■t\" ? • m S. S. & W. Wood's Medical Catalogue. Clinical Lectures on the Principles and Practice of Medicine. BY JOHN HUGHES BENNETT, M.D., F.E.8.E., Professor of Institutes of Medicine, and Senior Professor of CUnical Medicine in the University of Edinburgh. 1 vol. 8vo. 1005 pages. With five hundred Illustrations on Wood. Price, $6, free of Postage. "We recommend this volume with the most unqualified praise, to the attentive considera- tion of the practitioner and students. We have met with no work of late years on the prin- ciples of Medicine more likely to advance the true and rightful study of our art."—Medical limes and Gazette. " One of the most valuable books which have lately emanated from the medical press. No one devoted to the profession will fail to peruse these lectures, and acquaint himself with the discoveries of so ardent an explorer in the field of medicine."—New York Journal of Medi- tine. " We most heartily commend it to the yonng and old, the disciple and the master alike."— Charleston Medical Journal and Review. " A new work, in which the applications of the microscope to clinical medicine are treated by a master hand. The great value of this work is, that it embodies, in a clear and concise manner, all the applications of the microscope to practical medicine. It is, in fact, a perfect manual on this subject, and as much to be welcomed by all who consider diagnosis as the most important element in the study of disease."—New Orleans, Medical News and Hospi- tal Gazette. SILVER SUTURES IN SURGERY. BY J. MAEION SIMS, M.D., Surgeon to the Women's Hospital. 69 pages, 8vo., with Illustrations on Wood Price, 50 cents, free of Postage. OF NATURE AND ART IN THE CURE OF DISEASE. BY SIE JOHN FOEBES, M.D. (OXON.), F.E.S., Fellow of the Royal College of Physicians, Physician to the Queen's Household, etc., eta. From the Second London Edition. Price, $1, free of Postage. " The error which the author regards as the great taint of medical science, and which he combats throughout the book, is a want of trust in the powers of Nature to arrest the pro- cesses of disease, and a consequent overweening faith in remedial agents as the sole means of cure. His main object is to endeavor to expose these misconceptions, and to impress the minds of the younger and less prejudiced members of the profession with the truth and importance of the principles advocated, and also to prepare a work which might convey to educated members of the general public a juster knowledge of the real nature of disease, and the true character and powers of the medical art........We cannot but believe that the courageous advocacy by Sir John Forbes of views so much opposed to the prejudices of a large class in the profession, have contributed not a little towards the reformation of the drugging system. Most sincerely do we thank him as a benefactor of his profession and of mankind."—Brit, and For. Medico-Chirurgical Review. "This book gives explicit and coherent expression to that feeling of reaction against violent or perturbative practice, which has been going on In the profession for the last twenty-five years, and may now be considered as settled and fixed He explodes, almost by a simple statement of it, the opinion of disease being a separate entity destructible by the introduction into the system of an appropriate remedy; and he recalls to our attention, in a truly philo- sophical form, the sanative powers of Nature......All this, Sir John Forbes does ably > 4 well, and we listen to him with the attention due to a master in Israel."—Edinburgh. nfodical Journal. " In this volume Sir John Forbes aims to show that Nature has much more to do with tne cure of disease than Is generally supposed either by laymen or by the profession, and that Art •ocomplishes much less in that way than is commonly imagined. The book is designed not toerely for the profession, but for Intelligent readers generally."—British Quarterly Review. . . . . " We recommend this thoughtful and suggestive book to the careful perusal of -i\ who'value health, and especially to those who habitually resort to medicine. They will be toss ready to fly to pills *nd powders when they know tht» mischief these produce."— 7ks Critic. &'. 5. fy IV. Wood's Medical Catalogue. A MANUAL OF OBSTETRICS. BY THOMAS F. COCK, M.D., Physician to the New York Lying-in Asylum. Price $1, free of postage. " We doubt If more matter could well be compressed into the same space than has been done In this unpretending little book, which Is the very type of a ' manual.' It is Indeed, as our author calls it, a skeleton collection of facts ; and they are such facts as every one ought to be acquainted with."—New York Med. Times. " An excellent companion for the lecture-room."—Peninsular Journal of Med. " Incomparably the best tnultum in parvo we have seen."—Med. Chron. " A most excellent compendium of midwifery. It should, indeed, be the Obstetrician's Vade Mecum."—Nelson's American Lancet. " A plain, sensible, Judicious, and reliable manual."—Kentucky Med. Recorder. "An able and valuable work, abounding in useful information, from which all may reap bene- fit."—Med. Examiner. " Well adapted to the student attending lectures, as it presents to him at a view, briefly and yet as thoroughly as can well be, the facts which may be presented to his notice in the lecture- room. It must undoubtedly meet with favor, not only with the student, but likewise with the advanced practitioner, who can, without wading through a mass of speculative views, at once refer to any facts he may require to refresh his mind with, in moments of emergency and forgetfulness."—Eclectic Medical Journal. "It is a valuable book for students—Is cheap—and we advise our young friends to possesi themselves of It."—Nashville Journal of Medicine and Surgery. THE DUBLIN DISSECTOR; OR, MANUAL OF ANATOMY- Comprising a description of the Bones, Muscles, Vessels, Nerves, and Viscera; also the relative Anatomy of the different regions of the human body, • with the Elements of Pathology. BY EOBERT HAEEISON, A.M., M.B., Professor of Anatomy in the Eoyal College of Surgeons, in Ireland, &c Third Edition. With additions by EOBERT WATTS, JE., M.D., Professor of Anatomy in College of Physicians and Surgeons, N. Y. Price $1 25, free of postage. "A work of such sterling merit may well be the companion of every student in the dissect- ing-room."—Peninsular Jour, of Med. " Its descriptions are clear and accurate, and its Instructions to the dissector are such as te make the most advantageous use of material"—Buffalo Med. Jour. "Our experience enables us to recommend it cordially to every student of anatomy."— Stethoscope. " We consider Its method of arrangement to be one of the very best for communicating prac- tical anatomical knowledge, with a view at once to clearness, completeness, and economy ol material."—Memphis Medical Recorder. MATERIA MEDICA AND THERAPEUTICS. BY MAETYN PAINE, A.M., M.D., LL.D, Professor of the Institutes of Medicine and Materia Medica in Vie University of New York, <&c.t Ac Trice, $1 25 "It abounds in facts, presented in the fewest words." It "gives the essence of all the er»at treatises extant, on the Materia Medica, and therefore must always be a convenient book for reference as authority."—Boston Medical and Surgical Journal. " We have no doubt the objects of the profound author are fully carried out in the work and • it must prove of great assistance to a student attending his lectures."—Southern Medical and Surgical Journal. " As a text-book for the student, and as a convenient reference-book for the practitioner we regard it as a very valuable contribution to the profession."—Missouri Med. & Surg. JourmiL " To the young gentlemen attending his lectures It will prove a convenient and useful work " — Western Journal of Medicine and Surgery. " It will be found to be a useful and convenient book for determining readily the DroDertiea Mid doses of different medicines, and for ascertaining what are the proper doses and most an!. 5roved formula to be used in their administration, and as such we cheerfully recommeud ft.'1-- Torth- Western Medical and Surgical Journal. S. S. Sf W. Wood's Medical Catalogue. Microscopic Anatomy of the Human Body, IN HEALTH AND DISEASE. Illustrated with numorous drawings in color, by Arthur Hill H assall, M.B.; Member of Royal College of Surgeons of England, &c, &c. With additions to the Text and Plates, and an Introduction, containing instructions In Microscopic Manipulation, BY HENKY VAN AESDALE, MJ). Price $7, free of postage. 2 vols. 8vo., 79 plates. " Every page of it is a banquet, unfolding the marvels of creative wisdom and power. Such extraordinary displays of the minute organization of the internal mechanism of our bodies m the two conditions of health and disease, create a strange feeling of wonder and amazement. While the work teaches how to understand appearances, it also points out the physiological functions and anatomical relations of parts. In short, the why and the wherefore in the sub- jects treated of are presented in a clear light."—Boston Medical and Surgical Journal. " We express the conviction, forced upon us, after several years' consultation of slmilaj works, whilo pursuing microscopical studies, that there is none better arranged and illustrated, and none which will give so general satisfaction, as that of Mr. HassalL edited by Dr. Van Arsdale."—New York Journal of Medicine. " It Is marked by a simplicity of description, and by scientific accuracy in argument. With these (the plates) we are delighted. The coloring is magnificent—not too high, nothing extra- vagant about it, but truthful, ueat, accurate, and faithfully representing the object* as we have sometimes seen them In the choicest specimens of Parisian mounting."—Buffalo Med. Jour. " It is pre-eminently the best illustrated microscopic human anatomy that is accessible to us In this country."—Medical Examiner. " A work of acknowledged ability and interest."— Western Journal of Medicine and Surgery. " It is not merely a scientific, but it is furthermore a practical treatise; and in both characters It equally sustains a high character. The getting up of the illustrations is exquisite; each one arms a perfect picture."—Medical Chronicle. "The most complete in this department."—Nelson's American Lancet. " It is magnificently published. It Is the only complete work of the kind in the English lan- guage, and reflects high credit upon its learned and indefatigable author."—Southern Medical amd Surgical Journal. PRINCIPLES OF PHYSIOLOGY, Designed for the use of Schools, Academies, Colleges, and the General Eeader. Comprising a familiar explanation of the Struoturk and Functions of the Orhed."- 8. S. if W. Wood's Medical Catalogue. LECTURES ON THE ERUPTIVE FEVERS, AS NOW IN THE COURSE OF DELIVERY AT ST. THOMAS* HOSPITAL, LONDON. By GEOEGE GEEGOEY, M. D., Fellow of the Eoyal College of Physicians of London, Physician to the Small Pox and Vaccin- ation Hospital at High Gate, Corresponding Member of the National Institute of \\ ash- tngton, etc First American Edition with numerous additions and amend- ments by the Author, comprising his latest views. With Notes and an Appendix, embodying the most recent opinions on Exanthe- matlc Pathology, and also statistical tables and colored plates. By H D. BULKLEY, M D., Physician for the New York Hospital, Fellow of the New York College of Physicians a'.d Surgeons, etc., etc Price, $2 50, free of postage. " This is a beautiful volume, and got up in the most attractive style. The volume contains the fullest and most comprehensive account of that most interestinz class of diseases, the Ex- anthemata, to be met with in a single volume in the English language or in any languairo. We have no hesitation in saying that the smallest medical library is most lamentably detective without this book, and whoever procures It will feel that it is absolutely indispensable to the general practitioner."—Nashville Journal of Medicine and Surgery. "The very best which has yet been published on Eruptive Fevers; and one which it should be the duty of every physician to provide himself with."—Northern Lancet. " We cordially recommend it as the production of a man who has thoroughly investigated the subjects of which it treats."— Western Journal of Med, and Surgery. " This work abounds with valuable Information in regard to a class of diseases of very fre- quent occurrence and of fearful mortality."—Stethoscope. OPHTHALMIC EIEMOEANDA Respecting those Diseases of the Eye which are more frequently met with 1b Practice. By JOHN FOOTE, rELtOW OS" THE ROYAL COLLEGE OP SURGEOKS IN LONDON, ETC^ ETC. Price, 87$ cents, free of postage. *"A delectable, pithie and righto profitable worke'—a genuine mvltvmin parro—containing a brief account of nearly every ophthalmic disease, and the most approved treatment, without theory, or speculation, or doubtful practice. '—Buffalo Med. Journal. "A very useful little manual on Ophthalmic Diseases, drawn from the highest sources, and the best authorities, in the personal experience of the author, altogether forming a very conve- nient book of reference to the student and practitioner of medicine. There is no subject con- nected with the eye, passed over; and the rules of treatment laid down are in a high degree safe and judicious."—N. York Journal of Med. " His definitions are accurate, his descriptions are concise and clear, and his treatment of this very important class of diseases, is authentic, and in accordance xith sound experience."— Ohio Med. and Surg. Journal. THIRD EDITION OF Lectures on Materia Medica and Therapeutics, Delivered in the College of Physicians and Surgeons of the University of the State cf Nov York, by JOHN B. BECK, M.D., Late Professor of Materia Medica and Medical Jurisprudence, prepared for the press by Ms friend, C. E. OILMAN, M.D., Professor of Obstetrics, dtc, in the College of Physicians and Surgeons, New York. One voL 8vo. Price f 8, free of postage. -Admirable for students. Everything Is clear and concise."—Jy. Y. Medical Times. " As a text-book for the use of students, we know of no bettor treatise, and very few indeed, tnat are so well adapted."—American Journal of Medico! Science.. " Wo know of no work of its size on Therapeutics which is jo elaborate, and so worthy of &* soafldenoe of the profession, as this."—Boston Judical and Suraical Journal. & 5. ^ W Wood's Medical Catalogue. An ENTIRELY NEW AND VALUABLE WOHK on Digestion and its Derangements. The Principles of Eational Medicine applied to Disorders of the Uimentary Canal. BY THOMAS K. CHAMBERS, M.D. Price $2 25, tree of Posiasre. / " This is no common publication, to be taken up and thrown aside, but the result of deep stud? and patient investigation. The author has travelled step by step through the intestinai/caiml, assigning to each part, where possible, its definite symptoms and treatment."—Dublin Quar- terly Journal of Med. Science. " Digestion and its Derangements, Is one of the most interesting and instructive works of its kind that we have read ; and we believe Dr. Chambers has done good service to medical science !n showing, as he has done, the intimate relation which exists between physiology and practi- cal medicine."—Med.-Chirurgical Review. "A work of rare merit, and should be in the hands of every practitioner."— Eclectic Med. Journal. •' To the pr"-ritioner, no work is better adapted, and to the general reacer much will be found to direct in managing the digestive apparatus—an apparatus, when out of order, tho niuai difli- cult frequently to restore."—Ohio Med. and Surg. Journal. "Very few special works will compare with the one before us; the philosophical view of its author, their basis upon the strongest and firmest grounds, the lucid practical deductions, the felicity of expression, and the easy snd pleasing style, all tend to make it not only an agreeable but an eminently practical work."—Nelson s American Lancet. " We desire to direct the attention of the profession to this useful volume."—Cincinnati Medical Observer. " Should be studied by every one."—Charleston Medical Journal. " We sincerely recommend it as one of great value, which should be in the possession ol every practitioner."—Boston Medical and Surgical Journal. " Dr. Chambers wields a vigorous pen, and in the work before us the traces of a master mind Illuminate every page."—Western Lancet. "Dr. Chambers' book is one of the most philosophical which' has for some time emanate J from the British medical press. It is a book which we would, with a good conscience, recom- mend to a brother practitioner, or place in the hands of a pupil."—Association Med. Journal. "The volume abounds A-ith originality, as was, indeed, to have been expected from a physl- eian of such eminence as the late Dr. Chambers, who is not so much notorious for having ha(J for years the largest practice in England, as for having been one oi the most diligent cultivators of pathological medicine in the United Kingdom. Verily his 'decennium pathologicuin' is a monument perennius auro "—Medical Chronicle. On Rheumatism, Kheumatic Gout, and Sciatica; THEIR PATHOLOGY, SYMPTOMS, AND TREATMENT. BY HENEY WM. FULLEE, M.D, CANTAB, Fellow of the Eoyal College of Physicians, London, &c, &o. Price $1 75, free of postage. "One of the most complete, philosophical, and satisfactory treatises which has yet ap^eartd en the subject of rheumatism."—St. Louis Med. and Surg. Jour. " A valuable,,well-timed, and very complete monograph."—.V. O. Med. and Surg. Jour. •• A highly valuable work -on the pathology and treatment of rheumatism."—Peninsular Jour, of Med. '• The work Is one of much merit—plain, practical, and comprehensive."— Western Lancet. "Full without redundance, and learned without pedantry."—New Jersey Med. Reporter. " By far the most practical and useful treatise that has lately Issued from the press on the subject of rheumatism."—Up. Canada Jour. " An able exposition of all that Is known or recognized as plausible and correct upon this Interesting affection."—Georgia Blister and Critic. " One of the best practical works of modern times."— Winsloufs Jour, of Psychological Med- " A very valuable treatise on the subjects mentioned. Decidedly in advance of any other monograph upon the different forms of rheumatism."—Buffalo Medical Journal. "This volume must rank high as authority upon the diseases it so fully and ably describes It is a capital monograph, and well deserving of a prominent place in every library "—Net. ion's American Lancet. J' "Worthy of a^lace In the professional library, for its rich record of cases, Us abundant sta- tistics ofrheumatlsm, its clear statement of facts, and its useful suggestions."— & Y. Daily Times "It contains a more complete description of rheumatism in its manifoh. phases and relations fcfta ts to be mat wtr,b ia wsy ottsr w«u,*.>w« on tae s&b»?*t."—Mpj1*,u;1 A'sert 'n.nex LECTURES MATERIA MEDICA AND THERAPEUTICS, DELIVERED IN THE COLLEGE OF PHYSICIANS AND SURGEONS OP THE UNIVERSITY OF THE STATE OF NEW YORK. BY JOHN B. BECK, M.D.; LATE PEOFESSOE OF MATEEIA MEDICA AND MEDICAL JUTtlSPKl'DENCE. PREPARED FOR THE PRESS BY HIS FRIEND, C. R. GILMAN, M.D;, PEOFESSOE OP OBSTETEIOS, ETC., IN THE COLLEGE OP PHYSICIANS AND SURGEONS, N. Y. THIRD EDITION. N E W Y 0 R K : SAMUEL S. & WILLIAM WOOD, 389 BROADWAY. 1861. av :B3RkL 1*26! c. I FUfw-no. 101+30 j Hc^n f Entered according to Act of Congress in the year 1851, by A. S. BECK, In the Clerk's Office of the District Court of the United States, for the Southern District of New York. R. CRAIGHEAD. Printer and Stereotyper, (Caiton Builfcina, 81. 83. and 85 Centre st., N. Y. llmtrat nf tlit €nlk$t OF PHYSICIANS AND SURGEONS OP THE ^nikrsiig of i\z gtate of $tefa fori Gentlemen : I dedicate these Lectures to you in the hope that in their present shape they may meet with a portion of that favor with which you received them when they came from the lips of the Author. C. R. GILMAN. « PREFACE T0 THE FIRST EDITION. In presenting these Lectures to the friends and admirers of the late Dr. Beck, and especially to the Alumni of the College in which he labored so long and so faithfully, a word or two explaining my own connexion with them seems to be proper. After the death of my friend I was informed that he had partly prepared his Lectures for the press, and I was requested to look at the papers and give an opinion as to whether they were in a state fit for publication, and if so to prepare them for the press. With this request I felt very reluctant to comply. Quite a number of circumstances seemed to me to point out another person for this duty; and for myself, I felt that neither bv previous study nor by habits of thought was I at all rea- sonably fitted for this task. There existed, indeed, but one reason why I should be selected, and that, having undertaken the clutv, I have placed with a pride deeply mingled with sorrow upon the title-page. We were friends. For twenty-five years of constant intercourse, no shade of doubt, distrust, or ill- feeling, passed between us. This, and deference to the wishes of one whose devotion to his happiness when living, is only equalled by her zealous interest in his fame when dead, induced me to undertake this labor. I found, on examination, that on most subjects the Lectures had been re-written with apparent care ; on others, this was done only partially ; and in one or two VI PREFACE TO THE FIRST EDITION. instances the leaves of the old Lectures were intermingled with very small portions of the new manuscript. Such was the form in which these Lectures came into my hands. Though well aware of the great amount of labor which the preparing of such a mass of matter for publication would involve, I did not shrink from it; I believed that the Lectures contained a valuable digest of the present state of knowledge in this department, and that they would be acceptable to the profession and useful to medical students. Whether my estimate was the dictate of sound judg- ment or of partial friendship, the profession into whose hands I now commit the work will, of course, decide for themselves. In preparing the work for the press my agency has been merely ministerial. Where the manuscript was re-written, and free from verbal inaccuracies, it passed out of my hands untouched ; where it seemed to me that the language could be made more clear, verbal alterations have been made; where, as happened in a very few instances, a fact was stated inaccuratel}7, the state- ment was corrected ; further than this I did not feel at liberty to go. The opinions are those of Dr. Beck, not of his Editor. In some cases these opinions are contrary to those which I have formed, and been in the habit of teaching ; still they were his, and I did not attempt to modify or impugn them. In a few places I have added a few words where I thought by doing so I could make the book useful for students: in all cases these additions, une Mo imputantur" are included in brackets. To these remarks there are two exceptions of sufficient importance to be specially noticed and explained. On examining the manu- scripts I found proof of a fact of which I was before cognizant, viz. that on many of what are called the " New Remedies," Dr. Beck did not lecture. He was in truth, as these Lectures in almost every page will prove, not a runner after new things; his study was much more into the indications of treatment, the circumstances modifying the operation of medicine, and those kindred topics which I should call the philosophy of Materia Medica, than into the character and claims of new and fashion- able therapeutic agents. This explains the fact that many " new things" found no place in his Lectures. I had no disposition PREFACE TO THE FIRST EDITION. vii to alter them: in this respect I shared his opinions, and concurred heartily in his plan of teaching. Still there were two subjects which I supposed it proper to introduce into the book, although I found no notice of them in the Lectures. One was, to be sure, a new and fashionable, and a most extravagantly vaunted agent, Cod Liver Oil; still it appeared to me that in a matter with which the mind of the profession is at present so much occupied, something ought to be said. I have, therefore, prepared an article which. I hope may not be useless. The other subject to which I referred is Anaesthetics. These agents have been intro- duced during the period of Dr. Beck's failing health, and he never lectured on them. He knew that they were noticed incidentally by two of his colleagues, Dr. Parker and myself, and that I devoted considerable time to a rather full considera- tion of the whole subject; hence he felt the less necessity for treating of them. When, however, his Lectures came to be presented to the profession " in a book," and especially when they were o^ered to students as a text book of Materia Medica and Therapeutics, it was obviously proper that a consideration of those agents, whose use is so wide-spread, and whose utility is scarce now a subject of doubt, should appear in it. I accord- ingly prepared an article on Anaesthetics, in which I have tried to do justice to a class of remedies, the introduction of which into practice is, I firmly believe, a great boon to humanity. In conclusion, I have to acknowledge valuable assistance from Professor Lewis C. Beck, in the revision of the article on Proximate Principles; and to confess my own obligations for the matter I have added, to Pereira, whose book, a great store- house of valuable knowledge in the whole subject of Materia Medica, I have consulted with confidence, and used when I needed it with freedom. PREFACE TO THE SECOND EDITION. In preparing this edition for the press, the editor has felt it his duty to make only such changes in matters of detail as shall render the book more useful to students, as presenting an accu- rate view of the present state of knowledge on the subject of Materia Medica. It is the boast of the cultivators of Medical Science that theirs is in a pre-eminent degree a progressive science; hence the absolute necessity of revising Text books from time to time. Such revision it has been the editor's aim to give this book. As to those great principles of Therapeutics which constitute the distinctive merit of the work, they remain untouched. Time can only serve to confirm their truth and increase their value. * PREFACE TO THE THIRDJMTION. The Editor is again called tojthe grateful duty of revising an Edition of Beck's Materia Medica. That such a book should continue for so many years the text book of Materia Medica is proof that our science is becoming more settled, and in a good degree certain. In this Edition few changes have been made. The author was not, and the Editor is not a vaunter of New Remedies; few of these have been deemed worthy of record in a book which claims to establish new principles of Therapeu- tics, and give the best means of putting those principles into practice. New York, October, 1861. CONTENTS. Page Introduction...........11 Physiological and Therapeutical Effects of Medicines, 14 Modes in which Medicines may be brought to act on the System, 18 Circumstances Modifying the Effects of Medicines, 24 Classification of Medicinal Agents, 28 Combination of Medicines, 31 Proximate Principles.........36 Organic Acids, 38 Organic Alkalies, and the Allied Substances, 41 Oleaginous, Resinous, and Bituminous Principles, 44 Alcoholic and Ethereal Principles, 48 Sugars and their Congeners, 49 Emetics......•.....52 Effects on the System, 54 Various Circumstances Modifying the Effects, 57 States of System favorable and unfavorable to their use, 61 Mode of Administering, 63 Combination, 91 Application in the Treatment of Diseases, 66 Individual Emetics, 79 Cathartics...........92 Effects, 93 Circumstances Modifying the Effects, 97 Mode of Administering, 99 Therapeutical Effects, 101 Use in Particular Diseases, 102 Classification, 111 Individual Cathartics, 112 Saline Cathartics, 126 Mercurial Purgatives, 143 Combinations, 145 Anthelmintics.......... 150 Rules for the use, 154 Individual Anthelmintics, 155 SlALAGOGUES...........163 Mercury, 163 Its Physiological Effects, 164 Practical Applications of Mercury in the Treatment of Diseases, 176 Preparations of Mercury, 185 Diaphoretics........... 193 Effects, 193 Rules for their Application, 197 Practical Applications, 198 Individual Diaphoretics, 201 X CONTENTS. Page Expectorants...........209 Practical Applications, 211 Rules for Administration, 215 Individual Expectorants, 215 Antispasmodic Expectorants, 225 Diuretics............228 Effects, 228 Application in the Treatment of Diseases, 232 Rules for Use, 235 Individual Diuretics, 235 Emmenagogues...........261 Parturients...........265 Dangers from the Use of Ergot, 268 Sedatives............271 , Bloodletting and its Effects, 271 States of System favorable and unfavorable to Bloodletting, 281 Rules in Relation to Bloodletting, 294 Therapeutical Applications of Bloodletting, 295 Other Sedatives, 310 Refrigerants...........334 Practical Application in theJTreatment of Diseases, 339 Demulcents...........343 Narcotics............355 Effects, 356 Opium, its Properties, and Use in the Treatment of Diseases, 355- 377 Other Narcotics, 377 An-estiietics...........394 Effects, 395 Rules for Administration, 397 Applications to Disease, 398 Individual Anaesthetics, 401 Stimulants......... 405 Effects, 405 Practical Applications, 410 Individual Stimulants, 415 Nervines......... 433 Effects, 433 Diseases in which they are applicable, 434 Individual Nervines, 438 Tonics........ ako Effects, 452 As Antiperiodics, 455 Individual Tonics, 457 Astringents.......... • 49^ Individual Astringents, 495 Revulsives......... 5Q4 Divided into five Classes, 504 Individual Epispastics, 509 Practical Applications, 515 Alteratives .... ... 517 Application to Diseases, 518 Individual Alteratives, 520 Local Alteratives, 541 Chemical Alteratives, 547 MATERIA MEDICA and THERAPEUTICS. INTRODUCTION. By the Materia Medica is meant that branch of Medical Science which treats of the history, preparation, properties, and effects upon the living system, in health and disease, of the various agents which are used for the prevention or cure of disease. It includes two distinct depart- ments—viz. First, Materia Medica proper, embracing simply an account of the history and properties—physical and chemical—of medicinal agents, and of their effects on the system in health. Second, Therapeu- tics, That which relates to the effects of these agents in their applica- tions to the management of disease. It is in this extended sense that I propose to consider it in the following course of lectures; and I shall therefore, besides giving you a description of the various properties of medicines, endeavor to lay before you the general principles which are to govern you in their use. There are several points of view in which medicines are generally considered in the books—viz. their natural history—their physical, their chemical, and finally, their therapeutical properties. With regard k> the natural history of medicines, it is not my inten- tion to go into any minute botanical or mineralogical descriptions. I shall give only such general, concise notices as may be more immediately applicable to practical purposes; referring those who feel an interest in the subject to the Dispensatories for fuller information. Under the head of physical properties I shall call attention particu- larly to such circumstances as may assist in ascertaining the purity 2 12 MATERIA MEDICA AND THERAPEUTICS. of the article as used in medicine. This is a subject of great importance, and one often neglected. To those who know to what an extent the adulteration of medicines is carried, and how often, from this cause, the expectations of the physician are frustrated, it will scarcely be neces- sary to say anything to show the importance of such knowledge as shall enable the practitioner to be certain that he is really giving the medi- cine which he has ordered. In the next place, of their chemical proper- ties. A knowledge of the chemical properties of the medicines is no less necessary to the mere practitioner than it is to the scientific phy- sician. By discovering the active principles of vegetables, it has ena- bled us to separate them from inert matter, and thus not merely to improve the mode of their administration, but to increase their activity. For a striking illustration we need go no further than Peruvian Bark. Whoever compares the unwieldy and nauseous doses of this article as formerly given, with the elegant and condensed preparation made from it in the form of the sulphate of quinine, must at once admit the utility of chemical knowledge as applied to the Materia Medica. In addition to this, a knowledge of the chemical properties and relations of medi- cinal substances to each other, is the only thing which will enable the practitioner to avoid that very great though common error of giving articles which decompose each other, and either neutralize the powers of each, or produce compounds whose effects are entirely different from those intended. With regard to the Therapeutical properties, these are the most im- portant, and they shall claim the principal share of attention. To them a knowledge of all the other properties is only subservient. This is a part of our subject of no small difficulty. The virtues ascribed to medi- cines are so multifarious, and if we are to believe the reports of differ- ent writers, so positively contradictory, that it requires the soundest exercise of judgment, connected with no small share of experience, to decide what are really the effects of medicines upon the living system, and how they may be rendered available in the cure of diseases. And as we cannot in all cases call in question the accuracy of the statements of distinguished men, however contradictory they may at first sight appear, it will frequently become a subject of philosophical and instruct- ive inquiry to investigate the causes of this discrepancy. Such investi- gations are worthy of the highest efforts of intellect, as their object is to show that medicine is not an uncertain art, but a science, built upon fixed and rational principle. The principles upon which these investi- gations will be conducted are exceedingly simple. Without entering into any process of reasoning to establish it, the proposition may be assumed, that under similar circumstances the same medicines will produce similar effects. This is a self-evident proposition ; and by carefully apply. ing it, we shall be able, in most cases, to arrive at a satisfactory sola- INTRODUCTION. 13 tion of the contradictory accounts which are upon record in relation to the effects of medicines. In all cases, therefore, in which the effects of the same medicine are reported to be different, the first question to be determined is, was the medicine really the same ? From the ambiguity of nomenclature, and the fluctuations which it has undergone, it will not unfrequently be found that the same term has been applied to substances totally different. Independently of this general error resulting from the confusion of terms, there are other circumstances which require investigation to ascertain the character of medicines. The virtues of medicinal vege- tables especially, depend much upon the season of the year in which they are collected—upon the part of the plant used—upon the mode of preparation—upon the length of time they have been kept, &c, &c. So greatly do all these circumstances modify the character of medicinal substances, that illustrations might be given in abundance, in which, from ignorance or inattention, some of the most powerful articles in the Materia Medica have been rendered perfectly inert. Having determined the character of the medicine given, the next subject of inquiry is to ascertain the circumstances under which it was given. Here an exten- sive field of investigation opens upon us. Was the disease the same ? Diseases passing under the same name differ essentially in their general type and character. What was the stage of the disease ? If these questions cannot be determined with some degree of certainty, it is useless to object that the medicines are uncertain in their effects. Besides these, there are constitutional differences in patients which modify very greatly the effects of remedies, such as temperament, age, sex, habits, occupation, &c. Now, to appreciate justly the effects of remedies, all these circumstances are entitled to consideration, and in many cases they will lead to a solution of the contradictions which are found in medical writers. From the view just given, it is evident that the Materia Medica presents a wide field for practical study as well as philosophical research. In general interest and utility it yields the pre- cedence to no department of medical knowledge. In the circle of the sciences, it holds a most important station. It is the connecting link between strict medicine and the collateral sciences, Chemistry, Botany, Mineralogy, and Geology; while to the Therapeutical part of it every other branch of medical science is subservient. In conducting a course of instruction on a subject so important my object will be : First, to spread before my class the material facts and principles which consti- tute the science of the Materia Medica, and second, to give such a direction to your minds as shall encourage you to think and reason for yourselves. Essential as is the first of these objects, it is far exceeded in importance by the second. There is no science which, in its practi- cal applications, calls for such incessant exercise of the reason and 14 MATERIA MEDICA AND THERAPEUTICS. judgment as medicine; and if I shall be so fortunate as to aid in any good degree those who hear me, in disciplining their minds to habits of thought and reflection, my highest ambition as a teacher will be gra- tified. As preliminary to the consideration of medicines in detail, it will be necessary to make some general observations in relation to their effects, as well as the various modes in which these effects are propagated throughout the system. Of the Effects of Medicines.—The effects of medicines are divided into two classes—Physiological and Therapeutical. By the first, are meant the ordinary immediate effects which are produced on the system without reference to disease. By the second, are meant those effects which exhibit themselves in the alleviation or removal of the various morbid conditions under which the system may be laboring. Thus, for example, an emetic, if given a short time before the expected return of a paroxysm of intermittent, will frequently prevent it altogether. In this case, the nausea and vomiting which the emetic produces are physiological effects; while the prevention of the paroxysm is the therapeutical effect. Now, the distinction between these effects is obvious and important, and ought always to be kept in view. At present our business is only with the physiological effects. The thera- peutical will properly come to be considered when we treat of the ap- plication of remedies to the management of disease. Physiological Effects.—These are divided into local and remote. By the first, we mean those impressions which the medicine makes upon the part with which it comes in immediate contact. By the second, those which are the consequence of the local ones, and which show themselves in distant parts of the system. Of the Local Effects.—-In general, it may be said that there are two ways in which medicines may act upon the part to which they are applied. In the first place, chemically, they then corrode and destroy it. Ordinary caustics applied to the surface of the body, furnish an illustration of this mode of action. Second, they may modify the vital properties of the part. The modes in which the vital properties may thus be influenced, are various both in kind and degree. In some cases the sensibility and irritability of the part are increased, and a stimulant or irritant effect is produced. Stimulants of various kinds, introduced into the stomach, produce on the mucous membrane of that oro-an such an effect. So, also, in a still more striking manner, do rubefacients and blisters applied to the surface. In these cases, the nerves and blood- vessels are both implicated. That the nerves are affected, is evident from the heat and increased sensation, while the redness and distension show the effect on the blood-vessels. In other cases, the sensibility and irritability of the part, instead of being increased, are impaired, INTRODUCTION. 15 and then a sedative effect is produced. Here the impression seems to be limited in a great measure to the nerves, without involving materi- ally the blood-vessels. Of this mode of action, opium, aconite, and other narcotics furnish illustrations. In other cases, again, the local impression amounts to nothing more than exciting the absorbent vessels to which they are applied. This is the mode of action of many of those articles which are carried into the general circulation, and whose effects are manifested only in the relief of morbid conditions of the system. The local effects of the same remedy will vary : 1st. According to the part of the system to which it is applied, e. g. when applied to the eye, brandy will produce a very different effect than when introduced into the stomach. 2d. According to the state of the part at the time—e. g. to the inflamed stomach, the effects of wine are very different from those to the stomach in health. The remote effects, as already stated, are developed in different parts of the system. Like the local effects, they differ in character—some are stimulating and others are depressing—some alterative. Between the local and remote effects it is important to remark that there is no necessary similarity in the nature of their action. A medicine, for example, may be a stimulant to the part to which it is applied, and yet depressing to other parts of the system. An emetic, for example, is exciting to the stomach itself, but remotely depressing on the vascular system. Colchicum proves irritant to the stomach and bowels, while in its remote action it lowers, very strikingly, the circulation. No infer- ence, therefore, can be drawn from the local action of a medicine, as to its remote effects. These differ, also, greatly in the parts of the system where they develop themselves. In some cases, the mucous tissue is the part remote- ly affected, as is shown in the increase or diminution of its secretions. In some cases the nervous system is the part remotely acted on. Thus opium acts locally on the stomach and remotely upon the brain and nerves of the system generally. Sometimes the vascular system is the part upon which the remote impression is chiefly developed. Digitalis, for example, acts thus in a remarkable manner upon the heart and blood-vessels. In other cases, a^ain, the glandular system is chiefly affected. In this way mercury acts upon the salivary glands;. iodine on the breast, thyroid, and other glands of the system. In a great number of cases the remote effects of medicines, instead of being thus limited to particular parts, are developed in several conjoint- ly. Thus mercury, in its remote agency, involves the mucous, the vascular, the nervous, and the whole glandular system. 16 MATERIA MEDICA AND THERAPEUTICS. Of the manner in which these Effects are produced.—With regard to the local effects, our knowledge is confined within very narrow limits. All that we can say about it is, that the medicine, whatever it may be, comes in actual contact with a living surface, and produces upon it peculiar effects corresponding to the nature of the substance applied and the particular susceptibility of the part to which it is applied. In short, our knowledge does not extend beyond the simple expression of the fact itself. How it is, or why it is, that such effects are produced, are subjects entirely beyond our comprehension. With regard to the remote effects, the question which presents itself is of a different character—In what way is it that medicines, when locally applied, are capable of producing effects on different parts of the system ? How is it that agents taken into the stomach, or applied to the skin, can affect the brain, the lungs, the kidneys, the uterus, etc. This is a question by no means of easy solution, and has been greatly embarrassed by the theories and speculations of ingenious men. In discussing it, I shall endeavor to keep aloof from these theories, and confine myself to such views as may be sustained by fact as well as argument. There are only two ways in which different parts of the system can hold intercourse or be acted upon by one another. The first of these is through the medium of the nerves : the second through the medium of the circulation. It is only in one or the other of these two ways, there- fore, that the effects of medicinal agents can be produced in distant parts of the system. In other words, the impression made by the medicine upon the part to which it is applied must be conveyed sympa- thetically by reflex action to other parts; or the medicine must be taken into the circulation and actually carried to different parts of the system, and thus produce its remote effects. A candid review of all the facts connected with the subject will lead us, I think, to the con- clusion that in neither of these modes exclusively are the remote effects of medicines produced; but that, while in some eases they are produced by sympathy, in others, and that the very great majority, they are the result of absorption into the circulation ; and these are the points which I shall endeavor to establish. In the first place, of the production of the remote effects by sympathy. The human system is so constituted that no part of it is completely isolated from the rest. Impressions made upon one portion of it are extended with different degrees of force to others. An incessant inter- course is thus kept up throughout the complicated machinery of the animal economy, and the agents through which this is accomplished are the nerves. Now that some medicinal agents act through the nervous system is beyond doubt, and this is proved not so much by the rapid- ity with which these effects are evolved, though that was formerly INTRODUCTION. 17 much relied on, as by the character of the agents that produce them. Thus for example, ammonia held to the nostrils almost immediately rouses from a fit of fainting; a feather applied to the same part causes sneezing; the finger in the fauces causes vomiting, Ac. Now in these cases, as well as many others which might be adduced, the effect is doubtless produced through nervous agency. Experiments male upon animals with certain poisonous agents were thought to show thi- in a still more conclusive manner, but more accurate investigation has robbed the argument from rapidity of action of all its force, by proving that absorption may take place in an astonishingly short time— a time quite within that in which the most violent poisons act. Blake says that the time in which a substance may be absorbed by the capil- laries, and diffused throughout the bodv, may not exceed nine seconds. These experiments on the rapidity of absorption, and the exposition of the mode of operation on the reflex system of nerves, have thrown a flood of light on this formerly obscure subject. in the second place, of the production of the remote effects by the ab- sorption, of medicines into the circulation. In the investigation of this point two things require to be noticed. 1st, Are medicines actually absorbed? and, 2d, Are the remote effects the result of this absorption? Strange as it now appears to us it has been actually denied, and that by writers of authority, that medicines are ever taken into the circula- tion. The proof, however, is perfectly conclusive, and no one now thinks of denying that medicinal substances are taken into the circu- lation. This being so, another point remains to be settled, what is the precise mode in which their effects are finally produced ? The prevailing opi- nion is that the medicine, after being introduced into the circulation, is carried to different parts of the system, and produces its effects by actual contact with the parts or organs in which its agency is developed. In concluding the whole subject of the modus operandi of medicines, the propositions which in the present state of our knowledge are entirely defensible, are 1st, That medicines differ in the manner in which their effects are produced. 2d, That some produce their effects through the nerves or by sym- pathy. 3d, That some are absorbed into the circulation and produce their effects in consequence of such absorption. As to the mode in which agents introduced into the general mass of the blood come to affect one organ rather than another, our knowledge is very limited ; we can hardly go beyond the expression of the fact, that certain substances have under such circumstances a tendency towards one organ rather than another, or perhaps that one organ has, as a part of its peculiar 18 MATERIA MEDICA AND THERAPEUTICS. vitality, a special susceptibility to be affected by one agent when that is presented to it in the blood. The discussion of the modus operandi of medicines is not a mere sub- ject of speculation ; on the contrary, it has practical bearings of great importance, and it is on this account that I will dwell upon it. 1. Medicines are modified in their effects by a great variety of cir- cumstances, and in the treatment of many diseases it may be a matter of very great importance to determine whether the medicine which may be used produces its effects through the agency of the nerves, or by being absorbed into the circulation. In many diseases the fluids are manifestly changed in their condition, and these again react upon the solids. Is it unreasonable then to suppose that medicines, if absorbed into the circulation, must exert from this very circumstance some pecu- liarity in their operation ? 2. If medicinal substances be taken into the circulation, they must impregnate fluids secreted from the blood. Now milk is one of these ; and if this fluid can be thus impregnated, the sucking child must inevi- tably become affected. Besides, if it can be proved that the articles taken into the stomach are introduced into the milk, it must necessarily modify the effect of it even as an article of diet, and may thus exert a most material influence over the whole constitution of the child. In addition to all this, if the milk can be thus charged with medicinal agents, it may be found exceedingly useful as a vehicle for adminis- tering certain medicines at an early period of life, by giving to the mother. It is important in its application to medical jurisprudence. It has been found that most poisons are absorbed, and that they are eliminat- ed from the system mainly through the urine. If this be so, the urine ought to indicate their presence. Again, in the treatment of poisons, if they pass off by the urine, the more the quantity of urine is increased the more likely is the poison to be passed off also. Diu- retics, therefore, are a class of remedies which may be made very useful here. You perceive, that this description of the modus operandi of medicines involves a great many points of great practical importance. Of the various parts of the Body to which Medicines are apjdied.__ There are three different modes in which medicines may be brought to act on the system, viz. by applying them to some portion of the mucous membrane, by applying them to the skin, and lastly, by injecting them into the veins. Of the Application of Medicines to the Mucous Membrane.—Almost every part of this membrane may be made the seat of medical applica- tion, and in every case important effects may be produced. In the relative value and extent of these effects, however, there is a wide differ- INTRODUCTION. 19 ence, according to the part of the membrane to which the medicine is applied. The Mucous Membrane of the Stomach.—This is the surface to which medicines are usually applied, and from which effects are obtained, as a general rule, more prompt and important than when applied to any other part. The reason is obvious. Abundantly supplied with nerves, a primary impression may here be made with great effect. Placed, too, in the very centre of the system, and holding the most direct and con- stant intercourse with all the important organs of the body by means of its nervous communications, the stomach possesses a power of trans- mitting impressions unequalled by any other part. Besides this, it is supplied with a profusion of absorbing vessels, through whose agency substances may be introduced into the circulation, and thus carried to the remotest parts ; over and above all this, it is the simplest and readiest mode of introducing medicines into the system. It is, therefore, gene- rally resorted to, and in describing the effects of medicines, it is always to be understood that this is the mode, unless the contrary be stated. The doses of medicines, too, are always stated in reference to this mode. The Mucous Membrane of the Large Intestines.—To this, medicines are also frequently applied, and with great effect. It possesses, however, less sensibility than the mucous membrane of the stomach, and'therefore requires a larger dose of the medicine to produce the same amount of effect, as absorption is less active. Notwithstanding all this, medicines when applied here act with great efficiency, and not merely the local but the remote effects are obtained in the same way as when they are, applied to the stomach. The Mucous Membrane of the Nostrils.—Medicines are sometimes applied to the surface and make a powerful impression, not merely upon the part itself, but extend their effects to other parts of the system. The vapor of ammonia, by the impression which it makes on the nerves of smell, produces a general effect upon the whole system. The Mucous Membrane of the Lungs.—The. only way in which medicines can be applied here is by inhalation in the form of vapor, and as a general rule, the object had in view is to obtain their local effect upon the part itself, and they are employed for the correction of certain morbid conditions of this membrane. Notwithstanding, it is quite certain that impressions thus made, may be extended to other parts of the system. The attention of the profession has been very strongly directed to this mode of administering medicines by the general use of Ansesthetics, but of them hereafter. Besides the foregoing, there are other portions of the mucous mem- brane to which medicines are continually applied, such as the eye, the ear, the urethra and bladder, the vagina and uterus. In all these cases, 20 MATERIA MEDICA AND THERAPEUTICS'. however, the only object is to obtain certain local effects from the remedies, though the remote or so called constitutional effects may follow, as for example, Belladonna has produced its constitutional effects when applied to the os uteri to favor dilatation. 2. The next Mode of bringing Medicines to act on the System, is by applying them to the. Skin.—Blisters, rubefacients, frictions, cold and warm bathing, Ac, all produce their effects in this way. Moreover, many medicines usually introduced into the stomach, may be made to produce all their ordinary effects, by applying them to the surface, and this is frequently a mode of great value. The skin is an extensive sur- face, plentifully supplied with nerves, and hence possessing great sensi- bility. It is capable, therefore, of receiving the primary impressions of medicines. An objection to the use of medicines in this way arises from the greater density of the epidermis as compared with the epithe- lium ; this modifies external impressions, and. delays, though it does not prevent, absorption. To obviate this difficulty, two methods are resorted to—the one is to overcome it by .frictions, so as to bring the medicine in contact with the sensitive portion of the skin; the other is to remove the cuticle altogether by means of a blister, so as to enable us to apply the medicine to the denuded surface. The first of these methods is called the Iatroleptic method, the other the End&rmic method. Iatroleptic method.—This consists in the application of medicines by means of friction to the skin. That some medicines applied to the skin by friction are capable of producing the same effects as when taken into the stomach, is a fact well known. Thus, mercury rubbed in the form of ointment on the surface, produces salivation with as much, if not more certainty and rapidity, than the internal administration of the metal. Frictions with ointment of gold will produce all the specific effects of that metal on the system* A strong decoction of tobacco rubbed on the epigastric region, or on the skin of the head, will cause nausea or * Castor oil, applied to the abdomen by friction, according to Sigmond, will affect the bowels the same as if taken internally, especially if aided by the warm bath. He states that "obstinate constipation has yielded to this remedy, and where such violent and constant sickness has been present as to preclude the possibility of the internal administration of the oil, it has produced all its o-00d effects without adding to the distressing state in which the stomach is found I have seen, by these means, an action produced upon the bowels within a quarter of an hour after the friction has been employed, immediately on the patient leav ing a bath of a temperature of 98°, where calomel, jalap, neutral salts and lave ments had failed to relieve the intestinal canal, and when constant vomitino- ]iad commenced, and all idea of internal remedy had necessarily been abandoned »_ Johnson's Journal, vol. xxvi. p. 493. Croton oil, it is also asserted, will produce its usual effects on the bowels narti cularly if combined with castor oil.—Ibid. ' INTRODUCTION. 21 vomiting. Belladonna or stramonium rubbed on the eyebrow will dilate the pupil as certainly as when taken inwardly. Tincture of cinchona rubbed on the spine has cured intermittent fever, when the internal exhibition of it has failed.* Digitalis and squills, too, rubbed on the skin, have excited the action of the urinary organs and cured dropsy. The foregoing facts are sufficient to show that by friction on the sur- face, the effects of certain medicines may be fully obtained on the system. Endcnnic method.—This practice consists in first removing the cuticle from a portion of the skin, and then applying medicines to the denuded surface. This method is of recent origin, and we are indebted for it to M. Lambert, by whom it was first practised in one of the French hospi- tals, in 1828.f In this method, the first thing to be done is to separate the cuticle. The best mode of doing this is by the application of a com- mon blister of moderate size, say about four inches square. The only objection to it is the length of time which it takes to blister. When it is desirable to apply the medicine as speedily as possible, the cuticle may be separated by the use of a pomade made of equal parts of lard and strong liquor ammoniae.J By renewing this every five minutes, a blister will speedily be raised.§ The best part of the body for making the application is the epigas- trium. Having separated the cuticle, the medicine is applied in the state of fine powder, or if it be too irritating, incorporated with cerate or lard. Applied in this way, a number of agents have been found to produce all their ordinary effects on the system. Among them are the sulphate of quinine, the acetate and sulphate of morphine, strychnine, belladonna, stramonium, hyosciamus, aconitine, aloes, gamboge and colo- cynth, squill and digitalis. From the experiments which have been made, it will appear that * Broussais cured intermittent fever in this way. Phlegmasia?, vol. ii. p. 242. See also on the effects of the external application of bark, Dr. H. Jackson in Cald- well's Theses for 1806, p. 173; also Dr. S. Pye, in Lond. Med. Obs. and Inq. vol. ii. p. 245. f Essays sur la Methode Endermique par Ant. Lambert. Paris, 1828. \ Johnson's Journal, vol. xxii. p. 176. § "Where an instantaneous blister is required, the following has been recom- mended: "Cut a piece of cotton, linen, or of paper, of the size and shape for which it may be required; immerse this in spirits of wine, in strong brandy, or in eau de Cologne; lay it on the surface to be blistered, wiping the edges so that none of the fluid may moisten the surrounding parts; apply a lighted candle rapidly over the whole surface, that it may be burnt immediately. The ignition is exceed- ingly quick, and the cuticle will be found separated from the subjacent cutis."— Johnson's Journal, vol. xxvi. p. 494. On the endermic method, see also British and Foreign Review, voL v. p. 343. Lon. Med. Gazette, Nov. 1838, p. 233. Dunglison's Intelligencer, vol. iii. p. 50. Mad- den on Cutaneous Absorption, p. 138. MATERIA MEDICA AND THERAPEUTICS. medicines applied in this way act as promptly as, and sometimes more so than, when taken internally. Frequently, too, they do not require to be used in larger doses, though they generally require double the dose. A great objection to this mode is, that it sometimes produces a good deal of local irritation, causing painful and tedious sores. This I have w-itnessed myself in some of the first experiments which I made at the New lork Hospital with the sulphate of quinine. [Many of the substances above noted produce, even when diluted, extreme pain, and they should be used in delicate, nervous subjects, with great caution; especially are they likely to do harm in children. I have known at least one case of fatal convulsions produced in this way. —Ed.] 3. Injecting into the veins.—This is the last mode of introducing medicines into the system that requires notice. The first person who made any attempts at ascertaining the effects of medicines' introduced into the veins appears to have been Dr. Wren,—then of Oxford. As early as the year 1665, he made experiments upon dogs by injecting into the veins of the hind legs opium and the crocus metallorum. The dog in whom the Opium was injected was stupified, but did not die. In the other vomiting and death were the consequences.* About two years afterwards experiments.of a similar character were made at Pisa, by Frascati. Some of the mineral acids were injected into the veins of dogs. These proved fatal. The first attempt made to inject medicines into the veins of the hu- man subject appears to have been made about 1667 by Dr. Fabritius of Dantzick. The experiments were made upon three individuals—one male and two females—by injecting into the vein of the right arm a laxative solution. In all of them, a purgative effect was produced on the bowels, besides which they vomited freely. Two did well; one of the females, on the day following the operation, took cold from exposure and d.ed.f In the next year, 1668, Smith, a phvsician of Dantzick experimented upon two venereal patients, by introducing alterative medi- cines into the veins. One of these died, the other recovered The same experiments were tried the same year upon three other patients- one laboring under the gout, another apoplexy, and a third plica polo- mca-all are said not only to have borne the operation well, but to have been cured of their respective complaints.^ These were the earliest experiments of the kind made, and they cer- tainly show that medicines may be injected into the veins both of man and of animals without proving fatal, and that their effects may be pro- * Hale's Boylston Prize Questions, p. 72. f Philosophical Trans, for 1667. Hale, p. 74. \ Hale, p. 76. INTRODUCTION. 