^ ^ ^ ^ ^ Pulv. camph. 3ss. pulv. gum. arab. 3ii- terre simul et adde gradatim, aquae fontanae ^viii. syrupi simp.fi. M Dose, a table-spoonful every two or three hours. NARCOTICS. 59 HUMULUS LUPULUS.--THE HOP. I have already spoken of this plant, when treating of tonics. It remains, therefore, in this place, only to notice its narcotic powers—powers which it possesses to a very considerable degree, " and capable of pro- ducing all the phenomena of opium." The flowers are the only parts used in medicine, although the leaves are not without some anodyne properties. A pillow of hops is a very common mode of procuring sleep, in domestic practice. The narcotic principle of the hop seems to be particularly applicable to those cases where want of sleep and restlessness are kept up by an irritable state of the nervous system, and where opium cannot be taken from idiosyncrasy. It may be given in the form of an extract or of tincture. The tincture is made by infusing five ounces of hops in two pounds of proof spirits. The dose of this is from 3L to §ss. The extract is given in the dose of from gr. x. to 9ii. pro re nata. HYOSCYAMUS NIGER. This plant is every where found in abundance on the continent of Europe. Its root bears a considera- 60 NARCOTICS, ble resemblance to that of the parsnip, and fatal mis- takes have happened by taking the former root for the latter. The taste of this plant is nauseous, and its odour, which is almost wholly lost on exsiccation, stupifying. It contains resin, mucilage, extractive matter, gallic acid, some salts, and an alkaline ele- ment, which has received the name of hyocyama* Water extracts the narcotic power of hyoscyamus very freely; boiling water, however, destroys them. The best menstruum is diluted alcohol. The whole plant acts as a poison on the human sys- tem; but sheep, deer, and some other animals eat it with impunity. Taken in a very large dose, it occasions a hard, small, and irregular pulse; anxiety, headach, vertigo, diminution of sensibility, intoxication, a sensation of falling downwards felt even when in a recumbent position, delirium, coma, apoplexy, double vision, or entire loss of sight, subsultus tendinum, convulsions, risus sardonicus, paralysis of the tongue, a blue co- lour of the face and whole body.f Alibert states that a gangrenous eruption on the skin, particular- ly of the lower extremities, is sometimes a conse- quence of a very large dose of this substance. Orfila says, that two persons, who had eat some young shoots of hyoscyamus dressed with oil, were, accord- * Paris' Pharmacologia. t Burdach, Arzneymittellehre, B. iii. s. 525. Narcotics. gf nig to the report of Mr. Choquet, affected in the fol- lowing manner: dilatation of the pupils, difficulty of breathing, pulse small and intermitting, aphonia, tris- mus, risus sardonicus, loss of sense, which, connected with a strong propensity to sleep, exhibited a complete state of typhomania. The extremities became cold, the superior ones were agitated; the inferior paralysed,* and to these symptoms was added a deep carphologia. Stork, Mayerne, Creeding, and others regarded it as possessing very considerable curative powers in epi- lepsies, convulsions, and other spasmodic affections. Later experience, however, does not confirm these favourable sentiments of its virtues. In its remediate properties it approaches a good deal to those of opium. It differs, however, from this substance in heating the system much less, and in act- ing as an aperient on the bowels. It may therefore be employed with advantage where we wish to allay pain and irritation, and where opium is inadmissible on ac- count of its stimulating and constipating properties. It is highly recommended by Bree as an antispas- modic, in some cases of asthma.f In union with cam * Toxicology, p. 256. t His formula is this : R Tinct. Scillae. g". x. Acidi Nitrici. gte. vi. Extract, hyoscyam. gr. ill. Aq. fontanse 3iss. Misce. Fiat haustus, horis tertiis vel quartis durante parox ysmo repetendus, 62 NARCOTICS. phire, Dr. Gooch recommends this substance, in the dose of ten grains each, as one of the most useful anodynes in mania and melancholia.* In haemoptisis attended with great irritability of the system, and a violent spasmodic cough, olive oil in which a certain portion of hyoscyamus has been boiled, is recommended by Richterf and others as a very effi- cacious remedy. Borda speaks strongly in favour of the virtues of this article in spasmodic and inflamma- tory coughs, whether the result of protracted perip- neumony or arising from nervous irritability.! In tic doloureux hyoscyamus niger, in combination with valerian and the sublimed oxide of zinc, has been greatly praised. It was used, as we are informed, with much success by Dr. Meglin, of Colmar, in France. Hufeland, also, speaks favourably of its powers in this painful affection. * Observations on puerperal insanity. In the sixth volunic of the Trans, of Lond. College, of Physicians. 1820. t Richter gives this formula: R Ol. hyoscyam. coct. §ss. G. mimos. 3vi- Syrup, althaea |i. Misce intern, et affund. sensin. Aq. cerasor. nigr. §vi. M. S. a table-spoonful every hour. Richter's Specielle Therapie, vol. iii. p. 296. Harles, ih Hufeland's Journal der Pract. Heil-kund, vol. ix. No. 2, p. 56. £ Primae Linea. of S. Borda. NARCOTICS. £3 The leaves form an excellent anodyne cataplasm, and the smoke from its seeds, when applied by a funnel to a carious tooth, is recommended in severe fits of odontalgia.* Cullen thinks that this substance is more apt to produce delirium than opium. This accords with my own experience. I once prescribed the extract to an extremely nervous female; the first dose, which amounted only to one grain, produced the most per- fect delirium. In another case I observed similar effects, though much less powerful. This article is employed, either in the form of tincture or extract. The extract is given from gr. ss. to as much as the patient will bear. The tincture, made in the propor- tion of |ii. 3ii. of the dried leaves of the plant, to Ibi, of proof spirit, may be taken in the dose of g". to 3i. CONIUM MACULATUM. This is a very ancient article of the materia medica. The extract of cicuta is mentioned by Dioscorides as " multiplicis in medicina usus." It does not appear, however, that it was used internally either by the Greek or Roman physicians. As an external appli- cation it was employed in phagedenic and other ill- * Paris' Pharmacologia. (J4- NARCOTICS. conditioned ulcers; but its introduction into practice as an internal remedy did not take place until near the middle of the eighteenth century. " There is no instance/1 says Dr. Cullen, " in which the fallacy of experience appears more strongly than in the history of this article." Storck, speaking from his own experience, alleged, that it is the most effica- cious remedy we possess for the cure of various glan- dular diseases.* Dr. Cullen, however, and, since his time, physicians in general, have not found it to answer the high expectations which the experiments of Storck were calculated to excite. Still it must be confessed that it is an article of strong powers, and capable, under certain circumstances, in a variety of diseases, of doing a great deal of good. Even Cullen admitted its occasional valuable effects. " We have known it," says he, " useful in healing ulcers which had come upon scirrhous tumours, and which continued to be surrounded with such scirrhosity; and in some ulcers certainly that approached to the nature of cancer. Even in cases that might certainly be considered as truly cancerous, I am so far from being of the opinion of Bierken, of its rather aggravating the disease, that * Ant de Storck Libellus, quo demonstratur cicutam non solum usu interno tutissime exhiberi, sed esse remedium valde utile in multis morbis. Vindobon. 1760. 8vo. Ejusdem Libelus secundus, 1761. Ejud. Supplement: necessarium de cicuta, 1761. CumtabulisS. NARCOTICS. 65 I have found it in several cases to relieve the pains, and mend the quality of the matter proceeding from the sore, and even to make a considerable approach towards healing it; though I must own that I never was concerned in a cancerous case in which the cure of the sore was completed."* Dr. Chapmanf is, therefore, wrong in asserting that " its utility has been denounced by Cullen." He gave it all the credit which can be conceded to it at the present day. He, however, justly regarded the praises of Storck as ex- travagant; a judgment which is fully confirmed by general experience. The leaves of this plant possess a strong narcotic odour, and are slightly bitter and nauseous to the taste. Exsiccation destroys their acrid quality, with- out lessening, in the least, their narcotie principle. The active properties of the plant reside in a resinous matter, which may be obtained by evaporating its etherial tincture on hot water. This resinous sub- stance is of a dark green colour, " and has the pecu- liar odour and taste of the hemlock in perfection." It has received the name of conein.\ When taken in a moderate dose, it produces no sensible effects except vertigo and slight pain of the * Cullen's Materia Medica,vol. ii.p. 189. f Elements of Therapeutics, vol. ii. p. 239, first edition. \ Paris' Pharmacologia. VOL. IF. 9 QQ NARCOTICS. head. Taken, however, in a very large quantity, its effects are of the most violent kind. Anxiety about the praecordia is first felt; this is immediately followed by vertigo, great pain of the stomach, convulsions, dis- charge of blood from the mouth and ears, loss of sense, and trismus. As a remediate article cicuta admits of pretty ex- tensive application. It appears, however, to be now almost universally admitted, that very little if any ad- vantage can be expected from it in the treatment of genuine cancer. Alibert* states, that of more than one hundred women affected with scirrhous cancer of the uterus and other parts of the body, who were treat- ed with this remedy, in the hospital Saint Louis, not one received the least benefit. In scrophulous ulcers, however, cicuta is a remedy of value; and when united with minute doses of muriate of mercury, it forms an exceedingly useful medicine in almost every species of old and obstinate ulcer.f Dr. Percival has published some interesting cases of the good effects of hemlock in internal ulcerations. J Dr. Odier, of Geneva, also gives an account of a most distressing instance of obstinate ulceration in the * Elemensde Therapeutique, vol. i. p. 412. t Gataker. Essays on Medical subjects, with an introduction relating to the use of hemlock and corrosive sublimate, &c. in cancerous disorders. Lond. 1764. \ Bibl. Brit. Sc. et Arts. vol. xxxviii. p. 58. NARCOTICS. 67 oesophagus effectually cured by this remedy. His patient commenced with a small dose, and gradually increased it to the extent of eighty grains a day* Dr. Rutty, in a letter to Dr. J. Fothergill, gives the result of a large experience with this article, in the treatment of scrophulous and other malignant and corrosive ulcers; and it appears from this statement, that it is a remedy from which we may frequently expect impor- tant advantages in such cases.f Dr. J. Fothergill also states, that he has often used it with success in sa- nious ulcers with gleety and painful discharges of the vagina.| It is a medicine of very considerable powers in al- laying morbid irritability. As a palliative for quieting pulmonary irritation, Dr. Paris considers it by far the most efficacious remedy we possess. Although my own experience does not allow me to speak so favour- ably of its virtues in this way, yet I have witnessed in several instances its soothing effects in troublesome coughs. Dr. Donald Monro states, that a deeply con- sumptive young lady took six grains of the extract of hemlock every night on going to bed, and that it al- ways procured her rest, without heating her, or pro- ducing the uneasiness invariably felt from the use of opium. * Manuel de Medecine Pratique, p. 60, in a foot note. t Med. Observ. & Inquir. vol. ill- p. 229. | Ibid. vol. iii. 418. 6$ NARCOTICS. Cicuta has also been found serviceable in syphilis. Hunter recommends it combined with mercury in in- dolent buboes and swelled testicle. In syphiloid chancres, of an irritable and spreading character, cicuta, given in very large doses, will often do much good. In an extremely troublesome case of this kind I have lately obtained prompt and effectual relief from exhibiting this substance with the nitrate of silver. Narcotics were formerly much resorted to in the treatment of insanity. It seems, however, to be pretty generally admitted at the present day, that they can afford but little benefit in the diseases of the mind. Examples, however, do occasionally occur, of the beneficial operation of this class of remedies in men- tal diseases. The records of medicine, too, furnish us with proofs of their occasional efficacy in such affections; and we are, therefore, not permitted to regard them as entirely useless in this respect. Dr. Anthony Fothergill of Bath, has recorded several in- stances of the successful employment of cicuta in the treatment of insanity. Of the utility of this remedy in cutaneous diseases I can say nothing from my own observations. It has, however, been recommended, as a remedy of consi- derable value in leprous affections and elephantiasis. I have employed it a good deal in the treatment of chronic rheumatism, and I am satisfied, that, if given in strong doses, it will often afford useful results. It NARCOTICS. 69 is, however, much inferior in this respect to stramo- nium, of which I shall presently give an account. Cicuta has also been resorted to with success in tic doloureux. Dr. Fothergill* speaks well of its efficacy in this disease. Dr. Jackson, of Boston, has also pub- lished cases in which the good effects of this article are strikingly illustrated.! Dr. Butler| has strongly recommended this medi- cine in the treatment of hooping-cough. His extra- vagant praises of this article have, however, never been confirmed by other practitioners. I have used it very frequently, but never with any decided advantage. Belladonna is so greatly superior to the cicuta, in this disease, that it deserves a preference, perhaps, in all instances where a narcotic is wanted. The cicuta has also been employed in asthma; but it does not appear that it deserves any attention for its remediate powers in this disease. The same may be said of its use in epilepsy, chorea, and hysteria. In the cure of jaundice the powers of this article seem to be better established. Dr. J. Fisher, of Beverly, Massachusetts, has found it an exceedingly successful remedy in that variety of this disease which is occasioned by a spasmodic contraction of the biliary ducts. Drs. Bigelow and Jackson of Boston, give * London Medical Observations and Inquiries, vol. v. f New-England Medical Journal, vol. ii. No. 2. \ A Treatise on the Kinkcough, with an Appendix on Hem- lock, by Wm. Butler, M. D. Lond. 1775. 70 NARCOTICS. their testimony in favour of this article in the cure of this disease. " When the dose is gradually increased until its effects are distinctly felt in the head and sto- mach, the yellowness of the skin and eyes, in most cases, begins to disappear by the second day, and the disease is soon removed."* In whatever disease this remedy be given, it ought to be used in large doses. Dr. Fothergill has pub- lished some excellent observations on this subject. He observes, that its efficacy will always depend on its being given in as large a dose as the patient can bear. It should be given in sufficient doses to pro- duce some obvious effect on the system. Vertigo seems to me the most certair « yrk by which to judge of the necessary influence ot the medicine; and it is probable that we can never derive any de- cided advantage from its use, unless we give it to the extent of producing this effect. Not a little of the contradictory experience which has been published with regard to the remediate pow- ers of this article, may, perhaps be ascribed to the great diversity which it exhibits in its strength as it is found in the shops. M. Orfila instituted a set of ex- periments with a view of ascertaining the comparative strength of the extract of hemlock properly prepared and that which is usually sold in the shops. A drachm of this article prepared by himself was sufficient to * Thatcher's Dispensatory, p. 196. NARCOTICS. 7J poison a dog, .whereas it required an ounce and ten drachms of that obtained from the shops to produce the same effect * The extract is given in the dose of two or three grains, and gradually increased until some effect is produced. The powdered leaves, which, if good, have a fine lively green colour, are to be given in the dose of gr. iii. and increased until their influence becomes manifest. " Vinegar is considered its best antidote."f Hemlock has been mistaken for the following plants: * Orfila gives the following directions for preparing extracts: " 1. The plant must be taken when in full vegetation, and the flowers completely developed. Dried leaves treated with water are perfectly useless. " 2. The juice is to be expressed, if the plant be succulent; if it be not succulent, water must be added, and then expression employed. In both cases expression is to be made without heat. . " 3. The juice thus obtained is to be evaporated by a gentle heat in a very broad vessel, and in a water bath. When thus prepared the extract of hemlock is of a gold yellow and slightly reddish colour, whereas in the shops it is usually black." In the tenth volume of the London Medico-Chirurgical Transactions, Mr. J. T. Barry gives a communication concern- ing a new mode of preparing pharmaceutical extracts. He evaporates the expressed juice in vacuo. Professor Jaenisch, of Moscow, about the same time, proposed a similar mode for preparing such extracts. The superior quality of extracts made in this way must be obvious. t Paris. Orfila. 72 NARCOTICS. chaerophyllum bulbosum and silvestre, asthusa cyna- pium, cicuta virosa, scandens odorata, caucalis anthris- cus, and the common parsley. It is distinguished by the ferruginous spots on the stalks. ATROPA BELLADONNA.—DEADLY NIGHTSHADE. This is an European plant, and an exceedingly energetic narcotic. Its leaves are inodorous and of a slightly nauseous, sweetish, and subacid taste. It does not appear that they lose any of their peculiar properties by drying. According to the analysis of Vauquelin, this plant contains an albumenoid sub- stance, salts with a base of potash, and a bitter extrac- tive principle, in which the active properties of the vegetable reside. It appears from recent experi- ments, to contain also an alkaline element, to which the name of atropia has been given. The whole plant is extremely active. The berries, however, seem to be more intensely poisonous than the other parts; " and from their beautiful and inviting appearance they have often tempted the unwary" to fatal mis- takes. In the Journal de Sedilot, Decembre, 1813, p. 864, there is an account given by M. E. Gaultier deClaubry, of the symptoms experienced by upwards of a hundred and fifty soldiers who were poisoned by NARCOTICS. 73 eating the berries of this plant. They were affected by the following symptoms: "Dilatation and immobi- lity of the pupil; insensibility, almost complete, of the eye to the presence of external objects; or at least confused vision; injection of the conjunctiva by a bluish blood; protrusion of the eye, which, in some, appeared dull, and in others ardent and furious; dry- ness of the lips, tongue, palate, and throat; deglutition difficult, or even impossible; nausea not followed by vomiting; sensation of weakness; lipothymia, syncope: difficulty, or impossibility of standing; frequent bend- ing forwards of the trunk; continued motion of the hands and fingers; gay delirium, with a vacant smile; aphonia, or confused sounds, uttered with pain; inef- fectual desires of going to stool; insensible restoration of health and reason, without any recollection of the preceding state."* Alibert states, that in three children who had eaten the berries of this plant, nausea immediately came on; the pulse became feeble and irregular, and a de- lirium of the most singular character supervened. They cried, sang, and laughed alternately, and exhi- bited the most ridiculous and apparently involuntary gestures; the whole body was in agitation, and the countenance haggard and fixed.f * Orfila's Toxicology, p. 286, Dr. Nancrede's translation. t A. M. Giraudy has written a dissertation entitled " Le delire cause par la Belladonna a-t-il uncaraclere que lui ;oir proore?1 VOL. II. 10 74 NARCOTICS. Belladonna possesses very important remediate powers. By some it has been a good deal praised for its virtues in the cure of cancer. Cullen's success with this article, as he informs us, was various. He cured entirely a cancer of the lip with it. He also employed it with success in a scirrhosity of a woman's breast, and in a sore of a cancerous nature below the eye. In other cases, however, it proved entirely in- effectual. Alberti and Juncker speak favourably of it in scirrhus of the intestines and stomach. Haller, De Haen, Heister, and more recently Rahn of Zurich, have, however, not only not confirmed these favourable accounts of the powers of Belladonna in scirrhous and cancerous affections, but have, on the contrary, found it injurious in such cases. For the cure of hooping-cough this remedy enjoys, at present, a very high character in Europe. Borda speaks in terms of unlimited praise of the advantages he has derived from it in this disease. Children, says he, to all appearance past recovery have been saved by means of this remedy.* Hufeland, Shaeffer, and Marc, speak of it in similar terms of praise. They consider it, indeed, as almost entitled to the character of a specific in this disease. Wetzlerf is equally warn*. * Piimae Line*e. f Wetzler recommends this remedy to be given in this way: Take of the powdered root, mix it with a sufficient quantity of sugar, and divide it into parts containing one fifth of a grain NARCOTICS. 75 in its praise; and Alibert states, that in France a simi- lar success has attended the employment of this reme- dy. I have prescribed it in about a dozen cases. In two of these its good effects were promptly and strik- ingly manifested. In five or six, its advantages were much less obvious, and in a few it produced no change in the disease whatever. I apprehend, however, that the extract which I employed was not very good; it was old, dry, and black. From the very numerous and respectable testimonies we have in favour of its powers in this disease, it certainly has claims to atten- tion in the treatment of this harassing and intractable affection. According to Mr. Q, Bailey's experience, bella- donna is the most efficacious remedy we possess in tic doloureux.* He records many cases of extreme violence, which were effectually cured by this remedy, after every other mode of treatment had been tried without success. He usually exhibited from two to three grains of the extract, or from twenty to thirty minims of the tincture every four or five hours, while the paroxysm was violent, and in smaller doses when the pains were mitigated. He informs us that the each. This is a dose for a child under one year old, which must he repeated night and morning. * Observations on the use of Belladonna in painful disorders of the head and face. London, 1818. 7b NARCOTICS. employment of this remedy sometimes produces ver- tigo, impaired vision, insensibility, tightness across the breast, and a sense of suffocation and dryness in the throat; but these effects do not continue long, and have never been observed to leave any unpleasant consequences. It has been much spoken of by some German wri- ters, as a remedy for hydrophobia.* M. Miinch, of Hanover, and Bucholz, of Weimar, speak of their success in this way. Burdach also speaks favourably of its powers in this frightful disease. It is, however, but too certain that all such hopes are fallacious, and that we are yet entirely without any effectual means for arresting its dreadful and fatal course. By some physicians this remedy has been a good deal extolled for its powers in epilepsy. Greeding and Mayerne have published observations favourable to the employment of belladonna in this disease. Sub- sequent experience has not confirmed these expecta- tions. The belladonna has also been employed in mania and melancholia.f It is said to be particularly appli- cable to cases consequent to a suppression of some ac- customed evacuation, or the repulsion of cutaneous * T.II. Miinch kurze Anwcisung wie die Belladonna in tollen hund biss Anzuwenden ist. Gottingen, 1783. t Observationes practice circa usum Belladonna in Melan- cholia, Manise et Epilepsia. J. H. Munch. (Jotting. 1783. NARCOTICS. 77 eruptions. I know nothing of its powers, from my own experience, in these affections. That they are but inconsiderable, may lTe inferred from the almost total neglect of this article in the treatment of these dis- eases. Mr. Bailey* states that in a violent case of hysteria, which had withstood all other remedies, the efficacy of this article was conspicuously shown. It has also been recommended in other spasmodic diseases, such as chorea, asthma, spasmodic ischuria, dysphagia, &c. Burdach speaks of its successful employment in amaurosis, sciatica, loss of speech, and hemiplegia. The belladonna, in common with some other plants of this class of remedies, possesses the property of dilating the^pupils of the eyes in a remarkable man- ner, whether it be taken internally or only applied upon the external parts of the eyes. Advantage is taken of this property to dilate the pupils, in order to facilitate certain operations on the eye, as couch- ing, &c. The most convenient and effective mode of adminis- tering the belladonna, is by employing the powdered leaves or root. One grain of the powder of the leaves may be given to an adult morning and evening, and gradually increasing the dose to as much as can be borne. The root, if well dried, is somewhat stronger than the leaves, and must, therefore, be given in • Observations on the use of Belladonna, 78 NARCOTICS. smaller doses. The extract is extremely variable in its strength. If good, it must be commenced with in the dose of gr. ss. An over-Jbse produces so great an insensibility of the stomach as to render it almost impossible to excite vomiting by the strongest antimo- nial emetics. Vinegar is accounted the best antidote to this poison. It renders the operation of emetics more certain and prompt. STRAMONIUM.—THORN-APPLE. This is a very common plant in this country, known familiarly by the names of Jamestown weed, thorn- apple, or stink-weed. It is a powerful narcotic, and has of late become of considerable importance for its remediate powers. It contains gum, resin, carbonate of ammonia, and an alkaline principle which has re- ceived the name of Daturia* On being received into the stomach in an over-dose its effects are exceedingly violent. The pupils dilate very much, vertigo, delirium, tremors, retching, ex- cessive thirst, mania, and convulsions come on. The mania is of a very singular character, being attended with the most antique gestures, screaming, laughing * Paris' Pharmacologia. NARCOTICS. 7{) crying, and distorting the face continually. A deep coma comes on before death. We are indebted to baron Stork for the introduc- tion of this powerful article into regular practice. He used it in mania, epilepsy, and other convulsive affections; and the result of his experience was much in favour of its remediate powers.* Sidren also adds his testimony in behalf of the efficacy of this remedy in convulsive diseases.f The experience of Wedenberg and OdheliusJ was less favourable; nor has later experience, upon the whole, confirmed the hopes which the trials of Stork and others were cal- culated to inspire. The late professor Barton, how- ever, considered it " a medicine of great and valuable powers," in the treatment of mental, as well as other diseases. He advises large doses in mania. In one patient he carried the dose from two grains of the powdered leaves to sixty. " When the patient (a ma- niac,) had continued upon this dose for some time, she broke out into biles, upon various parts of the body, and was at length discharged from the'hospital cured."§ ' Ant. de Stork Libellus, quo demonstratur, stramonium, hyoscyamum, aconitum, non solum tuto posse exhiberi, &c. Vindob. 1762, c. iii. tab. 8. t Sidren de Stramonii usu in morbis convulsivis. Upsal,, ;772. In Baldinger's Sylloge, vol. ii. J: Wedenberg de Stramonii usu in morbis convulsivis. § Collection for an Essay towards a Materia Medica of the United States, p. 48, 80 NARCOTICS. This article has also been successfully employed in epilepsy. Dr. J. Fisher, a practitioner of high standing in Massachusetts, speaks very favourably of its employment in this disease occurring in young persons, and at regular periodical intervals. This article is more likely to prove beneficial when assisted by the simultaneous use of chalybeates. The patient should be kept under the constant influence of tITe medicine. He recommends the employment of a saturated tincture as most convenient for children. The dose is to be regulated by the dilatation of the pupil. It has also been used in chorea, tetanus, and palsy. I have never employed it in any of these affections; but I have no doubt, from its general properties, that, like many of the articles belonging to this class, it may be occasionally found successful in such cases.* Its chief importance, however, consists in the ex- cellent effects which it produces in chronic diseases attended with violent pain. Dr. Marcet is the first who noticed particularly its salutary operation in af- fections of this kind. '4 If I were called upon/' says * In the New-England Medical and Surgical Journal, vol. iv, p. 226, a singular case of spasmodic cough is reported, which yielded readily to the extract of stramonium, after a very great variety of other remedies had been tried in vain. The cough was attended with convulsions, subsultus tendinum, and other distressing nervous symptoms. NARCOTICS. 81 he, " to express in a few words the general opinion which I feel inclined to form from the opportunities I have had of studying the properties of stramonium, I should say that the most common effect of this re- medy, when administered in appropriate doses,* in cases of chronic disease attended with acute pain, is to lessen powerfully, and almost immediately, sensi- bility and pain; to occasion a sort of nervous shock, which is frequently attended with a momentary affec- tion of the head and eyes, with a degree of nausea, and with phenomena resembling those that are produced by intoxication; to excite, in many instances, nervous sen- sations which are referred to the oesophagus, or bron- chiae, or fauces, and which sometimes amount to a sense of suffocation; to have rather a relaxing than an astringent effect upon the bowels; to have no marked influence upon the frequency of the pulse, though, in a few instances, it has appeared to render it somewhat slower; to produce but a transitory and inconsiderable dilatation of the pupils; and to have but little imme- diate tendency to induce sleep, except from the state of comparative serenity and ease which generally fol- lows the symptoms I have just described."! * From one-eighth of a grain to a grain a dose, which should not be exceeded until its effects have been observed. t On the Medicinal properties of Stramonium, &c. by A. Marcet, M. D. In the Medico-Chirurgical Transactions, vol. vii. P. ii. VOL. II. 11 82 NARCOTICS. The diseases of this kind in which this remedy ap- pears to be most efficacious, are, chronic rheumatism, sciatica, tic doloureux, and the violent pains which sometimes attend cancerous affections. Dr. Scudamore states that he had succeeded with it in relieving gouty pains, dependent or immedi- ately connected with spasm. He found the stramo- nium more decidedly useful when given in combina- tion with lactucarium. " From much reflection on my experience," says he, " I am tempted to affirm that the former acts most as an anodyne, the latter as a sedative; and whenever both effects are desired, they will be most favourably procured from the union of the two preparations."* I have employed stramonium in rheumatism and sciatica, and the result of my trials has been exceed- ingly flattering. It appears to me to be the most efficacious remedy we possess in those cases of chro- nic rheumatism which are attended by an irritable, quick, but weak pulse, swelled joints, and unattended by any great pain, unless on being moved. I have used it in three cases of sciatica within a year past, and in every instance with the most decided advan- tage.! * A Treatise on the nature and cure of Gout and Rheuma- tism, &c. p. 129. 11 have seen the stramonium employed in domestic practice for the cure of rheumatism, above twelve years ago, while NARCOTICS. §3 Dr. Marcet tried it in three cases of tic doloureux. One case was essentially benefitted by it; in another its effects were equivocal, and in the third it failed entirely. Dr. Bigelow, of Boston, found it decidedly useful in a case of this kind.* In asthma it has been much employed by smoking the root and dried leaves in a common tobacco pipe. I have prescribed the use of it in this way in a num- ber of instances, and my patients have occasionally expressed themselves considerably relieved by it. The leaves, made into an ointment, form an excel- lent anodyne application to painful and irritable ulcers. It also affords much ease when applied to painful haemorrhoids. Dr. Bigelow states, that the stramo- nium ointment with the ointment of acetate of lead, forms one of the best applications in this affection. Like the belladonna, it produces great dilatation of the pupils, when applied to the external parts of the eyes. The following doses of the stramonium must be commenced with: Of the powdered leaves, one grain. powdered seeds, half a grain. practising in Lancaster county. I recollect that a rheumatic patient, upon whom I had in vain exhausted all the usual re- sources in this disease, was cured in less than two weeks, by an old woman, who administered a saturated tincture of stramo- nium seeds, in the dose of a tea-spoonful three times a clay, * Bigelow's American Medical Botany, vol. i. p. 23. 84 NARCOTICS. Of the inspissated juice or extract, one grain. extract of the seeds, from one-fourth to half a grain. tincture, from fifteen to twenty drops* ACONITUM NAPELLUS.—WOLFSBANE. This is a powerful narcotic poison, and was well known as such to the ancients. Ovid alludes to its baneful properties, and the fatal purposes to which it was sometimes applied by the wicked. Lurida terribiles miscent aconita novercae. Metam. i. 148. There are four species of aconitum possessing pretty nearly the same powers. The aconitum napellus, cammarum, neomontanum, and tauricum, all of which are indigenous to the alpine regions of Europe. The aconitum napellus is, however, almost exclusively em- ployed in medicine. The juice of this species has a disagreeable smell, and a nauseous acrid taste. Ac- cording to the analysis of Bucholtz, the fresh root con- tains a green resin, albumen, a bitter and acrid ex- tractive matter, with nitrates and acetates, gum, malate and citrate of lime. The acrimony of the plant is almost entirely destroyed by exsiccation. When * Bigelow's American Medical Botany, vol. i NARCOTICS. g^ taken in excessive doses it produces sickness, vomit- ing, giddiness, delirium, fainting, cold sweats, asphyxia, spasms, involuntary stools, apoplexy, and death. It has been known, on being introduced into a small wound of the thumb, to produce " pain in the fingers and arm, cardialgia, anxiety, with fear of suffocation, lipothymia, agitation, and finally gangrene, and copious suppura- tion."* When the leaves of this plant are chewed in small quantity they cause a sensation of numbness in the gums and lips, which continues for two or three hours.! ' Aconitum has been a good deal employed in the practice of the German and Italian physicians; and it seems still to enjoy no inconsiderable reputation among them. Storck first introduced this article into regular practice. The character, however, which he gave it was, upon the whole, too flattering; and later experience has not fully confirmed the favourable ac- count which he gave of its powers. There is, not- withstanding, sufficient testimony extant in its favour to establish its claims to our attention; and I am led, independent of such testimony, from my own experi- ence, to regard it as an article possessing valuable medicinal virtues. It is often of decided advantage in rheumatic and * Orfila's Toxicology, by Dr. Nancrede, p. 220. Alberti Jurisprudentia Medica, torn. vi. p. 724. t Brodie; in the Philosoph. Transact. An. 1811, p. 185. 86 NARCOTICS. syphilitic pains, consequent to a mercurial course. I have been in the habit, for several years past, of giving a dose of the extract of this plant to such of my patients as are suffering from pains of this kind, as an anodyne, on going to bed, and I have generally had reason to be satisfied with its effects. Borda,* an eminent Italian physician, commends its powers very highly in these affections. It has also been extolled for its virtues in chronic rheumatism and gout.! In a case °ftfte ^or" mer of these diseases I employed it in large doses, and derived some advantage from it. Its virtues ap- pear to be much enhanced by being united with anti- monials in cases of rheumatism. It is, however, so decidedly inferior to stramonium in this respect, that it may very properly be neglected for this latter re- medy in these affections. Borda praises it as one of the most valuable reme- dies we possess for relieving morbid secretions of the trachea and bronchia. " Crebro," says he, " etiam obstupui animadvertens extractum aconiti nedum sputorum redundantiam ocissime repellere, sed natu- ram eorum ita immutare ut mini omnem praepercep- tum abstergeret metum proximae desperatae phthiseos cui mors quasi saxum tantali impendet." Burdach states that it has been applied successfully * Primze Lineae. t Bohmer de usu salutarii extracti aconiti in Arthritide Halae, 1768. NARCOTICS. 87 to the cure of obstinate quartans. It has also been used with advantage, according to the same writer, in amaurosis. I need scarcely say that its once reputed powers in the cure of cancer, are entirely fallacious. Yet in the treatment of scrophulous, venereal, and other obstinate ulcers, it has been known to be of unequivocal advan- tage.* We have also accounts of its efficacy in goitre, scirrhous breasts, mesenteric obstructions, and nodes. The aconitum is generally employed in the form of an extract. Half a grain is sufficient to commence with, if it be good, and gradually increasing the dose to as much as can be borne without inconvenience. The tincture is to be commenced with in the dose of gtt. x. and gradually increased. SOLANUM NIGRUM. This is a very common plant in the United States, and generally found growing in gardens. It possesses * Vogler recommends the following compound in the treat- ment of arthritic and rheumatic cases: R Succ. inspiss. aconiti. napel. Antim. sulphuret. precipit. aa gr. i. Magnesia, gr. x. M. To be taken for a dose. 88 NARCO'lICb. a slightly foetid odour; its taste is insipid and herba- ceous. Alibert,* states, that a boy aged eight years, eat some of the black berries of this plant, which in- duced a state of coma and torpor, attended with fever. He complained of great pain in the pit of the stomach, and was harassed with nausea and retchings. According to the experience of M. Dunal, it would appear that the extract of this plant is not very poi- sonous, but that it has the power of slowly destroy- ing sensibility and irritability.! That the berries, however, are an active narcotic poison, I have had the most satisfactory evidence in a little girl, while I practised in Lancaster. Being called to visit this little patient, I found her lying in a deep apoplectic stupor—entirely insensible, all the muscles relaxed, the face flushed, and the pulse full and irregular. She continued in this state about six hours, and then gra- dually recovered. When she had become sensible again it was ascertained that she had eaten of the berries of this plant. The solanum nigrum was very early introduced into the materia medica. It was used among the ancients as an external application, either in the form of poul- tice or its expressed juice, in a great variety of dis- eases. J Caesalpinus states that it was frequently em- * Nouveaux Elernens de Therapeutique, Sec. torn. i. p. 417. f As quoted by Orfila. \ Dioscorides, lib. iv. c. 71. NARCOTICS. 89 ployed as an internal remedy in inflammations of the stomach and bowels, and for ardor urinae.* It had, however, fallen almost into entire neglect, until the attention of the profession was again called to it by M. Gataker, surgeon of Westminster hospital, in a paper read to the Royal Society, in 1757, and after- wards published in a separate work, under the title of " Observations on the internal use of the Solanum, or Nightshade." The account which this writer gives of the medicinal properties of the solanum nigrum, is highly interesting, and, I conceive, in no degree ex- aggerated. He describes the following as its effects when exhibited in proper doses: " I found," says he, " from repeated trials, made with great caution, and safety to the patient, that so small a quantity as one grain weight of the leaf, infused in about an ounce of water, and the liquor afterwards strained from the leaf, and taken at bed-time, would sometimes have a considerable effect; but that two or three grains sel- dom failed either to vomit, sweat, or purge the patient moderately, or to increase the quantity of urine. It sometimes occasioned a giddiness, especially when it made the patient sick; but neither the sickness nor giddiness were constant symptoms; and when they happened, they generally abated or entirely ceased after the first dose. The most common effects that I * De Plantis, 213. VOL. II. 12 90 NARCOTICS. have observed to ensue upon taking the medicine were, a heat or warmth diffused in a few hours over the body, a plentiful sweat succeeding this heat, and a purging the next day. If a sweat did not break out an extraordinary discharge of urine was the conse- quence, and frequently followed likewise by purging. One or more of the natural evacuations were almost always increased."* The disorders in the cure of which he found this plant to be more particularly ad- vantageous, are, foul and painful chronic ulcers; pains in particular parts of the body; scorbutic eruptions, and ulcers of a cancerous nature. He relates a num- ber of cases of each of these diseases, as having been successfully treated by this remedy, in his own prac- tice, and he gives some on the authority of others, equally favourable to its powers. From my own ex- perience I am entirely convinced that the remediate virtues of this plant are by far too much neglected. and that they are capable, in certain cases, of afford- ing important advantages. While practising in the country, I very frequently exhibited this species of solanum in obstinate herpetic eruptions, and foul and painful ulcers, and often with the most decided bene- fit. I have also employed it with much advantage in syphilitic eruptions attended with nocturnal pains. The dose, however, which I gave was much larger than that mentioned by M. Gataker. I commonly * Observations on the use of Solanum, p. 8. NARCOTICS. 91 commenced with two grains of the dried leaves made into a pill, night and morning, and increased the dose until considerable nausea was excited, or until effects indicating its complete influence, such as vertigo, tremor, and debility, or pain in the stomach, arose. As an external application it has been highly com- mended for the cure of erysipelas. SOLANUM DULCAMARA. The Dulcamara is a native of Europe and this country; though with us it is most commonly found cultivated as a garden shrub. It is a climbing plant, with woody, brittle stalks,—it flowers in July, and bears red berries. The young twigs and leaves are the parts employed for remediate purposes, and should be collected early in spring. It does not appear that this species of solanum was employed by the ancients as a medicine. Neither Theophrastus nor Dioscorides mention it in their works* The narcotic properties of this vegetable are much feebler than those of the plants I have already men- tioned. It is not, however, destitute of active quali- ties; for when taken into the stomach in very large - Gataker on the Solana. 92 NARCOTICS. doses, it is capable of producing vomiting, spasms, de- lirium, convulsions, and insensibility. Dr. Bigelow states, that he has known the dulcamara, when col- lected in full vigour, to produce vomiting, in the dose of a few grains of the powdered leaves, or of a small cup of the decoction. It generally, too, acts pretty strongly as a diuretic, and its effects on the bowels are almost constantly aperient. This plant was formerly regarded as a very impor- tant remedy; and it is still thought by many to pos- sess medicinal properties of very considerable value. From what I have myself seen of its effects, I am induced to regard it as a valuable article. It is of unquestionable service in herpetic and syphilitic erup- tions. Dr. Ciichton, physician to the Westminster hospital, states, in a letter to Dr. Willan, that he has found only two cases out of twenty-three of lepra grae- corum to resist the curative powers of the dulcamara.* Willan and Bateman add their testimony in favour of * The following is his method of employing this remedy: fake of stalks of dulcamara one ounce; water, one pound and a half; boil to a pound, and strain when cold. Of this decoction two ounces is to be administered at first, morning, noon, and night, and then gradually increased until the patient takes of it to the amount of a pint a day. At the same time the skin is to be washed with a stronger decoction. If it produces giddiness, syncope, or palpitation, the dose is to be decreased. The good effects of this treatment are generally not observed until it has. been continued for eight or nine days NARCOTICS. 93 the utility of this remedy in the treatment of cutaneous diseases. The latter says, " One of the most effectual remedies in lepra, under all its varieties, is the decoc- tion of the leaves and twigs of the solanum dulca- mara."* Alibert,! however, regards it as of doubtful efficacy in affections of this kind. From a very con- siderable experience with this remedy in the hospital St. Louis, he is led to consider it as at most but a use- ful auxiliary to more vigorous applications. Much of the contradictory experience in medicine depends, perhaps, on the different modes and doses of exhibit- ing remedies. It appears from the writings of this physician, that the medicine was employed in much smaller doses in his practice than is generally used by the English and American physicians. It is, there- fore, not improbable that Alibert's want of full success with this remedy, arose, in part, from his having used it in insufficient doses. It should, I think, always be given in doses sufficient to render its influence upon the system manifest, by the vertigo, palpitation, &c. which it produces. I have found the extract of dulcamara a very use- ful remedy for chronic venereal pains and stiffness of the muscles. Boerhaave and Werlhop speak highly of the powers * Practical Synopsis of Cutaneous Diseases. By Thomac Bateman, M. D. F. L. S. p. 34. t Elemens de Therapeutique- 9 J. NARCOTICS. of this remedy in phthisis. It need hardly be observed that subsequent experience did not confirm their senti- ments on this point. Linnaeus recommends it as a most powerful remedy in jaundice, rheumatism, and asthma* From its diuretic properties it has sometimes pro- duced useful results in dropsy. It is stated in the Gazette de Sante, that a Flemish lady " who had the reputation of possessing a specific for dropsy," em- ployed the dried stalks of this plant. Dr. Thatcher states, that " the bark of the root, simmered moderately for some hours, in fresh butter or cream, forms one of the most efficacious ointments to be applied to excoriated nipples of nursing wo- men."! Bergius observes that the narcotic properties of this plant are lost by drying; and that, of course, the fresh plant is much more powerful than when in a dry state. The best mode of exhibiting this remedy is in the form of decoction or infusion. The following formula, altered from Qnarin, is the one which I have com- monly prescribed: Take of the stalks (or twigs) of dulcamara §i. cut them into small pieces and bruise: steep them in a proper quantity of hot water for half an hour; boil afterwards for a minute or two over the * Materia Medica, § 95. * The Am. New Dispensatory. NARCOTICS. 95 lire. To a quart of the strained liquor, add of spirit. cinnamon. L. Ph. two ounces. Dose, a cup full three times a day." DIGITALIS PURPUREA. I have already treated of this article, under the head of Diuretics; but as all its other operations seem to depend, or, at least, are intimately connected with its narcotic properties, I have reserved for this place the principal part of its remediate history. This is a biennial plant, growing abundantly in the mountainous forests of Switzerland, and cultivated with us, both for the beauty of its flowers and for re- mediate purposes. When properly dried it possesses a faint narcotic odour, and a bitter, nauseous taste. " It contains extractive matter and a green resin, in both of which its narcotic properties reside.! It is also said to contain ammonia and some other salts. When taken in an excessive dose, it produces heavi- ness of the joints, indistinctness of vision, nausea, syncope, trembling, vertigo, pain in the forehead and in the bottom of the orbits, drowsiness, slow and tremulous pulse, vomiting, and occasionally diarrhoea, * Thesaurus Medicaminum, p. 113. t Paris' Pharmacologia. 91) NARCOTICS. with pain of the bowels, cold sweats, coma, convul- sions, and apoplectic death. It has also been known to produce an inability to retain the urine. Small and frequently repeated doses, occasion a peculiar distress- ing nausea, attended with anxiety and depression of spirits, debility, vertigo, false vision, great diminution of the frequency and force of the pulse; reducing it sometimes slower than forty strokes in a minute; languor both of body and mind. It sometimes renders the pulse irregular and convulsive, without diminish- ing its fulness. Its narcotic effects are by no means transient, they are, on the contrary, apt to continue long, and even occasionally to reappear after having subsided.* In administering this powerful remedy, we ought always to bear in mind, that it will occasionally mani- fest no operation for many days, and then all at once display its powers, and bring on very suddenly the most alarming prostration. Dr. Baildon states a fact in the Edinburgh Medical Journal, July, 1807, which is extremely interesting as well as curious. After having got his own system under the sedative influence of digitalis, he found his pulse not lessened in fre- quency when he stood erect, beating then at the rate of above a hundred in a minute; when he sat down it beat considerably slower; and when lying on his back it fell as low as forty. He tried this experiment * Burdach, Arzneymittellehre, B. iii. NARCOTICS. 97 on himself repeatedly, and always found the pulse to vary in the same manner. He states also that he ob- served the same results in other persons to whom he gave the digitalis. Other practitioners have observed similar variations in the pulse, in persons under the narcotic influence of this medicine. To Withering belongs the merit of having first re- gularly investigated the medicinal virtues of this plant. But, as is frequently the case with those who intro- duce a new remedy to the notice of the profession, he, without doubt, estimated its powers too highly. It is, notwithstanding, very deservedly considered as an important article of the materia medica; and although physicians do not now place much reliance in its powers as a remedy in phthisis, there are still enough virtues left it to entitle it to very great attention. The question whether digitalis be sedative or sti- mulant in is primary operation, is still a subject of controversy. Dr. Sanders, who has written an ex- cellent work on the foxglove, strongly advocates the latter doctrine, whilst others, with more correctness, contend for the former opinion * I am entirely per- * " If any person were incjined to write a satire on medical evidence, the different testimonies respecting the properties of this single plant would furnish abundant materials. ' It is a diuretic,' says one physician. «It has no diuretic power,' says another. ' It is a stimulant,' says a third. «It is a sedative,' cries another. 'It has no properties at all,' exclaims a fifth." Ferriar's Medical Histories VOL. II. 13 98 NARCOTICS. suaded that its operation is immediately sedative; for it is certain that its stimulant effects, if it has any at all, are extremely feeble, and by no means pro- portionate to its ultimate sedative influence. " The fact of the sedative effects of digitalis," says Dr. Fer- riar, " is so decisive, that I do not hesitate to employ this term, notwithstanding the jargon with which the public has of late years been abused, on the subject of sedatives."* By means of this remedy we may direct the action of the heart without evacuations, and often reduce its frequency and force more effectually than by any other means in oiir power. From its extraordinary effects of diminishing the force and frequency of the heart and arteries, it is prescribed in a variety of diseases where this effect is desirable, and where venesection possesses no ade- quate power over the circulation. It is chiefly on these effects that its reputed advantages in phthisis are considered to depend. Drake, Fowler, Beddoes, Mossman, Stafford, and others speak in terms of great confidence of the cura- tive powers of digitalis in phthisis. Drake! gives an account of fifteen cases of confirmed consumption treated by this remedy, out of which nine were cured, one relieved, and five died. Mr. Magennis,| physi * Essay on Digitalis, p. 2. t London Medical and Physical Journal, vol. ii. p. 268. \ Ibid. vol. v. 204. NARCOTICS. 99 ciau general at the naval hospital at Plymouth, insti- tuted an extensive course of experiments with this article, in consumption. Out of seventy-five, fifty-three were in the purulent stage, and twenty-five in the in- cipient. Of these forty-four were cured, twenty-two relieved, and but ten died. Dr. Beddoes also ex- presses, in very strong terms, his good opinion of the digitalis in this disease. "I daily," says he, "see many patients in*pulmonary consumption advancing towards recovery with so firm a pace, that I hope consumption will henceforward as regularly be cured by foxglove as ague by the Peruvian bark."