.%^ 1 >P >* 7 ^ \" -rf *JHLiJJi '^QQQ®QZ,QZ^T>Q®&UDZOOQUQl\QW2& nr '» Surgeon General's Office »3i OR ')• :agQ.aQQ-GCQ;aQQQgQgQ-3-ag-GgQCi i A N INAUGURAL DISSERTATION ON THE USE OF THE Nitric and Oxigenated Muriatic Acids, v IN SOME DISEASES. SUBMITTED TO THE EXAMINATION OF THE * Rev. JOHN EWING, S. T. P. Provoft; THE TRUSTEES AND MEDICAL FACULTY QF THE UNIVERSITY OF PENNSYLVANIA, ON THE TWENTY-SECOND DAY OF MAY, I798. FOR THE DEGREE OF DOCTOR OF MEDICINE, BY PHILIP GENDRON PRIO'LEAU, A. B. Of Charlcflon South Carolina—Honorary Member of the Philadelphia Medical and Chemical Societies. /6 % *> /;- . Ex principih nafcitur probability ; ex faSlis vero 1'Critjs, PHILADELPHIA: Printed by JOHN BIOREN. M DCC XCVIII. AN INAUGURAL DISSERTATION ON THE USE OF THE Nitric and Oxigenated Muriatic Acids, &C. T O CASPAR WISTAR, M. D. Adjunff Frofejfor of Anatomy, Surgery and Midwifery t UNIVERSITY OF PENNSYLVANIA. SIR, Jt gives me infinite fatif- fa£tion, to have an opportunity of thus publicly acknowledging my ob- ligations to you. The polite atten- tions I have received from your fa- mily, your unceafing endeavours to give me every opportunity of im- provement, which your extenfive ( vi ) practice afforded, and the invalua- ble precepts, which you have with fo much pleafure delivered to your pupils, all claim my warmeft thanks. —Accept then, fir, this my firft pub- lication, which is offered as a fmall mark of the gratitude and efteem of your fincere friend and affectionate pupil, PHILIP GENDRON PRIOLEAU. ON THE USE OF THE Nitric and Oxigenated Muriatic Acids, IN SOME DISEASES. ggaiaBafiBMa- ■ IN treating of thefe acids, it may be neceflary to premife, that it is not my intention to fpeak of their Chemical affinities to the fub- fubftances which furround us. As this is very accurately and minutely taken notice of, in every fyftem of Chemiftry, I mean to confine myfelf to their medical properties, and their effects on the human body, as this part is that, with which phyficians are, asyet, leaft acquainted. ( .8 ) In purfuing this fubjecc. then I fhall firft, in as concife a manner as I am able, give the hiftory of the difcovcrv of the ufe of the Nitric Acid in difeafes: Next relate fome cafes in which it was exhibited, and draw fuch conclufions from them as they juftly warrant : I fhall then treat of the Oxigenated Muriatic Acid in the fame manner, and endeavour to prove that thefe Acids act on the fame principle with Mercury in the cure of the Venereal Difeafe. ON THE NITRIC ACID. X HE hiftory, of the important difcovery, of the ufe of the Nitric Acid in fome difeafes, is as follows, Mr. William Scott, furgeon in the fervice of the Eaft India Company, (in Auguft 1793,) imagining that the obftructions of the liver, were occafioned by the bile depofuing its re fin ; and defirous of becoming acquainted with the modus operandi of the calces of mercury, which feem fo peculiarly qualified for removing thofe obftructions ; he inftituted a feries of expe- riments on the bile'. By mixing a quantity of the refin of the bile, (carefully feparated from its foda and lymphatic matter with which it is united,) and half its weight B ( io ) of the red calx of mercury with ten or twelve ounces of water, and expofing them to heat, he found, that part of the oxigene of the mercurial calx, had combined with the refin, and made it furprifingly more foluble in water. By his expe- riments on the bafe of the bile, having thus found that oxigene made it more foluble in water, and being at that time afflicted with chronic hepatetis, he refolved to take a quantity of oxigene united to fome fubftance, for which it has no great at- traction. After fome reflection on the fubject nothing appeared to him fo well calculated for the purpofe, as the Nitric Acid) which is known to confift of about four parts of oxigene, united to one part of nitrogene, with a certain portion of water. In Sept. 1793, (fays Mr. Scott,) " I began to take the Nitric Acid. I mixed about a dram of the ftrongeft I could procure, with a fufficient quantky of water ; and was happy to find that I could finifh that quantity, in the courfe of a few hours without any difagreeable effects from it,: the following is the journal that I kept of myfelf at that timfc. September nth 1793, ijt, day. Took at dif- ferent times about a dram of the ftrono- Nitric ( II ) Acid, diluted with water. Soon after drinking it, I felt a fenfe of warmth in my ftomach and cheft; but no difagreeable fenfation from it, nor any other material effect. id, I have taken to-day a confi^erable quan- tity of acid, diluted with water, as much as I could eafily drink during the forenoon. v ^d, I have continued the acid. I feel my gums affected from it, and they are fomewhat red, and enlarged between the teeth, I llept ill, but could lie for a length of time on my left fide, which from fome difeafe in my liver, had not been the cafe for many months before. I perceive a pain in the back of my head, refembling what I have commonly felt when taking mercury. 4th, My gums are a little tender: I continue the acid as before, I (till find a pain in my head, and about my jaws, like what arifes from mer- cury. I perceive no fymptoms of my liver com- plaint. §tb, I have taken the acid, and always feel an agreeable fenfe of heat after drinking it. I fpit more than ufual. ( '2 ) 6th, I continue the acid. I obferve my mouth forer to-day, and fpit more. ytb, I think I am now fufficiently oxigenated. I feel my mouth fo troublefome, that I fhall take no more acid. From this time my mouth got gradually well, and I found my health confiderably improved. Mr. Scott adminiftered the Nitric Acid in fe- veral cafes of tedious intermittents, in two cafes of diabetes, in each of which the fubjects were in the decline of life, and in a number of fyphilitic cafes with the happieft effects. This fhort account of the difcovery of the ufe of the nitric acid in difeafes, I have thought it my duty to give, in honour of the difcoverer : and it is done with mope pleafure,- as it was the refult of reflection and well directed experiments : and not as is frequently the cafe, (tumbled upon by ac- cident. Mr. Scott's account of the Nitrous acid, was firft publilhed in the Bombay Courier of April 30th, 1796. It has fince been republished in the ( '3 ) firft volume of Dr. Duncan's Medical Annals, and alfo in the firft volume of the New-York Medical Repofitory. In the latter end of Auguft 1797, I met with Mr. Scort's account of the Nitric Acid, in Dun- can's Medical Annals: and have fince that time given it in a number of fyphilitic cafes, with the happieft effects. As the fubject is new, and nothing is wanting to bring this invaluable medicine into general ufe, but facts in its fupport, I will relate fome of the cafes which came under my own obfervaticn. CASE I. September \fl, 1797. F. MCC-----r, came into the Alms-houfe as a pauper. She had four chancres on her labia pudendi and nymphs, which (he had contracted three weeks before. I directed her to take five drops of the Nitric Acid every hour in a little fweetened water, which fhe continued for a fortnight, her mouth was (lightly affected, three of her chancres had entirely healed and the other greatly diminifhed. She was at this time attacked with pleurify, fo violent as to make me neglect the fyphilitic complaint. Her pleurify ( 14 ) was cured by four bleedings and cathartics of glauber's falts and emetic tartar. I thought no more of her fyphilis for fix weeks after this, when (he informed me that her old complaint had re- turned. Upon examination I found that two of the chancers had re-appeared and were nearly of the fize of a fmall button. She recommenced taking the Nitric Acid; and continued its ufe three weeks longer, at which time (he left the Alms-houfe. But previous to her departure (he informed me; that her fores were entirely well, except (toufe her own exprefiion •,) Cc a fmall fpot about the fize of a pin's kead." December 27th, After being out of this inftitu- tion three weeks, (he this day called on me to requeft more Acid ; telling me at the fame time, that the fore which had not been entirely healed, had enlarged to a fize that would admit the end of her little finger. I gave her the Nitric Acid as before, and de- fired her to call on me every three or four days. She faithfully took the Acid for four weeks more, when the chancre appeared to be perfectly well. But by way of infurance I defired her to take the Acid two weeks longer, which lhe did. ( 7 ) I faw her the other day, it is upwards of a month fince (he has omitted the Acid, and (he in- formed me, that (he has been perfectly well ever fince. CASE 2d. October 8th 1797. T. D. aged twenty three years, was received a pauper in the Alms- Houfe ; He was afflicted with pains and ulcers in his limbs. The hiftory of his cafe is as follows; In January laft he was infected with the venereal difeafe, he had a gonorrhoea, chancres, and an enlargement of the glands in his groins, which had been difcuffed by mercury, and he confidcred himfelf as