGA. This is a native plant, very abundantly distri- buted throughout the United States, though flou- rishing best in Virginia. The root, which is the only part medicinal, is contorted and tuberculated, as if composed of joints, and by an effort of the ima- gination has been assimilated to the tale of the ser- pent, the name of which the plant bears. Early in the last century, the seneka was intro- duced by Dr. Tennent of Virginia, as a remedy in numerous diseases, and especially as a specific for the bite of the rattle snake, a case, in which it has Ions since lost all credit. But we have seen* that it is possessed of valuable properties, and I am now to say more of its utility in disease. The seneka is indisputably among the most pow- erful and diffusible of stimulants, exciting arterial action, and promoting freely the secretory and ex- cretory processes. It is, on this account, that it proves diuretic, emmenagogue, diaphoretic, sialo- gogue, as has already, more than once been noticed. But, perhaps, on no part of the system, does it exert its force more strikingly, than on the lungs and their appendages, the trachea and larynx. This is too conspicuously evinced to have escaped observation, and hence one of the very first applica- * Diuretics, emmenagogues. 17 tion of the remedy was to the treatment of pulmonary affections. To pneumonia, under almost all circumstances, it is, at least in popular practice, applied, and the confidence reposed in it, in some parts of our coun- try, has long been, and continues, exceedingly high. Considering, however, its very stimulating nature, it becomes sufficiently obvious, that it ought not to be thus indiscriminately employed. Excepting typhoid pneumonia, it is wholly inadmissible in the early stages of the acute complaints of the chest. But after inflammatory action has been reduced by previous depletion, it comes in exceedingly well as an expectorant, and perhaps also, as having a ten- dency to relieve congestion of the lungs, by pro- moting determinations to the surface. It is in this way, that it operates so beneficially in the pneumo- nia of infirm people, which is always attended with debility of the pulmonary organs, and conse- quently, with large and oppressive lodgments of phlegm or mucus. During the last twenty years, however, the se- neka has, in regular practice, been chiefly in repute as a remedy in cynanche trachealis. It was origi- nally brought into the treatment of this affection by Dr. Archer of Maryland, who spoke of its powers with unlimited praise. To every form and stage of the disease he thought it adapted, sometimes pre- scribing it as an emetic, and under, other circum- vol. n. g 18 m stances as an^xpectorant. It may certainly be so administered as to. answer each of these purposes, though the more correct opinion seems now to be, that its use should be restricted to the secondary, § or ultimate stages of the disease. # In my own practice, I have never attempted to do more with it. As an emetic, either the tartarised antimony or ipecacuanha has seemed to me prefer- able, as regarding certainty of operation, as well as inducing a greater degree of relaxation. But, to overcome hoarseness, and other sequelae or con- sequences of the disease, I have found it exceed- 0 ingly useful. The seneka may be given in powder or saturat- ed decoction. But the latter is greatly to be pre- ferred in the cases before us. CARBONAS AMMONIiE. Of this article, which is among the most import- ant -of the Materia Medica, I shall say a great deal in another place.* It may therefore, perhaps, be now sufficient to state, that it is habitually ad- ministered, and with great advantage, to relieve the lungs of oppression in the advanced stages of acute pneumonia, sometimes in consumption, as well as iu several other pectoral affections hereafter to be mentioned. " Stimulants. 19 POTASS^ CARB0NA9, ET SOD*iS CARB0NAS. Neither the vegetable nor mineral alkali has ever before been assorted with the expectorants. But that they operate beneficially in the diseases of the lungs, by favouring excretion, and restraining cough, is indisputable. It is well known that, of late, they have become very popular remedies in pertussis, with every description of practitioners, and the praise of originally directing them in this . Carb. potass, ty. pulv. cochin, gr. x. sacch. alb. 5' aq. |iv. Of this, half a table spoonful is the dose. 20 we have the concurrent evidence of many respectable physicians, and the popular voice, strongly ex- pressed. That, however, the full effect of the me- dicine may be attained, it should be given in much larger doses, than ordered in the preceding for- mulae. Nor are the powers of the alkalis limited alone to pertussis. On the contrary, I am persuaded, that they will be found beneficial in all cases, where a mild expectorant, or cough medicine, is de- manded. Of the comparative merits of the two, I cannot judge. Lately, 1 have got into the habit of prescribing the potash, and such appears to be the case with the other medical men of this city. But I am not aware, that this preference rests on any solid grounds. In what manner the alkalis operate, in these af- fections, is not very intelligible. It is alleged that they do good by neutralising or correcting, the acid sordes of the alimentary canal. That accumula- tions of foul, acrid matter do exist, especially in pertussis, and that the lungs will be sympatheti- cally affected, in consequence of gastric irritation, are facts as well attested as any in pathology. Coughs of an inveterate character, even running on to consumption, 1 have sometimes met with, which could be distinctly traced to this source. It is not, therefore, altogether improbable, that such may be the modus operandi of these substances. Nevertheless, I do not perceive the necessity of re- 21 sorting to a chemical solution of the problem. Con- trary to common opinion, the alkalis really exert a pretty decisive agency on the system. This is illustrated in several diseases, and particularly, in those of a periodical nature. It is well ascertained that a few grains of the carbonate of soda, added to a very small portion of Peruvian bark and Vir- ginia snake root, constitute one of the most effica- cious remedies in ague and fever. As the alkalis act in these cases, so most likely, do they in per- tussis by a strong and peculiar impression made on the stomach, and extended to the lungs by consent of parts. COLCHICUM AUTUMNALE. An oxymel or syrup of the meadow saffron, has been used as an expectorant on the authority of Baron Stoerk. I have not prescribed it myself, or seen it prescribed, and suspect, that in this view, it has very slender pretensions. Whoever is dis- posed to try it, should bear in mind, the great ac- tivity of the article, and accommodate it accordingly to the case. Elsewhere,* I have treated of this substance, somewhat at large, and mentioned par- ticularly, its supposed identity with the Eau Medi- cinale. All that I have since learnt, goes to con- firm the opinion, that the colchicum is the basis of ' Diuretics. Z2 the French nostrum. The former has been used pretty extensively, of late, in the practice of this city, in arthritic and rheumatic affections, and generally, with conspicuous advantage. In every leading effect, the two articles are analogous. It appears, from the old writers on the Materia Medi- ca, that the hermodactyle, a species of colchicum,* was, by the earlier physicians, much resorted to in gout, and who considered it so signally efficacious in the disease, as to bestow on it the title of " ani- ma artictilorum."-{ It is also strongly recommended in rheumatism. Besides which, it is ascertained that the hermodactyle enters largely into many of the most celebrated of the specifics for gout, such as the dia hermodactylum, the pulvis arthriticus Turneri, the Vienna gout decoction, the mixture of Wedelins, &c. It is also worthy of remark, that the effects of the first of these nostrums, as described by Al- exander of Tralles, are precisely similar to those usually produced by the Eau Medicinale, and ac- cording to him, that people who take it are " at once relieved of gout.79 But to return to our immediate subject. Wri- ters differ exceedingly as respects the degree of activity of the colchicum autumnale. By some it is represented as even virulent, while others treat of it as nearly inert. These contradictory state- ments can only be reconciled, on the supposition, * Colchycum Ulyricum. f Quincey's Dispensatory. 23 that the plant is not, at all times, possessed of the same powers. The roots, I am inclined to believe, should be collected early in the season, though not till they have attained full maturity ffond carefully dried previously to their being used. Like the squill, they contain, in the recent state, a large proportion of juice, which has little or no medicinal activity, though it is exceedingly acrid. Colchicum gives out all its' virtues to alcohol, wine, or water, and a tincture, or infusion, may be employed. But the formula now commonly adopted is the saturated vinous tincture prepared with one part of colchicum sliced, and two of Spanish wine. As an expec- torant, however, perhaps, the oxymel or syrup, might answer best. BALSAMICA. In the original acceptation of the term, balsams were those medicines by which wounds are heal- . ed, and of course included articles of very different qualities. But, the definition has been narrowed down so as to apply only to* a set of fluid," odorous, inflammable substances, which closely resemble the terebinthinate preparations. Consulting medical history, we shall find, that the vegetable balsams were once in such high re- pute, as to constitute the chief reliance in " colds, 24 coughs, and consumption." But, this vague and indiscriminate application brought them, after a while, into complete discredit, from which they have scarcelyityet recovered. Among those that mainly contributed to their rejection, was the cele- brated Dr. Fothergill, who loudly denounced the propriety of the practice, especially in phthisis.* As often happens in instances of this nature, he carried his objections too far, and has, in my opinion, done harm by abridging our resources. No doubt, all the balsamic medicines are actively stimulant, and hence totally unsuited to the in- flammatory state of any one of the complaints of the lungs, whether acute or chronic. But action having been sufficiently subdued by the direct de- pletory measures, I am sure, that they may be safely and advantageously prescribed in protracted coughs, and catarrhal consumptions. My own ex- perience has satisfied me on this point, and without hesitation I recommend an imitation of the practice. Numerous as are the balsamic articles, they still essentially correspond in their medicinal virtues, differing only as regards the degree of efficacy. As representing the whole- of them, I shall only notice the Tolu, which I have found to be the mildest, the least unpalatable, and in every view, the most valu- able as an expectorant. * Vid. London " Medical Observations." 25/ This is'procured, by incision, from a tree of South America, the Toluifera Balsamum. The juice speedily thickens so as to become concrete, has a yellow appearance, is somewhat fragrant, and of a sweetish taste. Both water and spirit act upon it, producing a solution, the one called the syrup, and the other the tincture of Tolu. The dose- of either preparation is forty or fifty drops, previously triturated with mucilage, which renders it mis- cible. INHALATIONS.' Of these, it is proper I should say something as a means of promoting expectoration, and to meet several indications, connected with an oppressed or ulcerated condition of the lungs, they have been resorted to, and not wholly without advantage. Every practitioner is familiar with the use of the vapour of water or vinegar in catarrh, pneumonia, asthma, and a variety of other affections, where ex- pectoration is difficult and deficient. To render this species of inhalation more stim- ulating, boiling water may be poured on Balsam Tolu, in the proportion of an ounce of the latter," to a pint of the former. This is well suited to those cases of the same diseases, in which the ac- cumulations of the chest are owing to debility*of the lungs, or are retained by the viscidity and tenacity of the matter. Mudge's Inhaler, so called from vol. II. D 26 • the name of the inventor, is very convenient for the application of the remedy. But, where it cannot be had, a common tea pot may be substituted. Nearly with the same views, sulphuric ether is strongly recommended, and we are told by very respectable authority,* that it? powers are improv- ed by several substances which are soluble in it. Cicuta is particularly praised, half a drachm of which, is to be digested in an ounce of ether, for several days, so as to form a saturated tincture. Of this, two or three tea spoonfuls are to be put in- to a wine glass, to be held up to the mouth, and inspired till the whole is evaporated. My know- ledge of this remedy enables me to speak confident- ly of its utility. I have tried it, often, in dyspnoea from different causes, and generally with advantage. It is very useful, as was originally suggested, in consumption, and especially, if it be repeated seve- ral times in the day. Not altogether dissimilar in its effects to these in- halations, is the practice of smoking certain sub- stances. The tobacco is one of this description, and though according to Stahl, it afford- no relief in ordinary catarrhs, it is highly beneficial in con- sumption. There is, probably, no foundation, for this distinction. But Stahl was so convinced of it, that he proposes it, as a criterion by which we may determine the precise nature of these cases. ' Certain asthmatic affections are those only in which * Dr. Richard Pearson • • §7 I have been able to trace any utility from the prac- tice. But, he who delights in cigars will tell us, that nothing more effectually promotes expectora- tion in recent catarrh, as well as in the chronic pec- toral complaints. During the last few years, no slight attention has been directed to the smoking of stramonium as a remedy in asthma, and other cases of dyspnoea. But strong as is the evidence adduced in its favour, I am inclined to suspect, that its powers are not con- siderable. My practice has presented me with cases suited 4o its exhibition, sufficiently varied, to determine its efficacy. In asthma, I have some- times mitigated the force of the paroxysm by its use, though I am not sensible that I ever, made any per- manent impression on the disease. To consumption, attended by violent cough, and impeded respiration, our medicine, in my hands, has proved now and then equally serviceable. It will, occasionally, under these circumstances, calm existing iritation, inducing a state of compara- tive ease, and, this it does, by its combined seda- tive and expectorant power. Even this, in^many of the cases of this terrible disease, is a' very de- sirable attainment. But, it is doubtful, Wheih-r it does more or even so much, as opium used in the same manner. It is the root of stramonium pre- viously washed, dried, and bruised, that is employ- ed for this purpose. By some writers, and among these is Dr. Bree, ix the author of a well-known Treatise on Asthma, it is asserted that the stramonium, when thus pre- scribed, is always useless, and very often highly * dangerous, or even fatal, by producing apoplexy, and other serious-complaints. To this, I can only reply, that my own experience teaches me differ- m ■ently. As yet, the ouly effects which I have ob- served from it, has been verv analogous to those induced by the sedative influence of tobacco. The practice has once more been revived in Europe and in this city, of attempting to heal ulcers of the lungs by the fumes of certain vulnerary and balsamic articles. What is the exacl degree of be- nefit derived from it, I cannot determine positively. My own experience is not satisfactory, though I will not absolutely condemn the practice. More than one of my medical friends speak favourably* uf it. and I am not disposed to controvert or deny their statements. Candour, however, compels me to say, that as respects the terebinthinate pre para- lions, and these are chiefly employed, I have uni- formly found them so irritating, that they could not be continued without doing manifest harm. Even sulphur or mercury, both of which are much milder, likewise prove offensive to the lungs, and excite violent coughing. I have said that this is an old practice renewed. By looking into the writings of more than a century back, we shall see, that the practitioners, of the time, were much attached to it. By Stahl, the 39 crude antimony is pointedly recommended with this view, and Bennet, in his work on Consumption, extols sulphur and the balsams. More rece.ntly, Mudge, to whom I have already alluded, prescribed the ether, tar, &c. and Linnaeus the hypericum, a resinous substance. But, though the practice will probably be found not to answer the purpose pro- posed, it still may be occasionally recurred to, use- fully, to stimulate the lungs to throw off their con- tents when loaded and oppressed. As to consumption much more may, I think, be ' expected from tar fumigations as very recently employed. Encouraged by the event of an ex- periment, made on a patient, placed in a rope manufactory, Dr. Crichton, now physician to the court of St. Petersburg!], has treated some few cases of this disease, with triumphant success, by the fumigations more conveniently applied. The s mode he pursues for doing this is, to put the tar in an earthen vessel over a lamp, or heated iron, so as to cause a volatilization, till the air of the ward is sufficiently impregnated, and this process is to be repeated three or four times a day. Without entertaining any very sanguine hopes. that this, or any other means will prove essentially useful in genuine consumption, I would not, in the slightest degree, discourage a trial of this new plan. It comes to us on good authority, and surely nothing promises more in these deep seated ulcers, than healing measures directly applied, and tar, 30 on every account, its acknowledged balsamic pro- perties in external sores, the tolerance of the lungs under the impression of its fumes, and the facility of its application, is the article which presents the strongest claims to our confidence and attention. To this it may be further added, as affording corrobora- tive evidence, that a residence in the cedar.and pine swamps of this country during the summer months. is well known, sometimes to have been productive of advantage in pulmonary cases. 31 DISCOURSE XXIV. Emmenagogues. These constitute a class of medicines which art1 supposed to promote the menstrual discharge. Of the precariousness of their operation, not a little has b«en said, it having long been a subject of com- plaint spiong practitioners, who are much consulted in the diseases of women. It does not seem to me that this uncertainty of effect is owing, as is gene- rally supposed, to the want of a power in these medicines to produce specific impressions on the uterus. Many of them, unquestionably, are pos- sessed of such a property. The true source of the failure of our practice in these cases, may, I sus- pect, be traced to the incorredlt views which we have hitherto entertained of the process of men- struation, and still more, to our having overlooked, in the application of our remedies, the very differ- ent states of the system with which the suppression of the catamenia may be connected. As yet, our practice has been, for the most part, exceedingly empirical. We have advanced blindly on, prescribing for the disease only, without adverting to those various circumstances which modify the action of remedies, and influ- ence most materially, the ultimate results. To 32 ■ avoid this error, I shall commence my account of Emraena^ognes, with some brief remarks on the nature of this function. Contrary to a very gene- rally received opinion, that the menstrual discharge is a mere effusion of blood, I hold it to be a pecu- liar fluid, produced by a genuine secretory action of the uterus. Could I indulge in any leugtheued examination of the -ubject, it would, I tlriuk. be perfectly easy to show that every other hypothesis concerning this function, is utterly irrecondRable with facts, and repuguaut to the laws of thojanimal economy. Many, indeed, of the crude notions of former times, in relation to it. may be. consi- dered a- discarded. No one, for instance, at pre- sent, whose knowledge has kept pace with the im- provement of physiology, think- of imputing it to luuar influence, fermentation, venereal appetite, or general plethora. Local congestion is the oulyj one of the older 4vJpotheses which is now at all -entertained. That there is an increased deter- mination of blood to the uterus at the period of menstruation, cannot be denied. But what does this prove ? Every gland, when excited by its ap- propriate stimulus, becomes a centre of fluxion, towards which blood is directed. This is com- mon to all the secretory organs, though it is more strikingly observable, in those which are called only into action periodically. As the secretions are produced out of materials supplied bv the blood, the effect which I have stated, is. indeed 33 absolutely necessary to the due performance of the function, and so far, the hypothesis is well founded. But were this topical accumulation the only circum- stance in the process of menstruation, the discharge should be pure blood, which confessedly it is not. Glands require, for the exercise of their secretory office, to be excited by some specific impression. The testicle is stimulated by lascivious desires to the elaboration of semen, and the uterus, in the same way, is called into action by an influence de- rived from the ovaries. That the latter is true, is sufficiently proved by the fact, that where these or- gans are wanting, or much diseased, a retention, or suppression of the menses uniformly happens. It is not my intention to enter into a formal expo- sition or defence of the doctrine of secretion. My object, at present, is merely to bring forward a summary of the leading arguments by which it is maintained. 1. That the uterus in its villous, and vascular structure, resembles a gland, and also in its dis- eases, being equally liable to scirrhus, cancer, &c. 2. That, like other secretory organs, blood is very copiously diffused through it. 3. That, by the arrangement of its vessels, it is evidently designed, that the circulation should be retarded for the purpose of secretion. The arte- ries are not only exceedingly convoluted, but they are larger, and with thinner coats, than their cor- responding veins. The "blood," says Haller, VOL. II. e 34 •• is brought to the womb in greater quantity, and more quickly through its lax and ample arteries, and, on account of the rigidity and narrowness of the veins, it returns with difficulty." 4. That, in common with other secretions, men- struation is often, at first, imperfectly performed, and is subject afterwards to vitiation and derange- ment. In the beginning, the discharge is generally thin, colourless, and deficient, and recurs at pro- tracted and irregular intervals, being analogous, in some of these particulars, to the seminal secretion. 5. That in many of the inferior animals, during the season of venereal incalescense, there is an ute- rine effusion, undoubtedly a secretion, which an- swers, seemingly, the same end as menstruation, namely, giving to the uterus an aptitude to concep- tion, and though this fluid usually differs from the menses in complexion, it is, in some instances, precisely similar. Whenever the venereal desire suf- fers a violent exacerbation, from restraint, or other causes, the discharge, in these animals, becomes red, as has been more particularly remarked in bitches kept from the male. 6. That, when the menses are suppressed, they cannot be restored by inducing plethora, nor the flow checked by venesection, or any other means of depletion,, besides which, no vicarious discharge relieves* the symptoms of suppression. Lastly. That the menses are a fluid sui generis, or, at least, varying very essentially from4)lood, hav- 35 ing neither its colour, nor odour, nor coagulability, and on chemical analysis present different results. To the objection, which has sometimes been urg- ed, that the uterus is not sufficiently glandular for the office alleged, it may be very satisfactorily re- plied, that there is hardly a viscus, or surface of the body, which is not competent to this purpose. It would really seem, that no operation of the ani- mal economy requires a less complex apparatus. Of what, indeed, does a gland consist, except a con- geries of vessels ? Even the most perfect of the se- cretions are accomplished by this simple contriv- ance. If a few vessels, " creeping through the coats of the stomach," can secrete the gastric liquor, why may not the infinitely more glandular organi- zation of the uterus, elaborate the menstrual fluid ? As yet we know of no glandular structure in ve- getables. They contain only tubes or vessels, through •which the fluids circulate. Notwithstand- ing, however, the want of glands, we find the sap of plants converted into oil, mucilage, acids, &c. Than this, surely no stronger proof can be required, of the extreme simplicity of the organs, by which the secretory transformations are effected! Who originally suggested the theory of secretion, I have not been able to ascertain. It has very ge- nerally been ascribed to the celebrated Mr. Hunter, though, I suspect, on very slender grounds. The only trace of it, which I can discover in his writings, is a vague expression in a paragraph of his Treatise 36 on the Blood. Afterwards, however, he furnished an extract from his Lectures to be published in Johnson's Midwifery, as exhibiting more fully his notions respecting this function. Treating of the death of the blood from lightning, and other sud- den causes, he includes the catamenia among the illustrations of his reasonings. " The blood," says he, <•' discharged in menstruation, is neither similar to blood taken from a vein of the same per- son, nor to that extravasated by an accident in any other part of the body; but is a species of blood changed, separated, or thrown off from the com- mon mass by an action of the vessels of the uterus, in a process similar to secretion, by which aetion the blood having lost its vital principle does not coagulate.*'* By admitting the truth of the preceding theory, we have, at once, an explanation of the modus operandi of Emmenagogues. It follows, necessa- rily from the concession, that amenorrhoea is caus- ed by an interruption of the secretory action of the uterus, and that the remedies which remove the suppression, operate by bringing the organ back to that precise condition, on which the exercise of this function depends. In order to effect this pur- pose, however, we must, in the first place, accurate- ly ascertain the state of the system, and apply, with equal discrimination, the appropriate remedy. Conformably to the preceding views, I shall arrange the emmenagogues medicines into such as are calculated to increase or to subdue action. 37 Of the Active Emmenagogues. POLYGALA SENEGA. *• Of this article, I have already treated, under the heads of diuretics and expectorants. To Dr. Hartshorne, of this city, we owe the credit of having discovered its admirable properties as an emmenagogue. Conversing with him, some years ago, on the extreme difficulty of ma- naging certain forms of amenorrho&a by the com- mon remedies, he told me, that he thought he had used, with advantage, the seneka in these cases. Confiding iu the accuracy of his observations, I determined to lose no time in making a trial of the medicine. This I have since done, both in my public and private practice, to a considerable ex- tent, and with sufficient success to warrant me in recommending it as one of the most active, certain, and valuable of the emmenagogues. The seneka may be used either in powder or in decoction, though I greatly prefer the latter mode.* My rule in the administration of the medicine, in these cases, is to give about four ounces of the decoction, more * In making the decoction, I put a pint of boiling water, to an oz. of the root, bruised, in a close vessel, and let it slowly simmer over the fire till the quantity is reduced one-third. • Where the medicine excites nausea, which it is sometimes apt to do, even in small doses, I have it prepared with the addition of an aromatic, such as orange peel, o^ cinnamon. • or less, during the day, according to the circumstan- ces of the case. But at the time when the men- strual effort is expected to be made, and till the discharge is actually induced, I posh the dose as far as the stomach will allow, having given as much as two ounces every hour. • In the intervals of the menstrual periods, I al- ways lay aside the medicine for a week or two, as, without these intermissions, if it does not lose its efficacy, it becomes nauseous and disgusting to the patient. While under a course of seneka, the general system is to be kept properly regulated, equally obviating excessive excitement, or debility, by the use of the appropriate remedies. Of all the emmenagogues which I have tried, this is the most efficacious, and will be found useful in all the forms of amenorrhoea, if administered with a due regard to the state of the system, and in other respects with correct discrimination. But I tiling it to be more particularly so, in those cases where the decidua exists. As yet, we are ignorant of the exact pro- cess by which this membrane is formed, though of this there is no doubt, that the vessels of the uterus, which pour out the catamenia, are the instruments by which it i»accomplished. Nor is it less certain,that while they are engaged either in the formation or -upport of this new pro- duction, menstruation ceases, the two offices ex- acting modes of action totally incompatible. It is obvious, under these circumstances, to change the 39 state of the uterus, and to excite it to a secretory effort, not only a forcible, but a specific impression must be made upon it. Deny to the seneka these spe- cific energies, and where shall we seek an expla- nation of its effects ? Were it simply a stimulant, or tonic, or sudorific, as is more generally supposed, it might induce excitement, or impart tone, or raise a diaphoresis, like many other articles of the mate- ria medica, but would it be so signally efficacious as an emmenagogue ?* JUNIPERUS SABINA. The savin is a species of the pine or cedar, an*d is a small evergreen shrub, with short, narrow^ prickly leaves. When old, it bears dark blue ber- ries. The leaves are the only part, at present, used as a medicine. They have a strong disagreeable smell, and a very acrid taste. Like the seneka, to which it is closely allied in many of its pro- perties, it is a warm, powerful, and diffusible sti- mulant, producing an increase of all the secre- tions, and determined with particular force to the uterus. It was, on this last account, long used for the purpose of accelerating parturition, and more especially to expel the secundines. The same * Much of what I have said, relative to the above article, was pub- lished in one of the early volumes of the Eclectic Repertory several years ago. My subsequent experience with the medicine, which has been rery considerable, has served to strengthen and confirm my confi- denceTn it. 40 view of its properties has led to its employment in order to procure abortion, in the inferior animals, and we have abundant proof of its success in these cases. By almost every one who has at- tended to the effects of our medicine, it has been remarked, that it is singularly prone to produce hsemorrhagy, and more frequently from the uterus than any other part. These proper- ties obviously pointed it out as an emmenagogue, and, accordingly," it was, at a very early period, resorted to in cases of suppression of the menses, though the first distinct and satisfactory report which we have of its use, was made about half a century ago, by Dr. Home of Edinburgh, who gave the strongest testimony in its favour. But the higher authority of Cullen, by whom it is slightingly spok- en of, seems to have abated much of the confidence previously inspired, and to have brought it, to a cer- tain degree, into disrepute. As an emmenagogue, it has, nevertheless, always been held in consider- able estimation, and is even now, extensively em- ployed. Hitherto I have never had occasion to resort to this medicine in amenorrhcea. But were I to judge from its general properties, I should suppose it well adapted to some of the forms of this disor- der. ' On the whole, I think the medicine worthy of a fairer trial, than perhaps has been made with it. Like the remedies generally, in amenorrhcea, 1 sus- 41 pect that it has been too indiscriminately employed. Whenever it is administered, we should recolleet, how active are its properties, and, of course, that it is only applicable to such cases as are accompa- nied with extreme atony, and even torpor of the uterine system.* RUBIA TINCTORUM. The madder has, for some time, been celebrated • as an emmenagogue. It is the root of a plant, cul- tivated in Holland, very abundantly as an article of commerce, which furnishes this medicine. Taken internally, madder tinges the urine as well as the bones of a red colour. It was on account of this wide pervading operation, that it came to be con- sidered by the older physicians as a deobstruent, or remover of visceral obstructions. But by Cullen, it is thought to have something hurtful or inju- rious in its properties, and he therefore rather discountenances its use. As an emmenagogue, he seems to entertain not the slightest confidence in it. Many respectable practitioners, however, and among these the late Dr. Barton, make a very different report of the medicine. " In my employment," says he, "of the powder of madder, both in public and private practice, I have so frequently observed it to show considerable effects upon the uterus, that it is without any de- ft * Diaphoretics. VOL. It. 43 gree of hesitation, that I speak of it as a remedy worthy of the attention of practitioners. It appears to be suited both to cases of retention and suppres- sion of the menses, though it is chiefly in the latter condition that I have employed it." Being convinced, that we are in possession of maify articles of the same class infinitely more effi- cacious, I have never prescribed the madder. As generally recommended, the dose of this medicine is from twenty to thirty grains. Much more, how- ever, may be given with perfect safety. ROSEMARINUS OFFICINALIS. The rosemary is another of those medicines which were once considered as powerfully acting on the uterus. This is a plant which grows wild in all the south of Europe, and is now cultivated in our gardens. It has an aromatic smell, aud a warm pungent taste. Exhibited in the form of decoction, it is an active and diffusible stimulant, operating with considerable force on the nervous system, and hence is said to be serviceable in hysteria, palsy, vertigo, &c. As an emmenagogue, it has been very favourably mentioned byBergius and other writers, though by Cullen it is contemptuously noticed. Not- withstanding this, however, I think that it is an ar- ticle of considerable emmenagogue virtues. I have used it in several cases with unequivocal suc- cess. It is a highly popular remedy in this city, 43 and no doubt much good is done by it. The com- mon mode of administering it is, to direct a tumbler full of the strong infusion for three successive nights, and then to intermit it for a short period. MENTHA PULEGIUM. As nearly allied to the rosemary in its general properties, I shall here introduce, with a few re- marks, the pennyroyal. The pulegium has also been supposed to have a particular relation to the uterus, and hence its efficacy as an emmenagogue. By Linn&us it was indeed maintained, that every variety of mint acts so strongly on the uterus, that haemorrhagy is very apt to be the consequence of its free use. But I am inclined to believe he was deceived in this respect. Certain it is, that his observations have never been confirmed. Entertaining the same impression as to its power, Haller tells us, that the pulegium, combined with steel, is an infallible emmenagogue. But this is language infinitely too strong and unqualified, the medicine having been used by many practitioners without any such infallibility. Cullen, who is more or less a sceptic with regard to all the emmena- gogues, speaks in the following terms of the pule- gium : " Another use," says he, " of it as an an- tispasmodic has been commonly asserted, which is, that it assists the menstrual evacuations of the fe- male sex. This, however, I believe to be on no 44 better foundation. At the time of menstruation the sex are often affected with dyspeptic, and spasmo- dic symptoms in the stomach, and I have known these symptoms relieved by an infusion of the pu- legium, or as it is commonly called the pennyroyal tea. But the same relief has obtained more cer- tainly by the use of peppermint, or the mentha crispa, though in none of them any specific power can be perceived. They have often been tried in cases of suppressed menses, and without any benefit at all." As an emmenagogue, I am not prepared to ad- vance any opinion on the pulegium, highly as it has been celebrated, excepting, that from the general properties of the plant, and its analogy to the rose- mary, which I know to be useful, I should pre- sume it not to be entirely destitute of such pro- perties. It is a remedy in high repute in domestic practice, and popular confidence, even though con- fined to the vulgar, is scarcely ever without some foundation. 45 DISCOURSE XXV. The Subject Continued. Of Mdd Emmenagogues, $"c. SECALE CORNUTUM. . I do not know that I am right in placing this arti- cle among the emmenagogues. But, I caunot give it another position with more advantage or propriety. Of the natural history of this extraordinary pro- duction, I am not prepared to say much. Nor, in- deed, is this exactly the place for such a discus- sion. It is sufficient for my present purpose to re- mark, that it has long been known, that more than one of the graniveous plants, as well as some of the grasses, are liable to a disease scientifically deno- minated clavus. The substance thus produced is, however, more generally recognised by the French vernacular title of ergot, or that of England and this country, the horned rye, spurred rye, &c. By medical men, it is called, as above, secale cor- nutum. Of the different kinds of grain, rye, it would jseem, is most apt to"take on this morbid condition, and particularly in a low damp soil, or where it is exposed to an intense heat, succeeding to continued rains. It is further stated, that it occurs more 46 abundantly on the margin of fields, than in the cen- tral parts, and that new grounds, or those lately cleared, are more favourable to it than such as have been long cultivated. Among the many conjectures as to its origin, it has been presumed to proceed from small larvae, others have traced it to a species of fermentation, at least as a preliminary step, going on in the plant, and we have facts to warrant in a degree, the suspicion of its be- ing propagated by contagion.* But on the W'hole^ I think it is most probable that it arises, like the several sorts of smut or blight, from a mushroom of the genus sclerotium, which is of a parasitical na- ture.f Ergot is an elongated excrescence, which fills the place of the seed within the glume or husk of rye. It is of an irregular curved form, some- thing like the spur of a cock, of a dark colour, un- pleasant taste, and brittle texture. It has been a very generally received opinion in Europe for a century or two, that bread made of grain vitiated in this way, occasions diseases of a very extensive and violent description. Of these, however, the most common is a species of dry gan- grene, pervading, at the same time, entire districts of country. * The abbe Fontana planted a number of single grains of rye; and upon the top of each placed several grains of ergot. The result was, a crop of this substm-re, showing something similar to infection, which, however, might be owing to larvae. f This is the hypothesis of De Condolle 47 Disorders of a different nature, such as low fe- vers, and the various bowel affections, which pre- vailed, at one period, among our troops on the Canadian frontier, to an alarming extent, were as- cribed by some of the medical men of the army to this cause, though on what foundation, I ani not suf- ficiently informed to determine. As an article of the Materia Medica, the credit of introducing it, must be conceded to this country. It is now eight or ten years since Dr. Stearns, of the state of New York, gave to the world an account of its wonderful powers in promoting lingering la- bours. By a very large number of practitioners it has since been tried with the same view, and though there may be some difference of opinion in relation to the degree of its utility, we have the most ample attestations in its.favour. My own experience with it, which is by no means narrow, enables me to speak very positively of its powers in this respect, and the same impression is entertained of it by several of ray medical friends, engaged in the practice of mid- wifery in this city. I have been supplied with some very strong facts of a similar purport by several of my correspondents, and still more might be col- lected from the medical journals of our country. But though its powers, in this respect, seem to be sufficiently admitted, some discrimination is re- quired in the selection of the cases to which it may be suited, as well as caution, in the use of the ar- ticle. 18 « The mode in which I have been accustomed to prescribe it, is to dissolve a drachm of the powder in a small portion of water, and to give one third of it every half, hour, till the effect is induced. Not more than ten or fifteen minutes elapse before the uterus is excited into strong and violent pains, which in all cases, that have come under my notice, con- tinued with little or no intermission, or abatement, for a very short time, and then entirely ceased. Considering the violence of the action of this medicine, it will always be prudent, previously to directing it, to ascertain that the os tincse is pretty well dilated, as we shall expose the woman to much pain, or, perhaps, even to a rupture of the uterus, as has beeu suspected, may destroy the foetus. As the ergot has not the slightest tendency. to overcome the rigidity of the soft passages, we must, under such circumstances, if delay be inad- missible, recur to copious venesection and other re- laxing measures. With this precaution, I have every reason to believe, that the medicine may with perfect safety be used in lingering labour, and in almost every instance, with such effect, as to ren- der unnecessary the application of the forceps. It is not unknown to me, that it has been alleged against our medicine, that when given to accelerate parturition, it sometimes destroys the life of the child. Were it true, this would, indeed, be a most discouraging consideration. But, I am entirely convinced that the objection is unfounded. By my- 49 self, and other practitioners of this city, it has been used, in probably fifty or sixty cases, without doing harm in any respect, and which is pretty strongly confirmed by reports from other places. No doubt, however, from the protracted and difficult nature of the labours in which the ergot is prescribed, that the child will now and then be born dead, inde- pendently of any agency of the medicine, though no such instance has come within my own observa- tion. Experiments made with much accuracy, by more than one of the graduates of this University, show, that the ergot, in whatever manner given, has little or no operation on the system of the male. The pulse is neither elevated nor depressed by it, and excepting some nausea, or vomiting from large doses, no other effect is manifested. To the uterus, its whole force seems to be exclusively di- rected. Exhibited to pregnant animals, it never fails, in a short time, to occasion abortion, and in women, not with child, some uneasiness about the womb is generally experienced after taking it. The strong affinity which it displays to the uterus would seem to give to the ergot strong pretensions as an emmenagogue. But repeated trials have convinced me that it is slenderly possessed of such powers. Nor, perhaps is it difficult to ac- count for its inefficacy in these cases. As I have already stated, amenorrhcea depends on a wrong or perverted action of the uterus, for the most part, VOL. II. G 50 slowly induced, and to remove . which, a gradual and steady impression on that viscus is required. Now, of all the articles of the Materia Medica, the ergot is most transitory in its effects, and hence little suited to remove any obstinate or deeply con- firmed morbid derangement. By its prompt and powerful action, it is much better adapted to some Of the forms of dysmenorrhoea. I have seen it in two instances afford much relief by bringing away the deciduous lining of the uterus. Much more advantage would appear to have re- sulted from its employment in uterine haemorrhage, and which, indeed, might have been anticipated from its acknowleged power in exciting uterine con- tractions. As yet, I have never prescribed it with this view. But its-utility rests on authority which may not be disputed. It is said more speedily than any other article to restrain flooding*, both be- fore and after delivery, and that given during par- turition, in women previously accustomed to pro- fuse discharges, it acts effectually as a preventive. There may be some exaggeration in the preced- ing statement, though on the whole, I am persuad- ed, that, in this as in every other application of the article I have mentioned, it will be found essen- tially useful, and that in whatever light it may be contemplated, it presents the strongest claims to our curiosity and attention. 31 HELLEBORUS NIGER. As an emmenagogue, the black hellebore was first introduced into practice by the celebrated Dr. Meade, who proclaimed its efficacy in the strongest terms. Influenced by his recommendation of the me- dicine, it continued to be almost universally employ- ed, till the time of Cullen, who in the spirit of distrust which he entertained with regard to all these medicines, pronounced it to be a feeble and precarious remedy. Controlled by his authority, practitioners seemed for some time to have nearly abandoned it, but it has once more regained its reputation, both here and in Europe, and by some of our best practitioners it is indeed consider- ed as the most valuable of the emmenagogues. Without going quite so far in its praise, my ex- perience warrants me in saying that it has many just pretensions. It is especially useful when it purges, in painful menstruation, attended with torpor and constipation of the bowels, and perhaps, with some degree of insensibility in the uterus itself. Of the powder of hellebore the dose is ten grains, in the form of pills, which may be repeated for several days. As an emmenagogue, however, it is more common to prescribe the tinctura melampodii, the dose of which is thirty to forty drops, every three or four hours, gradually increasing the quan- d% tity, so long as the stomach will bear it, without nausea or vomiting. To the articles already enumerated, I might per- haps add the cantharides, the terebinthinate prepa- rations, and phosphorus, each of which having sometimes been placed among the emmenagogues. But having tried the first two articles especially, to a sufficient extent to satisfy myself that they display no such properties, I shall dismiss them without any further observations. As respects the phos- phorus, more will be said of it in this view when I come to treat of stimulants. Connected as amenorrhcea is, very often with an exceedingly debilitated and flaccid condition of the system, the case will be found to be most ad- vantageously managed, at least in the commence- ment, by the cold bath, exercise, change of air, generous diet, and by some of the tonic medicines, among which, the bark and the preparations of steel are to be preferred. Nor is it unusual, to unite with the preceding medicines the foetid gums, or castor or musk, it being maintained, that certain states of amenorrhea exist, in which they are ser- viceable, as where the suppression depends on an irregular convulsive action of the uterus. Of these antispasmodics, I have employed no one except the assafcetida. Hysteria, on some occasions, is observed to be symptomatic of derangement in the uterine func- tion, and for the purpose of relieving this distressing affection, I have now and then given it, though not 53 with very pointed advantage. As emmenagogues, i hold, that the entire tribe of foetids to be inert, and if they ever do good, it is so rarely, as to have no solid claims to our confidence. Next, I proceed to the second division of my subject, or to those emmenagogues which reduce action. It is by no means uncommon to meet with cases of suppression of the menses, where the pulse is active, the habit plethoric, with a flushed lace, and even eyes inflamed, accompanied by pain in the back and head, and with acute and uncomfortable sensations of fulness in different parts of the body. No one could hesitate a moment under such cir- cumstances, to resort to venesection as the most prompt and effectual remedy. It not only unlocks, as it were, the secretory actions, but it obviates the danger which is too apt to ensue from vicarious haemorrhages in the brain, the lungs, or some other vital organ. I have more than once seen, after a copious bleeding, the menses very speedily to flow, and the obstruction perma- nently removed. Nor should we neglect, as aux- iliary means, to invite the circulating fluids to the lumbar region, by the interposition of active purgatives. As operating on the large intestines which lie in the vicinity of the uterus, the va- rious preparations of aloes have been much cele- 54 brated. There can be no doubt of their superior efficacy. Either combined with calomel, or myrrh, aloes almost always displays very active emmena- gogue powers.* With the same view of causing a determination to the parts, I have sometimes em- ployed with marked advantage, blisters, and espe- cially when applied to the inner part of the thighs. Before entirely dismissing the subject of emme- nagogues, I must say a few words in relation to one of the most distressing forms of ame- norrhcea, and which, indeed, to a certain extent, demands a peculiar treatment. Menstruation is occasionally performed with great pain and dif- ficulty, and the discharge comes away slowly and deficiently. This state of the uterine func- tion is called dysmenorrhea, and depends on * Not the least valuable, however, of these combinations is one known by the name of Hooper's pills. These are made according to the an- nexed prescription: g, Sal. mart, gss., pulv. jalap, 5*1., hiera picra, |ss., myrrh, gss., syrup com. q. s. ft. mass., div. in pill. Of these pills, which are prepared of a convenient size, two or three are taken at bed-time, for several nights successively. They puree ac- tively, and I presume it is by virtue of this property, that they operate so beneficially as an emmenagogue. In the original formula, I believe castor was added. The apothecaries of this city, however, have been induced to omit it, as rendering the pills offensive, without at all increasing their efficacy. 55 the imperfect secretory action of the uterus, by which sometimes an extraneous membrane is pro- duced. The remedies here, are to be adapted to the condition of the system. Most commonly it is associated with increased action, and where this is the case, blood-letting is indispensable. The warm bath is highly serviceable, and also fo- mentations to the region of the uterus. The ex- tract of hemlock and hellebore has been much extoll- ed in these cases. I have no experience with either of these medicines. It would be well to experiment with the stramonium, and I have, indeed, used it advantageously. The remedy, however, in which I repose the greatest confidence in painful menstrua- tion, is a combination of opium and camphor. I resort to it habitually, and scarcely ever without success. It is to be exhibited in the proportion of two grains of the one to ten or fifteen of the other. If the first dose should not answer, a second may be employed. But cases will occasionally occur where the suffer- ings are so severe as to demand the most immediate relief. Under such circumstances, an anodyne in- jection will sometimes operate very efficaciously. To do away that state of the uterus, on which this particular form of amenorrhcea depends, I have already mentioned, incidentally, some of the best means. To these however, may be added, the volatile tincture of gum guaiacum. My know- ledge of it is not great, having only used it in some few cases. But it is spoken of in very high terms ;>6 by Dr. Dewees, of this city, who has had much better opportunities of determining its effects. He entirely concurs in the opinion which I have delivered, that difficult and painful menstruation is most commonly owing to the existence of the deci- duous membrane, and that the healthy functions of the uterus can only be restored by its expul- sion.* After all, however, we are not to lose sight of the use of mercury in this disease. By a moderate salivation, continued for a wjeek or two, we shall sometimes succeed in curjng amenorrhcea, in its different forms, when every other mode of treatment has failed. 1 have now completed the consideration of the remedies in amenorrhcea. It would have been easy to have swelled the number of these articles to an almost indefinite extent. In the uncertainty of our practice in these cases, we have floundered about, trying every variety of medicine, without rule or discrimination. By the maimer in which I have distributed the articles, and the principles that have been suggested, 1 hope these medicines • As the tincture he recommends is somewhat different from that of the shops, I subjoin his formula. " 5» PuIy> Sum- guiac ^viii. carb. sod. vel. potas. Jiij, pulv. piment. §ij. alcohol, dilut. lbii. The volatile spirit of sal ammoniac to be added pro re nata, in the proportion of a drachm to every four ounces of the tincture, or less or more, agreeably to the state of the system." Vid. Coxe's Medical Museum, vol. ifi. 57 may hereafter be administered less empirically than hitherto has commonly been done. But in the treatment of amenorrhcea, we must be prepared fot disappointment. As already stated, the secretion of the menses is somehow influenced by the ova- ries. These organs are liable to a variety of dis- eases, and when in this state, a suspension of the menses is always the consequence, and cannot he restored. Cases of this sort are,, however, compa- ratively rare, and by constantly keeping in view the condition of the system, and applying our re- medies accordingly, we shall seldom fail in the management of the different forms of amenor- rhcea. To cure this disease is a matter of the utmost importance. No one state of the system has greater influence ovei -health, or is attended with such extreme anxiety and distress to the fe- male. As long as menstruation is interrupted, so long women are rendered uncomfortable, in mind and body. Next to the stomach and brain, the uterus exer- cises the widest dominion over the animal economy, and regulates, in the greatest degree, its different operations. This viscus, indeed, was considered by the earlier physiologists, on account of its multi- plied relations, as a distinct animal, controlling, with undisputed sway, all the functions of the body, whether in health or disease. Even more recently, the idea of its influence has been carried to scarcely VOL. II. h 58 a less extent. It was thought by Van Helmont, that the uterus impressed all the peculiar and dis- tinctive characteristics of the sex. "Propter solum uterum mulier est, id quod est." It is on this aceount, that there is hardly a disease to which women are liable, that is not either pro- duced, or aggravated by any permanent suspension of the uterine function. This is more particularly evinced in pulmonary consumption, being not only the frequent cause of this hideous malady, but, even where it takes place as an effect, it inva- riably increases its inveteracy, and heightens the difficulty of cure. Whether amenorrhcea produces insanity, I am not prepared confidently to say. It is difficult, in public institutions, where I have chiefly derived my experience, to get the exact history of the cases which are introduced. Of this, however, I am en- tirely persuaded, that where the menses are sup- pressed, the restoration of the secretory action of the uterus is indispensable to recovery. Truly can I declare, that among the many wromen who have come under my care, I have scarcely ever been able to effect a single cure while the amenorrhcea lasted, especially if it had long existed. But often have 1 had occasion to remark, that the moment the dis- charge was induced, the mind became tranquil, and 99 with it a subsidence of all those turbulent actions which had previously so greatly disturbed the sys- tem. From the high importance of this function, therefore, it will always be right, in investigating the chronic complaints of women, carefully to as- certain the state of menstruation. 60 DISCOURSE XXVI. Anthelmintics. By anthelmintics, we understand those medi- cines which either destroy or expel worms situated in any part of the alimentary canal. This class is exceedingly extensive, and has been variously ar- ranged. There is, indeed, hardly any article of the Materia Medica, which has not, under certain circumstances, evinced more or less of a vermifuge property. The anthelmintics are endowed with very differ- ent powers, and operate in several distinct modes. There is one set which may be considered as poison- ous to these animals. There is a second, which are mere evacuants of them, as the purgatives. There is a third, which are mechanical irritants. There is a fourth, which operate indirectly, by changing that condition of the stomach and bowels on which the generation, and, perhaps, subsistence of the worms depend. By some writers, the preceding division has been made the basis of an arrangement of these medi- cines. I do not perceive any very serious objection to it^ though as each species of worm requires, in 61 a certain degree, peculiar remedies, it will probably, in a practical view, be more advantageous to treat of them in this last relation. It is still, however, to be understood, that some of these articles are equally applicable to every sort of worm, and are thus indiscriminately employed. The worms which infest the alimentary canal of the human subject, may be divided into round and flat, each of which forms, according to the strict rules of classification, a genus. The species of the round worm, are the lumbricoides, the ascarides, and the trichuris. The teres,* as the first of these worms is some- times called, resembles so nearly the common earth worm, that it has been considered as the same, or a variety of the same animal. By closely in- specting the two, however, a very material differ- ence will be observable. The residence of the lum- bricoides is chiefly in the duodenum, jejunum, and ilium. They are rarely found either in the large intestines or stomach. When detected in the one or the other of these places, they are, for the most part, endeavouring to escape out of the body, hav- ing been rendered previously uncomfortable by dis- ease, or some active medicine. The teretes are from five to ten inches Ions, and are often found to exist in very great numbers. * Ascaris lumbricoidej". 63 Two hundred of them are recorded to have come away from a child of eight years of age in the course of a week, and I have known nearly half this number to be voided in a younger child in much less time. The ascarides* are very diminutive, not being more than half an inch long, and resemble a fine white thread cut into pieces, and, by reason of this, are called thread worm. Commonly, they occupy the rectum, though in some instances they have been met with in the stomach, and hence deno- minated maw worm. Of the different species of worm these are by far the most common, sometimes existing in numbers, almost incredible. The trichuris, or long thread worm, is about two inches long, with a tail twice the length of its body, having*; also a proboscis which it can protrude, or withdraw, at pleasure. It is of rare occurrence, and has not been very accurately described.! As yet I have never met with it. It is said to reside principally in the ilium. Of the flat worms, the taenia is the only one. This is a very extraordinary animal. It is of great length, being often from ten to fifteen feet, and found curled up, or entangled like a bunch of tape, to which it has been compared. By the * Ascaris vermicularis. ■jr I have not seen Hooper's book, which is said to contain a very accurate delineation of it. &8 late writers two species of taenia are described.* The extensive chain in the first of these con- sists of links, or joints, which occasionally fall apart, each one becoming a distinct worm, possess- ed for a time, of independent life, and from its re- semblance to the seed of the gourd, called vermis cucurbitini. Each species resides in the small in- testines. The origin of worms would constitute a subject of very curious and interesting speculation. It be- longs not, however, to my province to indulge to any extent in enquiries of this description. This would at once lead me into the intricate discussion relative to the generation and modes of nourishment of the whole tribe of parasitical animals, of which, indeed, little is satisfactorily ascertained. But, though not much has been determined as to the ori- gin of worms, we are pretty well acquainted with the circumstances which favour their production. In all cases of diminished strength and emaciation of frame, however induced, and especially if the bowels share in this debilitated state, we may, in children, suspect either their existence, or speedy generation. It has been observed that children after the first, and to the fifth year, are more liable to worms, than at any future period. Of this fact, there can scarcely be any doubt, though how to account for * Txnia osculis nfarg-inalibus, and Taenia osculis superficialibus. 64 it, is not so easy. It has generally been imputed to the circumstance of their having at this early season, a larger quantity of mucus in the bowels, which is thought to serve as a nidus or matrix, for the generation, development, and support of these auimals. This hypothesis unquestionably receives some support from the consideration, that a slim and penurious diet, consisting especially of crude vegetables, and unripe fruit, is favourable to the production of worms, and hence they always abound in the low and poorer classes of society. But, whence are derived the principia or rudiments of the animal? To this question, a satisfactory answer has never been given. It is alleged by some, that the primordial principle is taken into the sto- mach with food. But such a conjecture is re- futed, at once, by the fact, that these worms arc peculiar to the human species, not being seen in any other animal or position, and moreover, have sometimes been discovered in the stomach of foetus's and very young children, even within the month. Nevertheless, let it not be thought, for a moment, that I am disposed to lend any sup- port to the antiquated notion of equivocal gene- ration. By its adoption we should not be at all helped out of our difficulty, and certainly would depart very widely from a correct philosophy. It has long been a matter of controversy among practitioners, whether worms are in themselves noxious, or ever prove the original or accessary 65 cause of disease. This point was once very warmly debated. While on the one hand it was main- tained that almost all the complaints of children are influenced in a greater, or less degree by the irregular movements of these animals, it was on the other as strongly insisted, that they are entirely harmless, and therefore merit no sort of consideration. By some of these dis- putants it was even declared, that worms are high- ly useful in the animal economy, as executing the duties of scavengers, removiug the indigested sordes, and preserving clean the stomach and bowels. Nothing is less correct, or would be more dangerous than this extravagant notion, if carried into practice. Whoever is conversant with the complaints of children, and has attended to them, without any of those prejudices which pervert judgment, must ac- quiesce in this sentiment. I have had again and again occasion to w'itness a variety of diseases, which, either originated, or were kept up and ag- gravated by the irritation of worms. There is, in- deed, scarcely a complaint which the presence of these animals will not excite or imitate. Cases are recorded, of their producing epilepsy, chorea, tetanus, apoplexy, mania, hydrocephalus, ophthalmia, perverted vision, paralysis, especially of the muscles subservient to speech, syncope, pal- pitations of the heart, hiccup, dry cough, pleuritic pains, consumption, cynanche trachealis, rheumatic VOL. [I. I 66 pains of the joints, dysentery, convulsions, &c. &c. To these may be added, a peculiar fever, term- ed verminosa febris. This is a slow and irregular remittent. The exacerbations are always attended with heavy drowsiness : the remissions with a morbid vigilance. There is pain in the bowels, and at the pit of the stomach, with occasionally purging, and a good deal of gastric distress. The head is much affected, sometimes painfully, though for the most part, with stupor or delirium. The eye is wild, the pupil dilated, the alae of the nose contracted, the cheeks flushed, the forehead polished, as if glazed. The case, in short, presents so many of the appearances of hydrocephalus, that it is easily mistaken for that disease. Two symp- toms, however, most commonly attend, which are peculiar and distinctive. These are a very strange alteration of voice, and in some iustances, a total loss of speech. But, it is proper for me to state, that by Dr. But- ter, a name which holds a conspicuous place in the annals of our science, it is positively denied, that this species of fever is at all occasioned by worms. It is contended by him, with no little plausibility, that it proceeds entirely from crude accumulations in the intestinal passages, and he recommends for its cure, purging. In a great majority of cases I am persuaded he is right, though it is still mani- fest, to me, that he has laid down his position too 67 generally, and without making those exceptions which are found sometimes to exist. Considering, therefore, worms as a cause, and a very serious cause too, of disease, I shall endeavour to point out the symptoms by which the different spe- cies may be distinguished, and to assign to each the appropriate set of anthelmintics. As occasioning most of the affections which I have noticed, I shall commence with some observations on the lumbri- coides. It has already been mentioned, that worms may be suspected in a child where there is much emacia- tion, and especially weakness of the bowels, ac- companied by discharges of slime or mucus. The reverse of this, is said, sometimes to happen, as the most robust and florid children will have worms, and suffer much inconvenience from them, without any serious detriment to health. But, cases of this sort are exceedingly rare, so much so, that I am not aware of ever having met with worms under such circumstances. Among the more uniform symptoms of worms, are those of intestinal irritation, pains in the belly, alternations of diarrhoea, and costiveness, great thirst, variable and often voracious appetite. The child sometimes becomes hungry, almost immedi- ately after eating heartily, and at other times, the appetite is feeble and depraved, soliciting strange and outre articles, as dirt, chalk, &c. Besides which, there is foetid breath early in the morning, 68 a pale complexion, with occasional flushes, swell- ing of the lips, and especially the upper lip, en- largment of the nostrils, a livid circle round the eyes, tumidity or distention of the belly at night. The sleep is disturbed, the child often awaking with great terror, and is liable to starting and grinding of the teeth. During the day he picks his nose, is tormented with temporary headachy sometimes has a dry cough, with a slow fever, and a disposition to spasmodic or convulsive affections. Taken alone, no oue of the preceding circum- stances will be conclusive of the existence of worms.