23 duced upon the system. Since then various other experiments have been made with the same view. In 1823, Magendie injected warm water into the veins of a patient at the Hotel Dieu, laboring under hydrophobia. It had the effect of quieting the spasms, but he never- theless died at the end of some days. The same was tried in three other patients. In all it arrested the convulsions, without however saving the patients.* Still more recently, aqueous and saline fluids have been, in large quantities, injected into the veins, and in a few cases with apparent advantage, in Asiatic cholera. From all these experiments it appears that medicines may be intro- duced into the veins—and that they produce the same effects, and even more promptly, as when taken into the-stomach. Nevertheless, the practice is attended with too much danger to be resorted to except in very extraordinary cases. Relative value of the different modes of introducing medicines into the system.—Having noticed the different modes in which medicines may be brought to bear upon the system, I shall make a remark or two upon their comparative value. As a general rule there can be no ques- tion that the ordinary mode of introducing medicines into the stomach is, in every respect the best. Both the local and remote effects of medi- cines are produced more naturally and easily in this way than in any other. There is less trouble and inconvenience attending the adminis- tration, matters of no small importance. For ease and safety, then, this is to be preferred as a general practice. Cases and occasions, however, may occur in which some of the other modes are to be preferred. Such for instance as the following:—1. When the stomach will not retain medicines, and they are rejected by vomiting, or are passed by the bowels. A familiar instance of this is met with in using mercury as an alterative. It frequently, even when combined with opium, causes such a free action on the bowels as to interfere with its effects. In this case introducing it by friction on the surface is a most valuable and certain resource. 2. When some physical obstruction to swallowing occurs. 3. When some peculiar idiosyncrasy prevents the taking of medicines by the stomach. 4. In some cases in children from the difficulty of getting them to swallow medicines. In all these cases the external application may be suitable and pre- ferable. Of the different modes of applying them externally, the Iatro- leptic may be preferable in some cases, and the eudermic in others. This must be determined by the nature of the case and the character of the remedy to be applied. With regard to injecting medicines into the veins, it is a practice attended with too much hazard to warrant its * Diet. Mat. Med., vol. iii. p. 610. 24 MATERIA MEDICA AND THERAPEUTICS. adoption, except in cases of diseases intractable to the ordinary modes of treatment—such as hydrophobia, tetanus, and the like. Oj the various circumstances modifying the effects of medicines.—The human system is not always the same. It differs at different periods of life, in different climates, and under various circumstances. It is very evident, therefore, that the impressions made upon it must also vary. In making out, therefore, a full and complete history of the effects of medicinal agents, it becomes necessary to analyse in detail all the cir- cumstances which have an influence in modifying the condition of the system. 1. Age.—This modifies the condition of the human system, and, of course, the effects of medicinal agents. In infancy all the textures are exceedingly delicate, and much more easily affected by impressions made upon them than at any subsequent period. This is particularly the case with the mucous membrane and the skin, the two surfaces to which all medicinal agents are applied. The brain and nervous system, too, are more delicate, and exercise a more predominating influence over every other part of the body. Hence it is that the brain is so easily excited by irritations, and that convulsions and organic dis- eases of this organ are so common at this early period. The vascular system, too, is now in a condition entirely different from what it afterwards comes. Not merely is the power of the heart and blood- vessels much less, but there exists a great difference in the relative size of the arteries and veins, as well as in the quantity of blood which they circulate. In advanced life, in all these respects, the system has under- gone a complete revolution. The tissues, from being soft and delicate, become dense and firm—their sensibility and the activity of their functions are lessened. The brain and nerves, from being soft, become firm and solid—'their functions are impaired, sensation is blunted, and all the motions impeded. Hence pain can be much better borne in old age than in infancy. The blood-vessels, too, now become more solid, in many cases even ossified, and the venous blood in the system bears a much larger proportion to the arterial than it did at pre- vious periods, and venous congestions are common. From all this it is very evident that the system undergoes a great change, and it would seem as a matter of course that the effects of agents applied to it must be greatly modified by these changes, and such indeed is proved to be the case by observation and experience. Almost every medicinal agent is more or less modified in its operation according to the period of life at which it is administered. For example : Emetics are given at all ages, and yet how different are their general effects. In infancy vomiting is excited with little or no difficulty and so far as the mere mechanical process is concerned, attended with no danger. If, however, some active article be used, even in doses INTRODUCTION. 25 suitable to the age, the consequences may be fatal. Tartar emetic has thus been known to produce vomiting which ended in death. In advanced life, on the other hand, from the impaired sensibility of the organs concerned, vomiting is not so readily excited, while the mechanical process, which in children is attended with no danger, is now frequently destructive of life, owing to the tendency which there exists at this period to venous congestion of the brain. Cathartics afford a second illustration. In early life, as a general rule, this class of medicines operates much more readily than they do afterwards. As we advance in years, the intestines, in consequence of their repeated stimulation, have their sensibility impaired and their contractile power lessened, and cathartics make less impression ; accordingly, they require to be used in much larger doses, and the more active articles selected. On the other hand, it is to be recollected that the intestines of children are more liable to be lined with col- lections of viscid mucus; and when this is the case, they can bear much larger proportional doses. Opium furnishes another illustration. While to adults this drug may be given with perfect safety, in its effects upon children there is frequently nothing so uncertain. Not unfrequently the simplest preparations of it, administered, too, in reasonable doses, have been attended by alarming and even fatal symptoms. The syrup of poppies and Paregoric have both operated occasionally in this way. I shall notice only one other illustration, and that is Venesection. This is a remedy resorted to, and very properly, at all ages; and yet in many cases it is to be feared without due regard to the dif- ference of effect produced by it. As a general rule, children do not bear the loss of large quantities of blood so well as adults. One or two bleedings they may bear, if carried any further they sink under it, Nor do they recover from syncope, when induced by venesection, so readily as adults. On the contrary, such is the deficient reaction in them, that this state is always attended with more or less danger. In old age, the same general rule holds good. Moderate quantities of blood may be abstracted with beneficial effect, while the loss of large quantities is followed by great prostration of the powers of life. The foregoing illustrations, selected from a thousand others, which might be adduced, are abundant to show the importance of investigating the effects of remedies at different periods of life. Unless this be done, it is idle to suppose that they can be properly or even safely employed in the treatment of the various diseases to which the human frame, from infancy to old age, is liable. 2. Sex.—This modifies very greatly the condition of the human system, and it must therefore, also, as a matter of course modify the effects of medicinal agents. As a general rule, the constitution of 26 MATERIA MEDICA AND THERAPEUTICS. females is much more delicate than that of males. Their nervous sys- tem is also much more excitable. Hence impressions are more easily made upon them by medicinal agents. The more active articles accord- ingly require to be used with much greater caution in them. In vene- real hospitals it has been observed that only half the quantity of mercury is necessary to produce precisely the same effect as in males. Indepen- dently of the general delicacy of constitution, there is another circumstance attending the female which greatly modifies the effect of remedies, and that is a state of pregnancy. During this state, women bear blood-let- ting much better than at any other period ; for the purpose of subduing disease, it is frequently necessary to carry it to a much greater extent than under the ordinary conditions of the system* Tonics, on the other hand, are not borne so well, and do not appear to produce precisely the same effects. The Peruvian bark, accordingly, very frequently fails under these circumstances to arrest the paroxysms of intermittent fever. In the advanced stages of pregnancy, the use of emetics is frequently fol- lowed by a premature expulsion of the foetus. 3. Peculiar Habit and Constitution of Body.—This modifies very greatly the effects of remedies. Ceteris paribus, fat persons are vomited with more facility than lean ones. As a general rule, fat persons have less blood in proportion than lean ones, and on that account do not bear the loss of such large quantities. In delicate and irritable habits, blisters cause a great degree of nervous and vascular excitement, attend- ed not unfrequently with the most distressing effects on the system at large. There is, perhaps, no medicine which shows in a more striking manner the modifying effects of temperament than mercury—an article which, in robust constitutions, may be given with impunity, in nervous and irritable habits, especially if carried to any extent, is followed by effects the most disastrous, augmenting general irritability, and predis- posing the system to the invasion and development of various and even fatal diseases. 4. Climate and Season.—By the powerful effect which these exercise upon the human frame, they exert a modifying influence on the effects of remedies. So fully was the celebrated Baglivi impressed with the truth of this, that he frequently adds, in giving an account of his treat- ment, " Vivo et scribo in Mre Romano." Celsus has observed, that " medicines differ according to the nature of the climate; one kind being necessary in Rome, another in Egypt, and a third in France." To the same effect Baglivi says that, " The Spaniards, any more than the Italians, if their physicians may be credited, cannot well bear rough medicines of any kind." By some it has been supposed that in hot climates, and in warm weather, venesection was a remedy which ought * Though this opinion was formerly almost universal, I doubt its correctness__C KG. INTRODUCTION. 27 not to be resorted to for fear of the debility which it might induce. Erroneous as this opinion certainly is, there can be no doubt that under certain conditions of season and climate, this evacuation can be better sustained by the constitution than it can under others.' As a general rule it is more indicated and better borne during the winter and spring than it is at other seasons. In dry weather, too, it is better supported than it is in moist weather. Yet, as a general fact, the natives of moist and foggy England bear bleeding better than Ameri- cans ; it depends probably on their mode of life. Hillary remarks, that in Barbadoes, under equal circumstances of pain, inflammation, and other symptoms, he always found the blood much less sizy and buffy than it was in England, and a consequent modification of the treatment was called for. Mr. Boyle says the same of the coast of Africa. During the prevalence of the sirocco, it has been observed in Egypt, as well as in Italy, that owing to the depression occasioned by it, seda- tives cannot in any case be with safety administered. The effects of mercury, too, are modified very greatly by the nature of the season and the climate. In hot climates it is much more diffi- cult to bring the patient under the influence of this remedy, than in more temperate regions. On this account it is, that such large quan- tities are required and used in tropical regions. Independently, how- ever, of mere temperature, certain regions seem to be adverse to the kindly operation of this metal on the human system. In Egypt, accord- ing to Baron Larrey, the use of mercury, even in venereal disease, requires the greatest caution. If used with the same freedom as in Europe, it produces hepatic and various other affections. 5. Habit.__This greatly modifies the effects of many medicinal agents • but its influence is not the same in all cases : it diminishes the susceptibility of the system to the impression of some medicines—it greatly increases it to that of others. Opium furnishes a striking illus- tration of the first of these. The quantity of this drug that can event- ually be borne, after the system has been habituated to it, is really astonishing. The Malays will swallow from 20 to 30 grains, daily, with perfect impunity; and in civilized society, persons have been known to take almost any quantity without suffering any inconvenience. Mer- cury, on the other hand, observes a different law, and the system, so far from becoming habituated to its use, becomes more and more sensible to its operation. When a person, for instance, has been salivated several times, the smallest quantities of mercury will sometimes produce the most violent effects. 6. The actual condition of the System at the time of taking the Medi- cine, with regard to health and disease.—Ql all the circumstances which modify the effect of remedies, this is the most striking and important. 3 28 MATERIA MEDICA AND THERAPEUTICS. Medicines do not always produce the same effects in a state of disease which they do in perfect health. In different diseases, too, the effects of the same remedy differ entirely—almost every remedy and every disease furnishes an illustration of these facts. In apoplexy, for instance, the most active emetics fail to produce their ordinary effect. In cer- tain diseased states of the intestinal canal, and of the system, the most drastic cathartics can be made to produce little or no effect. In deli- rium tremens, quantities of opium have been given with very little effect, which, in the ordinary conditions of the system, would inevitably have been followed by apoplexy and death. In tetanic and neuralgic affec- tions, unaccompanied by inflammation, narcotics may be given to the greatest extent without producing any of their ordinary effects. In conoestion of the brain, and inflammation of serous membranes, im- mense quantities of blood can be taken without producing syncope, while in other diseases, particularly of an irritative character, the system succumbs immediately to the loss of the vital fluid. I have thus, in a general way, noticed some of the circumstances modifying the effects of medicinal agents. When I come to treat of them in detail, all these circumstances will necessarily come again under review, for more special and particular consideration. Of the Classification of Medicinal Agents.—In every department of knowledge, a general classification of the various subjects embraced in it is of the greatest utility. It simplifies the science, and thus facilitates the acquisition of it. It is, in fact, nothing more than a generalization of otherwise individual and detached facts, by some principle of com- mon relation. Any principle may be adopted as the basis of a classifi- cation, and almost every classification will be found to give rise to new combinations and interesting analogies. It is not to be inferred, how- ever, that it is a matter of indifference what classification is adopted; on the contrary, not a little of the interest, as well as character of the science, may depend upon the selection which may be made. The principles which, it appears to me, ought to be chiefly held in vieAv in the construction of a classification of the Materia Medica, are the follow- ing :—In the first place, the basis of it should not be theories, but well established facts. Unless it be so, it is evident that the classification must be fluctuating in its character, at the same time that it may lead to serious practical errors. In the second place, as the great object of this science is the investigation of the effects of medicinal substances upon the human system with a view to the cure of disease, such a clas- sification should be preferred as is best suited to the attainment of this object. By keeping these principles in mind we shall be able to form a pretty correct estimate of the value of the classifications which at various periods have been offered. INTRODUCTION. 29 Among the earliest attempts at arranging the articles of the Materia Medica was that of classifying them according to their sensible proper- ties, such as color, smell, taste, &c. Such a classification has the advan- tage of being founded on plain and obvious properties appertaining to medicinal substances, and this, so far as it goes, is much in its favor. It presents also a very interesting view of the analogies of these substances so far as their sensible properties are concerned. And if these proper- ties furnished any true index of their medicinal effects, the classification would be unexceptionable. Such, however, is not the case, and it fails, therefore, in the principal object for which an artificial arrangement may be useful. The next attempt was founded on the botanical relations between plants. This of course can only apply to vegetable medicines, and on that account is defective as the basis of a classification which ought to embrace all medicinal agents, whether animal, mineral, or vegetable. So far, however, as it can be applied it has been attempted by Murray and Do Candolle.* It is liable, however, to the same objection with that founded on the sensible qualities of substances, inasmuch as the natural affinities lead to no certain conclusions in relation to the medi- cinal properties of plants. By some the chemical properties of substances have been adopted as the basis of classification. This is evidently, however, the very worst that could be chosen, both for the uncertainty and imperfections, even at the present day, of the analysis of vegetable substances, and from its leading to no certain conclusions concerning the effects of medicines upon the living system. The last principle adopted as the basis of a classification is that of the medicinal properties, or, in other words, of the effects which they produce upon the living system. Of all the systems, this embraces the greatest number of advantages, and is the most decidedly practical and useful in its applications. Like the others, however, it is very far from being perfect. This arises from the limited extent of our knowledge in relation to the animal economy, as well as the effects of medicinal sub- stances upon the system. It is in consequence of this that so many different classifications have been proposed, all based upon the same common principle, but varying in the application of that principle according to the particular views which may be entertained in relation to the laws of the animal economy and the action of remedies. All this will be found abundantly illustrated by an analysis of the classifi- cations of Oullen, Murray, Young, and indeed every other modern writer * Essai sur les proprietes medkales des plantes, comparees avec leurs formes exterieures et leur classification naturelle. Par M. Aug. Pyr. de Candolle, Prof. &c. Seconde edition. Paris. 1816. 30 MATERIA MEDICA AND THERAPEUTICS. on the subject of the Materia Medica. In their details, however, all these classifications are liable to objection. By some, medicines have been classified according to the particular part or tissue of the svstem upon which they are supposed to exert a special influence. This is the basis upon which the classifications of Alibert and Eberle are founded. Specious as this is, it is nevertheless obnoxious to an objection which is insuperable. With the exception of those agents which are purely local in their operation, there is no medicine which is limited in its effects to any particular part of the body. Directly or indirectly, it extends its action more or less to other portions of the system. In applying it, therefore, to individual articles^ the principle of the classification is constantly violated.. For example, opium, in a classification of this kind, is placed under the head of those agents which exert their influence on the nervous system ; and so it does—but besides this it also exerts an influence on the vascular system, on the skin, on the liver, on the urinary organs, and thus the very prin- ciple of the classification is contradicted. So also with almost every other agent. This, therefore, can never furnish a solid foundation for a classification. From what has been said, it must be obvious how impossible it must be to frame a classification that shall be unexceptionable. In the one which I propose as the basis for the present course of lectures, my only objects will be simplicity and convenience, and I shall arrange medi- cines according to their more prominent and acknowledged effects on the system, first into Six Great Classes. 1. Evacuants. 3. Narcotics. 5. Revulsives. 2. Depressants. 4. Excitants. 6. Alteratives. The first class I subdivide into nine orders, as—1st. Emetics, 2d. Ca- thartics, 3d. Anthelmintics, 4th. Sialogogues, 5th. Diaphoretics, 6th. Diuretics, 7th. Expectorants, 8th. Emmenagogues, 9th. Parturients. Of Depressants, I make three orders, viz.—1. Sedatives, 2. Refrige- cants, 3. Demulcents. Narcotics I do not divide. Of Excitants there are four orders,—1. Stimulants, 2. Antispasmodics, 3. Tonics, 4 Astringents. Of Revulsives two, Internal and External. Of Alteratives two, Vital and Chemical. INTRODUCTION, 31 ON THE COMBINATION OF MEDICINES. {Condensed and Abridged from Barbier.) Of the Combination of Emetics with other Medicines.—For very obvious reasons the combination of emetic medicines with those of other classes must be exceedingly limited. They would, as a matter of course, be ejected before they could produce any decided effect. Some com- binations, however, of importance are in use. There are only three cases in which emetic medicines may be combined with other medicinal agents, viz.: — 1. When the emetic medicine enters into the composition in so small a quantity that it cannot excite vomiting. 2. When the matters associated with the emetic are only auxiliary to its operation as an emetic. 3. When by the union of different ingredients the emetic is decom- posed and loses its property. Combination of Emetics with Tonics.—These generally do not admit of combination. Tartar emetic, especially, is decomposed by most of the vegetable tonics and astringents, and therefore if united, the emetic property is destroyed. This is the case with cinchona, nut galls, columbo, &c. Hence vomiting, too, by tartar emetic may be arrested by the administration of a decoction of Peruvian bark. Emetics and Stimulants.—Combinations of these are not uncommon in pharmacy. The wine and tinct. of ipecac are instances. So also if tartar emetic be dissolved in alcohol. In all these the effects of the emetic and stimulant are observed. In analysing the effects of these compounds, we shall find that the stimulant property shows itself first; that it exalts the sensibility of the digestive passages, and thus gives more scope to the subsequent impression of the emetic ingredient. This combination is useful in cases of poisoning by opium, or where the stomach is rendered torpid by the poison. Here antimony acts much more powerfully and promptly, if given in alcoholic solution. This combination is also useful in cases of coma, while the relaxing effects will be inconsiderable and inefficient. When 70 MATERIA MEDICA AND THERAPEUTICS. the inflammation is mild in its character, or when active depletion has been premised, emetics may frequently be used with benefit. 2. When the inflammation is seated in such a structure, as that the operation of emetics will cause copious secretions from the part, as it does in many inflammations of the mucous membrane, the local depletion which they cause, together with their general effects on the system, not merely counterbalance all the objectionable effects attending them, but render them exceedingly beneficial. 3. When inflammation is complicated with functional derangement of the stomach and biliary organs. In cases of this kind, whatever be the seat of inflammation, emetics may frequently prove useful by correcting the condition of these organs, and in this way aid in simplify- ing the character of the disease. Diseases of the Head.—From the effects of emetics on the head as already detailed, it is evident that they are remedies which must be used with great caution in diseases of this part. Although valuable agents in some cases, they frequently are not merely useless, but posi- tively injurious. It is important, therefore, properly to discriminate between these cases. In all active inflammations or congestions of the brain, as a general rule, they ought not to be used. In the treatment of these conditions of the brain, the great object is to divert the flow of blood from this organ by every means in our power, and for this purpose we have recourse to all those agents which have a tendency to promote the flow of blood to other parts. From the effects of emetics in accumu- lating blood about the head, it is evident that they cannot be advisable in cases of this kind. Indeed, as a general rule, they necessarily aggravate the existing morbid condition of the brain. With regard to the use of emetics in apoplexy, great diversity of sentiment has existed. By some of the highest authorities in medicine they have been decidedly recommended—Sydenham, for example, advises an emetic to be given immediately after bleeding from the arm and jugular veins. Dr. Fother- gill, too, recommends them. The majority of physicians, however, are opposed to them, and I think that there can be no question that'they are agents which must generally prove injurious. There is one form of apoplexy, however, in which they may be used with advantage, and that is when the apoplectic seizure is occasioned by an overloaded stomach, as it sometimes is. In cases of this kind, after suitable deple- tion, emetics will be the most efficient agents in affording relief. Although, therefore, in active inflammation and congestion of the brain emetics are doubtful, yet there are other disordered conditions of this organ, in which they have been found exceedingly useful-—of these mania and intermitting headache may serve as illustrations. In mania, emetics may prove salutary in several ways. In the first EMETICS. 71 place in many cases of this disease there is present a torpid and de- ranged condition of the liver, stomach, and bowels. In many instances this condition is associated with the origin of the malady, while in others it may supervene as one of the effects of the primary disease. In either case it exercises a very powerful influence over the general course and severity of the disease. To correct this state of things is accordingly of great importance, and among the best remedies to begin with are emetics. By the impression which they make upon the mucous surfaces of the stomach, on the intestines, and the liver, and by the secretions which they cause from them, they relieve the congestion not merely of these but of the abdominal viscera. In this way they operate frequently indirectly in quieting the cerebral disturbance. In the second place, emetics may prove beneficial by the general relaxing effects which they produce—tranquillizing the vascular system and promoting a more equal distribution of the blood. In the third place, emetics sometimes prove salutary by the general shock which they give to the brain and whole nervous system during their operation. In either of these ways, or by the combined effect of the whole, this class of remedies may prove in many cases exceedingly advantageous. In using them of course you are to bear steadily in mind the general precautions already laid down. If the head should be crowded with blood, or if there should be great general plethora, they are to be ab- stained from until this is corrected. [Emetics are not as much used now as formerly in mania, and ipecac. is, I think, very generally preferred.] In Hysteric Convulsions, emetics are frequently the most efficient remedies that can be used, generally arresting the convulsions as soon as free vomiting is effected. Should the patient be full-blooded, or should there be great determination to the head, it is advisable to draw blood from the arm. Generally, however, amid the struggles of the patient, this is a difficult operation, and the cases are very rare indeed in which an emetic may not safely b« given at once. After the spasms are quieted, blood may then be drawn to an extent deemed advisable by the circumstances of the case. In the convulsions to which children are subject, emetics are no less serviceable than in those of which I have just spoken. Of course, I do not now allude to those convulsions which arise from organic affections of the brain, such as hydrocephalus and the like, but to the ordinary convulsions to which children are so liable, and which usually arise from dentition or from crude accumulations in the intestinal canal. In both cases, emetics of ipecacuanha will be found to operate with great efficacy in arresting the convulsion. In Epilepsy, the use of emetics was recommended so far back as the 72 MATERIA MEDICA AND THERAPEUTICS. time of Aretseus. The practice, however, does not appear to have been a very popular one, and it is only recently that it has been revived. The principal causes of this curious disease may be referred to two general classes, viz. organic affections of the brain, and irritations existing in the digestive organs acting sympathetically on the brain. In epilepsy arising from the last of these causes, there can be no doubt of the pro- priety of the use of emetics, as they operate directly in removing the cause of the disease. Even in cases, however, where epilepsy arises from some disordered condition of the brain, emetics may frequently be used, not merely with safety, but advantage, provided great fulness of the brain be not present, in which case they would be improper until after depletion. In young patients subject to this disease, the use of emetics is frequently attended with the happiest effects. Very gene- rally, in cases of this kind, occasional sickness at the stomach, flatulency, and other evidences of a deranged condition of the digestive organs will be found; and under these circumstances an emetic of ipecacuanha and sulphate of zinc combined, repeated every three or four days, will be found a remedy of great value. Although not tried, so far as my knowledge extends, I would suggest whether some prospect of advan- tage is not held out by the use of emetics in those hitherto intractable diseases, tetanus and hydrophobia. The article which should be pre- ferred in these cases is the tartar emetic, as most likely to produce a full relaxing and antispasmodic effect on the system. Many headaches depend upon some disordered condition of the digestive organs, and may be relieved by the use of emetics. In that species of it which is called intermitting, they will be found pre-eminently beneficial. This disease appears to be an intermittent in disguise, and requires to be treated upon precisely the same principles. In some cases, it may be cured by the simple use of antiperiodics, used as in intermittents. Cases, however, occur in which this does not answer until a full emetic has been given. It operates by two ways—by correcting any latent disorder of the digestive organs, and by giving a shock to the nervous system, by which the recurring morbid action is ob- viated. Diseases of the Throat and Chest.—In a great number of these affec- tions, emetics are remedies of inestimable value, and they operate bene- ficially in the following ways. 1. By promoting the secretions of the mucous membrane of the larynx, trachea, and lungs. 2. By aiding ex- pectoration. 3. By their general relaxing effects on the system. In Tonsilitis, an emetic of tartarized antimony and ipecacuanha may frequently be given with great advantage. Where the patient is ple- thoric suitable depletion should be premised. In many cases every advantage may be obtained by putting the patient on a solution of tar- EMETICS. 73 tar emetic with the view of causing nausea, without carrying it to the extent of actual vomiting. In Cynanche Maligna, if given sufficiently early in the disease, they are remedies much to be relied on. They dislodge the morbid secre- tions accumulated about the fauces, change the action of the part, and have a tendency to restore the natural secretions. From the great pros- tration which ensues in this disease, they are remedies which should be used with caution. In the advanced periods of it, emetics, if used at all, should never be of a debilitating character. Such articles should be selected as will vomit without producing much general prostration, as the sulphates of zinc and copper. In the severest of all the forms of inflammation, I mean Laryngitis, emetics are among our most valuable resources. From the rapidity with which this disease generally runs its course, such remedies are indicated as will operate with the greatest promptness, and among these venesection and emetics take the lead. Bleeding to syncope in most cases is the remedy first to be applied. After this an emetic of tartar- ized antimony and ipecacuanha is the article best calculated to afford .relief; and it does so, probably, by the copious secretions which it pro- duces from the fauces as well as by its general relaxing effects on the system. The importance of this remedy has not, it appears to me, been sufficiently insisted upon by those who have treated of this formidable disease. In Bronchitis, emetics are remedies of great utility, and they may be used with great freedom both in children and adults. In the early stage of the disease, they promote secretion from the inflamed membrane and produce general relaxation, while in the advanced periods they prove advantageous by expelling the superabundant secretion which is oppress- ing the lungs and interfering with the due performance of the function of respiration. In children, they are the only agents that we can resort to for relieving the lungs when oppressed by superabundant secretion. In adults, tartar emetic, and in infants, ipecacuanha or antimonial wine and squills, may be used. Bronchitis is sometimes complicated with hepatic disorder, and in these cases emetics are doubly advantageous. In Pertussis, or hooping-cough, emetics have been used from time im- memorial, and their use has received the general sanction of professional experience. A slight reference to the principal phenomena attending this disease will show how they may prove beneficial. Whatever theo- ries may be entertained in relation to the precise nature of this disease, it is certain that the mucous membrane of the larynx, trachea, and lungs is the principal seat of irritation, in consequence of which an incessant secretion of viscid matter is taking place. The irritation, however, is not confined to this part; other portions of the mucous membrane par- 74 MATERIA MEDICA AND THERAPEUTICS. ticipate in it, and especially that which lines the digestive organs. The secretions of the stomach and bowels are disordered—they become tor- pid and lined with viscid mucus. The liver, too, is congested and its secretions deranged. If such be the condition of things in the lungs, the stomach, liver, and bowels, it is easy to see how emetics may prove salutary. In the first place, they unload the stomach of viscid mucus and excite the torpid liver. Next, they act on the mucous lining of the larynx, trachea, and bronchial tubes, promoting secretion and causing the separation and expulsion of morbid matters accumulated upon it. Independently of all they prove salutary by their general revolutionary operation on the system, by determining to the surface and producing relaxation. Salutary as they are in this complaint, they are not to be used indiscriminately. Regard must be had to the actual condition of the system—the period of the disease—and the kind of emetic to be used. In the commencement of the disease, when the digestive organs are in the condition described, an emetic should be given with the view of producing its full effects, and for this purpose a combination of tartar emetic and ipecacuanha is the best that can be used. In using full emetics in this way there are some cautions which you are to observe. 1. To examine very carefully the evacuations which may be caused by emetics. Unless you do this, you can form no opinion at all of the effect of the remedy. 2. The use of full emetics ought not to be repeated too often. Although I approve highly of the use of these remedies, yet I think they have been much abused in this complaint, and the reason is because practitioners generally form no very distinct notion of the object they have in view in their use. From the incessant and long- continued coughing in this complaint, it is to be recollected there is always more or less determination created to the brain. Now, the effect of vomiting, as is known, is also to determine to the brain, and between the coughing and vomiting, if repeated too often, it will frequently be fouud that irreparable mischief is done to the brain ; and I think I have seen one case at least, in which the too free use of emetics laid the foundation for a subsequent attack of hydrocephalus, which terminated fatally. Caution is therefore necessary in the use of these articles. Even if you have no fears of this kind, always select mild articles if you design to repeat the emetics often; use ipecac, rather than tartar emetic. Phthisis Pulmonalis.—Emetics at one time enjoyed a much higher reputation in this disease than they do at present. That they may prove beneficial by their expectorant action on the bronchitis usually present in these cases at some period of the disease, is possible. So EMETICS. 75 too, they may promote secretion, equalize circulation, and keep up a determination to the skin—all objects of great importance. But in using emetics in phthisis, it should always be recollected that one of the leading features of the disease is great constitutional debility, and of course the use of a debilitating remedy like emetics should never be carried far, nor should such an article as tartar emetic be used at all. In Trachitis or croup, emetics are remedies of acknowledged efficacy. In the different stages of this disease they are, however, to be used with different modifications and different objects. If the disorder be taken in its very commencement, before general inflammatory action has yet come on, there is no remedy so admirably calculated to break up the disease as emetics. A single emetic not unfrequently relieves at once the stricture under which the trachea is laboring, restores the secretions of the mucous membrane, and renders respiration free. The best article to be used is a combination of tartar emetic and ipecacuanha, or the hive syrup. In the more advanced stage of the disease, where inflammatory fever is set up, emetics are also to be used. Here they should be preceded by venesection, and the solution of tartarized anti- mony answers best. This should be used in doses sufficient to produce full vomiting, and afterwards continued so as to keep up nausea and relaxation. In the latter periods of the disease, emetics may still be resorted to with advantage, although for a somewhat different purpose. Inflammatory action has now subsided, effusion has now taken place in the trachea, and a membrane has been formed lining the canal which mechanically obstructs respiration. By the act of vomiting, this mem- brane may sometimes be detached and brought up. For this purpose such emetics are to be used as will vomit without adding to the general debility. The best are the sulphates of zinc and copper. Diseases of the Abdomen.—In many of these, emetics are remedies exceedingly useful. They operate, 1, By relieving the stomach of foreign matters and morbid secretions. 2. By changing the condition of the mucous membrane of the stomach and promoting its secretions. 3. By exciting the secretions of the liver. 4. By the concussion which they give to the abdominal viscera during the act of vomiting. 5. By their general relaxing effects on the system at large. In all cases of Poisons taken into the stomach, whether mineral or vegetable, the first indication to be attended to is that of expelling the poison from the system. If the patient be seen soon after taking the poison, this can be done frequently by the administration of suitable emetics, as the object here is simply to evacuate the stomach and to produce this effect as speedily as possible. Such emetics are to be selected as operate with the greatest rapidity, and at the same time are confined in their effect, as much as possible, to the stomach. The best articles, therefore, to accomplish these objects are mustard and the 6 76 MATERIA MEDICA AND THERAPEUTICS. sulphates of zinc and copper Some poisons act as local irritants, and they produce vomiting and purging. In these cases, simple dilution with tepid water will be sufficient. In almost all disordered states of the stomach, the use of emetics would naturally suggest itself, and they have been accordingly exten- sively used. Experience, however, has shown that they cannot be used indiscriminately, proving salutary or noxious according to circumstances. As a general rule, when inflammation of the mucous membrane of the stomach, whether acute or chronic, is present, they are remedies which ought to be used with caution. If they should be considered necessary, the mildest articles should always be selected. Where disorder of the stomach is simply of a functional character, emetics sometimes are use- ful. They change the secretions of this organ, by the impressions which they make upon the mucous membrane, and in that way prove salutary. Upon this principle, they are sometimes prescribed with effect in dys- pepsia (see Eberie's Pract. vol. ii. 291). In this disease, however, they should be used with discretion, and such articles only selected as act mildly—such as ipecacuanha, &c. Tartar emetic is objectionable in every point of view. Dysentery is another disease of the abdomen in which emetics have been prescribed, and with many high authorities they have been in great repute. In some cases they prove exceedingly salutary, while in others they do not appear to do much good. The rationale of their operation I take to be this. In this disease, along with the local inflammation of the mucous membrane of the large intestines, there is often an engorge- ment of the liver and a deficient secretion of bile. This is evidenced by the character of the evacuations. They are simple blood and mucus. Now, the effect of an emetic is to promote the secretion of bile, and if it should do this freely, it would prove salutary in this present case in the following ways: 1. It would relieve the hepatic engorgement; 2. The quantity of bile thrown into the intestines might act on the bowels as a cathartic; 3. It would equalize the circulation, and act on the skin In all these ways it would be beneficial. If, on the contrary, the emetic only acted on the stomach without touching the liver, none of these beneficial effects would follow. In the use, therefore, of emetics in this complaint, there are two things to be attended to. In the first place the selection of a proper article, tartar emetic or ipecacuanha In the second place, it ought to be given early in the disease. It will then produce more effect than at subsequent periods. There are only two other affections of the abdomen which I shall notice, for the purpose of illustration—obstinate constipation and jaun dice. In the first of these, the use of emetics is an old remedy it was prescribed even by Hippocrates, and since his time it has been recom mended by many physicians, both ancient and modern. In many cases EMETICS. 77 of this kind emetics certainly produce an admirable effect, and they act both by relapsing spasm of the intestines and by promoting the flow of bile. The practice, however, does not always succeed. The cases of constipation in which I think it is most likely to do good, are those in which the disorder depends upon a torpid state of the liver. Jaundice arises from various causes; of these I shall not speak. One of them is, the lodgment of calculi in the ducts, the effect of which is mechanically to obstruct the passage of bile. Now, in this case, emetics have been prescribed in some cases with great effect. Dr. Duncan relates, that in two instances he saw upwards of thirty gall stones voided by stool soon after the operation of an emetic (Eberie's Pract. vol. ii. p. 377). In such cases, the relaxation caused by the emetic probably proves salutary in lessening the spasm of the duct. If this be the true explanation, it indicates at once the kind of emetic to be used. It ought to be one that will act freely on the liver, and at the same time cause great relaxation. Tartar emetic is such a one. The mild emetics will not answer. Hemorrhages.—It is evident that in cases depending upon the rup- ture of large vessels, emetics cannot be resorted to with any prospect of advantage. It is only when it occurs from capillaries that they can be at all applicable, and in these they have been found of great value. Of the manner in which they produce their beneficial effect, it is perhaps not easy to give a satisfactory explanation. It may, however, be in one or other of the following ways : 1. By their distributing more equally throughout the system the cir- culating mass, and in this way counteracting the local determination upon which hemorrhage depends. 2. By the revulsive effect which they produce upon the mucous membrane. 3. By their general alterative effect, more especially on the mucous membrane. 4. By the nausea whieh they produce. Whatever be the mode of their operation, however, there can be no question of their utility in a great number of hemorrhages. ILLUSTRATIONS OF THE EFFECTS OF EMETICS IN PROMOTING THE AB- SORPTION OF MORBID ENLARGEMENTS. Hernia humoralis.—In this affection, emetics may frequently be used with the most striking advantage; indeed, in certain stages of it, I know of no remedy so efficacious. Mr. Hunter long ago remarked, that he had known the swelling removed almost instantaneously, by the 78 MATERIA MEDICA AND THERAPEUTICS. use of emetics.* In a great number of cases I have tried the practice, and almost always with success. The rapidity with which the swelling is sometimes diminished is really astonishing. In the case of a gentle- man who had swelled testicles in consequence of gonorrhoea, all the ordinary antiphlogistic means had been used, together with a blister to the scrotum. On the seventh day from its commencement, although the inflammation had been subdued, yet the tumefaction remained undiminished. A full emetic of tartarized antimony and ipecacuanha was now given, and in two hours after its operation the size of the tes- ticle was reduced at least one-third. It is only, however, in the passive stage of this affection that emetics prove so beneficial. In the early stage, where inflammation is present, they produce little or no effect. Bubo.—In this, emetics have also been used, principally, I believe, in consequence of the recommendation of them by John Hunter. He relates a remarkable instance of their efficacy in the case of an officer who had a bubo at Lisbon. In his own words, " it came to a fair sup- puration, and was almost ready to burst. The skin was thin and inflamed; and a plain fluctuation was felt. I intended to open it, but as he was going on board a ship for England on the day following, I thought it better to defer it. When he went on board, he set sail immediately, and the wind blew so hard that nothing could be done for some days, all which time he was very sick, and vomited a good deal; when the sickness went of, he found the bubo had disappeared, and it never afterwards appeared."! Mr. Hunter explains the effect in this case upon the principle of "one irritation destroying another, and the sickness and the act of vomiting perhaps giving a disposition to absorption." In cases of this kind, the use of emetics is not followed, however, by the same marked effect as in hernia humoralis,—a single emetic produces but little effect, and they require to be repeated for several days in succession, imitating in this way as nearly as possible the effect of sea-sickness.J In morbid enlargements of other parts, emetics may sometimes prove very beneficial. Mr. Cruikshank mentions a case of swelling of the knee, which was cured by the patient vomiting for forty-eight hours, in consequence of his taking a large dose of the salt of tartar (carb. potass.) instead of soluble tartar (tartar potass.). Rush, vol. ii. p. 182. * Treatise on the Venereal Disease, p. 84. See also Benj. Bell, vol. i. p. 204 f On the Venereal, p. 250. X Swedian says, " Success has attended the use of emetics, repeated for two or three days; in this way buboes have been discussed, which were ready to burst" —P. 225. EMETICS. 79 INDIVIDUAL EMETICS. IPECACUANHA. This article is the product of the Cephaelis Ipecacuanha, a plant found native in the Brazils. It grows to about the height of a foot, and flour- ishes in moist and shady situations. The root is from four to six inches long, and about the size of a goose quill. The plant flowers in the months of January, February, and March, and during this period, the root, which is the part used in medicine, is collected. It is separated from the stem, and after being cleansed, is hung up in the sun to dry. In this state it is exported in bales. Physical Characters of the Root.—The root comes in pieces about three or four inches long, and at its thickest part about the size of a goose quill. It is irregularly bent and twisted, and surrounded by numerous rings of various sizes, separated from each other by circular grooves or depressions. It is from this circumstance that the genuine ipecacuanha root is termed annulated. The cortical part makes up the largest propor- tion of the root, constituting about four fifths of the whole. It is thick, of a horny hardness, and breaks with a resinous fracture. It is this which principally contains the active properties of the root The woody part is a thin cord of a whitish color, and is nearly inert. The. powder of the ipecacuanha is of a light yellowish color, having a faint and disagreeable smell, with a bitter, sub-acid, and nauseous taste. By exposure to light and air, the active properties of it are liable to be impaired. For the purpose of preserving it, therefore, it should be kept in vials well corked and secluded from the light. Varieties of the genuine Ipecacuanha Root—As found in the market, three of them are recognised, distinguished from each other by their color, viz. the brown, the red, and the grey. All these, however, are annulated and are derived from the same plant,—the cephaelis ipecacu- anha,—the varieties of color being owing simply to difference in the age of the root, the nature of the soil, the mode of drying, good for intemperate, dose 3 ij to § i. 4. Syrup.—Dose for children, 3 i to 3 ii- 5. Confection. Lenitive electuary.—This was formerly a good deal used, but has now gone out of fashion. CASSIA MARYLANDICA. ! Commonly known by the name of American Senna. It is a tall showy plant, growing in most of the States south and west of New York, com- monly found in moist situations and the borders of streams—flowers from June to the latter part of August. Flowers, bright yellow. The leaves —the officinal part—are smooth, green above, yellowish green below, from one to two inches long, a quarter of an inch broad, having the odor and smell of foreign senna. Effects.—An active cathartic very like foreign senna; by some thought less active, though this is denied by others, who deem it fully equal in strength. The difference probably depends on the different modes of collecting and preserving the leaves. SCAMMONY. This substance is obtained from the root of the Convolvulus scam- monia, a plant growing native in Syria. It consists of a number of slender twining stems, fifteen or twenty feet long, extending along the ground, or climbing upon neighboring plants. The root is perennial, from three to four feet in length, and from ten to twelve inches in cir- cumference. The mode of obtaining Scammony is the following:—About the beginning of June, the ground is removed from the upper part of the • 136 MATERIA MEDICA AND THERAPEUTICS. root, the top of which is then cut off in an oblique direction, about two inches below the origin of the stems. Small vessels or shells are fixed under the root in such way as to receive the milky juice which oozes from the cut surface. Each root furnishes only a few drachms, and the whole of this flows out in about twelve hours. The juice thus collected from different roots is put together, and on standing concretes into solid masses. This is the pure Scammony. Generally, however, while it is yet in the soft state, it is adulterated by mixing it with the expressed juice of the stalks and leaves, and not unfrequently with flour, ashes, fine sand, and chalk. As found in the market, scammony is of different qualities, depending upon the degree of adulteration. Formerly the best kind was called Aleppo scammony, and the inferior kind Smyrna scammony. These names are not used at present. The best kind is now called Virgin scammony, and the inferior kinds, seconds and thirds. Virgin scammony comes in amorphous pieces of a dark color, some- times covered with a white powder. As this powder effervesces with hydrochloric acid, it is chalk in which the pieces have been rolled. They are friable and break readily under the pressure of the fingersj presenting a black and brilliant fracture. When rubbed with the finger, moistened with water of saliva, it forms a whitish liquid on its surface. Its smell is cheesy ; and its taste, at first slight, becomes afterwards acrid. The inferior kinds of scammony come in large flat masses or cakes. The better sort, however, sometimes amorphous. Not so friable, and its fracture generally dull. Tests.—Good scammony fractures readily under the fingers; the fracture is dark and brilliant. Its specific gravity, according to Pereira, is only 1*210; if much heavier, it is impure. If, on touching the frac- tured surface with hydrochloric acid, effervescence takes place, it is adulte- rated with chalk. If iodine strike a blue color in a decoction of scam- mony, flour (starch) is present. When rubbed with the finger, moistened with water, a milky liquor is formed. Ether takes up 80 per cent, (the resin). Composition.—Principal ingredients, gum and resin. The proportions vary from 80 per cent, or even a little more, of resin, to so little as 29 per cent. That having the most resin is best. Being a gum resin, it is soluble partly in water and partly in alcohol. Diluted alcohol dissolves all but the impurities. Effects.—Scammony is one of the drastic hydragogue cathartics. It resembles jalap in its general action, being, however, more active and more liable to produce nausea. Generally operates speedily, and frequently gripes and causes a good deal of local irritation. Its action varies with the state of the bowels. If they are lined with mucus it passes through without producing much effect. • CATHARTICS. 1:57 In combination its action is rendered much milder. Scammony is useful in all cases when it is desirable to make a strong impression on the bowels. In torpid states of these organs, it is a valuable article. Whenever active irritation or inflammation of the bowels is present it is objectionable. Mode of Ail ministration.—Powder.—This is given intimately tritu- rated with gum arabic, starch, or sugar. This is supposed to render its action milder. Of this the dose must vary according to the purity of the article. Of Virgin scammony, six to ten grains for an adult; of the common, ten to twenty grains. For a child, from three to five grains. A good way of giving it is in the form of an emulsion with milk. Resin.—This operates like the scammony itself, only in smaller doses —eight to ten grains. Has no advantage over good scammonj7. GAMBOGE. This is the product of an unknown tree growing in Siam, and in the island of Ceylon. In Siam, it is procured by breaking the young shoots and leaves of the tree, and collecting in cocoa-nutshells the juice, which exudes in drops of a yellow color. It is then transferred into large earthen jars, where it remains until dried to a proper consistence, when it is formed into rolls and covered with leaves. Sometimes the juice is collected in the hollow joints of bamboo, and as it solidifies, the gam- boge forms into pipes. xVs found in commerce, it is in three different forms; in solid rolls, in cylindrical pipes, and in irregular masses. The two first are known by the name of pipe gamboge, the last cake gamboge. The poorest pieces of all the varieties are called coarse gamboge. Pipe is the best. Good gamboge is an opaque substance of a uniform orange color, bitter, and breaking with a conchoidal fracture; when taken into the mouth it has no taste at first, but afterwards leaves an acrid sensation in the throat. It yields a powder of a bright yellow color. The inferior hinds are harder, the fracture is earthy, and of a brownish not uniform color; has dark spots in it from the presence of foreign bodies; generally adulterated with starch, fragments of wood, Ac. Tests of its Purity.—1. The peculiar fracture. 2. If a decoction of its powder be tested with tinct. of iodine, if rendered green, starch is present Composition.—The best analysis of this article is that of Professor Christison. According to him the purest kind consists of Resin. This he calls gambogin or gam bogie acid, a brittle substance in thin layers of a deep orange color insoluble in water, but soluble in alcohol and more 138 MATERIA MEDICA AND THERAPEUTICS. so in ether. In doses of 5 grs. this acid produced free watery dis- charges, without griping or uneasiness. He infers from this that the activity of gamboge does not depend entirely on this acid, for if it did 5 grs. of it would be equal to 7 of gamboge, which is not the case. Soluble gum or arabin, analogous to gum arabic. Woody fibre, only a trace. Moisture. The proportions of these ingredients in the different kinds of the article are found to vary very much. The inferior kinds contain large proportions of woody fibre and starch. Gamboge is dissolved partly by alcohol and partly by water. It is also dissolved by the successive action of ether and water. Effects.—Gamboge is a powerfully hydragogue cathartic, promoting intestinal and urinary secretion, and producing liquid evacuations from the bowels. In larger doses it causes nausea, vomiting, griping, and copious watery stools. Sometimes it causes great irritation of the mucous membrane of the intestines. In over doses it acts as an acrid poison. The peculiarities of this article are, that it is very apt to affect the stomach. This is owing to its easy solubility in the juices of that organ, and that it operates very rapidly. It may be used in all those cases where we want an active cathartic to produce copious watery evacuations. In cases where the bowels are irritable, or where there is general debility, it is dangerous. This is one of the articles which entered into the composition of Morrison's pills, which have done so much mischief. Doses, d-c.—From the general propensity which gamboge has to affect the stomach from its ready solubility, the best form of giving it is that of pill, and in small doses, frequently repeated. Give a pill of 1, 2, or 3 grs. every three or four hours till it operates; a full dose is from 3 to 6 grs. Gamboge is generally given in combination to quicken the action of other articles. Pil. Camb. Comp., in which the gamboge is combined with aloes carb. potass., and soap, is a good cathartic in dropsy and congestion of the brain. [helleborus niger {black hellebore—the root). Hellebore was well known to the ancients, and its use by Melampus (b.c 1400) is the earliest instance on record of the giving of a purga- tive. Dr. Sibthorp, however, supposes that the ancients used the H. officinalis not the H. niger. The root consists of rhizome and radicles; taste acrid and nauseous. Effects.—Hellebore is an acrid, narcotico-irritant purgative, useful CATHARTICS. 139 only in torpid, phlegmatic habits, and where the pelvic circulation is languid. Though much lauded by the ancients, especially in mania, it is now little used. Forms.—Powder.—Dose, 10 grs. Tincture U. S.—[Hellebore, 3 iv; dilute alcohol, Oij. Macerate seven days and strain.] Dose, 3 i.] COLOCYNTH. The plant yielding this is the Citrullus colocynthis, the Bitter Cu- cumber ; native in Japan, Turkey, Nubia, the Cape of Good Hope, and the Grecian islands. In Spain it is cultivated. It is an annual plant, resembling very much the common garden cucumber. The stems are trailing and beset with rough hairs. The fruit which it yields is a round berry, about the size of a common orange, with a smooth skin of a yellow color. Inside it has a white spongy pulp filled with seeds. It is this pulp which is used in medicine. The mode of preparing it is to peel the fruit when yellow and ripe, and dry it in stoves. In this state it is exported. As found in the shops, it is in the state of the dried round fruit, generally peeled. The pulp is light and spongy, of a white color, and filled with seeds. It is destitute of smell, but has an exceed- ingly bitter and nauseous taste. The only part of the fruit possessing active properties is the pulp. The powder is of a pale yellow color. Composition.—Colocynth contains a peculiar bitter principle, called colocyntin. This is a resinous substance of a yellowish color, extracted by alcohol. It is brittle and exceedingly bitter. In alcohol it is very soluble; in water, sparingly so, imparting to that fluid, however, an intense bitterness. This substance possesses the active properties of the colocynth in a concentrated form. In doses of one or two grains, it is said to be a good substitute for croton oil. Besides this, colocynth contains a resinous matter, insoluble in ether; fixed oil, extractive matter, gum, and various salts. The virtues of colocynth are extracted by ether, alcohol, and water. Effects.