cured. Fourteen weeks ago, he took the fmall pox (and had the difeafe mildly) the na- tural way; (hortly after the fmall pox had run its ufual courfe and difappeared, fmall puftules arofe on his legs which degenerated into ulcers, in their appearance refembling thofe of a venereal nature. From which time to the prefent they have conti- nued to increafe, and he now has on his lower ex- tremities fix and twenty ulcers, he alfo complains of pains in his limbs. I gave him the following mixture, ( 8 ) ]£, Gum : Arab iv drach : iv. Aquse Menth : vi Unc : vi. Acid : Nit : ii drach ii F. M. With directions to take a table fpoonful every hour mixed with fweetened water. October nth, The third day after he began with the Acid, and when he had taken but four drachms of it, I found him lying on his bed, with his hand fupporting his head, and the faliva driv- ling from his mouth into a cup. His mouth was very fore, his gums had a (imilar appearance with thofe of perfons (lightly affected with mer- cury. The falivary glands were much enlarged. His breath at prefent, has no offenfive odour, though he fays that when he firft began to fpit, it was very difagreeable. The ulcers on his legs look cleaner. His mouth is fo fore that the Acid is omitted. October 16. His jnouth is much better, his ulcers are in a healing ftate but the pains in his bones ftill continue. He was defired to take the Acid again. November i. Has continued to take the Acid fo as to keep his mouth (lightly affected. His ( i7 ) ulcers have entirely healed, but the pain in his limbs (till continue. November 16. He has continued the Acid and is well in every refpect, except the pain in his limbs, which remains the fame. Finding the Acid after fo fair a trial incompe- tent to the removal of the pain, and believing the Rheumatifm to be fyphilitic, I thought it my duty to give him mercury. He took from the fifteenth of November to the eighteenth of De- cember calomel fo as to keep up the affection of his mouth, and a pretty confiderable ptyalifm, without producing the leaft alteration of the pain. He then left off the ufe of mercury and ufed friction with the flefh brum, and in the courfe of three weeks found himfelf almoft free from pain. He continued the friction and in a fhcrt time after was perfectly well. CASE III. Wm. L. Aged 29 was admitted in the Alms- Houfe for a venereal complaint. He has feveral times before had fyphilis, has at prefent noctur- nal pains in his bones, nodes on his fhins and an ill-conditioned ulcer on the calf of his right leg-. C ( i8 ) October 16, 1797. He was ordered the fol- lowing mixture: #, Gum Arab drach : iv. Aqua2 Menth Unc : viii. Acid : Nitros : drach ii. F. M. With directions to take a table fpoonful every hour mixed with fweetened water, and the ulcer to be dreffed with the Ung : Merc : Frcecip : Rub : October 21. He has taken four drams of the Acid ; he complains of forenefs of his gums ; the medicine he thinks has caufed a griping and loofenefs in his bowels, his ulcer looks cleaner and his nocturnal pains are lefs violent. October 25. He has continued the Acid ; the ulcer is clean and in a healing ftate, the nodes are lefs painful and begin to decreafe. October 30. Has continued to take from one to two drams of the Nitric Acid daily. His mouth is but (lightly affected j he has no fetor of the breath, and continues to mend in every refpect. ( '9 ) November 4. Has continued the Acid; his teeth are loofe and he has a moderate ptyalifm. November 20. He has continued to take the Acid. His ulcers have entirely healed, his nodes have difappeared, and he appears in every re- fpect to be perfectly well. It is now four months fince he left off the ufe of the Nitric Acid, and he has never had the return of a fingle fymptom of his old complaint. N. B. He has taken no mercury for upwards of a twelvemonth. CASE IV. February 7th, 1798. M. MCG----n, Aged 34, was admitted into the Alms-houfe for a vene- real complaint. She had a deep, illconditioned fyphilitic ulcer on the calf of her right leg; toge- ther with a fyphilitic difcolouration of the (kin on the face, neck, bread, and arms. The follow- ing mixture was prefcribed for her. & Gum : Arabic drach. iv. Aquae Menthas unc. vi. Acid : Nitros : drach. iii. F. M. With direc- tions to take a table fpoonful every hour, mixed t 2o ) with fome fweetened water. She was directed to drefs the ulcer with the ung: ex aerugine. Feb. 9th, She has taken the acid. No altera- tion in her difeafe. She complains of a little grip- ing in her bowels. Feb. 10th, She has continued to take three drams of the acid daily. She complains of a fwel- ling of the fubmaxillary glands ■, and her gums begin to fwell. The ulcer is lefs painful, and looks cleaner. The difcolouration of the (kin remains the fame. Feb. 13th, Has continued the acid. She com- plains of her mouth being fore and her teeth loofe. No fetor of the breath is obfervable. Her •ulcer is contracting, and the difcolouration of the fkin (lie thinks is leffening. Feb. 16th, Has continued the acid. Her mouth is very fore and (he fpits near a quart a day ; The ulcer is healing and the difcolouration of the fkin diminilhing. On account of the forcnefs of her mouth, the acid was omitted. Feb. 24th, Her mouth is much better, and the ptyalifm has ceafed. The ulcer is nearly healed I 21 ) and the (kin refuming its natural appearance. She was directed to recommence the ufe of the acid. Feb. 27th, Has taken the acid. Her mouth is (lightly affected, and (he continues to mend. March 2d, Has continued the acid. The ulcer has healed, -and the difcolouration of the fkin is faft difappearing. March 6th, Has taken the acid, her mouth is (lightly affected. She continues to mend. March 12th, Has continued the acid. She is in a profufe ptyalifm. Her (kin is of its natural colour, and (he appears perfectly free from her complaint. The acid was omitted. Her mouth in a week after the omiffion of the acid got well, and (lie was difcharged as cured. N. B. Not a fingle grain of mercury had been given in this cafe. As my prefent object is to (hew the efficacy of the Nitric Acid in the venereal difeafe. And as nothing will have a greater tendency to its ef- tablifhment, than its utility having been experi- ( 22 ) enced by medical gentlemen, of unblemifhed re- putations, in different quarters of the globe : and efpecially as the refult of their experience, is in the hands but of a few j I think it my duty to avail myfelf of fome of their cafes. And in order to make this paper lefs prolix. I will omit the recitation of feveral other cafes, which came under my immediate infpection. Within thefe few days I have had the good fortune, to meet with part of a fmall pamphlet, entitled, "Reports of the Effects of the Nitrous Acid in the Venereal difeafe." It contains twelve cafes by Mr. Hammick Junr. one of the furgeons of the Royal Hofpital at Plymouth, (in G. B.) which were felected from upwards of fifty cafes in which the Nitric medicine had been found efficaci- ous, and fent to Dr. Beddoes for publication. As the one now in my poffefiion is the only copy in Philadelphia, and I have fome reafon to believe it is the only copy as yet in America, and as it con- tains fome very decided cafes, which corroborate my experience on this fubject. I will take the liberty of relating fome of them. ( ^3 ) CASE V. George Hall, a Marine, thirty nine years of age, was received into the Royal Hofpital at Ply- mouth, on the feventeenth day of April, 1797, for a venereal complaint which he had contracted about three weeks before ; at this time he had a large, irregular, foul chancre on the lower part of the penis near the fcrotum, with an enlargement in the right groin, had never taken any medi- cine, or applied any thing to the chancre itfelf: the next day, the 18 th of April, he was ordered the following drink. & Acidi Nitrofi deluti drachmas jj Succi limonis uncias j Aquas fontanae libras jj M. Bibat quotidie. The ulcer was dreffed with the fimple white ointment: he continued this drink daily to the third of May, when the diluted nitric acid was changed for the fame quantity undiluted, which he took, with the addition of fyrup till the nth day of May, when the chancre was healed, the\ enlargement in the groin could not be felt, and in every refpect he became well, he was difcharged to quarters on that day to go on duty.. ( -4 ) N. B. This man never took a grain of mer- cury. CASE VI. Thomas Plangctt, Marine, twenty years of age, was received into the Royal Hofpital on the feventeenth day of April 1797, for a venereal complaint, which he had contracted about fixteen days before; had not ufed any medicine for it; he had now two large indurated glands in the right, and a large one ftill in the left groin and a venereal eruption on the pubis. The following day he was ordered ; 3$> Acidi Nitrofi drachmas 1 fs. Syrupi Simplici uncias vj. Aquae Fontanse libras jj. M. Bibat quotidie. He took it that day and continued it in the fame proportion daily to the 15th day of June, when the fwellings in his