* But if several of them concur, there can be little or no doubt, of the fact, and we are accordingly to resort to the proper remedies. • " The ambiguity of every symptom," says an intelligent writer, " ascribed to worms, except that of voiding them, is well known." 69 DISCOURSE XXVII. Of Particular Anthelmintics. Of these, one of the most efficacious is ca- lomel, which should be given in the largest dose over night, and worked off the succeeding , morning, by castor oil, or some more active cathartic. If the first dose does not answer, the medicine is to "be repeated several times, at the interval of two or three days. All the more drastic purgatives seem to pos- sess in a greater, or less degree, the power of removing worms. The treatment indeed, in these cases, consisted atone time, very much in the em- ployment of such articles. Whether they ope- rate in any other mode than as mere evacuants is exceedingly questionable. Even in this way, they often prove serviceable, and especially as aux- iliaries to the more determined vermifuge medi- cities. SI'IGELIA M ARIL AN DIC A. The pink root is an indigenous vegetable, which grows in all the southern states, and especially in South Carolina. Every part of the plant is pos- sessed, in some degree, of the vermifuge property, 70 though the root is incomparably the most active. This is a very powerful medicine, and sometimes induces all the effects of a narcotic poison. It is highly probable, that by virtue of this very property it proves so destructive to worms. But a different view of its modus operandi has been en- tertained by some, who considering it merely a pur- gative, refer to its action on the bowels, the whole of its vermifuge efficacy. To this representation I cannot agree. Certain- ly, in my hands, the spigelia has several times proved useful without at all purging, though I think it more effectual when it does so actively. This medicine may be given either in powder or decoc- tion. Of the former, the dose for a child is, from five to ten grains, and of the latter, an half ounce or more, to be repeated occasionally. But, which ever prescription is adopted, some brisk purgative should be added, and the calomel or'senna is to be selected, as the one or the other mode of exhibition is preferred. By this combination, we »unques- tionably increase the power of the medicine, and entirely prevent the train of unpleasant nervous affections to which I have alluded. Of late, we have a powder, prepared by an apo- thecary in this city, which has acquired no slender reputation in worms. It is vended as a nostrum, the composition of which is endeavoured to be concealed, though it is ascertained to consist of equal parts of spigelia 71 and senna, with a small portion of the leaves of savin, the latter article having long been known to possess some vermifuge properties. As an anthelmintic it is very efficacious, and I do not know than this, a better formula in most cases. Distinct from its vermifuge property, the spi- gelia has been thought to do good in irregular re- mittents. This was an opinion very early adopted by the southern physicians, and seems ever since to have been entertained in that section of the country. Of its correctness to a certain extent, my own ex- perience has satisfied me, and I can hardly doubt, that every practitioner who has largely used the medicine must have seen it do good in the febrile affections, especially in children, though no worms were brought away. HELLEBORUS FCETIDUS. This is a native vegetable, that is common also to many parts of Europe. As might be expected from the title, the smell of the recent plant is exceedingly offensive, and with a taste bitter, and remarkably acrid and nauseous. The foetid hellebore sometimes operates as an emetic and cathartic, though it is only used as a vermifuge: dried and pulverised, the leaves are commonly preferred for this purpose. The dose for an adult is from five to ten grains, to be repeated for several nights in succession. Though 1 have never used the hellebore, I do not 72 distrust its powers. It is most favourably spoken of by some of the ablest practitioners in this coun- try, aud in Europe. There was formerly in this city, a Dr. Dewitt, who acquired immense cele- brity in the treatment of worms by a medicine, the composition of which he disguised. But, ultimate- ly it was discovered* to consist of this species of hellebore, and a small portion of ethiops mineral. In the exhibition of hellebore, caution is neces- sary, it being poisonous, and sometimes operates very dangerously. MELIA AZEDARACII, The pride of India, has recently been much ex- tolled, as an anthelmintic. It is a very beautiful tree, which now grows in the southern states. De- nying it to be a native of the American continent, it is said by the naturalists to have been originally brought from Japan, and other parts of the eastern world. Be this so, or not, it has become completely naturalised among us, and flourishes well. It is known in different parts of the country, by va- rious other appellations, as the pride of China, or China tree, the poison berry tree, or tallow tree. As a vermifuge, the virtues of this tree reside in the root, or rather the bark of the root. The most * By the late Ur. Kulm. 73 common preparation of it in the southern states, where it has hitherto been chiefly prescrihed, is a saturated decoction, of which for an adult, a small tea cupful is directed for several mornings in suc- cession. It may also be exhibited in powder, though the former preparation seems to be pre- ferred. # My knowledge of this medicine is very nar- row. But the few trials 1 have seen made with it, lead me to attach some value to it. In Georgia especially, it has become a popular remedy, and I am assured, that it is even more used, at present, than the spigelia marilandica. It is indeed con- sidered by many respectable practitioners of that section of the country, as decidedly superior to all other medicines in the lumbricoides. Whether it is equally noxious to the other species of worms, does not so clearly appear. I have no knowledge myself of its utility either in taenia or ascarides. But 1 am told, that it has been advantageously em- ployed in the first of these cases. CIIEN0P0DIUM ANTHELMIN'ITCUM, The Jerusalem oak, has long been distinguished as a vermifuge. It is a native of nearly every part of the new world. Being exceedingly hardy, it grows almost equally well under every degree of latitude, and in every variety of climate. It is found in Canada, and in the Brazils.^ No portion VOL. IT. K 71 of the plant is destitute of efficacy. Expressed from the recent leaves, the juice is sometimes given to childreu, morning and night, on an empty sto- mach. It is more common, however, to reduce the seeds, emphatically called worm seeds, to a pow- der, and to administer them in the same way, mix- ed with molasses or s^up. The dose must in most instances, be repeated for several days. Lately, there has been extracted from the seeds of the chenopodium an oil, which * has become a fashionable remedy for worms, especially in children, so much so, as nearly to supersede all other anthelmintics in the practice of this city. It is indiscriminately prescribed in every species of worms, and is thought to be highly be- neficial. For a child of two years old, the dose is six or eight drops morning and night. After continuing it for three days it is to be intermitted, and a mercurial purge given. If worms are not then discharged, and their existence still suspected, we may again re- cur to its use in the same manner as before. This is the substance of the printed directions accompany- ing the medicine. The do9e, however, recom- mended is too small, and may be increased with safety and advantage. To the oil as well as to all other preparations of the chenopodium, the chief objection arises from its very unpleasant nature. It is to the taste an acrid bitter, and has an odour singularly offensive, 75 and so tenacious, that nothing can dispel or mitigate it, for some hours. Could we dispossess the article of these qualities, it might be considered, perhaps, as the most valuable of all the anthelmintics, ex- cepting the mercurial medicines. All of the preceding articles are of the growth of our own country, and it is worthy of remark, that it furnishes so large a proportion of the active anthelmintics. I shall now introduce a foreign medicine, which perhaps should not be over- looked. GEOFFR^EA INERMIS, The cabbage bark tree, is a native of the West Indies, and particularly of Jamaica. The bark is the only part used as a vermifuge, and may be pre- scribed in the form of powder,- decoction, or ex- tract. But the decoction is generally preferred, and is prepared by slowly boiling an ounce of the dried bark roughly pulverised, or bruised, in a quart of water, till it assumes the colour of Madeira wine. In the administration of this medicine we should proceed cautiously, as, in an improper dose, it will occasionally produce some very unpleasant conse- quences, such as violent vomiting and purging, delirium and fever. Even uniler any circum- stances, it has appeared to me very apt to dis- tress the stomach and bowels, and hence I have ;6 been deterred from freely using it, especially in children, though I am not the less convinced of its efficacy. To this point we have the concurrent testimony of all the West India practitioners, as well as of many of those of Europe and this coun- try. The dose of the decoction for an adult, is two table spoonfuls, of the extract three grains, and of the powder half a drachm. It should be repeated for several days, and then an active purgative exhi- bited. Those who are best acquainted with this medicine, direct that cold water should never be drunk during its operation, as it is prone to occa- sion very serious effects. Of this I know nothing myself, having indeed, very rarely used the ar- ticle. OF ASCARIDES. Next, I am to say something of the management of ascarides. As formerly mentioned, these are a a small worm which occupy the rectum, or at least most commonly the lower portion of the intestinal tube. They may be distinguished by the itching kept up in the anus, which sometimes amounts to an immoderate degree of irritation, and is gene- rally aggravated in bed, so that sleep is often pre- vented. Even inflammation and a considerable swelling about the fundament, I have known to take place, accompanied with tenesmus and bloody stools. 77 To these symptoms may be added all the sign* which denote the presence of the other description of worms. But there is one circumstance, which, in many cases, is con-elusive of their existence. They are apt, especially when disturbed, to creep out of the rectum, and at all events they may often be seen entangled in the excreincntitious dis- charges. Of the general remedies in this sjucics of worm, ealomel in combination with some drastic purga- tive, seems to claim the greatest confidence, it has been a good deal prescribed by me, and with very variable results, having sometimes found it ef- fectual, and in other instances, completely to fail, which however is pretty much the character of all the remedies. ALOETIO PREPARATIONS. As might be presumed, from their peculiar affini- ty to the rectum, the principal seat of ascarides, the aloetic medicines have proved occasionally service- able. Exhibited in the ordinary way as a purga- tive, the aloes will sometimes answer exceedingly well. But I cannot help thinking, that the hiera picra, which is known to consistof aloes and canella* alba, is a more powerful and efficacious remedy. Why it should be so, it is not easy to conceive, as the latter ingredient is in itself not active, and en- tors into the composition in a small proportion. But 78 it is idle to indulge in speculations relative to the operation of medicines. Hiera picra is becoming very popular in this city, as a cure for ascarides, and I suspect de- servedly. It has often succeeded with me, in cases which had previously baffled all my efforts. In the ordinary manner of prescribing it, an ounce of the powder is dissolved in a pint of ardent spirits, of which, being sufficiently digested, a table spoonful diluted.may be given to a child three or four years old, in repeated doses, till it purges feopiously. It is very probable that a wa- tery solution might answer as well as the spirituous. But this is the common one, and having found it successful, I have not ventured on any innovation. The strength of the menstruum is much abated by the ingredients. INJECTIONS. After all, however, these cases will often be more successfully managed by injections. The worms being situated in the rectum, within the reach of the remedy, may be mechanically washed out, or, what oftener happens, are destroyed by the deleterious substances used for the purpose. As an injection, nothing has answered better with me, than a drachm or two of aloes, dis- solved in a pint of milk. But with the same view, lime water, olive oil, the juice of rue. 79 or tansey, or wormwood, an infusion, or the smoke, of tobacco, camphor tea, a solution of as- safoetida, of the hepar sulphuris, of mercurial oint- ment, or of common salt, may all be tried. The last especially, I have prescribed with very unequi- vocal advantage. The injections having been repeated, as often as maybe deemed expedient, it will be right to give an active purgative. Being rendered sick and fee- ble by the previous remedy, the worms will now be readily brought away by the operation of the purge. TRICHUUIS. Of this worm I have little further to say. ' It is to be distinguished, so far as I know, by no pecu- liar symptoms, and probably might be managed with equal success, by some of the means which are re- sorted to in ascarides. TAENIA. This is by far the most difficult worm to remove. We have no symptoms which very clearly distin- guish it from .the lumbricoides. Its existence, per- haps, is more generally attended by a steady gnawing sensation at the pit of the stomach, and by an indescribable wretchedness, which is always in so cident to the gastric affections. Emaciation of the body is said more rapidly to take place from it, than the other worms, and in some cases, even amounts to atrophy. MERCURIAL PREPARATIONS. In the treatment of taenia, the mercurial prepa- rations have been tried, and probably on the whole, with greater success that any other class of reme- dies. They are, however, extremely fallacious, having indeed, in the few cases which have come under my notice, proved altogether inefficient. But they have undoubtedly done good in the hands of other practitioners. I have used the calomel, ethiops miueral, and corrosive sublimate. The latter, which has recently acquired considerable • reputation, should be given in solution, and in the dose of a fourth or sixth of a grain. DRASTIC PURGATIVES. Most of the drastic purgatives have, more or lesi-*-, been used in taenia. This is especially the cage with jalap, scammony, colycinthe, and above all, gamboge, which, in very large doses, is extolled as a sovereign remedy. Not less than .twelve or fif- teen grains will do, as the' most active purging is necessary for the expulsion of the worm. Of this practice, my own experience will not. enable me to 81 say much, though I am persuaded that the active cathartics will be found to be among our best re- medies under such circumstances.* THE POLYPODIUM FIL1X MAS. The male fern has been prescribed in taenia since the time of Galen. Too much has been said of its efficacy, in these cases, to doubt it altogether, and yet, from my own observations, I should be induc- ed to rate its powers very low. The dose of the fern is fiom one to three drachms, to be taken in syrup, 01 simply washed down with water. To promote its operation, a strong purgative is to be given after a few doses, and if the worm be not ex- pelled, the same course should be repeated. By Cullen, it is thought very doubtful whether the fern has any anthelmintic property, he being inclined to suspect, that all the effects imputed to it, may be referred to the cathartic with which it is generally combined. This suspicion, however, f does not seem to be well founded, as, in Germany, .where the medicine is much employed, and is * Gamboge enters largely into several of the nostrums for tenia. The famous specific of Herrensc-hwand, which, at one time, excited so much curiosity in Germany, was composed, according to his own de claration, of " from ten to fifteen grains of gamboge, with from fifteen to twenty of kali." But on bei-u* analysed by order of Elizabeth <3f Russia, there were found in it besides, both mercury and arsenic The specific of Clossius has also gamboge for its basis, VOL 11. 1 ■v 82 highly celebrated, it is always exhibited alone. Many cases might be adduced in support of its utility. There is one in particular related by Dr. Jones of New York, of a lady who, after taking numerous worm medicines, with little or no effect, drank a decoction of fern, a pint a day, till some gallons were consumed, when a worm came away measuring forty-five feet. It may be further re- marked, in support of its efficacy, that the fern constitutes the basis of Madame Nouffleurs' well- known remedy for tape worm, the secret of which was purchased by Lewis XV. of France, at a very exorbitant price.* The United States produce several species of fern, which probably possess the same powers as the European, though this is mere conjecture, as none of them, I believe, have hitherto been subject- ed to experitntmt. The most common American species is the Polypodium Virgjnianum, which * These are substantially the directions of Madame Nouffleurs: '• Three drachms of the root of the male fern reduced to a fine pow- der, and mixed with any simple water, and swallowed at a dose. Two hours after taking the powder, twelve grains of calomel, as much resin of scammony, finely powdered, with five grains of gutta gamba, must be taken in a bolus. If the patient is of a strong constitution, or been used to violent purgatives, this dose may be increased." The following is the once famous prescription of Stoerk, with which, he says, he has " destroyed all sorts of worms :" &. Sal. polycrest. pulv. jalap. —. valerian, al 3j. oxymel bcill. Jiv. m. exhibeatur adultis quater per diem |ss. juni- 01 ibus vero 5j- aut 3'ij." 83 grows in the neighbourhood of this city, as well as in many other districts of our country. DOLICHOS PRURIENS. Cowhage is another remedy for taenia. This is a plant of the West Indies, and the parts used in medicine are the hairs or spiculae attached to the pod. The operation of this article, is said to be purely mechanical, being supposed to prick the worms, and in this way to expel them out of the alimentary canal. It might be suspected that the same degree of irritation would be felt by the in- ner coat of the intestine, and that therefore the medicine might prove injurious. Experience, how- ever, has taught the contrary. Taken in the quan- tity of a table spoonful mixed in syrup or mucilage, it is said to be both a safe and efficacious remedy. I have never employed it. It is highly extolled by many respectable practitioners. STANNUM. Either the filings of tin, or the powder made by heating it nearly to the melting point, and shaking it briskly, may be employed as an anthelmintic. The dose is one or two drachms, mixed with syrup, to be taken for several mornings in succession, and then purged off by an active cathartic* It was * Alston, who first recommended the tin filings in taenia, gave in some instances, an ounce at a dose. S4 long supposed that the efficacy of tin in these cases is owing to the arsenic which .it contained. But, it has been found, that the purest metal answers as well, and its operation is now commonly referred to mechanical irritation. As however it is proved, that when reduced even to an impalpable powder, tin is not less effectual, this hypothesis must also be abandoned. Of late, it is conjectured that it acts merely by the hydrogen it generates in the ali- mentary canal, and which is supported by the alle- gation, that its powers arc increasd by a mixture with sulphur, by which sulphuretted hydrogen is evolved. In addition to the preceding remedies, there is a variety of others which have been suggested at different times, for the cure of the tape worm, among which may be enumerated sulphur, the blue and white vitriol, arsenic, and very recently the rectified oil of turpentiue. The last article, however, appears to me, to be the only one, the powers of which have been sufficiently attested, to be entitled to par- ticular attention. It is given in the dose of from half an ounce, to two ounces, in the morning when the stomach is empty. Commonly it excites an agreeable warmth without any sickness, or other gastric dis- tress. After a while, however, patients are apt to complain of giddiness, slight pain in the head, and sometimes, when taken in the largest dose, of thirst, 85 and other febrile sensations. But these speedily pass away, leaving behind no serious consequences. It appears that this remedy, which probably acts as a poison to worms, is most effectual when given by itself, and that strangury, and other unpleasant effects, are more likely to occur, if it be employ- ed in the ordinary small doses, than when exhibited so as to purge. My own experience does not ena- ble me to say much on the subject of this remedy in taenia, no unequivocal case having come under my care since I had a knowledge of it. Twice I have prescrihed it, where I suspected the existence of this species of worm, and in one instance a very large number of lumbricoides was evacuated, while in the other, no such effect followed, though the symptoms which led me to its use wereretr.oved. Yet of the utility of the turpentine in taenia, there ■".an be no doubt. The late periodical journals abound with proofs of it, proceeding from some of the most distinguished of the English practitioners,* and it has been successfully used in this city. Bold as the practice seems to be, I do not think We have any thing to apprehend from it. In one of the cases to which I have alluded, I gave a wine glassful of the turpentine for several days succes- sively, and the man declared, he felt no more from it, that from the same quantity of ardent spirits. Being so efficacious in taenia, it is reasonable to suppose, that the turpentine will prove still more ' Vid Eclectic Repertory, vol. i. p. 414. 86 so, in the less intractable species of worms. The fact which 1 have stated of its evacuating the lum- bricoides, is sufficient of itself to encourage us to a further trial in such cases. I have now completed the consideration of the best means for the destruction or expulsion of worms. Little, however, would be accomplished in most cases, were we not to prevent their reproduction, which can only be done, by the removal of the causes that promote their generation and nourish- ment. As formerly observed, every species of worm seems to have its origin and support in a weak and depraved condition of the digestive organs. The indication, therefore, is to restore to them their pro- per degree of vigor, which may be done by the exhibition of lime water, bitter tonics, the prepa- rations of steel, and by a due regulation of diet, and whatever else conduces to the confirmation of health. 87 DISCOURSE XXVIII. Epispastics. The etymology of this term warrants a more extensive meaning than is commonly affixed to it. Literally, it signifies to draw, and may be used in the same sense as attrahentia. But, as the epis- pastic substances generally excite a blister, the term is, at present, received as synonymous with vesicatoria or vesicantia. By the ancients, all the external applications which redden or inflame the skin, were called epispastice, and these were de- signated according to the several degrees of effect: the slightest entitled phmnigmoi, the next sina- pismi, the more active vesicatorii, and the strongest caustici.* In treating this subject, I shall arrange what I have to say under the three heads of rubefa- cients, blisters, and caustics. But as blisters are the most important, and will command the largest share of attention, it is right, perhaps, to commence with the history of these applications. Certainly by doing so, I shall escape from many repetitions, which otherwise would be unavoidable. * fan-'* Medical Dictionary. ' **ft- ** ■ s* BLISTERS. By these we mean such external applications as cause the exhalants to pour out a thin serous fluid, separate the cuticle from the true skin, and produce vesication. The manner in which this is done is very intelligible, and admits of a plain and satis- factory explanation. By the irritating nature of the substance, the extremities of the arteries are excited to an increased exhalation or effusion, which is collected, and is retained by the im- pervious cuticle. But, of the mode in which blis- ters operate in the cure of diseases, we are still uncertain, (hough this is a point which at differ- ent periods, has occasioned numerous disquisi- tions, and eager controversies. It is fortunate, that the calm and attentive practitioner has pursued his path unmoved by these speculations, and care- fully observing the effects of the remedy, has as- certained, with perhaps sufficient precision, the time and circumstances when it becomes proper to recur to it. Nevertheless, I can scarcely admit of any un- usual obscurity iu the modus operandi of the vesi- cating applications. No one I presume, at present, could be found to support the ridiculous hypothesis, which referred the effects of blisters to the ab- sorption of the acrid particles of which they are conpoj-ed, into the circulation, and to the subse- 89 quent stimulation thereby imparted to the system. Many arguments might be adduced to show that even strangury is never occasioned in this way, much less that we are to seek an explanation of the general ac- tion of blisters in the process of absorption. Not, how- ever, to press a point, which perhaps is of no great practical importance, I shall mention only one or two leading objections to the vulgar notion on this subject. It seems to me, that if strangury do thus arise, it ought invariably to take place on the applica- tion of a blister. But so far from this happening with uniformity, it is an incident of comparatively rare occurrence. Nor does it less follow, that this affection ought always to be in proportion to the size of the blister and the time it is kept on. These circumstances, however, have little or no influence in the production of strangury. It is moreover known, that the internal use of cantharides is sel- dom attended by any such effect, and when it does occur, it is more frequently from small than large doses of the article. These, perhaps, are reasons sufficient to refute the opinion to whieh I have alluded, without an appeal being made to the general improbability of any article reaching the circulation unchanged. It would really appear, in the case before us, that absorption is in a great measure suspended, since, were this process to go on, as usual, the fluid must be taken up as fast as it is effused, and no accumula- tion could take place. VOL. II. m 90 What is the exact cause of this species of stran- gury is not determined, though, it is well known that a great variety of articles, besides cantharides, and some of these by no means of an acrid nature, will excite it. Thus it is pretty constantly brought on by the solanum nigrum, and I have seen it caused by camphor.* We have some cases recorded of its proceeding from the use of opium. Even the diu- retics, and these too, of the mildest sort, including nitre, often occasion it. Whatever, in short, is pos- sessed of a peculiar relation to the urinary organs, has a tendency, exhibited largely, to induce stran- gury. As this is indisputably true, may we not account for it on the principle of extended action through the medium of sympathy ? Cantharides are uni- versally allowed to be one of the articles of the Materia Medica, which most conspicuously dis- play their affinity to the urinary organs. Applied in the form of a blister to the surface of the body, they excite a local impression, which, by virtue of the consent of parts, is propagated in the mode I have just mentioned. This, at least, is the solu- tion of the difficulty which accords best with my medical creed, and I think too, with the existing state of our medical intelligence. Contemplating the action of a blister, two modes are presented in which it may be serviceable • Heberden mentions a case of this sort, and I once saw it induced in typhoid pneumonia, from the free use of the medicine. 91 in the treatment of diseases. By the increased ac- tion which it excites, the primary effect of the re- medy is indubitably stimulant, though, from the quan- tity of fluid poured out, it would appear also to be ultimately evacuant. But among experienced prac- titioners, little hesitation prevails as to which of these modes of operation, the best effects of blisters are to be ascribed. Excepting, indeed, some cases of cellular dropsy, I am not aware that any very great advantage is derived from this sort of depletion. Certain it is, that the relief afforded is not at all proportioned to the quantity of fluid evacuated, and very often, the most signal benefit accrues to the patient, where little or no discharge takes place. It hence follows, that the salutary ten- dency of these remedies is to be referred chiefly to the stimulant or incitant power which they pos- sess. Demonstrated by the clearest evidence, it is now a principle admitted with regard to the living body, that an existing morbid action may be removed by inducing a new and different impression, in the same part. It is on this principle, that we can ex- plain the extraordinary efficacy of epispastics in all local inflammations. Nor is it less a law of the animal economy, that, in many instances, a very strong impression made on one part, has the effect of soliciting or drawing towards it, morbid action existing in some remote portion of the body. It is this, which we understand by the term revulsion, 92 and which we habitually perceive illustrated iu the operation of vesicatorics, and similar appli- cations. But, blisters have a more pervading effect, and hence are useful in complaints of a ge- neral or constitutional nature. They act here, as in the former case, by their stimulating power, in- creasing the force of the circulation, and heighten- ing excitement, as happens in typhus fever, and many other low diseases. That these remedies are cordial and exhilarating is further proved, by their efficacy in all nervous affections, whether distinguished by a preponde- rance of mental or corporeal infirmity, and weak- ness. It is somewhere recorded of the celebrat- ed Mr. Dunning, the eloquent barrister of the London bar, that on great occasions, when he was called upon to make the finest displays of his powers, either forensic, or parliamentary, he put on a blister, and found that while it elevated his mind, tone and vigour were imparted to his body. It seems, on the whole, in estimating these reme- dies, it will be prudent as a guide, in practice, to consider them as stimulants, sometimes acting by inviting morbid excitement from distant parts, at other times, by producing local impressions which overcome the existing one, and as calculated ge- nerally to sustain, or revive the strength of the sys- tem. But, it is not be concealed, that very differ- ent views have been taken of tlieir operation, and among others by Cullen, who depreciating the sti- 93 mulant and evacuant effect, is disposed to ascribe their utility chiefly to the property they possess of relaxing spasm. That they are, to a certain extent, antispasmo- dic, is sufficiently shown by the great advantage derived from them, as we shall hereafter see, in very many of the spasmodic affections. But this they do by a mere modification of the stimulant power, in the same way that they tranquillise the system and compose to rest, under circumstances of excessive mobility, either natural, or acquired, as in certain cases of morbid weakness. Next I am to make a practical application of blisters to the cure of diseases, and, considered in this light, they become exceedingly interesting and important. But as preliminary to the main discus- sion, I shall suggest some few rules for their em- ployment. 1. Let the blister remain on till it draws effectu- ally, aud the ordinary time required for this purpose is ten or twelve hours. But on the head, at least double this period, and here to prevent strangury, the hair should be removed several hours previously to the application of the blister, if such a delay be ad- missible. Children, owing to delicacy of skin, arc much more speedily blistered, aud hence in their eases, it may be earlier removed. Being continued too long, it is apt to induce gangrene, as I have witnessed in two or three instances. 2. It will be right, especially in local affections, 9* and in the whole of the phlegmasia, to apply the blister as nearly as possible over the immediate seat of the complaint, its efficacy, thereby, beiug very much increased. Let it also be as large as the nature of the part will allow. Large blister* give no more pain, and are generally beneficial in the ratio of their dimensions. 3. In those individuals liable to strangury, or where, from peculiar irritability, much pain is ex- cited, it will be proper to remove the blister after two or three hours, or as soon as the rubefacient effect is produced, to bathe the part with a mixture of olive oil and laudanum, or fresh lard, and re- apply the blister. This will sometimes succeed in doing away the inconvenience. But if it fails, a soft emollient poultice may be substituted, which, so far as I have tried, uniformly soothes irritation, and produces well filled vesications. As preven- tives, it will also be prudent to direct the free use of diluent beverages,as flaxseed tea, barley water, or a solution of gum arabic. To cure strangury, these same drinks are serviceable, though not so much so as the parsley or wild carrot tea. But if the affection be violent, as sometimes happens, we must resort to more efficient remedies, such as fomentations to the pubes, or the warm bath, or to camphor, balsam copaivse, and above all, to opium, and particularly in the form of an enema. 4. Never recur to blisters in diseases of the higher grades of action, till in some degree re- 93 duced by venesection and other depleting mea- sures. Too early employed in such cases, they hardly ever fail painfully to increase irritation, and exacerbate morbid excitement. 5. In the very advanced stages of disease, blisters should be applied to the thighs, shoulders, back, neck, breast or head, and never to the ankles or wrists, as here, on account of the lowness of temperature and feebleness of action at the time, they either do not draw at all, or if they do, it is imperfectly, oc- casioning weak erysipelatous inflammation, which is apt to become gangrenous. 6. In putting on a blister, care should be taken to adjust it to the part, and so to apply the bandages, as to secure it against slipping, which gives un- necessary pain, and prevents its drawing well. By strips of adhesive plaster this may be done, and they will be found exceedingly convenient in the application of blisters to portions of the body in which there is much motion, as to the sides, neck, &c. It is a common practice to bathe the part pre- viously with warm brandy or vinegar, in certain cases, however, where the drawing of the blister is doubtful from a low state of system, it will be bet- ter to excite irritation by frictions with the spirit of turpentine, or by a sinapism. 7. The usual dressing for a blister is simple cerate spread thinly on linen. If there is much irritation, lard perfectly fresh should be pre- ferred. To keep open a blister the weak epispastic, or saviu ointment is employed. 96 DISCOURSE XXIX. Of the Practical Application of Blisters. Conforming to the course which I have hitherto pursued, I shall commmence with some remarks on the use of blisters in the febrile affections. As a remedy in intermittents, they are not gene- rally employed, though undoubtedly, sometimes are useful. I have in more than one instance seen them successfully applied as a preventive of the paroxysm, so managed, as that the full impression shall be felt at the anticipated moment of attack. Even, where the eft'ect is not so striking or imme- diate, they are not without utility. Constantly kept up on the extremities, the irritation which they induce, will, after a time, so interrupt the trains of morbid association, constituting this form of fever, as frequently to put an end to the worst cases of it, acting here very much on the same principle as a mercurial salivation. Nor are they less demand- ed, in those cases of the disease, attended by visce- ral congestion, or indurations of a painful and in- flammatory nature. Little, indeed, will tonics avail, till such obstructions are removed, and with this view, a succession of blisters on the affected part ought never to be neglected. In relation to continued fevers, there is a wider 97 difference of opinion, as to the propriety of the ve- sicating applications. By some writers, they are altogether condemned, and among these, the most distinguished by weight of authority, is the celebrat- ed Fordyce. It was one of the notions of his great and original practical mind, that blisters have not the slightest tendency to arrest the progress of fever, maintaining, indeed, on the contrary, that by the new irritation which they occasion, they prove an acces- sory cause. Perhaps, it is not difficult to reconcile the con- trariety of sentiment on this point of practice. No- thing is more opposite than the effect of a blister, in the early and advanced stages of fever invariably doing harm, while there is much arterial action, and as uniformly proving beneficial in properly reduced states of the system. The continued fevers of this climate are either bilious inflammatory, or the typhus of crowded and ill ventilated places, the latter, however, occurring rarely, and scarcely ever, except in winter. My practice is to recur to blisters in the former of these fevers, whenever I find the disease to continue, after thorough evacuations of the alimentary canal, and blood vessels, and especially, if there be dis- played any typhoid disposition. Blisters, under such circumstances, should be applied to the ex- tremities, and by the stimulation which they im- part, are often productive of manifest advantage. VOL. II. N 98 But, in the yellow fever, a disease essentially dissimilar, though it has been maintained to be the same, in a more aggravated shape, blisters may be earlier resorted to, and differently applied. Taught by dissection, as well as by the leading phenomena or symptoms, that the stomach is the seat of this pestilence, inducing a malignant gas- tritis, a prompt application of a large blister over the region of this viscus is obviously indicated, and all experience confirms its utility. As regards typhus fever, a course somewhat dif- ferent should be pursued. It seems now to be as- certained, that the brain is the part on which it mainly expends its force. We have in the com- mencement of the disease evidence of a great de- termination to this organ, and not less in the sub- sequent and advanced stages. Now the plain and intelligible indication is, to prevent or do away congestion or inflammation, and which is most ef- fectually accomplished, by local measures, such as cold applications, topical depletion by leeches or cups, and finally, a blister, of sufficient dimensions, to embrace the whole cranium. It is not unknown to me, that objections have been raised to the last of these remedies. But they rest on no solid foundation, and are contradict- ed by the tenor of medical experience. There are certain points of practice so firmly settled as no longer to be disturbed by cavillers or wild specula- tists, and among these is the efficacy of a blister to 99 relieve the head in typhus fever, and especially where delirium exists. As well indeed, might a practitioner rise up and deny the power of bark in intermittent fever, or mercury in syphilis, as that of a blister in the case which I have mentioned. Eccentricities of this sort are common in the his- tory of the human mind, and from which we have no reason to hope that our science should escape. Considering the immense influence which recent experiments have proved, that the spinal marrow indirectly exercises over all the great functions of the animal economy, it seems not at all improbable, that much advantage might result from blisters and such like applications to portions, or, perhaps, in very obstinate cases of fever, to the whole of the spine. Nor are we entirely without facts to verify this conjecture, though these are derived, more from a trial of the remedy in the nervous and spas- modic, than febrile affections. To sustain the system in the sinking condition of typhus fever, it is a very favourite practice with many to apply blisters to the extremities. That they occasionally do good can hardly be doubted, yet they often fail to draw at all, and, even where we succeed, in this respect, the'action produced seems not always to be a very salutary one. As a more certain means, at least, of stimu- lation, sinapisms, or rubefacient embrocations, have been preferred, at this conjuncture, and, perhaps, on the whole they will he found to answer best. 100 Of the order of phlegmasia, I know not a single case, in which blisters are not employed. But of the numerous affections comprehended under this term, there are some in which the remedy is more particularly demanded. Every practitioner is aware of its efficacy in the whole of the acute pneumonic cases, though some discrepancy of opinion may be traced, as to the time when it should be applied. My own rule, and which I have reason to suppose is sanctioned by the best autho- rity of the present day, is to postpone the blister, especially in pleurisy, till some considerable reduc- tion of arterial action is effected. At this precise period, they prove unequivocally useful by extin- guishing the remnant of pain or oppression, and seem to arrest the further march of the disease. Hut earlier than this, I have found that they scarce- ly fail to occasion great distress to the patient, and assuredly aggravate the symptoms which they are intended to relieve. Candour, however, compels me to confess that an opposite course is pursued by some of the ablest practitioners of this country, and of Europe, and with alleged success, to which I can only reply, that the counter evidence decidedly pre- ponderates, aud that my own experience, which I slowly give up to any one, tells me that I am right. The preceding remarks have a reference only to confirmed, ordinary pleurisy. Either in the form- lai ing state of this very disease, or where it occurs in a debilitated system, and in the peripneumonies of aged people, a blister may unquestionably be appli- ed, at once, without any preliminary depletion. To the anginose affections, blisters are well suited, and particularly to cynanche tonsillaris, and trachitis or croup, though their application should generally be preceded by pretty active evacuations, and if attainable, by topical bleeding with leeches. Of the inflammatory affections of the alimentary canal, there is no one in which blisters are so un- equivocally useful as gastritis itself. Excepting, indeed, venesection, they are the only remedy enti- tled to much confidence in this case, and the same may be said of enteritis, &c. Dysentery, though not thus located by the noso- logists, is indisputably, when it assumes the in- flammatory shape, a case of this order. Most writers agree as to the utility of blistering in this disease, differing, however, in relation to the part where the application is to be made. Influenced by the apprehension of excessive pain when made to the abdomen, the extremities are very often pre- ferred. This is an instance of mischievous leni- ty, proceeding too, I am persuaded, from an erro- neous impression. Delayed, which it ought al- ways to be, till the force of inflammatory action is abated, it then is productive of comparatively little distress while drawing, and sometimes by the ease and comfort which it affords, even 102 composes to sleep. To the extremities blisters are, on the contrary, more painful, and of no avail un- less the case be so far reduced, or protracted as to partake of the nature of diarrhcea, or is blended with intermittent fever. Cholera morbus is another case in which blis- ters are employed. To check vomiting, they are often applied over the stomach, or to the extremities. Either position will do very well, though, in ex- hausted states of the system, the latter is to be pre- ferred. These remarks are equally applicable to cholera infantum, with this difference only, that blisters, here, are more rarely, and uever so urgent- ly required. Not less to overcome the spasm, which causes the pain and obstruction, than to obviate inflamma- tion, blisters are one of our most effectual re- sources in cholic, and on no occasion, perhaps, more conspicuously manifesting their antispasmo- dic power. It would be superfluous to go through in detail the several visceral inflammations, such as hepati- tis, splenitis, and nephritis, since, in the use of the remedy, we are governed by one common rule, namely, to withhold its application till the force of the case is broken, by previous depletion. As some practitioners, however, distrust the propriety of blis- tering in the affections of the kidneys, from the fear of inducing strangury, or otherwise adding to the existing irritation, it may be useful to observe, 103 that actual experience has shown the fallacy of these speculative objections, and fully attested the safety and efficacy of the practice. Of the utility of blisters in rheumatism every one is persuaded. Yet even here they are produc- tive of harm, if prematurely applied, and where it can be conveniently done, should be preceded by a local detraction of blood. My conviction is, that they are infinitely better adapted to chronic than acute rheumatism, almost always proving service- able in the former instance, and especially when they induce the suppurative process. By some writers it is recommended to blister the affected part in regular gout, and, as it proves so beneficial in analogous cases, we might imagine that it would be attended with the same re- sults. But on trial, I have been disappointed, and applications of this nature are no longer employed by me. It has indeed been alleged, that blisters have the effect of repelling the disease on some internal part of more value to life, and hence are hazard- ous measures. Experience, however, has taught me, that such applications are the very best means to invite, and fasten down, if I may use the expression, gout on the extremities, and I can have no idea of a remedy blowing hot and cold in this way. Nevertheless, in misplaced or retrocedeut gout, whether it attacks the alimentary canal, the lungs, brain, kidneys, or any other portion of the body, 104 blisters over the immediate seat of the complaint are highly serviceable and sometimes, even indispens- ably necessary. As one of the best means in phrenitis, they are much used, and such is the fact, in relation to all the affections of the brain, partaking, in any degree, of inflammation or congestion. No one disputes their utility in apoplexy, though doubts are entertained whether they should be put on the head or lower extremities. My own impression is in favour of the former position, and which is de- rived from comparative trials on a scale sufficiently extensive to determine the point. Of their use in paralysis, I have before said so much as to re- quire no further notice.* As a remedy in mania, blisters have been ge- nerally extolled. To be serviceable, however, they require to be used with great discrimination. Directed too early, or while much arterial action exists, they invariably do harm. But the sys- tem being reduced by copious evacuations, they are well calculated to subdue turbulence, and equalize excitement. It is common to place them on the head, and here perhaps they are most effectual, though while drawing, I have uniformly found that they produce an increase of the disease. If there- fore such an exacerbation is particularly to be de- precated, it will be prudent to make the application "' Cathartics 105 to the limbs, and this position should also be se lected in melancholia, and other weak forms of the disease, where it is desirable to arouse the .system out of its torpor by vigorous stimulation. Elsewhere I have said, that hydrocephalus con- sists in a peculiar action of the vessels of the brain, connected with a depraved condition of the chylo- poietic viscera.* As a part of the treatment of this case, blisters to the head are greatly relied on, and I believe deservedly. But we are to bear in mind, that they prove effectual, very much in proportion to the time they are kept on, and most so, when suppuration of the scalp takes place. Of the treatment of ophthalmia, and some other affections of the eyes, blisters constitute an essential part. It is customary to apply them behind the ears, or to the temples, or back of the neck, afford- ing most relief in the last named position, where the attack is obstinate. Applied to the brow, they are sometimes very successful, and may be put in cer- tain cases over the orbit of the eye itself, by pre- viously closing the lids with a thin strip of adhe- sive plaster. In more than one of the profluvia, or diseases at- tended by increased discharges, blisters are occasi- onally directed. Applied alternately to the ankles and wrists, they will very frequently relieve cases of protracted diarrhcea which have resisted every VOL. II. * Cathartics. O 106 other means. Much advantage have I also derived from them in leucorrhcea. They are sometimes bene- ficial on the lower extremities, though incomparably more so, when put over the lumbar vertebrae or sa- crum. Of their use in gonorrhoea, and gleet, I have learnt little from my own observations. The prac- tice, however, is commended by some of my medical acquaintance, and seems entitled to a share of con- fidence. Even still less do I know of their powers in diabetes. My opportunities have been slender of seeing this disease. But all the cases of it which have come under my notice could be traced dis- tinctly to gastric derangement. Nevertheless, the kidneys, though secondarily, are always much af- fected in it, and for the purpose of calming the irri- tation of these organs, blisters seem to promise well. We are fully aware of their utility in other cases of preternatural secretion, as well as of in- continency of urine, and there seems to be no good reason why they should not prove service- able in diabetes. It has become a practice of late, perhaps, more in this city than elsewhere, to treat some of the cases of hemorrhage by the vesicating applications. After arterial action is reduced by venesection, they are unquestionably serviceable in haemoptysis, and worn on the back of the neck, I have seen them suppress, in several instances, very trouble- some bleedings from the nose. As respects uterine hemorrhages, I am not able to say much, though 107 in that irregular species of menorrhagia, which oc- curs about the period of the cessation of the men ses, I have known some good result from blisters habitually kept on the ankles. Many of the exanthematous affections, in certain shapes, at least, demand the use of blisters. To sustain the system in typhoid, or confluent small pox, they have been found advantageous, and also in the same complaint, where the eruption suddenly recedes. Exactly with the same view, are they di- rected in measles, under similar circumstances, and moreover to relieve the violent catarrhal affection which often attends this disease. The utility of blisters in arresting the malignant forms of erysipelas is established by the amplest experience. To the late Dr. Pfieffer of this city, the credit of this valuable discovery has been ge- nerally accorded. But the practice is of an older date, and I think may be found in some of the writ- ings of M'Bride. With nearly the same advantage, blisters are prescribed in scarlatina, to support the system when approaching the typhoid state, and should the throat be affected, are still more important as a topical application earlier made. 108 * ' r DISCOURSE XXX. The subject continued. We come now to the class of Neuroses, in which I include both the nervous and spasmodic affec- tions. Of these there is a great variety, in all of which blisters are more or less employed. It has long been customary to vesicate the head in epilepsy, where the disease is supposed to origi- nate from some morbid condition of the brain. Cases of this sort, however, are rarely curable by any course of practice, and blisters consequently of little service. But, epilepsy seems also to de- pend, in many instances, on a certain mobility of the system, somehow connected with a disorder- ed stomach, and which observes the laws of peri- odical recurrence. It is in such cases that blisters, worn on the extremities, now and then dissever the trains of morbid association, and thus suppress the disease. W hat would be the effect of blistering the spine in epilepsy? Of the use of blisters in tetanus I have no expe- rience. Nearly half a century ago, however, a case was recorded by a West Indian surgeon* of a cure having been accomplished of this disease, by the application of a strip of blister plaster along the whole extent of the vertebral column, and this prac- * Mr. Carter. 109 tice, T have heard, has recently been imitated, and with sufficient success, to claim our attention. Certain spasmodic affections of the chest are sometimes benefited by the use of blisters, among which may be mentioned pertussis, asthma, and angina pectoris. Perhaps it may be entirely out of place to mention here, that they are prescrib- ed with advantage in some of the spasmodic com- plaints of the stomach, and particularly in gastro- dynia and pyrosis. In several of the cachetic cases, blisters are great- ly employed. To repress any inflammatory ac.'ion of the lungs in pulmonary consumption they ad- mirably co-operate with general and topical bleed- ing, and should be so repeated as to keep up a dis- charge from the surface. After, however, the sup- purative process has commenced, in any one form of the disease, they not only prove nugatory, but often increase the mischief, by aggravating the degree of irritation. Nevertheless, as expectorants, they are occasionally productive of relief, by invigor- ating the lungs in the protracted catarrhs of debilita- ted persons, and, perhaps, too, in some instances of consumption of this species. Much as blisters have been used in dropsy, I can not help suspecting, that they are an equivocal, if not an hazardous remedy. My allusion is to their use in anasarca and ascites. To evacuate the wa- ter in the former case, they are applied to the lower extremities, and though occasionally with success, 110 they much more frequently fail to do good, and sometimes, as I have myself seen, induce gangrene. From their application to the abdomen not a great deal can be expected. Yet, I have had one case of ascites, and know of another well authenti- cated, where the water was completely evacuated, and in a very short time, by this means. Of the efficacy of blisters in hydrothorax there is not the slightest doubt. The disease in the com- mencement is generally, I believe, of an inflamma- tory nature, and demands very active depletion, with the aid of a constant irritation on the sur- face of the chest. Even in the advanced stages some temporary mitigation of the more distress- ing symptoms is sometimes derived from the same measures. To the employment of blisters in erysipelatous inflammation, I have already alluded. Led by analogy, Dr. Physick, some years ago, made a trial of them in gangrene, and the success which he then stated, has been so fully confirmed by the concur- rent testimony of a large number of practitioners, as to place this very high among the great practical improvements. It would seem, that they are advantageous in cases of gangrene arising from very opposite causes, and differing essentially in character and circumstances. I have known them to arrest the affection, when resulting from active inflammation, and not less promptly in one case, at least, in an cedematous limb, connected with a very Ill cachetic and exhausted state of system. Cases, however, of gangrene occur, such as are occa- sioned by mechanical interruption to the circula- tion, in which they can be of no service, and these, I suspect, will be found to constitute the only ex- ceptions to the general use of the remedy. As our object is to check the progress of gangrenous action, the blister should be applied so as to em- brace the whole of the healthy margin, and is man- aged afterwards, in the ordinary manner. In another place* I have noticed the utility of blisters in amenorrhcea. But this is not the only case of suppression, in which they are serviceable. Wherever, iudeed, a natural discharge is checked either by torpor of the secretory organ, or restrain- ed by spasm, blisters will generally be found to af- ford relief, and such is espeeially true, in regard to retention of urine. Not a few of the local affections are advantage- ously managed by blisters. As a discutient appli- cation, their power is acknowledged in bubos, in mammary swellings, in enlargements of the testicles, and in scrophulous and other indolent tumors. Of all the means which I have ever tried, they are the most successful in relieving paronychia, if resorted to in the early or forming stage of the case. Applied behind the ears, they are useful in deaf- ness, whether of an acute or chronic nature, and not less so in the painful affections of the ear, pro- * Emmenagogues- 112 ceeding from an inflamed state of the membranous lining. Confessedly one of the most effectual of our remedies in odontalgia, is a blister to the cheek, and 1 have known it to suspend the pain when put on the arm. Even a sinapism will sometimes be productive of the same effects. As a remedy in taenia capitis, in obdurate tetter, and in many other herpetic cases of a local nature, the use of bHsters is familiar to most practitioners. Much has been said of late years in favour of blisters by Mr. Crowther, and other surgeons, in the acute aud chronic inflammations of the joints, and, from what I have seen of the practice, I can- not doubt of its great and decisive utility. To be successful, however, the discharge must be kept up, either by a repetition of the blisters, or by dress- ings with savin ointment. Of the numerous improvements in surgery which have been suggested by Dr. Physick, there is scarcely any one of more unequivocal utility, than the management, by blisters, of inflamed veins from the operation of bleeding. In most cases, a single one will prove adequate to the cure, though occasionally, where the arm is very stiff and tumid, a succession of them is demanded. The mode of application is, to confine a strip of the plaster along the whole course of the inflamed vein, making an opening for the pus or sanies to escape. To the cases which I have enumerated, many more might be added, in which blisters are em- 118 ployed. Enough, however, has been said to serve as a guide in their application, and to illustrate the great value of them as a means of combating disease. Next, therefore, 1 am to give some account of the articles which are used for the purpose of effecting, vesication. MELOE VKSICATORIUS, Vb'L LYTTA VESICATORIA. Of the genus Cantharis there are several species, but the one here introduced is most highly esteem- ed, and has long since supplanted all the rest in practice. As a vesicating substance, the Mylabrum Cichorei was employed by the ancient physicians, and, we are told, is continued, for the same pur- pose, by the Chinese. Cantharides are to be met with in Germany, France, Italy, and most of the countries of Europe. Being, however, procured chiefly from Spain, they are called Spanish flies, though the largest and best are brought from Italy. Cantharides are an insect of the beetle kind, having a lively tinge of blue and green, interspersed with a golden hue, appearing at stated seasons in large swarms on trees, the foliage of which they ravage and destroy. Caught, which is done bj shaking them off the trees into a cloth held under- neath, they are immersed in vinegar, or exposed to VOL. II. p 114 its vapour, and next dried by being placed in tht sun. Cantharides do not lose their virtue by age, or by keeping them in powder. Even these acrid in- sects are soon reduced, by some others feeding on them, to dust, which, however, is found to be as ac- tive as the recent fly, since only the inert parenchy- matous portion is selected as food.* f CANTHAR1S YITTATA, VEL LYTTA YITTATA. These are an American insect, having been met with, I believe, in no other section of the world. During the autumnal months they appear, in some seasons, in prodigious numbers, covering the leaves * Of the manner of preparing a blister plaster little need be said, so familiar to almost every one is the process. Commonly it is done by spreading a piece of soft leather, or new strong linen, of the proper form and dimensions, with baalicon ointment, and then working into it as lar tics may be employed to meet very opposite indi- cations. To command their stimulant power, they ought to be prescribed in small doses, frequently repeat- ed, and gradually increased, and the excitement which they enkindle is thu« sustained. But when the design is to mitigate pain, or to procure sleep, or to relieve irritation, or deaden sensibility, they should be exhibited in a full dose, and at more distant intervals. That the purer narcotics are endowed with the power which I have assigned to them, is very sa- tisfactorily proved, as we shall hereafter see, by the operation of opium, the article which, as most commonly resorted to, is best understood. It may be deduced from the preceding ac- count of narcotics, that they constitute a most important class of medicines, and are suscep- tible of a very diversified application in the practice of physic. But, to render them service- able, much caution and discrimination are neces- sary. Be it remembered, that the indications chiefly, which they are capable of fulfilling, are to excite and support the actions of the system, to assuage pain, and allay irritation, to relieve spas- modic affections, to induce sleep, and to check the morbidly increased secretions, and excretions. We have, however, a large number of arti- cles, that without possessing the narcotic proper- 139 ty in the slightest degree, are even more unequi- vocally stimulant, and which we recur to, in very many instances with manifest effect, where excite- ment is to be raised or sustained. These, of course, I shall treat of, and under the head of in- citants. Nothing, perhaps, in the exercise of our profes- sion is more difficult, than to fix the period, in the progress of a disease, or to ascertain the circum- stances, iu which it becomes proper to prescribe stimulants. As relates to the use of depleting re- medies, it is far more easy to come to a just deci- sion. Not to descend to details which, probably, would not shed any very distinct light, I will merely observe, that in making up our minds on this point, we must be guided by the state of the system. As in the administration of stimulants, we hope to overcome an existing action, by exciting a new and a stronger one, it is obvious that they can only be resorted to with any hope of advantage, in the feeble shapes of disease, or in more violent forms, reduced by previous evacuations. But, in deter- mining the exact point at which to commence the use of stimulants, we may also be aided by watch- ing their operation. Being ill-timed, they common- ly produce pain in the head, or delirious wan- derings, or morbid vigilance, or stricture of the breast, restlessness and anxiety, with a hot dry 140 «kin, parched tongue, and a quick, small, and cord- ed pulse. As it is of great importance that this set of ar- ticles should be correctly prescribed, I shall now endeavour to suggest some precise rules, on the subject. 1. It will generally be found best to begin with small doses, though we are to recollect that the action of these medicines by repetition, is more rapidly lessened than any other, so that, in a short time, the doses require to be con- siderably augmented. Exceptions, however, ex- ist, to the precept which I have inculcated. Cases of typhus fever, and some of the neuroses especially, are marked by such a loss of susceptibility to im- pression, that we are called upon, even in the early stages of these disorders, to exhibit stimulants freely. 2. It is wrong to combine many of these articles in one prescription, or to use any number of them at the same time. By directing them separately, or nearly so, we economise our resources in protracted dis- eases, and probably also, make a more distinct and powerful impression.Where itis expedient to deviate from this course, we should be careful to select such articles as are calculated to co-operate to the same end Much is sometimes gained by harmony in the action of medicines. 