IfcY&V. Kv.v .v.'.r.-. ;•..'•',-:;'., .^aHvy*' ■; >..?..*^*t..' ::.•..:•„■ rti'^ ^■^:'/■;.;■■;■■ ■ tw^r-'^v.;. •'■•v' ■ 5'A'.* ,■ :i."v.v v- ;v -,-\ ■•.',.,;•'. •'■ "ijV'";'--V*^-; .•/'■".'•"■'■,' ■'■ ^■^'/•X.-j.v ■■:■;••■ ^:^/:\U;:;>:"-;::y. Vv,"'!/'.'v V '•' '■■;.•' >' ■!' .".-y'.v.vr.j: 111 >■->... >J x».(.. MMw ■■■■■■■'•'■'■ for- a ~ " TREATISE OF THE MATERIA MEDICA AND imB* v JOHN EBERLE, M. D. EDITOE OF THE AMERICAN MEDICAL nECORDEB; Memter of the American Philosophical Society; of the Academy of Natural Sciences of Philadelphia; Corresponding Member of the Medico-Chirurgical Society of Berlin, &c. &c. TN TWO VOLUMES VOL. I. PHILADELPHIA.- PUBLISHED BY JAiMES WEBSTER. William Brown, Printer. 1822. El ft Y.I FV^-m ^.5^«a no . I District of Pennsylvania, to -wit: ,««***. BE IT REMEMBERED, That on the twenty-fifth day of Oc t seal.J tober, in the forty-seventh year of the Independence of the »***»** United States of America, A. D. 1822, James Webster, of the said district, hath deposited in this office the title of a book, the right whereof he claims as Proprietor, in the words following, te wit: "A Treatise of the Materia Medica and Therapeutics. By John Eberle,M.D. Editor of the American Medical Recorder; Member of the American Philosophical Society ; of the Academy of Natural Sciences of Philadel- phia ; Corresponding Member of the Medico-Chirurgical Society of Berlin, &c. &c. In Two Volumes. Vol. I. In conformity to the act of the Congress of the United States, intituled, " An act for the encouragement of learning, by securing the copies of maps, charts, and books, to the authors and proprietors of such copies, during the times therein mentioned." And also to the act, entitled, " An act supplementary to an act, entitled, ' An act for the encourage- ment of learning, by securing the copies of maps, charts, and books, to the authors and proprietors of such copies during the times therein mentioned,' and extending the benefits thereof to the arts of designing, engraving, and etching historical and other prints." D. CALDWELL, Clerk of the Eastern District of Pennsylvania. aiwm^Bw^w^ifo We know from experience, that the acquisition of knowledge is facilitated by having its objects present- ed to the mind in the order of some regular arrange- ment. Science, indeed, cannot exist without system. It is this which gives symmetry and beauty to its tem- ple, and without which, its most valuable materials would lie in rude and shapeless masses. When we fix our attention upon a diversity of mixed objects, we naturally, and almost unconsciously, begin our inquiries by separating them into groups or families, according to their various analogies or resemblances. We thus obtain a general view of their common and partial relations, and are thereby not only better enabled to investigate their individual characters, but also greatly assisted in retaining what we have learned concerning them, by the influence of association. We become systematic from the very • \ •. . . • I f iv INTRODUCTION. constitution of the human mind. To classify our ideas is the first step we make towards useful know- ledge; and the highest attainments of intellect are but a more extensive and intimate view of those various relations which subsist between the objects of human knowledge. The principle of systematic arrangement being thus essentially interwoven with science, it is obvious that perfection in classification can only be attained when science itself shall have become perfect. Such an era of intellectual glory is, however, never to be ex- pected; and we must be contented to approximate what we cannot reach. As things are not viewed under the same aspect by every observer, and relations seen by some, which are either unimportant or unnoticed by others, it fol- lows that arrangements founded on these views are exceedingly various and dissimilar. It is obvious, however, that the classification which includes the greatest number of the conspicuous and constant re- lations of objects, must best answer the purposes of such arrangement. The difficulty lies in fixing upon the strongest, most constant, and universal points of INTRODUCTION. y resemblance, and to bring them together under such a scheme of arrangement as will exhibit them in the order of their most essential and conspicuous affini- ties. In arranging the objects of natural science, as, for instance, those of botany, zoology, or chemistry, we bring into view only those natural relations of con- formation or character, which subsist among the ob- jects themselves. In medical science, however, we are obliged to enter upon a much more extensive and perplexing range of comparison. Here we must keep in view not only the relations of external agents with each other, but also those which they bear to living matter,—to the effects which they produce upon the animal economy. The difficulties which arise from these complicated relations are particularly experi- enced in the classification of the materia medica ; and hence the great imperfection and inadequacy of all the arrangements that have hitherto been proposed in this department of our science. Some writers have, indeed, been so strongly impressed with the insur- mountable nature of these difficulties, that they have thought it best to reject all systematic arrangement, and to describe remediate substances in an alphabetic VI INTRODUCTION. cal order. This simple mode of arrangement, it mus; be confessed, possesses some advantages which cannot be obtained by regular classification. We are parti- cularly enabled thereby to exhibit a connected view of all the remediate qualities and therapeutic applica- tions of each individual article, without those frequent repetitions which are unavoidable under every other known system of classification. But to counterbalance this advantage, which, in reality, is of no essential importance, we lose sight, by the adoption of such an arrangement, of those general physiological and thera- peutic relations between the living body and remedies, which are in themselves highly interesting, and which serve to give to this department of medicine the cha- racter of a science. A few have arranged the articles of the materia medica according to their chemical analogies alone. Burdach uses this mode of classifi- cation ; but his system is exceedingly complicated and imperfect. Arrangements of the materia medica founded exclusively on the physical properties of me- dicines are even more objectionable, in every point of view, than the alphabetical order. Without affording us the least instruction with regard to their therapeu- INTRODUCTION. vjj tic relations, they are necessarily very complex in their structure, and often bring articles together of the most opposite remediate properties. Cullen's ar- rangement, which is principally founded upon the general effects of medicinal agents, and partly also, in its minor subdivisions, upon their physical relations, is still viewed by many, and I believe justly too, as the most perfect classification that has hitherto been offer- ed upon this subject. But even this arrangement does not bring into view all those general analogies which subsist between the effects of medicinal substances, and which may be used with peculiar propriety as the basis of classic distinctions. Observation teaches us, for instance, that certain remedies direct their action specifically upon certain organs or structures in the animal economy. These specific affinities between external agents and the various parts of the living body are fundamental, and their notice is essential to a comprehensive and philosophical scheme of arrange- ment. Cullen, however, overlooked these particular views of the action of remedies, and founded his sys- tem on their ultimate medicinal effects alone. Thus the effect of opium in the living system is sleep. The VUI INTRODUCTION. medicine is, therefore, placed in the class of narcotics. This is well, so far as it goes. By this arrangement we at once know the general character of the effect; but we are not informed as to the particular organ or structure which is principally influenced, and by the peculiar excitement of which the more manifest effects are produced. If, however, we place the narcotics, as a genus, under the primary class of " medicines whose action are specifically directed to the nervous system," we exhibit at once, a general view both of the character of the effect, and of the organ principally concerned with the medicine in its production. Ali- bert, who saw the propriety of attending to this latter object, adopted a classification founded entirely upon the relations which remediate agents bear to particti- cular organs or structures, or, in other words, on their specific tendencies to affect particular parts of the or- ganization. His arrangement is, however, still more objectional than that of Cullen. It exhibits, it is true, an interesting physiological view of the connections which subsist between medicinal agents and the vari- ous subordinate systems in the living economy; but it wants those more useful practical distinctions derived INTRODUCTION. \x from the ultimate effects of remedies, and which con- stitute the basis of Cullen's classification. More recently Dr. Granville, of England, has pro- posed a new classification of the materia medica, which combines, to a degree, the advantages both of Cullen's and Aliberf s arrangements.* His primary or classic divisions are founded on the specific tendency of me- dicines to act upon particular organs, or systems of structure; and the old divisions of tonics, cathartics, &c. are introduced as secondary distinctions. This plan of arranging the materia medica appears to me to be superior to any that has hitherto been proposed. Dr. Granville has not, however, been altogether suc- cessful, I think, in the particular construction of his classification with regard to its minor divisions. He places stimulants, for instance, in the class of " medi- cines that act specifically upon the digestive organs;" whereas this genus undoubtedly belongs to his third class, which comprises those "medicines that act specifically on the circulating system." It may be said, however, that remediate agents of the stimulant * Vide London Med. and Phys. Journal, for April, 1822. VOL. I. 2 * X INTRODUCTION. class produce their effects upon the circulatory sys- tem, by a specific action primarily exerted upon the stomach; and that the location given to these medi- cines by Dr. Granville is, therefore, proper. But a1 though these remedies do certainly produce a primary excitement in the stomach, yet this primary impres- sion is constantly and specifically directed upon the circulatory system, where alone it becomes obvious. It is this ultimate effect alone which we consider of consequence, or which can be regarded as a mani- festation of the action of the stimulant. There are several other objections, of a similar character, which might be urged against the construction of this classi- fication, although its general scheme is unquestion- ably very good. It forms the ground-work of the arrangement which I have adopted in this treatise, and of which, without any further comment, I sub- join the following synoptical view: CLASSIFICATION OF THE MATERIA MEDICA. A. Medicines that act specifically on the Intestinal Canal, or upon morbific matter lodged in it. I. Medicines that excite discharges from the Alimen- tary Canal. a. Emetics. b. Cathartics. INTRODUCTION. XI II. Medicines calculated to destroy or counteract the influence of Morbific Substances lodged in the Alimentary Canal, a. Anthelmintics. b. Antacids. B. Medicines whose action is principally directed to the Mus- cular System. I. Medicines calculated to correct certain Morbid con- ditions of the System, by acting on the Tonicity of " the Muscular Fibre. Tonics. II. Medicines calculated to correct certain Morbid States of the'System, by acting on the Contractility of the Muscular Fibre. Astringents. C. Medicines that act specifically on the Uterine System. I. Medicines calculated to promote the Menstrual Dis- charge. Emmenagogues. II. Medicines calculated to increase the Parturient ef- forts of the Womb. y Abortiva. D. Medicines whose action is principally directed upon the Nervous System. I. Medicines that lessen the Sensibility and Irritability of the Nervous System* Narcotics. II. Medicines that increase and equalize the Nervous energy. Antispasmodics. E. Medicines whose action is principally manifested in the Circulatory System. xu INTRODUCTION. I. Medicines that increase the action of the Heart and Arteries. Stimulants. F. Medicines acting specifically upon the Organs of Secretion. I. Medicines that act on the Cutaneous Exhalants. §. General. a. Diaphoretics. §. Topical. b. Eftisfiastics. c. Errhines. d. Emollients. II. Medicines that increase the action of the Urinary Organs. Diuretics. III. Medicines that alter the state of the Urinary Se- cretion. Antilithics. IV. Medicines that promote the secretory action of the Salivary Glands. Sialagogues. G. Medicines thafcact specifically upon the Respiratory Organs. I. Medicines calculated to increase the Mucous Secre- tion in the Bronchia and to promote its discharge. a. Expectorants. b. Inhalations, H. Medicines whose action is purely Topical. Escharotics. A WIUBAV1ISIB OF MATERIA MEDICA AND THERAPEUTICS. CHAPTER I. Observations on the General Modus Operandi of Medicines. Whatever be our opinion with regard to the nature of animal life, certain it is, that the living economy is under the constant influence of extraneous causes, and subjected, by them, to an infinite variety of modi- fications. Concerning the essential nature of their action, however, it would be in vain to inquire. AH the information which seems to be attainable, in relation to their modus operandi, is, perhaps, a know- ledge of the organs upon which they primarily act; the medium through which their impressions are con- veyed throughout the system, and the successive order of the phenomena thence arising. The doctrines which prevail on this subject resolve themselves into the two following positions: 1. All vol. i. 1 2 MODUS OPERANDI medicines act primarily on the solids ; their impres- sions being conveyed through the system by the agency of sympathy. 2. Medicines are absorbed into the circulation, and act on the system through the medium of the blood. That the animal body possesses the faculty of transmitting impressions from one part to another, is an indisputable fact. Such a power is, indeed, essen- tial to the preservation of the living economy. The circle of vital actions would soon cease to revolve, were it not for some general connecting medium, by which the various organs of the body are brought into a mutual harmony and correspondence of action. The brain and its appendages—the nerves, constitute this connecting medium; for these parts alone receive and transmit impressions; and upon them, therefore, depend all those phenomena which are called sympa- thetic. This opinion has, however, been controverted on the score, as it is alleged, that sympathies exist between parts which have no direct nervous connec- tion with each other. It is not difficult to show, how- ever, that this objection is entirely without founda- tion; for it must be obvious to every one, on a mo- ment's reflection, that the nervous system brings every sentient and irritable part, under the immediate influ- ence of the sensorium commune, the brain; and that. therefore, all the parts of the body have a continuous nervous connection with each other, through the me- OF MEDICINES. g ilium of this common centre of feeling. That sympa- thetic actions are thus propagated through the system, may be inferred from the known laws of nervous excitement. An impression made on the nervous extremities of a part, is either altogether local or insulated in its effects, or it is communicated to the sensorium commune, whence it is reflected either upon the part in which the primary irritation exists, producing sensation in that part; or it is reflected upon other parts, exciting in them new motions and feelings. The fact, therefore, of the existence of sympathetic communications, and of their agency in propagating remediate impressions throughout the system, is incon- testible. It is, however, no less true, that many medicinal articles are absorbed into the circulation, and that they act on the animal economy through the medium of the blood. This opinion having been warmly contested of late, and rejected as " a relict of the humoral pathology," it may not be improper to enter into a particular ex- amination of the grounds upon which it is founded, and of the objections that have been urged against it. Before I enter more directly upon the proofs of the admission of remediate substances into the circu- lation in an indecomposed state, I shall make a few observations concerning the so common want of suc- cess in detecting, in the blood, certain substances re- 4 MODUS OPERANDI ceived into the stomach, or otherwise subjected to the action of the absorbents. Dr. Wollaston states, that he gave a person three and a half grains of prussiate of potash repeated every hour to the third time. The urine being examined every half hour, was found, in two hours, to be tinged, and to afford a deep blue, at the end of four hours. But in the serum of the blood which was then drawn, no prussiate could be detected. This experiment is, however, extremely fallacious. In the first place it must be observed, that probably but a small portion of the ten and a half grains of the prus- siate received into the stomach, was taken up by the lacteals. But this small portion could not have entered the circulation at once; it must have been introduced very gradually into the chyle; and as the kidneys, no doubt, commenced separating it again, as soon as any part of it was present in the circulation, it is obvious that but a very minute quantity indeed, could, at any particular time, have existed in the blood. It is, therefore, not to be wondered, that he could not detect this substance in the serum of blood drawn after the greater part of that which had been absorbed had already appeared in the urine, and consequently passed out of the circulation. For the portion of prussiate present in the blood, was not only very small, but was diffused through a mass of at least twenty-four pints of fluid. The urine, on the contrary, having gra- dually collected the prussiate, held in less, perhaps, OF MEDICINES. 5 than a pint, a much greater quantity of this substance than could have been present at any one time in the whole mass of the blood. Now, from the experi- ments of professor Macneven, it appears that it re- quires one-eighth of a grain to two ounces of serum before it can be detected by the most delicate tests.* It would, therefore, require more than ten grains of this substance in the blood, before it could be detected, supposing the serum to amount to about twelve pints. Hence, it is evident, that no inference can be drawn from experiments of this kind, which deserve to be regarded as militating against the opi- nions I am advocating. I have detected one-sixtieth of a grain of the prussiate in one ounce of urine; which accounts for the ease with which this substance is detected in this secretion, whilst in the serum it escapes our tests. It may also be observed that the articles usually employed in experiments of this kind, have a tendency to pass off very rapidly by the kidneys. It would seem that almost as soon as some of them arrive in the circulation they are again eliminated by the emunctories; and hence, although the urine may be- come highly charged with such substances, yet the blood, being so soon deprived of them again, shall con- * Experiments for ascertaining the Permanency of Chemical Com- pounds in their passage through the Fluids, in the New-York Medical and Physical Journal, June, 1822. 6 MODUS OPERANDI tain but a very minute portion, and this diffused through a large mass of fluid. Hence, too, we have an explanation of the fact, that certain substances, after having been received into the stomach or in- jected into the cavity of the abdomen, may be detected in the mesenteric veins, vena portarum, splenic veins, and thoracic duct, whilst in the blood generally no traces of their presence can be discovered. For, as many of the abdominal lymphatics open directly into the veins just mentioned, it is evident that the sub- stances which these lymphatics absorb and convey into the veins in question, must be in a much less diluted state than they can be after being mixed with the general circulating mass. If we admit the exist- ence of venous absorption, an opinion advocated by very high authority,* this explanation will be still more satisfactory. Great, however, as are the difficulties which exist in experiments of this kind, we are not without many well authenticated facts which prove the admission of foreign substances into the circulation. In the chyle of the thoracic duct, Musgrave, Lister, and Blumen- bach detected substances which had been thrown in- to the intestines of animals. But not to dwell on the testimony offered upon this subject by the older writers, we have abundant evidence of the existence * Magendie, Emmert. OF MEDICINES. 7 of this physiological fact in the researches of many of the most enlighted physiologists of the present day. The experiments of Mayer,* of Home,f of MagendieJ and the more recent and satisfactory researches of professors Tiedeman and Gmelin§ do not leave any doubt on this point. The experiments of the latter two physiologists prove, in a direct and conclusive manner, that almost all those substances which are usually found in the urine, after having been taken into the stomach, may be detected by proper manage- ment, in the serum of the blood of the venae portae, the splenic and mesenteric veins. These facts have been lately confirmed, by an extensive course of experiments on this subject by Drs. Harlan, Coates, and Lawrence, of this city. From the interesting and well digested report which these gentlemen have just published, of the results of their inquiry, it appears in positive evidence that camphor may, and does pass through the circulation. Having given a tabular view of sixteen experiments on living animals, they observe: " It is impossible to look over the above table with- out being struck with the obvious manner in which * In Meckle's Archiv fur die Physiologic f Philosoph. Trans, for 1811. t PreVis Elementdire de Physiologic § Versuche iiburdie wege, auf welchen substanzen aus dem magen und Darmcanal ins bhit gelangen, u. s. w. Von. F. Tiedeman, M. D. und I.. Gmelin, M. D. Heidelberg, 1820. 8 MODUS OPERANDI they indicate the route by which the chemical sub- stance (prussiate of potass) experimented on en- tered the circulation. In nearly every instance in which it ivas found in the blood, the contents of the thoracic duct, if examined, exhibited it in a much more obvious degree."* Still more recently, professor Macneven, in the able paper already quoted, has pub- lished the results of some experiments on the subject, which are entirely confirmatory of those I have al- ready mentioned. " I triturated/' says he, " one drachm of chrystallized hydrocyanate of potassa with fresh butter and crumbs of bread, which being made into a bolus, the same dog swallowed and retained. Between three and four hours after, Dr. Anderson bled him largely from the jugular vein. A dose of hydrocyanic acid was then administered, of which he died without pain, and the abdomen was laid open. The lacteals and thoracic duct were seen well filled with milk-white chyle. On scratching the recepta- culum, and pressing down the duct, nearly half a tea-spoonful of chyle was collected. Into this were let fall a couple of drops of the solution of permuriate of iron, and a deep blue was the immediate conse- quence." In another experiment of this kind Dr. Macneven found that, "whenever the mesenteric vessels, or the external coats of the intestines were * Philadelphia Journal of the Medical and Physical Sciences, for Feb. 1822. OF MEDICINES. 9 lightly scratched with the scalpel and touched with the solution of permuriate of iron, a strong blue was immediately exhibited." My friend, Dr. Ducachet, obtained a similar result in an experiment which he performed on this subject* The facts which have already been detailed, are, I think, quite conclusive on this point. It may not, however, be uninteresting to adduce a few other ob* servations in evidence of the admission of foreign substances into the circulation. Emmert, an emi- nent German physiologist, relates an experiment,! in which he passed a ligature round the abdominal aorta of an animal, and inserted the prussic acid into its legs. The extremities became cold, but some portion of irritability and sensibility remained. In seventy hours after its application the ligature was removed, and the effects of the poison immediately showed themselves. Similar experiments were per- formed with the poison woorara, by Mr. Brodie.| " He exposed the sciatic nerve of a rabbit in the upper and posterior part of the thigh, and passed under it a tape half an inch wide. He then made a wound in the leg, and having introduced into it some of the woorara mixed with water, he tied the tape moderate- ly tight on the forepart of the thigh. He thus inter- * New-York Medical and Physical Journal, No. II. April, 1822, | Archiv fur die Physiologie, Von. 1. F. Meckle. i Philosophical Magazine, June, 1811. VOL. I. 2 JO MODUS OPERANDI rupted the communication between the wound and the other parts of the body, by means of the vessels, while that by means of the nerves still remained. After the ligature was tightened, he applied the woorara a second time, in another part of the leg. The rabbit was not affected, and, at the end of an hour, he re- moved the ligature. Being engaged in some other pursuits, he did not watch the animal so closely as he could otherwise have done, but twenty minutes after the ligature was removed, he found him lying on one side, motionless and insensible, evidently under the influence of the poison." It appears, therefore, from these experiments, that the poisons employed had no power of affecting the system until they had entered the general circulation. Brodie's researches render it, indeed, extremely probable that woorara, as well as several other poisons, produce their deleterious ef- fects on the animal economy, by acting directly upon the brain, through the medium of the blood, and that they are not injurious unless they are absorbed into the blood-vessels. Besides the evidence of direct experiment, there are many other facts mentioned in the writings of physi- cians, which go to prove the absorption of foreign substances into the circulation. The effects of the internal use of nitrate of silver on the skin, is a striking fact in confirmation of this opinion. A considerable number of cases have been related, on the most re- OF MEDICINES. J [ spectable authority, in which the skin acquired a very dark, and, in some instances, quite a black colour, from the long continued use of this medicine.* It is well known, too, that medicines taken by nurses very often produce the same effects upon their suckling in- fants, as if these had taken the medicine directly into their stomachs. It is a fact equally well known, that the milk of cows becomes imbued with the odour and taste of the vegetables on which they feed. I am well aware, that it is denied by some, that these facts can be regarded as evidence of the transmission of foreign substances into the circulation. It is said,. for instance, that the process of assimilation com- pletely decomposes all substances subjected to its in- fluence; that, consequently elementary particles alone are admitted into the blood-vessels; and that these are recombined, and again rendered conspicuous when thrown into the secretions. That substances taken into the stomach, or other- wise subjected to the action of the absorbents, are not necessarily decomposed before they are admitted into the circulation, is fully demonstrated by what has already been said. Admitting, however, that the assimilating powers do decompose the substances subjected to their action, it does not, I think, form any valid objection to the ^ Lond. Med. Reposit. vol. v. May, 1817. J 2 MODUS OPERANDI doctrine which alleges, that the blood may become imbued with properties capable of producing reme- diate or morbific impressions, in consequence of the admission of certain substances into the circulation. When the milk, urine, flesh, &c. become impregnated with the peculiar qualities of substances taken into the stomach, the blood, from which these secretions are formed, must have contained either the substances themselves or their elements. It is evident, however, that blood which contains such elements, contains parts which do not belong to it in its natural and healthy state. Thus, in the instance given above, in relation to the discoloration of the skin by the inter- nal use of the nitrate of silver, if the substance were previously decomposed, and again regenerated in the skin, as has been alleged, we should then have silver, oxygen, and azote floating in a separate state in the blood, and without which no nitrate of silver could possibly be afterwards regenerated in the cutaneous vessels. In opposition to the opinion that remediate sub- stances enter the circulation in an active state, it is asserted in a late work on the Materia Medica, that " chyle, however diversified the materials may be out of which it is formed, whether animal or vegetable, has essentially an identity of nature/' This assertion is, however, entirely gratuitous, and contradicted by direct experiment. Dr. Marcet found that chyle OF MEDICINES. ] 3 formed from vegetable food contains nearly three times as much carbon, as that which is formed from animal food; and that the chyle from animal sub- stances, for the most part, enters into putrefaction in three or four days, whilst that from vegetables will remain unchanged for weeks, or even months. It moreover appears from these experiments, that chyle from animal food, is milky, and that, on standing, it becomes covered with a cream-like substance; whilst that from vegetable food is, generally, transpaient, resembling common serum, with a coagulum almost colourless, and does not collect a creamy substance on its surface.* There is, therefore, a very striking difference between the chyle formed from animal and vegetable substances. It has also been objected, " that it is incompatible with animal life that such active substances should be received into the circulation, since milk and other bland fluids have been known, when injected into the vessels, to occasion immediate death." It cannot be denied that substances forced into the circulation by a springe, and of a reduced temperature, may, and in fact genet ally do, occasion death. Such violent effects do not, however, always follow experiments of this kind. Drs. Smith, Wahrendorf, Borrichius, Magendie, and others, injected medicines into the veins of persons, and found them to produce the same effects as if they * Medico-Chirurg. Transact, vol. vi. p. 630. 14 MODUS OPERANDI had been received into the stomach. Sir E. Home performed similar experiments, and demonstrated anew that remediate substances may be thus intro- duced into the system, not only without fatal conse- quences, but with the same effects as if they had been taken internally. The experiments of Dr. Smith and Sir E. Home are published in the Transactions of the Royal Society of London. Although the introduction of foreign substances into the circulation, by means of an injecting apparatus, may often give rise to dangerous or fatal consequences, it by no means follows that the same violent effects must ensue from the introduction of the same articles into the blood, through the regular route of the ab- sorbents. In the one case, the substance introduced is suddenly and forcibly urged into the blood-vessels; whereas in the other, it passes into the veins, drop by drop, without any unnatural impetus, enveloped in bland and congenial fluids possessing the precise temperature of the blood. In confirmation of the correctness of this view of the subject, we need only advert to the fact, that chyle itself, when injected into the blood-vessels, will produce the same injurious effects that follow the introduction of other articles in the same way. It has also been said: "By the medication of the blood, were it possible, as is contended for, we must, in all instances, do harm. The whole mass of the OF MEDICINES. j .', circulating fluids is equally charged in this case with the medicinal substance, and therefore, while an action is going on in a diseased organ which may be salutary as to it, every sound part of the system becomes sub- jected to a similar impression, which could not fail to disturb the order of health, and create morbid de- rangements." To this hypothetical objection, I will oppose the observations of one of the editors of the New-York Medical and Physical Journal. "That every organ in the body/' says the writer, " has its peculiar and appropriate stimulus, by which it is ex- cited into action, is so universally admitted as to re- quire no process of reasoning to establish it. If this be so, then there can be but little difficulty, we think. in conceiving that a substance dissolved in the blood may circulate through the system, without producing any particular effects, until it reaches the organ upon which, from its peculiar properties, it is designed to operate. The reason why a medicine acts upon one organ in preference to all the other organs of the body,—why jalap, for instance, operates upon the intes- tines, and not upon the brain and lungs,—we can no more explain than we can the reason why the planets are kept revolving in their orbits. If we are told that the movements of the planets are the result of attrac- tion, so we may say that the determination of medi- cines to certain organs is occasioned by a similar attraction. This, however, explains nothing, and we 16 MODUS OPERANDI must, after all, be content with the broad fact, that such phenomena do occur, and that they are governed by certain laws; but the cause why they occur, must for ever remain concealed." I would not have thought it necessary to enter so minutely into this subject, had I not read, in a recent work of great pretensions, and which is much in the hands of medical students in this country, that " the ancient notion which would refer the operation of medicines to their entrance into the circulation, is per- fectly gratuitous, originating at a period of darkness, and when medicine was comparatively in its infancy, and is now abandoned by every one whose intelligence has at all kept pace with the progress of our science."* This is, indeed, a very extraordinary assertion, and well calculated to deceive minds who have not yet examined for themselves. Instead of this doctrine being abandoned by every one whose intelligence " has at all kept pace with the progress of medical science," it is well known, that the contrar) is the case,—that the most eminent writers and physicians of the age, believe in the admission of certain reme- diate substances into the circulation. If this unqua- lified declaration be correct, then we mu.st admit, that Armstrong, Paris, Murray, Alibert, Home, Aberne- thy, Cook, Johnson, Hosack—we might mention almost every respectable medical writer of the day, * Chapman's Elements of Materia Medica and Therapeutics. OF MEDICINES. |^ have not kept pace with the progress of our science, but that the author of the Elements of Therapeutics alone possesses this enviable advantage. From the foregoing observations, therefore, it is, I think, perfectly evident, that medicines may produce remediate impressions in both the ways mentioned in the beginning of this chapter. This, indeed, is the generally admitted doctrine on this subject, with all those who have " kept pace with the progress of medi- cal science." vol,. I. H CHAPTER II. A. MEDICINES THAT ACT SPECIFICALLY ON THE IN- TESTINAL CANAL, OR UPON MORBIFIC MATTERS LODGED IN IT. I. Medicines that excite Discharges from the Alimen- tary Canal. EMETICS. An emetic is a substance which excites vomiting by a specific, impression on the stomach, independent of mere distention from quantity, or of nauseous taste or smell. With regard to the mechanism of vomiting, experi- ments, apparently equally fair and conclusive, have led to very opposite results. Chirac,* a French phy- sician of the 17th century, published an account of some experiments which he had performed on living animals, with a view of ascertaining the particular process of vomiting. The" conclusions which he drew from his experiments are, that in the act of vomiting * Histoire de l'Academie Royale des Sciences, P. 12, An. 1709. EMETICS. 19 the stomach is quiescent, and that its contents are ejected solely by being forcibly compressed between the diaphragm and abdominal muscles. Magendie, without alluding to the experiments of Chirac, has lately arrived at the same conclusions, from a set of experiments he performed on this subject. The ex- periments of Haighton, on the contrary, seem to prove, very conclusively, that vomiting is chiefly, if not en- tirely, effected by the contraction of the muscular coat of the stomach; and this opinion is now almost uni- versally entertained on this subject. There can, how- ever, be but little doubt, that all the powers that have been mentioned, conspire to produce the act of vomit- ing. The stomach contracts, its peristaltic action is inverted, the diaphragm and abdominal muscles are brought into action, and thus, by the combined agency of all these powers, emesis is produced. How do emetics excite these actions of the stomach and muscles concerned in vomiting? The speculations of Darwin on this subject, though, perhaps, untenable upon the whole, are not without considerable plausi- bility. He alleges that the excitement of the stomach is greatly diminished by the action of an emetic; in consequence of which its peristaltic motion becomes inverted. When nausea is produced, (says he,) the stomach, as well as the whole system, is in a state of temporary debility. As the nausea increases in in- tensity, the natural powers of the stomach are more <2Q EMETICS. and more diminished, until they cease altogether, and give rise to an inverted motion of its muscular fibres. In confirmation of this view of the subject, he refers to the vomiting produced by causes manifestly debili- tating, such as syncope, concussion of the brain, &c. It is impossible to ascertain the precise nature of the changes which take place in the living system from the operation of extraneous causes. All that we can hope to arrive at in this respect, is a know- ledge of the general character and order of pheno- mena; a point, indeed, which it is but seldom allowed us to attain. When an agent is applied to the system, a longer or shorter train of actions occurs intermediate between the application of the cause and its ultimate or characteristic effect. In proportion as we trace these successive links in the chain of actions which results from the operation of a remedy, so do we succeed in attaining a knowledge of its modus ope- randi. With regard to the operation of emetics, therefore, we may trace, I think, the following series of actions. The emetic, in the first place, makes an impression on the sentient extremities of the nerves of the stomach. This impression is immediately re- ferred to thesensorium commune; in consequence of which its natural energies are diminished, as is evinced by the languor of both the intellectual and Corporeal powers. But as the sensation of an irritated organ depends, in reality, directly on a peculiar excitement EMETICS. 