—In small doses, colocynth acts as a safe and valuable cathar- tic, increasing the peristaltic action of the intestines, and promoting intestinal secretion. In full doses, it acts as a drastic and hydragogue, causing watery evacuations, severe irritation, griping, and sometimes bloody stools. It appears to pass rapidly over the small intestines, and to exert its principal effect on the large ones. If given in too large doses it has proved fatal, producing the effects of a narcotico-acrid poison. Analogous in its general operation to gamboge, except that gamboge operates more on the small intestines. Resembles aloes in 10 140 MATERIA MEDICA AND THERAPEUTICS. acting on the large intestines, but differs from it in producing more secretion, and being less tonic. Dose.—2 to 8 grains in powder, mixed with gum or starch. Seldom, however, given in this way. Generally in form of extract, and in com- bination. Ex. Colocynthidis Comjx—Is a very popular and a very active ca- thartic, much used in obstinate constipation. ELATERIUM. The plant which yields this article is the Mormodica elaterium. It was known to and used by Hippocrates. The common name is the wild or squirting cucumber. It is an annual, growing native in the south of Europe, especially in Sicily, Italy, and the south of France, in uncultivated and stony situations. In England, it is cultivated exclu- sively for medicinal purposes. In that climate, however, it does not survive the winter. The root of the plant is thick and fleshy, sending out trailing stems spreading in different directions, resembling those of the common cucumber. Its fruit, also, resembles that of the common cucumber, only being much smaller. It is about two inches long and one inch thick, of a greenish grey color, and covered with prickles. When perfectly ripe, the fruit separates from the stalk, and scatters its seeds and juice to a considerable distance. It is from this peculiarity that it derives the name of the squirting cucumber. The elaterium of medicine is the substance spontaneously deposited by the juice of the fruit when allowed to stand. The quality of the elaterium depends in a great measure upon the manner in which it is prepared. From a series of experiments made by Dr. Clutterbuck of London, it appears that the active principle of the cucumber resides only in the juice which surrounds the seeds. The fruit itself, the seeds, as well as the stalks, leaves, &c, contain little or none of it It is from this, therefore, that the pure elaterium is ob- tained. The best kind of English elaterium consists of thin, slightlv curled flakes, marked with the impression of the linen on which it has been ■dried; of a pale, greyish green color, becoming yellow by exposure; very light and friable; taste acrid and bitter, with very little odor It is readily reduced to powder. This is called E. album. The inferior kinds {E. nigrum) are hard, breaking with difficulty ; more curled gummy, and dark colored. ' iWy.-Elaterium differs greatly in its shape owing to the mode of preparation and actual adulteration. 1. From the Mode of Preparation.-That obtained according to Dr. CATHARTICS. 141 Clutterbuck's method, from the juice which has been allowed to flow spontaneously from the sliced fruit, is the strongest, but is obtained in very small quantity. Where the juice is forced out by strong pressure, more elaterium is made, but it is of inferior quality. By evaporating the juice a still inferior quality is produced. Then again, if the juice from which the elaterium is deposited be suffered to stand too long before it is separated, a mucilaginous matter subsides, which greatly impairs its strength. This renders the elaterium dark and gummy. The adulterations are with chalk and lime, generally of the Maltese kind. Tests.—It should be friable, of a pale green greyish color, floating on water, not effervescing on the addition of diluted hydrochloric acid. If it does, it shows the presence of chalk. If the acid solution be neu- tralized by ammonia, gives no precipitate on the addition of oxalate of ammonia. If chalk be present, throws down a copious precipi- tate (oxalate of lime). Touched with the tincture of iodine gives no evidence of presence of starch. If this be present turns it blue. Chemical Composition.— According to analysis of Mr. Hennel of Lon- don, elaterium contains in 100 parts, 40 parts of a peculiar crystallizable substance which he calls elaterin, 17 parts of green resin, starch 6 parts, woody fibre 27 parts, saline matters 6 parts. Effects.—Elaterium is among the most active of the hydragogue cathartics, causing free secretion and copious watery evacuations. If the dose be somewhat large it acts with great violence, causing sickness and vomiting, together with irritation, and in some cases actual inflam- mation of the mucous membrane of the bowels. From the local irrita- tion which it produces, general febrile excitement is apt to occur during its action ; the pulse becomes excited, the tongue and skin dry, together with great thirst As this article operates so powerfully, its use must be limited to those cases in which the bowels are torpid, and where it is desirable to excite a powerfully revulsive action in the intestines and to cause free intestinal secretion. On the other hand, whenever any local irritation of the intestines exists, it ought not to be used. In delicate habits, too, and in young subjects it is improper. This article is uncertain and variable in its operation, large doses at one time produce little effect, while small ones are sometimes followed by violent effects, owing either to difference in the strength of the article or in the state of the intestines. Mode of Administration.—The best form is that of pill, made with ex- tract of gentian. The dose must vary with the strength ; of the best kind one sixteenth to one eighth gr. is sufficient; of the ordinary kind one half a grain ; of the black kind 2 or 3 grs. are sometimes used. The 142 MATERIA MEDICA AND THERAPEUTICS. dose to be repeated every two or three hours until the desired effect is produced. Elaterin is crystalline, very bitter, no smell, neither acid nor alkaline; insoluble in water and soluble in hot alcohol. One sixteenth of a grain operates like a dose of elaterium. CROTON OIL. The plant which yields this is the Croton tiglium, a tree growing ten or fifteen feet high in China, Cochin China, Ceylon, the Molucca islands, and the greater part of the East Indies. The fruit is a capsule about the size of a filbert, with three cells divided by membranous partitions, each containing one seed. It is from the seeds that the oil is obtained. They are about the size of the castor oil seeds; viewed laterally they have an oblong shape, but from either extremity their shape is four-sided, having two of the sides convex and the other two somewhat flattened. The shell of the seed is black, but is covered with a soft yellowish brown epidermis. The kernel is of a yellowish brown color. The seeds have no smell; taste at first mild but soon becomes hot and burning, this con- tinues for some time. The seeds are imported from the East Indies in cases, and from the friction which they undergo during their transportation the epidermis is generally rubbed off. On their first introduction into Europe they were known by the name of Molucca grains. The croton seeds are actively cathartic, producing the effects of a hydragogue. This is the form in which this article is frequently used in the East Indies. The seeds are first well dried by a fire and the shells carefully removed. This is supposed to correct the acrimony of the seeds. They are then pulverized and made up into pills with honey, each pill containing 2£ grs. of the powder. Two of these pills are an ordinary dose for an adult. Mr. Marshall says this dose is about equal to 3 ss of jalap or to grs. vi of calomel. The stools are invariably watery and copious. It operates without nausea and griping, except in occasional instances. In Europe and in this country the only preparation that is used is the oil. Croton Oil—This is obtained by first roasting the seeds and then separating the shells ; after this subjecting them to strong pressure In this way 50 per cent, of their weight of oil may be procured The oil is of a reddish yellow color, with a faint odor'and of an unctuous thickness, like castor oil. Its taste is hot and acrid leaving an uneasy feeling in the mouth and throat, which continues for some hours. CATHARTICS. 143 Chemical Composition.—Dr. Nimmo, who early investigated the sub- ject, states the composition thus:—acrid purgative matter 45, bland fixed oil 55 = 100. This acrid matter was supposed to be of a resinous nature, but the subsequent analysis of Brande established the existence of a peculiar principle, crotonin, and an acid, crotonic. Croton oil is soluble in ether, the fixed and volatile oils. In absolute alcohol cold it is insoluble but soluble in hot, from which it is again de- posited on cooling. Effects.—Croton oil is an active hydragogue cathartic and operates with great rapidity, producing copious watery evacuations. In moderate doses, although it operates actively, it does not produce much nausea or griping. If the dose be somewhat large, it occasions considerable intestinal as well as general irritation. As a cathartic it is suited to those cases in which there is great torpor of the bowels and where an active revulsion upon those organs is desirable. In children and feeble habits, or where inflammation of the intestines is present, it ought not to be used. What is peculiar to this article is that the simple applica- tion of it to the tongue, without swallowing, will cause purging. One or two drops applied in this way will operate, and maybe resorted to in cases where the patient has lost the power of deglutition, as in apo- plexy, tetanus, itc This oil is variable in its action. Mode of Administration.—The ordinary mode is that of p>M, made up with crumbs of bread, each pill containing a drop of the oil. To an adult, one or two of these is an average dose. A better way is to take a pill every hour or two until the desired effect is produced. MERCURIAL PURGATIVES. CALOMEL. Of the history and properties of this most important article I shall speak at large under the head of sialagogues; I now refer to it only as a cathartic. In this respect, it is peculiar and produces effects widely different from those of other medicines of this class. The peculiar effects of calomel depend not upon its mere cathartic power, but on its action upon the liver and the mucous membrane of the bowels. The chief of these peculiarities are :— 1st. Its action on the mucous membrane is peculiar and often very salutarv— increasing the secretion, and seeming to enable the membrane to throw off any viscid mucus with which it may be coated. 2d. Its influence on the liver is marked, and its cathartic operation has been by some attributed to its increasing the flow of bile. 144 MATERIA MEDICA AND THERAPEUTICS. 3d. It is slowr, often taking from 8 to 12 hours to produce any effect —the motions are few and commonly large. 4th. The operation of calomel is rarely attended by much griping, but often by nausea and prostration even to the extent of fainting. 5th. The action of calomel is permanent, and it does not leave behind it that tendency to constipation which follows the use of many cathartics. 6th. There is yet another peculiarity in the operation of calomel to which I wish to call your especial attention, and that is that when given in large doses, it does not produce any corresponding irritation. On the contrary, it seems to act as a sedative to the intestinal canal. On this principle, scruple doses of calomel have been given in dysentery and other intestinal disorders. The purgative effect is not increased, and the irritation is lessened by thus doubling the dose. Its depressing effect on the whole system is very markedly increased. From a scruple of calomel, the alvine evacuations will be neither more numerous nor more copious than from six or eight grains, but the prostration will be far greater. Cases are recorded where by mistake very large doses of calomel have been taken, = i or more. The purgation was generally very moderate. Of late years immense doses of calomel have been given in Asiatic cholera and some other diseases. [Pereira gives some cases from the records of a London cholera hospital, in which calomel was given in frightful doses. Three drachms on the entrance of the patient into the hospital, and one drachm every hour till in some cases 20, 25, and 30 drachms were given. In none of these cases did violent irritation or profuse salivation occur. Seventeen out of eighteen cases recovered. The patient who died took 53 drachms in 42 hours, without sensible effects. The best that can be said of this practice is, that it did not kill.—Ed.~] For the purpose of testing the effects of calomel upon the stomach and intestines, Mr. Annesley instituted some experiments upon dogs which are very curious and interesting. He took three healthy dogs,°and gave to one 3 i of calomel; to a second, 3 ij ; to a third, 3 iij. After this they were tied up in a room. Twenty-four hours after they had taken the calomel, the dogs were all killed; and five minutes after they were dead, they were examined and the vascularity of the stomach was found to be in the inverse ratio' of the calomel which they had taken, i. e. in the dog who had taken 3 iij, the vascularity was the least, and so on. For the purpose of com- paring this with the condition of the stomach of a dog which had taken no calomel at all, an examination of another dog was made, and here the stomach was more vascular than in any of the others. From these experiments, Mr. Annesley draws the conclusion, "that the natural and healthy state of the stomach and intestinal canal is high vascularis and CATHARTICS. 145 that the operation of calomel in large doses is directly the reverse of inflammatory." Therapeutical Effects of Calomel.—Upon the use of calomel as a purgative in different diseases, so much was said in my general remarks on purgatives, that I will not now go into the subject in detail. Suffice it to say chiefly by way of recapitulation, that in fevers and inflamma- tions, whatever be the type of the former, or the location of the latter, calomel mayr with the precautions and restrictions which were detailed when I spoke of purgatives generally, be used with excellent effect. In jaundice, too, it will often produce the happiest results. For obstinate constipation depending on torpor of the bowels it may be also given with advantage. PILULA HYDRARGYRI {blue pill). This is a mercurial purgative, not so much used as a cathartic, yet capable, when given in adequate doses, of producing free purging, with most of the advantages which attend the operation of calomel.- Of its pharmaceutic history I shall speak under the head of siala- gogues. Its dose as a purgative should be from 15 to 20 grs. The practice of giving five grs. of blue pill at bedtime, and a senna draught in the morning, so highly recommended by the late Dr. Abernethy, has lost some of its favor with the profession ; yet for a very large class of cases of constipation it is of great value. Blue pill is an excellent pur- gative for children; five grs. given at night will commonly operate in the morning; and its influence, if given early in the febrile and inflam- matory affections of children, is usually most salutary. COMBINATION OF CATHARTICS. In what has been said of individual cathartics I have confined myself to a notice of the effects which they produce when given separately, and I have done this with the twofold design of showing that all cathar- tics do not act precisely alike, and to enable you to understand the prin- ciples upon which they are combined in our ordinary prescriptions. On this account I have omitted saying anything in relation to these combi- nations until the present time. After stating briefly the object to be attained by uniting different cathartics in one prescription, I shall ana- lyse the whole of them with the view of illustrating the principles upon which these combinations should be made. 1. The first object to be attained by combining cathartic medicines is to increase their activity. This may be done either by increasing the rapidity with which they operate or by increasing the actual effect produced, 146 MATERIA MEDICA AND THERAPEUTICS. 2. The second object is to make them act more mildly. A number of valuable cathartics, you now know, act with such intensity and pro- duce effects so unpleasant, in the way of nausea and griping, ■when given alone, that their use in this way is exceedingly objectionable. By judi- cious combination this may, to a very great extent, be obviated. 3. The third object is to obtain in one combination the effect of differ- ent cathartics. As I have already stated, these articles act in various ways—some increase the peristaltic motion—others cause copious secre- tions from the inner surface of the intestines—while others again act by promoting the biliary secretions. Now by uniting different cathartics all the effects may be produced by one prescription. These are the principal objects to be gained by combining these arti- cles, illustrations of which you will find in the notice which I shall now take of the different substances belonging to this class. Laxatives, generally speaking, do not admit of combinations. Being used for their mildness and simplicity, they do not require anything to modify their operation. In fact as a general rule, the best form in which they can be given is alone. They are sometimes, however, com- bined, and then their effects are very much modified. Castor oil is best administered alone. Manna and cassia, from the quantity in which they are obliged to be taken, are apt to sit heavy on the stomach and frequently to cause griping and uneasiness. On this account they are generally combined with the more active purgatives, of which I shall speak hereafter. Sulphur and cream of tartar are fre- quently combined, and the compound is more active than either sepa- rately. Sulphur and magnesia combined frequently answer an excel- lent purpose. You have a gentle laxative suited to acid states of the digestive organs. As magnesia only operates as a cathartic when it meets with an acid in the alimentary canal, its activity is promoted by following it with cream of tartar. Of Purgatives.—It is in these especially that the advantages of com- bination are shown. Senna.—This substance, as already stated, when given alone is apt to produce a great deal of griping. By combining it with manna this is corrected. It is rendered milder in its operation, though not less effec- tual—at the same time all the unpleasant effects of the manna when given alone are obviated by the senna. By combining senna with some of the neutral salts its griping effects are also corrected, while the com- pound is more active in clearing out the bowels than either separately. A very good combination consists of senna, manna, and epsom salts. It acts thoroughly yet pleasantly. Rhubarb.—This is a cathartic which is given very conveniently and advantageously alone. It is mild in its operation and sits easily on the stomach. It is frequently, however, combined with advantage. With CATHARTICS. 147 magnesia it forms a very valuable compound, in all cases where you wish an antacid effect together with a tonic purgative. This is pecu- liarly useful in cases of enfeebled and deranged stomach from over feed- ing or over drinking. The most common combination of it, however, is with calomel. Here you combine the peculiar operation of both— that of the rhubarb on the stomach and intestines, and that of calomel on the liver. With aloes, which is laxative and tonic, it forms a useful tonic. It combines the united operation of rhubarb on stomach and small intestines and aloes on large. Jalap.—This is a very active cathartic and operates well when given alone. Generally, however, it is combined. With equal parts of cream of tartar, it makes the pulvis purgans so commonly used. By this union the jalap is rendered milder and the whole effect is increased. United with calomel the double effect is obtained upon the liver and upon the intestinal canal. Scammony.—This is an active article and liable to gripe when given alone. This is corrected by combination with other cathartics, and what is singular those of a very active character. By a union of Aloes, Scammony, and Colocynth, in the form of the compound colocynth pill, you get a preparation more permanent in its operation than aloes alone, and yet without the irritation and unpleasant effects either of scammony or colocynth. Gamboge.—This is a very active griping cathartic, operating with uncommon celerity, and usually when given alone commencing its action in the stomach and causing nausea and vomiting. On these accounts it cannot well be given alone. By combination, however, it is rendered a manageable and valuable cathartic. With aloes, which is very slow in its operation, and docs not affect the stomach, it forms a purgative in which the effect of gamboge on the stomach and bowels is corrected, and yet more active than aloes alone. Generally speaking, gamboge is used only in small quantities, say gr. j., to increase the activity of other articles when you want to produce a strong hydragogue effect. Elaterium.—This is generally given alone. Croton Oil.—Generally speaking, this article has been used in its un- combined state, and principally with the view of getting the very active hydragogue effects which it produces. By combination, however, it may be made much more available as a general cathartic. In combination with Calomel or Blue pill, in the dose of half a drop to six or eight grains of the latter, its general efficacy has been increased, while the nausea and griping which it is apt to pro- duce have been obviated. With the compound pill of rhubarb, too, it forms a good combination. Neutral Salts.—Very commonly these are given by themselves, and 148 MATERIA MEDICA AND THERAPEUTICS. this is a very good way when the object is merely to wash out the exist- ing contents of the intestines. Their activity is considerably increased by mixing them together. This curious fact is illustrated in some mine- ral waters (such as Cheltenham salts). Another instance is in the sul- phate of magnesia, which acts with great effect if the muriate of mag- nesia be present. Of the combination of the neutral salts with senna and manna I have already spoken. Calomel.—This article enters into a great number of combinations, which it is unnecessary to enumerate. In all cases where the object is to promote the secretion from the liver, it forms a useful addition to cathartics. It may be given either alone, and then followed in five or six hours by some quick cathartic to carry it through the bowels, such as neutral salts; or it may be given in combination with other articles, such as powder of jalap, rhubarb, extract of butternut, may apple, croton oil, &c. dc. In this way you get the combined operation of calomel on the liver, and the other articles on the intestines. enemata {clysters). From the great susceptibility of the mucous surface of the lower bowels, it is evident that medicinal substances may be applied to it to produce impressions not merely on the intestine itself, but on the sys- tem at large. Hence enemata are used for a great variety of purposes. At present I shall only speak of them as agents intended to evacuate the bowels, either by their own powers, or by promoting the operation of cathartics. Used for this purpose, they are of very great value. Cathartic enemata operate in two different ways; first, by the mere stimulus of distension causing contraction of the gut; second, by an irritation of the mucous membrane of the rectum, they stimulate the muscular coat, and in that way provoke contraction. This impression is frequently conveyed to the upper portion of the large intestines. Enemata are capable of fulfilling three indications : 1. They' evacuate the lower portion of the alimentary canal. 2. They assist and expedite the operation of cathartics. 3. By the irritation on the intestine they act as revulsives, and thus relieve distant parts. They are made more or less stimulating according as they are intended for one or other of these purposes. To evacuate the lower bowels we use either those which act by mere distension, or those which are only moderately stimulating. 1. Warm water, warm gruel, molasses and water. These operate by distension only. The quantity to be given is from a pint to a quart Pereira objects very strongly to the large enemata recommended by CATHARTICS. 149 late authors, insisting that "it is rarely proper to use more than a pint." That " large quantities destroy the tonicity of the gut," Ac. I think experience has shown the entire safety and manifest utility of large enemata. Injections may be made slightly more stimulating by adding to the warm water, salt, oil, or soap. These are of course more efficient and better calculated to aid the operation of a cathartic. If a still more active enema is desired, decoctions or infusions of the various purgatives may be used, as dec. aloes, inf. sennse, solutions of the purgative salts, &c. If a strong revulsive action is required, dec. colocynth, or the spirits of turpentine (made into emulsion with gum arabic or eggs), may be tried. The instrument used, and the manner of using it, are by no means indifferent matters. The best instrument is the valve syringe, but the ordinary enema syringe, if good, will answer very well with care. The tube or bag to which a pipe is attached, and from which, the pipe being introduced into the rectum, the fluid is allowed to run by its own gravity, has the great advantage that it is impossible to do any harm with it. The common pipe and bladder are unhandy, but safe. The fluid should be injected very gradually, and the greatest care taken to avoid injuring the parts with the pipe. [Moving the bowels every day with a large enema of cold water has cured very many cases of chronic piles. It should be continued for a year, and resumed on any return of the difficulty. Even where cure is not effected, the comfort of the patient is much increased.] ANTHELMINTICS. Anthelmintics are those medicinal substances which possess the power of destroying and expelling worms from the human system. I shall first give you a brief account of some of the different kinds of worms which are found infesting the human body. They may be divided into two general classes, viz. those which infest the intestinal canal, and those which are found in other parts of the body. I shall treat of the first of these only. Of those Worms which infest the Intestinal Canal.—These are of five species, three possessing an alimentary canal, hence called hollow worms, Ccelelmintha—two having no abdominal cavity, called solid worms, or Sterelmintha. The hollow worms—nematoid worms—are ascaris lumbricoides, ascaris vermicularis, and tricocephalus dispar—called respectively the large round worm, the small thread worm, and the long thread worm. The solid worms are: Taenia solium, the common tape-worm, and Bothriocephalus latus, the broad tape-worm, formerly called Taenia lata. The Tape-worm, Tamia.—This is a very long worm, made up of flat articulations, united by means of a border or edge varying in breadth and thickness. It is of a whitish color, and varies in length usually from twenty to thirty feet. It generally occupies the small intestines. The head is turned upwards and firmly insinuated in the mucous mem- brane, while the body extends floating down the intestinal canal. There are two species which have been found in the human subject. Tamia lata, or, as it is now called, Bothriocephalus latus—the broad tape-worm. This species has been found chiefly in the inhabitants of Poland, Switzerland, Russia, and some parts of France. In other parts of Europe it is not found. In this species the articulations are broader than they are long, and the whole worm is broader and thicker than the other species—the taenia solium. The breadth varies from one eighth to one quarter or more of an inch. Its general length is from fifteen to twenty feet. Its color is dusky and not so white as the tamia solium. Tcenia Solium.—The solitary worm—so called from its beino- sun- posed that never more than a single one was found in the intestinal ANTHELMINTICS. 151 canal at the same time. Satisfactory observations have, however, proved this to be incorrect. This species is found in the inhabitants of Europe generally, with the exception of those nations in whom the taenia lata is met with, in whom it is not often found, though occasion- ally the two species of worm are found in the same individual at the same time. Among the Egyptians it is also common. It is not so broad or so thick as the other species. Its length however is greater, averaging from twenty-five to thirty feet. Its color is commonly a pale white. This species of taenia is never passed entire, and it possesses the curious property of parting with a number of joints and reproducing others to supply their place. This worm is Hermaphrodite, having a double sexual apparatus in each joint. Ascaris Lumbricoides. The long round worm. This animal is about the thickness of a common quill and from six to ten fingers' breadth long. When first passed it has a transparent appearance, but it soon acquires an opaque yellow tinge. The general shape of the body is cylindrical, but tapering towards the extremities. It is found both in children and adults; in the former, however, it is most common. Its natural abode is in the small intestines, more especially the jejunum and ilium. Occa- sionally it.passes into the stomach and makes its way out by the mouth. Unlike the taenia it exists in great numbers—fifty, a hundred, and even a greater quantity having been discharged, in a few days, from the same person. Occasionally it is found with other worms. Ascaris Vermicular is, also known by the name of Oxyuris vermicularis — the maw or thread worm. The common name by which they are known is ascarides. This is a small worm with an obtuse head, and varying in length from one line to five and six lines. The part of the intestines in which this worm is generally found is the rectum, sometimes also in the colon, and occasionally in the coecum. In children and young subjects they are more common than in adults. In females they are sometimes found in the vagina, from whence they have been known to pass up into the urinary organs. In some very rare cases, they have been detected in the stomach and oesophagus. The worm is never found alone, but always in conglobate masses. According to Bura, the ascarides live longer in the human body than any other worm. Tricocephalus Dispar—threadworm—the long thread worm, or capil- lary headed worm. This is a slender worm from one and a quarter to two inches in length, and in breadth not more than about half a line. Its color is usually white. This worm is not of a uniform size throughout its whole length. The extremity where the head is situated, is very slender and resembling a thread, and from this it derives its name. For about two thirds of its length it continues of this size. The remaining one third towards the tail is much larger. Pereira says " it does not appear that the long thread worm ever excites any symptoms." 152 MATERIA MEDICA AND THERAPEUTICS. Evidences of the Existence of Worms.— It is by no means easy to decide in all cases whether worms are actually present. This arises'mainly from two causes. In the first place they most commonly occur in very young subjects, who, of course, can give no accurate account of their symp- toms or sensations; and in the second place, the sympathetic irritations occasioned by worms in the intestines, are so diffused over the whole system, so remote frequently from the intestines, and so varied in their cha- racter, that it is not always easy to trace them up to their original source. The symptoms may be divided into two classes, viz. primary and secondary. 1. Primary Symptoms.—By these I mean the immediate symptoms of local irritation in the intestinal canal. The first of these is pain in the abdomen. As may naturally be inferred, from the moving nature of the irritating cause, these pains are not fixed in any particular spot but wandering over the whole abdomen. They differ, too, in intensity, vary- ing from a mere sense of uneasiness to pains of a more sharp and pricking character. Whenever the stomach and intestines are empty, these pains are aggravated, and on taking food they are usually relieved. The ab- domen becomes tumid and tender. The second symptom is derangement of the functions of the stomach and bowels. This exhibits itself in nausea, eructations, and sometimes vomiting. The appetite is variable—at one time entirely gone, and at another voracious. The bowels are irregular—sometimes costive, some- times relaxed. Not unfrequently tenesmus is present Such are the primary and local effects of worms, viz. irritation in the intestinal canal and a consequent derangement of the function of digestion. 2. Secondary Symptoms.—-These are various, and show themselves in almost every part of the system. The countenance is generally changed in its appearance. Usually it is of a pale or leaden color, with a red spot on the cheek. The eye becomes dull and frequently fixed ; the pupil is dilated, and the under eyelids become tumid and have a bluish streak upon them. The nose is tumid, and itches incessantly. Children are constantly picking their noses. The mouth is full of saliva ; the upper lip swollen ; the tongue foul and the breath offensive. The brain and nervous system are also greatly affected. There is head- ache, especially after taking food—singing in the ears. Disturbed sleep, and vertigo. Delirium and fainting have all been known to occur. Amaurosis, deafness, apoplexy, and epilepsy have resulted from the pre- sence of worms. The foregoing is a general account of the symptoms indicating the pre- sence of worms. You are not to expect to meet the whole of them in any particular case. ANTHELMINTICS. 153 After all, however, the only certain sign is the actual evacuation of worms from the intestinal canal. [And then we are not sure that the previous symptoms have resulted from worms.] Symptoms produced by the different species of worms.—I. Ascarides. —As these reside chiefly in the rectum, they cause an excessive irrita- tion about the anus, sometimes extending to the neck of the bladder. 2. Taenia.—As may naturally be supposed, the sensation occasioned by this worm is peculiar. Occasionally pricking or biting is felt-, most com- monly, however, it is that of something alive and moving. The abdo- men swells at intervals, and then subsides, as it were, by undulation. From time to time, also, a sense of coldness pervades the abdominal viscera; the appetite is voracious, while the more the person eats, the thinner he becomes. The complexion is livid, the eye is dilated ; con- fusion of the head and vertigo. There is sickness at stomach, and sometimes vomiting, with general weakness in all the limbs, and frequent trembling of the whole body. [These violent symptoms are by no means universal. I have known a man in the most florid health pass joints of taenia.] 3. Lumbricoides.—The sensation caused by these animals is much more severe generally than that of the taenia. This arises from the greater number of these generally present, and from their insinuating their sharp points into the mucous lining of the intestines. About the umbilicus, accordingly, severe colicky pains are frequently felt, together with rumbling of the abdomen. Origin of Worms.—The advocates for spontaneous generation have made the existence and multiplication of intestinal worms and other parasites the great foundation of their theory. Their whole argument amounts, when stripped of its verbiage, to this. We do not well see how a worm can have got into the intestines of a man, still less of a foetus in utero (where they have been found), or into the liver or the eye ; and therefore we will insist that it did not, but has been generated in the spot where we find it. This is an argument not from our knowledge, but from our ignorance, and is entirely unphilosophical. I need not tell you after this, that I do not believe at all in the spon- taneous origin of these animals. However they may originally get into the human body, they are propagated in the ordinary way, though only under certain circumstances of the human body are their germs developed. Circumstances favoring the development of worms.—These are various, and in a practical point of view are worthy of investigation. A knowledge of them is the only thing which can lead to a correct and philosophical use of the various remedies proposed for their extermina- tion. 1. A peculiar condition of the intestinal canal.—The precise condition of the intestines favorable to the development of worms is that in which 154 MATERIA MEDICA AND THERAPEUTICS. large accumulations of mucous and other secretions have taken place, and are found lining the inner surface. 2. Age.—It is a well known fact that children are more liable to worms than adults, and the reason is that there is a greater tendency in them to mucous and crude accumulations in the intestines. There are only two species of worms that children are liable to, viz. ascarides and lumbrici. 3. Sex.—As a general rule females are more liable than males. 4. Diet.—It is a fact well ascertained that certain kinds of diet are more favorable to the production of worms than others. This must necessarily be the case. The too frequent use of crude and raw vege- tables and fruits has this effect. The excessive use of sugar, milk, butter, and cheese, and abstinence from animal food, have the same tendency. In a still more striking manner does the abstinence from the use of salt produce this effect. 5. Climate.—Independently of mode of living, the climate seems to exercise a certain influence in developing worms. They are especially common in India and the western coast of Africa. I have already stated that the taenia lata is only found in the natives of the north of Europe. Taenia solium is very common in Switzerland. Blacks are more obnoxious to worms than whites. (Pereira.) 5. Disease.—In fevers worms are sometimes discharged. Now, in many cases of this kind, practitioners have been in the habit of ascribing the fever to the presence of these animals. This has been carried too far. Although there can be no question that the irritation of these animals is capable of producing febrile excitement in the system, yet in a great majority of these cases their presence is a mere coincidence, and so far from having been the primary cause of the fever, it is merely the condition of the system and of the intestinal canal occasioned by the fever which has favored their development. In debilitating diseases they are very common. Dr. Isaac Wood of this city says that when the cancrum oris prevailed endemically at the Alms House, the intestines of such children as died of it were found " stuffed full of worms." I believe with Pereira, that we know very little of the circumstances which favor or check the production of intestinal worms, and that referring their formation to a debilitated state of the alimentary canal is a mere hypothetical assumption. PRACTICAL RULES TO BE OBSERVED IN THE USE OF ANTHELMINTICS. These are few and simple, and directly deducible from what has already been stated. As worms are always associated with certain conditions of the system, and more particularly of the intestinal canal, you are carefully to analyze ANTHELMINTICS. 155 these. It is only by so doing that you will be enabled to make a proper selection of the articles appropriate to any particular case; and as in almost all cases the intestinal canal is in a deranged state, a general rule is to begin with those articles which shall correct this condition of it. Of course the first remedies are active cathartics, and especially those that possess the power of separating mucus from the inner surface of the intestines, such as aloes, senna, and the like. By these means alone you frequently not merely get rid of the worms, but you correct that condition of the intestines which favors their propagation. In cases where this condition of the intestines is accompanied with great laxity and debility, tonics are essential, and it is here that iron proves so valuable. If after the use of these remedies the worms still remain, recourse may be had to those articles which act more especially upon these ani- mals. After the worms are expelled, endeavor to fortify the constitu- tion against their return by the use of such means as the nature of the case may render appropriate. In cases of fever supposed to be owing to worms, do not be led astray by importunities of friends to treat it exclusively for these animals. CALOMEL. Calomel is certainly among the very best anthelmintics that we pos- sess. It acts, probably, simply by clearing away more effectually than any other medicine the mucus and other viscid materials generally found lining the intestinal canal in cases of worms, and in which these ani- mals are always found imbedded. [All this about worms imbedded in the mucus of the stomach and bowels is mere hypothesis—there is no proof of its truth.] It should be given in such quantities and so often repeat- ed, as to produce its full effect upon the whole secretory apparatus of the intestinal canal, and this object should be accomplished with as much rapidity as possible. The best plan, therefore, is to give it in large doses, with the view of making a decided impression at once upon the intes- tinal canal, and then following up its use by some active cathartic, for the purpose of carrying off quickly the matters which may have been separated by the action of the calomel. In this way the worm is first removed from its bed of mucus, and then hurried out before it has had time to make any new attachments. It should never be carried to the extent of producing salivation. This can do no good as a mere anthel- mintic, and may do much injury to the constitution. Mode of Administration.—To adults, from ten to twenty grains, and to children, from three to five grains, may be given at night on going to bed; to be followed early in the morning by some active and quick purge, such as castor oil, salts and senna, &c. In many cases a single 11 156 MATERIA MEDICA AND THERAPEUTICS. dose will in this way prove effectual. If it should not, however, it may be repeated again after an interval of two or three nights. [To these repetitions I should strongly object.] Other Cathartics.—All cathartics, to a certain extent, have the power of expelling worms. Bitter, nauseous, and drastic purgatives have been chiefly resorted to for this purpose. Among these, senna, aloes, gam- boge, jalap, which bleeding is not a proper remedy. In several cases which he records, in which death supervened in two or three days, no appearance of inflammation in the peritoneum could be detected, neither redness, adhesion, nor effusion of any kind. He thinks this form of the disease occurs in delicate and nervous habits, " when the pain and tenderness have followed an irritable cause, such as severe after pains or a griping purge—when the pulse, although quick, is per- fectly soft and even weak. The mode of treating these cases is by opiates (10 grs. of Dover's powders every three hours till the pain is gone), large poultices, and sometimes leeches to the abdomen.* TARTAR EMETIC. Of this important remedy I have spoken more than once, yet its influence as a sedative is too often essential in the treatment of disease to allow me to pass it by. Of its action as an emetic I have spoken at large. But independently of this, tartarized antimony exerts an influ- * As illustrating the extent to which bleeding has u gone out of fashion," the following fact was communicated to me by a leading hospital physician. He one day found in his wards a stout girl with single pneumonia. He remarked to the walker, " This is one of those rare cases which will bear bleeding. Let her lose a pint of blood." The young gentleman hesitating, the Doctor asked: " Have you ever bled a patient?" " No, sir." " Ever seen one bled ?" "No." "Have you a lancet?" •' No." " Well, I have not either; but I suppose some of the young men may have one." On inquiry it was found that of the twelve internes not one had a lancet—not one had ever seen a patient bled.—C. R. G. SEDATIVES. 311 ence over the vital powers, and especially over the circulation; it dimi- nishes the action of the heart and arteries, and operates as a direct and most powerful sedative. As such it is used every day in practice, and it is of course very important that you should be aware of the nature of its powers, and of the best way in which to avail yourselves of them in the treatment of disease. With regard to the mode in which tartar emetic produces its sedative effects, there has been much difference of opinion. By some it has been supposed to be merety the result of the nausea and general relaxa- tion which are known to follow the use of this medicine; while others maintain that without the intervention of these effects, it is capable of acting primarily and directly upon the vascular system so as to lessen its action. The latter of these opinions seems to be best supported by fact and observation. In acute cases of pneumonia and rheumatism^ very large quantities of this article can be given, and the only effect which it produces is to diminish vascular action, without causing other sensible operation, either in the way of nausea, vomiting, purging, or sweating. Facts of this kind unquestionably prove that tartar emetic does exert a primary and independent action as a sedative on the circu- lation. Notwithstanding this, for practical purposes, it is proper to extend our views of the operation of this agent somewhat further, and to embrace the effects of nausea as occurring frequently, most power- fully, in producing its effect upon the vascular system. Circumstances Modifying these Effects.—Age.—From the powerful effect of tartar emetic as a sedative, it is an agent which must be used with great caution in very young subjects. Indeed it requires to be prescribed with the same precaution as bloodletting. From inattention to this fact the most dangerous and even fatal consequences have resulted. Actual Condition of the System as to Disease.—This modifies in a remarkable manner the effects of tartar emetic. In health it acts as a sedative on the circulation, but at the same time in very moderate doses it affects the stomach with nausea and vomiting, and sometimes free purging and diaphoresis. On the other hand, in certain affections characterized by high inflammatory action, very large doses may be given without producing any other effect than that of moderating the action of the heart and arteries. This is particularly illustrated in pneumonia and rheumatism. For this interesting fact we are indebted to Rasori and the Italian physicians. It has since been confirmed by the French, English, and American practitioners. Illustrations of the use of Tartar Emetic in the Treatment of Dis- eases.—Fever.—As a remedy in fever, the reputation of this agent is well established. Under certain restrictions, with due precaution, it may be used in almost all the forms of febrile disease. The mode in which it proves advantageous is obvious from its effects. It operates 312 MATERIA MEDICA AND THERAPEUTICS. by diminishing the action of the heart and arteries, equalizing the cir- culation, and promoting determination to the surface, and in these ways proves eminently efficacious. Acting powerfully on the system, how- ever, its indiscriminate use is not unattended with danger. "V\ here irritability of the stomach is a symptom of the disease, tartar emetic almost invariably aggravates it, and if persisted in proves exceedingly injurious. Where great debility is present, especially in the advanced stages of fever, this article acts as a poison, prostrating the patient, and hurrying him out of existence. Under other circumstances tartar eme- tic may be resorted to with great benefit as an auxiliary, and sometimes as a substitute for the lancet. The best form in which it can be used is that of solution, in doses of about one-fourth of a grain, repeated every second hour. Inflammations.—As a general remedy, tartar emetic is used exten- sively in almost all inflammatory diseases where the stomach is not the seat of irritation, and with the same intention as in fever. In this country, as well as in England, the practice is to give it in moderate doses. Within a few years a new mode of administering it has origi- nated with the Italian physicians, and since then has been adopted in other countries. The peculiarity of the practice consists in the large doses which are given. It arose with the founders of a new theory which has been started within the present century, and which is called the contra-stimulant theory, or the new Italian doctrine. A brief notice of this doctrine may not be inappropriate, as explaining the rationale of their practice. According to this theory, all medicines are divided into two general classes, viz. stimulants and contra-stimulants. By contra- stiraulants are meant those agents which exert a positive action on the living fibre, opposed to that of a stimulant action, and hence their name. In other words, they are direct sedatives. Contra-stimulants are supposed to have the power of subduing excessive excitement, by a specific action of their own, independently of any evacuations being produced from the system. Tartar emetic is one of the substances placed in this class, and, as already stated, the peculiarity of the prac- tice founded on this theory consists in the large doses in which not merely this article, but the whole class of contra-stimulants, are admi- nistered. It is only, however, in a certain state of excitement of the svstem, or in the language of the theory, when the diathesis of stimu- lus exists, that these doses can be borne. When an opposite state of the system is present, the most injurious, if not fatal, results follow. When a patient bears these large doses well, and without producing any evacuations in the way of vomiting or purging, it is called a tolerance of the remedy, and he is said to tolerate it; and it is mainly upon the manner in which the patient tolerates the remedy that the propriety of its continuance is to be determined. SEDATIVES. 313 These are four of the leading points of this theory, and it is upon these principles that tartar emetic is used by them in inflammations. The disease in which it has been most extensively used is pneumonia, and the following will serve as a general illustration of the mode of giving it. If the attack is very acute, the patient is first to be bled to the extent of eighteen or twenty ounces. If the attack is mild, this may be omitted. He is then put upon the use of tartar emetic, in doses of one grain dis- solved in two or three ounces of sweetened water, to be repeated every two hours. Sometimes the first dose causes vomiting or purging.* After this, however, the patient will tolerate the remedy, and he may then go on taking it without any effect of this kind being caused, or any effect produced on the skin. Indeed, when tolerance of the remedy has been once established, it not unfrequently happens that patients become so costive as to require the administration of injections. In ordinary cases, after giving about six doses of the medicine, the patient may be left quiet for seven or eight hours, especially if he has any inclination to sleep. If, however, the disease be violent, and the oppression at the chest be great, the medicine is to be steadily continued until amendment takes place. In some cases, if the symptoms be urgent, the dose is increased to a grain and a half, or to two grains. When the disease is mild, the patient does not tolerate the medicine, and the ordinary effects of it are produced. When violent, on the contrary, instead of these effects, it acts more like an opiate, resembling in this respect the operation of large doses of calomel in dysentery. Generally, too, the sedative effects of the remedy are most decided when no evacuations take place. Among the advantages of this mode of treating pneumonia, it is urged that it does not leave the patient so liable to relapses, that the subsequent debility is by no means so great as that which follows the ordinary mode of treatment by copious and repeated bloodletting. Acute Rheumatism is another disease in which large doses of this remedy have also been tried, and with great success. In several cases of this kind I have prescribed a grain of tartar emetic every hour, and with evident success. The most striking cases, however, that have come to my knowledge are those which occurred in our state prison, as reported by Drs. Drake and Manley. In one case, fifty-nine grains of tartar emetic were given in five days, and the patient perfectly cured in eight days from the commencement. In a second case, three hundred and fifty-eight grains were given in nine days, and in a few days after the patient was well enough to leave the hospital and return to his work. In a third case, two hundred and forty-two grains were taken * According to Laennec, the greater number of patients vomit once or twice, and have five or six stools the first day. On the following day they have only slight evacuations, and often indeed vomit none at all.—N. Y. Med. and Phys. Jour., No. 26. 314 MATERIA MEDICA AND THERAPEUTICS. in seven days, and the patient was convalescent. In these cases, a grain was taken every ten or fifteen minutes, and in all of them, with the excep- tion of a little vomiting after the first few days, no evacuations were caused of any kind, and nothing occurred during the administration to cause the least apprehension from any ill effects which might have been anticipated from such large and repeated doses. Without recommending this practice to imitation, it must be conceded that it presents exceedingly interesting facts, in relation to the extent to which this article may be exhibited in certain conditions of the system. The practice is certainly gaining ground among the best authorities, both here and abroad. [It is now rarely resorted to, indeed tartar emetic is now little used compared with what it was.—C. R. G.] Mode of Administration.—This has already been incidentally noticed. The first dose may be either half a grain or a grain ; if this causes vomit- ing, a few drops of laudanum may be added to the second dose ; as soon as tolerance is established, the dose may be increased to a grain, or perhaps a grain and a half, and they may be repeated every two or three hours, sometimes indeed every hour, and continued till the disease gives way. DIGITALIS. This medicine was fully treated of under the head of Diuretics, when I called your attention to a somewhat detailed account of its powers as a direct sedative, as manifested particularly in its influence on the pulse. The diseases in which we could avail ourselves of this power were also named. I will not go here into any details, which would of course only be a repetition of what has been said already. One general principle in the use of this drug is sufficiently important to justify a repetition. I mean that digitalis is not a substitute for venesection in inflammatory affections. It is often a useful, sometimes an abused essential adjuvant, but never a proper substitute. HYDROCYANIC ACID {PrUSSk Add). This very extraordinary substance is procured from the laurel, peach, cherry, bitter almond, &c, &c. It was discovered by Scheele in 1782. He did not, however, make it pure. This was done by Gay Lussac. Hydrocyanic acid is a compound of hydrogen and cyanogen. It is procured in two very different states, viz. the pure anhydrous acid, sometimes called the acid of Gay Lussac, and the dilute, or medicinal, sometimes called Scheele's acid. Pure Acid.—This is made by decomposing the bicyanide of mercury with sulphuretted hydrogen, and then distilling off the acid with a very gentle heat, receiving the product in a cold condenser. SEDATIVES. dl° Properties.—Pure prussic acid is a limpid, colorless fluid, taste said to be at first cool, but soon becoming hot and acrid. Odor penetrating, and usually compared to that of peach blossoms. This is, however, not correct; its odor is very different; the mistake has arisen from con- founding the odor of the acid with that of volatile oils with which it is commonly associated in plants. It is exceedingly volatile, and if a drop or two be put on glass or paper, it instantly congeals, the rapid evapo- ration of one part of the acid producing cold enough to freeze the remainder. It is soluble in both water and alcohol, and is exceedingly prone to decomposition. Magendie says, that left to itself in well stopped phials, it sometimes decomposes in less than an hour. It can rarely be kept longer than a fortnight. It is not used in medicine. Medicinal Acid.—There are a great number of formulas for the pre- paration of this acid, for which I refer you to the pharmacopoeias. Properties.—Like the pure acid, this is colorless, and has the same penetrating odor. It is much more easily preserved than the pure, though in this respect there is a great difference according to the pro- cess by which it is prepared. That obtained from the action of sulphu- retted hydrogen, or the bicyanide of mercury, being most, and that from the action of sulphuric acid on ferro-cyanide of potassium, the least prone to decomposition* It should be kept in a cold, dark place, in well stoppered opaque bottles. Effects on the System.—Hydrocyanic acid appears to act immediately and directly on the nervous system, impairing the general sensibility and irritability of the body. This is perfectly obvious when animals are destroyed by it; and the same general effects, differing in degree, are produced by it when given in medicinal doses, provided they be effective. It is, therefore, a direct sedative, and unlike the narcotics in not having its sedative effects preceded by any excitement. Whether it acts on the nerves or by being absorbed, is still a matter of dispute. The predominating opinion is that it is so absorbed. The action, how- ever induced, is on the nervous system, and its effect is to impair energy and depress vital power. It does not directly produce sleep, and its powers as an anodyne are very trifling, if indeed it possesses any. On the Circulation.—Prussic acid lessens the force of action of the heart and arteries, yet it does not possess any power like that of digi- talis in making the pulse slow. On the Stomach.—Its action is directly sedative; it impairs sensi- bility and controls irritation at the same time ; it rather favors secretion. On the Bowels.—It is rather relaxing, though they are sometimes costive during its use.f * Christison, p. 116. f Elliotson, p. 23. 21 316 MATERIA MEDICA AND THERAPEUTICS. On the Kidneys.—Its effects are not marked, though by some it is thought to increase the flow of urine. Such are the effects of hydrocyanic acid on the system, and from them are deduced its practical application to the cure of disease. Affections of the Stomach.—Prussic acid has been a good deal used in the diseases of this organ. In controlling vomiting it is second in power to no known agent. In gastrodynia and pyrosis it has been much used, and often with excellent effects. In Pulmonary Affections.—In this class of diseases the acid had much more reputation than it has preserved. In phthisis it was once proclaimed as almost a specific. But experience has abundantly proved that except as a palliative it is of no sort of use in the disease. As a palliative, however, it is often of very great value; it relieves cough, checks night sweats, and by relieving irritation often promotes sleep. In short, it smoothes the pathway i-o the grave, and perhaps delays the progress of the patient, it can do no more. In Hooping Cough.—Here great advantage may be derived from the acid, if it be used after suitable depletion and evacuation. It mitigates and speedily arrests the spasmodic cough, and accelerates the cure. Dr- Thomson says, " in hooping cough I regard it as the sheet anchor of the practitioner." After an emetic and a brisk purge he gives nothing but the acid, gradually increasing the dose. In Chronic Catarrh it may be used to lull the cough, and diminish the irritability of the bronchial mucous membrane. In the Acute Inflammatory Affections of the Chest.—Though highly commended by Brera, it cannot be relied on. As a substitute for bleed- ing, when the inflammatory symptoms are subdued and great irritability remains behind, it will come in very well. In Dyspepsia.—If this seem to depend rather on an irritable state of the stomach than on inflammation, whether acute or chronic; if the food causes distress, and digestion is attended with pain, hydrocyanic acid will very often afford relief, and sometimes very promptly. In heart disease, though it is lauded by some, its powers are probably not great. Where irritable action of the heart and arteries depends, as in the absence of organic diseases it often does, on diseases of the stomach, the acid, by relieving the latter, may remove the former symptoms; where organic disease is present, it can do no good, and may do harm. Mode of Administration, Dose, dc.—Prussic acid is best taken in simple sweetened water; as it is very apt to rise to the surface, the patient should be warned to shake the phial well before taking the 'medicine. As a matter of prudence, only a small quantity should be left in the possession of the patient at once; and when a new parcel is obtained, the dose should always be small till it is tried, as the acid SEDATIVES. 317 varies so exceedingly in strength. Life has been lost by neglect of this simple precaution ! It is best to begin with a small dose, say one or two drops every three or four hours, increasing the dose daily by one drop, till the proper one is ascertained, by the appearance of some physiological effect—the most common of these is a dryness or stiffness of the posterior fauces, with sluggish movements of the tongue. The operation of this acid should be most carefully watched. External Application.