groins being gone, and the eruption having entirely difappeared, he was difcharged on that day, in order to go to quarters. N. B. This man had not ufed any mercurial preparation. (■t »5 ) CASE VII. John Burr, Seaman,, twenty feven years of age, was received into this Kofpital, on the 5th day of June, 1797, for a venereal complaint, contracted about a month before ; this man had not taken any thing for it. Its appearance at this rime was a large bubo in the right groin, which had fuppurated two days before ; two chancres appeared" on the lower pare of-the penis j he had phymofis with great inflamation, and an appearance tending to gangrene j and an ulcer on the fcrotum : the fame day he was ordered the following drink : & Acidi Nitrofi drachmas ii. Syrupi fimplicis -uncias viii. Decoct : lignorum libras ii. M. Capiat quotidie. The penis and bubo were poulticed, and the chancres dreffed with the fimple white ointment. He took his drink that night, and before he had taken it fix day <, there was an apparent alteration for, the better. He continued it to the 10th day of July, when his bubo, chancres &c. beinp- healed ; the phymofis entirely removed, and the D ' ( ^6 ) man in perfect health, he was ordered from the venereal ward, to another furgical ward, as he had a hermia. N. B. This man had never ufed mercury. CASE VIII. Samuel Pope, feaman, twenty years of age, was received into the Hofpital on the 4th day of June, 1797, for a venereal complaint, which he had contracted about ten days before. The ac- count he gave me was, that about fix days be- fore his arrival here, he found great pain and dif- ficulty in pafling his urine, attended with a phy- mofis, and a difcharge of matter from the ure- thra j that three days after that, he perceived a black fpot on the prepuce, which continued fpreading to the day of his arrival here, when a profufe haemorrhage taking place from the dor- fum penis, it alarmed him and he then applied to the furgeon for the firft time, who immediately fent him here. I found the whole prepuce entire- ly mortified, and the mortification had feized the upper part of the glans penis, from whence the prepuce had, from its weight in hanging down, been detached ; he had alfo much fymptomatic ( 27 ) fever: he was ordered to be vyell fomented twice a day, and the yeaft poultice to be applied, and to take the following drink : 5> Acidi Nitrofi drachmas ii. Syrupi fimplicis Uncias viii. Decocti lignorum libras ii. M. capiat quotidie. Capiat hora fomni opii grana ii. 5th Has bled fomewhat during the night, and the fphacelous on the glans feemed to have fpread ; the Nitric drink &c. continued as yef- terday. 6th Nearly the fame as yefterftay, only ap- pears to have lefs fever j drink &c. continued. 7th the whole of the prepuce (loughed off this morning ; the mortification on the glans had not fpread: Nitric medicine &c. continued. 8th There was a detachment of the (loughs, drink &c. ordered as ufual. 9th The (loughs came entirely off this morn- ing from the glans, fo deep as to occafion fome alarm that the urine would find its way out thro-jo-h the fide of the urethra. ( 28 ) loth Appeared to be better, and the nitric drink &c. were continued without any alteration (except the ulcer being dreffed with ointment on the 13th in lieu of poultice) to the 17th of July, when the wounds round the glans from whence the prepuce had (loughed off and elfewhere, were healed -, and he being in all refpects perfectly cured of the venereal difeafe, he was fent from the venereal ward to another furgical ward, as he had a lame arm from-a hurt he had received on board fome time before. N. B. This man had never ufed either Mer- cury or bark. The preceding cafes in my opinion juftly war- rant us in faying not only that the nitric acid is ufeful in the Venereal difeafe, but that it is at lead equal to mercury. But there is hardly a Practitioner, who has not met with fome cafes of fyphilis, in which he has had too juft caufe to lament the inefficacy of mercury, where either owing to idiofyncracy, or to the conftitution not having fufficient ftamina to contend both with the difeafe and remedy, or rather to the confti- tution being fo irritable, as to be unable to bear the action of mercury, fcr a fufficient leno-th of time, to eradicate the difeafe : in which cafes the ( 29 ) Phyfician is reduced to the extreme mortification of being a fpectator to the finking of his unfortu- nate patient out of^his miferable exiftence, with a difeafe, which befides being the molt painful, is, by the world, efteemed the moft loathfome and deteftable. With what honours then, (hould not fcience crown the man, who difcovered a remedy capable of fnatching a fellow creature, in fo deplorable a fituation, from the jaws of death. The nitric acid as will appear by the following cafes, is fuf- ficient to accomplifii fo defirable an end. And the gratitude of mankind in general, (hould pay the tribute juftly due to the ingenious Mr. Scott, whom reafon, reflection, and experiment, has con- ducted with fo much honour to the difcovery. In the pamphlet from which fome of the pre- ceding cafes were.taken we find alfo the follow- ing, which are much to our prefent purpofe. CASE IX. Thomas Homewood, fcaman, twenty fix years of ao-e, was received into this Hofpital on the twenty ninth day of March, 1797 for a venereal complaint, which he had contracted about a ( 30 ) month before. He had taken different medicines without effect, for it, onboard; the appearance of the difeafe, was, a very large and deep chancre, extending all the length of the penis on the back part; a large and extremely inflamed bubo in each groin, with a profufe difcharge of matter from the urethra, accompanied with great heat in paffing his urine. His buboes were or- dered to be fomented and poulticed twice a day, and two drams of the ftrong mercurial ointment to be well rubbed in on the thighs at night; which applications were continued to the fecond of April, when his buboes (now ready to fuppu- rate) were touched with the lapis infernalis and the efchars were thrown off on the 5th. The next night he ufed the friction again, and conti- nued it to the 10th, when I found him very weak and low, with a violent cough and much expec- toration of thick phlegm ftreaked with blood, profufe fweats, and fuch extreme debility, as not to be able to raife himfelf from his pillow, at- tended with diarrhoea. The chancre and buboes continuing very foul, the friction was difcontinu- ed, and he was the next day ordered the follow- ing drink : J£> Acidi Nitrofi drachmas ii. Syrupi Simpiicis uncias viii. Aquas Fontanas libras ii. M. Capiat quotidie. ( 3i ) The day after, finding himfelf fomewhat bet- ter, the drink was continued, and from the above alarming fymptoms yielding, and an entire altera- tion taking place both in his health and appear- ance of the ulcers, he took it to the loth of May j when he complained the drink vomited him. The Nitre Acid was then reduced to one dram daily, which he drank without any uneafy fen- fation in his ftomach, and continued it in that proportion to the 30th day of May; when his buboes and chancre being healed, and all the venereal complaints entirely gone, the drink was no longer ufed, and he was difcharged from the Royal Hofpital on the 5th day of June, in order to join his (hip. CASE X. Thomas Edmed, Seaman aged twenty four, was received into this hofpital on the ninth day of Feb. 1797, for a venereal complaint contracted about three weeks before, and had taken mercury on board for it. At this time he had a very bad phy- mofis : the prepuce being very thick and hard with a profufe difcharge appearing to come from chancres fituated behind the glans penis; he had alfo great difficulty in palling his urine, accom- panied with a chordee. This man was very deli- cate with fair complexion; he was ordered the ( 32 ) next day to rub well into his thighs at night; two drams of the ftrong mercurial ointment, and to apply twice a day, a poultice of lintfeed meal, &c. to the penis: he rubbed between the 10th of . February and i2th of March, twenty three times, and fumigated the part night and morning with the cinnab: factit: On this day, viz. 12th of March, he was ordered to forbear the friction, as he was low and weak, and his mouth very fore and fwollen; he fpat in the four and twenty hours nearly three pints; diarrhoea, cough, pain of bread, and his venereal complaint appeared much aggravated. He was put ©n a nutritive diet, with wine and cordials ; he was ordered an infufion of bark in lime-water; two grains of opium every fix hours, and a quart of the decoction of woods, to be taken daily. He was kept on that courfe without gaining ground in any refpcct, to the 12th day of April: he was ordered then mercu- rials in fmall dofes, combined in different forms ; various fumigations and poultices without the leaft fuccefs, until the fourteenth day of May, when* he complained of his being a great deal worfe ; fo weak that he could not quit his bed, or only be helped out to have it