* Unreasonable as these hopes may now appear to us, it is certain that considerable advantage may occa- sionally be derived from the employment of this medi- cine. When we consider the power which foxglove possesses of lessening irritability and the impetus of the circulation, we can hardly doubt that it is peculiarly adapted to the early stage of this disease. In incipient phthisis, Dr. Mossman! regarded this remedy as al- most a specific. In the commencement of this com- plaint, therefore, when inflammation is going on in the lungs, and before it has terminated in suppuration, digitalis may be of service by subduing the circulation, * Observations on the causes, early signs, and prevention of Consumption, 8cc. by Thomas Beddoes, M. D. 1799. t Essay on Glandular Consumption, in the Medical and Physicial Journal, vol. iv. p. 300 100 NARCOTICS. and thereby resolving the local pulmonic inflamma- tion. Dr. Ferriar* was the first who entertained this view of the modus operandi of digitalis in diseases of increased vascular action. Darwin, Fowler, and Drake referred the beneficial operation of this reme- dy in pulmonary consumption, to its power of dimi- nishing secretion and augmenting pulmonary absorp- tion. We know, however, that the foxglove has a pow- erful tendency to diminish the activity of the heart and arteries; and as the most effectual mode of re- ducing inflammation is to lessen the general energy and velocity of the circulation, so we may fairly infer that in phthisis, which, in its earlier stages, must be always attended with more or less pulmonic inflam- mation, digitalis if it act beneficially at all, does so by virtue of its sedative properties. This accords with the experience of Dr. Magennis. "I have met," he observes, " with several instances in which the digi- talis given freely and largely effected not the small- est reduction of the pulse; and in these the patients * " It is well known," says this judicious physician, " that bleeding with the lancet is very inadequate to the purpose of lessening (in some cases) the velocity of the circulation, unless it be carried to a dangerous excess. The foxglove furnishes us with the means of regulating the pulse to our wish, and of supporting a given state of velocity, as long as we judge it proper." Ferriar on the Medical Properties of the Foxglove,p. 12. NARCOTICS. |Q j uniformly derived no advantage whatever from its use.*" Measles are often attended with an inflammatory condition of the mucous membranes of the lungs and trachea about the time the eruption is subsiding; pro- ducing hoarseness, cough, and dyspnoea, and not un- frequently leading on to pulmonary consumption. To obviate these occurrences it is frequently necessary to adopt rigid antiphlogistic measures, of which bleed- ing and blisters are undoubtedly the most effectual. As an auxiliary to these means digitalis has been em- ployed with undoubted advantage. Dr. William Ha- milton of Suffolk,! says? it is " in the advanced stages of measles when the disposition of the membranes lining the chest to inflammation shall have ceased, or have been overcome by appropriate remedies, that its use will be found most effectual towards checking the consumptive tendency." Of its powers in pneumonia not much can be said. This is a disease too rapid in its course to allow of such tardy modes of reducing the activity of the circu- lation. We are enabled by the lancet to effect this purpose in a much more prompt and effectual manner. The employment of this article, though, perhaps, never to be depended on in this disease, as a principal * Lond. Med. and Phys. Journal, vol. v. p. 204. t Observations on the Digitalis Purpurea, by Wm. Hamil- ton, M.D. p. 154. 102 NARCOTICS. remedy, may notwithstanding become an useful aux- iliary after more prompt antiphlogistic measures have been employed, or where much general debility exists, attended with irritation of the lungs, difficult breath- ing, troublesome cough, quick and corded pulse, and a dry skin. This article is well spoken of by Drs. Currie and Ferriar* as a valuable remedy in active haemorrhages. Richter also recommends it as particularly useful in haemorrhages from the lungs and nose.! As a gene- ral practice, however, I agree with Dr. Chapman,! that wherever haemorrhage depends on an active state of the circulation, and where this requires re- duction, bleeding is at once the most direct, safe, and efficacious remedy. In hasmoptysis, however, where there is an irritable state of the heart and arteries, in- dicated by a small, quick, corded, and spasmodic pulse, digitalis will often afford important advantages when venesection is of no avail. It is particularly recommended under such circumstances by Frank, Richter, and Ferriar.§ In cases of threatened abortion, attended with hae- morrhage, Mr. Burns recommends the exhibition of digitalis and opium combined. By this remedy, if * Medical Histories and Reflections, p. 104 and 258. t Specielle Therapie, vol. iii. p. 296. \ Elements of Therapeutics, p. 265,first edition, § Observations, &c. p. 99. NARCOTICS. 103 given in strong doses, we diminish at once the contrac- tile efforts of the womb and the force of the circula- tion, and thereby lessen the chance of miscarriage and the haemorrhage. Digitalis has also been successfully applied to the cure of epilepsy. Burdach says it is particularly ser- viceable in this affection when attended with a stru- mous diathesis in children. In the cure of spasmodic asthma, Dr. Ferriar states that he has found digitalis in conjunction with opium "remarkably useful. By keeping the patient con- stantly under the influence of the medicines, (a grain of each being given every four or five hours,) I have even seen a permanent suspension of the symptoms of this disease. When the stomach will bear the digitalis without difficulty, I believe that very great and almost immediate relief may thus be obtained."* My own experience enables me to speak favourably of this practice. In two instances of this disease I derived very decided advantage from such a combination of opium and digitalis. The foxglove has acquired some character as a remedy in mania. From its sedative effects it would not be unreasonable to expect useful results from its employment in cases of mania, where, after frequent purging and bleeding, the arterial and nervous systems remain in a state of increased excitement. Mr. G. * Ferriar's Essay on Digitalis. 104 NARCOTICS. Hill has used this remedy with Considerable success in mania; and Dr. J. M. Cox* observes, that no case ought to be given up as hopeless in which this remedy has not been tried, and its employment persisted in, till some obvious effects have been produced. He con- siders it most efficacious in those cases of mania, where the circulation is increased without other febrile symptoms. " I had a patient," says he, " whose system was kept saturated, as it were, with digitalis for weeks in succession, whose mental wanderings seemed regulated by the slate of the circulation: when the pulse were at ninety he was constantly furious, at seventy perfectly rational, at fifty melancholic, and at forty half dead. This man was at length perfectly cured by such a dose of this remedy as kept the pulse pretty uniformly at about seventy, and yet he had some- times taken three drachms of excellent tincture of digitalis three or four days following." Dr. Currie also, in his observations on the digitalis purpurea, pub- lished in the fourth volume of the Memoirs of the Medical Society of London, states that he has some- times derived very great advantages from its employ- ment in this disease. Some of the old English writers on the materia medica speak highly of digitalis as an external appli- cation to scrophulous ulcers. In the Annals of Medi- cine, a periodical work, the beneficial effects of this * Practical Observations on Insanity, 8cc. p. 85. NARCOTICS. 105 article, as a local application in ulcers of this kind, are strongly set forth by Mr. Couch, of Polperro, in Corn- wall. A strong decoction of the leaves was employed by this gentleman. Like almost all other vegetables of great powers, this plant is found to be of very different strength, as it is met with in the shops. " It is therefore very impor- tant," says Dr. Paris,* " that the leaves of this plant be properly collected and accurately preserved; they should be gathered when the plant is beginning to flower; the largest and deepest coloured flowers should be also selected, for they are the most powerful; they should be also carefully dried until they become crisp, or they will lose much of their virtue. The powdered leaves ought to be preserved in opaque bottles, and kept from the action of* light as well as of air and moisture; a damp atmosphere has a very injurious operation, by carrying off those faint poisonous effluvia with which its efficacy seems to be intimately con- nected." It may be exhibited in substance, tincture, or infu- sion. The powdered leaves are to be given in the dose of gr. i. two or three times a day, and gradually increased, until its effects become apparent. If it be given with a view to obtain its diuretic effects, it will sometimes be necessary to combine it with opium, in * Paris' Pharmacologia. VOL. II. 14 106 NARCOTICS. order to prevent it from occasioning a vomiting or purging, which lessen or destroy its diuretic powers. The effects of an over-dose are most effectually coun- teracted by opium or brandy, and epispastics to the stomach. The tincture is very commonly employed. The dose of it is twenty drops, which is to be cau- tiously increased. The cataplasma digitalis is made thus: fol. digit, sice. §iii. (or fol. digit, recent, fiv.) aquae fbii. coque ad dimidium; strain, and with the decoction and lintseed meal make a poultice. When it is necessary to exhibit this remedy re- peatedly during the day, its effects ought to be watch- ed with the strictest attention, to prevent the alarm- ing and even fatal consequences which may arise from administering this powerful medicine incau- tiously. NICOTIANA TABACUM. Tobacco is endued with very active poisonous pro- perties, and may be applied to important remediate purposes. It possesses a narcotic foetid odour, and a somewhat bitter and extremely acrid taste. By che- mical analysis it is found to contain " mucilage, albu- men or gluten, extractive matter, a bitter principle, an essential oil, nitrate of potass, and a peculiar prin- NARCOTICS. 107 ciple upon which the properties of the plant are sup- posed to depend, and which has been named nicotin.'' Vauquelin considers this substance as approaching the volatile oils in its properties; it is colourless, of an acrid taste, and has the peculiar smell of tobacco; it occasions violent sneezing; " with alcohol and water it produces colourless solutions, from which it is thrown down by tincture of galls."* The active matter of tobacco is readily extracted both by water and by spirit, but more perfectly by the latter. By distillation the leaves afford an oil which possesses the peculiar powers of the plant in a highly concentrated state. When tobacco is received into the stomach in a large dose, or is applied to any other part of the sys- tem susceptible of its influence, it produces nausea, great distress of feeling, cold sweats, vomiting, trem- bling, vertigo, spasm, insensibility, &c. When taken in an enormous dose it destroys life very speedily. Brodie,! from a number of experiments which he per- formed on animals with this plant, was led to conclude that it destroys life by rendering the heart insensible to the stimulus of the blood, and thus stopping the circulation. Orfila asserts J that the action of tobacco is more energetic when injected into the anus than when received into the stomach. * Paris' Pharmacologia, p. 534. t Philosophical Magazine, for August, 1811. $ System of Toxicology, article Tobacco. 108 NARCOTICS. It seems to be almost equally active when applied to the external surface in parts where the skin is broken. Orfila mentions, upon the authority of Vau- dumond, instances where the decoction of the leaves applied to parts affected with itch, excited violent vomitings and convulsions.* I saw a child a few years ago thrown into alarming convulsions and syncope, by the imprudent application of tobacco ointment to an obstinate pustular eruption on the top of its head. As a remediate article tobacco may be very use- fully employed in many instances. Stahl recommended an extract of it, made by long boiling, as a very effec- tual and safe expectorant and diuretic remedy. Paris states, that long coction weakens the powers of this plant; the extract recommended by Stahl, may there- fore be a safer and more effectual remedy in conse- quence of having its poisonous parts dissipated by the long continued boiling, whilst its aperient, expectorant, and diuretic properties may not suffer any material diminution by such a process. Tobacco has been successfully employed in the cure of dropsy and dysury. Dr. Fowler! has written a work expressly on its virtues in these diseases; and he speaks of it as a remedy which, if properly administered, is capable of producing copious diuresis. He used it in * Recueil Periodique, torn. vii. p. 67. t Medical Reports of the effects of Tobacco in the cure of Dropsies and Dysenteries, by Thos. Fowler, M. D. Lon. 1785. NARCOTICS. 1Q9 the form of infusion, of which he gave about eighty drops. He observes, that the best time for adminis- tering it is two hours before dinner, and on going to bed. He asserts that he found it equally effectual in nephritis calculosa. Mr. Earl, surgeon of the found- ling hospital, London, has published an interesting paper on the efficacy of tobacco injections in retention of urine.* The cases to which he considers it as particularly applicable are those which depend on a spasmodic state of the urethra, and which sometimes supervene in consequence of accidental causes " in persons who have been long subject to strictures in the urethra, but who are still able to void their urine in a small stream." In instances of this kind it is often impracticable to introduce instruments into the blad- der, and it becomes necessary to overcome, the reten- tion by other means. Under such circumstances. therefore, Mr. Earle has employed tobacco injections with great success in three cases,-after all the usual means had been resorted to ineffectually. With a similar intention of removing constriction. tobacco is employed in cases of incarcerated hernia, and frequently with complete success. For this pur- pose either an infusion or the smoke of the plant is injected into the rectum. The very great relaxation which is thereby produced throughout the whole body, * Medico-Chirurgical Transactions, vol. vi. 110 NARCOTICS. generally enables the surgeon to reduce the protruded parts very readily. The same practice will often produce almost im- mediate relief in cases of obstinate constipation de- pending on a spasmodic constriction of the bowels. In employing tobacco injections it is, however, of the utmost importance to proceed with very great caution. If the quantity injected be too great, it will produce the most alarming symptoms; such as vomiting, cold sweats, universal prostration, syncope, and even death. I have known an empiric destroy, in less than twenty minutes, the life of a charming little boy,—the son of a gentleman at Lancaster, whose family I attended while residing in that place, by an immoderate injec- tion of the infusion of tobacco. In general a half a drachm of the leaves infused in eight or ten ounces of water, will be as much as can with safety be thrown into the rectum at one time. A cataplasm composed principally of this plant, ap- plied to the pit of the stomach, was employed with success, both in epilepsy and obstinate intermittents, by Dr. James Currie of Liverpool. The application was made about half an hour before the accession of the paroxysms of these diseases. As an external application either in the form of an ointment or infusion, it has been a good deal recom- mended in porrigo and other cutaneous diseases. I have used it in two instances in this affection, to a very NARCOTICS. HI great extent, without, however, deriving any perma- nent advantage from it. The late professor Barton was in the habit of applying a poultice of tobacco leaves pounded in vinegar to the region of the sto- mach, in cases of worms. " In consequence of this application," he observes, "worms are often discharg- ed after powerful anthelmintics have been exhibited internally in vain."* I have, in several instances, re- sorted to this practice in cases of worms, without the slightest benefit, although the existence of worms in the bowels was rendered certain by the frequent spontaneous discharge of them. STRYCHNOS NUX VOMICA. The tree which affords this article is indigenous to the eastern continent. It is particularly abundant along the coast of Coromandel, Malabar, and at Cey- lon. Its fruit, which is a berry of the size of a small orange, contains in its pulp the seed which is the officinal nux vomica. The deleterious effects of this article on cats, dogs, foxes, and certain birds, were long since observed by Gessner, Wepfer, Bunner, and others. By the more recent experiments of Des- * Collections for an Essay towards a Materia Medina of the United States, p. 63. 112 NAUCOIICd portes, Magendie, and Delisle, the peculiar powers of this substance have been more particularly elucidated. When given to dogs as a poison, it produces great anxiety, laborious and confined breathing, retching, and nausea, tremors, violent convulsions, tetanic spasms of extraordinary force, asphyxia from im- mobility of the thorax, and death. In animals thus killed, Delisle, Magendie, and Desportes never found the least trace of inflammation. It appears to extin- guish life by destroying the power of the respiratory muscles, and thus producing asphyxia. According to the experiments of Delisle, no effects whatever are produced when this substance is applied directly to an exposed nerve. When, however, thrown into the cavity of a serous membrane, it speedily proves fatal. Murray appears therefore to be wrong in attributing the deleterious effects of the nux vomica to its imme- diate operation on the nervous system.* Its effects upon the human system are similar to those which it produces in animals. Magendie and Delisle observed, that it has the power, when taken in a proper dose, of exciting strong spasmodic contrac- tions of the voluntary muscles without materially af- fecting the more important vital organs of the system. M. Fouquier, physician of the Hospital de la Charite, taking advantage of this singular property, conceived the idea of applying it to the cure of paralysis. He * Alibert, Elemens de Therapeutique, Sec. t. i. p. 435. NARCOTICS. U3 accordingly administered it to a number of patients affected with paraplegia and hemiplegia, and obtained from it very important results. The effects of a suf- ficient dose were, invariably, strong muscular con- tractions of more or less permanency; consisting sometimes of sudden and transient starts, and at other times of clonic contractions of a tetanic character. These contractions are, in general, stronger in the paralytic parts than in those which are healthy. M. Fouquier observes, that a very strong dose has some- times produced general tetanic convulsions, without however doing any mischief. Dr. Lescure* relates several cases of paralysis in which the nux vomica proved successful. He gave four grains of the ex- tract, divided into two doses daily, to a patient who had been for four years affected with paraplegia. The dose was gradually increased to six grains in the second week; the patient then began to feel heat in the stomach, a sense of constriction in the abdomen, difficulty of voiding urine, and now and then slight contractions of the muscles of the lower extremi- ties. The remedy was now omitted for a short time. On being resumed and continued for some days, for- cible and sudden contractions seized the paralysed limbs, and the retention of urine was more complete than on the former occasion. On again omitting * Journal Universel des Sciences Medicales, totn. xi. VOL. n. 15 114 NARCOTICS. the medicine these symptoms disappeared. It was then resumed in the dose of eight grains, and at the termination of three weeks, he again was taken with tetanic contractions, which continued four hours. The patient now gradually recovered the use of his limbs. The nux vomica has also been employed in inter- mittents, mania, epilepsy, gout, rheumatism, cutaneous eruptions, hydrophobia, scrophula, and hypochondri- asis. Hagstrom, a Swedish physician, asserts that he found it of great service in an epidemic dysentery. It was given in the dose of twenty grains of the powdered nut once a day in some barley-water, after the bowels had been duly evacuated by laxatives. It is also par- ticularly commended by Hufeland, for its good effects in an epidemic dysentery that occurred at Jena in 1795. A late German writer of great respectability, states that he used it in an epidemic dysentery that prevailed at Melle, a town in the principality of Osna- burg, in 1800. He gave it in doses of two and a half grains every two hours. " It sometimes allayed the pain, though in a few individuals it increased it."* It does not appear, upon the whole, that its efficacy in this disease is such as to entitle it to any particular attention. MM. Pelletier and Caventou have obtained a pecu- * Summa Observationum Medicarum, 8cc. L. I.Schmidtman. M.D. Beraline, 1819. NARCOTICS. H5 liar substance from this article, which contains its ac- tive properties in a highly concentrated state. It has received the name of strychnine* This substance " is highly alkaline, and crystallizes in very small four- sided prisms, terminated by four-sided pyramids; its taste is insupportably bitter, having a slight metallic flavour; it has no smell; it is so extremely active and violent, that in doses of half a grain it occasions seri- ous effects, and in larger ones convulsions and death."! It is sparingly soluble in water; in alcohol, however, it dissolves very readily; it forms neutral salts with acids, which become "blood-red by the action of con- centrated nitric acid." This remedy is given either in substance or in the form of an extract. Four grains of the powdered nut, or two of the extract, may be given three, four, or five times a day, and continued until its operation on the system is adequately manifested. It will in general be necessary to increase the dose gradually, in order to obtain its peculiar effects. The alcoholic extract alone is employed. In cases of poisoning from nux vomica, Orfila re- commends two spoonfuls of the following mixture every ten minutes, after the contents of the stomach have been evacuated: R aether vitriol. 3i. ol. tereb. 3ii- sacch. albi, Sss. aqua pura, 2ii. * Annals de Chimie, vol. viii.—x. t Paris' Pharmacologia. 116 NARCOTICS. RHUS TOXICODENDRON, VEL RADICANS. POISjN OAK--SWAMP SUMACH. This is a very common shrub in this country, and well known by its property of inflaming the skin to a very alarming extent, simply on coming in contact with its leaves, or even by a close approach to it, in persons who are particularly sensible to its influence. Mr. Van Mons of Bruxelles, has published a chemical examination of this species of rhus. He asserts that the poisonous exhalation of this shrub is a carbonated hydrogen gas. It contains also a considerable quantity of tannin, some gallic acid, a small portion of green fecula, and a still smaller quantity of gum and resin. It does not appear that it possesses any very dele- terious properties when taken internally. Orfila ob- serves that it blunts the activity of the nervous system after being absorbed. Alibert,* however, states that a M. Boullon inoculated himself, in his presence, with the juice of the rhus toxicodendron, with perfect impunity. On the skin, however, its poisonous proper- ties act with great energy. When touched or handled it produces in the course of two or three days very serious symptoms. The skin inflames and swells, being attended with a very distressing burning pain. If the face be affected the eye-lids are so tumefied as to * Elemens de Therapeutiques, torn. i. p. 452. NARCOTICS. H7 close up the eyes; the whole head is swelled and covered with little blisters containing serum. Some- times the whole body is enormously swelled and co- vered with serous vesicles. When the inflammation and swelling has in some degree subsided, the epider- mis begins to separate in little squamae, and an intoler- able itching is felt for some days longer. The arterial system, during an affection of this kind, is very con- siderably excited. These symptoms bear a very close resemblance to those of erysipelas; and it is observed by Mr. Van Mons, that they yield to the remedies commonly em- ployed for the cure of this latter affection. M. Gouan recommends aqua ammonia, diluted in water, as a useful application, but I believe nothing has as yet been discovered more effectual in such cases than the ap- plication recommended by the late professor Barton, namely, an aqueous solution of corrosive sublimate. The rhus toxicodendron has been a good deal praised for its remediate powers in the treatment of paralysis, herpes, and consumption. M. Dufresnoy, professor of botany at Valencia, speaks in very high terms of its efficacy in these affections. The experi- ence of Verdeyen, Koch, Van Baerlem, Rumpel, Burdach, and others is also in favour of its employ- ment in these and other affections. M. Pou, professor at Montpellier, cured a paralytic patient in a very short * Alibert, Elemens de Therapeutiques, torn. i. p. 454. 118 NARCOTICS. time with the extract of this plant. M. Gouan was equally successful in curing a young lady affected with hemiplegia. Dr. Alderson relates seventeen cases of paralysis, in all of which this remedy was usefully em- ployed.* The dose of the extract is at first about grs. xx. to be gradually increased until some effects on the system are produced. The powdered leaves are given in the dose of from one grain to ten, three or four times a day. TELA ARANEARUM. The spider's web has been long known as a do- mestic remedy for the cure of agues; and we find it mentioned in the dispensatory of Schroder, published in 1644, as possessing such remediate powers. It is to Dr. Robert Jackson, however, that we are in- debted for a more particular and satisfactory account of its powers, and consequently for the attention which it has lately received from the profession. This re- spectable physician, in a communication published in the Medical and Physical Journal,! states that Dr. * An Essay on the Rhus Toxicodendron, 8cc. by J. Alderson, M. D. t Medical and Physical Journal, vol. xxi. NARCOTICS. H9 Gillespie of Edinburgh had succeeded in curing a very obstinate case of ague by the spider's web, after various other means had been tried ineffectually. He then details his own experience with this substance in the treatment of intermittents, the result of which goes directly and strongly in favour of its remediate powers. " I think," says he, " I may venture to say that it prevents the recurrence of febrile paroxysms more abruptly and more effectually than bark or ar- senic, or any other remedy employed for that purpose with which I am acquainted; that, like all other reme- dies of the kind, it is only effectual as applied under a certain condition of habit; but that the condition of susceptibility for cobweb is at the same time of great- er latitude than for any other of the known remedies. The cobweb was rarely given before the subject was prepared by bleeding, emetics, or purgatives." The more obvious effects of this remedy when taken into the system is to allay irritation, to tranquillize the mind, and to induce easy slumbers. Dr. Jackson declares that the cobweb allays " morbid irritability, and calms irritations both of body and mind, in a de- gree far exceeding any drug or remedy within the cir- cle of our knowledge." He further observes that the effects which it produces characterize it as powerfully stimulant. When the pulse is quick, frequent, irre- gular, and irritated, it becomes slow, calm, and regular by its operation. In general the surface becomes \20 NARCOTICS. relaxed and covered with perspiration. If the pulse is slow, regular, and nearly natural, it generally be- comes frequent, small, irregular, and sometimes inter- mitting. Where languor and depression exist, " sen- sations of warmth and comfort are diffused about the stomach, and increased animation is conspicuous in the appearance of the eye and countenance." I have taken it very often, and have uniformly found it to produce a calm and delightful state of feeling, suc- ceeded by a disposition to sleep. This accords with the experience of Dr. Oliver of Salem, who found it to produce in himself " the most delicious tranquillity, resembling the operation of opium, and followed by no bad effects." In consequence of these soothing properties the cobweb has been found an excellent palliative in the advanced stage of consumption. Dr. Jackson details a remarkable case of asthma, in which the tranquillizing effects of this substance were conspicuously evinced. The complaint was hereditary and connected with malformation of the chest. The patient was unable to lie down in bed from a sense of suffocation, and was obliged to take the little sleep he could get in a half-sitting posture, being supported by pillows. In this distressing con- dition he one night took twenty grains of the spider's web, and obtained from it a sound and uninterrupted sleep all night, " a blessing to which he had been an NARCOTICS. 121 entire stranger above six years." The same writer states that he has found it very useful in the spasmo- dic complaints of females, which resist the powers of ordinary remedies. In chronic hysteria I have employed it with much advantage. I have found it particularly serviceable in women of a relaxed habit of body, accompanied with morbid irritability of the nervous system. In a case which I have at present under my care, my patient derives evident advan- tage from this article, in combination with the cya- nite of zince, lately introduced into practice by Dr. Hufeland of Berlin. Dr. Webster* of Boston, adds his testimony in favour of the remediate virtues of this substance. He has found it to produce very good effects in rheumatic headach, asthma, and chro- nic coughs. He has also derived much advantage from it in allaying the irritation which sometimes attends a mercurial course. He mentions the follow- ing remarkable effects of this remedy in an old and infirm asthmatic: "Slight but pleasant delirium was produced, and from the report of the persons who slept in the room with him, the effect, though of longer duration, was very similar to that of a dose of nitrous oxide gas, the muscular energy having been exceedingly increased, the patient could not be con- fined to bed, but danced and jumped about the room * New England Medical and Physical Journal, new series, vol. iv. p. 218. VOL. II. 16 [22 NARCOTICS. nearly all night: in the morning I found him quietly asleep. No unpleasant symptoms ensued." The same writer observes that the cobweb is an excellent application to irritable sores. It is generally given in the dose of five or six grains, repeated every third, fourth, or fifth hour. Accord- ing to the experience of Dr. Jackson, a dose of five grains produces nearly the same effects as one of twenty. HYDRO-CYANIC ACID.—PRUSSIC ACID. The prussic acid is the most prompt and fatal poi- son known. When perfectly pure, and brought into contact with a wound, or simply applied to the eye or tongue of an animal, it destroys life almost instan- taneously. When diluted, however, to a proper de- gree, it appears, from some late accounts of its em- ployment in diseases, to be capable of very important remediate applications. The prussic acid, as it is usually prepared for me- dicinal purposes, is transparent, without colour, of a bland and sweetish taste at first, becoming acrid and hot afterwards. Its specific gravity, at seven degrees of Reaumur, is 0.70583. It reddens the tincture of turnsole slightly. It boils at the temperature of 26° 5'. NARCOTICS. J23 under a pressure of 0.7Gm; and at 15° it congeals/ It is so extremely volatile, that when a portion is dropped upon a piece of paper, the part which almost instantaneously evaporates, produces a sufficient de- gree of cold to crystallize the portion of the acid re- maining on the paper. Its odour is strong and charac- teristic, resembling that of peach-blossoms and bitter almonds. When exposed to light it is soon decom- posed, resolving itself into carbonic acid, ammonia, and carburetted hydrogen gas. It is therefore neces- sary to keep it excluded from light, otherwise it will very soon become inert and useless. It is found in a variety of vegetable substances;—in bitter almonds; the kernels of black cherries; in the flowers and leaves of the peach-tree, and particularly in the kernels of the peach, and in the leaves of the primus lauro- cerasus. For medicinal purposes it is usually obtained from this latter plant, or from the prussiate of iron. This acid was discovered by Scheele, in 1780. It was soon afterwards ascertained to be highly poison- ous, by Schrader, who found that a ^ew drops, or even its vapour, very speedily killed some birds which he subjected to its influence. Its deleterious properties were afterwards more fully ascertained by the ex- periments of Ittner, Emmert, Coulon, Robert, Orfila, and more recently by those of Magendie. Ittner poured twelve drops of the acid into the mouth of a * Thenard Traite de Chemie, torn. iii. p. 462. 124 NARCOTICS. middling-sized dog. The animal immediately stag- gered and fell. His respiration was quickened, and his faeces passed involuntarily. He was seized with violent opisthotonos, and died in about an hour after the acid had been given him. The effects, however, of the highly concentrated acid are still more vio- lent, and indeed truly frightful. Magendie states,* that on plunging into the throat of a dog the extre- mity of a glass tube, that had been previously dipped into a phial containing some pure prussic acid, the animal instantly made two or three long and rapid in- spirations and fell dead. Not the smallest trace of sensibility in the muscular organs could be detected after death. In another experiment he applied an atom of the acid to the eye of a dpg, " and the effects were as sudden and as fatal as in the preceding expe- riment." " In short," says Magendie, " the prussic acid, prepared according to M. Gay-Lussac, is, with- out doubt, of all the known poisons, the most active and the most promptly mortal. Its deleterious and powerful influence permits us to believe what the his- torians have related of the criminal talent of Laucus- tus; and render the accounts of those extraordinary and sudden cases of poisoning, so frequent in the annals of Italy, less marvelous and incredible." The action of this acid appears to be immediately directed upon the nervous system. The excitation, * Journal of Science and the Arts, for 1818, No. viii. NARCOTICS. 125 however, which it produces in the system, is extremely transient, inducing almost immediate debility and torpor. When the dose is very large its action is so rapid and intensely energetic, as to cause, like light- ning, an almost instantaneous extinction of the vital properties. As a consequence- of its power to lessen irritability and sensibility, it diminishes the action of the heart and arteries, though in general this effect is not conspicuously manifested, unless the dose be excessive. Dr. Thomson, in a letter to Dr. Granville, observes that he has never seen its sedative effects preceded by an increase of the action of the heart and arteries, " a circumstance which distinguishes it from all other substances belonging to the class of narco- tics." - It does not appear to be capable of producing any inflammation in parts to which it is applied. Bitter almonds, however, whose active principle con- sists of this acid, inflame the stomach when swallowed. It is only of late that this acid has been extensively employed for remediate purposes; and if the accounts we have had of its good effects be not greatly exagge- rated,—a suspicion which can hardly be admitted, as they proceed frum sources so respectable and various, it is undoubtedly entitled to very great attention. Bitter almonds and lauro-cerasus, both of which owe their active properties to the prussic acid they contain, were formerly employed as remedies in the cure of intermittents. Hufeland states that he has 126 NARCOTICS. known two or three bitter almonds, swallowed a short time before the paroxysm, sufficient to prevent its ac- cession.* Bergius,! a^°jsavs that cases of ague have been cured by the bitter almond, after having used the cinchona and other remedies ineffectually. MM. Du- vignon and Parent,! °f Paris> state that during the first invasion of the allied army in 1814, a young English physician attached to the Russian imperial guards, effectually treated tertian intermittents with Scheele's prussic acid, combined with other substan- ces, in strong doses. Substances containing the prussic acid, as well as the acid itself, have also been employed successfully in the cure of some nervous disorders. The aqua lauro-cerasus, which is but a very diluted form of the prussic acid, has been much recommended by Hufe- land^ Thomasen, Thuassen, Baillie, Wurzer, and others, in mental disorders. Dr. Oliver of Salem, states, that in two instances of mania in females, the prussic acid has been of essential advantage. j| It has been particularly extolled for its good effects in hypo- chondriasis depending on disorders of the abdominal viscera, or on onanism. It has also been thought par- * Bibliotheque Med. torn. viii. s. 386. t Bergius Mat. Med. p. 400. \ Medical Recorder, vol. ii. p. 510. § Journal der Practish. Arzeneyk, B. ix. s. iii. II Thatcher's New Amer. Dispen. p. 433.—1821. NARCOTICS. 127 ticularly adapted to the cure of mania arising from suppressed excretions.* Dr. Shallern asserts that he derived very consider- able advantage from the employment of laurel-water in combination with belladonna, in cases of hydro- phobia. M. Dupuytren, however, employed the prus- sic acid in two instances of this hopeless malady, with- out the least benefit. A very large mass of testimony has of late been published, which goes directly and strongly in favour of its powers in the treatment of chronic nervous coughs, and phthisis pulmonalis. Magendie was, I believe, the first who employed the prussic acid in diseases of this kind.! Observing its remarkable pro- perty of diminishing general sensibility, without ma- terially affecting the respiration and circulation, he was led to the opinion that it might be advantageously employed in cases depending, as these affections ap- pear to do, on a morbid increase of sensibility. He accordingly prescribed it to a young lady who had been affected with a distressing dry, short cough for * Duvignon and Parent, in the Med. Recorder, vol. ii. p. 545. t Since writing the above I have seen an article in the New England Medical Journal, communicated by B. Lynde Oliver, M. D. of Salem, in which he states that he administered both the distilled water and saturated tincture of lauro-cerasus, in phthisis pulmonalis, as early as 1810, and generally with much advantage. 128 NARCOTICS. above eighteen months. He ordered her " six drops of Scheele's prussic acid, diluted with three ounces of a vegetable infusion, to be taken by spoonfuls every two hours," and in four days her cough disappeared entirely. He states that he afterwards employed the prussic acid in numerous instances of nervous and chronic cough, and always with the greatest success. Having found it thus efficacious in the treatment of dry and convulsive cough, he resolved on trying it in consumptive cases. The result of his experience, as given in his first report, is, that out of fifteen persons affected with pulmonary consumption, he invariably found the prussic acid, administered in small and re- peated doses, " to diminish the frequency of the cough, moderate and render more easy the expectoration, and lastly to procure the patients some sleep at night, without any colliquative sweats." In 1820, Dr. Ma- gendie published a small work " On the use of Prussic Acid in the treatment of Diseases of the Breast, and particularly in Phthisis Pulmonalis," in which much interesting evidence is offered, in addition to what he had already given, concerning the efficacy of this sub- stance in consumption and other pulmonary affections. Dr. Granville too, in a late work on the medicinal uses of the prussic acid, adds his testimony in favour of its powers in pulmonary and other diseases.* He * Further observations on the internal use of Prussic Acid. London, 1820. NARCOTICS. 129 relates seventy-nine cases of different diseases, all of which were cured or relieved by this potent article. A considerable number of these were phthisis in the early stages of the complaint, and a few of them were already far advanced. We have also some observations from Dr. Scudamore, which strongly indicate the good effects of this remedy. This respectable physi- cian prescribed the acid in the dose often drops a day to two young patients labouring under all the usual symptoms of confirmed phthisis. They both had a fatiguing cough, frequent pulse, were much emaciated, debilitated, and harassed with night sweats and copi- ous purulent expectoration; they also had that pecu- liar form of the nails which usually accompanies these symptoms. These two patients were perfectly cured by the employment of the acid. In the practice of professor Macneven of New-York, this remedy has been known to produce excellent effects in incipient phthisis. " I have used the prus- sic acid," says he, "with great advantage. It almost always removes cough, which accelerates and favours tubercular inflammation in predisposed habits, and thus in many cases prevents the disease."* I have employed it in five cases of phthisis. In two of these the cough, night sweats, and hectic symptoms were considerably relieved. In three I observed no * American Medical Recorder, vol. iii. p. 574. VOL. II. 17 130 NARCOTICS. obvious advantages from its use, and in one case it did manifest harm, by the excessive prostration which it produced. In the cure of hooping-cough this new remedy ap- pears, from ample testimony, to be very efficacious. Haneman recommends the aqua lauro-cerasus as exceedingly useful in this distressing affection. Dr. Oliver declares, that of all the various medicines which he has employed he has never found one which operated so suddenly in hooping-cough; and Dr. Granville asserts that in no case need hooping-cough be suffered to proceed longer than eight or ten days, if timely and cautious recourse be had to the prussic acid. We have, moreover, the evidence of Dr. John Elliotson, who has recently published an interesting work on the prussic acid, in favour of the good effects of this remedy in the present disease. He has also employed it successfully in a case of chorea; and in pyrosis and various other diseases of the stomach, he considers it a very valuable remedy. He does not, however, offer any thing which goes to confirm the accounts that have been given of its curative powers in phthisis; and he fears that it must be added to our list of remedies that have been fruitlessly applied to the cure of this disease. It has also been prescribed with advantage in asthma. Dr. Granville states that he has known it afford signal NARCOTICS. 131 relief in this affection. Dr. Oliver also speaks of it as a valuable remedy in this disease.* In chronic rheumatism the prussic acid has been employed with evident advantage. Dr. Coates! of this city, in a statement of the result of the use of the prussic acid in the Pennsylvania Hospital, in the sum- mer of 1819, observes, that "in two cases of severe chronic rheumatism, and in one of mania, the prussic acid was eminently serviceable, and in combination with subsidiary means effected permanent cures." Dr. Magendie prefers the pure prussic acid, as pre- pared by the process of Gay-Lussac, and diluted with six times its volume of distilled water, or eight times its weight of the same, to that prepared by Scheele's process, which is not sufficiently uniform in its power, on account of the liberty which the process leaves to the preparer. The difficulty of procuring this acid of an uniform strength, and the still greater difficulty of preserving it from deterioration, has hitherto been a very great objection to its employment in practice. It is therefore very desirable that so valuable and powerful a remedy as this is should be obtained in a more permanent form than the aqueous solution, which decomposes by light, by air, and by the water itself. Professor Thomas Cooper has introduced a preparation that promises to answer this purpose. * New-England Medical Journal. t American Medical Recorder, vol. iii. p. 145, 132 NARCOTICS. The following is his process: Into strong rectified alcohol, surrounded by ice, throw a quantity of the prussic acid gas, obtained from the prussiat of mer- cury. One ounce of such alcohol will, at 32° of Fahrenheit, absorb all the gas that can be procured from four hundred grains of prussiat of mercury slightly moistened with about fifty or sixty drops of muriatic acid, and exposed to a gentle lamp-heat in a small retort. Not more than two drops of this acid can be given in a day in doses of one-sixteenth part of a drop.* *Thc following very interesting remarks and experiments on the effects of hydrocyanic acid and its counter-poisons have been lately published by John Murray, Esq. F. L. S. M. W. S. &c. " I had always found, that the violent headach which some- times occurred in preparing hydrocyanic or prussic acid, was relieved and removed by ammonia, which induced me to think that the antidote to that acid, and virulent and formidable poi- son, migh^ be found in ammonia. A small portion of hydrocyanic acid was given to a healthy young rabbit, which proved fatal in ten minutes. Soon after its administration, the head declined on one side, violent spasm supervened, while the eye lost its lustre, and the animal died in dreadful convulsions. On dissection after death, the lobes of the lungs appeared paler than usual, coagulable lymph was found lining the tra- chea, as in cynanche trachealis, and the stomach was found in- flamed near the pylorus. The brain was not examined. The muscular fibre was still excitable by voltaic agency, but the excitability soon declined. NARCOTICS. 133 A drop or two of hydrocyanic acid on the head of a frog soon proved fatal. The colour promptly changed to an unwonted paleness. The sciatic nerves of the prepared limbs were moistened with hydrocyanic acid, but no suspension of the voltaic excite- ment supervened. It was accompanied by a tremulous move- ment of the muscular fibre, connected with the lines of the nerves: and this spontaneous irritability seemed increased by the application of alcoholic solution of iodine. It is a singular fact, that not unfrequently an alcoholic solu- tion of iodine, dropped on the muscular fibre of a frog, excited phenomena similar tQ.the action of the voltaic apparatus. It seemed also to renew excitability when the susceptibility had declined or was lost. When the symptoms were verging to a fatal issue in a frog, a drop or two of ammonia on the head effectually restored the animal. A greater quantity of hydrocyanic acid was given to a young rabbit than proved fatal in the cases detailed. Ammonia was occasionally applied to the mouth on a sponge. The animal exhibited no unhealthy symptom whatever. A considerable quantity of hydrocyanate of ammonia with excess of base, was administered to another rabbit, but without any deleterious effect. Half a drachm of hydrocyanic acid was given to a healthy young rabbit. The effects were prompt. Respiration became laborious and difficult, with a grating in the throat, the eye lost its brilliancy, the head dropped, it raised a sharp cry, and was convulsed. Strong ammonia was dropt into the animal's mouth, and it was repeatedly moistened with a sponge dipped into ammonia. It almost instantly revived, and even licked re- peatedly the finger which sometimes applied the ammonia, ap- parently quite sensible of the instant and continued relief af- 134 NARCOTICS. forded. The animal effectually recovered. Its lips were ex- coriated by the ammonia. Conscious of the complete antidote of this formidable poison found in ammonia, I took a quantity of hydrocyanic acid suffi- cient to produce violent headach, stupefaction, &c. but diluted ammonia afforded me instant relief. I occasionally applied it to the olfactory organs, and bathed the forehead. Since hydrocyanic acid has been introduced into our phar- macopoeia, and employed in phthisis pulmonalis, and accidental poisoning may be anticipated, it is of much moment to know an effectual barrier to its virulence; and such is my complete conviction of the antidote, that I would feel no hesitation what- ever in taking a quantity sufficient to prove fatal, provided there stood by a skilful hand to administer the remedy." CHAPTER X. II. Medicines that increase and equalize the Nervou* Energy. ANTISPASMODICS. Dr. Cullen, on entering into the general considera- tion of this class of remedies, says: " This is the most difficult subject that has occurred to me;" and it must be confessed, indeed, that there is no object of the materia medica surrounded with greater obscurity than the modus operandi of antispasmodics. Spasm occurs under such a variety of circum- stances, and in such opposite states of the system, that almost every article in the materia medica may, under peculiar circumstances, act as an antispasmodic. Thus spasm may depend on general debility, in which case tonics and general stimulants are serviceable. On the other hand, spasm may also proceed from, or at least be attended by, a plethoric condition of the system, as is sometimes observed in cases of hysteria, and then we derive advantages from bleeding. Thus too, spasm very commonly arises from gastric irritation, in 136 ANTISPASMODICS which case we resort to emetics and cathartics as the best antispasmodics. But although remedies of this kind may occasionally produce antispasmodic effects, yet they do this in an indirect manner; that is, by removing either the debility or the plethora, or the irritating cause upon which the spasm depends, and not by any direct influence over irregular or morbid muscular contraction. They are, therefore, not to be ranked with the antispasmodics strictly so called, any more than venesection is to be placed with the stimu- lants, because, in certain states of congestion, its em- ployment produces strength and fulness of the pulse. There are, however, substances which seem to ex- ercise a more direct influence over spasmodic muscu- lar motion. Of the modus operandi of these medicines we know but very little; nor can the utmost ingenuity hope to remove the veil which covers this subject, until the physiology of muscular motion and nervous influence shall be better understood. All that can be said, with ,any degree of plausibility, on this point is, that as the functions of the muscular system, are not only under the influence, but probably directly depen- dent on those of the nervous system, it is not unrea- sonable to infer that the remedies which calm the irregular actions of the former must do so by their action on the latter. ANTISPASMODICS. 137 ASAFCETIDA. This is the inspissated milky juice of a perennial plant, indigenous to Persia, and known to botanists by the name of ferula asafoetida. It is brought to us in dry, hard pieces, somewhat unctuous to the feel, and of a brownish, or reddish colour, interspersed occa- sionally with little shining tears of a whitish hue. Its odour is strong, foetid, and alliaceous, and its taste bitter and acrid. According to Brugnatelli, it con- tains sixty parts of gum, thirty of resin, and ten of essential oil. Alcohol and aether extract all its virtues. Asafoetida is one of our most penetrating nervine stimulants. Taken in a large dose it excites a more lively flow of spirits, increases the action of the heart and arteries, and induces vertigo. It also acts as a gentle laxative; but its long continued use is said to weaken the muscular power of the intestines.* I have, however, never observed such an effect from the use of this remedy, although I have frequently employed it for a long time and in large doses. It possesses considerable powers as an expectorant, and may be very usefully employed in cases where we wish to promote expectoration, and at the same time stimulate * Burdach's Arzneymittellehre, B.iii. s. 322. VOL. n IS 138 ANTISPASMODICS. the general system, or allay spasms or nervous agi- tation. As a palliative in nervous diseases, asafcetida is one of our most efficacious remedies. To allay hsyteric symptoms its employment is extremely common; nor do I know any other medicine more promptly bene- ficial in such cases than this one. It may also be advantageously employed to obtain temporary relief in hypochondriasis. Independent of its cheering influence in this affection, it is useful by awakening the dormant sensibility of the system to the action of other remedies. In the advanced stages of typhus, when the system is much debilitated, and subsultus tendinum, tremor, and slight delirium exist, asafcetida, given in combina- nation with other and more permanent stimulants, is often of very great service. It may also be employed with much benefit in all spasmodic affections of the alimentary canal, unat- tended by any active inflammation in this part. Much was formerly said of its employment in asthma and croup, and there can be no doubt that it may frequently afford much relief in this disease. In the latter disease Miller recommends, in strong terms, a mixture* of this substance in powerful and repeated * R G. asafoetida, 3ii> aq, ammoniac acetat. |i. aq. pulegii, |iii. Solve. Dose, a table-spoonful every half hour to a child two years old. ANTISPASMODICS. 139 doses. In the advanced stage of this affection, when by a successful antiphlogistic treatment, the inflam- matory condition of the system and of the parts af- fected have been considerably subdued, I have known the asafoetida to do much good in relieving the dry- ness and hoarseness of the cough, and establishing a more healthy secretion from the lining membrane of the bronchia. In hooping-cough, also, asafoetida will occasionally afford considerable advantage. I have, in a few cases, united this remedy with antimonials, so as to excite vomiting after a few doses have been taken; and it appeared to me that the relief obtained was both more complete and more permanent than is usually derived from emesis alone. In spasmodic pains of the stomach and bowels from indigestion, asafoetida is a remedy of very considerable importance.* In my own person I have found it par- ticularly advantageous for the relief of such symptoms when combined with small doses of opium. Richter states that a combination of asafoetida and ox gall is one of the most effectual remedies we possess for cor- recting that morbid condition of the stomach which favours the formation of acid. " Some patients," says he, " are constantly tormented with acid, eat what they may, and even though they take nothing but ani- mal food. In such cases equal parts of asafoetida and * Cullen's Mat. Med. article Asafcet. 140 ANTISPASMODICS ox's gall are of so great use, that I can now, from ex- perience, recommend them almost as a specific."* In cases of habitual costiveness, asafoetida often acts as a useful and invigorating aperient. It is par- ticularly serviceable when the torpor of the bowels is connected with nervous symptoms. In such cases this article may be very advantageously combined with the compound extract of colocynth. Asafcetida has been highly recommended in the treatment of caries.f Given in large and frequent doses it is said to promote the exfoliation of the dead parts and to improve the discharges. It is, however. of more unequivocal advantage in the cure of old and ill-conditioned ulcers; and it appears to be more espe- cially efficacious in cases that are attended with a scrophulous or rheumatic habit of body. J Asafoetida is given either in substance, emulsion, or tincture. The dose in substance is from gr. iii. to $i. or even more, according to the urgency of the symptoms. An emulsion made of two drachms of asafcetida, two yolks of eggs, eight ounces of water, and one ounce of syrup, is to be given in the dose of one or two table-spoonfuls, pro re nata. * Medical and Surgical Observations, p. 191. t Smucker's Chirurgishe Scriften. See also C. L. Smalz Beobachtungen ttber die guten Wurkungen des stinkenden Asants, by driisen-und knochengeschwiilsten, auch bey dem Beinpasz. In Loder's Jour. f. Chir. ii. Bd. iv. st. No. 7. \ Burdach's Arzneymitt. Lebi. B. iii. p. 327. ANTISPASMODICS. 