—A lotion made by mixing ten or fifteen drops of the medicinal acid with an ounce of water, is used by some to allay troublesome itching and irritation, in some of the cutaneous diseases. It has also been used with advantage to irritable ulcers. TOBACCO. This is the Nicotiana tabacum. It is a native.of America, and its use as an article of luxury was known to the natives long before the disco- very of this continent Baron Humboldt states that it had been culti- vated from time immemorial by the people of the Oronoco, and was smoked all over America at the time of the Spanish conquest Accord- ing to the same authority, the plant was " first discovered in the Mexi- can province of Yucatan in 1520, and it was there called Petum" From thence it was transported to the West Indies and North America. Its introduction into Europe took place in the year 1560, when Jean Nicot, at that time ambassador to the court of Portugal from Francis II., of France, purchased some of the seeds from a Dutchman, who had just brought them over to Lisbon from America. By Nicot the seeds were sent to France, and from these the plant was successfully raised in that country. From the agency which Nicot thus had in introducing the tobacco into France, it received, after him, the name of Nicotiana, the specific appellation, Tabacum, according to Humboldt, being " taken from the word tabac, the name of an instrument used by the natives of America, in the preparation of the herb;" or, according to others, from the island of Tobago, from which, by some, it is said to have been first brought to Europe. Into England it was introduced by Sir Francis Drake. It owed, however, all its popularity in that country to the cele- brated Sir Walter Raleigh, whose eulogium of it rendered it fashionable, and brought it into extensive use. The history of tobacco forms a curious chapter in the annals of our race. Next to intoxicating liquor, there is no substance which has gain- ed such an ascendency over human taste and appetite as tobacco. There is no nation on the face of the globe, civilized or savage, where it has not found its way. Europe, Asia, Africa, and America, are all familiar with it There is no condition of society in which it is not a favored 318 MATERIA MEDICA AND THERAPEUTICS. guest. You find it in the palace and the poor-house—in the stately mansion and the humble cottage—in the work-shop and the billiard- room. The lonely exile solaces his weary hours with it—the joyous freeman exults in its influence. Philosophy muses under its power— poetry is inspired and hardy labor cheered by tobacco. Wherever man is found, its influence is felt and acknowledged. The citizen whiffs his perfumed cigar—the poor man smokes his sooty pipe—the sailor chews his delicious quid—the matron rejoices in her pinch of snuff. On the mountain top and in the lonely valley—on the land and on the broad expanse of ocean—in the dark mines of Pennsylvania and in the glitter- ing halls of Paris—on the rugged hills of Switzerland and in the gold- bearing valleys of California—amid the snows of the North and under the burning sun of the tropics—in battle and in peace—in storm and in calm—in wealth and in poverty—in health and in sickness—the king and the subject—the master and the slave—youth, manhood, and old age—all, all bow to the magic power of tobacco. What is still further curious in relation to this plant is, that it gained this universal ascendency notwithstanding the most powerful opposition. By the wise it was reprobated, by the powerful it was denounced. Even popes and monarchs did not consider it beneath their dignity to engage in the general crusade against it. To give you some idea of the in- dignation excited against this article, I will quote the language of some of those who wrote against it. Old Burton, in his " Anatomy of Me- lancholy," of which the celebrated moralist, Dr. Johnson, says, it was the only book that ever took him out of bed sooner than he wish- ed to rise, gives the following anathema against tobacco. "Tobacco, divine, rare, super-excellent tobacco, .which goes far beyond all their panaceas, potable gold, and philosopher's stones, a sovereign remedy to all diseases. A good vomit, I confesse, a vertuous herb, if it be well qualified, opportunely taken, and medicinally used ; but as it is com- monly abused by men, which take it as tinkers do ale, 'tis a plague, a mischief, a violent purger of goods, lands, health: hellish, devilish and damned tobacco, the ruine and overthrow of body and soul."—Vol. ii. p. 109. Another writer, Joshua Sylvester, wrote a poem on tobacco, which he dedicated to Villiers, Duke of Buckingham. This book was entitled, " Tobacco battered, and the pipes shattered (about their ears who idly idolize so base and barbarous a weed ; or at least-wise overlove so loath- some a vanity), by a volley of hot shot from Mount Helicon."—American Quarterly, vol. ix. p. 14. In this work the author questions whether the devil had done more harm in latter ages by means of fire and smoke, through the invention of guns or tobacco pipes, and he conjectures "that Satan introduced the fashion as a preparatory course of smoking for those who were to be matriculated in his own college." SEDATIVES. 319 King James I. of England wrote a formal treatise against it, entitled, a " Counter Blast to Tobacco," in which he says the use of it " is a cus- tom loathsome to the eye, hateful to the nose, harmful to the brain, dan- gerous to the lungs; and in the black, stinking fume thereof, nearest resembling the horrible Stygian smoke of the pit that is bottomless." He states also that " if he should invite the devil to dine with him, he would among other things give him a pipe of tobacco, as particularly agreeable to him, to help digestion." The Popes Urban and Innocent XII. both published edicts of excom- munication against all those who took either snuff or tobacco. To re- strain the cultivation of tobacco in Virginia, and to prevent its exporta- tion into England, several arbitrary measures were attempted during the reign of James I. By some of the Swiss Cantons, smoking was consi- dered a crime second only to adultery; and to cap the climax of severity against this poor plant, Amurath IAr. made the use of tobacco a crime punishable with death. Still the fragrant weed flourished, and loyal sub- jects and devout Christians, sturdy republicans and slavish Asiatics, all, all resist the law and yield to the influence of Tobacco. Tobacco is an annual plant growing about four feet high. It is planted in the spring, and flowers in July and August. At one time it was raised to a considerable extent in some parts of England. At present that country, as well as the greatest part of Europe, is chiefly supplied from the State of Virginia. It is cultivated also in every part of the East Indies and in the Eastern Islands. Of the species of tobacco known by the name of Virginia tobacco there are two varieties—a broad and a narrow leaved sort. They do not differ, however, in their properties. In cultivating the plant it is not allowed to attain its full height, but is topped whenever a certain number of leaves are thrown out. This is done to promote the development of the leaves, by preventing the for. mation of the flowers and seeds. It is cut down in the month of Au- gust, and the plants hung up in pairs under sheds to dry, after which the leaves are separated from the stem, bound up in bundles, and packed in the hogsheads in which they are exported. The parts used are the leaves, which are about two feet long and four inches broad ; when fresh they are of a pale green color, and when carefully dried of a lively yel- low. Their smell is strong, disagreeable, and narcotic; their taste bitter and acrid. The active principles of tobacco are a peculiar oil-like alkaloid called nicotina, and a camphoraceous volatile oil termed nicotianin. It is the first of these upon which the active power of tobacco depends. In 10,000 parts of the leaf, 6 parts of nicotina were obtained and 1 of nicotianin. The empyreumatic oil of tobacco, which, as found in the pipe of the smoker, is an active poison, appears to be nicotina attached to a true volatile oil. [Christison.] 320 MATERIA MEDICA AND THERAPEUTICS. Nicotina is so active a poison that half a grain has been known to kill a dog. [Christison.] Tobacco leaves yield their virtues both in water and alcohol—more so in the latter. Effects.—These differ according to the mode of use and the object had in view in its use. Its effects are local and general. The first are stimulant. If applied to the nostrils in the form of snuff, it causes sneezing and increased secretion from the nose. Taken into the mouth and chewed, or applied in the form of smoke, it stimulates the salivary glands, and causes a flow of saliva. Its general effects on the system are sedative and relaxing. In large doses it is a virulent poison, acting principally on the brain and heart. It impairs the action of the heart, causing a sense of flutter- ing—excessive faintness—copious perspiration—sense of alarms—sickness and vomiting—coldness of skin—feebleness of pulse—convulsions and death. When used in medicinal doses, we give it simr>ly for the relax- ing effects which it produces, and particularly on the muscular tissue. It produces sickness—sometimes vomiting—relaxation of the bowels— lessens the force and frequency of the pulse—promotes the flow of urine, and causes general relaxation. With regard to the effects of tobacco, it is important to recollect that they are modified by a number of circumstances. 1. The quality of the tobacco. It is well known that the strength of tobacco varies very much, according to the climate, etc., in which it is reared. In warm latitudes it is mild ; in cold regions pungent and acrid. Bengal tobacco, I believe, is the weakest; next to this is the West Indian tobacco. Northern tobacco is the strongest. According to experiments, in 1000 parts of tobacco' the following proportions of nicotina were found in different kinds of this article : 8.64 in Havana tobacco, 10.00 in Virginia, and 11.28 in some specimens grown in France. (See Christison's Dis.) The soil, too, makes a difference in its quality. In a virgin soil it is mild, while in one richly manured it is very rank. (Rogers, 58.) 2. The habits of the person also modify very much the effect of this article. Thus you all know, that if a person has been accustomed to the use of tobacco, he can bear quantities of it which under other circum- stances would produce very unpleasant effects. From the mere force of habit, some persons can remain under the influence of tobacco in some shape or other from morning till night. 3. The age, sex, peculiar constitution, etc., also modify the effects. To children under four or five years it ought never to be given; it may prove fatal to them. Females are much more severely affected by it than males. Persons of delicate and nervous constitutions too, have their systems much more affected by it than the robust and strong. SEDATIVES. 321 A great difference is observed according as the stomach is full or empty. Tobacco acts upon the system in whatever way it is applied, whether by the mouth, rectum, lungs, skin, etc. Mode of Administration.—As a medicine it is little used except by the anus ; as a luxury, it is used by the mouth. There are two forms in which this article is used as an injection— smoke and infusion. The latter is the mode generally resorted to, and can be better regulated than the smoke. As tobacco is so powerful a poison, great care should be taken in not giving the injection too strong. One drachm in this way has proved fatal, and sometimes even half a drachm has produced the same effect. As a general rule, therefore, the best plan is never to exceed fifteen to twenty grains, infused upon a pint of boiling water, and draining. This will commonly produce sufficient of the relaxing effects without any of the poisonous ones. "If the in- jection does not come away in five minutes, it should be assisted by throwing up a large quantity of tepid water; and if its sedation be too great or lasting, such stimulants as ammonia and brandy ought to be administered." (Christison.) Sometimes it is used as a local applica- tion either in the form of cerate or a plaster made of snuff. As a luxury, tobacco, as you know, is used in almost every form. Pulverized and manufactured into snuff, we have every variety, from the acrid Scotch to the more delicate rappee; of cigars we have all sorts, and shapes, and sizes; and of tobaccos time would fail me to tell of the short cut and the long cut, the coarse cut and the fine cut, ladies' twist and Virginia twist, pig tail, negro head, and the thousand other forms into which human ingenuity has tortured this article. Of the Uses of Tobacco.—If tobacco in medicinal doses be the active article which it certainly is, it ought to be used with great caution. Like all articles of this kind, it ought to be reserved for such cases and emer- gencies as cannot be met by milder means, and such is the general judgment of the profession. There are cases, however, in which it has been used with advantage, where we require the profound relaxation which this substance produces. The class of cases in which it has been used with advantage are those in which muscular and fibrous tissue requires to be relaxed. ' Among these are tetanus, and retention of'urine? arising from spasmodic stricture of the urethra. Several cases are related by Mr. Earle, in which this succeeded where instruments could not be introduced, and where venesection and other remedies had failed. In ten or fifteen minutes after the tobacco enema, urine flowed. It is also used by the surgeons in cases of incarcerated hernia. Dr. Ainslee says the native practitioners in the East Indies are in the habit of apply- ino- the leaves warmed to the orifice of the anus in obstinate constipa- tion, and with uniform success in these cases. Applied in this way it generally vomits. 322 MATERIA MEDICA AND THERAPEUTICS. Formerly tobacco was used internally in dropsy as a diuretic. It is not used at present. Externally applied it has been used to promote absorption in swelled breasts or buboes. The snuff plaster is still occasionally used in croup, but it should be carefully watched, as the constitutional effects may be dangerous. With regard to the use of tobacco as an ordinary luxury, your opi- nion will be frequently asked when you get into practice. On this sub- ject I need not tell you there is a great difference of opinion. By some it is denounced as always injurious. By others it is considered not merely innocent, but even salutary. As is generally the case, truth lies in the middle. If the use of tobacco were attended with the conse- quences attributed to it by some, in what a miserable condition would the poor human race be, wasting under a slow and deadly poison which they are taking in daily, and yet, lamentable to say, totally unconscious of it. A good cause is never promoted by attempts to mystify the truth, and common observation settles the question that the moderate and daily use of tobacco does not always prove injurious. This is as a gene- ral rule; constitutions, however, are seriously and insidiously injured by its moderate use, while to all its excessive use is unquestionably detri- mental. As the result of a good deal of observation, the conclusions to which I have come in relation to the use of tobacco are the following: 1. It is not necessary for man. The inhabitants of the old world before they were acquainted with this article, enjoyed as vigorous health and lived as long as we do in the present day. 2. To some persons, and in certain conditions, it may prove salutary. I know a gentleman who consulted me about twenty years ago. He was plethoric, and was troubled with inordinate action of the arterial system, but otherwise well. I advised him to smoke moderately, and he is still living, and thinks he owes his life to the prescription. 3. To many it is positively deleterious. I am convinced that a laro-e proportion of the dyspepsias which are prevalent are owing, as their re- mote cause, to the use of tobacco. It impairs the tone of the digestive organs, and renders the whole system nervous. . To those predisposed to consumption, it is manifestly bad. This is a disease of debility, and everything that debilitates the system must be injurious. 4. To young people tobacco generally is injurious, and for a very obvious reason. Until a certain age, the human system does not receive its full growth and development. If a boy at the age of 14 or 15 beo-ins to use tobacco and spit freely, it must retard his growth, and perhaps lay the foundation of serious disease. 5. It is idle for the moralist or the physician to engage in an indis- SEDATIVES. 323 criminate crusade against the use of tobacco. The one may exhort and the other may command, but it will all be of no avail. It has become an artificial want, and people are not to be coaxed or blustered out of it. The physician, however, can do a great deal in preventing the abuse of it, and this he ought always to attempt. In every patient laboring under chronic disease this ought to be made the special inquiry and direction. With regard to the comparative effects of chewing and smoking, I go decidedly for the latter. If a man smokes as a gentleman, he can only do it at certain seasons and in certain situations. There must be an in- termission. But to chewing there is no limit or check. A man who chews may put a quid in his mouth when he wakes in the morning and keep it there till he goes to bed at night, aye, and all night too. In this way he is constantly kept under its influence. [Much might be said for my favorite pinch of snuff, but I forbear.—Ed.] COLCHICUM AUTUMNALE. This is a small, perennial, bulbous plant, growing native in the tem- perate regions of Europe, where it is found wild in moist meadows. The common name is the meadow saffron. In this country its cultivation has been attempted, but without much success. The parts used in medicine are the bulbs and the seeds. There are certain peculiarities attending the growth of this plant which are important to be recollected, as they throw light upon the effects of it as a medicine. At the time of flowering in the autumn, a new bulb begins to form on the side of the old one, which partly embraces it. As the new one increases, the old bulb gradually wastes away until the following May or June, when the one is perfected and the other entirely decayed. It is evident from this that the strength of the bulb must vary greatly at different seasons of the year. The proper period for gathering it in England is in June and August. If taken early in the spring the bulb is too young, and if taken late in the autumn the old bulb is exhausted by the new offset. The mature bulb is of an ovoid shape, and about the size of a walnut. When fresh it yields, on cutting, an acrid, milky juice. When dried it is of a brownish color, with a deep groove running through it, and has no smell, but an acrid, bitter taste. Mr. Donovan thinks that drying the bulb interferes with its powers, and Dr. A. T. Thomson says the acrimony on which its virtues depend is partially dissipated by drying and long keeping, and totally destroyed by a heat over 212°. Sir E. Home recommends the wine made of the recent bulbs cut up while 324 MATERIA MEDICA AND THERAPEUTICS. fresh, and immediately thrown into wine. As soon as dug up, it should be cut into slices and dried, otherwise it begins to vegetate. The seeds are small, and when ripe of a dark brown color. They should be gathered when fully ripe and then dried. Their active pro- perties reside in the husk. They should therefore not be bruised when used. All the virtues of the bulb are extracted by wine and vinegar. Effects.—In its effects on the system colchicum is peculiar. It acts as a sedative to the nervous and vascular systems, and at the same time promotes secretion. If given in moderate doses, it lowers the pulse and alleviates pain without producing any other manifest effect. If given in larger doses it causes nausea, vomiting, purging, accompanied with great prostration and depression of the pulse. Although placed by some writers along with diuretics, its action on the kidneys is very uncertain. According to observations of Chelius, a curious effect is produced by it on the character of the urine, and that is to increase the quantity of uric acid. Thus, it is stated that he found on the fourth day after using colchicum, the quantity of uric acid excreted was 0069 parts; after four days using it was 0-076 ; eight days, 0-091 ; twelve days, 0-112, nearly doubling the quantity in twelve days. In excessive doses it produces all the effects of a narcotico-acrid poi- son ; where it proves fatal there is generally found inflammation of the stomach and bowels. In relation to the use of this article as a medicine, there are two cir- cumstances worthy of recollection. The first of these is the uncertainty which attends its operation. This, as has frequently been remarked, is owing to the difference in the strength of the bulb, from causes already noticed. Another circumstance is that it sometimes acts very unexpectedly, with great activity on the system, and is attended with unpleasant, and even dangerous consequences. Dr. Armstrong accordingly lays it down as a rule, to discontinue the use of it as soon as it brings on sickness or purging. In some cases, too, it produces profound languor and lassitude, without either sickness or purging. This, too, indicates that its use ought to be stopped, for the patient may sink in this state of collapse. Armstrong alludes to a case where death resulted in consequence of con- tinuing the use of it after the purging and sickness had commenced. (Lectures, p. 354.)* In all cases, therefore, when a patient is under the use of this article he ought to be carefully watched. Forms of Administration. Substance.—The powder of the bulb in doses of from grs. iij. to grs. v. repeated about three times a day. Dr. Armstrong recommends that in this form it should never be used except * See also Beardsley, p. 118. SEDATIVES. 325 in combination with an aperient. If sickness should occur, so much of the powder may be absorbed as to prove dangerous. He states that he saw one patient's life nearly sacrificed by inattention to his circum- stance. Acetum Colchici.—The vinegar of colchicum is prepared by mace- rating two ounces of the dried bulb sliced in two pints of vinegar, and then adding a fluid ounce of alcohol to preserve the preparation from decomposition. Dose from half a drachm to a drachm. Tincture and Wine.—From the variable strength of the bulb the only way is to prepare a saturated tincture or wine. Of these the dose is from half a drachm to a drachm repeated three or four times a day. As the bulb is uncertain in its strength, the seeds have been lately used as a substitute. A tincture or wine is prepared by macerating an ounce of the seeds in a pint of Teneriffe wine. As the active properties reside in the husk, the seeds should not be bruised. The dose is from half to one drachm. With regard to all the preparations of colchicum, Dr. Armstrong remarks, that by long keeping or exposure to the light they become more or less impaired in their virtues. Hence he advises them to be kept in a dark place, wrapped in paper, or in opaque vessels. (Lec- tures, p. 353.) Colchicum is not a remedy used in a great number of diseases. It is particularly celebrated in the treatment of gout and rheumatism, and in these it sometimes proves exceedingly valuable. It is supposed to be the active ingredient in the celebrated remedy for the gout, the Eau Medicinale d'Husson. In gout it sometimes produces relief without any sensible evacuation, acting simply as a sedative. Generally, how- ever, you will find that the patient is not relieved until it acts on the bowels. In acute rheumatism, it is advisable to bleed before prescribing the colchicum, although by some it is considered to be a substitute for the lancet. You will not find, however, this to be the case any more than with digitalis. Both are good adjuvants to bloodletting, but not substitutes for it. Colchicum has also been used, and with some success, in [dropsy and in] inflammatory affections of the chest. ACONITUM NAPELLUS. This is commonly known by the name of monkshood or wolfs-bane. It is a perennial herbacous plant, growing from two to six feet in height, and found abundantly on the mountains of Germany, France, and Switzerland. Until recently the part used officinally was the leaves. At present, however, the root is preferred as containing more 326 MATERIA MEDICA AND THERAPEUTICS. of the active principle of the plant, and is more uniform in its strength. The root at the thickest part is about the size of the finger, and from four to five inches long, with numerous fleshy fibres arising from it. When fresh its color is brownish externally and white internally. Its smell is earthy, its taste bitter. After being chewed, it leaves a pecu- liar tingling and numbness on the tongue, lips, and fauces. The same effects on the mouth are produced by chewing the leaves. The root becomes of a darker color when dried. Composition.—No very satisfactory analysis of the root or leaves has yet been made. They contain, however, a vegetable alkali, aconitina, a peculiar acid, aconitic acid, and a volatile acid principle. The alkali exists in the state of a salt, aconitate of aconitina. Effects.—The effects of aconite are curious and peculiar. If a small quantity of the soft alcoholic extract be introduced into the cavity of the peritoneum of a dog, it usually causes vomiting, lessens the force of the circulation, impairs the muscular power so as to cause the animal to stagger, and destroys sensibility without causing stupor. The ani- mal will sometimes follow its owner around the room, recognise him by wagging his tail, and yet be totally insensible to pinching, pricking with needles, &c Before death slight tremors, but no regular convulsions, generally take place. (Pereira.) On the human subject the effects are the following. If the leaf or root be chewed, or a few drops of the alcoholic tincture applied to the lips, in a few minutes a sensation of numbness and tingling is produced in the part, which lasts for several hours. If the quantity taken into the mouth be somewhat large, the throat and palate become affected. Pereira describes the sensation " as if the velum and soft palate were elongated, and resting on the dorsum of the tongue. To relieve this, frequent attempts are made to swallow." When small and repeated doses of the alcoholic tincture of the root are swallowed, they cause a sensation of heat and tingling in the extre- mities, and occasionally slight diuresis. In poisonous doses, the characteristic symptoms are, numbness and tingling of the parts about the mouth and throat, and of the extremities, vomiting, contracted pupil, and failure of the circulation. Neither con- vulsion nor stupor, as a general rule, precedes death. It lessens directly the sensibility of the nerves and impairs the action of the heart It is perhaps, therefore, the purest sedative that we possess. The principal use to which the agent has been applied is that of les- sening morbid sensibility of the nerves, and as such it frequently proves very efficacious. In neuralgic affections, it is sometimes wonderful in its effects—a single local application effecting a cure. In rheumatic affections too, unattended by inflammation, it frequently proves verv useful. The best form of it in these cases is the tincture, locally applied. SEDATIVES. 327 About a century ago, this remedy was in great repute in a number of diseases, such as scrofula, phthisis, cancer, dropsy, &c. It was one of the drugs so highly recommended by Baron Storck of Vienna. After a while it went into disrepute, and it is only recently that its use has been revived. At present it is not supposed to be of much benefit in the diseases in which it was so much landed by Storck. Preparations.—The only preparations which ought to be depended on are the tincture and the alcoholic extract and aconitine. Tincture.—Take of the root, 1 lb.; alcohol, 2 pints. Macerate for 14 days, express strongly and filter. Dose.—5 drops three times a clay. To be used with caution. Ap- plied externally by means of a small brush. Alcoholic Extract.—U. S. Pha., | of a grain every three hours, in pill. Externally in the form of ointment, one part extract and two of lard, or spread on adhesive plaster. Aconitine.—This alkali was first discovered in 1825 by Brande and Peschier. It is obtained by taking the dried and bruised root of aconite, and boiling it in rectified spirit three times successively. Then strain all the liquors and let the spirit distil. Evaporate what remains to the consist- ence of an extract. Here alcohol extracts the aconite from the root, and the extract contains this principle in combination with aconitic acid and other matters. Water is then added to this extract, and the strained liquor is evapo- rated to the consistence of syrup. The water here dissolves out the aconite from the extract. To this diluted sulphuric acid and water are added. A sulphate of aconitine is thus formed, and this is again decomposed by the addition of a solution of ammonia, which precipitates the aconitine. In this state, however, it is impure. It is now to be again dissolved in diluted sulphuric acid and water, with the addition of animal charcoal. It is then to be strained, and the aconitine again to be precipitated by a solution of ammonia. It is then to be washed and dried. Properties.—Aconitine is found either as a white granular substance, uncrystallizable, or in the state of a transparent colorless mass, having the lustre of glass. It is destitute of smell, and has a bitter and acrid taste. This acrid taste, however, does not belong to the aconitine, inasmuch as it can be separated from it by combining the base repeat- edly with acids and decomposing the salt thus formed. Aconitine is little soluble in water, requiring 150 parts of cold and 50 of boiling water to dissolve it. In alcohol it is readily soluble. Aconitine com- bines with acids and forms salts. They do not, however, crystallize, but dry into a gummy mass. Their taste is very bitter. The solution 328 MATERIA MEDICA AND THERAPEUTICS. of nitrate of aconitine is colorless. That of the sulphate is yellow at first, and afterwards becomes of a dark violet. The alkalies decompose them, precipitating the aconitine. (Phillips.) Effects.—From the great activity of this article, it is not safe to use it internally. When pure, and deprived of its acrid principle, it appears to be the most virulent poison that we know of. The twentieth part of a grain dissolved in alcohol will destroy a bird with the rapidity of lightning. This was done with Morrison's aconitine. The fiftieth part of a grain of the same killed a sparrow in a few minutes (Phillips); and the same quantity nearly proved fatal to a female to whom it was given. (Pereira.) If a grain or two of aconitine, mixed up with a drachm of lard or a drachm of alcohol, be rubbed on the skin of the forehead, or any other tender part for a minute or two, an effect is produced analogous to that of veratrine and delphine. In some respects, however, the sensations differ. Veratrine " produces a strong sensation of tingling, or rather a sharp feeling, similar to that produced by receiving a succession of electric sparks on an uncovered part of the body." Delphine produces " a sensation of burning, not unlike that which manifests itself a short time after the application of a blister, but to an unpleasant degree." Aconitine produces " a sensation of heat and prickling;" to this succeed " a feeling of numbness and constriction in the part, as if a heavy weight were laid upon it, or as if the skin were drawn together, by the power- ful and voluntary contraction of the muscles beneath. This effect lasts from two or three to twelve or more hours, according to the quantity rubbed in." (Turnbull, p. 58.) Aconitine produces less local irritation than either veratrine or del- phine. Indeed, in no case does it produce any more local excitement than could be accounted for by the mere frietion. A minute portion of the ointment applied to the eyes causes almost insupportable heat and tingling, and contraction of the pupil. (Pereira.) There are two forms in which this substance is used as an external application, ointment and solution. Ointment.—This is prepared in the following way : R,. Aconitine gr. ij. Alcohol gtt vi tere optime. Et adde Axung. 3 i ut fit ung. If necessary, it may be increased to the strength of four or five grains to the drachm. This is to be rubbed on the part until the pain is relieved, and may be repeated three or four times a day, according to the effect produced. With regard to the aconitine, the same rule holds good as with the veratrine. Unless it produces the peculiar effects of the article on the skin, no good need be expected from it. SEDATIVES. 329 Solution.—One or two grains dissolved in a drachm of alcohol. This may be applied by means of a small sponge brush. Care should be taken in making these applications that the skin is not abraded. [Veratrum Album, U. S. White Hellebore.—Native of Central Europe. Stem of long leaf-stalks, sheathing each other. Root, the part used in medicine, composed of root-stalk, two inches long, and radicles. Taste at first sweetish, then acrid, bitter and permanent. Its medicinal proper- ties depend on the presence of the alkaloid veratrine. Effects.—A violent irritant poison, causing at first vomiting and purg- ing, then stupor and convulsions. Little employed. Preparation.—The best is the wine. U. S. P. Dose, gtt. xxx to gtt. xl. Veratrum Viride. American Hellebore.—Said to have been long known to the Aborigines, first introduced into practice by Dr. Osgood; much praised by Ware, Tully, and others. It resembles white hellebore, and like it contains veratrine. Effects.—Resembling hellebore, the less apt to purge.] Veratrine.—This vegetable alkali was first discovered in 1819, by Pelletier and Caventou, in the seeds of the Veratrum sabadilla, or the Helonias officinalis, a plant growing in Mexico. It was afterwards detected by them in the roots of the Veratrum album and the Colchicum autumnale. What is used in medicine, however, is obtained entirely from the sabadilla seeds. Mode of obtaining it.—The seeds of the sabadilla bruised are first boiled in alcohol, and this is repeated three times. The alcohol here dissolves out all Veratrine, along with veratric acid, coloring matter, and other compounds. The alcoholic solution is then evaporated to the consistency of an ex- tract. This is then boiled three or four times in water, to which a little sulphuric acid has been added. Here the veratrate of veratrine is de- composed, and converted into the sulphate of veratrine. The solution is then evaporated to the consistence of a syrup. This is then saturated with magnesia, and afterwards digested with a gentle heat in alcohol. Here the magnesia decomposes the sulphate of vera- trine, and sets free the veratrine, which is taken up by the alcohol. The alcohol is then distilled off. The extract which remains is then boiled in water, to which sulphuric acid and animal charcoal are added. To the strained solution ammonia is added, which throws down a precipi- tate, which is to be separated and dried. In the latter part of this process, the sulphuric acid unites with the veratrine, while the charcoal abstracts the coloring matter; the am- 330 MATERIA MEDICA AND THERAPEUTICS. monia then again decomposes the sulphate, and throws down the vera- trine. The article thus prepared is the one used in medicine. It is not, how- ever, considered as the pure alkali. It is a compound consisting of pure veratrine, sabadilla, resin of veratrine, and gum resin of veratrine. (Pereira.) Properties.—Veratrine is obtained in the form of a light brown or white powder, without smell; taste acrid aud burning, and producing a feeling of numbness and tingling, when applied to the tongue. In water, it is very sparingly soluble, but sufficiently so to render the fluid acrid; in alcohol and ether, very soluble. It restores the blue color of litmus, reddened by an acid, and unites readily with acids, forming un- crystallizable salts. When heated, it melts, and has the appearance of wax, and on cooling presents a mass of brownish transparent appear- ance; when ignited in the air, it is decomposed and totally dissipated. Effects.—By Magendie, the following results were obtained by expe- riments made upon animals. A very small quantity injected into the nostrils of a dog caused instantly a violent sneezing, which lasted near half an hour. One or two grains thrown into the throat caused a free salivation, which continued for some time. The same quantity injected into any part of the intestinal canal produced inflammation of the part with which it came in contact, succeeded by vomiting and purging. In large doses, it caused great acceleration of the circulation and respira- tion, quickly followed by tetanus and death. One or two grains injected under the pleura or tunica vaginalis produced tetanus and death in ten minutes. The same quantity injected into the jugular vein caused simi- lar effects in a few seconds. On dissection, the mucous membrane of the intestines was found inflamed, and the lungs engorged and inflamed. In the human subject, the smallest quantity taken into the mouth causes free salivation, and if applied to the nostrils, produces violent sneezing. AVhen given internally in medicinal doses, a sensation of warmth is produced in the stomach, which gradually extends itself over the abdo- men and lower parts of the chest, and afterwards to the head and extre- mities. If the medicine be continued, a sense of tingling is felt in dif- ferent parts of the body, and sometimes over the whole surface, accom- panied frequently by perspiration and a sense of oppression. To this succeeds a sensation of coldness, and if the medicine be still continued, nausea and vomiting take place; sometimes looseness and only occa- sionally purging are produced. Generally the force and frequency of the pulse are diminished under its use, but no narcotic effects take place. When applied externally, in the form of ointment rubbed on the skin, as a general rule, no local irritation is caused. In some cases a slight blis- ter, and in others an eruption appear on the part. The first effect ex- perienced is a sense of warmth and tingling in the part, and, according SEDATIVES. 331 to Turn bull, until this is produced, no effect is experienced from the medi- cine. This is a good criterion to judge of the purity of the article. After the ointment has been applied a sufficient length of time to influence the system, the heat and tingling extend over the whole surface, and the same sensations are produced as those accompanying its internal use. The pulse is also affected as by the internal use. Applied endermically the effects are still more decided, but the local irritation is so great as to preclude its use. Form of Administration.—In consequence of its acrid taste, the best form of giving it is that of pill. The formula recommended by Turn- bull is the following: Px, Veratrine grs. ij. Ext. hyoscyam. grs. vi. Pulv. rad. glycyr. grs. xii. M. Divide into twelve pills—one three times a day. Tincture.—Magendie directs four grs. to be dissolved in one ounce of alcohol. Of this he advises from ten to twenty-five drops to be given in a cup of broth as a substitute for the tincture of colchicum. As external applications, it may be used either in the form of oint- ment or tincture. The ointment is the best. This is made by rubbing up from fifteen grs. to 3 ss veratrine, with 3 i of olive oil and § i of lard. Of this a piece as big as a nut is to be rubbed with the hand for ten or fifteen minutes on the part affected. In doing this, care should be taken that the skin be not broken or denuded, otherwise great irritation will be produced. Where the ointment cannot be used, a tincture made of 3 i veratrine to § ij of alcohol may be applied in the same way. Besides the alkali itself, the tartrate, acetate, and sulphate, have been used. They produce the same effects, and are given in the same doses. Diseases in which Vefratrine has been used.—The diseases in which it has been used by Dr. Turnbull, and as he says with advantage, are: 1. Affections of the heart, unattended by organic disease; 2. Neuralgic affections. In these it seems to exert its power in the most striking manner. In some cases a single friction gives entire relief. 3. In chro- nic rheumatism ; 4. Gout; 5. Dropsy. In this case it operates by pro- moting the flow of urine. In all of the foregoing cases, the remedy was applied externally. Delphine.—This was first discovered in 1819, by MM. Lassaigne and Fenuelle. It exists in the seeds of the stavesacre {Delphinum staphisagria) in combination with delphinic acid. The mode of obtaining it recommended by M. Couerbe, is the follow- ing :__a saturated tincture of the seeds is to be evaporated to the con- sistence of a thin extract, and heated with water acidulated by sulphuric 22 332 MATERIA MEDICA AND THERAPEUTICS. acid. This solution, when filtered, is to be precipitated by ammonia. The precipitate, after being freed from its water, is to be taken up with alcohol, and again reduced to the consistence of extract, which is likewise to be dissolved in acidulated water. To this solution, when filtered, a small quantity of nitric acid is to be added, as long as any precipitate falls. The liquid freed from this precipitate is again to be thrown down by ammo- nia and the powder dried. (Turnbull, p. 49.) This is the delphine of commerce. Like veratrine, however, this is a compound substance, consisting of delphine, resinous matter, and staphis- acre (an acrid resin). To obtain the delphine separately, dissolve in ether. This takes up the delphine, but leaves the others. Properties.—When pure, delphine is in a state of white powder, without smell, but has a bitter and acrid taste. It is very sparingly soluble in water, whether hot or cold. It nevertheless imparts its bitter taste to the water. In ether it is soluble, and still more so in alcohol. Its solutions in these fluids have the property of rendering syrup of violets green, and of restoring the blue color of litmus when reddened by acid. It unites with the acids, forming salts which are bitter and acrid, and crystallizes with great difficulty. When heated, it melts and resembles wax in its appearance. On cooling it is brittle like resin. Effects.—In doses of half a grain, repeated three or four times a day, delphine may be given without producing any irritation of the stomach. In some cases it operates on the bowels, and most usually causes an increased flow of urine. When taken to the extent of a few grains, it gives rise to sensations of heat and tingling in various parts of the body, analogous to those produced by veratrine. In large doses, it is a narcotico-acrid poison. The salts of delphine act in the same manner as the pure alkali. When applied externally, in the shape of ointment or solution, it causes a sensation of burning, resembling very much the effect produced by a blister a short time after it has been applied. In almost every case it causes a blush of redness on the surface to which it is applied. In this respect it differs from veratrine, which causes no redness. Besides this, the local effect of delphine is more permanent than that of veratrine. Test of the goodness of Delphine.—Turnbull lays down the rule that unless a solution of it in alcohol, in the proportion of four grs. to the drachm, produce a sense of heat and pricking, after being rubbed on the forehead for three or four minutes, it is not good and ought not to be used. Form of Administration.—Internally, it may be given in pill. R, Delphine, gr. i. Extract hyoscyamus, Extract glycyrrhizae, aa grs. 12.—12 pills. One to be taken every three or four hours. SEDATIVES. 333 It is generally, however, used as an external application either as'oint- mcnt or solution, in the proportion of from 10 to 30 grs. to the ounce of lard or alcohol. These are to be rubbed on in the same way as the veratrine, from 10 to 20 minutes, or until the peculiar tingling sensation is caused in the part, and this is to be repeated three or four times a day. Diseases.in which Delphine is used.—In its general effects, delphine resembles veratrine, and has been used in the same affections. Chiefly used in neuralgic affections, paralysis, and rheumatism. ACTCEA RACEMOSA. Known by various other names, as Cimifuga racemosa, Cimifuga ser- pentaria, Macrotys racemosa, and by the common names of black snake root, cohosh, squaw root. This plant grows from four to six or eight feet high. It is found native in many parts of the United States, from Canada to Florida. It flowers in June and July. The part used is the root, which is perennial. As found in the shops it consists of a rough, tuberculated head, with numerous radicles, sometimes several inches long. These radicles are brittle, and easily separated. The color of the root is blackish exter- nally, and white internally. It has little smell, its taste is bitter and somewhat astringent leaving a sense of acrimony on the palate. The proper time for gathering the root is late in the summer or in the autumn. Its sensible properties are said to depend a good deal upon the time of gathering, mode of drying, etc. According to the analysis of Mr. Tilghman, it contains fatty matter, gum, starch, resin, green coloring matter, tannin, wax, gallic acid, sugar, oil, lignin, with salts of lime, iron, magnesia, and potassa. The virtues are yielded to water and alcohol. Effects.—In its general action on the system, this article appears to resemble very much the colchicum. It promotes the secretions of the mucous membrane, and at the same time produces an impression on the nervous system, and lowers the action of the heart and arteries. It is very much used by many American practitioners in rheumatism, and is said very often to produce excellent effects. It'has also been used in some nervous affections, as chorea. It had at one time great reputa- tion in affections of the lungs, as humoral asthma, chronic bronchitis; it was even said to have cured phthisis. That it may do good in the former cases is probable ; in the latter, certainly not. 334 MATERIA MEDICA AND THERAPEUTICS, Cold. Cold is used in medicine to produce two very different effects, which may be called its immediate and its secondary effects. The immediate effects of cold are to depress vital action ; it is one of the purest and most indisputable of sedatives; but cold is much more frequently used in the treatment of disease with a view to its secondary effect, or to the reaction which, when not too intense nor too long continued, it provokes. It is with the former of these uses of cold that we are now to deal. Cold as a sedative is used either— 1. To reduce the temperature of the part to which it is applied, or of the whole system. 2. To repress vital action, especially the action of the heart and arteries. The first of these uses of cold will be considered when I speak of re- frigerants, and the use and value of the remedy appreciated; it is with the latter or the proper sedative effects of cold that we have now to do. Cold, then, is used to repress vital action in internal inflammations, especially of the brain; the mode of applying it is either by cloths wet with cold water, by ice applied to the head, or by freezing mixtures. As to the use of cold cloths, I remark that their value, indeed their safety, depends altogether on the manner in which they are used. If the water used is quite cold, and the cloths are changed often enough to keep the heat of the part down, nothing but good can result; but if, on the contrary, the water be only moderately cold, and the cloths be allowed to remain on long enough to become warm, reaction takes place after each application, and the art of man could scarce contrive a more mischievous agent This is a very great objection to the use of this agent in this way. Everything depends on the nurse, and she is not always a safe dependence. Ice to the head.—This is generally applied in a bladder; it is free from the objection which I have stated against cold cloths, and if decent care be taken it will always do good, and never harm. The only way, indeed in which it can do harm, is by depressing the vital powers below the standard of life, and causing either fatal prostration of the whole system or gangrene of the part to which it is immediately applied. To guard against this remember— 1. The class of patients most obnoxious to this kind of mischief are those whose powers are reduced, and whose capacity of generating heat is small. The two extremes of life present us with illustrations of these states. The old man's powers are worn out, he resists cold badly his circulation is languid, his extremities are more likely to give way ■nder the local effects of cold. On the other hand, the young child, SEDATIVES. 335 especially the infant, has but a moderate power of producing animal heat, and besides his vital powers are weak. He, too, resists cold badly. But aside from age, constitutions differ, and of course the feeble, the ill-nourished, the depressed, and those whose vital powers are failing under the influence of severe disease, will suffer most from intense cold. The rule to be observed for all these facts is simply to moderate the degree of cold which you use to persons who from age or constitution are ill able to bear up against it, and to watch the effect of cold applica-. tions in such patients, and indeed in all patients. With these guards the application of the ice poultice (so called) may be resorted to in inflam- mation of the brain with the best effects. The freezing mixtures are only to be used as substitutes for the ice bag. If it is desirable early in an attack to make a very strong impression on the eerebral circulation, this can be done by pouring from a height ice-cold water on the head. This is a remedy of great power, and should be used with caution. It is not proper where serious organic mischief is suspected. It must not be long continued (three to five minutes is enough). 2. Great care should be taken to prevent excessive reaction after the cold dash by immediately applying to the head either cold cloths or the ice bag, and keeping it there for some time, watching always its effects, and removing the ice if it seem likely to endanger the vitality of the scalp, or the vigor of the general system. To Local Inflammations, the results of injury, cold water is an admir- able remedy. Here the great art is to apply the cold in a moderate degree, but continue it for a very long time. This, however, belongs rather to surgery than to medieine. Internal use of Cold as a Sedative.—This is resorted to in fevers, and especially in gastric inflammations. In fevers, cold water taken very freely is the form in which cold is best administered, because here you have with the sedative the action of that best of diuretics, water. In Gastric Inflammations.—Here ice may be given, and with the very best effects ; the feelings of the patient are the best guide as to the quantity, and it is very rarely necessary to put any restraint upon him in respect to what the Germans eall ice pills. The most admirable effects often follow the very free use of ice and iced water. In Puerperal Peritonitis.—When thirst is urgent, the use of ice will do more than any other agent to quiet the distressing nausea and allay the burning thirst which add so much to the sufferings of the patient. Michaelis of Kiel has recommended the free application of ice in blad- ders to the abdomen, while ice was taken by the mouth. In his hands the practice was very successful. REFRIGERANT'S. Refrigerants are those agents which possess the property of lessen- ing animal heat when preternaturally increased. They are sometimes called Temperants, from their lessening excitement. From the fact of their being used in inflammatory affections, they are sometimes also called Antiphlogistics. The term refrigerant is, however, perhaps the best. It is not my intention to go into any account of the various theories which have been offered in relation to the modus operandi of this class of agents. Ingenious as many of these are, they are never- theless unsatisfactory. The effects of refrigerants are simple and obvious. They lessen animal heat and moderate the action of the heart and arteries. It is to be observed, however, that they do this, if in any marked extent, only when the heat and circulation are above the natural standard. In the ordinary condition of the system they produce no very sensible effects. The individual articles of this class are not numerous, and they may be divided into three classes—1. Acids;. 2. Salts; 3. Cold. Vegetable Acids—Possess refrigerant properties in a considerable degree. Those most used are the citric, acetic, tartaric, and malic. Most commonly these are not used, except as they exist in certain vege- table productions in which they abound. These, therefore, will be briefly noticed. Lemon.—This is the product of the Citrus limonum or lemon tree a native of Asia, and from thence introduced into Europe. It is now cultivated extensively in the south of Europe and in the East and West Indies. The Spanish lemon is considered the best The juice of the lemon consists of, in 100 parts, dtric add 1.77, malic acid, gum and bitter extractive 0.72, water 97.51. The form in which this article is used is that of ordinary lemonade, and in that state it affords not only one of the most agreeable but valuable refrigerant drinks. In combination with the bicarbonate of soda it is used for the pur- pose of making the effervescing draught. A simple way of preparing this is to take 1 ss of lemon juice, diluted with an equal quantity of water, and add to this a solution of 15 or 20 grs. of bicarbonate of soda REFRIGERANTS. 337 in | ss of water. To be taken in the act of effervescence. Besides being refrigerant, this is a grateful stimulant to the stomach in cases of nausea and vomiting. It is also diaphoretic and diuretic Here a citrate of soda is formed, while the carbonic acid is diffused through the water. Orange.—This is the product of the Citrus aurantium, a native of Asia, but cultivated in the south of Europe, in the West Indies, and in Florida. The juice consists of citric acid, malic acid, mucilage, albumen, sugar, citrate of lime, and water. This is a most grateful refrigerant, allaying thirst and lessening heat. Citric Acid.—This acid is peculiar to the vegetable kingdom, and was first obtained in the solid state by Scheele in 1781. It is found in the juice of many acid fruits, generally in a free state, but sometimes in combination with potash and lime. It is found in the fruits of the genus citrus, in the cranberry, whortleberry, gooseberry, red currant, strawberry, raspberry, cherry, mixed with equal quantities of malic acid. In the tamarind it exists both with malic and tartaric acids. It is always obtained from the juice of the lemon and lime. It crys- tallizes in colorless rhomboidal prisms, which are slightly affected by exposure to a moist air. It is exceedingly acid, but destitute of smell. It is soluble both in hot and cold water, and, in small proportions, in alcohol. Citric acid answers as a substitute for lime juice when that article cannot be procured. Nine drachms and a half of the acid dissolved in a pint of distilled water form a solution equal in strength to recent lime juice. Of this solution or of lemon juice 3j of bicarbonate of potassa satu- rates 3 iijss, 3] of carbonate of potassa 3 iv, and 3j of carbonate of ammonia 3 vi. A scruple of the acid dissolved in a pint of water, and sweetened Avith sugar which has been rubbed on fresh lemon peel, makes a good substitute for lemonade.—U. S. Disp. Tamarinds.—This is the product of the Tamarindus Indicus, a large tree mowing native in the East Indies, Egypt, and Arabia, and from thence transplanted in the West Indies. In every part of India this tree is common, and in all the Eastern islands it grows luxuriantly. According to Ainslee, it is in Java that it attains the greatest perfection, and is an exceedingly beautiful tree. The fruit is a broad ash-colored pod, from two to six inches long, containing numerous seeds, surrounded by a viscid pulpy matter. Tamarinds are chiefly brought here from the West Indies, where they are prepared by placing the pods, previously deprived of their shells, in 338 MATERIA MEDICA AND THERAPEUTICS. layers in a suitable vessel, and then pouring boiling syrup over them. This congeals on becoming cool. Fresh tamarinds have a pleasant acid taste, without any sweetness. As brought to this country they are in the form of a dark-colored mass, with a sweet acidulous taste. According to the analysis of Vauquelin, the pulp of the prepared tamarind contains in 100 parts (besides the sugar which is added), citric acid, 9.40 ; tartaric acid, 1.55 ; malic acid, 0.45; super-tartrate of potassa, 3.25 ; gum, 4.70 ; gelatine or jelly, 6.25 ; parenchymatous matter, 34.35 ; water, 27.55. Sometimes copper is also detected in them. This is supposed -to be owing to the vessels in which they are frequently prepared. This may easily be ascertained by inserting a smooth iron blade in them. If cop- per be present a reddish crust will form on the blade. Effects.—Tamarinds are agreeably acid and refrigerant. If taken in sufficient quantities they also prove laxative. The common form of using them is that of tamarind water, made by infusing boiling water on the prepared pulp. VINEGAR. This is called Acetum, or the Acidum aceticum impurum, a peculiar fluid obtained from certain liquors undergoing the acetous fermentation. In wine countries it is obtained from vinous liquors, but in this country it is usually obtained from beer and cider. In its color, vinegar varies from a yellow to a deep red, according as it is prepared from white or red wine. According to analysis vinegar consists chiefly of acetic acid and water, in the proportion of five parts of the first to ninety-five of the second. Besides these, it contains various impurities derived from the liquors from which it is prepared, such as gum, starch, malic and tar- taric acids, coloring matter, a little alcohol, and small proportions of alkaline and earthy salts. Properly diluted, vinegar forms an excellent refrigerant drink, although not so agreeable as the other vegetable acids, and on that account not so much used. As an addition to gargles, it is frequently very useful as an astringent; as an external application, largely diluted with water, it is very valuable for sponging the surface, for the purpose of lessening morbid heat. Cold.—This is the most decided refrigerant that we know of; and in many cases is most advantageously applied in the management of disease. It may be applied in various ways. 1. In the shape of Cold air; 2. Cold water taken internally and externally; 3. Ice applied externally and taken internally. REFRIGERANTS. 339 PRACTICAL APPLICATION IN THE TREATMENT OF DISEASES. 1. Fevers.—Whatever difference of opinion may have existed at one time in relation to the use of refrigerants in febrile affections, scarcely any exists at present. That there ever should have been any doubt on the subject seems strange enough. If. refrigerant agents possess the power of lessening morbid heat, moderating the action of the heart and arteries, and allaying thirst, one would suppose that common sense as well as reason would have sanctioned, if not suggested, the propriety of their use in fever. In the practice of the present day they are gene- rally resorted to, and may be used with great advantage in all fevers, where the object is to diminish morbid heat and moderate the circula- tion. In many cases, too, they are the best remedies which can be used for the purpose of quieting irritability of the stomach. In some of the forms of fever in which this is a prominent symptom, besides the ordinary effervescing draughts, cold water and ice in small pieces are among our most efficient agents. The history of the use of cold water in fever is very interesting. Among the ancients it was a practice by no means uncommon. It was used by Hippocrates; and Galen, who wrote extensively on the use of water, recommends in the highest terms the administration of cold drinks, and even immersion in the cold bath, in cases of ardent fever. The form of affusion, however, as practised in modern times, does not appear to have been known to them, and their practice, such as it was, seems never to have been established upon any scientific or philoso- phical principles. Accordingly, like all other remedies used empi- rically, it sank before the wave of varying opinions and successive theo- ries, and eventually was completely lost in the medical practice of the civilized world. Among some of the ruder nations of Asia and Africa traces of it were, however, to be met with. Lavary, who travelled in Egypt, says it is customary for the inhabitants, when attacked by fever, to bathe in the Nile; and Bruce, the celebrated traveller, states it to have been common among the Abyssinians. The first regular and sys- tematic notice that we have of the practice, however, was in the early part of the last century, by De Hahn, by whom it was extensively used in an epidemic fever of a typhoid character, which prevailed in Breslau, in Silesia, in the year 1737. The" manner in which the water was applied was by means of " sponges soaked in cold water to every part of the surface in succession." In general, it was not resorted to until the eighth or ninth day of the disease, or when the case was becoming desperate from the failure of other remedies. Applied in this way, it must have frequently done more harm than good; at any rate, the practice made no progress. 340 MATERIA MEDICA AND THERAPEUTICS. It was reserved for Dr. William Wright, a British physician, who had resided previously in the West Indies, to revive the practice. In the year 1777, while on his passage from the West Indies to Liverpool, he was seized with a fever which prevailed on board the vessel. Hav- ing tried various remedies, but without effect, and finding, too, that whenever he got upon deck he felt better, and that just in proportion to the coldness of the air, he determined, as he says, " to put in practice on himself what he had often wished to try on others in fevers similar to his own." Accordingly, on the fifth day of the disease, he pursued the following treatment, which I shall give in his own words : " Sept. 9. Having given the necessary directions, about three o'clock in the afternoon I stripped off all my clothes, and threw a sea cloak loosely about me till I got upon deck, when the cloak was also laid aside ; three bucketfuls of salt water were then thrown at once upon me ; the shock was very great, but I felt immediate relief. The head- ache and other pains instantly abated, and a fine glow and diaphoresis succeeded. Towards evening, however, the same febrile symptoms threatened a return, and I had again recourse to the same method as before, with the same good effect. I now took food with an appetite, and for the first time had a good night's rest. " Sept. 10. No fever, but a little uneasiness in the hams and thighs— used the cold bath twice. "Sept 11. Every symptom vanished; but to prevent a relapse, I used the cold bath twice." Another person seized on board with the fever was treated in the same way, and with like success. The account from which the foregoing is drawn was published by Dr. Wright in 1787 in the London Medical Journal; and it was this simple narrative which struck the eye of Dr. Currie, and suggested the hints which afterwards led to the ingenious and beautiful investigations of this subject by that elegant scholar and accomplished physician. Thus it is that men of genius, seizing the rude ideas of inferior minds, have con- structed theories and perfected discoveries, which have rendered their names immortal. Having received the commendation of such high authority, as mio-ht naturally be expected, the remedy became exceedingly popular, and was extensively used, more especially in hospital practice, by Drs. McLean, Jackson, and others. Undergoing the same vicissitudes which have so strikingly marked the history of our art, it has again fallen into disre- pute. Believing it, nevertheless, to be a remedy of value, it may not be useless to designate the leading principles which should govern its use in fever. 1. It ought not to be used in the cold stage of fever. The internal organs are already in a state of oppression, and unable to react upon the REFRIGERANTS. 341 blood thrown into them. In this condition of things the application of cold to the surface will still further increase the oppression, and the con- sequence may even be fatal to the patient. 