made once a day ; his diarrhoea ftill continued, his cough and fweats in- creafed, his appetite was entirely gone; he had naufia, excruciating pains in his legs and arms at ( 33 ) night, and was exceedingly reduced; in this ftate he was ordered to leave off his bark, decoction of woods, opiates, &c. and to truft entirely to the following drink. J£> Acidi Nitrofi drachmam i ff. Syrupi fimplicis uncias viii. Aquas fontanas libras ii. M. bibat quotidie. Before he had taken this nitric medicine twelve days, he thought his pains were lefs fevere, and his diarrhoea fomewhat abated; on the feven- teenth day, the venereal complaint appeared bet- ter; he could get the prepuce a little way back, and he thought himfelf in every refpect better. On the twenty fixth day of taking this drink, he was able to walk about his ward with fome aflif- tance, and on the 16th day of June could get the prepuce entirely back over the glans penis. He continued his nitric drink to the ioth of July, when his venereal complaint was entirely well: diarrhoea, pains, cough, and fweats had left him, his apperite good, and grown plump and ftrong he was difcharged that day at his own defire, to join his (hip. I am informed that the ingenious Dr. Beddoes, in part the fifth, of his confiderations on factitious E ( 34 ) airs, has collected fome valuable information on the ufe of the Nitric Acid, in dileafes. I regret exceedingly, that though I have made every ex- ertion in my power, I have not been able even to procure a perufal of it. But I find in the New- York Medical Repofitory, a very interefting and fatisfactory cafe extracted from it, which I beg leave to repeat. The cafe above alluded to is in the words of Mr. Thomas Baynton, who gave it to Dr. Beddoes for publication. CASE XI. On the eighth of February, 1795, fays Mr. Baynton, I was requefted to vifit Mr.-----, with pains of the limbs, and ulcers of the throat and tonfils, which, from appearances, fufpecting to be a cafe of cynanche maligna, induced me to prefcribe bark, wine, and gargles. That plan was perfevered in until the 19th, without any ad- vantage, from that circumftance, conjoined with the fituation of his pains, and the times of their aggravation, I began, (though my patient was married, and the father of healthy, fine children) to fufpect the cafe to be venereal; and after ex- preffing my fufpicions, I learnt from him, that he had contracted fuch a difeafe fome years be- fore, and had at that time an ulcer on his penis; ( 35 ) but that he fuppofed himfelf perfectly cured, having paffed through a regular courfe of medicine for that purpofe ; it was with difficulty that I con- vinced him that his prefent fufferings were referable to fuch a caufe. However poiTefling his confidence, I prevailed upon him to commence a mercurial courfe, and he continued to take from that time . to the eighth of March, a grain of calomel, with an equal quantity of the ext. papav. three times a day, in the third part of a pint of the decoct. honor, cum rad. mezerii. On that day, in con- fequence of the appearance of fome eruptions, the form of the medicine, was exchanged for the fol- lowing: g, Hydrarg : Muriat: gr. iv. Aq. cinnam : unc. iv. M. cap. coch. larg. noct. maneque. This was continued until the 27th of April, and then a dram of the ung : Hydrarg : fort : was ordered to be rubbed into the thighs every night at bed time, and the former medicine omitted on account of the eruption having yielded, though die pains had increafed ; this with the decoction of the woods and mizereon, was continued till the middle of June. On the 20th of October, he began to take four grains of the blue pill, with ( 36 ) a quarter of a grain of opium three times a day; and it was continued without intermiffion, until the middle of January, 1796. On the 14th of that month, calomel, with opium, was again ufed in ' . (lead, and continued until the middle of February. On the 12th of July, he a^ain commenced its ufe, and continued to take it un- til the middle of Auguft laft, when I was obliged by the fulleft experience of the inefficacy of all the mercurial preparations that had been tried, to again requeft him to defift from the ufe of all medicines, except occafional opiates, to miti- gate his pain, which it had been neceffary for him to ufe with the greateft freedom during the whole of the mercurial courfe. It will here be neceffiry to remind you, that when I firft was called to his affiftance I found him labouring under only the conftitutional or fecondary fymptoms of the dif- eafe and as I did not keep any minutes of the cafe, I cannot fpeak with than exactnefs I would wifh of the particular effects of the different pre- parations of mercury that were exhibited. But I have the fullcft recollection, that the ulcers of the throat and the affection of the fkin, were removed in due time by the means that were adopted : and although there was a complete failure in my attempts to diflodge the poifon from the bones, I am not convinced that the failure ( 37 ) refulted from the incompetency of the mercury to produce fuch an effect—as the conftitution. of this patient was rendered fo irritable by the dif- eafe, or the means rnaueufe of, (orperhap;, both) that I was never able to impregnate the fyftem with a fufficient quantity to produce the defired effect; though it was exhibited with every pre- caution and united with every corrective that my judgment could fuggeft, conjoined with the ad- vantages of country air, bark, milk diet, and the occafional omiffion of all medicines, which for a time, anfwered fo well, as to make my dis- appointment the greater at each time of the dif- eafe returning. At laft, medicine of almoft every kind failed to afford even relief, and I was reduced to the neceflity of being content with the mere palliative effects- of opium given in large dofes. The peculiarities of this cafe are however too common ; and every practitioner that is much engaged in a large city, efpecially if it be a fea-port, muft have had to deplore fuch occurrences. It was my good fortune to meet with Mr. Scott's communication, in the way before defcribed, juft at a rime when I had ex- hausted my endeavours to cure this patient, and when I fay with him, that he wa:. indeed a fc rue- ful fpectacle," with little more than difeafed bones remaining, when he began the ufe of the ( 33 ) Nitric Acid ; and that he now appears in good health, I contemplate with aftonifhment the change that has been produced; more efpecially as he was always labouring under profufe fweats, diarrhoea, ptyalifm, from the mercurials that were exhibited, though they were fo guarded, and has now obtained a cure by the ufe of a mod power- ful Acid, without experiencing even momentary inconvenience, and in lefs time than would have been requifite to remove even the mildeft fymp- tom of the difeafe by any other known method. The gentleman who was the fubject of the above cafe, at the requeft of Mr. Baynton, drew up a very excellent account of his fufferings, and as in it, he has given a particular account of the effects of the Nitric Acid, I think it may not be im- proper to infert his letter, which is as follows. Dear Sir, Purfuant to your requeft at your laft vifit, I take up my pen to defcribe (ifpofiible) the deplorable condition, and fufferings I have endured for near two years laft, paft, and the almoft miraculous delivery therefrom, by your care and unwearied attention thereto. I was firft feized with ulcers of my throat and violent pain in my (hins at nioht, that threw me into fuch perfpiration, that for nine ( 39 ) or ten mornings, I was under the neceffity of changing my linen before I could poffibly get up ; which was foon followed by, or wiih excrcfcences or nodes from my knees'almoft down to my in- fteps, attended with violent pains in my head. My arms alfo were attacked with excruciating pains, where fwellings of a confiderable fize made their appearance. My knees alfo fwelled, and the pain fo acute, that I durft not move them the lead afide: (leep fled, nor did it return for ten weeks, and for twenty two weeks I could not bear to be moved without fuffering the mod ex- treme torture, notwithftanding your tender care to adminifter every thing you could devife and prefcribe for my relief. I knew you perfectly underftood my cafe ; but my difeafe feemed to baffle the power of medicine and every effort. Having for the laft thirteen weeks lived wholly upon milk, you advifed me to difcontinue the medicine, in hopes I might foon be able to make ufe of ftronger food, and recover a little ftrength. This treatment had the defired effect; and my pains for fome time feemed to abate, but alas ! they foon returned again! when you advifed another courfe of medicine, which operated more powerfully than it had hitherto done, and in a few months reftored me fo as to enable me to walk from my lodgings in the country to town. ( 40 ) The fatisfaction you expreffed on the occafion I fhall never forget, and with myfelf was in hopes of a radical cure. But at the end of