3. It is adviseable to change occasionally, the part of the body to which we apply stimulants. 141 as sensibility will be left in one place to a me- dicine, when completely exhausted in another. This is a principle of very extensive applica- tion in the practice of our profession. The excit- ability of the stomach being worn out, we should make an application to the bowels, or skin. We have the propriety of this practice exem- plified in the use of opium. Numerous are the cases, where, after it cannot be any longer given with advantage by the stomach, it will act very efficaciously, if injected into the rectum. <4. In the administration of stimuli, as indeed of all medicines, but more especially stimuli, we should endeavour to graduate the article to the state of excitability. This is a point of infinitely greater importance than is commonly imagined. Between certain conditions of the system and me- dicines there would seem to be an affinity or rela- tion, which when consulted, often leads to deci- sive advantages. It is not always that the most ac- tive article produces the greatest effects. Castor oil will sometimes purge, when a drastic cathartic proves wholly inert. In the low states of disease, I have witnessed, in some instances, more effects from wine whey, than strong toddy. This pro- ceeds from the article being in unison with the con- dition of the system. 412 DISCOURSE XXXII. Of the Practical Application of Stimulants. Next I should proceed, according to the course I have hitherto pursued, to make a practical ap- plication of stimulants to the cure of diseases. But, I shall in this instance, depart from my gene- ral plan, under the conviction, that I can accom- plish my views with greater advantage, and at the same time, avoid much repetition. To arrange the diffusible stimulants I have not been a little embarrassed, differing as they do so essentially, in their properties and uses. But per- haps, practical convenience will be sufficiently attained by bringing them under the three heads, incitants, narcotics, aud antispasmodics. Of Incitants. As one of the purest specimens of a stimu- lant, without any narcotic power, I commence with an account of the volatile alkali, or to speak with chemical accuracy, the carbonate of ammonia. CARBONAS AMMONIA. Of this article, I have before said something, when treating of diaphoretics and expectorants. but its great importance in the practice of. medicine. 143 entitles it to a much fuller notice than it has hitherto received from me. As relates to its chemical history, I shall only remark, that it is generally the result of animal putrefaction, though it is contained in some few plants, a point long denied, so much so, that the existence of the ingredient was held to constitute a characteristic difference between the animal and vegetable kingdoms. In every variety of febrile affection, in some one state, our medicine has been employed, though it is in the low, or typhus fevers that it is chiefly pre- scribed. Notwithstanding most writers seem to confide in its powers in these cases, aud even strongly recommend it, the exact circumstances in which we should recur to it, have not been defi- nitely laid down. It was ou a former occasion remarked, that in the early stage even of genuine typhus, there is always some degree of increased, if not inflammatory action. During the- continuance of this state our medicine is wholly inadmissible, the treatment here consisting of emetics, purga- tives, sometimes of bleeding, and subsequently of the milder diaphoretics. But in the more advanced stages of the disease, when the indications of in- creasing debility come on, the volatile alkali either alone, or in combination with opium and wiiie, is of all the remedies which I have ever tried, one of the most decidedly useful. 144 To every other form of continued fever, how- ever inflammatory in the commencement, the vola- tile alkali is not less suited when the symptoms of a typhoid tendency supervene. Of its use in intermittent fever, I have no experience. In the feebler shapes of the disease, it is sometimes pre- scribed with the bark, and has been advised by itself, previously to the accession of the paroxysm, which it is alleged to prevent, or if it fails to do so, moderates the force, and shortens the duration of it. Notwithstanding its stimulant properties, and the inflammatory nature of the cases, the volatile alkali is considered highly useful in some of the phlegmasia. By the British practitioners, it is mueb employed, especially in acute rheumatism, and without any or very little previous depletion. This mode of treating the disease will not answer among us. Everywhere in the United States it is, in the first stages, if not a purely inflammatory affection, at least one of violent action, and can only be managed by very active evacuations. Even in chronic rheumatism, I am not aware that I ever did more with it, than by large doses of the volatile tincture of gum guaiacum, into which it enters as a constituent part. What I kuow indeed of the two medicines, leads me to prefer the latter, as I think, that the ammonia in combination, displays better powers, in these cases than when* alone: The 145 guaiacum, however, proving offensive to the stomach, the alkali alone may be substituted. Extraordinary as it may appear, our medicine has been much extolled in pneumonia of the different kinds. This will be found to be the case by con- sulting some of the older writers. Even so late as thirty or forty years ago, it was the established practice in this city, to treat pleurisy, and other acute affections of the chest, by one or two bleed- ings, and then with the volatile alkali, and seneka snake root, exhibiting these medicines, with a view to their expectorant effects. Either the dis- eases of which I am speaking have undergone a very essential change of character, or this practice must have proved very destructive. No one at least, at present, would think of ex- hibiting our medicine in cases so entirely inflam- matory. Nevertheless, there are several forms of pneumonia, in which the volatile alkali may be re- sorted to, at a very early stage of the attack, and with considerable advantage. In districts subject to intermittent fever, a spe- cies of pleurisy often prevails, which seizing on the emaciated frames of the wretched inhabitants of such situations, is comparatively a feeble state of disease. Bleeding here, more than once, can- not be borne, and soon after the volatile alkali, and other stimulants become necessary. The pneu- monia of persons advanced in life, or of exceed- ingly delicate and debilitated constitutions, affords VOL. IT, 146 a second example, where our medicine may be early employed. To deplete to any extent, under such circumstances, would be fatal, aud sometimes, even from the commencement, we are compelled to resort to stimulants, among which uo one is so pro- per as the carbonate of ammonia with opium. But though in the primary stages of genuine pneumonia, I have maintained that the volatile alkali is precluded, still, towards the close of the at- tack, when, as sometimes happens, there are a hard cough, deficient expectoration, a hot skin, dry tongue, more or less encrusted, a weak tremulous pulse, and occasionally flushes of fever, with a va- riety of other signs, denoting great prostration of strength, our medicine, in small and repeated doses. will generally be productive of advantage. Not only in this, which not unfrequently is the pre- lude to consumption, but in some of the subse- quent and final stages of this disease, it has like- wise been employed, and certainly not without success. Towards the conclnsion of the case, it manifestly sustains strength, invigorates the powers of expectoration, relieves difficult breath- ing, aud in this way, where it does not cure, it pal- liates symptoms, and renders somewhat less pain- ful the ultimate scenes of existence. To the utility of our medicine in the w inter epi- demic of our country, and especially when it as 147 sumes the pneumonic form*, I have already had occasion to allude. Besides the several affections already enu- merated, the carbonate of ammonia is prescrib- ed in asthma, pertussis, and in the hoarseness and cough, which are the consequence of ill managed measles. Of its power in the two former diseases, I have little or no experience. As an ex- pectorant it might be serviceable, and also, perhaps, by correctiug the depraved state of the stomach, which, if it does not produce, certainly in some in- stances keeps up, and aggravates these affections. Nor is my knowledge extensive as respects the latter case. Now and then, however, I have tried it, and thought, not entirely without effect. It is here much extolled by several respectable writers. As a remedy in some of the complaints of the alimentary canal, the carbonate of ammonia is much used. It is said to have done good in pyrosis, and which I can readily believe, though I have had no experience with it myself. To relieve this most distressing affection, I have usually directed a very strict adherence to a milk diet exclusively, which I have found generally to succeed. Extreme debility of the stomach, attended with vomiting, as in drunkards, is often alleviated by our medicine. I have also used it beneficially in car- dialgia, and more so, when occurring in pregnant women. It may be given in a pill, or watery so- * Pneumonia typhodes. 148 lution, or a few drops of the volatile spirits of am- monia in water, will sometimes do perfectly well. But the neatest, and perhaps the most efficient pre- paration, is the one annexed.* Of this, a table spoonful or more may be taken, whenever uneasi- ness is felt. But, used immediately after each meal, it generally prevents the recurrence of the attacks, by neutralizing the acid which is evolv- ed in this depraved condition of the digestive function. In that gastric affection, familiarly denominated nervous, or siek headach, to which the valetu- dinary of both sexes are subjected, a dose of the volatile alkali will, in some instances, afford almost instantaneous relief, and if taken regularly for some time, a permanent cure may reasonably be expected. It is well known, that gout in its more feeble forms is prone to retrocede from the extremities, and either to w ander irregularly about the system, or to fasten on the stomach, or some other import- ant internal part. When this takes place, our me- dicine either alone, or in conjunction with opium, constitutes one of our means of combating the at- tack. By imparting tone to the stomach, it expels the disease, and fixes it aga n in its proper situa- tion. Gout, however, will make its approaches to *5». Aq. ammoniac, raagnes. calc. aa3i.> aq. cinnam. 3ii. aq. font. Ivi. 149 the alimentary canal in the more insidious guise of periodical colicks, or flatulence, cardialgia, and other symptoms of indigestion. These several af- fections are more certainly relieved by the volatile alkali alone, or with guaiacum, than any other re- medy with which I am acquainted. In dysentery, the carbonate of ammonia has ac- quired some repute. Exhibited in small and re- peated doses, it is said to relieve the griping and tenesmus, to correct the bloody discharges, and by producing a considerable determination to the sur- face, to accomplish even more. No part of this statement has come under my own observation, though it seems to me, to be not at all improbable or inconsistent with the acknowledged effects of the medicine. My own experience with it is limit- ed to the sinking states of ordinary dysentery, and to the typhoid forms of the disease, and in either case, it is confessedly one of the most important of our remedies. Diarrhoea, connected with long protracted de- bility of the bowels, I have more than once removed by combinations of opium, and carbonate of am- monia, and it is still more beneficial, where this state has been brought on by the habits of de- bauchery and intemperance. Numerous as are the diseases that enter into the class of neuroses, there is not one probably in which our medicine has not been employed. It 150 has been tried in epilepsy, chorea, hysteria, apo- plexy, palsy, tetanus and hydrophobia, and except- ing one form of palsy, and as a palliative in the hysterical paroxysm, I know not that it is of much importance in any of these cases. This, however, is not the language commonly held on this subject. Of late, 1 find, on the continent of Europe, and espe- daily in France, the carbonate of ammonia is ex- ceedingly commended in apoplexy. The writers who have made these reports, and they are of no ordinary character, do aver, that recoveries frequently take place by the copious ex- hibition of the medicine wholly unaided by vene- section or other evacuations. Coming with such authority, it is certainly worthy of trial, though I confess I do not repose much confidence in these representations. Considering the properties of the medicine, if it does good in apoplexy, it is probably in cases induced by gastric impressions. Of palsy there is one variety iu which the car- bonate of ammonia is unquestionably useful. It is the offspring of rheumatism. Being long affect- ed by this disease, the muscles lose the power of contraction, and the extremities, if they be the seat of the complaint, of motion. Cases of this description, have repeatedly come under my care, which so nearly resembled genuine palsy as not easily to be discriminated, though they may be generally known by more or less of pain or un- 151 easiness, and particularly during damp and cloudy weather. As rheumatism, they are to be managed, and in the selection of remedies, I have found the more stimulating diaphoretics to answer best, among which the volatile alkali is not to be overlooked. Of the utility of our medicine in mania, I have little to say from my own knowledge, though its efficacy is well attested. As a cordial stimulant, it may be serviceable in melancholia, and in the low shapes of the other form of the disease. But I cannot perceive distinctly the indications it is calculated to meet, as mania ordinarily appears. Much more, in my opinion, is it suited to the cases brought on by drunkenness, and, under such cir- cumstances, I have now and then afforded relief by uniting it with musk, when opium and cam- phor had proved unavailing. Among other purposes to which the volatile alkali has been applied, is the treatment of can- cerous and scrofulous ulcers. It is now about thirty or forty years since Martina, an Italian writer, gave to the world an account of several cases of cancer, which he declared he had cured by the internal and external use of this medicine. Not very long afterwards, Professor Hufeland in part confirmed this statement, by announcing the efficacy of the remedy in scrofulous ulcers approaching the nature of cancer.* These re ■ Jt was the caustic alkali they both employed ib2 ports, however, not being corroborated on further trial by other persons, the medicine lost all its re- putation, and has sunk, in this respect, nearly into forgetfulness. The last case in w hich I shall notice the pow ers of our medicine, is in the bite of venomous rep- tiles. Of the extent of its efficacy here it is not easy to determine, as there exists not a little con- tradiction on the subject. By several writers of the East Indies it is asserted, that it corrects the effects of the poison of the serpents of that coun- try, and the same account is given of it in the West Indies. We have more than one case of its successful application in the United States, recorded by respectable practitioners,* though its utility is denied by others of not less weight of authority.f It is recommended to be employed, internally in pretty large doses, while the bitten part is at the same time bathed with a solution of the caustic alkali. As yet no opportunity has occurred to me of testing its powers in such cases, and, 1 confess, thatl have no great confidence in it. The experi- ments of the Abbe Fontana, show that it is use- less in the bite of the viper, and I suspect, that it is equally so, in relation to other -erpents. Yet I have employed it advantageously to allay the pain and inflammation from the sting of the bee. the wasp, * Dr. Ramsay, &c. f Or. Barton, &c. 153 and other insects. The spirits of hartshorn is, with this view, as serviceable as any other preparation of ammonia. All the leading diseases in which the volatile alkali is prescribed, have now been enumerated. There is, however, a variety of other indications not noticed, which it is capable of fulfilling, that will not fail to occur to one engaged in the practice of physick. It is certainly a very highly important article of the materia medica, and is applicable to a large number of cases. Not long before his death, the late Dr. Kuhn, who was one of the most sagacious and discriminating practitioners of this country, told me with some em- phasis of manner, that after an experience of nearly half a century, if he were called upon to say with what single remedy he had done most good, he would without hesitation name the volatile alkali, aided by wine whey. After such praise from such authority, it surely would be superfluous to press this article on medical attention. In one respect the volatile alkali differs from every article of the class to which it is attached, and it would seem from all other medicines. The peculiarity to which I allude is this, that the ex- citement it raises approaches more nearly to that of healthy action, and hence it may be recurred to earlier, than stimulants generally, in the inflamma- tory affections, and with greater safety in mixed VOL. II. u 154 cases so equivocal or obscure, as to render uncer tain the propriety of stimulation. Of the preparations of ammonii. the one com- monly employed, as an internal medicine, is the carbonate, or sal: volatile of the shops. It may be given in the shape of a pill or julep, in the dose of five or ten grains, every hour or two, according to circumstances. The best form however is the latter, which may be made agreeably to the annex- ed prescription.* As the effects of this medicine are exceedingly evanescent, perhaps more so than any other, except the etherial preparations. I prefer giving it in small do*es, at short intervals, to the opposite mode, and 1 am persuaded, that in consequence I derive ad- vantages from it, which 1 should not otherwise experience.t * I*; Sal. volat. 9"ii. gum. arab., sacch. alb. ui 31. ol. cinnam. gtt. v. aq. fon? £ -. m. The dose, a table spoonful. f Incompatible substances. All acids, the fixed alkalis, lime, mag- nesia, alum, sulphate of magnesia, acetate, submuriate, oxy-muriate of mercury, super-acetate of lead, tartarized iron, and the sulphate of iron and zinc 155 DISCOURSE XXXIII. Camphor a. 1 have taken this article out of its ordinary po- sition in the materia medica. My reason for doing so and placing it here, is its close analogy to the preceding one in most of its medicinal qualities and uses. Camphor, though long considered as a gum, is a peculiar principle of vegetable composition. It is contained in small quantity in the rosemary, the sage, the starwort, the common sassafras of our country, and in a variety of other plants, chiefly of the aromatic kind. But as an article of commerce it is procured exclusively from the Laurus Cam- phora, which grows in the forests of Japan, exist- ing in distinct grains in the wood of the root, of the trunk, and of the branches of this tree. By merely scraping it out it is obtained, and subsequent- ly, is purified in Europe, and at present in this coun- try, by the process of sublimation. Camphor comes to us in large cakes, colourless and semitransparent, of a feel somewhat unctuous, having an odour highly aromatic, and a taste pun- gent and moderately bitter. Doubts were long entertained as to the precise medicinal properties of this substance. By most 156 writers, at one period, it was considered as a sedative, exceedingly cooling in its effects. But how such a notion could have been adopted by any one who had ever attended to its operation seems to me extraordinary, as few medicines more unequivocally display their stimulant powers. Experiments, very diversified in their character, made on plants, the inferior animals, and on the human system, demonstrate this point incontestably. Exhibited in a small dose, it increases excite- ment, and if pushed to a great extent, induces de- lirium, vertigo, convulsions, and sometimes death, resembling, in this respect, the articles with which it is usually assorted. No medicine, perhaps, has been prescribed for a greater variety of purposes than camphor, though of late its employment is much restricted, and I think particularly so in the practice of this city. Yet, it is unquestionably a valuable article, and ought not to be neglected from the caprices of medi- cal fashion. In every modification of febrile action, when approaching to the typhus state, camphor has been resorted to, and not without success. Combined with opium, it has especially been considered as one of the chief remedies in the low, or what were formerly denominated putrid fevers. By some practitioners, on account of its supposed an- tiseptic properties, it is even preferred, in these cases, to the volatile alkali. My own experience 157 does not enable me to decide confidently on the comparative merits of the two articles, under these precise circumstances. No doubt they are both well adapted to meet the indications that arise in any of the feeble forms of fever. But I confess that 1 lean to the volatile alkali. I have sometimes however in these cases, if protracted, alternated the medicines, so that the system might not lose its susceptibility by too long a use of the same ar- ticle, and I suspect the rule will be found salutary in practice. As respects our typhoid epidemic, camphor, in conjunction with ipecacuanha and opium, may be given in the advanced stages, with very conspicuous advantage. It excites perspiration, quiets nervous irritation, removes delirium, and abates the force of the disease. Nay, it seem- ed sometimes to answer even better than the car- bonate of ammonia, though the latter, is an inva- luable medicine under such circumstances. Camphor has been much celebrated in the exan- thematous fevers. It is directed for the twofold purpose of promoting the eruption, and to restore it to the surface, when, from any cause, it recedes. It is also exhibited in confluent small pox, to pro- mote the maturation of the pustules, and to change generally the character and condition of the dis- ease. Connected with this subject, there is a fact, which, perhaps, has not attracted sufficient attention. 158 It is stated by Kosentien as a point perfectly ascertained, that if the Sertuerner, another French chemist, it is as. eertained, th.\t this principle consists of an alkaline base, termed mor- phium, united, however, with the meconic acid, a peculiar one to opium, Forming a neutr.d salt, the meconiat of morphium. This salt is exceed- ingly active, though the pure morphium is still more so. Exhibit- ed in only half a grain, the latter is represented as producing the effects of the largest dose of opium. The meconic acid is not hatf so active. This is the amount I believe, of Mons. sertuerner's paper. B it, as I have not it before me, perhaps, in some respec;*; I may do injustice to his discovery. 221 as becoming sour by keeping. The solutions by the vegetable acids, have hitherto been repre- sented as comparatively feeble, though I suspect without sufficient foundation. Of such of these preparations, as are chiefly used, 1 must say a few words, more in detail. Except, that it is rather slower in its operation, I am not aware of any objection to opium in substance. Cer- tainly it is not so apt to be rejected, where the sto- mach is irritable, and especially if the pill has been prepared for some time. It is said also to answer better in the affections of the alimentary canal, as cholic, diarrhoea, &c. The average dose of opium is about one grain. Laudanum is a spirituous solution of opium, formely called Thebaic tincture, from opium hav- ing been originally procured from Thebes. The dose is about twenty-five drops, and for a child at the period of birth, half a drop, and is given in all the cases where opium is administered. Of the Elixir Paregoric, there are two kinds kept in the shops : the one an ammoniated,* and the other a camphorated tincture of opium.f These are of different degrees of strength, the first con- taining a grain of opium to the drachm, while the second has only this quantity in half an ounce. The camphorated tincture is a much less uupleas- * i inctura opii ammoniata. Pharm. Ed. | Tinctura camphorx composita. Pharm. Lond. 222 ant remedy, and is usually preferred. It is sup- posed to be well suited to the catarrhal, and other pectoral affections, occurring in aged people, and the dose is about one drachm, which, however, though it coutains little more than six drops of laudanum, is rendered more powerful, I thiuk, by some other ingredients, which enter into its compo- sition. To the above officinal preparations, may be add- ed another, which, under the demouiation of Black Drop, has long been vended as a nostrum in this city, and is now much employed here, and in Europe. Of the formula annexed,* the last is com- monly adopted, and the tincture thus made, is nearly three times the strength of laudanum. This preparation is one of very great value, and unques- tionably deserves a place in the shops. It is dis- tinguished by the property of being well received by the stomach, and while it produces the anodyne * Take of opium, four ounces, ______Sharp vinegar or lemon juice, four pints. Digest three weeks, and then add saffron, cloves, nutmeg, and cinnamon, of each an ounce, coarsely powdered. Continue the digestion a week longer, strain through flannel, and evaporate the liquor, till reduced to the state of syrup. % Take half a pound of opium sliced, ______three pints of good verjuice, one and half ounce of nutmegs, and half an ounce of saffron. Boil them to a proper thickness, and then add half a pound of sugar, and two spoonfuls of yeast. Set the whole in a warm place near the fire for six or ei^ht weeks, then place it in the open air, till it becomes a syrup. Lastly, decant, filter, and bottle it up, adding a little sugar to e:ich bottle 223 effect in the fullest extent, is not so apt to leave be- hind it any distressing consequences, such as sick- ness, head-ach, nervous tremors, &c. Most probably this superiority is owing to the acid menstruum employed. It is an interesting fact, aud one which lends much support to this conjec- ture, that laudanum, in a small portion of vinegar, operates much more kindly. This is indeed so true, that I have known several persons, who were utterly precluded from the use of opiates in the or- dinary forms, take this acetous mixture with great comfort and advantage. Cases, however, occur, in whieh insuperable difficulties exist to the administration of opium by the mouth, and under such circumstances, we resort to the anodyne enemeta, the mode of making which has already been described.* But this is a troublesome process, and which is often pertina- ciously resisted, or from irritability of the rectum, or from badness of the machine, or clumsiness of the operator, cannot be accomplished. As a substitute in such instances, I have often di- rected a suppository of opium, and derived from it, in the fullest degree, the desired effect. To slip a pill of opium into the rectum is so perfectly easy, that it may be done, without the patient even know- in«- it, and proves so little offensive to the bowels, * Enemeta. 224 that no effort is made to expel it, and consequently it is almost always retained. By some practitioners, no slender confidence is reposed in the application of opium, and par- ticularly laudanum, as an embrocation. But the practice is altogether delusive, and deserves no attention. Let it be managed as it may, opium ap- plied to the surface, in any form, produces no con-* stitutional impression. On this point I do not speak lightly. I have seen, independently of my general experience, a plaster, on which an ounce of soft opium was spread, worn by a child, for many hours, w ithont any perceptible effect on the circulation or other functions. Yet. as a mere lo- cal remedy, to assuage pain. I have no doubt of the efficacy of such applications, and there is even reason to suspect, from what has been observed by myself, that opium placed near the nostrils, so that its fnmes may be inhaled, will, by its action on the olfactory nerves, affect the system generally. In dismissing this subject, I shall once more re- mark, that, using opium by the rectum, it is neces- sary to treble the dose, and that however adminis- tered, the susceptibility to its impression is speed- ily wasted, so that we are called upon to augment the quantity considerably. The amount of this me- dicine, which sometimes has been taken, where the habit is confirmed by long continuance, would be incredible, were not the fact attested by indisput- able authority. I knew myself, a wine glassful of 225 laudanum, to be given several times in the twenty- four hours, for many months in succession, to allevi- ate pain from the passage of biliary calculi, and finally, the patient to recover, without at all suffer- ing from this excessive use of the article. But, what is still more extraordinary, in a case of cancer of the uterus, which was under the care of two high- ly respectable physicians of this city, Drs. Monges and Le Roche, the quantity was gradually increas- ed to three pints of laudanum, besides a consider- able portion of opium, in the same period. VOL. II. P f 526 DISCOURSE XXXYH The Subject Continued. LACTUCARIUM. This is the title lately given to a species of opium, or rather, to a substance, having the leading properties of opium, which is procured by in- spissating the milky juice of the common garden lettuce. It has long been suspected, that all the lactes- cent plants have more or less of the narcotic prin- ciple, and as regards lettuce, the point was well ascertained even in the earliest times. Among the fables of antiquity, we read of Venus, after the death of Adonis, throwing herself on a bed of let- tuces, to lull her grief, and repress her lewd de- sires. Allusions to its anodyne qualities, frequent- ly occur in the medical writings of antiquity, and we are expressly told, that Galen in the decline of life, suffering much from a morbid vigilance, had recourse to the eating of lettuce in the evening. which he found •• a sovereign remedv." Most of the older treatises on Materia Medica contain similar notices, iu relation to the plant, though I cannot discover, that it was subjected re 227 any pharmaceutical process, or incorporated with the regular remedies. This was, for the first time, done by Dr. Coxe of this University, who, more than twenty years ago, very elaborately investigated the subject, and show- ed by a series of experiments, that there is no es- sential difference between opium and the lactucari- um, as regards their medical effects, sensible quali- ties, or chemical composition.* Two or three years ago, the same enquiry was prosecuted by Dr. Duncan, sen. of Edinburgh, and without, probably, having any knowledge of what had been previously done, he was conducted to re- sults strikingly similar and confirmatory. As a medicine, he pretends not to any very great experi- ence with the article, though he tells us, that he " has seen manifest good effects from it, in allaying muscular action, alleviating pain, and iuducing sleep, the three great qualities of opium." But the information afforded us by Dr. Coxe is more exact, who indeed seems to have used, or caused the medicine to be used pretty extensively, and we learn, that in spasms of the alimentary canal, in diarrhoea, in cough, and in some other af- fections, its operation was precisely the same as opium. It follows, therefore, that, as a cheap sub- stitute for that medicine, it is worthy of attention, and might be manufactured in any part of the Unit- ed States, without much trouble or expense. Per- * Vid. Transactions of the Philosophical Society of Philadelphia, for the year 1797. 228 haps also, it may have some peculiar properties, which might adapt it to cases, where, fiom certain idiosyncracies, no one of the preparations of opium can be used. The dose, and mode of administra- tion of the two articles, are the same. TELA ARANEII. It is an old, and a very general notion, among the vulgar of most countries, that the spider s web, or the spider itself, is possessed of the powers of curing ague and fever, and is actually employed with this view. But. till lately, they have been re- jected in regular practice, and their curative effect in disease, if admitted at all, was imputed entirelv to the strong sensations excited by so disgustin°- a remedy. At his last visit to this city, some years a°-o. I was informed by Dr. Robert Jackson, of the Brit- ish army, that having largely experimented with the web, he had much reason to suppose that popular confidence in it was well founded. As a remedy in intermittents. he said, its powers were in- disputably ascertained, and that as an anodyne to allay pain, or calm irritation, it proved vastly su- perior even to opiates. By one of my pupils,** in whom I could place reliance, the subject was at my request, not long * Dr. Broughton of South Carolina, who made it the subject of his In- lugural Thesis 229 afterwards investigated, and by trial, on himself as well as on others, substantially confirmed the pre- ceding statement. But, in a very late work by Dr. Jackson, on fevers, I find a detailed account of his experience with the article, which is so exceeding- ly interesting that I cannot forbear to extract it.* • I think I may venture to say that it prevents the recurrence of febrile paroxysms more abruptly, and more effectually than bark or arsenic, or any other remedy employed for that purpose with which I am acquaint- ed : that, like all other remedies of the kind, it is only effectual as ap- plied under a certain condition of habit; but that the condition of sus- ceptibility for.cob-web is, at the same time, of more latitude than for any other of the known remedies The cob-web was rarely given before the subject was prepared by bleeding, emetics, or purgatives ; and, given to a subject so prepared, it seldom failed to effect a cure comparatively permanent; relapse, or conversion into another form of disease, being up- on the whole a rare occurrence where the disease had been suspended by this remedy. If the cob-web was given in the time of perfect inter- mission, the return of the paroxysm was prevented ; if given under the first symptoms of a commencing paroxysm, the symptoms were sup- pressed, and the course of the paroxysm was so much interrupted that the disease for the most part lost its characteristic symptoms, if it was not given until the paroxysm was advanced in progress, the symptoms of irritation, viz. tremors, starlings, spasms, and delirium—if such existed as forms of febrile action, were usually reduced in violence, sometimes entirely removed. In this case, sleep—calm and refreshing, usually fol- lowed the sudden and perfect removal of pain and irritation. Vomiting, spasms, and twisting in the bowels, appearing as modes of febrile irrita- tion, were also usually allayed by it: there was no effect from it where the vomiting or pain was connected with real inflammation or progress to disorganization. In cases of febrile depression, deficient animation and indifference to surrounding objects, the exhibition of eight or ten grains of cob-web was often followed by exhilaration;—the eye sparkled; the countenance assumed a temporary animation; and, though the course of the disease might not be changed or the dangers averted, more respite was obtained from a pill of cob.web than what arises from, 230 The spider's web has been, for some time past, pretty liberally prescribed by myself, and several of my medical friends, and particularly by Dr. Pbysick, and Dr. Dewees, and though we attach » belongs to the action of wine, opium, or any thing else within my knowledge- Further, the power of cob-web \.n< been tried, and its good effects have been proved in other forms of irritation besides those that are s*rict- lv febrile. In spasmodic affections of various kinds, in ^'.hmi, in peri- odic head-aches, in general restlessnesses and muscuLr irritabilities, its good effects are often signal, ll.e cob-web gives sleep, but not by nar- cotic power:—tranquillity and sleep here a pe^r to be the simple conse- quence of release from pain and irritation. C-ub-web has* also been ap- plied locally,—under my own eye, to ulcer->ted and irritable surfaces with singular good effect. A: first, the pain which it occas.oned was sharp,—but it was momentary; and the su-f^ces, which had been pain- ful, irritable, and untractable to other applies r,ns for weeks or months, were healed up in the course of two or three days at farthest:—the ex- periment wus made on su|ierficial sores only. 1 have not made a chemical analysis of the substance in question ; for mv chemical knowledge is not of the kind wh ch would enable me to conduct the operation correctly. The cob-web may perhaps be thought to belong to the class of poisons; but it is somewhat singular that I have not been able to discover much difference of effect from a dose of ten grains and from a dose of twenty. The changes induced on the exist- ing state of the system, as the effect of its operatioo, characterize it as powerfully stimulant 1. Where the pulses of the arteries are quick, frequent, irregular, and irritated; they become calm, regular, and slow— almost instantaneously after the cob-web has passed into the stomach: the effect is moreover accompanied, tor the most part, with perspiration and perfect relaxation c f the surface. 2. Where the pulses are slow, regular, and nearly natural; they usually become frequent, small, irre- gular,—sometimes intermitting. 3. Where languor and depression characterize the disease; sensations of warmth and comfort are diffused about the stomach, and increased animation is conspicuous in the ap- pearance of the eye and countenance. 4. The cob-web applied to a bleeding surface, occasions a very sharp and transient pain:—the bleed'- 231 different degress of value to the article, are all satisfied, that the representation of its virtues, to which I have referred, is very little, if at all exag- gerated. In doses of five grains, repeated every fourth or fifth hour, I have cured some very obstinate inter- mittents, suspended the paroxysms of hectic, over- come morbid vigilance, from excessive nervous mo- bility, and quieted irritation of the system from va- rious causes. Among those who have used it much, I find a contrariety of opinion, as respects its mode of operation : some considering it as highly stimu- lant, invigorating the force of the pulse, increasing the temperature of the surface, and heightening ex- citement generally: while others, witnessing no such effects, are disposed to assort it with those re- medies, which seem to do good, by merely sooth- ing the agitations of the system, and I confess, that I concur in the latter view of its properties. Whe- ther there is much difference in the web ofthe vari- ous species of spider, I am not prepared to say from my own observations. That hitherto used in this city, has heen collected in cellars, and is probably the product of the common black spider, which is to be generally met with in such damp places. I have ascribed the credit of this remedy to ing instantly ceases.—The cob-web here recommended is the produce ofthe black spider which inhabits cellars, barns and stables: that which is found upon hedges in autumn does not possess the same power, if it be actually ofthe same nature. 2S£ Dr. Jackson, but he has only revived it, as appears from the ensuing extract.* HYOSCYAMUS NIGER. Tuf. black henbane is native of several of the countries of Europe, and succeeds very well among us. Of all the articles of the materia medica, it is said most to resemble opium, at least, as regards its narcotic qualities. Every part of the plant is possessed of activity, aud the root not less than the leaves. Moderately exhibited, it invigorates the pulse, and occasions some augmentation of tempera- ture, which are followed by diminished sen- sibility, and sometimes by a general composure of the system, to sleep. In a larger dose, it oc- ' " Araneus, Offic. The spider. Both the spider and its web are used The spider is said to avert the paroxysms of fevers, if it be applied to the pulse of die wrist, or the temples ; but is particularly recommended against a quartan, being enclosed in the shell of a hazle nut. The web astringes and conglutinates, and is therefore vulnerary, restrains bleed- ing, and prevents an inflammation. The country people have a tradition, that a small quantity of spider's web, given about an hour before the fit of an ague, and repeated immediately before it, is effectual in curing that troublesome, and sometimes obstinate distemper. This remedy is not confined to our own country; for I am well informed, that the Indians about North Carolina have great dependence on this remedy for agues, to which they are much subject; and I am acquainted with a gentleman long resident in those parts, who assures me he was himself cured by it of that distemper. And indeed experience confirms the efficacy of this medicine in the cure ~i agues." James's Lh't^rtsatorv. 233 easions thirst, sickness, stupor, and dimness of vision, and in excess, excites delirium, or convul- sions, which are accompanied with a remarkable dilatation of pupil, distortion of countenance, a weak, tremulous pulse, cold sweats, terminating in death. Being so analogous to opium in its leading ef- fects, our medicine has been resorted to, in a va- riety of cases, as a substitute for that article. It is supposed to have in a considerable degree, the nar- cotic power, without creating constipation of the bowels. 1 have often used it with this view, though I confess that my hopes have not been realized. It undoubtedly will ease pain, or soothe irritation, and in this way sometimes disposes to rest. As au anodyne, however, it has been much extolled in mania, and is also prescribed in a variety of ner- vous and spasmodic affections, as epilepsy, chorea, asthma, pertussis, palpitations of the heart, &c. It is well known as a remedy in scirrhus and cancer, and in scrofulous and other indolent, or painful ulcerations, which it confessedly improves. To meet these last indications, it is exhibited large- ly, while the diseased parts are washed with a decoc- tion of it. The dose of the extract or of the pow- dered leaves, the only preparations commonly used, is two or three grains, to be increased very consi- derably, where it is continued for any length 01 time. There is also 1 believe a tincture to be met VOL. II. g g 234 with in the shops, the dose of which is thirty or forty drops. COXIUM MACULATUM. The cicuta is indigenous to Europe, growing. however, in many parts of the United States, and can now be procured in great abundance, and of an excellent quality, in the neighbour- hood of this city. No part of the plant is en- tirely destitute of strength, though the leaves are possessed of most activity. Cicuta was perfectly well known in the earliest times. The Greeks used it to inflict the punish- ment of death, and among the victims of its poison- ous agency, was one of the most celebrated of the philosophers of antiquity. Nothing however seems to have been ascertained respecting its medicinal virtues till near the middle of the last century, when baron Stcerk commenced his experiments with this, and many other of the narcotic plants. In a work which he soon after gave to the pub- lic on this subject, he proclaimed its efficacy in scirrhus, and in cancerous sores. The weight of his authority speedily attracted a good deal of attention to the remedy, and cases in attestation of its powers were published by mauy of the distin- guished practitioners in every section of Europe. So confidently were these annunciations made. 230 that the medical world appeared to be persuaded that what had so long been desiderated a reme- dy for these dreadful affections, was at length obtained. But a more candid estimate of its powers, has led to the conclusion, that while it is totally incompetent to a radical cure of genuine cancer, its utility as a palliative is undeniable. More than one opportunity 1 have had of observ- ing the beneficial effects of our medicine under these circumstances. Cicuta should here and in all similar cases, be given in very large doses, and at the same time the ulcers be repeatedly washed with a decoction, or covered with a poul- tice made of the leaves. Thus employed, if it does not advance the cure, it stays the progress of the disease, and mitigates, more perhaps than any thing which I have ever tried, the pain of these ter- rible cases. Combined with calomel, or corrosive sublimate, in minute doses, few remedies are more service- able in scrofulous ulcerations. These common- ly appear about the neck, or seize upon the fauces, the tongue, the scrotum in men, or the labia in women, and the rectum in both sexes, all which are sometimes of a very intractable nature. As might be presumed, cicuta has been found advan- tageous in the ulcerations of the advanced stages of the venereal disease and most unquestionably, is one of our best means, in the irritable sores of pseudo syphilis. 236 To some affections even more loathsome than the venereal, the cicuta has been deemed well suited : my remark has reference to several of the cutane- ous disease*. Even in leprosy, it has done good, so much so that cures have been effected by its persevering use. The practitioners of this city, or some of them at least, entertain favourable im- pressions of its powers under such circumstances. In the hands of Dr. Kuhn, it greatly relieved, if it did not entirely cure, a case of leprosy. Elephantiasis, which perhaps, is a species of this foul distemper, is certainly sometimes success- fully managed by the cicuta in conjunction w ith mi- nute portions of mercury. To this point we have the evidence of the West Indian, as well as of some ofthe European writers. No opportunity has ever occurred to me of seeing the medicine em- ployed in these more malignant diseases of the skin, though, 1 cannot doubt, with the facts before me which I have stated, of its utility, ^ly expe- rience is limited to the ordiuary herpetic and venereal eruptions in which I habitually prescribe it with conspicuous advantage. Combined with corrosive sublimate, or a very small quantity of calomel, too small even to excite salivation, I am in- clined to believe we improve its efficacy. Next I am to apply our medicine to some very different affections. No doubt in chronic rheuma- tism, cicuta has often done good. It is a very fa- vourite remedy in the East Indies. 1 have had re- 237 course to it in a few instances, always, however, with some one of the mercurial preparations. Com- binations of this sort determine to the surface, and promote perspiration. They moreover lull pain, and frequently compose the patient to sleep. It is said that this same prescription is well adapted to the second or third stages of pneumonic inflamma- tion, and there is some reason to presume, that it may be serviceable. Certain it is, that in pulmo- nary consumption, I have palliated symptoms by the use of mucilaginous mixtures, in which cicuta has been substituted for laudanum. It is far less stimulating than any of the prepara- tions of opium, and is not destitute of anodyne power. Cases are indeed recorded of confirmed genuine phthisis having been cured by this me- dicine alone. As yet I have never witnessed any such signal effects from it, though it is altogether likely, that it might contribute to heal scrofulous ulcers of the lungs. Much was once said of our medicine in asthma: the cases however to which it is more particularly applicable have not been pointed out with perspi- cuity. I formerly employed it a good deal in the Aims-House, and with varied success. To spas- modic asthma, it always seemed to me to be best suited, and as a palliative of the paroxysm, is, at least, deserving of some slight attention. Even more celebrated has been the cicuta in pertussis. That it proved beneficial in some in- 238 stances, is too well authenticated to be doubted: but it seems by degrees to have lost its character, and now is wholly rejected. Baffled in my at- tempts to cure this obstinate complaint, by the or- dinary remedies, I formerly resorted to it, and I am not sensible that I did more with it, than by laudanum or paregoric. Like an opiate, it allays the cough for the moment, but makes no permanent impression on the disease. The hemlock, at one time, maintained an indis- puted reputation in the nervous and spasmodic af- fections. It was particularly commended in epilepsy, hysteria, chorea, the tic doloureux, and in some of the complaints of the alimentary canal. But I sus- pect the minds of practitioners are now pretty wTell made up as respects its inefficiency in most of the cases which 1 have mentioned. No one I am sure would at present think of trusting to it, either in epilepsy or chorea. By very large doses I am inclined to believe that it is occasionally productive of advantage in neuralgia. I have seen eight or ten cases of this extraordinary affection here, and in Europe, and in most of them, the pain was at least palliated by the free exhibition of our medi- cine. One radical cure by it was effected by Dr. Fothergill, and lately, my friend, professor Jack- son, of Boston, than whom 1 should in vain look for higher medical authority, has greatly ex- 239 tolled it. By the very liberal and long continued use of it, I am told, he has been exceedingly suc- cessful in several instances of the disease. Eme- tics, however, have done so much in it, that in the practice of this city, they have nearly superseded every other mode of treatment. Cicuta has been very indiscriminately prescribed in mania, and of course, with very opposite results. Of its powers in these diversified cases, I cannot speak from my own experience. But it is obvious, that its ad ministration ought to be regulated by pretty nearly the same principles, which guide us in the use of opium. To puerperal insanity, and to that species which is induced by intemperance, it has been thought to be particularly suited. But I have not the least doubt, it is incomparably inferi- or to combinations of opium and camphor, in both cases. Iu concluding the history of this article, I wish to press its great importance. There are indeed several diseases, such as scirrhus, cancers, scrofu- lous, and some venereal ulcerations, in which it is of inestimable value. We have, perhaps, no me- dicine, or set of medicines, capable of producing precisely the same effects. Without it, the cases which I have just enumerated would be hardly manageable. Of the cicuta, I am led to enforce my recommendation the more strenuously, as its utility has been denounced by Cullen, as well as 24*0 by some later authorities, and is at present not a great deal prescribed. I have employed it very extensively both in pub- lic and private practice, and I am entirely persuad- ed, that it powers have been much less exaggerated by Stcerk, than is now generally supposed. As an active remedy, it has lost its reputation, I suspect, from its being usually found in the shops in a very inert state, and, probably, still more, from the small quantity in which it is exhibited. No article scarcely of the Materia Medica, suffers more by keeping, or which requires, in order to attain its full effects, to have its dose so rapidly and largely increased. The extract of hemlock which is imported from Europe, I hardly ever met with possessed of any strength. But the several preparations of the medi- cine from the American growth, may be had in our shops in great perfection. Being, however, at all times, an article of uncertain operation, I generally begin with about four grains, three times a day, and cautiously enlarge the dose, till it powerfully acts on the system. In many cases, 1 have given as much as half an ounce of the powdered leaves, or recent extract, in the day, and sometimes nearly double this quantity. My rule, in short, is gradually to increase the dose, till some very positive effect is produced, and the only circumstances which call for a reduction 241 of it, are giddiness, nausea, or purging. These coming on, we must intermit the medicine for a time, or lessen the quantity. Boldly prescribed, as I have directed, I may venture to repeat, that the cicuta will rarely disappoint our just expectations. VOL. II. Hll 242 DISCOURSE XXXVIII. The subject continued. ATROPA BELLADONNA. The deadly night shade is commonly considered as, perhaps, the most active of the narcotics. This is an European vegetable growing in different parts of Italy and Switzerland, which I believe has not been cultivated to any extent in this country. Belladonna is a perennial plant, usually found in dark and sequestered places, remote from other ve- getation. Every part of it is actively virulent. It bears a fruit, when ripe, resembling a cherry, which children have frequently eat, through mis- take. The symptoms excited by this indulgence are of the most alarming and distressing nature. These are dryness of the mouth, insatiable thirst, convulsive tremblings of the tongue, difficulty of deglutition, great anxiety about the prscordia, with an inability to vomit. Delirium next ensues, which is accompanied by gnashing of the teeth, and the most hotrible spasms and convulsions. At this period the pupil of the eye, remains widely dilat- ed, being insensible even to the strongest glare of 243 ; light. The face is tumid, and becomes of a dark red colour. The jaws are locked as in tetanus. Death ultimately takes place, and the body rapidly putrefies, emitting a stench singularly offensive. On dissection, all the marks of extensive mortifi- cation of the stomach, intestines and neighbouring viscera, are revealed. But, deleterious as are its effects, when taken in excess, belladonna may still be so managed, as to be rendered a safe and useful medicine. Experiments have shewn, that besides possess- ing a very considerable narcotic power, it slightly promotes most of the seeretions and excretions, and especially the perspiratory, urinary, and sali- vary discharges. Belladonna is one of those narcotic articles, which were much employed half a century ago, and in a very great variety of complaints. Those, however, who were led to its use, speak very con- tradictorily as to the result of their experience. As respects epilepsy, chorea, tetanus, and some other cases of neuroses, it is now pretty generally coneeded, that not much has been done with it. But of late it is strongly reccommended in neural- gia facialis, by an English writer,* and not a little has been said on the continent of Europe, of its powers in hydrophobia. The state of medical opinion is also low in rela- ' Bailey on Belladonna. 241 tion to its powers in the treatment of the several forms of mental derangement, and in the comatose affections, as palsy and apoplexy. But it has re- tained more reputation as a remedy for cancerous ulcers, and other kindred complaints. Even Cullen, who is proverbially sceptical on the subject of medicines, and especially of this very class, ex- presses some confidence in its efficacy. After admitting its uncertainty, he goes on to state, that he has known a cancer of the lip entire- ly cured, a scirrhosity in a woman's breast dissi- pated, and an ulcer below the eye, which assumed a cancerous aspect, considerably amended by its use. But, continues he, "I must at the same time own, that in several cases, both of scirrhosities and open sores, it has not answered my expectations." It would be easy to collect, from the writers of the period when the medicine was in repute, many additional facts of the same purport, as those which I have just mentioned in its favour, were it not superfluous to multiply authorities on this point. There can be little doubt from a survey of the whole evidence, that belladonna has occasion- ally been of service in these cases, and that either from the caprices of medical fashion, or from the dread of prescribing so poisonous an article, it has been prematurely abandoned. In its operation on the system, our medicine sometimes evinces, as I have before remarked, some diuretic properties, and hence has been used !S45 in dropsy, though whether advantageously, or not, I cannot say. Nor do I possess more knowledge respecting its use in intermittent fever, a disease in which it has been strenuously recommended. It is here exhibited as a substitute for opium to avert the paroxysm. Applied to the eye, in a weak watery solution, the extract of belladonna will widely dilate the pu- pil, and it is said, by the action which it induces, the crystalline lens is, in some degree, brought for- ward. To cause this effect, the medicine has re- cently been resorted to by surgeons, in the extrac- tion of the cataract, and to facilitate some other operations on the eye. As yet, I have never employed the belladonna, or had an opportunity of seeing it employed. But I cannot help thinking, that it might be made appli- cable to many useful purposes, and that we have too hastily excluded it from our practice. The dose of the medicine is one grain, either of the extract or powdered leaves, or twenty- five or thirty drops of the tincture, to be repeated every four or five hours, and gradually increased. SOLANUM NIGRUM. The black, or garden night shade, as this spe- cies is familiarly termed, may be met with very ge- nerally, throughout the United States. Whether it is indigenous or not I do not know, though I believe 246 it is considered by the botanists as a foreign plant, derived from the middle countries of Europe. In its mediciual qualities it closely resembles the bella- donna, and may be employed in nearly the same circle of cases. The chief difference consists in the latter commonly exciting the secretory actions, and particularly ofthe skin and kidneys more ac- tively, and also purges sometimes very copiously. Never having employed the article or seen it em- ployed, I am prepared to say little concerning it. But like other narcotics of the same family, it was at one time much extolled in scirrhus, cancer, scrofula, scurvy, syphilis, as well as in many ofthe nervous and mental affections. As a cataplasm, it is said to prove discutient, and lenitive to painful tumors, scrofulous, cancerous, or otherwise, and, moreover, " to abate the violence of inflammation in the eyes, head-ach, pain in the ears, acrid deflux- ions, syphilitic inflammations, &c. fee.-'' As a medicine, the dried leaves in the dose of a grain, infused in an ounce of boiling water, are given at bed time, and repeated every night. But the quantity is gradually to be increased, so that some of the sensible effects which I have meutioned, shall be constantly produced. It has, indeed, beeu remarked, that without such a deci- sive action on the system, it does no good in any one disease. 247 S0LANUM DULCAMARA. The woody night-shade, sometimes called bitter sweet, is also found abundant in this country, though it is said not to be intligenous. It delights in a damp soil, protected in some measure from the sun, and hence is to be met with on the side of ditches covered with bushes, or under the eves of houses not inhabited, or other shaded positions. Experience has shown, that while it possesses most of the properties of the preceding article, it is dis- tinguished by some peculiar ones, and is infinitely less deleterious or hazardous. But, even more powerfully than the black night- shade, dulcamara promotes the action of the bow- els, the skin and kidneys, and confessedly with much greater certainty. It proves, indeed, on some occasions, so actively diuretic, that it has been placed with that class of medicines, and it would not be difficult to collect some evidence of its doing good in dropsy. It is, however, in can- cerous, and the analogous cases already mentioned under the preceding article, that it has been chiefly employed, more particularly as a wash, where the sores are irritable and phagedenic. My own ex- perience with the dulcamara, is in some degree li- mited to the syphiloid affeetions, and now and then I have been exceedingly well pleased with its ef- fects. But I have also derived great advantage 248 from it in chronic eruptions, which I have known it to remove, when even the better established re- medies had totally failed. It is useful too, in chrn- nic rheumatism, and will occasionally afford relief in the painful affections of the advanced stages of syphilis. What are its powers as a deobstruent in glandular obstructions, in which it was once much celebrated, I cannot say from my own obser- vations. On the whole, I believe this to be a very valu- able article, and is entitled to a much more promi- nent place in the Materia Medica, than it at pre- sent occupies. Dulcamara is prescribed in strong decoction, of which the dose is an ounce, often repeated, and gradually increased till a pint or more is con- sumed daily. This may also be used as a wash. DATURA STRAMONIUM. This plant is also known by the more familiar title of Jamestown weed, and by a variety of other names, as henbane, thorn-apple, stink-weed, &c. Doubts have been entertained by botanists, whether the stramonium is a native of the United States. Be this as it may, it now grows in every section of the country. It is one of those vege- tables, which delight in a rich soil, and is most commonly to be seen on a dunghil, or other spots of great fertility. *49 The stramonium, in its operation on the living system, is among the most powerful articles of the materia medica. In many of its properties, it. is closely allied to the narcotic stimulants. This, though at one time denied, has been fully demon- strated. By very well-conducted experiments, it appears, that, even in a moderate dose, it pro- duces all those symptoms which denote universal excitement, and if the quantity be much increas- ed, actions follow, of the most violent and irregular nature. It has been known to excite tetanus, hydropho- bia, and the wildest forms of mental derangement. Cases of each of these affections, produced in this way, are recorded by writers of such respectability, as to leave no distrust of their truth. There is especially, in Beverly's history of Vir- ginia, a very curious account of the effect of this ar- ticle. It is related by this early historian of that state, that a party of British soldiers having eat freely of the stramonium as boiled greens, they were very soon attacked in a very strange way, or as he terms it, the "effect was a pleasant comedy, for they turned natural fools." " One would blow op a feather in the air, another would dart straws at it with much fury, and another stark naked was sitting up in a corner like a monkey, grinning and making mouths at them : a fourth would fondly kiss and paw his companions, aud sneer in their faces, with a countenance more antick than any VOL. II. i i 250 Dutch droll. In this frantic condition, they were confined, lest they should, in their folly, destroy themselves, though it was observed that all their ac- tions were full of innocence and good nature. In- deed, they were not very cleanly, for they would have wallowed in their own excrements, if they had not been prevented. A thousand such simple tricks they played, and after eleven days, returned to themselves again, not remembering any thing which had passed." The stramonium was originally introduced into the practice of physic, by Stoerck, to whom we are indebted for our knowledge of the properties of so many of the narcotic poisons. It was em- ployed by him in mania, in epilepsy, and in the spasmodic and nervous diseases generally. As is usual in the annunciation of a new remedy, he ascribed very valuable powers to this article, and was soon imitated in its use, by other prac- titioners, who confirmed, by their testimony, the accuracy of his observations. More diversified trials, however, gradually diminished its reputa- tion, till finally it ceased to attract any attention. Cullen is one of those who speak slightingly of its efficacy, but he does not pretend to have had much experience with it. In the late revival of the medicine, in the prac- tice of the American physicians, it has been more generally applied to the treatment of disease even than formerly, and especially by us of this city. 351 I have used it, and seen it used still more, in epi- lepsy. Judging from what I have seen, I should say, it is productive of no great advantage. But a very different report has been made of its powers by many eminent practitioners. It would be easy to collect from the medical records of this country and Europe, a considerable number of cases of epilepsy, which are alleged to have been cured or palliated by its steady exhibition. The practice of our hospital and alms-house might afford some of these instances, as at one period, it was a very favourite remedy in both of these institutions. No one, however, seems to have reposed such im- plicit confidence in our medicine as Dr. Archer of Maryland. In a communication on this subject, he does not hesitate to advance the opinion, that, " the stramonium, in regular epilepsy, is as effica- cious as the Peruvian bark in intermiltents." Other writers, however, such as Wadenburgh and Lind of Europe, and Fisher and Barton of this country, give us a much more temperate estimate of its properties in this disease. As the result of their experience, they state, that it will often palliate symptoms, and sometimes even effect a cure. After what I have said, it may be collected that my confidence is slender in the me- dicine, though I would not exclude it altogether in epilepsy. The stramonium has also been prescribed in 252 tetanus. No opportunity has occurred to me of witnessing its effects. I do not know that it promises much, though we are told by Dr. Arch- er, that he once succeeded in moderating the symptoms of the disease by this article, and that a pupil of his actually effected a complete cure by the same means. It is perhaps worthy of fur- ther trial. The evidence to the efficacy of stramonium in mania, is by no means deficient. Many of the Eu- ropean writers speak favourably of it. By Profes- sor Hufeland, it is said to be superior to all the other uarcotics, and that he has treated with it, very successfully, the most obstinate affections of the mind. The celebrated Bergius employs pret- ty nearly the same confident tone in recording its effects. He appears to have tried it in all the shapes of insanity, as in mania proper, in me- lancholia, in puerperal derangement, in the spe- cies which is caused by the habit of intoxication, and also in the low delirium of typhus fever. In the public institutions of this city, I have seen this medicine resorted to, in a great variety of mental affections, and with very diversified effects. It has undoubtedly, in some instances, proved use- ful. To this point we have the concurrent testi- mony of almost every practitioner who has been attached to these establishments. But the practice, so far as I have observed, has not been regulated 253 with sufficient discrimination, to enable us to desig- nate the precise cases, to which the medicine is best suited. All which seems to have been particularly at- tended to, is not to administer it in an active eru- dition of the system. I am myself disposed to be- lieve, that it will be found decidedly more effica- cious in melancholia, than in any other state of mental imperfection. To this conclusion, I am led by the whole tenor of my own observations. But it has been said by very respectable authority, to display its best powers in mania, produced, or as- sociated with epilepsy, and where the mind is sunk so low as to approach towards fatuity. The stramonium has been tried in several other affections. It has been given in tic doloureux, rheumatism and palsy, though, as we have no dis- tinct account of the results of the practice, I pre- sume not with much advantage. If, however, I were to determine from the properties of the ar- ticle, I should suppose it exceedingly well cal- culated to do good in each of these complaints, and probably in some other cases. Trials, far more extensive than I suspect have hitherto been made with it, ought at all events to be executed. It is inconceivable, that a medicine so extremely active, should not be more general in its practical applications. Of the diseases, in which it promises to be of the greatest service, are some of those of the 254 eye, as incipient gutta serena, and in certain forms' of neuroses, as well as the cachexia. Exhibited either alone or in combination with mercury, it has, indeed, been found by me useful as a substitute for cicuta, in venereal and scrofulous ulcers of an ill condition. It corrects the state of the sore, and subdues the pain and irritation so com- mon to these cases. In the management of the diseases I have enu- merated, it is proper to persevere in a course of the medicine for one or two weeks, commencing with small doses, and increasing the quantity by degrees, till it produces some striking effect, which is ge- nerally evinced by gastric distress, by giddiness, or head-ach, and still more by a dilatation of the pupil, accompanied by vision more or less de- praved. As an external remedy, stramonium has not been neglected. The leaves steeped in brandy are used as an embrocation to rheumatic limbs, and when boiled in milk, are said to make a fomenta- tion, which affords much relief in gouty and other painful swellings. WTiether either of these pre- parations is serviceable I do not know. They are, however, popular remedies. An ointment formed of stramonium, is also in common use, prepared by boiling the leaves, previously bruised, in lard. It is employed in burns, in haemorrhoids, in psora, and other her- petic eruptions. In each of these cases, I have 255 Witnessed its good effects, and particularly in piles. This ointment has moreover, on account of if! supposed relaxing power, been a good deal resorted to in the case of club feet, and the attes- tations to its efficacy, are indisputable. I once law it employed in a painful tumefaction of the knee joint, resembling white swelling with the most signal advantage. Every part of the stramonium is active. But the preparations employed as a medicine, are, an inspissated juice, or extract, and the dried leaves or seed powdered. Of each of these, the dose is about two grains two or three times a day, to be increased as circumstances demand. I have given twenty, thirty, and forty grains of the medi- cine in the twenty-four hours, by thus cautiously proceeding.