2. It should never be used when the heat of the system is not greater than natural. In judging of the degree of heat, it should not be deter- mined merely by the feelings of the patient, but by actual measurement with a thermometer. For this purpose the bulb of a small thermometer should be placed under the tongue, or in the axilla. The heat in these two places corresponds exactly, and will indicate the heat of the surface of the body, where covered from the contact of the external air. 3. It should never be used when the patient is in a state of perspira- tion. The reason must be obvious. It interferes with a process which is most effectually lessening febrile heat and excitement, at the same time that it would drive the fluids upon the internal organs when they are not in a suitable condition for reaction. 4. It should never be used when local inflammation or congestion of some internal organ is present. Both would inevitably be aggravated by it. 5. It should never be used in the advanced stages of fever, where there is great debility, and where the heat of the system is already much reduced. Under these restrictions this remedy may be used with great advan- tage in fevers, and the suitable period for it is when the exacerbation is at its height. In continued fever this generally takes place towards evening. Gene- rally speaking, it will prove most efficacious if used in the earlier stages of the disease. In applying this remedy certain precautions are necessary. Salt wa- ter is preferable to fresh, as it produces greater reaction, and the tempe- rature of it should be about 40°. The patient is to be placed on a stool in a large tub, and a bucketful of water is to be poured over his head and shoulders. He is then to be rubbed dry and put into bed. If the remedv agrees with him, it will be found in a short time afterwards that the heat is diminished, the pulse lessened in frequency, and indeed all the febrile symptoms are annihilated. If these effects should be pro- duced, it may with safety be repeated whenever the febrile exacerbation comes on. Such was the practice of cold affusions as recommended by Dr. Currie. At present it is but little used, and in place of it the safer and more con- venient mode of applying cold in the form of cold sponging has been adopted. Used in this way, it proves exceedingly salutary in allaying morbid heat, lowering the circulation, and soothing the patient Inflammations.—As a general rule, as has been already stated, the use of cold in cases of internal inflammations is objectionable. There are, however, two exceptions which require especial notice. 342 MATERIA MEDICA AND THERAPEUTICS. Phrenitis.—In cases of this kind, in addition to venesection, there is no remedy which exercises so powerful an influence as the application of cold to the head. It may be used in various ways—either by apply- ing cloths dipped in cold water to the head, or by a common bladder filled with ice, or what is still more efficient, pouring cold water on it from a vessel. In using this the patient is to be raised in bed, and the body to be protected from being made wet. A large empty basin is to be held under the chin, and the cold water is then to be poured from a pitcher on the crown of the head, the stream to be raised gradually as the patient can bear it. This is to be continued until the desired effect is produced. This mode of applying cold originated, I believe, with Dr. Abercrombie, of Edinburgh. " Applied in this manner," he says, " it is a remedy of such power that it requires to be used wTith much discre- tion. Under the operation of it I have seen a strong man thrown, in a very few minutes, into a state approaching asphyxia, who immediately before had been in the highest state of maniacal excitement, with mor- bid increase of strength, defeating every attempt of four or five men to restrain him."* The same remedy is recommended by Dr. Abercrombie in the convulsive diseases of children, in preference to the warm bath so commonly used.f Gastritis.—There is another form of inflammation in which cold may be used with great advantage, taken internally. Small pieces of ice swallowed have frequently an admirable effect in allaying the gastric irritation. [Intoxication and Narcotic Poisons.—To remove the effects of intoxicating drinks no agent can compare with cold affusion. I have tried this very frequently on men who were " dead drunk," unable to move; in ten minutes they walk about. It is, however, a remedy of very great power, and only to be used where there is vigor of constitu- tion. In poisoning by opium, Ac, it may be relied on with great confi- dence. I have again and again seen persons profoundly narcotized restored to sense and life by the continued use of cold affusion. It is, I am sure, not as frequently used, nor as confidently relied upon as it should be.—Ed.] Abercrombie on Brain, p. 174. f P. 175, also Tweedie, p. 146. DEMULCENTS This class of remedies was by many supposed to act only mechani- cally, by involving acrid matters in a mild and viscid coating, or by sheathing the surfaces to which they were applied, and thus protecting them from the action of irritants. This is an imperfect view of them. They do in fact act on the vital properties of the system, diminishing tone, relaxing and softening the tissues, and rendering them more flexi- ble. [This effect is probably owing to a dilution of the blood by the absorption of the watery part of the demulcent.] Effects.— On the Mucous System.—When taken by the mouth, emollients, by their bland influence on the nerves of the mouth, pharynx, oesophagus, and stomach, produce a direct soothing influence on those parts, and a like effect on the bronchial mucous membrane. Hence their use in irritations and inflammations of any portion of the gastric and pulmonary membrane. [Is it not possible that demulcents may in the same way affect the vagino-uterine mucous membrane, relax- ing its tissue and promoting secretion from it? If so, the popular notion, that these articles taken during the latter months of gestation facilitate parturition, may be easily explained. I have generally attri- buted their effect (in the reality of which I fully believe) to their opera- tion as laxatives.—Ed.] On the Blood and the Heart's Action.—The effect of demulcents must of course depend here, if not always, on the water in which they are taken: this would impoverish the blood and thus lower the heart's action, and diminish generally the tone of the system. On the Urinary Organs.—Here again these agents act purely as diluents. They increase the amount and diminish the acridity of the urine. Oil and water are the only essential emollients. For though i, boil- ing water a pint. Dissolve the gum in the water; add the sugar and boil to the consistence of a syrup. Also in the form of lozenges. TRAGACANTH. This substance is obtained from different species of Astragalus, but chiefly from the Astragalus verus. This is a shrub growing two or three feet high, and is a native of the north of Persia. The gum exudes spontaneously from the stem and branches in the heat of summer, and is suffered to dry on the plant before it is collected. It comes in small wrinkled pieces of a whitish color, without smell, and has a slightly 346 MATERIA MEDICA AND THERAPEUTICS. viscid taste. Although considered as a gum, it differs from this class of substances in the degree of its solubility in water. When put into water, it imbibes a large quantity of that fluid and swells, but does not dissolve nor form a fluid homogeneous mixture. It is turbid, and on standing separates from the water and settles down. In alcohol, it is, like gum, insoluble. The principal peculiarity of this substance is the power which it possesses of giving viscidity to water, this being much greater than that of the gums. It possesses this in a degree twenty-four times greater than gum arabic. It is on this account that it is so much used in pharmacy to give consistency to the manufacture of pills and troches. " It appears to be composed of two different parts, one soluble in water and resembling, though not identical with gum arabic; the other swelling in water but not dissolving." (U. S. Disp.) Effects.—Demulcent and nutritive, though difficult of digestion. In consequence of its great insolubility not much used internally. Princi- pally used in pharmacy. LIQUORICE. The plant which yields this is the Glycyrrhiza glabra, a native of Syria, Barbary, and the south of Europe. It is cultivated, also, in all parts of Europe. In the north of Spain it is raised to a great extent as an article of commerce. That which grows in Spain is considered the best, containing a larger proportion of saccharine matter. The plant grows about four or five feet high. The part used is the root, which is dug up when the plant is about three years old. It is long and flexible, and about the size of the little finger; externally of a brownish color, and yellow internally. It is without smell, and has a sweet, mucilagi- nous taste. If chewed with the bark on, it leaves a slight degree of bit- terness in the mouth. Composition.—According to analysis, liquorice contains glycyrrhizine, starch, asparagin, resinous oil, albumen, lignin, and salts. The glycyrrhizine is a modification of saccharine matter, scarcely soluble in cold water, but readily so in boiling water, and differing also from common sugar in not being capable of undergoing fermentation. The resinous oil is bitter, and it is to this the slight degree of acridity which the root possesses is owing. The extract is prepared from the root in the following way. The roots, dried and cleaned, are cut into small pieces and then boiled in water until the liquid is saturated. After the dregs have subsided it is poured off and evaporated to a proper consistence, when it is formed into rolls about five or six inches long and an inch in thickness. These are then dried and covered with leaves. In this state it is imported from Spain and Italy. When pure it is very black, dry, and brittle, DEMULCENTS. 347 with a glossy fracture and sweetish taste. In water it is completely soluble. Purity.—The roots are frequently worm-eaten and decayed. Those are the best which have the brightest yellow color internally and when the layers are distinct. The extract is very apt to be adulterated with various articles, such as starch and sand. It sometimes also contains a little copper. When pure the extract ought not to become moist when exposed to the air in a dry place, and it should dissolve in water without leaving any residue. What is called refined liquorice is nothing more than the foreign extract dissolved in water and the solution filtered and inspissated; this is usually then made up into little sticks called the pipe liquorice. When this is adulterated with starch it dissolves only partially in cold water, and immediately deposits a dirt}1' white powder possessing the properties of starch. When mixed with carpenter's glue it gives out ammonia, when heated in a glass tube or before a blowpipe. Effects.—Liquorice is an excellent demulcent article, admirably adapted to allaying irritations of the mucous membrane in various parts of the body. Hence it has been used with great advantage in catarrhal affec- tions, and irritations of the urinary organs. Of the root the best preparation is the decoction, made by boiling 3 j of the root in a pint of water for about ten minutes. As the bark is acrid, this should be taken off before it is boiled. The extract may be taken either in the solid form or in solution, or in the form of lozenges. marsh mallows {Althaea oflicinalis). This is a plant growing in Europe, on banks of rivers, and in marshy places, from which circumstance it derives its name. It grows to the height of four or five feet, and the part used is the root. When prepared for the market the epidermis is taken off. It is of a whitish color, destitute of smell, and has a viscous mucilaginous taste. Every part of the plant abounds in mucilage and starch, besides sugar. It also con- tains a peculiar principle which has been called althein, but which is identical with asparagin. Effects.—An excellent emollient and demulcent, and in general use as such in France and Europe generally. It is used in the form of decoction and syrup. In this country it is not much used, being considered inferior to gum arabic. 23 348 MATERIA MEDICA AND THERAPEUTICS. jujube {Rhamnus zizyphus). The tree yielding the jujube is cultivated in the south of France, in Spain, and in Italy. The part used is the fruit. This is of an oval shape, about the size of an olive, and of a reddish color. Internally it contains a yellowish mucilaginous pulp, with a sweetish and acidulous taste. It is demulcent and nutritive. If taken to any extent it proves laxative. It is used in the form of decoction. The jujube paste, which is so commonly sold in the shops, should consist of gum arabic and sugar, dissolved in a decoction of this fruit and evaporated to a proper consistence. The preparation, however, very seldom contains any of the jujube. [Would probably be no better if it did.] slippery elm bark {Ulmus fulvo\, the red elm or slippery elm). It is a lofty tree, growing to the height of 50 or 60 feet, and is indi- genous in this country, more particularly in the Northern and Western States. The part used in medicine is the inner bark, from which the epider- mis has been removed. It comes in long flat pieces of a fibrous texture, with a sweetish and mucilaginous taste when chewed. It contains fecula, gum, and ulmin. It abounds in mucilaginous matter, and by infusion or gentle boiling in water it is readily dissolved and forms an insipid mucilaginous fluid. Effects.—The substance is highly demulcent and nutritive. In times of scarcity the Indians are said to live upon it. Another use made by them of it is to facilitate labor. According to Mr. Rafinesque, it is " a specific to procure easy labor to pregnant women by using the tea for two months previous, well known to Indian women, whose easy partu- rition has often been noticed." Med. Flor. vol. ii. p. 271. It is also somewhat diuretic. Mode of Administration.—The common form is that of infusion made by macerating an ounce of the bark in a pint of cold water. When ground into powder it makes a kind of flour, which mixed with boiling water makes a mucilage. [The cold infusion of the unground bark is much more palatable.] It makes an agreeable demulcent drink. The powder made into a poultice is an admirable local application. BENNE. The Sesamum orientale, a native of the East Indies and Africa. From the latter region it was introduced by the negroes into the West DEMULCENTS. 349 Indies and the Southern States, especially Georgia and South Carolina, where it succeeds very well. In this latitude it grows very well, but never comes to seed. It is an annual plant, about three or four feet high, and yields a small, yellowish seed, which is particularly valuable for the quantity and quality of the oil which is obtained from it It is said that by expression ninety per cent of this oil is obtained from the seeds, a larger proportion than that yielded by any other known vege- table, and of a quality fully equal to the common olive oil. By the negroes the seeds are used as an article of food, boiling them with Indian corn, &c. The oil is without smell of a sweetish taste, and can be kept a long time without becoming rancid. In China and Japan it is used in cook- ing and as an article of food. Its properties are very analogous to olive oil, and like that in suitable quantities prove laxative. The part used in medicine is the leaves. These abound in mucilagi- nous matter, which is readily imparted to water. Effects.—-Emollient and nutritive. The oil is laxative, and is some- times used as a substitute for castor oil. Mode of Administration.—One or two of the fresh loaves stirred in half a pint of cold water in a short time form a thick viscid mucilage, which is used with much advantage in bowel affections, particularly of children. It may be drunk freely. When the leaves are not mean by this to say that opium should not be used in inflammatory complaints; it may be, and sometimes with great advantage, but there must also be some prelimi- nary or accompanying treatment to modify the inflammatory action to enable us to use opium safely. With regard to the condition of the system favorable to its user\t is that in which the bloodvessels have been properly evacuated, their action suitably reduced, the surface free, the tongue moist, and no determination to the brain present. When these conditions obtain, it may safely be given, should the case require it. OF THE APPLICATION OF OPIUM IN THE TREATMENT OF" DISEASES'. As a remedial agent opium has always and justly been looked upon as one of the most valuable in our possession. It has been styled the donum Dei, the gift of God to man, and Sydenham says of it, that it is "so necessary an instrument in the hands of a skilful physician that the art of physic would be defective and imperfect without it; and whoever is thoroughly acquainted with its virtues and the manner of using it,. will perform greater things than might reasonably be expected from the use of a simple medicine."* High as this panegyric is,, it is unquestion- ably just. Admirable, however, as this agent is, if properly used, it is equally true that in unskilful hands there is scarcely any capable of producing a greater amount of mischief That this must be the case is evident from the effects which it produces, and particularly from the difference in these effects, according to the dose in which it is given, and the precise condition of the system at the time. Too much care, therefore, cannot be exercised in studying- its effects, or in discriminating the condition of the system in which it may be safely and advantage- ously used. For the purpose of illustrating its effects, I will now notice briefly some of the diseases in which it is most frequently resorted to. Fevers.—In this class of diseases it is used continually, but for vari- ous purposes, according to the character of the fever and the condition of the system. In the intermittent form of fever, it is mainly used for one purpose, and this is to arrest or modify the paroxysm; according to the manner in which it is given, it may either prevent entirely the * P. 115. NARCOTICS. 369 return of the paroxysm, or mitigate its violence as well as its duration. To prevent the paroxysm altogether, it should be given in a suitable dose about an hour before the time of its expected return, and as a general rule it has the desired effect. As a general rule, you will not find it necessary to have recourse to opium in this way in the management of intermittent fever; the action of quinine is prompt enough to answer every purpose. Occasionally, however, you will find it a valuable resource, especially when danger is apprehended, either from the violence of the paroxysms or from the debility of the patient [Dr. Drake says of opium in the treatment of malignant intermittents, " of its great value no physician of experience can entertain a doubt. If there be no diarrhoea, however, it is not necessary to administer it throughout the intermission, but reserve it for the last dose of sulphate (of quinine) before the approaching chill. The quantity in which it is given is often entirely too small. Three or four times as much as would be required in an ordinary ague is not a large dose. Four grains of opium with eight grains of sulphate three or four hours before the chill."] By some opium has been given in the cold stage. This was the practice of Dr. Trotter. By Dr. Lind it was given in the hot stage, about half an hour after it had commenced, and with uniform success in shortening the paroxysm and mitigating all the febrile symptoms. When used in this way, he states it to be followed by refreshing sleep and a more free perspiration, causing in this way a more perfect inter- mission. On this account, he says, less bark is necessary to effect a final cure. The practice of Lind has been tried by others, and with similar success. In the continued forms of fever, opium is an article which should be used with caution, and in its use every regard should be had to the period of the disease and the actual condition of the system. Early in the disease when great excitement is present, characterized by a strong and frequent pulse, hot skinr flushed face, headache, and macerating in a pint of Teneriffe wine * Ellis's Formulary. U. S. Disp. 378 MATERIA MEDICA AND THERAPEUTICS. for fourteen days and filtering. This is nearly the same as the liquid laudanum of Sydenham. It is about the same strength as common laudanum, and may be given in the same doses. From the aromatics with which it is combined, it sits better on the stomach. As a local application, the wine of opium is recommended in cases of chronic oph- thalmia, two or three drops being introduced under the eyelids daily. Morphine—Modes of obtaining it.—There are various modes of ob- taining morphine from opium. The process recommended in the U. S. Pharmacopoeia is the following: Sliced opium is first macerated and worked up with water for a suitable length of time, then filtered, and to this added a mixture of alcohol and water of ammonia, when the mor- phia is deposited in crystals. To purify these, they are boiled in alco- hol, and filtered through animal charcoal. In this process the water extracts the meconate of morphine. This is decomposed by the ammo- nia, while the alcohol seems to suspend the coloring matter and render the crystals purer. Quantity of Morphine in Opium.—This has already been alluded to. As then stated, it varies not merely in the different kinds of opium, but in different samples of the same kind. The Smyrna opium contains the most, varying from nine per cent, or less to fourteen, the Constantinople only one half, and the Egyptian five sevenths of the quantity obtained from the Smyrna opium. Dr. Christison obtained from half a pound of the best Turkey opium 3£ drachms of morphine, and two drachms of narcotine. M. Dublanc procured as the mean of six trials eight per cent. of morphine and three per cent, of narcotine. Properties.—When pure, morphine is in small, beautifully white crystals. The primary form of the crystal is a right rhombic prism. It has a bitter taste, but is destitute of smell. In cold water it is insoluble —boiling water dissolves about one part in one hundred. It is soluble in forty parts of cold anhydrous alcohol, and thirty parts when boiling. In ether, it is nearly insoluble. It turns vegetable blues to green, and combines with the acids forming crystallizable salts—nitric acid turns it red. It consists of oxygen, hydrogen, carbon, and nitrogen. Effects.—Although the most powerful principle of opium, morphine is not used in medicine in its simple alkaline state. Owing to its great insolubility, it is by no means certain and constant in its effects, depend- ing for its activity, no doubt, upon the degree and kinds of acid it meets with in the stomach. In combination with acids it is, however, very soluble, and it is only in the form of salts, therefore, that it is used. Of these, the ones used are the acetate, sulphate, and hydrochlorate. Acetate of Morphine.—This is prepared by dissolving morphine in NARCOTICS. 379 dilute acetic acid, and then evaporating the solution to dryness. Acetate of morphine crystallizes in slender needles, but from its deliquescent nature is seldom obtained in a crystalline form. It is generally in the form of a powder. It is readily dissolved in water, especially where there is an excess of acid. In alcohol it is less soluble than in water. It may be given in pill or solution. One sixth of a grain is about equivalent to a grain of opium. Sulphate of Morphine.—This is prepared by dissolving morphine in diluted sulphuric acid. By evaporating the solution, crystals are formed. These are small, white, and feathery, resembling very much in appearance the sulphate of quinine. They can easily be distinguished, however, by adding concentrated nitric acid. This turns the sulphate of morphine red, but not the sulphate of quinine. Sulphate of morphine is soluble in twice its weight of boiling water, and if pure, is easily and readily soluble in cold water. As found in the shops, and especially if obtained from France, it is not always entirely soluble in water. This is owing sometimes to adultera- tions, but oftener to its containing some uncombined morphine, owing to the mode of preparation. This is corrected by the addition of a little acid. The sulphate may be given in pill and solution. One sixth of a grain is equal to a grain of opium. Solution of Sulphate of Morphine.—It is important to know that there are two solutions of this salt of very different strength—that of Magendie, and that of the United States Pharmacopoeia. Mage mile's contains sixteen grains to 3 j of water. Of this, five drops are equivalent to one sixth of a grain of the salt. U. S.Pharmacopceia contains one grain to 3 j of water—of this, eighty drops are equal to one sixth of a grain. Hydrochlorate of Morphine.—This is preparad by saturating the pure base with hydrochloric acid, and crystallizing. This is a colorless, inodorous, bitter salt, crystallizing in plumose acicular crystals; it is soluble in sixteen to twenty times its weight of water. It is also soluble in alcohol. The strength of this is the same as the two preceding. This is con- sidered by many as the best salt of morphine for medicinal purposes. To the acetate it is preferable, as it is more easily obtained in crystals, and is not subject to decomposition during its preparation. Effects of the Salts of Morphine.—In their action on the system they do not differ. They produce the same effects, and may be given in the same doses. Compared with opium and its ordinary preparations, 25 380 MATERIA MEDICA AND THERAPEUTICS. they differ in many important particulars. While they produce the anodyne and narcotic effects of opium, they are less stimulating—they are less sudorific—they do not have the same tendency to produce con- stipation, and they are less apt to leave headache, nausea, dryness of the tongue, and other unpleasant effects. In all cases, therefore, where the object is to allay pain and nervous irritation, and to produce sleep, they are preferable to opium. Where the object is to get an astringent effect on the mucous membrane, or a stimulant effect on the system, opium is to be preferred. In cases of chronic irritation, where the daily repeti- tion of an anodyne is called for, the morphic salts are invaluable. Another advantage attending them is, that they may be applied ender- mically. HENBANE. The Hyoscyamus Niger, growing two or three feet high, with large sea-green leaves, and straw-colored flowers. The whole plant has a dark, lurid appearance. It is found in every part of Europe, and extends to Asia. In this country it is supposed to have been naturalized, from the fact of its being found only in the vicinity of houses, road sides, in old fields, gardens, oisonous doses, the prominent effects are sickness at stomach, loss of vision, dilatation of the pupil, delirium,§ amounting sometimes to actual mania and stupor; in some cases spasms, and occasionally palsy occur. After continuing for a longer or shorter period, patients recover from these effects, although sometimes death is the result. [I have seen perfectly well marked chorea produced in a child of eight years by swallowing the seeds of stramonium. The symptoms went off in about twelve hours.—Ed.] Modes of Administration.—Powder.— Both the leaves and seeds are used. Of the powdered leaves, the dose is from two to three grains-; of the seeds, which are stronger than the leaves, one grain may be given twice a day. Extract.—Of this there are two kinds, the one made from the leaves, the other from the seeds. The extract from the leaves is prepared by bruising the fresh leaves in a stone mortar, sprinkling on them a little water, then expressing the juice, and evaporating to a proper consis- tence. Prepared in this way, it is uncertain as regards its strength, differing according to the mode of conducting the process of evapora- tion, and the season when* the leaves are gathered. The average dose is about a grain, night and morning, gradually increased until the sys- tem is affected. The extract from the seeds is prepared by macerating a pound of the seeds in a gallon of boiling water for four hours; then taking out the seeds and buising them, after which return them to the liquor; boil down to four pints, and strain while hot. After this evaporate to a proper consistence. The extract prepared in this way is about twice as strong as that from the leaves, and is more certain in its effects. The dose is from 4 to \ a grain twice a day. This may be increased every day or two \ of a grain, until some decided effect is produced. Tincture.—This is prepared by macerating four ounces of the bruised seeds in two pints of diluted alcohol for fourteen days, and then filter- * See Experiments by Cooper, in Caldwell, p. 174. for 1805. f Ibid. p. 184. X Cooper, p. 173. § For a striking illustration, quote from Cooper in Caldwell's Therap., p. 186. NARCOTICS. 393 ing. Of this the dose is from ten to twenty drops; may be taken two or three times a day, and gradually increased. Ointment.—One pound of the leaves cut into pieces, melted with lard, one pound; yellow wax, half a pound. Diseases in which it is used.—From the analogy in effect to the bel- ladonna, it has been found useful in very much the same kind of dis- eases. Affections of the Eye.—In cataract, inflammation of the iris, atients, "and is as regularly resorted to as the depletion and evacuations which precede 414 MATERIA MEDICA AND THERAPEUTICS. it. With much more propriety might it be called building up the phy- sician, for I have known more than one practitioner who owed a great portion of his business to this practice of building up his patients. Why it should render a physician popular is obvious enough : inde- pendent of the pleasurable excitement which is produced and repeated at each repetition of the dose, most patients are anxious to see and feel their progressive improvement, and this they imagine the stimulant enables them to do. With regard to this practice you cannot be too cautious. In some cases when disease has been long protracted, and when the powers of life have been greatly prostrated, gentle stimulants may be necessary. As a general rule, however, patients during conva- lescence will do much better if their recovery be trusted to the powers of nature, along with proper diet and exercise, than they will if goaded by stimulants. Their recovery may be slow, but it will be surer and unattended by any injurious effects. There are two reasons more espe- cially why physicians should be cautious in this matter: It renders convalescence more uncertain. Stimulants hurry the circulation and drive forward vital action. Now when, as during convalescence, the vital powers are weak, the over-tasking them is very apt to be followed by exhaustion, hence dangerous prostration. But there is another danger from the perturbing influence of stimulants on the circulation, viz. the unequal distribution of the blood, leading to congestion. This is especially to be dreaded where the convalescence is from some local phlegmasia, the organ that has been the seat of the disease is in a state very favorable to the occurrence of congestion or even inflammation. The moral clanger from taking stimulants during convalescence is very great. Under no circumstances is their use so seductive, never are their immediate effects more pleasant, never is the call for another and another dram more irresistible. Sickness, too, removes one of the great safeguards against the habit of intemperance. The fatal cup is always taken as a medicine, and this idea will hide from the patient and his friends the approaching danger, till the fatal habit is fixed for ever. Avoid, then, this dangerous practice of giving stimulants during conva- lescence. I do not say that it is never necessary; but you should 'always look upon it as a necessary evil, to be got rid of at the earliest possible moment. The rule is, never give stimulants when your patient is steadily, however slowly, gaining ground ; if you.are sure he is a lit- tle, be it ever so little, better every day, trust to time; far, far better is it that a hundred patients should remain in bed a week longer than they would have done had stimulants been used, than that one should by your means have been made a drunkard. In conclusion I would say that deeming stimulants, though of limited use (and you have seen that I am most anxious to limit their use), yet occasionally beneficial and sometimes essential, I have not hesitated to STIMULANTS. 415 say so. I am aware that making this avowaL I expose myself to the abuse of the ultra temperance people. But I have a duty to perform, and besides, the cause of truth can never be promoted by sacrificing one's sense of right to any notions however popular. Gentlemen, I am as much in favor of temperance as any one, and I look upon the temperance reform as one of the great moral triumphs of the age. But so good a cause does not require to be supported by a violation of truth : the unchastened zeal of many so called temperance men has already done much mischief and I fear will do much more. As an illustration of this senseless zeal I may mention that a young man lately wrote a thesis in which he laid down the rule that alcoholic drinks were never to be used ; that it were better to let the patient die. What a monstrous doctrine this I The duty of the physician is positive and specific, to save life.; and yet according to this notion he is, for the sake of a remote and uncertain consequence, to violate this duty and let a human being die, when he could have saved hiua. Upon the same principle, when you see a drunkard or an immoral man drowning, you may refuse to save him because the world would be better without his bad example. Such logic I do not understand ; I am sure it is not the logic of the Bible: the whole spirit and authority of that book go to enforce the rule that we are to do our duty, and leave consequences to an overruling Providence. INDIVIDUAL STIMULANTS. Stimulants may be divided into those which are local in their opera tion, or which act more especially upon the stomach and bowels, and those which are general or diffusible. The principal local stimulants are ginger, calamus, the aromatic seeds, cloves, mace, cinnamon, lavender, peppermint. The general stimulants are alcohol, ammonia, camphor, serpentaria, the peppers. •ginger {the rhizoma of Zingiber Officinale). Ginger is a native of the East Indies, and derives its name from Ginji, a mountainous district where it is particularly abundant It is naturalized and cultivated in the West Indies and Mexico. The plant grows to the height of two or three feet, and has a tuberous root in which the active properties reside. This is the part used. u In the West Indies the o-inger crop is gathered in January and February, after the stems have withered. After having been properly cleansed the root is scalded in 416 MATERIA MEDICA AND THERAPEUTICS. boiling water, in order to prevent germination, and is then rapidly dried." In this process it becomes blackened, and this constitutes the common black ginger of commerce. It is also imported from the East Indies, and is known by the name of the East India ginger. What is called the white or Jamaica ginger comes from Jamaica, and is prepared by selecting the best roots, and taking off the epidermis and drying them carefully in the sun. It is then carried to England, from whence it is brought to this country. Properties.—The dried ginger as found in the shops is round and knotty, and about the size of a finger. Externally it is covered with a dark-colored and wrinkled epidermis. Internally it is yellowish white. The white ginger differs from this only in having the epidermis taken off. It is of a yellowish white color externally, and smaller in size than the black ginger. Ginger yields a powder of a yellowish white color. It has a pungent aromatic odor of a peculiar kind, and a hot biting taste. Long exposure to the atmosphere dissipates these properties. Effects.—A pleasant cordial stimulant to the stomach, producing a sense of warmth in the organ, with some excitement of the system. It is said specially to stimulate the respiratory and genital organs. Its use is chiefly as a condiment As a medicine it is sometimes given to re- move flatulence or nausea, or combined with purgatives to correct griping. In the colic of young children it. may be used with advantage. , Dose.—Powder, 10 grs. or more. Generally used in an infusion. calamus {the rhizoma of Acorns Calamus). This is the sweet-scented flag, a plant growing abundantly in Europe, India, and America. In the United States it is indigenous, and is found along the borders of creeks and rivulets. It is also frequently an inhabitant of swamps and moist ground. The part used in medicine is the root. This is from six to twenty-four inches long, rough, and jointed. It runs horizontally, and is from half an inch to an inch thick- The root is taken up and simply dried, and is then fit for use. By the process of drying it is diminished in size, but neither impaired in its smell nor taste. Properties—As found in the shops the roots of this plant are of vari- ous sizes; externally of a yellowish brown color; internally whitish and of a spongy texture. Sometimes in the root which is found in the market, the external covering has been entirely pared off, and nothing but the internal part left. Its smell is pleasant and aromatic. Its taste, when first chewed, sweetish and aromatic, but afterwards becomin-r bit- ter and acrid. The active properties of calamus are extracted by boiling water. STIMULANTS. 417 Effects.—This plant has been celebrated for its medicinal virtues from time immemorial. It appears to have been known to the Greeks and Arabians, as it is noticed both by Dioscorides and Avicenna. Accord- ing to Dr. Ainslie, " it is a very favorite medicine of the East Indies." It is now little used except as a stomachic and carminative. [The aromatic seeds, anise, caraway, cardamoms, the peppers, piper nigrum, capsicum, and allspice; the condiments, as cloves, lavender, peppermint, «fcc, are all remedies of much the same character as ginger and calamus; their physical qualities are well known, and their use, whether culinary or pharmaceutic, probably familiar. They need not detain us.—Ed.] GENERAL STIMULANTS. Alcohol.—I come now to treat of alcohol—a subject which in its medicinal and moral relations is one of very great importance, and I shall therefore dwell upon it somewhat in detail. Origin.—The juices of certain vegetable substances, when subjected to the action of air and moisture, undergo what is called vinous fermen- tation, and yield various liquors possessed of stimulating and intoxicating properties. Thus, the grape yields wine, the apple cider, Ac. Now, these liquors contain in various proportions a peculiar fluid called alcohol, along with coloring matter and other principles. If they be subjected to another process, that of distillation, what is commonly called ardent sj)irits, is obtained—brandy, rum, gin, whiskey, &c. These contain alcohol, mixed with water and volatile oil, &c, and to the quantity and peculiar nature of these additional ingredients are owing the difference of color, flavor, &c, which characterize different forms of ardent spirits. By subjecting these again to a second and perhaps third distillation, alcohol is obtained in its pure state. When the distillation of spirit was first invented is not precisely known. The term alcohol is of Arabic origin, and hence it has been supposed to have been discovered by the Arabians. " The Greeks and Romans were ignorant of ardent spirits; but the use of the still was well known in the time of Geber, who lived in the seventh century; he describes very accurately the process of distillation by the Alembic, per descendorium et filtrum, in his work entitled Liber Investigationis Magisterii. The first spirits known in Europe was made from grapes, and sold as a medicine both in Italy and Spain under the name of alcohol. The Genoese afterwards prepared it from grain, and sold it in small bottles at a very high price, under the name of aqua vitce."— Thompson Dis. p. 572. Pure alcohol is a colorless fluid, has a fragrant odor, and a hot pungent taste. When exposed to the atmosphere it quickly evapo- 418 MATERIA MEDICA AND THERAPEUTICS. rates; it is extremely inflammable, burning with a blue, lambent flame, without any smoke; it boils at 173°; has never been frozen; it dis- solves a great number of saline bodies, and is the proper solvent for many of the proximate principles of vegetables. It is lighter than water; the difference between them becoming greater in proportion to the purity and concentration of the alcohol. Hence, the best test of its purity is its specific gravity. Prepared in the usual way, the specific gravity is *835, and this is the strength which it is ordered in the Pharmacopoeia. By careful rectification, however, it may be obtained of the specific gravity of *815, and even *800. Besides the property which alcohol possesses of dissolving a great variety of bodies, it prevents the putrefaction of animal and vegetable substance. What is called diluted alcohol contains about equal weights of alcohol and water and the specific gravity is *935. Effects of Alcohol.—In speaking of the effects of alcohol, I shall con- sider it: 1. As a medicine, and 2. As a poison. In its pure state alcohol acts as a powerfully irritant and caustic poison. To whatever part of the body it is applied it causes contraction and condensation of the tissue, and gives rise to all the symptoms of local inflammation, pain, heat, redness, and swelling. In its diluted forms (as in wine, brandy, Ac.) when taken into the stomach, it produces the effect of stimulating the part to which it is applied, creates warmth, and promotes the flow of blood. A temporary excitement is thus produced in the organ, the appetite is increased, and the general power augmented. Succeeding this local impression, the general system is affected, the action of the heart and arteries is increased, the brain and nervous system are stimulated, and there is a general feeling of increased mental power and muscular energy ; animal heat is developed, and the various secretions are promoted. These are the effects, when used in moderation, and when it operates kindly. By a law of the animal economy excitement is always succeeded by collapse and depression. The excitement and energy produced by alcohol are followed by languor and debility, and these are alwavs in proportion to the intensity of the preceding excitement Now, there are here two or three circumstances which are worthy of notice. « 1. The effects of alcohol are always proportioned to the excitability of the system. Hence, in young persons, in females, in nervous and sanguine temperaments, they are always the most decided. 2. The system becomes gradually accustomed to the impression made by this agent, and to produce the same effect requires larger and larger quantities. 3. In consequence of the agreeable excitement produced by alcohol and the subsequent collapse, a desire is created for the repetition of the STIMULANTS. 419 dose. This, if not peculiar to alcohol, is not the case with any other medicine, except perhaps opium. As a medicine, alcohol in its various forms is an agreeable and power- ful stimulant, and may be resorted to in all those cases where it is necessary to support the sinking powers of the system. In consequence of the great abuses of this article, it has become a question whether it was justifiable in a physician to prescribe it in the practice of his profession. By many the opinion was entertained that it ought never to be resorted to, and that we could get along very well without it. I was myself asked, not long ago, to sign a paper declaring that alcoholic stimulants were never necessary in the treatment of diseases. I told the gentleman who handed it to me that / did not believe it. He urged me, notwithstanding, to sign it, insisting on the good it would do. I told him that I chose to be governed by the old Bible rule, never to do evil that good might come of it. Now, to put your name to a thing you do not believe is evil, and you are never justified in doing it. Follow the Bible, and you will never go wrong. Questions of duty are there resolved, not according to the fluctuating notions of the day, but by the immutable principles of truth. As to the question whether we could get along without alcoholic stimulants, it is not worth discussing. We might as well ask, could we get along without opium or quinine. Mode of using Alcohol as a Medicine.—In its pure state it is never taken internally. It is always used in combination in the form of wine or some other liquor, of which it forms the active ingredient 1. Wine.—This is of various kinds, differing not merely in strength, but in its effects on the system. According to analysis, Port wine contains the largest proportion of alcohol, having about 23 per cent. Madeira contains about 221 per cent. Sherry, 18 percent. Claret, 14g ; Champagne (red), 11.30 — (white), 12.80; Burgundy, 111. Although champagne contains less alcohol than most of the other kinds of wine, it is proportionately more intoxicating from the large quantity of carbonic acid gas which it contains. Besides their strength, wines differ in other respects. Madeira contains a good deal of acid, and therefore is objectionable where there is acidity of the stomach, or where there is a disposition to lithic acid depositions in the urine. Sherry, on the other hand, contains little or no acid. Port is astringent and tonic, hence it is well suited to cases in which the bowels are relaxed. Claret and Champagne, on the contrary, are laxative. 2. Ardent Spirits.—These do not differ materially in strength. Brandy contains 53.39 per cent; Rum, 53.68; Gin, 51.60. They differ somewhat in their effects. Brandy is tonic and astringent Rum is sudorific, while gin and whiskey are diuretic, especially when taken 420 MATERIA MEDICA AND THERAPEUTICS. weak; the degree of dilution exerts a controlling influence over the effects of all forms of ardent spirits. 3. Fermented Liquors.— Cider and Perry contain 9.87 percent; Ale, 8.88 ; Stout, 6.80. These, too, differ markedly in their effects, aside from mere stimulation. Ale and Porter are more decidedly tonic; cider diuretic; Perry is scarcely known among us. Now, of alcohol as a poison. Like others, this may act as a quick or a slow poison. In the first way, from taking too large doses at one time. In the second, from continuing the use of moderate doses too long, resembling in this respect corrosive sublimate. Now, all these effects ought to be well understood by the physician, because they are all actual states of disease, and call for medical treatment just as much as poison- ing by arsenic or opium. I shall therefore describe them, and at the same time speak of the mode of treatment. 1. When taken in a large dose at once, alcohol operates as a deadly poison. Mr. Brande injected proof spirit into the stomach of a rabbit, and in five minutes he lay motionless and insensible, the respiration was laborious, and in one hour and fifteen minutes he was dead. In animals killed with this poison, the stomach is of a cherry red color. In the human subject, taking large quantities at once (as persons do who drink for a wager) coma comes on suddenly, the face is sometimes livid, more generally ghastly pale, the breathing is stertorous, the pupils sometimes contracted, more commonly dilated and insensible, and if relief be not offered speedily, death takes place sometimes almost imme- diately, at others after a few hours. It is not in this way, however, that alcohol is generally taken. It is used in smaller quantities and taken more gradually, and then it pro- duces various striking effects. 1. The first of these is intoxication. This is an effect peculiar to alcohol. There are, it is true, other agents which produce a sort of inebriation, such as opium, stramonium, camphor, nitrous oxide, the inha- lation of sulphuric ether, chloroform, etc., but this is different from that produced by alcohol, both in its general phenomena, as well as in its results. A paroxysm of intoxication may be divided into three stages. During the first the system is only pleasurably excited. The impression made imparts energy to the mind and vigor to the body. Care and anxiety are dispelled and a general serenity peiwades the system. The imagination becomes unusually stimulated, and wit and eloquence fre- quently flow forth in spontaneous exuberance. Such beino- the first effects of this kind of excitement, it is not to be wondered at that it has been so universally coveted by mankind. Go where you will__traverse the globe from pole to pole—and you will not find a people so savage as not to possess some substance capable of yielding this pleasure. It is the solace of the dejected, imparts confidence to the timid, courage to STIMULANTS. 421 the coward. Could the effects of alcohol be limited here, we should not have so much to regret in relation to its use. Other effects now follow of a different character, and constitute the second stage. In the first stage the brain, though powerfully stimulated, retains its controlling power, and the mental faculties, though highly ex- alted, are still under the command of reason. Not so now. The brain gradually loses its power, and a sense of giddiness is felt The senses become perverted—the vision is disordered—objects change their color and become multiplied—volition is now impaired or lost, and all the faculties become irregular in their action. The drunkard imagines a thousand things which have no existence. He is continually mistak- ing one person for another—incessantly talking, while his speech becomes thick and noisy. If he attempt now to use his muscles, he finds they have lost their power, and unable to support himself, he falls to the floor. This is the period which, in fashionable language, is called get- ting under the table. And now comes on the third stage, the third scene in this disgusting drama ; if consciousness be still retained, everything is confusion and chaos—the blood circulates wildly through the brain—the head throbs and the heart beats violently—strange noises ring through the ears— the faculties, still imperfectly awake, are creative only of wild and mon- strous images. Finally all this is overcome by sleep. Such, briefly detailed, are the phenomena attending a fit of intoxica- tion, or rather of poisoning. Now it is very evident that it is not possi- ble for the system to go through all this convulsive excitement without leaving its traces behind it Accordingly when the patient awakes from his slumber he is in no very enviable condition. The secretions are all shut up—the tongue is furred and dry—there is excessive thirst —the skin hot and feverish—the mouth foul—the breath offensive—the nervous system in a state of perfect exhaustion—the eye has lost its fire —the head aches and is giddy—there is sickness at stomach and a de- gree of dejection and prostration proportioned to the preceding excite- ment. Nor is this all. A person who has been once intoxicated will probably become so again. Every succeeding fit will increase his desire for the accustomed stimulus, while it undermines and destroys the power of resistance. Every case of intoxication does not terminate in this way. Some- times apoplexy and death are the results; then the drunkard's deep dreamless sleep " knows no waking." Another of the effects of the immoderate use of alcohol is the produc- tion of a peculiar disease, generally known by the name of delirium tremens. Other names are given to it, as mania a potu, mania tremulentia, brain fever of drunkenness. When fully formed this affection consists of a cer- tain degree of mental alienation, accompanied with a tremulous motion 422 MATERIA MEDICA AND THERAPEUTICS. of the hands and frequently other parts of the body. More commonly it occurs in persons who have been long accustomed to the intemperate use of liquor, and whose nervous systems, from that and other causes, have become greatly deranged. In some cases, however, it is brought on by a single fit of intoxication, and this I believe is more likely to happen when it has been the result of some mental trouble or affliction. The symptoms of this affection are, loss of appetite, oppression at sto- mach, followed by nausea and vomiting, tremor of the hands and mental aberration, the eye is wild and the whole manner furious and ungoverna- ble, differing, however, very much in different objects. They now become the prey of diseased sensation and disordered imagination. Generally speaking, fear and suspicion give the hue to all their fancies. In their incoherent wanderings they imagine themselves beset on all sides by knaves or enemies—their business has been ruined, their hopes are blasted, and even their persons are in constant danger. If the pa- tient should fall into a sound sleep, all this will pass off, and he will be restored to the integrity of his .faculties. In other cases sleep is unat- tainable, and then it runs on to a serious termination. The pulse be- comes smaller and more rapid—the skin is cold and covered with clam- my sweat—subsultus tendinum—coma or convulsions come on, and death closes the scene. It has been the general opinion that delirium tremens results from the sudden abandonment of liquor, after the immoderate use of it. Dr. Armstrong is of this opinion. On this subject Dr. Channing states an interesting fact In the almshouse at Boston, where habitual drunkards were daily admitted, and at once deprived of liquor and kept on a low diet, not a single case of delirium tremens occurred. (New Eno-. Jour. v. viii. p. 28.) But intoxication and delirium tremens are not the only effects of the abuse of alcohol. Various diseases are produced, functional and organic. That the stomach should be permanently deranged in its functions, from repeated and excessive stimulation, is not to be wondered at From the law of the system already alluded to, that excitement is followed by col- lapse, it is a necessary consequence that the tone of the stomach 'must sooner or later be permanently impaired, the appetite is lost, and the powers of digestion enfeebled *, not merely, however, functional disorder, but actual organic disease takes place as a necessary result of the con- tinued irritation and determination of blood kept up in the stomach. We have chronic inflammation of the stomach and scirrhus of the pylorus. Besides the stomach, other organs also suffer eventually from the poison- ous influence of alcohol. Among these the most prominent is the liver. From the repeated congestion to which it is subjected, it eventually becomes fatty, or cirrhosed. Along with this come ascites and jaundice from obstruction of the gall ducts. The kidneys, too, are affected with STIMULANTS. 423 a peculiar form of disease, which is generally accompanied with albumi- nous urine. This is the granular kidney of Bright. Not merely the solids suffer, the fluids also become affected. That alcohol is absorbed into the circulation is well established, and that it pervades every part of the system is abundantly proved by the poison- ous breath of the confirmed drunkard. The mind eventually suffers, and permanent mental aberration takes place, showing itself, according to the temperament of the patient, in the ravings of furious mania, or in the stupidity of hypochondriasis. If you wish for information on this subject, you have only to analyse the records of our lunatic asylums, and you will find that a large proportion of the cases of insanity arise from this cause. TREATMENT OF THE EFFECTS OF EXCESSIVE USE OF ALCOHOL. Intoxication.—This of course, resolves itself into two divisions, viz. the management of the fit of intoxication, and the cure of the habit. The first is comparatively easy, the second infinitely difficult {a.) Of the Fit.—As a general rule, the best plan is to let the person sleep it out and trust to the recuperative powers of nature. In some cases the symptoms are of such a nature as to make it desirable to break in upon the stupor under which the patient is laboring. In these cases the remedy first to be resorted to is vomiting. This is to be done with the double view of emptying the stomach, and of making the pecu- liar impression on the brain and nervous system which we know results from this process. To excite vomiting, copious draughts of warm water, or salt and water, or chamomile tea, will answer every purpose. In other cases more powerful articles are required, and then ipecacuanha or the vitriolic emetics may be used. When the insensibility is so profound as to render the patient unable to swallow, the stomach pump may be used. Next to vomiting, the bowels should be unloaded, and the quickest and best mode of doing this, of course, is by means of a stimulating injection. The common enema with a couple of tablespoonfuls of salt will answer every purpose. Cold applications to the head are also exceedingly advantageous, and ought to be continued for a length of time. This may be done either by cloths dipped in cold water, or by pouring cold water on the head, as in cases of poisoning by opium. If a person is found drunk in the streets, a very good plan is to have him carried to the next pump, and have cold water poured on his head for about a quarter of an hour. Very generally, this brings him to his senses. 424 materia medica and therapeutics. [This, as I before stated, is a remedy of very great power, and must not be used carelessly. I have known one instance where, used by non- professional persons, it had nearly destroyed life. In old, broken-down drunkards it is full of peril ; their system has so little power of resist- ance that, if the cold dash be carried far, reaction is impossible. Use this remedy, then, but use it carefully.—Ed.] Immersion of the whole body in cold water frequently counteracts the insensibility produced by drunkenness. This happens very fre- quently at sea. Sailors in a state of intoxication very often fall over- board ; when taken up, they are generally sober. Buffon states that "amono- the savages in the Isthmus of America the women throw their drunken husbands into the rivers, in order the more speedily to remove the effects of intoxication." With regard to the use of cold in this way, proper discretion must of course be exercised. If the person has already been long in the cold— if he is feeble, pulse small, Ac, nothing can be more injurious than this treatment. To sustain the action of cold, and be benefited by it, requires a certain degree of constitutional vigor as well -as animal heat. If proper reaction does not take place, it may prove fatal. When apoplectic symptoms are-present, as they not unfrequently are, the propriety of bloodletting becomes a question. In the use of this remedy, however, I would advise you to be cautious. Cases may occur in which depletion may be very proper, but, generally speaking, its effects are injurious, and sometimes even fatal; at any rate, bleeding should not be resorted to unless there be present a good deal of consti- tutional vigor. It is the observation of experience, that persons under the influence of liquor do not sustain well the loss of blood. Acids have long been celebrated as possessing the power of counter- acting the effects of drunkenness. Vinegar has, accordingly, been used in large quantities for this purpose with success. (See Macnish, p. 100.) {b.) The Cure of the Habit.—This, I fear, is a task almost hopeless. It depends not upon the physician, but upon the patient himself. He can do it, if he possesses sufficient fortitude and decision ; but unfortunately the habit of intemperance has already undermined so completely the moral energy, without which nothing can be done, as to render the case almost without a remedy. If moral energy sufficient be still left, the patient ought to be recommended to break off at once the use of ardent spirits. On this subject I am aware that a difference of opinion exists. By some it is supposed to be dangerous to break off immediately, and it is therefore recommended to be done gradually ; and various devices have been sug- gested for doing this. This is not meeting the enemy fairly. It is com- promising and sporting with him ; and lamentable experience, I believe, will prove that, in a majority of cases, such a course has proved abortive. In some cases, however, it has proved successful; for example, the cele- STIMULANTS. 425 brated Dr. Pitcairn once cured a Highland chieftain who was a patient of his " by exacting a promise that he .would every day drop a certain quantity of sealing-wax into his glass. He did so, and as the wax accu- mulated the capacity of the glass diminished, and consequently the quantity of whiskey it was capable of containing. By this plan he was cured of his bad habit altogether." (Macnish, p. 1 63!) Those who object to the immediate and total abandonment of ardent spirit, do it on the ground that the system may be brought into a state of dangerous collapse, and delirium tremens, «fcc, induced. This may certainly sometimes be the case, although it does not happen so frequently as is generally supposed. To obviate anything of this kind, a good plan (as recommended by Dr. Rush) is to substitute bitter vegetable infusion, beer, wine, and opium. He says, "by the temporary use of these, sub- stitutes for spirits, I have never known the transition to sober habits to be attended with any bad effects, but often with permanent health of body and peace of mind." The first thing then to be done is, to endeavor to operate upon the still remaining moral sensibility in such a way as may induce the person to make a great effort to break off the habit at once. The means by which this is to be brought about are obviously as different as the pecu- liarities of natural disposition in different individuals—as their modes of living—occupation—various relations in life, ttc, ttc. No general rule can be laid down for the physician, except to gain by every means in his power the respect and confidence of the patient, so far as to induce him to listen to his representations. When this is gained, he may sometimes address the reason, or the passions, or the fears, in such way as to pro- duce a salutary influence. The first mode, then, of attempting to cure the habit of drunkenness is addressed to the mind exclusively. The second is addressed to the body, and the principle upon which it is conducted is to associate with liquor something so unpleasant to the taste, smell, or its general operation on the system, as to give the person a disgust to it. This is the general principle on which all the nostrums for this purpose have been made. In many cases they have succeeded admirably. Dr. Rush says he once cured a negro of his fondness for liquor by putting a few grains of tartar emetic in his rum. He was so sickened by it that he thought he was poisoned. For two years after- wards he could not bear either the smell or the sight of rum. Generally speaking, the cure in this way is only temporary, unless aided by moral restraints. They are, however, exceedingly beneficial as giving time for reflection, Arc. 2. Treatment of Delirium Tremens. — On this subject I can only make a few remarks. Although various opinions are entertained in relation to the remedies proper in this curious affection, there can be no general difference in regard to the general principles upon which 426 MATERIA MEDICA AND THERAPEUTICS. the management of it ought to be conducted. In this disease there are two leading conditions of the system which require to be attended to. The digestive organs are generally more or less deranged, and the brain and nervous system in a state of irritation. Our remedies, therefore, ought to be directed mainly to the correction of these two conditions. ' With respect to the first, as a general rule, the best remedies that can be resorted to are purgatives, and of these the best are a mixture of rhubarb, magnesia, and mint water. By the judicious use of these, you unload the bowels, promote secretion from the liver and intestinal canal, determine from the brain, and in all these ways quiet nervous irritation, besides preparing the_ system for the subsequent use of other remedies. This, then, is the first thing to be done, and the extent to which it must be carried is to be regulated by the period of the disease and the peculiar symptoms attending it. As a general rule, purging as well as all other evacuating remedies should be limited to the earlier periods of the disease. Another class of remedies that has been highly recommended for the accomplishing the same object is emetics. These were, as before stated, first advised by Dr. Klapp of Philadelphia, in the year 1817, and since then have been approved by many distinguished physicians. The objects to be attained by them are to unload the stomach, to act on the liver and change the secretions from that organ, and by the general shock given to the system to produce a salutary impression on the brain and nervous system generally. If, therefore, the stomach and liver be much deranged, emetics may be valuable remedies. Great care, however, should be taken in the selection of the article used. Tartar emetic is too powerful a sedative, and in many cases has caused fatal prostration. If it be used at all, two things should be attended to : 1. That the patient's strength be not too greatly impaired to bear so active an article. 