21 in the sensorium commune, so we may infer, that the sensation of nausea is the immediate and necessary result of the diminished and peculiar cerebral excite- ment, referred to the stomach. That this is, in fact, the case, is demonstrated by the vomiting and nausea which is sometimes excited, at the sight, smell, taste, or even the thought of a disgusting object. Here, however, our progress is arrested. For we can trace no necessary connection between nausea and the me- chanical process of vomiting. We know not why a certain degree of nausea produces contractions of the organs concerned in this act, any more than we know, why a certain degree of venereal excitement calls into action the muscles concerned in ejectione seminis. These are mysteries, locked up in the bosom of our Creator, and about which it would be idle to spe- culate. When an emetic is taken, an uneasy sensation is first felt, which is sooner or later followed by nausea; this gradually grows stronger and stronger, while the pulse becomes feeble, frequent and irregular; the face turns pale and the skin becomes cold and shrunk: vomiting finally comes on, during which the face is red and turgid with blood. On the cessation of the vomiting the sickness goes off, leaving the system in a state of temporary languor, from which it soon re- covers. Contrary to what takes place with the operation of 22 EMETICS. other articles on the animal economy, emetics increase by repetition, the susceptibility of the stomach to their impressions. Cullen states that he knew a person so accustomed to excite vomiting in himself, that the one- twentieth of a grain of tart, antim. was sufficient to excite a convulsive action of the stomach. The evacuation produced by an emetic, is not merely confined to the stomach, but extends occa- sionally also to the duodenum, and even further. During the act of vomiting, there must be a consider- able pressure exerted upon the liver and gall-bladder, by the contraction of the diaphragm and abdominal muscles. In consequence of this a more copious discharge of bile into the duodenum takes place;* and this effect is facilitated by the relaxation which the previous nausea induces in the common duct. The bile, being therefore more copiously thrown into the duodenum, during the first efforts of vomiting, is readily conveyed to the stomach, both by the inverted motion of the intestine, and the pressure of the ab- dominal muscles. It is obvious, from this, that the first contents of the stomach may be thrown off with- out any admixture of bile, and yet, after one or two acts of vomiting, by which the contents of the duo- denum are brought into the stomach, this fluid may be copiously discharged. When, therefore, we do not observe any bile thrown off, until several full * Cullen's Materia Med. EMETICS. 03 evacuations have occurred, we may conclude that it did not previously exist in the stomach, but was brought into it by the preceding acts of vomiting. In c*holera, we generally find no bile in the dis- charges, until vomiting has continued for some time. In this case, the bile is undoubtedly furnished from the gall-bladder, which being compressed by the ac- tion of the diaphragm and abdominal muscles, during the acts of vomiting, pours its contents into the intes- tines. From this circumstance, therefore, we derive a caution against the imprudent repetition of vomits, on finding bile in each succeeding discharge, under the fallacious idea of expelling the whole of it from the primae vise. Besides the mere discharge of the contents of the stomach, vomits are useful by agitat- ing and compressing the abdominal viscera; and there- by giving a more vigorous impulse to the circulation in the portal vessels. They are, on this account, ad- vantageously employed, in diseases attended either by internal congestions, or where the circulation in the abdominal organs is morbidly sluggish. Vomits are moreover beneficial by the general shock which they give to the nervous system. It is by an influence of this kind, perhaps, that they are sometimes capable of arresting fevers, when administered in their form- ing stages. It has been satisfactorily ascertained, that effused fluids are often rapidly diminished during the opera- 24 EMF.TICs. tion of emetics, and hence it is inferred that they increase, either in a direct or indirect manner, the activity of the absorbents. Dr. Chapman supposes that there is a kind of antagonising power between the ab- sorbents and the blood-vessels; in consequence of which the activity of the former set of vessels, is indirectly in- creased from the operation of emetics by the reduction of the arterial action which they create. The cir- cumstance of a more rapid disappearance of effused fluid, during the employment of emetic remdies, ad- mits, however, of an explanation more philosophical, and, I think, satisfactory. When an effused fluid ac- cumulates in the body, it must be owing either to too rapid an exhalation from the arteries, or too slow an absorption by the lymphatics. Whichsoever be the case, it is quite certain that if we lessen the action of the exhalent vessels, the quantity of the effused fluid must diminish, although the action of the absorbents remain unaltered. It is in this way, therefore, I presume, that emetics act when they diminish dropsi- cal accumulations. They lessen the action of the heart and arteries, and consequently diminish exha- lation. If the lymphatics, therefore, preserve but their ordinary powers, they will diminish the quantity of collected fluid, or at least greatly retard the pro- gress of its ordinary increase. This effect, namely, diminished exhalation into the internal cavities, and consequent diminution of the fluid already collected, EMETICS. 25 may be further enhanced by the tendency which emetics have to determine the circulation from the internal to the external surface. With regard to the influence of emetics on the brain, I have already stated, that they appear to have an immediate power of diminishing its energies. They are, therefore, useful in diseases of the mind, at- tended by a morbid irritability of the brain, from their immediate influence in repressing this condition. They are, however, equally useful in mental diseases of an opposite character,—where the brain is in a state of torpor, as in hypochondriasis. But, as this disease is, for the most part, attended, and greatly influenced by abdominal congestions, as well as a sluggishness of the portal circulation, emetics would seem to produce their good effects in it chiefly by the agitation which they give to the body, and the activity they thereby impart to the abdominal circulation. They, however, undoubtedly also produce a new excitement in the brain, by the more direct influence which they excite upon this organ through the medium of the gastric nerves. In prescribing emetics, care must be taken that we do not administer them when there is much fulness of the vessels of the head, or where symptoms of general plethora exist, without premising an adequate detraction of blood, lest by the exertions during the VOL. i. 4 2Q EMETICS. act of vomiting, some blood-vessel burst, and apoplexy or dangerous haemorrhage be induced. From the extensive influence of this class of reme- dies on the animal economy, it may be readily con- ceived, that their remediate application must be vari- ous and important. In a great number of diseases. indeed, they are indispensable, at some period or other of their progress. I shall now, therefore, proceed to give a more particular detail of their practical applica- tion. Emetics constitute a very important class of reme- dies in febrile diseases. In the treatment of typhus. when exhibited in the forming stage of the disease, they often arrest its progress in a very prompt manner. "Antimonial emetics," says Dr. Armstrong, "have been very generally recommended in typhus fever, and, according to my observation, are serviceable when the fever is of the least complicated form, commonly producing an improvement in the condition of the skin, respiration, and pulse in particular; and, perhaps, it is on the power which they possess of de- termining the blood to the surface, and of changing the morbid states of the circulation, that their efficacy depends."* In typhus pneumoniea I have derived much ad- fantage from emetics, in every stage of the disease. They appeared to be particularly serviceable where * Armstrong on Typhus. Amer- edit. p. 94 EMETICS. 27 much distress and pain in the thorax, with signs of in- ternal congestion, were present. In such cases they promoted expectoration, and tended to re-establish the equilibrium of the circulation. They, moreover, tended to render the system more susceptible to the operation of stimulants. " In the typhoid and typhus pneumonica," says professor Potter, " that occasioned such lamentable mortality, of late years, throughout the United States, emetics, judiciously employed, were more beneficial than any other remedy. It was, in- deed, a novel spectacle to those who were accustomed to unsheath the lancet in almost every thoracic affec- tion, to behold a pneumonic fever, perhaps a hemoptoe, removed by the incantation of a single emetic." Emetics have also been recommended in the vari- ous forms of malignant fever. In the beginning of some fevers of this character, they may occasionally prove beneficial, though, as a general rule of practice, their employment is to be regarded of doubtful efficacy, eyen in the earlier stages of such fevers; and, in their advanced periods, for the most part, injurious. In iutermittents vomits area very common remedy. They, indeed, not unfrequently put a stop to the dis- ease, without the employment of any other medicine. There exists some difference of opinion with regard *to the in^ortance of exhibiting emetics, as a prepara- tive for tonic remedies. Judging from my own ex- perience, I am led to believe, that an emetic will, in gft EMETICS. general, render the subsequent employment of bark more certainly successful; and this seems to be in accordance with the sentiments of many of the best writers on this subject. Independent of the general impression which emetics produce on the system, and which, of itself, must aid in breaking through the chain of morbid associations, they appear to render the stomach more sensible to the impression of other remedies, and consequently give them a greater chance of displaying their full powers. In some of the exanthemata, emetics are often of essential service. They are especially useful in the early stage of scarlatina, both in its simple and malig- nant form. When aided by the warm bath, they tend to " free the system from the pressure of the plethora of the internal blood vessels, so frequently observed in the commencement of this disease, and by thus equal- izing the whole circulation, to render the future case most commonly mild and manageable."* Emetics have also been strongly recommended in some varieties of erysipelas. In the bilious erysipelas, which Desault regards as the common and genuine form of this disease, he trusted entirely to antimonial emetics. Renauldin, author of the article Erysipele, in the Dictionarie des Sciences Medicates, also adds his testimony in favour of the use of eme&s in this affection. * Armstrong on Scarlet Fever, p. 35. EMETICS. 29 In the first stages of measles and small-pox, when the chest seems to be threatened by an oppressive topical determination of blood, vomits are strongly in- dicated, and will, in general, afford very great relief. " In the beginning of measles," says Dr. Armstrong, " when the lungs have been exceedingly oppressed, and particularly when vomiting has been absent, I have often seen the most striking relief follow an anti- monial emetic, which may fairly be ranked among the most efficacious remedies in pulmonic congestions."* Emetics constitute an important auxiliary in the treatment of many of the phlegmasiae. In puerperal fever they were at one time in high repute. Where there is nausea and bilious vomiting in the beginning of the disease, one or two gentle emetics may be em- ployed with advantage. They cannot, however, be relied on as a principal remedy in the cure of this dan- gerous affection, and may, I think, be always omitted with propriety, except under the peculiar circum- stances just mentioned. In the treatment of croup, this class of remedies is of more unquestionable advantage. They are, indeed, altogether indispensable in managing this formidable malady, and will often procure effectual relief without any other remedy. In slight attacks, emetics, assisted by the warm bath, and the application of rubefacients * Practical Observations on Scarlet Fever, Measles, and Pulmonan Consumption, p. 130. 30 EMETICS. to the throat, will, in general, suffice to give a perma- nent check to the disease. But where the febrile symptoms run high, and the breathing is very difficult, bleeding is our sheet-anchor. Whenever, therefore, vomiting and the warm bath do not afford effectual and speedy relief, immedi- ate recourse ought to be had to the lancet. The bleeding should be carried to the extent of producing a decided impression on the system. " In all the cases of croup," says Dr. Ferriar, " which I have seen, I have found it necessary to bleed immediately, and when I have seen the patients sufficiently early to en- tertain hopes of saving them, I have directed the eva- cuation to be continued, so as nearly to produce faint- ing. This is the essential point of the cure, without which no relief can be effected. Even if the patient should not be seen till the day succeeding the attack, it is proper to bleed ad deliquium, if the subject be plethoric and the difficulty of breathing and restless- ness be great."* Independent of the relaxation which a decisive bleeding produces in the glottis, and the check which it gives to the tracheal inflammation, it has also the effect of greatly facilitating the operation of emetics, by removing the cerebral congestion, and the consequent insensibility of the stomach to the ac- tion of remedies. * Ferriar's Medica! Histories and Reflections, p. 137. Philadelphia edi 'ion, 1816 EMETICS. 31 The emetics should be continued at intervals until the disease is completely subdued. In the latter stages of the complaint they are useful by assisting to dis- charge the viscid mucus secreted in the bronchia. Emetics are also of great advantage in the other species of cynanche. In the commencement of cy- nanche maligna, an emetic will often afford evident advantage, and sometimes at once arrest the pro- gress of the disease. By this practice " we never fail to bring off a considerable quantity of acrid matter, which, by getting into the bowels, might induce a diarrhoea; an affection to be avoided by every possible means, as always adding to debility, and endangering the life of the patient." In cynanche laryngea, undoubtedly the most fatal variety of anginose disease, vomits have been known to afford unequivocal advantage. Dr. Armstrong, whose authority is entitled to very great respect, re- commends the employment of emetics in this fatal af- fection, as one of the most effectual means in our power for arresting its progress. He states, that in five cases of this disease, he exhibited "tartarized antimony, sometimes combined with ipecacuanha, in repeated doses, until free and frequent vomiting took place. No circumstance of my professional life," he continues, " ever gratified me more than the great and sudden relief which the vomiting afforded; in reality it removed all the urgent symptoms at the time, and 32 EMETICS. being excited as soon as ever the slightest signs of stricture in the larynx returned, at last completed the recovery."* Emetics are frequently very beneficial in the treat- ment of peripneumonia notha, where the inflammatory condition has been in some degree subdued, or where the stage of excitement has never developed itself fully from a strong tendency to oppressive venous conges- tions, emetics, in repeated, but gentle doses, are more useful than any other remedies we can employ. The patient generally brings up a large quantity of slime, and finds almost immediate relief. After the opera- tion of the emetic, suitable stimulants, such as small doses of opium and camphire, with some gentle dia- phoretic drinks, should be employed.f Of course blisters to the chest are never to be neglected. They are indispensable to relieve the local pulmonary af- fection. Emetics are no less useful in the treatment of pneu- monia biliosa, than in the preceding variety of pulmo- nic inflammation. Richtei\ says that they will often remove the excruciating pain in the thorax, as if by enchantment. Stoll§ also speaks in the highest terms of the utility of emetics in this form of pleurisy. Pro- * Armstrong's Practical Illustrations on Typhus Fever. American edit. p. 336. f Richter's Specielle Therapie, vol. i. p. 427. * Ibid. vol. i. p. 404. § Ratio Medend. vol. i. EMETICS. 33 fessor Potter, of Baltimore, in an interesting paper published in the Medical Recorder, adds his testimony in favour of this practice. " Experience has taught us," says he, " that they (emetics) are eminently use- ful after the violence of inflammatory action shall have been abated, as well as in all the milder degrees with which this disease so frequently commences."* I have never met with a case of this disease, and have, therefore, nothing to add from my own observation. In the treatment of every variety of acute ophthalmia, vomits have been recommended as particularly ser- viceable. By many very respectable writers, emetics are highly praised for their virtues in the cure of acute rheumatism. Hornf states, that he found emetics more useful in this disease than any other remedy. He repeated them every day, until from fifteen to twenty had been given. The result of this practice, he informs us, was exceedingly happy. There is a form of rheumatism, which occurs in low and marshy situations, and which Richter calls rheumatismus acu- tus gastricits, depending, according to Stoll, on an irritation from vitiated or redundant bile in the primae vise,f in which emetics are of unquestionable service. * Medical Recorder, vol. iv. p. 418. f Uber die heils. wirk. der Brechmittel in hitzigen rheumat. D. Archiv b. viii st. 2. $ Ratio Med. torn. ii. p. 25. VOL. I. 5 34 EMETICS. Lentin* also speaks of rheumatism connected with a bilious form of fever, in which he found vomits to produce very beneficial effects. Haygarth informs us, that, preliminary to the use of bark, in acute rheu- matism, he was in the habit, " of giving either the antimonial powder or tartarized antimony, generally the former, till the stomach and bowels were suffi- ciently cleansed."! Scudamore also speaks favourably of the employment of vomits in this disease. " If the patient be seized," says he " in consequence of exposure, shortly after some convivial occasion, on which he has indulged in improper diet, the present remedy should not, on any account, be neglected."! I have occasionally met with acute rheumatism, at- tended with manifest bilious symptoms, and in these cases I have employed emetics with much advantage. In the purely inflammatory form of this disease, unin- fluenced by the miasmata which produce our autumnal bilious fevers, I have, however, n^ver exhibited these remedies, and can, therefore, say nothing from my own experience of their value in such cases. Emetics have also been strongly recommended in gout. Scudamore thinks that they should not be used, " unless an evacuation of the stomach in a full degree is obviously indicated." He mentions a case, how- * De aere et morb. clausthal. p. 30. f Cilnical History of Rheumatism, &c. part i. p. t A Treatise on the Nature and Cure of Gout and Rheumatism, p. 298, EMETICS. 35 ever, in which the good effects of an emetic were strongly exemplified. Mr. Alexander Small, surgeon at Minorca, speaks in very high terms of the efficacy of tart, antim. in his own case of gout. He some- times gave it with bark, in which combination it acted as a mild aperient* Mr, Saundersf was in the habit of employing tar- tarised antimony so as to excite nausea, or full vomit- ing, in acute ophthalmia, with great success. In that variety of inflammation of the eyes, called Egyptian ophthalmia, Sir W. Adams speaks of the use of emetics in the strongest terms of praise. In gutta serena, also, emetics have been administered with very considerable advantage. Richter, who con- sidered the cause of this disease as seated in the ab- dominal viscera, employed them much in conjunction with the deobstruent pills which will be hereafter men- tioned, under the head of antispasmodics.! Of the propriety of employing emetics in haemop- tysis, I have great doubts, although there is not want- ing very respectable testimony in favour of this prac- tice. When we attend to what takes place during the operation of an emetic, it is difficult, I apprehend, to * Observations on the Gout, by A. Small, late surgeon to the ordnance .n the island of Minorca, in the Med. Observ. and Inquiries, vol. vi. p, 198. f A Treatise on some practical points relating to Diseases of the Eye, by I. C Saunders. t Richter's Medical and Surgical Observations, p. 254. 3fl EMETICS. enter upon the employment of vomits in the cure of this variety of haemorrhage, as recommended by Dr. Bryan Robinson, without entertaining considerable fears as to the result. During the process of vomiting there is a strong impulse given to the circulation; a full inspiration is made, by which the lungs become expanded, and a greater facility given to the escape of blood from the bleeding orifice.* Besides these ef- fects, there is undoubtedly some impediment created to the passage of the blood through the abdominal aorta, in consequence of the action of the abdominal muscles and diaphragm; and of course there will be a greater impetus given to the blood through the supe- rior arteries. It is true that both before and after the act of vomiting there exists a very considerable lan- guor in the circulation, which might favour the sup- pression of the haemorrhage; and if these remedies be exhibited only to the extent of inducing nausea, there can be no doubt of their being, in some degree, advantageous. The agitation and straining, however, during the efforts of vomiting, might very readily pro- duce much more mischief, than could be compensated by any advantage that might be derived from the sub- sequent languor. Cullen, indeed, who tried this practice states, that in one instance it increased the haemorrhage to a great and alarming degree. * An Essay on the Materia Med. by. J. Moore, p. 320. EMETICS. 3| In haemorrhages from the uterus there are, T think, much better grounds for expecting useful effects from the operation of this class of remedies. Independent of very respectable testimony in favour of the use of emetics in this variety of haemorrhage, we have a good anatomical reason, both for the advan- tages of vomits in menorrhagia, and for their occasion- al injurious effect in haemoptysis. During the act of vomiting, the abdominal muscles and diaphragm are thrown into a state of violent contraction. The natu- ral consequence of this is a degree of pressure on the abdominal aorta, both where it passes through the crura of the diaphragm, by the contraction of this muscle, and in its course through the abdomen, by being com- pressed in common with the other contents of this cavity. Hence there will be a slight impediment to the passage of the blood to the lower portions of the body, whilst it will be more forcibly driven into the vessels which pass off from the aorta within the thorax. The reason is, therefore, obvious why vomit- ing will sometimes not only increase, but give rise to a haemorrhage from the lungs; whilst, on the contrary, its effects in menorrhagia, so far as experience has taught us, are not only free from dangerous conse- quences, but very often of unquestionable service. The only case in which I have had recourse to this practice, was recently, in a delicate female, who, with menorrhagia, suffered under symptoms indicating the jy EM K IICS. use of a gentle emetic. I ordered her eighteen grains of ipecac, which brought on several copious bilious discharges from the stomach; and had the effect, be- sides, of giving a very decided check to the hemor- rhage. In the treatment of dysentery emetics are often of very great advantage. Where there is redun- dant or vitiated bile present in the primae viae, as is frequently seen in the dysenteries of hot climates and marshy districts, vomits would seem to be indispensa- ble. Sir John Pringle speaks very favourably of this practice; and Mr. T. Clark assures us that he derived the greatest advantage from the employment of emetics in this disease, when administered in the form of enemata.* Cleghorn, too, gives his testimony in fa- vour of emetics in this disease. " When they begin," he says, " like simple diarrhoea, without fever or fixed pains in the belly, the first thing to be done, is to empty the intestines of their acrimonious contents, as soon as possible." For this purpose he was in the habit of giving P. ipecacuanha, in combination with vitrum antimonii ceratum, in such doses as to bring on copi- ous emesis and catharsis.f In cases unattended with high febrile excitement, I have sometimes given an ipecacuanha puke, when first called to the patient, * Observations on the Nature and Cure of the Diseases of the East and West Indies. f Cleghorn's Observat. on the Epidem. of Minorca, p. 14-6. EMETICS. 39 and, I believe, always with advantage. It >.s evident, however, that where the fever runs high, emetics ought not to be used, before the arterial excitement has been adequately reduced by more energetic depletory mea- sures. In the treatment of diarrhoea also, this class of remedies will often prove very serviceable. In this and the former intestinal disease, vomits are useful, not so much by evacuating the contents of the stomach, as by the effect they have of equalizing the circula- tion, and, perhaps, also by deriving the superabundant; excitement of the intestines to the stomach. In that species of mania which arises from the in- temperate use of ardent spirits, emetics possess the most decided remediate powers. This practice was introduced, a few years ago, by Dr. Joseph Klapp, of this city, who has published the result* of a very large experience on this subject, exhibiting the most indubitable evidence of the superior utility of emetics in this very singular variety of mania. The import- ance of this treatment in mania a potu, seems now to be pretty generally acknowledged by the practitioners of this city. The late Dr. Albers, of Bremen, in a letter written a short time before his death, gave me an account of three cases of this disease, in which emetics were employed with decided advantage. The result was at least so favourable, as to induce him to * Vide. Eclect. Repertory, vol. vii. p. 251. Also Medical Recorder, vol. ii. and iii. 4Q EMETICS. express a determination to adopt the treatment in future. The stomach, in this disease, is often extremely in- sensible to the operation of emetics. It is, therefore, in general, necessary to employ very large doses be- fore vomiting can be excited. Where a full emesis is produced, the mental hallucinations are commonly much corrected, and in mild cases, sometimes entirely- suspended, by a single emetic. It will most frequently be necessary, however, to repeat the emetic two, three, four, or even five or six times, at such intervals as the particular circumstances of the case may require. In the. course of this treatment, the bowels must be kept relaxed by the exhibition of aperients, if the emetics do not produce this effect. Dr. Klapp does not think it necessary or even proper, to employ opium along with the emetic treatment, unless, perhaps, under the particular circumstances of extreme exhaustion, or hypercatharsis induced by the emetic articles acting violently on the bowels. It has been contended that a full opiate after the operation of the vomiting will greatly facilitate the cure, by inducing sleep, and tranquilizing the general excitement. Judging from my own experience, I am not disposed to regard the employment of opium as necessary to procure these advantages. Such is the power of emetics in this disease, that they will not only allay the mental aber- EMETICS. 4J rations, but often induce sleep more readily than opium under any mode of management. Emetics have also been much recommended in other varieties of mania, and in hypochondriasis. In this latter complaint I have employed them with evident advantage. An emetic will often rouse the hypo- chondriac patient from that state of mental and phy- sical torpor with which he is pressed down, and ren der his system more sensible to the operation of other remedies. Emetics are particularly advantageous in this disease, when alternated with alterative doses of blue-pill, and an occasional saline purgative. What- ever be our notions concerning the pathology of hypo- chondriasis, observation has fully demonstrated the in- timate connection of its symptoms with the particular condition of the abdominal viscera. In this disease there generally exists much congestion in the por- tal vessels, with torpor and functional derangement of the liver. By the employment of these remedies, therefore, we not only evacuate the alimentary canal of its vitiated contents, but also invigorate the circula- tion in the portal system, both by the mechanical agi- tation of the vomiting, and the specific influence of the mercury upon the vascular extremities of the hepatic system. In a case of puerperal mania, I derived the most decided benefit from the employment of emetics. The patient had been delivered of her first child four days", when she began to manifest symptoms of mental de- vol. j. 6 42 EMETICS. rangemcnt. She would neither speak nor take nour- ishment, unless greatly urged. After using a variety of means to induce her to speak, she replied, that she was talking to good spirits from the other world, and was determined to have nothing to do with the beings of this wicked place. She declared she was perfectly well, and stood in no need of any medicines. In this state she continued for three days, and then, all at once, became extremely loquacious. Her pulse was small and frequent, and the pupils of her eyes much contracted. Under these circumstances, I ordered her an antimonial emetic, which brought on pretty copious vomiting. She became evidently much tran- quilized by its operation, and seemed, at short inter- vals, to be sensible of her real situation. On the evening after the vomiting, I gave her an anodyne draught, which, however, did not procure her the rest I anticipated. On the next day, therefore, I gave her another emetic, which again operated well; and from this period she rapidly recovered the full possession of her reasoning faculties. In hysteria also, emetics are often of unequivocal advantage. They are, perhaps, to be employed use- fully in every variety of this disease; but in that form which is attended with complete suspension of the ani- mal functions, bringing on a state resembling syncope, I have found them to be particularly useful.* Dr. * * Medical Recorder, vol. iv. p. 124, EMETICS. 43 Dean, a highly respectable practitioner in the interior of this state, adds his testimony in favour of the em- ployment of emetics in hysteric affections. His ex- perience has led him to regard them as decidedly the most effectual remedy we possess, in the chronic form of this disease. "But it is in the chronic variety of this complaint," says Dr. Dean, " in which the com- mon routine of what are improperly termed antispas- modic medicines, produce no other than transient re- lief to the patient, that I have experienced the most permanent good effects from the administration of emetics. In cases of this description, where the pa- tients had laboured under this disease for ten years, and during that time, by the advice and direction of respectable physicians, exhausted, with at most but temporary benefit, the whole class of remedies which are usually prescribed, I have, by the continued exhi- bition of vomits, either entirely removed the complaint, or so far interrupted the habits of diseased action in the stomach, that antispasmodic and tonic medicines would, in general, complete the cure."* Dr. Joseph Smith, of New-York, has published some interesting observations on the employment of emetics in spas- modic diseases. " The experience I have had," says he, " of the utility of emetics in hysteria and epilepsy, enables me to assert, with confidence, that they are Medical Recorder, vol. iv. p. 259. 44 EMETICS. more efficacious than any remedy ordinarily em- ploy ed.v* In asthma emetics are of unquestionable advantage. They not only assist materially in expelling the viscid mucus from the bronchia, but operate in a direct man- ner in facilitating the transmission of the blood from the right to the left side of the heart, the impeded course of which forms, perhaps, the chief source of distress in this and other similar affections. That the operation of an emetic produces this effect, is evident from the circumstances which take place during the act of vomiting. During this process the diaphragm is drawn downwards, by which the thoracic cavity is enlarged, and the lungs are in a full state of inspira- tion, and therefore expanded to the utmost degree. The necessary consequence of this is, that the blood which had congested in the pulmonary arteries, right side of the heart, and large venous trunks, in conse- quence of the previous inadequate expansion of the lungs, is now, during the act of vomiting, permitted to pass on with freedom to the right side of the heart. And hence, in part, the temporary relief almost invari- ably obtained from full vomiting in this disease. In the treatment of hooping-cough also, emetics, in general, afford more relief than any other remedies we possess. Where the disease is attended with much arterial excitement, emetics are, however, inadequate * Transactions of the New-Vork Physico-Medical Society, vol. r. EMETICS. 4^y of themselves to prevent serious consequences, and require to be assisted by prompt and decisive vene- section. Much dispute existed at one time concerning the propriety of administering emetics in apoplexy. This subject is amply and warmly discussed in the fifth and sixth volumes of the London Medical and Physical Journal. As the power of vomiting to propel the blood to the superior parts of the body, from the causes which I have already mentioned in this chap- ter, is, however, very considerable, I am entirely con- vinced that, as a general rule, this class of remedies cannot be safely employed in apoplexy. This disease may, however, occur under circumstances of gastric irritation, which will not only render the employ- ment of an emetic useful, but absolutely indispens- able. When, for instance, apoplexy comes on im^ mediately after eating a very full meal, it would be exceedingly unwise, I think, to suffer the stomach to remain oppressed and over-distended by what had been eaten. But even under such circumstances, a copious abstraction of blood should, perhaps, always be premised to the emetic; for the apoplectic symp- toms may as yet depend simply on a turgescence of the vessels of the brain, which, from the further impetus given to the blood by the efforts of vomit- ing, may become ruptured, and bring on fatal apo- plexy. The occurrence of such an event will, how- 4(j EMETICS. ever, be rendered much less probable, if we lessen, to a considerable degree, the general mass of the cir- culatory fluid previous to administering the emetic. Where there is no strong reason to suspect an irrita- tion in the stomach, either from over-distention or from the presence of some irritating substance, I can- not conceive what advantage is to be expected from the administration of an emetic. If apoplexy be essen- tially connected with an engorgement of the cerebral vessels, it is obviously wrong to resort to a treatment which has a direct tendency to increase the fulness of these vessels by increasing the arterial, and retarding the venous circulation. Of the employment of emetics in epilepsy, the re- cords of medicine furnish us with very contradictory evidence. As in the treatment of apoplexy, so in that of epilepsy, their employment has been on the one hand as extravagantly praised, as it has been inordi- nately censured on the other. It may be observed, however, that, perhaps, in all cases where we have con- tradictory evidence, from respectable sources, in re- lation to the remediate powers of any remedy, it arises from its having been given either in different stages of the same complaint, or in different varieties dependent on a difference in the remote causes. We may, there- fore, safely conclude, that although as a general rule emetics may not be proper in epilepsy, yet that, oc- casionally this disease may present itself under cir- EMETICS. 47 :umstances which will render the employment of such remedies of the greatest importance. In the epilepsy of children, when there does not appear to be much fulness of the vessels of the head. and symptoms of gastric irritation are present, such as nausea, flatulency, disturbed sleep, and other marks of indigestion, emetics will be of essential importance. Dr. J. Clark advises, for this purpose, a solution of the sulp. zinc, in an aqueous infusion of ipecacuanha. to be repeated in six, eight, or ten days, according to circumstances. Dr. Thomas says, that when an at- tack of idiopathic epilepsy can be foreseen, there is, perhaps, no remedy which will be more likely to pre- vent the paroxysm, than an emetic administered about an hour before its accession. In a child, which had been about eighteen months affected with occasional epileptic convulsions, I succeeded in removing the disease entirely, by a long course of emetic remedies. administered every third day. The disease came on after an attack of ague, which was cured by arsenic. and was probably at last kept up from habit. I em- ployed the pulv. ipecacuanha. Of the utility of emetics in the early stages of indi- gestion there can be no doubt. In the advanced periods of this complaint, however, when the disease is no longer confined to -functional derangement of the stomach, but has extended to the neighbouring viscera, they are, in general, either useless or impro- 48 EMETICS. per. In recent attacks of indigestion, attended with distressing pains of the stomach, or symptoms of an oppressed state of the brain, an emetic will often pro- cure the most prompt relief. Dr. Revere, of Balti- more, in a most excellent paper on dyspepsia,* ob- serves, that in persons whose digestive organs have become much debilitated, food, which in the healthy state of the stomach is perfectly innocent and nutri- tious, will sometimes produce " great general distress, numbness of the scalp, violent colic, acute pain in the side and bladder, vertigo, apoplexy, and convulsions." In affections of this kind, emetics are obviously the proper remedies; and Dr. Revere relates several highly interesting cases in which their efficacy was promptly and conspicuously manifested. In the ordinary symptoms of indigestion, however, although an occasional vomit may be indispensable, yet, I think with Dr. W. Philips, that they should be cautiously repeated, and only for the removal of urgent symptoms evidently depending on the presence of some irritating matters in the primae viae. In dropsical diseases emetics have been much em- ployed. They have been prescribed in every variety of dropsy, but they appear to be more particularly applicable to the treatment of anasarca and ascites. It is supposed that their beneficial action on these affections depends on their power to increase the ac- * Medical Recorder, vol. iv. p. 50. EMETICS. 