* PRUNUS LAURO CERASSUS. This is not the common laurel of our country, d;ff ring indeed, very much from it in its appear •veil as its properties. The lauro ceras- o be found, so far as I know, in any sec- tion United States, except it be preserved as a c«j : i,i x: i vv nearly a century since medical atteu- i.io'i v .•, directed to this ai'icle. Experiments :.\) he time, and subsequently, most clear * Expectorants, Emmenagogues 256 ly* evince its prodigious power over the system.* Exhibited in a large dose, it extinguishes life at once, without a struggle. But if more moderately given, it occasions convulsions, tetanus, palsy, and those effects generally which are common to all the narcotic poisons. It is remarked by Cullen, as ra- th r a curious fact, in the history of this article, that, however violent its operation may be, it never produces any inflammation, as has been proved by inspection after death. To this circumstance, he seems disposed to ascribe the uniformly speedy and entire recovery of animals which have been subjected even to its most distressing effects. The laurel has not been much employed as a me dicine. In small doses, it is said to lower the- pulse, and to diminish the sensibility and irritabili- ty of the system. It has on this account been tried in pulmonary consumption, and agreeably to the reports on the subject, not entirely without suc- cess. In the mental or nervous affections, as hypochon- driasis, and hysteria, it is alleged to have done good, and we are told, that it imparts tone to the stomach, invigorates appetite, and exhilarates the spirits. As a remedy in intermittent, it has lately been much extolled, and I understand, is exceedingly efficacious in very inflammatory gonorrhoea, oph- thalmia, and similar cases, which, if it be, we can only explain by reference to its powers over the cir- culation. 257 As yet, I have never used the laurel, and of course have no experience withtt. Dst, to me it is mani- fest that it might be made an important remedy in many of the cases, in which the other narcotics have been so beneficially applied. I think it promises much in some of the forms of neuroses, and per- haps still more in scirrhus, cancer, and such like affections. It has, indeed, very recently been said by some German practitioners to cure hydrophobia, and we learn from the same source, that a cataplasm prepared from the leaves, is an admirable emollient application, to painful tumours and ulcers. As a medicine, the preparations of the laurel are a saturated tincture, and a distilled water, each made from the green leaves, which, in the re- cent state, are highly fragrant, and intensely bitter, resembling in a considerable degree, in these re- spects, the peach and cherry leaves, plants to which they are allied by botanical affinity. The dose ofthe tincture is from five to ten drops, and of the distil- led water from thirty to fifty drops. As just stated, our medicine is eminently narco- tic. This property is contained in a volatile prin- ciple, which is very apt to fly off in the several pharmaceutical processes, and probably1 resides in the prussic acid. The odour of this acid, it had long been observed, was similar to that of the laurel, the peach, and the bitter almond. But lately, it has been discovered by Bohn, a German chemist, that \'OT(. }1. K k 258 the distilled water of the almond coutains prussic acid. It is asserted too, by Schroeder, another German chemist, that it is to be met with in the dis- tilled water of the laurel, which is confirmed by Bucholz, a third chemist of that country, who de- tected it also in the essential oil. As the prussic acid itself is actively narcotic, are we not warrant- ed in the conclusion, that the narcotic power in all substances depends upon this principle?* * After the above was committed to the press, I had put into my bands a very important memoir relative to the prussic acid, by the well known Majendie of Paris. The researches of this ingenious experi- mentalist, while they lend some support to the hypothesis I have ad- vanced, are exceedingly curious and instructive in several other views. Concentrated prussic acid, prepared according to the process of M. Gay Lussac, he proves to be, of all known agents, the most decidedly ac- tive and deleterious in its effects on the living system. A single drop of it introduced into the throat, or applied to the eye, or injected into the vein of a dog, destroyed life as instantaneously as if he had been struck by a " cannon shot, or by lightning." Even the inhalation of the vapour of the acid, which, from the want of care, was done in one of these ex- periments, caused " the most excruciating pain in the chest, attended by a feeling of insupportable oppression, which lasted some hours." But, poisonous as this article is, it is ascertained that, when properly diluted with water, it may be safely prescribed as a medicine, and, in the pulmonary affections, has been actually used. What respects its medicinal application, is, however, so very interesting, that I shall cite the whole passage. "We know, says he, "from the experiments which Mons. Coulon made on himself, that it may be given to-the dose of sixty drops with- out producing any very serious inconvenience. Besides, the pretty fre- quent use made in medicine, of the laurel water, in which the prussic acid enters, as a component principle, proves that it may be introduced into the stomach. Nothing, therefore, shews any impropriety in its use as a remedy, a circumstance which has already induced some French 25« DISCOURSE XXXIX. The subject continued. DIGITALIS PUERPERA. As a medicine, though known for several centu- ries, digitalis has not been very long introduced into regular practice. In the year seventeen hun- dred and seventy-five, Dr. Withering was induced and Italian physicians to give it in various disorders. If their success has not been equal to their expectations, it is because they did not seem sufficiently aware of its mode of action on the animal economy; and without this knowledge it is impossible to make a right use of any new remedy. "In studying the phenomena of poisoning by prussic acid, I have of- ten observed, that animals, in which no trace of sensibility, or muscular contractility could be found, would often continue to breathe for several hours, freely; while their circulation, though much accelerated, remain- ed apparently unaltered. These animals indeed might have been said to be dead with regard to their external functions, though still enjoying life through their nutritive faculties. " This property of extinguishing the general sensibility without any ostensible injury to the respiration and circulation, the two principal functions of life, induced me first to believe, that the prussic acid might be advantageously used in cases where the disease seemed to owe its origin to a vicious augmentation of sensibility. From that moment I de- termined to employ it whenever any such case should offer itself to my attention. "About three years ago I was consulted in behalf of a young lady, 260 to make a trial of it in the treatment of dropsy, iu consequence of finding it mentioned in a popular prescription against this disease, and the success attending the experiment was so great, that he aged twenty-seven; who, for the space of eighteen months, had been dis- tressed by a short cough, which became stronger in the evening and in the morning. Alarmed at these symptoms, which seemed to indicate an affection ofthe lungs, her friends took the advice of several of the most distinguished medical practitioners of the capital, who all prescribed the usual remedies in such cases, but without success. I ordered her six drops of Scheele's prussic acid, prepared by Pelletier, diluted with three ounces of a vegetable infusion ; to be taken by spoonfuls every two hours. The following day the cough had considerably diminished, and it disap- peared entirely on the fourth. " The cough, however, having made once more its appearance six months afterwards, I repeated the same remedy with an equal success. " Since then I have had repeated opportunities, but chiefly with young ladies, to employ the prussic acid in cases of nervous and chronic coughs; and have always obtained the greatest success, without having observed any inconvenience from it. In nO case have I gone beyond the dose oT ten drops, taken at intervals during twenty-four hours, and diluting it with several ounces of some fluid vehicle. " Very lately I have succeeded in calming by this same means a con- vulsive cough, with which an elderly lady of a nervous temperament had been greatly affected, and which for six days previous to my seeing her, had come on by alarming fits, depriving her of all rest. I was so much the more willing to adopt in this case the use of prussic acid, as the pa- tient could take neither opium nor any preparation of poppies without being grievously incommoded. " After thus having ascertained the efficacy of the prussic acid in the treatment of dry convulsive cough, I thought it was indispensable for me to inquire whether the same means might not be employed with sue- cess to combat the cough and other symptoms which overpower the unhappy consumptive—and whether it would not influence, or even sus- pend the progress of pulmonary consumption. " The result of my trials has been favourable with regard to the first of firs* ronjrct-u-es j and on fifteen persons, afl'ecttd with phthisis, who 261 soon afterwards announced it to the public as a most valuable remedy. It immediately arrested much attention, and has since been fully investigat- ed by a number of distinguished practitioners, who had been placed under my care tor the last three years, I have constant* ly found that the use of the prussic acid, given in small but repeated doses, diminished the frequency of the cough, moderated, and rendered more easy the expectoration, and lastly, procured the patients some sleep at night without any colliquative sweats. Those who are accus- tomed to follow the march and progress of phthisis, and witness the suf. ferings without number, by which individuals attacked by this terrible malady are overpowered, will easily appreciate" the real benefit of this success. " Since the beginning of the month of August last to this day (Novem- ber) I have had many opportunities of studying the effects of prussic acid on a great numberlof phthisical patients at the hospital of La Cha- rite. Mons.Lerminier, physician to that hospital, in which such diseases are very frequent, has, at my request, agreed to administer the prussic acid in about twenty cases, at the dose of four drops properly diluted with water. " The greater number have shewn evident signs of amelioration, and some seem much better at this moment. The cough is considerably di- minished. The expectoration lias become easy, and sleep came to short- en their sufferings. These improvements became more evident, where the disease was in an incipient state; a circumstance which is not difficult to explain, when it is considered, that the lungs are in a state of disor- ganization, in the second, and above all, in the third stage of consump- tion. " Yet as I wish to state merely, in this place, the exact effects ofthe prussic acid, I must avow, that amongst the patients of La Charite, who have used it, some, whose disease was near its end, did not derive any very sensible benefit from it; and that in two instances, in which the pa- tients bad taken the acid at too short intervals, they experienced some head-ach, and a kind of vertigo which lasted some seconds. In a third case it was feared that the acid had proved injurious. " From all that precedes, I think I am warranted in concluding, that the prussic acid, given in small doses, mixed with a certain quantity of 262 confirm the previous account of its virtues not only in dropsy, but also, to a certain extent, in a variety of other diseases. As a diuretic, I have treated of this article pret- ty much at length. But there are many cases of disease, in which it is greatly employed, where its good effects are ascribed to the power it possesses of reducing arterial action, and lessening general excitement. It is in this relation of a narcotic se- dative that it claims to be inserted in this place. Directed by these views of the powers of digitar lis, it has, by some of its more ardent admirers, been tesorted to, even in the early stages of phleg- masia. Absurd as this practice was, many of the ablest physicians adopted it, and who were completely deceived in the result, by the warmth of their devotion to it. In this most extraordinary course the lead was taken by tha celebrated Fer- water, may be advantageously employed as a palliative treatment of con- sumption, with a view of calming the cough, facilitating the expectora- tion, and procuring sleep; and that as such it must be considered as the first among the substances usually employed for similar purposes; as it does not seem to excite, like the opiates, any colliquative sweat. " It still remains to inquire, whether, by the assistance of the prussic acid and of its marvellous activity, we might not hope to render the march of phthisis more slow, and even to cure it. But these questions, in themselves so important, on account of the too fatal prevalence of the malady, cannot be decided by a small number of facts and experiments. They ought, on the contrary, to be multiplied as much as possible, tak- ing at the same time into consideration all the circumstances which- might influence the results; and divesting ourselves of all sort of pre- judice."—■ Majendie on the use qf Prussic Acid. £63 riar, who maintained the digitalis to be a com- plete substitute for the lancet. It is well known, says he, " that bleeding is very inadequate to the purpose of lessening the velocity of the circulation, unless it be carried to a dangerous excess. The fox-glove furnishes us with the means of regulating the pulse to our wish, and of supporting a given state of velocity, as long as we judge it proper." Entertaining these impressions, he was led to ex- hibit the medicine in cases of synocha, and, as be informs us, " with much advantage." Nor was the confidence of Currie less in its powers. I have, he says, " employed the digitalis to a very consi- derable extent in inflammation of the brain, of the "heart, and of the lungs, and in rheumatism, and have succeeded with it, in situations, where I should otherwise have despaired." By Mossman, another eminent practitioner, we are told, that "by a judicious management of the medicine, variously combined, pneumonic in- flammation may be obviated with as much certainty as the progress of intermittent fever is arrested by the Peruvian bark." In a subsequent publication, he further remarks, " my prediction respecting the future reputation of the fox-glove, will, I have no doubt, be eventually accomplished. In this town and neighbourhood, the plant is now in more gene- ral use than any other healing agent, and either iu a solitary or combined form, it is employed in al- most every case of increased vascular action. In 264 pneumonic inflammation, and in active haemor- rhage, it certainly possesses powers approximating to specific, and even in cases of continued fever, of various types, I have repeatedly witnessed the most beneficial effects from its administration." By recurring to the periodical publications of the day, it would not be difficult, were it necessary, to swell the number of authorities in favour of the use of this medicine in the phlegmasia^ and in- flammatory fevers. Whatever may have been the support given to this practice, in the first mo- ments of excitement, it is now wholly abandoned, or very feebly sustained. The phenomena of active haemorrhage seemed also obviously to call for the use of digitalis, and it has been accordingly had recourse to, in bleedings of every part, from the nose, the uterus, the sto- mach, and the lungs. Many proofs might be ad- duced in confirmation of its efficacy in this form of haemorrhage, and particularly in haemoptysis and uterine floodings. The publications of the time are filled with cases of its successful administration, supplied too by Currie, Ferriar, and Drake, not to mention a number of other respectable names. Notwithstanding the weight of authority in its fa- vour, 1 am not a convert to the propriety of the practice. Digitalis can never be substituted for venesection in active haemorrhage. That increase of arterial action, which causes the rupture of the vessel, is only to be removed by the lancet. Yet, 365 there are cases, in which our medicine may be ser- viceable. Previously to the flow of the blood in active hae- morrhage, the pulse is commonly full, quick, and hard, accompanied with all the symptoms of the fe- brile condition. The lancet here is indispensable, and also in the first stages of the effusion. But, after a considerable loss of blood, the pulse be- comes soft, the skin is cool, and many of the in- dications of inflammatory diathesis disappear. But though the impetus of the circulation be lessened, it still continues more rapid than in health, and the newly formed cicatrix is unequal to resist it, even when thus diminished. The vessels are therefore again ruptured, and a repetition of the haemorrhage takes place. It is not always safe un- der such circumstances, to resort to direct depletion, the system being so much reduced as not to bear it. Digitalis, on these occasions, is one of our re- sources, and often displays its best powers. As no great inflammatory disposition exists, it abates the force and velocity of the pulse, and this effect may be prolonged without difficulty, till the wounded vessel is completely healed, and recovers its natu- ral capacity of resistance. Even here, however, I doubt whether it is equal to the preparations of lead, ipecacuanha, or squill. But it is well to be in possession of a number of remedies, of nearly similar properties, since cases may arise in which, VOL. II. l 1 serf owing to peculiarities of constitution, or other causes, some one may be preferable. But I have said, that our medicine has likewise been much employed" in uterine haemorrhages* These may take place either in the impregnated or unimpregnated state of the womb. The former are usually denominated floodings, and the latter menorrhagia. Floodings are to be managed on ge- neral principles. Attended by fulness and activity of pulse, we must have recourse to venesection, and afterwards to those medicines which are cal- culated to subdue and keep down action. It is with this view that digitalis, if at all admissible, would be proper. But though it has been so ge- nerally commended, I doubt whether it is exactly adapted to these cases. I have heard of several instances, and knew of one, where the bleeding be- came most profuse untler its operation. To check this species of haemorrhage*,- a medicine seems to' be required to have the two-fold power of lower- ing the force of the circulation, and coustringing the gigantic vessels of the pregnant uterus. Digi- talis, instead of doing this, has decidedly the con- trary tendency of producing a greater degree of re- laxation, and therefore of aggravating the mischief. I do not say that such is invariably the consequence, or that the medicine is not occasionally serviceable, but I am convinced that we have remedies infi- nitely better suited to these eases; and that, on the 267 whole, the use of digitalis is precarious, and some- thing dangerous. Let me here repeat, what I believe I have before said, that those uterine haemorrhages which ob- serve a periodical regularity, are too apt to be con- founded with an increased flow of the menses. To this error, we are, perhaps, to impute, in some mea- sure, the uncertainty of four practice in these cases. My own experience tells me, that all very profuse sanguineous discharges from the uterus are he- morrhages, or in other words effusions of pure blood, and these are often to an extent to threaten immedi- ate danger. Genuine menorrhagia, on the contrary, even when most copious, is never alarming, except in its remoter consequences. The former complaint may be checked like other hsemorrhages, by an ap- propriate treatment. But the latter, as resulting from a natural secretory action of the uterus, will run on to the usual period of its termination whatever may be done, unless the discharge is suppressed by some rash and violent interference. In menorrhagia proper, little else is required during the flow than rest, a cool room, some laxative, as cream of tartar, to open the bowels, and occasionally, if there be pain or irritation, an anodyne. But in the intervals of menstrua- tion, we should endeavour by various means to make such an impression on the system, as may restore to the uterus its healthy actions. Much was said at one time, of the utility of dt 268 gitalis iu some of the neuroses, as well as in ma- nia. Of the former class of diseases, it has been mostly commended in epilepsy. Never having prescribed it in a single case, I know little of it myself. But I have seen it employed both iu Eu- rope and this country, in almost every shape of epilepsy, and never with any manifest advantage. Digitalis, I suspect, in mania, is a more impor- tant remedy. It has at least been very liberally prescribed in this disease, and sometimes with effect. My experience, however, does not en- able me to state, with any precision, the indications which it is best calculated to fulfil. Were I to use it, which I have not done, it would be in the acute stages of the disease, though after venesection, purging, and other directly depleting remedies. Exhibited uuder these circumstances, it might, perhaps, lessen the irritability of the system, and contribute towards calming the agitations of the patient. With very few, or perhaps, not a single excep- tion, digitalis has been used in all the pectoral af- fections. It is even now prescribed in the decliuing state of acute pneumonia, and iu asthma, angina pecto- ris, dyspnoea generally, and in the cough and hoarseness which follow measles, &c. &c. Con- formably to the ordinary prescription in most of these cases, it is simply added to some cough mixture, to keep in check the activity ofthe circula- 269' tion, which it sometimes does exceedingly well. But it is to its use in pulmonary consumption that I wish more particularly to call attention. A few years have only elapsed, since the confi- dence of practitioners was so strongly placed in this remedy, that consumption, even in its last stage, was by its agency to become almost entirely subject to our control. Need I sr.y, that these high wrought expectations, and brilliant prospects, have never been realized ? Yet, it does appear, af- ter making the amplest deductions for the exagge- ration of the moment, that digitalis has evinced some valuable powers in the disease. To deny it, indeed, would be to discredit altogether, some of the strongesf evidence which has ever been present- ed in favour of any remedy. By Darwin, it was early spoken of as an impor- tant article in the treatment of some of the forms of phthis, and not long afterwards it began to at- tract a very general attention. Ferriar resorted to it in several cases, with considerable success, but no one has used it so extensively as Drake, and his opinion relative to its properties is alto- gether favourable. " This mediciue," says he, u has for several years been given in pulmonary haemorrhage with effect, and certainly will continue to be, with the intelli- gent, whatever maybe the result of its trial in phthi- sis. I am happy, however, to say, that the success which has hitherto attended the exhibition of digi- 270 talis iu phthisis, has been very considerable. Ma- ny patients in its confirmed state have been cured by this remedy, and almost all have been relieved. Life has ever been protracted by it, and when death has taken place, whilst the system was under its influence, it has been free from pain or struggle. My expectations here have been fully answered." The papers from which I have extracted the pre- ceding observations, contain the history of fifteen well delineated cases of confirmed consumption treated by digitalis, and the result is, that nine were completely cured, one relieved, and five died. These cases, if authentic, are sufficient alone to en- title the medicine to a very great degree of confi- dence. But I doubt exceedingly, whether so large a proportion of cures was ever effected by any se- parate article of the materia medica, or, perhaps I might add, by a combination of all our resources. Nearly about the same time that Drake was using this medicine, a series of trials was also made with it by Fowler, and scarcely with less success. Next came the celebrated Beddoes, who, in an essay on consumption, after stating that his experiments fully corroborated all the preced- ing accounts of the efficacy of digitalis in this dis- ease, makes use of the following emphatic lan- guage. " 1 daily see many patients in pulmonary consumption, advancing towards recovery with so firm a pace, that I hope consumption will hence- forward be as regularly cured by the fox-glove, as S7i ague by the Peruvian bark. Could we obtain a single auxiliary to fox-glove, such as we have in many instances for the bark, I should expect, that not one case in five would terminate, as ninety- nine in the hundred have hitherto terminated. But I believe that a majority of cases will yield to fox- glove alone. It is evident that no new cases need be suffered to advance beyond the first stage, with the application of this medicine, and few into it." In the year 1800, M'Grinnes*, physician-gene- ral of the Naval Hospital at Plymouth, in Eng- land, determined, if possible, to ^settle the ques- tion, of the degree of efficacy of digitalis by an ex- tensive and diversified set of experiments, with the medicine. Every advantage for an enquiry of this sort he commanded. The cases under his care were numerous, and being, in a public institution, he could enforce those observances in the exhibition of the medicine, which are necessary to the accu- rate appreciation of its properties. But, with every allowance for the peculiarly favourable circum- stances in which his patients were placed, his suc- cess was extraordinary, aud wholly unprecedented. The number of cases which he has reported* amounts to seventy-seven, of which, fifty-three were advanced in the purulent, and twenty five in the incipient stage of the disease. Now, of these, forty-four recovered, twenty-two were discharged" much relieved, and ten only died. It is worthy of remark, that in all the instances of recovery, the 272 pulse was reduced by the medicine, considerably below the natural standard, and the amendment seemed commensurate with the reduction. In the several medical journals of the period of which I am treating, many papers on the subject of digitalis in consumption are given by very respect- able practitioners. Without any particular analy- sis, we may collect generally from them, that this medicine very frequently effected cures, and even where it failed to do so, it almost invariably pro- duced some alleviation of the symptoms. Not- withstanding, however, all these accumulated re- ports respecting the vast powers of digitalis in the disease, it has of late, most unquestionably, lost much of its reputation, and seems to be falling into disuse. To the extravagant praise which it once received, there has succeeded a more temperate and just estimate of its value. Comparatively very little, has recently been written upon it. The pe- riodical journals no longer contain any of those il- lustrations of its efficacy, or discussions relative to its properties, which, only a short time ago, engag- ed so much attention, and even the regular treatises on consumption, do not always notice it as a reme- dy of much importance. But this surely is running, in some degree, into the opposite extreme. No doubt can be entertain- ed of the efficacy of our medicine in the pulmonary affections. It is equally true, however, that its suc- cess has been very various, and for the most part 273 extremely precarious. It appears, that though a considerable number of cases, under the general de- nomination of phthisis pulmonalis, have received advantage from digitalis, yet, where the disease was so far advanced, as to be unequivocally mark- ed, the benefit has not been permanent, and on the whole, it may be safely affirmed, that the chance of success with this medicine, is infinitely less than has been generally affirmed. Determining from my own experience I should say, that it is only suited to the early stages of consumption, and such seems to be the view which is taken of its powers by all the very recent writers whom I have con- sulted. In a work of Kinglake, better known by his Treatise on Gout, fourteen cases of the disease are given, chiefly in the incipient stage, in about one half of which our medicine was decided- ly advantageous. But in the suppurative or ulcera- tive stages he accomplished only one cure. It is stated by M'Clean, a writer on the fox- glove, "that it will sometimes cure, when the most approved remedies fail. When of itself it is insufficient to subdue the disease, it will prove a valuable auxiliary to other means. It has always with me quieted and soothed the sufferings of the patient more or less, and where it ultimately failed, it lengthened the duration of life, and smoothed the avenues of death. This is all I appre- hend it will be found capable of performing, but this is doing a great deal. Those who expect won- vol. u. m m 274 ders from it, or that it will in general cure consump- tion, will be disappointed." In a still more recent work on consumption, by Reid, nearly the same language is held. He observes, " that it is only in the early stages of this disorder, that we can with any confidence hope for a cure. But that, however violent the previous symptoms, if no expectoration of purulent matter has taken place, we may, in general, with safety pronounce the disease curable, aud that this reme- dy, under due regulation, and with sufficient atten tion to other circumstances of regimen and diet, be then employed with a prospect of almost invariable success. Fox-glove,*' continues he, " although great, has limited powers, and both reason and ex- perience authorize the conclusion, that where the substance of the lungs is generally diseased, and extensively ulcerated, neither the digitalis, nor any other agent, can effect more than to alleviate the patient's sufferings. This indeed forms the distinct- ive and melancholy character of pectoral and other affections of organs, which undermine the fabric of mortality, and divide the slender thread by which existence is supported." To these foreign authori- ties, I may add the sentiments of the medical men of this country, who, whatever might have beeu their confidence at one time in the remedy, seem now very generally to distrust its powers, and though it continues to be prescribed, it is more from the poverty of our resources in this disease, than 275 from any high expectations of its performing a great deal. In the preceding review, I have traced, with some minuteness, the progress of medical opinion relative to the powers of digitalis in pulmonary consumption, that we may be enabled more justly to appreciate its efficacy, and to determine how far this celebrated remedy is deserving *of our confi- dence. Notwithstanding, however, the detail in which I have indulged, 1 do not know that I have succeeded in my design, the particular forms or cases of the disease still not being clearly made out, to which the digitalis is applicable. Nor, per- haps, can it be done. After all, much must be left to the sagacity of the practitioner, and the power of discrimination, which is alone to be acquired by observation and reflection. I have before said, that it seems, at present, to be very generally admitted, that the medicine is only useful in the early stages of the complaint, and of this I am fully persuaded. But even here it proves exceedingly precarious, and very often is manifestly injurious, by prostrating strength, and accelerating the march of the disease. Like mer- cury, and some other articles of the materia medi- ca, digitalis would seem, in many instances of con- sumption, to exchange its medicinal for a poisonous action on the system, and whenever this happens, wre have a train of affections induced, which hurry the case to a fatal issue. 276 Yet, every practitioner has probably been now and then surprised by effects so strikingly salutary from the medicine, that his confidence in it be- comes once more revived, and thus encouraged, he proceeds with its use, till, by the frequency of its failures, or the mischief it occasions, it is again abandoned in disgust and despair. No doubt much of the uncertainty of the arti- cle may be ascribed to the very vague and indis- tinct notions entertained with regard to consumption, including under one general denomination, which is too commonly done, affections of the lungs, that both in their nature and treatment are essentially different. As the result of no slender experience with digitalis, I am prepared to state, that the only case of phthisis, in which it can be much relied on, is in the incipient stage attended with a slight haemoptysis, a small, quick, irritated pulse, short and impeded respiration, and n hard, dry, diminu- tive cough. By subduing irritation, and regulat- ing vascular action, it sometimes proves advanta- geous, and though even here it will very often dis- appoint us, still, in the management of such a case, it is one of our resources which ought not be over- looked. STRYCHNOS NUX VOMICA. Nux vomica is the kernel or nut of the fruit of a jree growing in the East Indies, to which Linnaeus 277 has given the above title. With little odour, the nut is very bitter, and in its operation evinces some narcotic properties. Largely given, it vio- lently disturbs many of the functions of the animal economy, exciting vomiting and purging, accelerat- ing the pulse, impeding respiration, and occasion- ing much anxiety and distress about the precordia, followed by nervous tremors, or convulsions, and. sometimes by paralysis or tetanus. But, it is said, that whatever may be the severity of its ope- ration, no signs of inflammation are discoverable by dissection, corresponding, in this respect, with the cherry laurel. In common with the rest of the narcotics, nux vomica was at one period pretty generally employ- ed, and is reputed to have done good even in plague, by inducing a plentiful perspiration. But though this statement may be made on equivocal authority, we have sufficient reason to believe that the medicine has manifested no inconsiderable power in the more obstinate forms of intermittent fevers, and particularly in quartan agues. The German writers who seem most conversant with the article have also commended it in mania, and the whole of the neuroses, including epilepsy, and hydrophobia, as well as in chronic rheumatism, gout, cephalagia, the lues venerea, scrofulous sores, and chronic eruptions. To these diseases I may add dysentery, in the epidemic form of which, as 278 it prevailed some years ago in Sweden, it is stat- ed to have displayed remarkably beneficial effects. It was here prescribed in a large dose once or twice a day, evacuations having been premised, proba- bly as a substitute for opium. But we are told by Bergius, that though it suspended the complaint, for a time, relapses uniformly took place, and that • its immediate operation was sometimes unpleasant, and its remoter consequences painful and distress- ing. I have, moreover, understood, that it has proved serviceable in fluor albus, and in virulent gonorrhoea, the nut, when given in the former of these cases, being previously roasted. Notwithstanding all this, our medicine seems never to have had a well established reputation, and so little is it at present estimated by the Brit- ish practitioners, that it is retained in no one of the pharmacopoeias of their colleges. But recently, me- dical attention has been called to it by some inter- esting communications relative to its use in paraly- sis. It was remarked, in describing the effects of this article on the system, that it sometimes induc- es a4etanic rigidity of the muscles. Being per- suaded that this is a very constant effect, or one which at least may be commanded, Doctor Fou- quier of Paris, some years ago, conceived, that it might be applied to the cure of palsy, considering the latter disease to depend on an opposite or re- laxed state ofthe muscular fibre. During the inter- val which has since elapsed, the medicine has been 279 fully tried, and his own experience, as well as that of Dumeril, Majendie, Hebreard, Husson, Asselin, and other highly distinguished physicians, confirms the truth of the speculation, and the value of the practice. Not long after the administration of the medi- cine, we are told, that the tetanic condition takes place, and which is to be continued by the repeti- tion of the dose, for a greater or less time, as the circumstances of the case may seem to demand. This state is represented as having all the charac- teristics of real tetanus, and may be partial, or uni- versal, according to the force and extent ofthe im- pression made. What is very curious, it is de- clared that, by a sort of elective affinity, the action of the medicine, when it is given in the proper dose, is directed to the affected limb, leaving all the sound parts untouched, and this is apt to take place in proportion as the limb is deprived of sen- sation and motion. But, however violent or gene- ral the tetanus may be, no danger results from it: the patient, on the contrary, is so little disturbed, that he often sinks into a sweet sleep. To attain the precise effect which is desirable, it is recommended to exhibit four grains of the me- dicine in substance, or two grains of the alcoholic extract, several times iu the day, watching with care the operation of each dose, that no mischief shall result. But it is sometimes required very largely to increase the quantity, so much so, that 280 in some cases thirty, or forty, or fifty grains of the powder have been given at a time. What degree of credit is to be attached to this very extraordinary account, I am unable to deter- mine. I have never employed the medicine, though I understand it has been done in our public institu- tions, in a few cases, and with little or no success. But I do not think that we should draw any con- clusion against the practice from so imperfect an experiment. Confessedly, it comes to us supf rt- ed by some of the best authorities of Europe, and -o confidently affirmed, that there is scarcely room for doubt or deception. Even admitting, that it was fairly tried in the cases to which I have just alluded, we may discover sources of failure, without impeach- ing its general value, or the credibility of those by whom it is reported. As much as most diseases, paralysis is diversified by its causes, and while the more simple cases of it are easily managed, there are others, proceeding from some alteration of structure, or mechanical pressure of the brain or its depen- dencies, which are placed beyond the reach of all our resources. 281 DISCOURSE XL. Of Antispasmodics. MOSCHUS. Of this set of remedies, the first article which presents itself is musk. This is one of the few substances which, as a medicine, we derive from the animal kingdom. The animal* which affords it is a native of Siberia, Thibet, China, and many other parts of the eastern world. Musk appears to be a peculiar secretion, which is deposited in a sac near the umbilicus of the male. It is imported in small membranous bags, and comes to us in grains which are of a black colour, of a bitter taste, of an unctu- ous feel, and with a very strong and peculiar odour. Musk was at one time a very favourite remedy, and as might be supposed from its powers, more particularly so in all the nervous and spasmodic af- fections. It has been given in tetanus, and accord- ing to Heberden, with considerable advantage. He exhibited it in combination with opium, and says, never without affording more or less relief. * The moschus moschiferus. n n 288 To this point many additional authorities might be cited. The West-Indian writers, especially of an early date, bear very decisive evidence to its effica- cy in these cases.* Musk has also been much used in hydrophobia, alone, or with other medicines, such as opium, camphor, valerian, cinnabar, &c. But in common with every other mode of practice, has wholly fail- ed to cure, or even essentially to mitigate the symp- toms of this horrible disease. Nor does it appear that it has been productive of much greater service in epilepsy, chorea, or, indeed, of any of the chro- nic affections of this class. By the powerful and prompt impression it makes on the nerves, it has sometimes been resorted to with utility, in the hysteric paroxysm, and on the same principle, evin- ces a beneficial effect in spasmodic asthma, and in pertussis, in palpitations, and in most other similar complaints. Musk has acquired great reputation in the treat- ment of gout of the stomach. It was originally, I believe, employed in this case by Pringle, whose practice has been since imitated, and fully confirmed. Cullen is among those who report fa- vourably of it, declaring that he has relieved many patients, by the free use of this medicine, who would probably otherwise have sunk under the at- tack. This is high praise from him, who is always * Vid. Hillary, &c. 288 sparing in his commendations of remedies, and I am inclined to suspect, not at all exaggerated. Like most of the articles to which it is allied, musk has been used in the various states of mental derangement, and is very highly extolled by Hil- lary, and several other respectable authorities. In the first edition of his Materia Medica, which was surreptitiously published, Cullen asserts, without any sort of reservation, that he has done more good with it in mania, than by any other re- medy. As, however, he advanced in life, and had a wider scope of experience, he seems to have had his confidence in its powers considerably abat- ed, and speaks of it in language infinitely more measured and qualified. Musk continues to be employed in all the low states of disease, and it is here that it unquestionably displays its best powers. As early as the time of Meade, it was applied to the management of typhus fever, and has since, amidst the vicissitudes of its fortune in other respects, maintained, with little or no diminution, its reputation. Perhaps, no article, in the latter stages of low fevers, has been exhibited with more advantage. The symp- toms which it is particularly calculated to re- lieve, are, nervous tremors, subsultus tendinum, singultus, and delirium. Conjoined with volatile alkali, musk has been celebrated for its powers in arresting gangrene. 284 and, by Mr. Simmons, an eminent surgeon of Man- chester in England, this practice is most strongly recommended. The dose of our medicine is from ten to twenty grains every three or four hours. It is best exhi- bited in the form of bolus, or julep,* but as it is to many very unpleasant to take, we are compel- led, when the stomach is weak, or in the case of children, to direct it as an injection. An artificial musk is prepared, by pouring three drachms and a half of concentrated nitric acid, on one drachm of the oil of amber, and afterwards thoroughly washing the product. As possessing the properties of natural musk, it is prescribed for similar purposes, though on the authority of the ce- lebrated Bailey of London, it is used more particu- larly in whooping cough. By him it is highly ex- tolled in this disease, and his praise is never hastily or gratuitously bestowed. The few trials, however, which I have made with it, have not inspired me with an increased confidence in its powers in this disease: yet, in some other cases, and particularly in the spas- modic affections of the alimentary canal, I have de- rived great advantage from it. As the natural musk can hardly ever be procured unadulturated, I suspect it would be best in most instances, to substitute the factitious. It is given in the shape * ]$> Mosch. gum. arab., sach. alb. aS 3j., aq. font, ^iij.5 in. ft. julep. The dose a table s*poonful. 285 of an emulsion, or julep, and in a dose the same as the natural musk. CASTOR. This is a substance procured from the castor fiber, or beaver. Near the rectum of this animal in both sexes there are two little bags, containing a brownish oily matter, which is castor. The best of this article is imported from Russia. That which is commonly found in our shops is derived from Ca- nada, and the northern parts of New England, and is of a very inferior quality. Formerly castor was in much repute as an anti- spasmodic. By Van Switen, De Haen, and many other German practitioners, it was highly esteem- ed, in the neuroses, and especially in epilepsy. It has, how ever, lost its reputation, and now is only occasionally directed by some practitioners of the old school, in the hysterical paroxysm. Cas- tor may be given either in powder or tincture, the dose being, of the former ten or fifteen grains, and of the latter one or two drachms. FERULA ASSAFOeTIDA. In some of its properties, assafoetida closely re- sembles the preceding articles. It is a foetid con- crete juice, obtained from a large plant like the 286 fennel of our gardens. The plant is a native of Persia, and has not been cultivated in this country. It might, however, be raised in any part of the United States, as I have seen it flourish in the bo- tanical garden at Edinburgh. Assafcetida comes to us in large irregular masses, composed of num- berless little shining lumps or grains, which are of various hues. It has a strong pungent smell, some- thing like garlic, and a bitter acrid taste. By keeping, it loses its sensible properties, .and be- comes comparatively inert. Of all the foetids, this is one of the most powerful and efficacious. Its action is quick and penetrating, and may be given with great advantage, to meet a variety of indications. In many of the affections of the nervous system, it is much prescribed, and is indisputably useful in hysteria, and hypochondria- sis. It was formerly prescribed in epilepsy and chorea, and it is said, with success, though I doubt this exceedingly, its powers beiug entirely too fee- ble to contend with such violent diseases. Of late, it has been a good deal substituted for musk, in the last stages of typhus fever, without, however, so far as I have seen, half the effect. To some of the complaints of the alimentary ca- nal, it seems to me to be well adapted, and espe- cially in states of weakness and derangement by intemperance or other bad habits. It will, under such circumstances, restore tone to the parts, pro- mote digestion, remove the tendency to flatulence, 287 invigorate the general system, and renovate the ani- mal spirits. Being laxative, it also will obviate costiveness, which is a common,and one ofthe most mischievous attendants on this depraved state of the stomach and bowels. , By many practitioners, our medicine has been exceedingly commended in all the spasmodic af- fections of the chest. Its use is perfectly familiar to me in asthma, and I can speak of its efficacy with confidence. I do not, indeed, know that we can manage the distressing paroxysm of this dis- ease, by any other means, with much greater cer- tainty of relief. To be effectual, it should be given in pretty considerable doses, and often repeated. Nor is its reputation less iu whooping cough. The practice in this complaint, at present, in this city, or at least, that practice which I think is ve- ry generally adopted, consists in the first place, in purging on alternate days, for a week or more, with calomel, and after the disease is some- what broken, which it will generally be by this course, to complete the cure by the exhibition of the watery solution of assafoetida. In very inve- terate cases, however, we bring into this plan of treatment, some auxiliary remedies, as emetics, blisters, and even venesection. But these are not often required, if the calomel and assafoetida be judiciously prescribed, and the case otherwise has been properly regulated. But there are several other pulmopary affec- 288 tions, in which assafoetida is beneficially employ- ed. It is often prescribed in the second stages of obstinate catarrh, particularly where the expec- toration is deficient, and some tightness and diffi- culty of respiration exists. In circumstances of the same, kind it is also applicable to protracted pneumonia, croup, measles, and pulmonary con- sumption. Whenever, indeed, an active expec- torant is demanded, the watery solution of assafoe- tida will be found useful. Chemical resolution shews assafoetida to be a gum resin, having, however, very little of the latter ingredient in its composition. It may be given in pills, or tincture, or watery solution. The latter, I think, in many respects, is the preferable mode of exhibiting the medicine, as it acts in this way more promptly than the pill, and is less stimulating and heating than the spirituous preparation. The dose is from five to ten grains.* ALLIUM SATIVUM. Garlic evinces very diversified powers, aud in some respects is similar to the preceding article. Notwithstanding I have already noticed it on seve- ral occasions,* I deem it of so much value, as to require some further attention. Its claims to be * Expectorants. f Anlilithics, Expectorants, Rubefacients. 289 considered here, not chiefly on its efficacy in the spasmodic or convulsive complaints of the lungs, and especially in asthma, pertussis, in certain cas- es of dyspnoea, of croup, and tussis senilis. Con- vulsions in children are also relieved by it, and I have known it highly serviceable in dyspepsia attended with gastrodynia, palpitations of the heart, nervous tremors, vertiginous affections of the head, &c. This last is a common and* trou- blesome complaint, occuring in gouty and intem- perate persons, and is often a source of great anxiety and alarm. It is not at all dependent on fulness of the vessels, and I believe, nearly always is purely of gastric origin. Be this as it may, I have found it more readily to yield to garlic, than to any other remedy. To the stomach enfeebled by excess of stimulation, garlic commonly proves exceedingly cordial, and it may be remarked that drunkards recur to it almost instinctively. Whe- ther our medicine is of use in any of the neuroses, except hysteria, in which it is sometimes beneficial. ly prescribed, I have not heard. By Bergius, garlic was employed in intermittent fever with success. Exhibiting one clove of it morning and evening, gradually increasing the quantity, he says, that it hardly ever failed to put off the paroxysms, and that in some instances he completely cured, by the same practice, confirmed quartan agues. Of the truth of this statement, to a certain extent, I entertain no doubt. I have wit- vol. n. oo 290 uessed myself effects, almost as striking from the medicine. Given in any kind of ardent spirits, garlic is much used by the common people of this city, for the cure of ague and fever, and I have re- peatedly seen some of the most inveterate cases of the disease removed by it. Ofthe external use of garlic, I have already said something under the head of rubefacients. But I may here, perhaps, add one or two observations with advantage. The expressed juice of it, well nibbed on the spine twice a day, is thought beneficial in whoop- ing cough. There is nothing improbable in the fact, and I am not sure that I have not seen good effects from the remedy. In deafness from rheumatic affections of the head and other causes, we are told by Bergius, which is corroborated by the testimony of Cullen, that gar- lic introduced into the meatus auditorius externus, will occasionally afford relief. It may be applied in two ways, either by cotton or wool soaked in the juice, or the clove itself may be put into the ear, wrapt in any thing soft. Whether it will cure deaf- ness I do not know, but I have mauy times witness- ed good effects from this very simple remedy in the ear-ach, though a warm cataplasm of garlic is still more effectual. 291 OLEUM SUCCINI. By distillation, an oil is procured from amber, a peculiar bituminous substance dug out of the earth, or found on the coast of the north of Europe. This oil was formerly a good deal prescribed as an an- tispasmodic, in some ofthe neuroses. It has, how- ever, gradually lost reputation, and is, at present, hardly retained in the treatment of any disease ex- cept pertussis, where it is still highly commended. Yet, I have sometimes recurred to it with great ef- fect, in the singultus of low fevers, and it is un- questionably entitled to attention, as a remedy in pyrosis, and especially where this affection is at- tended with cramps or spasms. Nor am I altoge- ther convinced that its former reputation in chronic rheumatism and palsy was unfounded : it is at least useful as an external application in both cases. The dose of the oil of amber is from ten to thirty drops. OLEUM CAJEPUTI. Cajeput oil is highly fragrant, having in some degree the odour of turpentine or camphor, and the taste of peppermint. It was once supposed to be procured from the melaleuca leucadendron, a tree of Iudia, though this is now denied, and with ap- parently more certainty, it is ascribed to one of the 292 same class, on which the title of melaleuca cajeputi is conferred. Like most of the articles to which it is allied, this oil is actively stimulant, and is not without an- tispasmodic powers. Though not very long incor- porated into the materia medica, its reputation is pretty well established as a carminative or anti- spasmodic in tympanites, flatulent cholic, and whooping cough : and as a diffusible stimulant, is not less prescribed in chronic rheumatism, in pal- sy, hysteria, and some other of the neuroses. Of these eases, it is now most used in pertussis, and probably with the greatest effect. Externally it is applied to relieve arthritic and rheumatic pains, and in sprains and similar affections. It is also a cure for tooth-ach, put on lint or cotton. The dose of cajuput oil is from five to ten drops, though in the adulterated state in which we generally re- ceive it, much more may be given. ETHER SULPHURICUS. When alcohol and the mineral acids are distil- led, a liquor arises which is called ether. The product in this case varies according to the acid employed, though there is a considerable resem- blance in the general properties of the whole. Of these preparations, sulphuric ether is preferred for medicinal purposes, and it is to it I shall confine my observations. 293 Ether is a powerful stimulant, and antispasmo- dic, somewhat analogous to alcohol in its leading effects, though more powerful and less permanent. As an active incitant, it is sometimes prescribed in the low states of disease, and particularly in ty- phus fever. But its impressions are so evanescent that not much is gained by it, and it is difficult to imagine a case, in which it should supersede wine, &c. With infinitely greater advantage, it is em- ployed as an antispasmodic in cholic, cronp, sin- gultus, retrocedent gout, in cholera to check vomit- ing, and in certain other spasmodic or nervous affections, as in the hysterie paroxysm, in asth- ma, angina pectoris, &c. Externally applied, it affords relief in muscular pains, also in cephalal- gia, and is an excellent remedy in burns. The dose of ether is from a drachm to half an ounce, according to the urgency of the case. But, there are some modifications of ether, in which it is di- luted, and may hence be given more freely. Of these, the anodyne mineral, liquor of Hoffman, which differs from ether chiefly in containing more alcohol, is incomparably the best, and is now only employed. As a narcotic, calming irritation, and lulling to sleep, it would seem indeed to be supe- rior to ether itself, and will unquestionably some- times succeed in these respects, when even opiates fail. 294 DISCOURSE XL1. HYDRARGYRUS. Next I enter upon the consideration of mercury in its various relations. This article has most com- monly been treated of, under the head of sialo- gogues, or that description of substances which pro- mote the salivary discharge. An increased flow of saliva may be excited either by chewing acrid matters, or by the internal exhibition of certain medicines. The first are with great propriety, termed masticatories. These, as conduciug to no practical purpose, I shall wholly exclude. The articles which excite salivation, through the medium of the general system, as a pretty uniform result, are limited to the mercurial preparations. It is true, there is a series of others, which occa- sionally evince this power, such as arsenic, copper, lead, the narcotic stimulants, the mineral acids, and above all, the polygala senega. But the effect is partial, exceedingly uncertain, and even when it occurs, answers no curative indication. Consider- ing mercury, therefore, as the only real salivaot 295 medicine, I am unavoidably led to rescind the class of sialogogues. To me it has, moreover, appeared absurd to af- fix a title to an article of so diversified an opera- tion as mercury, from an effect that is incidental, not possessed by all its preparations, and which, in many instances, at least, is not necessary to the cure of diseases. Being so peculiar in its properties, it is very diffi- cult to assign to mercury its proper position among the articles of the materia medica. But I do not know that a very precise adjustment in this case is of much consequence. As partaking in a consid- erable degree the powers of each class, it may per- haps, be as well put between the stimulants and tonics, as any where else, and it is here, that I shall, at least for the present, locate it. In making an application of mercury to the cure of diseases, I must unavoidably be led into a very copious discussion. It is known that no article in the materia medica is possessed of more va- rious powers, or which, perhaps, in the present state of our practice, is employed in so many and diversified cases. Of the medicinal properties of mercury, the an- cients were totally ignorant, the physicians both of Greece and Rome considering it, on the contrary, highly poisonous. As a remedy, the first that used it were the Arabians, who enriched the materia me- *9G dtca with so many valuable articles. But they re* stricted it to the cutaneous affections, which they treated with ointments, prepared somewhat iu the way of those now in use. Among the earliest of its applications was to the cure of lues venerea, a disease, which at that time was spreading its ravages over the fairest portions of Europe, and menacing the most calamitous conse- quences to human happiness. It has been said by some writers, that this diseoVery, probably the most important which our seienee claims, was the result of accident, or at least the offspring of empirical prac- tice. By comparing, however, the evidence which has been brought into the controversy on the sub-7 juct, it appears, I think pretty distinctly, that mer- cury was originally adopted as a remedy in the ve- nereal disease, by regularly educated practitioners, to which they were led by analogy, having observed its efficacy in other complaints, accompanied with ulcerations, or cutaneous eruptions. In treating of mercury, I shall commence with its use in fever. This would be a very interesting enquiry, could I enter fully into the subject. But it presents so ample a field, that, with my limits, I dare not encounter it. All which I can attempt will be little more than a few desultory remarks. The introduction of mercury into the treatment of the febrile affections, is by no means a new prac- tice. By consulting the writers of the early part 297 of the seventeenth century, we shall find that it was occasionally prescribed, though the reme- dy seems not to have commanded entire confi- dence. Of those who employed it, the celebrated Radcliffe was among the most conspicuous. Ever since, however, the reputed success of the mercuri- al treatment of yellow fever in the West Indies, it has become fashionable in this country to resort to the medicine in every variety of the febrile condi- tion. The fever of tropical climates, is indiputably managed with greater advantage by the liberal exhibition of mercury, than by any other course. To this point we have the concurrent evidence of the highest authorities. Many ofthe West Indian practitioners would appear to trust exclusively to this remedy. When the yellow fever occurred among us, the same practice, so far as relates to the copious use of mercury, was imitated. It was ap- plied, as well to evacuate the bowels copiously, as to excite salivation. At first this plan was deemed singularly efficacious, so much so, indeed, that in the enthusiasm of the moment, it was proclaimed, that death never took place after the mercury evinc- ed its effects on the system. But a cooler and more deliberate observation soon exposed the illu- sion, and we all came ultimately to distrust the propriety of the practice. The fact turned out to be, that the mild cases of the disease got well with* out it, and when violent, so rapid was the career, vol. II. p p m that death took place long before the system could be brought under the mercurial impression. As described by their best writers, the yellow fever of the West Indies is a bilious disease, the hepatic system being mainly affected in it. But the very reverse of this takes place in the pestilence of our cities. Dissections very numerous, and made under every variety of circumstances, have shewn conclusively, that it is purely a gastric affection, in which the biliary organs have little or no concern. These were rarely found deranged even ih the slightest degree. The stomach, on the contrary, was universally met with in a state resembling that which is produced by the action of the corrosive poisons, or in other words, presenting the pheno- mena of malignant gastritis. After a considerable fluctuation of opinion, the practice which at last was adopted, consisted of copious venesection in the early stage of the case, pretty plentiful purging with calomel and the neu- tral salts, of sweating, continued for a length of time, or cold affusions, and of a succession of blis- ters to the region of the stomach as well as to the extremities. As I have described, such is the out- line of a system, embracing certain details, appli- cable to peculiar symptoms or cases, as they may appear under various modifications. Condemning the mercurial practice in this case, I am, however, far from doing so in relation to the ordinary autumnal fevers of our climate, and es- 299 pecially those which prevail in the southern states, Not less from wbat I have observed myself, than from information derived by my correspondence with the physicians of that section of the country, I am clearly of opinion, that the disease is highly bilious, requiring for its cure strong mercurial purges, to an extent far greater than we are accus- tomed to employ/Whether it be expedient to urge the medicine in these cases, to the point of salivation, I am not prepared to pronounce decisive- ly. As a general rule, it obviously cannot be neces- sary. No doubt, however, there may occasionally be instances of protracted duratiou, or peculiar ma- lignity, in which a salivation may be necessary. This has sometimes been my own practice in our bilious fevers. By some practitioners mercury, of late, has been employed in typhus fever. We have heard of the suc- cess of the treatment by purgatives in these cases.