141 GJALBANUM. This substance is the inspissated milky juice of a perennial plant indigenous to Africa, and known to botanists by the name of bubon galbanum. Galbanum is a tenacious substance, of a whitish colour when recent, changing to a yellowish red when old. When broken it presents a variegated appear- ance from the number of white tears with which it is interspersed. Its taste is bitter and acrid, and its odour foetid and strong. One fourth of its weight will be dissolved if tritu- turated with wine, water, or vinegar. To effect a permanent suspension in these fluids the addition of half its weight of some mucilage, or the yolk of eggs, is necessary. The best solvent, however, is a mixture of two parts of rectified spirits and one of water; this will dissolve all but the impurities of this substance. Galbanum has been a good deal recommended in hysteric affections; it is said to be peculiarly adapted to cases of this kind attended with a relaxed state of the system, and a deficiency or a suppression of the catamenia. I have never employed it in spasmodic diseases. But in one case of habitual asthma, at- tended with a troublesome cough, I have found it ex- ceedingly useful. In spasmodic and flatulent colic galbanum will of- 142 ANTISPASMODICS. ten afford very considerable advantage. For this pur- pose I have known it to be combined with the ol. ricini, with very good effect. In addition to its anti- spasmodic virtues, it possesses no inconsiderable ex- pectorant powers. In the latter periods of pneumonia, when there is considerable cough, and a difficulty of expectorating the tough mucus of the bronchia, a solu- tion of galbanum in vinegar of squills is said to act very beneficially. It has been thought to possess very considerable deobstruent and discutient properties. It enters into the composition of Smucker's visceral pills, so highly recommended by Richter and others in the cure of gutta serena.* Externally galbanum is applied to discuss indolent tumours. The gum is given in the form of pills in the dose of from d\. to 3i. Dose of the tincture is from 3i. to 5iii. * The following is Smucker's formula: R G. galbani, G. sagapeni, Sapon. venet. aa 3i. Pulv. rhaei. 3SS- Tart. emet. in aq. font. q. s. sol. gr. xvi. Succ liquiritiae 3i- M. fiant. pil.'gr. i. Sumat quotid. No. xv. ANTISPASMODICS 143 GUM AMMONIACUM. According to Wildenow, this is the inspissated juice of the heracleum gummiferum, an umbelliferous plant, indigenous to the interior parts of Africa, the desert of Barka., and the western regions of Egypt. Externally this substance is of a brownish, and inter- nally of a whitish, reddish, or deep yellow colour. It has a faint balsamic odour; its taste is nauseous, at first sweet, but soon becoming bitter and acrid. It is composed of gum, resin, gluten, and some volatile oik Neither water nor alcohol dissolve it completely. In vinegar, sethereal oils, and nitric aether it is, however, perfectly soluble. The antispasmodic powers of this substance do not appear to be of much importance. In, spasmodic colic it may, however, be given with much advan- tage. In this affection, when given in large doses, it not only tends to allay the spasm of the intestines, but also to promote their discharges. In chronic hysteria connected with a cachectic state of the system, and a deficiency of the catamenial discharges, it is very ad- vantageously combined with tonics, and particularly with chalybeates. This substance has been thought to possess very important deobstruent properties. It has, accordingly, been much recommended by the German physicians 144 ANTISPASMODICS. in obstructions of the glandular viscera of the abdo- men, and for the cure of such affections as are more or less intimately connected with derangement of those organs. Richter has employed this remedy in combi- nation with other medicines with much success, in the cure of gutta serena; a disease which appears to be not unfrequently dependent on functional disorder of the abdominal viscera. "Experience," says this •eminent writer, " confirms me more and more in the opinion that the cause of gutta serena is most fre- quently seated in the abdominal viscera, and daily justifies me more in recommending the use of deob- struent visceral medicines. I can affirm, that I have frequently performed a complete cure in cases where I hardly expected it, and in some where the disease had actually continued for several years* G. ammoniac has also been used in hypochondriasis, chronic rheumatism, caries, ulcers, and cutaneous eruptions. As an external remedy, it enters into the composition of a variety of plasters; and forms an ex- cellent application to discuss chronic and indolent swellings and glandular indurations. For this pur- pose it is softened by vinegar, or the vinegar of squills, and spread on leather. * He recommends the following pills: R. G. ammon. asafoetid. sapon. venet. rad valerian, summitat. arnic. aa. 3H. tart, antim. gr. xviii. pil. pond gr. ii. quarum sumat ter quotid. No. xv, ANTISPASMODICS. 145 Of its expectorant powers, which are very consi- derable, I shall speak particularly when I come to treat of that class of remedies. The most agreeable way of exhibiting ammoniac is in the form of an emulsion. 3U. of this substance must be triturated with the yolk of an egg or 3ss. of gum. arab. gradually adding Siv. of water. The dose of this is one or two table-spoonfuls every two or three hours. It is also conveniently given when dissolved in the liquor ammonii acetat. Two drachms of the former may be dissolved in three ounces of the latter. MUSK. This substance is produced by a quadruped of the ruminant kind called moschus moschiferus, a native of Thibet, Tartary, China, Siberia, and the kingdom of Tangut. The fluid which forms this substance is secreted principally by the male; that which is ob- tained from the female possesses but very little odour. It is secreted most copiously by the animal during its oeriods of veneral incalescence. The bag in which this secretion is formed is situ- ated immediately behind the umbilicus. It is about three inches long and of an oval shape, having one side convex and the other flat. The musk comes vol. 11. 19 146 ANTISPASMODICS. to us in round thin bladders, covered with light brown hairs, of the size of a pigeon's egg.. It consists of small grains of a dark brownish colour, having a some- what unctuous feel. Its odour is very peculiar, dif- fusive, and durable, " and it has the curious property, when added in minute quantity, to augment the odour of other perfumes, without imparting its own." Its taste is bitter. It contains resin combined with vola- tile oil, a mucilaginous extractive matter, minute por- tions of albumen, gelatine, muriate of ammonia, and phosphate of soda. iEtius is the first who mentioned this substance as an article of the materia medica. Since his time it has been generally regarded as a very important re- mediate article. It is undoubtedly one of the most diffusive, penetrating, though fugacious stimulants we possess. It acts particularly on the nervous system, giying a lively impulse to its powers, and a temporary exaltation both to the mental and corporeal energies. It elevates the pulse without increasing the heat of the body. Cullen thought it the most powerful antispasmodic we possess, and there appears to be no reason to think that, in this respect, he has estimated its powers too highly. In all spasmodic affections it has accord- ingly been much employed, and its effects in thi? way have often been exceedingly useful. Dr. Cullen relates the case of a gentleman affected with spasm ANTISPASMODICS, 14>J of the pharynx, preventing deglutition, and almost respiration. This case was effectually relieved by this remedy, after a very great variety of other me- dicines had been used abortively. Dr. Owen relates a striking example of the efficacy of musk in an obsti- nate convulsive affection of a young lady.* Dr. Hillary speaks favourably of its powers in the treatment of ' This case occurred in a young lady who, having received a slight electric shock from a charged vial, felt, in a few hours after, slight convulsive motions, which recurred once or twice a day. The convulsions gradually increased in violence, until they became extremely alarming. " Her fits always began with a disagreeable, rather than painful sensation at her stomach ; almost at the same instant her mouth and all her features be- came distorted. Her head was suddenly and violently drawn down to her breast, and the next moment backwards. Her legs, arms, and in short every muscle of her body, at one time or other of the fit, seemed to be violently agitated, and became spasmodically contracted. Her paroxysm used to continue ten or fifteen minutes, at the decline of. which, as if nature was quite exhausted or overcome, her muscles became at once re- laxed, and she fell into an hysteric fit of crying, which was suc- ceeded by a* comfortable sleep." After oleum succini, with small doses of musk, valerian, opium, bark, steel) cold-bath, aether, castor, and the foetid gums had all been tried ineffectu- ally, he ordered her half a drachm of musk, to be taken every hour. " It was no sooner in the stomach, than the fit, at the beginning of which the first dose was taken, began to abate, and in a minute or two entirely went off. In four days she was entirely free from the disease."! t Med. Observat and Inquir. vol. iii. p. 186. 14S ANTISPASMODICS. tetanus, as it occurs in hot climates.* Dr. Richard Huck. also, adduces strong testimony in favour of its remediate effects in this disease. He gave it to the extent of half an ounce, with a drachm of opium, in the course of twenty-four hours, and by this treatment cured a considerable number of tetanic patients.f Dr. Wall states that he found this remedy highly efficacious in convulsive hiccups, given in the dose of ten grains.J When given in doses under six grains, he never saw it produce any perceptible advantage. Its powers in the cure of mania, though recom- mended by several writers of high respectability, are more doubtful. In hysteric mania I have seen it given in one case with evident advantage; though its bene- ficial effects were but temporary. From its antispasmodic powers it has, indeed, been employed in every variety of spasmodic disease:—in subsultus tendinum, epilepsy, spasmodic colic, spasms of the stomach, cholera, cynanche trachealis, asthma, and even in hydrophobia. Berger, a Swedish physician, recommends musk as a highly efficacious remedy in hooping-cough. He gave it to children in doses of fifteen grains every six-hours, and he asserts that the fits of coughing were very * Cullen's Materia Medica. t Medical Observations and Inquir. vol. iii. p. 330. \ Philosoph. Trans. No. 474. ANTISPASMODICS. 149 generally prevented after six* or eight doses had been taken. In gout the good effects of this remedy are much extolled by Pringle and Cullen. "In another dis- ease," says the latter, " I can vouch for the powers of musk, and that is in several circumstances of gout." When the gout falls upon the stomach, musk, accord- ing to this writer, is an invaluable remedy. In retro- cedent gout, affecting the stomach, lungs, or head, large doses are said to give very speedy relief. Hav- ing never used it in this disease, I can say nothing either for or against its employment. In the advanced stage of typhus, when great debility, subsultus tendinum, tremors, hiccup, delirium, pale urine, pale and cold skin, and a frequent, small, and corded pulse are present, musk is one of our most valuable remedies. It is also a very useful medicine in the typhous stage of the exanthemata, as well as in the latter stages of peritonitis, enteritis, and pneumo- nia, when typhoid symptoms supervene. Schmidt; a very respectable German writer, says that musk is particularly useful in the typhus of habitual drunk- ards. Musk is said to afford much relief in the morbid vigilance, which sometimes attends hypochondriasis. It has also been recommended in vertigo unconnected with any evident fulness of the cerebral vessels. This remedy has been employed with advantage in combi- 150 ANTISPASMODICS. nation with opium or ammonia, to check the progress of mortification.* Musk is generally given in substance, in doses of from six to thirty grains, repeated according to cir- cumstances. It may also be exhibited in the form of ajulep.f There is an article made with the oil of amber and nitric acid, which having nearly, if not altogether, the powers of musk, has received the name of artificial musk. It is made by pouring three and a half drachms of nitric acid on one drachm of ol. succini, and then carefully washing the product. This substance ap- pears to be nearly equal in all respects to the natural musk, and is given in the same dose. In pertussis it has been highly recommended; and I have, in my own practice, found it decidedly useful in this dis- ease. * Observations on Gangrenes, Mortifications, &c. by C. White, F.R.S. 1790. 11$, Mosch. 3H. Sacch. albi. §i. Pulv. g. arab. 3ii- Aq. font. gvi. M. Dose, a table-spoonful every two or three hours. ANTISPASMODICS. 151 CASTOR. This substance is obtained from a small animal found in Canada, Poland, Russia, Siberia, the north of Germany, &c. and known to naturalists by the name of castor fiber. Near the anus of this animal, there are four small membranous bags, two of which are principal, the other two accessory. These bags contain a fluid which thickens on being exposed to heat, and forms an unctuous concrete substance. It is this substance which forms the castor. The castor has a brownish black colour, possess- ing a peculiar penetrating, disagreeable odour, and a taste somewhat bitter and sharp. The best cas- tor is brought from Russia and Poland; it comes to us in large black bags, and has a very strong odour. It contains volatile oil, resin, mucilage, extractive matter, iron, and small portions of the carbonate of potash, lime, and ammonia. It contains also, accord- ing to the analysis of Laugier^ a small portion of ben- zoic acid. Castor was formerly esteemed as one of the most active articles of this class of remedies. Its reputation, however, as an antispasmodic does not seem to be considerable at the present day. It was at one time regarded as possessing narcotic properties, but this opinion appears to be entirely without foundation 152 antispasmodics. In combination with asafoetida and aether, F have very frequently employed it in hysteria. I have also occasionally given it by itself with considerable ad- vantage in hysteric affections. To derive any advan- tage from it, however, it should be given in very large doses. Instead of giving from thirty to sixty drops of the tincture, as is commonly directed, I generally ad- minister from two to three tea-spoonfuls of it at a dose. It often affords considerable relief in spasmodic and flatulent colic. It has also been recommended in asth- ma, epilepsy, vertigo, and in the delirium of typhus. Burdach speaks well of its employment in irregular labour pains. Dr. M. Morris, physician to the Westminster Hos- pital, speaks very highly of the efficacy of this article in combination with Peruvian bark, in the cure of hooping-cough. He gave eight grains of castor and fifteen of the bark every four hours, with perfect suc- cess.* Alcohol and proof spirit extract its active properties; water does so but feebly. It may be given in the form of tincture or in substance. ♦Medical Obser. and Inquir. vol.'iii. p. 28o antispasmodics, 153 alium sativum. This is one of the most diffusive vegetable stimu- lants we possess. Taken into the system its peculiar odour very soon manifests itself in the perspiration, the urine, and the pulmonary exhalation. It contains an acrid aetherial oil, which readily inflames the skin, a viscid gummy substance, a sharp extractive matter, resin, and some salts.* Garlic does not appear to possess any very impor- tant powers as an antispasmodic. It is, nevertheless, sometimes of considerable advantage in cases where expectorant and antispasmodic remedies are indica- ted. It is accordingly recommended in spasmodic asthma; and in pertussis and croup it is much in use as a domestic remedy. It cannot, however, be em- ployed with safety in these diseases until the inflam- matory symptoms have been subdued by depletory measures. In the advanced stage of croup, when the disease has lost its acute character, I have employed it, while practising in the country, with considerable advantage. In chronic catarrhal affections, attended with a cold, phlegmatic habit of body, this article is often very serviceable. ' Pfaff. vol. ii. 20 154 antispasmodics. It is also recommended in the treatment of hys- teria, gastric pains from flatulency, and nervous tre- mors. Dr. Chapman asserts that it is an exceedingly useful remedy in those vertiginous affections which sometimes trouble gouty and intemperate persons. Its employment in the cure of intermittents, though sanctioned by the authority of Bergius, is of very little consequence. Garlic may be ranked, in this respect, with that host of unimportant articles which have at one time or other been employed to cure agues, and which, though no doubt sometimes serviceable, have not sufficient power to entitle them to any particular consideration. Lind and Cullen recommend garlic in the cure of scurvy; and Sydenham speaks well of its powers in dropsy. This substance is a very common domestic remedy for the expulsion of worms. I have known it to be given with decided advantage for this purpose. It is generally administered in the form of a decoction, with milk, on an empty stomach. VALERIANA. There is perhaps no medicine which has been more extravagantly praised on the one hand, and ANTISPASMODICS. 155 neglected on the other, than valerian. In some of the modern works on the materia medica it is not even mentioned, whilst in others its virtues are greatly ex- tolled. That it possesses medicinal powers worthy of very considerable attention is, however, too well established to admit of a reasonable doubt. The valerian is a perennial plant, indigenous to England and Germany. The root, which is the only part employed for medicinal purposes, is fibrous, with a central knob, and possesses a strong, peculiar, and unpleasant odour, and a warm, bitter, and sub-acrid taste. It contains gum, resin, fecula, extractive mat- ter, and an essential oil possessing the peculiar odour of the root, but is considerably milder in taste. The root of this plaut, when growing on a dry and elevated soil, contains much more essential oil, and is therefore stronger than that which is found growing in low and moist grounds. It loses much of its strength by being kept long, and it ought to be preserved in closed vessels. In its general operation it acts as a stimulant, producing considerable antispasmodic ef- fects. It excites the action of the heart and arteries, promotes perspiration and diuresis, and when taken in very large doses, produces anxiety, vomiting and purging. For some time after Fabius Columa had cured himself of epilepsy by means of this substance, it was regarded as almost a specific in this disease. A 15b" ANTISPASMODICS. more extensive experience, however, showed that, though not destitute of valuable properties, its powers had nevertheless been greatly overrated. At present, indeed, its reputation in this disease seems to be al- most entirely gone. Alibert states, that he tried it with a number of epileptic patients in the hospital St. Louis, and he assures us, that during an experience of six years, he obtained nothing but negative re- sults.* By Quarijk however, this medicine is highly recommended in cases of epilepsy in infants, depend- ing on some irritation; as, for instance, the irritation produced by worms in the stomach and bowels; and Burdachf says, that it is particularly applicable in cases of this disease depending on a suppression of the catamenia in young females. In hemicrania and vertigo assuming a regular pe- riodical form, valerian has been recommended as an efficacious remedy by Cullen. Dr. Barton, also, adds his testimony in favour of its employment in this af- fection. Cullen, who placed considerable reliance in its antispasmodic powers, speaks favourably of its use in hysteria and other spasmodic diseases. In chronic hysteria in females of a cold, phlegmatic tem- perament, valerian in combination with bark is a valu- able remedy. I have employed it in such cases with * Elemens de Thferapeutiques, &c. t Burdach's Arzneymittellehre, B. iii. p. 342. ANTISPASMODICS. J 57 evident advantage. Hill,* who wrote a small book on the employment of this remedy in nervous dis- orders, speaks very highly of its powers in such com- plaints. In every form of asthenic fever, valerian may be very generally employed with advantage. In typhus or nervous fever, either in its simple or complicated form, when there exists a spastic condition of the sys- tem, characterized by a small, quick, and frequent pulse, a rapid and short respiration, cold and pale skin, trembling and delirium, it has been recommended as very useful, when given in large doses and combined with ammonia or bark. Vaidy considers it prefer- able to the cinchona in this disease. It appears, how- ever, well established by the extensive experience of M. Chaumeton, that it is, upon the whole, consider- ably inferior to this latter article.f A decoction of this root, administered in the form of a clyster, is strongly recommended by Horn, for the relief of tormina and tenesmus. It has also been much employed as a remedy in gutta serena. Both Richter and Smucker speak favourably of its virtues in this disease. It is best given in substance. The dose of the pow- der is from 3ss. to 3iii. three or four times a day. It * Valerian, or the Virtues of that Root in nervous Disorders London, 1758. 8vo. f Alibert, Elemens de Therap. torn. ii. p. 119. 158 ANTISPASMODICS. may also be given in the form of tincture, in the dose of 3ii.—gss. The infusion formed of 3ii. of the root to gvii. of water, is given in the dose of §ii. two, three, or four times a day. Decoction impairs the powers of this article. The ammoniated tincture is a very useful preparation. Its dose is 3ss.—5ii. twice a day. SYMPLOCARPUS FffiTIDA.--SKUNK-CABBAGE. This is a very common plant in the United States. It grows in wet and marshy situations, and is easily recognised by its exceedingly offensive odour, being almost entirely similar to that of the skunk or polecat. The inflorescence which appears in April, consists of a boat-shaped, inflated spathe, variegated with red and yellow spots, acute and incurved at the top, con- taining an oval spadix, having perfect tetrandrous flowers. The fruit, which consists of the maturated spadix, is a globular fleshy mass, containing large oval seeds. The spathe, with its spadix, is the first part of the plant which appears above ground; the leaves afterwards shoot forth, and bear some resemblance to those of cabbage. This plant is perennial. The skunk-cabbage possesses very considerable antispasmodic powers. Shoepf, speaking of the root antispasmodics. 159 of this plant, calls it " incidens, califaciens, expecto- rans," and mentions it as useful in phthisical coughs. As a palliative in the attacks of spasmodic asthma, it is very highly recommended by the Rev. Dr. Cut- ler and others. I have, in several instances of this disease, derived very considerable advantage from the employment of this remedy. The powdered root, in the dose of from thirty to fifty grains, is to be given during the paroxysm, and repeated according to the urgency and obstinacy of the symptoms. The medi- cine ought to be continued for some time after the paroxysm has entirely subsided. Dr. Thatcher of Boston, states, on the authority of a correspondent, that two tea-spoonfuls of the pow- dered root of this vegetable, gave very promp: and effectual relief in a case of hysteria, after the ordinary remedies for such cases had been used without bene- fit. The same writer states that it has afforded much advantage in chronic rheumatism, in wandering spas- modic pains, and in hooping-cough. In chronic cough attended with a cold, phlegmatic habit of body, I have employed the powdered root of this plant with the most decided benefit. In an old man, who had been for many years afflicted with a very troublesome cough and difficulty of breathing, I found r>< ammon. carbonat. 3SS< acl' menth. pep. 3vii. syrupi aurantii 5ss. M. sumatur octava pars. R ammon. carbonat. 9'iiss. G. arab. Sacch. albi aa. $i. aq. cinnam. iii. aq. font. 3iii« Dose a table spoonful. STIMULANTS. 179 and nitric acids, nitrate of silver, acetate of lead, muriate of mercury, sulphate of zinc, tartarized iron the fixed alkalies, lime, alum, magnesia and sulphate of magnesia. OLEUM TEREBINTHIN.&. This is a limpid essential oil, possessing a strong penetrating odour, and a hot, bitter and pungent taste In hot alcohol it dissolves without difficulty; but on suf- fering it to cool, it again separates. It is completely soluble in six parts of sulphuric aether. It unites with sulphur, wax, resins, and balsams, when ex- posed to a gentle heat. The alkalies have no action on it. The oil of turpentine is an exceedingly active and penetrating stimulus; and admits of a great variety of important remediate applications. As a general stimulus in the low states of fever the turpentine is but seldom prescribed. It has however been recommended in the treatment of yellow fever, by some practitioners both of the West Indies and of the United States. Dr. Physick was, I believe, the first who employed it in this disease. He prescribed it, with much benefit, for allaying the irritability of the stomach, and consequent violent vomitings, which 180 STIMULANTS. occur in this fever. It does not appear however, from the experience of other practitioners, that it deserves any very particular notice in this respect. Lately the oil of turpentine has been much recom- mended as a remedy in puerperal fever. Dr. Brennan of Dublin was the first who administered it in this disease, and his report of his experience with it is very favourable.* Other English practitioners have since employed it with benefit in this dangerous ma- lady; but I am not aware of its having, as yet, been employed with any particular advantage by the physi- cians of this country. In genuine puerperal peri- tonitis, I should, indeed, be very unwilling to employ this stimulant. It is not improbable, I think, that the cases in which it has been given with success, were of that variety of puerperal fever which seems to depend entirely on intestinal irritation, and which simulates, very perfectly, genuine puerperal peri- tonitis. In the treatment of epilepsy the spirit of tur- pentine is a valuable medicine. Dr. Latham speaks in high terms of its effects in this disease; and Dr. William Money, surgeon to the Royal Metropolitan Infirmary for sick children, employed it with much advantage in cases of this kind;f Dr. Paris also thinks * Transactions of the Fellows and Licentiates of the King and Queen's College of Physicians of Dublin. t Medico-Chirurgical Review and Journal, Sept. 1822, p. 451. STIMULANTS. Jg| it may prove beneficial in cases of this kind by un- loading the bowels, and by the peculiar cerebral ex- citement which it produces, when given in large doses, and which is evinced by a species of intoxica- tion, " unaccompanied by that hilarity and elevation of thought that so usually follow the potation of spi- rituous liquors. I am inclined to believe, however, that it often acts beneficially in cases of this kind by destroying worms in the alimentary canal, a very frequent cause of epilepsy. Turpentine is a medicine of very considerable utili- ty in chronic rheumatism. In sciatica, especially, it was employed with much success by Dr. Cheyne and Dr. Francis Home.* Of its efficacy in this form of rheumatism I have, in several instances, had unequi- vocal evidence. Cheyne gave it with honey, in doses of from one to four drachms, three times a day. Home, however, used it in much smaller doses, and his sue cess was not less than that of Dr. Cheyne. I have commonly given from twenty to thirty drops, three times a day, on sugar, and at the same time directed frictions with the camphor liniment, recommended by Home and Ferriar, for lumbago.f This remedy has lately been much extolled for its efficacy in removing obstinate obstructions of the * Clinical Experiments. t Pulv. camph. ^ii. Ungt. basilic. 5i. sapon. commun. 5iss. pulv. scm. sinap. "j)i. Fiat unguent. 182 STIMULANTS. bowels. Dr. Kinglake gives an account of two cases in which the turpentine manifested decidedly bene- ficial powers. The first case was one of extreme obsti- nacy ;" bleeding, the warm bath, blistering, lenient and brisk cathartics, with repeated clysters, were assidu- ously but unavailingly used. The case appeared almost hopeless, when the spirit of turpentine was adminis- tered in doses of two drachms, conjoined with half an ounce of castor oil, every two hours. The first and subsequent doses, to the number of four, remained on the stomach, when full and complete catharsis was produced."* Dr. Paris also adds his testimony in favour of the utility of turpentine in cases of this kind. " In obstinate constipation depending on affections of the brain, I have lately had several opportunities of witnessing its beneficial effects. In an unfortunate instance of hydrocephalus acutus, in a boy of thirteen years of age, it brought away an accumulation of feculent matter almost incredible as to quantity, after the total failure of the strongest doses of ordinary pur- gatives."! In chronic cases, attended with flatulence, acid eructations, a sallow countenance, a foul tongue, with griping and acrid stools, the oil of turpentine will frequently produce highly beneficial effects. Dr. Prichard declares, that he never employed any reme- * Lond. Med. and Plus. Jour. No. 271. t Pharmacologia, p. 540. STIMULANTS. 1Q3 dy with so much benefit as oil of turpentine, in cases attended with such a state of the bowels. " It occa- sions moderate and regular evacuations, corrects the tendency to a frequent repetition of griping and irri- tating stools, and relieves, or completely removes flatulence. At the same time the oil of turpentine exerts a peculiar sedative or tranquillizing power on the nervous system; it lessens irritability, the disposi- tion of starting and convulsive twitching of the mus- cular fibres, and promotes sleep."* Formerly the spirit of turpentine was frequently employed in hepatic obstructions, and especially in jaundice from the obstruction of the bile-ducts by biliary concretions. Its use in these affections is now, however, entirely neglected. In the treatment of obstinate gleets, turpentine, ad- ministered internally, will often produce very good effects. I have also known it to be employed with success in gonorrhoea; but in recent cases it is too irritating to be early given in this affection. As an external remedy turpentine admits of a great variety of useful applications. In the treatment of burns and scalds it is undoubtedly a remedy of great utility. Kentish, who first employed the turpentine in cases of this kind, directs that it be mixed with a portion of basilicon ointment, with which pieces of linen are to be spread, and laid on the injured part, be- * Prichard on Diseases of the Nervous System, p. 26". 184 STIMULANTS. ing careful not to let tfie ointment extend over the sound skin. When this is done very soon after the burn has been received, it hardly ever fails, in a short time, to remove the burning^ain and violent inflamma- tion of the part, and to establish a regular suppuration. Mixed with oil, and introduced on cotton into the ears, turpentine has been found serviceable in deaf- ness arising from a diseased action of the cerumini- ferous glands.* I have already spoken of the vermifuge powers of this article, under the head of Anthelmintics; and I shall hereafter again have to notice it when I come to speak of rubefacients. As an anthelmintic, turpentine is given in doses of from one to three ounces. When used as a stimulant or diuretic, it is given in doses of from ten to forty drops. Two ounces of the oil, incorporated with a pint of mucilage, forms a very valuable clyster, in ob- structions of the bowels and flatulent colic. Dr. Nimmo recommends the following method for purifying the oil of turpentine for medicinal use, "without diminishing its efficacy, but greatly lessening its disagreeable taste and its injurious effects upon the kidneys: To eight parts of the oil add one part of the strongest alcohol, and let them be well agitated; in a few minutes a separation takes place; the oil, unless very impure, falls to the bottom, and the alcohol, hav- * Paris' Pharmacologia. STIMULANTS. J 35 ing dissolved the impurities, floats at the top. Pour off the alcoholic portion, add an equal quantity of alco- hol as before, agitate and separate the liquids. If this be repeated three or four times, the oil becomes nearly tasteless, almost without smell, and when a portion of it is evaporated, it leaves no residue. The oil, how- ever, speedily undergoes alteration, and returns to its original state of greater or less impurity." PHOSPHORUS. Phosphorus is a compact substance, of a pale yel- low colour,, readily cut with a knife, and exhibiting when broke a vitreous fracture. It is exceedingly combustible, inflaming at the medium temperature of the atmosphere. It has an acrid taste and a strong alliaceous odour. It becomes fluid when put into hot water, and assumes the appearance of an oil. Alco- hol and water do not dissolve it; but in the essential and fat oils, and in sulphuric aether, it is quite soluble. Phosphorus is one of the most active and penetrat- ing excitants with which we are acquainted; produc- ing, when incautiously taken, exceedingly violent and dangerous effects. When rubbed upon the skin it immediately creates a burning pain and inflammation of the part to which it is applied. Taken inwardly, vol. 11. 24, 186 STIMULANTS. in the dose of from one-eighth to one-fifth of a graie> it produces an agreeable warmth, and temporary vigour of the powers of the system, and increases very considerably the secretion of urine. In somewhat larger doses it produces restlessness, heat, an irritated and feverish pulse, furred tongue, engorgement of the vessels of the head, stricture and dryness in the breast, violent burning and pain in the stomach, nausea, and bilious vomiting. Two or three grains produce ex- cruciating burning pains in the stomach and bowels, attended commonly with distressing vomiting and hic- cup; a sinking of the powers, the pulse becoming gradually imperceptible, and the whole surface of the body cold, and death. The inflammation in the sto- mach and bowels is generally of small extent. The stomach is commonly found much distended, and the intestinal canal closely contracted in different places. It is said, that when given even in moderate doses, it is apt, on being long continued, to produce indurations of the stomach, chronic vomiting, constipation, atrophy, and death. Weikard states, that he once gave to a paralytic patient two grains of phosphorus incorpo- rated with some conserves. On the following day the dose was increased to three grains, and he proposed augmenting the dose progressively, when all at once, on the third night, the patient was seized with violent contractions. Blisters were applied, and copious draughts of mucilaginous drinks given. Nevertheless STIMULANTS. 187 the patient sunk and died on the fourth day.* Brera relates a similar occurrence in his practice. He ad- ministered two grains to a paralytic woman. After the first dose she appeared to be better; on taking the fourth dose, however, she began to complain of violent burning pain in the stomach and bowels, and in forty- eight hours after, she died.f Mentz, a German physician, is said to have been the first who published any thing relative to the remediate employment of this article. J It is highly recommended by some authors in the treatment of typhus fever. Lobstein says, that when given in this disease the ef- fects frequently appear after four hours, but sometimes not till twenty-four. "The vital warmth returns, transpiration is restored, the pulse improves, the urine is voided freely, and commonly turbid, with a sedi- ment; the abdomen loses its tension; the excrements have a sulphureous smell, and shine in the dark; the delirium ceases, and the patient recovers his recollec- tion, the mental faculties return, and a beneficial sleep restores the strength in a few days."§ I do not doubt * Alibert, Matiere Medicates, &c. vol. i. p. 192. t Brera Rifflessione Medico-prattishe sull' uso interno de Fosforo. Pavia, 1798. | Menzius, Dissertatio de Phosphori loco Medicinae Assumti Virtute Medica. Wittemb. 1751,—in Haller's Disp. Pathol. torn. vii. p. 288. § J. F. D. Lobstein Recherches et Observations sur le Phos- phore a Strasburg, 1815. Vid. Lond. Med. and Phys. Journal, for October, 1816, 188 STIMULANTS. that its cautious use in the latter stages of this disease may often be followed by salutary consequences. Still, however, as it is an exceedingly active substance, and apt to produce dangerous effects when improperly taken, its use should not be ventured on without the utmost caution. Burdach states that it is especially efficacious in the typhus of the exanthemata, where the eruption has receded or does not come out suffi- ciently, from deficiency of action in the system. Phosphorus has also been given with success in spasmodic and convulsive diseases. Handel mentions several cases of epilepsy which were cured by this remedy. He relates the case of a girl who had fre- quent attacks of epileptic convulsions, and who was entirely freed from the disease by taking, in a mistake, some water out of a vial containing phosphorus. In- structed by this case, he says that he afterwards gave it to other epileptic patients, and with much success.* Alibert, on the contrary, states that he gave this sub- stance in one-grain doses, every twenty-four hours, to six epileptic patients, and continued its use for nearly two months, not only without deriving any advantage, but, in the majority of cases, with evident injury. Lobstein, who appears to have paid great attention to the remediate employment of phosphorus, attributes the dangerous effects which have been observed to arise from its use, to the improper mode in which it * Alibert, Mat. Med. vol. i.p. 192. STIMULANTS. jgg has been usually administered; namely, in pills, elec- tuaries, or emulsions. Its beneficial effects, he ob- serves, are only produced when the remedy is com- pletely dissolved in its vehicle. He found, from much experience, he says, that its solution in vitriolic aether, with the addition of some aromatic essential oil, is a safe and convenient mode of exhibiting this medicine. From one-eighth to one-fourth of a grain of the phos- phorus may be thus given at a (lose; and experience has shown, that one grain in twenty-four hours is, for the most part, quite sufficient. It is said that phos- phorus agrees much better, and can be borne in larger doses, when the atmosphere is dry and clear, than in cold and damp weather. " It ought never to be taken on an empty stomach, but always an hour after the patient has taken nourishment; salad and acid food, and drink in general, even beer, is improper. To quench the thirst, a mucous solution of salep, with sweet and generous wine, is the best beverage; the patient must also refrain from drinking immediately after having taken phosphorus. In acute diseases, where there is commonly but little appetite, broth, with a little nutmeg, or vermicelli, sago, &c. may be taken; but in chronic disorders, where digestion is not impaired, veal, beef, and mutton, either boiled or roasted; also light vegetables, such as carrots, French beans, &c. are a fit diet. Cabbage, turnips, onions, radishes, rape, cole, peas, &c. must be avoided, caus- 190 STIMULANTS. ing a sensation of fulness in the region of the stomach, together with anxiety, insupportable heat, and often vomiting and diarrhoea. The food must neither be too hot nor too cold. In case the patient go out, it is of the greatest importance to be on his guard against catching cold, which is apt to occasion vertigo and diarrhoea, or a relapse."* From what we know of this substance, therefore, there is much reason to believe, that, in the hands of a prudent physician, and employed with the precau- tions mentioned above, it will be found a safe and valuable remedy. ALCOHOL. This is a colourless and transparent fluid, obtained from vinous liquors by distillation. Its specific gravity is .815. It boils at the temperature of 176°, and does not congeal at any known degree of cold. It burns with a pale blue flame, and leaves no residue. In a state of perfect purity, alcohol consists of a combina- tion of carbon, hydrogen, and oxygen. " It dissolves soap, vegetable extract, sugar, oxalic acid, camphoric. * Lond. Med. and Phys. Jour, for Oct. 1816. See also Lob- stein's Monograph, already referred to, and Lobstein Lobel's Observations, in Horn's Archiv. 1810, B. ii. No. 2. STIMULANTS. jgj tartaric, gallic, and benzoic acid; volatile oils, resins, and balsams; it combines also with sulphur and the pure fixed alkalies, but not with their carbonates." Alcohol is an exceedingly active and diffusible stimulus. The effects which arise from its influence on the living system, are so well known that it would be superfluous to give a description of them. Brodie, who made experiments with alcohol on living animals, concludes that it is not absorbed, and that its general effects depend on a sympathetic impression on the brain by means of the nerves of the stomach. This he infers from the following facts: 1. Animals that die from the action of alcohol exhibit a decided inflam- mation of the stomach, but the brain is never found inflamed. 2. The effects produced by this fluid fol- low its application so rapidly that it would seem im- possible that there could be time for its absorption. 3. Persons labouring under the influence of spirituous liquors are frequently restored by vomiting. 4. When alcohol is introduced into the stomach, combined with rhubarb, this latter substance can never be detected in the urine when examined after death.* According to the experiments of Orfila, however, it would appear that alcohol is sometimes absorbed into the circulation; and this opinion is corroborated by other authenticated facts.f Be this as it may, it is evident that the phe- * Philosoph. Trans, for the year 1811, p. 178, first part. \ A singular fact of this kind is related by Dr. Cook, in his 192 STIMULANTS. nomcna which result from an over-dose of alcohol, depend directly on the action which it exerts upon the sensorium commune. The effects which alcohol produces are, indeed, very analogous to those which arise from concussion or compression of the brain; and it is not improbable that the symptoms which arise from large draughts of alcoholic liquors, depend mainly on the inordinate flow of blood which they determine to the vessels of the brain, and the conse- quent compression of this organ. Alcohol in its pure state, is seldom employed as an internal remedy. In the various forms of ardent and vinious liquors, however, it is an exceedingly com- mon remedy in all cases of general debility unac- companied by local inflammations. In the treatment of typhus fever, brandy and wine have long been con- sidered as a principle remedy. When the stage of excitement is over, and stimulants are indicated, there Treatise on Nervous Diseases,* on the authority of Mr. Car- lisle : " A few years ago," says Dr. Cook, " a man was brought dead into the Westminster Hospital, who had just drunk a quart of gin for a wager. The evidence of death being quite conclu- sive, he was immediately examined, and within the lateral ven- tricles of the brain was found a considerable quantity of a limpid fluid, distinctly impregnated with gin, both to the sense of smell and taste, and even to the test of inflammability. The liquid appeared to the senses of the examining students as strong as one-third of gin to two-thirds of water." * Vol. i. p. 221. STIMULANTS. igy is, indeed, no remedy more grateful and beneficial than the prudent use of generous wine. Where the prostration is great, it may be given in very large and repeated doses without inducing the slightest intoxi- cating effects. Whenever this is the case, and it pro- duces a fuller, stronger and slower pulse, and renders the skin moist and of a natural warmth, we may be assured that its influence is beneficial. If, however, it render the pulse more frequent and corded, flush the countenance, and induce restlessness, delirium, thirst, and a dry and burning skin, then its effects will be injurious, and we are admonished of the necessity of at once laying aside its use. Wine has been employed with much advantage in tetanus. Rush says, " it should be given in quarts, and even in gallons, daily." Currie saw a patient cured of this disease, in the Liverpool Infirmary, " by drinking nearly a quarter cask of Madeira wine." Dr. Hosack also speaks highly of wine in this disease, and advises its being given without any other stimu- lant* In the chronic form of bowel complaints, the use of the red wines, particularly of port, is almost inva- riably attended with salutary effects. The slight astringency which these wines possess, renders them peculiarly serviceable in such cases, and wherever a * Rush's Medical Inquiries, vol. i. p. 186. vol. 11. 25 194 STIMULANTS. stimulus is indicated and a looseness of the bowels exists, they ought never to be neglected. During the state of convalescence, from acute diseases, when the vital powers return slowly to their wonted vigour, wine may be employed with very great benefit. In the debility of old people, wine is especially useful; Pliny, speaking of its salutary effects, says: ....-.....vino aluntur vires, sanguis Calorque hominum. And it has indeed been emphatically called, uthe milk of old age." In relaxed and cachectic subjects, the moderate enjoyment of wine is commonly attended with very agreeable and salutary effects. It imparts vigour to mind and body, and infuses a genial glow throughout the whole system. Ovid well understood its benign influence. Vina parant animos, faciuntque caloribus aptos, Curafugit multo, diluiturque mero. Tunc veniunt risus, tunc pauper cornua sumit, Tunc dolor et curse, rugaque frontis abit, Tunc aperit mentes aevo rarissima nostro Simplicitas, artes excutiente Deo. Alcohol is also used as an external application to sprains and rheumatic swellings; diluted with water, it has been much recommended as an application to burns. STIMULANTS. ] 95 CAPSICUM ANNUUM.—RED PEPPER. This is a native of South America; cultivated in large quantities in the West-India islands, and fre- quently also in our gardens, for the beauty of its red pods. The taste of the pods, which are the only parts of the plant employed either for medicinal or economical purposes, is exceedingly pungent and acrimonious. They contain an oily matter, extractive and fecula. Oersted has obtained the acrid principle of pepper separately, which appears to possess some of the characteristic properties of an alkali. The virtues of the capsicum are entirely extracted by alco- hol and aether. This substance is an active and agreeable stimulus, and admits of very useful remediate applications. Bergius recommends it as an effectual remedy in obstinate intermittent fevers, connected with much debility and torpor of the digestive organs and intes- tinal canal. Capsicum has also been prescribed in the latter stage of typhus; and in certain circumstances of this disease, it undoubtedly is a very useful remedy, as I have in several instances experienced in my practice. When the alimentary canal becomes torpid, and ceases to expel the flatus, giving rise to symptoms of tympanitis, the capsicum with spirits of turpentine, 19b' STIMULANTS. has afforded me very great advantages. I do not think, however, that this article is well calculated to answer our purposes, where we wish merely to ex- cite the general powers of the system. It is, as Dr. Chapman correctly observes, more a local than a ge- neral and diffusive stimulant, and answers therefore exceedingly well, where general debility is accom- panied by much torpor or relaxation of the alimentary canal. In the treatment of cynanche maligna, capsicum has been much recommended, both as a gargle and an internal remedy. Mr. Stuart,* in particular, speaks very highly of its powers in this disease. He directs " two table-spoonfuls of the small red pepper, or three of the common Cayenne pepper, and two tea-spoonfuls of fine salt to be beat into a paste, on which half a pint of boiling water is to be poured, and strained off when cold; an equal quantity of very sharp vinegar being added to this infusion, a table-spoonful every half hour is a proper dose for an adult." Mr. Stephens gave it to four hundred patients labouring under this disease, and "it seemed to save some whose state had been thought desperate." It was also employed with great benefit in this disease by Mr. Collins. He ob- served, that swallowing the infusion produced slight convulsive motions, and, a sensation of heat in the oesophagus and stomach, and in a short time after a * Medical Commentaries, vol. xii. STIMULANTS. I97 general glow over the body was felt, without materially changing the state of the pulse. Mr. Collins also used this remedy successfully in intermittent fevers.* Dr. Makitrick states, that he has found this medi- cine very serviceable "in that morbid disposition which he calls the cachexia africana, and which he considers as a most frequent and fatal predisposition to disease among the slaves." Capsicum has also been used in partial paralysis; and Dr. Wright says, that it is an excellent remedy in lethargic affections. Lately this medicine has been recommended as highly useful in the advanced stages of acute rheuma- tism. About five years ago I employed it in a case of this kind, in large and frequent doses, with evident advantage; and I have heard of other practitioners who have given it in this disease with very favourable results. Capsicum may be given in the form of pills or tinc- ture. The dose of the powder is from ten to thirty grains. * Wilson on Febrile Diseases, vol. ii. p. 141. 198 STIMULANTS. CARYOPHILLI AROMATICI.—CLOVES. These are the unexpanded flower-buds of a beau- tiful tree of the family of myrtles, indigenous to the Molucca islands, and now carefully cultivated by the Dutch, at Amboyna. The whole tree is strongly aro- matic; but the flower-buds, which are collected in October and November, when they are still green, and dried in the sun, after having been exposed to smoke for a few days, are the only parts met with in com- merce,, or employed for domestic or medicinal pur- poses. The taste of cloves is highly aromatic, pungent, and permanent. Their odour is strong, fragrant, and aro- matic. By distillation they yield about one-eighth their weight of an essential oil. Water extracts from them a nauseous and slightly astringent extract, con- taining very little of their peculiar aromatic taste. All its virtues are completely extracted by alcohol and aether. Cloves are the most stimulating of all the aromatic remedies, and may be used with advantage in all cases where we wish to produce a strong local impression on the stomach. They have accordingly been fre- quently prescribed with very good effect in flatulent colic, and in cholera morbus. In the latter affection I have known the tincture of them administered with STIMULANTS. 199 prompt relief to the patient. The cloves are, how- ever, much more commonly employed as adjuncts to other remedies than in an uncombined state. The essential oil is used as a local application in toothach They may be taken in doses of from five to fifteen grains. ZINGIBER.—GINGER. This is the root of a plant* growing spontaneously in the East Indies, and now abundantly cultivated in some parts of the West. The root is tuberous, a little compressed, and marked with irregular prolongations, which often give it a palmated appearance; the surface is of a pale or ash colour, and sometimes purple. Its taste is exceedingly acrid, producing a glowing heat throughout the whole cavity of the mouth. Its odour is highly aromatic, frequently producing sneezing when held to the nose. It contains, according to Vauquelin, a peculiar acid, a resino-extractive matter, fecula, and an essential oil. The watery and alco- holic extracts are extremely acrid. Ginger is a powerful, but not very diffusible stimu- lant, and appears to possess very useful remediate powers. In an atonic and torpid state of the alimen- * Amomum Zingiber, Linn. 200 STIMULANTS. tary canal, attended with colic pains and other dys- peptic symptoms, ginger often affords very great re- lief. The dyspeptic symptoms and pains in the sto- mach which are common in gouty persons are fre- quently much relieved by taking the infusion of this root. It has also been employed with success in the cure of intermittent fevers accompanied with torpor of the abdominal viscera;* and in hooping-cough, where the lungs are much oppressed with slime, it is said to be a remedy of very considerable utility. It is usually given in the form of an infusion. By decoction its aroma is dissipated. The dose of the powder is from ten to twenty grains.f PIPER NIGRUM.—BLACK PEPPER. Pepper contains, according to the analysis of Pfaff, a mild essential oil, having the peculiar odour of the pepper: a dark brown extractive, possessing no acri- mony; and a green, acrid, inflammable resin. Alco- * Burdach. t Ginger Beer.—" The following is the receipt by which this popular beverage is prepared : Take lump-sugar half a pound, of cream of tartar half an ounce, bruised ginger an ounce, boil- ing water one gallon. Ferment for twenty-four hours with yeast." STIMULANTS. 201 hol and aether extract all its virtues, but water docs so only partially. Pepper is a very permanent and general stimulant, and may be employed in a variety of cases with con- siderable advantage. Lately it has been recommended as an efficacious remedy in intermittent fever. Dr. Louis Frank, privy counsellor and principal physician to her majesty Maria, duchess of Parma, has published a summary of his experience of the utility of black pepper in this disease, from which it appears that its powers in this respect are not inconsiderable. Dr. Frank states, that by the use of this remedy fifty-four out of seventy patients were completely cured in a short time, without relapse. The mode in which he gave the pepper was, to dip the seeds into mucilage of gum arabic, and afterwards into some powdered colomba to disguise it, and then to administer them as pills. The dose is from five to eight pills twice a day.* None of his patients required more than from seventy to eighty pills for perfect recovery. In an atonic and torpid state of the intestinal canal, a few grains of pepper swallowed two or three times a day, are often very beneficial. Pepper has also been employed in chronic rheumatism with good effects. It is, however, more frequently given in combina- tion with other substances, particularly with tonic * Journal Complementaire du Dictionnaire des Sciences Medicales, No. 22. vol. ii. 26 202 STIMULANTS, bitters; and it may be thus employed with much ad- vantage in weakness of the digestive organs, paralysis. and intermittent fever.