2. It ought only to be used in the early stage of the disease. Having in this way corrected the condition of the digestive organs, the next thing to be done is to quiet nervous irritation and produce sleep. This is effected in two ways : 1. By the abstraction of all kinds of stimulants, and letting the patient wear himself out until he falls asleep. Thus, by keeping a patient in a dark room, so arranged that he cannot injure himself, and leaving him entirely alone, he will frequently, after a while, become exhausted and fall asleep. When sleep is attained the fit passes off and the patient recovers. 2. Opiates.—On this subject there is a difference of practice, some giving them in very large doses and repeating till sleep is produced. Others take a moderate course, using opiates occafionally and in smaller doses. As to the merits of these two plans : STIMULANTS. 427 1st. If the former succeed, if sleep, deep and continued, result, the cure is nearly certain, but, 2d. If it fail, the patient is certain to be injured, and very probably may be'killed outright. Use it therefore, if at all, with care. [I have used chloroform with most admirable results in this disease ; calm, quiet, and protracted sleep followed its administration, and the patient was entirely rational on waking.—Ed.] Many persons have been led into the use of liquor from the idea that it has a good effect on the mental faculties ; and this notion has been sustained by the fact that some men never can make any great mental effort without the aid of artificial stimulation. In this way I fear many a noble spirit has been wrecked, habits of intemperance having been gradually acquired under the pleasurable excitement of moderate stimu- lation, endirig in the total prostration of mind and body. Now, with regard to this idea of stimulating the mental faculties, let me lay down a few common-sense precautions. First with regard to the imagination : If any man takes liquor to stimulate his imagination, let him first be sure that he has an imagination to stimulate. This imagination is a rare gift, vouchsafed by God to only a few of his creatures. If a man has no imagination he may stimulate till he is tired, without finding cor- responding results. He might as well try to draw water from the flinty rock, or strike fire from a potatoe. Remember the old philosophical axiom, ex nihilo nihil fit. Even if a man is satisfied he has an imagina- tion he should recollect that liquor only stimulates it to a certain extent; bevond this it only makes the man ridiculous; for the imagination, sub- lime and soaring as it is, requires to be well balanced. Recollect, ff alco- hol stimulates the imagination, it impairs the judgment and clouds the reasoning faculties. Now, it is not imagination, but judgment and rea- son, which is required in the grave business of life. In the practice of our own profession, especially, we want no flights of fancy : we want sound judgment and plain common sense; we do not want a man in the clouds, we want him on terra firma, and therefore physicians, above all others, should be careful how they go ballooning it in the air. Rely on it their patients will not follow them. Alcohol can only stimulate the faculties, it cannot create them; it must stimulate a man's faculties such as they are. If he has mind it may develop that to he sure; but if he is naturally stupid, it will be just as sure to develop his stupidity. It can do nothing more. There is an old maxim, in vino Veritas, which is generally translated to mean, that under the influence of wine a man speaks the truth ; but it means a o-reat deal more. Its true meaning is, that under the influence of wine a man's true character is developed. That is the maxim. Wine acts like nitrous oxide gas. Hence it is that when a knave wants to 28 ^28 MATERIA MEDICA AND THERAPEUTICS. take advantage of another man and find out his true character, he tries to get him under the influence of liquor. Let a man, therefore, beware how he suffers himself to be duped in this way. The truth is, gentle- men, the less a man in health has to do with alcohol the better. To the young this is peculiarly applicable. Their blood courses rapidly enough in their veins already without any stimulation. In the ordinary business of life the great thing is to keep cool and collected, and when great enterprises are to be undertaken let the enterprise—let the occa- sion be the stimulus. Do you think Napoleon or Wellington needed any other stimulus than the great stake for which they were contending at the battle of Waterloo ? Look even at the picture, disgraceful in some respects, but instructive in others, presented by the recent pugi- listic combat in our country. Read the account of the training which Tom Hyer and Yankee Sullivan underwent, and see if liquor was one of the aids to which they resorted ? I make these remarks, gentlemen, not so much for yourselves, but for the sake of the patients. Judicious advice, cautiously given, has saved many a man from ruin. Aqua Ammonia.—Aqua ammonia is water holding in solution am- roonkcal gas. Water is capable of holding a third of its weight of gas, or 430 times its volume, and increases in bulk about two-thirds. The aqua ammonia of the shops, however, does not contain this proportion, but varies according to the mode of preparation. Properties.—Aqua ammonia is a colorless liquid, with a caustic alka- line taste, and a pungent odor. Turmeric paper when held over its fumes is turned to reddish brown. It is lighter than water, and its strength varies with its specific gravity. It readily attracts carbonic acid from the atmosphere if not kept in tight bottles. It unites with oils, and forms liquid soaps or liniments. Sp. gr. varies from 880 (aq. ammon. fortiss). to 960. Effects.—In its local action aqua ammonia is irritant, whatever be ■the part to which it is applied, the degree of irritation varying with the strength. When applied to the skin, if of any strength, it causes red- ness, heat, pain, and eventually actual vesication. If held under the nostrils, its fumes produce irritation of the mucous membrane of the eye, of the nostrils, and if inhaled a similar effect is produced upon the air passages. Taken into the stomach in small quantities, it produces a slight sense of warmth in the mouth, throat, and epigastric region. In large quantities, it acts as an irritant poison. In its remote action it produces the effects of a stimulant; the pulse is rendered fuller and more frequent; the muscular and nervous power of the system is aug- mented ; the heat of the surface is increased, while a tendency to per- spiration is induced. From this combination of properties, it is an article of great value •STIMULANTS, 429 lind may be used with advantage in many cases where a prompt and efficient stimulant is required. From the tendency which it has to act on the skin, it may, as well as the carbonate, be used frequently in febrile affections at a much earlier period than many other stimulants. Mode of Administration.—From five to ten drops may be given in a cup of cold water or milk, and repeated every two or three hours, or oftener, as it is very evanescent in its operation. Ammonia has been given, and in a few cases with success, to cure the bite of venomous snakes. Carbonate of Ammonia.—This salt is prepared by triturating mu- riate of ammonia and carbonate of lime together, and then subliming from a retort into a cold receiver. Properties.—When recently prepared it is in colorless, translucent masses, about two inches thick, moderately hard, and of a striated and crystalline appearance. Its smell is pungent, and its taste sharp and penetrating. " Turmeric paper when held over it is turned of a red- dish-brown color by the ammonia, which escapes." It is soluble in four times its weight of cold water. By boiling water or alcohol it is decomposed with effervescence. When exposed to the atmosphere it gradually loses its smell, becomes opaque and friable, and is converted into the bicarbonate. Effects on the System.—Carbonate of ammonia is a local as well as a general excitant Smelling and inhaling its vapor cause irritation of the mucous membrane of the nose, larynx, and trachea. When swal- lowed in moderate doses, it produces no obvious local effects', in larger doses it proves emetic, and in still larger doses it causes irritation, pain, and sometimes actual inflammation in the stomach. In its remote action on the system it increases the force and frequency of the pulse, and operates on the skin as a diaphoretic. [It is the stimulant for extreme prostration after uterine hemorrhage; of the many valuable practical hints for which I am indebted to my old master, the late Dr. Joseph Parrish of Philadelphia, no one has been of more value to me than the emphatic, " Pour down the volatile alkali as fast as she can swallow it,1' in a case of tremendous uterine hemorrhage. " Peace to the good man's memory, let it grow Greener with years, and flourish in the lapse of ages."—Ed.] Mode of Administration,—The best forms of giving this article are in pill or in solution. From its volatile nature it should never be given in powder. The pill may be made with some vegetable extract, and should be kept in a tight bottle. [The dose is from five to ten grains every two or three hours. The Volatile julep—carb. ammonia 3 i, pulv. gum. Ara- 430 MATERIA MEDICA AND THERAPEUTICS. bic. 3 ij—sacch. alb. 3 ij, water six ounces, is the form I use. The dose is a tablespoonful.] As an emetic it is used sometimes in paralysis—dose grs. xxx. Camphor.—This is a substance found in a great number of vegetables, such as peppermint, sage, thyme, other parts of the system. The whole nervous system is more or less impressed. The vascular system is excited, and the pulse becomes more frequent and fuller. These effects, however, are not invariable. The bowels are differently affected;, while in some cases they are moderately relaxed, in others no effect is produced on them. As already stated, these agents do not produce any of the stupor and insensibility which characterize narcotics. Some of them are supposed to induce a tendency to sleep, but they do this only so far as they relieve the system 434 MATERIA MEDICA AND THERAPEUTICS. from pain and other morbid symptoms for which they may be pre- scribed. Most of the articles of this class are absorbed into the circulation, and their odor can be recognised in the various secretions. The effects of this class of agents are all produced very quickly. In this respect they differ from a great proportion of other medicinal agents, and they are very transient, and therefore to keep up a certain effect they require to be repeated at short intervals. There is no class of agents where purity is of more importance than the one we are considering. Unless they are pure, little or no effect is produced by them, and it is from this cause no doubt that so much of the discrepancy in relation to their effects has arisen. There are various ways in which the quality of these articles may be changed. In the first place, by long keeping, they lose their odor, and with this much of their active power. In the second place by actual adulteration. This is especially the case with such articles as musk and castor, the price of which is very high, and therefore the temptation to adulterate propor- tion ably great. From the stimulant operation of these agents, they are contra-indi- cated in all cases in which there is great plethora or inflammatory action. As a general rule, too, they ought never to be prescribed until after the bowels have been properly evacuated. It is only after due preparation of the system that these can be used with advantage—and if thus used they will do much more than might otherwise be expected. DISEASES IN WHICH NERVINES ARE APPLICABLE. Nervines acting as stimulants to the nervous system are used mainly •for the purpose of exciting that system and controlling spasm. They are accordingly given in diseases characterized by impaired nervous energy and spasm. A condition of the System characterized by Impaired Nervous Energy may be induced by whatever has a tendency to debilitate and exhaust. Profuse evacuations of various kinds, and protracted disease, are the most common causes of it Although in most cases of this kind a judicious course of ordinary tonic treatment is the most efficient that can be adopted, yet advantage may frequently be derived from the specific action of some of the agents of this class. In the nervous debility which succeeds disease, valerian sometimes operates admirably in steadying the nerves. In the advanced periods of fever, musk is a stimulant which is frequently advantageous. By Dr. Graves it is highly recommended in those cases in which congestion of the brain is apprehended and yet a stimulant is required. NERVINES. 435 Spasmodic Diseases.—These are the diseases in which this class of agents are specially recommended. A very little acquaintance with their history will, however, show that in a large majority of cases they have done but little good, and indeed it is not to be expected that they should. Spasm is a morbid condition, depending upon such a variety of causes, and accompanied with such different and even opposite states of the system, that it is impossible any one set of remedies should have a specific control over it And yet antispasmodics have in fact been invested with this power. That they should have disappointed such expectations is by no means wonderful. Let us briefly review some of these diseases. Epilepsy.— The causes which produce this curious disease are various. They may be advantageously divided into those which act immediately on the brain, and those which act primarily on some other parts of the system and secondarily on the brain. Under the first may be ranged various me- chanical causes producing pressure on the brain, such as malformation of the cranium, injuries of the same, depression of bone, tumors, &c, an overload- ed state of the vessels and effusions in the brain, strong mental emotions. Under the second may be arranged intestinal irritations of various kinds, more especially the irritation caused by worms, biliary concre- tions, calculi in the kidneys and bladder, acrid substances introduced into the stomach, the suppression of accustomed evacuations, and the like. In the condition of the system, too, there is a wide difference. While in some cases it is plethoric, in others it is marked by general debility. Now it is evident that arising from such various and opposite causes the same mode of treatment cannot be uniformly applicable. It is idle to suppose that any remedies possess a specific power of con- trolling epileptic spasm or convulsion. Experience has abundantly proved this. The general management of the disease divides itself into that which is required during the paroxysm and that during the inter- vals. During the first, little, if anything, can be done with much effect, and the great object is during the intervals to endeavor to correct the condition of the system upon which the recurrence of the paroxysms appears to depend. If the disease is connected with an overloaded state of the blood-vessels, venesection and evacuants areto.be resorted to. If it depend upon intestinal irritation, emetics, cathartics, anthel- mintics, &c, will be required, according to the nature of the cause of the intestinal trouble. If general debility and irritability be present, tonics will be the appropriate remedies. By pursuing this course of management, viz. by removing the cause of the disease and correcting the existing condition of the system, much may, in general, be done to eradicate it. With regard to the use of antispasmodics, the result of experience has demonstrated that little reliance can be placed on them. 436 materia medica and therapeutics. The only one that has had much reputation is Valerian. Of these the older writers speak in the highest terms. Tissot says, if epilepsy resist Valerian it must be incurable ! ! Alibert, on the other hand, says that he tried it for six years in the Hospital of St. Louis and always without success. It is said, however, that he used the infusion, which is almost inert. Still Valerian is very far from being a specific. In many cases it may prove serviceable by its stimulant operation on the nervous system, while in others it is inefficacious. In young subjects where the disease is recent, and where it is not connected with any organic difficulty, this remedy may be good. In using it, however, special regard should be had to the condi- tion of the system. As it is stimulating in its action, it should be used with great caution where plethora or local determination exist. To obtain its best effect, too, it should be used in full doses. Chorea.—This is a disease in which we might suppose the agents commonly called antispasmodics could be used with advantage, and experience has proved that as auxiliaries they may frequently be very valuable. As general remedies calculated to control spasms, however, they are very ineffectual. Like epilepsy, chorea arises from various causes and is associated with different states of the system. It is im- possible, therefore, that any one mode of treatment or any particular set of remedies can answer in all cases. Under different circumstances, bloodletting, purgatives, tonics, revulsives, &c, are all useful remedies, and so are antispasmodics. In cases marked by fulness of habit or an inflammatory diathesis, they are always improper. On the other hand where this is not the case and where the temperament is highly nervous and excitable, they may frequently be used with advantage in conjunction with other agents. By Copland, after the preliminary exhibition of purgatives and the use of suitable depletion, Valerian is highly recommended in connection with tonics. Eberie has found assafcetida, in combination with quinine, successful after due evacuations. Pills containing one gr. of sulphate of quinine and two gr. of assafoetida were given every four hours. In chorea coming on about the age of puberty in females, assafcetida has been specially recommended. Hysteria.—There is no disease in which the power of antispas- modics is more strikingly shown than in this. Even here, however they are not to be looked upon as specifics. Hysteria, like all spasmo- dic affections, depends upon various conditions of the system, and the treatment must be directed accordingly. During the convulsion according to the state of the patient, bleeding, emetics, enemata, &c, are among the remedies first to be employed, with the view of removing the cause which may produce it. Among the agents proper, after this NERVINES. 437 to act specifically on the nervous system, some of the antispasmodics, in combination with opium, may be employed. Of these ether and assafcetida are among the best. Ether is very prompt in its action, and in combination with laudanum, is efficient in controlling spasm. The tincture of assafcetida and laudanum also acts very well. Where it is difficult to get anything into the stomach, the same may be accom- plished by an enema. For this purpose, from a scruple to half a drachm of assafcetida may be rubbed up with half a pint of water, with the addition of a drachm of laudanum, .and this injected into the rectum. In chronic hysteria, independent of convulsion, in which the whole nervous system appears to be in a deranged condition, some of the agents of this class are the remedies resorted to, and at the head of the list is assafcetida. It acts with more power and efficiency than any other agent. Besides stimulating the nerves, assafcetida is useful in these cases by proving laxative. In some cases, sulphuric etlier and laudanum, in doses of ten drops of laudanum, and twenty of ether, repeated every two hours, answer a good purpose. Valerian, too, frequently proves beneficial, and particularly in cases where a tonic to the digestive organs is required; the tincture is the best preparation. Castor, too, in some cases proves salutary—so does the skunk cabbage. Dr. Thacher states that in a case of violent hysteria, in which musk and other antispasmo dies had failed, two teaspoonfuls of the powdered root in spirit and water afforded immediate relief. Eberie states that he has given this frequently in chronic hysteria, and with advantage. He gave a wineglass of the injusion ( § i of the root to a pint of water) every four or five hours. After all, however, antispasmodics are mere auxiliaries, and more may be done in the intervals by tonics and other remedies calculated to cor- rect the general condition of the system. Spasmodic Asthma.—In this complaint antispasmodics have been ex- tensively used, and in some cases with benefit. The simple inhalation of the vapor of ether frequently proves exceedingly beneficial; assafce- tida has also been given with advantage. Of the simple antispasmodics, however, the skunk cabbage is the most efficacious. This remedy was first recommended by the Rev. Dr. Cutler, by whom it was frequently found successful when all others had failed. From thirty to forty grains of the dried pulverized root were given every two or three hours during the paroxysm, according to the urgency of the symptoms. After the paroxysm has subsided, the use of the remedy is to be persevered in for some days. This mode of treatment is said to have been obtained from the Indians, who repeat the dose for several mornings after the paroxysm has passed off. By others this remedy has been tried, and with bene- ficial results. 438 MATERIA MEDICA AND THERAPEUTICS. The antispasmodic, however, which answers better in this disease than any other, is the lobelia inflata. This has already been noticed under the head of emetics. As there stated, it combines the action of an emetic and antispasmodic. I have used this at the New York Hospital with success in a case in which all other remedies failed. Colic.—This is a disease which arises from various causes, and is con- nected with varying conditions of the digestive organs. The treatment 'must of course vary according to the severity of the case—bloodletting, evacuants, warm bath, opium, and the like, are the remedies to be depended upon. As to antispasmodics, they can only be useful under Certain circumstances. In the milder forms of it, and where it arises merely from disordered functions and flatulency, they are frequently of great service. In this way, as gentle stimulants, they may be used with advantage in gastrodynia and dyspepsia. In these assafcetida frequently proves a valuable remedy. Where anything like active irritation or inflammation is present, these ought to be abstained from. In the griping to which children are subject, connected with a disor- dered state of the bowels, assafcetida sometimes proves exceedingly beneficial. INDIVIDUAL NERVINES. MUSK. This is an animal product. It is obtained from the Moschus moschi- fcrus, an animal inhabiting the mountains of Eastern Asia, and dwelling on the highest of the snowy peaks. It resembles the deer a good deal in appearance, and is seldom longer than three feet. On the belly of this animal, between the umbilicus and the prepuce, is a bag covered with hair, of an oval shape, which contains the musk. It is about three inches long and two broad, and is found only in the males. Internally it is lined with a smooth membrane having irregular folds in it It is this membrane which is supposed to secrete the musk. In the young animal there is no musk found; it exists only in the adult. The quan- tity which the sac contains is from one to two or three drachms. By rubbing against the rocks the animal frequently expresses a part of the musk, and this is said to be the purest kind. Generally, however, the musk is obtained by cutting away the bag, and this is usually done while the animal is still alive. A small hollow reed is inserted into the bag for the purpose of admitting air, and it is then suffered to dry. It is in this state that the musk is imported from China. " NERVINES. 439 Physical Properties.—Musk in the living animal is a viscid secretion. When dried, it is converted into friable, solid grains. They are unctu- ous to the touch and of a reddish-brown color, resembling a good deal dry coagulated blood. Its taste is bitter and disagreeable, and its odor is powerful and peculiar—exceedingly diffusible and permanent. In combination with other perfumes, it is said to possess the property of increasing their odor without imparting its own. Varieties of Musk.—There are two kinds of musk brought to the market, both coming in bags, convex and hairy on one side, and flat and destitute of hair on the other. 1. The Chinese or Tonquin musk. This comes from Tonquin, and is brought from China. The sacs are smaller and rounder than the other variety, and the hair which covers them is of a red color. 2. The Russian, called also the Kabardine musk, comes from Siberia, and is imported through Russia. In this the sacs are larger and longer, and covered with a coarse white hair. The best mode of purchasing the musk is in the bag. Chemical Composition and Properties. — According to the analysis of Guibourt and Blondeau, musk contains the following constituents, viz. water, ammonia, stearine, elaine, cholesterine, an acid oil combined with ammonia, a volatile oil, hydrochlorates of ammonia, potash, and lime, an undecided acid, partly saturated with the same bases, gelatine, albumen, fibrine, a highly carbonized matter soluble in water, a soluble calcareous salt with a combustible acid, carbonate of lime, phosphate of lime, hair and sand. Musk is soluble in water ; boiling water taking up about 80 parts in 100. Alcohol dissolves about 50 parts in 100. Ether takes up nearly the whole. Effects on the System.—When taken internally, musk produces un- pleasant effects on the stomach, producing eructations with sense of weight, dryness of the fauces, vertigo, oppression of the brain, headache, followed with disposition to sleep. Large doses induce faintness, vertigo, trembling of the limbs, pulse more frequent and fuller. Therapeutic Effects.—Musk being an excitant to the nervous system, is proper where such an agent is desired. It is used in low fevers, in spasmodic affections unaccompanied with cerebral fulness. Dose.—From 10 to 20 grs. either in bolus or emulsion. The tincture is a bad form. valerian. The tree which yields this is the Valeriana officinalis, a plant indi- genous in England and on the continent of Europe. The part used in medicine is the root, which consists of slender twisted fibres, coming off from a tuberous head. The proper period for digging up the roots is in 440 MATERIA MEDICA AND THERAPEUTICS, the autumn when the leaves decay, or in the spring before the flowers expand. They should then be kept in a dry place. The best comes from England. Physical Properties,—The root of Valerian is of a yellowish-brown color externally and white internally. AVhen fresh it has scarcely any smell, but on drying acquires a strong foetid odor. Its taste is first sweetish, but afterwards bitter and aromatic. Effects and Uses.—These were referred to when speaking of antispas- modics generally. As a stimulating antispasmodic, it is relied on by many in hysteria, and will sometimes remove milder forms of epilepsy. It is an excellent remedy in hemicrania where the state of the system will admit of a stimulant. Mode of Administration.—Valerian is used in powder, infusion, and tincture. The powder is apt to disagree with the stomach—the infu- sion is of uncertain strength. The best form is tincture. The ammoni- ated tincture is a very valuable antispasmodic. Dose.—Powder 3 i. Tincture § ss. ASSAFCETIDA. The plant which yields this drug is the narthex assafcetida. It grows native in the south of Persia, with a stem about nine feet high and seven or eight inches in circumference at the base. The root is perennial, and when fully grown is as large as a man's leg. It contains a large quan- tity of a foetid milky juice, which is the substance used in medicine. The mode of obtaining it is the following : When the root is four years old (until which time it is not fit to yield it), at the season when the stem begins to wither, this is torn off from the root, which is then ex- posed by digging away the earth that surrounds it. In this state it is left screened from the sun for forty days. The top of the root is then cut off transversely, and after forty-eight hours the juice which has exuded is scraped off. Another slice is then cut off, and this operation is re- peated until all the juice is exhausted, when the root dies. This process occupies about six weeks, and during this time the root is protected from the sun's rays. The juice thus collected is then put together and dried, and this is the assafcetida used in medicine. It comes to this oountry either from India or by the way of Great Britain in bags or cases containing from one to two hundred or more pounds. Physical Properties.—Assafcetida, as imported, is in large irregular masses adhering together, externally of a brownish yellow color, and interspersed with tears of a white, red, or violet blue. When broken it presents a variegated, shining surface of a whitish color, which, on expo sure, changes to a reddish brown. Sometimes, but rarely, the assafce- NERVINES. 441 tida comes in separate tears. The odor is foetid and resembles that of garlic, and its taste is sharp, acrid, and bitter. The best kind is that which is clear in its appearance, of a pale reddish color, and contains a great number of the whitish tears, and has the peculiar odor very strong. On long keeping and exposure to the air, it becomes hard and brittle, and at the same time loses much of its odor and somewhat of its taste. Even when dry, assafcetida is pulverized with difficulty. Chemical Composition and Properties.—According to the analysis of Pelletier, assafcetida contains in 100 parts, resin, 65 ; gum, 19.44 ; basso- rine, 11.66; volatile oil, 3.60; supermalate of lime, 0.30.—(Guibourt.) It belongs, therefore, to the class of gum resins. It is soluble in alcohol, forming a clear solution, which becomes milky on the addition of water. Triturated with water it forms a milky opaque mixture, from which the resin is gradually deposited, unless yolk of egg or mucilage be added. Effects and Use.—This is one of the most valuable and most reliable of the antispasmodics, and from its action on the bowels will often pro- duce the best effects in hysteria and other kindred affections. Its effects on the bronchial secretion have already been noted. (See Ex- pectorants.) It also stimulates the uterus, and perhaps the whole genital apparatus, in the male as well as the female. Skunk Cabbage.—This is known by various names, such as the Dra- contium faetidum, Ictodes jcetidus, Symplocarpus foitidus. This sino-ular plant is indigenous in this country, and is found growing in wet woods, swamps, and on the margins of brooks and rivulets. It flowers about the end of April or the beginning of May. The root is the part used in medicine. The proper period for collecting it is early in the sprino- or in the autumn. It should be carefully dried for use. Physical Properties.—The root of this plant consists of a thick body, with numerous radicles. The body is two or three inches long and one inch thick. The radicles are about the thickness of a common quill. Externally the root is covered with a brownish epidermis; internally it is white and amylaceous. When fresh it has a peculiarly foetid odor. This is supposed to depend upon the presence of a volatile oil which is dissipated by heat and exposure. Its taste is acrid, but it loses this by long keeping. As the virtues of this article depend upon its sensible properties, it is evident that they become impaired by keeping. The recently dried root should therefore always be preferred. Chemical Properties.—"It seems to contain a volatile acrid principle, readily dissipated by heat; a resinous substance, and a gummy or muci- laginous principle. The seeds contain a considerable quantity of fixed oil."—Edwards's Manual, p. 308. Effects.—This article, if given in moderate doses, proves stimulant and antispasmodic. In large doses it causes nausea and vomiting, and 442 MATERIA MEDICA AND THERAPEUTICS. powerfully affects the nervous system, producing sometimes headache, vertigo, and impaired vision. It was originally introduced into practice, by the Rev. Dr. Cutler, by whom it was highly recommended in asthma. It has been used with occasional success in hysteria, chronic catarrh, pertussis, and chronic rheumatism. Mode of Administration.—The best form is that of powder in doses of from 10 to 20 or 30 grains. As the volatile oil is more apt to be dis- sipated when in powder, it should never be pulverized until required for use. cajuput oil. This oil was formerly supposed to be the product of the Melaleuca leucodendron. The tree which yields it is now, however, found to be a different species, and is called the Melaleuca cajuputi, a small and beautiful tree, growing native in the Molucca Islands. The oil is con- tained in the leaves, and is obtained from them by distillation. From the small quantity which the leaves contain, the oil bears a high price. It is brought from the East Indies in glass bottles. Properties.—This oil is of a beautiful greenish color, transparent, and very fluid ; its taste is pungent and aromatic, and its odor is penetrat- ing, and resembles that of a mixture of camphor and turpentine. It is lighter than water, exceedingly volatile, and burns without leaving any residue. When dropped in water, it diffuses itself over the surface and rapidly evaporates. In alcohol it dissolves very readily. Adulterations.—From the high price of this article, every temptation is held out for its adulteration, and this accordingly is frequently done. The articles principally used for this purpose are the oil of turpentine, the1 oil of rosemary, camphor, &c. Its purity is ascertained by some of its properties already mentioned. 1. Drop some of it on the surface of water, and if it be pure it will diffuse itself rapidly over it, and evaporate completely. 2. It burns rapidly when ignited without any residue.—3. It dissolves entirely in alcohol, which is not the case when sophisticated with tur- pentine. Effects.—When taken internally, cajuput oil acts as a local and general excitant. It produces a sense of warmth in the stomach, and speedily extends its influence to the rest of the system ; the pulse is increased in force and frequency, blood determined to the surface, and perspiration induced. Its use, therefore, is principally in those cases in which it is desirable by means of an excitant to equalize the circulation, and to determine to the surface. Dose.—The dose is from two to six drops well rubbed up with sugar. Applied externally, it forms a good stimulating embrocation in cases of rheumatism—one part of cajuput oil diluted with four parts of olive oil. NERVINES. 443 strychnos nux vomica. This is the Vomica Nut It is obtained from a tree growing in various parts of the East Indies. It is of a middling size, with a crooked and thick trunk. This tree yields a round fruit about the size of an orange, covered with a smooth, hard rind of a beautiful golden yellow color, and filled with a soft, jelly-like bitter pulp. In this pulp are imbedded a number of seeds, generally from three to five. These are the vomica nuts of medicine and commerce. They are round and flat, with a depression in the centre, resembling somewhat in shape the button of a coat. They are from half an inch to three quarters of an inch in diameter, and about a quarter of an inch in thickness, of a yellowish grey color when good (when inferior they are black) ; their taste is bitter and acrid, but they have no smell. Chemical Properties.—Besides several other less important ingre- dients, the vomica nut has been ascertained to contain the three follow- ing principles, upon which its active properties are supposed entirely to depend. 1. Strychnine, a peculiar alkaline principle. 2. Brucine, another alkaline principle. 3. Igasuric acid, so called from the Malay name of the bean of St. Ignatius. This acid, since named Strychnic, exists in combination with both of the alkaline substances just mentioned, forming Igasurates or Strych nates. Effects on the System.—The effects of this article on the system are decided and peculiar. According to the experiments of Magendie, it appears to be established that the nux vomica possesses the singular pro- perty of exciting the spinal marrow and the nerves issuing from it, as well as the muscles supplied by the nerves, without at the same time affecting the functions of the brain, except indirectly. Hence, when given in suita- ble quantities, it produces spasms of the muscular system precisely simi- lar to those of tetanus, the muscles becoming sometimes rigidly fixed, while at others there are violent states of spasm alternating with fits of relaxation. On the digestive organs it acts as a tonic, and accordingly it will be found that during its use in moderate doses, the appetite is gene- rally improved, at the same time the evacuations from the bowels are rendered less frequent. " In general, the superior extremities are bent, and the inferior ones extended. The intellectual faculties are not dis- turbed, but there is sometimes present a sort of intoxication. Sometimes the urinary and genital organs are irritated. When the dose is a little too large, there comes on difficulty of respiration, swallowing, speaking, and urinating, general agitation and sweat, but all this is ordinarily un- attended with danger."—Bayle, vol. ii. p. 241. 29 444 MATERIA MEDICA AND THERAPEUTICS. These, then, may be considered as the effects of this agent on the sys- tem when used in suitable doses, viz.—a tonic to the digestive organs, and an excitant to the spinal marrow and its dependent nerves and muscles. To produce these effects, it is requisite to give it in suitable doses, and continue it for a certain length of time. Modifying Circumstances.—1. Dose.—This modifies very greatly the effect of this agent. When given in very small quantities, no sensible effect follows. When given in moderate medicinal doses, it produces twitching, pricking, and slight spasms of the limbs; if the quantity be still further increased, decided tetanic spasms are brought on, propor- tioned to the quantity taken, and the length of time its use may have been continued. Finally, if it be given in still larger doses, it acts as a decided poison. For the purpose of ascertaining the mode in which death takes place, numerous experiments have been made upon animals, " Half a drachm of the powder killed a dog in forty-five minutes, and a grain and a half of the alcoholic extract thrust into a wound killed another in seven minutes. The animals uniformly experienced dreadful fits of tetanic spasm, and died during a paroxysm. The cause of death appears to be prolonged spasm of the muscles of respiration. The spasm of these muscles is apparent in the unavailing efforts which the animals make to inspire. The external muscles of the chest may be felt during the fits as hard almost as a bone, and according to an experiment of Wepfei-, the diaphragm partakes in the spasm of the external muscles." According to Fonquier the diaphragm is ordinarily feebly and slowly affected by this agent Hence it is that in the medicinal use of it, the general tetanus which occurs is attended with little danger. According to the experiments of Magendie, the division of the spinal marrow and even complete decollation do not interfere with the peculiar action of this substance. On the human subject the effects are the same as those in animals, and the mode of death is analogous. " With regard to the dose requisite to prove fatal, the smallest fatal dose of the alcoholic extract yet recorded is three grains." " Hoffman mentions a fatal case caused by two fifteen grain doses of the powder; and in Hufeland's Journal there is another caused by two drachms, which was fatal in two hours." 2. The Actual Condition of the System as to Disease.—The action of this substance on the spinal marrow and the muscles is the same in a state of health as in disease, with this very striking difference, which was first observed by Fouquier, and afterwards confirmed by others. In cases of paralysis, the first effects of the remedy are felt in the paralyzed limb. In most cases, when spasmodic contractions begin in the para- lyzed parts, they do not extend beyond this, unless the dose be consider- ably increased. NERVINES. 445 Mode of Administration.—\. Powder.—In this form it is seldom given, being uncertain in its effects. It may be given in doses of from four or five grains, repeated three or four times a day, until its effects are felt 3. Alcoholic Extract—This is a preferable form to the powder, still somewhat uncertain from the variable strength of the article. This may be taken in pill in doses from half a grain to two grains, to be repeated three times a day. This quantity per diem may be increased gradually until the desired effect is produced. " In general, from four to six grains a day will be sufficient to produce tetanic action; but sometimes it has required as much as twenty-four or thirty grains in the day." It is important to recollect, that if the use of the medicine is discontinued, on its being recommenced the smallest doses must be given, and then gradually increased. 4. Tincture.—Ext. nucis vom. grs. iij.; alcohol, |i. M. Of this from twenty to thirty drops may be taken at a time. This is also a good friction to the paralysed part. Strychnine.—This alkali was discovered in 1818 by Pelletier, who found it in the Strychnos nux vomica, and from hence it derives its name. Since then it has been found in the Strychnos ignatia, the Strychnos colubrena, and in the Upas tiente of Java. It exists asso- ciated with another vegetable alkali, brucine, and both are in combina- tion with strychnic acid, formerly called the igasuric acid. It is obtained by boiling the bruised nux vomica in spirit three times successively, and pouring off and straining the several liquors. Distil off the spirit, and evaporate what remains to the consistence of an extract Here the alcoholic extract contains Strychnate of strychnine, with some admixture. This is now to be dissolved in cold water and strained. The water dissolves out the strychnate of strychnine, and separates some fatty matter united with it. This is then to be evaporated with a gentle heat to the consistency of a syrup, and while warm magnesia is added to saturation. After standing for two days, the supernatant liquor is poured off. The magnesia decomposes the strychnate, forming strychnate of magnesia, which is held in solution, while the strychnine is precipitated. The precipitate is then to be boiled in spirit strained, and distilled. To this add sulphuric acid mixed with water, and afterwards solution of ammonia. Here a sulphate of strychnine is formed, which is again decomposed by aramonia, and the strychnine precipitated. This is then again dissolved in boiling spirit and set aside, that pure crystals may be formed. Properties.—When pure, strychnine is a white crystalline substance ; 446 MATERIA MEDICA AND THERAPEUTICS. when obtained by spontaneous evaporation, it is in minute crystals; but when rapidly evaporated, it is in a granular form. It is without smell, but has an intensely bitter taste. The bitter is so intense that it im- parts its taste to 600,000 times its weight of water. It requires about 6,600 times its weight of cold, and 2,500 times its weight of boiling water, to dissolve it. In boiling alcohol it is soluble, but scarcely at all in cold. Strychnine acts like the alkalies on vegetable colors, neutralizes acids, and forms crystallizable salts. It is unaffected by the atmosphere. It is neither volatile nor fusible, being melted by heat only at the moment of decomposition, which takes place, however, at a comparatively low temperature. Purity.—As this article is very expensive, the temptation to sophis- tication is strong; as the quantity which is used at a dose is small, it is of course very important to have it pure, otherwise constant disappoint- ment must occur during its use. The articles with which it is most commonly sophisticated are, mag- nesia and phosphate of lime. To ascertain the presence of these the following tests will answer : 1. Dissolve in boiling alcohol. If pure it will be entirely soluble. 2. Subject to a calcining heat, with the access of air. If pure it will be entirely decomposed and dissipated. In its ordinary form it is frequently associated with brucine. This is ascertained thus : 1. Moisten the suspected strychnine with nitric acid; if it assume a blood-red color, it contains brucine, if not it is pure. 2. Mix a solution of the strychnine with a solution of chloride of tin; if it produce a brown precipitate, it contains brucine, if not it is pure. Effects on the System.—These are the same as the nux vomica, only more energetic. When given in sufficient quantities it is, next to the hydrocyanic acid, the most rapid and potent poison we know of. Its terrible effects have been illustrated by numerous experiments upon animals. Dr. Christison killed a dog in two minutes with the sixth part of a grain, injected in the form of alcoholic solution into the chest. A wild boar was killed in the same manner with the third of a grain in ten minutes. Dr. C. thinks there is little doubt that half a grain thrust into a wound might kill a man in less than a quarter of an hour Modes of Administration.—The ordinary and best mode of using it is the form of pill made with the conserve of roses. The best way is to begin with the J-j or the T'7 of a grain, repeated three times a day and increased until the characteristic effects of the article are produced. With respect to giving strychnine in the form of alkali, it is well enough to recollect that the activity of it depends upon the degree of acid in the stomach. To obviate the variable effect which might thus • NERVINES. 447 be occasioned, Dr. Thomson recommends that it should be given in the form of acetate. This he directs to be prepared by dissolving gr. j of pure strychnine in 3 j of distilled vinegar. Six minims of this contain one-tenth of a grain, which is a good dose to begin with. This may be gradually increased. Tincture.—This form is recommended by Magendie: Strychnine, grs. iij. Alcohol, | j. M. Dose, 6 to 24 drops. Salts of Strychnine.—Of these there are several. The only one used by Magendie is the sulphate. This acts in the same way as the strychnine, only more active. One twelfth of a gr. is a dose. APPLICATIONS OF NUX VOMICA AND ITS ALKALIES IN THE TREATMENT OF DISEASES. Serapion appears to have been the first physician by whom the Nux Vomica was used as a medicine. The Arabians gave it as an antidote against the bites of serpents. Between the sixteenth and eighteenth cen- tury, physicians resorted to it occasionally as a remedy for the plague, for taenia, hydrophobia, dysentery, and various nervous affections. It was not, however, until within a few years that any great use was made of it as a remedial' agent In 1811, Dr. Fouquier, reflecting the fact esta- blished by Magendie, in relation to the peculiar action of the Nux Vo- mica in producing tetanic spasm of the muscles dependent on the spinal marrow, thought it might be applied with advantage in cases of paralysis. He accordingly tried it in a large number of cases, and found it to be a most valuable remedy, proving in many cases a perfect cure. Since the discovery of the strychnine this has been still further tested, and its effi- cacy in many cases fully established. Like all other remedies, it is by no means infallible. In some cases it does no good, while in others it causes effects which no other is capable of producing. Everything de- pends upon the nature of the case. Whenever paralysis is the result of some organic derangement of the brain, such as tumors pressing upon the substance of that organ, diseased alterations in its structure, or extra- vasations of fluid which cannot be absorbed, then this remedy will be of no avail. On the other hand, where the paralysis depends upon simply diminished nervous excitement, it has been completely cured by the use of this article. Dr. Thomson says he considers " strychnine or the ext of nux vomica most useful in those cases of palsy that proceed from seda- tive impressions on the intestinal nerves, such, for example, as occur * 448 MATERIA MEDICA AND THERAPEUTICS. when carbonate of lead taken into the stomach produces colica pic- tonum; and indeed in every case of palsy of the motor nerves only, which is readily known by the sensibility of the paralytic limb remain- ing after the power of motion is lost, and by the entire state of the sen- sorium commune."—Vol. i. p. 255. In paraplegia it has generally been found more successful than in hemiplegia. The first effects of the remedy in all cases are convulsive twitchings of the paralysed parts, and no benefit is derived from its use until this effect is produced and conti- nued for some time. If plethora should be present, this is to be corrected by venesection, purgatives, and other appropriate treatment. It is a great advantage attending the use of this powerful agent (strychnine) that it does not at all impair the tone of the stomach ; on the contrary, it has a tendency to increase the appetite and promote digestion. In having recourse to the strychnine, the best way is to commence with small doses, increasing them gradually, according to the effect produced. One eighth of a grain twice a day is sufficient to begin with. This may be cautiously increased to one sixth, one quarter, or even half of a gr. twice a day. Should any unpleasant symptoms occur, of course its use should be discontinued, and when the symptoms subside it may again be re- sumed. By observing these general precautions, there is no danger in using this otherwise potent agent. Besides paralysis, strychnine has also been used with success in chro- nic diarrhoea. This, as you probably know, is a very serious disease, and sometimes incurable by any means that we yet are acquainted with. In some cases which had obstinately resisted all other treatment, this remedy effected a cure. Whenever any inflammatory condition of the mucous membrane of the intestines is present it is not to be used. When this is not present, and especially when the disease occurs in fee- ble constitutions and in old people, this remedy is exceedingly advan- tageous. Besides the effect which it produces on the intestines, it acts as a tonic to the stomach, and in this way, no doubt, aids very materially in effecting the desired relief. One twelfth of a grain two or three times a day is sufficient. In recommending this article, I would not advise you to fly to it at once before trying other means. Your best plan is to reserve it till everything else has failed. In certain cases of amenorrhcea, depending upon diminished action in the uterine vessels and the system, this remedy has also been used with considerable success. It stimulates the vessels of the uterus, and im- proves the general tone and vigor of the system. A very good plan in these cases is to combine its use with purgatives, especially when there is a tendency to costiveness, as there frequently is. Brucine.—This was discovered in 1818 by Pelletier, and by Caven- tou in 1819, in the inner bark of the brucia antidysenterica. It there NERVINES. 449 exists combined with the gallic acid, in the state of a gallate. Since then it has been found united with strychnine in the nux vomica and St. Ignatius bean. Brucine is a crystalline substance of a white color, desti- tute of smell, but intensely bitter. In water it is more soluble than most other vegetable alkalies, requiring only 850 times its weight of cold and 500 of boiling water for its solution. In alcohol both cold and hot it is very soluble. Tested with nitric acid, it produces a blood-red color. [This blood-red color changes to yellow by heat. This is the test of brucine, and if it happen with strychnine, shows the presence of brucine. It is permanent in the air, but melts at a temperature a little above 212°. On cooling it forms a mass resembling wax.] Effects on the System.—These are the same as the strychnine, only it is less active. It is considered to be about T\ only as active as the strychnine. Modes of Administration.—Pill, of \ to \ gr., to be increased gradu- ally. Creasote.—This is a peculiar substance discovered by Reichenbach. It is obtained from tar and pyroligneous acid. It is a colorless, transparent liquid, of an oleaginous consistence. It has a disagreeable penetrating odor, resembling that of smoked beef, with a burning caustic taste. Its specific gravity is 1.037, boils at 397° Far., and is not congealed at the temperature of—16.6° Far. It burns with a smoky flame, combines readily with acetic acid, water, alcohol, ether, and the alkalies. It coagulates albumen. Fresh meat placed for an hour in a solution of creasote and well dried, may be exposed to the heat of the sun without putrifying. In eight days it becomes hard and smells like good smoked meat. Effects on the System.—Applied to the tongue pure creasote produces severe pain. The tongue, however, is neither red nor tumefied, but con- tracted. Along with this there is a smoky taste in the mouth. Applied to the skin it produces a feeling like that of a burn—causes rubefaction, and destroys the epidermis, which splits and falls off in little rough scales. From experiments made upon animals, it appears that creasote acts as an irritant to the surfaces with which it comes in contact, whether this be the skin or the mucous membrance. In its pure state, if taken internally, it proves poisonous and destroys life. As a medicine it can of course be used only in the state of dilution. As a remedial agent creasote has been used principally as an external application, although in some cases it has been given internally. As an external application, creasote has been much commended in burns, especially those which are attended with excessive suppuration or fungous granulations. It is also used in chilblains. As a styptic it will often control a mere oozing of blood, but over haemorrhage from 450 MATERIA MEDICA AND THERAPEUTICS. vessels of any size it has no power. It has been used in indolent flabby ulcers, in scrofulous and venereal ulcers, and even in cancer. In all these cases it should be watched, and if it irritate, should be suspended. Creasote is often put into carious teeth, and sometimes checks the pain. In some of the scaly eruptions it has, when properly diluted, the best effects. Internally, it has been used in a number of cases. 1. Phthisis Pulmonalis.—In this disease, creasote has been recom- mended as aiding expectoration and also cicatrization of ulcerations. By Dr. Elliotson of London it was tried, but, as he says, without any good effect when given internally. When used in the way of inhala- tion, however, he reports favorably of its effects. His mode of using it was to put one drop of creasote into rather less than a pint of cold water, and add one drop every time it is employed in order to maintain the strength of the liquid. Through this water the patients were made to breathe for four or five minutes four or five times a day. In those cases in which the ulceration is confined to the mucous membrane, and in cases of simple bronchitis, Dr. Elliotson thinks it has been of decided benefit. Also in asthma. 2. Vomiting.—As an agent for arresting this troublesome affection, Dr. Elliotson thinks that the efficacy of the creasote is fully established. From the stimulant character of this article, it is only suited to those cases of vomiting in which inflammation or structural disease of the stomach is not present. In all other cases, he has found it eminently advantageous in arresting not merely vomiting but nausea. In colic, the vomiting attending pregnancy, sea-sickness, &c, he recommends its use. One or two drops in an ounce of water may be given every hour or half hour till the effect is produced. 3. Diarrhoea.—Creasote has been used with good effect in simple diarrhoea, cholera morbus and cholera infantum; also as a gargle in malignant sore throat. Modes of Administration.—Internally it is used either in pill or mix- ture. One or two drops dissolved in camphor mixture, or the same quantity made up into a pill, may be given three or four times a day. This may gradually be increased to eight drops. Inhalation.—This may be done either by steeping paper in it and placing this in approximation with the nostrils, or by heating the crea- sote in the neighborhood of the patient, so that he cannot fail to inhale it, in this way; or a portion of it may be poured into hot water in a Mudge's inhaler, and the creasote vapor inhaled in the usual manner. Externally it may be applied in the form of lotion or ointment. The lotion is made by adding from two to eight drops to each ounce of distilled water. The ointment is made by rubbing up ten drops with an ounce of lard. NERVINES. 451 For dressing ulcers the creasote water may be used first. Sometimes the purest creasote is used in these cases. To stop hemorrhage the best way is to imbibe a few drops of pure creasote on cotton or lint and apply it. SOOT. A well known substance of peculiar smell and bitter, disagreeable taste. Its composition is very complex, its most important soluble parts are, according to Berzelius, a pyrogenous resin united with acetic acid, creasote, ammonia, . Arsenitis ammoniae grs. iv. Aq. dist . 3 iv. M. This is also used by Biett in the same way as the preceding. Liquor Arsenici et Hydrargyri Iodidi.—Solution of the Iodide of Arsenic and Mercury.—Donovan's solution. Take of iodide of arsenic and red iodide of mercury thirty-five grains each, distilled water half a pint. Rub the iodides in half an ounce of water, and when dissolved, add the remainder of the water, heat to the boiling point, and filter. This preparation has been found very useful in the treatment of diseases of the skin, and will, perhaps, cure a larger proportion of chronic cases than any other one remedy. Dose from five to ten drops. ZINCUM. 1. Oxide of Zinc.—This is commonly known by the name of the flowers of zinc. There are two ways in which this- may be prepared : (a.) By the combustion of metallic zinc in a crucible. During this pro- cess it unites with the oxygen of the atmosphere and is sublimed. {b.) By adding water of ammonia to a solution of sulphate of zinc, a precipitate is thrown down, which is to be separated and dried. Here the sulphuric acid unites with the ammonia, and is held in solution, while the oxide of zinc is precipitated. This substance is a white powder, without taste or smell. It is inso- luble both in water and in alcohol. Effects.—The oxide of zinc possesses tonic properties, but its powers in this way are comparatively feeble. As a remedy in epilepsy and other spasmodic diseases, it was first introduced into practice by the celebrated Gaubias, and from the high authority from which it ema- nated, gained considerable celebrity, which, however, it has not since maintained. Mode of Administration.—The. best form of giving it is that of pill made up with confection of red roses, in doses of one or two grains, and gradually increased. Copper.—There are only two preparations of this metal used in medicine. 1. Sulphate of Copper.—This salt has already been described under the head of emetics. When given in small doses, it acts without pro- ducing any sensible local effect, as a general tonic, This is proved by the TONICS. 489 fact that it is capable of arresting the paroxysms of intermittent fever. By Dr. Donald Monro it was prescribed in 1785, in some cases of this disease with success, after the Peruvian bark and other medicines had been administered without any benefit. Mode of Administration.—It may be given in doses of from one fourth of a grain to one or two grains made into pill with extract of cinchona, to be repeated three or four times a day. 2. Cuprum Ammoniatum.—This salt is prepared by rubbing up sul- phate of copper with carbonate of ammonia, until the effervescence ceases. It is then to be wrapped in bibulous paper and dried with a gentle heat A double decomposition here takes place. Part of the sulphuric acid goes to the ammonia, forming a sulphate of ammonia, while the carbonic acid escapes with effervescence, and the copper re- mains in a state of sulphate. The compound therefore appears to be a mixture of subsulphate of copper and sulphate of ammonia. As found in the shops this substance is a violet-colored mass, with an ammoniacal smell and a styptic and metallic taste. On exposure to the atmosphere, its color changes to green, owing to the escape of ammonia. It is soluble in water. Effects.—As a tonic this substance operates in a manner similar to the sulphate of copper. It is milder, however, and therefore may be given in considerably larger doses. Its use originated with Dr. Cullen. Mode of Administration.—The best form is that of pill made up with bread, in doses of half a grain gradually increased to five grains, two or three times a day. Nitric Acid.