* It is proved by actual examination, that in this disease, the whole of the intestinal canal is loaded with a dark mucus, singularly irritating and offen- sive. Being removed by purges, and none answer, it is said, so well as the mercurials, the system, which before was prostrate, recovers its tone, and the progress of the disease, if not arrested, becomes more mild and manageable. But there is another stage of typhus fever, in wfcich the same medicine proves serviceable. To- * Cathartics. 300 wards the close of an attack, it is alleged, that calo- mel given in minute doses, every two or three hours, to stimulate the blood vessels, and not to purge, will now and then produce the most astonishing effects. It here acts, in other words, by exciting a mer- curial fever, which subverts the existing state of things. But to effect this purpose, the powers of calomel are very much improved by using at the same time opium, volatile alkali and wine, and mercurial frictions in place of calomel may some- times be substituted. As a remedy in intermittent fever, mercury is not unfrequently prescribed. No one will question the propriety of mercurial purges, as a preparative to the use ofthe Peruvian bark, or other tonics, in recent attacks of the disease. This, however, is not the application to which I allude. Cases of inter- mittent, kept up by visceral congestion, or long con- tinued habit, are very common in miasmatic dis- tricts, and it is under such circumstances that sali- vation often becomes indispensable to the cure, act- ing here, by the removal of the obstruction, or dis- severing morbid association, as the case may be. Not a little is said of the efficacy of the mercu- rial preparations in all the cases constituting the order of phlegmasia}. There are some of these affec- tions, however, iu which the medicine has proved peculiarly serviceable, and consequently is more employed. The diseases of the larger glands are of this description, and espeeially the various mor- 801 bid conditions of the liver. In the early stage of the attacks of this organ, mercury is rarely demanded except as a purge. The case is better treated by copious blood-letting, topical and gene- ral, and other directly depleting remedies. Yet, should it, from extraordinary obstinacy, or defec- tive practice, run on to the chronic stage, or even prove refractory to the remedies mentioned, then a thorough mercurial course can only be trusted. All other remedies and modes of treatment, in con- firmed hepatitis, are only feeble temporizings, or dangerous tamperings. In conducting a patient through a salivation in this disease, it will be proper to introduce the mer- cury into the system gradually, unless the symp- toms are urgent, and in order to mitigate pain, and subdue febrile action, which will occasionally arise, we shall have to recur, in some instances, very frequently to venesection and to blisters. The li- ver in chronic hepatitis may be affected by scir- rhus, by an abscess, by tubercular ulcerations, or placed in a variety of other states, hitherto not ac- curately defined, and which cannot be satisfactorily discriminated by any set of symptoms. Nor is it of much importance, as pretty nearly the same treat- ment is to be pursued under all circumstances. In several of the anginose, or throat affections, mercury is prescribed. The first practical appli- cation indeed of this medicine in the United States, except in syphilis, was to the case of cynanche 302 maligna. Nearly a century ago, it is said, that Dr. Douglass of Boston employed it in this complaint, to excite salivation, and since that period his prac- tice has been variously imitated, some using calo- mel merely as a purgative, and others combining with it opium, or ipecacuanha, or both, for the pur- pose of determining more particularly to the surface. As to my own personal experience, I cannot say much relative to the treatment of this disease by mercury. It has seldom occurred here, since I en- tered into business, and never as an epidemic. In the few sporadic cases, which have come under my care, I have, after emetics, freely used calomel as a purge, and found it to answer extremely well. But 1 shall never think of salivating in this disease. By some of the southern practitioners, mercurial gar- gles are highly spoken of to cleanse the foul ul- cers which are incident to the worst forms of malig- nant sore throat, and they seem to me to be well adapted to this purpose, though I have not used them myself. In cynanche trachealis, some of the respect- able practitioners, both of this country and of Eu- rope, trust exclusively to calomel. This medi- cine was originally employed in croup, by the late Dr. Kuhn, of this city, who prescribed it so early as the year 1770* The Scotch physicians are tie- voted to the remedy, and consider it as almost in- fallible, or such at least, seems to be the opinion of some of the most distinguished of their writers. SOS By one of them it is said, " that in every case where it was employed, previous to the occur- rence ofthe lividness of the lips, and other mortal symptoms, it has completely succeeded, both in curing the disease and in preventing any shock to the child's constitution." His manner of exhibit- ing the calomel would appear daring, even to rash- ness, were we not acquainted with the insensibility of the system in this disease, to remedial impres- sions of every description. To a child of two years old, he has given upwards of one hundred grains, in twenty-four houas • With Dr. Hamilton, to whom I have alluded, the professor of midwifery at Edinburgh, I am well acquainted, and from his high standing and character, I entertain not the slighest doubt of the veracity of these representations. Nevertheless, I will not take upon myself to support or recommend his practice. The mode which 1 have suggested of managing this disease, at least as it appears in this conntry, I must think decidedly more effectual, and certainly less hazardous, as well as repugnant to popular prejudices.* Mercury is at present greatly employed in pneumonic inflammation. This practice, I am in- clined to suspect, originated with the New Eng- land physicians. Encouraged by its success in ma- lignant sore throat, as just mentioned, they seem to have extended the remedy to almost the w hole of the phlegmasia. The only European writer, so far * Emetics. 304 as I know, who has advocated the same sort of treat- ment, is Hamilton, of Linn Regis, and it is certain, that it prevailed in this country long before his time. Of the efficacy of the practice, there cannot be a doubt, though it requires some powers of discrimi- nation to make the proper application of it. In all cases of genuine pneumonia, it will unquestionably be expedient to premise very copious depletion. But after vascular action is sufficiently reduced, small doses of the medicine, with opium and ipeca- cuanha, repeated every two or three hours, are highly serviceable, and especially where there is much oppression. This combination in the secondary stages of pneu- monia notha, and especially when it occurs in per- sons advanced in life, is truly an invaluable remedy. It represses difficulty of respiration, promotes the discharge from the bronchia, allays cough, and confirms recovery. As an expectorant, the modus operandi of mer- cury is very intelligible. By powerfully stimulating the excretories, it enables them to throw off the im- pacted mucus, or phlegm which is afterwards cough- ed up and expelled. But it is not alone as an ex- pectorant, that we are to ascribe the effects of this remedy. Directed with skill, there is something in the union of calomel and opium, exceedingly strik- ing, in all cases of reduced inflammation, and parti- cularly so of the lungs. Either too early or late in the case, it proves alike ineffectual. The exact 305 point to recur to it, is when the regular depletory measures having been urged as far as seems consis- tent with safety, the disease still continues unsub- dued. In the course of the last fifteen or twenty years, our remedy in chronic pneumonia, or pulmonary consumption, has been very highly extolled. But this is by no means a novel practice. As long ago as the beginning of the last century, mercury was used by the well know n Radcliffe, in the cure of William, then king of England. It appears, how- ever, to have fallen into utter neglect, till it was re- vived by Dr. Rush and other practitioners of this country* That the remedy has occasionally been success- ful, can hardly be denied. It would, indeed, be easy to collect from within my own knowledge, or, which are on record, a very considerable number of cases, where the disease was said to be removed by a salivation. But whether any one of these was genuine consumption, it is difficult to determine. At all events, the remedy is exceedingly fallacious, and at present, commands little attention. Even those, who, at one time, confided most in its powers, have ceased, in a great measure, to use it. As yet, I have never had the good fortune to ef- fect a single cure of real confirmed tubercular phthisis by mercury, though my trials with it have been almost innumerable. Convinced am I, that in my private practice, and in that of public institu- vol. n. Q q 306 lions, which at different periods I have attend ed, mercury has been employed in several hun- dred cases. The result of this extensive experience with it, is, that in no one instance of consumption, accompanied with extensive ulcerations of the lungs, whether tubercular, or otherwise, was mercury of any service. Nevertheless, there are certain pulmonary affec- tions, in which it is indisputably useful. Where the case depends upon venereal taint, as it will very commonly be found to do among the vagrants of our large cities, or where it proceeds from previous dis- order of the chylopoietic viscera, as is by no means unusual, especially among debauched people, or those residing in miasmatic districts, mercury, pro- perly exhibited, will do more than any other plan of treatment. The case, however, in which it can best be prescribed, is in the incipient stages of consump- tion, proceeding from ill-cured pleurisy, or catarrh, and this is by far the most common form of the complaint to be met with in this city. Commenced prior to ulceration having taken place, or advanced to any extent, a moderate salivation continued for several weeks, will almost invariably arrest the progress of the attack, and after a while wholly irradicate every tendency to the disease. What, upon the whole, I wish to impress, with respect to mercury in consumption, is, that under the circumstances which I have just stated, it will 307 be productive of advantage, though in consump- tion caused by tubercles, or even by an extensive abscess, it is eminently mischievous. In the for- mer of these cases especially, it seems uniformly to operate as a poison, breaking down, as it were, the fabric of the constitution, and accelerating, with frightful despatch, the fatal issue. During the season, when such sanguine expecta- tions were indulged as to its powers over this for- midable disease, it was indiscriminately resorted to in all cases, without the slighest regard to cir- cumstances. The consequence was, that the prac- tice gradually declined, and is now nearly aban- doned. Of mercury, as a remedy in rheumatism, 1 have not much to say. It seems to be sufficiently admit- ted, that in all cases of the disease which prove in- tractable to the ordinary measures, it should be tried. Exactly as in pneumonic inflammation, the union of calomel, opium, and ipecacuanha, is here used with benefit. The propriety of a salivation, how- ever, in this disease, is disputed. By Clarke, who has written on the diseases of long voyages, we are told, that though mercury was otherwise of' the greatest service, it never failed to aggravate and protract the complaint, when it touched the mouth. But this opinion, which, if not peculiar to the writer who advances it, is certainly not confirmed by ge- neral observation and experience. In my own practice, I have often carried mer- 308 cury to salivation in rheumatism with very marked advantage, and such is the course pursued habitu- ally by the practitioners of this city. Cases, indeed, of the disease do sometimes occur, which will not all yield till the mouth becomes affected, and, to ac- complish a radical cure, the mercurial impression must be sustained for a very considerable period. To salivate in syphilitic rheumatism is a prac- tice universally pursued. No one will doubt the propriety of this course, where there is really a remnant of venereal contamination. But 1 cannot help entertaining the conviction, that such cases are of much rarer occurrence than is generally imagin- ed. My experience teaches me to consider for the most part, what is usually called syphilitic rheu- matism, as purely a mercurial affection brought on by the profuse and indiscreet employment of the medicine. But whether my theoretical notions on this subject be correct or not, I have at least found, that such cases are infinitely more manageable by a different system of treatment, substituting in the place of mercury, sarsaparilla, &c. Nevertheless, I do not mean to convey the idea, that in the rheumatic affections following syphilis, we are ne- ver to resort to mercury. My object is merely to enjoin some degree of caution and discrimination in its use in such cases. Mercury has been found beneficial in certain forms of ophthalmia. Every one will admit its uti- lity when the case has its foundation in venereal 309 contamination. But independently of any vitiation of this sort, the eyes are subject to a very protract- ed species of inflammation. The cases to which I allude, are usually attended with considerable uneasiness of the head, and particularly by pain, often exceedingly acute, over the orbit of the eye. Examples of such affections, I have repeatedly witnessed, which have continued with unabated violence, for many weeks in succession, resisting the most active remedies, such as general and topi- cal bleeding, purging, and blistering, which have, at once, given way to a very slight salivation. 310 DISCOURSE XLI1. The subject continued. In the management of haemorrhages, it some- times becomes necessary to have recourse to mercu- ry, and particularly in hamoplysis, which pertina- ciously resists the milder measures. The impres- sion on the mouth made by a salivation invites moi% bid action from the lungs, and by the general and re- volutionary operation of the remedy on the system, it may entirely supplant the disease, substituting its own peculiar action in place of it. Nor am I aware that the remedy is much less effectual in uterine hamorrhages, though, perhaps, it is not so often employed. The case in which it proves most ser- viceable, is in those regular discharges of blood which take place at the period of the cessation of the menses, or as sometimes happens at a much more advanced age, which though they may arise from mere relaxation of the vessels of the womb, are more frequently caused or associated with a tendency to scirrhus. Combined with cicuta, and aided by a milk diet, these cases, if not too long delayed, will generally submit to mercury. As might he anticipated, mercury has not been neglected in the proffluvia, aud especially the bowel 311 affections. Every one knows its superior powers as an evacuant in obstinate constipations, from whatever cause proceeding. Besides its efficacy in the spasmodic constrictions of the intestines, it is said to be singularly beneficial in cholica pictonum. By Clarke it is advised that fifteen, twenty, or thir- ty grains of calomel be given at a dose, and he states, when thus exhibited, it hardly ever fails to open the bowels and to remove the disease. But in a late tract on this subject, of very great merit, by Clutterbuck, calomel is directed in small and repeated doses, with a view to salivation. Each of these modes of employing the medicine may be serviceable, though they are adapted to very differ- ent stages of the disease. Largely given, it is cal- culated at once, to break the force of the attack, by overcoming constipation, and the other to subdue any lingering affections which may still exist.* As a part ofthe treatment of dysentery, the mer- curial medicines have been deemed very important. By Cleghorn, who acquired so much reputation by his work on the diseases of Miuorca, six or eight grains of calomel, with one of opium, were exhi- bited with a view to purge, and, he declares, that * My plan of treating colica pictonum has been so recently men- tioned, that I shall, in noticing the subject again, merely remark, that when it proceeds from lead, which is by no means tlfe only cause of it, I know nothing which so effectually removes the paralytic affections and other consequences ofthe disease, as a moderate salivation. 312 it answered more effectually than any other medi- cine. I have already mentioned* the advantages derived from large doses of opium and calomel in those unrelenting obstructions of the bowels depend- ent on spasm, and it is quite conceivable, that on the same principle, such a combination might be useful in certain cases of dysentery. As I have stated, Cleghorn originally prescribed ealomel and opium as a purgative, but he was ulti- mately convinced ofthe superior efficacy of saliva- tion in these cases. This taking place, he even asserts that a cure invariably followed. Nor does the efficacy of the practice rest exclusively on his own authority. On the contrary, it has been equal- ly successful in the hands of Lind, in the west, and was found not less so by Balfour, and by Yeates and Maclean, in the East Indies. Each of these writers approves of exciting salivation spee- dily in dysentery. Having in another place detailed my mode of managing this disease, I shall not now indulge in any recapitulation of it. Combinations of calomel, ipecacuanha, and opium, with a view of quieting irritation and determining to the surface, have, at all times, been a favourite prescription of mine. Before dismissing the subject, I will only further remark, that jn protracted or chronic dysentery, I have frequently salivated, and found it sometimes * Cathartics, Opium, &c. 313 the only means by which I could effect a cure. Yet, in the acute forms of the disease, I should presume that it can hardly be expedient to resort to this very unpleasant alternative, though, it is probable that whenever salivation is excited, it will have a beneficial tendency. My remarks are applicable chiefly to the disease as it appears in this city. There can be no doubt, that in warmer climates, as the East and West In- dies, and in the southern sections of our own coun- try, where the hepatic system is deeply implicated in this and in most other affections, that the mercu- rial treatment of dysentery is much more frequently demanded. As it occurs here, dysentery is an highly inflammatory affection, calling, in the first instance, for the prompt and free use of all the di- rect depletory measures. To this general charac- ter of the disease there is one exception. Dysen- tery, among our poor and depraved classes of so- ciety, now and then wears the typhus type, and such is generally the case when it breaks out in crowded and ill ventilated apartments, being, un- der such circumstances, propagated for the most part by contagion. Assuming this form, depletion cannot be urged to any great extent, and I have early put the system under the mercurial impres- sion, and been well pleased with the result. As a deruier resource in diarrhcea, mercury should not be overlooked. Cases of a very pro- tracted and obstinate nature I have repeatedly seen VOL. II. it r 314 to yield to it. It is, indeed, an almost indispensa- ble remedy where indications exist of derangement in the chylopoietic viscera, and even if this is not so, it proves of service by instituting a new set oi actions. Exactly on the same principle, mercury is pre- scribed in dyspepsia. No inconsiderable propor- tion of the cases of this complaint which have come under my care, could be clearly traced to some visceral obstruction, and commonly of the li- ver. Of the utility of mercury here, no one will dispute. But there are some other instances of dyspepsia, Which proceed from a wrong action in the vessels of the stomach itself, producing a vi- tiated secretion of the gastric liquor, sometimes acid, or otherwise exceedingly disordered. Minute doses of mercury alone, or in conjunction with ipecacuanha and opium, I have known to redress the mischief, and perfectly re-establish the healthy condition of this viscus. Of the class of neuroses, there is, perhaps, no case in which mercury has not been used and even extolled. As relates to epilepsy, I cannot say much of its powers. 1 Jiave seen it tried in a large num- ber of instances of the disease, and I fear with lit- tle or no advantage. It is, however, said by some practitioners, to have effected cures, and even where it does not do so much, that it mitigates the symptoms, and suspends the paroxysms. I confess that I have experienced no such effects 315 from it, and after sufficient experience, I am half disposed to reject it altogether in this disease. Epilepsy is undoubtedly sometimes occasioned by effusions of water into the ventricles of the brain, and if mercury ever does good, it is proba- bly under such circumstances. But desperate in- deed must be the case which proceeds from this cause! Of the utility of mercury in tetanus, I am not prepared to advance any very confident decision. This is a disease which arises from a variety of causes, and requires the same diversity of treat- ment. Cases of it proceeding from a constipated state of the alimentary canal, which submit very readily to active evacuations, and mercurial purges, under such circumstances, are useful. But in symptomatic tetanus, or that originating from wounds, or other injuries, I do not know that mer- cury is of the least service, the progress of these cases being so rapid for the most part, that long be- fore it can take possession ofthe system, death en- sues. But its efficacy is attested by very many writers, and as its use, particularly in the shape of frictions, cannot interfere with other remedies, it may still be retained in the management of this dis- ease. As a preventive of tetanus, I suspect that mer- cury is serviceable. To fulfil this indication, the wound'is to be dressed with strong mercurial oint- ment, and small doses of calomel are exhibited in- 316 ternally. This is the ordinary course pursued in the warm climates of the East Indies, and which is reported to be attended with distinguished suc- cess. Highly as mercury has been celebrated in hy- drophobia, I do not think it necessary to indulge in any copiousness of remarks on the subject. Me- dical opinion seems now to be pretty well made up as to the impotency of this and all other medicines in the prevention, as well as the cure of this most intractable disease. As a prophylactic, nothing can be trusted except a complete excision of the inocu- lated point, and as relates to the cure we have not a single remedy, as I have before more than once said, in which the slightest confidence can be re- posed. Believing as I do, that the disease cousists in a tribe of associated motions, the primary link of which commences at the original seat of irritation, I am thoroughly persuaded that the extirpation of the part at any period prior to the accession of the attack, would prove as effectual as if it had been done when the bite was originally inflicted. Nor, indeed, do I know whether the extirpation of the part on the first signal of the attack, might not avert the further progress of the disease, precisely in the same way as the removal of the irritation of the wound puts an end, in some instances, to the series of convulsive motions which constitute teta- nus. Nothing is much more preposterous than the 317 eommon opinion, that the virus iu this case, enters the circulation, and in this way produces its ef- fects. All diseases, thougjj it is more strikingly illustrated in such as are propagated by inocula- tion, commence at a point, and are generally ex- tended through the medium of sympathy, or asso- ciation, till more or less of the whole system is brought into participation, producing what is call- ed a constitutional affection. Do we not arrest altogether lues venerea by the destruction of chan- cre, though the latter may have existed for many days, and are we not equally apprised of the fact, that the same thing happens with respect to vacci- nation, and hence care is always enjoined to pre- vent any injury of the pustule? To the cases already enumerated in which mer- cury is commended, may be added paralysis, tic doloureux, dysphagia, gutta serena,* and several others that do not require to be particularly detail- ed. It may be collected from what 1 have said, that though 1 do not repose much confidence in its * Exhibited for a long time as an alterative, and afterwards urged to a salivation, it is said that mercury is sometimes productive of very great advantage in this complaint. But this state ofthe eye is depend- ent on such a variety of causes, that our practice must be exceedingly empirical, and of course not very successful. It is true, that Mr. Ware, the celebrated oculist, has told us, that mercury is chiefly useful in those cases accompanied by a very contracted pupil, and which he con- siders, are most probably occasioned by an internal inflammation. Whe- ther such instances arc readily to be disth.^uished, I will not pretend to decide. 31S powers in some of the more formidable of these af- fections, still, where any one of the class can be traced to a sympathetic connection with a disor- dered condition of the digestive apparatus, it holds out, I think, the best prospect of success, and should never be neglected. To treat mania by the mercurial medicines, if not an American practice, is certainly much more prevalent among us, than in Europe, it is one, at least, to which the medical men of this city are ex- ceedingly devoted. Yet, 1 do not thiuk that we have determined, with sufficient precision, the cases to which it is best suited, and hence the results of our experi- ence are very different, and even contradictory. It is resorted to in each form of mental derangement, as well in furious mania, as iu melancholia, and perhaps, with nearly equal success. All which is particularly attended to in the employment of the remedy is, to see that the system is properly re- duced, or in other words, brought down by bleed- ing, purging, and other evacuations, to the point of salivation. This being premised, mercury un- questionably will often effect cures under circum- stances apparently the most discouraging. It is, in short, a principle with the practitioners of this place, to appeal to salivation as a resource in all cases of insanity, which have pertinaciously re- sisted other modes of treatment, and, though this 319 may be empirical practice, it is fully justified by the frequent success of which it is productive." That the utility of mercury in the mental affec- tions may in part be ascribed to its general powers over disease, seems highly probable. But I can- not help entertaining the conviction, that it does infinitely more good by specifically acting on the chylopoietic viscera, correcting the derangement in this system of parts, which would seem to be the cause, in very many instances, of the morbid stales of the mind. Extraordinary as this location of in- sanity may appear to such as have not contemplat- ed the subject, it neither wants the support of au- thority, nor the evidence of analogy, or of positive facts. It is now pretty generally conceded, that the whole class of neuroses is of gastric origin, or, at least, generally so, and considering the close af- finity which exists in the physiology as well as pa- thology of the nerves and brain, it is surely no great stretch of generalization to embrace within the same view the two sets of cases. Can it be denied that the cephalic and mental disorders are very 'frequently induced or imitated by impressions on the stomach and its dependences from the narcotic poisons, worms and other causes? Every practitioner of much experience has proba- bly seen this repeatedly illustrated in apoplexy, pal- sy, hydrocephalus, cephalalgia>in the depravation of vision, and in mania, melancholia, and hypochon- 320 tliia, and all which is abundantly confirmed by dissection. It had long been a matter of surprise with patho- logists, that, in the diseases of the mind, the mor- bid appearances of the brain should be so few and slight, sometimes indeed, none whatever existing, even though the case were furious mania. Being conducted under the predominant notion that the brain must necessarily be the seat of these affec- tions, examinations were rarely extended beyond this organ, and consequently, the real source of mischief continued unrevealed. But of late, the cultivators of morbid anatomy in Europe, have thrown a very clear and distinct light on this subject, demonstrating incontestably, that we are to seek in the chylopoietic viscera, for the causes of very many of the nervous and mental com- plaints. The facts thus developed, have laid the foundation of a correct pathology with respect to this interesting set of diseases, and will, no doubt, as has already iu some measure been done, lead to a more exact and successful mode of treatment. But, while I maintain generally the « onnection of these cases with certain disordered states of the abdomi- nal viscera, I myself am not at all disposed to deny, that they may take place as idiopathic af- fections of the celebral and nervous systems. Many of the cachexia are treated by mercury. In dropsy of every form it is prescribed, aud some- times proves among the best of our remedies. 321 Elsewhere, I have dwelt with the strongest empha- sis on its powers in hydrothorax. Combined with the squill in the proportion which I there stated, it is, indeed, so effectual in this disease, as almost to take it out of the catalogue of the reproaches of our art. To ascites and anasarca it is also v^ell suited, though not so conspicuously as in the accumula- tions of the chest. These varieties of dropsy, how- ever, do often arise or are kept up by visceral ob- structions, and whenever this happens, mercury is indispensable to the entire removal of the eomplaiut. Nor, perhaps, does it do less good, in some in- stances, by arousing the action of the lymphatics, a system of vessels on which much of its power is usually expended. Yet it must be confessed, that it often disappoints our expectations, and that the cases have not hitherto been accurately designated to which it is applicable. To me it has always appeared to be alike inappropriate to febrile or in- flammatory, and to the weak and leucophlegmatic dropsy, and certainly so, if the latter be associated with any scorbutic or strumous contamination, mer- cury always acting hostilely in such depraved ha- bits. Dropsy, with some degree of tone and sound- ness of constitution, is the sort in which mercury operates most beneficially, though even here it should not be resorted to, till arterial action is pretty well reduced. As regards its utility in the complaint denomi- VOL. II. RS 62% itated hydrocephalus internus, medical opinion does not seem so unanimous or decided. There are some practitioners who believe, that neither this nor any medicine is of the slightest service, while others, more sanguinely maintain, that by a proper perseverance in a mercurial course, it proves very manageable. It is manifest, that these contradic- tory accounts proceed from the opposite views which have been entertained of the pathology of the case. The proximate cause of the disease, or the dis- ease itself, consists in an increased and altered ac- tion of the vessels of the brain, producing an effu- sion of water into the ventricles, or some derange- ment in its organic structure, from the continuance of morbid impressions on it. Now, it is very ob- vious, that our success will be different under these opposite circumstances. Attacking the disease it- self, we shall most gene-rally cure it, however we may be baffled in our attempts to remove the effect of it. Of course, it would be wrong to resort to mer cury in the incipient or early stages of hydroce- phalus. The treatment, at this period ought to con- sist of venesection, very copious purging,, and tht application to the head of cups, leeches, and blis- ters, with a most strict adherence to the antiphlo- gistic plan in all its parts. By pursuing steadily such a course, the disease will very often be ar^ rested. But it is worthy of particular recollection. 333 that iu hydrocephalus, it is by no means rai*e, at the expiration of ten or fifteen days, where the dis- ease has advanced rapidly, for the more violent symptoms to subside, so as to induce an expecta- tion of a speedy recovery. This is sometimes a most treacherous and fatal calm, as it results from effusion having taken place. The vessels which had previously been so much excited, are in this way relieved, and the attack is completely sus- pended. After a short interval, however, the ex- traneous fluid acts as a re-exciting cause, and the disease returns with redoubled force. Under such circumstances, the case may be considered as des- perate, or nearly so. Effusions into other cavities may be taken up, but experience teaches us that it rarely happens in these cases. As yet, no one, except Muscani, has pretended to have detected absorbents in any por- tion of the brain, and by many, their existence, even at the present day, is denied. But surely, their not having been satisfactorily ascertained, is owing to the imperfection of our anatomical re- searches, as the phenomena of growth, not to men- tion other facts, sufficiently attest, that they must belong to every organ and part of the animal ma- chine. An absorbent is as necessary an ingredient in the composition of a living body as a blood vessel, each being indispensably necessary to the execu- tion of its primary and most important vital func- 324 tions. Even admitting, however, the existence of lymphatics in the brain, it is still not less true, that they act very feebly and incompetently in the hy- drocephalic affections. Yet, on this account,, we should not be discouraged from urging the use of mercury in these cases. By the common consent of practitioners, it seems now to be conceded, that no plan of treatment holds out such prospects of success. Even where effusion has not taken place, it is serviceable by changing the action of the vessels, and diverting the complaint from the head. But, if water exists, it is the only remedy entitled to the slightest confidence. To be effectual under such circumstances, the mercury must be applied in a very bold and deci- sive manner. It should be exhibited in as large a quantity as the stomach and bowels will bear, and externally applied in the shape of frictions, with the strongest ointment, most diligently and copi- ously. To do less than this, in these desperate cases, is to trifle with the remedy, to practise injus- tice to ourselves, and to cut off the only chance which the patient has of salvation. I have remarked, that the proximate cause of this disease is an increased and altered action of the vessels of the brain, and that the effusion is merely the effect, and which I now add, is not a uniform one. It has, indeed, been recently held by ft writer of great intelligence, that the effusion, so 325 far from constituting the disease, is not either the principal, or even accessory cause of death in the case, but, on the contrary, operates to the pro- traction of life, by imparting to the brain a certain degree of tone and support, which, under such circumstances, it would lose. Whether this is only a plausible hypothesis, or is really the fact, I will not take upon myself positively to pro- nounce. Certain it is, however, that water will continue in the ventricles, or, at least, we have every reason to suspect its existence, in some in- stances, for weeks or months, or years, without destroying life. But though I place the proximate cause of hy- drocephalus iu a morbid action of the brain, I am not the less persuaded, that, in a large majority of cases, it commeuces in a disordered state of the stomach, or some one of the chylopoietic viscera. To this conclusion I am conducted, by the well known association which exists between all these parts, and by various considerations which may be deduced from the history ofthe disease, such as the great disorder observed in the chylopoietic vis- cera, sometimes for weeks before the appearance of hydrocephalic symptoms, the removal of theso symptoms by purgatives, and other remedies di- rected to the alimentary canal, the extreme tender- ness felt in the regions of the stomach and liver, the obstinate constipation attending at this period, jn the peculiarity in the stools, indicating extreme 326 "vitiation of the biliary secretion, and the phenome- na exhibited on dissection, proving the previous existence of no slight disease in most of the abdo- minal contents, and especially in the stomach and liver, and sometimes none at all in the brain. Of the use of mercury in the diseases of the skin every one has heard. Exceedingly numerous as these affections are, there is hardly one in which it is not prescribed. The success, however, which we derive from it is very variable, and on the whole, we may consider it, in most of them, as a precarious remedy.* But it often happens, that when it fails given internally, it will answer if applied directly to the surface iu the form of an unguent or wash. This is especially the case in itch. No quantity of mercury taken internally will re- move the complaint, or even make any very sensi- ble impression on it, though used in the way I have meutioned, it is very effectual. Whoever has attended much to hospital practice, where cases of psora and syphilis are often to be met wi*!i in the same person, must have seen this re- mark very repeatedly exemplified. The fact is, no diseases are so unmanageable by constitutional remedies, as those of the skin, and particularly of the cuticle. This proceeds from their being seated at the extreme verge of the sys- * It is remarked by Willan, in his work on the diseases of the skin, that if he could only point out the proper application of mercury ;n these complaints, the end of his labours would not be entirely lost. 327 tern, and in a great degree removed beyond ttit- sphere of the circulation, and the agency of the vital powers. Exactly as disease is near to the great organs which sustain life, so is it violent, and I believe curable, provided we proportion the pow- ers of our remedies to the vehemence of the case. As regards the exanthematous, or acute affeetions of the surface, except as a purge, mercury has entirely lost its reputation, not being now used even as a preparative to the smallpox, the purpose for which it was longest retained. But it is still directed in some of the chronic cases, and particularly of a herpetic nature, though, as I have just mentioned, not with much certainty of success. Of course, I do not include in this remark, the venereal erup- tions. Considering the analogy between lepra and some of the diseases in which mercury is advanta- geously prescribed, we might presume it would be adapted to it. Little confidence, however, seems to be reposed in it by those who have had opportunities of making the trial. It is stated, that, though for a time it arrests the disease, it hardly ever fails to relapse in an aggravated shape. Yet, in elephantiasis, which is commonly held to be a species of leprosy, we are told, that the best treat- ment consists in mercury and the stimulating dia- phoretics. Of these diseases, I have seen too little to advance any opinion relative to the practice to be pursued in them. In relation to the use of our remedy in scrofula S2S there is some difference of opinion. Cullen tells us, that he has never found " mercury or antimony in any shape, of service in the disease." But he is certainly mistaken, as later experience has suf- ficiently shown. Copious purging with calomel is exceedingly effectual in the commencement of scro- fula, and small doses of it, or corrosive sublimate, variously combined with the narcotics or tonics, as the case may require, are prescribed with ad- vantage in the advanced stages, to discuss tu- mors or resolve indurations. But with this view it requires to be continued for several weeks, or even a longer time, and so managed, as to attain its alterative without the salivent effect, the latter always proving, when fully established, at least, very highly mischievous. Of scrofula, however, we have little in the Unit- ed States, as it never originates among us. The cases occasionally met with, are confined to foreign- ers, or their immediate descendants.. The plenty and comfort of our happy land allow not of its pro- duction, and soon eradicate any hereditary tenden- cies to it. I have already said something of the value of mercury in the glandular affections. As common- ly seated in structures of this sort, it is right, that I should here make a remark or two on scirrhus and cancer. But these are subjects coming more immediately within the province of surgery, and of which I have no great experience. It appears, 329 from the older writers, that mercury, among a va- riety of other remedies, was much used in these cases, and though we are not without some facts of its occasional success, its reputation, at least, in open cancer, is entirely gone. The present opi- nion seems to be, that it rather aggravates than benefits the disease, though it is still admitted to be useful in the discussion of scirrhous tumours, in that stage of simple obstruction which precedes the alteration of structure or organization. With this view it is given in small doses, and applied in the shape of frictions, or of a plaster, to the tumour. Much might be said of the use of mercury in ul- cers generally. To do justice, however, to this subject, requires more surgical skill and discrimi- nation than 1 possess, and therefore I decline it. VOL. If. Tt 330 DISCOURSE XLI1I. The subject continued. The use of mercury in the venereal disease has been so ably and fully discussed by many distin- guished writers, that it would be superfluous in me to engage in any elaborate disquisition relative to its applications. My design is merely to call at- tention to one or two remarks, which I deem of some consequence. In the universal terror excited by this disease, practitioners were disposed to suspect almost every disordered appearance of the genitals, or neigh- bouring parts, as having its origin in venereal con- tamination. This solicitude, has unquestionably been the source of much mischief, and, as it still prevails to a very considerable extent, the same consequences daily arise from it. Contrary to a very general impression, I am entirely persuaded that syphilis, as well as the other form of the dis- ease, is, comparatively, a rare occurrence, so much so indeed, that I believe a very large proportion of the cases in which I am consulted, with the vene- real aspect, are really not of this nature. In all warm climates, the secretory surfaces of the organs of generation, are apt to take on a mor- 331 bid state, by which the discharges become deprav- ed, and often extremely acrid, excoriating the parts, and producing ulcers, so nearly resembling the true chancre, as readily to be confounded with it, by one who is hasty in observation, or possessed only of a narrow and imperfect experience. By consulting the medical writers of antiquity, and especially Celsus, we shall find an interesting record of a great variety of affections of the genital system, which, in all the leading circumstances, are analogous to venereal cases. The Old Testament itself, also furnishes us with the same species of evidence. The ancient inhabitants of the east, were exceedingly subject to such complaints, and there can be no doubt, that the practice of circum- cision, like many other parts of the Mosaic code, relative to the preservation of health, was institut- ed with the view of preventing these very diseases, and that in order to add solemnity to the obser- vance, it was interwoven with the existing system of religion. By the removal of the prepuce, this end is attained, as well by avoiding the entangle- ment of the virus in the folds of the membrane, as by the greater consistence which is given to the texture of the surface. The ulcers to which I have alluded, or some of them at least, commence like the chancre* some- times run precisely the same course, and are productive of very similar effects. Cases have sometimes occurred to me, where, from negli- 33& gence, or improper treatment, or great malignity, the ulceration has assumed a very alarming aspect. I have seen it to exteud its ravages so as to produce deep excavations in the very substance of the pe- nis, and at the same time, throwing up very irregu- lar and unhealthy granulations. But though, unquestionably, the disease which I have described, is very distinct from the venereal, as is shown by its exacting a different treatment, it still so closely resembles it in many of its charac- teristics, as even to exhibit not a few of the consti- tutional affections. An hundred times I have known this description of sores produce, as I be- fore stated, effects very similar to lues venerea, such as swellings in the groin, followed by diseas- ed throat, and even by eruptions on the surface of the body. There has lately appeared a work, by Mr. Car- michael, a distinguished surgeon of Dublin, in which my views on this subject are fully enter- tained, and even carried to a greater extent than I have hitherto ventured to do. Without descending to details, in which it would be improper for me to indulge, I may, perhaps, convey his opinions in a summary or general state- ment. This very original and ingenious writer maintains, that there are at least three distinct poi- sons, which, operating on the genital organs, pro- duce primary local symptoms, followed by second- ary constitutional diseases. 333 1. The syphilitic, characterised by chancre, suc- ceeded by a scaly eruption, which he considers as the only species caused by venereal contamina- tion. %. The gonorrhozal, characterised by a superfi- cial ulcer, destitute of induration, and of elevated and retorted edges. The virus of gonorrhoea, he also alleges, occasions severe excoriations of the prepuce and glands. What, however, is very pe- culiar in his notions on this point, is, that while he insists on the total difference in the nature of the two diseases, he unhesitatingly avers, that gonor- rhoea is sometimes followed by constitutional affec- tions analogous to those of lues, such as nodes, pains in the limbs, cutaneous eruptions, which, however, instead of being scaly as in syphilis, are papular. The third poison is characterised by a primary sloughing ulcer, which is often phagedenic from the commencement, and is followed by a pustulous eruption, and a train of constitutional affections.* • Mr. Carmichael does not seem exactly to understand either the nature or source of the poison, which produces this third species of disease. My own impression is, that it is derived from the morbid se- cretions, which I have already noticed. These will undoubtedly occa- sion such ulcerations as I have frequently observed myself, and which, as he has already stated, are described by the writers of antiquity. Depraved secretions, however, are not confined to the genitals of the male. The vagina is very apt to take on diseased action, and to throw out virulent and corrosive discharges, which very seriously affect the male organs. I know an individual whose wife has for some years had a species of lcucorrhoea, with whom he can never have connection, with- 334 In each of the preceding syphiloid, or imitative diseases, Mr. Carmichael, excluding entirely mer- cury from the general treatment, trusts the cure chiefly to antimony, sarsaparilla, and its kindred articles. The local applications he employs are, lotions of the muriate or submuriate of mercury in lime water, a grain of the former, or ten of the latter,* being added to the ounce. As a wash, the compound spirit of lavender, alone or diluted, is also a favourite remedy. Differing as we may, as to the degree of confi- dence to be attached to the opinions, every one must be pleased with the new views which have been preseuted of a very complicated subject, and, perhaps, without indulging an improper enthusi- asm, we are warranted in anticipating the most in- teresting results, by pursuing the same track of ob- servation and inquiry. As respects the management of real syphilis, my own experience, which is by no means circum- scribed, has satisfied me that, though on the whole, out inducing a most inflammatory gonorrhoea, often attended by exco- riation, and considerable ulcerations. Lately I had him under my care, when, to other symptoms, was added, a very frightful phymosis, and, on the subsidence of the tumefaction, I discovered on the crown ofthe glans penis, a deep phagedenic ulcer, which, before it could be ar- rested, did immense mischief to the parts. Nor is this, by any means, the only case of the sort which I have seen, though never to the same extent. * I generally add a drachm to the ounce, and find it much more ef- fectual. 335 mercury is to be preferred to all other remedies, we most wantonly and unnecessarily push the use of it. In ordinary attacks of the disease, I know that a very moderate salivation will suffice, and it will always be more effectual under such circum- stances, to induce it gradually, than suddenly to change the state of the system, by the profuse use of mercury. The local affections may be cured by a steady perseverance in the topical applica- tions, without at all recurring to the constitutional treatment. Never have I found it necessary, in the early stage of chancre, to prescribe mercury. Between its first appearance and the extension of it to the inguinal glands, always several days, and even months will intervene. During this interval, we may safely trust to the topical remedies. Be- lieving indeed, that the constitutional symptoms proceed entirely from sympathy with the primary affection, and that, iu no instance, is the virus ab- sorbed, I have often confided in this plan, even af- ter buboes had taken place, and have, in succession, healed the chancre, and dispersed the buboe. Consulted in the incipient stage of the disease, I endeavoured, at ouce, to destroy the chancre, and so effectually, as to preclude the possibility of the general system becoming implicated. This may be done by the proper application of an escharotic, such as burnt allum, which converts the syphilitic ulcer into a common healthy sore, and which, when judiciously treated, very speedily heals. 336 My practice in this case, is, indeed, precisely si- milar to that adopted in the bites of rabid animals. By the timely interposition of the knife and caus- tic, we aimost invariably prevent canine madness, and I am sure, that there is not less certainty in the syphilitic cases. The fact is, that all dis- eases, propagated by inoculation, or in other words, by the introduction of a virus under the skin, are so entirely sympathetic, that if the pri- mary irritation be arrested or changed, we also arrest, modify, or completely change the character of the constitutional affection. By some recent publications,* it appears, that the practice of treating syphilis in all its stages, without mercury, has been adopted, pretty gene- rally, in Great Britain, and more particularly by the surgeons of the army. To this course they were probably led by having witnessed its efficacy in Portugal, where it seems to be almost univer- sally pursued. Chancre they manage by very le- nient dressings, and the constitutional affections, with a decoction of sarsaparilla aud similar arti- cles. Even with this defective treatment of the pri- mary ulcer, the proportion of cases in which se- condary symptoms take place, is very small, and these are speedily and effectually cured, no re- * These are from Professor Thompson of Edinburgh, and Me»sr» Rose and Guthrie, two eminent army surgeons, 337 lapse occurring in any instance. The occasional failure of this plan to arrest the disease, does not, as an objection, apply to mine. It will be per- ceived, that my proposition goes to the extirpation of the local affection at once, and where this is properly done, it must necessarily afford a perfect security against any constitutional attack. That the means I have suggested are adequate to this end, an experience of more than twelve years, and in many hundred cases, fully warrants me in as- serting. Allowing, however, that this expedient occa- sionally fails, and the system becomes affected, where is the increased evil or mischief? Let the patient in other words return to me after a few weeks, with an ulcerated throat, and other symp- toms of confirmed lues, what happens? Enter- taining, as I do, the conviction of the superiori- ty of the mercurial treatment, I should instantly commence it, and with the certainty of effecting a cure as promptly, and with as little inconvenience, as if it had originally been employed. As, there- fore, no more mercury is required to eradicate, than to prevent the complaint, there cannot be a comparison between the two modes of practice in these cases. But, I am prepared to go further, and to avow my total want of confidence in the powers of mer- cury to cure chancre or hinder the contamination of the system. My reason for thinking so is, that VOL. n. u u 338 I have several times seen a chancre take place, and extend its ravages as usual, though at the time, the individual was fully under the impres- sion of mercury. Cases of this nature are by no means rare in the public institutions of great cities. Thus, we see patients, while in a deep salivation for dropsy, hepatitis, consumptiou, or some other complaint, contract chancre, followed by buboes, &c. Whether the disease, if not checked, would further extend itself, my experience does not allow me to say. The fact seems to me, that chancre, which is a mere local injury, is so seated on the con- fines of the system, that it cannot be approach- ed, or is very slowly so, by general remedies, and must be managed with direct applications. No more, in my opinion, can we cure a chancre by mercury exhibited internally, than suspend the ca- reer of the vaccine or variolous pustule, or disperse a paronychia, or heal any minute and ordinary- sore. As respects the nature of the remedies, I have nothing peculiar to offer in chancre. Like every other sore, the virus being first destroyed, it is to be treated according to circumstances. I may, however, remark generally, that all ulcers of the penis, whether of the glans or prepuce, are dispos- ed to take on a lax and phagedenic character more or less, and hence call for stimulating dressings. Lotions will sometimes answer much better than ointments. 339 The vulgar notion, so widely prevalent, that in lues venerea, the whole system is saturated with a virus, which must be either corrected, or eliminated by mercury, has led to its most pro- fuse use in such cases, and the consequence of this preposterous practice is, that a state of things, pro- perly enough denominated the mercurial disease, is brought on, not less horrible than syphilis itself, and infinitely more unmanageable. In my opinion, it may be laid down as a rule, that in a very large majority of cases of what are called the secondary forms of lues, we have alone to encounter the effects of the abuse of mer- cury. Even iu genuine syphilis, in its advanced stages, much less mercury is required than is commonly prescribed. My practice here, is to keep up a slight salivation, excited by the medicine very gra- dually iutroduced into the system, foV two, three, or four weeks, regulating the period exactly as I perceive the patient to be affected. If his condi- tion be improved by it, we should proceed, but where the contrary happens, and he becomes worse, we are to conclude that the course is wrong, and immediately to abandon it. It is now upwards of twelve years, since I openly promul- gated the preceding opinions and modes of prac- tice, and though sanctioned, or at least some of them, by European authority of the highest cha- racter, theyjiave been commonly considered among 340 us heretical and unfounded. But a different fate now awaits them. Even by many of those who for- merly denounced them, most loudly, their truth is at length perceived, aud fully recognized. With this I close what I have to say rela- tive to the application of mercury in the cure of diseases. It would have been easy for me to have expatiated much more fully on this subject. But I have stated its more material uses, and sufficient- ly poiuted out the principles which regulate the general employment of the medicine. As formerly mentioned, there is scarcely one disease in which mercury may not, under certain circumstances, be advantageously exhibited. It was a maxim of a practioner,* once of great distinction in this city, that in all cases where other forms of treatment fail, we should revert to mercury as a dernier alternative. By pur- suing this course he acquired immense celebrity for the number and variety of his extraordinary cures, and did more than any one else, to elevate the medicine to its preseut conspicuous rank in the materia medica of this country. But eminently beneficial as mercury is upon the whole, it sometimes, either by improper use, or from idiosyncracy of constitution, or other causes, is productive of effects, of so serious a nature, as to require the best exertions of our skill. It is not * Dr. Thomas Bond. 841 to be expected, that I am here to deliver any de- tailed account of the mercurial affections. Enough, perhaps, it will be for me to state, that there, is hardly one form or symptom of syphilis, either in its primary or secondary stages, which these will not so closely imitate, as to perplex and confound the judgment even of the most enlightened and ex- perienced. By referring to the writers who have lately treat- ed this subject, and especially, to Mathias, Alley, Crampton, Pearson, Abernethy, and Carmichael, it will be seen that mercurial chancres and buboes are very common occurrences, and also ulcerations of the throat, together with all the complaints seat- ed in the periosteum,tendons, cartilages, ligaments, fascia, &c. Eruptions of a very unpleasant character are also the consequence of mercurial impressions. These of late have attracted attention, and not a little has been written concerning their nature and appearance. By one of the ablest authorities, they are denominated hydrargyria,* from the source of the disease, and as they assume different degrees of malignity, he has, for the sake of perspicuity, divided them accordingly. The cure of all these affections consists, not as is usually practised, in a repetition of the mercury. Every preparation of the sort is, on the contrary, to be proscribed, and * AUpv, and by Pearson, Eczema Mercuriale. 342 we are to substitute a diet generous and nourishing, with whatever else has a tendency to cheer the mind and corroborate the body. To the preceding diseases, I may add, as more ordinary effects, inflammation, ulceration, and some- times even gangrene of the mouth and fauces. The discovery of a remedy, or plan of treatment, calculated to check this inordinate operation of mercury, has long been desiderated. Much has hitherto been confided in active purging, under these circumstances, and particularly with sul- phur. My impression, however, derived from pretty ample experience, is, that it is productive of no advantage, and I am not certain that it does not increase the mischief. Cases, at least, have come under my observation, where the mercu- rial action was completely developed, which had laid dormant in the system, and, by the continu- ance of the purging, was carried to a very great height. Even in minute doses, with a view to its alterative effect, I have never witnessed any bene- fit from sulphur. The only constitutional remedy from which I have derived the least advantage, is the free exhibition of opium. This not only re- lieves the pain and irritation incident to the case, but also restrains the discharge and other symp- toms, by counteracting the mercurial action. Co-operating with this general remedy, we have some local applications which are useful, and of these, by far the most effectual are blisters to the 343 throat. Being, however, themselves painful and unpleasant, they are only adapted to extreme cases. Gargles and washes, of every variety, arc much prescribed, and perhaps may sometimes be used beneficially. They are mostly astringent, such as an infusion of bark, of galls, of sage, or lime water, the solution of borax, the diluted mineral acids, &c. But the neatest of these lotions, is a strong decoction of green tea, sweetened with ho- ney, and the most efficacious, the solution of su- gar of lead. The latter, however, will not answer in genteel practice, as it stains the teeth for some time, of a dark colour. Distrusting the powers of all these remedies, Mr. Pearson has adopted a mode of practice which is somewhat peculiar. It is recommended by him that the patient lay aside the ordinary coverings of the face, and expose himself freely to a cool, though a perfectly dry air, and iu the country if possible. Of the utility and safety of this prac- tice, I entertain no doubt, having often adopted it myself with advantage. Now and then, owing to some unintelligible cause, mercury operates as a poison, producing effects totally different from its ordinary agency as a remedy, and which seem not at all influ- enced by the quantity taken, or the severity of the ptyalism. The mode in which it displays this dele- terious operation is not uniform. But it most gene- rally appears in the shape of what has been denomi- 344 nated by Mr. Pearson, erethismus. As in most in- stances of poison, there is here a very sudden, and sometimes unexpected prostration of strength, at- tended by anxiety about the pracordia, irregular action of the heart, a small quick pulse, occasional vomiting, nervous tremors, a pale contracted coun- tenance, a sense of coldness, &c. In this state, a very slight exertion, such as attempting to walk, or rise from bed, will instantly prove fatal. The treatment of this case, is to intermit the mercury, which, if it could be continued, wrould be useless, to give cordials, such as volatile alkali, a free ven- tilation, and when practicable, an entire change of air. After a time, in such cases, we may again re- cur to the remedy, and with the ordinary advan- tage. 345 DISCOURSE XLIV. The subject continued. To complete the consideration of mercury, it re- mains for me only to say something of its natural and pharmaceutical history. Mercury is a metal which is found imbedded in the earth, in many parts of the world, sometimes procured in perfect purity, and is then called vir- gin mercury. But, most commonly, it is discover- ed in a state of mixture, or combination with extra- neous substances, from which it is separated by chemical processes. It is now universally admit- ted, that mercury in its native or metallic state, has no medicinal powers independently of its pondero- sity, and hence it is no longer employed. To fit it for our purposes, it is variously modified by chemical and pharmaceutical treatment, and, when thus changed, it becomes, confessedly, one of the most active, and, at the same time, extensively use- ful articles in the whole compass of the materia medica. The processes by which these conver- sions are accomplished, may perhaps be reduced to oxidation, in different degrees, and a union with acids, constituting the mercurial salts. By long continued trituration with saecharine, VOL. n. x x 346 mucilaginous, oily, or cretacious substances, the particles of mercury are minutely divided, and be- come slightly oxidised, by having their surfaces repeatedly brought into contact with the atmo- sphere. These preparations are among the most mild and efficacious, and are much less apt to induce the morbid effects of the metal. They are numerous, though, as the whole agree in the leading and material properties, I shall only no- tice such as are in use in the present reformed state of practice. PILULJE HYDRARGYRI. The blue pill is made by triturating quicksilver with the conserve of roses, or any mucilaginous matter, till the globules are entirely extinguished. The formula of the several pharmacopias are not precisely the same, which is to be regretted, as it leads to uncertainty iu our prescriptions. Gene- rally, I direct that the pills shall be so prepared, as each to contain about two grains of the metal, one of which may be given morning and night, or oftener in certain cases. This is undoubtedly among the mildest of all the mercurial combina- tions, and is, by no means, destitute of activity. In equal doses, it will excite salivation nearly as soon, and as effectually as calomel, and is infinite- ly less harsh in its operation. Being not at all disposed to purge, when exhi- 347 bited in small portions, it is in debilitated, or irri- table bowels, peculiarly useful. It is, under such circumstances, greatly to be preferred either to ca- lomel alone, or in combination with opium. There is, indeed, no indication which can be fulfilled by mercury, the purgative effect excepted, to which this preparation is not adequate. The blue pill, is accordingly much prescribed in all cases where salivation is demanded, and more especially in the several states of syphilis. UNGUENTUM HYDRARGYRI. Of this there are two kinds, the weaker and the stronger. The first is made by rubbing together one part of mercury and suet each, and three parts of lard, till the globules entirely disappear. The second is prepared precisely as the first, only it contains au equal proportion of the ingredients. But I have sometimes directed it of double this strength. As the manufacture of the mercurial ointment, agreeably to the preceding formula, is a tedious and operose undertaking, various substances have been added in order to facilitate the process. But most of these are inadmissible, as they affect, in some way, the excellence of the ointment. The spirits of turpentine, which is most generally re- sorted to for this purpose, renders the ointment 348 irritating to the skin, and sulphur, which is also used, is supposed, and perhaps correctly, to di- minish the powers of the mercury. With the same view, rancid oil has been proposed, and per- haps may be adopted without detriment to the oint- ment. But nothing answers so effectually as a small pittance of rhubarb. It very speedily ex- tinguishes the mercurial globules, and I believe does not impair the energies of the ointment. In union with unctuous matter, mercury exists partly in a state of extreme mechanical division, partly oxidated, and partly, as some have recently conjectured, united with sebacic acid. The oxi- dation of the metal, was long doubted, and in- deed, even entirely denied by many. But it is now ascertained that this process takes place, and it seems highly probable, that the efficacy of the ointment is in some degree owing to this circum- stance. It has also been alleged, and with suffi- cient plausibility, that the portion of sebacic acid formed in animal fat, when exposed to the air, may combine with this oxide, and the improvement of the ointment by keeping, a fact long known, is per- haps owing to the gradual formation of this sebate of mercury. Among the advantages of these pre- parations, they afford two modes by which mercury may be introduced into the system. As an enema, or injection, the ointment is sometimes, in great emergencies, employed, one or two drachms of the strongest kind, being intimately blended with a 349 small portion of mucilage, and in this way all the ordinary effects of mercury can be produced. The ointment, however, is much more com- monly applied by friction to the inner side of the thighs. Two or three drachms of it are rubbed in every night and morning, in ordinary cases. But where the immediate and full impression of the remedy is called for, the frictions must be extend- ed more or less over the whole surface, and parti- cularly to the axilla, and other porous portions of the body. The effect may still further be promot- ed by the wearing of socks filled with the oint- ment, or flannel drawers coated with the same, or by wrapping the patient in blankets done in a si- milar manner. Of course, the cases must be of the most alarm- ing nature to justify such treatment, as mercury so profusely applied, might bring on a condition of the system, which, if it did not suddenly terminate life, would at least, render it most deplorably wretched. But such cases do occur, as the last stages of malignant fever, or hydrocephalus, or te- tanus, or hydrophobia, with a variety of others of the same desperate character, which might be enu- merated, where this intrepid practice would be fully warranted. The application of mercury by inunction, fre- quently becomes indispensable iu the practice of me- dicine. Cases are of common occurrence, where, 350 owing to inability to swallow, or to peculiar ir- ritability of the bowels, it is impossible to admi- nister it internally. It does sometimes happen, when neither of these impediments exists, that mercury will produce no impression on the sto- mach. What is the condition of this viscus which prevents its operation, is not distinctly un- derstood. But of the fact there can be little or no doubt, having often had occasion to remark it my- self. Nor is it less certainly known, that under circumstances of this gastric insusceptibility to the medicine, it will frequently produce all its ef- fects when used in the shape of friction. But how the mercury operates when thus applied, is a mat- ter of controversy. Till very recently, it was supposed that the mercurial particles, were taken up by the lym- phatics opening under the skin, and thus con- ducted into the system. But this is utterly denied by all those who disbelieve in cuticular absorption. They maintain, that by the act of friction, a mer- curial exhalation is made to arise which enters by the lungs, or operates on the olfactory nerves. The facts in support of each of these hypotheses are very strong, and go far to demonstrate that this effect may take place in both of these ways. It is unquestionably true, that if frictions be used with the precaution of a glove, or some other protection to the hand, that salivation very rarely happens to the person employed in the application of the oint- 351 ment, while the patient will experience its full ef- fect. This is a fact, which surely it is very diffi- cult to reconcile with any other supposition except cutaneous absorption, or, at least, to an action of some kind on the surface. But on the other side, it is as well authenticated, that effluvia from mercurial frictions, will often produce complete salivation. I have known, in the course of my own practice, two instances, and have heard of several more, in which salivation Was excited in patients placed in the same ward with those employing mercurial inunctions. It is, moreover, by no means a rare event, for persons engaged in the manufacture of the ointment to be- come fully salivated by the exhalation which is disengaged in the process. Even from very moderate trituration of quick- silver, effluvia arises, w hich, taken into the lungs or stomach, or acting on the olfactory nerves, will occasion the amplest mercurial effect. To this purport, there is a fact of the most decided and unequivocal description related in one of the numbers of the Medical and Surgical Journal, of Edinburgh. During the late siege of Cadiz, a British ship of the line, having on board many casks of quicksilver, had upwards of five hundred of her crew profusely salivated in consequence of the casks bursting and discharging the mercury into the hold of the vessel. In this case, it appears, that the slight trituration of the quicksilver against 353 the lining of the ship, from the agitation of the waves, disengaged an exhalation which produced this mischief. But, to revert to the original hypothesis, there seems nothing in the case before us to militate against the new doctrine, which denies to the skin the power of absorption, as a natural and re- gular function. Every one must admit, that, under certain circumstances, such an effect will take place. In one of my early discourses, 1 showed that it might be done in one or two ways, either by forcing the substance under the scales of the epi- dermis, as in the instance of frictions, or by long continued bathing, or topical fomentations, the cu- ticle becoming so changed in its organization, as to admit of transudation, or the insinuation of the fluid under its squamous structure, so as to come in con- tact with the mouths of the lymphatics situated within. But here a questiou arises, how does mercury operate when thus applied. Does it it act by entering the circulation, or by local impression propagated through the medium of sympathy ? On a former occasion, 1 so fully discussed this point, that I am not disposed at present to dwell upon it. My opinions remain unchanged. It is still my most deliberate conviction, that whenever a sub- stance is applied to a susceptible portion of the body, either internally or externally, an action is excited, which is extended to a greater or less de- 353 gree, according to the circumstances which I for- merly indicated. There is, indeed, no other hy- pothesis which has the slightest foundation in fact, or that is at all consistent with the existing state of our knowledge. The ancient notion on this sub- ject, especially, which would refer the operation of medicines to their entrance into the circulation, is perfectly gratuitous, originating at a period of darkness, and when medicine was comparatively in its infancy, and is now abandoned by every one whose intelligence has at all kept pace with the progress of our science. VOL. II. Yy 334 DISCOURSE XLV. The subject continued. Continuing the same subject, I am now to no- tice, the rest of the mercurial preparations which I deem worthy of attention. These are still nume- rous, and some of them highly important, though most of them I have already disposed of under other heads.