49 tivity of the absorbents. I have already expressed my doubts with regard to the supposed influence of emetics on the absorbent system, and stated, what appears to me to be the correct explanation of the modus ope- randi of medicines in this respect. By the nausea they create, they lessen the momentum of the blood in the system of capillary vessels, as is clearly evinced by the paleness and shrunk appearance of the skin during this state. The momentum of blood being, therefore, diminished in the extreme vessels, it is obvi- ous that exhalation, which depends on the activity of these vessels, must receive a simultaneous check. The absorbents, however, not being under the same influ- ence, pursue their functions uninterruptedly, and thus gain on the antagonizing, but weakened, exhalants. Emetics may also do good by promoting the return of blood through the portal system of vessels, and thus removing a source of congestion in the capillaries of the peritoneum and lower extremities, by which an increased exhalation of serum may have been favoured. Emetics have also been recommended in diabetes. Richter relates several cases that were effectually cured by them. Where it is evidently connected with gastric irritation, as in the cases mentioned by Richter, vomits will, no doubt, do much good. This writer mentions an instance of this disease, where an emetic brought up a very great quantity of bilious matter; " and I can assert with truth," says he, " that next VOL. I. 7 50 EMETICS. morning there was not a vestige of diabetes or of any other complaint present."* We have also the testi- mony of Frank, in favour of the employment of this class of remedies in the present disease. Emetics are, indeed, a very common remedy in the treatment of diabetes with the German physicians; and many cases may be found in their writings illustrative of their beneficial effects. In the treatment of jaundice emetics are often of essential service. They are particularly calculated to promote the passage of a gall-stone through the com- mon duct. By the nausea which they create, they relax the duct, whilst the mechanical pressure and agitation caused by vomiting tend to push the calculus forward in the relaxed tube. Emetics have often a very strong effect in reducing the inflammation and swelling of the testicles in hernia humoralis. I have, in several instances, witnessed the surprising effects of a strong antimonial vomit, in re- ducing these painful swellings; most generally, how- ever, these remedies do not produce any perceptible change in these affections. Emetics have also been a good deal recommended to reduce indolent buboes: their effects in this way, do not, however, appear to be considerable. Q,uite recently Dr. Hosack has published some very interesting observations on the utility of emetics in • Medical and Surgical Observations, p. 84. EMETICS. 5J constipation. He details seven cases of this kind, from which it appears, " that in the commencement of constipation, or in its more advanced stage, when the symptoms of inflammation have been subdued by the lancet, emetics may be very advantageously exhibited, both for the purpose of removing the hepatic obstruc- tions, and of counteracting the spasmodic constriction and pain ordinarily attendant upon this disease."* CALLICOCCA IPECACUANHA. This plant was first discovered about the middle of the seventeenth century. It is a native of South America, and has been well described by M. Brotero, professor at the University of Coimbre, in the Me- moirs of the Linnean Society of London. It appears to be a species of the genus Callicocca, of Shreber, and is accordingly described in the books under the name of Callicocca Ipecacuanha. It has been ascer- tained that the ipecacuanha root, as it is brought to us from Brasil, is not always taken from the same plant, namely the Callicocca Ipecacuanha. According to Linnaeus it is not unfrequently obtained from the psycotna emetica; and Decandolle asserts, that the ipecacuanha, as it is found in our shops, is very often * New-York Medical and Physical Journal, vol. i. No. 1. p. 60. Ajg EMETICS. a mixture of the genuine root with the roots of some species of violets, apocynae, euphorbia, &c. It is also said to be occasionally mixed with the roots of several species of the genus Ionidum* To what degree these adulterations may deteriorate the value of the ipecacuanha, I am unable to say. It is certain, how- ever, that they must interfere with its peculiar virtues, and tend more or less to modify and render uncertain its effects. The ipecacuanha root consists of very tortuous branches, of the thickness of a goose-quill, surrounded by numerous prominent rings, separated by deep grooves. Externally its colour is brownish or blackish grey; internally it is white or faintly yellow. It has a faint disagreeable smell, and a bitter sub-acrid taste. Magendie and Pelletier have ascertained that ipeca- cuanha contains a peculiar principle, to which they have given the name of emetin,f and upon which the emetic properties of the root seem entirely to depend. * Nouveaux El^mens de The'rapeutique, Pari. L. Alibert, t.i. p.236. f The following is the formula introduced into the new codex of Paris, for the preparation of this substance. " Let ?i. of the powder of ipeca- cuanha be macerated in ?ii. of ether, with a gentle heat, for some hours, in a distilling apparatus; let the portion which remains be triturated and boiled with 5iv. of alcohol, it having been previously macerated in it; filter, and let the remainder be treated with fresh portions of alcohol, as long as any thing is taken up from the root; mix these alcoholic solutions and evaporate to dryness ; let this alcohol extract be macerated in cold distilled water, in order that every thing soluble in that menstruum may be dissolved ; filter, and evaporate to dryness; this extract is emetin ; in EMETICS. 53 It consists, when pure, of little transparent laminae. of a brownish red colour, possessing very little odour, and a taste resembling that of the powdered ipeca- cuanha. Emetin is decomposed in a heat of about 212°. Water dissolves it in every proportion, with- out affecting its composition in the least. It deliquesces in a moist air. Alcohol dissolves it readily, but ether has no action on it. " JYitric acid dissolves it, but at the same time decomposes it; dilute sulphuric acid has no action on it; muriatic acid and phosphoric acid dis- solve it without altering its nature; acetic acid dissolves it with facility; corrosive sublimate precipitates it from its solutions; but tartarized antimony has no effect upon them. Gallic acid, the infusion of galls, and acetate of lead precipitate it."* According to the analysis of Pelletier, ipecacuanha contains : sixteen parts of emetin, two of oil, six of wax, ten of gum. forty of starch, and twenty of woody fibre. Of a hundred parts of ipecacuanha, alcohol takes up about twenty-one; proof spirits somewhat more than thirty-two, and boiling water nearly forty-seven. This substance is, undoubtedly, the most important vegetable emetic we possess, and in many instances preferable to every other article belonging to this class. It is mild in its operation, and may be safely exhibited this state, however, it contains a small quantity of gallic acid, but which is too inconsiderable to affect its medicinal qualities." Paris Pharmacol. * Paris Pharmacologia. 51 EMETICS. under circumstances of general exhaustion, or intes- tinal irritation, which would render the employment of antimonial emetics injurious. In all cases where the stomach is irritable or debilitated, the ipecacuanha is decidedly the best emetic. It seems to have less tendency to weaken the digestive powers of the sto- mach than any other article of this class; it would ap- pear even to exert some tonic power upon this organ, when given in very minute doses, as I have more than once observed in my own person. It possesses ano- ther advantage over antimonial emetics, which in many cases is of great importance; it is much less apt to act upon the bowels, and to pass off by copious and ex- hausting stools, than the preparations of antimony. This is of immense consequence in many diseases; for we often find it useful to procure emesis, in cases where a rapid catharsis would prove highly injurious. It is, nevertheless, not destitute of properties capable of exciting the peristaltic action of the intestines. It will, in general, after having acted upon the stomach, prove gently aperient, and excite, moreover, in a very particular manner, the cutaneous exhalants;—circum- stances which render it peculiarly adapted to the treat- ment of several intestinal diseases. Its powers as an antidysenteric, was, indeed, the very first circumstance which brought this remedy into notice. Piso, as early as 1649, and before any of it had been brought to Europe, mentioned the ipe- EMETICS. 55 cacuanha as a common remedy for dysentery, in the Brasils. Its character in this respect, though not equal to what it once enjoyed, appears to be well deserved, since, by the most eminent writers who treat of this disease, it is mentioned as a principal remediate article. Ipecacuanha is given in dysentery, with a view either to its emetic or sudorific operation, though the latter is, in general, the principal intention for which it is em- ployed. On this account, therefore, it is commonly given in combination with other substances, which have the effect of increasing its tendency to excite the cutaneous emunctories. Moseley, who adopted the sudorific plan of treating this disease, was in the habit of giving small doses of ipecacuanha and opium, in combination, and upon which he seemed to place his chief dependence. There can be no doubt that this treatment will sometimes remove dysentery, but common experience would seem to show that it cannot be safely relied on as a principal part of the treatment of such cases. In the dysenteries of this country, at least, more promptly evacuant measures are necessary, and if ipecac, be used in the early stage, it should, perhaps, always be given in the first place to the extent of inducing full vomiting. Sir John Pringle was in the habit of giving it in small doses, and repeating it until both vomiting and purging were produced. To ensure its operation on the bowels, Cleghorn gave it in union with the 5Q EMETICS. cerated glass of antimony, in such doses as to produce a full emeto-cathartic effect. In the latter stages of the complaint, however, when the arterial excitement has been considerably subdued, there is no remedy which is so well calculated at once to mitigate the distressing tormina, and to keep up an agreeable and salutary moisture of the surface, as ipe- cacuanha and opium combined. If calomel be united with these two articles, we heighten, still more, the curative effects of the composition; for of all the arti- cles in the materia medica, the latter substance appears to be the most powerful in equalizing the circulation. Mr. Playfair, in a paper published in the tenth volume of the Edinburgh Medical and Surgical Jour- nal, has given an account of a new mode of using ipe- cacuanha in this disease; and which he states to have proved exceedingly successful. He gave from half a drachm to a drachm of this article, in union with from thirty to sixty drops of laudanum, keeping the patient for some time after in a horizontal position. When the medicine was rejected, he repeated the dose. He states that this practice is applicable only to the early stage of the disease. He practised in Bengal. The ipecacuanha has also been administered in the form of an enema, in dysentery; and its effects, when thus employed, have been much praised.* For * Observations on Fevers and other Diseases of the Indies. By Thomas Clark. London, 1801. EMETICS. 5; this purpose three drachms of the bruised root are to be boiled in a quart of water down to a pint. This is to be administered as an enema, all at once, to an adult. This injection is also greatly extolled for the relief it affords in internal piles. In a case of this kind I have myself had an opportunity of witnessing its good effects. Ipecacuanha, given in small doses, so as to puke gently, has been much praised for its effects in the cure of chronic diarrhoea, and more particularly if the dis- ease be attended with symptoms of gastric impurities. Dr. Samuel Pye, has published a number of cases illus- trative of the good effects of the ipecacuanha in this disease. He administered it in small doses, sufficient, however, to produce vomiting, and repeated the medicine from day to day, with an occasional anodyne mixture, until the disease disappeared.* The same practice is recommended by Dr. Fothergill, and may, indeed, be found in perhaps every work that treats on this disease. Much has been said of the efficacy of nauseating doses of ipecacuanha in haemorrhages. Dr. A. N. Aasheim, a Danish physician, has published some in- teresting observations on the employment of this reme- dy in haemoptysis. He gave one-fourth of a grain every three hours during the day, and every four hours during the night. The third dose, in general, excited * Medical Observat. and Inquiries, vol. i. p. 240. VOL. I. 8 £g EMETICS. slight vomiting. By this treatment, Aasheim remarks, the bleeding was put a stop to; the cough became less severe, and the skin, which before was dry, was ren- dered moist, and soft to the feel.* There can be no doubt that this treatment will occasionally prove en- tirely successful, for, without ascribing to ipecacuanha any astringent or antispasmodic virtues, by which it has been supposed to arrest haemorrhages, we have an obvious explanation of its operation in these cases, in the restraint which it exercises over the action of the heart and arteries, during the nausea which it creates. If the advantages of venesection in haemorrhagy pro- ceed from its diminishing the impetus of the blood, and I can see no other reason for it, certainly we may apply the same explanation to the modus operandi of nauseating doses of ipecacuanha in similar cases, since they have a power perhaps equal to venesection, in diminishing the force and activity of the circulation. In addition, however, to the curbing influence of this remedy on the action of the heart and arteries, some- thing, undoubtedly, must also be ascribed to its power of equalizing the circulation and exciting the cuta- neous emunctories. In uterine haemorrhage, this article has been found still more decidedly beneficial than in the other haemorrhages; and this may, per- haps, be accounted for in the way I have already at- tempted to do, when speaking of the general applica^ v Alibert Matiere Medicale, tome i. p. 248. EMETICS. 59 tion of this class of remedies to the cure of diseases. Bergius relates a violent case of uterine haemorrhage, which he successfully cured by giving half a grain of this remedy every half hour. I have never used the ipecacuanha in cases of this kind, but I can well con- ceive of the propriety of the practice. Ipecacuanha vomits have been thought to be pecu- liarly serviceable in asthma. Vomiting, by whatever article excited, must of itself, simply from its mechani- cal operation, be useful in the asthmatic paroxysm. By the contraction of the diaphragm, it augments the cavity of the thorax, and allows the lungs to expand more fully, by which the transmission of blood through these organs is greatly facilitated, and a principal source of uneasiness in this disease temporarily re- moved. Besides this effect, it aids, in no inconsider- able degree, to expel the viscid mucus from the bron- chia, and thereby gives a greater opportunity for the oxygenation of the blood. But independent of these general effects, ipecacuanha has been supposed to possess antispasmodic or other peculiar powers calcu- lated to act beneficially in this disease. It appears to me, however, that in this respect it possesses no ad- vantages over the other emetics generally employed, except in its acting more mildly, and not being apt, like the antimonial preparations, of passing off rapidly by the bowels, and debilitating the digestive organs. It must not be concealed, however, that Akenside, who gQ EMETICS. published a paper on the use of this article, in the present disease,* states, that he found it equally use- ful, whether given to the extent of producing vomiting or only in nauseating doses. It must, however, also be observed, that in the paroxysm he administered it so as to produce vomiting, whilst, after the paroxysm had passed off, he continued its use every morning in nauseating portions. In the Memoirs of the Medical Society of Copen- hagen, there are some very interesting remarks on the employment of ipecacuanha as an anti-emetic, by Dr. Schonheyder. He relates the history of a case of ileus, in which small doses of this article proved successful, after every other means of relief had been fruitlessly employed. " On lui avoit donne plusieurs remedes inutilement. Son estomac ne pouvait rien retenir; et il vomit pendant plusieurs jours desmatieres fecales d'une grande fetidite. La soif etoit tres-incommode; l'abdomen n'etoit ni dur, ni tendu, ni douloureux. On avoit essaye de lui donner de l'eau de sedlitz, qui avoit ete rejetee. Schonheyder tenta des-lors d'administrer l'ipecacuanha par doses pri- sees. La seconde dose enleva toute la propension que le malade avoit a rejeter les alimens; le malade qui etoit tourmente par la soif, put boire considerablement. On continua ; et de jour en jour il alia mieux."f Burdach states, that it is very useful in habitual * Memoirs of the London College of Physicians. f Alibert Matiere Medicale, t. i. p. 249. EMETICS. Q\ vomiting from morbid irritability of the stomach. In such cases, however, it must be given in very small doses. Alibert mentions, on the authority of J. W. Guld- brand, a Swedish physician, that ipecacuanha has been found to manifest important emmenagogue powers. He refers to two obstinate cases of amenorrhcea effec- tually cured by it. Ipecacuanha has also been applied to the cure of indigestion. Daubenton gave it in doses just sufficient " to excite a slight sensation of vermicular motion of the stomach, without carrying it to the point of nau- sea."* I have used it in my own case, in doses of one-fourth of a grain every morning, noon, and even- ing, with evident advantage. In a case which I have under my care now, I give it in union with phosphate of iron, and my patient derives much advantage from this combination. With regard to the proper dose of this article, we should find it difficult to arrive at any definite conclu- sion, from a reference to authorities. Dr. Pyef re- cords upwards of one hundred and fifty cases, in all of which vomiting was produced effectually, and in by far the greatest majority repeatedly by two, three, and four grain doses. Cullen expresses his doubts with regard to the correctness of this state- * Alibert. f Medical Observations and Inquiries, vol. i. Q2 EMETICS. ment; but we have the testimony of Chaumenton and others in confirmation of the vomitive power of small doses. Those who are in the habit of prescribing the Dover's powder, or the more simple combination of ipecac, and opium, for diaphoretic purposes, know how apt they are to excite vomiting, although the quantity of ipecacuanha be but very small. It would appear, indeed, as if the opium which enters into these compositions, enhanced the emetic properties of the ipecacuanha. The medium dose of powdered ipeca- cuanha, with a view to its emetic effects, is about twenty grains; although much larger doses may be given without detriment, as the greater part of it is commonly thrown up by the first discharges. I am in- formed by Dr. Joseph Hartshorne, of this city, that the addition of powdered gum arabic, destroys almost entirely the peculiar nauseous taste of ipecacuanha. The officinal preparations are the pulvis ipecacuanha? compositus, and the vinum ipecacuanha. The powder becomes inert by long exposure to the air and light. All vegetable astringents, as infusion of galls, &c. vegetable acids, especially the acetic, weaken its power. Dr. Irvine found that gr. xxx. administered in |ii. of vinegar, produced only some loose stools. EMETICS, 63 LOBELIA INILATA. This is a biennial plant, and indigenous to the United States, in many parts of which it grows in great abundance. For a particular description of this species of lobelia, the reader is referred to Dr. Bige- low's American Medical Botany, and to Dr. Barton's Vegetable Materia Medica, of the United States, where accurate figures are given of the plant. The leaves and capsules of this plant are exceedingly acrid, and when " held in the mouth for some time, they produce giddiness and pain in the head, with a trembling agi- tation of the whole body; at length they bring on ex- treme nausea and vomiting. The taste resembles that of tartar emetic."* As an emetic the lobelia inflata is extremely active, producing, in strong doses, " great relaxation, debility, and perspiration." Concomitant with its emetic ope- ration it sometimes acts on the bowels and produces purging. Shoepf merely notices this plant as " as- tringent and used in ophthalmia," without saying any thing further concerning its medicinal powers. Our knowledge of its virtues as a medicine has been chiefly derived from the account given of its effects by the Rev. Dr. M. Cutler, whose experience with it appears to have been very considerable. He has found it par- * Bigelow's Medical Botany, vol. i. p. 179. 64, EMETICS. ticularly serviceable in asthmas. u It has been my misfortune," says he, " to be an asthmatic for about ten years. I have made trial of a great variety of the usual remedies with very little benefit. In several paroxysms I had found immediate relief more fre- quently than from any thing else, from the skunk-cab- bage, (pothos foetidum.) The last summer I had the severest attack I ever experienced. It commenced early in August, and continued about eight weeks. Dr. Drury, of Marblehead, also an asthmatic, had made use of a tincture of the Indian tobacco (lobelia inflata) in a severe paroxysm, early in the spring. It gave him immediate relief, and he has been entirely free from the complaint from that time. .1 had a tincture made of the fresh plant, and took care to have the spirit fully saturated, which I think is important. In a paroxysm, which, perhaps, was as severe as I ever experienced, the difficulty of breathing extreme, and after it had continued for a considerable time, I took a table-spoonful. In three, or four minutes my breath- ing was as free as it ever was. In ten minutes I took another spoonful, which occasioned sickness. After ten minutes 1 took the third, which produced sensible effects on the stomach, and a very little moderate puking, and a kind of prickly sensation through the whole system, even to the extremities of the fingers and toes. Since that time I have enjoyed as good EMETICS. 65 health as, perhaps, before the first attack."* Other practitioners have employed this article with decided advantage in asthmatic affections. Dr. W. P. C. Bar- ton mentions a case of this kind in which he exhibited a tea-spoonful of the tincture every two hours, with speedy and obvious benefit. Dr. Stewart also, as I am informed by Dr. Barton, has obtained unequivocal advantages from the employment of this remedy in a case of spasmodic asthma. Dr. Cutler has found it a very useful pectoral "in consumptive and other coughs depending on mucus accumulated in the bronchial vessels." From my own experience I have nothing to add, with regard to the remediate powers of this species of lobelia, in asthmatic affections. As an emetic, how- ever, I have employed it in one case of croup, with very great benefit. I have also used.it effectually in- stead of tobacco, in the form of an enema, to facilitate the return of a strangulated hernia.f The plant should be collected in August, and plucked up by the roots. Every part of the plant possesses active qualities, but the roots and the inflated capsules are decidedly the most powerful. It may be given either in the form of powder or tincture. The latter is, however, the most convenient mode of exhibiting this remedy. The formula adopted in the American * Thatcher's Dispensatory. f Barton's Vegetable Materia Medica, vol. i. p. 197-9. VOL. I. 9 gg iiMETICS. Pharmacopoeia, for making the tinctura lobeliae, is given below* As an emetic, we may give from ten to twenty grains of the powdered leaves, to an adult. In smaller doses its effects are expectorant. The satu- rated tincture is administered in the dose of from twenty to forty drops, to children of one or two years old. SPIILEA TRIFOLIATA. This is an icosandrous plant, and found iu consi- derable abundance throughout almost every part of the United States. Its root is perennial, sending up annually several slender stems, to the height of seve- ral feet, branching above, and of a reddish colour. It flowers in June and July, and delights in hilly woods or on the borders of rivulets. The root, which con- sists of "long, brown, slender branches, radicating from a thick tuber," is the part employed for medici- nal purposes. It is said that the cortical part of the root alone possesses active qualities. " The predomi- nant soluble ingredients in this root, appear to be a bitter extractive matter and resin. When boiled in water, it imparts to it a beautiful deep red, wine colour. * B Lobelix uncias duas. Alcoholis diluti octantem unum. Digere per dies decern, et per chartam cola. EMETICS. fa and an intensely bitter taste. This decoction under- goes no change from alcohol or gelatine, though it gives a precipitate with muriate of tin. Water dis- tilled from the root has its peculiar flavour with little of the bitterness. A large portion of resin is precipi- tated on the addition of water to an alcoholic tincture of the root."* From my own experience with this plant, which has not been inconsiderable, I am led to regard it as very little inferior to the officinal ipeca- cuanha, as an emetic. Like this latter article it is a safe and efficacious vomit. WThile practicing in Lan- caster county, I employed this plant very frequently as an emetic, in the treatment of intermittent and bilious fevers, and it very seldom disappointed me of the desired effect. Dr. Bigelow, however, observes, that from his own experience with this remedy, he was led to regard it as an emetic of very uncertain operation. Given with opium I have found it particularly ser- viceable as a sudorific in dysenteric affections; and from what I have observed of its effects in other cases, it appears to me that the opinion entertained by the late Dr. Barton, of its possessing tonic properties, is not without foundation. In small doses, from two to four grains, I have taken it myself, when suffering from dyspepsia, and generally with evident advantage. As an emetic it should be given in the dose of about * Dr. Bigelow's American Medical Botany, vol. iii. p. 14. 68 EMETICS. thirty grains of the powdered root. It should be col- lected in September. Accurate figures of this plant are given in the first volume of Barton's Vegetable Materia Medica of the United States; and in the third volume of Bigelow's American Medical Botany. EUPHORBIA IPECACUANHA. This plant is found no where except in the United States. The root is perennial, long, tuberculated, from half an inch to an inch in diameter, and of a yel- lowish colour. It is light and brittle when dried, and has a sweetish and not very disagreeable taste. Dr. Bigelow subjected this root to chemical examination, from which it appears that;—" sulphuric ether digest- ed on the powdered root dissolved a part of it; and this ethereal solution gives a precipitate if alcohol is added to it. Alcohol alone takes up another portion of the root, and assumes a pearly turbidness after water is added. Both the ethereal and alcoholic so- lutions, evaporated to dryness, leave a residuum which is fusible and inflammable. The decoction gives no precipitate with gelatin or sulphate of iron. With alcohol it gave out a white precipitate, which rendered the solution turbid, and subsided in flocks. The cold infusion exhibited the same phenomenon in a smaller EMETICS. gg degree. From these experiments we may infer that the root contains caoutchouc, resin, mucus, and pro- bably fecula." For a good description and figure of this plant the reader is referred to Dr. Barton's Vege- table Materia Medica, vol. i. p. 213, and to Dr. Bige- low's American Medical Botany, vol. iii. p. 111. The emetic virtues of this plant had been but little noticed until they were more particularly investigated by Dr. Barton, the present professor of botany in the University of Pennsylvania. In his excellent work, to which we have just referred, he observes: " That the Euphorbia Ipecacuanha is possessed of virtues en- titling it to supersede the use of the imported ipeca- cuanha, my own extensive experience with it, corro- borated by the numerous trials of the medicine by professor Hewson; my brother, Dr. J. R. Barton, of the Pennsylvania hospital, and others, all embolden me to declare." Dr. Bigelow states, that in the trials which he has made with it, he has found it, in the majority of instances, to operate with as much ease as the other emetics. In large doses, however, " it excites active and long continued vomiting, attended with a sense of heat, vertigo, indistinct vision, and prostration of strength."* From what I have myself seen of this remedy, I am satisfied that it is well wor- thy the attention of the profession. Given in the dose of from fifteen to twenty grains, the powdered root of * American Medical Botany, vol. iii. p. 112. 70 EMETICS. this plant acts as a safe and efficacious emetic. It seems to have a greater tendency to act on the bowels than ipecacuanha, as I have known it to produce very considerable purging. In the dose of twenty-five grains, Dr. Barton has found it to produce hyperca- tharsis, which continued for fourteen hours. It may be advantageously substituted for ipecacuanha, in the various " combinations into which this latter substance enters as a part." As the officinal ipecacuanha is but seldom very good, or perhaps, unadulterated, it is a matter of very considerable importance to attend to such native articles as promise to become adequate substitutes in its place. In this respect there is, per- haps, no indigenous vegetable known, which deserves greater attention from the profession than the euphor- bia ipecacuanha. SCILLA MARITIME. The squill belongs to the liliaceous plants. It is a maritime plant, and found in very great abundance on the sandy coasts of Portugal, Spain, Sicily, &c. The root, which is the only part employed in medicine, consists of a large bulb, composed of fleshy scales, which overlap each other and give it a pyriform shape. It has no odour, but is bitter, nauseous, and acrid to EMETICS. 17 J the taste. The recent root will inflame the skin if kept in contact with it for any considerable time. According to the analysis of Vogel it contains six parts of gum, twenty-four of tannin, six of sugar, thirty-five of bitter principle, (Scillitin, which is white, transpa- rent, and breaks with a resinous fracture,) and thirty of woody fibre.* The squill, when taken in very large doses, acts with great and dangerous violence on the animal economy. It has been known to produce excessive tormina, colic, and even convulsions. Alibert asserts that he has per- formed many experiments on animals with this sub- stance, and that the result confirmed what had been said of its effects in this respect. It is chiefly employed as a diuretic and expectorant: for both of which purposes it is, indeed, one of our most valuable remedies. It is but little used as an emetic. In the pectoral diseases of very young chil- dren, however, it may often be resorted to with pecu- liar advantage. I have been a good deal in the habit of prescribing the syrup of squills, so as to produce vomiting, in the catarrhal affections of infants; and it has appeared to me to be followed by greater relief than usually attends the operation of other articles of this class. The active principle of this root is readily and per- fectly extracted by any of the usual menstrua. The * Paris' Pharmacologia, 12 EMETICS. officinal preparations are, Acetum scillas, PH. scillae. composit. Pulv. scill. Syrup, scillae. matim. Tinct. scill. To procure an emetic effect, the fluid preparations must be given in the dose of an ounce or more to an adult. A tea-spoonful of the syrup is generally suffi- cient to puke a child under a year old. Alkalies diminish both the bitterness and acrimony of this root. Vegetable acids do not materially affect either of these qualities, but are supposed to increase its expectorant powers. ANTIMONY. Antimony is a hard and brittle mettle, of a bluish white colour, resembling tin in its lustre. It is of a lamellated texture, and when handled imparts a pecu- liar smell to the fingers. It enters into fusion at a de- gree of heat a little above red, and when suffered to cool presents a stellated appearance on the surface. This substance was known to the ancients under the name of stibium, but was not employed as an inter- nal remedy until about the middle of the sixteenth century. About this period Basil Valentinus pub- lished his Currus Tnumphalis, in which we find vari- ous preparations of this metal mentioned, and their internal employment enthusiastically recommended. EMETICS. 73 Paracelsus became its warm advocate, and announc- ed it as a powerful and efficacious remedy in plague. In the plague which ravaged Bohemia, in 1562, anti- mony wa3 extensively employed. But as its virtues were imperfectly understood, it was frequently admi- nistered improperly, and occasionally attended with violent and dangerous consequences.* It was, there- fore, soon denounced by the Medical Faculty of Paris. as a fatal poison; in consequence of which the French parliament issued a severe decree against its internal employment, in 1566. In 1603, the celebrated Theo- dore Turquet de Mayerne, was prosecuted for having sold antimonial preparations, contrary to the decree of parliament; and Besnir, an eminent physician of that time, was expelled the Medical Faculty of Paris, for having given this proscribed re edy. After this decree had been suffered to stand for more than half a century, it was at last repealed, and antimony soon be- came one of the most boasted and popular articles of the materia medica. In pursuit of an universal remedy, the alchemists of the sixteenth and seventeenth centuries subjected this metal to an infinite variety of chemical processes, from which has resulted an astonishing number of prepa- rations, differing, however, more in the degree than in the quality of their remediate powers. The pure metallic antimony is entirely insoluble in * Matthiol. Comment, in Dioscorid. lib. v. c. 59. p. 838 70L. I. 10 74 EMETICS. water and alcohol. Vegetable acids, however, act upon it, though but feebly; and hence cups of this metal were formerly employed to impart an emetic quality to wine. Crude Antimony.—Sulphuret of Antimony.—In this state ,<>?' combination antimony is at present not frequently employed in medicine, and never as an emetic. As an alterative, however, it has been much praised by many writers of eminence; and it is not improbable that, in many cutaneous, and other chronic disorders, its powers are too much neglected. In the Transactions of the Society of Copenhagen, Dr. J. W. Guldbrand has published an elaborate and interesting paper on the anti-arthritic virtues of crude antimony. He declares it to be a most valuable remedy in the treatment of chronic rheumatism. Qjiarin gave it in this disease, in combination with three parts of sulphur; and Stoll, who speaks highly of its employment in affections of this kind, recommends it to be used in union with myrrh. The general operation of antimo- nial remedies, when given in minute doses, appears to be, an excitation of the capillary vessels throughout the whole system, but more especially those of the cutaneous surface. Such an operation has a direct tendency, not only to equalize the general circulation, and thereby to remove chronic inflammations wher- ever they exist, but also to excite a new action in the extreme vessels of the skin, and consequently to re- EMETICS. 75 lieve those disorders of the cutaneous surface which depend on deranged functions of its vessels. Anti- mony is, indeed, one of the most important remedies we possess, in the treatment of many of the diseases of the skin. In its crude state it has been much em- ployed for this purpose, both by itself and in union with other substances, such as cicuta, guaiac, dulca- mara, &c. It is, however, undoubtedly inferior in this respect to many of the more active preparations of this metal. In the treatment of plica polonica, La- fontaine regards it as almost an infallible remedy.* In the cure of scrofulous affections the sulphuret of antimony is much extolled by some writers. It appears to be particularly applicable to those cases that are connected with cutaneous eruptions, or ulcerations. Kotrum recommends it in union with equal portions of burned sponge, sulphur, cicutae and pulverized oyster-shell, as a valuable remedy for goitre. Richter states that he cured scrofulous fistula lachrymalia by means of the internal employment of the black sul- phuret of antimony. This substance is given in powder, in the dose of from ten to thirty grains. If it act as an emetic in consequence of meeting with an acid in the stomach, it ought to be given in combination with an alkali or absorbent. Antimonii Sulphuretum Praicipitatum.—This is a * Burdach's Mat. Med. vol. ii. p. 376 7g EMETICS bright orange-coloured, styptic, but inodorous powdei It is composed of about thirty parts of sulphur, fifty- live of sub-oxide of antimony, and fifteen of sulphu- reted hydrogen. It is entirely insoluble in water. This preparation is diaphoretic, cathartic, or emetic, accord- ing to the dose in which it is exhibited. In the cure of cutaneous diseases this medicine has been more generally recommended than any of the other antimo- nial preparations. It has unquestionably considerable claims to attention for its powers in this respect; al- though it is, upon the whole, perhaps, less efficacious in these affections than the black sulphuret of anti- mony already noticed. In eruptions depending on a syphilitic taint, it is very advantageously employed in combination with mercury. For this purpose I have been much in the habit of prescribing Plummer's pill,*' which is, indeed, a very useful remedy in almost every variety of chronic disease of the skin. The precipitated sulphuret of antimony has been recommended as peculiarly serviceable in the cure of chronic rheumatism. In this disease it is given in union with camphor, opium, or guaiac.f ' 5> Calomel, Antim. sulph. prxcipit. aa z\\, Pulv G. guaiac. - - z'w. Sapo. venet. - - - zii. M F. pil. aa gr. iii. Take from two to four, morning and evening f Burdach's Mat. Med. vol. ii p. 407. Phil. Conrad. Fabricius, Diss, de .ulphuris antimonii aurant: eximio iisu in arthritide. Helmot, 1759. EMETICS. 7 7 The dose of this preparation is from two to six grains, three or four times daily. It is to be gradually aug- mented until it excites slight nausea; and ought never to be given with acids or acidulous salts, if it be employed with a view to its alterative effects, as these substances have the power of very considerably increasing its emetic properties. Where there is reason to suspect the existence of an acid in the primae viae, it ought to be admitted in union with soap, magnesia, or aromatic confection.* Antiynonii Tarlarizatum.—This is by far the most important antimonial preparation, whether we consider it in relation to its powers as an emetic, or its more imperceptible operation on the animal economy. With regard to its chemical composition, opinion is as yet unsettled. By some it is considered as a triple salt, consisting of tartaric acid, oxide of antimony, and potass. Others hold it to be a bi-tartrate of antimony. There exists also much difference of opinion in re- lation to its degree of solubility. According to Dr. Duncan, it is soluble in three times its weight of water, at 212°, and in fifteen at 60°. Mineral acids, alkalies, and their carbonates, and many of the metals, soaps, hydro-sulphurels, and many infusions and decoctions of bitter and astringent vege- tables, decompose this salt, and render it inert, or at least destroy its peculiar powers. " One ounce of the * Paris' Pharmacologic. 