—This acid is obtained by decomposing nitrate of potassa by means of sulphuric acid. It is a colorless or pale yellow fluid, emit- ting, when exposed to the air, white suffocating vapors and possessing strong acid properties. It is highly corrosive and tinges the skin yellow, the tint remaining till the epidermis is separated. When exposed to the air it attracts moisture and becomes weaker. It unites with water in every proportion, and while mixing, heat is evolved. In its pure state, it is seldom employed except for pharmaceutical purposes. The diluted acid is made by the addition of six fluid ounces of water to one of acid. In its effects upon the system nitric acid acts as a general and efficient tonic. It is particularly valuable when the constitution has been broken down during a long protracted course of mercurial remedies. In these cases it not merely promotes the general health, but it also lessens the mercurial action upon the mouth and fauces. In chronic hepatitis and dropsy, consequent upon a shattered constitution, it has been found emi- nently serviceable. Besides its effects as a general tonic, the nitric acid produces a pecu- liar taste in the mouth, and when carried to a certain extent some- 490 MATERIA MEDICA AND THERAPEUTICS. times brings on salivation, and at the same time acts moderately on the bowels. Its dose is from 20 to 30 drops, given in §* iij or § iv of water three or four times a day. Besides being given internally, it has been much used in India in the form of a bath in combination with muriatic acid. This is made by taking two parts of muriatic and one of nitric acid, and adding water until the whole is about as sour as vinegar. When the feet are put in this bath it is remarkable that it produces the same effects that it does when taken internally, and in addition to this causes a peculiar excite- ment and irritation of the skin. The nitro-muriatic acid bath is used chiefly in syphilitic cutaneous diseases and in hepatic affections. It was formerly very popular, but hardly retains its reputation. Cotyledon Umbilicus. [A perennial herbaceous plant, about six inches high, flowering in June and July, a native of England, found in dry stony places. It seems to be a gentle tonic to the nervous system, and has been chiefly used in epilepsy. It is highly recommended by Graves of Dublin, and others, but the trials of it in this country have not been very encouraging. A fluid and a dry extract are used. Dose of the former a fluid drachm, of the latter five grains, to be increased if necessary.] ASTRINGENTS. The term astringent is applied to a class of agents which possess the power of corrugating the animal fibre. They have been defined to be those substances which, " when applied to the human body, produce contraction and condensation in the soft solids, and therefore increase their density and force of cohesion." This definition is imperfect only so far as it does not include in it any recognition of the general tonic influence which most of these agents exert over the system. The local effects of astringents are obvious. When applied exter- nally to bleeding vessels, they contract the vessels and arrest the bleed- ing ; hence called styptics; when taken into the mouth they have a peculiar and rough taste, and produce a sense of constriction in the parts with which they come in contact As a consequence of this con- striction the small vessels circulate less blood, the secretions of the mouth and fauces are lessened, and the general sensibility of these parts to other impressions temporarily is impaired. When swallowed we infer that analogous effects are produced upon the mucous membrane of the oesophagus, stomach, and intestines with which they come in contact. At the same time that they act upon these parts by constring- ing them and lessening expectoration and secretion, they also affect their vital properties, by imparting tone to them. This at least is the case with a great proportion of them. Accordingly, if given in mode- rate doses like tonics, they promote the appetite and assist digestion. If, on the other hand, they be given in very large doses, they disorder the functions of digestion, cause pain, and not unfrequently produce nausea and vomiting. The remote effects of astringents are similar in character, although less in degree than the local effects. Various portions of the mucous tissue, though not locally acted on, nevertheless participate in the effects of these agents. This is particularly the case with the mucous mem- brane lining the pulmonary and urinary organs, and under the continued use of astringents, exhalation and secretion are diminished from these parts. The skin is strikingly affected in a similar way. In the ordinary condition of the system it becomes, under the use of astringents, dry 32 492 MATERIA MEDICA AND THERAPEUTICS. and contracted; and if excessive evacuations take place they are re- strained. On the muscular system the effect of astringents is analogous to that of the pure tonics. From the direct impressions made by them upon the mucous membrane of the stomach and bowels, the muscular tissue of these organs is most particularly acted on. The effect, however, does not stop here. The muscular fibre of the heart and arteries, and indeed of every other part of the system, participates more or less in the same impression. On the vascular system the effects of astringents are striking and important. In consequence of the contraction which they produce in the small vessels of the part to which they are applied, together with the impaired secretion which they occasion, the blood is accumulated in the larger trunks. If this be continued for any length of time, the heart and bloodvessels become crowded, reaction now takes place, the pulse is full and hard, general plethora ensues, and as remote conse- quences, local congestions and hemorrhages may occur. •On the brain and nervous system astringents produce no direct effect, except from the properties which they possess in common with tonics. In this way they increase the energy of the nervous system. Indirectly, however, as pure astringents they may exert a powerful agency on this part of the system. By checking the secretions they produce general plethora and local determination to the brain, which not unfrequently is followed by cerebral congestion and paralysis. With regard to the manner in which the remote effects of astringents are brought about, whether by the actual introduction of these agents into the circulation, or by the mere transmission of the local impres- sions, it is impossible to say. In some cases, doubtless, it may be in the first of these modes; in the majority, it is probably in the latter. Be this as it may, that various parts of the animal economy are thus more or less influenced is certain. From the preceding analysis of the effects of astringents, it is very evident that they cannot be used with safety or advantage in every state of the system ; they ought not to be used where a general plethora exists. In such a state, if by the use of astringents the ordinary secre- tions be checked, the general fulness of the bloodvessels must be in- creased, and apoplexy or some analogous effect may be produced. So, also, when a discharge is taking place from the system in a full habit, such as diarrhoea or hemorrhoids, or the like ; if this be arrested by the use of astringents, the consequence must be injurious, and sometimes fatal. In these cases nature is endeavoring to relieve herself from over- fulness by a critical evacuation, and any interference with this may be hazardous. They ought not to he prescribed where febrile or inflammatory ASTRINGENTS. 493 excitement is present In fevers and inflammations one of the great objects is to relax the whole system of capillary vessels, or in other words, to promote all the secretions, and generally just in proportion as this object is accomplished will the excitement be lessened. On the contrary, astringents checking the secretions necessarily increase the existing excitement and frequently cause local obstructions. They ought not to be prescribed where excessive secretion depends upon, or is associated with, active irritation either local or general. To this rule exceptions, however, exist, which will be mentioned hereafter. They ought not, as a general rule, to be prescribed where there is much disorder of the digestive organs, as indicated by furred tongue, defective secretion of bile, costive bowels, &c. In all cases this should first be corrected by appropriate remedies. Otherwise, not merely will astringents fail in producing their intended effect but the disorder of the digestive organs will be aggravated. There are various modes in which astringents may be made to act on the system : 1. By applying them directly to the part which it is desired to con- stringe. In this way they may be used as injections to many parts of the system, as the eye, the ear, the fauces, the urethra, the rectum, Ac. This is the most efficient mode of producing the intended effect. 2. By taking them into the stomach. In this way they act not merely on the parts to which they are immediately applied, but they extend their influence to distant parts. 3. By applying them to the skin—cold, applied either to the whole surface in the shape of cold baths, or local applications of cold water and ice, extends its astringent influence to the internal parts of the body. 4. By injections into the rectum. In this way they not merely affect the rectum itself but extend their influence to other parts. Hence, in uterine hemorrhage, one of the most efficient agents is the injection of cold water into the rectum. [The quantity of fluid should be large.—Ed.] From what has been already stated concerning the effects of these agents upon the system, it is evident that their therapeutical agency must be mainly limited to the accomplishment of two objects: 1. To the restraining of excessive evacuations from the system whether in the form of blood or various secreted fiuids. 2. To the producing contractions of relaxed animal fibre, and thus imparting tone. It is with a view to these effects that they are used in various diseases. In those affections which are characterized by increased secretions of various kinds, these secretions take place from diflerent textures and different organs, and the effects of astringents will of course differ accordingly. Over the secretions from some textures they exer- cise a very marked control, over those from others very little. 494 MATERIA MEDICA AND THERAPEUTICS. Of Mucous Membranes.—This membrane throughout its whole extent is liable to discharges, constituting a very large and exceedingly trouble- some set of affections. They result from different causes ; in some cases from actual inflammation, in others from irritating and enfeebling causes. In both cases the effect is the same—an increased discharge from the part. From what has already been stated in relation to the effects of astringents, it is very evident that unless used with great discretion, they will not mere- ly fail of producing their intended effect, but will be positively injurious. As a general rule, the only condition of the system, and of the part affected, in which they can be used with safety and advantage, is that in which the discharge is of a purely passive character, or in other words where all local inflammation and general excitement have been previ- ously subdued. If used antecedently to this their necessary effect must be to augment the distension of the vessels concerned, and thus aggra- vate the inflammation. [This is the general rule, and may, with very slight variations, be applied to all the different mucous membranes, and thus guide us in the use of collyria, of gargles, of injections, and of astringents taken into the stomach to control excessive discharges from the alimentary canal. In all these cases, if the astringent is used while yet acute or sub-acute inflammation is present, it is sure to do harm. It is only when this has been subdued, and when a passive congestion or a mere relaxation of the membrane is present that astringents are proper. No one now doubts but that leucorrhoea gained its character of a most intractable disease mainly from the indiscriminate use, or rather abuse, of astringent vaginal injections.—Ed.] The second form of excessive evacuation, to restrain which we use astringents, is haemorrhage. These discharges, whether from the lungs, the bowels, or the uterus, are all more or less under the influence of astringents judiciously applied. To get, however, a good effect from them, they must be used with due regard to the cause of the discharge and the state of the system. As a general rule it is just in proportion as the haemorrhage is more or less markedly passive that a good effect may be expected from astringents. The other class of affections in which astringents are used is where the object is to produce a constringing and then a tonic impression on the relaxed parts. The good effect of astringents in passive diarrhoea is to be explained in this way. The surgeons have made an ingenious application of astringents in the treatment of reducible hernia. Mr. Lizars applied a very strong decoction of oak bark to the groin over a hernial tumor, the hernia having been reduced, and by long-continued use the skin and subjacent parts were so constringed as to prevent the hernia from coming down. ASTRINGENTS. 495 INDIVIDUAL ASTRINGENTS. Tannin, or Tannic Acid.—This is a peculiar substance existing in astringent vegetables generally, and is the chief cause of the astringency of vegetable matter. It is frequently associated with gallic acid, as in gallnuts, in most kinds of bark, and in tea; but in kino, catechu and cinchona little gallic acid is present. [Chemists recognise two kinds of tannic acid; one from galls which produces a bluish black precipitate with the sesqui salts of iron, the other from catechu, cinchona, Ac, a greenish black. The former is very rea- dily converted into gallic acid, and is called by some gallo-tannic acid; it is the substance ordinarily described as Tannic acid.] " It may be obtained in an impure state, by digesting bruised gallnuts, oak bark, &c, in a small quantity of cold water and evaporating the solution. Thus obtained it is in the form of powder; yellowish white; no smell; taste purely astringent without bitterness. Effects.—Tannin is a pure and powerful astringent, and may be given in all the cases where such an agency is required. It has been used in diarrhoea, dysentery, fluor albus, in haemorrhages, and in chronic catarrh, It has some reputation as a stomachic. A grain twice a day is said to increase the appetite. Dose.—1 to 4 grs. every four hours, or oftener. Gall,e.—Gallnuts.—These are excrescences produced on the branches of the quercus infectoria, a species of oak growing in Asia Minor, five or six feet high. The cynips gallae tinctorial punctures the young branches of the tree and there deposits its egg. A morbid irritation ensues. In a few hours an excrescence is formed, and in a day or two attains its full size. This is the gall. Within this the insect undergoes its various changes; the egg is hatched; and the larva, feeding upon the interior of the gall, makes a hole in it. Finally it changes into the state of fly and then eats its way out Galls are found in the market in two different states, according as they are gathered before or after the insect escapes. The black, blue, or green galls, gathered before it escapes; the white galls after. [The gall is sometimes produced by the plant lice or aphi- dians.] Gallnuts are nearly round ; in size from a pea to a hazelnut, with small tuberosities on their surface. The best are the black, blue, and green galls. They have no external opening; are heavy, compact and brittle, and break with a resinous fracture. Internally of a whitish color, with a small hole in the centre. The white are inferior, have a loose texture, break with a powdery appearance, and have a large cavity in the centre communicating externally. These contain much less astrin- gent matter—powder greyish. 496 MATERIA MEDICA AND THERAPEUTICS. Galls have no smell, but a bitter, astringent taste. Best galls are from Aleppo. Composition.— Tannic acid, gallic acid, a peculiar volatile oil, and a peculiar acid discovered by Braconnet, and called by him Ellagic acid. The proportion of tannin in galls is greater than in any other known substance. As analysed by Sir Humphrey Davy, 100 parts contained 37 parts soluble in water and 63 parts insoluble (lignin). Of the solu- ble parts 26 were tannic acid ; 6.2 gallic add ; with a little extractive ; 2.4 mucilage, and 2.4 saline or earthy matters. Galls give up their active principle to water, alcohol, and alkalies. Incompatibles.—Metallic salts which throw down tanno-gallates. Isin- glass throws down tannate of gelatine. Infusion of einchona, tannates of cinchonine and quinine. Infusion of opium, tannates of morphine and codeia. Effects.—One of the most powerful astringents we possess. From its bitterness not much used internally. Forms.—Powder.—Dose.—10 to 20 grs. Infusion.— § ss to § j. Tincture.— 3 ss to 3 j; used principally diluted with water as an astrin- gent wash or gargle. Ointment.— § j to 3 vij of lard. Ung. Gallae Compositum.—Galls finely powdered, 3 ij; opium pow- dered, 3 ss; lard § ij, M., an excellent application to piles when not very much inflamed. Besides being used as a simple astringent, galls in the form of infusion are used as an antidote in cases of poisoning by the organic alkalies and those vegetables which contain them, such as nux vomica, hellebore, opium, &c. They form in these cases a tannate with the alkali, which has less activity than the alkali, because probably less soluble. Also in cases of poisoning by tartar emetic.—Pereira. CATECHU. This substance is obtained from the Acacia catechu, a tree twelve or fourteen feet high, growing abundantly in the mountains of Hindostan. It is an extract obtained from the wood. The exterior white part of the wood is first cut off, and then the interior, which is reddish brown, cut into small chips, is boiled in water until all the soluble matter is dis- solved. The decoction is then poured off and evaporated, until it becomes of a certain consistence, when it is spread upon cloth, cut into small pieces, and suffered to dry. This is the catechu of medicine. It comes in masses of different shapes and sizes, sometimes in square cakes, at others in roundish or irregular masses. The color varies from a red- ASTRINGENTS. 497 dish brown to a deep chocolate or liver color. Its texture is brittle; fracture sometimes rough, at others resinous; no smell; taste bitter and astringent, leaving behind a sensation of sweetness. There are a great many varieties of this article; they are all, however, the same substance, differing only in the mode of preparation. Catechu is almost entirely dissolved by water and by alcohol. Composition.— Tannic acid, a. peculiar extractive mucilage. In 1833 a peculiar substance was discovered in it, which was called catechine (catechinic acid). According to the analysis of Sir II. Davy the proportions of ingredi- ents were the following : Bombay Catechu. Bengal Catechu. Tannin, . . . 54.5 . . 48.5 Peculiar extract, . . 34.0 . . 36.5 Mucilage, ... 6.5 . . 8.0 Insoluble impurities ) ^ q Y 0 (lime and sand), J 100.0 100.0 All the varieties of catechu are adulterated with sand, starch, and other impurities. Effects.—-One of the best and most powerful astringents, and slightly tonic. Forms of Administration.—The solid lump is allowed to dissolve in the mouth. This is better than the catechu lozenges. Powder.—Dose grs. x to xx. Infusion.—Catechu 3 vj, cinnamon 3 i, water a pint Dose z\ to | ij. Tincture.—Dose 3i—a very pleasant addition to chalk mixtures. The inspissated juice of the Pterocarpus marsupium, and other plants. U. S. The best kind is the East Indian, from the P. mar- supium, a lofty tree growing in the mountains of Hindostan. It comes to us in small angular shining fragments of a deep brown or reddish color ; opaque, hard, and brittle. In the mouth it softens, sticks to the teeth, and colors the saliva red ; has no smell; an astringent, followed by a sweetish taste—easily pulverized. Its best menstruum is diluted alcohol. Composition.— Tannic acid and peculiar extractive 75, red gum 24, insoluble matter 1. Recently catechine has been discovered in it. Incompatibles.—The same as galls. Effects.— A stringent, without any tonic power—inferior to catechu. Forms.—Powder, x to xxx grs. Infusion, 3 i to 3 ij. Tincture, 3 1 498 MATERIA MEDICA AND THERAPEUTICS. to 3 ij. Locally, in powder, to flabby ulcers, and as a gargle, injection, and wash. OAK BARK. The species of oak from which this is obtained in Europe is the Qutrcus pedunculata, or the Quercus robur, growing in England and all over the continent. In this country it is obtained from the Quercus alba, a species of oak very analogous to the English oak. It grows in every part of the Union, but abounds most in the middle states—so called from the white color of the bark. Oak bark, deprived of its epidermis, is of a light brown color; coarse fibrous texture, and not readily pulverized; has a feeble odor, and a rough, astringent, bitterish taste. Water and alcohol both extract its virtues. Composition.— Tannic acid, gallic acid, tannates of lime, magnesia, and potash, uncrystallizable sugar, pectin, and lignin.—Pereira. The proportion of tannic acid in the bark varies with the size and age of the tree, and the season of the year when gathered. The young bark contains the most; and according to Sir II. Davy, the bark collected in the spring contain four times the quantity of that gathered in the winter. The* inner part of the bark contains the greatest proportion of tannin, the circular or middle portion less, while the epidermis contains none at all. Effects.—Astringent and somewhat tonic. Administration.—Powder, 3 ss to 3 i- Decoction, \ i to § ij. Principally used as a local application—gargle —injection. [I have cured chronic eczema with it.] Statice Caroliniana {Marsh Rosemary).—A small maritime plant indigenous in this country, from six to twelve or more inches in height; grows in the salt marshes along the sea coast from Maine to Florida. The part used is the root: this is large, spindle-shaped, fleshy, rough, and of a purplish brown color. No smell; taste bitter and astringent. Water extracts its virtues. Composition.—Tannic acid, gallic acid, extractive matter, and some common salt. Effects.—Powerfully astringent. Forms.—Decoction.—Boiling 3 ij in § xii of water ; used; internally and externally. The decoction of marsh rosemary is much used as a gargle in the different varieties of sore mouth, venereal sore throat, cynanche ma- ligna, &c. In the second stage of diarrhoea it has great reputation in some parts of the country. ASTRINGENTS. 499 geranium maculatum {Spotted geranium, Crow's foot, Crane's bill). A perennial plant from one to two or three feet high, growing in every part of the United States in low grounds and damp woods. The part used is the rhizome, which is taken up in the autumn and dried; comes in pieces two or three inches long, and one-third to half-an-inch thick; externally, rough and dark brown; internally, pale flesh color; has no smell; taste astringent, but not bitter or unpleasant; if properly dried brittle and easily reduced to powder. Its virtues extracted both by water and alcohol. Composition.— Gallic acid in large quantity, tannic acid, small quan- tity of mucilage, starch, red coloring matter, resin, a small quantity, and a crystallizable vegetable substance. Effects.—An excellent astringent of considerable power; has the advantage over many other articles in this pleasant taste. Hence a good article for children and delicate stomachs. Administration.—Powder.—Dose twenty to thirty grains. Decoction.— 3 i of bruised root boiled a few minutes in a pint, of water or milk. Dose § i to § ij. [An excellent article for children.] Tincture.—Dose 3 i to 3 ij. ACETAS PLUMBI. This salt is known by the common name of the Sugar of Lead, and is generally prepared by the manufacturer on a large scale. Physical Properties.—Sugar of lead is a white crystalline salt with- out smell; its taste is sweetish and astringent. When exposed to the atmosphere it slightly effloresces; soluble both in water and alcohol; water at 60° dissolving four times its weight. Chemical Composition.—One eq. of acetic acid, 51 ; one of prot of lead, 112 ; and three of water, 27 = 190. Test of its Purity.—Dissolved in distilled water free from carbonic acid, if pure, it makes a perfect solution. To ascertain this, sulphuric acid, or sulphuretted hydrogen in excess, being added to the solution to throw down the lead, the supernatant liquid should be completely vola- tilized by heat; any fixed residue is impurity. (Pereira, vol. i. p. 516.) Incompatibles.—" All those acids and their compounds which form with oxide of lead salts nearly insoluble in water, as the sulphuric, muriatic, carbonic, citric, and tartaric. It is decomposed by lime water, by the alkalies, ammonia, potash, and soda; the two latter, if added in excess, redissolve the precipitate at first formed. Hard water usually contains three ingredients which decompose it, viz. carbonate of lime, 500 MATERIA MEDICA AND THERAPEUTICS. sulphate of lime, and muriate of soda; and hence, when dissolved in such water, the solution is always turbid. It is decomposed by solution of sulphuretted hydrogen, which gives a black sulphuret; liquor ammo. niae acetatis also decomposes it, on account of the carbonic acid diffused through it." (Phillips, p. 127.) Effects.—Sugar of lead acts as an astringent to the part with which it comes in contact, whether taken internally or applied externally, by coagulating the albumen of the tissues and forming an insoluble com- pound. Taken internally in moderate doses, its immediate effect is to constringe the vessels of the mucous membrane of the alimentary canal, and so lessen secretion from them. Hence costiveness is one of its immediate effects. If its use be continued, the same astringent effect is extended to other parts of the system. This is especially manifested in the mucous membrane, the skin, and the urinary organs, in all of which the secretions are lessened. In addition to this the temperature of the body is diminished, and the pulse is lessened in force and frequency. In its general operation, therefore, it acts as an astringent and a sedative. If the use of it be persisted in too long, it produces, in common with the other preparations of lead, certain striking effects on the nervous and muscular systems; one of these is a form of colic,, called the paint- er's colic ; the other is a peculiar kind of paralysis. If a large dose of the sugar of lead be taken at once, it acts as an irritant poison. Mode of Administration.—The ordinary mode of giving sugar of lead is in pill, in doses of one or two grains, repeated every two, three, or four hours, according to circumstances. Most generally it is given in combination with opium. Solution.— | ij to a pint of water. Diseases in which used.—Haemorrhages, excessive secretion from the mucous membranes, cholera, diarrhoea, chronic dysentery, night sweats. Goulard's Extract.—This is the liquor plumbi subacetatis, or the solution of the subacetate of lead. It is called Goulard's Extract, from M. Goulard, a surgeon of Montpelier, by whom it was more especially introduced into notice. According to the United States Pharmacopoeia, this is prepared by taking of the acetate of lead and of the semi-vitrified oxide of lead (litharge) each eight ounces, mixed in a glass vessel, and boiling for twenty minutes in two pints of distilled water, then filtering through paper. During this process the protoxide is dissolved and a subacetate is formed, which is held in solution. Properties.—Goulard's Extract is either transparent or colorless, or it has a slight greenish yellow tint, arising from impurities in the distilled vinegar : its taste is sweetish and astringent. It is readily decomposed. ASTRINGENTS. 501 Common spring water throws down the oxide of lead in large quan- tities. Carbonic acid throws drown the carbonate of lead. This hap- pens from mere exposure to the atmosphere. Even distilled water, if exposed to the atmosphere, produces the same effect, by the carbonic acid which it contains. From the effect of carbonic acid on it, it should always be kept in tight bottles. Effects and Uses.—This is only used externally as a local application, and its effect is analogous to that of the solution of sugar of lead. It acts as a local astringent and sedative in cases of local inflammation. When used it requires to be diluted; about four drachms require a pint of water to be added. It is an excellent application to piles where there is little inflammation. ALUM. This is a triple salt consisting of alumina, potash, and sulphuric acid. In some places it is found native, effloresced on the soil in volcanic regions. This is the case near Naples. The alum "is collected and lixiviated, and the solution made to crystallize by slow evaporation in leaden vessels sunk in the ground."—U. S. Disp. Most commonly, however, it is obtained from the alum ores. It is also manufactured by a direct combination of its constituents. This is the mode in this country, where all the alum for domestic purposes is now prepared. Properties.—Alum is a white crystalline salt, with a sweetish, acidu- lous, astringent taste, without smell. On exposure to the atmosphere it slightly effloresces, its solution reddens litmus paper, "but changes the blue tinctures from the petals of plants green. It cannot, therefore, be properly said to contain an excess of acid."—(U. S. Disp.) Alum is soluble in 15 times its weight of cold water, and three fourths of its weight of boiling water. Alum contains a large proportion of water of crystallization, amounting to nearly 50 parts in 100. By exposure to heat it undergoes watery fusion. By increasing the heat the alum swells, the water is driven off, and it becomes a white, friable, spongy mass. This is called Alumen exsiccatum, dried alum, or Alumen ustum, burnt alum. Effects.—Alum is one of the most powerful astringents that we possess. When first taken internally, if the stomach be at all delicate or irritable, it is apt to cause gastric uneasiness, nausea, and sometimes vomiting. To a certain extent this may be obviated by combining it with some aromatic. The best plan is to begin with small doses, and to increase gradually as the stomach is found to bear it. On the bowels 502 MATERIA MEDICA AND THERAPEUTICS. the general effect is to produce constipation. In large doses, however, it, on the contrary, causes irritation, griping, and purging. In its general operation on the system alum proves stimulant. Its use, therefore, should be limited to those cases in which a stimulant astringent is required. Burnt alum differs from common alum only in not having any water of crystallization. It is more astringent. N Forms of Administration.—Substance.—It may be taken in powder or pills made up with some tonic or aromatic, in doses of from five to ten grains. Alum Whey.—This is made by boiling 3 ij of alum with a pint of milk, and then straining. Of this a wineglassful at a time may be taken. This is a very pleasant and good way of administering alum. As a Local Application. Powder.—The burnt alum is applied to indolent ulcers to destroy spongy granulations. Solution.—As a gargle, collyrium, and injection. Plug.—A solid stick of alum cut round, introduced into the vagina in cases of haemorrhage from uterus. [Vaginal Injection.—A very weak solution of alum will suit a larger number of cases of vaginal relaxation and free secretion than any other astringent I know of. It should be very weak—my rule is to make it just strong enough to taste of alum.—Ed.] SULPHURIC ACID. In its pure state, sulphuric acid is not used in medicine. In a state of dilution there are two preparations which are officinal: 1. The Acidum Sulphuricum Dilutum.—This is prepared by adding gradually, and then mixing, one fluid ounce of sulphuric acid with thirteen fluid ounces of water. 2. Acidum Sulphuricum Aromaticum —-This is known by the com- mon name of the Elixir of Vitriol. It is prepared by digesting for three days in a close vessel three ounces and a half of sulphuric acid with two pints of alcohol, then adding bruised ginger one ounce, and cinnamon bruised one ounce and a half, and letting the whole macerate for a week, and then filtering. This forms a dark brown liquid, having an acid taste and peculiar aromatic odor. Both these preparations of sulphuric acid are taken in the same doses and in the same way. From ten to thirty drops, in a cup of cold water, may be repeated three or four times a day. Effects.—In the two preceding forms, sulphuric acid is astringent, refrigerant, and tonic. It gives tone to the digestive organs, improves the appetite, and checks excessive secretion. Over the skin it exerts a ASTRINGENTS. 503 peculiar agency, checking profuse sweating more effectually, perhaps, than any other astringent. On the urinary organs its effect is to increase the secretion of the urine, and to render it acid. Under its use the milk frequently acquires a griping- quality. If the use of this acid be continued too long, it produces a slow irri- tation of all the digestive organs, heat and pain in the stomach, griping, purging, and general constitutional irritation. In its pure state it acts as an irritant poison. ACETIC ACID. It is only in its impure state, or that of vinegar, that this acid is used internally. Effects.—Vinegar is astringent, refrigerant, and tonic. Taken in mo- derate quantities it gives tone to the digestive organs, and increases the appetite. In its general action, it lessens the heat of the system, checks secretion, and gives tone. If taken in too large quantities it irritates the digestive organs, causing pain and griping, and if persisted in, pro- duces general emaciation. On this account it is frequently given to correct too great obesity. Mode of Administration.—One or two ounces may be added to a quart of water and drunk freely. Matico.—This remedy was brought to the notice of the profession in the United States by Dr. Ruschenberger, U. S. N., who obtained a knowledge of it in South America. It consists of the leaves and unripe fruit of a species of pepper, probably the Piper angustifolium. It has a pleasant aromatic odor, and a slight taste. It is very strongly recom- mended as an astringent to check haemorrhages from leech bites, etc., where it can be directly applied. It is also used internally in epistaxis, haemorrhage from the bowels, uterus, etc., and cases have multiplied in which most wonderful effects are said to have been realized from it. Whether subsequent experience will confirm the hopes excited by these reports, is of course uncertain. Mode of Administration.—Infusion.—( 3 i to Oj water.) Dose § j. REVULSIVES. By Revulsives are meant those agents which excite an action in one part of the system, and in consequence overcome a morbid action exist- ing in some other part. They are also called Derivatives and Counter- irritants. Usually these terms are limited to those agents which are applied to the external surface of the body. They might, however, be applied with equal propriety to agents taken internally. It is only with those acting on the surface that we have now to do. Before giving an account of individual revulsives, I will make a remark or two upon the principle upon which they are supposed to act In observing the operations of the animal economy, in various states of derangement from perfect health, it is remarked that morbid actions or irritations are frequently transferred from one part to another, and that in this case the primary one not uncommonly yields altogether to the secondary. This has been observed so repeatedly as to justify us in considering'it as a kind of general law. It was in accordance with this that John Hunter laid down the too sweeping generalization that two diseases could not exist at the same time. Why it is, or how it is, that one irritation thus yields to another, it is impossible to say, and I shall therefore not spend any time in useless speculation in relation to it. Now it is upon this simple law or fact that the use of all external revulsive agents is founded, experience having shown that actions or irritations excited by artificial means are capable of producing effects precisely analogous to the spontaneous irritations set up by nature. Re- vulsive medication, then, is nothing more than an imitation of the method of cure frequently instituted by nature herself. This is the principle upon which the use of revulsive agents is founded. They may be divided into several classes according to the degree of effect which they produce. 1. Those which simply promote the flow of blood to the part 2. Those which produce moderate irritation. 3. Those which blister. 4. Those which produce eruptions of various kinds. 5. Those which destroy the texture of the part—caustics, issues. REVULSIVES. 505 1. Those which Promote the Flow of Blood to the Part.—To this class belong friction, warmth applied in various ways, such as bottles of hot water, bags of hot salt, etc., warm bathing, local and general. These, though simple, are important and valuable revulsive agents. Under continued friction the sensibility and heat of the part are aug- mented, while at the same time an increased flow of blood takes place. The warm bath is still more effective, especially if impregnated with salt. By these agents the most striking and beneficial results are frequently produced in the way of revulsion. 2. Those which produce Moderate Local Irritation.—They are commonly called rubefacients. By this is meant those substances that simply produce redness, and a certain degree of irritation of the part to which they are applied, without causing any discharge. They are used with great advantage in many cases where the operation of blisters would be unnecessarily severe. Among the best of this class are the following: Aqua Ammoniae.—This may be used either pure or in combination with sweet oil, and in either way makes an excellent rubefacient applica- ton. A piece of flannel soaked in aqua ammoniae and laid on the skin will, in a very short time, excite considerable pain, redness, and inflam- mation. If the strong aqua ammoniae is used, it will blister very speed- ily. The more common form of using it is in combination with sweet oil, and then it forms what is known as the volatile liniment. In this preparation a chemical union takes place between the oil and the ammonia, and a white soap is formed, which is kept fluid by the water of the ammonia. The proportion of oil and ammonia must vary with the strength required. In some cases equal parts are necessary, while in others a third or a fourth of ammonia will answer. For children the proportion of ammonia, of course, must be less than for adults. Siuwpis.—This is perhaps the best of all the rubefacient articles and from it is derived the term sinapism. If it be desired to have its full strength, it is prepared by mixing the pounded mustard with water into a thick paste or poultice. The common practice is to mix it with vinegar; this, however, rather impairs the strength of the mustard. Applied to the skin in this state in a very few minutes it causes a sense of warmth in the part, and in the course of half an hour severe pain. When taken off the skin is red and burning. If it be left on too long, actual vesication takes place, and in some cases troublesome ulceration follows. This, therefore, should be avoided. The best plan is to remove it as soon as severe pain is felt, and be careful in leaving it too long on parts possessed of little vitality. By adding flour, its strength may be regulated. In applying it to children, this should be specially attended to. Although an exceedingly efficient and useful rubefacient, this article, therefore, requires to be managed with caution. 506 MATERIA MEDICA AND THERAPEUTICS. Capsicum.—This is an excellent rubefacient, and used in various forms. It may be made into cataplasm, or the saturated tincture may be rnb- bed on the surface. As a liniment it may be prepared by mixing it with hog's lard. Another simple and good form of using it, where counter-irritation is to be made to the feet, is to dust the insides of the stockings with the dry powder. This keeps up a moderate degree of heat and irritation in the feet, and is exceedingly useful where there is a tendency to coldness of the extremities, accompanied with head-ache. Oil of Turpentine.—This is also a good rubefacient. If applied undiluted it causes considerable smarting and irritation, and is sometimes followed by a vesicular eruption. In this state it may be used in the way of friction, by means of a piece of flannel soaked in the turpentine. The more common way in which it is used is that of a liniment, in combination with other rubefacient articles. Tincture of Cantharides.—This is sometimes used as a rubefacient; and the experiments of Dr. Alexander prove, that when made by putting 3 i of cantharides into § iv. alcohol, it is just strong enough to cause irri- tation of the skin, and not vesicate. This is exactly the strength ordered in the U. S. Pharmacopoeia. An ordinary blister, if taken off early enough, may be made to produce a rubefacient effect only. Camphor dissolved in alcohol is a common and useful rubefacient. It is one of the ingredients in the common opodeldoc, which consists of soap 3 iii, alcohol Oj, camphor, oil of rosemary, oil of origanum, each 3 ss. Pix Burgundica.—This is the resin obtained from the Pinus abias, or fir tree. The ordinary mode of using it is in the form of plaster. Applied in this way it excites in the course of a day or two consider- able irritation of the part, which is followed by a slight effusion of serous fluid. From the mildness and slowness of its action, it is not adapted to cases where a prompt revulsion is called for. For the pur- pose of rendering it more active and irritating, a small portion of blis- tering ointment may be added to the pitch, while cooling, just before the plaster is spread. Allium sativum.—Garlic has long been known and used as a local irritant. It sometimes, though not often, causes vesication. It is used very much in the same way and in the same cases as mustard. As an application to the feet of children after soaking them it is excellent. Oleum Monardae Punctata.—The Monarda punctata, or horse mint, is a native plant of this country, and yields an oil which possesses admir- able rubefacient properties. If rubbed on the skin it speedily causes redness and irritation, and sometimes vesication if its application be too long continued. It was first noticed by Dr. Atlee, of Philadelphia, who recommends it in the form of a liniment with camphor and opium. Properly diluted it may be used in all cases where an ordinary rubefa- cient is required. REVULSIVES. 507 3. Those which blister.—These are called epispastics or vesicants. The term is applied to those agents which possess the power of irritat- ing and inflaming the skin in such a way as to be followed by the for- mation of vesicles. The effects of these agents are obvious. The part to which they are applied undergoes all the changes of ordinary inflammation. Increased sensation is first experienced, then comes on heat, redness, swelling, and pain. To these succeeds an effusion of serous fluid from the excited ex- halants, and a consequent separation of the cuticle, forming a vesicle or blister. On removing the epispastic and discharging the serum, the part, unless again irritated, gradually heals, new cuticle forms, and in a few days the whole is restored to its natural state. With these local effects the constitution is more or less sympatheti- cally affected. Like all local inflammations, the effect of blisters is to increase the action of the heart and arteries. The vascular excitement thus produced, however, is rarely excessive, and speedily subsides with the removal of the cause producing it. The nervous system, too, is ex- cited by the action of blisters. In certain conditions of that system, the stimulus of these agents increases the tone and energy of the brain. This is so marked that some persons have resorted to the application of them previously to great mental efforts. The celebrated English barris- ter, Dunning, is reported to have been in this habit Dr. Thompson states, that the late Sir James Mackintosh tried the effect of it in one of his efforts before the House of Commons, and with great success.— Vol. ii. p. 535. Blisters, then, act both as local and general stimulants. This double operation it is important to bear in mind in the application of these agents in different stages of disease. The effects of blisters are modi- fied by— {a.) Age.—From the peculiar delicacy of the skin in young subjects blisters produce their effects much more speedily than in adults, at the saine time that the constitutional irritation which they occasion is much greater. In some cases, especially if left on too long, the inflammation runs rapidly into gangrene, and proves fatal. In young subjects, there- fore, the greatest caution should be exercised in watching the effects of blisters. [I think that blisters should be banished from the therapeutics of children.] In old persons, too, from the torpid condition of the capil- laries, the inflammation of a blister may readily assume an unhealthy character. {b.) Sex.—From the greater delicacy of the female system, blisters as a o-eneral rule are apt to produce more irritation than in males. In the use of them this fact ought always to be borne in mind. During the state of pregnancy their effect is modified. The system then is in a state of increased excitability, and in consequence of this the local 33 508 MATERIA MEDICA AND THERAPEUTICS. as well as general irritation which they produce is apt to be much greater. According to Dr. Dewees they are more apt during pregnancy to produce strangury. In some cases, too, premature labor has been produced by them. Dewees records two instances of this sort.* The peculiar Character of the Skin.—It is well known that in this ' respect there is every variety. In some persons the skin is naturally thin, delicate, and irritable. In these the slightest causes frequently ex- cite an unnatural degree of inflammation, followed by proportional con- stitutional disturbance. In others, again, the skin is thick, tough, and torpid; in these, of course, local irritations are more tardily pro- duced, and affect the system less. Now, in these different states of the skin it is evident that the effects of blisters must differ considerably. {d.) Temperament or general habit of Body.—This also greatly mo- difies the effects of blisters. In irritable habits they frequently cause a great degree of nervous and vascular excitement. I have met with cases of this kind in which a state little short of phrensy has been induced. In habits of an opposite character they produce little or no constitu- tional irritation. In persons much reduced and broken down by debili- tating causes, troublesome ulceration and gangrene not unfrequently follow their application. {e.) The part to which the Blister is applied modifies its effect A blis- ter applied to the scalp takes twice the time to produce its effect that t does on other parts. If a blister be applied to the scalp immediately after the hair is shaved off, strangury is almost always produced, an eftect which does not follow if the application be delayed for twenty- four hours.f (/.) The length of time the Blister is kept applied modifies greatly its effects. In the case of the ordinary blister, if the application be conti- nued beyond a certain time, strangury is apt to be induced. {g.) The actual condition of the patient as to disease.—No circum- stance modifies in so important a manner the effects of blisters as this. If applied in the early stages of high inflammatory or febrile excitement, they act as general irritants, increasing heat and quickening the pulse ; while in the more advanced periods they produce a salutary revulsion without any of these effects. In certain conditions of the brain and nervous system, the skin loses its sensibility, and blisters do not produce any effect. From what has already been advanced, it must be evident that there are certain conditions of the system in which blisters are contra-indi- cated. As a general rule they ought never to be used where there is present a high degree of general febrile or inflammatory excitement The reason of this must be obvious, if we reflect for a moment upon the * Treatise on Females, p. 128-9. f Percival's works, v. i. p.. 129. REVULSIVES. 509 effects of a blister. These are local irritation and general excitement. Now in all cases where a local inflammation exists, the difficulty of resolving it by any means will always be proportioned to the degree of general excitement accompanying it. If a blister be applied when the general excitement is already very great, one of the effects will be to aggravate this, and thus to counteract the beneficial agency of the blister as a revulsive. Under these circumstances the primary inflammation, instead of being relieved, must »be aggravated by the increase of the general excitement. Hence it has been generally observed that if blis- ters be applied in cases where great general excitement is present, ante- cedently to suitable evacuations, they do more harm than good. They merely add fuel to the fire. Another condition of the system in which they are contra-indicated is that in which great constitutional exhaustion is present. From the impaired state of the vital powers, gangrene and death may ensue. The condition of the system most favorable to their use is that in which the general excitement is rather below than above the natural standard. In this state of things irritations are most readily transferred from one part to another. Modes in which Blisters prove Curative.—There are three : 1. By exciting a new action in the part to which they are directly applied. In this way they sometimes arrest the progress of erysipelas. 2. Bv their stimulating effect on the general system. In this way they sometimes prove beneficial in low fevers, in paralysis, &c. 3. As derivatives they relieve inflamed and congested parts by direct- ing the flux of blood to the surface and from the diseased part or organ. INDIVIDUAL EPISPASTICS. CANTHARIDES. The insect used for ordinary blistering is the Meloe vesicatorius, or more properly the Cantharis- vesicatoria. It is found adhering to the leaves of a number of plants, such as the ash, elder, lilac, white poplar, •fee, in Spain, France, and Italy. From its having been made an article of commerce more particularly in Spain, it has received the name of the Spanishfly. The mode of collecting them is by simply shaking them from the branches of the trees early in the morning, while they are yet in a torpid state from the cold of the previous night. This is done by persons covered with masks and gloves, who receive them on cloths spread under the tree. After this they are instantly put into a.sieve 510 MATERIA MEDICA AND THERAPEUTICS. and exposed to the fumes of boiling vinegar. This kills them, and after this they are dried either by the sun or in a stove. The cantharides belong to the beetle tribe of insects. They are from six to ten lines in length, and two or three in breadth, of a golden greenish color, and when alive have a foetid, penetrating odor, by which swarms of them may be detected at a distance. At Dijon, in France, it is stated that the public walks were at one time deserted in con- sequence of the disagreeable odor occasioned by these animals.—Diet. Mat. Med., vol. iv. p. 300. When dried they retain a good deal of this offensive odor; their taste is acrid. The powder which they yield is of a greyish brown, mixed with shining particles. To have them good they should be kept perfectly dry; when suf- fered to become moist they lose their vesicating property. They should, therefore, be occasionally spread out and exposed to the air. If kept in bottles tightly closed, they retain their virtues for a great length of time. Adulterations.—In the state of powder cantharides may very easily be adulterated by the admixture of various articles. The only way to obviate this is to buy in the insect state. In this state, however, they are frequently mixed with another insect, the Melolontha vitis. This is distinguished by its square form and black feet; as this insect does not possess any vesicating power, it should be carefully separated. Chemical Composition, dc.—By the researches of modern chemistry the vesicating property of the cantharides has been found to reside in a peculiar principle which is called Cantharidin. This was discovered by Robiquet in 1810. It is obtained in small crystalline micaceous plates, insoluble in water and cold alcohol, but soluble in boiling alcohol, ether, and oil. Effects.—The effects of cantharides applied as a blister are those already described under the head of epispastics generally. In addition to these, however, they produce under certain circumstances strangury, a peculiar irritation of the urinary organs, accompanied by a spasmodic constriction of the sphincter of the bladder. There are great pain and difficulty in voiding urine, and the quantity which is discharged is exceedingly small. The circumstances under which this effect is most likely to occur, are those in which the protecting power of the cuticle is either impaired or entirely destroyed. Thus: 1. When the blister is kept on so long that the cuticle is entirely removed, and the blister then comes in actual contact with the sub- jacent parts. 2. When the blister is applied to a part recently shaved, as a scalp. 3. When the blister is applied to parts where the cuticle is already REVULSIVES. 511 destroyed, either by previous blistering, wounds, ulcerated surface, or the like. Under all these circumstances may this effect be produced. Modes of Application.— The Ointment.—Tins is the ordinary and best mode of applying cantharides for the purpose of vesication. This ointment is made of resin, wax, and oil, or lard. In preparing it, great care should be taken not to add the flies to the other ingredients while they are hot, as heat impairs the vesicating power. This is the reason why in the pharmacopoeia it is directed that the flies are to be added just as the other ingredients are cooling and becoming solid. For the same reason, in spreading a blister, care should be taken not to soften the ointment by means of heat. In preparing and applying a blistering plaster, there are several things important to be observed: 1. The plaster should be spread thick. If this is properly done, the vesication is not only more certain, but is produced in a shorter time. On the other hand, if the plaster be spread thin, the vesication is apt to be imperfect and in patches, and requires a longer time. Linen is better than leather. 2. The practice so very common of sprinkling the plaster over with dry fly powder cannot be too severely reprobated. Although intended to make the blister more potent, it always has a contrary effect. The blister never draws so well, probably in consequence of its not adhering so closely to the skin. Besides strangury is much more apt to follow from the particles of the powder adhering after the blister has been removed. 3. Let the surface to which the blister is applied be properly cleansed, and if it be cold and torpid, or if you wish the blister to act verv promptly, stimulate the skin by some rubefacient, as turpentine, mus- tard, or the like. 4. It is important that every portion of the blister plaster should be kept in actual contact with the skin, otherwise the vesication will be in patches. To prevent this, put a bandage over the blister, or fasten its edges down with adhesive straps. 5. The usual period for leaving on a blister in an adult is twelve hours, but there is every variety, as before noted, in the sensibility of the skin; the best plan is to raise a corner of the plaster after eight hours, and if small vesicles are formed, the work is done, the plaster may be removed, and simple cerate substituted. 6. AVhere blisters are used to subdue internal inflammation, they should be large ; the same amount of irritation follows a small as a large blister, and the amount of proper and useful counter-irritation is null. 7. Remember that in internal inflammations, the great principle on which blisters prove curative is that they excite an irritation more powerful than the inflammations. Of course, when the'inflammation 512 MATERIA MEDICA AND THERAPEUTICS. runs high, this is impossible; always under such circumstances reduce the inflammation to the blistering point by venesection, evacuants, Ac. 4. Agents which produce Eruptions and Pustules.—These differ very materially in their effects from blisters. They are more permanent in their operation. The inflammation which they produce is of the phlegmonous character, while that excited by blisters is erythematic. (a.) Tartar Emetic.—Although the peculiar effects of this substance on the skin had been previously noticed, and some practical applica- tions had been made of it, yet it was not until the year 1821 that it was fully brought before the public as a revulsive agent. In an essay written expressly on this subject, Dr. Jenner gave, at that time, a full account of its successful application, and since then it has been in exten- sive use. There are two modes in which it may be applied—in the form of strong solution or of an ointment. Rubbed on the skin in either way, local irritation is first produced, which is succeeded by a crop of pustules, resembling in their appearance and progress those of small-pox. The first of these modes was originally suggested, in 1773, by Dr. Bradley, of London. The second is that recommended by Dr. Jenner, and is the one commonly used at present. The formula for the ointment, as proposed by Dr. Jenner, is the following: IJ Antimon. Tart, (subtil, pulv.) 3 ij. Ung. Cetacei . . 3 ix. Sacch. alb. . . . 3 i- Hyd. sulph. rub. . . gr. v. M. The sugar is added merely to prevent the ointment from becoming rancid. Every purpose, however, may be answered by simply rubbing up a suitable proportion of tartar emetic with lard. The length of time which it takes to produce its effects, varies with the strength of the application and the susceptibility of the skin. When it is desirable to brino- out the pustules as speedily as possible, the skin should be previ- ously prepared by friction, either dry or with strong vinegar. The oint- ment should then be rubbed on the part briskly for ten or fifteen minutes. In this way a crop of pustules will be brought out in a few hours. Where it is not .required to produce the effect so rapidly, a portion of the ointment may be rubbed on the part for a few minutes twice a day; and, generally, in the course of one, two, or three days, the effect will begin to show itself. When the solution is used, after preparing the skin by friction, it should be applied as hot as it can be borne. Pustules are thus rapidly produced. " They are small and numerous, and speedily heal, leaving REVULSIVES. 513 no traces behind them."—Thompson, vol. ii. p. 555. This is a mode well suited to females. When the eruptions come out large and full, they are sometimes ex- ceedingly painful, and cause a good deal of irritation. The best dress- ing in this case is a bread and milk poultice or simple cerate. If it be desirable to keep out the eruption for some time, fresh appli- cations of the ointment may be made. From the effects of tartar emetic thus applied, it is evident that its action is entirely different from that of an ordinary blister. It not merely irritates the skin, but produces actual disease of that structure, and to this circumstance, no doubt may its efficacy in many cases, as a revul- sive, be attributed. (6.) Croton Oil.—Rubbed on the skin, croton oil produces, after two or three days, a fine pustular eruption. It is usually combined with two or three parts of olive oil. As a revulsive it is less severe than tartar emetic, and more permanent in its operation than a blister. It some- times, but rarely, purges, which is an objection to its use. (c.) Nitro-Muriatic Liniment.—A liniment composed of nitro-muri- atic acid and spirits of turpentine, produces effects somewhat similar to those of croton oil. It is made by mixing two parts of acid with one of turpentine, and five of camphorated oil or simple lard. Rubbed with a sponge on the skin it will cause redness and heat in four or five min- utes. If continued, small vesicles make their appearance, and a further rubbing causes excoriation and a free exudation of serum. As a local irritant this has the advantage of producing immediate effect The pain is said not to be very severe. This is said to be the liniment of the notorious London Quack, St. John Long. There remain only to be considered those revulsives which destroy the texture of the parts to whieh they are applied, or so affect it as to cause a permanent suppuration, or as the phrase goes, keep up a discharge from the part. These are issues, setons, and moxas. Issues.—These are artificial ulcers created in different parts, to pro- duce local irritation and a purulent discharge. They are made in different ways: 1. By making permanent blisters. This is done by dressing the blistered surface with some irritating salve, as savin or the like, so as to keep it open and promote suppuration. The best salve for this purpose is Ung. cantharidis one part, Ung. Sabinae seven parts. 2. By making an incision of suitable size, and putting one or more peas in it, securing them by a bandtige or an adhesive strap. 514 MATERIA MEDICA AND THERAPEUTICS. 3. By applying pure nitric acid or caustic potassa to the part, and thus destroying the vitality of the skin. When this sloughs out, the sore may be kept open either by peas or by the occasional use of an irritating salve. 4. Issues may be made by the actual cautery. In using this, great care is required to have the iron at a white heat, and to apply it rapidly. This is much used in France, especially to the os uteri. Seton.—This is a cord of silk or thread inserted by means of a flat seton needle under a small portion of the skin and cellular tissue; it soon excites a suppuration, which may be increased by drawing the thread backwards and forwards, and also by putting an irritating oint- ment on the thread and drawing it into the wound. Of these modes of getting a discharge from the skin the blister issue is the least severe, the seton the most so, and probably the most effectual. The nitric acid issue is preferred by most surgeons, I believe. Situations in which Issues or Setons may be made.—They should not be put over a bone or tendon when covered only by skin, nor in imme- diate proximity to a large nerve or blood-vessel, nor on the belly of a muscle. The best situations are:—1st The back of the neck. 2d. The middle of the humerus, near the insertion of the deltoid. 3d. In the hollow on the inside of each knee, above the flexor tendons. 4th. On each side of the spinous processes of the vertebrae. These are the best places, but issues may be put where there is beneath the skin enough cellular substance to protect the parts below. Effects as compared with Blisters.-—Issues produce less local irritation and more discharge, and their operation is much slower. Moxa.—This remedy was introduced by Baron Larrey, who became acquainted with it during Napoleon's campaigns in Egypt It is made by rolling carded cotton or some similar combustible into a cylinder about an inch long and half as thick. This is applied to the skin and kept in contact with it by means of a metallic ring and handle. The moxa is then set on fire, and the combustion hastened, if necessary, by a blow- pipe. The influence of the fire should be limited by covering the part with a bit of wet cloth, having a hole in its centre the size of the moxa; when the combustion is completed the parts should be washed with strong aqua ammoniae, which greatly relieves the pain. An eschar is thus formed, and when the slough separates it may be dressed with ointment, stimulating or not, as it is desired to heal or keep open the sore. The effect of the moxa differs from the actual cautery with the iron, in that the heat being more gradually applied penetrates deeper. The same rules and restrictions as to the parts on which they may or may not be placed, apply to moxas as to issues. Moxas are made of cotton, recommended by Larrey ; this may be previously REVULSIVES. 