three months, my hopes were deftroyedby a violent relapfe, which ibon confined me to my bed. My legs (if poffible) were worfe than before, for not only my fhins, but the main bones pained me dreadful- ly. One node formed (a little below my right knee) in a (liort time almoft as large as an hens egg; The pains from my moulders to my fingers ends I can fcarccly defcribe. The finews of my arms, thighs and legs, ftiff and contracted, my fingers I could by no means bend; they were fixed by difeafe and every joint fwelled. The bones of my head lhared equally with the parts I have defcribed ; and nothing but death was ex- pected to put a period to fuch a fcenc of rnifery. Added to this my body was a rueful fpectacle, a mere fkeleton; fo that difeafe had nothing left but my vitals for its prey. This, Sir, is a faint defcription of the ftate and condition you found me in about three weeks ago, when you vifited me, and with joy in your countenance told me, a new difcovery had been made of a medicine that you had great hopes would reach my cafe; and with your wonted goodnefs of heart cheared up my drooping fpi- ( 4i ) , rits, by defcribing to me its mildnefs and efficacy in feveral cafes fimilar to my own. Encouraged by this information, and relying upon your judge- ment, I was determined to give it a fair trial. I began, and continued to take the quantity as pre- ferred. At the expiration of feven days I found it begin to operate, as you had before defcribed, by creating a faliva in my mouth. On that day I had a defire to be lifted from my bed, and to fit up a little, which was done with fome difficul- ty ; but could not bear my feet on the ground, my knees being alfo in a very debilitated ftate but found my pains greatly abated. I fpit a great deal the next night, which was very thin, and not difagreeable. On the eighth day my pain feem- ed quite gone ; and I requefted again to get up, when to my great furprize I found myfelf capable of bearing the weight of my body on my legs. On the ninth I was capable and abfolutely walk- ed from my bed to my chair, the diftance of fix feet without affiftance. I befpoke a pair of crutches, but, thank God, I never ufed them, nor have had occafion for them; for on the tenth day I walked feveral times backwards and for- wards in my room without crutch or flick, or any other affiftance whatever. On the eleventh day I walked from one room to another, and finding F ( 42 ) it attended with no extra pain, but ftiffnefs and weaknefs in the fhins, I abfolutely walked up a pair of flairs of fourteen or fixteen fteps, and down again. My appetite was now reftored to an amazing degree, infomuch that I found I could not continue the ufual quantity of medicine (which in fact feemed to have operated more like a charm than a medicine) but I continued taking about three parts in four thereof daily. And I have the pleafure further to inform you, that I have walked out feveral times, and yefterday in parti- cular I walked more than a mile, and was in hopes to have furprized you (which I know would have been an agreeable one) by paying you a vifit at your own houfe : but was informed you was from home. Be allured I (hall always efteem it a pleafure to anfwer any queries reflecting my cafe, and the efficacious operation of the acid in fo wonderful a cure. - Believe me to be, Dear Sir, Briftol, Nov. 25th, 1796. To Mr. Baynton. The utility of the nitric acid is not confined to the venereal difeafe alone. Mr. Scott who gave it a fair and ample trial in the Chronic Hepatitis, ( 43 ) thinks it even preferable to mercury in that dif- eafe. Two cafes of Diabetes which came under his care, in both of which the patients were in the decline of life, yielded to the nitric medicine. In the little pamphlet above fpoken of, and from which I have extracted fome of the preceding cafes; a very deplorable cafe of lumbar abcefs is related, by Mr. Sandford, Surgeon of the Wor- cefter Infirmary; which was fuccefsfully treated by the nitric acid. CASE XII. On the 25th of March, fays Mr. Sandford, R. H. aged 22, a farmers labourer, was fent to the Worcefter Infirmary with a lumbar abcefs, that for fome weeks paft had fuppurated, and dif- charged itfelf through a fmall opening above Pou- part's Hgament in the right groin; the thigh on that fide was confiderably enlarged, inflamed, and painful on preffure. Upon his admiffion I thought his cafe fo hopelcfs, and fearful that little could be done to benefit him by medicine or furgery. I was only anxious to have him fent back into the country as foon as poflible, being apprehen- five that confinement in the Hofpital would only haften his death, which at this time feemed inevi- table. ( 44 ) Before he quitted the Infirmary and was made an out-patient, it occurred to me, that it was pro- bable the nitric acid might be tried to advantage in this cafe. I accordingly began by giving him one dram mixed with a pint of water which he took io the courfe of four and twenty hours. He faid it felt warm at his ftomach, and at firft taking flufhed his face ; he continued it however with little interruption from April 4th, to June 10th, a week after which time, he walked from his houfe (eight miles from Worcefter) and called upon me. The wound in his groin' was only drefied fuperficialiy, with a fimple cerat of wax and oil. The difcharge he informed me, had gradually leffened, till it ceafed entirely. The fwelling and inflamation of the thigh had gradually fub- fided, and afiifted by the moderate preffure of a calico roller, was finally reftored to its ufual fize and action. As a proof that this unexpected cure was prin- cipally effected by the means of the Nitric Acid, the poor fellow had a relapfe once or twice during his confinement at home, for want of his medi- cine, the quantity difpenfed to him from the ( 45 ) Infirmary having been all taken before he had an « opportunity of fending for more. I have had an opportunity of trying the Nitric Acid but in one cafe of Scrophula. The refult of which I will now lay before the reader. CASE XIII. December 27th, 1797. F. D—th, aged 20, a pauper in the Alms-houfe, was afflicted with fcro- phula which (he faid (he had had for two months previous to this time. She alfo informed me that her brother had fome years ago fuffered with a fimilar affection, and though fhe could not in- form me whether her parents ever had the dif- eafe, yet I think it probable, from her brother being affected with it, that it was hereditary. At prefent the glands on the right fide of the neck are very much enlarged and very painful. The tumours have opened and difcharged from three fmall ulcers a great deal of matter. On this day (December 27th) I gave her the Nitric medicine. 30th. She had taken daily two drams cf the Acid diluted with water. There is no alteration. ( 46 ) January ift 1798. Has continued the Nitric medicine as before, (he fays her gums feel fore and (he fpits a little. 3d. Has continued the medicine. She com- plains of her mouth being fore and teeth loofe ; her ptyalifm is increafed. The pain in her neck is greatly diminiftied, the ulcers look better, and difcharge lafs. January 6th. She complains much af her mouth, and difcharges about a pint of faliva in the day. She has very little pain in her neck, and the ulcers continue to mend. January roth. Has continued to take the me- dicine as ufual. Her mouth continues in the fame fituation. She has now no pain in her neck, and the ulcers continue to mend. She continued the Nitric Medicine from this time to the 28th day of January, in fuch man- ner as to keep her mouth (lightly affected. At which time two of the ulcers had healed, the other was nearly well, and the tumour fomewhat diminifhed. During the whole time of hex ptya- lifm (he never had a fcetor of the breath. ( 47 ) It muft here be obferved, that unfortu- nate girl, had from her infancy been afflicted with epelepfy, and generally had three or four fits a week. But during the falivation which continued nearly four weeks (he had but five fits. The epelepfy has almoft converted her into an idiot. And (he never from this time could be prevailed upon either by entreaty or threats to take any more of the medicine. The affection of the neck continued for fome time, after the omiflion of the medicine, without alteration. But at the time of my writing this, (which is upwards of two months fince the medi- cine was left off,) the tumour is of the fame fize, and the ulcer, which was nearly healed, and had ceafed to difcharge, has now enlarged its limits and runs much more. The very beneficial effects of the Nitric Acid in this cafe, and the relief received during its exhibition, certainly warrants me to conclude, that if it had been perfifted in, it would in a (hort time have eradicated the difeafe for which it was given. I have feen the Nitric Acid given with advan- tage in feveral cafes of Chronic Rheumatifm. And ( 48 ) in one cafe in particular it produced the happicft effects. CASE XIV. March 20th, 1798. J—s S----th aged 41, was admitted into the Aims-houfe