78 EMETICS. decoction of yellow bark is capable of completely decomposing 9i. of this salt."* Rhubarb also destroys its powers; it is said, that the infusions of gentian or wormwood do not decompose it. The alkaline sul- phates, if perfectly neutral, do not affect this salt. When, however, "there is an excess of acid, as in alum and bi-sulphate of potass, &c. then its decomposition is effected, and a white insoluble sulphate of antimony is precipitated." " It appears, therefore," adds Dr. Paris, "that the famous ; erne to-purgative' of the French school, consisting of sulphate of soda and tar- tarized antimony, in solution, is by no means the un- chemical mixture which some have considered it to be, and that it really produces its effects from the opera- tion of its original ingredients, and not from that of the compounds (sulphate of antimony, tartrate of soda, and sulphate of potass) which have been erroneously supposed to result." Its effects on the living economy are various, ac- cording to the dose administered. Given in very minute doses, as one-sixteenth or one-twelfth of a grain, it increases pulmonary secretion, and promotes expectoration. Exhibited in the dose of one-quarter or one-third of a grain, it augments the cutaneous transpiration, as well as the secretion of urine. In the dose of one-half to one grain, it increases the secre- * Paris' Pharmacologia: from which work chiefly I have taken the chemical and pharmaceutical character of this salt. EMETICS. 70, tion of the saliva, the gastric and intestinal mucus, and occasions nausea, and alvine discharges. In a still stronger dose, from two to four grains, it speedily ex- cites nausea, and full and perfect emesis. If it be given in an over-dose, it produces inflammation of the stomach and bowels. Magendie states that he found the mucous coat of the digestive and pulmonary or- gans of those who had died of excessive doses of this substance, to exhibit marks of inflammation.* It also affects the nervous system, producing vertigo, anx- iety, insensibility and delirium. Brodie thinks that tart, antimony acts directly on the brain; in some experiments which he performed with this substance he saw paralysis, insensibility, and torpor produced, unattended by any other effects to which these symp- toms could be ascribed as secondary results.f Its most important operation, however, independent of its emetic effects, is to diminish the force and frequency of the pulse. Its control over the action of the heart is sometimes so great as to produce syncope. Brodie-, * De 1'Influence de l'Emetique sur I'Homme et les Animaux. A Paris, 1815, 8vo. f Orfila gives the following general symptoms of poisoning by tartar emetic. " Rough metallic taste, nausea, copious vomitings, frequent hic- cup, cardialgia, burning heat in the epigastrium, pains of the stomach, abdominal colic, inflation, copious stools, syncope, small contracted and accelerated pulse, skin cold, sometimes intense heat, breathing difficult, vertigoes, loss of sense, convulsive movements, very painful cramps in the legs, prostration of strength, death." To these symptoms difficulty of swallowing is sometimes joined. $Q EMETICS. after having given large doses of this salt to animals, found, on opening them, that the heart beat with great feebleness, and, although artificial respiration was kept up, it soon ceased to act altogether. As a vomit, tart, emetic is, perhaps, the most im- portant article we possess. Its effects are certain, prompt, and energetic. It occasions a more complete agitation and impression upon the whole nervous sys- tem, than ipecacuanha; nor is it apt, like this latter substance, to leave the bowels in a constipated state. It acts also with greater certainty on the skin, produc- ing diaphoresis; and finally, it acts in smaller doses, and is less disagreeable to the taste. I will now proceed to consider its therapeutic ap- plication, in which, however, I shall confine myself to its more important and peculiar remediate effects. Tartarized antimony, either with a view to its emetic effects, or as a means to curb the action of the heart and arteries, and to induce diaphoresis, is now one of the most common remedies in all febrile diseases. Cullen, who was particularly fond of prescribing this remedy in fevers, thought that its good effects were immediately connected with the nausea which it pro- duces when given in certain doses. This opinion is,j^ however, controverted by Fordyce, and more recently by Balfour, Lenthois, and others. It is contended by these writers, that this medicine is much more effica- cious in fevers, when it produces little or no sensible EMETICS. SI effects on the stomach, than when it excites nausea. The two latter writers especially, bring forward strong proofs of its possessing sedative powers, independent of its diaphoretic or nauseating effects. The experi- ments of Brodie, already mentioned, are also in evi- dence of the correctness of this opinion. From my own experience, I am entirely persuaded, that this substance has the power of diminishing inflammatory or arterial action, independent of any of the effects just stated. I have a patient now under my care, who is using very minute doses of this medicine in inci- pient phthisis, according to the directions of (,en- thois, and he is sensible of very great relief; all the hectic symptoms are manifestly mitigated; he has never taken the medicine to the extent of producing nausea. Upon this subject Dr. Chapman gives us some " curious" speculations. " Medicines," says he, " seem to do good in the cure of fever by exciting their own specific or peculiar action, and when they disorder the stomach by sickness, they depart from this, and, if they do not act as poisons, always become nugatory, or more or less mischievous." That tartar emetic has a tendency to lessen febrile excitement, independent of its nauseating effect, ap- pears to be beyond a doubt; yet the declaration that the nausea which it creates, renders its anti-febrile effects "nugatory or mischievous," is wholly gratuitous, VOL. i. 11 Q2 EMETICS. and unsupported by experience. All that can be cor- rectly said upon this point is, that the good effects of this remedy in acute diseases are not confined to nau- seating doses; just as the anti-syphilitic powers of mercury are not confined to its salivating effects. The idea that tartar emetic " departs from its spe- cific or peculiar action when it creates nausea," is to me altogether incomprehensible. Nausea is but an intermediate link in the chain of effects produced by this remedy; and to say that its peculiar operation ceases when this effect supervenes, appears to me to carry with it its own contradiction, and certainly is without the shadow of a proof. We might, with just as much propriety, assert that when mercury produces ptyalism, it departs from its peculiar or specific action, and becomes " nugatory or mischievous." Dr. Chapman seems to think that he explains the febrifuge operation of antimonials, by asserting that, "like mercury, lead, arsenic, bark, &c. they operate by virtue of a peculiar power." This, it must be con- fessed, is not very edifying; since, to say that an agent produces its effects " by virtue of a peculiar power," is, indeed, to utter what no one will deny, but what cannot convey the least information concerning the nature or character of its operation. It appears to be ascertained beyond a doubt, that tartar emetic has a specific power of moderating the action of the heart and arteries; and upon this power, EMETICS. 83 there is much reason to believe, its good effects in acute diseases mainly depend. Although this effect of the remedy, namely, the reduction of arterial excite- ment, unquestionably takes place, independent of nau- sea, yet there are no facts which can lead us to believe that it ceases when the nausea comes on Every thing, on the contrary, clearly demonstrates, that when nausea does supervene, the action of the sanguiferous system is still more prostrated. It is not reasonable, there- fore, to say, that nausea renders the febrifuge opera- tion of this substance "nugatory;" an assertion which is indeed contradicted by universal experience. From what I have observed of the operation of antimonials in the cure of fevers, I am of opinion that its good effects will be most decidedly manifested, when it is given in doses just sufficient to create and sustain very slight nausea. Much of the advantage of this, as per- haps of all other remedies, depends, I conceive, on keeping up an equable impression upon the system. If the degree of the action be greatly varied, irregular and fluctuating determinations must take place in the body. For it must be observed, that, in proportion as the action of a remedy rises in degree, so does it suc- cessively bring under its more especial influence par- ticular organs of the system; and hence, if its impres- sions fluctuate in intensity, there will.be a correspond- ing fluctuation in the action of the organs upon which the peculiar powers of the remedy determines it to y J, EMETICS. act. Thus a dose of tartarized antimony first acts upon the nerves and brain, whose influence, according to the experiments of Brodie, it diminishes. As a necessary consequence of this, the capillaries, being more immediately under the nervous influence, fall into a corresponding state of relaxation, and give rise not only to a determination of blood from the central to the exterior vessels, but also to a freer separation of the perspiratory fluid. If the action of the remedy rise still higher in intensity, it brings under its influ- ence the stomach, giving rise to the sensation of nau- sea; this effect being the result of a greater degree of sedative operation than the preceding ones, it is, of course, attended with an augmented relaxation of the cutaneous capillaries, and consequently with a more profuse discharge of perspiration. A still higher de- gree of the influence of the remedy directs its action more especially upon the muscular fibres of the sto- mach, diaphragm, and upon the abdominal muscles, all of which it brings into violent and simultaneous contraction. From all this it is evident that, by fre- quently varying the degree of action of our remedy, we keep up an irregular fluctuation of the excitement of the organs which it affects, a circumstance which I conceive must interfere very considerably with its salutary operation. It is upon this principle, therefore, that I would ob- ject to the employment of nauseating doses of antimo- EMETICS. Q5 nial remedies, and not upon the supposition that their febrifuge effects are incompatible with their nauseating operation, as is imagined by Dr. Chapman. In or- der to obtain the full advantages of these remedies, their action must be kept up for a considerable time. But it is often extremely difficult to keep up a nausea for any length of time, in consequence of its distress- ing effects upon the patient. It is, therefore, not often sustained with uniformity, and generally very fre- quently interrupted. Hence we have its chief action at one time concentrated upon the stomach and cuta- neous capillaries, and again suddenly withdrawn from these, to be directed exclusively upon other parts. These disadvantages are, however, wholly avoided by exhibiting the remedy in doses insufficient to excite nausea; since, in such under-doses, its effects are con- fined exclusively to the nervous and sanguiferous sys- tems; whose actions it moderates without producing any fluctuations in the excitement of particular organs. If, in prescribing antimonials, we can keep up a con- tinued and uninterrupted nausea, for an adequate length of time, we shall, I am persuaded, obtain the full advantages of the remedy. But as there is a dif- ficulty in effecting this, it will, I think, be best either never to carry it to the point of producing nausea, or perhaps, as I have already said, just far enough to ex- cite this sensation in a very slight degree. This may gg EMETICS. be further illustrated by the effects which mercury pro- duces on the system. Thus, while we keep up a uni- form ptyalism, we fully obtain the peculiar sanative effects of this substance, in, perhaps, as short a period as is possible. If, however, it becomes frequently in- terrupted, and again renewed, we derive much less benefit from it than we do either from a course of con- tinued salivation, or from one in which the mercury is never carried to the extent of producing this effect. I conceive, therefore, that the antiphlogistic opera- tion of the antimonial preparations depend upon their sedative effects; first on the nervous system, and con- secutively on the heart and arteries; and that these effects will be the more advantageous as they are more equably diffused throughout the whole system. Dr. Balfour, in a late work on the sedative effects of tartar emetic, speaks in the highest terms of small doses of this remedy in febrile affections. " Tartar emetic," he says, " is eminently efficacious in chronic as well as acute disorders; in topical affections as well as in general derangement; and its efficacy in either case is not confined to nauseating doses. From its natural and powerful tendency to equalize the nervous power, it cannot fail, even where blood-letting is necessary in the first instance, to supersede the neces- sity of recurring to it so often, and carrying it to that degree which is found necessary when the lancet alone EMETICS. 87 is trusted to, for the removal of inflammatory com- plaints."* Mr. Lenthois, of Montpelier, has lately published a work, in which he adduces strong testimony in favour of the salutary operation of very minute doses of this remedy in phthisis pulmonalis. This mode of employ- ing it is as follows: a grain of tart, emetic is to be dis- solved in eight table-spoonfuls of distilled water. This is to be mixed with six or eight pints of water, but never more than twelve, nor less than six. u This is to be used for drink, either alone or with other drink, at meals, or with wine at all seasons and hours, and without any limited time, it being attended with no in- conveniency." If these views of the operation of tartar emetic be correct; that is, if, independently of its nauseating ef- fects, it possesses the power of moderating the action of the heart and arteries, then there can be no doubt of its better adaptation to the cure of haemorrhages than any of the other articles of this class. In slight, but protracted haemorrhagy, attended with an irri- tated state of the arterial system, small and frequently repeated doses of this remedy have been known to produce decided advantages. From my own experi- ence I can say nothing of this practice. I have already mentioned the employment of eme- * Observations Illustrative of the Sedative Effects of Emetic Tartar, p. 8—12. £8 EMETICS. tics in hernia humoralis. In this affection the tart. antimony is decidedly more efficacious than the other emetics. It should, however, always be given so as to produce full vomiting; or, at least, to excite strong nausea. James' powder, a preparation which approaches very nearly to the character of tartar emetic, is said to be highly useful in hydrocephalic affections. Dr. William Stoker, of Dublin, who speaks particularly in favour of the employment of this remedy in these affections of the head, has also published some very favourable results of its use in apoplectic cases. He states that it has an obvious tendency to diminish the determination of the blood to the head; and that a continued use of it, in small doses, has the effect of removing the disposition to apoplexy.* Tartar emetic is sometimes employed, in nauseating doses, to bring on relaxation of the muscles, in order to facilitate the reduction of dislocated joints. Dr. Chapman says, that he has known it to be advantage- ously administered in the form of an enema, for the purpose of evacuating the stomach, in order " to re- move poison which had been swallowed." • He has also used the remedy in this way, in a case of tetanus, " with such complete success" that he entertains ' * the hope that, under this treatment, the disease may here- * Dublin Medical Essays, anno 1806. See also vol. ii. p. 43, of the " Transactions of the King and Queen's College of Physicians, Ireland." EMETICS. g9 after be divested of some portion of its terrors and mortality." This practice has, 1 believe, never been resorted to by any other physician. Dr. Witzman, a Russian physician, has lately re- commended the employment of tartar emetic for re- moving opacity of the cornea. The remedy is to be applied in the form of an ointment, composed of fresh butter and castor oil a.a 3i. tart, antim. gr. iv. and afterwards gradually increased to twenty grains. A small portion of this ointment is to be put into the eye every morning and evening: and a warm compress applied pretty firmly to it, for two or three hours after the introduction of the ointment, in order to allay the pain which it sometimes creates* Tartar emetic, as has already been stated, is capa- ble of acting with great violence, and when the quan- tity taken is enormous, its effects are eminently dele- terious. If it excites great vomiting, with cramp in the stomach, the patient should be directed to take copious draughts of sugar and water. ": If the vomit- ing do not cease after the tartar emetic may be sup- posed to have been ejected, and the pain is augmented, a grain of opium may be given, and repeated at an interval of a quarter of an hour, for two or three times, if the symptoms be not calmed." When the symptoms continue still to increase, leeches should be applied to the anuomen and throat. If the individual * Russian Physi6o-Medical Repository, &c. edited by E. Martini. voi,. i 12 UO EMETICS who has taken the antimonial preparation does not vomit, and yet suffers from the other symptoms, several glasses of sugar and water should be taken; if, in spite of this, vomiting do not occur, the following should be given at repeated doses: " put four or five gall-nuts into two quarts of water, let them be boiled together for ten minutes and then strained. Experi- ence has proved that gall-nuts are to be preferred to any other astringent; but, in default of them, two ounces of Peruvian bark, or the bark of oak or willow may be employed."* If, notwithstanding these ap- plications, the symptoms continue, we must resort to general and local depletions, blisters or fomentations to the region of the abdomen, together with copious draughts of mucilaginous drinks, warm bath, &c.. SULPHAS ZINCI.—WHITE VITRIOL. White vitriol has a styptic, metalic, and somewhat acidulous taste. " It is composed of one proportional" of oxide, and one proportional of acid ;v its crystals, which are four-sided prisms, terminated by four-sided pyramids, " contain seven proportionals of water. It * Orfila's Directions for the treatment of persons who have taken poi- sons, page 60. EMETICS. 91 is dissolved by 2.5 times its weight of water at the temperature of 60°. Alcohol has no action on it. The alkalies, earths, hydro-sulphurets, astringent vegetable infusions, and milk, destroy or weaken its powers. v* Its remediate effects vary according to the dose in which it is administered. Given in a small dose, from one-half to two grains, it acts as an astringent tonic. In larger doses, from ten grains to 3ss, it is strongly emetic. Sulphate of zinc is, perhaps, the most prompt eme- tic with which we are acquainted; and hence it is peculiarly applicable to cases where poison has been swallowed, and where, of course, it is of the utmost consequence to procure speedy and effectual vomit- ing. Previous to the discovery of tartarized antimony and ipecacuanha, this preparation of zinc was very commonly employed as an emetic in all cases where emesis was desired. At present, however, its use as an emetic, is almost entirely restricted to the purposes for which I have just mentioned its peculiar applica- bility. The objection alleged against its employment in this way by Cullen, namely, " that it is apt, if not thrown up again immediately, to continue a disagree- able nausea, or even vomiting longer than is neces- sary," does not appear to be well founded. Moseley, indeed, gives quite a contrary character to this re- * Paris' Pharmacelogia. 92 EMETICS. medy. His experience with it was very extensive, and his opinion upon this point is, therefore, entitled to much respect. He affirms, " that the patient is not harassed with its operation; that it is never violent as antimonials are, and generally instantaneous and sud- denly over, always leaving the stomach strongly invi- gorated ft either does it cause spasms in the viscera, nor any nervous affections, mischiefs often produced by the antimonials." I have exhibited this substance, with a view to its emetic operation, in a very considerable number of instances, and sometimes to the extent of thirty grains, without ever noticing any of the disagreeable conse- quences mentioned by Cullen. It does not appear, indeed, that its effects on the system, even when taken in excessive quantities, are eminently deleteri- ous. Orfila mentions the case of a young lady, who, by mistake, took a solution of two ounces of white vitriol. On his arrival " he found the lady in a dread- ful situation; her countenance was pale and sunk; the extremities cold, the eyes dim, and the pulse convul- sive." Vomiting, however, soon came on, which was promoted by draughts of warm water. After the greater portion of vitriol had been evacuated " he set about decomposing the rest by means of the fixed alkali, diluted with sugar-water." The vomiting now ceased instantaneously, and in less than two hours she was free from every painful or alarming sensation. EMETICS. gg Moseley speaks highly of this remedy in the treat- ment of dysentery. " I give it," says he, " at first without alum, in sufficient doses to cause evacuations, and afterwards with the alum, in nauseating doses, and frequently with opiates at night."* I have used this preparation in the dysentery of children, after it had assumed a chronic character, and generally with con- siderable advantage. I have always, however, confined myself, in these cases, to the employment of nauseat- ing doses; and it should never, I think, be used, until the inflammatory symptoms have been moderated by depletory measures, and the bowels frequently evacu- ated by suitable laxatives. In referring to the testi- mony of Moseley, in favour of this practice, it must be recollected that he employed it in tropical dysenteries; a circumstance which may, perhaps, account for its less favourable results in the treatment of more north- ern climates. Mr. Bampfield, who has published an excellent book on tropical dysentery, makes the follow- ing observations, in relation to Moseley's zinc mixture in dysentery. "The mixture of sulphas zinci and alum, recommended by Dr. Moseley, has nearly the same effects on the intestines, as the infusion of sima- rouba, if there be an excess of alum. It is extremely * The following is his formula, for exhibiting the white vitriol with alum. Sulp. zinci Ziii. sulp. alum. zi. pulv. coccinel. gr. iii. aqua buli- entis Ibi. Mix these in a, mortar, until the solution is cold and the sedi- ment deposited, then pour it off. Dose* a table-spoonful for an adult. $4, EMETICS. difficult to adapt the proper quantity of alum to the astringent effect required; when it produces consti- pation, the morbid secretions, tormina, &c. are in- creased, and sometimes induce an actual relapse, and when the excess of sulphas zinci maintains a free dis- charge of natural faeces, the morbid secretions are diminished."* In the treatment of diarrhoea, this remedy appears to be more decidedly advantageous, and is certainly less hazardous than in dysentery. Dr. Moseley speaks also highly in favour of the em- ployment of the zinc solution, in colica pictonum. After the bowels are evacuated by suitable purgatives, a table-spoonful of the solution is to be taken every five or six hours, until the pain ceases. Of this prac- tice I can say nothing from my own experience, nor does it appear to have gained much credit with the profession. To relieve hooping-cough, the sulphate of zinc is, undoubtedly, a remedy of very considerable powers. For this purpose I have prescribed it with unequivocal advantage. I think it decidedly superior to antimo- nial emetics, in cases where there is much pulmonic oppression, with difficult respiration. The only ob- jection to its use is its very disagreeable taste, a cir- cumstance, indeed, which renders its employment by * Practical Treatise on Tropical and Scorbutic Dysentery, p. 19;" London,1819. EMETICS. 95 children, extremely difficult, and often altogether im- practicable. As an expectorant, in chronic catarrhal affections, attended with oppressed breathing and a tough mu- cous expectoration, the same writer who I have al- ready so often mentioned; speaks in exalted terms of his "vitriolic solution." He directs it to be taken in slightly nauseating doses, three or four times a day. In phthisis, attended with bloody expectoration, he declares this remedy to be often of signal service. In all these affections I have occasionally employed it, but never with any decided advantage. Dr. Paris, however, adds his testimony in favour of the use of this remedy in pectoral complaints. " In affections of the chest," says he, " attended with inordinate secre- tion, I have witnessed much benefit from its exhibi- tion, particularly when presented in the form of lozenge." Under the head of astringents this remedy will be again noticed, to which the reader is referred for an account of the various other uses to which it has been applied in medical practice. " The white vitriol of commerce," says Dr. Paris, " ought never to be used in medicine, since it generally contains the sulphates of copper and iron." m EMETICS. SULPHAS CUPRI.--SULPHATE OP COPPER.--BLUE VITRIOL.—BLUE COPPERAS. This salt occurs in the form of rhomboidal prisms of a deep blue colour, having an exceedingly harsh and stiptic taste. It consists of one portion of perox- ide, with two portions of sulphuric acid, constituting, therefore, an oxy-sulphate. It dissolves in four parts of water, at the temperature of 60°, and in less than two, at the boiling point. It is not soluble in alcohol The operation of blue vitriol, as an emetic, is ex- ceedingly prompt, but its impressions upon the gene- ral system appear to be much less powerful and ex- tensive than those of the other articles of this class. When taken into the stomach it very speedily excites strong efforts at vomiting; and though the agitation of the body which it creates is very considerable, yet its impressions seem to be a good deal confined to the stomach, since, neither during the operation, nor after it is over, does the patient experience that distressing relaxation, and general prostration of the system which is occasioned by the other emetics. As an emetic, this remedy has been very little em- ployed, except in the cure of phthisis pulmonalis. Dr. Marryatt* appears to have been the first who em- ployed the sulphate of copper in this way. He re- * Therapeutics; or, the Art of Healing, 21st edition, 1806. EMETICS. Qij commends it to be given with tart, emetic, in doses of little more than two grains of each, two or three times a week. Nothing is to be drank during its operation, and hence he calls it the dry vomit. When diarrhoea attends, he gives one grain of the sulphate of copper with five grains of ipecacuanha. In the first volume of the Transactions'of the Col- lege of Physicians of Philadelphia, there is a paper by Dr. Senter, on phthisis pulmonalis, in which he de- clares that he u has restored more persons labouring under hectic fever from glandular suppuration, by vomiting every second or third day with the sulphate of copper, and giving in the intervals as much as the stomach would bear of Dr. Griffith's myrrh mixture, than by all other methods he has ever tried." He considers this preparation of copper, when united with ipecacuanha, as one of the safest and most efficacious emetics we possess. Dr. Thomas,* also adds his tes- timony in favour of the good effects of this practice. He says that he has adopted it in the treatment of many cases of incipient phthisis " with infinite advan- tage." Dr. Samuel Fort Simmons,f likewise speaks very favourably of this remedy in consumption. When this preparation is taken into the stomach in * Modern Practice. f Practical Observations on the Treatment of Consumption London 1780. VOL. I. 13 98 EMETICS. excessive doses, it acts as a strong poison, producing pain in the throat, stomach, and intestines, accompa- nied with violent vomitings. " To these alarming symptoms are joined frequent and foetid eructations; hiccup, difficulty of respiration, and almost suffoca- tion ; the pulse becomes small, hard, and accelerated, and in certain cases it may be said to vibrate under the finger like catgut. An inextinguishable thirst, difficulty of making water, cramps, the extremities of an icy coldness, horrible convulsions, general decay of strength, the features of the face changed, delirium— death." To counteract these effects it has been found that the white of eggs, beat up with water, is the best remedy we possess. Sugar is also useful, and by many has been highly praised as an antidote to this poison. Orfila admits the propriety of its employment, but he says it is not a counter poison. " Liver of sulphur, the alkalies, gall-nuts, Peruvian bark, char- coal, &c. considered as counter poisons, are useless, often dangerous, and ought, therefore, to be banished."* The alkalies and their carbonates, sub-borate of soda, acetate of ammonia, tartrate of potass, muriate of lime, nitrate of silver, sub-acetate and acetate of lead, oxymuriate of mercury, all astringent vegetable infusions and tinctures, decompose it and alter or de- stroy its effects.] * Orfila. t Paris' Pharmacologic emetics. gg In the dose of from two grains to fifteen, this article acts as a prompt emetic; from one-eighth to one-fourth of a grain, it operates as a tonic. MERCURIAL PREPARATIONS. The subsulphas hydrargyri flavus, or turpith mine- ral, is the most active and prompt emetic of the mer- curial preparations. It was, at one time, a good deal employed for this purpose, but it is now almost entirely- neglected, on account of the violence of its operation, and its aptness sometimes to excite salivation. It has been recommended for the cure of virulent gonorrhoea, and hernia humoralis, in which affections it has been said to act beneficially, both as a mercurial and an emetic. In leprous diseases, it has also been employ- ed with advantage, particularly when it affects robust constitutions. It has likewise been administered with good effects in putrid sore-throat, croup, and in pe- ripneumony. It is given in the dose of from two grains to six or eight. Given in smaller doses, it acts as an alterative and diaphoretic. Dr. Hope, senior, states that it forms snTexcellent errhine by mixing it with powder- ed liquorice-root | OQ EMETICS. The corrosive sublimate has also been employed with a view to its emetic effects. Its use, however, for this purpose, has been properly abandoned, as violent and dangerous. % CHAPTER III Cathartics. Cathartics are medicines which evacuate the con- tents of the intestines downwards, or which, when given in proper doses, produce purging. As, in many parts of the intestinal tube, its contents are carried forwards in a direction contrary to their gravity, a very considerable force, it is evident, must be pretty constantly exerted from above downwards, in order that the alvine evacuations may be regularly effected. This force consists in the peristaltic action of the intestines:—that is, in a regular series of con- tractions of the muscular fibres of this organ, from above downwards. Constipation, therefore, depends either upon a cessation, or an inadequate force of this peristaltic action, or upon some mechanical resist- ance to its natural propulsive power, or upon both these causes combined. Whatever, therefore, increases the alvine dis- charges, acts either by increasing the peristaltic ac^ tion of the bowels; or, by removing the impediments to its regular powers; or, finally, by producing both these effects. J0£ CATHARTICS. It is in this latter way that cathartics produce their evacuant effects. For, while they excite the peristaltic or propulsive action of the intestinal canal, they also augment the effusion of its natural secretions, and thus at once increase the force of the propelling power, and diminish the resistance of the substances propelled, by lubricating the internal surface of the bowels and attenuating their contents. Independent of the different degrees of evacuant powers which these remedies possess, they also differ essentially from each other in relation to the particular parts of the intestinal tube upon which they more im- mediately exert their actions, as well as in the nature and appearances of the discharges which they produce. Thus, gamboge, calomel, and a few others, act more particularly upon the upper portion of the intestines; castor oil, colocynth, &c. possess a more extensive range of operation; while aloes acts almost entirely upon the lower portion of the bowels. With regard to the particular character of the evacuations, produced by the articles of this class, the diversity is equally remarkable.—We find, for instance, that jalap and the saline purgatives produce copious watery discharges; castor oil, rhubarb, &c. merely evacuate the contents of the bowels; while others, like calomel, increase the secretion of bile, and carry off this fluid in augmented quantities. It is not improbable, as Dr. Paris observes, that the diversity which exists in relation to the part CATHARTICS. IQij of the intestinal tube upon which different purgatives act, is owing to the different degrees of " the solubility of the active elements" of these remedies. " It is, for instance, easy to conceive," says this writer, " that a medicine may act more immediately and especially upon the stomach, small or large intestines, according to the relative facility with which its principles of ac- tivity enter into solution; that those which are dissolved before they pass the pylorus are quick and violent in their effects, and liable to affect the stomach, as is ex- emplified by the action of gamboge, &c. whilst some resinous purgatives, on the other hand, as they con- tain principles less soluble, seldom act until they have reached the colon. Colocynth has a wider range of operation, since its principles of activity reside both in soluble and insoluble elements. Aloes again, being still further insoluble, pass through the whole alimen- tary canal before they are sufficiently dissolved, and act, therefore, more particularly upon the rectum." A knowledge of these circumstances is of very great consequence, both in a therapeutic and pharmaceuti- cal point of view. For it will not only enable the practitioner to modify the peculiar action of these re- medies, by changing the degree of their solubility, but also to select those articles which are peculiarly adapt- ed to the particular circumstances of the diseases for which they are prescribed. Thus, for instance, in ascites, we would be naturally led to employ those pur- J 04 CATHARTICS. gatives that have a tendency to evacuate much serum from the intestines, such as the saline cathartics; whilst in cases attended with redundancy or vitiated bile, we would resort to such as act especially upon the upper portion of the bowels, and at the same time influence the functions of the biliary system. Again, if, in addi- tion to the mere effect of unloading the contents of the bowels, we wish to produce a determination to the pelvic viscera, as, for instance, to the uterus, in ame- norrhoea, we select aloes as the appropriate purga- tive, in consequence of its more particular action on the rectum. Besides the more immediate operation of evacuating the contents of the bowels, cathartics produce other effects on the animal economy, to which no small part of their remediate powers may, with reason, be as- cribed. 1. They diminish the action of the heart and arte- ries, and consequently act with more or less advan- tage in all diseases of a sthenic character. This effect they produce, not only by evacuating the bowels of vitiated or accumulated contents, and thereby remov- ing a source of general irritation, but also, by abstract- ing from the contents of the blood-vessels themselves, by augmenting the secretion of serous fluid from the exhalants of the alimentary canal. In this respect the operation of these remedies resembles, in some degree, those of blisters; which, though acting pri cathartics. 105 tilarily as stimulants upon the sanguiferous system, reduce its action as a secondary effect, by the effusion of the serum which they occasion. 2. They promote the absorption of fluids, from the internal cavities. This effect they produce by a two- fold operation; namely, by depriving the blood-vessels of a considerable portion of their serous contents, and by augmenting, as a consequence of this, the reabsorp- tion of serum, from those cavities, in which it may ex- ist in a state of morbid accumulation. To render this explanation intelligible, it will be necessary to enter into a more particular exposition of the grounds upon which it rests. It appears to be conclusively established, both by direct experiment* and p; hoio- gical observations, that absorption is accelerated in proportion as the quantity of fluid circulating in the blood-vessels is diminished. It would appear too, that there is a constant effort in the system to preserve the regular proportion of serum in the blood, and that its inordinate loss by one emunctory, is counterbalanced either by a greater absorption from some of the inter- nal cavities, in which it may be accumulated, or by the diminished action of one or more of .the other serous emunctories. Thus when the exhalants of the peri- toneum effuse a preternatural portion of serum into the cavity of the abdomen, producing ascites, the mor- * Journal of Experimental Physiology, by M. Magendie, 1821. VOL. I. 14 j0g CATHA.UTICS. bid diminution of this fluid in the blood-vessels is, in some degree, counteracted by the diminished action of the cutaneous exhalants, and of the kidneys. The moment, however, that the kidneys are excited into a more perfect performance of their functions, then (this check to the morbid diminution of the serum of the blood being removed) some new supplying power is requisite to keep up the necessary proportion of serous fluid in the blood-vessels; hence the absorbents are called into action, and the dropsical fluid is reab- sorbed into the circulation, and thence eliminated by the regular emunctories. From these facts, therefore, we readily perceive the manner in which active ca- thartics promote the absorption of dropsical effusions. By irritating the exhalants of the internal surface of the intestines, a very greatly increased secretion of serum is suddenly produced by the action of these remedies. As a consequence of this, not only is the further effusion of dropsical fluid diminished by deriv- ing the blood from the exhalants of the cavities to those of the intestines, but its existing bulk is also directly lessened, by the absorbents assuming a more vigorous action, in order, to supply the deficiency which the purging has suddenly induced in the serous portion of the blood. This view of the subject will aid us, I think, in accounting for the fact mentioned by Dr. Paris and others, that cathartics often increase the effects of diu- retics. If, for instance, we give a diuretic to a drop- CATHARTICS. JQ7 sical patient, a slight, but insufficient increase of uri- nary secretion, for the most part, follows; the absorp- tion is, of course, proportionally small. Let a cathartic be now administered. This will excite a sudden and considerable increase of serous evacuation by the bowels; hence, an unusual demand for a restitution of this constituent portion of the blood is created; and, by consequence, a new impulse given to the supplying or absorbing vessels; which, continuing after the ope- ration of the cathartic has ceased, will have the effect of supplying the kidneys with a larger portion of the elements of their secretion, and, therefore, enable those medicaments which are calculated to increase their action, to operate more effectually. 