* sulphuretum hydrargyri rubrum. This is the cinnabar of the shops, made by mix- ing crude mercury with melted sulphur, and after- wards subliming the powder. It is probably a mere sulphuret, though some chemists seem to think otherwise. Besides this, which is denomi- nated factitious, there is a natural cinnabar, dif- fering from it only as regards the degree of pu- rity. Neither of the two preparations is at all pre- scribed at present, as internal remedies, though they are a good deal employed in the form of fu- migations. This is among the most ancient modes * Emetics, Cathartics, Anthelmintics, Escharotics, 355 of affecting the system with mercury. But, owing to some circumstance, it lost its reputation, and was rejected. Of late the practice has been reviv- ed, and is occasionally resorted to in Europe. By Mr. Ahernethy, whom 1 saw « ; ploy it with distinguished success, it is highly commended. He contends that fumigations will affect the sys- tem, when all other means have failed, and in gene- ral very speedily. Like inunctions too they are applicable to many cases, where, from irritability of the bowels, or other causes, mercury cannot be administered internally. A bath has been invented for the more conve- nient and complete application of the mercurial fumes. It consists of little more than encasing the patient's body, so that the vapours-as they ascend, surround it, and are prevented flying off. Thus treated, the eminent surgeon whom 1 have named, declares that, he never knew a case of syphilis which was not radically cured. Yet, it must not be concealed that Mr. Pearson, whose au- thority in every view, is not less respectable, en- tertains .an opinion somewhat different as to the efficacy of the remedy. It is said by him, that though it will arrest very promptly the disease, and hence is useful in violent and malignant cases,' its effects are not permanent. Tt only sus- pends for a time the attack, which inevitably re- turns in an aggravated shape. But this is a matter of such consequence in a practical light, 35(5 that I shall cite his own words. "The conclu- sions," says he, " which 1 deduce from my experi- ments are the following :— "That where checking the progress ofthe disease suddenly is an object of great moment, where the body is covered with venereal ulcers, or where the eruptions are large and numerous, so that there scarcely remains a surface large enough to absorb the ointment, the application of the vapour of mer- cury will be always attended with evident advan- tage. But, in addition to these remarks, I think it right to subjoin, that it is extremely difficult to in- troduce a sufficient quantity of mercury into the animal frame, in this way, so as to secure the pa- tient against the hazard of a relapse. I therefore consider it as a mode of treatment by no means eli- gible in general practice. " The vapour of mercury, when applied to ve- nereal ulcers, to fungi,* and excrescences, is a me- dicament of singular efficacy, and merits the con- fidence of the surgeon. But little or no account should be made of the mercury which is thus re- ceived into the circulation; for we ought never, in these cases, to introduce a smaller quantity of the specific by inunction, for the purpose of securing the constitution, than if no fumigation had been employed." It is not easy to reconcile such opposite state- ments. May it not, however, in some measure he done, by supposing that the deplorable cases of 357 lues, which came under the care of Mr. Pearson, in Lock Hospital, the chief source whence his ex- perience is derived, required for their entire cure, more mercury than can be introduced through this medium? As yet, I have never had occasion to imitate this practice, nor do 1 know that it has been done in this city. Confident am I, however, not less from what I saw myself, than from the character of Mr. Abernethy, that this plan of treat- ment is fully adequate to the extermination of most of the cases of the venereal disease. But, whatever difference of opinion may be en- tertained on this point, there can be none, I think, as to the efficacy of mercurial fumigations in certain ulcers, whether proceeding from vene- real taint, or otherwise. The fauces especially, are prone to take on a state of ulceration, which will continue, in some instances, for a succession of years, pertinaciously resisting the ordinary reme- dies. Two or three such cases I have met with, which very readily submitted to mercurial fumi- gations. The same species of ulceration is still more frequently to be found on the prepuce, or glans penis, or the labia pudendi, or surround the anus, and which is managed with not less success. iiydrargyrus muriatus corrosivus. Corrosive sublimate, or oxymuriate of mercury, is composed of the metal highly oxidated, and com- bined with a large proportion of muriatic acid. 358 This is the most powerful of all the mercurial preparations. The dose cannot safely exceed a fourth of a grain, nor should more than one grain be given in flie twenty-four hours. The usual dose to commence with, is one-sixth or eighth of a grain exhibited in the form of pill, or solution in water or ardent spirits. The first is the more agreeable, though perhaps the latter mode is to be preferred, as the quantity may be precisely ascer- tained. Corrosive sublimate has been employed with va- rious views. Externally, as we have already seen,* a solution of it is much used as a stimulating wash or escharotic in chancre, in sores general- ly of an indolent tendency, and in various cuta- neous diseases. It also forms one of the best gar- gles in venereal sore throat, and when reduced by free dilution, is resorted to as an injection in gleet, and as a collyrium in certain cases of ophthal- mia. But it is as an internal remedy, and par- ticularly in the secondary stages of syphilis, that it displays its most active powers, and has acquir- ed the highest reputation. No small difference of opinion however, is entertained as to the degree of its efficacy in these c.ises. Of those who think con- temptuously of the anfivenereal powers of our me- dicine, Mr. Pearson is by far the most conspicu- ous, aud his ample experience gives him every claim to be heard upon the subject. * Escharotics. 359 After tracing with some minuteness (he progress of medical sentiment with regard to the properties of this preparation, he goes on to observe : "When the sublimate is given to cure the pri- mary symptoms of syphilis, it will sometimes suc- ceed, and more especially when it produces a con- siderable degree of soreness of the gums, and the common specific effects of mercury. But it will often fail of removing even a recent chancre, and where that symptom has vanished under its use, I have known a three months course of the medicine fail of securing the patient from a constitutional af- fection. The result of my observations is, that simple mercury, calomel, or calcined mercury, are preparations more to be confided in for the cure of primary symptoms than corrosive sublimate. The latter will often check the progress of secondary symptoms very conveniently, and I think it is pe- culiarly efficacious in relieving venereal pains, in healing ulcers of the throat, and in promoting the desquamation of eruptions. Yet, even in these cases, it never confers permanent benefit, as new symptoms will appear during the use of it: and on many occasions, it will fail of affording the least advantage to the patient from first to last. 1 do indeed, sometimes employ this preparation in venereal cases. But it is either at the begin- ning of a mercurial course to bring the constitution under the influence of mercury at an early period, or during a course of inunction, with the intention 360 of increasing the action of simple mercury. I sometimes prescribe it also, after the conclusion of a course of frictions, to support the mercurial in- fluence in the habit, in order to guard against the danger of relapse. But, on no occasion whatever, do I think it safe to confide in this preparation singly and uncombined, for the cure of any true venereal symptom."* Opposed to this great practitioner, there are many of the most distinguished names belonging to our professsion. Commencing with Bazil Va- lentine, who seems to have been the first to pre- scribe it, we have a pretty regular chain of autho- rity in support of its efficacy down to the present times. It is true, some conspicuous exceptions might be cited to the contrary.f The practitio- ners of the Continent have always reposed much confidence in this preparation. It is highly extolled by Van Swieten, De Haen, Boerhaave, and by nu- merous writers of a more modern date, of every country. There are not wanting, indeed, some very emi- nent authorities, who insist that in every state of syphilis, recent or advanced, it is by far the most certain, and in every view the preferable prepa- ration of mercury. Not however, superfluously * Pearson on various articles of the Materia Medica in Lues Venerea. ■j- Bloomfield, formerly surgeon in chief to the Lock Hospital. The late Dr. Kuhn told me that Cullen, in his clinical lectures, also main- tained that it is not effectual. 361 to multiply citations on this point, I shall be con- tent with referring to the remarkable record which is given us by Dr. Locher, chief physician to the Venereal Hospital at Vienna. It is stated by him, that from the year 1754 to 1762, he cured not less than four thousand and eighty persons of lues venerea in its different forms, by the corrosive sub- limate alone, and without inducing salivation, or any unpleasant constitutional effects. To arrive at a satisfactory conclusion where the evidence is so contradictory, cannot be easily done. Directed by my own experience in this case, I now always treat syphilis iu its primary form by calomel, or the blue pill, and by inunctions, using corrosive sublimate only in the secondary stages of the disease. Whether this course be right or wrong, I believe it is the one pursued by most ofthe best practitioners, of this country and of Europe. In dismissing this article, I have only further to mention, that it has been applied in a new way to the cure of gonorrhoea, by Mr. Addington, a surgeon of good repute, in London. Three grains of corrosive sublimate, in an ounce of the spirits of wine, are dissolved, of which one half is to be taken on going to bed. The immediate effect is a very profuse salivation, which continues for an hour or little more. But, during even this short period, the patient will spit several pints. The succeeding day a dose of salts is prescribed, and at night, the residue of the mercurial mixture. The VOL. u. z z 36^ next morning salts again, and then the cure is completed. Of this very singular practice, I know nothing myself, and at present can hardly recom- mend it to imitation. But as suggested by Dar- win, might it not prove useful in hydrophobia, tetanus, &c. ?* IIYDRARGYRUS MURIAT1S MITIS. The last of the preparations of mercury which I shall notice, is calomel. It differs chemically from corrosive sublimate, merely iu the metal being less highly oxidated, and in that oxid being combined with a smaller proportion of muriatic acid. This preparation therefore, is a submuriate of mercury. To what I have already said, under various heads, upon this subject, I can add little. Ca- lomel, as is well known, is incomparably the most valuable ofthe mercurial medicines, and is suscept- ible of the widest application in the practice of our profession. I shall just state, that when used as a salivant it is given in doses of one or two grains * Incompatible substances. Alkalis, and alkaline earths, tartrate of potash, and antimony—superacetate of lead—sulphur—sulpburet of potash—and soaps—iron—lead—copper—and bismuth, in their me- tallic state decompose it. The following- vegetable infusions also pro- duce precipitates, viz. The infusions and decoctions of chamomile flowers, horse radish root—columbo root, catechu,—cinchona bark rhubarb—senna—simarouba bark, and oak bark. 363 in pills several times in the day, and if it purges, opium should be combined with it.* It will be perceived from the preceding inquiry, that there are at least four modes by which the system may be put under the mercurial impres- sion, of each of which I have treated, and also of the appropriate preparations for the purpose. But it sometimes happens, owing to peculiarity of con- dition, that there is a total insusceptibility to the action of the medicine, and in spite of all our ef- forts, salivation cannot be induced. It is in highly excited states of the system, that we most common- ly meet with this resistance to the remedy, and especially where much fever prevails. The ac- tions of the two are incompatible, and that of the disease must be subdued before the remedial one can take place, with which view, all the depletory measures are to be called into requisition. Now and then, however, we are equally frus- trated in our attempts to salivate under different circumstances, or in cases, at least, in which there is no uncommon arterial vigouror general excitements. Copious purging, I have found here, almost in- * Incompatible substances. Alkalis and lime water instantly turn i black. It is also decomposed by soaps, sulphurets of potass and anti- mony, and by iron, lead, and copper. 364 variably to succeed in awakening susceptibility to the remedy, so that the desired end is fully attained. Of the modus operandi of mercury in the cure of disease, a question, once of great interest and warmly discussed, I have nothing new to say, and shall therefore dismiss the subject with one or two remarks. The well known explanation of VIr. Hunter, that its efficacy in syphilis depends on its general and permanent stimulant power, by which it induces and keeps up an action that ulti- mately supersedes the morbid one, may be extend- ed, it seems to me, to all other cases. Confessedly there is no article of the materia medica so diffu- sive in its effects, which, pervading the whole sys- tem, enters into every recess, and acting on every part, leaves no morbid impression untouched. It is by virtue of this general and revolutionary ac- tion, that it is calculated to meet such a vast va- riety of indications, to an extent indeed, that it has come to be prescribed, as I formerly mentioned, in all cases, with one or two exceptions, where other modes of treatment have failed. Of all the notions relating to the mode of operation of mercury, that, which alleges its en- trance into the circulation, is surely the most gra- tuitous and absurd. Elsewhere* having stated, somewhat in detail, the leading objections to this theory of the action of remedies, 1 shall here * Disccurse on the Modus Operandi of Mcdicir.es. 365 merely observe, as an additional ground of refuta- tion, that hy the medication of the blood, were it possible, we must, in all instances, do more harm than good. Thus, as the whole mass of the cir- culating fluids is equally charged in this case with the medicinal substance, while a salutary action is going on in the diseased organ, every sound part of the system would be subjected to a similar impres- sion, which could not fail to disturb the order of health, and induce morbid dements. Against all this however, it is said, that mercury has actually been found in the cells of the bones, and Boerhaave is cited for the fact. It is stated by the same high authority, " that he once saw with his own eyes, and hence could not be deceived, in the semen of a ram, the germs of the future ani- mal, following each other exactly like a flock of sheep entering a pen." Without meaning, at all, to impeach the veracity of this truly pious and illustrious man, I cannot forbear to remark, that such statements strongly remind us of the uncertainty of human testimony, where the judgment permits itself to be perverted by the ardour of fancy, or by an ambitious desire to establish preconceived notions. 366 DISCOURSE XLVI. Of Tonics. In the widest acceptation of the term, this class of remedies is extremely extensive, since it in- cludes every means which invigorates the powers of life. But more technically, the term is employ- ed in a narrower sense. By tonics, we usually understand, the medicinal substances which are exhibited to correct debility. What is the mode, in which they act, in restoring tone to the body, has never been very distinctly ascertained. To me however, it is obvious, that it cannot be, either by mechanical or chemical laws, as has sometimes been alleged. Like that of all other articles of the materia medica, their operation must be regulated by prin- ciples incident to vitality alone. They are stimu- lants, differing only from those substances of which I have already treated, by producing greater per- manency of impression. More than once, in the progress of the discus- sion, relative to the modus operandi of medicines, 1 have stated, as an indisputable proposition, that a high degree of excitement, suddenly raised, is uniformly succeeded by a proportionate languor and debility. This is especially evinced in the 367 action of the diffusible stimulants. But, at the same time, I shewed it was equally true, that, if this excitement be slowly created, there will be no correspondent depression, even though the sustain- ing powers be withdrawu. It hence appears, that it is by virtue of this law alone, that tonics pro- duce their effects. In their action, this class of medicines exert a very wide and pervading influence over the sys- tem. Commencing their operation on the stomach, they strengthen the digestive organs, augment the force of the circulation, promote the secretions, or restrain them, when morbidly increased, impart tone to the muscular fibre, brace the nerves, and renovate generally the power and functions of the animal economy. As regards the principle which gives the tonic power, some difference of opinion has been enter- tained, which scarcely now deserves to be noticed. Among other conjectures of this sort, it was sup- posed by Cullen, to be the same quality as that which occasions bitterness. But though it holds to a very considerable extent, there would seem to be no necessary connection in the case. Exceptions at least are numerous, as we see very strikingly in opium and digitalis, which are bitter though not tonic, and conversely, galls, and the whole of the metallic tonics, which are bitter not in the slightest degree. While possessing, in common, the power of 368 overcoming exhaustion, or supporting the strength of the system, there are three sections of this great class of medicines, each of which is marked, to a certain extent, by properties peculiar aud distinct. These, as usually designated, are the bitters, the aromatics, and astringents. But it is the last divi- sion alone which has any very strong claims to our attention. Cullen has defined astringents to be " such sub- stances as applied to the living body produce con- traction, and condensation in the soft solids, and thereby increase their density, and force of cohe- sion." By consulting his reasoning on this subject, it will very clearly appear that he considered astrin- gents as acting on the living, precisely as they do upon the dead body. The operation of this class of articles he does indeed illustrate by the process of tanning or makitig of leather. But surely there is no sort of analogy in the two cases. In tanning, the astringent liquor soaks through every part of the skin, and a chemical action takes place between it and the animal fibre. By this union the hide is rendered more dense and firm, putr'faction is prevented, and we have fabricated what is termed leather. But apply the same as- tringent to the living body, and no such changes take place. As I have repeatedly insisted, so long as vitality endures, every chemical action or com- 369 bination is repelled, by powers and resources pe- culiar to the animated condition. Nevertheless, there would seem to be a class of articles endowed with the property of cor- rugating or contracting the living fibre. This is especially evinced by the sensation which they im- press on the tongue and fauces, and perhaps still more conspicuously by their efficacy in restraining haemorrhages from bleeding wounds. But how7 as- tringents operate has never been very intelligibly explained. By Darwin their effects were ascribed altogether to the power of promoting absorption. Whether they have such a property is exceedingly doubtful, and even conceding it to them, it will not in the slightest degree account for their suppres- sion of hamorrhages. Little is the evidence, after all, which we pos- sess of the existence of any corrugant or astrin- gent article. The weight of the. two facts which I have just mentioned as supporting the hypothesis, is very much done away by the recollection that we have many articles, such as opium, ipecacuanha, the cretaceous preparations, &c. which are produc- tive of nearly similar effects, without exhibiting any sensible qualities of the kind. But whatever may be the principle on which they act, the collection of remedies denominated astringents, are indisputably capable of meeting a variety of indications, and are daily employed in no small circle of diseases. vol. n. 3 A 370 As operating slowly and permanently, they are substituted, very often, for the purer tonics in cases of debility. It is however in checking or suspend- ing evacuations, whether of blood, or other dis- charges, that their powers are most signally dis- played, and their superior utility fully recognized. Of Particular tonics. Besides the articles of the materia medica pro- perly denonrinated tonics, we have a variety of other means conducing to the same end, which are too important to be wholly overlooked. Of these, I shall, in the first place, very briefly treat, rather suggesting some precepts for the regulation of their employment, than indicating, in detail, the cases of disease to which they are applicable. Among the means to which I allude to overcome debility, or to invigorate the system, is a properly regulated diet. Neglected as this commonly is, it is still confessedly of the highest importance in the practice of our profession 1. Let the diet of the patient be always accom- modated to the state of the system. After recove- ries from acute diseases, it should at first, consist of the lightest vegetable matter, and, especially the farinaceous articles, such as rice, tapioca, arrow root and sago. To these may succeed eggs, oys- ters, game, and the white poultry, and finally, where we wish the fullest tonic effect from diet, 371 beef and mutton. But in making the selection, we should be influenced not a little by the palate of the person himself, since the pleasure which is re- ceived in eating is of itself no ordinary Stimulus, and particularly to a very debilitated system. Nor is the influence of national habits to be overlooked. What may be very offensive to an inhabitant of one part of the world, might prove highly grateful and even salutary to another person. 2. Enjoin on the patient, whatever may be the nature of the case, to eat much more frequently than the common meals. The stomach has been pronounced, by a very sagacious observer,* to be, in one respect, like the school boy. It is always doing mischief when not employed. This short aphorism contains a vast deal of medical wisdom. By eating often, while we prevent evil, we sustain the system by a constant impression through the stomach. 3. As a general rule, solid food is to be pre- ferred to fluids It is usually more comfortable to the stomach, and restores strength with greater ra- pidity. This applies particularly to persons of plethoric tendencies, or who are subject to active inflammations. 4. No point is more cardinal and important in diet, than simplicity. This holds equally true both as regards acute and chronic diseases, and * Sir William Temple. 378 there are some cases, .such as the affections of the stomach, in which a restriction to a single article of food is indispensable to the cure. Next to diet, in point of efficacy as a tonic, are the hot and cold baths. Though so different in temperature, they produce effects not very dissimi- lar. Each when judiciously managed, will very rapidly, in many instances, invigorate the body. The hot bath acts directly on the system as a sti- mulant, or tonic, increasing all its actions. But the cold bath operates differently, producing at first, languor and depression, after which however, a strong reaction takes place, and the system is pow- erfully invigorated. This is a sure test of its effi- cacy. 1. The bath is to be used in the morning or at twelve o'clock. The latter hour answers best for invalids. To be efficacious, it should be repeated daily, and without remaining in it beyond a few minutes. Continuing longer, under the influence of cold, it is apt to depress the system below the point of reaction, and to do much harm. 8. It should not be employed, when the body is debilitated, by fatigue, or is in a state of perspira- tion, however slight. Experiments have proved that no danger arises from the application of cold to the body, when heated, or even perspiring, pro- vided the system be not previously exhausted. But if it be, no reaction takes place, and very serious eonsequences ensue. 373 As relates to the warm bath, most of the preced- ing rules are no less applicable. Like that, it should, be used at mid-day, and repeated frequently, to produce any very great ef- fect. But the patient is to continue in it considera- bly longer, and it is always to be taken in a warm room, at least, in winter. After coming out of it, he is to be rubbed thoroughly dry, aud if a high degree of stimulation be desired, frictions ought to be actively applied. To contribute to the same end, certain stimulating articles may be added to the water, as salt, cayene pepper, nitric acid, &c. As a tonic, exercise is undoubtedly among the most decisively useful, and has been divided into two kinds, active and passive. It is proper, in extreme debility, or in the first stage of convales- cence from an acute disease, to begin with the second species. This consists chiefly of frictions, which may be made with the naked hand, or with a "brush, either alone, or with the addition of some stimulating matter. Much more than is com- monly imagined, frictions are an important remedy in the management of disease, as well as the pre- servation of health. Every practitioner is aware of their great utility in some of the sinking states of acute diseases, and especially when made with , irritant substances. Not less so are they, in many of the chronic affections, and particularly such as are directly or indirectly connected w ith the alimentary canal, and in which, 1 include some 374 of the neuroses. It was the practice of Boerhaave, as I find by his " Medical Correspondence,"* to insist much on the efficacy of the remedy in all cases of this description, and experience has taught me that his advice was judicious. Equally as a luxury, and as conducive to health, the use of frictions is interwoven with the habits of most of the oriental nations, and with the same view, has been lately adopted in Europe, and particularly by the individuals of fashionable life, who are desirous of retaining beauty of com- plexion, or ambitious of a general rejuviuescence. The ordinary course pursued in this respect is to rub, at least once a day for half an hour or more, the whole body with fine dry salt, which creates a universal glow, renders the skin smooth and florid, imparts vigor to the muscles, improves appetite and the powers of digestion, and in all its tendencies is highly salutary. Next to this simple mode of promoting the ac- tions of the body are the cradle, and the chamber horse. The latter affords a very pleasant exer- cise and is much resorted to in Europe. Besides these, other contrivances have been devised for this purpose, or as an amusement for persons con- fined to the house, and among which, may be enumerated the shuttle cock, dumb bells, &c. Ofthe external modes of taking exercise, swing- * A work, at present too little consulted. 375 ing, sailing, walking, and riding, constitute the most important. The benefit of all of these, is more or less heightened by the influence of the open air. Each is more particularly suited to certain cases, and exacts some degree of discrimi- nation in making the proper application, though of all of them, equitation is generally preferred. It is appropriate to a very large number of cases, of ac- tual disease, and more than any other means of exercising, removes debility, whether chronic, or recently induced. In prescribing exercise, the following instruc- tions are to be attended to. 1. Commence with what I have called the passive exercises, in extreme debility, follow- ing acute diseases. The excitability here is so excessive, that a more powerful impression is apt to re-excite fever, and to induce a relapse. 2. Be careful of fatigue, and with this view, always direct the patient to discontinue the exercise, while he still feels an inclination to a further indulgence. 3. Never permit exercise to be taken either on a full or empty stomach, and for this reason, it is not safe for the patient, especially if he be much debilitated, to go out before breakfast. 4. Let the mode of exercise be adapted as much as possible to the seats of debility, or disease. 376 DISCOURSE XLVII. Of Medicinal Tonics. Of this class, nature has been lavish in her sup- plies. Two of her kingdoms at least, are exu- berant in articles, possessed of such powers. I shall first treat of the vegetable and next of the mineral tonis, which, on the whole, is perhaps, the most convenient arrangement of these medi- cines. As agreeing in their leading properties, most of the rules suggested as proper in the use of stimu- lants are scarcely less applicable to tonics, and to these I beg leave to refer. I will here only observe, that it is of great importance to adapt with preci- sion the medicine to the particular circumstances of the case, and in paroxysmal diseases more par- ticularly, to continue with some regularly the use of it during the whole twenty-four hours, so that the impression once made, shall sustain no great diminution. CINCHONA OFFICINALIS. In every view the Peruvian bark claims a pri- ority of attention. The tree which furnishes it is a native of Peru, and, of course, could not have been known to Europe till after the discovery of 377 the new world. More, however, than a century subsequently elapsed before the medicinal virtues of the bark were detected, or at least fully ascer- tained.* The history of the introduction of this article into the practice of physic, is not altogether unin- teresting. It is related that the lady of the vice- roy of Peru, whose name was Cinchon, was cur- ed of an obstinate intermitting fever with it, under the direction of one of the natives of the country. The fame of this cure was soon diffused, and the remedy came into general use. To commemorate this incident, Linnaeus, in the spirit of gallantry, conferred the title of Cinchona on the medicine. The knowledge of the properties of bark, was acquired by accident originally. We are told that an Indian being ill of a fever drank freely of a pool of water, strongly impregnated with the bark from some trees having fallen into it, and was thereby relieved. Of the natural history of the cinchona, not much was accurately ascertained till recently. So late indeed, as the time of Linnaus, only two species were known. Twelve other species have since * It was first received in Europe in 1640, and soon after sold by the Jesuits as an important remedy. From this circumstance, it acquired the title o( Jesuit's Bark. It, however, lost its reputation for a time, and was once more renewed by Sir Robert Talbot, who employed it with such success, that Louis 14th of France was induced to purchase the secret of the composition of his powder, called the English powder, at an exorbitant price. 3b 378 been added. But of these, only three species, the pale, the red, and the yellow, are incorporated with the materia medica, the powers of the rest not being sufficiently determined. In the nomencla- ture of the botanists, they are denominated cin- chona lancifolia, cinchona cordifolia, and cinchona oblongifolia. The process of curing the bark is very simple. Being stripped from the trunk and branches of the tree, it is dried by exposure to the sun, and after- wards assorted according to the qualities of the pieces. As it comes to us, there is a very material dif- ference in the appearance of the three kinds of bark. The pale bark, is in the form of small twisted twigs, and is covered with a rough coat of a grey- ish brown colour. If good, its taste is more bitter, astringent, and aromatic than perhaps the red. The red bark, is in large thick pieces, usually flat, though sometimes quilled, it has a rugged brown coat externally, with a smooth one within of a dark red colour. The yellow bark, is in flat pieces, not twisted like the pale, and is smooth externally. Its inner surface is of a light cinnamon colour, approaching to a yellow. In odour, it does not differ from the other species, though it is infinitely more bitter. As a medicine, the comparative efficacy of the different species of bark is not easily determined, 379 owing to the variable state in which they are found in the shops. At its first introduction, the red was represented as much superior to the pale, and prac- titioners seemed to acquiesce in the correctness of the statement. But the very preference which, in consequence, was given to it, led to so general an adulteration of the article, that it lost much of its reputation. When obtained pure, however, there can be little doubt of its superiority. But both of the preceding species have since, to a certain extent, been superseded by the yellow bark. Comparative experiments made some years ago, with the three species on a very large scale, in the clinical wards of one of the London Hospitals, afforded very conclusive evidence of its greater ac- tivity in the treatment of many diseases. These observations have since been confirmed by the ex- perience of many practitioners in different parts of the world. Nevertheless, it is asserted by some respectable authorities, that its intense bitterness renders it very unpalatable, and that also, it is more apt to excite nausea, and to be either rejected by the stomach, or to run off by the bowels. My own experience with the medicine teaches me that these objections are in some degree well founded, and on the whole, when perfectly pure, I consider the red bark as preferable to the other two 6pecies. In its action on the system, bark displays the peculiar powers of a tonic. There are few sensi- ble effects from it, when, it agrees perfectly well 380 with the patient. It is slow, and almost impercep- tible in its operation, producing little or no altera- tion in the state ofthe pulse, or any ofthe functions of the animal ceconomy. The power, therefore, which it possesses as a tonic, is only evinced by the gradual removal of a disease or by the restora- tion of strength. In making the application of bark to the cure of diseases, I shall not, on account of its vast impor- tance, too hastily dismiss the subject. It has al- ready been mentioned, that this medicine was origi- nally employed in intermittent fever, a case in which it has maintained an unrivalled reputation, amidst all the revolutions of opinion, and vicissi- tudes of practice, that have subsequently taken place. Little diversity of sentiment now exists, with re- gard to the rules to be attended to in its adminis- tration, though formerly, nothing was more unset- tled. Among the early notions on the subject, was the very absurd one, that in an intermittent, some time should be allowed to elapse before the bark is exhibited, in order that morbific matter may be thrown off by the paroxysms. This was the ad- vice of Boerhaave, who says " Cum morbus jam aliquo tempore duravit." The commentator on his aphorisms, Van Swieten, unites with him, and we see the same concurrence on the part of Sydenham, and the whole of the distinguished practitioners of that and the preceding &^. 381 Directly the reverse of this course is now uni- versally admitted to be the proper practice, aud the fact is fully established, that the earlier we commence with bark in this disease, the more speedy and complete will be the cure. The only cir- cumstance indeed, which warrants the slightest de- lay iu its use, is the state of the alimentary canal, and perhaps, sometimes of the system generally. Doubts are expressed by some writers, whether there really be a uecessity of preparing the system, in any way, for the exhibition of the bark, and I am acquainted with several practitioners who act on the supposition of its inutility. But this is by- no means the common opinion, or the established practice. It seems now to be pretty well agreed, that though occasionally the bark may at once be used without any evacuations, still as a general principle it is hazardous to undertake the cure of the disease, on this plan. At present, it is usual to evacuate previously the alimentary canal, either by puking or purging, and with this view the eme- tic tartar or calomel is prescribed. Emetics however, in very modern times, and especially in this section of the country, have in a great degree given way to mercurial purges. These undoubtedly will, generally, answer exceedingly well, though cases of an intractable nature do often present themselves, in which an emetic can hardly, if at all, be dispensed with. They operate here, not only as evacuants, but 382 still more by producing impressions on the stomach, which dissever and break down those tribes of wrong or perverted associations, on which intermit- tent, and all other diseases of periodical recurrence seem to depend. Of their efficacy, under such cir- cumstances, my own practice has supplied me with the most abundant and conclusive evidence. But besides the evacuation of the prim© via, ve- nesection is also sometimes demanded. Intermit- tent fever is always more or less inflammatory in the commencement, and which diathesis is some- times kept up with considerable pertinacity. With- out the loss of blood in these cases, the bark would probably be rejected, and consequently of no use, or if retained, could only have the effect of aggra- vating the symptoms which it was intended to re- move. My rule, therefore, is never to resort to it till I have prepared the system by the several eva* cuations, so that, it may receive beneficially the impressions of this invaluable medicine. By pur- suing this course, carefully adapting it to the state of the system, I am persuaded that the bark will display such a certainty of effect, that it would al- most be entitled again to be considered as it former- ly was, a specific iu intermittents. This species of fever is not unfrequently associat- ed with visceral obstruction, and where this exists, the bark has been held inadmissible. " That there may be cases of this kind, says Cullen, to forbid the exhibition of bark, I have not sufficient experience 383 to determine. But, I am well persuaded, that it would be very dangerous to admit of any general rule on this subject. I am convinced, continues he, that it is in the cold stages of fever, that accumu- lations of blood are formed in the liver and spleen: that such accumulations are increased by every re- petition of the cold stage, and consequently by the repetition of paroxysms, and I am therefore clearly of opinion that even considerable obstructions of the viscera, if without inflammation, ought not to prevent the exhibition of the bark in such quantity as may prevent the returns of the paroxysms. The question has several times occurred to me, in the case of persons who, having frequently laboured under intermittents, had tumours and indurations remaining in the hypochondriac, and had, when in that condition, a return of the intermittent fever. In such cases, I have freely employed the bark, and never found it to increase the affection of the liver or spleen : and in other such cases, I have constantly found that the avoiding the bark, and admitting therefore, the repetition of the paroxysms, brought on disorders which often proved fatal." The practice on this point may, in my opinion, be very easily adjusted. In cases of visceral obstruction, where no in- flammatory action existed, I have never hesitated, even for a moment, to employ the bark, so as to put an end to the intermittent fever. But under dif- ferent circumstances, or, in other words, where 1 384 there was pain iu the obstructed viscus, accompa- nied by some activity of pulse, I have uniformly found the bark so far from doing good, to be une- quivocally mischievous. The treatment here, is to resort to venesection, blisters, and sometimes to a slight salivation, which will most commonly cure both complaints. At one time it was much debated, whether the bark should be given immediately preceding the paroxysm. Cullen is decidedly in favour of the practice. Determining, however, from what I have observed myself, I cannot hesitate to pro- nounce him wrong. Exhibited at the moment of the expected attack I have found, that, instead of preventing, it aggravated it, greatly increasing the fever and distressing the stomach. But there are some writers who have gone so far as to contend that no remission should be allowed in its use, and recommend its continuance in every stage of the paroxysm. As yet, I have not been induced to make the experiment, having perceived, that a dose of bark, while the slightest degree of fever existed, never failed to be productive of mischief. In the cure of fevers of this kind the common mode is to give an ounce of bark, in divided doses, of a drachm, or more, in the course of twenty-four hours. But in the West Indian islands, I am told, the practice is to direct an ounce of the bark, to be taken at a dose, early in the morning, and to with- hold the further use of it altogether for that day. 385 There is a gentleman of this city, who T know- adopts this plan, and has experienced from it complete success. Nevertheless, I have my doubts whether it could be generally followed, as few stomachs, I suspect, would bear such a dose. The fact however is interesting, and should not be neglected, as cases may occur in which it might be beneficially applied. But in some persons, such is the irritability of the stomach, that bark in substance cannot be retained even in the most minute dose. This being the case, we resort to the uiedi-ciue either in decoction prepared by itself, or in union with some aromatic, as c'oves, cinnamon, orange peel, or Vir- ginia snake root. The last of these articles I think, is to be preferred, since it renders the mixture quite as pleasant to the taste, is as comfortable to the stomach, and decidedly more efficacious. Com- binations too, of this sort will frequently cure intermittents, when the bark alone has failed, and are particularly adapted to children, and delicate women. Cinchona is hardly less employed, in remittent than intermittent fever, and sometimes with suc- cess. This might have been anticipated, as they appear to be essentially the same disease, arising from similarity of cause, prevailing at the same season, and mutually exchanging character in many instances, in their progress. But at one time, the bark was peremptorily forbid in these cases, under VOL. n. 3 c 386 the supposition that the remission is never suffi- ciently complete. To the celebrated Morton the credit is ascribed of overcoming this prejudice, and for having fully established the utility of bark. Yet whatever may be the propriety of the practice in some of the countries of Europe, it is among us to be received with much caution, and discrimination. Remittent fever in the United States, or at least in those parts with which I am conversant, is generally a bilious disease, more or less inflamma- tory, which in its commencement requires venesec- tion, and throughout all Us subsequent stages is best managed by evacuations of the alimentary canal, and by mild diaphoretics. Cases, however, do undoubt- edly occur, and more especially in those districts of country greatly exposed to marsh exhalations, and where the intermittent is the dominant type, which demand the use of the bark. It generally happens here, that the inflammatory diathesis is less, the remission longer, and more distinct, and the case, in all its features, partakes in a greater de- gree of the mild intermittent character. Yet, even under such circumstances, I have remarked, that bark could only be sparingly used, and when con- joined with the serpentaria it answered better. Iu several forms of continued fever bark is occa- sionally employed. Cullen informs us that " when intermittent fevers have changed into remittents, and these have become continued, or when either this transition has been manifestly perceived, or 387 that, from the place of the patient's habitation, from the season of the year, and from the nature of the prevailing epidemic, there is reason to conclude that a fever has arisen from the same marsh effluvia which produce intermittent or remittent fevers, we may consider it as essentially of the intermittent nature, and treat it accordingly." This adv ice, if applied to the fevers of our country, would prove highly mischievous. The case described, is pre- cisely our continued, bilious, inflammatory au- tumnal fever, which I have already shewn, even in the instances characterized by remission, is rarely susceptible of the use of the bark. I believe that the only continued fever, to which our medicine is well adapted, is typhus. This disease, by which I mean the typhus gravior and mitior, ofthe nosolo- gists, has hitherto been held by most writers to have its origin exclusively in human effluvia or contagion. That this is generally true, and always so, when it breaks out in ships, hospitals, jails, or other crowded places, cannot be denied. But it is equally demonstrable, that it sometimes proceeds from marsh exhalations, and especially in the United Spates. Notwithstanding, its different modes of production, typhus fever seems nearly always in its primary stages to be either congestive or inflammatory, and hence stimulants as well as tonics are precluded. Yet tbere is a point in the progress of these fevers, whicli.is to be learnt by attention to the pulse, and othe/ circumstances, at 38b which the bark may be introduced with advantage. This is neither in the commencement, nor at the close ofthe case. As long as the pulse is excited, the skin hot, the tongue parched, the eye wild, the head affected, our medicine is inadmissible, and not less so when subultus tendinum, low delirium, and other indications of great exhaustion, supervene. The symptoms of the first stage, are most effectu- ally removed by venesection, purging, cold ablu- tions, or mild relaxing diaphoretics: and those of the filial stage, by opium, wine, volatile alkali, and blisters. Between these opposite extremes, there is a point, at which the disease betrays some tendency to give way, or remit, and particularly if it has been occasioned by marsh effluvia, when the bark alone, or what I am sure is better, with the serpen- tatia. and, perhaps, wine, may be employed very beneficially. 389 DISCOURSE XLVIII. The subject continued. No little difference of opinion prevails as to the propriety of bark in some of the phlegmasia, aud rheumatism is one of these cases. As this is a disease, in the acute stages, highly inflamma- tory, I cannot conceive that bark can be used with- out very great harm, though the subject is viewed in a different light by some of the English writers. As the result of an extensive experience with the remedy, we are told by Haygarth " that bark, in the rheumatic affections, is only inferior to mercury in syphilis." After evacuating the alimentary canal, l^ the antimonial preparations, he begins with it in the small doses of twenty, thirty, or forty grains, repeated every two or three hours. Bleeding he altogether condemns, as having a tendency to ren- der the disease chronic, and to protract the cure. To the same effect, we have several concurrent authorities, and among these are the equally cele- brated names of Kothergill and Saunders, though neither they, nor any one else, go to the same ex- tent, as I have mentioned, in praise of it. Condemning, as I do, this practice in the early period of the disease, I am still inclined to suspect, 390 that there are certain cases or states of it, to which the bark is not inapplicable. It is well remarked by Cullen, that in many instances, after copious depletion rheumatism loses the phlogistic diathesis, becomes remittent, and in a considerable degree a periodical disease. The bark, in such cases,, he says, is an important medicine, though it requires some caution, as it will occasionally bring back the exacerbations to such a height, as again to de- mand direct depletion. There is, however, a case of rheumatism, in which the bark appears to be a much less ambigu- ous remedy. Being generated in low and marshy districts, the disease, sometimes puts on distinctly the remittent, or intermittent character, and as in such situations the system is commonly emaciated and reduced, our medicine may at once be resorted to. Examples of this sort have come under my care very often in the Alms House, and the bark has been found indispensable, either as the princi- pal or auxiliary means, in the treatment. In the arthritic affections, our medicine has been too much extolled, to be overlooked, though I confess that my confidence in its powers are slender. It was a favourite remedy with Sy- denham, who urges its, long continuance, and by- Gregory it is also commended. There is a late writer, who denominates it a "divine remedy." The cases, however, have not been very precisely pointed out, to which it is appropriate. But if 391 seems to me to be suited best, aud perhaps only, to the disease when occurring in an iufeebled state of the general system, and of the stomach especially. To this rule there is one exception. Contracted by exposure to the causes of intermittent, gout, is sometimes associated with that disease, or at least, assumes its guise, and can only be managed, under such circumstances, by evacuations of the alimentary canal and by bark, of the truth of which I have the most irrefragable evidence. Of the use of bark in the exanthematous affec- tion, not a great deal need be said. As the consequence of an opinion which was once entertained, that it promotes the suppurative process, it was not a little trusted to in the erup- tive fever of small pox. But the practice is no longer continued, it being now an object, as much as possible, to check fever, and to lessen the eruption. Cases however may occur, where from debility of the vital powers, the pustules never appear, or if they do, imperfectly, and become confluent, in which the bark may be advantageously prescribed. Measles, which almost constantly prevail in some one of our large cities, are a disease always of an inflammatory nature. It is by no means rare to bleed even children, several times in the early stages of an attack, pursuing the whole antiphlo- gistic plan at the same time, to the fullest ex- tent. The bark, of course, under these circum- stances, is inadmissible... But, in some of the sub^ 393 sequent stages of the disease, after the more active symptom^ have been removed, there is occasion- ally, it is said, a lingering obscure fever, more or less of the intermittent or remittent type, to which our medicine has been thought well adapted. No such a case, however, have I seen. To the putrid or typhoid measles, as described by Wat- son, I should suppose the bark much more ap- propriate. As regards erysipelas, the case is much the same. The disease, as it appears among us, is al- most invariably marked by an inflammatory dia- thesis, and is only to be managed by emetics iu the first instance, and afterwards, if it prove intracta- ble, by bleeding, purging, and blistering. But elsewhere, it has certainly assumed a different character. It is a curious fact, that the English and Scotch writers describe erysipelas, in the most ^opposite terms. By the former it is represented as a very feeble state of disease, aud by the latter, as purely inflammatory, and their practice is regu- lated accordingly. The bark is strongly recom- mended by the English authorities, and we are told especially by Fordyce, that a drachm of the powder, given every hour, is the most effectual of all remedies. I have already remarked upon the character of the disease, as it appears in this coun- try. There are, however, some exceptions. Erysipelas is often the effect, or concomitant of the depraved habits of the vicious and the drunken. 393 In my attendance on the Alms House, I have occa- sionally met with instances of this sort, among the victims of intemperance, which abound in that in- stitution, and have learnt that the tonic and stimu- lant remedies are alone calculated to afford relief. Of the use of bark, in scarlatina, I have little to say, not having any experience with it in the dis- ease. It is observed by Cullen, that in the species of scarlatina, properly called anginosa, there are cases exactly the same as cynanche maligna, in which the bark is the chief remedy. But, conti- nues he, " I maintain, that there is a scarlatina anginosa, in which the bark is superfluous, and has been often hurtful." This is undoubtedly true. Each of these affec- tions may be connected, either with a highly ex- cited, or reduced condition of the system, and a judicious practitioner will adapt his remedies ac- cordingly. But in this country the inflammatory form ofthe disease is by far the most predominant, and sometimes demands pretty copious depletion. Dyspepsia is one of the complaints of the ali- mentary canal, in which bark has been much em- ployed. Cases of it are conceivable, in which the medicine might be useful, though in all my trials with it, I confess that I have been disappointed. Dyspepsia, from an obstructed state of the chylo- poietic viscera, certainly would not be, at all, bene- fited by it, and even in the cases dependant on mere debility of the stomach, to which it would seem VOL. II. 3d 394 most appropriate, I hive not found it to do well, rather oppressing than invigorating that viscus, and sometimes ex-citing nausea and much gastric distress. Not less scarcely, has it been commended in dysentery. This disease is very improperly placed among the profluvia. As regards our own country, at least, it is a genuine phlegmasia, consisting of fever, with local inflammatory determinations. Being uniformly of this nature in the beginning, the bark, of course, is inapplicable. But in the advanced state, says a great practical writer, " when some symptoms of putrescency appear, or when the disease has changed in some measure into a diarrhcea, the bark may possibly be resorted to with advantage." My owu observations, how- ever, teach me differently, and I cannot indeed, conceive a case of true, unmixed dysentery, in which our medicine in any stage, or under any circumstances, could be demanded. But the dis- ease occasionally presents itself in the shape of an intermittent, and whenever it does, the bark ac- cording to some becomes indispensable to its cure. To resort to our medicine in this case is no new practice. It was so prescribed by Morion, the co- temporary and rival of Sydenham, who has since been imitated by Cleghorn, and many other practi- tioners. The bark here is directed to be given in the interval oi the febrile paroxysm, and some- 395 times% with opium. To what I have already said of this practice, I beg leave to refer.* The bark is greatly prescribed in hamorrhage, though not always with sufficient discrimination. In the active form of the disease, there can be no doubt of the total inadmissibility of the medi- cine. Of this description are the bleedings of the lungs more particularly. But even here, it has been directed, though mischievously. Cases how- ever of haemorrhages do exist, in which the bark is indisputably serviceable. Not to mention such as are incident to low fevers or scurvy, it is ad- mirably suited to the cases of menorrhagia, pro- duced by extreme laxity of the uterine vessels. Combined with the carbonate of iron, it answers ex- ceedingly well, or what perhaps is still more effi- cacious, it may be infused in lime water, in the proportion of two ounces to the quart, and then digested for a few days. Next in order come to be considered the uer- vous and spasmodic affections. There is hardly one of these cases in which the bark is not habitu- ally employed, though it is in epilepsy that it has acquired the greatest reputation. This extra- ordinary affection proceeds from such a variety of causes, and consequently presents such a diversity of character, that no one system of treatment can be applied to the whole of the cases. On mure * Cathartics- 396 than one occasion, I have insisted on the superior efficacy of the depleting plan, by evacuations of the alimentary canal, and occasional bleedings, to every other which has hitherto been devised. But after the end is accomplished, for which these re- medies are employed, the bark, and other tonics, are indispensably necessary, in some instances, to the confirmation of the cure. Cullen, who expresses no great confidence in the bark in epilepsy, seems to entertain a very high idea of its powers in chorea. Treating of this disease, he says, " there is one convulsive disor- der, in which I have found the bark remarkably useful." He seems indeed to have preferred it to all other remedies. The reports of such a writer, who is so conspicuous for his scepticism as to the virtues of medicines, are entitled to much respect. But let us not on this account too hastily repose con- fidence in its powers. Whatever they may be, there is hardly one case of chorea, in which the use of bark ought not to be preceded by a persevering course of opposite measures. This is a disease, which, in its early stages, emphatically calls for deple- tion. Even active purging will not always suf- fice, and repeated venesection becomes necessary. Like its kindred affections, it is distinguished by obstinate constipation of the bowels, and a ple- thoric state of the head. As a remedy in tetanus, I know nothing of the bark. It was used by the late Dr. Rush in this 397 disease, who has reported favourably of it. But as he prescribed it iu conjunction, with the very libe- ral exhibition of wins, his experiments are not at all satisfactory. Cinchona was, at one time, a very popular remedy in pertussis. This curious affection, though ultimately spasmodic, is often, in the primary stages, of a febrile and inflammatory nature. During this state, mercurial purges, venesection, and the antimonials, are our best means. But, as is observed by Cullen, *** when the complaint is more advanced, and the force of the contagion is probably gone, and the paroxysms are kept up merely by habit, I am pretty certain, that the bark will then put an end to it, provided only that no congestion has been formed or continues in the lungs."* The bark has been very generally and indiscri- minately directed in asthma. This disease is divided with much propriety into several species, which, though agreeing in their leading character- istics, differ very materially as regards their origin and even treatment in some instances. To no one of the cases is our medicine calculated, in the slightest degree, to be serviceable during the pen- dency of an attack. But as a powerful tonic, the bark may no doubt be advantageously made to con- * It has of late become a very fashionable practice in England, to treat whooping cough with a combination of bark and the cajiput oil, with what success however I do not know. 398 stitute a part of the regular course of treatment which is intended to corroborate the system, with a view of preventing the recurrence of the pa- roxysms. To this end it seems to be well fitted, and especially in these cases of the complaint, which are attended by flatulence, acidities, and other in- dications of gastric infirmity. 