* * Ward's celebrated paste for fistula and piles, contains a large proportion of pepper. It is thus prepared : Take black pepper and elecampane, powdered, of each fviii. powdered fennel seeds |xxii. honey and sugar, of each tbi.; beat, and mix them well together in a mortar. Dose, the size of a nut- meg three times a day. CHAPTER XII. P. MEDICINES ACTING SPECIFICALLY UPON THE ORGANS OF SECRETION, I. Medicines that act on the Cutaneous Exhalants. DIAPHORETICS. These are medicines that increase the natural trans- piration by the exhalants of the cuticular surface. When they augment this discharge to such a degree as to produce sweat, they are called sudorifics; the term diaphoretic being usually applied to such articles as increase the insensible perspiration. But as these two terms express simply a stronger or weaker opera- tion of the same kind, it is customary in classifications of the materia medica to employ only the latter as a general appellative for the remedies of this class. Obstructed perspiration may depend on very oppo- site states of the general system. We find it connected with high febrile action, and also with a slow and lan- guid circulation. It is evident, therefore, that the re- 204 IMAPHORfcTItS medies which are calculated to restore this function when its defect or loss is associated with high vascular action, must be very different from those which arc calculated to excite it in an opposite state of the sys- tem. In the former case our diaphoretics must be such as have a direct tendency to lessen the action of the heart and arteries, and at the same time relax the mouths of the transpiratory vessels. Hence cold ab- lutions, refrigerants, antimonials, and bleeding are very often directly and manifestly diaphoretic. W^here, on the contrary, torpor of this function is accompanied with a languid circulation, and a pale, shrivelled, and cold skin, recourse must be had to diaphoretics of a stimulant character. Although, perhaps, every stimu- lant may, under certain circumstances, produce sweat- ing, simply by increasing the action of the heart and arteries, yet it must not be supposed that the stimulant diaphoretics act solely by giving a general increase of momentum to the blood, since many of these remedies undoubtedly possess a peculiar tendency, not only to determine the circulation to the capillaries of the cu- ticular surface, without materially augmenting the ac- tion of the heart and arteries, but also specifically to excite the activity of the perspiratory vessels. Dia- phoretics, therefore, act either by relaxing the mouths of the perspiratory vessels, or by increasing their acti- vity, or by establishing an increased flow of blood to DIAPHORETICS. 405 them, or, finally, by at once producing both the former and the latter of these effects. Although many of our diuretics are manifestly sti- mulant in theirprimary operation, yet by the increased evacuation which they produce, they are all ultimately antiphlogistic in their effects. Those of the refrigerent class are eminently so, and they therefore constitute very important remediate means in all acute febrile disorders. It is not, however, simply by the depletion which they produce that they act beneficially in acute affections. Much advantage is undoubtedly derived from the evaporation and consequent abstraction of morbid heat which constantly takes place during dia- phoresis. In this way a very considerable source of irritation is obviated. There is another effect by which these remedies do good, especially in the inflam- matory affections of internal organs: By increasing the flow of blood to the skin, they relieve, in some degree, the internal inflamed vessels, and thus, by a kind of local abstraction from the affected organs, often contribute materially to the reduction of the disease. Health is very intimately connected with the regu- lar performance of the perspiratory function. When- ever the transpiration by the skin is suddenly checked, more or less derangement of the system is invariably the consequence. That portion of the circulating fluid which nature designs to be cast off by the cuta- 206 DIAPHORETICS. neous emunctories, as no longer fit for the purposes of the animal economy, is retained, and becomes a source of morbific irritation to the heart and other organs. That obstructed perspiration may prove detrimental to health in this way, can, I think, hardly be doubted; for it is obvious, that the accidental obstruction of any important emunctory must give rise to an accumula- tion of recrementitious elements of the blood, and im- part to it morbific qualities. Frequently the injurious consequences that might result from the retention of the perspirable matter is in part, if not wholly, obvi- ated by the vicarious action of the internal emunc- tories, and particularly of the kidneys. There is, however, another mode in which the sudden repulsion of the perspiratory discharge may excite morbid phe- nomena in the animal economy: It disturbs the regular current of the circulation; the blood retreats to the vessels of the internal organs, giving rise to congestions, inflammation, and fever. One of the most frequent external causes of obstructed perspiration is exposure to a cold and humid atmosphere. When the body is ex- posed to the influence of this cause, the circulation in the sub-cutaneous vessels is immediately and manifest- ly diminished, both in velocity and in volume, and the skin becomes pale, shrunk, and cold. As a natural and necessary result of this condition of the circulation on the surface, the blood is repelled to the internal vessels, and much of that recrementitious fluid which DIAPHORETICS. £07 nature intends, and the welfare of {he economy re- quires, to be cast off by the skin, is retained in the system. There is, therefore, under these circum- stances, a superabundant portion of deteriorated blood forced upon the heart, which, acting upon it as a pre- ternatural stimulus, brings on sooner or later reaction, or the stage of febrile excitement. From the manifest influence, therefore, of the per- spiratory function over the health of the body, it is obvious that those remedies which are calculated to restore the regular action of the cutaneous exhalants, must be of much importance in the cure of diseases. Sudorifics have, indeed, been among the earliest and most common remedies in every nation. Valuable, however, as their judicious employment undoubted- ly is, there is perhaps no other class of medicines which has been so frequently and perniciously abused in the treatment of diseases. Van Helmont and his followers, believing that acute diseases were to be cured by expelling some morbific matter after its pro- per concoction, employed the most stimulating sudo- rifics together with high temperature, in every grade of febrile exacerbation. This practice appears to have been exceedingly common during the seventeenth and early part of the eighteenth centuries. It is easy to perceive that its effects must have been highly per- nicious. It is not, however, to be concluded from this that diaphoretic remedies are injurious, even in the 208 DIAPHORETICS. most vehement febrile excitement. Quite the con- trary, indeed, is the fact; for diaphoresis is, perhaps, always salutary in fevers of high excitement, and the more so in proportion as the arterial action is vehe- ment. The utility or perniciousness of this discharge, in acute disorders, depends on the means that are used to excite it. It is the employment of heating or stimu- lating remedies for this purpose, that renders the prac- tice so injurious. If we elicit perspiration by cool applications, or by the use of diaphoretics of the re- frigerent kind, we in general derive unequivocal ad- vantage from it. Having premised these general observations con- cerning the nature and employment of diaphoretics, I come in the next place to say something relative to their particular application in certain diseases. Dia- phoretics are in general strongly indicated in all those febrile affections which arise from the influence of atmospheric vicissitudes. As the first link in the chain of morbid actions in diseases from this cause, is torpor of the perspiratory vessels, it is always of great consequence to attend to the full re-establish- ment of this important function in their treatment. In the phlegmasiae, diaphoretics are indeed among our most common, and certainly also among our most useful remediate means, when judiciously employed. But it must not be forgotten, that where the febrile excitement runs very high, the stimulating diaphore- diaphoretics. 209 tics will often do injury, unless the inordinate action of the heart and arteries be previously moderated by bleeding, and evacuations from the intestinal canal. It is not so, however, with the refrigerent or relaxing diaphoretics; these may be resorted to with advantage, in fevers of the most violent inflammatory excitement. In the treatment of remittent and continued fevers, diaphoretics are among our most common and useful remedies. A hot and dry skin is invariably attend- ed with augmented distress, in whatever disease it may occur. When this is the case, nothing affords so much relief to the patient as a free flow of the perspiration. In general however it is not necessary to excite copious sweating, as every advantage deriv- able from this source, may be obtained by a degree of diaphoresis just sufficient to keep the skin moist. Before resorting to remedies of this class, the contents of the alimentary canal should be well evacuated. An attention to this is especially necessary in cases where there is reason to suspect the existence of vitiated secretions in the bowels. When the action of the heart and arteries is of a high grade, recourse must be had to cooling applications, and to the refrigerent or relaxing diaphoretics, such as nitre, antimony, acids, &c. But in fevers of low vascular excitement, at- tended with a dry and burning skin, the stimulating diaphoretics must be used, in conjunction with relax- ing applications to the external surface, such as cool VOL. II. 21 210 DIAPHORETICS. or tepid affusions, &c. In the congestive forms of typhus, nothing is of greater importance than the ap- plication of such external means as are calculated to excite the action of the skin and sub-cutaneous vessels. The application of heat, by means of blad- ders or bottles filled with hot water, and the use of rubefacient frictions of the most active kind, tend in a powerful manner to draw from the congested ves- sels of the oppressed internal organs, and to re-estab- lish the equilibrium of the circulation. Although we should endeavour to keep the skin soft and gently moist in every stage of typhus, copious sweating is not to be encouraged, except in the early stages of the complaint, before the system has become greatly de- bilitated. The very intimate sympathetic connection which subsists between the cutaneous surface and the lungs, renders the employment of diaphoretic remedies par- ticularly advantageous in the treatment of the inflam- matory affections of these organs. When the skin is moist with perspiration, the breathing is generally more free, the pain and distressful feeling in the throat less severe, and expectoration easier. In the treatment of acute rheumatism, diaphoretics are very commonly employed, and they are undoubtedly some- times of much service. The advantages, however, arising from copious sweating in this disease, are ge- nerally but temporary. It mitigates, for a while, the diaphoretics. 2\l violence of the pain, but is apt to produce much de- bility, and to render the system exceedingly sensible to the influence of atmospheric vicissitudes. Gentle diaphoresis is not liable to this objection; "and the employment of antimony, in conjunction with calomel and purgatives; or of antimony or ipecacuanha with opium in moderate doses, so as to produce a favoura- ble determination to the surface, is entitled to our fullest regard in this disease."* Some writers have spoken very favourably of the employment of diaphoretics in gout. It will certainly always be useful to preserve a moisture and comforta- ble temperature of the skin; but profuse sweating can seldom be of advantage, and must often do harm by increasing the susceptibility of the surface to atmos- pheric changes. Medicines of this class, as is observ- ed by Dr. Scudamore, are also apt to weaken the digestive organs, a circumstance which is to be par- ticularly avoided in this disease. Whether gout be primarily seated in the stomach or not, it is certain that it is invariably attended by much derangement of the digestive functions, and it is therefore a matter of some importance, when we wish to excite a diapho- resis, to use such articles of this class as have the least tendency to weaken the powers of the stomach. When the skin is hot and dry, much relief may be * Scudamore on the Nature and Cure of Gout and RheU' mat ism. 2\2 DIAPHORETICS. obtained by sponging the body with tepid vinegar and water, by cool drink, and a moderate temperature* I have known a gentleman who always, in his attacks of gout, derived much advantage from a weak infu- sion of the eupatorium perfoliatum, a plant which, along with its diaphoretic, possesses considerable tonic powers. In no class of diseases are diaphoretics more cer- tainly useful than in the bowel affections. Vogeler, Stoll, Akenside, and Bichter, were among the first who particularly recommended sweating in the cure of dysentery. More recently, Dr. Moseley has be- stowed the highest encomiums on the sudorific plan of treating this affection. He affirms, rt that the inter- mittent fever is not cured with more certainty by Peruvian bark, than dysentery by diaphoretics."f As this disease is essentially connected with a con- gested and inflamed condition of the vessels of the intestinal canal, and as there exists a very intimate re- lation between the cutaneous capillaries and those of the internal organs, it is obvious, from the general effects of diaphoresis, that it must prove salutary in this affection. It will not only act as a general depletory measure, but also, in an especial man- ner, derive from the vessels of the affected parts, and thus aid very materially in the reduction of the * Scudamore on Gout. t Treatise on Tropical Diseases. diaphoretics. 21S disease. The influence of the morbid condition of the cutaneous exhalants on those of the bowels, and vice versa, is often manifested in a very conspicuous way. We observe, for instance, dysentery, diarrhoea, and inflammation of the bowels to ensue from the sudden suppression of perspiration; and on the con- trary, these diseases, from whatever cause they may arise, are almost invariably attended with a dry skin. By exciting the cutaneous emunctories in these affec- tions, therefore, we break the chain of morbid actions, equalize the circulation, and give an exit to those recrementitious matters which nature designs to be cast off by the skin, and whose retention cannot but prove injurious to the animal economy. Useful, there- fore, as the operation of appropriate diaphoretics evidently must be in dysentery, general experience does nevertheless not warrant us in attributing to them all the efficacy in this disease which some wri- ters, and particularly Dr. Moseley, have ascribed to them. In cases which arise from the sudden appli- cation of cold to the body, sweating is undoubtedly our chief remedy. In the ordinary autumnal dysen- teries, however, or in such as arise from the influence of marsh miasmata, our principal attention must be directed to the biliary organs, and to evacuations from the intestinal canal. After the contents of the bowels have been sufficiently evacuated by mild mercurial purgatives, and bleeding premised if the 214 diaphoretics. febrile excitement run high, diaphoretics are always highly useful. For this purpose small doses of opium, ipecacuanha and calomel answer exceedingly well. This combination tends at once to allay the local irritation and pain of the bowels, to correct the biliary secretion, and to determine the circulation to the surface and excite diaphoresis. What has just been said of the utility of diaphoretics in dysentery, may be applied with equal force to the treatment of diarrhoea. But as in this disease the intestinal exhalants are rather in a relaxed than in an inflamed state, diaphoresis \i not often adequate of itself to give substantial relief. In addition to those remedies which excite the cutaneous emunctories, and determine the circulation to the external surface, it is generally necessary, also, to resort to such means as are calculated to restore tone to the intestinal ex- halants; such as astringent and absorbent remedies. Where the diarrhoea depends on vitiated secretion, either of the biliary organs or intestinal glands, neither sweating nor astringents are of much service, unless they are aided by alterative doses of mild mercurial remedies. In the treatment of cholera infantum, much advan- tage may always be obtained by exciting the action of the skin. Here however we can seldom employ diaphoretic remedies,, on account of the extreme irritability of the stomach, characteristic of this dis- diaphoretics. 115 ease; and we are therefore obliged, for this purpose, to resort to external means, such as frictions, with stimulating or mildly rubefacient articles, the warm bath, flannel rollers applied tightly round the body, &c. The application of a broad flannel roller round the abdomen, is especially useful in the chronic form of this disease, as well as in protracted cases of diarrhoea and dysentery. "By this very simple expedient," says Dr. Chapman, " I have done great good in these complaints, having very much used it, as is well known, both in public and private practice, long be- fore the appearance of Dr. De war's book, where it is particularly noticed."* Whatever plan of general treatment we pursue in this disease, we may always derive essential advantage from the concomitant em- ployment of such applications to the surface as are calculated to excite the action of the sub-cutaneous capillaries. When we consider the intimate relation which ex- ists between the functions of the skin and the kidneys, we would at once be led to expect advantage from the employment of diaphoretics in diabetes. Experi- ence, however, does not furnish us with much evi- * Dr. Dewar's book, entitled, " Observations on Diarrhxa and Dysentery, Hfc." was first published in 1801. Dr. Chap- man must therefore be mistaken, as to his having used the flan- nel roller, " both in private and in public practice before the appearance of Dr. Dewar's book." 216 diaphoretics. dence of their utility in this respect. A few cases are on record which yielded to the employment of such remedies. Cornick* and Wernerf relate instances which were successfully treated with the pulvis ipeca- cuanha compositus, given in doses of from ten to thirty grains. But we know that opium has been used with success where no particular diaphoresis was produced, and we are therefore not fully warranted, in these cases, to ascribe the benefit derived from this powder to its diaphoretic operation. Dobson cured a case by the warm bath. As the skin is always remarkably dry and harsh in this disease, there can be little doubt that the warm bath or frictions would, in general, answer very well as auxiliary means. Diaphoretics have also been employed in dropsy. It is, however, generally exceedingly difficult to excite sweating in affections of this kind, nor does this dis- charge, if it can be.induced, often afford any particular advantage. There is nevertheless very respectable tes- timony extant in favour of this practice, and it is said to be more especially useful in such cases of the disease as arise from obstructed perspiration, or appear as a consequence of measles, scarlatina, or rheumatism. Richter speaks well of the use of diaphoretics in cases of this kind.f Monro and Cotunnius employed Dover's * Medical Commentaries, vol. x. t London Medical Journal, 1790, vol. xi. p. 221. t Specielle Therapie, torn. iii. p. 58. diaphoretics. oi-y powder and opium with antimonials, with success in dropsical affections;* and Frankf states, that warm bathing is one of our most efficacious means in cases connected with arthritic affections, or arising from repelled cutaneous eruptions. The ancients excited sweating, in dropsy, by burying the patient up to the neck in heated sand or ashes ;| and Lysons cured cases by placing his patients in rooms heated to a very high temperature. I have never resorted to diapho- retics in dropsy, but I have no doubt that they may often prove serviceable, especially in such cases as depend on a primary disorder of the perspiratory func- tion. Richter says, that they may be advantageously employed with diuretics. Before dismissing this part of my subject it will be proper to say something concerning the rules that are to be attended to in administering these remedies. When we wish to excite sweat, the patient must be confined to his bed. If the pulse be strong, full, and tense, venesection is to be premised. The state of the general system is to determine the choice of the diaphoretics to be used. When the action of the pulse is vehement, antimonials, neutral salts, acidulated drinks, cool ablutions, &c. must be employed. Where no inflammatory excitement is present, recourse must * Observations on the Nature and Treatment of Dropsy, t De Curand. Homin. Morbis, 1. vi. p. 136. t Celcus de re Medicina, lib. iii. cap. 30. VOL. II. 28 218 diaphoretics. be had to stimulating diaphoretics. When the sweat once appears, it should be supported by copious draughts of gently stimulating drinks. The best time for using diaphoretics is after digestion is completed; during the performance of this function the emuncto- ries of the skin are less disposed to action. When the sweat flows, purging and bleeding must be avoided, as they have a tendency to check it. The temperature of the room should be kept at a medium point; and sudden transitions from a warm to a cold air carefully avoided after the sweating has subsided. 1HE ANTIMONIAL PREPARATIONS. The preparations of antimony deserve to be placed at the head of this class of remedies. When taken in large doses they all produce vomiting; but, exhibited in minute portions, they excite the action of the cuta- neous vessels, and give rise to a free transpiration by the skin. It is well known that all emetic substances are capable of exciting sweat when given in nauseating doses. Nausea is invariably accompanied by great relaxation of every irritable part of the system. The cutaneous exhalants especially are always greatly re- laxed when under the influence of this feeling, and are thereby rendered more permeable to the watery DIAPHORETICS. *>19 portion of the blood. The diaphoretic operation of antimony does not, however, appear to depend alto- gether on its nauseating or relaxing effects; and in this respect it differs from the other diaphoretics taken from the class of emetics. It does not appear, for in- stance, that ipecacuanhahas any tendency to excite the vessels of the skin when given in such doses as are insufficient to produce nausea. Antimony, however, possesses a direct and specific influence upon the ca- pillaries of the skin, as is demonstrated by its occa- sional effect of removing obstinate cutaneous diseases, when exhibited in minute doses. Its effects upon the cutaneous exhalants, when given so as not to excite nausea, appear to be simply an increase of the insen- sible perspiration; when we desire to produce free sweating by the antimonial preparations, they must be given so as to cause some degree of sickness of the stomach. In all sthenic diseases the preparations of this metal are decidedly the best diaphoretics we possess. For, independently of the diaphoretic ope- ration of tartarized antimony, it appears to possess the power of moderating the action of the heart and arteries,*—a virtue which must render it peculiarly adapted to cases of high febrile excitement. But whether it be endued with sedative powers or not, certain it is, that it has not the least tendency to aug- ment febrile irritation, and may therefore be employed * Balfour, Lenthois. 220 DIAPHORETICS. during the most violent arterial excitement. It has been alleged that antimonials do most good in fevers when they do not produce any sensible evacuation by the skin. From my own observations upon this sub- ject I am inclined to believe that there is some foun- dation for this opinion, and the circumstance does not appear to me to be altogether inexplicable. The function of perspiration is more or less deranged in all febrile disorders, from the very commencement throughout their whole course. Torpor of the cuta- neous exhalants would appear, in many instances, to be the very first link in the chain of febrile actions. This is especially the case in those fevers which de- pend on atmospheric vicissitudes. It is evident, there- fore, that the greater portion of those recrementitious elements which nature is constantly casting off in the form of perspiration, remains mingled with the mass of the blood, and becomes an additional source of febrile irritation. Now, whatever contributes most to restore the natural action of the cutaneous emuncto^ ries, must also most effectually obviate this source of irritation to the heart and arteries. This appears to me to be the point upon which the explanation of the circumstance in question turns. When antimonials are given in very minute doses, they augment that in- sensible discharge of matter, the uninterrupted elimir nation of which is essential to health. They simply invigorate the natural secretory action of the exhalants, DIAPHORETICS. 221 and enable them to throw off, in a duly elaborated form, those substances which it is their function to eliminate. When given, however, so as to produce copious sweat- ing, they give rise certainly to a much greater discharge. but this discharge being more the result of a relaxa- tion of the exhalants, and a consequent readier trans- mission of the watery parts of the blood in a crude state, than of the increased activity of the secretory excitement of these vessels, it does not so well answer the purposes in the animal economy which nature in- tends to fulfil by this emunctory. Sweat cannot be regarded as consisting entirely of recrementitious matter. It unquestionably contains a considerable portion of fluid whose retention could not prove detri- mental to the living economy. It is not so, however, with the matter that passes off by insensible transpira- tion. This being a product of regular secretion, and essential to the welfare of the animal economy, is necessarily wholly recrementitious. It is not to be supposed, however, that the regular discharge of the insensible transpiration will be as effectual in all inr stances as free sweating. The contrary is the fact. In all fevers connected with inflammation, especially of the internal organs, copious perspiration is bene-* ficial, both as a general depletory measure, and as a powerful means of deriving the circulation from the affected organs to the surface. But in idiopathic fevers, attended with a dry and constricted skin, and 222 DIAPHORETICS. without any particular indication for direct depletion, we in general derive more advantage from antimonials given in such.doses as are just sufficient to restore the ordinary action of the perspiratory vessels, and to give softness to the skin, than by pushing them to the ex- tent of producing free sweating. In the account given of antimonial preparations in a former part of this work,* I have already mentioned their use in chronic cutaneous eruptions, in which in- deed they often display very important powers. When employed % in diseases of this kind, they are always prescribed in such doses as produce a slow and insen- sible operation on the system. They probably prove beneficial, chiefly by keeping up a regular discharge of the insensible transpiration by the skin. As a diaphoretic, antimony is employed in various states of preparation. Formerly a great deal was thought of James's powder, a nostrum which, accord- ing to the analysis of Mr. Pearson, consists of phos- phate of lime and antimony. M. Pulli, a French chemist, has made a very rigorous analysis of this substance; according to him, thirty-six grains of James's powder, contain fourteen grains of per-oxyde of antimony, eight of phosphate of lime, nine of sul- phate of potass, and seven of potass.f This prepara- tion is recommended as peculiarly beneficial in febrile * Vol. i. p. 74. t Alibert, Elem. de Thcrap. torn. ii. p. 36;. DIAPHORETICS. 223 affections. Within a few years past Dr. Cheyne of Dublin, has published some observations concerning its employment in hydrocephalic and apoplectic cases, from which it would appear that it possesses an ob- vious tendency to diminish the flow of blood to the head, and to remove the disposition to apoplexy.* In persons predisposed to apoplexy, or frequently alarm- ed by the usual precursory symptoms of this disease; such as a sense of fulness in the head, vertigo, indis- tinct vision, tinnitus aurium, &c. the long continued use of this remedy is said to prove highly useful. Dr. Cheyne recommends the following method of exhibit- ing James's powder, in cases of moderate determina- tion of blood to the head. The patient is to begin with about two grains at bed-time, and to increase the dose by half a grain every night, until some sensi- ble effect is produced upon the stomach, bowels or skin. If it excite nausea, the dose must be reduced. When the skin becomes soft, or the bowels affected, the dose must not be further increased. Its use must be persisted in for a length of time. Dr. Cheyne says, that the addition of a little rhubarb to this pow- der renders it less apt to excite nausea. Drs. Cramp- ton and Stoker of Dublin, also mention its good ef- fects in cases of this kind. The pulvis antimonialis, which is an imitation of James's powder, is an excellent diaphoretic in febrile * Dublin Hospital Reports, vol. i. 1818. 224 diaphoretics. diseases. It is given in doses of from four to eight grains, repeated every third or fourth hour. When exhibited in larger doses it is apt, like all the anti- monial preparations, to excite vomiting and purging. The kermes mineral, which is a hydro-sulphuret of antimony, is held in high esteem by the German and French physicians; and it is certainly entitled to much more attention than it appears to receive from the pro- fession in England and in this country. It is better adapted than any other preparations of this metal, to cases that require along continued use of antimonials, or where there is much weakness of the digestive or- gans. Its operation on the stomach is mild, and it may be given a long time without weakening this organ, or bringing on an increased disposition to nausea or vomiting. It is said to be particularly beneficial in obstinate scrophulous eruptions of the skin. It is chiefly in chronic disorders of the eruptive kind, that its good effects have been particularly no- ticed. As an emetic, or diaphoretic in febrile disor- ders, it is at present seldom employed in any country. As an alterative, it is given in doses of from a half to one and a half grains, either alone, or in combina- tion with guaiac, calomel, extract of cicuta, solanum dulcamara, &c. The precipitated sulphuret of anti- mony resembles kermes mineral, both in composition and medicinal properties. Its dose is from four to ten grains. • DIAPHORETICS. 225 But of all the antimonial preparations the tartar emetic is unquestionably the most valuable, in every point of view. It will seldom fail to produce dia- phoresis when properly managed, and it is now almost the only preparation of this metal employed for this purpose. As a diaphoretic in febrile diseases, it is usually combined with some of the saline articles of this class. In union with nitre, it forms one of our most efficient refrigerent diaphoretics, and it is in this way that it is commonly prescribed for this purpose. When we take into consideration what has already been said concerning the sedative effects of this pre- paration, it must appear obvious that it is peculiarly calculated to do good in sthenic diseases. Given in doses of from one twelfth to one eighth of a grain, it has been known, in common with the other prepara- tions of this metal, to produce excellent effects in chronic cutaneous affections. When employed for this purpose it may be advantageously combined with gum guaiacum, extract of cicuta, &c. or given dis- solved in the infusions of sarsaparilla, solanum dul- camara, burdock, or sassafras-root. It is a singular fact that tartarized antimony has its emetic powers greatly diminished by giving it in union with Peru- vian bark. A knowledge of this circumstance may sometimes be turned to much advantage in prescrib- ing this latter substance in intermittents. Cases of this disease are occasionally met with, in which the vol. h. 29 226 DIAPHORETICS. bark appears rather to do harm than good, in conse- quence of a general inflammatory condition of the system. In such instances we may unite the tartarized antimony with the bark, administer it to the extent of from one to two grains every three or four hours with- out producing vomiting, but with a manifest antiphlo- gistic operation. When exhibited with the bark in cases of this kind, it keeps up an agreeable moisture of the skin, reduces imflammatory action, and there- by favours the febrifuge operation of the cinchona * I have already noticed the employment of very mi- nute doses of this preparation in phthisis pulmonalis.f One grain of it dissolved in six or eight pints of water, and used exclusively as a common drink, is stated by M. Lenthois to have proved successful in a number of cases in his practice. I have used it in one case with a better effect than any other remedy I have ever tried in this disease. Perhaps the very large quantity of water which is taken in this way may contribute some- thing to its good effects. A very free use of bland drinks, with abstemiousness, will often do more to- wards restoring health m chronic inflammatory affec- tions than any other remedies we possess. * PfafiV System der Materia Medica, B. li. p. 402. t Vol. i. p. 87. DIAPHORETICS 227 RADIX IPECACUANHA. This article is but seldom employed by itself as a diaphoretic, nor does it appear to display any particu- lar powers in this way. Its operation in augmenting the discharge by the skin depends, probably, entirely on its relaxing influence by the nausea it creates. It does not, certainly, evince any manifest diaphoretic powers, unless it be given in nauseating doses. Com- bined, however, with opium and vitriolated tartar, it helps to form one of our most valuable diaphoretics— the pulvis ipecacuanha compositus,* or Dover's pow- der, as it is usually called. " f n this composition," says Dr. Paris, " the opium is so modified that it may be given with perfect safety and advantage in in- flammatory affections accompanied with increased vascular action. It would seem that whilst the opium increases the force of the circulation the ipecacuanha relaxes the exhalant vessels, and causes a copious dia- phoresis. The sulphate of potass is also an important ingredient, for experience has fully proved that ipecac. and opium in the same proportions, have not so pow- erful an effect without it." It seldom fails, by proper management, to excite free diaphoresis, and in a va- riety of diseases its effects are peculiarly serviceable. * This composition consists of ipecacuanha one part, opium »ne part, and sulphate of potass eight parts. 22S diaphoretics In the treatment of dysentery, after the bowels have been sufficiently evacuated by mild purgatives, it gene- rally proves highly beneficial. It not only determines the circulation to the surface, but also allays the pain and irritation of the bowels by its anodyne properties. In obstinate cases it may be very advantageously com- bined with small doses of calomel, and given at regu- lar intervals until the gums become tender. In ar- thritic affections this composition is particularly useful. Given in small doses, two or three times in twenty-four hours, it proves a valuable remedy in the declining stage of acute rheumatism. It may, indeed, be employed with advantage in every variety of symp- tomatic fever, attended with much pain and a dry skin I know of no remedy more useful in peripneumonic inflammations than this one, after proper venesection has been made. It at once assuages the pain and promotes diaphoresis and expectoration. Drs. Brooke, Percival, Cheyne, and Crampton, speak highly of its efficacy in hydrocephalus. Of its powers in this dis- ease I can say nothing from my own experience; I must confess that I should not be inclined to employ it, since opium, in whatever shape it be given, has a manifest tendency to increase the flow of blood to the head. Where the cephalic affection is purely sympathetic, depending on gastric irritation, opium given in this way may, perhaps, be serviceable. But diaphoretics. 229 in idiopathic hydrocephalus there would be reason, I apprehend, to fear danger from its employment. This powder has also been successfully used in the cure of diabetes.* It does not appear, however, that its virtues in this respect are superior, or, indeed, even equal to simple opium. Favourable accounts have likewise been given of its effects in dropsy.f It is given in doses of from five to fifteen grains. When taken with the view of exciting sweat, the pa- tient should be cautioned not to drink any thing for at least one hour after the powder is taken, as it is very apt to produce vomiting when this precaution is not attended to. NITRAS P0TASS.3S. The nitrate of potass, or saltpetre, crystallizes in white, semi-transparent, six-sided, and flattened prisms, terminated, for the most part, by dihedral summits. It has a sharp, slightly bitter, and cool taste. It is solu- ble in seven parts of cold water, and in its own weight at 212°. Alcohol has no action whatever on it. It is not changed by exposure to the air. It is decom- * Cornick, Med. Comment, vol. x. Werner, Lond. Med. .Tour. 1790, vol. xi. p. 111,221. t Dr. Chapman's Therapeutics, vol. i. 230 diaphoretics. posed by alum, sulphate of magnesia, sulphuric acid, the sulphates of zinc, copper, and iron, and partially by the sulphate of soda at the temperature of 32°. When nitre is taken in doses of from ten grains to fifteen, its effects are gently diaphoretic, diuretic, and refrigerent. In doses of from thirty to sixty grains it generally proves aperient; and when swallowed in much larger quantities, its effects are those of an acrid poison, producing violent and obstinate vomiting, bloody stools, with all the symptoms of gastric inflam- mation, convulsions, and death. Taken in very large doses it often acts particularly and violently on the nervous system, giving rise to " a sort of intoxication, palsy, convulsions, and other nervous symptoms."* Dr. John Butler relates the case of a woman who be- came affected with a convulsive disease resembling chorea, after having swallowed by mistake two ounces of nitre.f The diaphoretic effects of nitre are not very ma- nifest, its operation in this way being commonly con- fined to an increase merely of the insensible perspi- ration. It possesses, however, an obvious tendency to moderate the action of the heart and arteries, and to diminish febrile heat; and it is consequently one of our most common remedies in diseases attended * Orfila, Directions for the Treatment of Persons who have taken Poison, p. 65. f Edinburgh Med. and Phys. Jour. No. 53. diaphoretics. 2S\ with high vascular excitement. When employed for this purpose it is usually combined with emetic tartar, to which occasionally a small portion of calomel is added. The emetic tartar is a very important addi- tion. It increases its diaphoretic operation, and adds very considerably to its general antiphlogistic powers In fevers attended with derangement of the biliary organs, the nitre and emetic tartar are very advan- tageously combined with small doses of calomel* By such a composition we excite at once the secretory functions of the skin and the liver, and moderate the action of the heart and arteries. In bilious remittents I commonly employ this medicine until the gums be- come slightly affected, interposing occasionally a saline purgative. As soon as this effect is induced we very often find the disease to assume a perfect intermission, or at least to become much more mild and manage- able in its progress. In simple inflammatory fevers the calomel should be omitted. Dr. Wilson Philip speaks very highly of the effects of nitre in conteract- ing a tendency to inflammation in the advanced stages of indigestion. " Of all the medicines," he observes, " which I have employed to counteract the inflamma- tory tendency in the second stage of dyspepsia, I have found none equal to the nitrate of potass taken in a considerable quantity of water in which a little gum * S> Sal. nitrL 3ss. tart, antim. gr. i. calom. ppt. iv. Divide in pulv. x. one to be given every two or three hours. 232 diaphoretics. had been dissolved."* Selle,f Richter,f and others recommend a saturated solution of nitre in brandy as one of the most effectual remedies in haemoptysis. A table-spoonful of it is to be given every half hour. When nitre has been taken in such quantities as to threaten dangerous consequences, the best treatment, according to Orfila, " consists in causing the patient to swallow a large quantity of sugar and water, of warm or cold water, or of a decoction of linseed or mallows; by this means the stomach is filled, vomiting caused, and the poison ejected." If symptoms of inflamma- tion ensue, bleeding, together with leeching and blis- tering of the abdomen, and copious draughts of muci- laginous drinks, must be resorted to. preparations of ammonia. The carbonate of ammonia has a very considerable tendency to increase the activity of the cutaneous ex- halants. By itself, however, it is rarely employed as a diaphoretic; but saturated with the acetic or citric acids, it forms a pleasant and very useful medicine for this purpose. These preparations are usually given in * Treatise on Indigestion, p. 222. t Med. Clin. $ Specielle Therapie, B. iii. s. 302. DIAPHORETICS. 23S doses of a table-spoonful every hour or two, and they seldom fail to excite a flow of perspiration, when as- sisted by warm and gently stimulating diluents. They seem to hold a middle rank between the relaxing or refrigerent and the stimulating diaphoretics. They do not stimulate or heat the system, nor yet depress or relax it in their primary operation. They tend certainly, in a manifest manner, to moderate febrile excitement, but this appears to be the result simply of the increased discharge by the skin. In fevers attended with a dry and hot skin and a very irritable state of the stomach, the acetate of ammonia, or spiritus mindereri, is peculiarly beneficial. It allays the irritability of this organ, and, by promoting perspiration, mode- rates at once the action of the heart and arteries and the febrile heat. When the arterial excitement is not of a very high grade, and the skin is torpid, a small portion of laudanum may be advantageously united with this preparation. In cases of this kind I have known the aqua ammonia, given in warm wine whey, in the proportion of about forty drops of the former to one pint of the latter, to produce excellent effects. vol. n. 30 334 DIAPHORETICS. EUPATORIUM PERFOLIATUM. This plant is indigenous to the United States, and well known by the various familiar names of boneset, crows wort, vegetable antimony, thorough wort, &c. Its stem is erect, round, hairy, branching at the top, and rises to the height of from two to five feet. The leaves are horizontal, serrated, rugose, and gradually tapering off from the middle, where they are perforated by the stem, to the extremities. The flowers are white, collected into large corymbs at the termination of the branches, and appear in July and August. It grows in low meadows and marshy places. The whole plant is intensely bitter, " without as- tringency or acrimony." Its bitter extractive, in which the medicinal qualities of the plant appear to reside, is equally soluble in water and alcohol. The decoc- tion forms copious precipitates with muriate of tin, nitrate of mercury, nitrate of silver, and acetate of lead. It contains a very small portion of tannin, as is evinced by the solution of isinglass forming a slight precipitate with its tincture* From Dr. Anderson's experiments it would appear that the leaves are the most active parts^ of the plant.f The eupatorium perforatum possesses important * Bigelow's American Medical Botany, vol. i. p. 34. f Inaugural Dissertation. New-York, 1813. DIAPHORETICS. 235 medicinal properties. When taken in large doses it excites vomiting and purging; hi smaller doses it pro- duces copious perspiration, and acts as a gentle tonic. It has been much recommended by some practitioners of the United States as a remedy in intermittents. Dr. Anderson states, that this remedy was used in nearly every case of intermittent that occurred in the New- York Alms-house in 1812, instead of the Peruvian bark, and that it uniformly proved successful. I do not doubt that it has sometimes proved successful in this disease; but the result of my own experience with it does not lead me to form a very high opinion of it in this respect. 1 have known it to remove the disease, in a few in- stances, by producing vomiting and copious perspira- tion. But in the great majority of cases in which I have tried it no manifest advantage was obtained. It has also been administered with very good effects in remitting fevers; and we have the testimony of Dr. Bard and Dr. Hosack in favour of its usefulness as a diaphoretic, in yellow fever. As a diaphoretic it may generally be employed with much benefit in catarrhal fevers. In slight cases of this kind, a weak infusion of it, drank warm on going to bed, will often remove the disease very speedily. It but very slightly increases the action of the heart and arteries, and may therefore be employed with advantage in every variety of inflam- matory affection. In acute rheumatism the infusion of it, used as a common drink, produces very excel- 236 DIAPHORETICS. lent effects. It seldom fails to excite a moderate dia- phoresis, and by this effect to procure considerable relief to the patient. It can, however, be considered only as an auxiliary to more efficient remedies, and as such it is unquestionably an article of considerable consequence. In the epidemic typhoid pneumonia of the winters of 1812, 13, and 14, the eupatorium was a good deal employed by some practitioners, and its effects are stated to have been very salutary. It has also been recommended as a good medicine in obsti- nate cutaneous diseases. Dr. Barton speaks well of its powers in affections of this kind. Dr. Thatcher says, that in anasarcous swellings of the extremities, depending on general debility, the alcoholic tincture of this plant " may be safely recommended as an ex- cellent tonic."* Dr. Burgon, of Bucks county, in this state, has found it very useful in cases of anorexia consequent to drunkenness. "In such cases," he says, " I have used a cold infusion with evident bene- fit, and I prefer it to any article I have hitherto em- ployed; it very speedily restores the tone of the sto- mach, and no unpleasant effects follow its adminis- tration."! Dr. Bigelow, also, adds his testimony in fa- vour of its good effects as a tonic in loss of appetite and other dyspeptic symptoms, " as well as in general debility of the system." I have found it particularly * The American Dispensatory. t American Medical Recorder, vol. iii. p. 331. DIAPHORETICS. 237 useful in very old people labouring under indigestion; it gives tone to the stomach, and renders the skin soft and comfortable. The warm infusion, as is observed by Dr. Bigelow, is an excellent substitute for chamo- mile tea, to promote the operation of an emetic. The powdered leaves are given in doses of from ten to twenty grains, as a tonic or. diaphoretic; or an in- fusion made by pouring a quart of boiling water on two drachms of the leaves, may be used in draughts of about a gill every three or four hours. For excellent figures and descriptions of this plant, see Dr. Bigelow's American Medical Botany, and Dr. Barton's Vegetable Materia Medica of the United States. ASCLEPIAS TUBEROSA. This plant is a native of the United States, grow- ing in dry and sandy soils, and well known as a domes- tic remedy by the familiar names of butterfly weed and pleurisy root. The root, which is the part em- ployed for medicinal purposes, is large, fleshy, spindle- shaped, or branched, of a brownish colour externally, and white and striated internally. It sends up nume- rous round, and generally decumbent stems, very hairy, and of a reddish colour. The leaves are scat- 238 DIAPHORETICS. tered, narrow, oblong, hairy, waved at the edge, hav- ing footstalks at the bottom, but none at the top. The flowers, collected into umbels at the top, are of a bright orange colour, and appear in July and August. The root of this plant has a slightly bitter taste with- out any traces of astringency, and yields its active principles entirely to boiling water, Its effects upon the system are those of a diaphoretic and expectorant, without in the least heating the system, or materially exciting the action of the heart and arteries. It pro- duces a gentle tonic operation, and when given in large doses proves mildly laxative. It is, indeed, one of our most useful indigenous medicinal vegetables, being applicable in every case where diaphoresis and expectoration are to be promoted. In pleurisy, catarrh, and other pulmonary complaints, this root often evinces highly beneficial powers. The late Dr. Barton spoke in favourable terms of its employment in affections of this kind; and Dr. Benjamin Parker of Bradford, Massachusetts, as is stated by Dr. Thatcher, has been led, from a very extensive experience with this root, to regard it " as possessing the peculiar and almost specific quality of acting on the organs of respiration, powerfully promoting suppressed expectoration, and thereby relieving the breathing of pleuritic patients in the most advanced stage of the disease.* He gave it in the form of a strong infusion, in doses of a tea-cup * Thatcher's Dispensatory. DIAPHORETICS. £39 full every two or three hours. WTe have also the evi- dence of Dr. Bigelow in favour of the remediate pow- ers of this article. " I am satisfied," says he, " of its utility as an expectorant medicine, and have seen no inconsiderable benefit arise from its use as a palliative in phthisis pulmonalis.* While practising in Lancaster, I frequently em- ployed this remedy in catarrhal affections, and gene- rally with manifest advantage. I have also witnessed its good effects in pneumonia and phthisis pulmonalis; and in one case of acute rheumatism I prescribed it, with much apparent benefit. The asclepias has also been recommended as a useful medicine in the fever, diarrhoea, and other distressing symptoms which fre- quently accompany dentition. Dr. Burgon of Bucks county, speaks very highly of its powers in this re- spect. " It is peculiarly adapted to the diseases of children," he says, "as they freely take it, from its not possessing any disagreeable taste or smell." He recommends the following mode of administering it. Boil two drachms of this root, in a pint of fresh milk, down to three gills. An ounce of this is to be given two or three times in twenty-four hours. It very seldom fails to excite a copious perspiration, and at the same time proves gently laxative.f Dr. Burgon re- commends it also in cholera infantum, and marasmus. * American Medical Botany, vol.. ii. p. 65. t American Medical Recorder, vol. iii. p. 334. 240 DIAPHORETICS. This root may be given either in substance or in decoction. The latter is however considered the best mode of administering it. About a gill of the strong decoction may be taken two or three times a day. The powder is given in doses of from twenty to forty grains. GUAIACUM OFFICINALE. The guaiacum officinale is a considerable tree, in- digenous to the West Indies and the Brasils. Both the wood and the resinous substance which exudes from incisions made into its trunk, possess important medicinal virtues. The wood is compact, heavy, of a yellowish colour, and has but little smell, and a bit- terish and slightly acrid taste when chewed. The gummy resinous substance, or gum guaiacum, comes to us in large irregular masses of a greenish-brown colour; it is brittle, and exhibits a shining uneven fracture. When reduced to powder it is of a grey- ish white colour, becoming greenish on being left ex- posed to the air. It melts in a moderate degree of heat, and becomes soft and tough when chewed. It has a sweetish bitter taste, and produces a peculiar sensation of acrimony in the fauces when swallowed. It has a very faint and peculiar balsamic odour, and diaphoretics. 24,1 when thrown upon hot coals evaporates in fumes, which are exceedingly irritating to the lungs. About nine parts out of a hundred of its substance are dissolv- ed by water; aether dissolves about forty parts in the hundred, and alcohol ninety-five. It is readily solu- ble in the solutions of the alkalies and in their carbo- nates. The mineral acids dissolve, and at the same time decompose it, being therefore incompatible with it.* Nitric acid changes the tincture of guaiacum to a beautiful blue colour; which by adding water lets fall a copious precipitate of a light blue, but which soon turns to a green, and finally to a greenish white co- lour. With concentrated sulphuric acid it forms a dark carmine red solution, which throws down a lilach coloured sediment on adding water. Accord- ing to Mr. Hatchett, gum guaiacum is a peculiar substance, possessing neither the characteristics of a resin nor of a gum. Gum guaiacum acts as a pretty strong and general stimulant upon the system. It excites the action of the heart and arteries; increases the heat of the body; and promotes the serous excretions, especially those from the skin and lungs. When taken in very large doses it produces nausea, anxiety, purging with vio- lent pains in the abdomen, and deep sleep. Its con- * Paris' Pharmacologia. VOL. II. 31 242 diaphoretics. tinued use has been known to excite a gentle saliva- tion.* Guaiacum was first introduced into medical prac- tice as a remedy in syphilitic affections. Many of the most celebrated medical writers of the preceding cen- tury, recommend it as one of our most useful articles in cases of this kind. At present, however, it holds but a very subordinate rank among our anti-syphilitic remedies. Mr. Pearson, who had ample opportunities of estimating the value of medicines of this kind, says that " guaiacum will often suspend the progress of certain secondary symptoms of lues venerea, for a short time; such as ulcers of the tonsils, venereal eruptions, and even nodes; but that he never saw one single instance, in which the powers of this medicine indicated the venereal virus."f In the treatment of rheumatism also, this article has been long considered as peculiarly serviceable; and it is unquestionably a remedy of very considerable value in this disease. In the acute form of this powerful affection, after the inflammatory symptoms have been considerably sub- dued, and wandering pains and swellings of the joints continue to harass the patient, the volatile tincture of guaiacum will often afford great relief. It is occa- sionally also prescribed in gout; but its employment * Burdach's Arzneymittel. B. iii. p. 163. t On the effects of various Articles in the cure of Lues Ve- nerea, &c. DIAPHORETICS. 2 iS in this disease can only be resorted to with propriety during the intervals of the fits, as it is much too heat- ing to be given in the paroxysm.