3. Cathartics have a tendency to remove the torpor which sometimes prevails in the portal circulation, and thereby to promote the biliary secretion. This they do by exciting " a brisk peristaltic motion of the intestines, whereby the blood which is accumulated, and, as it were stagnated in the portal circle, is pro- pelled forwards."* 4. They produce a powerful derivation of the cir- culation from the superior to the inferior parts of the body, on the principle of ubi irritatio ibifluxus; and hence their utility in cephalic diseases. It may be observed, that, under particular circum- stances, bleeding has a decided effect in increasing the * Johnson on the Diseases of Tropical Climates. 108 CATHARTICS. susceptibility of the intestinal canal to the operation of cathartic medicines. " I have often noticed this fact," says Dr. Paris, " in contending with a plethoric dia- thesis; whenever the bleeding preceded the purgative, the effects of the latter have been uniformly more speedy and considerable; in obstinate constipation the same fact has been observed, and mild remedies have been known to act more powerfully, when preceded by blood-letting, than potent ones have when exhibited antecedent to it." Having premised these general observations, I shall now pass on to a more particular account of the prac- tical application of this class of remedies. There is no class of articles belonging to the materia medica, whose application is more extensive, or whose aid is more essential to the medical practitioner, than this one. In almost every variety of febrile disease, ca- thartics are among the most indispensable and im- portant curative means we possess. The alimentary canal has been, not unaptly, called the "store-house of diseases." Whatever may be the original febrile cause; whether seated in the bowels or elsewhere, it is certain that the secretions which are poured into the alimentary canal are, perhaps in almost every in- stance of fever, changed from their natural or healthy condition, to a state which renders them additional causes of irritation, to the already preternaturally ex- cited system. Hence, simply with a view to remove CATHARTICS. J 09 these additional supporters of febrile action, cathartics are important and indispensable throughout the whole course of nearly all acute diseases. But they are beneficial not merely by evacuating the vitiated and irritating contents of the bowels, but also on account of their direct depletory effects on the sanguiferous system, and their consequent power of reducing arte- rial excitement. In fevers of high vascular excitement, or in the first stage of all febrile diseases, we should, therefore, al- ways select such cathartics as are calculated at once to evacuate completely the contents of the bowels, and to occasion an abundant effusion of serous fluid from the intestinal exhalants. Hence, saline cathartics, in the ordinary synochous fevers, are decidedly the most advantageous. If, however, the disease be attended by an obvious functional derangement of the biliary system, as is generally the case in remittent and inter- mittent fevers, then it will be necessary to employ such cathartics as have a tendency, in addition to the effects just mentioned, to correct the disordered hepa- tic secretions. For this purpose we unite calomel with other appropriate cathartics. But, upon this point, I shall speak more particularly when I come to the consideration of the particular articles of this class of remedies. Typhus fever, having been long considered as es- sentially characterized, ab initio, by debility, cathar- HO CATHARTICS tics were, of course, almost universally held as im- proper in its treatment, until Dr. Hamilton, of Edin- burgh, pointed out their utility, in his inestimable work on purgatives. That they are, in fact, not only safe, but eminently useful, in the management of this form of fever, is now sufficiently established by the concurrent testimony of the ablest practical writers of the present day. Dr. Rush has, long since, observed, that purgatives are often found to remove, in a sudden and remarkable manner, the apparent debility which frequently exists in the latter stages of acute diseases. In the yellow fever he often saw the prostrated strength of a patient suddenly renovated by the operation of a single purgative. That debility is, conspicuously pro- duced by the impression of irritating matters on the intestinal nerves, is a fact too frequently witnessed to admit of a moment's doubt. Who has not seen the impression of indigestible food, in persons of debilitated digestive organs, bring on the most alarming prostra- tion of the vital powers? Why do we so strenuously restrict our debilitated convalescents from taking food, which, in health, would be deemed altogether insuffi- cient to sustain the natural powers? It is because we fear, and justly too, lest it either prostrate the already debilitated vital energies, or raise a tumult in the sys- tem dangerous to life. If the natural ingesta are thus able to affect the animal economy, when not fortified by strong digestive powers, is it not reasonable to expect CATHARTICS. J | ] similar pernicious consequences from the retention and irritation of the vitiated matters, on the intestinal nerves of the debilitated typhous patient? That the contents of the intestines must necessarily be more or less vitiated in all febrile diseases, but especially in the low typhus fever, is rendered certain, I think, not only from the actual, appearance of the discharges them- selves, but also from the necessary results of the sus- pended digestion and morbid intestinal secretions which occur in these fevers. From this view of the subject, therefore, we can readily perceive the utility of employing mild purgatives in the latter stage of typhus fevers; since we thereby free the system from a pow- erful cause of irritation, and at once renovate the vital powers, and enable the intestinal emunctories to re- cover their natural functions. " I have directed a strict attention," says Dr. Hamilton, " to this practice for a long time, and I am now thoroughly persuaded that the full and regular evacuation of the bowels re- lieves the oppression of the stomach, cleans the loaded and parched tongue, and mitigates thirst, restlessness, and heat of surface; and that thus the latter and more formidable impression on the nervous system is pre- vented; recovery more certainly and speedily pro- moted, and the danger of relapsing into the fever much diminished."* These observations apply particularly to the latter stages of typhus, for, in the commence- * Hamilton on Purgatives | 12 CATHARTICS. ment of this disease, when vascular excitement is pretty active, brisk purgatives will be beneficial, not only by unloading the bowels of their irritating con- tents, but also by their direct depletory effects on the blood-vessels. Upon the modus operandi of purga- tives in typhus, Dr. Armstrong* makes the following remarks, which, though correct, do not, as this re- spectable writer would seem to think, invalidate the foregoing remarks concerning the mode in which these medicines produce their good effects in typhus. "Purgatives seem beneficial by unloading the intes- tines of faeces and excrementitious matters, which, when retained, excite and keep up much general irri- tation. But is it not exceedingly probable, that they have another and far more salutary effect, in restor- ing healthy secretion, and in removing irregular dis- tributions of blood from the head, liver, and other parts? The full operation of aperients sometimes reduces the morbid heat of the skin and the morbid force of the pulse, almost as effectually as the affusion of cold water or venesection; consequences which surely in- dicate, that their action extends further than the mere removal of fecal matter from the intestinal canal." It cannot, indeed, be denied, that the consequences here mentioned do sometimes follow the operation of ca- thartics; but when we reflect that the very circum- stances of a hot and dry skin, an irritated pulse, mor- * Treatise on Typhus Fever, p. 102. Am. edit. CATHARTICS. \\$ bid function of the intestinal exhalants, and irregular distributions to the head, liver, and other vital parts, are, in reality, often produced by irritating matters lodged in the intestines; it will appear evident, that these symptoms will be mitigated by purgatives, not by any operation independent of their mere evacuant effects, but solely, perhaps, by removing those irritat- ing matters from the bowels, by which the morbid phenomena are aggravated, or produced. Dr. Armstrong makes, however, another observa- tion on this subject, to the reasonableness of which I readily subscribe. tc I believe," says he, " that purga- tives are also beneficial by preventing, through their operation, the absorption of the morbid secretions and excrementitious matter of the intestines; for when these have been allowed to be retained in typhus, I have generally observed a considerable increase of irritation, with an offensive odour from the lungs and from the skin; and, on the contrary, when the morbid secretions and excrementitious matter have been re- gularly evacuated, there has mostly been a diminution of irritation, with an absence of this peculiar odour." I have already said that some purgatives excite the intestinal exhalants to a copious evacuation of serous fluid, and thereby occasion a very considerable reduc- tion of vascular action, whilst others appear to do little more than merely evacuate the contents of the bowels. This circumstance should be always kept in mind vol. i. 15 1J4, CATHARTICS. when prescribing purgative remedies in typhus. For while cathartics of the former kind are best adapted to the first stage of the disease, when it may be ne- cessary to reduce the general excitement, they are, undoubtedly, less proper in its advanced stages than purgatives of a milder character, when our object is, in general, merely to unload the irritating contents of the bowels, with as little reduction of the vital powers as is possible. In all the exanthematous fevers cathartics are very important remedies. Their beneficial operation in these diseases would seem, I think, to depend chiefly on their power of determining the -circulation from the cutaneous to the intestinal capillaries. That the exanthemata are peculiarly characterized by strong morbid excitement in the cutaneous vessels, is per- fectly obvious from the manifest character of these diseases themselves. It would, therefore, appear rea- sonable, a priori, to suppose that whatever is calculated to moderate the action of the vessels of the surface, is, by this effect, equally calculated to moderate the cha- racteristic symptoms of these diseases. It is upon this principle that cold air and tepid ablutions act so bene- ficially in affections of this kind. Experience has taught us the fact, that an increased action of the ves- sels of the intestines, or an afflux of blood to these organs, is almost invariably attended by a simultaneous diminution in the action of the extreme vessels of the Cathartics. H3 cuticular surface, or, in other words, by a partial de- sertion of the blood from these vessels, and vice versa. Hence, sudorifics are useful in checking intestinal fluxes; and hence too, cathartics, by exciting intestinal exhalation, act beneficially in the exanthematous fevers. Undoubtedly^ however, something is also to be ascribed to the mere removal of the irritating con- tents of the intestines, and to the general reduction of arterial excitement, which these remedies occasion. In the early stage of scarlatina simplex and anginosa, purgatives are of essential service. Their utility in this disease has been particularly dwelt on by Dr. Hamilton, in his work on purgatives; and Dr. Arm- strong adds his testimony in favour of this practice— a practice which is, indeed, pretty universally recom- mended at the present day. In order to derive the full advantages of purgatives, it is necessary to produce brisk and copious evacuations. For, if the views just given of the modus operandi of purgatives, in af- fections of this kind, be correct, it is evident that such cathartics as act briskly upon the bowels, must be most efficacious in this disease. Dr. Armstrong recom- mends the employment of sulphate of magnesia with tartrate of antimony., so as to excite rapid purging and vomiting. The same observations apply to the use of purgatives in erysipelas. In no disease are cathartics more decidedly bene* ficial than in dysentery. Such is the tenderness of the HQ CATHARTICS. inflamed intestinal canal in this disease, that even its ordinary contents become a source of great and painful irritation. One of the first steps, therefore, in its treat- ment, is to remove these irritating matters by the em- ployment of such purgatives as produce a speedy and full action on the bowels; and, as the secretions which are poured into them are, perhaps, in all instances in a vitiated state, these remedies must be occasionally employed throughout the whole disease. As our prin- cipal object is, however, to remove those substances from the bowels which have a tendency to irritate, it is obvious that our purpose will be best answered by such means, as will evacuate them with the least possible irritation. It is, therefore, of considerable conse- quence to select such cathartics as are least harsh in their operation, though sufficiently active to induce copious evacuations. Cathartics are exceedingly useful in puerperal fever and peritonitis. Active purging in the onset of these diseases, is, indeed, often sufficient effectually to arrest their future progress. Used in conjunction with de- cisive venesection, cathartics constitute, in fact, the only remediate measures upon which any reliance de- serves to be placed. There is generally much diffi- culty in moving the bowels in these affections, and we must, therefore, employ strong doses of the most ac- tive of these remedies. I am decidedly of opinion, both from theoretical considerations and practical CATHARTICS. H7 observation, that the benefits of purgatives in these diseases will, in general, be proportionate to the acti- vity of their operation. Drs. Abercrombie* and Brous- sais, however, are of opinion that purgative medicines are injurious in peritoneal inflammations. The lat- ter writer observes, that these remedies are hurtful, " because the vermicular contractions which they ex- cite in the intestines, must increase the morbid sensi- bility of the peritoneum." The following observations of Dr. James Johnson upon this subject, appear to me to be highly judicious. " In abdominal inflammation, provided the mucous tissues are not inflamed, purga- tive medicines excite the secreting vessels, not only of the whole internal surface of the intestines themselves, but of the glandular organs whose excretory ducts open into the primae viae, and thus powerfully deplete locally the vascular system of the abdominal viscera. When the portion of peritoneum reflected over the intestines is inflamed, but where the villous coat is un- affected, I hesitate not to assert, from personal expe- rience, that constipation of the bowels will, in nine cases out of ten, be a feature of the disease; and in such cases we maintain that to excite the natural action of the mucous membrane, immediately after proper vascular depletion, is a powerful mean of checking the peritoneal inflammation; in the same way that a * Researches on the Pathology of the Intestinal Canal; in the sixty- third number of the Edinburgh Medical and Surgical Journal. H8 CATHARTICS. free expectoration from the mucous membrane of the lungs, relieves the vascular turgescence and inflamma- tion of the parenchymatous structure or pleural cover- ing of the same organ."* Dr. Marshall Hall, gives an account of a disease peculiar to puerperal women, resembling very closely genuine puerperal fever, in which purgative medi- cines would appear to be the only remedies offering any prospect of success; and in which bleeding, ac- cording to his experience, is almost certainly fatal. Dr. Hall's description of this disease, as distinguisha- ble from puerperal fever, properly so called, is, how- ever, by no means satisfactory. He has pointed out no marks by which it may be discriminated from this latter disease; there can, however, be no doubt, that great prostration of the vital powers, pain and arte- rial excitement, may sometimes arise from intestinal irritation in puerperal women, without the existence of any local abdominal inflammation; and under such circumstances we can readily perceive, that bleeding, especially if copious, would be improper, since it would create additional debility without removing the cause of irritation, which would, indeed, by this very prac- tice, become more pernicious in its effects. From the general antiphlogistic operation of cathar- tics, it is evident that they are not inapplicable in the treatment of acute rheumatism. They are, in fact. * Medico-Chirurgical Review, No. 2, Analytical Series. CATHARTICS. \\Q much recommended in this disease by writers of great respectability. "The advantage," says Dr. Scuda- more, " of making a detraction from the general cir- culation by the channel of the alimentary canal, is no less remarkable in rheumatism, than in every other inflammatory disease. In proportion as we pursue this practice upon a continued principle from day to day, do we obtain its good effects in acute rheuma- tism; the circulation becomes moderated; the inflam- matory diathesis subdued, and the absorbent system is excited to increased action. Hence, we powerfully promote the removal of those excessive secretions of the synovial membranes, which have been already described as causing the distention and impeding the motion of the affected parts. A saline purgative, administered in small doses, and at repeated intervals, is the most advantageous."* Drastic.purges are, how- ever, as a general rule, not to be employed in the treat- ment of this disease. These are, in some degree, in- compatible with that regular action of the cutaneous exhalants which seems to be indispensable in the re- moval of this painful affection. Laxatives, on the contrary, are of unquestionable service; they remove the sources of intestinal irritation; tend gently to equalize the circulation, and lessen the action of the heart and arteries, by their evacuant effects upon the extreme vessels of the intestines. As an auxiliary to other antiphlogistic measures, they can seldom be * A Treatise on the Nature and Cure of Gout and Rheumatism, p. 299. 120 CATHARTICS. neglected with propriety in the cure of acute rheu- matism. Nearly the same thing may be said in rela- tion to the use of cathartics in the treatment of gout. Whatever be the real nature of this disease, it seems certain that there is, perhaps, always functional de- rangement of the secretory organs of the alimentary canal, and especially of the liver and portal system of vessels.* There is no difficulty, therefore, in account- ing for the beneficial operation of purgatives in gout; since they not only remove the vitiated and irritating contents of the bowels, but tend also to correct the action of those glands whose products are poured into the alimentary canal, and, by detracting from the general circulation, to moderate the febrile excite- ment, and especially to promote and invigorate the portal circulation, which, according to Scudamore, is in a morbidly engorged condition.f Dr. Sutton, in his Tracts on Gout, &c. speaks strongly in favour of the employment of cathartics in this disease. Dr. Scuda- more states, that " he has invariably employed, with the greatest advantage, purgative and diuretic medi- cines conjointly, so that the exhalant vessels of the alimentary canal, and the secreting function of the kidneys are stimulated to increased action at the same time." Such a union of purgatives and« diuretics is particularly serviceable in those cases that are attended with dropsical effusions in the extremities. * Dr. Scudamore on Gout, p. 74. f Ibid. p. 100. CATHARTICS. 121 There is no acute disease in which purgative medi- cines are more indispensable than in hydrocephalus internus. The pathology of this disease has, of late years, been much elucidated. It appears to be now pretty generally admitted, that hydrocephalus is very often dependent on gastric irritation. The alvine dis- charges, in this disease, afford unequivocal proof of great functional disorder of the liver. They very commonly consist of large quantities of black, or green and glary bile, and are seldom, if ever, found to exhibit the appearance of natural and healthy evacuations. In post mortem examinations of hydrocephalic chil- dren, Dr. Cheyne "found in the liver the remains of great inflammatory action, and also proofs that undue irritation had existed in the alimentary canal."* And Mr. Abernethyf states, that on dissecting the body of a child that had died of " unequivocal symp- toms of hydrocephalus," he found the brain perfectly healthy, the only diseased appearance being in the bowels. Dr. Cheyne also mentions the case of a girl, who, complaining in the evening of headach, was put to bed by her mother, and soon fell asleep; next day, at noon, she was still sleeping profoundly, respiring fully and slowly, with now and then a heavy sigh: the eyes were fixed, the pupils large and immovable. She had been very costive for some days previous, and * Cheyne on Hydrocephalus. f Surgical Observations, part ii.p. 190 VOL. i. • 16 122 CATHARTICS. was languid; she was ordered an enema, and thi:? roused her so far as to swallow a bolus of jalap and calomel. This operated powerfully; and brought away " two chamber-potfuls of the most extraordinary collection of faeces" the doctor ever saw. The pa- tient recovered immediately. This case shows, in a striking manner, the powerful influence which intes- tinal irritation, from the presence of acrid or vitiated matters, may have upon the brain. We have a further confirmation of the correctness of this pathology of hy- drocephalus, in the fact, that cholera infantum very often terminates in unequivocal symptoms of hydroce- phalus. Nor is it an uncommon thing to see children who have long been harassed with indigestion and diarrhoea, die with symptoms of hydrocephalus acutus. Indeed, proofs of the morbid influence of visceral irri- tations on the brain are so various and palpable, that the most careless observer must have often noticed them.* But, whether the disease be an idiopathic, or only a secondary affection of the encephalon, purgative medicines are amongst the most important of our remediate resources. It is evident, however, that where the disease is dependent on a primary irritation in the bowels, cathartics are more especially indicat- • This pathology of hydrocephalus is particularly advocated by Drs. Cheyne and Yatts Spurzheim thinks that it is sometimes dependent on primary gastric irritation, but generally, an idiopathic cerebral affection. CATHARTICS. 123 ed, since they tend, at once, to remove the remote cause of the disease, and, by determining an afflux to the intestines, to lessen the flow of blood to the brain. The bowels should, therefore, be actively moved, in every instance where hydrocephalic symptoms super- vene, whatever other measures be adopted. They have a more powerful effect in lessening the action of the circulation in the head, than any other internal remedies we can employ. " Should we ascertain," says Dr. Cheyne, " that the alimentary canal is torpid, and imperfectly performing its functions, admitting an accumulation of feculent matter, or that the secretions flowing into it are vitiated or diminished in quantity, which we discover by the peculiarity in the appear- ance, or the pungent foetor of the stools, we must, by steadily pursuing the purgative plan, endeavour to effect a change; for while this is produced in the ap- pearance of the stools, by the stimulating quality of our medicines, we are effecting a most important change in the hepatic system, alimentary canal, and all the parts, including every organ essential to life, which is connected with them."* For the same reason that cathartics are prescribed in hydrocephalus; namely, to determine the circula- tion from the head, and to remove the causes of intes- tinal irritation, are they useful in apoplexy. What- ever be the speculative notions entertained in relation * Essavs on the Diseases of Children, by John Cheyne, M, I* [24 CATHARTICS to the pathological character of this disease, all expe- rience would seem to testify in favour of the employ- ment of active cathartics in its cure. As the advan- tages derived from these remedies, in the present disease, arise probably more from the strong tendency they have to diminish the afflux of blood to the ence- phalon, and directing it upon the intestines and other gastric viscera, it is evident that the more rapidly they purge the more beneficial will be their operation. Hypochondriasis is, in general, obviously the result of a deranged state of the chylopoietic viscera. We may frequently trace the successive grades of dyspep- sia up to the full formation of this deeply distressing complaint. It is almost invariably preceded by dis- order of the digestive organs. The appetite is either morbidly increased, or depressed; a distressing sense of fulness is experienced in the stomach, and there are foetid eructations, with a white tongue, obstinate consti- pation, and headach. Yet in this disease active purging does not appear to be proper; for, as the gastric symp- toms just mentioned, and upon which those of the men- tal affection would seem to depend, arise from a de- bility of the digestive organs, it is easy to understand why drastic purgatives rather do harm than good. For, although they might effectually remove the viti- ated contents of the intestines, >et, as their operation would have a tendency to weaken still more the already debilitated chylopoietic organs, it is evident that they CATHARTICS. \25 cannot be employed with propriety in this affection. The same objection does not, however, stand against the use of laxatives in this disease. These, on the contrary, are indispensable auxiliaries in its treatment. By gently exciting the action of the bowels, they tend to restore the natural intestinal and hepatic secretions, and to remove the torpor which, in this disease, pre- vails in the portal circulation. Purgatives ought to be united with mild bitter tonics, and given in such a way as to procure one, or at most but two good eva- cuations every twenty-four hours. There is often an amazing quantity of faecal matter impacted in the lower bowels of hypochondriacs, which has a strong influence in keeping up the disease, and which it is almost impossible to remove by purgatives. When there is reason to suspect the presence of such accu- mulated contents, there is no way by which we can so conveniently, and at the same time so effectually and beneficially remove them, as by the daily employ- ment of mild and copious laxative injections. These, indeed, should never be neglected in the treatment of this and other chronic diseases, dependent on gastric derangement and accompanied with intestinal torpor. Hysteria is a disease closely allied to the preceding; and its intimate connection with disorder of the di- gestive viscera, is demonstrated by the symptoms of wandering pains in the abdomen, flatulence, acid and foetid eructations and constipation, which characterize 126 CATHARTICS. the hysteric constitution.* "In my opinion," says Dr. Hamilton, " these symptoms afford conclusive evi- dence, that this gastric affection is primary, and that the other multifarious symptoms of hysteria depend on it. I have, therefore, thought it reasonable to attend particularly to the state of the stomach and intestines, and to employ, in the first place, purgative medicines, to remove the constipation of the body which most commonly prevails in hysteria." I have been much in the habit of employing purgative medicines in hys- teria. In some cases I have succeeded in putting a stop to the paroxysm by means of a brisk cathartic, after all the ordinary remedies for cases of this kind had been tried with little or no advantage. Purgatives will, however, produce very little benefit in this dis- ease, unless they be administered in doses sufficient to occasion full and active purging. They may be very advantageously united with the foetid gums, par- ticularly asafoetida. Dr. Hamilton observes, what, indeed, I have myself repeatedly noticed, that " the first purgatives seem, on some occasions, to aggravate the symptoms; but the practice must not be deserted on this account. The additional irritation which pur- gatives may give in the first instance, soon passes away; and perseverance in the use of them removes that irritation which gave rise to the disease, which, of course, disappears in proportion as the bowels arr * Dr. Hamilton CATHARTICS. 127 relieved of the oppressive mass of accumulated faeces." It is evident, however, that in a disease, which, like this one, is so intimately connected with disordered digestive powers, the employment of tonic and gently- stimulating remedies will often be found necessary along with purgatives. Chorea is another of the neuroses in which the em- ployment of purgatives has been especially recom- mended. That it is often dependent on gastric irri- tation, and connected with great faecal accumulations in the lower intestines, I have not the least doubt; and that, in such cases, purgatives must be peculiarly ap- plicable, is at once obvious. Dr. Hamilton is the first who directed the attention of the profession to the purgative plan of treating this disease. It appears, however, as is stated by this writer, that the exhibition of purgatives in the present disease, is countenanced by the practice of Sydenham, De Haen, and Dr. Stoll. " Chorea," says Dr. Hamilton, " consists of two stages. In the first, while the intestines yet retain their sensibility, and before the accumulation of faeces is great, gentle purgatives, repeated as occasion may require, will readily effect a cure, or rather prevent the full formation of the disease. In the confirmed stage, more sedulous attention is necessary. Power- ful purgatives must be given, in successive doses, in such a manner that the latter doses may support the effect of the former, till the movement and expulsion 128 CATHARTICS. of the accumulated matter are effected." It is abso- lutely indispensable to pursue this treatment in a firm and decided way, in order to derive permanent advan- tages from its employment. " Half measures, in in- stances of this kind, will prove unsuccessful." It must be confessed, however, that, although cho- rea may frequently, perhaps generally, have its origin in the alimentary canal, yet we sometimes meet with cases which do not seem to depend upon causes seated in the abdominal viscera, or which, at least, do not yield to the most complete and efficient course of pur- gative remedies. I have seen two cases in which purg- ing was practised copiously and regularly for a rea- sonable length of time, with no alleviation, but, on the contrary, with a manifest aggravation of the con- vulsive motions of the patients. One of these patients was finally cured by tonics and antispasmodics; the other did not recover. I have, however, seen five other cases, two in my own practice and three in the practice of other physicians, which were effectually cured on the plan recommended by Dr. Hamilton. I am, therefore, fully persuaded, that, although this mode of treating the disease will not always succeed, it holds out a more certain and rational prospect of success than any other treatment with which we are at present acquainted. Respecting the employment of purgatives in the> CATHARTICS. J29 treatment of tetanus^ no very satisfactory recommen- dations have been advanced. When this disease arises from general causes, or, more properly speaking, perhaps, when it does not depend on any local mechanical injury, it would seem, from the reports of Drs. Hamilton and Burns, to be occasionally remediable by the vigorous employment of purgative remedies. In the treatment of trismus nascentium, or the locked-jaw of infants, also, purg- ing has been successfully employed. Dr. Chalmers says, " I have cured one case of the jaw-falling of in- fants, by purging with an infusion of rhubarb, to which a few grains of musk and a little ol. tart. per. deliq. were added."* When once formed, however, this disease of infants is but very rarely cured. I know of no authority for the assertion made by Dr. Chap- man, that " the utility of purging is indisputably esta- blished in trismus nascentium." A very few solitary cases appear on record, in which these remedies were employed with seeming success; but their utility is far, I am sorry to say, very far, from being " indis- putably established," in this fatal variety of spasmodic disease.f * London Medical Observat. and Inquiries, vol. i. p. 109. j- The following observations on spasmodic diseases are quoted by Dr. Hamilton from Camper's Anatomico-Pa'thological Demonstrations. "Nervis descriptis ad symptomata accedo, quae ex eorum unionibus fa- cile explanatur; Ordiar autem a pedum tremor, qui hysteiicis familiaris est. In antecessam vere monere debeo, omnia terribilia hysterica symp* VOL. t. 17 130 CATHARTICS. In the treatment of marasmus, a disease unequivo- cally and essentially connected with morbid derange- ment of the digestive organs, purgatives constitute our most important remediate resources. In the first stage of this disease, which, according to Hamilton, extends from its commencement to the ac- cession of the febrile symptoms, and in which " the bowels are not altogether torpid, neither are they overloaded with accumulated faeces, mUd purgatives will, in general, effect a cure." When, however, the disease has advanced into the second, or febrile stage, more active aperients must be regularly and persever- ingly employed. For this purpose, Dr. Hamilton re- commends the exhibition of small, but frequently re- peated doses of the purgative medicines; " so that the latter dose may support the effects of the preceding tomata, quae turn in singulis1, turn in universi corporis locis quotidie vide- mus, ab acrimonia putrida primas vias occupante omnino dependere; excrementorum enim foetor intolerabilis, fauces, et alia qua praeter natu- ram sunt, rigorum et convulstonum accessum annuntiant. Res igitur ita se habere videtur; plexu mesenterico inferiori affecto, nervi omnes cum eo conjuncti, lumbales scilicet, et proinde crurales, atque obturatores nervi affifiuntur. Si acrimonia tanta est ut etiam rectum intestinum irritare queat, nervi lschadici in concensum trahentur, rigebitque pes in- teger, concucietur, et per vices quiescet, donee animi deliquium tumul- tum sedet. " Infantum irtferiorum extremorum convulsiones, ex ascaridibus rectum intestinum occupantibus, banc theoriam eonfirmant. " Purgantia, etiam drastica licet imprudentur adhibita, propterea for- san, epilepsia spurias, choream sancti viti, aliosque spasmodicos sanarunf morbos qui desperati a medicis habebantur." CATHARTICS!, 131 ones. When the bowels are once opened, stronger purgatives, given at longer intervals, will accomplish the cure." In my own practice I have obtained the happiest results from the continued employment of purgatives, together with a light but nourishing food, in the treatment of this disease. Dr. Hamilton speaks favourably of the use of pur- gatives in the treatment of chlorosis. " The slightest attention to the history of the disease," says he, " evinces that costiveness precedes and accompanies the other symptoms. Costiveness induces the fecu- lent odour of the breath, disordered stomach, depraved appetite, and impaired digestion. These preclude a sufficient supply of nourishment, at a period of growth, when it is most wanted; hence paleness, laxity, flacci- dity, the nervous symptoms, wasting of the muscular flesh, languor, debility, the retention of the menses, the suspension of other excretions, serous effusions, dropsy, and death." He accordingly recommends purgative medicines, until the bowels are well emptied, after which he has recourse to tonics. I have never used purgatives in this disease, nor should I be dis- posed to employ them to the extent recommended by Dr. Hamilton. The costiveness, as well as the ame- norrhcea, is, I think, in some instances at least, the consequence and not the cause of the general debility and torpor of the system. There can be no doubt, however, that these effects may, of themselves, con- |32 CATHARTICS. tribute to keep up that state of the general system which in the first place produced them. And hence, although purgatives will be proper, to remove at least one of these symptoms, namely, constipation, still, our main dependence ought to be placed on the employ- ment of tonics, nourishing diet, and exercise. The same author speaks in very high terms of the employ- ment of purgative medicines, in that variety of vomit- ing of blood which " attacks females who are from eighteen to thirty years of age." The attack of this variety of haemorrhagy " is preceded by great languor and oppression, both about the chest and the praecor- dia; and by a sense of fulness of the praecordia; by cough, dyspnoea, and sometimes by pain of the breast; by loss of appetite, headach, vertigo, and disturbed sleep; the eye is dull, the countenance is expressive of much distress, the pulse is feeble, and the bowels are constipated." " In this state of impaired health, a particular fit of sickness and nausea is the imme- diate forerunner of the attack of the vomiting of blood," I have never had a case of this kind to treat, and can, therefore, say nothing in relation to the uti- lity of purging in its treatment. Dr. Hamilton, how- ever, speaks strongly in favour of this practice. " My success," says he, " has been so uniform, that I now lay it down as a certain position, that the proper ex- hibition of purgative remedies affords sure and effec- CATHARTICS. \ 33 tual means of removing the vomiting of blood which I speak of." Cathartics have long been considered as important remedies in the cure of dropsies. As I shall, however, have occasion to speak more particularly on this sub- ject when I come to treat of cremor tartar and elate- rium, it will be unnecessary to dwell particularly on this point in the present place. I shall now, therefore, proceed to an account of the particular articles belonging to this class of remedies, \u CATHARTICS. Of the Particular Cathartics. RADIX JALAPjE.--JALAP. Jalap is the root of the Convolvulus Jalapa, a pe- rennial plant, indigenous to the southern parts of the United States, Mexico, and some of the West India islands. It is brought to us, either in transverse slices or in pieces of a pyriform shape; these are compact, solid and heavy; rugous and blackish externally, and of an obscure grey colour internally.