515 soaked in a solution of nitre or chlorate of potash ; or of a coil of paper similarly soaked and dried, or the bulb of the sunflower. Their effects do not vary, the degree of inflammation depending on the closeness with which the moxa is applied to the skin, its size, and the intensity of the combustion. PRACTICAL APPLICATION OF REVULSIVES. 1. Of those which simply promote the flow of blood to the surface. Wherever internal congestions exist, and the surface is consequently cold, torpid, and comparatively bloodless, revulsives of the first class are proper. Hence their use in the early stages of fevers, inflam- mations, and congestive diseases. Their range is from the slight dull- ness produced by transient exposure to cold, and cured by soaking the feet at bed-time, to the intense congestion of typhus, when the whole body may be enveloped in hot blankets, or the hot bath used. 2. The rubefacients act in the same way, and are appropriate in the same wide range of cases. 3. Of Blisters.—These, though acting on the same principle, are used in cases where the difficulty to be overcome is of a more serious and more permanent character. As blisters are extensively used, and as their use, unlike that of the two previous classes, is pretty sure to do harm when it does no good, let us refer in detail to some of the diseases in which they are used. 1. Fevers.—Here everything will depend on the stage of the disease, and the state of the system. Blisters should never be used till the general excitement has given way to the use of evacuants ; then they aid in breaking up the remains of the disease, and preventing or removing local determinations. 2. Inflammations.—The use of blisters in internal inflammations is very common and very beneficial. The same rules are to control the time of their application as have been so often repeated. The general excitement must be in some degree subdued, the vehemence of inflam- matory action checked, else will blisters add fuel to the flame, and increase the diseased action they were meant to control. The good they can do is limited to certain stages of the disease, and states of the system. To go a little into the consideration of particular inflammations: 1. Those of the Thoracic Cavities—Here blisters show their best powers, and if only the disease has been checked by depletion, or if its original character was not too violent, they will produce great and good results. 2. In Inflammations of the Abdominal Viscera.—Here, too, blisters will sometimes produce the best curative effects. An objection to their 516 MATERIA MEDICA AND THERAPEUTICS. use is that they deprive us of the use of pressure as a test of the pro- gress of disease. This is an additional reason for not using them very early. 3. Inflammation of the Brain.—Here, too, blisters are, by universal consent, remedies of great value, but a question is raised as to where they should be applied. Some shave and then blister the scalp; others apply the blister to the nape of the neck, or even to more distant parts. I believe the latter is the true practice; from the peculiarities in the cerebral circulation, it is, I think, impossible, or nearly so, to cause determination to the scalp, without causing a like determination to the brain itself. Hence the advantage of putting the blister at a distance; and this I believe common experience has sanctioned. The best places are over the stomach, on the back of the neck, along the spine, and upon the extremities. They create a revulsion from the brain, take off the current of blood from the organ, and often produce a most salutary influence on the disease, co-operating markedly with other remedies, as purgatives, j ftj ft>j Age. BATHS FOR CHILDREN. Water. Iodine. Iodide of Potassium. 4 to 7 36 quarts. 30 to 36 grs. 7 to 11 75 " 48 to 60-72 11 to 14 125 " 72 to 96 Troy. 60 to 72 grs. 96-120-144 " 144-192 " Troy. BATHS FOR ADULTS. Age. No. 1. " 2. " 3. Water. Iodine. 200 quarts. 240 " 300 " 2 to 2£ drs. Troy. 2-2A-3 " 3-34. Iodide of Potassium. 3 4 to 5 drs. Troy. 4-5-6 " 6-7 These baths are generally ordered three times a week. Lugol, p. 180, 3. Iodides of Mercury.—Of these there are two, the Protiodide and the Biniodide, Protiodide of Mercury.—This is never found in 526 MATERIA MEDICA AND THERAPEUTICS. nature. It is a greenish yellow powder, without smell, and with a slight metallic taste. By exposure to light it is decomposed, and its color changed. It is insoluble in water and alcohol, but soluble in ether, and slightly so in an aqueous solution of the iodide of potassium. Preparation.—It is prepared by rubbing up mercury and iodine in equal proportions, with the addition of a little alcohol, until globules are no longer visible. The alcohol is added to aid the solution of the iodine. It consists of one equiv. of iodine and one of mercury. Mode of Administration.—The dose of this is from one to two grains daily for adults. Pill.—This may be made by rubbing up of the protiodide gr. j., with extract of juniper grs. xii., and liquorice, q. s.; divide into eight pills. Of these two may be taken, night and morning, gradually increasing the dose. Ether of the Protiodide.—Made by dissolving one part of protiodide in 48 parts of sulphuric ether. Of this from 5 to 20 drops may be taken in distilled water, gradually increasing. Ointment.—Protiodide 3 ss, with lard § j. Biniodide of Mercury.—Like the protiodide this is not found in nature, but prepared artificially. It is a powder of a beautiful scarlet color. It is insoluble in water, but soluble in alcohol, ether, solutions of iodide of potassium, otassa fusa, or fused potash. It is prepared by evaporating a solution of potassa in a clean iron vessel over the fire until ebullition ceases and the potassa melts. It is then poured into proper moulds. The best kind of moulds are of iron and of a cylindrical shape. In this process all the uncombined water is driven off by the action of heat, and the potassa remains in the state of hydrate. It contains one equivalent of potassa 48, and one of water 9• = 51; or in 100 parts, 84 potassa and 16 water. When perfectly pure, the hydrate of potassa is of a white color. The officinal preparation, however, owing to impurities, is greyish or bluish. It is soluble in water and alcohol, but usually not entirely so, in conse- quence of the impurities; when pure, it is entirely soluble. It has a very strong affinity for water and carbonic acid, which it attracts rapidly from the atmosphere, and, in consequence of this, it deliquesces. Hence the necessity of keeping it in tightly-stopped bottles. Purity.—The officinal hydrate contains various impurities, such as peroxide of iron, carbonate of potash, silica, alumina, Szc, which exist in the carbonate of potash, from which the solution of potassa is prepared. These, however, do not interfere with the medicinal virtues of the article. They may be separated by digesting it in alcohol, which takes up only the pure alkali; by evaporating this alcoholic solution to dryness and fusing the mass thus obtained. Effects.—This is the strongest caustic that we possess, and hence was known by the name of causticum commune accrrimum. When applied in the solid form to any part, it quickly destroys its vitality, and extends its action to the parts beneath, forming a slough, which is afterwards thrown off, leaving behind it an open ulcer. The principal use of this article is to form issues. In using it for this purpose, however, it is necessary to be cautious. As it is very deli- quescent, it is apt to spread, and thus extend its effects too far. A piece of adhesive plaster should, therefore, be first applied to the part, with a hole cut in it of a suitable size where you intend making the issue. To this open part the caustic, moistened at one end, should be rubbed until 546 MATERIA MEDICA AND THERAPEUTICS. the part becomes discolored or dies. It is then to be washed and a poultice applied. When the eschar separates, the issue is to be con- tinued by keeping a pea in it It is also used to destroy warts and fungous growths. Potassa cum Calce.—This is also called the Causticum commune mitius, or the Causticum commune cum calce. This is prepared by eva- porating solution of potassa to one third, and then adding as much newly slacked lime as will bring it to the consistence of a solid paste. This is then to be preserved in well-stopped bottles. This consists of the mixed hydrates of potassa and lime. It possesses the advantage of being less deliquescent than the caustic potassa. It is, therefore, more manageable. It is milder and slower. Its general action, however, is the same. When applied, it is made into a paste with rectified spirits. Arsenious Acid.—Although commonly ranked among them, this article produces effects very different from the simple caustics. AYhen applied in small quantities to the sound skin, it does not pro- duce any effect. When applied in considerable quantities, however, it has been known to cause local irritation, followed by a pustular erup- tion, and in some cases the constitutional effects of it have been deve- loped. Several cases are recorded in which this article has been applied by mistake to the head for hair powder, and in all these constitutional effects have followed. One proved fatal. When rubbed on the sound skin in the shape of ointment, it produces generally a pustular eruption ; sometimes an eschar, and not unfrequently the 'system becomes consti- tutionally affected.—(Christison.) AVhen applied to surfaces deprived of the cuticle, the effects are much more energetic. Great local irrita- tion is caused, while the poison is absorbed frequently with great rapidity, and all the constitutional effects of it developed. Applied to eruptions, ulcers, and wounds, it has frequently proved fatal. In its application to ulcerated surfaces, there is a circumstance of great interest which has frequently been noticed; and that is, that while some persons are affected by a single application, " others have had it applied for a length of time without experiencing any other consequence than the formation of an eschar at the part."—(Christison.) For this two reasons have been assigned. The first is, the difference in the quantity applied. AVhen a large quantity is applied, the part is speedily disorganized, and absorp- tion is thus prevented. On the other hand, where the quantity is small, the local effect is trifling, and absorption readily takes place. A second is the condition of the sore to which it is applied. If there be any bleeding vessels, absorption takes place very readily, and the system is easily affected. On the other hand, if there be no bleeding vessels, this effect is much less likely to happen.—(Christison, p. 223.) ALTERATIVES. 547 The practical conclusions to be drawn from the foregoing are import- ant, and they are the following : 1. The arsenic should always be applied strong, so as to disorganize the part as speedily as possible. 2. Before applying it the part should never be prepared by cutting and paring, so as to cause bleeding. By attending to these precautions, the absorption of the article may probably in many cases be prevented, and many evil effects obviated. AVhen properly applied to an ulcerated surface, the part is destroyed and sloughs off; a new action is thus created, and a healthier secretion promoted. The disease in which arsenic has been chiefly used is cancer, and this is the article generally resorted to by empirics. In many cases it no doubt serves a good purpose in improving the character of the sore, and perhaps retarding the progress of the disease. Experience, how- ever, has abundantly shown that it cannot eradicate the disease, while from the absorption the most dangerous and even fatal consequences have resulted. By regular practitioners it is, therefore, in a great mea- sure abandoned. It is also used in Lupus with advantage, and more recently in Ony- chia, maligna with great success. (Pereira.) Mode of Application.—The best form is the ointment This is made by rubbing up one scruple of finely-powdered arsenious acid with one ounce of simple cerate. This must be applied with caution and the effects watched. The preparation used for onychia maligna is arsenious acid, grs. ij; spermaceti oint 3 i. [Hydrargyri Supernitras {the Acid Nitrate of Mercury).—A so- lution of the nitrate of mercury in nitric acid, under the name of the acid nitrate of mercury, is much used as a caustic in Paris, and has been adopted by some practitioners in England and the United States. It is chiefly used in cases 'of severe and extensive ulceration of the os uteri. It should be applied by a brush, and very great care taken that it does not fall upon the vagina, or touch the healthy tissue of the uterus.—Ed.] CHEMICAL ALTERATIVES. The two most important classes of chemical alteratives are: 1st. Antacids, or those remedies which obviate acidity of the stomach by combining with and neutralizing the acid. 548 MATERIA MEDICA AND THERAPEUTICS. 2d. Lithics, or those remedies which are given to counteract the dis- position to form urinary calculi. I shall speak of each of these in their order. Antacids.—The presence of acid in the stomach is essential to the performance of its functions. It is of course only when this is in excess that it becomes a proper subject for medicinal treatment. It is not yet well settled what acids are present in the gastric juice, nor in what state they exist in that fluid, some supposing that muriatic, acetic, and lactic acids exist in a free state. Blondelot, on the other hand, denies altogether the existence of free acid in the stomach, insist- ing that the acidity of the gastric juice depends on the presence of the acid biphosphate of lime. The probabilities are that free acids exist, and that the same acid does not exist in the gastric juice of different animals, nor in that of the same animals at all times; for though the acidity is essential, it seems that this quality in the absence of one acid can be communicated by another. The acids which are thought to exist in the normal state in gastric juice are, as before stated, the muri- atic, lactic, and acetic, and it is probable that when acid is in excess, it is by the increase of one or other of these. They are in all cases deve- loped from the food ; muriatic from animal food, lactic and acetic from vegetables. It is then to saturate the excess of these acids, and not to neutralize the gastric juice, or remove acid from the stomach, still less to render it alkaline, that antacids are given ; and if you remember, 1st. That the excess of acid is generated from changes in the food. 2d. That these changes depend on imperfect digestion. 3d. That digestion cannot but be imperfect, when there is in the stomach sufficient alkali to neutralize the gastric juice, you will readily understand the reason for a fact, long familiar to practical men, viz. that it is very possible to remove an effect of disease, and yet not remove, but actually aggravate the disease itself. Here the essence of the dis- ease is the disposition in the stomach to produce an undue quantity of acid from the food, and in neutralizing this, excess of acid, and thus removing an effect, we may aggravate the disposition in the stomach, which is the disease. This injurious effect of antacids may be, in part and for a time, pre- vented by the use of vegetable bitters, and alkalies ought not to be long used, without giving the tonics; but even with these the evil effects cannot be prevented entirely, if the remedy is used freely, and for a long time. Always, therefore, discourage the long-continued use of alkalies, especially the too common practice of taking them immediately after each meal. Magnesia.—Under the head of cathartics this earth has already been ALTERATIVES. 549 noticed, and it was then mentioned that it was used in three forms, viz: the sulphate, the carbonate, and the pure magnesia, or magnesia usta. In either of these two latter forms, magnesia may be used as an antacid. The difference between them is, that when the carbonate is used, large quantities of carbonic acid gas are extricated in the stomach. In some instances the extrication of this gas is objectionable, from the distension of the stomach which it occasions. Generally, however, no harm can arise from it, and the stimulus of the gas is, in many cases, rather grate- ful than otherwise to the stomach, and whenever nausea and vomiting are present, may be exceedingly beneficial. As an antacid, magnesia is one of the most efficacious articles that we possess. Next to ammonia, it has the greatest power of neutralizing acids of any of the alkalies or alkaline earths. It is peculiar to this article that, when it combines with an acid in the stomach, it proves purgative. In this respect it differs from the other antacids. Mode of Administration.—It may be given in doses from 3 ss to 3 jj in milk and water. To correct the flatulence which it occasions, a small quantity of some aromatic may be added. In dyspeptic states of the stomach, a little of the compound spirit of ammonia is frequently bene- ficial. Of the pure magnesia the dose may be about one third less than that of the carbonate. Creta—Chalk.—This is a friable carbonate of lime, and is found in great abundance in different parts of Europe. In the South of England, particularly, it exists in great quantities. Marble is the hard carbonate of lime. AVith the acids chalk effervesces, the carbonic acid gas being extricated. AVith muriatic acid it effervesces violently, and dissolves almost entirely, leaving a colorless solution. When by levigation and washing the chalk is separated from any im- purities that may be associated with it, it is called Creta preparata or Pre- pared chalk. This is the form in which it is used in medicine. As an antacid, it has been and is still used. It differs from magnesia in not producing any purgative effect. On the contrary, it proves absorbent and astringent It is, therefore, used with much advantage in eases in which magnesia would be improper. The dose of it is from 3j to 3j. The common form in which it is prescribed, is that of the chalk mix- ture. Lime AVater.—This is a limpid, colorless fluid, without smell, and having a strong, stvptic, acrid taste. It changes vegetables blues to o-reen. It unites with oil, forming an imperfect soap. When exposed to the air, a pellicle forms on its surface, which, when it becomes of a certain thickness, cracks and sinks to the bottom. It is then succeeded 550 MATERIA MEDICA AND THERAPEUTICS. by others of a similar character. The explanation of this is the follow- ing : The lime of the lime water attracts carbonic acid from the air, and forms a carbonate on the surface, which is the pellicle just mentioned. By successive formations the whole of the lime is thus abstracted. It is for this reason that it is necessary to keep lime-water in closely stopped bottles. As an antacid, lime-water is much used, and is an article of great value. Besides the power which it possesses of neutralizing acid, it has the still further property of dissolving the sordid mucus with which the stomach and bowels are generally loaded in dyspeptic and otherwise debilitated states of these organs. In the same way it proves serviceable in cases of worms by dissolving the slimy mucus in which these animals are imbedded. The dose is from 3 j to 3 ij, or 3 iij. AVhere the stomach is irritable, a good form of giving it is, mixed with an equal quantity of milk. Potash.—Carbonic acid combines with potash in two proportions, constituting a carbonate and a bicarbonate. {a.) Carbonate of Potassa.—(Salt of Tartar.)—As found in the shops, this salt is in white grains, with an alkaline and nauseous taste; it changes vegetable blues to green, and unites with oils and forms soap. On exposure to the air it is very deliquescent, and forms a fluid of the consistence of oil. This salt contains one proportion of carbonic acid with one of potassa. It is soluble in water, but insoluble in alcohol. (0.) Bicarbonate of Potassa.—This salt is prepared by passing a stream of carbonic acid gas through a solution of the carbonate of potassa. When it ceases to absorb carbonic acid, it is to be filtered and eva- porated slowly until regular crystals form. This salt contains twice as much carbonic acid as the preceding 'carbonate, or two proportions of acid to one of potassa. This is white, crystalline, without smell, and having a weak alkaline taste, without any acrimony. On exposure to the atmosphere it does not undergo any change. It is soluble in about four parts of cold water. Effects on the System.—In their effects, these salts do not differ much. They are both powerfully antacid, and extend their operation from the stomach to the urinary organs, increasing the secretion of urine, and altering the chemical constitution of that fluid. Although possessing the same general properties, however, the bicarbonate has great advan- tages over the carbonate. It is less nauseous and acrid in its taste, and agrees better with the stomach. The dose is from grs. x to grs. xxx, in some mucilaginous vehicle. (c.) Liquor Potassje.—{Solution of Potassa).—This is another form in which potassa is used. It is prepared by making separate solutions ALTERATIVES. 551 of carbonate of potassa and caustic lime in boiling water, and then mix- ing these together, and when cold, straining, &c. Here the lime attracts the carbonic acid from the potassa, and leaves the alkaline base in a state of purity. To prevent its absorbing carbonic acid from the atmo- sphere, it should be kept in glass bottles, with ground stoppers. The liquor potassa;, when pure, is a limpid, colorless fluid ; its taste is acrid and caustic. It changes vegetable blues to green, and does not effervesce with acids. It is a powerful antacid, and extends its opera- tions to the urinary organs. It does not, however, appear to possess any advantage over the carbonate, and is more apt to disagree with the stomach. The dose is from gtt. x to gtt. xxx, taken in broth, milk, common table beer, or some bitter infusion. Soda.—Like Potassa, Soda combines with carbonic acid in two pro- portions. {a.) Carbonate of Soda.—This salt is in large white crystals. It is without smell. On exposure to the atmosphere it effloresces and crumbles into a white, opaque powder. It consists of one proportion of carbonic acid and one of soda. {b.) Bicarbonate of Soda.—This salt is prepared in the same way as the bicarbonate of potassa, and contains two proportions of the acid to one of the soda. It forms in crystals—less soluble in water than the carbonate. AVhen dried, these crystals effloresce and lose part of their carbonic acid, so that what is usually found in the shops under the name of the carbonate is intermediate between the carbonate and the bicarbonate, forming a sesquicarbonate of soda. [A mixture of the two carbonates.—Graham.] Effects on the System.—The carbonates of soda are analogous in their operation, the only difference being that the bicarbonate is less alkaline and unpleasant in its taste, and generally sits better on the stomach. The carbonates of soda are generally more used than those of potassa. They are more pleasant, sit easier on the stomach, especially if their use is to be continued, and at the same time appear to be more effica- cious. The dose is from grs. x to grs. xxx or xl, dissolved in water or almond mixture. A very pleasant mode of giving soda is in soda water. The taste of the soda is here almost entirely covered by the carbonic acid. Carbonate of Ammonia—(Volatile alkali).—This salt does not exist in nature, but forms spontaneously in the decomposition of animal matter. It is also prepared artificially for medicinal purposes. It.has a penetrating, pungent odor, and an acrid taste. It is usually 552 MATERIA MEDICA AND THERAPEUTICS. in white semi-transparent masses of a crystalline appearance. On exposure to air it effloresces. It should be kept in well stopped bottles, for when exposed to the air, it gradually loses ammonia, becomes opaque, pulverulent an(l 'ess pungent, and ultimately passes into a hydrated bicarbonate of ammonia. It possesses alkaline properties, and is soluble in about three parts of cold water. Effects.—As an antacid this salt possesses very active properties. Besides neutralizing acid, which it does very effectually, it has the advantage of being powerfully stimulant, and is on this account particu- larly useful in debilitated states of the stomach, accompanied with acidity and flatulence. Form.—Pill or bolus, in doses of from ij grains to x grs. chemical alteratives. Lithics.—Under this head I shall treat of those remedies which are calculated to correct some of the most common morbid states of the urine which are manifested by deposits. To make this subject intelligi- ble, it is necessary to say a few words on the urine in health. Healthy urine, when recently voided and yet warm, is an amber- colored fluid, having a peculiar aromatic smell, and a saltish, disagreea- ble taste. On cooling, the smell changes to that usually called urinous, which it retains till it begins to decompose, when it has a foetid ammoniacal odor. Its specific gravity may vary from 1005 to 1030 but its usual range is from 1015 to 1020. The quantity voided is sub- ject to remarkable variations, even in perfect health, sometimes falling below 20 ounces, and at others exceeding 50. The average is about 32, or two pints. The quantity of solid matter in the urine is, like all its other qualities, subject to vary from a great number of causes. Its average is about 64 grains in 24 hours. This supposes that 32 ounces of urine of the specific gravity of 1020 are passed, each ounce of the fluid containing 20 grains. Not only does the urine of different persons, and of the same persons at different times, vary, but there is a pretty regular change which the fluid, in all healthy persons, undergoes at different periods of the day. That passed after rising from bed in the morning, and of course after several hours of abstinence from food or drink, is commonly called urina sanguinis. It furnishes a fair specimen of the average density of the whole urine. That passed soon after the digestion of a full meal called urina chyli, is of high specific gravity, while that which flows after the taking of large draughts of water, called urina potus, has a low specific gravity, is of pale color, and is sometimes nearly pure water. The urine is a very complex fluid, and chemists are scarcely yet agreed alteratives. 553 as to its composition. Into the niceties of this analysis I need not enter: my purpose will be served by calling your attention to a very general view of its composition. It contains in one thousand parts : 1. AVater,.....from 930 to 960 2. Urea, .......24 to 14 3. Uric acid...... 1*3 to 0-90 4. Alkaline and earthy salts, 15 to 5 5. Other solid matters ... 30 to 20 Of these constituents of urine the most important are urea, uric acid, and the alkaline and earthy salts, these latter being chiefly phosphates of soda, lime, and magnesia, sulphates of potash and soda, muriate of ammonia, and chloride of sodium or common salt. The proportion of these several ingredients may vary very much without exceeding the limit of health. When, however, the quantity of any one is very much either increased or diminished it constitutes, not always a disease—this is a matter of great importance and to be kept always in view—but a symptom of some diseased state of the system, very generally connected, more or less intimately, with faulty digestion. But the urine becomes morbid, not only by the faulty proportions of its normal ingredients, but it sometimes contains matters which are not properly constituents of the fluid ; of these the most important are albumen, sugar, pus, blood, and bile. None of these are ingredients in healthy urine, yet even their presence is not always to be taken as an evidence of disease ; it may be that they exist there in consequence^ of the vigorous efforts the system is making to eliminate noxious matters. From what is above stated it is obvious that morbid states of the urine may be divided into two general classes: 1. Those in which some normal constituent of the urine is in excess. II. Those in which the urine contains some principle which is not found in it in the state of health. 1. Morbid states of the urine in which some normal ingredient is in excess.—The normal ingredients of the urine which are most fre- quently found in excess are : 1. Urea; 2. Uric acid and the urates; 3. The phosphates. 1. Urine in which urea exists in excess.—Urine in which urea is in excess has a high specific gravity, and is very prone to decomposition; it has no other peculiar physical property. Test.—Add to a small quantity of urine in a watch glass about an equal quantity of pure colorless nitric acid; if crystals appear urea is in excess, and the time within which they form, which may vary from a few minutes to two or three hours, and the quantity of crystals, will enable us to judge of the amount of the excess; or put two or three drops of urine in a plate of glass and add two or three drops of nitric acid; if 554 materia medica and therapeutics. crystals form they can be detected by the microscope : and by a com- parison of healthy urine tested in the same way, a good idea of the quantity of urea may be formed. Symptoms.—A frequent desire to void urine, though the quantity passed at one time is commonly moderate. The quantity voided in twenty-four hours may not much exceed the normal standard, though it commonly does a little, but a remarkable feature of the disease is the facility with which diuresis is produced by trifling causes, as anxiety, a slight chill of the surface, ani the like. There is pain in the back, indis- position to exercise, low spirits, with dyspeptic symptoms of greater or less severity. 2. Urine in which lithic acid or the lithates predominate.—Urine con- taining excess of lithic acid is usually of a high color, and if the excess is considerable the acid is deposited as the urine cools. It always appears as crystals, though they are often so small as only to be recog- nised by the microscope.* The urine is acid, but not of high specific gravity, unless, as not unfrequently happens, there is excess of urea also. Lithate of Ammonia.—This is often seen with lithic acid, and the urine containing it is usually high-colored and turbid, sometimes it is clear when passed, and of low specific gravity. The lithate is deposited as the urine cools as an amorphous mass. It has commonly a fawn color, verging towards red. It is the most common of the urinary deposits. The only one with which it can be confounded is earthy phosphates, and from them it is distinguished by being redissolved when the urine is heated and falling down again when it cools. It is dis- solved by adding liquor potasse. Lithate of soda is usually found, and sometimes in very large quantities, in urine containing lithate of ammo- nia; this is particularly true of the urine of gouty patients, in whose systems lithate of soda often abounds to such a degree that it is depo- sited in the joints, forming the so-called chalk stones. It has also been found in the blood of arthritics. Lithic acid and the lithates are also found in excess in the urine, in most cases of inflammatory disease, in rheumatism and gout. It is very common in fever. It is often increased by check of perspiration from cold, and sometimes accompanies chronic skin disease. When too much animal or highly nitrogenized food is taken, or the digestive organs are impaired so that they are unable to assimilate the usual quantity, the excess of nitrogen will often be eliminated from the kidneys as lithic acid and lithates. This is one of the cases where the presence of a urinary deposit is evidence of the efforts of the system to eliminate a * The color is yellow or red, varying through all the shades of pale and deep fawn color to intense orange red. ALTERATIVES. 555 noxious principle. On the other hand, in all diseases of debility, in anemia, hysteria, chlorosis, the quantity of lithic acid is below the nor- mal standard. Therapeutics.—Where this acid or the lithates are in excess, the treatment must be directed by two indications. I. To remove the diseased state upon which the disposition to form acid in excess depends. II. To promote the solution of the acid and its salts. The means for fulfilling the first indication are : Those calculated to restore the healthy functions of the skin, and pro- mote diaphoresis; and those which improve digestion. Of the former the most available are the warm or vapor bath, fol- lowed by very free and even violent friction of the whole surface, and moderate exercise ; these measures will often produce the best effects. To improve the digestion, alteratives, and, if needful, mild tonic laxa- tives, as rhubarb, and soda or magnesia, may be followed by vegetable tonics, and in some cases chalybeates. Of the preparations of iron those arc to be preferred in which the metal is united to an organic acid, as the ammonio-tartrate, the citrate, or lactate. Attention to diet is all-important; here, as in most other eases, the best rule is to take such articles only, and in such quantities, as the patient finds by experience he can thoroughly digest. Solvents of lithic acid and the lithates.—These are the proper and literal lithics. Their use is generally secondary to that of the remedies which have been mentioned as proper to remove the diseased state of the system on which the formation of the excess of acid depends. Still they are of importance, for they may ward off for a while the dreaded evil calculus, and give time for the proper operation of the other and more important class of remedies. Of the solvents of lithic acid the most important is water. This is the best lithic, not only for this, but for most other urinary deposits. All other lithics will usually fail, hardly acting at all, unless their operation be aided bv free dilution ; and, on the other hand, very many of them act promptly and with great power, when presented to the system with plenty of water. Two or three pints a day is the proper quantity to be taken, and if a larger amount can be swallowed without impairing the digestive powers, the chance of the acid being " washed away" is greatly increased. A very curious proof of the efficacy of water as a lithic is afforded by the Medical History of Malvern Springs in England. These waters have, for a very long time, enjoyed great reputation in cases of o-out gravel, and other chronic affections; to their efficacy we have the testimony of Prout, Bird, and other writers. Now the water of Malvern Springs differs, except as to temperature, from common spring water, solely in its extreme purity, approximating that of distilled water. 36 556 MATERIA MEDICA AND THERAPEUTICS. Potash.—This alkali may be given in various forms, as the liquor potassae, the carbonate, bicarbonate, tartrate, citrate, and acetate. The liquor potassse should be given in full doses, say 3 ss thrice a day in some mild fluid, or weak, bitter infusion. It is apt even in this form to offend the stomach, and its use cannot be persisted in a long time with- out seriously impairing the digestion. The bicarbonate of potash is a very efficient and rather pleasant lithic, it may be given in doses of 3 ss thrice a day. It is made more pleasant and grateful to the stomach by giving it with a few drops of some weak acid, acetic or citric, to be taken in the state of effervescence ; here the citrate and carbonate are taken together, in proportions which vary as more or less acid is added. If sufficient is added to drive off all the carbonic acid, you then have, of course, a solution of the salt of the vegetable acid, and this is the best way of taking citrate or tartrate of potash. Acetate of Potash.—This is the best lithic salt of potash. It is less apt than the others to disorder the digestion, and by the use of the full dose, 3 ss, three times a day, the urine may be kept alkaline, and the lithic acid diathesis kept in check for a long time. Still it must never be forgotten that this alkaline state of the urine may induce the form- ation of deposits of the phosphates, nor will the stomach always escape an evil influence even from this salt Salts of Soda.—Of these, those chiefly used are lithics, the carbonate, the borate, the phosphates, and the salts of vegetable acids, in the form of effervescing mixtures. The carbonate is inferior to the salt of potash —so also are the salts formed with vegetable acids, though they are verv much used in the form of soda powders. Borate of Soda—{Borax).—The virtues of borax as a lithic have long been celebrated among the Germans, and much relied on from the power its solution has of dissolving lithic acid ; in this it excels either of the alkaline carbonates. It has, too, the advantage that it can be used for a considerable length of time without any bad effects on the digestion. It is said to have a stimulating influence on the uterus, and to be on that account objectionable in females. Dr. G. Bird says he has known it to produce abortion in two cases. Phosphate of Soda.—The solvent powers of the solution of this salt are equal to those of borax, and it has been used as a lithic in manv cases; its agreeable taste is a great recommendation; it seems to sit well on the stomach, if given in a state of sufficient dilution. Dose.— 3 i to 3 ss twice a day. It may be taken in broth or cruel; its taste very nearly resembling that of common salt. In concluding the subject of the alkaline treatment of lithic acid diathesis, it is proper to repeat that alkalies exert no curative in- fluence. The benefit to be derived from their use is palliation, and not cure. They correct acidity in the products of mal-assimilation, and ALTERATIVES. 557 for this purpose should be given in moderate doses, two to four hours after eating. Urine in which Phosphates are in excess.—Urine containing phos- phates in excess is usually pale and of light specific gravity, 1.010, and secreted in large quantity.* It is usually acid when passed, but soon becomes alkaline when the phosphates fall in large quantity, as they are not in the absence of acid soluble in the urine. Unless the urine becomes alkaline, this deposit (spontaneous) of phosphates will not take place, even though they exist in very great quantity. The phosphatic deposit is white, or yellowish, or greyish white ; it is readily dissolved by adding hydrochloric acid, and reappears when this acid solution is supersatu- rated with ammonia; they are not affected by adding the alkalies or their carbonates, nor are they dissolved by heating the urine. On the contrary, if they exist in excess, the urine, though previously clear, is made turbid by boiling, so that we might suppose albumen was present Adding nitric acid pretty freely to the urine will, by dissolving the phosphates, render it plain that albumen is not present. States of disease in which Phosphates occur in excess.—If the excess is but occasional, and varying in degree even when present—if the urine be deep-colored and of high specific gravity, the cause of the deposit is dyspepsia. The particular form of this disease in which we find these deposits, is that connected with great irritability, both of the system at large and the stomach, prostration of nervous energy, and oeneral evidence of wear and tear of body and mind. When the urine is pale, of low specific gravity, and when the phosphates abound equally at all times of the day, and when this state of things continues for a considerable time, the phosphatic deposit probably depends either on organic disease of the bladder, prostate, or kidney, or some morbid state of the spine, consequent on injury or idiopathic disease. Therapeutics.—The deposit of phosphates very generally indicates a severe, and it accompanies a number of utterly incurable diseases. The prognosis is, therefore, always grave when the deposit is constant. When it is but occasional, it generally depends, as before stated, on an irritative form of dyspepsia, but even here the probability is, that the nervous system is suffering severely. A'ery little can be done by lithics proper, in either of these fonns of disease. Some practitioners have strono-lv commended acids with a view of directly correcting the alka- line state of the urine. It is very doubtful whether either of the mine- ral acids have any such power, though some have attributed it to the nitric. * Sometimes the urine containing excess of phosphates is high-colored, and of a great specific gravity ; this usually occurs where the precipitate depends on dys- pepsia, and is only occasionally present. 558 MATERIA MEDICA AND THERAPEUTICS. Benzoic acid has been highly praised, but its operation is excessively uncertain. These cases must be treated on general principles, and with particular reference to the disturbed state of innervation. Narcotics will always be required, and in many cases you will give them very freely. Tonics and alteratives judiciously combined, a well-regulated, plain, though nutritious diet, and good hygienic management, will do all that art can do for the more severe cases.- • The e » d. INDEX, Absorption of Medicines, 14, 17 Acetone, 38 Acetum, 338 Acid, acetic, 38, 338, 503 arsenious. 485, 546 benzoic, 39 citric, 39. 337 empyreumatic, 451 gallic, 39 hydrocyanie, 40, 314 lactic, 39 meconic, 39 nitric, 489 oxalic, 40 prussic, 40, 314 pyroligneous, 38, 451 sulphuric, 502 tannic, 40, 495 tartaric, 41 valerianic, 41 vegetable, 337 Acids, 33; organic, 38 Aconite, 3'2 5 Aconitine, 327 Actoea racemosa, 333 Affusion, 201, 423 Alcohol, 4S, 417 Alkalies, organic, 41 Allium sativum, 507 Aloes, 121 Alteratives, 517 chemical, 547 local, 541 Althoea officinalis, 347 Alum, 501 Ammonia, 262,428 carbonate of, 429, 551 Ammoniac, 221 Ammoniae, aqua acetatis, 204 Anaesthetics, 394 Antacids, 548 Anthelmintics, 150 Anthemis nobilis, 90 Antimonialis pulvis, 204 Antimony, tartrate of, 82 vegetable, 206 wine of, 86 Antiphlogistics, 336 Antispasmodics, 432 Apium petroselinum, 252, Apoeynum canabinum, 24S Aqua acetatis ammonias, 204 Aqua ammonia?, 429, 505 Arable, gum, 50, 344 Arbutus uva ursi, 256 Argentum, 482 Aricinine, 471 Aristoloehia serpentaria, 208 Arrow-root, 51, 351 Arsenic, 162, 485 Arum triphyllum, 220 Ascarides, 151 Asclepias tuberosa, 207 Aspidium, 158 Assafcetida, 440 Astringents, 4911 Atropa belladonna, 387 Balsams, 47 Bark, Peruvian, 462 Barley, 350 Baths, cold, warm, hot, and vapor, 202, 203 Bearberry, the, 256 Belladonna, 387 Benne, 348 Black draught, 135 Black wash, 192 Bleeding, 271, 310 Blister, instantaneous, 21 Blisters, 507 Bloodroot, 219 Blue pill, 145, 187 Blue ointment, 188] Boneset, 206 Borax, 556 Brucine, 43, 448 Buchu, 255 Butterfly weed, 207 Cabbage, skunk, 441 Cahinca, 258 Cajeput oil, 442 Calamus, 416 Calomel, 143, 148, 155, 191 Calumba, 457 560 Camphor, 161, 430* Cantharides, 249, 509s Caoutchouc, 47 Capsicum, 506 Carbo ligni, 123 Carminatives, 33 Carrot, 255 Cassava, 353 Cassia fistula, 118 marylandica, 135 Castor oil, 20, 112 Catechu, 496 Cathartics, 25, 92, 111 Chalk, 549 Chamomile, 90 Charcoal, 123 Chenopodium anthelminticum, 159 Chimaphila, 256 Chinoidine, 43 Chlorine, 216 Chloroform, 49, 402 Cicuta, 3S3 Cimifuga, 333 Cinchona, 460 Cinchonine, 42, 471 Citrin ointment, 189* Clysters, 148 Cod liver oil, 534 Codeia, 362 Codeine, 42 Cohosh^ 333 Colchicum, 325 Cold, use of, as a sedative, 334; as a refrigerant, 338; as an anaesthetic, 403 Colocynth, 139 Conium maculatum, 283- Convolvulus panduratus, 246 Copaiba, 250 Copper, sulphate of, 86 Cornus florida, 471 Corrosive sublimate, 190, 32? Cotyledon umbilicus, 490 Cowhage, 157 Crane's bill, 499 Cream of tartar, 130, 238 Creasote, 449 Creta, 549 Crosswort, 206 Croton oil, 142, 147, 513 Crow's foot, 499 Cubebs, 253 Cucumber, bitter, 139 squirting, 140+ Cucurbila pepo, 162 Datura stramonium, 331 Daucus carota, 255 Delphine, 331 Demulcents, 31, 33, 216, 343 Dextrine, 51 Diaphoretics, 19S: Digitalis, 239, 314 INDEX, Dinner pill, 12? Diuretics, 228 Dogwood, 471 Dolichos prariens, 15T Dover's powder, 206 Dragon-root, 220 Effervescing draught, 20G Elaterium, 140 Elixir proprietatiis, 123 " salutis, 135 Emetics, 24, 31, 52, 67 Emetine, 43, 80 Emmenagogues, 260- Emollients1, 3& Enemata, 148 Epispastics, 507 Epsom salts, 128' Ergot, 264 Ether, sulphuric, 48, 226, 403 Eupatorium, 206 Expectorants, 209 Fats, 44 Fecula, 51 Fern, 158 Ferrum, 475 Flag, sweet-scented, 41G Flax seed, 349 Fowler's solution, 487 Foxglove, 239 Call nut, 495 Gallae, 495 Gamboge, 137, 147 Garlic, 507 Gentian, 450 Geranium maculatum, 499> Ginger, 415 Glauber's salts, 126 Gold, 531 " chloride of, 531 " oxide of, 532 Goulard's extract, 50G* Guiac, 261 Gum, 50 " ammoniac, 221 " arabic, 50, 344 " resins, 47 Gutta percha, 48 Hellebore, black, 138; white, 329; Ame- rican, ib. Hemlock, 383 Hemp, Indian, 248 Henbane, 380 Hive Syrup, Coxe's, 91, 227 Hop, 382 Horsemint, 506 Hydrargyri bichloras, 190 " oxidum, 188 "■ piluhe, 14 5-, 18© INDEX. 561 Hydrargyri proto-chlor., 143, 170, 207 " unguentum, 188 " unguentum nitratis, 189 Hydrargyrum, 163 " cum creta, 188 Hydrocyanic acid, 314 Hyosciamus niger, 380 Hypnotics, 355 India rubber, 47 Indian sage, 206 " hemp, 248 " meal, 351 Inhalations, 216 Iodine, 522 " preparations of, 523 Ipecacuanha, 79, 216, 227, 233 Iron, 475 " ammonio-tartrate, 486 " carbonate, 56, 477 " citrate, 481 " filings, 156, 475 " lactate, 481 " muriated tincture, 258, 481 " oxide, 476 " phosphate, 480 " sulphate, 156, 479 " tartrate, 480 Issues, 514 Jalap, 124, 147 James's powders, 204 Jamestown weed, 391 Jerusalem oak, 158 Jujube, 348 Juniper, 217 Juniperus communis, 247 " sabina, 261 Kino, 497 Kooso, 162 Lactucarium, 381 Laudanum, 376 Laxatives, 111 Lead, acetate of, 499 Leeches, 291 Lemon, 336 Lignin, 50 Lime water, 549 Linseed, 349 Liquorice, 346 Liriodendron tulipifera, 473 Lithics, 552 Lobelia, 88 Lobeline, 89 Lupulin, 383, 406 Macrotys racemosa, 333 Magnesia, 114, 548 " carbonate, 115 " sulphate, 128 I Male fern, 158 Mallows, marsh, 347 Manna, 117 Marsh rosemary, 498 Materia medica defined, 11 Matico, 503 May apple, 125 Meadow saffron, 323 Meconine, 22 Medicines, effects of absorption of, 14, 17 " modus operandi of, 16 " methods of applying, 18 '• circumstances modifying the effects of, 24 " classification of, 28 ? " combination of, 31 Melia azedareck, 161 Mercury, 163, 258, 520 " pathological effects of, 170 " modes of introducing, 172 " black oxide, 188 " chlorides, 190 " iodides, 525 Mindereri spiritus, 204 Monarda punctata, 507 Monkshood, 325 Morphine, 42, 378 " sulphate, acetate, and hy- drochlorate of, 378, 379 Moxa, 514 Mucuna pruriens, 157 Musk, 438 Mustard, 89 Myrrh, 224 Narceine, 42 Narcotics, 34, 355 Narcotine, 42, 362 Mervines, 433 Neutral mixture, 205 salts, 147 I Nightshade, American, 125 " deadly, 387 Nitre, 235 " sweet spirits of, 239 Nitro-muriatic liniment, 513 Nux vomica, 443 Oak bark, 498 Oatmeal, 350 Oils, 44; enumeration of the more m- portant, 45-47 Opium, 25, 357 Orange, 337 Oxydum hydrargyri cinereum, 188 Paint, Indian, 219 Papaver somniferum, 357 Paregoric, 377 Pareira brava, 257 Parsley, 254 Parturients, 264 562 INDEX. Peru, balsam of, 222 Peruvian bark, 462 Phosphorus, 431 Phytolacca decandria, 125 Pill, blue, 145. 187 Pink root, 160 Pipsissewa, 256 Pix burgundica, 507 Pleurisy root, 207 Plumbi acetas, 499 Plummer's pill, 191, 521 Podophyllum, 139, 158 Poke weed, 125 Polygala senega, 217, 227 Polypodum filix mas, 158 Pomegranate, 159 Potash, 550 Potassa, caustic, 545 " citras, 205 " cum calce, 546 Potassa? nitras, 235 " carbonas, 550 " liquor, 550 " et sod. tart., 129 " acetas, 239 " sulphas, 131] " supertartras, 130 " tartras, 129 Potato, the wild, 246 Powders, antimonial, or James's, 504 Pride of India, 161 Principles, vegetable proximate, 36 Prunus virginianus, 474 Prussic acid, 40, 314 Pseudomorphine, 42 Puccoon, 219 Pulse, 273 Pulvis antimonialis or Jacobi, 204 Pulvis Doveri, 206 Pumpkin, 162 Purgatives, 32 Pyrola umbellata, 256 Quassia, 458 Quicksilver, 163 Quinine, 42, 458 " sulphate of, 452 Quinoidine, 43 Red precipitate, 189 Refrigerants, 31, 336 Resins, 47 Revulsives, 504 Rheumatism weed, 256 Rhubarb, 119, 146 Rice, 351 Ricini oleum, 112 Rochelle salts, 129 Rubefacients, 505 Saffron, meadow, 323 Sage, Indian, 206, Sago, 51, 352 Sal de duobus, 131 Sal diureticus, 239 Salep, 354 Salicine. 472 Salix, 472 Salt, common, 161 Saltpetre, 235 Sanguinaria, 219 Sarsaparilla, 537 Sassafras, 539 Savin, 261 Scammony, 135, 147 Scilla maritima, 86, 219, 227, 246 Secale cornutum, 264 Sedatives, 271 Seignette, salt of, 129 Senega snakeroot, 217 Senna, 132, 146 Setons, 514 Sialagogues, 163 Silver, nitrate of, 483, 541 " oxide of, 485 Simaruba, 459 \ Sinapis, 89, 505 Skunk cabbage, 441 Slippery elm, 348 Snakeroot, 217 black, 333 Soda, 551 " carbonate and bicarbonate, 551 " sulphate, 126 " phosphate, 132 Soot, 451 Soporifics, 355 Spigelia marylandica, 160 Spiritus mindereri, 204 " etheris nitrici, 239 Spurred rye, 264 Squaw root, 333 Squills, 86, 219, 227, 246, 263 Stannum, 157 Starch, 51 Statice caroliniana, 499 Stinkweed, 391 Stramonium, 225, 390 Strychnine, 43, 445 Strychnos nux vomica, 443 Styptics, 491 Sudorifics, 193 Sugar of lead, 499 Sugars, enumeration of various, 49, 50 Sulphur, 116 Swallow-wort, decumbent, 207 Tamarinds, 118, 337 Tannin, 495 Tapioca, 353 Tar, 217 Tartar, cream of, 130, 238 " emetic, 82, 204, 216, 227, 310, 512 INDEX. 563 Tasteless purging salt, 132 Temperants, 337 Thebaine, 42 Thorn apple, 391 Thoroughwort, 206 Tobacco, 225, 317 " Indian, 88 Tolu, balsam of, 217, 223 Tonics, 31, 452 Tragacanth, 345 Turmeric, red, 219 Turnip, Indian, 220 Turpentine, oil of, 158, 248, 265, 506 Turpeth mineral, 90 Urine, states of, 552 Uva ursi, 250 Valerian, 439 Vegetable antimony, 206 Venesection, 25 Veratrine, 43, 329 Veratrum album, 329 " viride, 329 Vesicants, 507 Vinegar, 338 Vitriol, white, 85 " blue, 86 Vitriolated tartar, 131 Volatile alkali, 551 Wake-robin, 220 Wash, yellow and black, 191 Water, 156, 201, 555 Willow, 472 Wintergreen, 256 Wolfs bane, 325 Worms, account of the various kinds which infest the human body, 150; symptoms of, 152: their origin, 153; medicines for expelling, 155 Wormseed, 160 Yellow wash, 191 Zinc, oxide of, 488 " sulphate, of, 85 f th» kind ever published in this country."—American Journal of Medical Science*. "The text and plates both being excellent, the book Is a treasure indeed."—Boston Jn.tit.-ui and Surgical Journal. A TREATISE ON THE Etiology, Pathology, and Treatment of Congenital Disiooa tions of the Head of the Femur. Il.Ll'8I'KATK"> WITH PLATES. By JOHN MURRAY CARNOCHAN, M.D., Lecturer on Operutic Surgery with Surgical and Pathological Anatomy, etc., etc. "Typographically, this is one of the most beautiful works that has emanated from the medi- oal press of this country. The plates, drawn from nature, are well finished, and are very cred- itable to our draughtsman. The work itself treats of one of the forms of congenital deformity, the cause of which is unknown, and the cure doubtful. The work fills a gap which has lon^ been void, and the practitioner will gladly welcome its accession."—Literary World. " This is a praiseworthy attempt to draw the attention of the profession to a remarkable pathological condition of the coxo-femoral articulation, which has frequently been inistakeu for other diseases of this part, especially morbus coxariua, cojarthrocace, or the so-called hip- disoase."—O/do Med. <& Surg. Journal. " By far the most complete and systematic work in the English language, and the only ona which contains any directions for treatment."—Brit. Am Mud. & Physical Journal. " It is remarkable, In view of the numerous and exceedingly "aluable treatises and contribu- tions made by English surgeons on the pathological condition of the joints, that th* subject of congenital dislocation of the head of the femur, should have been so almost entirely unnoticed "We feel a pride that the first monograph on this subject in the English language is from the pen of an American, and that is creditable to its author."—Am. Journal Med. Science*. "The work before us, giving an account of a special department of surgery, cannot tail to prove of interest to the practical surgeon, as it appears to be an elaborate ami faithful <'eHneo- tlon of a very distressing and badly-understood affoction, which, until recently, has been dewiie.i Incurable, and to which the attention of the profession has been directed only within the laa» few years,"—Medical Examiner. __________________ THE YOUNG STETHQSCOPIST; OK, THE STUDENT'S AID TO AUSCULTATION. By UKWRT •• SOWinXOH, tti^.., OFB Of *"*u» »irvsU,. Jour. Med. Science. "We are acquainted with few works so practical, concise, clearly written and dlsrlnim-<.fc*,- by such sound s.'nse as this."— Medical Times and Gazette. w«wen, «na distinguished THE DISEASES OF WOMEN AND CHILDREN. BY GUNNING S- BEDFORD, A.M., M.D., Professor of Obstetrics, the Diseases of Women and Children, and Clinical Mid- wifery, in the University of New York, Author of the Principles and Practice of Obstetrics. SIXTH EDITION, CAREFULLY REVISED AND ENLARGED, 8vo, 653 pp. S. S. * W. WOOD, 389 BROADWAY, NEW YORK. Price, $3.25, free of Postage The rapid and wide-spread circulation of this eminently practical work is. vr» think, without precedent—having reached its Sixth Edition in little over four years from the day of its first publication. It is a storehouse of knowledge for the student and practitioner of medicine—full of practical precepts and bed-side information. Rarely has any medical publication met with such universal commendation from the medical press, both at home and abroad. " Successful as the work has been at home and abroad, we were not prepared to pee it achieve a success exceedingly rare in the history of American medical authorship, viz., a Translation into the French language. "We congratulate the author upon this high compliment paid to his labors in the still new field of uterine pathology, where so many struggle vainly for reputation. "While this translation is the highest possible acknowledgment of the value of Dr. Bedford's labors, it secondarily reflects creditably upon the rising importance of the American school of medicine.—American Medical Times. " "We hail the advent of such a work, abounding in practical matter of the deepest interest, and illustrated by principles and laws ordained by nature. Nor can we refrain from expressing our surprise and gratification at finding the book so remarkably exempt from the superficial views that abound in the great thorough- fare of medicine. The rapid sale of this work we believe to be unprecedented in the history of medical literature in this country, which must be highly gratifying to the author, showing, as it does, the degree of estimation placed upon his labors by the medical public."—If. Y. Jour, of Med. and the Collateral Sciences. " "We are quite sure that the work will be a welcome addition to professional li- braries in Great Britain as well as America."—Brit, and For. Med.-Chir. Review. " "We think this thw most valuable work on the subject ever presented to the profession. "We have perused every page of the book with interest, and speak, therefore, from personal knowledge."—Cincinnati Med. Jour. " A careful perusal of Dr. Bedford's book has led us to believe that its value wfl. continue to be acknowledged, and the author recognized as a most able and acute practitioner of medicine. The work is of the most practical character; every thing is made to tend toward the relief and treatment of disease, and remarkable skill is shown in quickly arriving at an accurate diagnosis. To get at once to the point is the pervading characteristic of the author's teachings. We cordially recommend it to all practitioners and students of medicine."—London Lancet. " It is to be regretted that we have not more such books in Great Britain."— London Medical Times and Gazette. " The style of the author is very graphic. The book not only proves Dr. Bedford to be a sound physician and an excellent clinical teacher, but it also affords evidence of an extensive acquaintance on his part with the literature of his subject on this side of the Atlantic."—London British Medical Journal. " An examination of this work convinces us that the author possesses great talent for observation, and that his opinions are sound and practical. He shows an intimate knowledge of the doctrines of the ancients and the opinions of the moderns. The variety of instruction contained in this volume, the ability with which it is pre- sented, and the truthful practical character of the doctrines advanced, give to it very great value."—Gazette Medicate, Paris. S. S. 4* W. Wood's Medical Catalogue " The working men in America arc always on the look-out tor the new ligb's. rising over the old world, ami they oiten too hastily adopt as the pure gold of science. the crude lucubrations which must find place with more valuable matter in the weekly medical press. But this observation does not apply to our author, who is creditably known by other works, and in the one before us shows himself to bo a judicious physician, anxious alike for the good of his patients and of his pupils; one who has acquired the happy art of teaching how to get at the characteristics of disease, and how to drag at the chain of effects, until the mind grasps the first link in the chain."—Rankin's Half- Yearly Abstract of the Med. Sciences. " The subjects have been developed with no ordinary powers of clinical instruo h,m."_jV. Y.Med. Times. ■ ' We have been both pleased and instructed by a perusal of the book, and con fidently recommend it, therefore, to the profession, as an excellent repertonum of clinical medicine. The eminently practical ideas of the author, clothed in simpla and perspicuous language, are delivered in quite an attractive, affable, and off-hand manner."—Philadelphia Med. Examiner. " It is not often that British critics commend an American book; so when their approval is obtained, we may rest assured that the work commended is of no ordi- nary merit. Dr. Bedford's book is characterized by Dr. Churchill as worthy of its author, a credit to his country, and a valuable mine of instruction to the prof ession at large.' We have read every page of the work, and feel called upon to say that we regard it the most valuable contribution on the subject ever offered to the profes- sion."— Charleston Med. Journal and Review. "A work of great practical interest—one well calculated to interest and instruct the busy practitioner; it points out to him the most modern therapeutical agents, and their method of administration; and, above all, gives beautiful and satisfactory explanations, physiologically, of the symptoms of disease. This latter quality is a great merit of the book. As a faithful representation of the daily labors and duties of a physician of our day, and as an accurate delineation of the diseases of women and children, it is well deserving of our praise."— Virginia Med. and Surg. Jour. " We were actually fascinated into reading this entire volume, and have done so most attentively; nor have we ever read a boot with more pleasure and ■ n.nt. There is not a disease connected with infancy or the female system which is not most ably discussed in this excellent work."—Dublin Quarterly J'/nniid of Medical Science. " Professor Bedford's book is a good one. We like it, for we can digest a dinner o^er it without going to sleep, and that is more than we can say of most medical books."—New Jersey Med. Reporter. " To read this work is to be struck with its truthfulness and utility ; we find all tnat is useful in practice, ably communicated, and elegantly expressed. American works are not generally read on this side the Atlantic, but we recommend Dr Bedford's book as worthy of the very best attention of the profession."—Midland Quarterly Journal of the Medical Sciences, London. " We have said, on former occasions, that the man who will bring forward clinical or practical instruction to bear upon the medical teachings of our country, will be immortalized. We want practical observations—fresh from the bed-side. Dr. Bed- ford's volume is drawn from an extensive clinic, founded by him in the University of New York, and is fortified by much reading and research. This is a good book, and the profession owes Dr. Bedford hearty thanks for the labor he has bestowed upon it."—Philadelphia Med. and Surgical Journal. " The work before us is eminently practical, and therefore valuable as a contri- bution to medical knowledge. Prof. Bedford's extensive opportunities have enabled him thus to bring together a large number of the most interesting cases of female and infantile affections, and to indicate his views of their treatment. In the_ accom- plishment of the task, the author has evinced a degree of discernment which will, doubtless add materially to his already extended reputation."—Southern Med. and Surg. Journal, Augusta, Georgia. " No one can read this book without becoming convinced that it contains much valuable instruction, and is the result of a large experience in this specialty."— New Hampshire Jour, of Med. "The work contains graphic descriptions of the diseases of women and children, with judicious advice as to treatment."—Boston Med. and Surg. Jour. Price $3.25, by mail, free of postage. i its kind. Tbe view of the author seems to be to condense within a moderate comr-us the great mass of materials furnished by other and more voluminous works."—New Orleans Jlet/ical and, Surgical Journal. "The subjects are well chosen, and suitably arranged; covering all the ground usually em- braced in a course of lectures on obstetrics, all of which are presented in a ol jur and forcible manner. The style is luminous and readable Throughout, the work is illu£.tii.ted by wood- outs exhibiting the different stages of labor, the organs involved, and the instruments employed In delivery."—St. Louis Medical and Surgical Journal. "The student will find It replete with accurate and lucid instruction."—Loudon Med. Gazette. "This is an excellent b«ok. It is commended to us by the position and rich practical expe- rience of the author. It is comprised within limits which will not exhaust while it improves, and is not so expensive as to make it a very serious question whether it shall be bought or net. It consists of thirteen lectures, on important matters; embracing, in short, what it behooves every practitioner to know, and to know thoroughly."—Boston Medical & Surgical Journal, "The mechanism of parturition, the keystone of correct operative midwifery, is detailed with singular clearness and perfection. The chapters on Natural Labor leave nothing to be desired, while those on Difficult Parturition—and how embarrassing, how wearying cases of this kind are, every one engaged in obstetrical practice,,but too well knows—seem to us to supply fully the wants of the student, as to their causes and the remedy. Wo earnestly recommend it to tbe learner as the monograph, par excellence, on the subject."— The Annalist. " As an elementary treatise on the Obstetric art, and as a text-book for students, we are oi opinion that Dr. Murphy's Lectures should rank very high. The style is plain, simple, con- cise, and agreeable; and the principles of practice taught are based upon an enlarged view oi the philosophy of the.art, as well as ample practical experience."—Western Lancet. These Lectures "contain a large amount of sound practical matter. From a careful perusal of them, we feel satisfied that not the student merely, but also the practitioner, may derive much valuable Information, conveyed in a pleasing and unassuming style."—Dublin Quar- terly Medical Journal of Science. A MANUAL OF DISEASES OF THE SKIN, From the French of M. M. Cazenave