* In gouty affec- tions of the stomach, so frequently experienced in the irregular form of the disease, the volatile tincture of guaiacum is said to prove very serviceable. Many authors speak very favourably of the use of this reme- dy in old scrophulous affections and in various dis- eases of the skin. Mr. Pearson says, " I have given the decoction of guaiacum with the best effects, to a great number of patients, in cutaneous diseases, in ozoena, and scrophulous affections of the membranes and ligaments." In combination with sulphur, anti- mony, mercury, dulcamara, &c. it has been recom- mended as an excellent remedy in tinea capitis, herpes and psora. It is also much prescribed in af- fections arising from the influence of mercury; and in such cases I have had several striking examples of its usefulness. The tincture of guaiacum has also been recommended in gutta serena, and in painful menstruation. Dr. Dewees of this city has been long in the habit of employing it in this latter affection; and he speaks with much confidence of its efficacy in this respect. The dose of gum guaiacum in substance is from gr. x. 3ss. The tincture is taken in doses of from one to two tea-spoonfuls. It may also be very conveni- * Scudamore on Goutjp, 189. 244 DIAPHORETICS. ently given in the form of an emulsion, made by rub- bing the powdered gum with the yelks of eggs, and gradually adding water to it.* DAPHNE MEZEREUM. This is a low shrub, growing spontaneously in the high and woody parts of Spain, France, and the southern districts of Germany. The bark is the only part of this shrub employed for medicinal purposes. It is thin, light, externally of a reddish grey, and inter- nally of a yellowish white colour; the parenchyma or internal substance of the bark is of a dark green co- lour. It has an acrid and burning taste, but no smell. It contains, besides extractive matter, an acrid resinous substance, which according to Pfaff, bears a strong resemblance to the active principle of cantha- rides.f The bark of the root is much more active than that which is obtained from the stem or branches. Applied to the skin in a fresh state or in powder, moistened with spirits or water, it produces inflam- mation and vesication, attended with a good deal of * "Jesuit drops. This is nothing more than the Elix. Anti. venereum of Quincey, consisting of guaiacum, balsam of copai- i>a, and oil of sassafras, made into a tincture by spirit." t System der Materia Medica, B. iii. p. 195. DIAPHORETICS. 24<5 burning and smarting in the part. Taken internally in large doses it occasions vomiting, violent pain in the stomach, inflammation, gangrene, and death. In smaller but full doses, it sometimes produces heat in the stomach, nausea, vomiting, griping pains, diar- rhoea, vertigo, headach, weakness, anxiety, convul- sions, &c. It affects the respiratory organs, giving rise to pain in the breast, difficulty of breathing, cough and hoarseness. It promotes the secretory action of the kidneys; and has been known to bring on bloody urine. It also increases the activity of the cutaneous exhalants.* The mezereon bark has been much recommended in a variety of affections. In obstinate diseases of the skin it was formerly a good deal prescribed; and it has been particularly commended for its powers in affections depending on a syphilitic taint, or in such as arise from the injurious influence of mercurial reme- dies. Its reputation in this respect does not, however, appear to be very great at present. Mr. Pearson states, that " from all that he has been able to collect in the course of many years' observation, he feels him- self authorised to assert unequivocally, that the meze- reon has not the power of curing the venereal disease in any one stage or under any one form." Some later writers have spoken more favourably of its pow- ers in affections of this kind, and especially in the * Burdach, Arzsneymittellehre, B. iii. p. 169. 246 DIAPHORETICS. mercurial diseases. It has also been recommended in chronic cutaneous eruptions. Dr. Cullen states, that he found it successful in diseases of this kind; and Dr. Pearson knew it to confer temporary bene- fit in an instance or two of lepra. I have not had a great deal of experience with this remedy myself, but from its effects in some old syphilitic complaints, in which I prescribed it, I am inclined to attribute to it considerable remediate virtues. Dr. Withering states, that he has known this bark to produce very good effects in difficulty of swallowing. He mentions one case of this kind, of very long standing, which was entirely cured in two months by chewing the meze- reon root. The best mode of exhibiting this remedy is in de- coction. Half an ounce of the bark, with the same quantity of liquorice root, may be boiled in three pints of water down to a quart, and given in doses of half a gill four times a day. SMILAX SARSAPARILLA. This is a climbing plant, growing in low and humid situations in various parts of South America, and in the western parts of the United States. The root, which is the only part employed in medicine, is com- diaphoretics. 247 posed of a great number of long and slender creeping radicles, of a yellowish brown colour externally, and white within. It has a slightly bitter and mucilaginous taste, but no odour. It contains fecula, in which its active properties appear to reside, and vegetable albu- men. Boiling water readily and completely extracts its active principles. The medicinal character of this root has been very variously represented. According to some writers, it possesses no powers whatever; whilst others repre- sent it as being endued with highly valuable properties. When first introduced into practice, it was strongly recommended as a remedy in venereal affections. It did not, however, long sustain its character in this re- spect. Cullen thought it unworthy of a place among the materia medica; and Pearson declares, that "he feels himself authorised to assert, that the sarsaparilla has no power of curing any one form of the lues vene- rea." Lately, however, it has again come into notice, and many of the most respectable practitioners of the present day employ it, and speak of it as a medicine of very useful powers in complaints of this kind. It is thought to be particularly useful in those chronic venereal disorders which resist the influence of mer- curial remedies, as well as in those affections which occasionally arise from the action of mercury. My own experience with this root has not been extensive; but from what I have seen I am inclined to regard if 248 DIAPHORETICS. as capable of affording considerable advantages, when employed as an auxiliary to other more efficient re- medies. It has also been recommended in scrophulous and rheumatic affections, and in some of the chronic dis- eases of the skin. Qjuarin regarded the decoction of sarsaparilla as the most useful remedy we possess in gout, when administered conjointly with antimonial remedies. Sydenham, also, considered it useful in the declining stage of this affection; and Scudamore says, it will sometimes prove beneficial during the state of convalescence. It is usually given in union with other articles of the same kind, particularly with guaiacum, mezereon, sassafras root, &c* According to the experiments of Mr. Battley of London, it appears that the active properties of sarsa- parilla reside exclusively in the cortical part of the root, and that its virtues may be effectually extracted by infusion in cold water. The woody or central part possesses no medicinal powers whatever; and it fol- lows, as Mr. Battley observes, "that when the cor- tical part has been materially injured, or when, in the * The once celebrated Lisbon diet drink is made according to the following formula: R R. sarsaparillae, R. chinae, aa |i. nucum juglandis cortice siccatarum, No. xx. antimonii sulphureti |ii. lapidis pumicis pulverizati |i. aquae distillatae tbx. To be made into a decoc- tion. DIAPHORETICS. 249 preparation of the medicine the ligneous part of the root has been chiefly regarded, the remedy so pre- pared must be, in a great measure, if not wholly, in- efficacious."* Thedecoctum sarsaparillae compositum of the Lon- don and Dublin Pharmacopoeias, is taken in doses of from liv. to 5vi. three or four times a day. LAURUS SASSAFRAS. The laurus sassafras is a very common tree through* out every part of the United States. Its bark has a fragrant smell, and an agreeable aromatic taste. It contains a large proportion of an essential oil, upon which its taste and odour as well as its medicinal pro- perties appear to depend. It is said also to contain a small proportion of camphor, and some resinous mat- ter.! ^ active principles are extracted both by alco* hoi and water. The watery infusion is red, possess* ing the peculiar odour and taste of the sassafras, and changes to an olive green colour by the addition of sulphate of iron. The bark and pith of the young branches contain a great deal of mucilage. " A very small quantity of pith, infused in a glass of water, * London Medical Repository, for Feb. 1819. t Pfaff's Mat. Med. vol. iv. p. 242. vol. ii, 32 250 DIAPHORETICS. gives to the whole a ropy consistence, like the white of eggs. This mucilage has the uncommon quality that it is not precipitated, coagulated, or rendered turbid by alcohol."* This mucilage is an exceedingly good application in acute ophthalmia, and it is no less useful as a demulcent in catarrhal and dysenteric af- fections. The sassafras was at one time held in very high esteem as a remedy in syphilis, cutaneous eruptions, scrophula, and rheumatism. At present it is not much employed in practice, but I am convinced from my own experience with it, that it is entitled to much more attention than it now receives. Alibert speaks very favourably of its virtues in rheumatic affections. He administered it frequently at the Hospital St. Louis, and it always appeared to him, he observes, to exert a manifest action on the cutaneous emunctories. He mentions a case of chronic rheumatism which yielded to the infusion of sassafras, after a very great variety of other remedies had been tried ineffectually. He speaks also of two cases of gout in which the sassafras was employed with complete success.f I have known the long continued use of an infusion of this article effec- tually to cure a case of inveterate rheumatism. Sassafras enters as an ingredient into the decoctum sarsaparilla comp. It is generally employed in the * Bigelow's American Medical Botany, vol. ii. p. 145. t Alibert, Nouveaux Elemens de Therapeutique, torn. ii.p. 302. DIAPHORETICS. 251 form of an infusion; but the oil is the most efficient, and therefore the best preparation. When this is used it should be rubbed up with mucilage, sugar, and water. The infusion of the flowers is also frequently employed. XANTHOXVLUM FRAXINEUM—PRICKLY ASH. The prickly ash is a tall shrub, indigenous to the United States, in many parts of which it grows in con- siderable abundance. The bark is aromatic and very pungent to the taste, the pungency being perceived only after it has been held in the mouth for some time. The leaves also are considerably aromatic, but have not the pungency of the bark, and resemble those of the lemon-tree in odour. " The rind of the capsule is highly fragrant, imparting to the fingers, when rubbed between them, an odour much like the oil of lemons. The odorous portion is an essential oil residing in transparent vesicular points on the surface of the cap- sules, and about the margins of the leaves. The acri- mony which resides in the bark, has its foundation in a different principle, being separated by decoction, but not by distillation * The bark of this shrub is a warm stimulant and dia * Bigelow's Amer. Med. Bot. vol. iii. p. 158. 252 DIAPHORETICS. phoretic, being analogous to mezereon and guaiacum both in its sensible and medicinal properties. In this country it has been a good deal employed as a remedy in chronic rheumatism, and I have no hesitation in saying, from my own experience, that it is a medicine of very considerable value in this complaint. Its con- tinued use has been known to produce salivation. " A lady in Buckingham," says Dr. Burgon, who had taken a considerable quantity of the tincture for rheumatism, was completely salivated by it, and challenged her physician with giving her mercury. I have heard much of its salivating, but have never witnessed this effect from its administration: chewing the capsules powerfully promotes the flow of saliva."* Dr. Bigelow states that he gave the bark of this shrub in doses of ten and twenty grains, in rheumatism, with considerable advantage. " In one case," he observes, "it effectually removed the complaint in a few days;" but in some instances he found it entirely ineffectual.f I once employed this remedy in a case of rheumatism attended with an obstinate eruption on the skin, and succeeded perfectly in relieving both these affections. I had reason to believe that the disease depended on a syphilitic taint. This article has also been recommended as an ex- cellent remedy in malignant ulcers. For this purpose * American Medical Recorder, vol. iii. p. 333. t Amer. Med. Botany, vol. iii. DIAPHORETICS. 253 it is used both internally and externally. Several in- stances of its efficacy in this respect are related in the Medical and Physical Journal, and in the Transac- tions of the Medical Society of London. It has also been found very useful as a topical stimulant. It is generally given in decoction. One ounce of the bark to a quart of water, boiled down one third, may be taken in doses of a gill, repeated five or six times in twenty-four hours. The powdered bark may be given in doses of from twenty to thirty grains. For an excellent figure and description of this shrub, the reader is referred to Bigelow's Medical Botany, vol. iii. SAPONARIA OFFICINALIS. This plant is common to France, Germany and England, and is now naturalized and abundant in the United States. It has a long, creeping, articulated and knotty root, of a reddish brown colour externally, and white within. The stem is erect, branched, jointed, and from five to eighteen inches high. The calices are cylindric, and the flowers white. It grows among rubbish along road sides, and near neglected out-houses. It flowers in July. The whole 254 DIAPHORETICS. plant has a bitterish and slightly acrid taste. The infusion of the leaves assumes a pale black colour on adding to it some sulphate of iron; the decoction of the root however undergoes no change by the addition of this salt. A saponaceous substance may be obtained from the decoction of the recent leaves, which appears to contain all the active properties of the plant. Alco- hol extracts an acrid and penetrating substance.* The soapwort has been highly recommended for its medicinal powers. Alibert, whose opinion merits great deference, observes that it is surprising that this plant is not more frequently employed; its erer- getic properties entitling it to a distinguished rank in the materia medica. In rheumatic affections de- pending on a syphilitic taint, and in arthritic pains, it is stated to be an exceedingly useful remedy. " It often happens," says Alibert, "that venereal affec- tions resist the powers of mercury; the symptoms in- creasing instead of diminishing under its influence. In such cases the saponaria produces excellent ef- fects. I have very frequently administered this reme- dy in scaly tetters, (dartres furfuraceus,) and I have had occasion in a great variety of instances, to be satis- fied that this valuable plant is too much neglected by practitioners."! I once saw a case of herpetic erup- * Alibert, El&nens de Therap. vol. ii. p. 333. t Ibid. vol. ii. p. 332. DIAPHORETICS. 255 tion entirely cured by the use of this article, after it had resisted almost every other treatment recom- mended in such cases. It is also said to be very ser- viceable in scrophulous and other ill-conditioned ul- cers; particularly in venereal ulcerations of the throat and mouth.* The saponaria is usually given in decoction; and the root is said to be much better for this purpose than the plant. The decoction may be made by boil- ing two ounces of the root in two quarts of water, down to one quart; the whole of which is to be taken in twenty-four hours. SULPHUR. I have already given an account of the medicinal powers of this substance in the chapter of cathartics, and need, therefore, in this place do little more than to notice more particularly its tendency to act upon the cutaneous system. Sulphur has been long cele- brated, both as an internal and an external remedy in the cure of chronic cutaneous diseases. It has also been highly recommended in rheumatic and gouty affections, and in diseases of the lymphatic system.^ * Burdach, Arzney. B. iii. p. 150. f Alibert, Soemmering, De Morbus vasorum absorber tium, &c 256 DIAPHORETICS. Not to repeat, however, what I have said upon this subject in the first volume,* it will here be necessary only to add something concerning the effects of this remedy when applied externally in the form of fumes. Sulphureous fumigations have been highly extolled, within a few years past, in the treatment of a great variety of obstinate complaints. Dr. Gales, of Paris, was the first who introduced this method of applying sulphur. The apparatus which he used for this pur- pose consisted of a wooden case, having an aperture in the upper part. The fumes arising from iginited sulphur are applied to the naked body of the patient seated in this box, with his head out of the aperture at the top. Around the edge of this opening a leather bag is fixed, which being fastened round the neck, prevents the fumes of the sulphur from reaching the eyes, nose, er mouth. The immediate effects experienced from fumiga- tion, is a sense of prickling heat in the skin, which is soon followed by profuse perspiration. The dis- eases in which sulphureous fumigation has been found most beneficial, are chronic rheumatism, psora, lepra and herpes. Dr. Gales relates many cases of this kind, in which the good effects of this treatment were surprisingly prompt. Dr. de Carro of Vienna, who introduced the sulphureous fumigating baths into Ger- many, has, also, published the result of his experi- * Page 178 DIAPHORETICS. 251 ence with this remedy; and we are informed that, in the majority of the cases, " the benefit derived was very striking, and the shortness of the period neces- sary for the cure really astonishing." Alibert observes, that the pustular and papular itch are not equally benefited by sulphurous fumigation. The former variety is almost always exasperated by the contact of sulphurous vapours, whilst a liquid application, com- posed of a certain proportion of sulphur of potass and sulphuric acid, readily cures it. This is also the case in long standing and cachectic cases, attended with brown crusts of different sizes scattered over the arms and thighs. Frictions with sulphur ointment alter- nated with simple baths, are generally sufficient to remove this variety of the disease; whilst fumigations often are followed by no evident advantage. The papular itch, however, may be treated with peculiar advantage by fumigation.* It appears from the observations of MM. Alibert and Biett, that many persons are wholly incapable of supporting the influence of sulphurous fumigations. It sometimes produces alarming syncopy, and a sense of suffocation. Alibert points out the following coun- ter-indications to the employment of the sulphurous vapour bath. 1. A predisposition to apoplexy. 2. Asthma and chronic catarrhal affections in old people, * Alibert, E16mens de Therap. vol. ii. p. 487. vol. ii. 33 258 DIAPHORETICS. and a predisposition to phthisis. 3. Organic affec- tions of the heart. 4. Pregnancy. That sulphur applied in the form of fumes will of- ten act very beneficially in cutaneous affections, can- not be doubted. It would appear however from later experience, that its powers were at first considerably exaggerated, and that its good effects are pretty much confined to those cases in which sulphur applied in the form of ointment, or the application of diluted sulphuric acid, has been found serviceable. It pos- sesses however the advantage of acting much more promptly, and of exciting profuse perspiration, which latter circumstances will sometimes enable it to af- ford relief in rheumatic and other affections connect- ed with torpor of the perspiratory function. CHAPTER XIII. Epispastics. The term epispastic was anciently applied to all such articles as produce redness, inflammation, or vesica- tion when brought in contact with the cuticular sur- face. At present however it is used in a more limit- ed sense; being restricted to those substances alone which excite the exhalants to an abundant effusion of serum under the cuticle, producing vesication, or in common language, blisters. The modus operandi of vesicatories in the cure of diseases, has been a sub- ject of very considerable controversy. Much of their beneficial operation was formerly ascribed to the eva* cuation they produce. That they do some good in this way, though not so much as has been sup- posed, I cannot doubt. I suspect however that more advantage is derived from the secondary, or puru- lent discharge than from that which is the imme- diate consequence of vesication. To be convinced of the effects of discharges of this kind, we need only advert to the manifest influence which the occurrence 260 EP1SPASTICS. of abscesses, or the production of artificial eruptions are known, occasionally, to produce on diseases. The suppression of a small discharge from behind the ears of children, is often followed by the most dangerous consequences, and its re-establishment is as generally manifestly beneficial. It is frequently observed too, that the good effects of blisters do not occur until the secretion of pus commences. It is, after all, highly probable that the discharge from a vesicated surface is in the majority of cases salutary, more by its secon- dary effects in keeping up a new determination to the part, than by its direct influence as an evacuation. When we advert to the nature of the diseases iu which blisters act most beneficially, it appears evi- dent, I think, that their salutary operation must de- pend mainly on diverting the circulation from the affected organs, and directing it upon the vesicated part. Thus blisters applied to the side in peripneu- mony, establish an increased determination to the surface, and by this effect produce a derivation from the inflamed vessels of the pleura and lungs, and enable them to recover their healthy state. A blis- tered surface may be considered in the light of a new excretory organ, the formation of which requires the establishment of a new current or determination of blood. So long as the discharge continues, so long will there be an especial demand of blood in the blis EPISPASTICS. 261 ' tered part, and a consequent derivation of the circu- lation from the inflamed and engorged vessels of the „ neighbouring organs. It is by thus rendering a con- stant supply of blood necessary in blistered parts, and thereby sustaining the local determination to the sur- face, and not by evacuating any morbific matter, that the discharge from blisters, for the most part, appears to do good. It is nevertheless quite probable that blisters do sometimes act beneficially by their direct depletory effects. In erysipelas, for instance, we of- ten derive immediate and decided benefit from blis- tering the affected part. To explain this, as is com- monly done, by ascribing it to the establishment of a new action in the part, appears to me exceedingly vague and unsatisfactory. Is not the direct evacua- tion of serum from the inflamed vessels sufficient to explain the advantages obtained in cases of this kind from blistering? In erysipelas the cutaneous capilla- ries are especially involved in inflammation. Why therefore should we not expect benefit from an appli- cation which is calculated in a direct way to lessen the contents of these engorged capillaries? Blisters have also been supposed to do good by their stimulating and cordial effects. " That these reme- dies," says Dr. Chapman, " are cordial and exhila- rating, is proved by their efficacy in all nervous affec- tions, whether distinguished by a preponderance of 262 EPISPASTICS. mental or corporeal infirmity, and weakness." It ap- pears to be well ascertained, however, that in all cases of real debility vesicating applications can prove ser- viceable only when employed in such a way as simply to produce a rubefacient effect; blistering under such circumstances being almost invariably detrimental. In nervous affections, attended with weakness, blis- tering is without doubt often beneficial. But it must not be inferred, that the good effects of blisters in such cases are in any particular degree dependent on their " cordial or exhilarating" operation. For it is to be observed, that the weakness which attends nervous affections, is frequently immediately dependent on irregular determinations to some of the internal or- gans, and that in proportion as we obviate such deter- minations or congestions, and thereby relieve some oppressed vital organ, so do we remove the weakness to which they give rise. It is by an operation of this kind chiefly, I conceive, that vesication is found oc- casionally to produce invigorating consequences, in nervous affections. Cullen ascribes the beneficial operation of blisters to their supposed power of relieving spasm. That the skin frequently becomes moist and relaxed from vesication, is certain; but it is very questionable whether this can be properly ascribed to the direct antispasmodic or relaxing powers of such applica- tions. By relieving pain, irritation and congestions epispastics. 263 of the internal organs, blisters may give a general healthy impulse to the various emunctories of the sys- tem, and enable the cutaneous capillaries to resume their regular action. The utility of blisters in some of the spasmodic affections, would seem to counte* nance the idea of their possessing direct antispasmo- dic powers. Their effects in this way, however, must be referred to the same operation that has been men- tioned in relation to their employment in nervous af- fections. In whatever manner we may account for the opera- tion of blisters, experience has fully demonstrated their utility in a great variety of affections. In the treatment of febrile diseases they are capable of af- fording very important advantages. Physicians have, however, by no means been unanimous in recom- mending them in fevers. Dr. Fordyce rejected them as not only useless, but even pernicious. The autho- rity of this eminent physician has however not been sufficient to countervail the testimony, which the expe- rience of the majority of the profession has brought forward in favour of the beneficial effects of blistering in fevers. In the treatment of intermittents, blisters cannot be considered as an ordinary remedy. Under certain circumstances of the disease, however, they may occasionally be employed with great advantage. Cases occur which are attended with an irritated pulse and a dry skin during the intermission, and 264 EPISPAST1CS. which are found to resist the most liberal use of bark, &c. In such cases the application of blisters to the wrists or ancles, or a large one laid between the shoulders, will generally produce such a change in the character of the disease, as to enable the bark fully to display its febrifuge powers. In continued fevers, blisters judiciously managed are undoubtedly often of great advantage. It must be admitted, however, that unless they are well timed as to the period of the disease, they are not only useless, but frequently manifestly injurious. As a general rule, blisters are inadmissible in the commencement of febrile affections. Where inflammation or danger- ous congestion of some important internal organ is present, they are nevertheless sometimes of essential service, and may be resorted to in the very beginning of the disease concomitantly with venesection and other antiphlogistic measures. But in idiopathic fe- ver, without any evident congestions or inflammation, they seldom fail to do harm when employed before the alimentary canal has been duly evacuated, and the action of the heart and arteries moderated by proper depletory measures. There is a period in the course of continued fevers intermediate between their stage of high excitement and the appearance of symptoms of collapse, in which blisters will generally produce une- quivocal good effects. This is what has been called the blistering point, an expression familiar to those who EPISPASTICS. 265 are acquainted with the writings of Rush. Those who have contemplated fevers most attentively have noticed, that they often begin to decline immediately after the occurrence of some particular spontaneous evacuation, or on the appearance of abscesses, &c. It is also ascertained that such " critical movements" do seldom if ever occur during the primary stage of febrile excitement. It appears, therefore, that there is a tendency in fevers, at some period of their course, to throw a more than usual burthen upon some of the emunctories, or to establish particular determinations, giving rise to haemorrhage, abscesses, &c. as the first movement towards amendment. It is at this period in the course of febrile diseases, during which efforts of this kind are sometimes observed to occur, that blisters appear to be particularly serviceable. It is only, however, when the indications of a change of action in the system are obscure or imperceptible that vesicatories are admissible; for, during what is com- monly denominated a critical discharge, they would be obviously improper. The utility of blisters in con- tinued fever unattended by any particular local affec- tion, appears to me therefore to depend on giving an impulse to the sanative powers of the living economy, and at the same time establishing a new secreting surface, towards which the humours are especially directed. In cases attended with symptoms of parti- cular affection of any of the important internal viscera, vol. n. 34 266 EPtSPASTlCS we employ blisters upon a different principle. In in stances of this kind our object is to relieve the op- pressed organ, and we accordingly apply the blister as near the affected viscus as is practicable, in order more effectually to derive the blood from the engorged or inflamed vessels. Thus, in fevers attended with delirium, and other symptoms of inflammation and engorgement of the vessels of the brain, blisters are applied to the head, not so much with a view of ar- resting the progress of the general disease as of re- lieving and protecting this important organ. Percival observes, that in fevers attended with a general dispo^ sition to inflammation, without any one part suffering more than another, blisters always act injuriously. When, however, local inflammation of any of the in- ternal organs is connected with the fever, vesication is almost universally useful. Experience, he says, demonstrates, that in such cases blistering the skin near the affected part lessens the flow of blood to it, and thus contributes to resolve the inflammation, and consequently the general febrile excitement.* Blisters are very important remedies in the treat- ment of the different varieties of phlegmasial diseases. In acute pulmonic affections especially, they are often indispensable. Some difference of opinion exists among physicians as to the proper time for applying blisters in pneumonia. It is contended by some that * Essays, Medical, Physiological, and Experimental. EPISPASTICS 267 they do more mischief than good when resorted to before the action of the heart and arteries has been considerably reduced; while others allege that they may be advantageously applied in the very commence- ment of the disease. That blisters may be very early resorted to in pneumonia with advantage, I am entirely persuaded from repeated experience. Without doubt, however, they will perhaps always act with more de- cided benefit when applied after the vehement arterial excitement has been somewhat moderated by deple- tory measures. But they may nevertheless generally be resorted to very early with advantage; and more especially as several bleedings may be practised be- tween the time of their application and the commence- ment of vesication, and the general momentum of the circulation be thus diminished before the stimulus of the epispastic has time to disturb the system. In re- lation to this point Dr. Armstrong makes the following observations: " It has sometimes struck me very forcibly," says he, " that the precipitate application of blisters to the chest, before general or local blood- letting, is a prejudicial practice; at least I have occa- sionally seen hydrothorax rapidly follow it, from the increase of the general and topical excitement which blisters thus applied had apparently produced. This point therefore is, perhaps, deserving of further inves- tigation in the acute pulmonary inflammation."* In * Practical Illustrations on the Scarlet Fever, p. 154 268 EPISPASTICs. pleurisy and other acute pulmonic affections, ihe blis- ter should be laid immediately over the part which appears to be principally affected. Some very cele- brated writers, however, recommended them to be applied on the thighs or legs. Baglivi observes, that cases of pleurisy sometimes occur in which great difficulty of respiration and suppression of expectora- tion come on about the fifth or sixth day, whether bleeding has or has not been practised. " Two blis- ters applied to the legs and thighs in such cases, will not only promote the expectoration, but remove the difficulty of breathing, and produce a favourable change."* This practice, as Alibert observes, is sanctioned by the following aphorism of Hippocrates: "In pulmonis affectibus, quicunque tumores fiunt ad crura, boni; nee potest quidquam melius accidere si mutato sputo, sic appareant." In the treatment of hepatitis, both chronic and acute, blisters are often highly serviceable; and in inflam- mation of the bowels and peritoneum they are indis- pensable. In all these affections the blisters should be large, and applied immediately over the affected parts. In acute hydrocephalus also, blisters over the scalp can never be neglected with propriety. In all these affections, however, it is necessary to observe, that bleeding forms the primary and most essential curative measure. In acute rheumatism, after the * Alibert, Elem. de Therap. EPISPASTICS 269 violence of the general excitement has been consider- ably reduced, blisters will commonly procure great relief when laid over the parts particularly affected. They are also useful in some varieties of the chronic form of this complaint, and particularly in sciatica. "In the worst chronic states of local rheumatism of the«nerves," says Dr. Scudamore, " I have seen the cure obtained, or very material relief afforded, by the successive application of blisters."* In the cure of gout blisters have been recommended by some writers and condemned by others. Rush and Musgrave speak favourably of their employment both in acute and chronic gout; whilst Cullen and Scudamore consider them as at least hazardous. . It is unnecessary, however, to mention particularly every variety of phjegmasial disease in which blisters may be employed with advantage. With the excep- tion, perhaps, of nephritis, they may be considered as primary remedies in all internal inflammatory affec- tions. In nephritis, however, they are inapplicable on account of the tendency which cantharides pos- sesses of irritating the urinary organs, and conse- quently of increasing the inflammation of the affected parts. We need only advert to the modus operandi of blisters in the cure of internal inflammatory affec- tions, as explained in the beginning of this chapter, to see their general applicability in the various forms of * Treatise on Gout and Rheumatism, p. 316. 1 270 EPISPASTICS. these complaints. For it is obvious that every reme- diate measure which has a tendency to divert, in any degree, the circulation from the affected parts, and direct it upon external and less important ones, must be capable of procuring beneficial effects in this class of diseases. In the treatment of dysentery, and especially of cholera, blisters may often be applied, both to the ex- tremities and the abdomen, with great advantage. , In the latter of these affections blistering with can- tharides is much two slow for the very rapid course of the disease. The nitric acid has, however, been re- cently employed for this purpose with the happiest effect, being exceedingly prompt and active as a vesi- catory. In cholera infantum, blisters, or at least rube- facients, are of essential utility. Applied over the region of the stomach, they often allay the inordinate irritability of this organ in a very effectual manner. Blisters have also been frequently resorted to in the exanthemata, and particularly in confluent small-pox, and in measles, when the eruption recedes suddenly, or symptoms of pulmonic inflammation and oppression supervene. " In subjects who have been much ema- ciated by measles," says Dr. Armstrong, " and who are afterwards afflicted with visceral inflammation, considerable care is often required as to the applica- tions of blisters; for the blistered portion of the skin is sometimes liable to run rapidly into gangrene, or EPISPASTICS. 271 else it becomes a sloughy sore, which is very diffi- cult to heal, and which occasions an irritation. The skin is one of the principal seats of the measles. It is exceedingly stimulated during the eruptive fever, and suffers a correspondent loss of tone as that fever declines; and as this cutaneous debility is greatest in emaciated, or in broken-up habits, so the surface in them is less able to resist inflammation, without end- ing in gangrene or in an ill-conditioned sore."* In the treatment of erysipelas blisters are recom- mended as very efficacious. They are to be applied immediately on the inflamed part, and suffered to lie until vesication is produced. To arrest the progress of gangrene, blisters are among our most valuable remedies. Cotunnius states, that he once saw the lower extremities of a patient labouring under putrid fever, become gangrenous, and that the gangrene extended to every part of the legs except to those upon which blisters had been laid. The mortifica- tion terminated about a finger's breadth from the margin of the blisters.f Blisters, observes Rcemer, appear therefore to possess the power to arrest the progress of mortification-! It is to Dr. Physick, how- ever, that we owe our knowledge of the real value of * Practical Illustrations on the Scarlet Fever, Measles, &c p. 172. t De Sedibus Variolarum. t Chirurgishe Arzneymittellehre, torn. i. p. ^18 212 EP. SPASTIC S, this remedy in gangrene. The blister should be large enough to cover all the sound parts in contact with those which are in a state of gangrene. " I have witnessed the effects of blistering," says Dr. Dorsey, " in a variety of instances, and have no hesitation in recommending them in preference to all other local remedies. After the first dressing of the blister, it will generally be found that the mortification has ceased to progress, and in a short time the separation of the sloughs commence."* Blisters have also been employed with much benefit in some varieties of haemorrhage. They are especi- ally useful in epistaxis; an alarming case of which I once saw effectually arrested by a blister laid on the back of the neck. Dr. Robert Archer of Norfolk, has related a remarkable instance of the utility of blisters in a case of this kind. The patient was near- ly exhausted; every means that could be suggested had been tried in vain. On the fifth day a blister was applied to the back of the neck. This application "produced an astonishing effect, for it no sooner be- gan to vesicate than the haemorrhagy ceased, as if by a charm." The patient recovered rapidly; but as soon as the blister healed the bleeding returned. The blister was renewed and kept open for some time; the haemorrhage immediately ceased, and the patient re- covered his health.f * Elements of Surgery. t American M.-diral Recorder, vol. i. p. 16. EPISPASTICS. 27S In the treatment of spasmodic affections blisters often display very considerable powers. Several cases are related of their successful application in tetanus. Dr. William Carter of Canterbury, gives an account of a case of this kind from a wound, in which lie ap- plied a blister between the shoulders the whole length of the spine, and directed an active purge every two or three days, giving, on the intermediate days, oil of amber and asafcetida. By these means the patient recovered his health in less than three weeks.* In the cure of epilepsy blisters have been more fre- quently employed than, perhaps, in any other of the spasmodic diseases. Mead,f Baumes, and Percival mention cases of the successful application of blisters in this disease. Richter observes, that vesicatories are most applicable in such cases as are attended with an irritated condition of the brain during the intervals, connected with a dull and soporose disposi- tion and a small and trembling pulse. J The blisters are said to act most beneficially when laid on the calves of the legs. Rivereius§ and Piso cured invete- rate cases of epilepsy by applying them to the scalp and keeping them open for a considerable time. * Medical Transactions of the Lond. College of Physicians; vol. ii. p. 34.—1772. t De imperio Solis et Lunae, etc. cap. ii. p. 8. | Richter's Specielle Therapie, vol. vii. p. 710. § Opera, lib. i. sect. 2, cap. 6. VOL. IT. 35 374 EPISPASTICS. That cases of epilepsy have been cured by this reme- dy, we are not permitted to doubt. It does not ap- pear, however, from the aggregate experience of the profession on this head, that they are entitled to any particular confidence in this intractable complaint. In a great variety of local complaints vesicatories are of essential service. In inflammations of the joints, both acute and chronic, they are highly useful. They should be laid immediately over the affected joint, and kept discharging for a long time. This remedy, together with rest and a general antiphlo- gistic regimen, will frequently produce the happiest effect. The application of a blister to the tract of an in- flamed vein is a practice of much value. This treat- ment was first introduced by Dr. Physick. "A small plaster of simple cerate, spread on linen, is to be applied to the orifice, and over this a blister is to be laid, large enough to cover the whole inflamed part, extending three or four inches from the orifice in every direction."* In incontinence of urine, depending on paralysis of the sphincter of the bladder, blisters laid on the sa- crum have been employed with much advantage.! Oliphant relates two instances of this kind, one of which was in a man of seventy-two years of age, in * Dorsey's Surgery. t Lond. Med. Observat. vol. i. p. 318. EPISPASTICS. 215 which the application of a blister over the os sacrum gave perfect relief.* Blisters have also been found very serviceable in some of the chronic cutaneous diseases. Blochj and RichterJ employed them with great success in herpetic eruptions. Ambrose Pare, also, relates a remarkable case of an eruption in the face cured by this remedy. The patient was a lady of distinction; her face was covered with innumerable little ulcers, and considerably swollen. The physicians considered it as a case of elephantiasis. After employing a vast variety of remedies without, the least advantage, they applied blisters over the affected parts. These had hardly lain an hour before she experienced violent pain in the bladder, which was soon followed by tor- mina, vomiting, and fever. The blister drew well, and the disease disappeared, and never afterwards re- turned^ * Gesner's Endeckungen, B. iii. p. 725. t Schmucker's Chirurg. Schriften, vol. ii. p. 96 | Richter's Medical Library, vol. iii. p. 289. $ Opera, lib. xx. cap. 27. 276 EPISPASTICS LYTTA VESICATORIA.— CANTHARIDES The cantharides are a beautiful and well known insect of the beetle tribe, being exceedingly abundant in the southern parts of Europe, and particularly in Spain. They delight to dwell on the leaves and flowers of the ash, the black poplar, the elder, and lilach, from which they are collected in June and July, and afterwards destroyed with the fumes of strong vinegar, and dried in the sun.* These insects have a peculiar sweetish and nau- seous odour. When first taken in the mouth they have very little taste, but on being chewed they be- come considerably burning and acrid. Hippocrates directs the heads, wings, and feet to be thrown away, as being, according to his notion, particularly poison- ous. Galen, Pliny, and Ettmiiller, on the contrary, thought that the bodies were the most poisonous; and that the heads, wings, and feet possess the power of counteracting the poisonous effects of the bodies. Cantharides have frequently been the subject of chemical analysis. According to Mr. Robiquet, they contain, 1. A blistering principle, to which Dr. Thomson has given the name of cantkaradin. 2. A green concrete oil. 3. A yellow fluid oil. 4. Apecu- * This mode of destroying cantharides is of very ancieiv date. Dioscorides recommends it particularly. EPISPASTICS. 211 liar black substance, soluble in water and proof spi- rits, but not in pure alcohol. 5. A saponaceous or yellow substance, soluble both in water and alcohol. 6. Uric acid. 7. Acetic acid. 8. Phosphate of mag- nesia. 9. A parenchymatous substance* The blis- tering principle, or cantharadin, when obtained in a separate state, consists of small plates of a micaceous lustre. It is insoluble in cold alcohol and in water. Boiling alcohol however dissolves it, but precipitates it again on being cool. iEther and the oils dissolve it readily. Although not soluble in water, it is ren- dered so by the presence of the yellow or saponace- ous substance with which it exists naturally in a state of combination. The blistering property is very high- ly concentrated in the cantharadin. An atom of it dissolved in sweet oil, and applied to the skin with a bit of paper, produces vesication in five or six hours.f Neither the black substance nor the green oil pos- sesses vesicating powers. Cantharides have a peculiar tendency, whether * Annals de Chcmie, torn, lxxvi. t The cantharadin may be obtained by the following process: Boil the cantharides in water repeatedly, until all the soluble parts are extracted ; filter the decoction, and evaporate it to the consistence of an extract. Digest this extract in concentrated alcohol, then pour off the alcohol, and evaporate it; sulphuric aether, added to this alcoholic extract, will take up the canthara- din, which may be obtained in a pretty pure state, by evapora- tion.—Pfafs Mat. Med. vol. iii. p. 243. 278 Ll'iSPASTICS. taken internally, or applied as a vesicatory to the skm. to act upon the urinary organs, and especially to pro- duce irritation and inflammation of the neck of the bladder, and consequently strangury. It has been much disputed, whether strangury be produced by the absorption of the acrid portion of the cantharides, or whether it be merely the result of a sympathetic im- pression conveyed to the bladder. That the stran- gury proceeds from the absorption of the acrid princi- ple of the cantharides, is exceedingly probable from the fact that no other vesicating substance produces this effect. It is moreover very unlikely that the blad- der should possess so extensive a sympathy with the surface of the body, as it must do if strangury from blistering be the result of a sympathetic impression; for, on whatever part of the body blisters be laid, strangury may be the result. Dr. Chapman observes, that " if strangury do thus arise, it ought invariably to take place on the application of a blister," which, however, is an incident of rare occurrence. But wherefore should strangury more frequently follow blistering, if it be occasioned by the absorption of the cantharides, than if it depend on a sympathy between the skin and bladder? We might with just as much, and perhaps more plausibility, say, that if strangury- arise from a sympathetic connection between the ex- ternal surface and the bladder, it ought more con- stantly to follow blistering. We know that turpentine EPISPASTICS. 219 occasionally produces strangury when taken inter- nally, and that it is absorbed, and conveyed out of the system by the urinary organs. But are we to deny the absorption of this substance because it does not always produce strangury? The fact of its absorp- tion is unquestionable. Dr. Chapman also states, that " it is known that the internal use of cantharides is seldom attended by any effect, and when it does occur, it is more frequently from small than large doses of this article." Against the correctness of this statement I may with confidence appeal to the gene- ral experience of the profession. By large doses of this article strangury may be generally induced, whereas small doses seldom produce any sensible ef- fect whatever. Nor is it a fact that the internal use of cantharides is seldom attended by this affection of the bladder. In a highly interesting paper, published by Dr. J. Klapp, on the emmenagogue powers of cantharides, nineteen cases are detailed in which this remedy was administered internally, and in eight of which symptoms of strangury supervened.* Blisters are particularly apt to excite strangury when applied to the head immediately after the scalp has been shaved; and more especially if the skin be wounded. This may be attributed to the greater fa- cility which the absorbents possess of taking up the the active principle of the fly, when the cuticle has * American Medical Recorder, vol. ii. p. 37 280 EPISPASTICS. been abraded and wounded by shaving; and hence^ when cantharides are applied from twelve to twenty- four hours after the head is shaved, this effect hardly ever ensues,* To obviate, or relieve strangury, much benefit may be derived from the free use of mucila- ginous and mild diuretic drinks, as barley-water, in- fusions of flaxseed, parsely, melon-seed, and par- ticularly of marshmallows, or of our common round- leaved mallows, (malva rotundifolia.) In addition to these, opium, taken into the stomach or administered in the form of a clyster, is always of essential service. Much benefit is also to be derived from warm bathing, or from fomentations to the perineum and pubis. Formerly camphor was a good deal recommended as a remedy for strangury; and it does not appear to me to be wholly inefficacious in this respect. When speaking of this article under the head of narcotics, I adverted to its evident tendency to diminish venereal sensibility, or perhaps more properly speaking to lessen the activity of the genital organs. This effect of camphor, would seem to depend on an operation directly the reverse of that of cantharides,—namely, a diminution of the flow of blood to those parts. But as the operation of camphor in this respect is slow, it can seldom be employed with any particular advantage in cases of this kind, which require much more prompt means of relief. After the violence of the * Percival's Medical Essays, vol. i. EPISPASTICS. gg] symptoms is over, and some pain or irritation re- mains at the neck of the bladder, it will nevertheless often prove useful, as I have in several instances wit- nessed. Cantharides seldom produce complete vesication under ten or twelve hours. Before applying a blister, the skin upon which it is to be laid, or the surface of the plaster, should be moistened with vinegar or brandy. When the blister is drawn it must be opened and dressed with simple cerate spread on linen. To Jkeep up the discharge from a blistered surface, an ointment made of a small portion of cantharides and lard, is one of the best applications. Savin ointment is also very good for this purpose. When a blister is in a state of painful irritation, sweet oil, lard, or a soft bread and milk poultice should be applied. LYTTA VITTATA.--POTATOE FLY. This insect is said to belong exclusively to the United States. It feeds chiefly on the potatoe plant, and upon which it is often found in immense numbers about the end of July or beginning of August. It resembles in outward form the cantharides; being, however, somewhat smaller, and of a different colour. Its head is red, with black antennae; the wing-cases vol. ii. 36 EPISPASTICS. are black, with a pale yellow margin, and a stripe of the same colour along the middle of them; the tarsi have five joints. " The abdomen of this insect is a hard white substance, about the size of a grain of wheat, which, when powdered, appears like meal, and when rubbed with water forms a milky emulsion." Dr. Isaac Chapman of Bucks county, in this state, was the first who publicly noticed the vesicating pro- perties of this species of Lytta.* According to his experience it is equal if not superior, in this respect, to the cantharides; and this has been confirmed by the experience of other practitioners. The late professor Barton gave a decided preference to the American fly. " Long keeping," he observes, " provided it be carefully kept, does not materially impair the blister- ing property of the lytta vittata. At the end of three or four years after being collected I have found it equal in power to the best shop cantharides." Dr. Gorham of Boston, states, that in an extensive series of experiments with this fly, he found it equal if not superior in every respect to the cantharides. Admi- ninistered internally, it produces the same effects upon the urinary organs, and is applicable to the same medicinal purposes as the Spanish fly. There are other native species of this genus of flies which possess valuable vesicating properties. The lytta atrata is a very common insect in this country. * Medical Repository, vol. ii. EPISPASTICS. 283 In the autumn it is found in great abundance on some of the syngenesious plants, such as aster, soledogo, &c. "Though inferior," says Dr. Barton, "to the lytta vittata, it is well worthy of the attention of phy- sicians." The lytta marginata is not so common, but is an exceedingly powerful vesicatory. The lytta cinerea is said to be no less powerful than the latter species; it is, however, very scarce. I may also, in this place, mention the meloe niger, which was first noticed as a vesicatory by the late professor Woodhouse. According to his experiments with this fly, it seems to possess very active vesicating properties. It is about half the size of the potatoe fly, and dwells particularly on the ambrosia trifida. NITRIC ACID. The nitric acid has been recently introduced into practice as a very valuable vesicating application in certain rapid and dangerous affections. Dr. Kenedy has published an interesting paper on this subject in the Edinburgh Medical and Surgical Journal. It has been found particularly efficacious in the cholera of India, a disease so rapid in its progress and fatal in its consequences, that nothing but extensive blistering of the epigastric region appears to be capable of 284 EPISPASTICS. arresting its course. Blistering with nitrous acid, being exceedingly prompt, and attended with much local irritation, is, according to the experience of Mr. Powell, surgeon at Bombay, a remedy of great pow- ers in this affection. "The good effects," says Dr. Kenedy, " of this sudden and powerful counter-irrita- tion, were strikingly illustrated in the case of an Eu- ropean, who received immediate relief in the burning sensation at the stomach on the acid blister being ap- plied; and who the next morning, being annoyed with spasms of the extremities, requested the same remedy might be applied; it was accordingly done, and so great was the relief obtained to one Leg, that he cried out for God's sake to apply it to the other, which was similarly affected." Another patient, he observes, was brought in, and supposed to be past recovery. His stools past off involuntarily; the extremities were cold, and the pulse could not be felt. " The acid blister was applied to the stomach, and the patient got well." Two parts of the acid is to be diluted with one part of water; with this mixture the surface over the affected part is to be rubbed. As soon as the patient experiences pain from it the acid is to be neutralised by washing the surface with a solution of carbonate of potash. " The cuticle can now be easily detached, and leaves the cutis vera raw, upon which a common blister may be laid to keep up the irrita- tion."