* When pow- dered, it has a peculiar and somewhat nauseous odour, and a slightly acrid and sweetish taste. It contains a large proportion of resin, upon which its purgative powers seem entirely to depend. It contains also a gum, which, though almost wholly destitute of laxa- tive properties, is extremely active as a diuretic, and some extractive matter, with fecula and salts, enter into its composition. It appears that a combination of the resinous, gummy, and extractive principles of this root, " is requisite for the production of its full * Jalap is sometimes mixed with briony root; but this may be readily dis- tinguished from jalap by its pale colour, its spongy texture, and its great- er lightness and bitterness, and by its not burning so readily when held to the flame of a candle.—Bcrdach. CATHARTICS. J 3^ cathartic effect;" and hence, proof spirit is its proper menstruum.* The officinal preparations of this sub- stance are: The, pulvis jalapae, compositus; extract jalapaz; tinctura jalapm; tinctura sennas composita. The Prussian Pharmacopoeia contains a formula for preparing the sapo jalapinus, which is said to operate mildly and promptly.f The resin acts powerfully, but is apt to produce violent griping pains. Its dose is from gr. x. to 9l It should be well rubbed up with sugar or vitriolated tartar, in order to obviate its griping effects. Jalap is commonly given in the form of powder. From twenty to forty grains may be given at a dose, according to circumstances. In combination with calomel it forms one of the mildest and most effective purges with which we are acquainted. This combi- nation is particularly applicable, when we wish to emulge the biliary organs, to excite the healthy func- tions of the liver, and to produce prompt and copious alvine evacuations. Hence calomel and jalap are very generally preferred to the other purgatives in the treatment of bilious fevers, jaundice, hepatitis, &.c. The proportion in which these two substances may- be combined varies considerably. About ten grains * Paris. f This is made by taking equal parts of castile soap and of resin of jalap, and digesting them in a sufficient quantity of alcohol, with a moderate degree of heat, and evaporating to the consistence of a conserve. }36 CATHARTICS. of the former with fifteen of the latter, forms a very suitable mixture. A combination of jalap and cremor tartar, in the proportion of about twenty-five grains of the former, with forty to sixty of the latter, forms an exceedingly useful cathartic in dropsical cases. It powerfully ex- cites the intestinal exhalants, causing them to pour out large quantities of serous fluid, in consequence of which it produces very copious watery evacuations. It is on this account too, that this combination forms a peculiarly efficacious cathartic for reducing local inflammations; such as that of the hip disease, oph- thalmia, &.c.; for it not only abstracts copiously from the general circulation, but also excites a strong afflux to the intestinal exhalants, and thereby diminishes the determination of the circulation to the parts affected. Dr. Aiken asserts that " fifteen grains of jalap, with two or three grains of ipecacuanha, purge more than twice the quantity of jalap by itself." RADIX RHEL—RHUBARB. There are two sorts of rhubarb met with in the shops; the rheum palmatum, and the rheum undula- tum. The former is brought from Russia and Turkey, and is considered the better sort. It consists of round CATHARTICS. 13 Extract, elaterii gr. i. sp. aether, nitros |ii. tinct. scill. oxymel colchic. sing. |ss. syrup rhamni §i. M. ft. solutio. cap 3i. ex equae pauxillo ter, quater-ve in die. CATHARTICS. 1(J5 Of all the articles of the materia medica, this has held the greatest reputation among the ancients for its remediate powers, and especially for its virtues as a cathartic. It was particularly esteemed in the treat- ment of mania, melancholia, and gout. For the cure of this latter disease it is mentioned, by Aretasus, as superior to every other remedy then known. Black hellebore is an exceedingly active cathartic, and, when given in an over-dose, is apt to produce the most alarming effects. It occasions very copious watery evacuations, and hence it has been a good deal employed in dropsical affections. Dr. Ferriar reports several cases of this kind, in which the good effects of this remedy were conspicuously evinced. He pre- scribed it in the form of Bacher's tonic pills;* a pre- paration which, on various accounts, deserves much more attention than it appears to receive from the profession of the present day. " When the tonic pills have succeeded with me," says Dr. Ferriar, "they have operated early, by producing copious watery stools. Their action is easy, but in cases of long stand- ing, contrary to Mr. Bacher's assertion, they evidently weaken the patient, however cautiously given."f From two to six of these pills may be given three times every day, according to the effects they produce. * The formula for preparing these pills is given under the article helleborus niger, in the class of Emmenagogues. x Medical Histories, vol. i. p. 46. l(j(j CATHARTICS. The black hellebore is now but seldom, if ever employed by itself, or in substance, with a view to its cathartic effects. From twenty to thirty grains of the powdered root are said to be a proper dose for this purpose. CALOMEL, OR SUBMURIATE OF MERCURY. Of all the articles of the materia medica, calomel is undoubtedly the most important, whether we con- sider it in relation to its purgative operation, or to its more extensive and specific influence upon the animal economy. Under the head of mercury, I shall con- sider the remediate powers of this article, so far as they depend on its constitutional or specific effects, and confine myself, in this place, merely to a consi- deration of its virtues as a purgative. Given in proper doses, either by itself or in combi- nation with other articles of this class, it produces copious evacuations, without evincing any harsh or drastic effects. Along with its cathartic effects, ca- lomel has the peculiar power of exciting the biliary organs, and it is, therefore, particularly adapted as a purgative to all diseases attended with functional de- rangement of the hepatic system. A combination of calomel and jalap, forms one of our most useful and CATHARTICS. 167 common purgatives in bilious diseases, as well as for the ordinary purposes to which remedies of this kind are usually applied. Where we wish to procure easy, but copious ahine evacuations, we will, in general, find our intentions fully answered by giving three or four grains of calomel in the evening, and exhibiting on the following morning an ordinary dose of any of the milder cathartics. Calomel, from its possessing very little taste, is well suited as a cathartic for children. In my own prac- tice I seldom employ any other purgative in the dis- eases of children. It evacuates more freely, and, at the same time, more mildly, than, perhaps, any other article of this class, the intestinal mucus which is of- ten morbidly accumulated in the bowels of children. Of late it has been much recommended as a cathartic in dysentery. Dr. James Johnson speaks strongly in favour of large and frequently repeated doses of calo- mel in this disease, as it occurs in tropical climates.— He gave scruple doses three or four times a day, and he affirms that it was generally followed by great alle- viation of all the distressing symptoms which attend this complaint. When calomel is given in very minute doses it has a direct anti-cathartic effect, by lessening the morbid irritability of the intestinal canal. It is, indeed, one of our most valuable remedies for excessive purging. Dr. Ayre, of Hull, in his very valuable work on bilious 168 CATHARTICS. affections, adduces satisfactory testimony of the utility of small doses of this remedy in cholera, diarrhoea, &c. From an eighth to one-fourth of a grain, given every half hour or hour, will very often put a speedy stop to the most violent vomiting and purging. I have em- ployed it in this way with much advantage in cholera infantum, and especially in chronic diarrhoea, in which latter affection I regard it as decidedly the most im- portant remedy we possess. In affections of this kind it is, perhaps, most effectually administered in union with prepared chalk; or, as I have sometimes given it, with small doses of some astringent vegetable powder, as, for instance, the powdered root of geranium ma- culatum. Calomel is also frequently employed as a vermifuge; but as I shall have occasion to mention it again in rela- tion to its powers in this way, in the chapter on Anthel- mintics, I shall dispense with any further remarks on it in this place. The usual dose of calomel, as a cathartic, is from eight to twenty grains; ten grains may be considered as a medium dose. If given in too large a dose it is apt to excite vomiting. CATHARTICS. 160 OLEUM RICINI.--CASTOR OIL. This oil is obtained by expression, or decoction, from the seeds of the ricinus communis, a plant which grows wild in the East and West Indies, and in some parts of South America, and which is now cultivated in this country. It is a yellowish or colourless oil, possessing a faint peculiar sweetish taste, and scarcely any odour. On being swallowed it excites an unpleasant acrid burn- ing in the throat and fauces, which, however, is but very slight when the oil is fresh and entirely free from rancidity. It is wholly soluble in alcohol and sul- phuric aether; and mixes more readily with caustic ley than any other oil. These circumstances distinguish it from the other fat oils, and enable us without diffi- culty to detect its adulterations. Castor oil is a very mild, unirritating, but certain and prompt cathartic, procuring copious faecal evacu- ations, without appearing to excite the intestinal emunctories, since it hardly ever occasions any very liquid or watery discharges. Where we wish simply to evacuate the contents of the bowels, or avoid cos- tiveness, there is no article belonging to this class of remedies, so well adapted as castor oil to answer our intentions. Independent of the mildness and complete- ness of its operation, it is less apt than any other ca- vol. i. 22 170 CATHARTICS. thartic to leave the bowels in a dry or costive condi- tion. In cases of obstinate constipation, castor oil, though often insufficient, by itself, to procure adequate eva- cuations, acts, in general, with much advantage when given some hours after the exhibition of a full dose of calomel, or calomel and jalap. No laxative is more commonly employed in the treatment of dysentery than this one; and when the stomach can bear it, it is, without doubt, a very im- portant remedy. " Oleum ricini," says Dr. Bamp- field, " is, perhaps, better calculated to afford relief in dysentery than any other aperient or cathartic; for its action is not only mild and generally effectual, but I have observed, that some of it passes undecomposed, in its oily form, through the intestines, and appears on the surface of the excrement, and hence may serve as a sort of sheather or defence to the diseased intes- tines, from the stimulus of faeces and morbid secre- tions." A common mode of prescribing it in this disease, when there is much tenesmus and griping, is in union with a full dose of laudanum. Given in this way it is much less apt to be rejected by the stomach, and it moreover mitigates directly the sufferings of the pa- tient, and loses but very little of its aperient effects.* * The following is an excellent mode of exhibiting castor oil in cases of this kind: Ol. ricini $i. vitelli ovi q. s. tere simul et CATHARTICS. 171 Castor oil has also been much recommended in the treatment of colica pictonum. It is particularly use- ful in this disease to put the bowels in motion, after large doses of calomel and opium have been adminis- tered. In the form of an emulsion* it is a very excellent aperient for children. Castor oil has also been highly recommended as a remedy for the expulsion of the tape worm. Dr. Odier, of Geneva, and Dunant, employed it with much suc- cess in expelling the unarmed tamia;] and Brera states that " it sometimes serves wonderfully well to expel also the armed taenia."J After having previously ad- ministered three drachms of powdered male fern, Odier gave the ol. ricini, by table-spoonfuls every half hour until full purging is induced. Brera, however, recommends it to be given to the extent of three ounces for a dose. " In my journal," says he, " I have two cases of armed taeniae expelled by three ounces of this oil, taken by a patient during three suc- adde syrupi papaveris 3ii. tinct. opii g" x. aquae distillatse fiss; fiat haustus. * R Ol. ricini |i. sacch. alb. %i. album, ovi. q. s. tere simul et adde, gradatim aq. menthae £ss. aq- fontanae £ii. Dose for a child one year old, a tea-spoonful every hour. t Manuel de Medicine-Pratique, par L. Odier, p. 225. t A Treatise on Verminous Diseases, by V. L. Brera, pro- fessor of clinical medicine at Pavia, p. 234. 172 CATHARTICS. cessive days, and by another taken twice a day for a week." The celebrated S. G. Vogel* has introduced a com- position which strongly resembles castor oil, and which forms an excellent substitute for it when it is rancid. It consists of nine grains of resin of jalap, three grains of Venetian soap, to be triturated in a mortar with an ounce and a half of oil of olives. The dose is a table- spoonful. Dr. Schmidtman speaks very highly of this mixture in dysentery. He says it always allays the pain and severe excitement of the intestines, but at the same time gently and completely evacuates their contents. OLEUM OLIVJE.--OLIVE OIL. Olive oil is of a pale yellowish colour, without odour, and of a pleasant bland taste. When perfectly pure it congeals at a temperature of 38° of Fahrenheit. With the exception of the oil of almonds, it is the lightest of the fat oils, having a specific gravity of no more than 0.915. It is composed of forty-nine parts of carbon, thirty oxygen, and twenty-one hydrogen. It possesses less activity as a laxative than the oleum ricini; it is, nevertheless, in many eases, a very useful * Summa Observationum Medicarum, &c. CATHARTICS. J 73 aperient, and is much employed for this and other purposes, in medicine. This oil was very extensively used by the Roman physicians as an external application in the cure of diseases. Celsus, Galen, and Aetius were much in the habit of employing oily frictions; and have left us some excellent observations in relation to the cases in which they are applicable, A good deal has been said of the utility of frictions with this oil in dropsy. Cases of ascites are said to have been cured, by such frictions assiduously applied to the abdomen.* Dr. Donald Monro informs us that, although unsuccessful in his attempts to cure ascites in this way, he found it effectual in some cases of ana- sarca.! It is probable, however, that very little, if any thing, is to be ascribed to the oil in such cases. It is well known that frictions, whether with or without any in- termediate substance, have a very considerable ten- dency to excite the activity of the absorbents; and it is not unlikely that all the good that has ever been done in this disease by oily frictions might have been obtained by frictions with the dry and bare hand. This oil has also been much recommended, both as an internal and an external remedy against the ef- * Oliver, Stork, Burdach, &c. f Alibert. Nouveaux Elemens de Therapeutique, vol. ii. p. 252. 174 CATHARTICS. fects of the bites of venomous snakes and insects.' It does not, however, appear to be entitled to any atten- tion for its supposed remediate virtues in cases of this kind. The external application of warm olive oil has been much employed as a remedy against the plague. Bald- win especially speaks in the highest terms of this practice. , According to this writer the patient is to be briskly rubbed all over with the warm oil, which is to be repeated every day, and assisted by warm drinks and the heat of a bed, until a copious perspiration is excited. This practice is only effectual when early employed.f To blunt the activity of certain poisonous substances brought into the stomach, olive oil is of unquestionable utility. Its powers, in common with other oily or fat substances, to prevent the deleterious effects of lead upon the system are well known to those who are much exposed to the influence of this poison, it being a common practice among such persons to fortify themselves against its effects, by the daily use of olive oil, or some other fat or oily substance. * Abr. Vater diss, de antidoto novo adversus viperarum mor- sum praestantissimo. Viteb 1736. Ejusdem. Progr. pro olei olivarum efficaciam et virtutem adversus morsum animalium venenatorum confirmat. 1751. t Osservazioni circa unnuovo specifico, contra lapeste,ritro- vato e fatto sperimentare, da 9. Baldwin. 1800. CATHARTICS. 175 Burdach says,* that it should never be given where narcotic poisons have been swallowed, since, as he observes, it is not only useless but absolutely injurious in cases of this kind. Olive oil may be advantageously employed as an aperient in cases of habitual costiveness, and in colica pictonum. It operates, commonly, with considerable promptness and certainty, and may be conveniently exhibited with other articles of this class, as manna, the resin of jalap, &c. In ileus it is said to be an exceedingly good remedy given either alone or in combination with opiates. Gallesky recommends it to be given in the dose of a table-spoonful every hour until the bowels are moved and the pains abate. Malacarnef has published a memoir on the internal employment of olive oil in wandering arthritic pains. He gave from one to two pounds of the oil, having previously added a portion of culinary salt to it, in the course of two or three days. He speaks very favoura- bly of this practice. This oil has also been recommended as a vermifuge; its powers in this way are, however, of no conse- quence. Olive oil is often adulterated by the oil of poppy seeds. This fraud may be readily detected " by ex- * Arzneymittellehre, B. ii. S. 118. t Samlung Auserlesener Alhandl. Bd. xii. St. iv. S. 579 i 76 CATHARTICS. posing the oil to a freezing temperature; when the olive oil will congeal, while that of poppies will remain fluid; and since those oils which freeze with most difficulty are most susceptible of rancidity, the admix- ture of poppy oil must be regarded as injurious; it also deserves notice, that the peculiar habitudes of oil of olives with per-nitrate of mercury, offer a distinguishing character, by which the adulteration of the oil may be satisfactorily detected; for if the per-nitrate (made by dissolving six parts of the metal in 7.5 of nitric acid of sp. grav. 1.36, at a common temperature,) be mixed with olive oil, the mixture, if kept cold, will, in the course of a few hours, become solid, whereas if it has any admixture of the oil of grains, it will not undergo such a change. The contamination derived from lead, which is frequently immersed in the oil for the pur- pose of removing its rancidity, may be detected by shaking one part of the suspected sample with three parts of water, impregnated with sulphuretted hydro- gen, in a stopped vial."* SULPHUR SUBLIMATUM. The sulphur of commerce is extracted from pyrites by sublimation. In volcanic districts, it is occasion- * Paris' Pharmacologic. CATHARTICS. 177 ally found in a perfectly pure and crystallized state; and it exists in a combined state in some animal and vegetable substances. It is insoluble in water and alcohol, but perfectly soluble in both the essential and fixed oils. Linseed oil is one of its most powerful solvents. Sulphur was much esteemed for its remediate pow- ers by the ancients, and continues to this day to hold a very important rank among the articles of the ma- teria medica. When taken in the dose of from one to two drachms, it acts as a mild and pretty certain laxative, producing one or two copious evacuations, without either heating the system or griping the bow- els. Deen used ^vith advantage in the chronic form of cholera infantum;! and I have known it to be given with excellent effects in a case of diabetes. The best form for exhibiting this remedy is an in-< fusion. A cup full of this may be taken every three" t Treatise on the Diseases of Jamaica, p. 186. $ Dr. Chapman's Mat. Med. vol. ii. p. 270. 366 ASTRINGENTS. or four hours. The extract is, also, frequently em- ployed. RUBUS VILLOSUS. The bark of the blackberry root is a pure and powerful astringent, and is now a good deal employed as such both in popular and in domestic practice. The sulphate of iron changes the colour of both the infusion and decoction into a beautiful dark purple, and occasions a copious precipitate. Gelatin, also, produces a copious white and opake precipitate. The alcoholic solution undergoes a partial decomposition on adding water to it. The precipitate thus formed is of a flocculent appearance, and when dry " exhibits the common resinous properties on exposure to heat."* This root has been much extolled by some late American writers for its efficacy in the cure of chro- nic dysentery, diarrhoea, and cholera infantum. I have myself employed it with advantage in the latter complaint. I prefer, however, using the geranium maculatum, as being much more pleasant to the taste. I have seen an infusion of the blackberry root used in a case of haematemesis with apparent advantage. I * Bigelow's American Medical Botany, vol. ii. p. 163. ASTRINGENTS. 367 have, also, known it to be used with very good effects as an application in the form of a cold poultice, in haemorrhoidal tumours. As an astringent, this article may, no doubt, be usefully employed, wherever such remedies are indicated. The berries of this bramble have also been used in medicine. Dr. Mease says, " a jelly made of black- berries when on the turn from red to black, is much used in the United States for gravel." It has been said that a decoction of the root of this plant is very useful in gravelly complaints. I am not aware, how- ever, that there is any foundation for this opinion. KINO. This is an inspissated vegetable juice, possessing very great astringency. The natural history of the trees from which it is obtained is, as yet, but imper- fectly known. The kino of commerce consists of three distinct kinds: " The first is in very small jet- black fragments, perfectly opaque, without smell, crackling under the teeth when chewed, not colouring the saliva, after some time imparting only a slight astringent taste, pot fusible, and difficultly reduced to powder." There is another kind which consists of large pieces, of a very dark brown colour, resinous j 368 ASTRINGENTS. appearance, and interspersed with little air cells; very thin pieces of it are translucent, and of a ruby red colour; when chewed it crackles under the teeth; its taste is at first slightly acid, which soon changes to a very bitter and astringent one, " succeeded by a pecu- liar sweetness. It is infusible, and forms a reddish brown powder." This variety of kino is obtained from the juice of the coccoloba uvifera. There is a third variety of this substance which consists of dark brown pieces of different sizes. It is generally covered with a reddish brown powder, has a resinous and un- equal fracture, and is often mixed with bits of leaves, twigs, &c. Very thin pieces are transparent; it crackles but slightly under the teeth, and its taste is astringent, followed by sweetness. This variety is ob- tained from the eucalyptus resinifera, a tree indigenous to New South Wales.* " The London college," says Dr. Duncan, " have indicated the butea frondosa as the source of kino, but certainly erroneously. It, however, produces, in large quantities, a red juice very analogous to kino, and which may unquestionably be used as a substitute for it. The production of these substances from so many different trees in Africa, America, Asia, and New Holland, show that kino is to be considered as a genus of which these are species." Kino contains a very large proportion of tannin, and does not possess any of the characteristic habi- * Dr. Duncan's Dispensatory. ASTRINGENTS. 369 tudes of the resins or gum-resins. According to Vau- quelin's Analysis, one hundred parts of kino consist of seventy-five of tannin, twenty-four of red mucilage, and one of fibrous matter* Cold water dissolves about four-fifths of its substance; but in hot water it is much more soluble; and hence the decoction, on cooling, lets fall a copious reddish brown sediment, and becomes turbid. Alcohol dissolves the whole of this substance except its impurities. " It is remark- able," says Dr. Duncan, " that alcohol dissolves kino entirely, but does not dissolve the residuum of the decoction." The solutions of kino form a greyish yellow precipitate with acetate of lead,—a reddish yellow one with nitrate of silver,—a yellowish white one with tart, antimon.—and a green one with sul- phate of iron. Gelatine, also, precipitates the solu- tions of kino.! By exposure to heat kino becomes soft, and if the heat is very considerable, it slowly enters into fusion. This substance was first introduced to the notice of the profession as a useful remediate article, by Dr. John Fothergill, about eighty years ago.J It has been recommended as an efficacious remedy in intermittent * Ann. de Chimie. torn. xlvi. p. 321-332. t Pfaff's Mat. Med. torn. ii. p. 200. $ A letter from Dr. John Fothergill to the Medical Society, concerning an astringent gum brought from Africa. See Med. Observ. and Inquir. vol. i. p. 358. vol. i. 47 370 ASTRINGENTS. fevers, given either by itself or in conjunction with some of the bitter tonics. In the advanced stages of diarrhoea, and in chronic dysentery, it is very fre- quently employed; and Ldo not doubt that it will generally answer all the useful purposes in these com- plaints, that can be obtained from astringents. In the bowel complaints of children, especially, it may often be very advantageously given in union with chalk and small portions of laudanum. The aqueous solution of kino has been highly recommended as an injection in the cure of fluor albus and gonorrhoea. In the former of these complaints a solution of this substance in lime-water, is said to be particularly useful. Its use in this way is objectionable, however, on account of its staining every thing with which it comes in con- tact, of a blood red colour. It has, also, been em- ployed with good effects in diabetes; and Pemberton speaks very favourably of its virtues in pyrosis. Some practitioners have found it to produce excellent effects in certain varieties of haemorrhage, more especially in protracted menorrhagia from laxity of the solids. Gillespi recommends a solution of kino in red French wine, as an excellent application to foul scorbutic ulcers* Kino is given in substance, in doses of from ten to thirty grains. It is, also, very frequently given in the * Lond. Med. Jour. vol. iv. p. 373. ASTRINGENTS. 371 form of tincture; from twenty to forty drops of which may be administered for a dose. CATECHU EXTRACTUM. The tree, mimosa catechu, which furnishes this extract, is a native of Hindostan, and is said to be par- ticularly abundant on the uncultivated mountains of Rotas and Pallamou, in the province of Bahar, west- ward of Bengal.* Catechu is, however, also obtained from other species of mimosa; and at Bombay it is principally prepared from the nuts of the areca cate* chu. The catechu obtained from the mimosae, is prepared from the internal part of the wood by de* coction, and evaporation in the sun. This substance comes to us in compact, hard, brit- tle, flat pieces, of a dark brown colour; and, when broken, exhibiting light and dark brown streaks. It possesses a powerfully astringent taste, succeeded by a slight sensation of sweetness in the mouth. It has no odour. Its specific gravity varies from 1.28 to 1.39. Formerly it was thought to be a mineral pro- duct, and was, therefore, described under the impro- * For a good account of the tree producing the catechu, and of the mode of preparing this substance, see Med. Obs. and Inquir. vol. v. p. 148. 372 ASTRINGENTS. per name of terra japonica. Hagedorn and Boulduc,* were among the first who opposed this error, and who established the fact of its vegetable origin. According to Mr. Davy's analysis two hundred grains of Bombay catechu contains one hundred and nine grains of tan- nin, sixty-eight of a peculiar extractive matter, thir- teen of mucilage, and ten of residual matter. Bostock found traces of gallic acid in catechu. That which is brought from Bengal contains less tannin. It is almost wholly dissolved both by water and proof spirits. The oxysulphate of iron produces a beauti- ful green precipitate with the aqueous solution of this substance, which changes to an olive green, with a faint shade of brown by the further addition of some muriate or nitrate of iron. Lime, barytes, and stron- tian produce copious light brown, and the preparations of copper dark brown precipitates. It also forms a copious precipitate with gelatine. The concentrated muriatic and sulphuric acids produce pale precipitates, and the fuming nitrous acid destroys its property of precipitating the solutions of lime and iron. The catechu was formerly much employed by phy- sicians, and it is unquestionably an article of strong and useful astringent powers. In diarrhoea and the advanced periods of dysentery, it is equal if not supe- rior to any of the vegetable astringents we possess. It is also said to be a very valuable remedy in fluor * Mem. de l'Acad. des Sciences de Paris, A. 1709, p. 228. ASTRINGENTS. 373 albus, when employed in the form of an injection. Combined with gentian it has been used with suc- cess in obstinate intermittents.* In relaxation of the uvula, and ulcers of the mouth and fauces, it has been known to produce very excellent effects. It has, also, been prescribed with much advantage in general re- laxation of the system with debility of the digestive organs. Clysters of a solution of catechu have been recom- mended as highly useful in restoring tone and energy to the bowels in cases of colica pictonum.! Mr. James Kerr states, that this substance forms a principal in- gredient in an ointment of great repute among the Hindoos, composed of sulphate of copper 3iv. cate- chu %\v. alum 3ix. white resin l'iv. reduced to powder and mixed with olive oil and water sufficient to bring • the mass to the consistence of an ointment. This ointment they use in all kinds of ulcers. "A gen- tleman," says Mr. Kerr, " of great practice, told me he used this ointment with success beyond expec- tation." The catechu is administered both in the form of a powder and of tincture. The former is given in doses of from grs. x. to $i. The latter from thirty to sixty * Dr. Barton, in a note to Cullen's Mat. Med. vol. ii. p. 31. t Chirurg. Arzneymittellehre, Von C. L. Romer, B. i. s. 119. t Medical Obs. and Inq. vol. v. p. 158. 374 ASTRINGENTS. drops. It is, also, occasionally prescribed in the form of an electuary and in lozenges. The latter by gradu- ally dissolving in the mouth, may be very conveniently and beneficially used in relaxation of the palate and fauces. SUPERACETAS PLUMBI. The acetate or sugar of lead consists of irregular masses resembling lumps of white sugar, " being an aggregation of acicular four-sided prisms, terminated by dihedral summits." Its taste is sweet and styptic. When exposed to the air it slightly effloresces; and it • is decomposed by heat and light. It is soluble in twenty-five parts of water, and also in alcohol. The aqueous solution is turbid and of a milky colour, but becomes transparent on adding a small portion of ace- tic acid to it. It is decomposed by the " alkalies, alkaline earths and their carbonates, most of the acids, alum, borax the sulphates and muriates, soaps, all sulphurets, ammoniated and tartarized iron, tartarized antimony, undistilled water." When taken internally the sugar of lead produces a sensation of constriction on the fauces and along the whole course of the oesophagus. It accelerates the ASTRINGENTS. 375 frequency of the pulse, but does not augment its strength or volume.* The effects of the continued influence of lead on the animal body, are of a nature so distressing and dan- gerous, that it was long before physicians would ven- ture on the internal employment of the saturnine preparations. We find, however, that the sugar of lead was occasionally used as an internal remedy as early as the days of Paracelsus. This eccentric genius extolled it as a remedy of great powers in diseases of the thoracic viscera, all of which he included under the general name of asthma.! Its internal use was, also, strongly recommended in all species of dropsies, by Goulard: and Wuerz and Gramannus, of the six- teenth, and Libavius, Raumer, and others, of the seventeenth centuries, employed it freely as an internal medicine. The use of lead in this way, was, how- ever, strongly opposed by Stahl, Hoffmann, Boerhaave, and subsequently by Sir G. Baker,j and the authority of these names proscribed almost wholly, for a time, its internal employment. But the apprehensions of the profession, in this respect, gradually gave place to the accumulating testimony of experience in favour of * Semmes' Inaugural Thesis, on the effects of lead, &c. Philad. 1801. f Paracelsi Opera Omia, vol. ii. | Medical Transactions of the London College of Physicians. vols, i, and ii. 1772. 376 ASTRINGENTS. its general inoffensiveness; and it is now pretty com- monly admitted, that, although not destitute of delete- rious properties, the sugar of lead may be exhibited internally in a variety of affections with great benefit and without the least injury, if managed with pru- dence and judgment. It must be confessed, however, that this remedy has been known to produce injurious effects even under the most judicious administration; and we are, therefore, not to resort to it with an en- tire assurance of its being uniformly innoxious. Like all our heroic remedies, it is capable of doing a great deal of good, and, also, under unfavourable circum- stances of administration and constitutional predispo- sition, much harm. The sugar of lead was very early recommended as a useful medicine in phthisis pulmonalis. The Phar- macopoeia Bateana contains the formula of a tinctura anti-phthisica,* into which sugar of lead enters as a principal ingredient, and which is stated to be " truly a good medicament in those consumptions which pro- ceed from ulcers of the lungs."! Ettmuller, also, employed the sugar of lead internally in this disease. * R Sacch. saturn. - ^ii. Sal. martis .... |j. Inf. spir. vin. lb Dose, from twenty to forty drops. t Pharmacopoeia Bateana, or Bates' Dispensatory, fourth edi- tion, by \\ illiam Salmon, M.D. 1693. ASTRINGENTS. 377 More recently this remedy has been particularly re- commended in this affection by Horn,* Amelang,! Remer, Kopp,| Hildenbrand,§ Jahn,|| and others. I have myself, in a few instances, given it in this dis- ease, and its effects were always manifestly beneficial. It generally lessens both the night sweats and expec- toration, and often very considerably relieves the cough. It is especially useful as a palliative in the advanced stage of the complaint, when the patient is harassed by frequent colliquative discharges from the bowels. To check internal haemorrhages the sugar of lead is, undoubtedly, the most efficacious remedy we pos- sess. It was occasionally resorted to in cases of this kind by the older physicians, but its virtues in this respect have only become duly appreciated during the last twenty or thirty years. The efficacy and safety of the sugar of lead in haemorrhages, rests now upon the evidence of a very extensive experience. Monro, Hill, Reynolds, Barton, Amelang, Williamson, Jahn, Richter, Heberden, and many others have written in favour of its employment in such affections. It ap- * Horn's Archiv fur Medicinische Erfahrung. 1812, torn, i t Hufeland's Journal of Pracktischen Heilkunde, tem. xxii p. 3. 4 Ibid. torn. xi. p. 62. § Ibid. torn. viii. No. 4, p. 3. || Materia Medica, p. 2. vol. 1. 48 378 ASTRINGENTS. pears to be equally applicable to the treatment both of active and passive haemorrhages. When, however, the pulse is full and hard, bleeding is obviously an es- sential preliminary to the use of the lead. The late Dr. Barton was in the habit of prescribing this remedy in combination with small portions of opium or ipeca- cuanha. " Seldom," says he, " have I been disap- pointed in my expectations of benefit from this medi- cine, which, of all the articles of the materia medica, seems to me to possess the greatest command over the movements of the arterial system."* From my own experience with this remedy, in haemorrhagy, I am induced to entertain a very high opinion of its powers. In a single instance only have I known its use to be fol- lowed by symptoms of colic, and these readily yielded to a few doses of castor oil and opium. The sugar of lead has also been recommended in the cure of dysentery and diarrhoea. To this pur- pose it appears to have been very early applied, as we find it mentioned by several of the older writers,— particularly by Ettmuller and Adair, who speak highly of its remediate powers in dysentery. Drs. Moseley and Jackson have also added their testimony in fa- vour of its usefulness, under certain circumstances, in this disease. " In chronic dysentery," says Dr. Jack- son, " a solution of sugar of lead, viz. ten grains of the acetate to one drachm of the chrystals of tartar * Cullen's Mat. Med. vol. ii. p. 21, in a note. ASTRINGENTS. 379 and two parts of boiling water, given every three or four hours, to the quantity of two ounces for a dose, gives evident relief on many occasions, and in no in- stance within my knowledge has any inconvenience arisen from the supposed deleterious effects of the lead."* Moseley employed this substance in the form of enemata, where the tenesmus was inveterate and harassing, attended with frequent discharges of bloody mucus, or purulent matter, and great soreness about the anus.! T>r- Bampfield, another late writer on tro- pical diseases, states that Dr. Ainslie, at the artillery hospital at the mount of Madras, showed him cases " where this medicine was said to be strikingly use- ful." He does not, however, add much in favour of this remedy from his own experience. He says, that during its exhibition animal food should be abstained from.| Quite recently, Dr. Harlan, of this city, has published cases illustrative of the efficacy of this me- dicine in dysentery,§ and he seems to entertain a very high opinion of its powers as well as an entire convic- tion of its safety. My own limited experience with this article, in dysentery, has by no means been satis- factory. I have found it in a few instances to produce * Jackson on Febrile Diseases, vol. ii. p. 61. t Moseley on Tropical Diseases, p. 404, fourth edition. t Practical Treatise on Tropical Dysentery, p. 198. London, 1818. § American Medical Recorder, vol. v. 3QQ ASTRINGENTS. constipation with a distressing pressing down of the bowels, without affording any relief to the tormina. I have no doubt, however, that cases may occasionally occur in which the sugar of lead will be found advan- tageous. But, as a general practice, I am not dis- posed to think favourably of the remedy. Of the employment of sugar of lead in intermittents I know nothing from my own experience. Some writers of the last century have spoken well of it in this disease, but I suspect that its powers in this re- spect are not entitled to much attention. * In some of the neuroses this article has been found decidedly beneficial. Saxtorph,* Richter,! Ossan,| and others employed it with success in epilepsy and hysteria. Dr. Rush,§ also, cured a case of epilepsy with this remedy; and in the New-York Medical Repository,l| I have reported a remarkable case of this disease, in which the sugar of lead proved completely successful. In this case the fits returned regularly about the periods of full moon. I prescribed three grains of the sugar of lead to be taken mornings and evenings, commenc- ing three or four days before the expected return of * Act. Reg. Soc. Med. Hafniensis, vol. iii. 1792. t Specielle Therapie, vol. vii. p. 266. t Osann. Dissertatio de saturni usu Medico, maxime intern©, 1809. § Philadelphia Medical Museum, vol. i. No. 1. || Vol. ii. No. 1. New Series. 