399 DISCOURSE XLIX. The subject continued. Next, I am to say something of the powers of bark in the cachexiae, and first of its use in pulmo- nary consumption. As a general rule this practice is unquestionably pernicious. But there are certain cases of the disease in which, perhaps, the medicine should not be altogether neglected. CuLlen has very pre- cisely described one of these. I have, he says, "met with cases, in which, with all the symptoms of phthisis, the exacerbations of hectic were marked with more or less of a cold stage, and re- gularly, at stated periods, commonly quotidian, but sometimes tertian. In such cases, I have given the bark, with the effect of suspending the paro- xysms, and at the same time, with the relief of al- most all the other symptoms of the disease. But, continues he, I have never, under such circum- stances, made a complete cure." There is however a second case of phthisis, or at all events of pulmonary affection, in which the bark is a less ambiguous remedy. The case to which I allude, is of extreme debility, accompa- nied by wasting of the flesh, and a small dry 408 cough, in which is thrown up mucus of a sweetish taste, and not foetid, as in genuiue consumption. No hectic fever, or chills, or sweats exist. The patient however lingers in a very uncomfortable condition, and fills all who are immediately inter- ested in his fate, with the utmost solicitude. But at this stage of the disease, I am disposed to believe, that there is no very serious injury of the lungs, these organs partaking only of the general debility of the system. Cases of this de- scription are sometimes relieved by a course of tonics, among which the bark has been found to be not the least advantageous. Deciding from what I have seen myself, I should say, that this form of pulmonary derangement is often to be met with, and it is highly probable, that it is precisely the case which was so successfully managed by Sydenham, by riding and other modes of invigo- ration. It is here too, that mercury and digitalis prove so conspicuously detrimental, by exhausting the strength, and undermining even the very props of vitality. As a part of the practice in scrofula, the bark is deserving of our respect, it being now universally considered as one of the means with which we most effectually combat that disease. The treatment of it naturally divides itself into such as is applicable to two very distinct pe- riods. The first is that, in which, without any sore, or tumefaction, there is sufficient evi- 401 'dence of a strumous disposition. At this time, the bark alone, or iu union with steel, together with a change, of air, exer*fise, sea bathing, and a ge- nerous diet, constitute the best remedies. Nor is our medicine hardly less useful in the second period, when the disease becomes fixed, and has fully disclosed itself. I have already mentioned, I believe, that it is here such signal benefit has been derived in some instances from combinations of bark and mercury. To command the advantages how ever, of this combination, wc must studiodsly avoid urging the mercury too far, as it Ts well ascertain- ed, that a deep impression from it aggravates all the worst symptoms of scrofula. It is given with a view only to its alterative effect, while we endea- vour to sustain the powers of the system, by the tonic operation of the bark. Even in the ultimate stage of this disease, when large ulcerations, or abscesses, with copious dis- charges of an illaudable pus, exist, the bark has not always been appealed to without effect. It is, indeed, under these circumsftj c **s, that its powers have been the most celebrated by many practi- tioners.* f * Combinations of bark and cicuta are here also prescribed, and with advantage. ■j- In the management of rickes, an affection, allied in some mea- sure to certain forms of scrofula, we proceed on prett nearly i.Ju- same plan of cure, and hence have often a recourse to the bark, in various states of combination. VOL. II. 3 v 403 The bark, at one period, bad attained no little reputation even in the cure of cancer. To this point, we have especially, "ihe testimony of De Haen, and Akenside. It is now however, pretty well ascertained, that in common with all other modes of treatment, it fails in this intracta- ble affection, though it is well known, that it is eminently serviceable in all ulcers of a foul and phagedenic character, proceeding from, or connected with a weak and depraved condition of the system. It is here exhibited internally, to sus- tain the general strength, while either as a wash or a poultice it is locally applied. To' some of the forms of dropsy, bark has been thought to be adapted, and I can easily conceive, that it might do good, under circumstances of ex- treme debility, and where the powers of the sto- mach are much disordered or impaired. But there ** is another description of cases, to which it is still better suited. Dropsy, of every species, sometimes appears in the intermittent character, either as ori- ginating in miasmatic districts, or as the effect of long protracted ague and fever, and the bark when properly employed, is one of the most valuable of our remedies. As might be supposed, our medicine has been re«orted to iu scurvy. Whatever may be the cause of this disease, it is undoubtedly one, the essence of which is debility, in which the diges- tive organs largely participate. Either as a pre- 403 venlive, or for the cure, in the early stages of scurvy, the bark, I should presume, ought to yield to some other remedies, or modes of treat- ment, of more approved efficacy. But in the pro- gress of a case, symptoms do frequently arise, which demand the use of this very active tonic. It is accordingly much commended by Lind, whose experience was ample, and we have the no less authority of Milman for the fact, of cures having been made in several instances by the bark alone. In that description of scurvy, which dis- plays itself in the gums, the bark is admitted, on all hands, to be peculiarly serviceable. It may be used as a lotion, or as a dentrifice, alone or mixed with myrrh. In several of the diseases, improperly placed in the class of Locales, the bark is an important part of the treatment, and leucorrhcea is one of these cases. By most writers, the vagina is deemed to be the seat of the discharge, and in consequence of this error, the practice in the case is exceedingly un- successful. It has long been my opinion, that the uterus itself, is the part chiefly affected, and that the discharge is a mere vitiation of the menstrual fluid, owing to the wrong or perverted state of the secretory function. To this conclusion, I was con- ducted, by having remarked, that in genuine fluor albus, menstruation is uniformly suspended, and is never restored while the complaint continues. Dis- sections also shew, that the uterus is in a disordered 404 state, having been commonly found pale, flabby, aud relaxed.* Conforming my practice to this theoretical view, I always attempt the cure of leucorrhcea, by di- recting my remedies to the uterus, through the in- tervention of the general system. The bark is one of the medicines alone, or in combination with steel, which I have employed with most success. Combinations of bark and the balsam copaiva, prepared in the form of an electuary, I have some- times prescribed with no less benefit in this disease, in old gleets, and in a still more afflicting case, the gonorrhoea dormientium. This latter affection, in which there is an involuntary emission of semen during sleep, often proceeds from constitutional de- bility, but is more generally caused by excessive venery, unnaturally indulged. To complete our present enquiry, it remains for me only to say something relative to the use of the bark in sanserene. Of all the medicines which have been recommended in these cases, none cer- tainly has acquired so much reputation. Being a powerful tonic, it probably operates Jiy strengthen- ing the system, and thus maintaining in every part the necessary tone for resisting the progress of the disease. Much injury, however, has unquestiona- bly been done by the too general and indiscriminate application of the bark. • Discharges from the vagina I am sensible take place, nn>l v.hich may be cured by washes. Cut "hese are di-TL*rent from real leuconh-ccx 405 Gangrene may be preceded or not, by active inflammation. In the former species, none of the tonics or stimulants are, proper in the early stages. Copious venesection and purging will much more effectually arrest the teudeney to gangrene, and bark can never be useful, till the inflammatory state subsides, and the patient begins to sink, and particularly, when, with these circum- stances, we are able to perceive the beginning of a separation between the dead and living parts. But gangrene sometimes originates in debility, err is the effect of a low typhoid state of fever, and where this happens, the bark may be early resort- ed to, and perseveringly continued. Every practitioner seems however to admit, that the powers of the bark in these cases, are im- proved by uniting to it some other articles ; such as camphor, volatile alkali, musk, or serpentaria, and that we ought also to bring into co-operation, the more stimulating beverages, among which wine, or strong wine whey, is to be preferred. The very great success, attending the appli- cation of blisters in gangrene, has had the effect in some degree, to throw into disuse the bark. But whatever may be the efficacy of these* appli- cations, and no one has more confidence in them than myself, I am still of opinion that the to- tal rejection of our medicine is improper. The bark may most commonly be dispensed with in gangrene from wounds or other injuries, and as 406 under these circumstances, there is generally fever of the inflammatory species, it might even be mis- chievous. But as I have before stated, this same affection is not unfrequently the concomitant, or the consequence of constitutional debility, and surely here, it becomes an highly important in- dication, to renovate, or sustain by general reme- dies, the powers of the system. Of the use of bark, in the cure of diseases, I have nothing more to say. Before however dis- missing the subject entirely, I will add some re- marks on the several modes of exhibiting this va- luable medicine. It has already been mentioned, that the usual manner of doing it, is iu powder, mixed with some fluid, as milk or coffee, or wine and water, or an infusion of serpentaria, or liquorice. Many persons however cannot take it in substance. It therefore becomes us to extract, by means of some agreeable menstruum, its active principles. These, according to the latest ana- lysis, are bitter extractive, tannin and gallic acid, united with some mucilage and resin, of which the two last are not soluble, in any one vehicle. The three other constituents, on the contrary, in which all its ^activity resides, are very soluble both in water and alcohol. These menstrua are hence much employed. In making the infusion, it is customary to put one ounce of the bark coarsely powdered to a pint of boiling water in a close vessel, and after stand- 407 » ing till it becomes cold, it is decanted for use. The dose is proportioned to the strength ofthe stomach, though even in the largest quantity it is a feeble preparation, and is hence seldom prescribed. The decoction is greatly to be preferred. Different formula are used for this process. The one which I most approve requires that two ounces of coarsely powdered bark be put into a quart bot- tle of water, which after being lightly corked, is to be placed in a pot of water, and boiled for two or more hours. This is a very elegant preparation, and one of considerable efficacy. The dose of the decoction is a wine glassful. The tinctures are prepared either with wine or brandy, but, on a variety of accounts, are now so little prescribed that I shall not notice the urocess". By a tedious pharmaceutical operation the ex- tract of bark is made. It is seldom resorted to, being feeble and precarious. To the dispensato- ries I refer for the formula of both of the preced- ing preparations. To correct some inconveniences' occasionally produced by the bark it is frequently combined with other remedies. When it excites vomiting, or oppresses the stomach, we add an aromatic, as formerly stated: when it purges, opium: when it induces constipation, rhubarb : and where there is much acidity of the stomach, magnesia, or small portions of the mineral or vegetable alkali. Notwithstanding, however, the various means 108 which have been devised, to secure the due administration of the bark, cases are of common occurrence, in which it cannot be given by the mouth. This is owing most generally to the irri- tability of the alimentary canal, by which it either at once is rejected, or runs off so speedily, as to leave no salutary impression. It is usual, under such circumstances, to resort to injections, and these are represented sometimes to answer exceed- ingly well. 1 have never employed the bark in this way, except in some very few instances among chil- dren, it being difficult to persuade adults to ac- quiesce in the repetition of the enema, as often as is necessary to the attainment of the effect of the remedy. I have perhaps done some good with it, though I am not prepared to state, that it is ade- quate to the arrest of intermittent fever, or to the cure of any very obstinate disease. Besides the objection to the practice, which I have just mentioned, there is another arising from the uncertainty of the, retention of the medicine, and this objection alvyays exists, in a greater degree, when it is most demanded, the bowels be- ing cither already irritable, or become so, after a short time, by the frequent introduction of the pipe. The best formula", for such an injection, is to entangle two or three drachms of the powder- ed bark, iu the mucilage of starch, flax seed, or gum arabic in the smallest quantity : so that it may operate as slightly as possible, as an extrane- 409 ous stimulus, and to do away irritability, it is pro- per to add a certain portion of laudanum each time. In the external application of bark, different plans have been proposed. Cataplasms of it, put over the stomach, are said to have proved serviceable, and baths of a warm decoction, either as a pediluvium, or large enough for the immer- sion of the whole person, still more so. As a remedy in intermittent fever, I have irever tried either of these, contrivances. They probably however would be useful, and I have learnt, they- have actually proved to be so, in the hands of some country practitioners. My employment of the remedy has hitherto been confined to the pur- pose of restraining inordinate vomiting in cho- lera morbus, to the violent retchiugs of malignant fever, and to some cases of chronic diarrhoea, as the last stage of what is called the summer complaint in children. To meet this indication, or indica- tions, it is eminently calculated, and will sometimes afford relief in circumstances of apparent despera- tion. This latter practice, 1 believe, originated with me. The bark of the black oak of our coun- try, such as is furnished by the tanners, I have preferred, not ouly on account of its cheapness, but as being more active. In a dry state, bark has also been applied to the surface. It is said by Darwin, that if the powder be strewed pretty abundantly in a bed, in vol. n. 3 v 410 which a patient lies, it will cure ague and fever. To believe this, even on such high authority, re- quires a considerable stretch of credulity. But when applied in a different way, it has cer- tainly produced this effect. The mode in which I mean, is to quilt it in a pad, which is to be worn around the body. Doubts have been ex- pressed whether the bark jacket, as it is called, is of any utility except in the case of very young children. Though best adapted to patients in an early period of life, I am very sensible that I have witnessed advantages from it among grown persons, and especially in very delicate women. Nevertheless, it will totally fail in a great majority of instances, and on all occasions proves a very miserable substitute for the bark ex- hibited internally. The manner in which these external applications act is easily to be explained. Tonic impressions made on the surface are imparted, through re- verse sympathy, to the stomach, which being thus invigorated, is rendered capable of resisting the insurrection of the chain of associated motions, constituting intermittent, the primary link of which chain commences in that viscus. 411 DISCOURSE L. The subject continued. SERPENTARIA VIRGINIANA. As perhaps, most nearly allied to the Peruvian bark, in many of its leading properties, I am next to treat of a native vegetable. The serpentaria is a species of a family of plants, to which the title of Aristolochia is affixed, and Linnaeus, in conse- quence, denominated this article, aristolochia ser- pentaria. But I prefer, on many accounts, the good old name of Virginia snake root, and shall accordingly retain it. The serpentaria is a perennial plant, native of the United States exclusively. The root is the only part used as a medicine. It has an aromatic smell, and a pungent bitterish taste. In its effects, it partakes of the mixed qualities of the stimulant and tonic. It is moreover actively diaphoretic, and sometimes promotes the urinary secretion. Endowed with these valuable properties, it has of course been employed pretty extensively. Be- ing however most commonly united with the bark, I have already in the history of that article applied 412 it to most of the indications, which it is competent to meet. Among the more early uses of the medicine, was in the cure of intermittent fever. Whether alone it is adequate to this purpose, does not clearly ap- pear. It was used by Sydenham, in conjunction with wine to prevent the recurrence of the paro- xysm, and from his account not without advan- tage. As a general rule, he says, that in all cases, where it is expedient to combine wine with bark, the effect will be much increased by adding ser- pentaria. The correctness of this observation has been fully confirmed by subsequent experience, aud it is now very much the practice to unite the two arti- cles in the low states of disease. I have remarked, that it is still doubtful whether the serpentaria by itself will cure ague and fever. Be this as it may, it is certainly a powerful auxi- liary to the bark in these cases. It not only adds to its efficacy, but, what is of great consequence. enables the stomach to retain the medicine. To remittent fever, the serpentaria seems to me to be better adapted. It has here, in mauy cases. an indisputable superiority over the bark, inasmuch, as it is rarely offensive to the stomach, and may be given, without injury, in those obscure states of the disease, where the remission is not readily dis- cernible. There is one preparation, however, of the medicine, which often evinces Mich decided 413 eificacy even in the most intractable cases of inter- mittent, thatl shall mention it.* Why the serpentaria or bark, in this manner pre- pared, should possess any peculiar powers, it is not easy to determine. But the fact is indubitable. I have seen it exemplified as well in my own, as in the practice of other persons. As a popular remedy, more particularly, the snake root is much resorted to in the management of the secondary stages of pleurisy. After bleed- ing, it is the ordinary practice in many parts of our country, to resort to a strong infusion of this article with a view of exciting perspiration, and the re- sult is said to be generally favourable. Catarrhs, rheumatims, and other winter affections, incident to rustic life, arc managed in the same way. It is also a favourite remedy in dropsy, to which, I should presume, it might be adapted, and espe- cially, if the case weir of an intermittent type. In that species of pleurisy which is properly enough designated by the epithet bilious, I have repeatedly had occasion to recur to the serpentaria, and always with more or less utility. I know not indeed any modification of disease, in which it dis- plays its powers more advantageously. The bilious pleurisy has all the characteristics of pneumouie * 1$, Cott. peruv. §ss. rad. serpent. 51. soda carb. gr. xl., ni. div. in pulv. iv. Of which powders one is to be taken four times a day. 414 inflammation, with the addition of some of the symptoms incident to autumnal fever. There are considerable head ach, much gastric distress, aud almost always violent vomitings of bile. It differs also from ordinary pleurisy in having less activity of inflammation, and consequently in not bearing the same extent of depletion. The system indeed will often be very evidently depressed by one or two bleedings. In this case, the practice which has been commonly pursued is, after the removal of comparatively a small portion of blood, and the thorough evacuation of the alimentary canal, to administer very freely draughts of the infusion of serpentaria, in order to excite copious diaphoresis. As an epidemic, the bilious pleurisy prevailed in the neighbourhood of this city many years ago, and I am informed was managed most successfully by the practice which I have detailed. It is not, however, one of the ordinary complaints of the climate of the middle states. The cases which I have seen of it, have, for the most part, oc- curred in persons coming from districts of coun- try exposed to marsh exhalation, and who have had previously a bilious fever. I have only one more remark to make on the properties of this article, and which is, that it is admirably suited to check vomitings, and to tran- quillize the stomach, and more particularly in bilious cases. It is given for this purpose in de- 415 coction, in the small dose of half an ounce or less at a time, and frequently repeated. EUPATORIUM PERFOLIATUM. Of this, I have treated under the head of dia- phoretics, where it is mentioned, that to the power of exciting vomiting, is added other ac- tive properties, as those of a diuretic, and espe- cially a tonic. It is deserving of remark, that its operation depends, not a little, on the mode in which it is exhibited. As a warm beverage either in infusion, or decoction, it will puke, or stimulate the surface, or kidneys. But if given in cold decoc- tion, or what answers still better, in substance, it hardly ever fails to evince its tonic effects. I have had lately put into my hands a very well written tract, in which the properties and medicinal applications of this article are discussed more fully than has hitherto been done.* By the reports of the writer, it appears, that in the Public Institutions of New York, it has been most extensively em- ployed in intermittent, remittent, and yellow fever, in typhus pneumonia and in catarrhal fevers, in several cutaneous affections, in dropsies, and for the removal of mere debility. By properly regu- lating the manner of administering the medicine, it has, according to him, fulfilled successfully. * Anderson on the Eupatorium, -Sec. &c 416 all these diversified indications. After making a due abatement, for the confidence iu which new and favourite remedies are always announced to the public, I entertain little suspicion of the accuracy ofthe accounts to which I have alluded. My own observations, together with communications which I have received from highly respectable sources, would indeed nearly confirm every part of the preceding statement relative to the efficacy of this medicine, and especially in intermittent and remit- tent fever. To these affections, it seems to be particularly- adapted, inasmuch as having the united proper- ties of a diaphoretic and tonic, its use may be con- tinued in the successive stages of the paroxysm, as well as during the apyrexia. EUPATORIUM PILOSUM. This a second species of this numerous family of plauts. It is perhaps better known to many by the provincial title of " wild hore hound." The plant grows in almost every section of our country, and is fully incorporated among the domestic re- medies. By the president of the Medical Society of Georgia it is said, " that it serves as an excel- lent substitute for the Peruvian bark, aud indeed, that among the planters in or near the sea board, it supersedes the bark in the cure of fevers. It i, tonic, diaphoretic, diuretic, and mildly cathartic, 417 and does not oppress the stomach, as the bark is apt to do, hence it may often be exhibited where the cinchona is inadmissible. It is usually given in the form of infusion: One ounce of the dried leaves infused into a quart of water may be taken daily in doses of from two to four ounces every hour or two. It may advantageously be combined with Peruvian bark, and though it may sometimes fail of producing the desired effect, I think that it wrell deserves a station among the articles of the materia medica." In this sentiment I entirely coincide. My own practice has not afforded me many opportunities of using it, but I distinctly recollect that in Virginia, my native state, it was a common, and an effica- cious remedy in the cases which have been men- tioned, and to these 1 might add the catarrhal affections, or obstinate coughs, and also as a bitter tonic in weak and depraved states of the stomach. It was indeed in these latter cases that it appeared to display its best powers. The popular mode of using the horehound is as a tea, and sometimes for coughs, it is made into a syrup or candy. CHIRONIA ANGULARIS. Of the centaury, we have a species which is, in no respect, if at all inferior to the European. It is the chironia angular of Linnaus. The centaury of the shops, is the chironia centaurium. Native VOL. n. 3 G 418 centaury is a very beautiful annual plant, growing abundantly in the middle and southern states, every part of which is medicinal, though the lowers are infinitely more so. It is a very pure bitter, with some little aromatic flavour, and is by no means unpleasant to the taste, or offensive to the stomach. As a remedy, it is resorted to extensively, by every description of practitioners, regular and irre- gular, in our intermittent and remittent fevers. Like some other articles, it has the advantage over the Peruvian bark, of being susceptible of employ- ment in every stage of these diseases. The usual mode of prescribing it, is in strong infusion, of which copious draughts are directed to be repeat- edly taken. CORNUS FLORIDA. By our forests, we are supplied with two spe- cies of cornel or dog wood, each of which is an useful tonic. These are the cornus florida, and cornus cericea. By a graduate of our school,* both of these articles have been very ably investi- gated. . It appears from his experiments, that, on analysis, they present the same results as the Peru- vian bark, and, that their effects on the system are also essentially similar, though rather more stimulanting. * Dr. Walker of Virginia 419 The cornus florida is too familiar to require any description. But the cericea is probably less known by this title. It is the shrub, which is vulgarly called the red dog wood, the red willow, the red rod, aud grows exclusively, in marshy or damp soils. As so closely allied to the Peruvian bark, in their sensible and chemical properties, it is pre- sumable that these two substances might be ap- plied to the same extensive circle of cases, though no such application, has hitherto been made. The cornus florida is much employed as a substitute for the bark in ague and fever, and I suspect its use is nearly limited to this case. Of its efficacy here I entertain not the slightest doubt, though I have no very extensive experience with it. Con- current accounts from many distinguished practi- tioners have fully satisfied me on this subject. The bark of each species of cornel may be ex- hibited in all the forms in which the Peruvian medicine is used, and nearly in the same dose. PRUNUS VIRGINIANA.* This is a native tonic, of very peculiar and valu- able powers. It is the wild cherry tree in the com- mon language of the country. The bark of the trunk, or of the root, which is still more active is the * Cerasus Virginiana, of Michaux. 420 part used. To the taste, it is a mixture of the bitter, the astringent, and the aromatic, resembling not a little the flavour of the peach kernel. On the system, it, at first, produces the effects of a narcotic stimulant, which however are followed by the more permanent impressions of a tonic. Of late years, our medicine has acquired, and I believe deservedly, considerable reputation in a variety of diseases. Among the earliest applica- tions which were made of it, was to the cure of intermittent fever. In this case I have not much knowledge of it, but it is even extravagantly spoken of by some highly respectable practitioners. My experience with it is chiefly confined to the pulmonary affections. In the Alms House I have experimented largely with it, for several years past, and had often reason to be satisfied with the results. It is well suited to the hectic of phthisis, and perhaps equally so, when proceeding from other causes, as it is reputed to have done good in psoas abscess attended with this species of fever, and colliquative sweats. Nor is this all. By a judicious administration of the medicine we shall often find, in the case of consumption, the cough relieved, diarrhcea restrain- ed, profuse perspirations abated, appetite invigor- ated, and the general strength sustained, though still, it is a mere palliative, and will not cure the disease. Much relief has been procured in several in- 421 stances of asthma, which have come under my care, by the long and persevering use of the medi- cine. It has been prescribed by me in both spe- cies of the complaint, the pituitous and spasmodic, without any regard to the distinction between them, and I am not sensible with any material difference. Conformably to my own experience, which however is not sufficiently enlarged or diversified to pro- nounce any very confident opinion, I should say that, upon the whole, I have rendered as much service in this distressing complaint by it as any other remedy. Being a tonic, it is to be given in the intervals of the paroxysms, so that by renovat- ing or supporting the tone of the pulmonary sys- tem, it may ward off the repetition of attacks. Not a little has been said of the powers of our medicine in dyspepsia, and in the chronic stages of dysentery, diarrhcea, and cholera infantum, and though I have never tried it in any of these cases, I am persuaded, that it might be beneficially done, under precisely the same circumstances in which we resort to the Peruvian bark, and other corro- borant substances. The cherry tree bark may be given in substance, or in tincture, decoction, or infusion, and in rather a larger dose, than the same preparations of the Peruvian bark. 422 DISCOURSE LI. „ The subject continued. CUSPARIA FEBRIFUGA. The augustura, as it is usually called, is a late, and I suspect, in some respects, an important acquisition to the materia medica. It is a tree which grows in South America, the botanical history of which was unknown, till that country was visited by baron Humboldt, who ascertained it, and conferred on it the above title, by which it is now universally recognized. As it comes to us, the bark is in small wrinkled pieces, having an un- pleasant smell, and a taste bitter and slightly aro- matic. Augustura was originally introduced as a re- medy for intermittent fevers, and at the same time acquired so much reputation, that it promised even to supplant the Peruvian bark in these affections. But more enlarged experience corrected these san- guine anticipations, and as often happens, medical opinion, with respect to this article, ran into the opposite extreme* Its character was so rapidly depressed, that though only brought into the prac- 423 tice of physic in the year 1778, we, for a consider- able period, heard nothing of its employment. Very recently, however, our attention has been recalled to it, by some of the most respectable of the English practitioners. It is particularly re- commended by Brand and others in the low states of fever, who insist that it is to be preferred to cin- chona, as, while possessing all the virtues of that article, it is not so apt to offend the stomach, or to excite purging. By these same practitioners it is also extolled in chlorosis, in pertussis, in pe- riodical head-ach, in dyspepsia, and in a variety of other gastric and nervous complaints. In the affections of the stomach especially, it is pro- nounced, by Pearson, to be incomparably superior to all the vegetable tonics. My own experience teaches me nothing of its powers in any of the preceding cases. As yet, I have only used it in chronic diarrhcea, and in the last stages of dysen- tery. It has here answered pretty well as an as- tringent, though I am not sensible of having de- rived any very extraordinary advantages from it. Notwithstanding this, I repose no slender confi- dence in it, and would be pleased to see it subject- ed to fairer, and more extensive experiments than I have made. It may be administered in infusion, decoction, tincture, or powder. The last mode is best, and the dose is from a scruple to a drachm, in water or any similar vehicle. 424 COLUMBO. Of the plant which supplies the Colombo, no botanical account has been obtained, on which we can rely. It is however said to be a herbaceous vegetable, and most probably is a species of fra- sera. Being brought from Columbo, a city in the island of Ceylon, it is designated accordingly. The root is only used, which is imported in small pieces, possessing some aromatic odour, and is in- tensely bitter. Like the articles geuerally of the class to which it belongs, the columbo was once tried in intermit- tent and remittent fevers, and though perhaps not altogether ineffectual in these cases, its powers were comparatively so inferior, that it has ceased to be employed. The only case of fever to which, at present, it is thought to be applicable, is that of hectic, and here it is certainly, sometimes, pre- scribed with advantage. It is in the various complaints of the alimentary canal, acute, as well as chronic, that it has con- fessedly displayed its greatest powers. By the writers of the warm climates, and particularly of the East Indies, the columbo is represented as a very valuable remedy in checking the violent bilious vomitings incident to cholera morbus. It has also been celebrated in diarrhcea, dystentery, and cholera morbus. In each of these cases I 425 have much employed it, and often beneficially. To the later stages of dysentery, after pain and inflammation have ceased, the medicine alone is adapted. But I have derived still more advantage from it, in the cholera of children, and exactly under similar circumstances. It will here restore tone to the alimentary canal, and renovate generally the strength of the system. Cullen speaks highly of our medicine, in dys- pepsia, and I am inclined to believe, that his report relative to it has been fully corroborated. I cer- taiuly have, seen it do good. It may, in the gastric affections, be either given alone, or with other sub- stances, as the preparations of steel, &c. But I apprehend nothing is gained by such combinations, serving on the contrary only to destroy or vitiate the purity of the bitter, on which the chief excel- lence of the article depends. Columbo may be exhibited in powder, infusion, or tincture. But the first of these forms is to be preferred. The dose for an adult, is from half a drachm to two drachms to be mixed with water.* * Not long since, a plant which is commonly considered as a species of columbo, but which is more probably a gentian, was discovered in the vicinity of Marietta in the state of Ohio. It appears from the most authentic accounts which we have had of the plant, that it is a large and well proportioned one, of seven or eight feet in height. The plant is triennial. Experiments prove it to be equal, if not superior to the imported. But of this I am not entirely persuaded, as from the specimens which I have seen, the root is of a lighter culotir, and VOL. II. 3 II 426 GEM IT AN A LUTE A. This is one of the purest of the bitter tonics, and is a valuable article, though it was once pro- nounced to be deleterious.* It is a native of se- veral of the countries of Europe, and is found iu no section of the new world. The root is the only medicinal part of the plant. At one time, and especially by the Scotch physi- cians, gentian was supposed to be possessed of considerable febrifuge powers, and was accord- ingly employed in intermitlents, though with what success is not well determined. Cullen seems not altogether to reject it, and Lind speaks decidedly in favour of it. The probability however is, that it does not deserve much attention in these cases. As among the most agreeable of the bitter tonics, its claims are much higher as a remedy in debili- tated states ofthe alimentary canal, as in dyspepsia, and diarrhcea, and particularly in the former case, it being found very often to excite appetite and promote digestion, and hence is a leading ingre- dient in most popular i6 bitters or stomachics," as well as the officinal preparations of this nature. It seemed to have infinitely less of the bitter principle. The properties of plants however are much influenced by soil, position and culture, and when more attended to, perhaps our native medicine may be im- proved. * By Haller. 427 was formerly commended in the calcareous and arthritic affections, and enters largely into the com- position of the famous Portland powder. Com- monly, it is prescribed in tincture or infusion, though it may be given in powder, in the dose of twenty or thirty grains. QUASSIA EXCELSA. This, which is more generally called bitter quassia, is a tree of some size growing in Surinam, and along the coast of South America. Every part of it is intensely bitter, though the wood is preferred as a medicine. To a West Indian negro, called Quassi, who first used the article in fevers, it owes its title. Not a little was said of its powers, at one time, in the several forms of febrile affection, intermittent as well as continued, by some highly respectable practitioners. But in this res- pect it has nearly lost its character, so that it is never employed in any of these cases, except as a tonic in the convalescence, or to check bi'ious vomitings. Nor has it more reputation in gout or calculus, or the neuroses, where it was formerly so much commended. The only cases indeed, iu which any great degree of confidence is reposed in it, are those of debility, and especially of the stomach and bowels, it very often proving useful in both dyspepsia and diarrhcea. Quassia is gene- rally prescribed in infusion. But pills made of 428 the extract are sometimes directed, though less advantageously. QUASSIA SIMAROUBA. The simarouba, which is a species of quassia, is found in St. Domingo chiefly. Like the preceding article, it was once a good deal thought of in the febrile affectious, and intermittents particularly. But it can hardly now be considered among the remedies in these cases, and is only retained as being occasionally useful in diarrhoea, and the ad- vanced stages of dysentery, after thorough evacua- tions. It is the bark ofthe root that is medicinally employed, which may be given in powder, in the dose of twenty or thirty grains, or infusion, the latter answering best. SWIETENIA FEBRIFUGA. This is a species of mahogany, so called after Van Swieuten, and, was greatly extolled in inter- mittents, by Roxburgh, who first brought it into notice. But subsequent experience has by no means realized what he said in its favour, though there can be little doubt that it is well suited to the disease as it appears in the East Indies. Being actively astringent, it may sometimes be substituted for the Peruvian bark, where it purges, and would probably be useful in any of 429 the bowel affections whether connected or not, with that disease. The bark is the medicinal part of the tree, and may be exhibited in the dose of half a drachm in substance, and in the same proportion in tincture, decoction, or infusion. CROTON ELEUTHERIA. Cascarilla is chiefly imported from the West Indies. It grows however, in the southern extre- mity of the United States. As it comes to us, the bark is in small quills of a gray colour, having an aromatic smell, and a warm bitter taste. Cascarilla maintained for a long time, great re- pute in different kinds of fever, and during the early part of the last century, when the use of Peruvian bark was so strongly resisted, by the dis- ciples of Stahl particularly, it nearly supplant- ed that article. It has not however, for many years, been employed in these cases, and though I do not know from my own experience whether it was justly discarded, still I cannot help suspect- ing, that at present its powers are underrated. Endowed with several of the leading properties of the serpentaria, it is reasonable to suppose, that it might do good under similar circumstances. As a remedy in hectic, I cannot doubt of its efficacy, having often witnessed it myself, and the analogy between these two forms of fever is sufficiently close to warrant Us extension to the former case. 430 The dose of this article is half a drachm, and may be given in powder, tincture, &c. HUMULUS LUPULUS. The hop is a .native of England, and has hith- erto chiefly attracted attention as an article of com- merce, from its importance as an ingredient in malt liquors. But it is also possessed of some va- luable medicinal qualities, and deserves a place in the materia medica. The flowers of the plant are alone used, which are odorous and aromatic, bitter and astringent, and decidedly tonic and anodyne in their effects. Of the bitters, there is scarcely one more agree- able to an enfeebled stomach than the hop, and hence it is very advantageously prescribed in dys- pepsia, particularly where it proceeds from intem- perance. But it is, perhaps, as a narcotic that it has the highest claims. The fact of its being pos- sessed of this property was long known, so gene- rally so indeed, that a pillow of it came to be a popular expedient to quiet nervous irritation and procure sleep.* But an exact investigation of its powers was first made about twenty years ago by my friend Dr. De Roche, in his inaugural essay, at Edinburgh, and since that period the arti- * It is said to have been directed by Dr. Willis in the case of the king of Great Britain, and with effect My own trials of it have not however inspired any confidence in its powers. 431 cle has been greatly employed in regular practice, both in Europe and this country. As an anodyne, it may be substituted with ad- vantage for opium, where the latter from idiosyn- crasy or other causes, does not suit the case. It is singularly well adapted to drunkards, and I have found it a useful auxiliary in the treatment of mania a potu. Whenever indeed, the nervous system or the stomach is much deranged, the hop will always prove more or less beneficial. As an antispasmodic it is certainly not without power. It has been prescribed in the neuroses, with what effect I do not know. I have sometimes tried it in the advanced stages of typhoid fevers, where nervous tremors or subsultus tendinum existed, and derived good from it. It is also serviceable in spasmodic uneasiness of the uterus, either before, or subse- quently to delivery. The hop may be exhibited in decoction or in- fusion, in tincture, or pill made of the extract. As a tonic I have found the infusion best, and as an anodyne the tincture. The former may be taken in the dose of a large wine glassful, and the latter in that of a tea spoonful, each to be repeated, and increased, as the case may demand. In treating of lithoutriptics, I noticed the sup- posed powers in this respect of the infusion of hop as well as of malt liquors. Notwithstanding how- ever what has been said in favour of the latter by some writers, they are charged with laying the 432 foundation of gout, and calculus. Yet we have some very strong evidence against sueh an opinion. It is recorded by Cyprian, a lithoto- mist, whose reputation as an expert operator was diffused all over Europe, that of the fourteen hun- dred patients whom he had cut for the stone, there was not one who had used malt liquor as a common drink. It is also stated, by Haller, that of one hundred persons who died under his care, with gravel, no one drank beer. By Sydenham, who was himself a victim of gout and stone, evidence of a similar import is furnished. "To prevent bloody urine, says he, whenever I am obliged to go very far in my coach on the stones, I always drink a large draught of small beer before I set out, and another on the way, if I am abroad a considerable time. By which means I secure myself pretty well from bloody urine. A draught of small beer serves me instead of supper, and I drink another draught after 1 am in bed, and about to compose myself to sleep, in order to cool the hot and acrid humours lodged in the kidneys, which breed the stone." Nevertheless, the predominant opinion among physicians at the present time seems to be, that malt liquors are prejudicial in the respect to which I have alluded, and as it is founded on very en- larged experience, it is, perhaps, safest as a guide in practice to consider it correct. 433 DISCOURSE LII. Mineral Tonics. In commencing the history ofthe mineral tonics^ I shall bring into view, in the first place, some of the preparations of iron. As medicines, they are entitled to this precedence, on account of their superior utility, and extensive employment. As a remedy, iron was very early introduced into the practice of physic. It seems indeed to have been known even to the primitive cultivators of our science, and has always been regarded as one of the few metallic substances friendly to the animal system. This opinion has perhaps proceeded uot less from the comparative mildness of the effects of iron, than from its constituting, as was supposed, one of the elements of the blood, and of certain parts of the solids. It has also, on this account, been very generally classed among the medicines presumed to operate, by entering the circula- tion. Even conceding the fact of its passing un- changed the digestive and assimilative processes, it would afford no sort of support to this ancient hypothesis. Being an ingredient in the animal composition, it is reasonable to suppose, that it would, of course, be admitted into the blood yes- vol. ir. 3 f 434 ■jels to a certain extent. But probable as this appears, the contrary has nevertheless been shewn. Experiments exceedingly numerous and well contrived, which were originally made by Dr. Edward Wright, and subsequently repeated by Dr. Hodge of this university, under every circum- stance of care and attention, demonstrate, most conclusively, that none of the preparations of this metal, can be detected even in the chyle. But it is contended, that under the use of chaly- beates, the blood uniformly becomes more florid, and as this quality is thought to depend in part on the iron it holds, it is deemed pretty strong presumptive evidence of the metal being absorbed. No doubt such an effect is produced, and so it is in an equal degree, by any medicines, or course of life, which invigorates the system, and infuses the glow of health. The blood of every animal which has been examined, is found to possess iron, however various their food, or habitudes, and as in many instances the metal could not possibly have been taken in, it is obvious, that it must be generated by the processes of the animal economy, in the same manner as many other things are elaborated.* Iu its operation on the system, iron evinces all * Amidst the contradiction and uncertainty which exist on this point, it would seem to be the best established opinion, at present, that irou in no one shape can be detected in the blood. By the calcination how- ever of this fluid, it is then developed, though in what precise state 435 the effects of a powerful and permanent tome, no medicine perhaps leaving behind it such lasting impressions. The indications, therefore, that it is calculated to fulfil, are numerous and important, most of which, however, are embraced within the sphere of chronic debility. In discoursing on other substances, with which it is customary to com- bine these preparations, I have anticipated, in a great measure, the application of the latter to the cure of diseases. This is more particularly so, as regards some of the cases of the class of neu- roses, as hysteria, hypocondriasis, and its conco- mitant affections, as well as chlorosis, amenorrhcea, dyspepsia, &c. Diseases, however of a very different nature, are advantageously treated by iron. Thus, in hsemorr- hagy, it has been celebrated front the earliest periods of antiquity, and under the idea of its being actively astringent. But there is no evi- dence of its having this property in any great degree, nor is the assumption of it necessary to the explanation of the good effects which it occasion- ally displays in these affections. To menorrhagia, attended with extreme laxity of the uterine vessels, and general debility it is perhaps best suited. I have here now and then still remains doubtful. Experiments made by feeding animals oft ve. getables containing not a particle of iron, the blood of which, however, on calcination, displayed the usual portion of the metal, fully warrant the above hypothesis of the article being created, 436 employed it, and not without advantage. It may appear somewhat surprizing, that the same remedy- should be applicable to two such opposite cases, as the suppression, and inordinate flow ofthe menses. But the apparent paradox is readily reconciled, as each of these complaints has its origin in causes which are equally to be removed by the tonic power of the article. Much has been said of the efficacy of our medi- cine in the cachectic diseases. Combined with bark, I have already intimated, that, iu scrofula, ricketts, dropsy, and even in pulmonary con- sumption, it may be so managed, as to be ser- viceable. Nor, perhaps, was it unknown, that, in all obstinate ulcers of a feeble or phagedenic cha- racter, from whatever cause proceeding, much ad- vantage might be derived from the chalybeate articles. Of late, however, the practice has been applied with greater precision to the cure of cancer by some of the English surgeons, and especially Mr. Carmichael, who recommends the medicine to be continued for a great length of time, in large and increasing doses, while the ulcer is sprinkled with the powder of the carbonate, or some of the saline preparations, or washed with the muriated tincture. Of the success of this treatment I know nothing from personal experience, it never having been tried by myself, nor so far as 1 have heard, by any other physician of this city to any extent. But it 437 comes to us from sources sufficiently respectable to entitle it to some degree of confidence, and even if it fails to cure cancer, it may palliate symptoms, and at all events, do good in ulcers of a less formid- able and inveterate character. It was, at one period, a practice to employ the chalybeate preparations in the advanced stages of diarrhoea, and even dysentery, though, till lately, they seem to have been altogether superceded by other medicines. Whether they really possess any extraordinary powers in these cases, I cannot pretend to deter- mine. It is now quite fashionable to prescribe the sulphate of iron, variously combined, under the circumstances which 1 have stated, and, perhaps, still more in the cholera infantum of our great cities.* This medicine of course, is only suited to the more advanced period of the disease, after tormena, tenesmus, and other symptoms of irritation have sub- sided. It is also proper that the bowels should be previously well evacuated. Though my own ex- perience will not enable me to say a great deal in ■ * 1. R, Sal. mart. $\. acid, sulph. ijss. aq. font. gx. M. The dose for a child from 3 to 10 drops, and for an adult from 20 to 30 drops three or four times a day, 2. Sal. mart. pt. ii. acid, sulph. gtt. x. sacch. alb. 3'. aq. font, f • M. The d isc is a tea spoonful, for a child, to be repeated as above directed, and for an adult in the same pro- portion. 438 favour of this combination, it has been so highly extolled, that I cau hardly doubt its claims to our attention. It has been an opinion, that iron, in a pure, metallic state, has no active operation on the system. But this does not appear to be well founded. The metal is easily soluble in the gas- tric liquor, as was long since proved, and when re- duced to powder, as in the state of filings, is em- ployed with advantage. By chemical and other processes, iron is con- verted into a variety of forms, which constitute a set of very important remedies. At different pe- riods, the whole of these have been used, more or less, accordingly as they were estimated. But in the present reformed state of our science, so con- siderable a retrenchment has taken place, that not many are retained in practice. Believing, indeed, that the properties ofthe whole class are embraced by a few preparations, which are recommended, not less, from their efficacy, than superior neatness and conveniency of administration, I shall exclude all the rest. RUBIGO FERRl. The carbonate, or rust of iron, is one of these preparations. It is more active than the pure me- tal, and less irritating, and, perhaps, uncertain iu its operation than the chalybeate salts. Commonly 439 it is given in powder, in the dose of from five, to twenty grains, mixed with syiup, or mucilage. In cases of debilitated stomach, some aromatic may advantageously be united to it, such as the powder of ginger. It is also exhibited in the shape of pills, and sometimes as a chalybeate wine. As a stomaehic, and agreeable tonic, the last form answers extremely well. My mode of preparing it is as follows.* SAL MARTIS. The green vitriol or sulphate of iron is a second preparation of great value. Its tonic power is considerable, and hence is calculated to meet a variety of indications. But I do not know that, in any respect, it is to be preferred to the carbonate, except, that the dose being smaller, it can be exhi- bited more conveniently, and is, on this account, better suited to some cases. It is always given in pills, in the dose of from two to five grains, either alone, or in conjunction with bark, assafoetida, or such articles. * IJ,. Rub. ferr. $iss. cort. aurant. rad. gent, aa |ss. vin. lusitan. ft ii. M. The vessel containing these ingredients is to be exposed to the sun, or near the Are, for three days, and to be repeatedly shaken during this time. This is a very superior preparation to the chalybeate wine, made agreeably to the direction of the dispensatories. 440 The phosphate of iron has lately been incorporated with the materia medica. It is active, and, in most of its properties, resembles the preceding prepara- tion. To similar purposes it is therefore adapted, and is prescribed in nearly the same dose. TINCTURA FERRI MURIATIS. Ill point of activity, the muriate of iron exceeds most of its kindred preparations. It is now always employed as a tincture, and in the dose of from fifteen to thirty or forty drops. But in cases of great irritability of the stomach, not so much as even the smallest quantity mentioned, can be taken without exciting nausea or vomiting, and hence it is by no means a favourite medicine with practitioners. It is, however, sometimes prescribed in dyspepsia, and is beneficially used in certain eases of suppression of urine, from spasm. CUPRUM. Of the metallic tonics, copper next presents itself. This is not, like other metals, insipid and inodorous. It has, on the contrary, an unpleasant styptic taste, and when rubbed, emits a perceptible smell. Notwithstanding these sensible qualities, it has been held to be altogether inert, in its me- tallic state, except as a mechanical irritant. But it is obviously not so. as when a piece of it is swal- 441 lowed, it is acted upon by the gastric liquor, and a train of effects is produced, more or less violent, among which not the least conspicuous, is some- times a pretty copious salivation.* As a medicine, however, it is never employed in this state. To convert it to our uses, it is subjected to certain chemical processes, by which several preparations are formed. VITRIOLUM CffiRULEUM. Of the blue vitriol or sulphate of copper, I have already in part treated, under the head of emetics. But it is applicable to some other purposes, which I am now to notice, and of these, perhaps the most important is to the cure of intermittents. It has been used in these cases more particularly by Dr. James Adair, and Dr Donald Monro, the latter of whom adopted the annexed formula, f By this practice it appears, that he cured some intractable cases of the disease. On his au- thority, I have of late very much prescribed this medicine in protracted intermittents, and with such signal advantage that I am disposed to rate it very * The late professor Barton was accustomed to relate the case of a child, who, having swallowed a cent, continued for some time, to dis- charge daily several pints of saliva. t & Vitiiolum caeruleum gr. iv. extr. cort. peruv. gr. xxxii syrup q. s. m. div. in pill. xvi. One of these pills he gavtj four times a day, and continued them for two weeks VOL. U. 3 K 442 highly. To quartan agues it is especially adapted, so much so indeed, that I know not a remedy en- titled to greater confidence. My mode of pre- scribing it is to commence with a fourth of a grain at a dose, united to a small portion of opium, to be repeated three or four times a day, gradually in- creasing the quantity. From its great power in this case, I am inclined to suspect, that it is deserving of more attention than it has hitherto received in the diseases of a periodical recurrence. It would, at least, be well to try it fairly in epilepsy. As an injection in gleet, a solution of blue vitriol answers better than any which I have used. It may be made in the proportion of two grains to the ounce of water. Of double this strength, it proves an incomparable wash in chancre, and still stronger, it is of all applications the most effectual, in the sloughing ulcers of the penis, whether venereal or otherwise. I have sometimes found it necessary in these cases, almost to saturate the solution, and with which the sore should be touched several times a day. This latter practice I learnt from my friend Dr. Washington of the navy, and have found it exceedingly successful. CUPRUM AMMONIACUM. By Cullen, and most other writers, this prepara- tion is greatly preferred. It is milder in its opera- 443 tion, without being it is said at all inferior in point of efficacy. The cases to which it has hitherto been considered chiefly applicable, are some of the class of neuroses, as hysteria, chorea and epilepsy. In the latter disease especially, it has no doubt very ofteu done good. Cullen declares, that in many instances, it has cured epilepsy, though in others it does not succeed. By an Italian writer,* it is stated that he hardly ever failed of effecting cures of epilepsy with it, provided the disease was of the idiopathic species, and the system of the patient a good deal exhausted. The latter part of this statement contains an im- portant practical observation. The cuprum ammo- niacum is a powerful stimulant, and hence requires, in order to the attainment of its beneficial effects, the reduction of action by previous depletion. This is a rule indeed, which I have endeavoured to enforce with respect to the employment of all the tonic and stimulant medicines in the nervous affec- tions. Our practice in these cases has always been destitute of principle, and on this account is distinguished by contrariety of opinion relative to the powers of our remedies, and by an opprobrious deficiency of success. It has been my lot to witness the very extensive employment of this preparation of copper in epi- * Dr. Ballo of Genoa. 444 lepsy. I have experimented with it myself, and seen it still more tried in public and private prac- tice, in Europe, and in this country. The result of this large and diversified experience isr that, though in some instances, and particularly in children, it will protract to a more distant interval the recurrence of the paroxysms, it nevertheless has not, within my knowledge, accomplished one single cure. But let me not at the same time discour- age its use. The medicine comes to us too strongly recommended to be hastily abandoned, and at all events, it is one of the means by which the disease may be mitigated or suspended. In the exhibition of this preparation, it is pru- dent to commence with doses not exceeding a grain, though they may soon be considerably augmented. It is advised by Cullen to intermit the medicine after a month, lest the introduction of a large quan- tity of it into the system might, like lead, induce deleterious consequences. But I suspect there is no cause of solicitude on this subject. By myself, it has been continued for several months together, without the slightest mischief. The Italian writer, to whom I have alluded, gave in one case sixteen drachms in the whole, and Dr. Russel, in another, nine grains three times a day for a considerable period, and so far from doing harm, completely cured their patients. The preparations of copper have also been pre- scribed in some of the cachexise. This practice I 445 am inclined to believe originated with Boerhaave, who reposed much confidence in its powers in dropsy. But there are not many traces of its hav- ing been imitated since his time. Copper, however, is a diuretic, and perhaps might be advantageously introduced into the treatment of that disease. 44b' DISCOURSE LIII. The subject continued. ZINCUM. In its metallic state, zinc exerts no very sensible action on the system. By combinations however several active preparations are produced, the first of which, is the oxid, or FLORE'S ZINC I. The flowers of zinc have not been a little cele- brated in the nervous and spasmodic affections. This preparation is used very generally in this city, and I have the most authentic evidence of its having done good in epilepsy, and the analogous affections, especially chorea. Commonly, however, it is prescribed in too small a dose to be productive of the greatest advantage. It has, at least in my hands, been of little use, till the quantity was in- creased to fifteen or twenty grains, several times in the day. I have more than once given a drachm of it in the twenty-four hours. The only disagree- able effect from such a quantity is nausea, which. however, is not of a distressing nature. We 447 may safely commence with a dose of four or five grains.* VITRIOLUM ALBUM. This preparation is highly estimated, and libe- rally prescribed by many practitioners, in all the cases, which I have just enumerated. It would not be difficult to collect from the records of our public institutions, and the histories of private practice as well as from other sources, much con- clusive evidence of its efficacy. 1 have myself, in chorea and epilepsy, resorted to it with advantage, though still I think it inferior to theoxid. In treating of emetics, I remarked, that our medicine had been thought useful in whooping cough. It is not, however, by exciting vomiting, that it operates only, though, in this way, it is be- neficial. It is also exhibited in small doses, with a view to its tonic and antispasmodic properties. This was the favourite practice of Dr. Saunders, who considered it as incomparably the most suc- cessful plan of managing the disease. It was also commended by the late Dr. Kuhn of this city. That in some of the forms of asthma, the pre- * Exactfy this course I find to be recommended in a late English work of great merit, Bedingfield's Medical Practice. As regards my- self, it is however known to be original, having publicly taught and employed the practice long before the appearance of this work. 443 paratious of zinc might be of service, it is reason- able to presume. But I have here no satisfactory experience with it, and I do not know that it has been tried by any one except myself. As an injection iu gonorrhoea, and gleet, and as a collyrium, its utility is sufficiently known. Em- ployed as an injection in recent gonorrhoea, it may be either alone, or united with the sacch. saturni in equal portions.* In gleet, however, the solution may be nearly double as strong, or what 1 think answers still bet- ter, is to add a small portion of corrosive subli- mate, f As a collyrium, there should not be more than one grain of zinc to the ounce of water, or, if it can be had, rose water.;t * & Vitriol, alb. gr. x. gum. arab. 5'ii. tinct.rtheb.Ji. aq. font. fviii. t 5, Vitriol, alb. gr. x. corros. sub. gr. ii. aq. font. §viii. i- Of the acetate of zinc, I have not much to say. It has only been employed within a few years. As an emetic, it is said to operate ac- tively and very promptly, in the dose of five or six grains, and seems to be adapted to all the purposes for which the sulphate is proposed. By some of the English practitioners it has been highly extolled, as an injection in gonorrhoea, being preferable to the sulphate, as exciting less pain and irritation. Having abandoned altogether the treatment of this complaint by injections, I have no experience with this remedy. But it is used by some of ray medical friends, who corroborate all that has been reported of its efficacy. It is to be employed in the same quantity, and in like manner, as the white vitriol. The fact, indeed, is that in 149 BISMUTHUM. The only preparation of this metal which has been introduced into practice is the oxid, or as some of the chemists believe it to be, the sub- nitrate. To Dr. Odier of Geneva, we are indebted for this acquisition to the materia medica. It ap- pears, that so early as the year 1786, he published a paper on the subject, in which the attention of physicians was solicited to the powers of the me- dicine, in several of the affections of the stomach. But prejudices arising against this mineral, which have since been proved to be wholly unfounded, prevented it gaining ground, as a remedy, on the continent of Europe. The first notice of its being employed in Britain, is in the Medical and Physi- cal Journal, for July 1799. It is mentioned by the editors of that work as a medicine either neglected or forgotten,((though, say they, it is stated to be a powerful remedy in spasmodic pain of the stomach and bowels, particularly if it arise from organic debility, or a relaxed and emaciated constitution." But to Dr. Marcet, a very distinguished practi- tioner in London, the credit is certainly due of reviving this medicine, and perhaps of establishing the common formula, where the white vitriol and sugar of lead are united, we have, from the chemical action which takes place, an ace- tate of zinc. VOL. II. ^ L 450 its reputation. In a paper which he has published relative to its use, he says, " 1 have had frequent opportunities in Guy's Hospital of trying the oxid of bismuth, in spasmodic affections of the stomach, and those trials have fully confirmed the opinion, which I formerly gave of its great utility." Con- fidence in the medicine being thus inspired, it crept soon into general use, ami the most ample evidence was collected in confirmation of the pre- ceding statement of its efficacy. Nor perhaps has less been done with it in the United States. It has been very extensively employed, by the most emi- nent physicians of New-York, who concur in re- porting very favourably of its powers, in all the affections connected with dyspepsia, as gastrodynia, cardialgia, pyrosis, and in the depraved state of the stomach which is incident to pregnancy. In Boston, it is also a remedy, in which much confidence seems to be placed. The editors of the New-England Medical Journal, who are highly respectable, thus express their opinion of its utility. " The action of this substance on the stomach is that of a mild and effectual tonic, and from our own experience of its virtues, we do not hesitate to affirm with Odier, Marcet, Bardsley, and Moore, that in pyrosis, cardialgia, and more particularly gastrodynia, it operates more speedily, and with more certainty, than any other article of the materia medica." As yet, I do not understand that bismuth has 451 been much employed in this city. I have tried it in several of the gastric affections, to which it is considered most applicable, and I confess that ray expectations have been disappointed. But my confidence has not, on this account, altogether ceased in the remedy. No cases are more difficult to cure than those to which I have alluded, and none in which the powers of medicine are so often baffled and counteracted, by the neglect of the re- gulations as to diet, and other circumstances, the strict observance of which, is indispensable to success. Bismuth is a safe and active medicine, and therefore has strong claims to our attention, inde- pendently of the weight of evidence which has already been collected in its favour. It is usual to exhibit it in the dose of five or six grains twice or thrice a day, mixed in any convenient vehicle, such as sugar, or gum arabic, or, it may be made into the pills, which is perhaps the preferable mode.