for a Rheu- matic complaint. He informed me that twelve weeks previous to his admiffion into thislnftitution, and immediately after a recovery from a pleurify, he was attacked with pain in the joints of his arms, ancles, and knees, which always became eafier after being warm in bed. This complaint conti- nued to encreafe until the prefent, and he now is confined to his bed, his knees are fwollen, and he is incapable of the flighteft motion without fevere torture. He was ordered to take the Nitric Medicine ; and for five days took daily three drams of the Acid. At this time he found himfelf fo much better as to be able to move his limbs, the pain and fwelling had confiderably abated. The Acid foon after being taken produced a fenfe of warmth in the ftomach, which he compared to the fenfation he had often experienced after a dram of Ardent Spirits. He continued from this time to take from one dram of the Acid to two drams daily. On the eighth day of the exhibition of the medi- cine, his mouth was fore, his teeth fo loofe, that C 49 ) he was apprehenfive they would drop out, and he fpit about a pint in the day. On- the 15th of April to which time he had continued the Acid, he was able to walk about, free from pain, and faid he was as well as he ever was in his life. The Acid appeared to increafe both his appetite and ftrength. He was on this day at his own requeft difcharged from this Inftitution. I have in two inftances g-iven the Nitrate of Alumine, one patient took a dram of it daily for five days, and it produced a falivation and fore mouth, that could be diftinguilhed from the fame effects produced by mercury, only by there being no fcetor in the breath. The ptyalifm continued very profufe for fix weeks after (he omitted the medicine. The fecretion of urine was fo much diminifhed by it, that without my making enquiries to afcer- tain that effect, (he told me, (lie made little or no water and was apprehenfive that fome bad confequences would arife on that account. In the other cafe, it was taken but for two days, and the only effect it produced, was, in fome degree leffening the fecretion of urine. ( So ) If on further trial it fhould be found pretty generally to produce this effect, it will fugged the propriety of giving it, even in preference to the Nitric acid, in cafes of diabetes. The nitrate of alumine which was ufed, I made by precipitating the clay from the common alum or fulphat. of alumine, by the vegetable alkali, and wafhing the precipitate a number of times, to free it from the fait formed by the vegetable alkali and vitriolic acid, then adding the nitric acid and evaporating with a very gentle heat. The fait thus formed is more aftringent than com- mon alum. FROM the preceding cafes it is evident, that the firft effect the Nitric Acid produces on the body, is a fenfation of heat at the ftomach, foon after it is fwallowed, which for the moll part is agreeable. This, though mod frequently the cafe, is, by no means an univerfal occurrence. For in fome of the patients to whom I gave the medicine no fuch fenfation was experienced. I have myfelf (in order to afcertain the effect it would have upon my pulfe) taken at one dofe forty drops, and a fellow ftudent of mine, at my requeft, took fixty, ( 5i ) and neither of us, experienced that fenfation of heat in the ftomach. Nor had it, in an hour (which was the time we attended to the pulfe) the leaft effect on the pulfe. When taken in any confiderable quantity, viz. from two drams and upwards daily, we find that from three to fifteen and twenty days (according to the idiocyncrafy of the patient) it produces a forenefs of the gums, loofenefs of the teeth, pty- alifm, increafed heat of body, and in every refpect incrcafes the combuftion of life. This increafed heat and action in the arterial fyftem, does not arife to fuch an height, as to wear down the fyftem and bring on indirect debility. On the contrary, it appears to give ftrength and vigour to the body. We have even feen a cafe where the pa- tient ,has been fo much debilitated as to be unable to raife his head from the pillow, and after the exhibition of this medicine for a (hort time, he regained his ftrength in a moft rapid and aftonifh- ing manner. There is no medicine which Phyficians have more reafon to regret the want of, than a tonic which will act on every part of the fyftem, and the exhibition of which can be continued lor a ( 52 ) fufficient length of time, to produce durable effects. I (hall not I hope be confidered as chimerical, nor as giving virtues to medicines which they do not poffefs, when I fay, that I have no doubt but that the Nitric Acid will hereafter be acknow- ledged to poffefs thefe two properties. The effect it produced (in fome of the preceding cafes,) in reftoring tone and ftrength to every part of the fyftem, juftifies the opinion of its being an uni- verfal tonic. And that it can be given (if proper care is taken in the exhibition) for a fufficient length of time to produce durable effects, I think is evident from the cafes above alluded to. We have (cen every ftage and form of fyphilis cured by this medicine, and even in habits broken down by the antecedent ufe of mercury, under which the diforder gained ground. The patients recovered their health and ftrength in a (hort time, without the "ufe of diet drinks, bark, or any other tonic medicine whatever. The Nitric Acid is well known to have a (Irons affinity to calcareous earth, which earth is a com- ponent part of the teeth, and from a fuppofition ( S3 ) of a decomposition of the teeth, an objection to its ufe may arife. That the acid in an undiluted ftate will have this effect, no doubt can be entertained. But this objection, can have no weight, when applied to the diluted acid, efpecially if it is combined with fugar, fyrup, or mucilage of any kind. For in none of the cafes in which I have feen it ex- hibited, have I heard the lead complaint of this kind, nor did the teeth in a fingle inftance appear to have differed the lead injury. Yet I think it advifable and prudent, always to wafh the mouth immediately after every dofe of the acid. If after what has been faid any perfbn (hould be timid on this account, his fears may be done away, and the objection obviated, by taking it through a glafs funnel, in which manner it does not come in contact with the teeth. OF THE Oxiginated Muriatic Acid. THE nitric acid is known to be compofed of an active principle, Oxigene, and an inert one Nitrogene. Its beneficial effects in difeafes, have by Mr. Scott been attributed to the active prin- ciple alone. In contemplating the fubject, it occurred to me, that if the cure of fyphilis and fome other difeafes, were to be effected by oxigene, other fubdances might be found, which contained a larger proportion of it, than the nitric acid, and which would, with greater facility part with it. The Muriatic acid, is capable of combining with a very large quantity of oxigene, forming then, what by Chemids is called, the Oxiginated Muriatic Acid, or the Dephlogidicated Marine Acid. From this Oxiginated Muriatic Acid con- taining a very large proportion of oxigene, and from the facility with which it is decompofed. It appeared to me to be well calculated for the oxigenation of the fydem. C 55 ) As reafon dictated, and my fituation gave me the opportunity, I thought myfelf judifiable in trying the experiment. I have never in the courfe of my reading, or in the converfation of my me- dical friends, met with, or heard of, the Oxigena- ted Muriatic Acid being given in difeafes: and as from my experiments, it appears to be a very va- luable medicine.* I think it my duty in this place, to lay before the reader, the refult of my enquiries on this fubject. CASE I. Feb. 12th, 1798. M__S----, aged 18, was admitted into the Alms Houfe with a venereal complaint, (he had a fyphilitic difcolouration of the fkin, eruptions on almod every part of the body and particular- ly on her head, forming a true venereal Tenia Capitis, and an ill conditioned ulcer on the upper and back part of the cefophagus. The forenefs of her throat and the eruption on the dun, com- menced as nearly as die could recollect, about fix weeks ago. Upon inquiry I found that fix months previous to this, (lie had chancres, and a bubo which fuppurated, for which at that time (he took fome medicine which did not produce a ptyalifm or forenefs of the mouth. ( 56 ) She took the following mixture $, Oxig. Muriatic Acid drach. iv. Gum Arab. unc. fs. Aqus Menthse unc. vi. M. F. Cap1, coch. mag. q. q. hora. Feb. 13th. She had taken four drams of the acid, the gums between the teeth were a little fwollen, and there was a (light ulceration, or ra- ther, a diminution of gum at the roots of the teeth, and (lie made more water in the night than (he had been accuftomed to do. 15th. Has continued to take about half an ounce of the acid daily. Her mouth remains in the fame fituation as on the 13th. The pain in her throat is confiderably lefs. And the urinary difcharge is confiderably increafed. Feb. 20th. Kas continued the medicine as ufual. She complains of her teeth being loofe, but has no ptyalifm or fcetor of the breath. Has no pain in the throat and the ulcer there is near- ly well, many of the eruptions have difappeared, and the others are drying up fad. The fecretion of urine is fo great that (lie is obliged to rife three four and five times in the night to difcharge it. ( 57 ) 26th. Has continued the medicine. Her teeth are loofe, and (he fpits a little, but hrs no fcetor of the breath. The ulcer in her throat has healed, the eruption on her body has entirely difappeared and thofe on her head 2re nearly well but the difcolouration of the fkin dill conti- nues. Her urinary difcharge continues increafed. March yd, 1798. Has continued the medi- cine. Her mouth is in the fame date as on the 26th, of Feb, The eruption is entirely well and the (kin is renaming its natural colour, (he con- tinues to difcharge a large quantity of urine. 