* * Observations on the use of Nitrous Acid as a substitute EPISPASTICS. 2S5 TARTARIZED ANTIMONY. Although not a vesicating substance, tartar emetic deserves to be particularly mentioned in this place, as possessing the power of exciting a peculiar pustu- lar eruption, frequently followed by highly salutary consequences. The best mode of using it for this purpose is to incorporate it with simple cerate or lard, in the proportion of a drachm of the former to about an ounce of the latter, and to apply it either by fric- tions or spread on leather and worn in the way of a plaster, on the skin. Dr. Jenner, who has recently published a most valuable essay on the influence of artificial eruptions on certain diseases,* recommends the tartar emetic ointment to be made according to the following formula.! The effects which arise from inunction with this ointment are, a sense of itch- ing or prickling in the part rubbed, commonly appear- ing on the second or third day after the frictions have for Blisters, by Dr. Kenedy, F.R. S. E. in the Edinburgh Me- dical and Surgical Journal, for Oct. 1820. * American Medical Recorder, vol. v. p. 684. t Antim. tart, (subtil, pulv.) 3"- Ung. cetacei, %lx. Sacch. albi. 3*4 Hydr. sulph. rub. gr. v. M. fiat unguent. i The sugar prevents the ointment from becoming' ranoid 286 EPISPASTICS been commenced. " If the part so affected be rubbed or in any degree irritated (from which few can re- frain at first) an eruption of small watery pustules takes place immediately." If the patient abstain from irritating the part, the eruption will appear somewhat later. " The pustules," says Dr. Bradley, " are uni- formly compared by patients to variolous pustules; but they are much smaller, not so red at the base, nor so tense and white when fully suppurated." I have, however, seen them much larger than the variolous pustules, and they are generally very painful. In the essay already quoted, Dr. Jenner adduces a number of cases in which this ointment was applied with the happiest effects. He employed it with success in mania, phthisis, asthma, chronic hepatitis, chorea, epilepsy, and in various othor anomalous cases. This application has also been highly recommended as a remedy in hooping-cough. " Of all the remedies," says Dr. Bobinson, "I have found beneficial in hoop- ing-cough, frictions upon the region of the stomach with the tartarized antimonial ointment have been the most remarkably and most undeviatingly useful. The eruption on the stomach is frequently accompanied with a slight degree of inflammation about the remote parts in females, with a spare eruption of minute pimples; and, on this occurring, the disease uniformly begins to abate. In cases where the patient is of a full habit and the inflammatory diathesis runs high, it EPISPASTICS. 287 may be proper to apply a few leeches to the feet pre- viously to the use of the antimonial ointment. But I have used it with advantage, even in cases where the fever was attended with delirium at night. I have never seen the eruption produced in this way threaten the bad consequences from gangrene which not un- frequently supervene when the blisters are applied too early in hooping-cough, when the inflammatory dia- thesis runs high, and before blood has been abstracted. The effects of the ointment in other respects are also widely different. When it does produce an erup- tion, it almost always affords relief; whereas I have never seen an instance where the application of a blister has been of the smallest service in hooping- cough, except after blood-letting, when there have been manifest symptoms of inflammation."* This accords with the experience of Dr. Jenner: "With tartarized antflbony," observes this distinguished phy- sician, " we can not only create vesicles, but we can do more,—we have at our command an application which will at the same time both vesicate and pro- duce diseased action on the skin itself, by deeply de- ranging its structure beneath the surface. This is probably one cause why the sympathetic affection ex- cited by the use of cantharides and those changes pro- duced by tartar emetic are very different." The eruption should be kept up for some time, * London Medical Repository, January, 1821. 288 EPISPASTICS. either by the re-application of small portions of the diluted tartar emetic ointment to the affected part, or by other gently stimulating ointments. If they be- come much irritated and very painful, a soft bread and milk poultice, or an ointment made with equal parts of sweet oil and wax, will in general afford relief, without interfering with the eruption. SETONS AND ISSUES. The effects of setons and issues are very analogous to those of the articles already mentioned in this chap- ter. Being, however, very permanent in their opera- tion, they are often peculiarly applicable in certain chronic affections where it is generally necessary to keep up a long continued influence 2m the system. Among the Greek and Roman physicians, the use of caustic issues was frequently resorted to. Hip- pocrates employed them in gout, sciatica, chronic diseases of the liver, spleen, and lungs; and iEthius mentions their use in palsy and asthma. Celsus, also, employed them in affections of the joints, in epi- lepsy and in phthisis. Boerhaave and De Haen, in modern times, recommended them in the treatment of the scrophulous disease of the hip joint; and Mr. Pott speaks highly of their efficacy in diseased or in- EPISPASTICS. 289 curvated spine. A caustic issue on each side of the diseased vertebrae has been frequently known to give perfect relief in such affections. Dr. Rogers, pro- fessor of natural philosophy and chemistry at Wil- liamsburg, Virginia, has recently published some highly interesting observations on the employment of caustic issues. He relates several cases of phthisis pulmonalis which yielded entirely to their influence. In a case of this kind, which, from the strong hectic symptoms, the constrained state of the respiration, and the appearance of the matter expectorated, was con- sidered altogether hopeless, a caustic issue formed on the sternum inter mammas, performed a perfect cure in the space of about three months. " In chro- nic affections of the breast," says Dr. Rogers, " this remedy is less troublesome, less painful, gives more permanent caustic irritation, and appears to me much more efficacious than blistering, however managed. So strongly am I impressed with this sentiment, that for several years I have trusted no case of the kind to any course of remedies without the aid of that under consideration. In chronic catarrh I have found it of singular utility."* Dr. Rogers has also employed them with perfect success to prevent abcrtion in habits prone to this accident, as well as in the treatment of leucorrhcea and menorrhagia. Issues have likewise * American Medical Recorder, vol. iv. p. 222. vol. ii. 37 290 EPISPASTICS. been applied with much advantage in vertigo, gutta serena, chorea, and tetanus. Dr. Hartshorne of this city has employed them with success along the spine, in this latter affection; and Dr. Lewis, of Pittsburgh, has related a case of this disease which yielded to the application of caustic potass along the tract of the spine.f When setons or issues are employed for the re- moval of local affections, they should be applied as near the affected part as practicable. In general dis- eases, however, they may be inserted on some con- venient part of the extremities, as on the inside of the leg, just below the knee; or on the arm, near the in- sertion of the deltoid muscle. * Eclectic Repertory, vol. vii. p. 245. t American Medical Recorder, vol. iii. p, \7t EPISPASTICS. 391 Rubefacients. The articles which belong to this class do not vesi- cate, but simply produce a redness and inflammation of the part to which they are applied. Their modus operandi in the cure of diseases, depends probably on the same principles that have been mentioned above in relation to the operation of epispastics. They con- centrate the excitement, and produce a determination of the circulation to the part upon which they imme- diately act. Without, however, entering into any dis- cussion upon this point, 1 pass on directly to the con- sideration of the individual articles of this class. SEMINA SINAPIS. Mustard is one of the most useful rubefacients we possess. Its action on the skin is prompt and powerful, producing, when good, pain and inflamma- tion in fifteen or twenty minutes. It contains fecula, mucilage, a bland fixed oil, " and an acrid volatile oil upon which its virtues depend, and which on stand- ing deposits a quantity of sulphur and an ammoniacal salt." Water extracts nothing but tasteless mucilage 2 92 EPISPASTICS. from the unbruised seeds; when bruised they im- part all their active principles to water; but very sparingly to alcohol. The mode of using this article, as a rubefacient, is to make a paste with the farina of the seeds and vinegar, and to apply it in the shape of a poultice to the skin. The pain which such an ap- plication produces is generally exceedingly severe, and if suffered to remain on too long it is apt to oc- casion troublesome sores. These sinapisms, as they are technically called, are often of great service in the treatment of diseases. In apoplexy and comatose af- fections they are applied to the feet, in order to pro- duce a revulsion from the engorged vessels of the brain. They are, also, very beneficial when applied to the abdomen in spasmodic affections of the sto- mach and bowels; as well as in all painful affections unattended by high arterial excitement. In the low states of fever, they will sometimes manifest very use- ful effects, by their general stimulant operation, and their tendency, when applied to the lower extremities, of lessening the cerebral congestion, which always exists more or less in the latter periods of typhous fevers. Mustard seed is also used internally as a medi- cine. The unbruised seeds are particularly recom- mended in paralysis, dyspepsia, chlorosis and chronic rheumatism. Powdered mustard mixed with warm water, in the proportion of a table spoonful of the for- mer to a pint of the latter, acts promptly as an emetic. EPISPASTICS. 293 CAPSICUM ANNUUM. This is an excellent rubefacient. It may be em- ployed for this purpose, either by mixing the powdered capsules in proof spirits, or in the shape of a saturated tincture. In paralysis or torpor of the extremities, and in the low states of fever, friction with either of these preparations is sometimes very serviceable. Wearing socks dusted with red pepper, is said to be very useful in diseases of (he bowels attended with cold feet. The cataplasms of capsicum have also been recommended as good applications to the feet, in the delirium and coma of typhous fevers. The diluted juice of the pods has been employed with excellent effects in chronic ophthalmia. ALIUM SATIVUM. Garlic is frequently employed to produce rubefa- cient effects. It is, however, apt to vesicate, and where mere inflammation or redness of the skin is desired, it is not so well suited as the two preceding articles. Sydenham speaks highly of the application of garlic to the soles of the feet, as a powerful means of producing revulsion from the head. The late pro- 29 i EPISPASTICS. fessor Barton thought it an excellent application in deafness from atony or rheumatism. For this pur- pose he recommended a clove of the garlic to be sur- rounded with cotton and introduced into the ear; or wool or cotton moistened with the juice and applied in this way. It has also been emp oyed with success, in the form of an ointment, to discuss indolent tu- mours.* OLEUM TEREBINTHIN^. Turpentine is strongly rubefacient, and is one of our most common applications for purposes of this kind. There are some peculiar habits, however, in which it cannot be used on account of its occasioning violent smarting and erysipelatous inflammation. It is usually employed in the shape of a liniment, in union with alcohol and other rubefacient articles. When applied to the skin in an undiluted state, it excites considerable burning pain, with redness, and generally a vesicular eruption. It is an excellent ap- plication to the throat in cynanche tracheahs; and may, indeed, be applied with advantage in all in- stances where remedies of this kind are indicated. * Thatcher's Dispensatory. EPISPASTICS. 295 Of the use of this article in burns and scalds, I have already spoken under the head of Stimulants* OLEUM MONARDiE PUNCTATA. The oil of the monarda punctata?, a beautiful na- tive plant of this country, is a most powerful rubefa- cient. Its powers in this respect were first noticed by Dr. E. A. Atlee of this city, in an interesting paper published in the second volume of the American Medical Recorder. It is exceedingly active, produc- ing heat, redness, pain, and vesication in a very short time, when applied to the skin. Dr. Atlee states, that he has used it with much advantage, as a rubefacient liniment, in chronic rheumatism, difficulty of hearing, periodical headach, paralytic affections, cholera in- fantum, and typhus. " During the prevalence of the epidemic typhus in our city a few years ago," says he, " I was much pleased with its effects in the remarka- ble sinking state, and coldness of the extremities, to which the patients were subject. The arms, breast, and legs were bathed with this liniment,f omitting the * The following is an excellent rubefacient liniment: §, Ol. oliv. |x. ol. terebinth. Jiv. acidi. vitriol. 3iii« Misee. f R> Ol. monard. punct. ^ss. Tinct. camph. §ii. Tinct. opii. 3ii. M 296 EPISPASTICS. laudanum, and in a few minutes a comfortable glow succeeded." In the treatment of cholera infantum, I have myself employed it with great and prompt ad- vantage. By bathing the abdomen and extremities with the oil properly diluted, it speedily produces redness of the skin, and very generally relieves the gastric irritability. From my own experience with this oil I am satis- fied that it is one of the most active rubefacients we possess; and that it will be found to answer exceed- ingly well in all cases where such remedies are indi- cated. AQ.VJE AMMONIA. This article is very frequently employed as a rube- facient. In union with sweet oil, it forms an excel- lent application in a variety of affections. Pringle thought it particularly useful in cynanche tonsillaris, and it is still much used as a liniment to the throat in this and other similar affections. Its rubefacient powers are, however, not very great, its application being seldom followed by much redness, unless in young subjects. EPISPASTICS 297 CAMPHORA. Camphor dissolved in alcohol is one of our most common rubefacients. The celebrated Steer's opo- deldoc consists of soap §vii. alcohol §ii. camphor §ii. liquor ammon. 3iv. and oil of rosemary §ss. This mixture is a very useful stimulating liniment in rheu- matic affections. Dr. Ferriar recommends the fol- lowing ointment as an efficacious application in lum- bago.* He speaks very highly also of frictions with ramphor dissolved in vitriolic aether tinctura cantharides. The tincture of cantharides possesses but feeble rubefacient powers; it does not, like most of the other articles that have been mentioned under this head, produce much burning heat in the part to which it is applied, and it is seldom even that it can be made to produce much redness of the skin. It has neverthe- less been recommended as peculiarly serviceable in chronic rheumatism and paralytic affections. » R Pulv. camph. ^ii. ung. basil. |i. sapo. commun. fss. pulv. sem. sinap. 9i. Fiat unguentum. VOL. II. W 29S EPlSPASTlfcS, PIX BURGUNDICA. This resinous substance is obtained from the Nor- way spruce fir, (pinus abies,) by making incisions through its bark. Spread on leather, it is much em- ployed as a rubefacient application, and its effects are, indeed, often highly useful. When applied to the skin, it generally begins to produce a prickling heat in the course of about twenty-four hours, followed com- monly by numerous small red pimples, exuding a serous fluid, and occasionally also by vesication. In lumbago a plaster of this substance worn over the loins often proves very serviceable. Applied between the shoulders or to the breast, it is also frequently attended with very good effects in diseases of the lungs, particularly in chronic catarrh, hooping- cough, and spitting of blood. In chronic diarrhoea and dysentery I have known very excellent effects to arise from a large burgundy pitch plaster worn on the abdomen. Enveloped in cotton and introduced into the ear, it has been found serviceable in difficulty of hearing depending on a rheumatic affection or atony of the ear. EPISPASTICS, £99 Errhines. These are medicines, which, when applied to the Schneiderian membrane, increase its natural secre- tions. In persons not habituated to their use, they generally produce sneezing, and hence they are also called sternutatories. The practical application of these remedies is but very confined. Their use is restricted exclusively to the cure of some affections of the head. Their modus operandi is not difficult to understand. By irritating the Schneiderian mem- brane, they occasion an afflux to this organ, and an increase of its secretions, and consequently a deriva- tion of the circulation from the surrounding or neigh- bouring parts. Hence, they have been found service- able in rheumatic affections of the head, in pains of the ear, in ophthalmia, toothach, and various other affections of these parts. I proceed to mention a few of the principal articles employed as errhines. NICOTIANA TABACUM. Tobacco, in the form of snuff, is extensively used as a luxury. In persons not habituated to its use, in 300 EPISPASTICS. this way, it acts as a pretty powerful errhine. By repetition, however, it soon loses its power of increas- ing the discharge from the nose; and, on this account. it can seldom be employed with particular advantage in cases that require a pretty long use of such a re- medy. It has been said, that when snuffing produces a considerable discharge from the nose, which is sometimes the case even in such as take it habitually, it cannot be laid aside without the risk of injurious consequences. "From my own experience," says Dr. Cullen, " I am led to repeat here, that whenever the discharge has been considerable, the laying aside snuffing, and therefore suspending that discharge. may have very bad effects." All artificial discharges become constitutional by long continuance, and can seldom be suddenly checked without producing inju- rious effects ASARUM EUROP2EUM. The asarabacca, besides its emetic and purgative properties, is powerfully errhine. When snuffed into the nose, it produces violent sneezing and a copious discharge of mucus from the nostrils, and frequently also a plentiful secretion of saliva, continuing some- times for several days. It must be employed in mo- EPISPASTICS. 301 derate doses, as its effects are often exceedingly vio- lent when snuffed in large portions. A few grains of it snuffed once or twice a day has been known to produce excellent effects in toothach, ophthalmia, headach, and other affections of the head. HELENIUM AUTUMNALE. This is a syngenesious 'plant, indigenous to the United States, in many parts of which it grows in great abundance. The whole plant is intensely bit- ter, and may be usefully employed as a tonic. As an errhine, the powdered leaves are recommended by the late professor Barton as safe and valuable. I have prescribed it in a few cases, and found it to produce profuse discharges of mucus from the nose. It is less violent in its effects as a sternutatory than the asarum and produces quite as much discharge. TURBETHUM MINERALE. This is a very valuable errhine. It seldom fails, when snuffed up the nose, to produce very copious fluid discharges. When employed for this purpose, it is 502 EPISPASTICS. generally mixed with the powder of asarum, or with common snuff. In affections of the eyes and ears, this errhine has been found to produce valuable ef- fects. Dr. Barton states, that he has employed it in cases of epilepsy, gutta serena, &c. and that he can confidently recommend it as a remedy entitled to at- tention. In two instances in which he used it consi- derable salivation was produced. Various other errhines are mentioned by writers on the materia medica, but of which I consider it super- fluous to give any particular account. It will be suf- ficient merely to mention their names, the principal of which are: beta, betonica, majorana, hedera teres- *ris, euphorbium, origanum, achillea, ptarmica, &c. CHAPTER XIV. //. Medicines that increase the action of the Urinary Organs. DIURETICS. Diuretics are such remedies as promote the dis- charge of urine. Some articles of this class appear to be absorbed into the circulation, and act directly upon the secretory vessels of the kidneys ; others pro- duce their effects in a more indirect manner, by acting primarily on the stomach, and propagating a sympa- thetic action to the kidneys. There are others also, that act by promoting absorption, and thereby aug- menting the quantity of serous fluid in the blood-ves- sels, in consequence of which the renal emunctories are excited into increased action.* That many articles of this class are absorbed into the circulation, and act directly upon the secretory vessels of the kidneys, is demonstrated by the re- appearance of these substances in the urine. I have, * Murray's Materia Medica. .m DIURETICS. however, already dwelled particularly on this sub- ject when speaking of the general modus operandi of medicines, and shall therefore say nothing further on this point, in the present place. With regard to the latter mode of producing diuresis, that is, by ex- citing the action of the absorbents and inducing a re- pletion of serous fluid in the blood-vessels, it will be proper to be more explicit. The emunctories of the animal system, are the outlets to the effete matters, or the superabundant and imperfectly animalized fluids circulating in the blood-vessels. They are " the scavengers of the animal economy," whose ac- tion is in proportion to the quantity of the materials which they have to eliminate. If the blood be drain- ed of its serous portion by dropsical effusion, the skin and kidneys, being less excited to active excretion, on account of the deficiency of the materials which they are destined to remove, become inactive, whilst the exhalants from which the dropsical effusion takes place, continue by a sort of vicarious office to separate from the blood its watery portion. If in this state we prescribe a remedy whose effect is simply to excite the secretory vessels of the kid- neys, as, for instance, squills, we will seldom produce any augmented secretion of urine, because, the neces- sary materials for the secretion of the urine do not oxist in sufficient abundance in the blood. If how- diuretics. 305 ever we unite with this simple diuretic another arti- cle, possessing the power of exciting the re-absorption of the effused fluid, we at once stimulate the vessels of the kidneys, and furnish them with an augmented portion of the materials of secretion. It is on this account that we often derive so much advantage from the union of squills and calomel in dropsy; and it is upon the same principle that the action of diuretics is increased by copious draughts of mild diluents. The system r^pears to be equally incapable of bearing with impunity, either too small or, too large a portion of serous fluid in the blood. As soon as this part of the circulating mass becomes more than ordinarily augmented, the kidneys or the skin are excited into action to reduce its quantity; and hence, we often excite the action of the kidneys, by indulging our pa- tients in the free use of mild drinks. But although diluents are certainly useful, in cases of dropsy, to excite the action of the kidneys, yet when once this effect is produced, and the absorption of the effused fluid takes place, they ought to be less liberally used, since, by supplying the blood-vessels with a sufficient quantity of watery fluid, there will be a less demand made upon the absorbents, and consequently a slower reduction of the dropsical effusion. The action of diuretics is also promoted, in full and phlogistic habits, by whatever lessens arterial vol. n. 39 306* Diuretics excitement, or diminishes the quantity of fluid circu- lating in the system. Thus, bleeding and cathartics are often of essential service in this way. To some there may appear to be a contradiction, in this state- ment, to the one made above,—that copious draughts of diluents increase the efficacy of diuretics, by furnishing the vessels with a more abundant share of watery fluids. The fact however is otherwise. In opposite states of the system these contrary means produce, indeed, precisely similar results. They both increase diuresis by favouring the absorption of watery fluid. The only difference that subsists between bleeding and plentiful dilution in this respect is, that the former increases the activity of the absorbents, and lessens the rapidity of serous effusion, whilst the latter acts simply by furnishing the absorbents of the alimentary canal with a greater quantity of fluid for absorption. It must also be observed that bleeding and cathartics can only be useful for purposes of this kind, when the blood-vessels are fulf and active; whilst, on the contrary, copious draughts of bland liquids are particularly suitable, where the system is less plethoric, and the blood has already been much exhausted of its serous portion. We find no diffi- culty in understanding how the discharge of urine may be promoted, by the plentiful use of water; but of the manner in which depletion, or the reduction of arterial excitement, acts in increasing the vigour of DIURETICS. 307 the absorbents we know nothing. The fact however is fully ascertained, not only by the effects of bleeding and purging in the treatment of dropsy, but also by the direct experiments of Magendie, who has recently demonstrated, what indeed had been noticed before, that absorption is accelerated or retarded in propor- tion as the quantity of fluid circulating in the blood- vessels is increased or diminished.* Much dispute existed formerly with regard to the propriety or impropriety of allowing dropsical patients to indulge freely in the use of mild and diluent drinks. Although it must be admitted that copious draughts of water will in general increase the quantity of urine, yet I cannot believe that any essential advantage will often result from a very great indulgence in this way. For if the urine is increased, by the use of much drink, it must be observed, that the source of this in- crease is not so much in the absorption of the drop- sical fluid deposited in the cavities of the body, as in the absorption of the water taken into the stomach and bowels from without. And hence, however co- pious the urinary discharge, the dropsical swellings will often diminish but triflingly, or remain stationary, or even sometimes increase. To torture the patient, however, with excessive thirst, is not only useless, but absolutely pernicious. A pretty free use of mild drinks should always be allowed; thirst ought never * Journal of Experimental Physiology, by M. Magendie, 1821 308 DIURETICb to be suffered to become so intense as to produce gc neral irritation. How an increased secretion in the kidneys can re- duce dropsical accumulations, is difficult to perceive. It cannot be wholly from any direct action which diuretic remedies may exert on the absorbent sys- tem; since we have it from very high authority* that dropsies have been cured by the free use of diluent drinks alone; and it will hardly be contended that such a remedy could exercise any direct influence over the absorbents. I am inclined to believe that the explanation must be sought for in the following circumstances. When the discharge from the kid- neys is much increased, in a case of dropsy, we not only determine the serous discharge to these emunc- tories, but lessen the general mass of this portion of the blood, and consequently lessen the effusion from the exhalants furnishing the dropsical fluid. Now if the exhalation from these vessels be diminished, and the regular discharge from the kidneys be re- established, the dropsical accumulations must gradu- ally disappear, although the absorbents remain in the same condition, with regard to the degree of their ac- tivity. But independent of this effect of diuresis in diminishing accumulations of effused fluids, there are other results which we have reason to believe take place, concomitantly with those just mentioned, and * Dr. Cullen. DIURETICS. 309 which still further increase the efficacy of diuretics in dropsy. I have stated above that depletion favours, in a very decided way, the absorption of fluids; hence when the blood-vessels are suddenly deprived of a portion of their serous fluid, by the action of a diure- tic, nature, making an effort to sustain the necessary proportion of this component part of the circulatory mass, excites the absorbents into more vigorous action, in order to supply the deficiency which the animal economy experiences. From the great and rapid reduction of strength. produced by excessive discharges of urine, as in dia- betes, it is evident that the general powers of the system are much under the control of diuretic re- medies. They are accordingly often resorted to as depletory remedies in the treatment of sthenic dis- eases. In gout, and rheumatism especially, they have been recommended as highly useful, when em- ployed in conjunction with cathartics. Dr. Scuda- more, speaking of the treatment of this disease, says, "In imitation of nature's efforts to remove redundant matter by the medium of the kidneys—an action, the existence of which I think myself entitled to infer from my experiments—we are to keep the corre- sponding treatment attentively in view; and I have in- variably employed, with the greatest advantage, purga- tive and diuretic medicine conjointly, so that the ex- halant vessels of the alimentary canal, and the secret- 310 diuretic s- ing function of the kidneys are stimulated to increas- ed action at the same time."* In the treatment of chronic dysentery too, diuretics have been prescribed, with a view of determining the discharge of fluids from the intestinal vessels to those of the kidneys.f Celsus, in his account of the treat- ment of dysentery, says, " Et ea, quae urinam movent, si ea consecuta sunt, in aliam partem humorem aver- tendo prosunt."| On the principle here mentioned by Celsus, diuretics are sometimes found to produce use- ful results in affections of the breast and head. I have known a case of gutta serena cured by the employ- ment of cream of tartar and calomel, in large doses, the immediate and only sensible effect of which was constant and copious diuresis. Diuretics have also been known to produce benefi- cial effects in certain affections of the pulmonary or- gans. Upon this subject Dr. Armstrong makes the following interesting observations. "The apparent benefit which I have seen to result from sudorifics and diuretics in some cases of threatened consump- tion, would alone seem to indicate the applicability of medicines which act upon the kidneys and skin in certain examples; but as my own experience is defec- tive on this point, I recommend it to the notice of * Scudamore on Gout, p. 100. t Bampfield on Tropical Dysentery, p. 165. J: Celsus, deMedicina, Lib. iv. Cap. xv. de Dysenteric DIURETICS. 3 J ] others, as well from practical as pathological con- siderations." Again, he observes: "As the skin and kidneys both closely sympathize with the lungs, is it probable that diseases of the latter might be benefited by certain articles of food which operate on the for- mer?" Diuretics are said to be a powerful auxiliary in the cure of ulcers situated on the lower extremities, and attended with oedema of the leg.* In various affections of the urinary organs, diuretic remedies are especially indicated, and often afford very decided advantages. In ulcers of the kidneys, or inflammation of the mucous lining of the bladder and urethra balsamic, diuretics may in general be use- fully employed. These appear to act, in the cure of affections of this kind, by medicating the urine, which, coming in immediate contact with the diseased part, act upon it as a local remedy. It is in this way, no doubt, that balsam copaiva and turpentine cure gonorrhoea. They impregnate the urine with their peculiar medicinal qualities, which, being passed through the urethra, acts upon it in the same way that injections do. If we admit, as I am fully disposed to do, that dis- eases do occasionally depend on a deteriorated state of the blood, we must regard diuretic remedies as a most important class of medicinal agents in the cure * Lond. Med. and Phys. Jour. No. 162. 312 DIURETICS. of such diseases. The kidneys, perhaps, more than any other emunctory of the animal economy, are an outlet to such portions of the circulatory mass as are effete, or foreign and inimical to the regular actions of the system. We find, too, that the solution of dis- eases is more frequently attended by a critical dis- charge of urine than by any other of the excretions. Diuretic remedies have accordingly been recom- mended in a variety of chronic diseases, which appear to be accompanied by a morbid condition of the fluids; such as scurvy, elephantiasis, &c. In the beginning of this chapter it is stated that cathartics promote the operation of diuretics. It must be observed however that quite the contrary effect ensues from purging, when induced either by the diu- retic medicine itself, as sometimes occurs when the dose is very large, or from the simultaneous exhibi- tion of some cathartic medicine. When purging is thus produced, a check is put to the absorption of the diuretic remedy, in consequence of the rapidity with which it is hurried through the alimentary canal; and there is, moreover, a direction given to the discharge of the humours, by the intestinal exhalants. These observations are particularly applicable to the saline diuretics, having a vegetable acid as a constituent. "This super-tartrate of potass or cream of tartar acts in well regulated doses, as we all know, upon the kid- neys; the tartaric acid being in this case abstracted, DIURETICS. 313 and assimilated by the digestive process, and the alka- line base at the same time eliminated and subsequent- ly absorbed; but if we increase the solubility of the compound, by reducing it to the state of a neutral tar- trate, (soluble tartar,) or by combining it with boracic acid, or some body that has a similar effect; or, what is equivalent to it, if we so increase the dose of the cream of tartar that catharsis follows its administra- tion, then diuresis will not ensue, since no decomposi- tion can take place under such circumstances; for it is a law of the animal economy, that the process of assimilation and absorption are arrested or very im- perfectly performed during any alvine excitement"* DIGITALIS PURPUREA. Under the head of Narcotics, an account is given of the remediate effects of digitalis, so far as they seem to depend on its sedative virtues. In the present place, therefore, I have only to speak of it in relation to its property as a diuretic,—a property to which, indeed, it owes some of its most important medicinal effects.! * Paris' Pharmacologia. f The appearances of the urine were at one time regarded as of the utmost consequence, in forming a proper opinion of vol. ii. 40 3] 4 DIURETICS. * The diuretic powers of this medicine, seem to be entirely independent of its narcotic effects. It is even stated by some very eminent writers, that its diuretic and narcotic operations are incompatible. Dr. Fer- riar observes, " that when given in such quantities as to excite nausea, or to produce evident narcotic ef- fects, it does not operate as a diuretic.'' Withering expresses the same opinion. Although it must be admitted that the sedative and the character of diseases.—At present this excretion is unques- tionably too much neglected ; by an attention to it we will often be greatly aided, in our judgment of the nature of diseases. Dr. Prout, observes: " A diminished flow of urine accompanies active inflammation, and an inflammatory state of the system in general. The urine is invariably of a deep colour. "An increased flow of urine, or diuresis, very constantly ac- companies those diseases connected with a peculiar state of nervous irritability, as hysteria. It may be also produced by certain passions of the mind, as fear. Lastly, it may be induced by local irritants acting on the urinary organs themselves. In those cases the urine is always of a pale colour. " Thus, generally speaking, nothing can be more opposite than the conditions of the system, and consequently the princi- ples of practice, indicated by a diminished or increased flow of urine. Hence, they are symptoms of primary importance in all diseases in which the urine is concerned; and, whatever may be the disease, seldom fail of furnishing us with a clue to the principles upon which it is to be treated."—An Inquiry into the JYature and Treatment of Gravel, Calculous and other Diseases connected with a deranged operation of the Urinarx, Qrgav* Lond. 1821. p. 35. DIURETICS. 315 diuretic powers of digitalis are very generally exerted independently of each other, yet there can be no doubt, that though not necessarily connected, they are occasionally found to act concomitantly, and are at least not incompatible.* Conceiving that the cura- tive powers of digitalis in dropsy are dependent upon its sedative effects, Blackall and Paris disapprove of the common practice of prescribing this remedy in combination with calomel, since this latter article always excites the action of the heart and arteries, and is therefore inconsistent with the sedative opera- tion of digitalis. I feel persuaded however that this ob- jection is rather hypothetical than founded on ex- perience and correct observations. Were it a fact, that the diuretic powers of this medicine are depen- dent on its sedative effects, the impropriety of such a combination would be evident; but as no such de- pendence subsists between these powers, inasmuch as the diuretic effects of the medicine are generally conspicuously evinced, when the action of the heart and arteries is least reduced, and on the contrary sometimes entirely wanting when the sedative effects are most powerful, it does not seem reasonable to * Dr. Ferriar observes, " that the diuretic action of digitalis, though independent of its sedative powers, may sometimes take place in conjunction with the latter, and may even co- operate with it, by its effect on the system as an evacuant." Essay on Digitalis 316 DIURETtCS. ascribe any unfavourable consequences to the mere stimulant effects of calomel upon the diuretic opera- tion of digitalis, with which it is sometimes combined. Although digitalis occasionally acts very powerfully as a diuretic, it is not to be regarded as very certain in its operation. In general, where it produces any good effects in dropsy it does not require long before it manifests its diuretic powers. Dr. Ferriar observes, in relation to this point: "if no beneficial effects be perceivable, in the course of a few days, I exchange the digitalis for some other diuretic." I have myself repeatedly noticed this circumstance in my experience with this remedy; and I believe that it will seldom be proper to continue it more than seven or eight days, if no manifest diuretic effects ensue. Great diversity of opinion exists among writers concerning the remediate powers of this medicine in hydropic diseases. Some physicians of eminence, have extolled its virtues in the most extravagant terms; whilst others have not been willing to concede to it any properties in this respect whatever. The weight of good testimony is, however, in favour of the anti-hydropic virtues of this article, and almost all agree in opinion, at present, that, though not very commonly adequate to the cure of dropsy, it is never- theless a remedy of valuable powers, and deserving of particular attention in the treatment of such affec tions. DIURETICS. 317 Dropsy is a disease by no means so uniform in its character and causes as is generally supposed. It arises in the most opposite states of the system, with regard to' vascular action and repletion; it is depen- dent on various organic affections; appears as a conse- quence of different acute and chronic diseases; and is attended with distinct characters of urinary secretion. These circumstances point out some diversity in the character of the disease itself, and it is no reasonable to suppose that any one particular remedy is equally applicable to the disease under all these diversities of disposition. It appears, indeed, from the experience of physicians, that digitalis is peculiarly under the in- fluence of circumstances of this kind, and hence, no doubt, have arisen the contradictory statements that have been made by writers concerning the anti-hy- dropic effects of this medicine. By Dr. Withering we are informed, that in his practice the digitalis seldom succeeded in curing ascites or anasarca, in persons of tense fibre and great general strength of system; on the contrary however it hardly ever failed to produce conspicuous diuresis in persons having a feeble or in- termitting pulse, much laxity of fibre, with a pale countenance and cold skin. Dr. Maclean, in his ex- cellent work on hydrothorax, confirms these observa- tions, and observes, in addition to what Withering has said, that he seldom derived any benefit from the me- dicine in persons of a fat corpulent habit, connected 318 DIURETICS. with a dull sluggish irritable fibre, but that he gene- rally succeeded well in relieving those of a " weak, delicate, irritable constitution, with a thin, soft, smooth skin, which in the anasarcous limb is transparent." Dr. Thomas states, that in cases where the urine does not coagulate by heat, he usually found digitalis unsuccessful; where the viscera were sound, how- ever, or the habit not entirely depraved, he found it to succeed. He also observes, that when the digestive organs fail, and there is frequent sickness or diarrhoea, with a bad habit of body, the use of this remedy has appeared to be injurious. With regard to its relative value in hydrothorax, ascites, and anasarca, the evi- dence of practitioners is contradictory, and does not af- ford any conclusions worthy of confidence. Dr. Black- all, who has paid very great attention to the different varieties of dropsy, and. especially to circumstances connected with the urinary secretion, observes, that in dropsies consequent to scarlatina, in which he in- variably found the urine to coagulate by heat, he de- rived the most important advantages from the use of digitalis, with blood-letting. As digitalis generally operates most beneficially in dropsy when united with other diuretic or hydragogue remedies, it is not commonly employed alone, but combined usually with calomel, squills, Dover's pow- der, cream of tartar, &c. Dr. Ferriar was in the habit of giving cream of tartar early in the morning*. DIURETICS. 319 in doses sufficient to purge, and digitalis, with opium, in increasing doses, every evening. If there was naturally a tendency to purging, he gave the digitalis " in half-grain doses, at intervals of five, six, or eight hours, with the usual precautions." I have seldom em- ployed this medicine by itself in dropsy. My practice has almost invariably been to combine it with acetate of potass or squills, and frequently also with calomel and Dover's powder, as directed by Dr. Ferriar.* Squills and the saline diuretics appear to be particularly qua- lified to increase the diuretic properties of digitalis. The reason of this does not appear to be very difficult to explain, if we adopt the opinion expressed by Dr. Maclean concerning the modus operandi of this medi- cine as a diuretic. He regards the beneficial effects of digitalis, in dropsy, as dependent mainly upon its powers of increasing the activity of the absorbents. This opinion derives very considerable support from the fact, that this remedy very rarely produces any diuretic effects in persons unaffected by dropsical effusions, and in whom, consequently, no sudden re- pletion of the vessels, by absorption, can take place. The same circumstance takes place with regard to the operation of calomel. In^subjects where no effu- * The formula which Dr. Ferriar generally used, contains pulv. digitalis gr. £, calomel gr. i. pulv. Doveri gr. viii. made into pills. To be taken at bed-time, and repeated during the day according to circumstances. 320 MURElLwS. sions exist, this remedy hardly ever manifests any diuretic operation. In persons, however, labouring under dropsical collections, the diuretic effects of this medicine are often very powerful and sudden. These effects can hardly be explained upon any other prin- ciple than the absorption of the dropsical collections, in consequence of which the vessels become suddenly overcharged with serous fluid, which is eliminated either by the bowels in the form of a diarrhoea, or by the salivary glands, or the kidneys. If these views be correct, and I am much inclined to put confidence in them, the fact that squills and some of the saline diu- retics have a tendency to increase the diuretic opera- tion of digitalis, would appear to be explicable upon the principles mentioned in the preliminary observa- tions to this chapter; namely, that whilst the absorp- tion of the effused fluid is increased by the action of the digitalis, and consequently a greater portion of serum poured into the blood-vessels, the other reme- dies act more immediately upon the kidneys, and in- crease their functions, by which the absorbed fluid is again eliminated. From this view of the subject we see, too, why calomel has a greater tendency to in- crease the diuretic effects of squills than of digitalis; for with the former it produces the double and direct effect of absorption and renal action, whilst with the latter it can only produce increased absorption, which may or may not excite the action of the kidneys. DIURETICS. 331 The best form for administering this medicine with a view to its diuretic operation is, an infusion of the leaves. The infusion of digitalis, directed by the Lon- don and Edinburgh Dispensatory, may be taken in the dose of from §ss. to §i. twice a day, and gradually increased, until symptoms arise which require its suspension, such as slow pulse, accompanied with nausea, palpitations, faintness, purging, and great prostration. Dr. Blackall, in his excellent treatise on dropsies, mentions another symptom of the undue ef- fects of this medicine, which it may be of importance to bear in mind; he states, that the continued use of the digitalis, or an over-dose ^)f it, occasionally produces a tensive pain of the head, extending sometimes over one eye, and attended with a disturbance of the brain, which precedes other bad symptoms, and which, if not attended to and speedily obviated, often terminates in convulsions or death. Its narcotic effects, when too violent, are best coun- teracted by stimulants, such as brandy and water, opium, and volatile alkali, &c. The sulphate of iron, and the infusion of cinchona, produce precipitates, when added to the infusion of digitalis. vol. ii. _ 41 i 322 DIURETICS. SCILL^E RADIX.--SCILLA MAR1TIMA.—SQUILL ROOT.* This is one of the most certain, efficacious, and valuable diuretics we possess. Like digitalis, it is rendered much more active in its operation as a diu- retic, by combining it with some other articles of this class, and particularly by giving it in union with calomel. I have already spoken of the propriety of uniting it with calomel, in cases where we wish to evacuate dropsical effusions. The squill seems to in- crease diuresis by stimulating the kidneys to invigo- rated action, and calomel,* it. is well known, has a powerful tendency to promote absorption. By uniting these articles together, therefore, we obtain a remedy which enables us at once to excite the action of the absorbents and the kidneys, and thus, in the most ef- fectual manner, promote the removal of dropsical collections. The late Dr. Home of Edinburgh, sup- posed that the diuretic effects of this medicine were greatly enhanced by uniting it with such articles as are capable of promoting its emetic operation; or by giving it in sufficient doses to produce decided impres- sions on the stomach and bowels. Directly the re- verse of this opinion was strenuously advocated by Dr. Cullen, who maintained that the diuretic effects * A particular account of the natural history of this root has already been given under the head of Emetics, DIURETICS. 323 of the squill are generally much less conspicuous when it operates strongly on the stomach and intes- tines, than when it produces no sensible operation on these organs. The reason of this he conceived to be, that by such effects on the bowels the medicine was "prevented entering the blood-vessels, and thereby reaching the kidneys." Whether we admit this ex- planation or not, the fact is, I believe, fully established that not only this, but every other article belonging to this class of remedies, is less apt to produce diuresis when it either purges or vomits, than when no such effects are produced. Upon this subject Dr. Blackall observes, " it never operates so favourably as when it is given in the fullest quantity which the patient can bear without sickness." This corresponds with the experience of other late writers who speak of this re- medy. It appears to be admitted on all hands, that the remedy is, in general, more apt to afford relief in hy- drothorax than in any of the other varieties of dropsy.* " In the early stage of this disorder," says Dr. Black- all, "medical treatment does a great deal, principally by means of diuretics: and squills is by far the most powerful of them." " It is particularly useful," he says, " where, with an oppression of the chest, the urine is scanty, high-coloured, full of sediment, and without serum. Its use, however, is not limited to this state; I have sometimes seen it render service * Blackall, Maclean, Van Swieten, &c. S2i DIURETICS. where the urine is partially coagulable. But in pro- portion as that symptom becomes more marked by its extreme constitutional characters, inflammation, and a weakness of the digestive organs, it fails in its effect, or is even injurious." He recommends it to be given at first in the dose of thirty drops of the vinegar or tincture of squill, three times a day, and gradually increased to forty or fifty drops. When it does not act entirely as it could be wished, " the addition of a grain of calomel," says the same writer, " every night, is frequently followed by a great flow of urine at the same time that the salivary glands are affected." Dr. Maclean also speaks in very high terms of the efficacy of squills and calomel in hydrothorax. I have my- self uniformly obtained more advantage in this disease, by these two articles in union with nitre, than from any other diuretic I have ever employed. Such a combination is particularly efficacious when it pro- duces inflammation of the gums and the glands about the throat. The reason why calomel and squills are more apt to afford relief in hydrothorax than in the other varieties of dropsy, may be owing to a three- fold operation: it promotes absorption, excites the urinary discharge, and, by determining the circula- tion particularly to the glands of the mouth and throat, it causes a derivation from the exhalants of the pleura, and thereby lessens the dropsical exhalation. The exhalants of the cavity of the thorax would be more DIURETICS. 325 likely to be influenced by such an afflux to the glands of the mouth and throat, than those situated more re- motely, and hence, perhaps, arises the more speedy relief which is commonly procured in hydrothorax by such a combination of remedies, than in ascites and anasarca. The expectorant operation of squills, is also a circumstance which would seem to render it more suitable in dropsies of the chest than the other diuretics. The diuretic operation of squills is said to be as- sisted by the mistura ammoniaci and spiritus aetheris vitriolici ;* and Dr. Ferriar observes, that " in some habits the combination of tincture of squills with syrup of buckthorn proves very powerfully diuretic." Dose: from one to four grains, in substance. Tincture and vinegar of squills, from thirty to sixty drops. COLCHICI RADIX.—COLCHICUM AUTUMNALE.—THE BULB OF THE MEADOW SAFFRON. The colchicum autumnale is a perennial plant, growing in abundance in the temperate climate of Europe, and may be conveniently cultivated in our gardens. 'The root is a double succulent bulb. * niackall. 326 DIURETICS. The flower is large, of a purple colour, and comes directly from the root. The leaves appear in spring, and are radical and spear-shaped. Corolla consisting of a simple petal divided into six lance-shaped erect segments. Capsule three-lobed, divided into three cells, containing globular seeds, which are not ripened until the ensuing spring, when the capsule rises above the ground upon a strong peduncle. It flowers in autumn, when the old bulb begins to decay, and a new one is formed. In the following May the new bulb is perfect, and the old one wasted and corrugated. The roots are dug for use in the beginning of summer."* When fresh, this root possesses extremely active powers, producing, according to the observations of Stcerk, when taken in a dose less than a grain, " a burning heat and pain in the stomach and bowels, strangury, tensemus, thirst, total loss of appetite," and in larger doses, violent and even fatal effects. Its ac- tive principle resides in a milky fluid, and consists of an essential oil. It contains extractive matter, " which, when in solution, undergoes a chemical change." It has been ascertained by Sir E. Home, that the deposit which takes place in the vinous infusion produces nausea and griping, and that the efficacy of the medi- cine is not destroyed by removing this deposit. It contains also an alkaline principle in combination * Thornton's Family Herbal. DIURETICS. 327 with gallic acid;* which when snuffed into the nose produces violent sneezing, and vomiting and purging when swallowed. When taken in a duly regulated dose, it generally acts upon the bowels and kidneys, producing commonly one or two brisk alvine evacua- tions, and a pretty copious diuresis. Neither of these effects are however very constant results of its exhibi- tion, nor does it appear that they are essential to its remediate influence, in many of the diseases for which it is prescribed. By the ancients colchicum was much employed as a remedy in arthritic and other diseases. It appears also from their writings, that they indiscriminately ap- plied the names hermodactylus and colchicum to the same plant; though colchicum is the most ancient name, and it seems, too, that the name hermodactylus was applied to several species.f It is thought by many, that the colchicum autum- nale, which has of late become so important a remedy, is the hermodactylus of the ancients. This appears indeed very probable, when we compare the descrip- tion which Dioscorides gives of colchicum, with Withering's account of the English meadow saffron. They agree perfectly in giving the very same distin- * Annals de Chimie, torn. xiv. Mai, 1821. t Medical Sketches, B. G. Kerr. From this little Work I have drawn the principal part of my historical account of this plant. 