* i ARGENTUM. This metal is distinguished among other circum- stances by an insusceptibility to oxidation. But the acids which readily yield oxygen, act upon it, * Bismuth, I have learnt, has been much used of late in the treat- ment of intermittents, and with success. 452 and speedily dissolve it, particularly the nitric acid, which is commonly employed. The solution when evaporated affords the nitrate of silver, which being again dissolved and cast in moulds, forms lunar caustic. Nitrate of silver is the only preparation of the metal which is employed internally. It ap- pears, that even in very early times it was exhi- bited, and that the harshness of its operation led to its disuse. To Dr. Simms of London, we owe its re-introduction into the materia medica, who, some years ago, was induced to apply it to the treatment of epilepsy, and, as he informs us, with great advantage, having cured several cases by it. Not long afterwards, he was followed by Drs. Cappe, Bostoch, Wilson, M'Ginnis, and some other practitioners, who also boasted of their suc- cess in the same disease. In this city, it has been sufficiently tried, both in private and public practice, as well by other phy- sicians as myself, and I am inclined to believe, that our decision would not be very strongly in its favour. If it be admitted to palliate symptoms, or to protract the return of the paroxysms, I suspect that this is the extent of what could be said of its effects. In the kindred affection of chorea, our medi- cine is also alleged to have been productive of ser-, vice, and I have reason to credit the fact. It is particularly extolled by Dr. Powell of London, 453 a practitioner of deservedly high reputation, in the treatment of that terrible disease, angina pec- toris, the nitrate of silver has lately been used, and a case of a complete cure by it, is reported, on the authority of Dr. Cappe, of one of the provincial towns of England. Upon the whole, I think this article merits some attention, though the evidence of its efficacy is still very dubious and unsatisfactory. It is given in the dose of half a grain at first, and gradually increased so as to amount to ten or twelve grains a day, it being previously dissolved in water, and then worked up into pills, with the crumb of soft bread.* AURUM. As long ago as the time of the alchymists, this metal was supposed to be possessed of medicinal properties, and was actually employed, though soon afterwards it came to be expunged from the * Perhaps we do injustice to this medicine by giving it in too small doses. By Dr. Powell, to whom I have just alluded, who is said to em- ploy it with signal advantage in most ofthe nervous affections, from two to five grains are given every six hours. In one case of epilepsy,! gradually augmented the dose to eighteen grains in the twenty-four hours without producing any troublesome effect. Even, however, in this large quantity, it did not cure the disease. Of late, however, the periodical journals of England, contain some cases where the skin assumed a permanent livid hue, by the continued use of this article in large doses, which, perhaps, ought to create some degree of caution with regard to its employment. 454 materia medica, as being either hurtful to the system, or inefficacious. It is again, however, brought forward, as a powerful remedy, in the management of several diseases. In a publica- tion by Dr. Chritien of Moutpelier, which appear- ed some years ago, its powers are extolled with all the extravagance of enthusiasm. It appears ac- cording to him, that gold may be employed in the state: 1. Of minute division. 2. Of rxide. 3. Of oxide in combination with ammonia. 4. Of oxide in combination with the oxide of tin. 5. Of muriate. Numerous detailed cases are reported of the effects of each of these preparations, though they differ very much in activity, the oxides producing more speedy effects than the powdered gold, and the muriate a more powerful action than the oxides. They were all administered by friction on the tongue, cheeks, or gums. The first was prescribed to the extent of three grains a day: The second in the dose of half a grain, gradually increased to one or two grains: The third and fourth in rather smaller quantities, and the fifth from one-tenth to one-fifteenth of a grain. From the evidence which the author has fur- nished us, we may collect, that within a very short 455 time, these medicines cure chancres, warts, second- ary ulcers, sore throats, and other forms of inve- terate lues, and that likewise, they are of the greatest utility in the affections of the uterus, of the stomach, and in glandular, and lymphatic com- plaints. If it should really prove to be true, that these arti- cles are endowed with such properties, they will be an invaluable acquisition to the stock of our remedies, as it appears that they effect the most radical cures of syphilis, without producing salivation, or any derangement of the functions of the body, and that no season, no temperament, and no complication of the disease, can create any obstacle to their ex- hibition, or detract in the slightest degree from their efficacy. But of this I am entirely distrustful, and have indeed learnt, that, on trial by the British practi- tioners, no part of the preceding statement was substantiated. ARSENICUM. In its metallic state, arsenic is inert. But at a high degree of temperature it is oxidated rapidly, e forming a white vapour, which condenses. This product used to be regarded as an oxide, though of late it is more generally believed to be an acid, and is called the arsenous acid. But, whatever may be its precise nature, whether an oxid or a 456 weak acid, this is the substance which is generally employed as a medicine. In the course of the last twenty years, our me- dicine has been very extensively employed in the treatment of diseases. But it is in intermittent fever, that its efficacy is best ascertained, and per- haps most highly appreciated. That it has been advantageously used in such cases, I am not at all disposed to deny, though I must still say, that its powers are very much over- rated, and that whoever expects any great uni- formity of success from it, will often, very often, be disappointed. Whether these failures proceed from intrinsic deficiency in the powers of the re- medy, or from the very loose and indiscriminate manner in which it is applied, I am not prepared to decide. So much however I may state, that in all the weak forms of intermittent fever, either approach- ing to typhus, or associated with a cachectic con- dition of the system, arsenic will prove inefficient, and most generally mischievous. This might in- deed be anticipated from its acknowledged effects on the system. The bark, as well as most other substances employed in intermittents, seems to ope- rate more or less by imparting tone to the stomach, and through it to the system. But arsenic, though placed with the tonics, has no one property of this class of articles, and produces diametrically oppo- site effects. 457 During its immediate action, there is more or less of nausea aud lassitude, and among its re- moter consequences, many of the symptoms of ex- treme debility, and depravation of the system, such as cedematous swellings of the face and extremities, cold and pallid surface, reduced pulse, nervous tre- mors, with a very considerable exhaustion of muscu- lar power. It would hence appear to be wholly inap- plicable to the cases of debility, and in further confirmation of this fact, 1 can state, that with the patients of the Aims House, who are nearly all of this description, either from age, or intemperance, it has invariably failed in my hands. But even when judiciously administered, and under circumstances the most propitious, it will not cure the disease. Compared with the Peruvian bark, it is decidedly inferior, and 1 think ought rarely to be prescribed to the exclusion of that article. Cases however may arise in which we shall be warranted in having recourse to it, and especially in children, to whom it is infinitely better suited on many accounts. Doubts have been expressed, whether the use of the article should be limited to the intermission, or continued during the successive stages of the paroxysm. My own impression is, that no rule need be strictly adhered to on this subject. The only objection to the continuance of the medicine throughout the fit, which I have observed, is, VOL. II. 3 M 458 that it is apt to nauseate and distress the stomach, which at this time, is very irritable. It is now a fact pretty well authenticated, that in some instances where arsenic has totally failed by itself, cures have been accomplished by combining the bark with it. By some indeed, it has been con- tended, that the one medicine prepares the system for the operation of the other, like a mercurial course, and that it will be found useful, in all very refractory cases of ague and fever, to precede the bark by a temporary exhibition of arsenic. Of this 1 have no knowledge myself, though the observation seems to me to be entitled to some re- spect. As might be supposed, arsenic is used in remittent and continued fevers, where there is a tendency in the case to give way, and is probably sometimes useful in hectic fever. Even in the phlegmasiae it is prescribed. Dur- ing my attendance on the London hospitals it was a favourite remedy in rheumatism, and it is cer- tainly much commended, in the same cases, by several practitioners of this city. Commonly it is considered as best adapted to acute rheumatism accompanied with pain and in- flammation. But surely no one ought to trust here to arsenic, who could command the depleting reme- dies. In chronic rheumatism of a moderate degree of action, it obviously promises more. But even in this case, it ought not to supersede medicines, the efficacy of which is so much better established. 459 Nevertheless, I have sometimes used it under such circumstances, not without advantage, and espe- cially where, as by no means rarely happens, the case is marked by the intermittent type. Of the class of neuroses, there are some diseases in which our medicine has evinced considerable powers. It is said to have done good in epilepsy, chorea and tetanus. Exhibited very freely in the latter disease, in conjunction with laudanum, it has cured several cases, if the testimony of a highly respectable practitioner can be credited* To some of the forms of asthma arsenic would seem to be appropriate. I once gave it, in large doses, in a singularly intractable case of spas- modic asthma, with apparent advantage. Pa- roxysms, which recurred almost every ten or fifteen days, were suspended for upwards of nine weeks. But what finally became ofthe case 1 do not know. It is said, that in angina pectoris, an affection not wholly dissimilar to asthma, arsenic has been found useful, and especially in one case which was cured by its long and persevering employment.! To these may be added the spasmodic affections gene- rally, though more particularly of a periodical nature, as tic douloureux, cephalalgia, &c. By those who have insisted on the analogy be- * I state this fact on the authority of Dr. Taylor, a graduate of this university. The prescription consisted of ten drops of Fowler's solu tion, and fifty of laudanum, every third hovrt- f By Dr. Cappe, of York- 460 tween arsenic and mercury, it is strenuously urged in glandular obstructions, as ofthe spleen, the liver, &c. But if ever productive of advantage here, of which I greatly doubt, it is probably in those cases which have been produced or are kept up by inter- mittent fever. Of the use of arsenic in cancer, I have little or no personal experience, and though this was among the very earliest applications of the medi- cine, the degree of its utility is by no means deter- mined. As, however, this article has constituted the basis of almost all the popular remedies for cancer, it is presumable that, at least, it is possess- ed of some peculiar powers, in the healing of ob- stinate ulcers. It is administered internally, while at the same time, it is applied locally to the sore, in the mode described under the head of escharotics. Arsenic is one of those medicines which have long been known to have a relation to the surface of the body, and it has accordingly been habitually employed in the eruptions of the skin, from leprosy down to the lowest species of herpes. Alone, or with cicuta, which I am convinced i enhances its properties, I have often prescribed it in these affections, and sometimes with great success. These are the chief diseases in which arsenic is prescribed. It would have been easy for me to have swelled the catalogue to any extent. But 1 am wholly incredulous as to the sanguine represeuta- 461 tions which have been made, from time to time, re- lative to its extraordinary powers. I have tried this article in a very wide circle of cases, and gene- rally with so little advantage that my confidence in it has decreased, and is daily decreasing. The more I see of its use, the greater is my distrust of its powers. But very recently, I have given it in the mercurial dise se, and was pleased with, the effect. As yet, however, my trials in this case have been too few, to allow me to speak of it in any confident tone. Arsenic is prescribed in several forms, the most popular however of which, at present, is that denominated Fowler's solution, or the liquor ar- senicalis of the London college. It is the arse- nite of potash, and is given in the dose of five drops twro or three times a day, gradually increased till nausea, cedematous swellings, &c. take plac^. The arseniate of potash is a second prepara- tion, which differs from the preceding among other respects in being a crystallized salt. It has the sanction of the Dublin college, and is a good deal used in the dose of a sixth or eighth of a grain. By some practitioners, the oxid, or acid, as it may be, is preferred in the solid state, made into pills. The dose is exactly the same as the preceding preparation. It was thought by Darwin, however, that a still better mode is a solution of the oxid in water, which he made by boiling more than a saturated solution for half an hour, letting 462 * it subside, and then filtering through paper, of which eight or ten drops are the quantity to be taken at once. My own conviction is, that there is no great superiority in any one of these preparations. They are all sufficiently active, and may be exhi- bited with nearly equal convenience. The fluid preparations are however safest, as being suscepti- ble of a more accurate division. 463 DISCOURSE LIV. Of Astringents. These T shall dispose of as derived from the vegetable and mineral kingdom. The property of astringency is very widely diffused among plants, the number being almost infinite which possess it in a greater or less degree. But in what it con- sists has long been a matter of controversy, and is still scarcely determined with absolute precision. As a peculiar acid can be traced in all the more active astringents, termed gallic, from its abounding most in galls, it was for a time very ge- nerally ascribed to this principle. But in the progress of more accurate inquiries into the sub- ject, it was ascertained that this could not be it, since, other objections apart, the acid itself, in a separate state, has no such property. Aware of this difficulty, the late professor Woodhouse, who investigated this point with his usual industry, was led to the conclusion, that the acid exists in tlfis case combined with alum, forming a galleate of alumine. But this has been proved to be not less erroneous. The later researches of Seguin have brought into view another principle of vegetable composition, which, as giving to astringents the property of tanning, is denominated tannin. That 464 this is the principle of astringency seems to rest on pretty solid grounds, and is now generally admit- ted. Tannin is styptic in taste, has the power of corrugation, and is universally met with in vegeta. ble astringents, circumstances which sufficiently support the hypothesis. CORTEX QUERCI. I shall commence with an account of the bark of the different oaks. That of the English oak, or the quercus robur, has been a good deal em- ployed, and is certainly calculated to fulfil many of the indications for which this description of articles is prescribed. Exhibited in the dose of half a drachm, every two or three hours, it is said by Cullen and other writers to suspend, with tolerable certainty, the paroxysms of intermittent fever. In the same quantity, it has been found useful in haemorrhage, of feeble action, in diarrhoea, and in the last stages of dysentery. As a gargle in sore throat, or as au injection iu leucorrhcea, or, as a wash, in hemorrhoidal tumors, or in prolapsus of the anus or uterus owing to relaxation, it is much more employed. Several species of our native oak do not appear to be at all inferior to the foreign, and are resorted to under similar circumstances. Of these, the white oak most nearly resembles the English in 463 its properties. The bark of the Spanish oak, how- ever, is more generally used in the United States, and has acquired no little reputation in the cure of ague and fever, in gangrene, and a variety of other cases. But by some practitioners the bark of the chesnut oak is preferred. It seems to be admitted that the bark of the black oak is less valuable than any of the rest, and is very apt, from the greater quantity of extractive matter which it contains, to purge and even to run off copiously by the bowels. As internal medicines, 1 have not the slightest experience with the bark of any one species of the American oaks. But I have no doubt of their possessing powers sufficiently active to entitle them to attention, though at the same time, I repose no confidence in those representations which would place them above, or even on a footing with the Peruvian bark. QUERCUS CERRIS. These tubercular productions are caused by the bark, or leaves of the oak, being pierced by an insect of the genus cynips, resembling the common gnat. The sap or juice escaping through this puncture is inspissated, and gradually hardens into the knotty substances, which we denominate galls. Being mere excrescences, they have all the qualities of the tree from which they are formed. vol. n. 3 N 466 The most active are imported from Aleppo, and are the product of the eastern section of Europe. Those, however, of our own country, are by no means deficient in activity. As possessed in a very eminent degree, of the principle of astringency, galls are used in many of the cases in which such medicines are prescribed. But they are thought more particularly adapt- ed to chronic diarrhcea of long standing, pro- duced, or kept up, by debility, or to restrain the colliquative purgings incident to the last stages >f pulmonary, and other affections. It is customary, under such circumstances, to give them in simple infusion, or in powder, in the dose of half an ounce of the former, or of ten or twenty grains of the latter preparation. But their power is very consi- derably improved, by adding to the infusion, the prepared chalk, with laudanum.* Externally, they are used as an ointment in hemorrhoidal tumours, and with great success, where inflammation is previously reduced. To be of much service, however, the ointment should be made considerably stronger than usually is done. As directed by me, it generally contains three parts of lard, and two of finely powdered galls. When the tumours are seated so far up the rectum, * "§, Gall, infus. ^iv. cret. prep. 3'ii. tinct. theb. gr. xl. M. The dose is a table spoonful. 467 as to prevent an application ofthe ointment, a strong infusion of the galls may be injected several times a day, and in the prolapsus of the uterus, and of the rectum, this same prepaiation will prove equally beneficial as a wash. Nur has less been said of its utility in gonorrhoea, in gleet, and leucorrhcea, or as a gargle in weak states of the throat. By Swediaur, who is among the most experienced practitioners of Europe, in the two former com- plaints, galls are very highly extolled as an in- jection. KINO. The substance distinguished by this name, was introduced about half a century ago into the ma- teria medica, ^.s a powerful astringent, little being known with regard to its origin, except that it came from Africa, and was most probably the exudation of some plant. Even at the present moment this point is not satisfactorily determined.* The prevailing opinion seems to be that, whatever may have been t^iQ source of the primitive kino, that, which is now found in the shops, is made from various * It is stated by the Edinburgh college to be the product of a tree of New Holland, the eucalyptus resinefera, whereas the Dublin Col- lege ascribe it, on the authority of Roxburgh, to the butea frondosa. It is said by Duncan to be afforded by the coccoloba uvifera. Of late, it has been conjectured that there are several species of the article, which may be produced from different trees. 488 astringent vegetable substances. Tt is, however, occasionally to be met with in a state of purity, and then, has a very different appearance from the fac- titious preparation. That which is the natural product comes iu much larger masses, is intermixed with the bark and fibres of the plant, is Of a less brittle texture, and united to its astringency has a maukish sweet- ish flavour, while the fabricated species looks like a common resinous extract, purified and dried, is of a smoother and much darker surface, and has a taste blended of astringency and bitterness. Among those that most early employed our me- dicine was Dr. John Fothergill, who alleges that he gave it in intermittent fever of the most obsti- nateaiharacter with great success, so much so in- deed, that he effected cures by It in cases, which resisted the Peruvian bark. In the practice of this city, the kino is a good deal prescribed. I have used it myself, and seen it still more used in ague and fever. By itself, I have no idea that it is competent to contend against this disease. But in conjuf ction with some of the more active bitters, and opium, it will occasionally evince considerable powers.* It was also prescribed by him in me- norrhagia, and we are informed by another high * 5, G. kino 5ii. rad. gent- § ss gum. opii gr. ii. M. div. in pulv. xii. One to be taken every two hours during the in- terval of the paroxysms. 469 authority, that it is exceedingly useful in the hemorr- hages which follow parturition. Of late our medicine has acquired some charac- ter in diabetes, and in several of the affections of the stomach, and particularly in pyrosis. It is here recommended in the strongest terms by Pemberton in his excellent treatise on the diseases of the vis- cera.* It is, I suspect, by restoring the stomach to a sound condition, that kino proves beneficial in dia- betes, more or less disorder of the gastric func- tions being always associated with that disease. The most common application, however, of our medicine, at present, is, to diarrhoea, and to cer- tain states of dysentery. To *restrain purging under any circumstances, I am not acquainted with any article more serviceable. Many prac- titioners prefer giving it here simply in a watery solution, but, I think it succeeds better in tincture, conjoined with prepared chalk and laudanum. \ As an injection in gonorrhoea, kino is directed by Mr. BellJ of which I cannot speak from any ex- perience of my own, though I presume, that it * ]$> Gum. kino gr. x. gum opii. gr. i. mucil. g. arab. gr. v. ft. pill, ii- Of which, take one every four hours. t & Tinct. kino. cret. prep, aa 3'v- tinct. theb. gr. xl. aq. font |iv. M. A table spoonful every two or three hours. \ 5, Pulv. kino. 3"- pulv. alum. $i. mucil. g. arab. §1. aq. font. Jfci. M. et collat. 9 470 would be better adapted to gleet than to the acute states of the complaint. It is somewhat curious, and deserves to be re- collected, that kino combined with Colombo, con- stitutes a pretty certain and powerful purgative. I do not know that this fact has been before noticed, but I have observed it too frequently, to doubt its correctness. It is one of the anomalies produced by the combinations of medicines. MIMOSA CATECHU. Catechu, or terra japonica, as it was formerly called, is an extract from a species of the sensitive plant. It is an active astringent, containing, ac- cording to chemical analysis, more of this princi- ple than any other substance, and is employed in nearly all the cases to which the preceding article is deemed applicable. The powder sprinkled on chronic ulcers, and especially of a venereal nature, such as ulcerated bubo, is highly commended by the surgical wri- ters, and I have found it useful. Catechu may be given in substance, in the dose of ten or twenty grains, or in tincture, or waiery solution. It is often combined with kino advan- tageously. i •471 . HJEMATOXYLON CAMPECHIANUM. As an astringent logwiooM is prescribed. It is of a deep red colour, and is much used also as a dye. But at the same time, it is by no means de- ficient in medicinal virtues. As a decoction, or infusion, it has proved conspicuously beneficial in chronic dysentery, in diarrhcea, and above all in the declining stages of cholera infantum. It is in this latter complaint, that it is chiefly prescribed by our practitioners. The infusion is best suited to the cases of children, of which, a table spoonful repeated every two or three hours is the proper dose. The extract of logwood has been pro- posed as a substitute for kino. 0 V1SCUM. Of the misleto, once so celebrated, I have not much to say. It is known as a parasitical plant, growing on different trees, as the oak, the apple, and more particularly the gums of our country. But whatever may be the source of its nourishment, *•» its properties are precisely the same. It affords, therefore, an additional proof of the great power, which vegetables, in common with animals, pos- sess, of digestion and assimilation, through their absorbent apparatus. The misleto is a pretty active astringent, and *7"« was formerly much trusted 'in the treatment of epilepsy, and analogous diseases, of which we have many cases of cures having been accomplish- ed by it, and besides wtt^ph, it is reputed to have proved serviceable in quartan agues. I know no- thing of it myself, and am disposed to think it has been very much overrated. It is, however, an interesting article as connected with the ancient superstition of the druids, and perhaps still more as an object of natural history. Being so abundant in the United States, it is worthy of trial in several diseases, and especially in nephritis, a case in which it is said to have done good. The virtues of the plant are resident chiefly in the bark, which may be given in pow- der, in the dose of forty or fifty grains. GERANIUM MACULATUM. This plant, called spotted geranium, or crowfoot, grows in the neighbourhood of this city^- It is also to be found in other sections of the United States. By its sensible qualities, as well as from its effects on the system, this species of geranium seems to be highly astringent, and promises to(become here- after an important acquisition to the stock of our remedies. As a styptic, a strong "decoction of it has been found active, and is much used for this purpose, in many parts of the country. It is also 473 prescribed in internal haemorrhages, and especially those of the alimentary canal. To diarrhcea, and the chronic stages of dysen- tery, and cholera infantum, it is moreover known to be adapted. It is stated further, on good au- thority, that some of the Indian tribes rely on this article almost exclusively in the cure of the vene- real disease. But I do not know to what form of the disease they apply it. Judging from its gene- ral properties, we should suppose that it might be useful as an injection in gonorrhoea and gleet. It appears, however, that they use it as a beverage. Even in this way, it may be serviceable in these complaints, as they frequently submit to astrin- gents and other general remedies. Confessedly, the medicine has done good in nephritis, and I have always remarked, that those articles which ope- rate on the kidneys extend their impressions, more or less, over the whole of the urinary and genital organs. The virtues of the plant are in the root, which as an internal medicine, in the bowel affec- tions espeeially, is prepared by being boiled in milk. PRINOS VERTICILLATUS. The black alder is another of our indigenous astringents deserving of some notice. This shrub is well known. It grows almost in every section vol. n. 3 o 474 of the United States, and delights in a damp, marshy soil. The bark as well as the berries, is decidedly astringent, and the latter put into wine or spirits form au elegant tincture. The bark itself may be used either in substance or decoction. It is said to cure intermittent fever, and is also suc- cessfully administered in the incipient stages of gangrene, as a substitute for Peruvian bark. But in these cases 1 know nothing of its powers. The only application which I have ever made of the medicine has been to the cure of the chronic cutaneous affections. Exhibited as a weak decoction or infusion, and steadily persevered in for some weeks, it will often remove the different species of herpes. RUBUS PROCUMBENS ET RUBUS VILLOSUS. The first of these is the dew berry, and the second the black berry. Both of these plants are so well known, that it would be superfluous iu me to say any thing of their natural history. In popular practice, each of them has long been used as an astringent in the bowel affec- tions. The knowledge of the fact induced me some years ago to try them in these cases, and I was so exceedingly pleased with the result, that I 4?5 have since very liberally prescribed them. Every part of the plant is actively astringent, as the root, the leaves, and the bark, and may be em- ployed. But the root is to be preferred. The mode in which I have used it is in decoction, taking about an ounce of it bruised to a pint of water. Thus prepared, we have a beautiful claret coloured liquor, having its bitterness, which is not very great, tempered by a pleasant aromatic flavour. Of the vegetable astringents this, I have reason to believe, is among the most active and decidedly efficacious in certain cases. To the declining stages of dysentery, after the symptoms of active inflammation are removed, it is well suited, though 1 have given it, I think, with greater advantage, under nearly similar circum- stances, iu cholera infantum. To check the inor- dinate evacuations which commonly attend the pro- tracted cases of this disease, no remedy has ever done so much in my hands. Even two or three doses will sometimes so bind the bowels, that purgatives become necessary. Being so powerfully astringent, this medicine is useful in all excessive purgings, from whatever cause proceeding, and especially in the diarrhcea of very old people, as well as when it occurs at the close of diseases. During my attendance in our public institutions I had abundant opportuni- ties of testing its efficacy in these cases. 476 As yet, my experience with this article is limit- ed pretty much to the cases which I have men- tioned. But I cannot help believing, that it will hereafter be found to be susceptible of a more diversified application, and perhaps, under all cir- cumstances, where an agreeable bitter tonic, or as- tringent, is demanded. As an antilithic, and, in- deed, as a corrective of all the depraved states of the stomach caused by debility, I am fully per- suaded that it will display very valuable powers. Of the comparative utility of the dew and black berry, I am hardly entitled to decide very confi- dently. My impression however is, from what I have observed of their effects, that the former is the superior medicine in every respect. Certain it is, that it is more pleasant to the taste. It would be easy, very much to enlarge the cata- logue of indigenous astringents, our forests and fields being redundant with articles of this de- scription. But their properties have been imper- fectly examined, and I know nothing of their me- dicinal applications myself. 477 DISCOURSE LV. Of Mineral Astringents. PLUMBUM. The preparations of lead are various. But I shall confine my observations to those only which are produced by a combination with the acetic acid. Two of this kind exist. The first, Which is the saccharum saturni of the old nomenclature, is a super acetate of lead. Of late, this has become a very important internal remedy, in the estimation of many practitioners. Among the earliest applications of it, was to the cure of intermittent fever, and we are not without some authority in its favour. Distinct from other facts, we are told that during the late war it was resorted to with much advantage by some of the physicians of our army. It is stated, that in many instances, it proved superior even to the arsenic or Peruvian bark, in the management of the more re- fractory instances of ague and fever. But these accounts, I suspect, are exaggerated, and should be received with doubt and hesitation. My expe- rience with the lead in intermittent fever is not great, though I have tried it sufficiently to per- 478 suade me, that, if ever it does good, it is rarely, and deserves to be placed among the most preca- rious of our remedies. To treat hsemorrhages by this preparation of lead is an old practice. It was common in Eu- rope, and was recommended even by one or two of the early writers of this country. But in con- sequence of certain publications which appeared from Sir G. Baker, and other distinguished men of England, pointing out, in the strongest terms, the danger of the remedy, a sort of panic terror seized upon physicians, and it was generally aban- doned. To the late professor Barton, the credit is un- doubtedly due of dissipating these idle alarms, and for having fully re-established confidence in the safety and efficacy of the practice, at least among us. In every species of haemorrhage, whether active or passive, and from whatever part of the body proceeding, the lead has been found useful, accord- ing to the reports of different practitioners. No- thing, however, is more certain, than that the use of the medicine ought always to be preceded by co- pious venesection, where fulness and activity of pulse exist. This precept applies with particular force to the case of haemoptysis. If venesection be not here practised, the lead will prove ineffi- cient, and sometimes even mischievous. Nor will a single bleeding always suffice. The rule under m such circumstances is to deplete so long as there is increased vigour in the circulation. Lead, however, has been infinitely more cele- brated in uterine than in any other haemorrhage. But to be advantageously prescribed here, the cases must be properly discriminated. These hsemorrhages may precede or follow delivery, though in either event, if the flow be copious, the medicine will prove wholly inadequate to the emergency, as such is the magnitude of the arte- ries of the gravid uterus, that hsemorrhages can only be checked by the obliteration of the mouth ofthe vessels, through the contractions of the uterus itself. Often, in the course of a very few minutes, were these floodings not arrested, death must be the con- sequence. On the treatment of them in detail, it would be improper for me to enter. I shall in- deed merely remark, that if they come on, in an alarming manner, prior to delivery, the child and secundines are as promptly as possible to be re- moved, and then cold applications applied over the whole extent of the abdomen. The lead, under such circumstances, I repeat would be altogether unavailing. This medicine is applicable only to the moderate degree of haemorrhage, which some- times precedes miscarriage, or is incident occa- sionally to regular parturition, from a partial de- tachment of the placenta. But to hsemorrhages which take place in the 480 unimpregnated state of the uterus, it is still better adapted. These it hardly ever fails of relieving, when boldly and judiciously administered, and such indeed will be found to be the case in all the ordinary hemorrhages. By Heberden, it is said that if ever there was a remedy which deserves to be considered as a specific iu any disease, it is surely the saccharum saturni uterine in haemorr- hage. My experience, will not allow me to go quite so far in praise of the medicine, though I am prepared to concur in a very high eulogium on its powers in these affections. To the complaints of the alimentary canal, acute as well as chronic, lead has been considered by some as well suited. As an astringent, it is said to be serviceable in dyspepsia, and more par- ticularly in pyrosis. Exhibited with the same view, it is probably productive of greater advantage, in dysentery, cholera infantum, and diarrhcea, in each of which cases it has been very liberally prescribed in this city, and in other parts of the United States. It would indeed be no difficult task to collect very respect- able testimony to its decisive efficacy in these bowel affections. But judging from what I have seen myself, I should say, without hesitation, that we have many articles so incomparably superior, that to resort to it, in preference to them, under such circumstances, would be criminally to tamper with the health, and perhaps the life of a patient. 481 As part of the treatment of some of the cases tiff neuroses, our medieirte has acquired no inconsider- able reputation. During the last ten or fifteen years, ' it has been very fairly tried in the public and pri- vate practice of this city in epilepsy, and though in some cases of the disease occurring iu children, it manifestly mitigated the paroxysms, it has never, so far as I have been able to learn, effected one solitary cure. To chronic affections like epilepsy, the lead does not seem to be appropriate, as they require, for their removal, the steady continuance of a course of treatment for a period longer.than, perhaps, as respects .this article, it is safe to do. Experiments have also been made with lead in chorea, and I am inclined to believe with nearly the same results. To the treatment of tetanus, lead, has not, so Yar, as I know, been hitherto applied. Its ap- plicability, however, to this affection \fras long ago suggested by Mr. Hunter, and since arsenic, an article which resembles lead in many of its pro- perties, appears on pretty authentic evidence to have cured some cases of the disease, it might perhaps be useful. But to be so, under such cir- cumstances, it should be given in very large doses, combined with the free exhibition of laudanum, and other auxiliary means. Much of late has been alleged, as to the powers of our medicine in pertussis. By some^ of the English writers, it is described as almost an infalli- VOL. H**. 3 P 48* ble remedy in this ohstiuate disease. When I firs; received this information, 1 employed the article iu several cases, and could not perceive any very sen- sible effect from it. Notwithstanding, therefore, what is affirmed in its favour, I cannot help plac- ing it very low, amoug the remedies in whooping cough. Confiding however at one time, in the reports of the efficacy of lead in the disease, I was induced from analogy to try it in several cases of asthma. But the result of my experiments was not at all satisfactory, the slightest impression, so far as I was able to observe, not having been made on any one case. In union with camphor, lead has been prescribed in several of the forms of mania, and it is said with some effect. But as this prescription is a compound one, embracing so very active an ingre- dient as camphor, the evidence to the efficacy of the lead is too ambiguous to be trusted. As an injection in gonorrhoea, a solution of saccharum saturni, in the proportion of two or three grains to the ounce of water, is a very popular "re- medy. Diluted still more, this solution forms a safe and efficacious collyrium, and rendered stronger, is usefully applied in superficial inflam- mations, and a saturated solution mixed with one^ 483 third of vinegar, or brandy, proves among the most active of our diseutients.* In the employment of lead, there is one mode which I have fouud applicable to most cases. It is, to give about two grains of it, with a quarter of a grain of opium, made into a pill, as often as cir- cumstances may seem to demand. But to haemorr- hage, and especially where it is profuse, it will be necessary to repeat the dose very frequently, and even to enlarge it considerably. During the twenty- four hours, I have gifen as much as half a drachm of lead without experiencing from it auy unpleasant effects. Perhaps, we prescribe this medicine in too minute doses. What would be the effect of exhibit- ing ten grains or a scruple of it at once, it is not easy to determine. But I do really believe it might be safely done, and if so, the most beneficial conse- quences would probably result from it in copious haemorrhages. Two drachms of the medicine I have known to be taken at once by mistake, and the only effect was pretty active purging. As in the case of calomel, and some other articles, perhaps we shall find that the immediate irritation, as well as permanent operation of lead, is greater from a small, than a large dose. * Goulard's extract, though differing from the preceding preparation in its chemical composition, being a true acetate of lead, is precisely similar in its effects, and is employed for the same external purposes, in a state of dilution. 4 484 ARGILLA. This earth in a pure state is without activity. But all its saline combinations are more or less pos- sessed of an astringent property. The sulphate of alumine* however is the preparation almost exclu- sively employed as an internal medicine, and it is this which I shall only notice. Alum, ;'s it is commonly called, has been well spoken of by respectable autlrorities in intermittent fever. Cullen gave it in combination with nutmeg. But he says, that it proved so irritating to the sto- mach as not to be a desirable medicine. It is, on the contrary, asserted by Lind to be, when used in this way, the most efficacious remedy he ever tried, except the Peruvian bark. To reconcile such conflicting reports is not very easy. My own ex- perience enables me to advance no opinion on the subject, though I confrss, I have little confi- dence in the medicine in these cases. Neverthe- less, it appears that alum is possessed of some febrifuge powers. It was recommended by Chal- mers, in the bilious fevers of South Carolina, and under similar circumstances, is favourably mention- ed by Adair. The latter directs it in union with canella alba and bark. By Darwin it is supposed * I believe the chemists of the present day consider it as a super sulphate of alumine and potash. » 485 to be better adapted to fever, connected with intes- tinal disease.' To the chronic affections of the bowels, it is certainly applicable. Exhibited in minute doses, it has rendered service in some of the cases of protracted dysentery, in diarrhcea, and especially cholera infantum. It is here usually given in solution, with laudanum, gum arabic, aud sugar, and if these ingredients be well put toge- ther, the mixture is not unpleasant. To restrain other discharges alum is also much prescribed. Combined with bark, it is said often to do good in leucorrhcea, and I have reason to suspect, that it is really sometimes useful. Nor does it seem to be less advantageous in diabetes. This is no new practice. It was employed by the celebrated Dover, and according to him with distinguished success. The remedy has since been tried, and its efficacy fully attested. It would be easy to collect the history of several cures which it has accomplished in this city. Beneficial however as our medicine may be in the preceding cases, it is still more so in haemorrhages. It is, indeed, in some of these affections, that it con- fessedly displays its best powers. To every va- riety of haemorrhage, it has been thought suited, and is indiscriminately prescribed in both the ac- tive and passive states. But this is wrong. Be- ing powerfully astringent and even stimulant, alum should never be prescribed without the previous reduction of arterial action. 486 To uterine haemorrhage the use of alum is at present chiefly restricted, which was indeed the original application of the medicine, by Van Hel- mont, who acquired great fame by the cures he effected with it. No doubt it is serviceable in these cases, though the use of it, of late years, has been in a considerable degree superseded by arti- cles of greater efficacy. There is still, however, one case in which it retains its reputation unim- paired. It is menorrhagia, dependent on extreme atony ofthe uterine vessels. The dose of alum is from five to ten grains. To prevent its exciting nausea, which it is apt to do, when freely administered, an aromatic may be joined with it. But the neatest and perhaps as au effectual mode of administering it, is that of whey, which is prepared by boiling two drachms of pow- dered alum in a pint of milk, and the dose is a wine glassful. Externally, alum is employed as the basis of gargles in uleerated sore throat, as an injection in gleet, and as a collyrium. But in recent ophthal- mia, much more relief will be afforded by the alum curd, as it is called. This, which is the coagulum formed by rubbing a piece of alum in the white of an egg, is an exceedingly cooling preparation, aud will sometimes reduce pain and inflammation very rapidly. It should be spread on a fold of linen, and applied over the eye. Dissolved in water, with an equal portion of the 487 sulphate of zinc or copper, alum constitutes one of the most effectual of our styptics, and when burnt and reduced to powder, is an excellent escharotic. BARYTES. Of the preparations of this earth, the muriate, formerly called terra ponderosa, is the only one employed. Not many years ago it was intro- duced into practice, and promised to be a con- siderable acquisition to the materia medica, and especially as a remedy in the glandular and lym- phatic affections. We are assured by Dr. Crawford that it has cured the most inveterate cases of scrofula, and is also beneficial in cancer. Of this statement a part is confirmed by Dr. Clarke, a highly respectable writer, who says that cases of scrofula, in the negroes of the West Indies, which resisted mer- cury, the bark, and many other of the active re- medies, very readily yielded to the muriate of ba- rytes. Nearly the same account is given of it in scro- fula by Mr. Pearson, and he also speaks confidently of its utility in checking the progress of malignant venereal ulcers. At one period, I experimented freely with this medicine, in all the preceding cases, and with so little success that I have since been disposed altogether to abandon it. It may be 488 given in the dose of fifteen or twenty drops several times in the day. CALX. As a lithontriptic, I have already treated of this substance, in the shape of aqua calcis, which, per- haps, is the common mode of using it. Mixed with an equal portion of milk, and exhibited in the ' small dose of a table spoonful, to be repeated every half hour, or even oftener in some instances, the lime water is an incomparable remedy to calm irri tability of the stomach, and so check vomitings from whatever cause proceeding. Nor is it scarcely less useful as a tonic and antacid, in dys- peptic and other vitiated states of the stomach. Besides these affections, it has been found ser- viceable, as an astringent in leucorrhcea, in the last stages of dysentery, in diarrhcea, and in cho- lera infantum. I know not, indeed, of any remedy which is so well suited to the bowel affections of very young children. Commonly, they are subject to purgings, produced or aggravated by excessive acidity in the primae viae, which it perhaps neu- tralizes, and thus relieves the complaint. Being also without taste, or nearly so, it is easily given , under all circumstances. Externally, lime water is employed as a wash in old ulcers, and blended with an equal part of 489 olive oil, it forms an excellent application to recent burns or scalds. The muriate of lime, or what was once called fixed ammonia, is a preparation of perhaps some value. Distinct from its tonic or astringent pro- perties, it has recently been celebrated both in Europe and this country in venereal, scrofulous and similar affections. My own experience does not enable me to say much of this article. It has occasionally been prescribed by me, though 1 am not aware with any very conspicuous advantage, and I suspect, such would be the report on the subject, by the generality of the practitioners of this city. The dose is from half a drachm to a drachm of the saturated solution.** Two other preparations of lime, the creta pr«- parata, and oculi cancrorum, each of which is a carbonate, are much employed, though chiefly, as an antacid, or astringent, to check diarrhcea, and for the latter purpose especially, are prescribed in the form of the cretaceous julep or mixture. Of the phosphate of lime, I shall say no more, than merely to observe, that it is no longer used, the little reputation, which it once acquired from purely theoretical views, in ricketts and mollities ossium, being entirely gone. < * Edinburgh Pharmacopoeia. VOL. II. 3 Q 490 ACIDUM NITRICUM. Of the miucral acids, the nitric is perhaps the most useful. Not many years ago, it was intro- duced, as a remedy, in the treatment of syphilis, and received an extensive trial. That it did good, in some of these cases, can hardly be doubted from the very great weight of testimony which was collected in its favour. But the result of a more enlarged experience with it, seems to be, that though it cannot be relied upon in the primary stages, it often proves highly beneficial in the secondary forms of the disease, and not less so, in repairing the mischievous consequences from an undue mercurial impression.** * As I have stated, such would seem to be the present estimate of its powers in these cases. It is, however, due to Mr. Scott, by whom the article was originally recommended, and in a very confident tone, to mention, that he has recently come out with a defence of his former reports, coupled by an explanation of the cause of the failure of the remedy in the hands of other practitioners. It is alleged by him, that while in India, whence he transmitted the accounts alluded to, the article he employed was produced from a manufactory, in which, from the very nature of the process carried on, as he has sihce discovered, nitro-muriatic acid was formed. To this mixed acid, he therefore ascribes the great effects he experienced from what he supposed at the time to be pure nitric acid, and from a compound of one part of muriatic and three of nitric acid, he now de- rives, as formerly, all the advantages in syphilis and other diseases. It further appears, that with nearly equal utility, the remedy may be ap- plied externally in the shape of a bath, either partial or general, as the case may demand, the " acidulated water being made about as sour as vinegar, or of such a strength, as to prick the skin a little after an exposure to it for twenty minutes or half an hour." In the syphilitic or pseudo syphilitic cases, in whatever way the acid 491 Nitric acid is diffusible in its operation, pervad- ing every part of the system, and imparting more or less v igour to all the functions. It is, hence, an • exceedingly useful remedy in a great variety of affections besides the cases already mentioned. Of these, perhaps, the most striking arc certain forms of hepatitis, and especially where there is too much debility to justify the use of mercury, or when it has already been used ineffectually. To most glandular diseases, it is indeed well adapted. Of all the remedies which 1 have ever tried, it has proved with me the most successful in those ill conditioned scrofulous sores which approach to the nature of cancer. More than one of these cases, which had previously resisted the best modes of treatment by the ablest surgeons of this city, I have speedily cured by the free internal use of nitric acid, aided by dressings with the citrin ointment. Communications too, of its extraordinary efficacy, under similar circumstances, have been made to me by several of my correspondents. Nitric acid is also prescribed in the complaints of the alimentary canal. I have sometimes used is employed, he considers every trial as inconclusive where "aptya- Rsm, some affection of the gums, or a very evident constitutional effect does not urise from it As with mercury the system should be kept charged with it for a longer or shorter time, according to circum- stances." What is the precise degree of credit to be given to these statements I am unable to determine. As yet my own experience with the re- medy, is too narrow to allow me to express any positive opinion in re- lation'to its superior efficacy. But the character of Mr. Scott is such as to shield him against any ungenerous imputation, and to claim for Iiim a fair hearing on this subject. 492 it with effect in dyspepsia, and particularly when arising from sympathy with a diseased liver. But in the treatment of diarrhoea and dysentery it is much more used. It here operates as an astrin- gent, and frequently with advantage. Nor is it less serviceable, perhaps, in scabies and other her- petic eruptions. But to attain its full effect, in these very intractable affections, it must be long and steadily continued. With whatever view nitric acid is prescribed, not less than from one to two drachms should be taken in the twenty-four hours, and in some in- stances much more. We commence with small doses and gradually increase them to this quan- tity. The usual mode of directing it, is to dilute a drachm in eight ounces of water, which may be sweetened with syrup, and its sharpness obtunded by mucilage. In dismissing the consideration of nitric acid, I cannot help remarking, th it of all the articles of the materia medica, it is the best substitute for mercury. Their mode of action may not be exactly- alike, though (hey are serviceable in precisely the same description of diseases. It is therefore a rule with me, where mercury is indicated, and can- not be used owing to certain circumstances, which often happens, I resort to the acid, and sometimes With great eiied.* * LithontripUcs. 493 ACIDUM MURIATICUM. Of the muriatic acid, I have little to say. It has been tried in all the cases in which the nitric is employed, though not with equal success. The dose is nearly similar.* Of late, the oxy muriatic acid, has been a good deal extolled, and par- ticularly in the more obstinate chronic eruptions. What is the precise extent of its powers under such circumstances, my experience does not enable me to determine very confidently. I have given it in several cases of herpes, and though it did well, I am not sensible of its superiority over the nitric acid. ACIDUM SULPHURICUM. The sulphuric acid is prescribed chiefly in the shape of elixir vitriolf which is the acid, in a state of dilution with an aromatic united. It is a very pleasant and useful tonic, and is either given alone, in the dose of fifteen or twenty drops, every two or three hours, or with the bark, &c. Commonly, it is now prescribed with the view of invigorating appetite, and of restoring tone to the digestive organs. But, at one time, aud that not * Antilithics. f Acidum sulphuricum aromaticum 494 very remote, its powers were much more highly appreciated, and it was thought even to be service- able in some of the cases of neuroses, as chorea and epilepsy. No one, at present, however, would think of confiding the treatment of such diseases to so feeble a remedy. To haemorrhage, it is much better suited. It is here a popular remedy, and I have sometimes seen it used with very good effect in restraining moderate uterine effusions. In epistaxis and haemoptysis, it is still more prescribed. The elixir vitriol, in all these cases was the favourite remedy of Sydenham. In the course of the last few years, much has been alleged of its utility in the eruptive complaints. Continued for a long period, it has undoubtedly done good in psora, and might prove adequate to the removal of some other analogous affections. Externally, it may be applied to the same pur- pose. In the proportion of one drachm of the acid, to an ounce of lard, an excellent unguent is formed, with which I have cured taenia capitis and itch. But a neater preparation in the latter case, is the acid diluted, and applied as a lotion to the sur- face several times a day. With this, I have re- moved itch almost as speedily, as with the ordi- nary sulphur ointment, and it is exempt from all disagreeable properties. THE END. ERRATA VOL. I. Page IS line 14, from bottom, for hunitrni. >ead humoral. 16 — 6, from top. for etriiienne. iv:id elemema. 22----11, from bottom, for duari air. read desert air. 30^— 4, from top, for practicable, read practical. 47---- 6,--------for stimulas, re.id stimulus. 59----12. from bottom, for uduurous. read odorous. 63 —14, f.om lop, for ref'Keren's read refrigerants. 65---- 9,--------dele on the system. ------15, from bottom, for o/ieration, read influence. 69---- 2.----——----for thorax, read abdomen. —---- 9. fro-i' iop. for >t. read its. 79----17,-—----for,>erifonceal. read peritoneal. 84---- 7, from bottom, insert with, after emetics. •95---- 1, from top. for in, read it.' 102---- 3. from bottom, for tp-oivn, read cultivated. 103---- 7, —————— for drank, read drunk. 113---- 7. — for antimonk, read antimoine. 115---- 4,-----------dele to be 119---- 5. from top, for even, read ever. 122---- 3, from bottom for (-xanthomatous, read exanthematous. 140---- 5,-----------dele the. 141---- 4, from top dele the. 141 —— l-i,--------for worse, read worst. 143 — 9,--------for them, read these articles. 151----14,--------dele referenie, *ind place it in line 15, after epidemic; and in note, fur Pneumonia typhoid's,read Peripneumonia typhodes. 154— 12, from top. for sphere, read verge. t 155 —— 3, from bottom, for irritability, read inirntability. 156----13, from top, insert the after to. 161 — 5, from bottom, insert of after generality. 162----12,-----------dele case. 174 — ll,-----------for required read requires. 179---- 5, from top, for tifi, read life. 188 — li,--------for rolicy, read colickv. 190--- 7, ———— dele reference, and place it after sulphur, ia line 6. 227 —— 11,—*-----dele -with this view. 230----11, from bottom, insert it, before is. 261 ——: l, ^———— for ursincc. read urinae. 270 — 12, from top. for seneka, read senega. 274 ———— note, for medical, read medico. 279----13, from top. insert and after acid. 281---- 9, from bottom, dele the. 288---- 4, from top. for ncetmed, read aerated. 304 8, from bottom, for age. read old. 319 —— 12, —----dele physician and poet. 323---- •, ——----for peritonwat, read peritoneal. — —— 8,———— for fo, re.id n. 324----12,--------for phlegmasia, read phlegmasia. 325----10,--------for humeral, read humoral. 350---- 3, from bottom, dele chronic, 386 —-14, from top, for dispositions, read depositions- ERRATA VOL. II. Page 6 line 7, from below, for expectorant!.; read expectorant. 9----5. for tor>r,ena, read torraii.a. 9----2, for application, read applications. 32----13, for cqnjestion, read congestion. 48——15, from top, for «> his been, read or as has been. 62----3.from bottom, Xorjifeen, read fifty 62----P, from top. for torn/nun. read abundant. 80— 7, from top, for that any other, read than any other. 85--- 3, from below, for that from, read than from. 92---- 3,----—— for not be, read not to be. 263----11, from top, tor Lyne, read Lynn. 220----9, — for contiiuent. read constituent. 222----9, —•—— for demoniation. read denomination. 22?----IS,--------for enemeta. read enemata. 248----10, ' for and is entitled, read and entitled. 2.*>9 ,t top ofthe page, for Digitalis Puerpera. read Digitalis Purpurea. 287----3, from bottom, for .vphaUigia, ivad cephalalgia. 323----: 6, from top, for Mu.tcani, read M*iscani. 437---- 5, from bottom, for torment, lead tormina. 29----10, from tip. for croup, read cramps. 311---- 5, ' for cholica, read coli. a. 317—— 4, iVom bottom, for doulo. rox. read douloureux. 33 ----6, from bottom, fl.r m he has already Vtafrd, read as has been already stated. 334----12, from top. for the opinion t, 'end the preceding opinions. 335----u,--------for the extension of if. read the extension of the diseased action. 351----1.5, from bottom, for arise.; real -mse. 365----10, from top, for dan nts, read derangements. ■125----line at bottom, for morbus, read iiikmum. rXDEX. Page Animal life, definition of 40 Absorption, cuticular 55 Antimonial preparations 113, 332 Aloe perfoliata 205 Apium petrosclinum 240 Antilithics 276 Alkalies, lithontriptic 286 Aqua calcis 289 Acids mineral 291 Allium sativum 302, vol. ii. 14. 124 288 Ammonia preparations of 341,ii.123 Asclepias decumbens 346 Arabicum gummi ii. 7 Ammoniacum ii. 11 Arum triphillum ii. 15 » Anthelmintics ii. 60 Ascarides ii. 76 Aloetic preparations ii. 77 Antimony tartrite of ii. 125 Akimen ustum ii. 128 Arsenic white oxyde ii. 129 Alcohol ii. 181 Atropa belladonna ii. 242 Antispasmodics ii. 281 Argentum ii. 451 Aurum ii. 453" Arsenicum ii. 455 Astringents ii. 463 Argilla ii, 484 Acidum nitricum ii. 489 Acidum mum'icum ii. 492 Acidum sulphuricum ii. 493 Balsamum copaiva: 260 Balsamicae, expectorant ii. 23 Blisters ii. 88 ------ rules for their employ- ment ii- 93 ------ their practical applica- tion .. 96 Black drop ii- 222 Bismuth i«- 449 Barytes »■ 487 Classification of Materia Medica 60 Copper, its preparations 133 Corrosive sublimate 136, ii. 131 Cathartics 143. ii. 113 ----------rules for their ex- hibition 1**' VOL. II. Page Cathartics their practical ap- plication 148 Carbo vegetabilis 193 ------antidote to ar9enic 196 Calomel, cathartic 200 Cassia senna 207 ------marilandica 209 Convolvulus jalapa 211 ----------scammonia 213 Colocyntlius 217 Cucumis agrestis 218 Cantharkles, diuretic 257 Colchicum autumnale 267 ii. 21 Chemaphila umbellata 273 Calculi, composition of 278 Camphor 341. ii. 122, 155 Carbonas ammonia: ii. 18,142 --------Potasses ii. 19 --------Sodse ii. ib. Capsicum annuum ii. 177. 123 Caustics ii. 1 '.5 Calx hydrargyri alba ii. 130 Citron ointment ii. 131 Carvophilli aromatici ii. 179 Conium maculatum ii. 234 Castor ii. 285 Corrosive sublimate ii. '^57 Calomel 362 Cinchona officinalis 376 Cheronia angularis ii. 417 Cornus florida ii. 418 Colombo ii. 434 Croton eleutheria ii. 429 Cuprum ii. 440 Cusparia febnfuga ii. 422 Cortex quei-ci ii. 464 Calx ii. 488 Crow foot ii. 472 Diuretics 226 -------— rules for their exhi- bition 234 Digitalis purpurea 242, ii. 259 Daucus carota 301 Diaphoretics 307 -----------rules for adminis- tering them 308 Daphne mezereum 358 Drastic purges, anthelmintic ii. 80 Dolichos pruriens ii. 83 3 R u INDEX, Page Page Diffusible stimuli ii. 132 Kino ii. 467 Datura stramonium ii. 259 Laxatives ii. 183 Emetics 68 Lobelia syphilitica 272 Lithontript'cs Laurus sassafras 276 tion 74 362 102 Lichen islandicus ii. 5 129 Litta vittata ii. 114 Elaterium 218 Lunar caustic ii. 128 Enemata 220 Lactucarium ii. 126 Eau medicinale 269 Logwood ii. 471 Eupatorium perfoliatum 343 Lime ii. 488 External mode to produce Modus operandi of mecli cines 40 sweating 369 Mosely's vitriolic solution 139 Expectorants ii. 1 --------used in colica pic- ------------rules for admi- tonum 140 nistering them ii. 3 Magnesia 191, 303 Emmenagogues ii. 31 Mt-loe vesicatorius 257, ii- 113 Epispastics ii. 88 Menstruation, its nature u. . 32 Escharotics ii. 125 Mentha pulegium ii. 43 Ether sulphuric ii. 292 Melia azedarach ii. 72 Exercise, mode of prescrib ing Mercurial preparations ii. 80 it ii. 373 Meloe niger ii. 116 Eupatorium perfoliatum ii 415 Mineral vesicatories ii. ib. ----------pilosum ii. 416 Murias hydrar. coriosiv. ii. 131 Ferula asafoetida ii. \*> 285 Moschus ii. 281 Ft-rri rubigo ii. 438 Mercury ii. 294 Gamboge 214 --------its use in consump- Guaiacum officinale 354 tion IK 305 Gl\ cyrrhiza glabra ii. 6 --------in rheumatism ii. 307 Geonrea inermis ii. 75 --------in haemoptysis ii. 310 Gentiana lutea ii. 426 --------in bowel com- Gold ii. 453 plaints ii. 311 Galls ii 465 --------in epilepsy . ii. 314 Geranium maculatum ii. 472 --------in tetanus ii. 315 H;story of materia medica 1 ii. 318 Helleborus niger 215, ii. 51 --------in dropsy ii. 320 Humulus lupulus 300 --------in cutaneous affec- Helleborus fcetidus ii 71 tions ii. 326 Hydrargyrus nitrat. rub. ii. 129 -------- in glandular affec- Hyoscyamus niger ii. 232 tions ii. 328 Hydrargyrus ii. 294 -------- venereal disease ii 3.50 Hydrocephalus, its treat- Mineral tonics u. 433 ment ii. 322 Mimosa catechu ii 470 ------------its pathology ii 325 Misletoe ii. 471 Hydrargyrus muriatus corrosi- Muriatic acid ii 492 vus ii. 357 Muriate-of lime ii 489 Hydragyrus muriat. mit. ii. 362 Nitric acid ii. 489 Hiimu'"s lupulus ii. 430 Nicotiana 129 ,255 H