1813. ASTRINGHNTS. 3gJ the paroxysms, and continued it for five days at each period. The medicine was thus taken at five succes- sive periods of full moon, and the patient, who had been affected with the disease upwards of eight years, was permanently cured thereby. The sugar of lead has also been prescribed in other spasmodic diseases. Kramp, a German writer, cured a case of spasmodic dysphagia by it, and Ett- muller employed it in melancholia, in which he says " it is esteemed a specific."* It is said, also, to have been given with advantage in tetanus.! Lately this remedy has been highly spoken of in the cure of hoop- ing-cough. I have used it in five or six cases of this disease, and in a few instances it appeared to do some good. Its efficacy in this respect is, however, not sufficiently great to entitle it to much attention, and more especially as its employment can certainly not be said to be without some risk of unpleasant conse- quences. The sugar of lead is one of the most useful reme- dies we possess for the reduction of external phleg- monous inflammation. In ophthalmia it has long been an exceedingly common remedy; and, although appli- cations of this kind are by far too indiscriminately made, it may often be resorted to with great benefit. When the inflammation does not depend on a consti- * Allen's Synopsis Medicinae, vol. i. s. 437. t Burdach, Arzneymittellehre, vol. ii. p. 241. 382 ASTRINGENTS. tutional cause, and is unaccompanied by much excite- ment of the general circulation, saturnine collyria will, in general, prove very serviceable. Under opposite circumstances, however, such applications will not only do no good, but almost invariably produce mis- chief. The use of this remedy has been no less com- mon, as an injection, in gonorrhoea, than in ophthal- mia; and it certainly is very often adequate to the re- moval of the disease. The solution of sugar of lead, made into a cold poultice with the crumbs of bread, is also an excellent application in phymosis, hernia humoralis, and swelled inguinal glands. Applied in the same way, it fre- quently affords great relief in inflamed haemorrhoidal tumours. This remedy has also been much praised by some writers for its effects in erysipelatous inflam- mation arising from external causes. By others, how- ever, its use in this affection has been condemned; and my own experience has furnished me with no evidence of its usefulness in this respect. The sugar of lead may be given in doses of from half a grain to six grains, according to the nature and ur- gency of the symptoms for which it is administered. It is frequently given in the form of pills, in combination with opium. In administering this preparation of lead, care must be taken that the patient do not at the same time receive other substances into the stomach which have the power of decomposing it. The sulphates of ASTHIVGENTS. 3§g magnesia and alum, for instance, would decompose the acetate and produce a sulphate of lead, which is entirely insoluble, and consequently inert.* Dr. Paris advises, that in taking the sugar of lead the patient should abstain " from all potation except cold water or draughts composed of diluted acetic acid, for at least an hour after the ingestion of the medicine." The immediate effects of an enormous dose of su- gar of lead are, a sweet astringent taste, with a sense of constriction in the throat, pains in the stomach, with retching, or vomiting of bloody mucus, bowels consti- pated or relaxed, with bloody evacuations, foetid eruc- tations, hiccup, a sense of constriction in the thorax, with difficulty of respiration, great thirst, painful mic- turition, cramps of the extremities, cold sweats, con- vulsions, general sinking of the vital powers, and death. To counteract these effects, experience proves that much advantage may be derived from the early use of solutions of Glauber's salts, Epsom salts, and hard water. Orfila says that the liver of sulphur, which has been recommended by some, is pernicious. If the symptoms be not early subdued by these measures, and signs of gastric inflammation come on, the warm bath, fomentations and leeches to the abdomen, with copi- ous draughts of infusions of linseed or mallows, or of water sweetened with sugar, should be resorted to.! * Paris' Pharmacologia. t Orfila's System of Toxicology, vol. i. p. 484. 384 ASTRINGENTS. SULPHAS ZINCI. The emetic and tonic properties of this article have already been noticed; and to complete its remediate history, it remains, therefore, only to speak of its vir- tues as an astringent. In chronic ophthalmia, a weak solution of the sul- phate of zinc often produces excellent effects. It is certainly preferable, in such cases, to the acetate of lead, as having, besides its constringing, a greater roborant effect upon the dilated and debilitated capil- laries of the inflamed part. As an astringent injection in gonorrhoea, its employment is very common. Its indiscriminate and unguarded use in this disease is, however, by no means to be approbated. It is much too harsh and irritating, and frequently gives rise to injurious consequences, when employed in the acute stage of the affection. When the discharge has as- sumed the character of gleet, it may generally be used with advantage. In injections for this complaint it is usually united with sugar of lead, to which some mu- cilage and a small portion of laudanum is commonly added. Used in this way, it also forms an excellent application in fluor albus. The sulphate of zinc has been employed with much benefit against opacities of the cornea, and in ptery- gium or thickening of the conjunctiva. Himly used it ASTRINGENTS. 3Q5 with success in tumours of the sclerotica and cornea, applied in the form of powder mixed with sugar. It has also been successfully used as an escarotic in polypus of the nose; and in fungous tumours in the external meatus of the ear. A solution of it forms a very excellent gargle in aphthous affections of the mouth, for which purpose it is highly recommended by Selle, Armstrong, Hertz, and others. The sul- phate of zinc is a remedy of very considerable powers in chronic cutaneous eruptions. The famous ointment of Jasser consists principally of this article. I have frequently employed itin the form of a lotion in scabies with perfect success. Of its use in bowel complaints I have already spoken under the head of Emetics. SULPHAS ALUMINA. Alum is an earthy salt, consisting of sulphuric acid and alumina, with a portion of potass, or ammonia, or sometimes of both. " It crystallizes in regular octo- hedrons, whose sides are equilateral triangles." Its taste is sweetish, rough, and exceedingly astringent. It dissolves in fifteen times its weight of water at 60°, and in three-fourths of its weight at 212°. It is also soluble in alcohol. When exposed to the air it slightly effloresces. " By the action of heat it first undergoes vol. i. 49 386 ASTRINGEN'I S. the watery fusion, then loses its water of crystalliza- tion, and lastly a great part of its acid," assuming a white, spongy appearance, friable and very light. It is decomposed by the alkalies and alkaline salt, carbonate and muriate of ammonia, carbonate of magnesia, tartrate of potass, lime-water, superacetate of lead, the mercurial salts, " as well as by many vegetable and animal substances, especially galls and kino."* Hence, as Dr. Paris observes, the addition of alum to vegetable astringents is very injudicious. Alum was well known to the ancients, but it does not appear to have been used by them as an internal remedy. Dioscorides and Hippocrates praised its ef- fects as a lotion, in various kinds of ulcers, and par- ticularly in sores of the mouth, and in spongy, swelled gums. Van-Helmont, Helvetius, Mead, and Thomp- son, were among the first who brought its internal use into particular notice. Lind speaks very highly of the powers of alum given with nutmeg in intermittent fever. He declares that, except the Peruvian bark, it proved more suc- cessful in his practice than any other remedy he ever used. Cullen speaks less favourably of it. During the present season, I have prescribed it in four cases combined with nutmeg and serpentaria. One of the patients was cured after using the remedy four or five days. According to Dr. Darwin, alum is particularly * Paris* Pharmacologia. ASTRINGENTS. 387 suited to the cure of fevers attended with disease of the bowels. Alum is said to be one of the most effectual reme- dies we possess in colica pictonum. Grashues was the first who used it is this disease. Richter speaks in the most exalted terms of its effects in this painful and often intractable complaint. The testimony of a great many other eminent writers might be adduced in fa- vour of its virtues in this respect.* Fifteen grains of the powdered alum is to be given every two or three hours, either by itself or in combination with opium.! In chronic discharges from the bowels, alum, either alone or in combination with other articles, has been frequently employed with considerable advantage. The alum whey forms an excellent remedy in such cases. I have known the use of powders composed of ten grains of alum, fifteen of calamus aromaticus, and one fourth of a grain of opium, to arrest a chronic diarrhoea of long standing very promptly, without any disagreeable consequences. Alum has also been suc- cessfully employed in internal haemorrhage. Van- Helmont gave it with much success in uterine hae- * Sommer, in Hufeland's Journal d. pract. Heilk. B. vii. st. 1, p. 73. Gebel, ibid. B. viii. st. 2, p. 195. Percival, Observ. and Experiments on the Poison of Lead, p. 71. Lentin Memo- ral. circa aerem, vetae genus, sanitat, et morbos clausthaliens. p. 115. t Richter's Specielle Therapie, B. iv. p. 201. 388 ASTRINGENTS. morrhages; and Cullen states that he found it service- able in bleedings from the uterus, but not in those from the lungs. This, he thinks, was owing to the latter variety of haemorrhage being almost invariably of the active kind. In protracted sanguineous dis- charges from the uterus, connected with great relax- ation of the solids, alum is undoubtedly a very valua- ble remedy. In cases of this kind it is very advan- tageously administered in combination with Peruvian bark. Where the pulse is active it ought not to be given without prev ions depletion. Leake used a solu- tion of this substance in the form of an injection in this variety of haemorrbage. Alum has also been much extolled for its remediate powers in leucorrhoea; and, employed as an injection in this disease, it is certainly capable of doing considerable good. I have prescribed it occasionally in this way, though never with any decided advantage. Where this disease is attended with great relaxation of the general system, or with that habit of body which has been denomi- nated leucophlegmatic, alum combined with the rust of iron, is said to be peculiarly beneficial. Diabetes is another disease in which alum has been successfully used. Its employment in this complaint was particularly recommended by the celebrated Dr. Mead, and by Dover. Selle, also, states that he cured an obstinate case by giving the patient thirty grains of ASTRINGENTS. 389 alum three times daily.* The majority, however, of those who have tried the alum in this disease, do not speak favourably of its powers; and it does not, at present, enjoy any particular reputation in this respect. Used as an auxiliary to other measures, the alum whey may, no doubt, often be serviceable. As a principal remedy, however, it is certainly not to be relied on. The alum has also been recommended in flatulent colic, gastric debility, and in colliquative sweats, &c. As an external application, alum may be advantage- ously employed in a variety of complaints. In relax- ations of the uvula and cynanche tonsillaris much benefit may often be derived from the use of gargles containing alum. " In many persons," says Dr. Cul- len, " who are liable to be affected with swellings of the tonsils, we have known the disease prevented, or soon removed by a decoction of oak bark, to a pound of which a half a drachm of alum and two ounces of brandy were added."! In ophthalmia, after the inflammation has been somewhat subdued by local and general depletory measures, or in the chronic form of the complaint, the alum curd,| as it is called, will, in general, prove very * Beitraege zur Natur and Arznei. &c. B. i. t Mat. Med. vol. ii. p. 12. | This is made by rubbing a piece of alum with the white of eggs in a plate until a coagulum is formed. It is applied to the eye between two pieces of fine linen. 390 ASTRINGENTS. serviceable. Cullen states, that he has found the so- lution of alum, in the proportion of five grains to the ounce of water, still more effectual than the coagulum aluminosum. In the beginning of acute ophthalmia, these applications will very generally prove hurtful. Alum has also been used as an injection in gonorrhoea. In gleet it may be useful, but in recent gonorrhoea it is much too harsh and irritating, and ought never to be employed. CALX. As a mild astringent, lime-water is a remedy of very considerable utility. In the advanced periods of dysentery, in diarrhoea, and in cholera infantum, it often produces excellent effects. In the chronic form of the latter disease I have been in the habit of pre- scribing it in union with a weak infusion of cinchona, and it has very generally appeared to me to be of ser- vice. Where there, is acidity in the primae viae, at- tended with vomiting or diarrhoea, the lime-water is doubly indicated. In such cases it at once corrects the vitiated contents, and allays the morbid irritability of the stomach and bowels. It is, indeed, one of our most useful remedies to check inordinate vomiting. For this purpose it is usually administered with milk. ASTRINGENTS. 391 given 111 doses of a table-spoonful of each, every twenty or thirty minutes. Under the head of Antacids I have already noticed its utility in dyspeptic cases attended with acidity of the primae viae. Hoffman asserts that lime-water is the most effectual remedy we possess in scurvy arising from the con- tinued use of salted provisions. This, however, is not confirmed by the experience of others.* As an external remedy, lime-water may often be advantageously used in old fungous ulcers, attended with inordinate discharges of a serous matter. It has also been recommended as affording great relief from the pain and fetor of malignant ulcers. It is even as- serted to have been used with success in genuine can- cer. Baumbach, a German writer, relates two cases of cancerous ulcerations of the lips and breast, which, he says, were effectually cured by the internal and ex- ternal use of lime-water.! In the cure of porrigo larvalis, or crusta Iactea, lime-water, used both exter- nally and internally, is recommended by Barlow, Dreiszig, and Wichmann,J as an efficacious reme- dy. Hufeland recommends a liniment made of equal parts of lime-water and sweet oil, as one of the most * Burdach, Arzneymittellehre, B. iii. p. 500. t Vogel, resp. Baumbach. Diss de curatione cancri occulte et aperti per aquam calcis vivae potam praestiia. f Ideen Von Diagnostick, B. i. p. 50. 392 ASTRINGENTS. effectual applications on herpes* This liniment, with the addition of a portion of laudanum, is also a very excellent application in burns and scalds. I have re- peatedly seen its virtues in this respect exemplified. Much was said a few years ago of the efficacy of the muriate of lime in scrophulous complaints. Four- croy, Beddoes, and Hufeland have published very favourable accounts of its effects in this disease. I have known it to be employed in several instances of external scrophulous ulcerations, but, although it was given in large doses, and continued for a considerable time, it did not evince any beneficial operation. It is certain that it has not answered the expectations that were at first excited by the accounts given of its ef- fects by Beddoes and Hufeland. The mode of giving it is, to dissolve one drachm of it in two ounces of water, of which thirty or forty drops are to be given every three or four hours. BARYTES. The only preparation of barytes employed in me- dicine is the muriate. This salt has a bitter and pun- gent saline taste. Given in a moderate dose, it does not manifest any sensible operation. An inordinate * Journal der Practischen Heilkunde, B. xxiii. st. 3, p. 209. ASTRINGENTS. 39g dose, however, excites nausea, vomiting, and some- times anxiety, palpitation and vertigo. Hufeland states, that he has known this medicine to produce a con- tinued feeling of distressful anxiety for several days without any other obvious effect. It often occasions, when first used, and especially in patients who have worms, slight griping pains, with diarrhoea. It gene- rally keeps the bowels somewhat relaxed. It has no perceptible effect upon the pulse. Hufeland says, that it appeared to him rather to retard than accelerate it. The excretory organs are more obviously influenced by this remedy. It generally augments the urine and cutaneous exhalation. Applied to the skin, it produces a smarting, burning pain, and when concentrated it proves escarotic* The muriate of barytes, or, as it was formerly called, terra ponderosa, was first introduced to the notice of the profession by Dr. Crawford,! of England as a re' medy of great powers in scrophulous affections. This writer assures us that he has found it successful in many of the most confirmed cases of scrophula. Mr. Pearson and Drs. Clark and Hamilton, have pub- lished observations confirming Dr. Crawford's state* ments upon this subject. In Germany and France this remedy has found a number of able advocates. * Hufeland, Dartstellung der Medicinishen Krafte der Salz« sauren Schwererde, p. 15. t Duncan's Medical Commentaries, vol. iv. Dec. 2, p. 433. vol. I. 50 394 ASTRINGENTS Goerling, Fourcroy, J. A. Schmidt, Petermann, and especially Hufeland, have published statements illus- trative of its beneficial effects in affections of this kind. It can, indeed, not be doubted that it has been found useful in this disease; but later experiments with it in this country, as well as in Europe, do not justify the high praises that have been bestowed on it. Fer- riar, Kretschmar, Fleisch, Henke, Richter, &c. em- ployed it in large and continued doses, without de- riving the least advantage from it.* Some writers, amongst which are Girtanner and Arnemann, have represented it as frequently productive of highly inju- rious and even poisonous effects. In a single instance of violent and obstinate scrophu- lous ophthalmia in a child, I prescribed the solution of this substance, and had the satisfaction to see my pa- tient get well under its use. In employing this medi- cine, it is necessary to continue its use for a long time. In very tedious cases, Hufeland observes, its use should be interrupted every eight or fourteen days, and a pur- gative interposed. This remedy is said to be most useful when there is an inflammatory and very irri- tated condition of the lymphatic system present, or where the bowels are loaded with irritating and bilious matters. It is especially efficacious when the disease appears in the form of cutaneous eruptions. In cases attended with great relaxation and weakness, or * Richter's Specielle Therapie, vol. v. p. 623. ASTRINGENTS. 395 where symptoms of hectic are present, it seldom does any good, and often harm. Nor can it be used with benefit in cases complicated with scorbutic affections.* The muriate of barytes has also been used with ad- vantage in herpetic eruptions, scabies, porrigo, scir- rhus, amenorrhoea, and mania; successful examples of all of which are mentioned by Hufeland and others. The dose of this remedy is from ten to fifty drops every three hours, of a solution of one drachm in an ounce of distilled water. It should always be com- menced with in a small dose, and gradually augmented. The sulphuric and nitric acids, the alkalies, mag- nesia, tartarized antimony, burned sponge, and flow- ers of sulphur decompose it. Antimonial wine renders it slightly turbid, but does not entirely decompose it. It may be given with vegetable extracts and syrups, and decoctions, alcohol, corrosive sublimate, arsenic, without having its composition affected. ACIDUM NITRICUM. The nitric acid has, within the last twenty or thirty years, become an article of very considerable import- ance in therapeutics. M. Alyon, a French physician, introduced it to the notice of the profession as an * Hufeland, op; citat. J96 ASTRINGENTS. exceedingly valuable remedy in syphilis. He pub- lished a number of cases illustrative of its efficacy in this disease; and it was soon afterwards tried by seve- ral eminent English physicians, whose reports on its effects were very favourable. Cruickshank, Scott, Sandford, and Hammick, published observations tend- ing to confirm its character as an efficacious anti- syphilitic remedy. But no one was more extravagant in its praise than Beddoes.* As is usual, however. with new remedies, it did not long sustain the reputa- tion it at first acquired. The result of the experience of the profession on this subject is,—that in old cases of syphilis, connected with a cachectic condition of the system, the nitric acid is capable of mitigating the disease, but is inadequate to a perfect cure. In cases of this kind, and especially when symptoms of scurvy are complicated with it, much benefit may commonly be derived from the alternate employment of the acid, and mercurial remedies. Where mercury fails to remove the symptoms entirely, and rheumatic pains, nodes, ulcers, &c. remain, the acid will sometimes prove highly serviceable. It is seldom sufficient to prevent the occurrence of secondary symptoms; though it will often remove them after they have made their appearance. The nitric acid has been recommended as a very useful medicine in chronic hepatitis, as well as in * On the effects of Nitrous Acid, &c. 1797. ASTRINGENTS. 39»J scrophulous ulcerations. I have used it in some cases of the former disease with advantage: but I have not known it to perforin a perfect cure. This acid has also been recommended in dysentery and diarrhoea, but its use in this way does not appear to merit much consideration. This acid may also be beneficially used as an ex- ternal application to syphilitic ulcers,* and in certain chronic cutaneous eruptions.! Plenk recommends an ointment made of nitric acid and ung. althaeae, of each half an ounce, and two drachms of ung. juniperi, ap- plied twice a day, as highly efficacious in tinea capitis. The nitric acid may be taken from one to two drachms daily, diluted in a quart of water, to which six or seven ounces of syrup is added. Its use increases the ap- petite, accelerates the pulse, augments the secretion of urine and saliva, and when long continued, pro- duces a tenderness of the gums.J The nitro-muriatic acid has lately attracted very considerable attention, both as an external and an in- ternal remedy. Dr. N. Scott was the first who noticed the superior remediate powers of this mixed acid.§ * This is said to be an excellent ointment for purposes of this kind. R Acid nitric, concentr. $i. pingued. vacc. §i. misce int. sub leni igne et adde, opii. puriss 3i. fiat unguentum. fAIyon,Essai surles proprietesmedicinalesd'oxygene, 1798. | Richter's Specielle Therapie, vol. v. p. 321. § Beddoes' Contributions. :m ASTRIM.UNTS. It appears to have a very particular tendency to act upon the glandular system, and especially to excite the secretory action of the liver and cutaneous exhalants. " As a very general rule for its employment," says Dr. Scott, " it may be observed, that whenever the mer- curial preparations are indicated, the nitro-muriatic acid will be found useful, with this difference, that in cases where mercury is highly injurious from delicacy or peculiarity of constitution, or from other causes, the nitro-muriatic acid may be employed with safety and advantage." It is inadmissible in acute diseases. It is especially recommended in chronic hepatitis and in functional disorders of the liver. In these diseases Dr. Scott considers it as the most effectual and the safest remedy. It is said, likewise, to be very effica- cious in syphilitic and pseudo-syphilitic affections. Dr. James Johnson, who appears to place considerable reliance on the nitro-muriatic bath, in the treatment of chronic hepatitis, gives the following directions for preparing and using it: " Into a glass vessel capable of holding a pint or more of fluid, put eight ounces of water, and then pour in four ounces of the nitric acid of the London Pharmacopoeia, and four ounces of muriatic acid. One ounce of this mixture to a gallon of warm water, will form a bath of medium strength, and such as Mr. Astley Cooper commonly prescribes. The proportion may be increased to one ounce and a half, or diminished to half an ounce of the solution to ASTRINGENTS. 399 the gallon of water, according to the age, strength, delicacy, or other peculiarity of the patient. The feet and legs of the patient ought to be immersed in this bath at a comfortable warm temperature, say 96°, and kept there twenty minutes or half an hour, just before going to bed. This may be done every night, or every second night, and the same bath will remain good for five or six nights."* It is proper to observe, however, that several very respectable physicians, who have published the result of their experience with the nitro-muriatic acid bath, have not found it to answer the expectations which were excited by the publications of Dr. Scott and others. Mr. Guthrie, deputy inspector of military hospitals, states, as the result of his experience with this remedy, that it is of very uncertain operation, and that no dependence can be placed on it. He does not, however, contend that the remedy is entirely destitute of useful powers. " It seems often," he says, " not to produce any effects whatever, however extensive its application; and yet the complaint for which it has been used shall slowly subside or disappear, whilst in other instances it remains stationary or gets worse."! From my own experience I know very little of this remedy. I have employed it in a few instances of functional derangement of the liver; but as it was * On the Influence of Tropical Climates. t Medico-Chirurgical Transactions, vol viii. for 1817. 400 ASTRINGENTS. alternated with mercurial remedies, I am not able to say how much of the beneficial result is to be ascribed to its operation. It appears to be beyond a doubt, however, that it is possessed of very useful remediate powers. But no one will now pretend to say that it approaches mercury in any of the diseases in which it has been recommended. It may, nevertheless, be sometimes usefully substituted for mercury, where this article cannot be given on account of- idiosyncrasy, debility, or other causes. It may even occasionally happen to prove effectual where mercury has done no good, or has been hurtful. This has been observed of a variety of articles whose remediate powers are in no respect equal to this metal. ACIDUM SULPHURICUM. The sulphuric acid is a medicinal agent of very considerable importance. By the German physicians this acid is very frequently prescribed in haemor- rhagies; and some of the older English writers re- commend it very highly for its powers in such cases. Sydenham especially considered it as a remedy of great use in haemorrhagy. At present it is only pre- scribed as an auxiliary, after the immediate violence of the discharge has been restrained by more active ASTRINGENTS. ^Qj measures. In spitting of blood, and in slight but pro- tracted bleedings from the uterus, it often answers very good purposes. As a tonic this acid is very fre- quently administered. It seems to be particularly adapted to invigorate the digestive organs during con- valescence from febrile diseases. Sometimes, how- ever, it will produce unpleasant affections of the sto- mach, such as pains and nausea. When this occurs it must, of course, be at once discontinued. The sulphuric acid is a very efficacious remedy in certain chronic eruptive diseases. The use of it in this way originated, I believe, in Germany. Dr. Cothenius, principal physician of the Prussian army, employed it for the cure of the itch, in 1756. It has, since that time, been employed and commended by many of the most eminent physicians of Europe. Crollius, Tissot, Baldinger, Hafenreffer, Gahn, Rich- ter, and a number of other writers have mentioned its virtues in this respect. Richter observes, that the external application of this acid, diluted with water, is, perhaps, the most useful of all our remedies in itch complicated with a scorbutic habit of body.* Dr. Kinglake, also, has found this acid very effectual in cases of this kind-! Dr. Fosbroke, of Berkeley, in England, has recently published a paper on the use of dilute sulphuric acid in cutaneous affections, in * Specielle Therapie, torn. vi. p. 179. t London Med. and Phys. Jour. 1801, p. «14. VOL. T 5\ 402 ASTRINGENTS which he relates several very striking examples of in efficacy. He prescribed it in an obstinate case of lichen agrius, with prompt success. It was taken in a decoction of elm bark and of the wood of solanum dulcamara, " using, at the same time, as a wash, a decoction of the deadly nightshade.* It should be taken in as large doses as the stomach will bear; from one to four drachms, properly diluted, may be taken in twenty-four hours. It is usually employed in the form of the acidum sulphurium aromaticum, or elixir of vitriol. Made into an ointment with lard, it forms a very efficacious application in diseases of this kind. In this way I have repeatedly employed it with prompt success in the itch. I have also cured a distressing case of prurigo formicans, by the external and inter- nal use of this remedy alone. The ointment is made by simply incorporating the acid with lard, in the pro- portion of about thirty drops to an ounce of the latter. Quite recently I have been informed by Dr. J. R. Lucas, of Brunswick, Virginia, that the sulphuric acid, properly diluted, forms an exceedingly effica- cious injection in gonorrhoea.! I have tried it in one instance with success. About eight drops of the acid should be mixed with eight ounces of water. when used for this purpose. • London Medical and Physical Journal, for July, 1822- vol. xlvii. p. 483. t American Medical Recorder, for October, 1822. CHAPTER VIII. MEDICINES WHOSE ACTION IS PRINCIPALLY DIRECTED TO THE UTERINE SYSTEM. /. Medicines that promote the Menstrual Discharge. EMMENAGOGUES. Under this class are arranged such remedies as are supposed to be capable of promoting the menstrual discharge. It is very doubtful, however, whether any of the articles which have hitherto been employed for this purpose, possess any direct influence-over the uterine secretions. We know, at least, that their emmenagogue effects are very uncertain; and that re- medies of the most opposite character do occasionally, under peculiar circumstances, produce such effects. That the menstrual discharge is a secretion, and not a mere effusion of blood from the extremities of the uterine vessels, is an opinion now pretty generally entertained. This opinion is distinctly expressed by Allen, in a quotation from an author whom he does 404 EMMENAGOGUES. not mention. " I dare assert," says he, k- that the menses proceed entirely from the superfluous chyle concocted into a viscid humour, which by degrees mixes with the mass of blood, and, as is well known of all the several other secretions, is separated by the glands situated there for that very purpose, as mani- festly appears on the dissection of those parts. The menses are considerably more viscid and thick than the rest of the blood, and have generally an ungrateful and unusual smell, very different from what is drawn off by bleeding, or flows from an haemorrhage."* Bor- deu, too, in his invaluable Treatise on the Glands! advances the same opinion. Whatever opinion we may adopt in relation to the nature of this evacuation, certain it is, that whenever it becomes irregular or suppressed, the health always suffers more or less disturbance. Even the peculiar destiny of the sex,—the noble prerogative of becom- ing mothers, is destroyed, and with it, often, the ten- derest hope of the female. I have already said that it does not appear probable that any of our emmenagogues exert any direct action upon the uterus. If this were the case, we might, I think, calculate with much more certainty, on the ope- ration of these remedies, than experience teaches us to do. If we attend particularly to the effects of these * Synopsis Medicinae, vol. ii. p. 232. f Traite des Glandes. EMMENAGOGUES. 4Q5 articles, we discover that many of them have a de- cided tendency to increase the flow of blood to the pel- vic viscera generally. This is also the case with some other means occasionally resorted to for the restora- tion of obstructed catamenia, and which cannot be pro- perly placed under the head of emmenagogues. Thus ligatures on the thighs, the semicupium, and fomenta- tions to the external parts of generation, can only act by creating a local plethora in the vessels of the pel- vic viscera, and consequently of the uterus. I have known the extirpation of large haemorrhoidal tumours to restore suppressed catamenia, by which the local drain of blood from these parts was removed, and the ordinary fulness of the uterine vessels re-established. It is not necessary that we should regard the menstrual discharge as a mere effusion of blood, arising from local uterine plethora, in order to admit this explana- tion of the modus operandi of emmenagogues. The phe- nomena are perfectly compatible with our notions of the secreted nature of the menstrual discharge. There is an intimate relation between the degree of exalta- tion in the vital properties of a part, and the quantity of blood circulating through it. We find, accordingly, that whatever increases the flow of blood to a gland, increases also its secretion. It is in this way, perhaps, that all irritations increase the peculiar secretions of the organs to which they are applied. They produce an immediate flow of blood to the organs irritated, the 40G EMMENAGOGUES. vital properties of which are thereby elevated, and a larger secretion of their peculiar fluid lakes place. We can, therefore, readily understand how an in- creased determination of blood to the pelvic viscera may very often remove torpor in the uterine vessels, and thus restore the suppressed catamenia. Although emmenagogues are a class of remedies expressly set apart as means for removing catamenial obstruction, they yet, in reality, constitute but a small portion of our remediate resources in such cases. In a very great number of instances we find it necessary to have recourse to general remedies, to the exclusion of such articles as are technically denominated emmenagogues. If, for example, the catamenia cease to flow in conse- quence of a general relaxation or debility of the sys- tem, our best curative means, of course, are such as invigorate the vital powers. Hence, tonics, exercise, the cold bath, an invigorating diet, &c. do occasionally produce the best effects in cases of obstructed men- struation. A suppression of the menses is also fre- / quently attended by a state of the system directly the reverse of that of debility and relaxation. There is a rigidity of fibre unfavourable to the regular per- formance of some of the organic functions; the habit is full and inflammatory, and though apparently vigor- ous, easily subdued by any unusual exertion. In cases of this kind, all the stimulating emmenagogues would, without the use of previous depletory mea- EMMENAGOGUES. 407 sures, not only be ineffectual, but injurious. Bleed- ing, a temperate diet, tepid bath, &c. are here the proper remedies; and they often restore the regular evacuation of the catamenia, in a prompt and effec- tual manner. In prescribing, therefore, for suppression of the menses, it is of the utmost consequence that we at- tend to the general state of the system. Without such attention, indeed, our success must not only be ex- tremely precarious, but our remedies very often in- crease the mischief we are called upon to remedy. Alibert justly observes, that there are few disorders which depend on such a variety of causes, or are con- nected with such diflferent conditions of the general system, as obstructed catamenia. Hence, its reme- dies are so various, and often of such contrary charac- ter; and hence, too, the great uncertainty of all our remediate measures in such cases. RADIX HELLEBORI NIGRI. The plant which furnishes this article is indigenous to the Austrian Alps, the Appenines, and the Py- renees. The root, which is the only part employed in medicine, consists of numerous black fibres, springing from knottv branches, which issue out of a central 108 EMMENAGOGUES. radical tuber. Its taste is acrid, bitter, and nauseous, and, when chewed, it imparts a benumbed feeling to the tongue.* Water and alcohol draw from it a bitter and acrid extract. According to the analysis of Vauquelin, its constituent principles are, a very acrid essential oil, a small portion of extractive matter, faecula, a vegeto- animal substance, and salts. Geise considered the acrid oleo-aetherial fluid as a peculiar principle, to which he gave the name of hclleborinum. According to Pfaff, however, this sub- * The root of black hellebore is not unfrequently adulterated by other roots, some of which are powerfully poisonous. The roots of the adonis vernalis, trollius europaeus, actaea spicata, astrantia major, helleborus fceditus, veratrum album, and aconi- tum neomontanum, are occasionally mixed with or entirely substituted for it. The root of the adonis vernalis may be dis- tinguished from that of the black hellebore by the fibres not issuing from branches, but immediately springing from a cen- tral tuber: they are also more numerous and more fleshy, exter- nally darker and internally whiter, than those of the hellebore. The principal root of helleborus fceditus is thin, not knotty, nearly straight, with fewer fibres, which are short, very black, and much more acrid than those of helleborus niger. The root of actaea spicata is spindle-shaped, jointed, yellow within, with woody fibres. Trollius europaeus has a very short radical tu- ber with branched fibres, which have neither taste nor smell when dry. The root of astrantia major is articulated, spindle- formed, and slightly acrid. That of aconitum napellus is round- ish, spindle-shaped. *» EMMENAGOGUES. 409 stance approaches more to the character of a resin than to an essential oil. It is best extracted by alco- hol, and is distinguished by its leaving an exceedingly acrid taste in the back part of the mouth and fauces, when chewed.* The root loses its active properties by age. Its fibrous are much more powerful than its knotty or tuberous parts. This is one of the most ancient articles of the ma- teria medica. Ctesias, who lived in the time of Plato, and anterior to Hippocrates, speaks of it as a medicine of important virtues. It was particularly celebrated with the Greek and Roman physicians as a remedy in mania. The extraordinary cures performed at the island of Anticyrus, famous for its hellebore, are cele- brated by the poets and historians of antiquity. The doses which the ancients employed were, however, much larger than we would venture upon at the pre* sent day, and its effects accordingly were often exces- sively violent. It appears, indeed, by the accounts which have reached us of the employment of this article among the ancients, that they never expected to cure, without producing with it symptoms of a very violent character. Hence Oribasius, in his treatise on the use of hellebore, has two chapters, entitled " Quae faciendum sit quum strangulatio occupat eos * PfafF's Mat. Med. torn. iii. p. 253. vol. I. 52 .» 