328 DIURETICS guishing marks to the plant which they respectively describe. Now Serapon, in his description of hermo- dactylus, employs " the very words in which Diosco- rides describes colchicum." It is therefore quite evi- dent that these writers must have had the same plant in view in their descriptions. It appears also, that in England, at no very remote period, colchicum was known by the name of hermodactylus. " In an Eng- lish translation of Wirtzung's Praxis Midicinae Uni- versalis, printed in the time of Queen Elizabeth, we have the following passage: ' Hermodactvlus, in Greek colchicum, in Latin ephemerum deleterium. Our common hermodactylus is the hermodactyle root and true colchicum, which Galen calleth ephemerum deleterium.' "* And Sir John Hill says, in his British Herbal, that "no one who has seen the hermodactylus of the east, and compared it with the meadow saffron of England, can for a moment doubt that they are the same plant." The colchicum was in high repute among the an- cients, and prescribed for the very diseases in which it is at present so much commended. It had, however, nearly sunk into total neglect, when Mr. Want of London, within a few years past, again brought it into notice, as forming the active principle of the eau me* dicinale, D'Husson so much extolled for its remediate powers in gout. This opinion concerning the iden- * Medical Sketches. DIURETICS. 329 tity of the colchicum and the eau medicinale, is advo- cated by Sir Everard Home, in a paper published in the Philosophical Transactions;* but is strongly con- tested by Scudamore and others. Be this as it may, it seems to be conceded very generally, that the colchicum is a remedy of great powers in gout and rheumatism. It is not, however, allowed on all hands to be always a very safe remedy. It is stated, by very high authority, that although gene- rally speedily effectual in removing the local symp- toms of pain and inflammation in gout, it has a ten- dency " to leave the disposition to the disease much stronger in the system, and lead to still more calami- tous, because still more constant pains of the chronic form of the disease."! This writer, however, does not disapprove of col- chicum when properly administered, but speaks of it, on the contrary, in terms of confidence and praise. When given in the subjoined formula,J " it produces all the good effects," he says, " of which the medicine in its other forms is capable, and is not chargeable with any one ill consequence." * Part ii, 1816. t Scudamore on Gout, p. 108, Amer. edit. t R Magnes grs. xv. ad xx. magnes sulphat 3»- ad 3ii- aceti colchici 3i. ad 3'ii. with distilled water most agreeable, and sweetened with syrup. To be taken at once, and repeated every four or six hours. VOL. II. 42 330 DIURETICS. From my own experience I can say nothing of its effects in gout; in chronic rheumatism, however, I have had unequivocal evidence of its efficacy. In a late work on the colchicum autumnale, it is stated to be equally efficacious in the chronic and inflammatory forms of this disease. The author, Mr. Haden, asserts, that in his practice, " it has proved itself a remedy* of eminent power, in controlling the action of the heart and arteries, and in curing those states of the constitution which we are taught to name diseases of excitement."* In pure inflammations, he says, if given every four hours until it purges freely, the pulse will become nearly natural, from being either quick and hard, or slow and full. The form in which he employed this remedy is a powder, composed of one part of powdered colchicum, three of carbonate of potash, and five of sulphate of potash. Of this he gave one drachm three or four times a day, in half a pint of warm water, in the state of effervescence, with tartaric or citric acid. If this failed to move the bowels freely by the second or third day, he gave salts or the infusion of senna, to quicken its operation. As the strength of this preparation must depend much on the manner in which the colchicum is dried, and * Practical Observations on the Colchicum Autumnale, as a general remedy of great power in the treatment of Inflamma- tory Diseases, both acute and chronic, 8cc. by Charles T. Ha- den, surgeon. 1820. DIURETICS. 331 as, moreover, its active powers are much weakened by this process, it is evident, that the remedy must be liable to great variations of strength. Within the last year, the seeds of the colchicum autumnale have been introduced to the attention of the profession, as a remedy of extraordinary powers in the cure of chronic rheumatism, and greatly supe- rior in every respect to the root of this plant. Dr. W. H. Williams, of Ipswich, in England, to whom the credit is due of having first brought before the profession the remediate properties of the seeds, says: " Much as the powers of the root of this plant have been extolled by different writers, I cannot omit this opportunity of declaring my decided conviction, that, however successfully different preparations of it may have been occasionally administered, its uncertain effects, the violence sometimes accompanying its ope- ration, the little reliance to be placed upon the experi- ments hitherto made to ascertain the exact period of the perfection of the bulb, and the deterioration it frequently undergoes in keeping, are objections so weighty, that its value in the materia medica is insig- nificant, compared with the immense advantages at- tending the exhibition of the seeds." He states, that he exhibited the vinum seminum colchici* to a * R Sem. colch. autumn, siccat. §ii. Vini Hispanici (Sherry Agnl.) Octan. i. Digere per dies octo vel decern., subinde agitando, dein per 332 DIURETICS. great many patients, some of whom were severely afflicted with chronic rheumatism, and he declares that he was astonished by the rapidity with which the pains were removed and the use of the limbs restored. He directs it to be given two or three hours after breakfast, and repeated at bed-time. " With respect, more especially, to the vinum seminum colchici," he says, " of the safety of which I have experienced such abundant proof, I cannot contemplate an extensive use of it in many painful diseases, besides chronic rheumatism, without entertaining the hope and belief that we have at length found the happy desideratum; a powerful, yet mild medicine, capable of substituting calmness, tranquillity, and balmy sleep, in the place of pain, weariness, and restless nights,—a renovation of long lost limbs, and comparatively robust health, in lieu of feebleness and emaciation."* I fear, however, that this flattering account of the sanative virtues of chartam cola, et in vasi probe clauso usui serva. Dose 3!- twice a day, gradually increased to 3»i« Dr. Williams states, that " the acidum aceticum and the spiritus ammonise aroma- ticus, imbibe the powers of the seeds in the same proportion as sherry; that an abundant aqueous extract may be obtained from the seeds, but no oil, and that water distilled from them appears totally inactive." * Observations, with Cases illustrative of the salutary pow- ers of the Seed of Colchicum Autumnale, 8cc. &c. by William Henry Williams, M. D. F. L. S. See London Medical Reposi- tory for August, 1820, and June, 1821. DIURETICS. 333 our remedy will not be verified to the full extent. There can, nevertheless, be no doubt, from the statements we have had, that it possesses very active powers; and although it is not probably entitled to the high encomiums bestowed upon it, there are just grounds to expect from it very important remediate results. With regard to the employment of colchicum with a view to its diuretic operation, late experience does not appear to speak much in its favour. By baron Stoerck, however, it was regarded as a very powerful diuretic, and exceedingly useful in dropsy. Having ascertained by experiments on himself that the oxymel of colchicum, taken in doses of a tea-spoonTul, pro- duced copious discharges of urine, he made trial of this remedy " in the hospital at Vienna, in desperate hydropic and other serous disorders, in which it was always found to act without disturbance as a most potent diuretic, after the common medicines employed with that intention had failed." He commenced with a drachm twice a day, and gradually increased the dose to an ounce, and occasionally an ounce and a half a day. I have seen it employed in one case of dropsy only, and in this instance it excited copious diuresis, without, however, effectually removing the disease. This remedy has also been recommended in hu- moral asthma; of its powers in this disease, however, 308 DIURETICS. there is nothing extant, so far as I can ascertain, which is calculated to attract the attention of the pro- fession. Dr.' Paris thinks " that acids and oxygenating sub- stances render the vinous infusion drastic; on the con- trary, alkalies render its principles more soluble, and its operation more mild, but not less efficacidus." The saturated vinous tincture is given in the dose of from 3SS. to $[. Mr. Richard Battley, chemist, of London, who ap- pears to have paid very particular attention to the na- ture and properties of this root, and the best time for taking it, says, " that this root is deprived of its power, progressively, from the time of throwing out the new bulb until its final disappearance; and that, although very little change of appearance occurs during the winter months, it really undergoes a decided change during that period; that August before the new bulb is thrown out, is the proper season to procure the root; and that the various opinions, as to the medicinal pro- perties of colchicum have proceeded from the various states in which it has been brought into use. " The root, when dug up in August," should be im- mediately cut into transverse slices, equal in thick- ness to a half crown; to be then exposed, in wicker baskets without placing the pieces in contact, to a temperature of 170° to 180°, and so to remain until dried, which will require from two to three hours.'* * London Medical Repository, for July 1820, DIURETICS. 335 NICOTIANA TABACUM. Tobacco possesses very considerable diuretic pro- perties, but on account of its extremely unpleasant and sickening effects, it is seldom employed as an in- ternal remedy. Dr. Fowler, who has writen a work on the employment of this remedy in dropsy and dysury, speaks very highly of its efficacy in these dis- eases. He recommends it to be used in the form of an infusion; and observes that the best time for ad- ministering it is about two hours before dinner, and on going to bed. Dr. Ferriar also employed it in some cases with success ^ though he does not speak of it as deserving much confidence. He gave it, occa- sionally, in combination with other diuretics,* giving at the same time purging doses of cream of tartar in the morning. He states that he succeeded in several very unfavourable cases by this plan of treatment, and he thinks " that the action of the kidneys may in ge- neral be excited in this manner." I have employed the tincture of tobacco in two cases of dropsy, and although considerable diuresis was produced, no per- * R Oxymel colchic. Oxymel scilla. Tinct. nicotian. Spi. aether, nitros 5a p. ae. misce. capeat cochleare pai- vulum ex aqua p'auxillo quater in die. 336 DIURETICS. manent advantage was gained. Tobacco has also been recommended in nephritis calculosa, and of late by Mr. Earle, in retention of urine from stricture. Under the head of Narcotics, I have already spoken of its employment in this way; to which the reader is referred for a particular account of its various reme- diate powers. LYTTA VESICATORIA. Under the head of Epispastics, I have given a par- ticular account of the chemical character, and of the external employment of cantharides, and shall there- fore confine myself in the present place, to a considera- tion of its powers as an internal remedy. Cantha- rides are a very ancient article of the materia medica. Hippocrates speaks of their internal employment in dropsy and amenorrhoea, and they are particularly mentioned in the writings of Dioscorides, Galen, and Pliny. When taken internally, in an excessive dose, can- tharides occasion a burning sensation in the fauces, throat, and stomach, producing inflammation of the intestines, and frequently blisters of the mouth and oesophagus. The heart and arteries are greatly ex- cited, the pulse becoming full and hard, and the skin DIURETICS. 337 hot, like in inflammatory fever; the thirst is excessive and unquenchible; great anxiety is experienced, at- tended with retching, vomiting, diarrhoea, pains in the bowels, back and joints, itching of the skin, vertigo, syncope. But the most distressing and prominent operation of this article is its action upon the urinary organs. It produces, when taken in an over-dose, in- flammation of the neck of the bladder and urethra, occasioning thereby the most painful dysury; the urine comes off drop by drop, being generally mixed with blood and attended with excruciating pain; some- times an entire suppression of it takes place, accom- panied with the most distressing efforts to micturate. These symptoms are generally accompanied by the most tormenting erections. These are the effects of the medicine when exhibited in exorbitant doses; when employed in small ones, instead of producing difficult and painful discharges of urine, or its total suppression, it excites a copious diuresis, and may often be very usefully employed where this evacuation is to be promoted. In cases of dropsy attended with a weak and languid circulation, cantharides will frequently produce very good effects. It appears to be more especially useful in those cases of anasarcous effusions which some- times supervene in persons recovering from scarlatina and other acute fevers. Dr. Ferriar reports some vol. n. 43 338 DIURETICS. cases of this kind which speedily yielded to the con- joint employment of bark and tincture of cantharides. Cantharides have been recommended as particu- larly serviceable in hydrothorax, accompanied with a relaxed habit of body. They are also mentioned by some writers as serviceable in humoral asthma, and in other chronic affections of the breast. Burdach says, that cantharides, in union with bark, or opium, or asther, are very serviceable in chin-cough, after it has already continued for a considerable time, and is attended with considerable atony of the general sys- tem. It should be given so as to excite slight pain in passing urine. From what I have seen in my own practice, I am strongly inclined to believe that cantharides may' be usefully employed in incipient phthisis, when it occurs in young females of relaxed habits of body and suffering from amenorrhoea. In the oedema which often accompanies suppression of menses1* in young chlorotic females, I have found the tincture of cantharides, with bark, a most useful remedy. By this remedy we at once invigorate the general system, promote the action of the kidneys, and determine the circulation to the uterine vessels, and thereby fre- quently reinstate the catamenia, and with them, health. From their powerful tendency to act upon the uri- * See what is said of this remedy in the chapter of Emmena- gogues. DIURETICS. 339 nary organs, cantharides have been much employed both for the cure of incontinence of urine, and sup- pression of this discharge from torpor or paralysis of the bladder. Nothing, indeed, has as yet been disco- vered which is so effectual in the former of these affections as this remedy. Where the incontinence arises from a paralysis of the sphincter of the bladder, we in general derive essential advantage from can- tharides, given to the extent of producing slight stran- gury. It is equally serviceable for that species of incontinence of urine which many young people ex- perience during sleep. We thus not only strengthen the sphincter muscles of the bladder, but greatly in- crease the sensibility of the neck of this organ, as well as of the upper part of the urethra, in consequence of which these parts contract the moment the urine comes in contact and irritates them, and thereby pre- vent its escape. An excellent mode of employing cantharides for affections of this kind is, to apply them externally, in the form of plaster, to the sacrum.* Cantharides were formerly a good deal employed in gonorrhoea and gleet. Of late they have again been particularly recommended in the latter affection and in leucorrhcea. In the second volume of the Edinburgh Medical and Surgical Journal, Dr. Robert- * Of the use of Blisters applied to the region of the Os Sa- crum, in the cure of Incontinence of Urine, &c. by Thos. Dick- son, M. D. Medical Observat. and Inquir- art. xxvii. vol. 2. 340 DIURETICS. son has published an interesting paper on the employ- ment of cantharides in these diseases. In gleet I have derived the most satisfactory results from this remedy. It is necessary, however, to give it in doses sufficient- ly powerful to produce a considerable ardor urinae, and this effect should be sustained for some time. I have been less successful with the remedy in fluor albus; though in some cases I have known it to pro- duce unequivocal good effects. " There is no article of the materia medica," says Dr. Hosack, "used in any. individual disease, the value of which ought to be estimated more highly than lytta in cases of seminal weakness and impo- tency." The introduction of this remedy in cases of this kind, in the United States, is due to Dr. Francis, of New-York. In a letter which I have lately re- ceived from him, he observes: " My experience of the remediate powers of the cantharides, and its perfect safety and innocence, when given to a great extent, is such that I administer it in doses of two or three drachms a day, and on some occasions have given it to the amount of one, two, or three ounces in twenty- four hours. I have not yet failed in a single case of impotence, though I have had instances of this dread- ful disease of four, five, or six years standing." Dr. Hosack mentions a remarkable case of this kind which came under the care of Dr. Francis and himself. It was induced by the mismanagement of a neglected DIURETICS. 34 [ syphilis, and the injudicious use of strong lead injec- tions. The patient was reduced to such a state of mental anguish as to induce him to seek a termination from his wretchedness by self-destruction. " With this view he took nearly six ounces of the tincture of cantharides during the night. Yet no dangerous symptoms occurred: he admitted he felt a degree of warmth throughout his body to which he had been a stranger, and that his mind was less depressed than before the commission of this act of folly." He was now induced to take two drachms and a half of the tincture of cantharides three times a day, in union with a dessert-spoonful of the tincture of amara, and to use a generous diet. In the course of three weeks he was completely relieved; " his virile powers resumed their wonted vigour, nor has he to the slightest de- gree relapsed into his former state of weakness.'" It appears from experience, says Dr. Robertson, that the quantity of lytta requisite to keep up the irritation in the urinary organs is always proportionate to the " existing debility either of the general habit or of the generative organs." The use of cantharides in cases of this kind must not be soon relinquished if they should not immediately produce any obvious amend- ment. "Perseverance in the use of the remedy,'" says Dr. Hosack, " is a practical precept that must here be enforced. The extent to which it may be * Appendix to Thomas's Practice, sixth edit. p. 1034 34 ^ DIURETICS. carried would, unaided by experience, seem incredi- ble. Cures have been effected within a few days; at other times, from peculiarity of condition, as many months or years have been required to accomplish the object in view." Cantharides also have been recommended in cuta- neous eruptions. Dr. Mead* and Dr. Carmichael mention their success in this respect. It does not appear, however, that the remedy possesses any par- ticular powers in cases of this kind. The strangury produced by cantharides is best obviated by copious draughts of bland liquids, such as flaxseed tea, gum arabic water, decoctions of barley, melon seeds, &c. The dose of cantharides in substance is. from one to two grains. It is best given with opium or extract of hyoscyamus. The tincture may be given from thirty to sixty drops. BALSAM COPAIBA. The treef which affords this resinous liquid, grows spontaneously at Guiana, Brazil, in the country around Tolu, and in the Spanish West Indies. Deep * Medica Sacra, p. 24. t Copaifera Officinalis, Linn. DIURETICS. 343 incisions are made in the trunk of the tree, from which the balsam flows in considerable abundance. When it first issues from the tree it is very liquid, and nearly colourless. On being kept, however, it ac- quires the consistence of oil, and assumes a pale golden colour. Although susceptible of considerable inspissation, it never becomes solid. Its taste is aromatic, acrid and bitter; and its odour fragrant, and peculiar. It is always transparent, whatever be the degree of its consistency. By distilation with water it affords a very odorous pale-coloured essential oil, leaving an insipid resinous substance. The action of alcohol on this balsam de- stroys its transparency, and gives it a very disagreeable odour.* In water it is quite insoluble; but alcohol, and the expressed and essential oils, dissolve it with facility. It forms white saponaceous compounds with the pure alkalies, soluble in water. Balsam copaivae is a stimulant diuretic, imparting to the urine a bitter taste and peculiar smell; in large doses it acts pretty powerfully as a cathartic, and in exorbitant doses, it sometimes produces "a sort of vibratory feeling in the brain, or causes a frebrile anxiety, with a mental disturbance border- ing on insanity/'f The free use of this remedy is sometimes followed by an eruption like the nettle- * Alihert, Elemens de Th6rapeutique, tom.ii. p. 341. A Dr. J. Armstrong. 314 DIURETICS rash, especially when it disorders the stomach. It has seldom been employed simply with a view to its diuretic operation, although in some diseases of the mucous linings of the urinary and genital organs, it is a remedy of unquestionable utility. In the cure of gonorrhoea, the reputation of this substance has long been very considerable, and it seems indeed to be very well founded. Many practi- tioners depend almost exclusively on its employment in this disease, and my own experience, independent of the authority of others, leads me to place very great confidence in its powers. Dr. Armstrong, in his work on scarlet fever, makes some excellent ob- servations on the mode of administering this remedy in virulent gonorrhoea. This article, he says, " has been so generally restricted to the advanced stages, that, so far as I know, there is only one writer who advises it, and that by a short paragraph, in the in- flammatory state." He recommends it as generally a speedy and effectual remedy " in the primary as well as in the last stage of gonorrhaea," and states that he derived his knowledge of the efficacy of its early use in this disease from Dr. Pearson Dawson, " who had prescribed it with great success for more than twelve years, in the very commencement of virulent gonor- rhoea."* Dr. Armstrong gives it, at first, in doses of * Dr. Chapman in his Therapeutics recommends precisely the same practice. He seems, however, not to have read what DIURETICS. 345 sixty drops, formed into an emulsion with sugar, mucilage and water, repeated every morning and even- ing. The dose must sometimes be increased to the amount of three, four, or five drachms in twenty-four hours. To be entirely effectual the use of the copaiva should always be continued for a week or ten days after the discharge ceases. When there exists much ardor urinae, the copaiva may be allowed to act pretty freely on the bowels. To restrain its purgative operation where this becomes troublesome, some laudanum should be given with it. The good effects of this remedy will be much pro- moted by an antiphlogistic regimen, rest, and cleanli- ness. These remarks on the use of copaiva in gonor- rhoea, are drawn from Dr. Armstrong's excellent ac- count of his experience with this remedy. For several years past I have pursued this plan of treat- ment, and I am fully satisfied that it will in general be found much more effectual, and certainly less apt to produce injurious consequences, than the common practice of employing strong astringent injections. I have, however, frequently employed, conjointly with the copaiva, injections of very weak solutions of su- gar of lead, especially towards the end of the disease; Dr. Armstrong had said on this subject; for he speaks of the practice here recommended, as peculiar to himself, and does not refer to the work of Dr. Armstrong. VOL. II. 41 346* DIURETICS. and it has appeared to me that the cure has been expedited and confirmed thereby. In the gonorrhoea of females, the balsam copaiva is less useful than in males. This is easily accounted for, when we advert to the circumstance, that in the latter, the urine, which becomes strongly impregnated with the balsam, passes immediately over the diseased surface of the urethra, and thus acts in a manner like an injection on the affected parts. In the female, how- ever, no such immediate local impression can take place, inasmuch as the vagina, and not the urethra, is the part principally affected. That the urine be- comes medicated by the copaiva is beyond a doubt, both from the taste and odour which it acquires in persons who take it; nor do we see any reason to doubt that a medicated fluid passing along the urethra from the bladder outwards, should not be as effectual as if it passed from a syringe inwards. Balsam copaiva has also been recommended as a very useful remedy in chronic inflammation of the bronchia, and similar affections. Dr. Armstrong con- siders it among the best remedies we possess in affec- tions of this kind. "It seems," he observes, "in many cases, to exert a specific influence over the mucous membrane of the trachea and its branches; it increases the flow of urine, it not unfrequently keeps the bowels regularly open, and sometimes it acts upon the skin, causing an itching or an eruption." DIURETICS. 34^ I have employed this article in a few cases of what I considered chronic inflammation of the bronchia; but its effects were not such as to induce me to think a great deal of its powers in this way. Dr. Armstrong observes, that the copaiva sometimes produces an itching or eruption of the skin, both of which fre- quently alleviate the cough very much. This remedy, combined with sulphur, was much employed by Mor- gagni in chronic pulmonary diseases, and Dr. Arm- strong states, that he has often exhibited such a com- bination with manifest advantage.* To render it more pleasant, and less apt to offend the stomach, it may be very conveniently formed into a mixture with the yolk of egg, or mucilage and water.f It is very frequently found in an adulterated state in the shops. M. Bucholz says, that it is impure if it do not dissolve in a mixture of four parts of pure alcohol and one of rectified aether. Rape oil, says Dr. Paris, is often mixed with it, " in which case, if dropped into the water, the drops will not retain their spherical form, as they invariably will, if pure." * Armstrong on Pulmonary Consumption, p. 274, 2d edit. t Bal. copaiv. §ss. spt. lavend. comp. spt. nit. dulc. ai 3ii. !aud. §i. g. arab. 3ii. aq. font. |iv. M Dose, a table-spoonful morning, noon, and night, 348 DIURETICS. PIPER CUBEBA. Th?s plant is a native of Java, the Philippine islands, of Guinea, and the Isle of France, and furnishes the cubebs of commerce, an article which has lately at- tracted considerable attention as a remedy in certain diseases. The cubebs, which are the berries of the plant, are of a light brown colour, wrinkled on the surface, about the size of black pepper, and furnished each with a slender pedicle. According to the ana- lysis of Vauquelin, they contain: 1. A volatile oil, which is nearly solid. 2. Resin resembling that of balsam copaiva. 3. A portion of another and coloured resin. 4. A coloured gummy matter. 5. An extrac- tive principle, similar to that contained in leguminous plants. 6. Saline substances* The cubebs are a warm and aromatic stimulant. In some persons they are mildly aperient, but m others they produce a contrary effect. Taken in the dose of from one to two drachms, they are considerably diuretic, giving a deeper tinge and peculiar odour to the urine. Within a few years past this article has been highly recommended, by some practitioners, in the cure of gonorrhoea. Mr. Jeffreys, senior surgeon of St. George's and St. James' General Dispensary, London, has lately published the result of his experi- * Annals of Philosophy, for March, 1822. DIURETICS. 349 ence with the cubebs in this disease, from which it appears that, out of twenty-seven cases which were treated with this remedy, eighteen were cured, six relieved, and three failed.* In only three of the cases cured did the disease continue beyond the twelfth day. The majority of cases were well before the eighth day. Dr. Jeffreys thinks that this remedy is more decidedly beneficial in the more inflammatory form of the'disease. He observes also, that the good effects of the medicine commonly begin to show them- selves within forty-eight hours after the exhibition of the first dose; and that in those cases which yield only partially to its influence, the disease is put in such a state as to dispose it to, yield more readily to the balsam copaiva. Several other writers of respecta- bility have published favourable reports of the effects of cubebs in gonorrhoea. I have myself employed it in, perhaps, a dozen cases; and have found it decid- edly beneficial in some instances. The general result of my experience with it, however, does not lead me to regard it as superior, or even equal, to the pure balsam copaiva administered in large doses. The cubebs have also been prescribed with advan- tage in leucorrhoea. Dr. Trail of Liverpool, states, that he has employed it in this disease, and that, in every instance, he has found it to mitigate the violence of the complaint, and in several cases to remove it entirely. * Practical Observations on the use of Cubehs, p. 64, 350 DIURETICS. The cubebs may be given either in the form of powder or of tincture. The former is given in doses of from 3i. to 5iii. two or three times daily. From one to two or three drachms of the tincture* is given three or four times during twenty-four hours. APIUM PETROSELINUM. This, the common parsley of the gardens, possesses very considerable diuretic properties, and is much used, as such, in domestic practice. The root has an agreeable sweetish taste, and the whole plant is slightly pungent and aromatic. The root is consider- ably more diuretic than the other parts of the plant, as I have frequently had occasion to observe in my practice. Given in the form of decoction, it seldom fails to produce a very considerable increase of urine. I have employed it very advantageously in suppressions of urine, and particularly in the stranguary which sometimes supervenes on the use of cantharides and turpentine. I have also known it to give considera- ble relief in nephritic affections, attended with painful * The tincture may be made according to this formula 8» Bacc. piper, cubeb. ^iii. Spiritus vini tenu. O. i. Digere per dies septem, et cola. DIURETICS. 35| micturation. I have commonly prescribed it together with the malvarotundifolia, or with water-melon seeds. These additions are especially suitable in cases of stranguary. It in general lies easy on the stomach, and is by no means unpleasant to the taste. DAUCUS CAROTA.--WILD CARROT. The wild carrot grows in very great abundance in many parts of the United States. In the vicinity of this city, particularly, it is one of the most common plants. The seeds of this species of carrot have a warm and moderately pungent taste, and a very agreeable aromatic odour. They are considerably diuretic, and are much used by the country people in suppressions of urine and painful micturition. In my own practice I have derived the most une- quivocal advantage from an infusion of these seeds in anasarcous swellings of the lower extremities. They have also been employed with success in the other varieties of dropsy. In a consultation letter which I received from the late Dr. Wistar, in the case of the late Judge Yeates of Lancaster, who laboured under hydrothorax, the doctor observes: "The wild carrot seeds, in infusion, have also been sometimes successful in hydrothorax." They hardly ever fail 352 DIURETICS. to produce pretty copious diuresis; and an infusion of them may be drunk to almost any extent, without nauseating the stomach. The common garden carrot is also applicable to useful medicinal purposes. When boiled and beaten into a pulp, it forms an excellent cataplasm to ill-con- ditioned ulcers, " allaying the pain, checking the sup- puration and foetid smell, and softening the callous edges. A marmalade of carrots, on account of their strong antiseptic qualities, has been successfully used for preventing and curing- the sea-scurvy. An infu- sion of these roots has also been found to afford con- siderable relief to persons afflicted with the stone and worms, but especially the tape worm. It may be given to the extent of a pint a day."* This plant is figured in Barton's Med. Bot. vol. i. ERIGERON HETEROPHYLLUM. This plant is common to the United States and Europe; and is found in very great abundance in al- most every part of this country. It rises to the height of two or three feet; " the stems are roundish, striated, pubescent, and about the thickness, below, of a pipe ptem, gradually tapering towards the top, where it is * Thatcher's Dispensatory DIURETICS. 353 divided into numerous spreading branches." The radical leaves are ovate, acute, deeply toothed, and supported by broad winged petioles, half the length of the leaves. The stem-leaves are sessile, lanceolate, acute, deeply sinuated, or remotely serrate-toothed in the middle. The leaves of the branches are lanceo- late, entire, and closely sessile. All the leaves, except those from the root, are ciliated at and near the base. The flowers borne in terminal, rarely lateral, co- rymbs, are numerous, " and of the sun-flower shape. The disk or centre is bright yellow," and the ray- florets capillary, numerous, white, blue, and some- times pale purple. It flowers from August to late in the fall.* This plant is well entitled to attention for its pow- ers as a diuretic and antilithic. In this city it has been a good deal employed, within a few years past, in nephritic and gravelly affections. Dr. Physick employed it in a case of dysury, attended with great pain and irritability of the bladder, with much relief to the patient. Dr. Wistar, in a letter to me, some years ago, says, " I once attended a gentleman who suffered with gout and hydrothorax; the squill produced great disturbance and pain of the stomach, and thus did more harm than good. This gentleman was greatly relieved by the infusion of scabious, which he took * Barton's Vegetable Mat. Med. vol. i. p. 23? VOL. IT. 4.5 3j4 DIURETICS. very freely." In another letter, already referred to in the preceding article, he says, " The infusion of scabious, taken plentifully, once gave complete relief in a similar case, (hydrothorax, with gout,) but it has sometimes failed." I have been much in the habit of prescribing this plant in gravelly and hydropic diseases. It has seldom failed to produce pretty copious diuresis in my practice, and the advantages derived from it have been such as to give me a very high opinion of its remediate powers. It will, in general, lie easy on the stomach, and has no tendency to weaken the digestive powers. Some of my patients have even found an increase of appetite from its use, and I do not recollect an instance where it became injurious to the stomach. . "My own experience," says Dr. W. P. C. Barton, " with this plant, enables me to bear testimony to its diuretic virtues. If it be not among the most powerful medicines of this class, it has the estimable property of being innocent to the stomach. I have used a strong decoction of this plant in a case of nephritis, at the Naval Hospital, and my success in this instance far exceeded my sanguine expectations. and emboldens me, with some degree of confidence. to recommend the scabious in similar cases."* The plant should be collected when in flower. The best way of using it is in decoction, of which a pint * Vegetable Mat. Med. vol. i. p. 23ft, DIURETICS. 355 or two may be taken in twenty-four hours. For ex- cellent figures and descriptions of the Erigeron He terophyllum and E. Philadelphicum, see Dr. W. P. C. Barton's Vegetable Mat. Med. vol. i. CHIMAPHILA UMBELLATA.—WINTER GREEN.—PIPSIS- SEWA. This plant is common throughout every part of the United States, growing in dry shady woods, and preserving its verdure during the winter season. The root is perennial, creeping, and of a yellowish colour. The stems are semi-procumbent, hard and woody at the base, from six to eight inches high, "and marked with the scars of the former leaves." The leaves generally grow in whorls, opposite or scattered, subsessile, lanceolate, somewhat wedge-shaped, acute- ly serrate, decurrent on the petiole, coriaceous, and of a deep shining green colour. The flowers appear in June and July, in a sort of umbel, variegated with purple and white. When chewed it imparts an aro- matic pungency to the taste, and when bruised it has a strong and unpleasant smell. This vegetable has been but recently introduced into regular practice, and from the accounts which have already been published of its eflficacy in various 356 DIURETICS. diseases, it would appear to be entitled to much credit. Schoef speaks of it as " astringent and co-roborant," but says nothing of its diuretic qualities. During the American revolutionary war, it was employed as a tonic remedy in typhus fever. It was formerly a good deal used in some parts of the United States as a domestic remedy for rheumatism. Of late it has been introduced to the particular notice of the pro- fession as a valuable diuretic medicine. Dr. Som- merville, of the British army, deputy inspector of the military hospitals in Canada, in a paper published a few years ago, adduces some very interesting facts demonstrative of its good effects in dropsical diseases. He states that the diuretic effects of a strong infusion of this herb were always very considerable, and that one patient to whom he gave it experienced an agree- able sensation in the stomach soon after taking the medicine, and a very considerable increase of appe- tite. He states, also, that Sir Walter Farquhar em- ployed this remedy in the case of a lady labouring under abdominal dropsy, in which the diuretic effects of the medicine were very strikingly manifested. Dr. Marcet, in consequence of Dr. Sommerville's paper, tried the extract of this plant at Guy's Hospital, in doses of fifteen grains, with manifest advantage. Other writers speak favourably of this remedy as a diuretic. In my own practice I have employed it in one case only; and, although it evidently produced a consider- D1ERETICS. 357 able increase of urine, it did not afford any decided advantage. The bruised leaves will sometimes produce red- ness, vesication and desquamation, when applied to the skin.* The pipsissewa has also been successfully employed in the cure of intermittents. Dr. Mitchellf relates several cases of this complaint, which were effectu- ally removed by the use of this remedy. It has also been recommended as an excellent antilithic. The late Dr. Barton says, that " all his trials and inquiries respecting this plant have convinced him that it is an important antilithic, not less so than the uva ursi." I have used it in some cases of this kind, but did not derive any particular advantage from it. I suspect that its antilithic powers are entitled to very little at- tention. This vegetable has of late been a good deal em- ployed in cancerous affections, and some very re- markable cases are published in testimony of its reme- diate powers in this way. Although I am perfectly satisfied of its total inutility in cases of this kind, I have nevertheless in several instances known its inter- nal employment to produce excellent effects, in the * Barton's Collection towards an Essay on the Materia Medica, third edit, part ii. p. 21. t Inaugural Dissertation on the Medical Properties of the Pyrola Umbellata. Phila. 1803. '358 DIURETICS. cure of ill-conditioned ulcers, and venereal eruptions. It may be given in the form of a strong decoction, to the extent of a pint in twenty-four hours. The watery extract of this plant has also been employed, to the extent of five scruples in twenty-four hours. SUB-CARBONAS POTASSiE*.—KALI PR.EPERATUM. Both the carbonate and sub-carbonate of pot- ash, occasionally manifest considerable diuretic pow- ers. Upon the subject of the modus operandi of the saline diuretics, Dr. Cullen observes, " With respect to the whole of them, it is to be observed, in the first place, that as it seems to be determined, by the nature of the animal economy, that all saline substances re- ceived into the mass of blood should soon pass out again by the excretions, and particularly by that of urine, it will be obvious that, as all saline matters are more or less stimulant, they must all of them, in passing by the kidneys, be more or less diuretic." From the reappearance of these salts in the urine, after having been taken into the stomach, there can hardly be a doubt of the correctness of this explana- tion of their modus operandi in producing diuresis. * The chemical history of this article has already been given in the chapter of Antacids. DIURETICS. 359 This is rendered still more probable by the fact, that when they prove laxative, and are thereby prevented from being absorbed, by the rapidity with which they are carried out of the body through the alimentary canal, they produce little or no diuretic effect. To obtain the full diuretic operation of the neutral salts, it is therefore necessary to exhibit them in such small doses, as to prevent them from acting on the bowels as a purgative, and they must be repeated at short and regular intervals. The diuretic effect of the fixed alkali is said to be enhanced by combining it with bitters, as was the custom of Sir John Pringle. Dr. Cullen observes that by giving the alkali in this way, he " commonly found it to prove diuretic." He also adds, that " alka lines may be often prevented, by purging, from reach- ing the kidneys; and that their diuretic effect max- be often more certainly secured by giving an opiate at the same time." Dr. Mead was in the habit of using such a combination, and he represents the practice as a very useful one. Formerly, the carbonate ol potash was much employed in the cure of dropsy WTe find it recommended in the works of Ettmuller, Willis, Sydenham, Monro, Mead, Mascagni, ice. ami other writers of the early and middle periods of the last century, as an efficacious remedy in this disease. Monro speaks particularly in praise of it, when given in combination with rhubarb. " In the cure of those ^gQ DIURETICS dropsical patients whose constitutions are so weak that they cannot bear purging, it is to be attempted," says Sydenham, rt by diuretics: those are the best which are made of the lixivial salts." I have employed the carbonate of potash in combi- nation with squills, in persons labouring under hydro- thorax attended with indigestion and acid in the sto- mach; it is obvious that in cases of this kind such a combination is especially indicated, and in the few instances in which I have tried it, I have had much reason to be pleased with its effects. Dose from gr. x. to 3ss. ACETAS POTASS.E.—SAL DIURETICUS.— TERRA FOLI- ATA TARTARI. This salt is obtained in foliated laminar masses; it is extremely deliquescent, and possesses a sharp and pungent taste. One ounce of water at 60° dissolves four hundred and four grains. Four parts of alcohol, by weight, will dissolve one part of the salt. It con- sists of forty-five parts of potass and forty-eight of acetic acid. " It is decomposed by tamarinds and most sub-acid fruits; by almost every acid, as well as every variety of neutral salt, whether alkaline, acid.. or metallic." DIURETICS. 361 This article was formerly much employed as a diuretic; though at present its reputation as such does not appear to be very great. In combination with other diuretics it is, however, still frequently prescribed; and I have myself, in some instances, used it with evident advantage in the way recom- mended by Dr. Maclean in his work on hydrothorax.* Alibert, however, speaks of it as a very efficacious diuretic in dropsy. "This remedy," says he, "is so well suited to the sensibility of the absorbents that its administration is frequently followed by very salutary effects." He mentions a case of anasarca that was effectually cured by this remedy alone, after many other diuretics had been long tried in vain. Aucun de ces sympt&mes ne s'etoit adouci, quoiqu'il eut fait un assez long usage des preparations scilli- tiques. Nous lui prescrivimes simplement I'acetate de potasse, a. la dose de quatre grammes (un gross), dans une tasse de petit-lait clarifie: cinq jours apres, il y eut une evacuation des plus abondantes par la voi des urines, qui fit disparaitre tous les accidens."f He observes that he might cite many other cases treated * 5, Bacc. juniper, contus. fjii. infunde in aq. ferv. lb. ii. per horas aliquot, dein cola, colatur. adde kali acetat. f ss. spir, junip. e. §ii. M. This is to be used in draughts of about a gill, three times a day, as an adjuvant to a more active diuretic mixture composed of nitre, squills, and calomel. f Elemens de Therapeutique, vol. i. p. "27 vol. 11. 46 362 DIURETICS, in the hospital Saint Louis, which show " the reme- diate powers of this valuable medicine." It cannot be given in powder or pills on account of its extreme deliquescence. The dose is from $i. to 5i.; in the dose of from iii. to 3iv. it proves mildly cathartic. NITRAS POTASSiE.—NITRE.--SALTPETRE. In another place the chemical history of this salt is fully detailed, together with the various remediate powers which it possesses independent of its diuretic operation. As a diuretic, nitre is not very powerful. It may nevertheless be advantageously employed, either alone, or conjointly with other diuretics, in dropsical affections; particularly in cases attended by much arterial excitement, where it produces the two-fold advantage of diuresis and a reduction of the action of the heart and arteries. Alibert observes, that when given with a view to its diuretic effects it should be administered in copious draughts of some mild liquid. When exhibited in this way it is much more active „ as a diuretic, than when given in substance. The dose, as a diuretic, is from gr. x. to gr. xv. In exor- bitant doses, it excites vomiting, spasms, convulsions, blood-stools, and even death. DIURETICS. 363 SUPER-TARTRAS POTASSiE.—CREAM OF TARTAR. I shall not repeat here what I have already said respecting the chemical character of this remedy. Possessing both hydragogue and diuretic properties, the cream of tartar would seem to be peculiarly suited to the treatment of hydropic diseases. By many, in- deed, it is considered as one of our most efficacious remedies in such affections. When given in a large dose, it acts upon the bowels, producing copious watery stools; and, at the same time, excites the kid- neys to an abundant secretion of urine. By this com- bined operation upon the kidneys and bowels, the remedy often evinces a powerful control over drop- sical accumulations. To increase its diuretic effects it may be advantageously given in union with digitalis, as was practised by Dr. Ferriar. This accomplished writer observes, in those cases in which he employed the cream of tartar successfully, it operated very early, " producing an increased flow of urine within twenty-four hours. It commonly diminishes the swellings very speedily, and for the greater part, lessens the patient's size more quickly than the in- crease of urine would lead us to expect." It is quite evident, indeed, that the power of this remedy, in evacuating dropsical accumulations, does not depend exclusively on its property of exciting the renal em une- 364 DIURETICS. tories, but in a considerable degree also, on its powers to increase the action of the intestinal exhalants. Cream of tartar is apt, by frequent repetition, to weaken the digestive organs; to obviate this effect, cordials and tonics ought to be employed along with it. In doses of 3iv. to 3vi. it acts as a hydragogue: in smaller ones it acts simply as a diuretic. To in- crease its diuretic operation, it should be given in solution. 3i. of the cream of tartar to a pint of boil- ing water, and flavoured with lemon peal and sugar, forms an excellent and cooling diuretic drink. SPIRITUS JETHERIS NITROSI. The dulcified spirits of nitre is a colourless fluid, extremely fragrant, and of a pungent acidulous taste. It consists of a portion of nitric aether and nitric acid in union with alcohol. " With the green sulphate of iron it strikes a deep olive colour, and with the tinctures of guaiacum it produces a green or blue coagulum." Though by no means a very certain or active diu- retic, the sweet spirits of nitre may sometimes be administered with much advantage, as an auxiliary remedy in dropsy.* * Dr. Paris gives this formula, as a highly stimulating diu- DIURETICS. 365 It is not however often employed in dropsy, and is certainly, perhaps, never to be depended on as a prin- cipal remedy in this disease. In the diseases of chil- dren, it is a very common remedy, and as it possesses considerable diaphoretic powers, it may be very use- fully employed, not only in diseases of the urinary organs, but also as a general remedy in febrile cases. From its pleasant taste it can in general be easily given to children. When administered as a diuretic it should be given in large doses, not less than three drachms at once to an adult. In doses of ten to thirty drops it acts as a gentle diaphoretic. TINCTURA MURIATIS FERRI. The muriated tincture of iron possesses considera- ble diuretic powers. It has been especially recom- mended in suppressions of urine depending on spasm. Given in doses of ten or twelve drops every ten or fifteen minutes, it sometimes procures prompt relief in the most obstinate cases of this kind. " To the good effects of this medicine," say Dr. Thomas, " I can myself bear testimony, having tried it in some retic. R Tinct. Lyttae M. x. Spirit. JEtheris Nitrici 3L Mis- turae Camphorese 3x11. Syrup Zingiberis 3i- Fiat Haustus ter in die sumendus. 366 DIURETICS. cases „of spasmodic suppression with success. After six doses the urine usually flows easily. In a case of chronic dysury, attended frequently with discharges of bloody urine, and a constant feeling of uneasiness or soreness about the neck of the bladder, I pre- scribed this remedy with decided and permanent ad- vantage, after a very great variety of medicines and modes of treatment had been employed with but tem- porary benefit. In a letter which I lately received from my friend Dr. Francis of New-York, he ob- serves, "the muriated tincture of iron is acknow- ledged by all as a valuable diuretic. But in cases where there is much local irritation, as in some affec- tions of the prostate gland, and in disorders about the neck of the bladder, its action is, at times, excessively painful. Under such circumstances," he continues, "I have found the muriated tincture of gold prefera- ble. Indeed the gold deserves far more notice as a diuretic than as an antivenereal remedy." CHAPTER XV. III. Medicines that alter the state of the Urinary Secretion. LITHONTRIPTICS, OR ANTILITHICS. These are medicines capable of correcting the lithic diathesis, or of dissolving urinary calculi. The urine, even in a state of health, is by no means a simple ho- mogeneous fluid. It contains various substances, in such proportion as to be held in permanent solution; some of which are liable, from particular causes, to be augmented beyond the proportion which the urine is capable of holding in solution, and which are there- fore deposited, creating urinary sediments, gravel, and by further accretion, calculi. A disposition in the system to form such an excess of urinary sediments, is denominated the lithic diathesis, and constitutes a very important object of medical attention. It ap- pears from the researches of chemists, that these uri- nary depositions are of very various, and even opposite characters, as they occur in different individuals, or in the same individual, at different times and under dif- 368 lithontriptics. ferent circumstances of health, diet, exercise, drinks, &c. All the varieties of urinary deposits described by authors may, however, be regarded as composed of the four following elementary substances. 1. The lithic acid and its compounds. 2. The oxalate of lime. 3. The cystic oxide. 4. The earthy phos- phates.* Almost all the pulverulent and amosphous sediments consist either of the lithic acid and its compounds, or of the earthy phosphates. The yel- lowish, or nut-brown, reddish brown or lateritious, or pink sediments are of the former kind. The white precipitate consists of the latter substances. The particular state of the system which favours the for- mation of the lithic acid or lithates, is called the lithic acid diathesis, and that which gives rise to the phos- phates, the phosphatic diathesis. What the essential characters of these diatheses are, it would be in vain to inquire. Observation and experience, however, have given us some information with regard to the causes which favour their rise. Thus, it appears, that an excess of lithic acid is especially favoured by what- ever tends to weaken the digestive organs; and espe- cially by those causes, either dietetic or otherwise, which produce acidity in the primas viae It is on this account that persons who live chiefly on vegetable food, are most subject to lithic acid sediments in the urine. Those circumstances which appear to favour * Prout on Calculous Affections, p. 110. UTHONTRIPTICS. 369 the formation of phosphatic diathesis, are, injuries done to the back, and whatever produces a nervous state of the system, as fear and mental anxiety, and also, the long use of alkaline remedies.* With re- gard to the influence of the ingesta or urinary de- posits, Dr. Wilson Philip draws the following con- clusions from an interesting and long series of ex- periments which he performed on this subject, f " 1. That acid and acescent ingesta tend to increase the deposition of lithic acid from the urine, and to pre- vent that of the phosphates. 2. That a diet composed of a large proportion of animal food tends to lessen the deposition of lithic acid, and to increase that of * A deposition of the earthy phosphates from the urine has been long observed to be attended by very distressing symp- toms, though no one seems hitherto to have generalized them. They consist in great irritability of the system, and derange- ment of the chylopoietic viscera in general; such as flatulence and nausea, obstinate costiveness, or peculiarly debilitating diar- rhoea, or both, frequently alternating; and the stools are ex- tremely unnatural, being either nearly black, or clay-coloured, or sometimes like yeast. These are always accompanied by more or less of a sensation of pain, uneasiness, or weakness in the back and loins. There is a sallow, haggard expression of countenance; and as the disease proceeds, symptoms somewhat analogous to those of diabetes begin to appear."—Prout^s In- quiry into the Mature and Treatment of Calculous Affections, p. 152. t Medical Transactions of College of Physicians in London, vol. vi. 1820. *0L. II 47 370 UTHONTRIPTICS. the phosphates. 3. That every thing which promotes the action of the skin tends to prevent the deposition of lithic acid, and to occasion that of the phosphate. 4. That dyspepsia tends to increase the deposition of lithic acid, and to lessen that of the phosphates, both by producing acidity of the primae viae, and by ren- dering the skin inactive. 