12th. Has continued the medicine. Her fkin is perfectly clear and of the natural colour ; and (he appears to be well. She was therefore dif- charged from the venereal ward. CASE II. February 2d, 1798. C . e N—e aged 20 years; applied to me for affidance. She had four fmall chancres, two about the clitoris and the others on the nymphas, which (he had con- tracted two weeks before. I defired her to take the following; H ( s« ) 5> Gum : Arab unc : fs. Aquas Menth : unc : vi. Oxig : Muriat: Acid drach : iv. M. Capiat : coch : Mag : q. q. : hora. 6th. She had taken the above mixture daily. Her chancres were lefs painful. She difcharges more urine than cuftomary. 12th. She has continued the medicine, (he has no pain in her chancres and upon examination I find that two of them have healed and the others are better. 20th. Has continued the medicine. Her chancres are nearly well i has ftill a great urinary difcharge. February 28. Has continued the medicine, her chancres have healed and (he thinks her- felf well. I directed her to take the Acid a fortnight longer by way of infurance which (he did. In this cafe the Acid did not appear to affect the mouth with forenefs or ptyalifm. N. B. This patient did not take a grain of mercury. ( 59 ) The chancres were dreffcd with fimple cerate. CASE III. February 8th, 1798. M— D----n, aged 30 years put herfelf under my care for a chancre, which fhe had contracted three weeks before. I gav* her the following mixture ; & Gum : Arab : unc : fs. Aquas Menth : unc : vi. Oxig : Muriat : Acid drach : iv. M. F. Capiat, Coch : Mag : q. q. hora. She took from this time to the twentieth of March about four drams of the Acid daily, wherj her chancre was healed ; the medicine had no fenfible effect on the fyftem, except its powerful action as a diuretic. N. B. No mercury had been taken by this patient. CASE IV. A— M----, aged 29 has for the two years laft paft, been a fufferer with the venereal difeafe, its firft commencement was with pains in the bones, which were foon followed by nodes, ( 60 ) fhe has been feveral times relieved by medicine, and though (he has, under the care of different phyficians, gone through four courfes of mercury, yet the difeafe has never been eradicated. She was admitted into the Alms-houfe in No- vember 1797; with nocturnal pains, an ulcer in the throat, and an other on her forehead, which expofed part of the frontal bone, from which there was an exfoliation. On the fixth of No- vember (he began her fourth mercurial courfe, and continued it until the 9th of January 1798, with little or no relief. For though both the ulcer in the throat, and that on the forehead had healed, her pains had not abated, and nodes appeared on different parts of her head, and one on each hu- merus near its articulation with .the fore arm, which prevented the motion of thofe- joints. By the ufe of mercury, the continuance of the dif- eafe, and the occafional occurrence of a diarrhoea, which it was difficult to reftrain, the unhappy patient was very much emaciated and fo debili- tated as to be unable to rife from her bed. She had in addition to the fymptoms juft now related, a diarrhoea, night fweats and cough. The mercury was omitted as the difeafe under i:s ufe, was rapidly gaining ground. ( 61 ) On the 19th of February, the patient, in the above fituation, was directed to take ten grains of the nitrate of alumine every two hours. This medicine for two days agreed with her. It check- ed the diarrhoea, and fhe thought it diminifhed her flow of urine. But on the third day her fto- mach rejedted it and it was omitted. She took for fome days opium to allay her pains and the irritation of the ftomach. On the 30th of Febru- ary, fhe commenced taking the oxigenated muri- atic acid. For the firft three days after her com- mencement with this medicine, fhe took three drams of the acid per day. In which time fhe found confiderable benefit from it. Her pains were lefs violent and fhe was in better fpirits. The medicine had no other fenfible effect except proving diurectic in a confiderable degree. From this time fhe took from a dram and half to two drams of the acid daily. On the tenth day of taking this medicine, fhe found that her pains had almoft left her, and fhe had fo far recovered her ftrength, as to be able to get out of bed and walk acrofs the floor. Her nodes were leifenino-. o The only objection fhe had to the medicine was its proving powerfully diuretic. She complained that in the night (lie could not remain long enough in bed to get warm, on account of the frequent calls to evacuate her urine. In three ( 62 ) weeks (he was able to make her own bed, her nodes were faft difappearing, and (he could bend her elbow joints with eafe. The acid continues to prove mod powerfully diuretic. She took the acid condantly till the id, of April, (one month) when it was difcontinued, on account of her mouth becoming very fore, and a pTofufe ptyalifm taking place. Her pains have entirely left her, and very little appearance of her nodes remain, on an average (he difchargCs three large potfuls of urine a day. Orf the 16th of April her mouth was well, her pains did not return, her nodes have all difappeared but one which is on the malar bone and that one was on the decline. She thinks herfelf perfectly well. I advifed her to take the acid three weeks longer by way of infurance. The preceding cafes certainly prove, id, That the Oxiginated Muriatic Acid, is competent to the removal of fyphilis in any of its forms, and in as (hort a time, at leaft, as could be done by mer- cury. 2dly, That a falivation by it, is not neceffary in the cure of the difeafe, for in Cafe 2d, and 3d, no ptyalifm was induced. ( 63 ) £dly, That it acts as a tonic. And 4th. That it proves powerfully diuretic. From the oxigenated Muriatic Acid, in every inftance in which it was exhibited, proving pow- erfully diuretic, I flattered myfelf that it would be found an invaluable medicine in dropfy. And a cafe of hydrothorax, which I (hall proceed im- mediately to relate, (and which was the only cafe of dropfy, in which I had an opportunity of giving it a trial,) tends not a little to corroborate the opinion. March 28th, 1798. E. S. A pauper in the Alms-Houfe, complained to me, of an anxiety about her bread, a difficulty of breathing, which was encreafed when die attempted to walk fad, and more efpecially when die afcended the dairs, (he had frequent dartings in her deep and palpitations of her heart, fhe had alfo with thefe fymptoms cedematous legs, and fcantinefs of urine. The dyfpnea, die told me, fhe had had for a fortnight, and the fwelling of the legs (he difcovered a week ago. She took the following medicine'. J$> Aquas Menth unc : vi. Ox : ig : Muriat : Acid drach : iv. M. capiat coch : Mag : q. q. hora. ( 64 ) March 29th, 2d day. She had taken the Acid as directed without the lead alteration. 3d day. Has continued the Acid ; has made a great deal of water, and thinks her difficulty of breathing is fomewhat lefs. 4th day. Has continued the medicine the fe- cretion of urine is fo much increafed that fhe was obliged to rife five times lad night to difcharge it. She thinks too, that die difcharges much more at a time, than fhe was accudomed to do before the ufe of this medicine. The affection of her bread and difficulty of breathing, are much lefs troublefome and her legs are not fo much fwollen. 