410 EMMENAGOGUES. qui Elleboruin sumpsenint," and "Quae faciendum sit ubi vox et sensus amiltitur."* When given to animals in large doses, hellebore produces the following effects: slow and difficult re- spiration; slowness and sometimes irregularity of pulse; vomiting of mucous and bilious matter: an in- creased flow of saliva; trembling and unsteadiness; vertigo; convulsions followed by tetanus, and diminu- tion of heat. The animal finally becomes cold, respires after long intervals, and dies.! From a variety of ex- periments performed by M. Orfila on dogs, he con- cludes, 1. That powdered hellebore, applied to the cellular texture, is rapidly absorbed into the circula- tion; 2. That its local effects are confined to the pro- duction of slight inflammation; 3. That "the part which is soluble in water is that in which the poison- ous property of the hellebore resides;" 4. That the alkaline extract of black hellebore, which forms part of Bacher's tonic pills, is also extremely active. J When taken into the human stomach it manifestly increases the force and rapidity of the circulation, and excites a sensation of warmth throughout the whole * Medical Sketches, by G. Kerr, p.. 22. t A Memoir upon the effects of Helleborus Niger and Albus, by M. Schabel, of Weissenburg, read in Sept. 1818, to the Society of Emulation, of Paris. J System of Toxicology, by M. P. Orfila, M. D. translated by J. G. Nancrede, p. 208, EMMENAGOGUES. 411 body. When taken in large and repeated doses, its effects are often, as I have already stated, very violent. Independent of the powerful vomiting and purging which this article is known sometimes to produce, its long use occasions a singular feeling of coldness in the abdomen, muscular debility, anxiety about the heart, slow and small pulse, headach, stiffness of the mus- cles of the neck, pain in the glands about the throat, slimy whitish mucous discharges from the bowels, spasms, delirium, haemorrhages, &c* The emmenagogue virtues of this article remained unnoticed until the celebrated Mead announced them to the public. As is usual with those who introduce new remedies, he lavished the most extravagant en- comiums on the emmenagogue powers of this sub- stance. On the continent of Europe, especially with the Germans, this remedy stands in no small repute. But in England, as well as in this country, the authority of Cullen, who regarded it as nearly inert in this way, has thrown it into unmerited neglect. It seems to me quite certain, however, that both Mead and Cullen were wrong in their estimates of the powers of this medicine, and that it is entitled neither to the extravagant praises of the one, nor the unquali- fied condemnation of the other. Indeed, within a few * Buchner de salutarii et noxio Ellebori Nigri usu. Halae, 1748. Burdach's System der Arzneymittellehre, vol. iii. p. 124. Hartman de virtute Hellebori Nigri. 412 EMMENAGOGUES. years past, its reputation as an article of the materia medica seems to be again advancing. Hellebore appears to possess a very considerable tendency to determine the circulation to the hypogas- tric and pelvic viscera. This is evinced by the sense of weight and pain which patients generally experi- ence after having taken it for some days; I have known this determination to be so great as to produce a profuse haemorrhagy from the uterus. From its stimulant properties, one would be led to regard it as inapplicable to cases where there is a ful- ness of habit, or in a sanguine constitution. Yet Mead, Lewis, and other eminent writers say, that it is pre- cisely in such cases that its emmenagogue virtues are most conspicuous. Burdach, however, in his excel- lent work on the materia medica, asserts that it is particularly valuable in cases of torpor, where the face is pale and leucophlegmatic, and the pulse soft. To this latter opinion I am inclined myself; at least, my own experience goes directly in favour of it, inde- pendently of the theoretical considerations which point that way. In a recent work on the materia medica* it is stated that it is especially useful as an emmenagogue when it purges, in cases attended with torpor and con- stipation of the bowels, and " perhaps with a degree of insensibility of the uterus." My own experience, * Elements of Therapeutics, 8cc. by Dr. N. Chapman. EMMENAGOGUES. 4]g however, leads me to a contrary conclusion. It does not appear to me that its cathartic effects are, under any circumstances, necessary, or even accessory to the the attainment of its emmenagogue results. I have been much in the habit of employing this article in amenorrhoea, and it has always appeared to me, that, whenever it purged freely, as it generally does if it purges at all, it was less apt to evince the desired ef- fects. If, indeed, its emmenagogue powers depend upon its tendency to produce a local plethora in the uterine system, we can easily imagine how an active catharsis should lessen these effects. It may be exhibited in substance, or in the form of extract, infusion, or tincture. The extract is given in the dose of from six to ten grains. The tincture is most commonly employed; its dose is from twenty to forty drops, two or three times a day, in a cup of some aromatic tea, such as rosemary, pennyroyal, &c. Bacher's pills answer extremely well. They are com- posed of equal parts of the extract of hellebore, myrrh, with a small portion of powdered carduus benedictus.* Given as an hydrogogue, these pills have been taken to the extent of thirty a day, in three doses of ten * & Extracti ellebori. nigr. Extr. myrrh aquos. - - ax %\. Pulv. card, bened. - - 5*"' M.ft. In pilulas divid. ail gr. i. pondere. 414 EMMENAGOGUES. each, at the distance of an hour between every dose. Taken in this way they produce very copious evacu- tions by stool and urine. " During their use the pa- tients must be enjoined to drink plentifully of mild liquids. Upon a due attention to this circumstance, viz. dilution, the success of the remedy as a hydra- gogue in a great measure depends."* JUNIPERUS SABINE. Savin is a small evergreen tree, of the cedar species, indigenous to Italy, Portugal, and Switzerland, where it grows in elevated situations in considerable abundance. It is cultivated, with us, in gardens, and is, perhaps, of all other articles of this class, the most commonly known for its emmenagogue virtues. Its leaves contain a large portion of a very pungent essential oil, to which the medicinal virtues of the plant may be fairly ascribed.! When taken internally it powerfully excites the vascular system. It produces a manifest flow of blood to the uterine system; and, when taken in large doses, occasions great heat, agitation, haemorrhage, and in- flammation of the bowels. * Thesaurus Medicaminumj p. 62. t Cullen. EMMENAGOGUES. 4]r; The testimony of Dr. Home, of Edinburgh, is strong in favour of the emmenagogue powers of this plant; and until the time of Cullen, it was very ge- nerally regarded as one of the most potent articles of this class of remedies. By this writer, however, whose authority, though great on all subjects, has, perhaps, often been too implicitly received, the reputed emme- nagogue virtues of this substance were considered as unimportant. It, therefore, soon fell into general dis- repute both in England and in this country. When amenorrhoea depends on a relaxed state of the general system, or on an inactive and torpid con- dition of the uterine system, the savin may be often very advantageously employed.* It need hardly be observed, that its great stimulant properties render it inapplicable in cases attended with a high degree of phlogistic diathesis. Wedekind,! a German writer of great respectability, says, that this article may be applied with very great advantage in the treatment of that atonic, or relaxed state of the uterus, attended with an unnatural secre- tion and soft swelling of this organ, which is some- times met with in women of advanced age, who have suffered much from repeated child-bearing or abor- * Bayler iiber die heilkraft der sabina. Burdach's Arzney- mittellehre, vol. iii. p. 300. t Wedekind uber die anwendung der sabinae by fiauenzimer- krankheiten. In Hufeland's Journal, vi. Bd. 1 st. nr. 3. 416 EMMENAGOGUES. tions, and which is generally attended with a train of hysteric disturbances. I have occasionally employed this article in cases of amenorrhoea, in females of a relaxed habit of body; and, though sometimes without success, I have had sufficient evidence of its powers in this way to esta- blish, in my opinion, its just claims to our attention. Savin has been employed in various other affec- tions, in some of which its remediate powers seem to be very considerable. Rave, a German writer of respectability, speaks in the highest terms of its use in chronic rheumatism.* I have employed this remedy for more than ten years past, in this disease, and I can truly say that its good effects have, in my practice, often been surprisingly prompt and decisive. Savin, according to some writers, possesses active anthelmintic powers.! From my own experience I can say nothing of its virtues in this respect. Werlhof speaks well of this article in caries of the bones. It has also been much extolled, by some German writers, for its remediate powers when ap- plied to old and obstinate ulcers, either in the form of decoction or of poultice. As an escharotic application to venereal warts and other fungous excrescences the powdered savin is not unfrequently employed. And an ointment made of it is one of the most excellent * Uber die anwendung der Sabina by der gicht, Sec. 1794. t Alibert. Burdach. EMMENAGOGUES. 417 applications we possess for keeping up a discharge from a blistered surface. It is given in substance in the dose of from one to two scruples three or four times a day. It is almost impossible to pulverize it without previously drying it in a high degree of heat; and, as the active part is an essential oil, very readily volatilized by heat, the pow- der is always an improper form for exhibiting it. The best way is to beat it up with honey or with any kind of syrup, into the consistence of a conserve. A de- coction of one ounce of the leaves to one pint of water, boiled down to half a pint, with the addition of two ounces of syrup, may be conveniently given in the dose of a large wine-glass full every two or three hours. The oil is given in doses of from one to six drops. Hartman gives the following prescription, into which savin enters as a most powerful emmenagogue: R Pulv. hellebor. nig. ^iv. Pulv. G. myrrh. Ferr. ammoniat. Extract sabinae. aa. 5ss. Syrup, croc. q. s. ut, fiant pilulae ponder. aa. gran. unae. Three to be taken three or four times a day.* The compound tinct. of savin, L. Ph. is given in the dose of a drachm twice a day. * Thesaurus Medicaminum, p. 145. VOL. I. 53 418 EMMENAGOGUES. MENTHA PULEGIUM.—PENNYROYAL. The plant which goes by the name of pennyroyal in this country, is the cunila pulegoides, and not the mentha pulegium, as is commonly thought by those who are not acquainted with botanical distinctions. These two plants are, however, so nearly allied to each other, both in botanical character and in their sensible properties, that we would be led, a priori, to expect, which in fact appears to be the case, an entire similarity in their medicinal powers. As a popular remedy for suppressed menstruation there is, perhaps, no other article so generally em- ployed. Its emmenagogue virtues are, however, ex- tremely problematical. Cullen considered it as per- fectly useless in this respect, although he thinks it of service in " the dyspeptic and spasmodic symptoms of the stomach," which some females experience about the period of menstruation. From my own experi- ence I can say nothing in favour of this article, al- though I have prescribed it very frequently. As a vehicle for the exhibition of other emmenagogue remedies, an infusion of the pennyroyal is much in use in some parts of Europe, and in the interior of our own country. EMMENAGOGUES. 419 ROSMARINUS OFFICINALIS. The rosemary is a plant well known in this coun- try as a common garden shrub. It is indigenous to Spain, Italy, and the south of France. Water draws from it a bitter extractive matter. A very odorous^ resinous principle is extracted from it by alcohol. It also yields a very pungent essential oil by distillation. Proust has discovered a sixteenth part of camphor in this oil. M. Margueron has found that oil of rose- mary decomposes the nitrate of mercury, the oxymu- riate of mercury, the yellow sulphate of mercury, and the caustic muriate of antimony.* It is much in use as a domestic remedy for obstructed catamenia, and it would appear from the testimony of several respectable writers, that its powers as an emmenagogue are not inconsiderable. Cullen, however, attributes to it no virtues in this way. Dr. Chapman, on the contrary, gives it a better character, and alleges that he has used it in several cases " with unequivocal success." Murray does not mention it as an emmenagogue. I have employed it in but a very few cases, and can therefore say but very little of it from my own experi- ence. As a warm, aromatic stimulant, it may often be given with much advantage'in nervous disorders, such * Alibert, Matiere Med. vol. ii. p. 127. 420 EMMENAGOGUES. as vertigo, palsy, and spasmodic pains of the stomach. It has also been extolled in the treatment of glandular swellings in infants.* But its usefulness, says M. Alibert,! is particularly conspicuous in chlorosis, a disease which is very generally complicated with a weakness of the abdominal viscera, or an aberration of their sensibility. The same author states, that a vinous infusion of this plant is an excellent remedy in chronic diarrhoea. It is generally used in the form of an aqueous or vinous infusion. The essential oil is given from two to ten drops, on sugar. Rosemary is a principal in- gredient of the preparation known under the name of Hungary water. RUBIA TINCTORUM.--MADDER. This is a perennial plant, and cultivated as an arti- cle of commerce in different parts of Europe. The root, which is the only part of the plant employed, is long, slender, of a red colour, and succulent, with a white ligneous pith in the centre. Its taste is slightly * J. C. Speis, Rosmarini Historia Medica. Helm, 1818. t Nouveaux Elemena de Therapeutique et de Mature Medi- cale, vol. ii. p. 128. EMMENAGOGUES. 421 bitter and somewhat austere, and imparts both its taste and colouring principle to water. When given to animals with their food it soon gives a red tinge to the bones and the urine. Mr. Gibson,* of Manchester, has experimented largely with this article, in relation to its effects upon the bones and secretions of animals, and he has established the fact, that its colouring principle is manifested only where it meets with phosphate of lime, which acts as a mor- dant in fixing and evolving it. It is chiefly upon the evidence of Dr. Home in favour of its emmenagogue virtues, that its claims to notice are founded. By this eminent physician it was regarded as the safest and most powerful emme- nagogue known. He asserts, that out of nineteen cases treated with this remedy fourteen were cured. By the late Dr. Barton also, it was thought to possess no inconsiderable powers in this way. Respectable as these testimonies are, it is still very doubtful whether this article possesses any such powers. Very few physicians employ it at the present day; and what- ever may be its virtues, it does not possess the confi- dence of the profession as a remediate article. I have employed it frequently, but never derived the slightest advantage from it. It appears, indeed, to have very little influence of any kind upon the functions of the * Transactions of the Manchester Literary and Philosophical Society. ,{22 EMMENAGOGUES. animal economy; nor has Cullen's suspicion with re- gard to its supposed deleterious qualities ever been confirmed. It is given in substance, in the dose of from 9i. to 3ii.* POLYGALA SENECA. This plant, indigenous to the United States, is entitled to very great attention for its various and im- portant medicinal virtues, whatever we may think of its. powers as an emmenagogue. Dr. Hartshorne, of this city, appears to have been the first who noticed the emmenagogue virtues of this article. Dr. Chapman speaks of it in the highest terms of praise. " Of all the emmenagogues which I have tried," says he, " this is the most efficacious, and will be found useful in all forms of amenorrhcaa." And again: " I have used it with sufficient success to warrant me in recommending it as one of the most active, certain, and valuable of the emmenagogues." From my own experience, however, as well as from * Dr. M'Clellan informs me that he saw a case of amenor- rhea, in the Pennsylvania Hospital, in which §ss. was given, by mistake, instead of 3SS- It produced a slight discharge of blood from the uterus. The medicine may, therefore, be usu- ally given in too small a dose. EMMENAGOGUES. 493 that of some of the most respectable physicians of this city, I am led to a very different estimate of the pow- ers of this remedy as a promoter of the menstrual dis- charge. I have tried it repeatedly, but hitherto uni- formly without success. I am not, however, disposed to regard it as wholly inert in this respect. The tes- timony in favour of it is too respectable to allow me to doubt its occasionally manifesting such powers. I am nevertheless entirely convinced that Dr. Chapman has expressed an opinion much too favourable of its efficacy as an emmenagogue. It is best given in the form of decoction. An ounce of the bruised root to a pint of boiling water, and boiled down one-third, will make it sufficiently strong. Three or four ounces of this decoction must be given during the day. It should be commenced six or eight days previous to the regular period of menstruation, and gradually increased to as much as the stomach will bear.* CANTHARIDES. Agreeably to the ideas given'in the commence- ment of this chapter, concerning the modus operandi of emmenagogues, we should be led, a priori, to ex- * Chapman's Materia Medica. 424 EMMENAGOGUES. pect such virtues in cantharides: for they have un- doubtedly a very considerable tendency to determine the circulation to the pelvic viscera. The emmenagogue properties of cantharides have been noticed by Allen,* Adair,! ana* Burdach.J The latter writer says: " In obstructions of the catamenia, arising from debility and torpor of the uterine system, fly plasters laid on the lower part of the abdomen, or on the sacrum, have been known to do good; or the tincture of cantharides may be given internally, in combination with tincture of aloes." Adair recom- mends this latter combination as very useful in ame- norrhoea. Allen, in enumerating a variety of emme- nagogues, mentions cantharides in union with cam- phor, but makes no further observations as to the powers of this mixture. Within a few years past Dr. Joseph Klapp, of this city, has directed his attention particularly to the emmenagogue virtues of this article, and has published the result of his experience upon this subject, furnishing thereby much interesting evi- dence in favour of the existence of such properties in cantharides.§ In my own practice I have found this article to dis- * Synopsis Medicin3e,vol. ii. p. 235. t Essays on Fashionable Diseases, &c. t System der Arzneymittellehre, B. iii. s. 107. § Medical. Recorder. EMMENAGOGUES. 425 play very decided emmenagogue virtues in several in- stances. In the majority of cases, however, I have found it to fail in common with other articles of this class.* In exhibiting this remedy, it is necessary to attend to the state of the general system. When the habit of body is full and inflammatory, venesection ought al- ways to be premised to the exhibition of this medi- cine. In cold and phlegmatic temperaments, its ac- tion in this way, would seem to be most conspicuous. It seems to be peculiarly adapted to those cases of amenorrhcea which are attended with fluor albus. In this affection it appears to do good by exciting the mucous membrane of the uterus and vagina to a new train of actions, independently of its powers to in- crease the determination of blood to these parts. Twenty drops of the tincture is to be given three times a day, and gradually increased until symptoms of strangury supervene. * I was directed to the employment of cantharides, as an emmenagogue, by Dr. Klapp's publication, prior to which I was not aware that this article had ever been used for such purposes. VOL. I. 54 426 EMMENAGOGUES. ALOES EXTRACTUM. The natural history of this article has already been given under the head of Cathartics. Agreeably to the opinion expressed in the beginning of this chap- ter, relative to the modus operandi of emmenagogues, there is no difficulty in perceiving how aloes should prove emmenagogue independent of any specific vir- tue in this way. When speaking of this article before, its peculiar tendency to act upon and stimulate the rectum were particularly pointed out. The effect of such an irritation, by a well known law of the animal economy—ubi uritatio ibi fluxus—is, an afflux of blood to the rectum and neighbouring organs. Hence the pernicious consequences of aloetic purges in per- sons labouring under haemorrhoidal affections. In cases of this kind it is exceedingly apt to bring on bleeding from the tumours in the rectum, or, at least, to render them turgid and inflamed. In males a long course of aloetic medicines seldom fails to bring on piles. In females, on the contrary, where there is no strong tendency to haemorrhoides, it more commonly brings on copious discharges of blood from the uterus, or in amenorrhoea, re-establishes the regular flow of the catamenia. In patients of a delicate and relaxed habit of body, with a constipated condition of the bowels, we may often derive very great advantage EMMENAGOGUES. 427 from a combination of aloes, steel, and myrrh.* Where amenorrhoea is connected with haemorrhois, which is not unfrequently the case, aloes is an impro- per remedy. Instead of re-establishing the menstrual discharge, it is apt to increase still further the haemor- rhoidal affection; and by thus establishing a more copious discharge from the vessels of the rectum, a derivation from the uterine vessels, and with it a dimi- nution of the menstrual effort takes place. In chlo- rotic females small doses of aloes and iron will some- times produce very happy effects. I have known it to be prescribed with prompt success in a case of amenorrhoea, in combination with pulv. ipecacuanha, in the proportion of ten grains of aloes to one grain of ipecacuanha, every morning, noon, and evening. The semicupium is an excellent auxiliary to this, as, in- deed, it is to all the other articles of this class. It does not appear that the emmenagogue effects of aloes is proportionate to its cathartic operation. Small doses, just sufficient to unload the bowels, will, in general, do better than such as are large and more active in their purgative effects. * R Pil. aloes cum myrrh. Pil. ferri comp. aa %i. Sodae sub-carbonatis. Qi. M. Divide massam in pilulas xxx. Dose, two, twice a day. 428 EMMENAGOGUES //. Medicines that increase the Parturient Action of the Uterus. ABORTIVA. As yet we know of but one article which has any decided tendency to excite the propulsive efforts of the gravid uterus, and this is the secale cornutum, or ergot. This article is a parasitic fungus, occupying the glumes of the rye, (triticum secale,) of the genus scle- rotium, and natural order fungi. For an interesting account of its natural history the reader is referred to a paper by Dr. William Tully, published in Silliman's Journal of Science and the Arts, vol. ii. p. 48. There is no article of the materia medica more eminently calculated to excite our admiration of that wonderful and mysterious connection of the various organs of the animal economy, by which a slight im- pression upon one part is instantly propagated to another, and there manifested often by the most vehe- ment actions. Taken internally in a large dose, il excites nausea and vomiting, attended sometimes with vertigo, pain in the head, and increased excitement of the vascular system. Its power, however, of increasing the partu- rient efforts of the womb, is by far its most prominent EMMENAGOGUES. 420 and important character. As a partus accelerator, it stands alone in the materia medica, and is capable, by its prompt and certain operation, of affording the most happy results, in the hands of a cautious and judicious practitioner. When labour is protracted in consequence of feeble or irregular contractions of the uterus, this medicine, administered under due precautions, hardly ever fails to excite vigorous and effectual contractions. In a large majority of cases the ergot may, indeed, be re- garded as a very fit substitute for the forceps and vectis. When once the uterus is under its influence, the parturient efforts generally continue uninterrupt- edly; the contractions of the womb never totally cease, but keep up a constant propulsive effort. It commonly manifests its operation in twenty or thirty minutes after its exhibition. Sometimes, however, the effects do not show themselves until a much longer time has elapsed. The force of the contractions are often sur- prisingly vehement; and it is, therefore, obvious that this medicine cannot be given indiscriminately, or without a proper regard to circumstances. Should it be improperly given, before the os uteri is soft and in a state to dilate, or has already considerably dilated rupture of the womb might ensue. If the mouth of the uterus is considerably dilated, and no particular rigidity of the external parts present, 430 EMMENAGOGUES. it may be given with perfect safety and with almost a certainty of success. By some physicians it is supposed that this article exerts a deleterious influence on the foetus: the life of which, they assert, it not unfrequently destroys. If this be true, it forms, indeed, a very serious objection to its employment. My own experience with this article has not been sufficient to enable me to speak with confidence upon this point; I suspect, however, from what I have myself seen, and from the detailed experience of others, that there is no good foundation for this opinion, and that the cases which have been recorded by some practitioners, as demonstrative of its injurious effects,* are to be considered in the light of accidental coincidences, rather than the positive results of the medicine.! * Vide Dr. Chatart's paper in the Med. Repos. for 1820. t Dr. Hosack, speaking of this article, says: " The ergot has been called, in some of the books, from its effects in hastening labour, the pulvis ad fiartum; as it regards the child it may, with almost equal truth, be denominated the pulv is ad mortem— for I believe its operation, when sufficient to expel the child, in cases where nature is alone unequal to the task, is to pro- duce so violent a contraction of the womb, and consequent con- volution and compression of the uterine vessels as very much to impede, if not totally to interrupt the circulation between the mother and child." New-York Med. b" Phys.Jour. vol. i. p. 206. EMMENAGOGUES. 43 ] The cases to which it seems particularly applicable are: 1. Where abortion becomes inevitable in the early part of pregnancy, and the contractions are feeble with considerable haemorrhage. In such cases the exhibition of this article will not only shorten the suf- ferings of the patient, but in a great degree remove the danger. 2. In cases of alarming haemorrhage near the close of utero-gestation, not occasioned by attachment of the placenta over the os uteri, and not accompanied by efficient contractions. 3. In puerperal convulsions in which a speedy de- livery becomes necessary. 4. In lingering labour, the os uteri being sufficiently dilated, and the parts properly relaxed. 5. In retention of the placenta from a want of con- traction of the uterus. 6. " In subjects liable to haemorrhage after delivery from laxity and deficiency of contraction."* In such cases the haemorrhagy may be entirely prevented by the exhibition of a proper dose of ergot fifteen or thirty minutes previous to the time when labour would other- wise be expected to terminate. 7. To restrain haemorrhagy after delivery. Ergot has been recommended as an emmenagogue, but I believe upon a very slender foundation. I have * Dr. E. A. Atlee. Vide Med. Recorder, vol. iv. p. 141. 432 EMMENAGOGUES. prescribed it in four cases, with a view to its emme- nagogue effects, but without the least advantage. It seems, indeed, to exert very little influence on the vascular system; and when we consider, that as an uteri contractor, it must tend rather to diminish than to increase the quantity of blood in the vessels of the womb, its emmenagogue powers will at once appear very doubtful. This article was used, out of the profession, as a promoter of parturition, more than a century ago. In regular practice, however, it was not known until Dr. Stearns, of Albany, brought its virtues before the pub- lic; and to him, therefore, belongs the merit of hav- ing first directed the attention of medical men to the extraordinary powers of this article. In Europe it was at one time regarded as a power- ful and extensive cause of disease. Epidemics of a very fatal character were ascribed to the effects of the ergot, mixed with the rye which was ground up for bread stuff. What foundation there is for this opinion I cannot undertake to say. It appears to me unphi- losophical, however, to account for epidemics by as- cribing them to a cause which must be always, in i> degree, present, APPENDIX. Hie following articles, which appear to be worthy of notice in a work of this kind, were omitted through mistake, in their pro- ficr filaces. SANGUINARIA CANADENSIS. THIS plant is generally known by the name of Paccoon, or blood-root, and grows abundantly throughout every section of the United States. It is among the earliest of our spring plants, shooting up its humble but beautiful white flowers, as soon as the frost leaves the earth. The root, which is the only part employed as a medicine, is red, horizontal and tuberous; its taste is acrid, leaving an impression in the fauces some time after it is chewed. According to the very accurate and minute analysis of this root by Dr. Fitzgerald Bird, it appears to con- tain cinchonin, extractive matter, a gummy matter, a resin, and gallic acid, in a state of combination.* The colouring principle of this root resides chiefly in its resinous parts, the alcoholic solution being always more than twice as highly coloured as the aqueous.f The medicinal properties of the sanguinaria, have been very variously represented, and its powers do not appear to be, as yet, well understood. Dr. Bigelow considers this root as an acrid narcotic. Dr. Bird says that " its medicinal properties are in every respect similar to those which characterize the cin- * An Inaugural Dissertation on the Sanguinaria Canadensis, by Fitzge- rald Bird, of Georgia. New-York, 1822. f Bigelow's Medical Botany, vol. i. p. 79. vol. i. 55 436 APPENDIX. polypus very considerably for a time, I could not succeed in obtaining any permanent advantage by its use. Dr. Francis very judiciously observes, that in cases of high general excitement, or in active local inflammation, its employ- ment cannot but prove injurious; for, whatever may be its ulte- rior effects, it is always actively stimulant in its primary opera- tion. Two ounces of the powdered root to a pint of diluted alcohol, are recommended as proper proportions of making its tincture CROTON TIGLIUM. The oil which is obtained from the seeds of this plant, has been recently introduced to the notice of the profession, as one of the most active purgatives known. It is generally supposed to be a new remedy, but this is a mistake; both the seeds and oil were very early noticed and employed in medicine. Se- rapion, the younger, mentions this plant and its seeds. (De Simplicibus, c. 261.) M. Pomet, chief druggist to Louis XIV. in his General History of Drugs, speaking of the seeds of Tig- Hum, says, " the use of these kernels is to purge, and it is in- deed one of the greatest purgatives we have." M. Lemary speaks of the oil of these seeds " as being capable of exciting purging, simply by rubbing the stomach and belly with it."* Rumphius, also, speaking of this plant says, " Olim grana (Tig- lii) per totam Indiam Orientalem crebro in usu fuerat ad lym- pham hydropicum per alvum praeprimis eliminandam, in iis vero, quorum ventriculus debilis simul emesis subsequuta. For- tioribus bina grana sufficerunt, aliis granum unum cum semisse. Variis aliis in morbis in quibus purgantia fortiora opportuna * Vide Mr. Iliff's Paper, in the 97th No. of the London Med. Repos. APPENDIX. 437 videntur, ista in India adhibent. Et hanc quidem acrimoniam oles ipsi seminis inesse, tarn ex dictis quam inde apparet, quod olei ex siccis granis expressi gutta una cum canariensi vine capta vulgare apud chirurgos in India degentes purgans con stituerit."* The seeds are also mentioned by Dr. Flemming in the 11th vol. of the Asiatic Researches, as having been formerly well known and employed in Europe as hydragogue purgatives. Bergius, Lour, Linnaeus, and Burdach speak of the grana Tiglii as powerfully purgative. According to the experiments of Dr. Nimmo, alcohol of sp. gr. 825, dissolves only a portion of the oil. The part which re- mains undissolved, is destitute of the characteristic acrimony of the oil, " this property being entirely transferred to the alco- holic solution, which answers the medicinal properties of the entire oil in a more certain manner, and unattended by several inconveniences formerly experienced from its use." The oil contains forty-five parts of acrid principle, and fifty-five of fixed oil. The acrid principle is united with a resinous substance, which is dissolved by alcohol, sulphuric aether, volatile and fixed oils.f The oil itself is converted into a saponaceous mass by means of an alkali. This oil is powerfully purgative. Given in the dose of from one-half to one drop, it produces copious evacuations, and ge- nerally with very little or no griping or other inconvenience. Mr. Iliff, apothecary to the South London Dispensary, whose experience with this remedy has been very extensive, thinks, however, that it produces nausea and griping more frequently than has been supposed; nor does it appear to be uniformly certain in its operation. Mr. Iliff states that he gave nine drops in a case of apoplexy, in three drop-doses, without any operation * Vide Medico-Chirurgical Review for Sept. 1821. Rumplrius HetLs Amboininu, torn. iv. p. 98. ■j- London Medical Repository, vol. xvii. 438 APPENDIX. whatever; whereas ten grains of calomel, which was afterwards resorted to, acted briskly.* We have also the testimony of Dr. Carter, one of the physi- cians of the Kent and Canterbury Hospital, in favour of the employment of this article as an active purgative. He says that he employed it in seventeen cases, in one of which only did it fail to operate. Croton oil has been successfully used in ma- niacal cases. Sir George Tuthill, one of the physicians to Bethlem Hospital, has found it beneficial in affections of this kind. It has also been used with advantage by Dr. Pearson;t and it is said to be an excellent hydragogue, and to have proved very serviceable in hydropic cases. Professor Francis of New- York states in a letter to me, that " he is induced to pronounce the oil of croton a powerful and certain and speedy purgative, and free in its action from griping. In a case of most obstinate and very long continued costiveness, he says it effected what neither the elaterium, nor the other vegetable drastics, nor mercury could accomplish." He thinks it will be found pecu- liarly serviceable in habitual torpor of the intestinal canal. This oil appears to make a very powerful and prompt impres- sion on the nerves. The editor of the London Medico-Chi- rurgical Review*, says, that " cases of tic doloureux have been lately relieved, and even removed, by a drop or two of oil of croton applied to the tongue. The effect on the nerve was al- most instantaneous." Mr. Frost says that he has seen instances in which the application of this oil to the tips of the fingers "produced a sense of numbness in the fingers, hand, and arm, (but no local inflammation) dryness in the throat and headach, which continued for several hours." It generally, however, * London Medical Repository, vol. vxii. f A Sketch of the Botanical Literature, &c. of Croton Tiglium. By John Frost, Esq. See London Med. Repos. July, 1822. t No. 6, p. 428. New Series. APPENDIX. 439 produces a very considerable degree of local inflammation when applied externally. It may be conveniently given in the form of pills, made with the oil and crumbs of bread. The violence of the action of this oil may be lessened by giv- ing it in union with some aromatic, and particularly with any of the volatile oils : viz oleum, caryophillorum, cinnamoni, Sec. Roasting, or baking the seeds, previous to extracting the oil, is said also to lessen the violence of its action. The vegetable acids are likewise said to moderate its action.* Dr. Frost re- commends the following formula for exhibiting this oil.f PUNICA GRANATORUM. The bark of the pomegranate tree has been recently intro- duced to the notice of the profession, as a very efficacious re- medy for the removal of the tape worm. It was first noticed, I believe, as a powerful vermifuge, in Dr. Fleming's catalogue of Indian Medicinal Plants and Drugs, published in 1810. Dr. Pollock afterwards published a case of taenia in an infant, in which this article was employed with complete success.\ Quite recently, the favourable accounts which had been published of this remedy in taenia, have been amply confirmed by P. Breton, Esq. surgeon to the Rhamgur battalion in the East Indies. He relates eight cases which were promptly and completely relieved by this medicine. In almost every instance the taenia was expelled, * Lond. Med. Repos. June, 1822. | R 01. Expressi Sem. Crotonis g» i. Olei Caryophillorum, gtt i. Confectionis Rosse Gallicse gr. iv. Misce et sit pilula. ! Edinburgh Med. and Surg. Journ. vol. x. p. 4h< 440 APPENDIX. entire and alive, in the course of from three to six hours after first taking the remedy. He employed it both in the form of decoc- tion and of powder. The former he made by boiling two ounces of the bark in a pint and a half of water down to three-fourths of a pint. Of this he gave a wine-glass full every half hour, until four or five doses were taken. Of the powdered bark, he gave twenty grains every hour four or five times repeated. The remedy is apt to occasion nausea, and occasionally also, when taken in strong doses, giddiness and faintness. When these effects ensue, the use of the medicine should be suspended for a time. " The temporary suspension and renewal of the medicine," says Mr. Breton, " may be successfully adopted under such circumstances."* PRUSSIATE OF IRON'. The prussiate of iron has been lately employed with much success in the treatment of intermittent fevers. Dr. Zollickoffer of Baltimore was the first who noticed its powers in this way He relates a number of cases in which it was successfully used.f He gave it in doses of from four to six grains every four hours. During the present season, I have known this remedy to be employed with considerable success by several practitioners of this city. I have prescribed it in five or six cases, in three of which, it removed the disease very promptly. In cases of chil- dren, it is a very convenient medicine, being destitute of taste or smell, and the dose forming but a very small bulk. It sets easily on the stomach, and may be administered in every stage of the disease. * Medico-Chirurgical Transactions, vol. xi. f American Medical Recorder, vol. v. p. 540. END OF VOL. I NLM032744151