5. That indolence has the same tendency, both by inducing dyspepsia and by lessening the activity of the skin in proportion as it impairs the vigour of the circulation. 6. That an acid passes by insensible as well as sensible perspira- tion." Dr. Prout observes, that " an unusually heavy meal, especially of animal food or of bread, is invaria- bly followed by a deposition of the lithate of ammonia from the urine." From these observations it is evident that our most efficacious antilithic means, are such remedies as are calculated to invigorate the digestive organs, and to correct the morbid contents of the primae viae: and especially a proper attention to the nature and quan- tity of the food. With regard to lithontriptics, or those articles which are supposed to have the power of dissolving urinary calculi, it is obvious that they can produce no solvent effects until they are brought into immediate contact with the calculi. Their modus operandi must there- fore be very different from that of the antilithic reme- dies. These appear to produce their remediate ef- UTHONTRIPTICS. 371 fects chiefly by favouring healthy digestion and chylifi- cation, and by preventing the formation in the diges- tive and chylopoietic organs of an undue proportion of those materials from which the urinary deposits are formed by the kidneys. The former remedies, on the other hand, pass through the circulation, and being thrown into the urinary organs, exert a solvent power upon the lithic concretes, existing in the kidneys and bladder. When we reflect how great an influence diet and the particular state of the digestive organs have upon the nature and quantity of urinary deposits, it would appear highly probable that the ingredients out of which these deposits are formed by the kidneys, are prepared for them in the digestive and assimilative organs, and that they are not formed by the renal emunctories "from whatever may be presented to them indiscriminately."* If this be the fact, it is clear that the remedies which check the formation of uri- nary sediments act before they reach the kidneys; and that in proportion as they are adapted to restore the healthy condition of the digestive and chylopoietic or- gans, so are they calculated to act beneficially in the lithic acid diathesis. It is very questionable, however, whether we pos- sess any remedies capable of dissolving calculi existing in the urinary organs. The attempts at removing * Prout. g>72 UTHONTRIPTICS. calculous concretions by remedies of this kind having hitherto, with very few exceptions, proved abortive, is a fact which sufficiently warrants the scepticism which prevails on this subject. Still, as it is ascer- tained that some substances exert an evident solvent power upon calculi out of the bladder, and as it is moreover equally well established that these very sub- stances, when taken internally, are absorbed and car- ried to the bladder, there would appear some reason to expect advantages from the employment of reme- dies of this kind in calculous cases. Mascagni states, that after using the carbonate of potash, he found his urine so impregnated with it as to convert the yellow colour of turmeric to a brown, and to evince no slight solvent power upon a calculus put into it. It must, however, be observed, that the alkalescence of the urine, produced by the internal use of an alkali, is but very transient. Mr. Brande states, that in the ex- periments he made on this subject, he found " that the effects of the alkali, in becoming prominent in the urine, was at its maximum probably in less than a quarter of an hour after it had been taken into the stomach; and in less than two hours the whole of the alkali had passed off." In speculating upon the lithontriptic power of cer- tain substances, it must not be forgotten that well at- tested cases are on record, in which the internal employment of such remedies was followed by a com- UTHONTRIPTICS. 373 plete cessation of all the symptoms indicating the pre- sence of urinary calculus, and where, notwithstand- ing, the calculus still remained in the bladder, as was demonstrated by the introduction of a catheter. Early in the last century a Mrs. Stephens received a large pecuniary reward from the British parliament for discovering a remedy which she used with signal suc- cess in calculous affections. It was found, however, that although her patients got rid of all their painful symptoms, the calculi were not dissolved. De Haen relates a remarkable case of this kind, in which he gave, from November, 1756, to June, 1757, seventeen pounds of Venetian soap, fifteen hundred pounds of lime-water, and the same quantity of milk. Under this treatment the patient gradually got better until all his calculous symptoms entirely vanished. Notwithstanding this apparent cure, the presence of a calculus was still demonstrable by the sound.* Sir E. Home mentions two cases where the symptoms had subsided under the employment of alkaline medi- cines, but on dissection the calculi were found in great size, only imbedded in cysts. He moreover states, that in some instances the calculous concretions * Calculi verus martyr sumptis libris 17, saponis Veneti, 1500libris lactis, et 1500 libris aquae calcis, liberatus sic fuit, ab ejus sympto*.:>aubus, ac si ultra no adesset calculus; qui tamen et post curam, et elapso post eandem anno, praesens de- monstratus cathetere fun.—Ratio Medendi, vol. i. p. 138. 3*4 UTHONTRIPTICS. increased rapidly while the patients were taking these remedies regularly. One patient took alkaline medi- cines four or five years, and "at his death the bladder was found nearly filled with light spongy calculi of different sizes, not less than three hundred and fifty in number. Another who had taken soda, both mild and caustic, for some months, and then submitted to the operation on the symptoms increasing, was found to have a calculus, which was surrounded with a coat of triple phosphate one tenth of an inch thick, the rest being a mixture of uric acid and phosphates." Whytt supposes that, in cases where the symptoms disappear under the use of lithontriptics, the calculi, though not dissolved, have their asperities removed, and that they are coated by a mucilaginous crust, by which they are prevented from doing injury to the tender parts with which they are in contact. " Exemplo nobilissimi equi- tis H. Whalpole aliorumque, debuit concludere si calculi non solverentur, eis tamen asperitates demi, cir- cumvolvique crustam mucilaginosam, quae ne noceat calculus, efficiat."* Dr. Marcetf also contends, that although little or nothing can be expected from this class of remedies, in destroying calculi already formed, " yet in some instances the sharp edges of small cal- culi may be so blunted by the internal use of chemical solvents, as to allow them to be passed with less diffi- * I have not access to the works of Dr. Whytt, and therefore quote from De Haen's Ratio Medendi, vol. i. p. 136. t Marcet on Calculous Disorders. London, 1817. UTHONTRIPTICS 375 culty and inconvenience." Where therefore the symptoms of calculus disappear under the internal use of solvent remedies, we cannot conclude positively that the calculi have been dissolved and removed out of the system, especially if they be located in the kid- neys, in which case we can derive no information from examinations with the sound. Experience is therefore decidedly opposed to the opinion which ascribes any very particular solvent power to this class of remedies. From the same source. however, we learn with equal assurance, that these remedies are often of unequivocal advantage in cer- tain gravelly affections, and especially in counteract- ing the tendency which often prevails in the system to form an excess of lithic matter with the urine. I would, however, ascribe very little to the solvent pow- er of these remedies, nor can I believe that they pro- duce any very considerable effect by the power they may have of neutralizing the uric acid before it has time to form concretions, and thus prevent, as Mr. Brande supposes, the further increase of calculi/ The medicines which are most useful in this respect, tend to correct acidity in the primae viae, and to favour the digestive process; circumstances which I have al- ready said have a very intimate relation with the gene- ration of lithic matter by the renal emunctories. In treating of the particular articles of this class of * Philosophical Transactions, for 1810, Part I, 376 UTHONTRIPTICS. remedies, I shall have occasion to speak more espe- cially on this point; to which, therefore, I now pro- ceed. CARBONAS SODjE et POTASSiE. When we advert to what has already been stated, concerning the tendency of acid and acescent ingesta to increase the secretion of lithic acid and its com- pounds, by the kidneys; and of the influence of an acid condition of the contents of the primae viae from indigestion, there can be no difficulty in perceiving that the fixed alkalies may operate beneficially in urinary depositions composed of lithates or lithic acid. For, whether we admit their solvent power or not, it would appear quite reasonable to suppose that, as these urinary sediments are more copiously secreted by the kidneys when morbid accumulations of acid exist in the stomach and bowels, the remedies in ques- tion would, hy removing this exciting cause, tend to correct the renal secretions. I would not, however, ascribe every thing, in this respect, to the mere ant- acid properties of the alkalies. They are, undoubtedly, absorbed to a degree into the circulation, and again thrown into the urinary secretion, and may thus exert some remediate effect, not only by their imme- UTHONTRIPTICS. 37f dhte action upon the secretory vessels of the kidneys, but also, in a small degree, perhaps, by their solvent properties. Be this as it may, there can at present be but little doubt of the utility of alkaline remedies in correcting the lithic acid diathesis, or of occasionally affording relief in nephritic and calculous affections. It is thought by some late writers* that the alkalies are inferior to magnesia, as antilithics; and Sir E. Home accounts for their inferiority, by supposing it to de- pend on the greater insolubility of the magnesia, and its consequent longer retention in the stomach, affording it thereby a greater opportunity of counteracting "the formation of uric acid." I am much more inclined, however, to adopt the opinion of Scudamore on this subject. He contends, " that although some advan- tage is afforded to the alimentary canal by its power of neutralizing acid matter, yet that its (magnesia) chief superiority over the alkalies depends on its pur- gative qualities; so much more easy is it to arrest the morbid process of digestion by a medicine which re- moves the cause, than by one which merely has the effect of temporary correction." When the lithic acid sediments prevail, we almost invariably find the digestive process out of order, and much acidity in the alimentary canal; and from what I have already said concerning the connection be- * Sir E. Home, Brande, Scudamore, Prout, &c VOL. II. 4.£ §7$ UTHONTRIPTICS tween such a state of the digestive organs, and the secretion of uric acid by the kidneys, it is quite plain that the alkalies are the proper remedies. For al- though it does not appear that they reach the urinary passages in sufficient quantity to exert any particular solvent power upon the pre-existing calculous matters in these organs, still, however, the prevailing tendency of the system to form lithic matter may be checked, " by the beneficial changes which they produce dur- ing the first stages of assimilation, by neutralizing excess of acid, or otherwise disturbing those affini- ties, which, in the subsequent process of assimilation and secretion, give rise to calculous affections."* In- dependent of the effects which are here ascribed to the action of the alkalies, they appear to possess very considerable power in allaying the morbid irritability of the urinary passages. It is very different, however, with the white urinary sediments. These, as has been observed above, consist of earthy phosphates, forming a triple compound with ammonia, and are in general unconnected with indigestion, and acidity in the primae viae. In urinary sediments of this de- scription, the alkalies are not only useless, but abso- lutely pernicious. " The white sediments," says Mr. Brande, " may always be abundantly formed by alka- line medicines, and persons who habitually drink soda water, or take magnesia, are frequently voiding it * Marcet UTHONTRIPTICS. 379 Its appearance, in the latter cases, has often led to serious errors. I have known soda water, exhibited in a case of a stone in the bladder, produce abundance of white sand, which the ignorance of the patient and his medical attendant led them to refer to the solvent power of the medicine upon the stone, which they thought was giving way, and being voided; whereas great mischief was doing by giving the urine more than its usual tendency to deposit the phosphates, and consequently to augment the size of the calculus."* The alkaline carbonates are generally given in pre- ference to the pure alkalies. They appear to answer equally well, and are much less offensive to the sto- mach. " The stomach," says Dr. Paris, " appears to bear the protracted exhibition of the carbonate of potass and soda with more temper than it does any other alkaline combination. From twenty to fifty grains of carb. of soda or potass may be taken two or three times a day. The liquor potassae, or sodae, may be taken in solution in doses of from g". xv. to g". 1. two or three times a day, in veal broth or table beer," which latter is said to disguise its nauseous flavour completely. Whilst pursuing a course of alkaline remedies, it will be useful occasionally to interpose a purgative medicine. Upon this point Dr. Paris ob- * Brande's Observations on the Medico-Chemical Treatment of Calculous Disorders. Quarterly Journal of Science and the Arts, No. 12. gg0 UTHONTRIPTICS. serves, " but we must not combine it (the purgative) with the lithontriptic, for it is a law, that catharsis suspends the process of absorption." If it were true that the antilithic power of the alkalies depended on their being absorbed and conveyed to the urinary or- gans, this caution would no doubt be very proper. But this is extremely doubtful; and it appears moreover that magnesia, whose powers in this way are superior to those of the alkalies, operate most beneficially when it produces a purgative operation. Besides, the existence of such a law is by no means established. Every one must, indeed, admit that while purging is going on absorption must be dimi- nished; but it is mueh to be doubted whether it is suspended. Rhubarb impregnates the urine with its colour, notwithstanding its purgative operation;—here absorption is not suspended. From Mr. Brande's experiments, it appears very clearly that neither the carbonates nor sub-carbonates of the fixed alkalies exert any sensible action on uric acid; and it seems equally clear, from what this able writer says, " that an alkali administered to a calculous patient stands no chance of reaching the uric concretion in a caustic state.3' If these facts be correct, and there can scarce- ly be a doubt on this point, we have a very plausible explanation of the inefficacy of the alkaline carbo- nates as solvents of urinary calculi. Alkaline solu- tions have been injected into the bladder through th,e UTHONTRIPTICS. 3gJ urethra; I have not, however, learned that any decided advantage has been gained from such a practice. Fourcroy and Vauquelin paid particular attention to this mode of dissolving urinary calculus. Incompatible substances: " acids and acidulous salts, borax, muriate of ammonia, acetate of ammonia, alum, sulphate of magnesia, lime-water, nitrate of silver, ammoniated copper, muriate of iron, submuri- ate and oxymuriate of mercury, acetate of lead, tar- tarized antimony, tartarized iron, the sulphates of zinc, copper, iron, &c." MAGNESIA. The antilithic powers of magnesia are very consi- derable, and appear to be pretty generally acknow- ledged by the practitioners of the present day. Mr. Brande, in a very interesting paper published in the Philosophical Transactions, first directed the attention of physicians to the efficacy of this remedy in pre- venting.the formation of certain varieties of. urinary depositions. Instead of pursuing the hopeless inquiry after an efficient solvent for urinary calculi, physi- cians and chemists have of late endeavoured to ascer- tain the nature of urinary sediments, and the causes which influence their increase and decrease, " with ggg UTHONTRIPTICS. the view of administering such preventive medicines as may indispose the system to produce those concre- tions, or check their growth, without altering the tone of the constitution." From some trials made by Mr. Brande, he found that magnesia diminished the quan- tity of uric acid in the urine more promptly and con- spicuously than any of the alkalies, however largely administered. He relates four cases in which the antilithic powers of this remedy are said to have been unequivocally displayed.* The first was a gentleman whose urine was constantly highly charged with uric acid, which was deposited in the form of red sand or crystals. He successively took the subcarbonates of soda and potass, without any benefit from the former, and but small relief from the latter. He was finally directed to take fifteen grains of magnesia three times a day; in a week after commencing with this remedy the uric deposits had diminished sensibly. The medi- cine was continued for eight months, and the urinary deposit disappeared entirely. Another patient, suffer- ing from a similar complaint, after having tried the alkalies ineffectually, was wholly cured by taking twenty grains of magnesia, night and morning, for six weeks only. The third case is that of a person who succeeded in removing repeated attacks of uric acid, * On the efficacy of Magnesia in preventing an increased formation of Uric Acid, &c. by W. T. Brande, M. D. in the Philosophical Transactions, 1810, Parti UTHONTRIPTICS. 383 by the use of magnesia. The fourth case was a con- firmed calculous tendency, which yielded almost com- pletely to the free use of magnesia. Dr. Scudamore, whose opinion deserves great weight, does not admit the claims which are allowed to magnesia as a remedy in gravelly affections. " I condemn," says he, " any unlimited confidence in this medicine, as being, in most cases of complaint, a very inadequate remedy for the disease which is existing. The gravel and the gout are, as it were, but symptoms of the morbid ac- tion of other parts; and such primary disease and true cause, is to be found in the digestive organs. But the gravel has a deeper foundation than the mere pro- duction of acid matter in the alimentary canal. In these cases we must look with vigilance to the state of the stomach, of the liver, and of the bowels, and of all the stages of digestive assimilation, in connection with the wrong functions of the kidneys, in a manner less superficial than the rule of placing all our de- pendence on magnesia, or upon any alkaline medicine whatever, seems to imply. We shall learn that these remedies are useful, and even important, as auxiliary parts of treatment, but that they do not deserve any higher character, or stronger dependence."* It is scarcely necessary to observe, from what has already been said, that magnesia, like the alkalies, can only be properly administered in gravelly affec- * Scudamore on Gout, p. ?S6. 33i UTHONTRIPTICS. tions when the urinous precipitate is of the uric acid description; without an attention to this circumstance, the use of magnesia may become very pernicious in calculous complaints. I have lately employed this re- medy in the case of a person much harassed by indi- gestion, and whose urine was loaded with an uncom- mon quantity of uric acid. The vessel into which he discharged his urine was coated with a crust of this substance. I ordered him twenty-five grains of mag- nesia three times a day, with an infusion of gentian and orange peal. In less than three weeks the uric deposit had nearly disappeared; but I could not suc- ceed in removing it wholly, although he took it for upwards of four months. Magnesia has lately been strongly recommended as a remedy for diabetes. Dr. Trotter has published an account of five cases which were effectually cured by this remedy. He directed his patients to take from one drachm and a half to two drachms of the pure magnesia in twenty-four hours. The relief obtained from it was generally very prompt, and the cure in the course of a few weeks perfect* * London Med. and Phys. Jour. vol. xxxix. p. 366, and vol xlvii. p. 460. UTHONTRIPTICS. 385 AQUA CALCIS. Lime-water* was formerly much employed in cal- culous affections; and there can be no doubt of its having sometimes manifested very useful powers in these complaints. Like the two former articles, it possesses but little or no solvent power upon urinary concretions, when taken internally, but appears to act chiefly by its power of correcting that state of the digestive or- gans upon which the lithic acid diathesis would seem to depend. Wrhytt, De Haen, Alston and others mention cases of its successful application to the removal of the symptoms of calculous complaints. It appears that, like the alkalies, it has been known to give effectual relief in calculous complaints, without, however, dissolving or removing the calculus. I have already quoted a case of this kind from De Haen, and similar ones are related by Whytt, Alston and others. In nephritic affections, depending on calcu- lous concretions, or on too abundant a secretion of uric acid, the free use of lime-water will often afford great relief. Lime-water is generally directed to be given in milk to the extent of from a pint to a quart daily. * Contains about ?J^ of lime. VOL. II. 19 ggg UTHONTRIPTICS. Whytt gave it in combination with soap; but it does not appear to be more powerful in this way, and is much more unpleasant to take, than when mixed with milk. Attention must be paid to the nature of the urinary deposit; its exhibition where the phos- phates predominate, would prove not only of no avail, but very pernicious. Lime-water has been employe^ for various other remediate purposes. It has been much recommended for its good effects in diabetes. Dr. Ferriar con- stantly gave it as an auxiliary remedy with cinchona, opium and uva ursi. Shutz and Wilhelm, two Ger- man writers, detail cases of diabetes mellitus and in- sipidus, in which the use of lime-water alone proved successful* It has also been employed with advan- tage in dysury depending on excess of lithic acid in the urine. In a case of this kind I prescribed it with the happiest effect. Pringle, Mar, and others recom- mend lime-water with milk in phthisis, and not a few cases have been reported in testimony of its efficacy. As gout is always connected with a lithic acid dia- thesis, lime-water having a tendency to counteract such a disposition, may often be usefully employed in the chronic form of the complaint. It is very advan- tageously united with bitters in gouty complaints. In the cure of obstinate scorbutic ulcers, lime-water has been known to produce very excellent effects. * Hufeland's Journal of Practical Medicine, vol. ii. p. 128. UTHONTRIPTICS. 387 There is a case of this kind related in the first volume of the London Medical Observations and Inquiries, which was effectually relieved by taking three pints of lime-water every day for five months, after a multi- plicity of other means had been tried without any benefit. The ulcer was of several years standing, and situated on the left leg. Hoffman asserts that there is no remedy equal to lime-water in that variety of scurvy which proceeds from the continued use of salted diet. Baumbeck speaks well of lime-water as a remedy in cancer; but it is scarcely necessary to observe, that in this respect it is not entitled to the least attention* It has also been found useful in chronic dysentery, leucorrhcea, and chlorosis. It may in general be usefully given, in all cases, attended with a sluggish, phlegmatic habit of body, and an acid state of the contents of the alimentary canal. As an external remedy lime-water may be applied to very useful purposes. WTith olive oil it forms a most excellent liniment for burns and scalds; and with corrosive sublimate, it constitutes the aqua phagede- nica, a highly useful wash for foul and sluggish ulcers, particularly of the syphilitic kind. According to Hufeland and others, lime-water, mixed with some mucilaginous decoction, forms an * Vogal. Repos. Dissertatio de curatione cancri oculti et aperti per aquam calcis vivse pbtam prsestita. Gotting. 1769. 38g UTHONTRIPTICS. exceedingly useful injection for the removal of asca- rides. If the internal use of lime-water occasions heat and thirst, the sweet spirits of nitre ought to be given two or three times a day, according to the advice of Whytt. It is, in general, useful to employ some bitter tonic infusion whilst taking the lime-water. Acid drinks must be avoided during a course of lime-water. MINERAL ACIDS. The alkalies and alkaline earths, as has been stated above, are the appropriate remedies in the lithic acid diathesis. They can only be employed with propriety, as antilithics, when the urinary deposits are of the red or lateritious kind, or, in other words, consist of cal- culous matter, in which the uric acid predominates. As might be supposed, quite the reverse obtains in relation to the employment of the mineral acids in calculous affections. These are by no means fit re- medies when the sediments are of the uric acid kind; but their antilithic power is generally very unequivo- cally evinced in complaints in which the phosphatic diathesis prevails, and where the calculous sediments are white, or of that species in which the earthy phos- phates predominate. " When from any cause," says lithontriptics. 389 Mr. Brande, " this white sediment appears, the inter- nal use of acids will, in most cases, diminish or remove it." It is asserted by those who employ the alkalies and acids in calculous complaints, on chemical prin- ciples, that the urine " has a tendency to deposit white sand whenever its natural acidity is diminished, as is shown by the addition of a little alkali to recently voided urine, which immediately throws down a white powder." The modus operandi of acids in prevent- ing such deposits would therefore appear to be easily explained; for as it is demonstrable that acids taken into the alimentary canal show themselves again in the urine, it is evident that, to obviate the depositions of this white sediment, we need only to exhibit an acid internally, with a view of augmenting the acidity of the urine, and thereby enabling it better to hold its earthy phosphates in solution. Dr. Scudamore opposes the chemical theory on this subject, and maintains that the phosphates are deposited, notwithstanding the ex- istence of a free acid in the urine. " I have now arrived at the end of an extensive examination of specimens of urine depositing the phosphates, and also holding them in solution, yet still having the power of reddening litmus in the usual manner."* He thinks that the mineral acids are useful in cases where the gravelly deposit consists of the earthy phosphates, simply by their tonic action on the stomach. That * Scudamore on the Gout, p. 256. Amer. edit. 390 UTHONTRIPTICS. acids may prove advantageous in such complaints, by their tonic operation, can hardly be doubted. But if any considerable share of their good effects depended on a tonic influence, we ought, I think, to see them as efficacious in the lithic acid depositions as in those consisting of the earthy phosphates, since the former are generally even more conspicuously connected with a weakened state of. the digestive organs than the lat- ter. Still, however, it is undeniable, that bark, exer- cise, bitters, and mineral tonics, are often successfully employed in complaints attended with urinary deposits of this kind. " The febrile affections of children are very frequently attended by an apparently alarming deposit of white sand in the urine, and a dose of calo- mel will often carry off both the fever and sand." Whatever may be the modus operandi of mineral acids in diminishing the earthy phosphates in the urine, their utility in this way seems to be fully esta- blished. The nitric, the muriatic, and the sulphuric acids, have each been employed to check the formation of white urinary sediment. The nitric acid is thought by Mr. Brande to be more liable to occasion those symptoms of indigestion which are attended by flatu- lency and eructations, than the other two acids, " and in a few particular cases its long continued use has rendered the patient reluctant to food; though many LITHONTRIPTICS. 391 instances might be cited of its tonic effects, as a pro- moter of digestion and increaser of appetite." The sulphuric acid has a much more uniformly tonic effect, and may usually be persevered in much longer than the nitric and muriatic acids, without pro- ducing griping and other disagreeable gastric affec- tions. The muriatic acid, though mostly agreeing very well with the stomach, is apt, by long use, to act upon the bowels, and to bring on a troublesome diar- rhoea. " This circumstance," observes Mr. Brande, " however, often recommends it; for constipation very frequently attends the state of the body which favours the formation of white sand." " When the mineral acids agree," says this writer, " they are usually very effective, and in a few days they diminish or entirely prevent the formation of the sabulous deposit; but where they disagree they rather increase the quantity, or they tend to the production of a mucous secretion, probably from the coats of the bladder, which enve- lops and is voided with the sand, and which, in par- ticular cases, may certainly tend to increase the risk of its agglutinations, and pf the formation of a concre- tion in the bladder. The mineral acids, too, almost always disagree with children, who are equally liable with adults to an increased secretion of the phosphates, and in whom prompt and effectual treatment is equally requisite to prevent the formation of a stone in the 392 LITHONTRIPTICS. bladder."* In cases of this kind recourse must be had to the vegetable acids. The tartaric acid may be given freely, either in a pure state or combination, as in cream of tartar. From five to twenty grains of the former, and from twenty to sixty of the latter, may be administered two or three times a day. The citric acid is, however, preferable to the tartaric, and may be administered in doses of from five to sixty grains; it rarely proves inconveniently purgative, and is very effectual in modifying the secretion of urine. Although the vegetable acids, when properly admi- nistered, will seldom increase the phosphatic diathesis, yet it appears from the observations of the same wri- ter I have just quoted, that cases do occur where a copious white deposit is attended with a peculiar irri- tability of the bladder, and which are aggravated by any of the acids just mentioned. When a copious white sabulous deposit in the urine is connected with a biliary derangement, as is some- times the case, it will be best to depend rather on an acescent regimen than on medicine; "and to obviate costiveness, if necessary, by an occasional dose of magnesia in a glass of sour lemonade."! * Brande on the Medico-Chemical Treatment of Calculous Disorders. Quarterly Journal of Science and the Arts, No. 12. t Brande. UTHONTRIPTICS. 393 CARBONIC ACID. This gaseous acid was at one time much in vogue as a solvent for urinary calculi. It appeared from the experiments of Hales, that water impregnated with carbonic acid, has the power of gradually dissolving m urinary calculi; and it was demonstrated also that, when taken into the stomach, this acid soon makes its appearance in the urine. Hence it was concluded, that, by means of this aerial fluid, we might readily dissolve "human calculi while yet in the bladder;" an opinion which was zealously advocated by Perci- val, Saunders, and others. AVhether or not the opi- nion of these men be correct with regard to the modus operandi of carbonic acid, in gravelly disorders, there appears to be no-reason to doubt its occasional utility in preventing the white urinary deposit. Where, from peculiar circumstances, in cases of this kind, the other acids disagree with the patient, the carbonic acid, Mr. Brande observes, will often afford very de- cided advantages. This acid may be very conveni- ently taken, as it is dissolved in the artificial mineral waters, "or it may be administered in the form of a saline draught, in the state of effervescence; which is best done by dissolving thirty grains of carbonate of potash, and twenty grains of citric acid, in separate tea-cups of water, and then mixing the solutions in a vol. n. 50 394 LITHONTRIPTICS. large tumbler, and drinking the whole during efferve- scence. This dose may be repeated two or three times a day, or oftener if expedient."* VYJE URSI FOLIA.—BEAR BERRY. The uva ursi is an evergreen, creeping plant; with small oblong, oval leaves, resembling very closely those of the common garden box. It is indigenous both to Europe and the United States. The leaves have an odour bearing some resemblance to that of hyson tea, and are of a bitterish and sub-astringent taste. They contain, "tannin, mucilage, gallic acid, extractive, resin and traces of lime;" and yield their active prin- ciples both to alcohol and water. The virtues of this plant are variously represented by writers on the majteria medica. Alibert says, " all that can be said of this remedy is, that its action is, under certain circumstances, manifestly diuretic;" and he declares that its supposed specific power in nephritic and other diseases of the urinary passages has not the least foundation. The weight of testimony is however greatly in favour of its remediate powers in disorders of this kind. The account given by De Haen, of its efficacy * Brande, Philosoph. Trans. 1813, p. 213. LITHONTRIPTICS. 395 in diseases of the urinary organs, is indeed exceed- ingly flattering, and although few other practitioners may have been equally successful with it, there is, notwithstanding, sufficient evidence extant to warrant us in regarding it as a very important remedy in such diseases. De Haen relates some very remark- able instances of the successful use of uva ursi in calculous and nephritic affections. He employed it with much success, also, in a case of ulceration of the penis and perineum from calculus in the bladder, and in purulent discharges from the urinary passages. He insists, however, that this remedy is wholly inef- fectual in cases where there is much derangement of the internal urinary organs, whether from calculi, pus, or the too frequent and long retention of urine. "Magis confirmor," he says, "magisque in eo, quod in hoc opere toties monui, nullarum earn virium esse, ubi in systemate urinoso interno multa facta fuerit, sive a calculo, sive a pure, sive ab urina, saepius diu- tiusque retenta, degeneratio."* He states, that in several instances of urinary calcu- lus, this remedy afforded complete relief, " although the catheter showed that the calculus still remained." It does not appear from late experience, however, that any dependence is to be placed on this remedy in calculi of the bladder. In nephritic affections from gravel and other cases, we have abundant proof * Ratio Medendi, vol. iii. p. 117. 396 LITHONTRIPTICS. of its utility. Dr. Ferriar, whose testimony deserves the highest respect, says " I have given this remedy (uva ursi) in a considerable number of nephritic cases, in very moderate doses, and always with manifest advantage." It must be confessed, however, that we are by no means warranted in ascribing all the good effects of the practice detailed by Dr. Ferriar to the uva ursi. He states, that " when the pain was very acute and the pulse quick, he began the cure with bleeding and a gentle purgative, composed of manna and a neutral salt. This purgative he repeated twice a week, and on the intermediate days directed the patient to take five grains of uva ursi, and half a grain of opium, three or four times a day."* Out of sixteen patients treated in this way he cured twelve. It is impossible to say how much of the good effects of this treatment is to be attributed to the uva ursi. That however some, perhaps a considerable share, of the success is to be ascribed to this remedy, may be inferred from its beneficial operation in diseases of this kind, when administered by itself, as I have myself witnessed in several instances. Dr. Ferriar observes, that he never found it necessary to give it in larger doses than five grains, and that in doses of a scruple or half a drachm he found it to produce nausea, even when given with opium. The same circumstance is mentioned by Lewis. " In all the cases," says he, " that * Medical Histories, vol. i. p. 56, LITHONTRIPTICS. 397 have come to my knowledge, it produced great sick- ness and uneasiness."* In that variety of urinary disease which is attended with copious white sediment in the urine, especially in the last portions discharged, occasioning pain and irri- tation in the urethra, Dr. Prout states, that " he has often seen the greatest advantage from the combined use of muriatic acid, hyoscyamus, and uva ursi, to- gether with the use of alterative purgatives." I have a patient under my care now, who has been for up- wards of two years exceedingly afflicted with a pain in the region of the right kidney, attended with all the usual symptoms of renal calculus. He has been gradually getting better under the use of uva ursi and opium, in closes of twelve grains of the former with half of the latter, three times a day; and is at present almost entirely free from any symptom of his disease. The late professor Barton thought it particularly serviceable in nephritis depending on gout. " In my own nephritic paroxysm," he observes, " alternating with attacks of gout in the feet, I have certainly found the medicine of much service: and I confidently and with much pleasure recommend it to the notice and trial of other sufferers from the same affection."f Of the modus operandi of uva ursi in nephritic and calculous disorders, we are entirely uninformed;, nor * Materia Medica. t Barton's edition of Cullen's Materia Medica, vol. ii. p. 422. 398 LITHONTRIPTICS. will I consume the reader's time by speculations upon a topic which has been so fruitlessly attempted by many of the ablest physicians. . The remediate employment of uva ursi has, how- ever, not been confined to affections of the urinary organs; it has been equally extolled in the cure of other maladies, particularly in diabetes, consumption, leucorrhcea, heematuria, and gonorrhoea. In the treatment of diabetes, Dr. Ferriar was in the habit of giving it in conjunction with cinchona, opium, and lime-water.* Dr. Bourne, professor of the practice of physic in the University of Oxford, speaks very highly of the efficacy of uva ursi in the cure of pulmonary consumption. He states, that out of sixteen cases treated with this remedy, nine were cured, four relieved, and three died. He gave the medicine in ten-grain doses, with half a grain of opium, three times a day.f It is best administered in the form of powder. The dose is from gr. x. to 5i. * B Pulveris uva ursi, corticis Peruvian, aa Qi. opii gr.ss. quater in die sumend. bibat aquse calcis §ii. post sing. dos. pul- veris. t Cases of Pulmonary Consumption, &c. healed by Uva Ursi, to which are added some Practical Observations. Lon- don, 1806, p. 393. UTHONTRIPTICS. 399 HUMULUS LUPULUS. The hop was at one time much recommended for its supposed lithontriptic properties. It has also been accused of being favourable to the production of calculous affections. From my own experience I can say nothing in favour of its antilithic powers. Nor do I believe that it is entitled to any attention for its properties in this respect. Several of the bitter as- tringent vegetable medicines have been commended for their good effects in cases of gravel and calculus. The gentiana lutea and quassia have been particularly mentioned as useful in affections of this kind. From the frequent connection of gravel and disordered function of the digestive organs, and the apparent de- pendence of the former on the latter, it is not at all unlikely that these articles may often produce bene- ficial effects in nephritic and gravelly disorders. They may in general be very usefully given conjointly with the alkaline antilithics, as has already been stated when speaking of these remedies. CHAPTER XVI. IV. Medicines that promote the Secretory Action of the Salivary Glands. SIALAGOGUES. HYDRARGYRUS. It does not appear that the Greek and Roman phy- sicians had any knowledge of the medicinal proper- ties of mercury. They regarded it as a dangerous poison, and excluded it from the materia medica.* It was first employed by the Arabians, as an external remedy in the itch and other cutaneous eruptions. The corrosive sublimate and red precipitate, two of the most active preparations of this metal, are men- tioned by Geber; and both Rhazes and Avincenna speak of the outward employment of mercurial reme- dies. In Europe mercury was used externally in cutaneous disorders, as early as the twelfth century, by Gilbert, Theodoric, and others; but it was not em- ployed as an internal remedy until early in the six- teenth century, when John de Vigo first gave it in * Auvxft.it £e t%ei pOxpjucijo -orotic to-x rot (&uptt fox Qi%pu>ox.u$2 INDEX. Hydrophobia, treated by opium, ii. 42. Hydro-cyanic acid, ii. 122. Hyoscyamus niger, ii. 59. Hyoscyama, it. 60. used in mania, ii. 62. Hypochondriasis, cathartics used in, 124. Hysteria, treated by emetics, 42. cathartics used in, 125. treated by opium, ii. 41. chronic, spider's web used in, ii. 121 Hamulus lupulus, 297. narcotic, ii. ;-9. lithontriptic, ii. 399. I.J. Jalapte radix, 134. James's powder, 88. Jamestown weed, ii. 78. Janiperus snbi?ia,414. Jasser's ointment for psora, 178. Jaundice, "reated by emetics, 50. Jerusalem oak, 205. Impotency, cantiiarides useful in, ii. 340. Incontinence of urine, cured by can- tharides, ii. 339. Indian tobacco, 63. useful in asthma, 64. turnip, ii. 487. Indigestion, opium used in, ii. 33. Infusum sennx limoniatum, 143. laxativum viennense, ib. Inhalations, ii. 494,496. Intermittents, emetics used in, 27. opium used in, ii. 17. camphor used in, ii. 53. cured by spider's web, ii. 119. Johnson's cathartic pill, 159. Ipecacuanha, 51. employed in dysentery, 55. in haemorrhages, 57. in asthma, 59. as an anti-emetic, 60. in habitual vomiting, 61. as an emmenagogue, ib. in indigestion, ib. mode of prescribing it, 62. peculiar taste destroyed by gum arabic, ib. American, 68. Ipecacuanha, increases the effects of jalap, 16. diaphoretic, ii. 2?7. promotes the effects of mercury, ii. 409. Iron, 298. sulphuret of, used in dropsy, 302. Juglans cathartica, 147. Issues, ii. 288. Kali preparatum, ii. 358. Kino, 367. Lactucarium, ii. 45. Lapides calcarix, antacid, 226. Laurus sassafras, ii. 249. Lead, acetate of, 374. Leucorrhaa, astringents used in, 349. Ume, 390. Lime-water, antilithic, ii. 385. Lithontriptics, or antilithics, ii. 367. Liquor morphi citratis, ii. 14. Liriodendron tulipifera, 279. Lobelia inflata, 63. used in asthma, 64. in croup, 65. Log-wood, 364, Lozenges, Ching's, 221. yellow, ib. brown, ib. Lumbricoides, 195. * Lunar caustic, tonic, 320. escharotic, ii. 518. Lytta cantharis, emmenagogue, 423. Lytta, vesicatoria, epispastic, ii. 276. diuretic, ii. 236. Lytta vittata, ii. 281. marginata, ii. 281. M. Madder, 420. Magnesia, a cathartic, 180. used as an antidote, 184. produces dangerous concretions in the bowels, 183. antacid, 228. lithontriptic, ii. 381. Magistery of bismuth, 318. index. 533 Magendie, process of vomiting, 19. Male Fern, 210. Malignant fever, emetics used in, 27. Mania, treated by camphor, ii. 54. digitalis used in, ii. 104. prussic acid used in, ii. 126. Mania a potu, treated by emetics, 39. treated by opium, ii. 37. Marasmus, cathartics used in, 130, Mathieu's famous vermifuge, 218. Mayapple, 145. Measles, cinchona used in, 257. Medicines absorbed into the blood, 3-17. Melia azedarach, 203. Meloe Niger, ii. 283. Menispermum columbo, 285. Menorrhagia, treated by emetics, 37. Mentha pulegium, 418. Mercurial preparations, emetic, 99. ointment, ii. 455. Mercury, ii. 400. absorbed into the circulation, ii. 402. its morbid effects, ii. 405. how its effects may be promo- ted, ii. 407. its immediate effects, ii. 410. used in yellow fever, ii. 412. in bilious fever, ii. 414. in intermittents, ii. ib. in typhus, ii. ib. in hepatitis, ii. 418. in pneumonia, ii. 419. in cynanche tracheahs, ii. 420. in cynanche maligna, ii. 224. in phthisis, ii. 423. in rheumatism, ii. 423. in ophthalmia, ii. 4~6. in dysentery, ii. 426. in diarrhoea, ii. 430. in colica pictonum, ii. 431. in dyspepsia, ii. 432. in hypochondriasis, ib. in mania, ii. 433. in tetanus, ii. 434. in hydrophobia, ii. 435. in dysphagia, ii. 436. in gutta serena, ii. 438. in dropsy, ib. in hydrocephalus, ii. 440. in cutaneous diseases,ii. 441. in scrophula, ii. 442. Mercury, used in venereal disease, ii. 444. rules for using it,ii. 448. Mezereon, ii. 244. Mimosa catechu, 371. Mineral acids, antilithic, ii. 388. Modus operandi, in general, 1. Momordica elaterium, 160. Monardx Oleum, ii. 294. Morphia, ii. 6. Mortification, treated by opium,ii. 44. cured by blisters, ii. 270. Moschus moschiferus, ii. 146. Mustard, rubefacient, ii. 297. Muriatis Ferii tinctura, ii. 365. Muriate of gold, 328. Muriate of barytes, 392. Musk, ii. 145. N. Narcotics, ii. 1. their effects, ii. 3. Nectoux's account of senna, 140. Neuralgia,cured by belladonna,ii. 75. Nicotiana tabacum, errhine, ii, 299. diuretic, 335. Nightshade, deadly, ii. 72. Nicotiana, narcotic, ii. 106. its poisonous effects, ii. 108. used in dropsy and dysury, ii. ib. injections of it, ii. 109. Nitras argenti, tonic, 320. escharotic, ii. 518. potassce, ii. 362. Nitrate of potash, diaphoretic, ii. 229. Nitre, ii. 362. Nitric acid, 395. used in tinea capitis, 397. epispastic, ii. 28 escharotic, ii. 524. Nitro-muriatic acid, 397. Nouffer's specific for tape worm, 211. Nux vomica, ii. 111. Nymphomania, camphor useful in, ii. 55. O. Oak bark, 352. inhaled in phthisis, 354. Obstructions of the bowels, turpen- tine used in, ii. 182. Oculi cancrorum, 227. 534 INDEX. Oleum succini, ii. 164. monurd.t punctata, ii. 295. croton, 436. Ricini, 169. olevarium, 172. used in ascitis, 173. in ileus, 175. in wande ring arthritic pains, 175. terebinthinte, anthelmintic, 214. useful in gastric worms,215. rubefacient, ii. 294. Opium, ii. 4. its component parts, ii. 5. its effects, ii. 11. used in typhus, ii. 16. in intermittents, ii. 17. in gastritis and enteritis, ii. 19. in rheumatism, ii. 20. in chronic catarrh, ii. 23. in pneumonia, ii. 24. in phthisis, ii. 25. in small-pox, ii. 26. in scarlatina, ib. in dysentery, ii. 27. in cholera, ii. 29. in dropsy, ii. 30. in diabetes, ib. in indigestion, ib. in haemorrhages, ii. 34. in colica pictonum, ii. 35. in mania a potu, ii. 37. in tetanus, ii. 39. in chorea, ii. 40. in epilepsy, ib. in hysteria, ii. 41. in hydrophobia, ii: 42. in venereal complaints, ib. in mortification of the toes, ii. 42. Opium and hyoscyamus, useful in mania, ii. 62. Ophthalmia, acute, cured by emetics, 35. Orobanche virginiana, 361. Oyster shells, powdered, antacid, 227. Oxydumzinci, 314. Paralysis, cured by nux vomica, ii. 113. Patassx carbonat, expectorant,ii.249. Pennyroyal, 418- Pepper, red, ii. 195. rubefacient, ii. 293. black, ii. 200. Peripneumonia notha, use of emetics in, 32. Pertussis, cinchona used in, 260. Phosphate of iron, 308. Phosphorus, ii. 185. Phthisis, opium used in, 25. cinchona used in, 261. digitalis used in, ii. 98. treated by prussic acid, u. 127. cantharides used in, ii. 338. Pilule hydrargyri, ii. 452. Pink-root, 200. Pipssisewa, ii. 355. _ Pix burgundix, rubefacient, ii. 298. Piper cubeba, ii. 348. Pleurisy root, ii. 237. Plummei^ 8 p\U, 76. Phthisis, opium uied in, ii. 24. diaphoretics used in, ii. 210. biliosa, use of emetics in, 23. Podophyllum peltatum, 145. Poison oak, ii. 116. Polygala senega, 43,2. Polypodium felix mas, 210. Polecat weed, ii. 158. Pomegranate, 403. Potassx carbonas, antacid, 229. sub-carbonas, ii. 358. Potash, nitrate, diaphoretic, ii. 229. Potassafusa, ii. 5l7. Potatoefy, ii. 281. Powder of Ethiopia, 218. Precipitated sulphuret of antimony, 75. Prickly ash, ii. 251. Pride of China, 203. Prumis virginiava, 271. diminishes the pulse, 272. used in chronic hysteria, 274, Prussic acid, ii. 122. its effects, ii. 124, its antidote, ii. 133. used in mania, ii. 126. in phthisis, ii. 127. in nervous cough's, ii. ib. in hooping-cough, ii. 130. in asthma, ii. 130. in chronic rheumatism, ii. 131. Prussiate ofiro7i, 440. used in intermittents, ib. index. 535 Puerperal fever, emetics used in, 29. cathartics used in, 116. camphor used in, ii. 51. convtdsions, camphor used in, ii. 56. Pulmonary diseases, diaphoretics used in, ii. 310. Punica granatorum, 439. Q. Quassia excelsa, 289. simarouba, tonic, 291. astringent, 362. Querci cortex, 352. Quince seeds, ii, 515. R. Radix jalapx, 134. Rhxi, 136. Rad. helebori nigri, 407. ipecacuanha, diaphoretic, ii. 227. polygala, expectorant, ii. 483. scillx, expectorant, ii. 485. diuretic, ii. 322. Red precipitate, sialagogue, ii. 472. Remittents, bark used in, 252. camphor used in, ii. 53. Rhxum palmatum, 136. Rheumatism, acute, emetics good in, 33. cathartics used in, 118. opium used in, ii. 21. camphor used in, ib. prussic acid used in, ii. 131. cured by turpentine, ii. 181. and gout, cinchona used in, 254. Rhus toxicodendron, ii. 116, Richter's deobsrruent pills, ii. 144. Ricini oleum, 169. Robiquet's mode of making morphia, ii. 6. Rosmarinus officinalis, 419. Rubefacients, ii. 291. Rubia tinctorum, 420. Rubus vilosus, 366, S. Sabina, 414. Saffron, meadow, diuretic, ii. 325. Sal diureticus, ii. 360. Saltpetre, ii. 362. Sanguinaria canadensis, 433. Sapo jalapinus, 135. Saponaria officinalis, ii. 253. SarsapaHUa, ii. 246. Sassafras, ii. 249. Scabiosa, ii. 353. Scammony, 155. Scarlatina, emetics used in, 28. cinchona used in, 263. opium used in, ii. 26. simplex, cathartics used in, 115. anginosa, cinchona used in, 258. Scilla maratima, as an emetic, 70. diuretic, ii. 322. expectorant, ii. 485. Scillitin, the active principle of squill, 71. Secale cornutum, 428. Selway's essence of senna, 143. Sem. sinapis, rebefacient, ii. 291. colchici, in rheumatism, ii. 331. lini, ii. 514. cydoniorum, ii. 515. Senega snukeroot, expectorant, ii. 483. emmenagogue, 422. Senna, American, 144. Sennx folia, 140. analysis of, 141. deteriorates in a humid atmos- phere, 143. Serpentaria virginiana, 266. Setons, ii. 288. Sialagogues, ii. 402. Skunk-cabbage, ii. 158. Slippery elm, ii. 506. Small-pox, opium used in, ii. 26. Smilax Sarsaparilla, ii. 246. S?nucker's visceral pills, ii. 142. Snakeroot, Virginia, tonic, 266 Sodx carbonas, antacid, 229. expectorant, ii. 492. Soluble tartar, 190. Soapwortfii. 253. Solanum nigrum, ii. 87. dulcamara, ii. 91. useful in herpes, &c. ii. 92. Spanish flies, ii. 276. Spider's web,u. 118. used in intermittents, ii. 119. its soothing effects, ib. in asthma, ii. 120. in hysteria, ii. 121. Spigelia marylandica, 200. Spiria trifoliuta, 66. used with opium in dysentery,64. 536 index. Spiritus xtheris nitrosi, ii. 364. Spiritus mindereri, ii. 233. Spurred rye, 428. Stanum, 217. Staughton's elixir, 289. Stimulants, ii. 166 Story's worm cakes, 221. Stramonium, ii. 78. used in rheumatism, ii. 82. in tic duloureux, ib. Strangury camphor ust-d in, ii. 57. Strychnos nux vomica, ii. 111. its effects, ii. 112. used in paralysis, ii. 113. Strychnine, ii. 115. Sub-carbonas potassx, ii. 358. Submuriate of mercury, 166. employed in very minute doses by Dr. Ayre, 167. sialagogue, ii. 469. Subsulphas hydrargyri flavus, emetic, 99. Succini oleum, ii. 164. Sugar of lead, 370. used in dysentery, 379. in epilepsy, 380. Sulphas sodx, 185. magnesix, 185. potassx, 187. ferri, tonic, 305. cupri, tonic, 310. zinci, tonic. 314. astringent, 384. aluminx, 385. Sulphate of zinc, as an emetic, 90. an over dose not very poisonous, 92. used in dysentery, 93, ■ in colica pictonum, 94. in hooping-cough, ib. in catarrhal affections, 65. of copper, as an emetic, 96. used in consumption, 97. Sulphur sublimntum, 176. used in rheumatism, 179. in dysentery, ib. in anasarca, 180. diaphoretic, ii. 255. .Su'phuret of antimony, 74. o/nwz,.used in dropsy, 302. Sulphuric acid, 400. xther, antispasmodic, ii. 160. Svpcv-tartras potassx, 188. ii. 36.3. Superacetatis plumbi, 374. Sweet spirits of nitre, ii. 364. Swamp sumach, ii. 116. Symplocarpus fxtida, ii. 158. T. Txnia described, 192. Tartar emetic, 77. promotes expectoration, 78. curbs the action of the heart and arteries, 80. its modus operandi in fevers, 81-86. its utility in febrile diseases, 86. in consumption, 87. in haemorrhagy, ib. in opacity of the cornea, 89. remedies that counteract its poisonous effects, ib. Tartras potassx, 190. Tartrate of iron, 302. Tela aranearum, ii. 118. Terebinthinx oleum, anthelmintic, 214. stimulant, ii. 179. used in chronic rheumatism, ii. 181. in obstruction in the bow- els, ii. 182. Terra japonica, 371. ^ Testacea, antacid, 226. Testx ostrearum, 227. Tetanus, cathartics used in, 129. treated by opium, ii. 39. Thoroughwort, ii, 234. Tic doloureux, cured by belladonna. ii. 75. Tin, 217. Tinctura anti-phthisica, 376. cantharides, rubefacient, ii. 297. muriatis ferri, ii. 365. Tobacco, narcotic, ii. 106. errhine, ii. 299. diuretic, ii. 335. Tonics, 230. their modus operandi, 231. Trichocephalus described, 193. Turpentine oil, rubefacient, ii. 295. Turbethum minerale, errhine, ii. 301. Turpith mineral, an emetic, 99. Typhus, cinchona used in, 253. opium used in, ii. 16. camphor used in, ii. 51. index. 537 Typhus fever, cathartics used in, 109-114. U.V. Valeriana, ii. 154. Venereal complaints treated, by opi- um, ii. 42. Vermifuge, of Mathieu, 218. Virginia snakeroot, tonic, 266. Vitriol, white, emetic, 90. green, tonic, 305. blue, tonic, 310. white, tonic, 316. astringent, 384. Vitriolated tartar, 187. Ulcers, of the legs, cured by diapho- retics, ii. >11. Ulmus fulva, 507. Unguentum Hydrargyri, ii. 454. Volatile alkali, stimulant, ii. 170. Vomiting, Mechanism of, 18. explained by Chirac and Ma- gendie, 19. the effects of, 22. Uvx ursi, lithontriptic, ii. 394. W. Walnut, white, 147. Warners cordial, 139. Webster's dinner pills, 154. White precipitate of mercury, ii. 474. Wild-cherry bark, tonic, 271. lessens the action of the heart, ib. Wolfsbane, ii. 84. Worms, symptoms of, 196. Worm cakes, Story's, 221. Xanthoxylum Fraxineum, ii. 251 Yellow worm lozenges, 221. Zinci sulphas, as an emetic, 90. oxidum, tonic, 314. sulphas, tonic, 316. astringent, 384. Zingiber, ii. 199. FINIS. VOL. II. 68 ERRATA. VOL. I. Page 32, 72, 75, 93, 151, 154, 178. 332. 266, 271. 279, 380, 302, 303, 303, 3*0, 385j line 2, for apocunce, read apocyna. 11, for meUle, read metal. 17, fbi acuta!, read cicuta. 26, for aqua bulcntis, read aquae bullientii. 16, (or .-pir/rua, read spicata. 26, for stumarhio, read sio .;. vir%inianus, rt»d virgi- ni.ma. 17, for gum mucous, read mucus. 8,for prinw, readprinos. 27, for sulphuret, read black oxide. 2, for ihL remedy, read sulphu- ret of iron. 6, for ■vuler.cities, read Valenci- ennes. 11, lor cortlee. read chordee. 15,for alumina, read alumina:. Page 387, line 2f>, for vetce, read vit;:'. 391 28. for occulte. read occulti. 392. 1. for on, read in. 402, 10, for sul;-hunum read sulpliu- rnuin. 408, 15 and 22, for Jor.dilus, read fee- ndus 413, 22, for hydrogogue, read hydra- gogue. 414, 8, f .r junifxrut sabtnov, read ju- nipiins sa-bina. 422, 5, for few-a, read iruega. 4 22, note for Dr. M'Clellan, >ead Dr. Cal- houn. 42i,line 12, for wi'atlo. read irritatio. 427, 13, for iiu acuanlia, read ipecacu- anha:. 433, 6, for paccuon, ivad <