5th day. She is better in every refpect. She continued from this time, to the 10th of April, (the 13th day fince her commencement with this medicine) from three to four drams of the Acid per day. The affection of the bread, has feveral days fince difappeared, (he is able now to afcend the dairs without the lead inconvenience, which at the commencement with this medicine, fhe was not able to do without, fitting down to reft herfelf. The oedema of her legs are no more to be feen, and (he appears in every refpect perfectly redored to health. ( 65 ) In the above cafe it mud be obferved, that although the patient was ordered to ufe diluents freely, yet from an idea that it would encreafe her fwelling, (he drank as little as pofiible, yet notwithstanding this it proved powerfully diu- retic. Now almod all diuretics, and even digitalis itfclf, which is judly edeemed one of the mod powerful we are acquainted with, produce little or no effect that way, without the ufe of diluents. I would not from this, be imagined, to recom- mend the prohibition of diluents, when the Ox- * igenated Muriaric Acid is exhibited as a diuretic. So far from it, that I am perfuaded, that the free ufe of drinks, increafes the action of this, as well as all the medicines of the diuretic clafs. My only intention in mentioning this, was to edablidi the fact, that the Oxigenated Muri- atic Acid, proved powerfully diuretic, (at lead in this cafe) without the affiftance of diluents. I* The Oxiginated Muriatic Acid which was ex- hibited in the preceding cafes, contained the larged pofiible quantity, of Vital air. I made it by didilling the common Muriatic Acid on Manganefe. ( 66 ) THAT the utility of the Nitric and Oxige- nated Muriatic Acids, in curing difeafes is owing entirely to the oxigene they contain, will I am perfuaded, from a knowledge of their compofi- tion, be controverted but by few. And in my mind there exids not a doubt, but that mercury acts on the fame principle with them, in the cure of lues venerea and fome other difeafes. I am well aware, that it is the almod univerfal opinion among Phyficians, that the anti-venereal properties of the different preparations of mer- cury, belong exclusively to the femi-metal, and that the different preparations, only ferve the purpofe ofdifpofing it, to be taken into the fyf- tem. It may not therefore be improper in this place to take fome notice of this opinion. It is a fact well afcertaincd, and familiar to every practitioner, that mercury in its crude date, has no effect on the human body. Indances have been known where it has been taken from one to two ounces daily, for feveral years with- ( 67 ) out producing the lead evident effect on the con- ditution. * It is alfo a fact well afcertained, that thofe pre- parations of mercury, which have the greated quantity of oxigene in their compofition, are the mod active. A very driking example of the activity of the different prepararions of mercury being owing to the quantity of oxigene they contain, appears on comparing the effects of calomel and corrofive fublimate. The calomel is a very mild prepara- tion of mercury, and the corrofive fublimate, is a very active one. And the only difference in their preparation is, that calomel is made with the common muriatic acid, and the corrofive fubli- mate with the Oxigenated muriatic acid. In this cafe, the greater activity of the corrofive fublimate, can be attributed to nothing elfe, than its fuper- abundant oxigene. In the mercurial ointment, it is generally fup- pofed, that the mercury is merely in a date of extreme divifion, and that the lard made ufe of ferves no other purpofe, than to keep the pi; ti- cks of quickfilver feparate. * Gertanner on the principle of irritability. ( «S ) In anfwer to this opinion, I will obferve, that mercury, like all other metals, is capable of oxi- dation ; this has been proved by a -number of experiments. I have at prefent lying on the table before me, near a dram of a dark coloured oxide, which was taken, from a vial containing mercu- ry, which an old woman, now in the alms-houfe, from fome fuperditious notions, had worn next her fkin for thirty years. The oxidation here, mud have been effected by the almod inceffant agitation of the mercury by her motions, in this great length of time. The lard then, in making mercurial ointment, ferves the purpofe of dividing the mercury, and thus expofes a larger furface of the metal to the air for oxidation. Every man who has evrr rub- bed down mercury for his own ufe, mud know, that the longer the trituration is continued, and of courfe the greater the furface expofed to the air, the more powerful will be its effects, and the deeper colour will it affume. Now both lard and mercury are white, and if their mixture in making an ointment, was mere- ly a mechanical diffufion, and no chemical com- bination, the ointment (hould be white alfo; but this is not the cafe, and as the oxide of mercury ( 69 ) is of a black or dark grey colour, is it hot more reafonable to fuppofe that the mercury is oxided, and this oxide gives its colour to the lard. The fame arguments will apply to the blue pill and other preparations of the fame kind. As there is very little doubt but that all the preparations of mercury contain oxigene, a quedion may arife, are there any proofs of a decompofition of the different preparations of mercury in the body ? The anfwer is, yes, num- berlefs facts prove it. Doctor Garthfhore, men- tions an indance of a Gentleman, who took cor- rofive fublimate only, and who had thofe parts of his flute, which were filver, on which he played, evidently tarnifhed with mercury. Mr. Clare, in an effay flyled a new mode of curing lues venerea fays, that he has repeatedly feen gold rings on' the fingers, gold watches, and money in the pocket, become white and black from corrofive fublimate, calomel or mercurius calcinatus exhibited by the mouth. Now, neither, corrofive fublimate, calomel or mercurius calci- natus, either in their own form or mixed with water, have the lead effect in amalgamating either aold or filver. And of courfe thefe preparations muft have been decompofed and the mercury re- ( 7o ) duced to its priftine ftate, before the above amal- gamation could take place. I could quote num- berlefs inftances, from authors, of mercury being found in its revived ftate in different parts of the body after death. But nothing can tend more to the eftablifhment of this doctrine, than fome experiments made by Dr. Thomas Kirkland " many years ago'' (fays the Dr. in his Child-Bed Fevers, page 114) "I gave a fcruple of calomel to a dog that was very ill. It did not purge him and he died in the night. Next morning we opened him when I found, to my great furprize, the mercury returned to its priftine ftate, and globules of quickfilver adhering to the coats of the ftomach." He likewife mentions that feve- ral other fimilar experiments were followed by the fame refults. Mercury and Nitrcgene in their fimple ftate are known to be fubftances that produce no effect on the conftitution, and it is more than probable that the bafe which with oxigene forms Muriatic acid, is likewife inert. Now as thefe three inert fubftances, which in their nature are perfectly diffimilar, are each united to oxigene, a fubftance of active properties, and we find that the different preparations formed by their union, are all eafy 6f decompofition, and all produce the fame effect ( 7i ) in fome difeafes, and as the effect produced is in proportion to the quantity of oxigene contained in the preparation. I think we may with juftice conclude, that the power of thefe medicines de- pend on the oxigene alone, and that the inert fubftances, act only as vehicles to conduct it into the fyftem. I have, in the preceding pages, given, in as concife a manner as I was able, the refult of my inquiries on this fubject. It was my intention when I firft undertook it, to have afcertained the effects of a number of, other fubftances, which contained a large propor- tion of Oxigene and are eafy of decompofition: as Oxigenated Vinegar, Oxalic Acid ; Oxigena- ted Muriate of Potalh, and many other fubftan- ces,* all of which I am perfuaded will be found * Since this effay has been in the hands of the Printer, I have feen the fourth number of the firft volume of the Medical Repofitory which is juft publiihed. In it I have the happinefs to find that Mr Cruikfhanks, has given the Oxigenated Muri- atic, and the Citric Acids, as well as the Oxigenated Muriate of Potalh, in fyphilis with fuccefs. In the fame No. we alfo find that Mr. Alyon, ufed the Superoxigenated Muriate of Potafh in cafes of chancre and fyphilitic ulcers, and found the good effe&s from it, more expeditious and more certain than thofe of any mercurial preparation. ( 7- ) to poffefs nearly the fame medicinal properties. But ''he fhortnefs of time (fix weeks) which was alloted for the preparation of this effay ; and a large portion of that time being neceffarily oc- cupied in my duty as an apothecary to an inftitu- tion in which there are an hundred patients, and only another gentlema . and myfelf to attend to them, obliged me, for the prefent, to abandon this very interefting fubject. It would be injuftice in me to clofe thefe pages, without paying the debt of gratitude, due the phyficians and furgeons, of the Alms-houfe and houfe of employment of Philadelphia, Drs. Samuel Dufneld, William Boys, John Church, and Thomas C. James, who have generoufly per- mitted me to exhibit the Acids in fome of the preceding cafes. And I now- beg leave to return them my fincere thanks both for this, and other favours conferred, fince I have had the honour of being a pupil in that Institution. FINIS. \ I Mea.. Hist. WZ ? °\ 5?'u £•] ""■j £*■ JL